Patient Sociodemographic Factors Research Articles

Prescriber Adherence to Antihypertensive Prescription Guidelines and the Impact of Patient Socioeconomic Factors: A Cross-Sectional Study Using Data From the IrishLongitudinal Study on Ageing.

Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines. A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models. A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent). This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.

Making it work for all: equity in single ventricle monitoring.

Interstage monitoring programs for single ventricle disease have been developed to reduce morbidity and mortality. There is increased use of telemedicine and mobile application monitoring. It is unknown if there are disparities in use based on patient socio-demographic factors. We conducted a retrospective cohort study of patients enrolled in the single ventricle monitoring program and KidsHeart application at a single centre from 4/21/2021 to 12/31/2023. We investigated the association of socio-demographic factors with telemedicine usage, mobile application enrollment and usage. We assessed resource utilisation and weight changes by program era. There were 94 children in the cohort. Patients with Norwood and ductal stent had higher mean telemedicine visits per month (1.8 visits, p = 0.004), without differences based on socio-demographic factors. There were differences in application enrollment with more Black patients enrolled compared to White patients (p = 0.016). There were less Hispanic patients enrolled than Non-Hispanic patients (p = 0.034). There were no Spaish speaking patient's enrolled (p = 0.0015). There were no patients with maternal education of less than high school enrolled and all those with maternal education of advanced degree were enrolled (p = 0.0016). There was decreased mobile application use in those from neighbourhoods in the lowest income quartile. There were decreased emergency department visits with mobile application monitoring. Mean weight-for-age z-scores had increased from start to completion of the program in all eras. Differences were seen in mobile application enrollment and usage based on socio-demographic factors. Further work is needed to ensure that all patients have access to mobile application usage.

Diversity, geographical distribution and predictive factors of Hepatitis C virus genotypes and subtypes in Rwanda

BackgroundExisting data on the prevalence of hepatitis C virus (HCV) genotypes and subtypes in Rwanda need to be strengthened. The aim of this study was to identify HCV genotypes and subtypes among HCV-infected patients, as well as their geographical distribution in Rwanda, and to identify the social and economic factors that could influence HCV epidemiology which would make it possible to target national preventive and management actions for infected patients. MethodsThis study included 560 patients with confirmed chronic HCV infection. Patients were recruited from various health facilities in the four provinces of Rwanda as well as in the City of Kigali and had never received treatment with direct-acting antiviral (DAAs). HCV viral loads were measured using Cobas® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, version 2.0. HCV genotyping was performed using an in-house sequencing protocol targeting the NS5B central region. Genotypic HCV prevalence was correlated with patient geographic location, sociodemographic, behavioral, lifestyle, and clinical factors. ResultsHCV genotype 4 was detected in 99.3% of the patients, while genotype 3 was identified in 0.7%. A total of eight (8) HCV subtypes were detected, with 4k being the predominant subtype nationwide (49.5%), followed by subtypes 4r (21.2%), 4q (16.2%), 4v (7.9%), 4b (2.0%), 4l (1.8%), 4c and 3h represent 0.7% each. Our findings reveal subtype distribution variations among provinces. Subtype 4k was prevalent across regions, particularly in Kigali (64.0%) and the Eastern Province (61.6%). Subtype 4q was more common in the northern province (40.7%), 4r in the southern (43.9%) and western provinces (37.1%), and 4v in the eastern province (17.8%). Farmers exhibit a distinct infection profile compared to other occupations, showing a lower prevalence of subtype 4k but a higher prevalence of subtype 4r. ConclusionsOur study revealed that HCV infection is unevenly distributed in Rwanda, dominated by HCV genotype 4, with considerable heterogeneity in the repartition of the different subtypes. We found potential associations between rural/urban lifestyles and HCV subtype profiles. Determined HCV distribution and diversity can serve as basis not only for HCV infection awareness and prevention campaigns, but also success and guidance for personalized treatment.

Depressive symptoms are linked to age-specific neuroanatomical and cognitive variations

Depression is a heterogeneous disorder, both in terms of patient symptomatology and in patient sociodemographic factors. Here, we examine the contribution of age to this heterogeneity, by characterizing the associations of depressive symptoms with cognitive performance and brain structure across the lifespan. We analyzed data from the Cambridge Centre for Aging Neuroscience (Cam-CAN) cohort (N = 2591, age 18–99). A subset of this cohort (N = 647) underwent structural MRI. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Cognitive assessments were performed using The Addenbrooke's Cognitive Examination Revised. Generalized linear models were employed to examine the relationship between depressive symptoms and cognitive performance. Statistical parametric mapping explored age-dependent associations between depressive symptoms and grey matter volume. Cognitive performance was associated with a significant age by depression by cognitive domain interaction, indicating that older individuals with more depressive symptoms had a lower cognitive performance, particularly in the fluency domain. Structural MRI revealed preferential depression-related reduction in grey matter volume in the left and right hippocampi in older adults. By contrast, in younger adults, depressive symptoms were more strongly associated with grey matter volume reduction in the left superior frontal gyrus and left middle frontal gyrus. Collectively, these findings indicate that the associations of depression with cognitive performance and brain structure are age-dependent, suggesting that the pathophysiological mechanisms underlying depression may differ between young and older adults. Recognizing these differences will support the development of better diagnostic tools and therapeutic interventions for depression across the lifespan.

Patient safety culture and associated factors of regional public hospitals in Addis Ababa

BackgroundPatient safety culture is the result of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment, style, and proficiency of health providers’ safety management. Globally, millions of adverse events occur annually, with a significant burden on low- and middle-income countries. The burden of injuries and other harm to patients from adverse events is likely one of the top 10 causes of death and disability worldwide. This study aimed to assess patient safety culture and its associated factors in regional public hospitals in Addis Ababa.MethodsAn institution-based cross-sectional study was conducted among 494 healthcare professionals working at regional public hospitals in Addis Ababa. The data were collected using a pretested structured self-administered questionnaire from June 3 to July 30, 2023. The data were entered into Epi info version 7.2 and exported to SPSS version 26.0 for analysis. Binary logistic regression analysis was used to determine the associations between the patient safety culture (dependent variables) and socio-demographic factors, health care providers and system’s. Multicollinearity was checked using VIF, and the adequacy of the final model was assessed using the Hosmer and Lemeshow goodness-of-fit test.ResultOverall, 48.8% (95% CI: 44.3–53.1) of participants had a good patient safety culture, for a response rate of 93.3%. Factors significantly associated with patient safety culture, as identified through factor analysis, included having 6–10 years of experience (AOR = 1.81, 95% CI = 1.13–2.88), having more than 11 years of experience (AOR = 3.49, 95% CI = 1.27–9.56), reporting adverse events (AOR = 2.47, 95% CI = 1.37–4.45), participating in patient safety programs (AOR = 3.64, 95% CI = 1.91–6.92), and working in obstetrics and pediatric wards (AOR = 0.47, 95% CI = 0.23–0.94) and (AOR = 0.21, 95% CI = 0.097–0.44), respectively.ConclusionThe overall level of patient safety culture in regional public hospitals was low (< 75%). Factors such as having 6 or more years of experience, reporting adverse events, participating in patient safety programs, and working in obstetrics and pediatric wards were significantly associated with patient safety culture.

Evaluating the patient sociodemographic factors affecting dental students' clinical communication skills using a three-perspective approach.

This study aimed to assess undergraduate dental students' communication skills in relation to patient sociodemographic factors using a three-perspective approach; the student, the patient, and the clinical instructor perspective. A cross-sectional study was conducted using validated modified-communication tools; Patient Communication Assessment Instruments (PCAI), Student Communication Assessment Instruments (SCAI), and Clinical Communication Assessment Instruments (CCAI).Moreover, 176 undergraduate clinical year students were recruited in this study whereby each student was assessed by a clinical instructor, a patient, and self-evaluation. The clinical communication skills domains were not significantly influenced by patient sociodemographic factors, including sex, educational background, and the number of visits (p > .05). However, this study revealed a statistically significant difference in the domain of "caring and respectful" of the SCAI between the low- and middle-income groups. Overall, most of the patient sociodemographic factors did not affect clinical communication skills. However, patient income groups played a significant role in one of the communication domains.

Post-acute care facility utilization and outcomes among Medicare beneficiaries undergoing inpatient cancer surgery.

11088 Background: Patients with cancer using post-acute care facilities have poor outcomes, including delayed return home and increased health care utilization. However, little is known about post-acute care use and outcomes among patients with cancer undergoing surgery. Methods: We examined Medicare claims of 100% of fee-for-service Medicare beneficiaries from 2010-2022, to identify patients who underwent inpatient cancer-directed surgery and were thus eligible for a post-acute facility stay. We used billing codes within 3 days of hospital discharge to identify post-acute facility stays, defined as skilled nursing facility (SNF), long-term acute care hospital (LTACH), or inpatient rehabilitation facility (IRF) stays. We used logistic regression to identify patient sociodemographic and clinical factors associated with post-acute care facility use. We also compared hospital readmissions within 30 days and days at home (defined as days not in an acute or post-acute facility) in the 90 days after discharge by setting, using Chi-square and Wilcoxon rank sum tests. Results: We studied 1,637,792 Medicare beneficiaries who underwent inpatient cancer surgery from 2010 to 2022. About half (48.9%) were women; median age was 73.0 years. The most common cancer diagnoses were colorectal (28.4%), lung (14.4%), and prostate (12.1%), and 22.7% had a Charlson comorbidity index (CCI) of ≥3. Overall, 16.0% of patients were discharged to a post-acute care facility (11.4% SNF, 4.5% LTACH/IRF). Discharge to post-acute care was greater among patients who were aged ≥80 vs 65-69 (Adjusted Odds Ratio[AOR] 3.85, 95% Confidence Interval[CI] 3.79,3.90), had CCI ≥3 versus 0 (AOR 2.92, 95%CI 2.88,2.95), were dual-eligible (AOR 2.01, 95%CI 1.99,2.04), or had metastatic cancer (AOR 1.26, 95%CI 1.24,1.28). Patients undergoing brain or spinal surgeries for primary or metastatic cancers had highest odds of PAC facility utilization. Compared to those discharged home, patients discharged to post-acute care facilities had a higher 30-day hospital readmission rates (18.6% vs. 9.5%, p&lt;0.0001), and fewer days at home in the 90 days after discharge from their index surgical admission (median 68 vs. 90 days, p&lt;0.0001). Conclusions: Patients with cancer undergoing inpatient surgery who are older, have comorbidities, or have advanced disease have higher rates of post-acute care facility use, and such post-acute care is associated with higher hospital readmissions and fewer post-operative days at home. Further work is needed to improve pre-operative decision-making and optimization as well as to develop supportive care and rehabilitative interventions that can improve post-operative outcomes for patients who need post post-acute care.

Impact of sociodemographic patient factors on prescriber adherence to antihypertensive prescription guidelines: a cross-sectional study using data from The Irish Longitudinal Study on Ageing

Abstract Introduction Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several international prescribing guidelines have been created to address this. However, prescriber adherence to these guidelines may be influenced by sociodemographic patient factors such as socio-economic status, gender and age. Aim To examine the effects of gender and other patient factors, including age, geographical location, educational attainment, duration of disease, socio-economic status, smoking status, and previous history of cardiovascular diseases on prescriber adherence to hypertension prescription guidelines. Achievement of blood pressure goals (&amp;lt;140/90 mmHg) with adherence to prescription guidelines was also assessed. Methods This study is a secondary analysis of cross-sectional data from the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA), which included 8,175 Irish adults ≥50 years of age. Participants were included in the present study if they reported a previous doctor diagnosis of hypertension. Antihypertensive medication regimens were compared and categorised according to the 2011 National Institute for Health and Clinical Excellence (NICE)[1] prescription guidelines, which included the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and thiazide diuretics in the treatment of hypertension. In this study, the antihypertensive medication regimens of participants were categorised based on age categories (&amp;lt;55, ≥55, and all age groups), and compared to the 2011 NICE Guidelines which differentiate treatment in those ≥55, and &amp;lt;55 years of age. The effects of patient sociodemographic factors on prescriber adherence to the guidelines, and the effects of guideline adherence on blood pressure control, (defined as blood pressure&amp;lt;140/90 mmHg), were determined using multinomial logistic regression models. The mlogit, RRR code in STATA 17 SE was used to report relative risks (RRs). Results A total of 2,992 participants were included, of whom 54.9% were women. The mean age of participants was 65.69 years (±9.23). Male gender, older age and lower socioeconomic status among participants were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥55 years (RR 0.75 [0.62 to 0.91]), and female patients across all age groups (RR 0.80 [0.67 to 0.95]). Better blood pressure control was seen with medication regimens adherent to prescription guidelines with a mean of 140.38 (±18.98)/83.09 (±11.02) mmHg compared to a mean of 141.66 (±19.86)/84.77 (±11.71) mmHg in those non-adherent to guidelines. Conclusion This study highlights the effects of patient gender on prescriber adherence to antihypertensive prescription guidelines. A study strength is the use of a large, nationally representative cohort that used a standardised protocol of data collection within the Irish population. A potential limitation is the inclusion of self-reported data, including doctor diagnosis of hypertension. The results of this study may emphasise a larger issue of the systemic undertreatment of women within healthcare; however, these results should be interpreted in the context of 2011 guidelines, which have since been superseded by 2019 NICE guidelines. Further research may seek to determine possible reasons for such differences in hypertensive care. Reference 1. Linden B. NICE guidance on primary hypertension National Institute for Health and Clinical Excellence (2011) Hypertension: Clinical Management of Primary Hypertension in Adults. NICE Clinical Guideline 127. British journal of cardiac nursing. 2011;6:582-584.

Cannabis use disorder and perioperative outcomes following complex cancer surgery.

Cannabis usage is increasing in the United States, especially among patients with cancer. We sought to evaluate whether cannabis use disorder (CUD) was associated with higher morbidity and mortality among patients undergoing complex cancer surgery. Patients who underwent complex cancer surgery between January 2016 and December 2019 were identified in the National Inpatient Sample database. CUDwas defined according to ICD-10 codes. Propensity score matchingwas performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type. The primary composite outcome was in-hospital mortality and sevenmajor perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications). Among 15 014 patients who underwent a high-risk surgical procedure, a cohort of 7507 patients with CUD(median age;43 years [IQR:30-56 years]; n = 3078 [41.0%]female) were matched with 7507 patients who were not cannabis users (median age;44 years [IQR:30-58 years); n = 2997 [39.9%]female). CUDwas associated with slight increased risk relative to postoperative kidney injury (CUD, 7.8% vs. no CUD, 6.1%); however, in-hospital mortality was slightly lower (CUD, 0.9% vs. no CUD, 1.6%) (both p < 0.001). On multivariable analysis, after controlling for other risk factors, CUDwas not associated with higher morbidity and mortality (adjusted odds ratio: 1.06, 95% CI: 0.98-1.15; p = 0.158). CUD was not associated with a higher risk of postoperative morbidity and mortality following complex cancer surgery.

Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care.

Screening for mental health problems has been shown to be effective to detect depression and initiate treatment in primary care. Current guidelines recommend periodic screening for depression and anxiety. This study examines the association of patient sociodemographic factors and clinic characteristics on mental health screening in primary care. In this retrospective cohort study, electronic medical record (EMR) data from a 14-month period from 10/15/2021 to 12/14/2022 were analyzed. Data were retrieved from 18 primary care clinics from the Corewell Health healthcare system in West Michigan. The main outcome was documentation of any Patient Health Questionnaire (PHQ-4/PHQ-9/GAD-7) screening in the EMR within the 14-month period at patient level. General linear regression models with logit link function were used to assess adjusted odds ratio (aOR) of having a documented screening. In total, 126,306 unique patients aged 16 years or older with a total of 291,789 encounters were included. The prevalence of 14-month screening was 79.8% (95% CI, 79.6-80.0). Regression analyses revealed higher screening odds for patients of smaller clinics (<5,000 patients, aOR 1.88; 95% CI 1.80-1.98 vs. clinics >10.000 patients), clinics in areas with mental health provider shortages (aOR 1.69; 95% CI 1.62-1.77), frequent visits (aOR 1.80; 95% CI, 1.78-1.83), and having an annual physical / well child visit encounter (aOR 1.52; 95% CI, 1.47-1.57). Smaller positive effect sizes were also found for male sex, Black or African American race, Asian race, Latinx ethnicity (ref. White/Caucasians), and having insurance through Medicaid (ref. other private insurance). The 14-month mental health screening rates have been shown to be significantly lower among patients with infrequent visits seeking care in larger clinics and available mental health resources in the community. Introducing and incentivizing mandatory mental health screening protocols in annual well visits, are viable options to increase screening rates.

Association between sociodemographic factors and diagnosis of lethal prostate cancer in early life

ObjectiveA subset of patients are diagnosed with lethal prostate cancer (CaP) early in life before prostate-specific antigen (PSA) screening is typically initiated. To identify opportunities for improved detection, we evaluated patient sociodemographic factors associated with advanced vs. localized (CaP) diagnosis across the age spectrum. MethodsWe conducted a retrospective cohort study using the National Cancer Database, identifying patients diagnosed with CaP from 2004 to 2020. We compared characteristics of patients diagnosed at the advanced (cN1 or M1) versus localized (cT1-4N0M0) stage. Using multivariable logistic regression, we evaluated the associations among patient clinical and sociodemographic factors and advanced diagnosis, stratifying patients by age as ≤55 (before screening is recommended for most patients), 56 to 65, 66 to 75, and ≥76 years. ResultsWe identified 977,722 patients who met the inclusion criteria. The mean age at diagnosis was 65.3 years and 50,663 (5.1%) had advanced disease. Overall, uninsured (OR = 3.20, 95% CI 3.03–3.78) and Medicaid-insured (OR 2.58, 95% CI 2.48–2.69) vs. privately insured status was associated with higher odds of diagnosis with advanced disease and this effect was more pronounced for younger patients. Among patients ≤55 years, uninsured (OR 4.14, 95% CI 3.69–4.65) and Medicaid-insured (OR 3.39, 95% CI 3.10–3.72) vs. privately insured patients were associated with higher odds of advanced cancer at diagnosis. Similarly, residence in the lowest vs. highest income quartile was associated with increased odds of advanced CaP in patients ≤55 years (OR 1.15, 95% CI 1.02–1.30). Black vs. White race was associated with increased odds of advanced CaP at diagnosis later in life (OR 1.17, 95% CI 1.09–1.25); however, race was not significantly associated with advanced stage CaP in those ≤55 years (P = 0.635). ConclusionsSociodemographic disparities in diagnosis at advanced stages of CaP were more pronounced in younger patients, particularly with respect to insurance status. These findings may support greater attention to differential use of early CaP screening based on patient health insurance.

COPD With Lung Cancer Among Older United States Adults: Prevalence, Diagnostic Timeliness, and Association With Earlier Stage Tumors.

Chronic obstructive pulmonary disease (COPD) is a common comorbidity among patients with lung cancer, and an important determinant of their outcomes, however, it is commonly underdiagnosed. Our objective was to estimate the prevalence of COPD among a cohort of U.S. lung cancer patients, the timing of a COPD diagnosis relative to their lung cancer diagnosis, and the association between an earlier diagnosis of COPD and stage of lung cancer, with consideration of patient sociodemographic modifying factors. We conducted an analysis of the Medicare-linked Surveillance, Epidemiology, and End Results database including patients aged 68+ years who were diagnosed with lung cancer between 2008 to 2017. Exposure: Prevalence of COPD was identified using claims and subclassified based on the timing of its diagnosis relative to the lung cancer diagnostic episode-"preexisting" if diagnosed > 3 months before lung cancer, and "concurrent" if diagnosed around the same time as the lung cancer (+/-3 months). Outcome: The stage of cancer at diagnosis (early versus late) was the outcome. Among 159,542 patients with lung cancer, 73.5% had COPD. Among those with COPD, 34.4% were diagnosed within 3 months of their lung cancer diagnosis and considered to have "concurrent COPD." We observed a positive association between preexisting COPD diagnosis and early-stage lung cancer (prevalence ratio= 1.27; 95% confidence interval= 1.23-1.30), in adjusted models which were stronger for male, non-Hispanic Black, and Hispanic patients. Seven out of 10 patients with lung cancer have COPD, however, many do not receive their COPD diagnosis until around the time of their lung cancer diagnosis. Among these patients, an early COPD diagnosis may improve early detection of lung cancer.

Melanoma Detected Through Teledermatology Versus In-Person Visits.

Background: Early detection of melanoma improves survival; however, patients face long wait times to receive dermatology care. Teledermatology (TD) is a promising tool to optimize access to care and has shown promise for the identification of malignancies but has not been well studied for melanoma. We evaluated the utility of TD as a triage tool to allow high-risk lesions of concern to be seen more expeditiously. Methods: Patient sociodemographic factors and histological characteristics of 836 melanomas biopsied between March 2020 and November 2022 in the University of Pittsburgh Medical Center health system were retrospectively evaluated, stratified by initial appointment type of TD versus in-person visit. Results: Patients first seeking care through teledermatology had shorter wait times to initial evaluation (p < 0.001) and eventual biopsy (p < 0.001), and these melanomas had higher Breslow thickness (p < 0.001), were more ulcerated (p = 0.002), invasive (p = 0.001), and of a more aggressive subtype (p = 0.007) than those initially evaluated in-person. TD was also utilized by a higher proportion of younger (p = 0.001) and non-white (p = 0.03) patients who identified their own lesion (p < 0.001). Conclusions: TD may be a strategy to improve melanoma outcomes by providing an accessible avenue of expedited care for high-risk lesions associated with worse clinical prognosticators of disease.

Unique Breast Cancer Screening Disparities in a Safety-Net Health System

Breast cancer screening (BCS) disparities leave historically underserved groups more vulnerable to adverse outcomes. This study explores granular associations between BCS and patient sociodemographic factors in a large urban safety-net health system. A retrospective review among female patients ages 50-74 within an urban safety-net health system was conducted in 2019. All patients had a primary care visit in the past 2 years. Multiple patient health and sociodemographic characteristics were reviewed, as well as provider gender and specialty. Bivariate analyses and multivariable logistic regression were performed in 2022. The BCS rate among 11,962 women was 69.7%. Over half of patients were non-White (63.6%) and had public insurance (72.3%). Patients with limited English proficiency made up 44.3% of the cohort. Compared to their sociodemographic counterparts, patients with White race, English proficiency, and Medicare insurance had the lowest rates of BCS. Serious mental illness and substance use disorder were associated with lower odds of BCS. In multivariable analysis, when using White race and English speakers as a reference, most other races (Black, Hispanic, and Other) and languages (Spanish, Portuguese, and Other) had significantly higher odds of screening ranging from 8% to 63% higher, except Asian race and Haitian Creole language. Female (versus male) and internal medicine-trained providers were associated with higher screening odds. Multiple unique variables contribute to BCS disparities, influenced by patient and health system factors. Defining and understanding the interplay of these variables can guide policymaking and identify avenues to improve BCS for vulnerable or traditionally under-resourced populations.

Frequency of Perceived Conflict between Families and Clinicians at Time of Clinical Ethics Consultation in Hospitalized Children

Background Little is known about the frequency of conflict between clinicians and families at the time of pediatric clinical ethics consultation (CEC) and what factors are associated with the presence of conflict. Methods We conducted a retrospective cohort study at a single, tertiary urban US pediatric hospital that included all hospitalized patients between January 2008 and December 2019 who received CEC. Utilizing the hospital’s CEC database that requires documentation of the presence of conflict by the consultant at the time of CEC, we determined the frequency and types of perceived conflict between families and clinicians. We also assessed the bivariable association between conflict and patient age, patient- or family-reported race/ethnicity, language for care, insurance status, clinical setting, and consultant involvement. Results Perceived conflict between clinicians and families was present in 44% (91/209) of CEC. We observed a higher occurrence of clinician-family conflict within certain consult topics than others, in particular, informed consent/parental permission (69%), cultural considerations (67%), benefit/harm assessment (58%), and limitation of life-sustaining treatment (58%). We found no other significant associations between the presence of perceived conflict and patient sociodemographic factors or CEC factors. Conclusions Conflict between healthcare teams and families appears common in CEC, particularly with certain consult topics. Further study is needed to better understand conflict types, causes of conflicts, management and mediation strategies, and outcomes.

Cannabis Use Disorder and Perioperative Complications

Cannabis use is growing in the US and is increasingly perceived as harmless. However, the perioperative impact of cannabis use remains uncertain. To assess whether cannabis use disorder is associated with increased morbidity and mortality after major elective, inpatient, noncardiac surgery. This retrospective, population-based, matched cohort study used data from the National Inpatient Sample for adult patients aged 18 to 65 years who underwent major elective inpatient surgery (including cholecystectomy, colectomy, inguinal hernia repair, femoral hernia repair, mastectomy, lumpectomy, hip arthroplasty, knee arthroplasty, hysterectomy, spinal fusion, and vertebral discectomy) from January 2016 to December 2019. Data were analyzed from February to August 2022. Cannabis use disorder, as defined by the presence of specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. The primary composite outcome was in-hospital mortality and 7 major perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications) based on ICD-10 discharge diagnosis codes. Propensity score matching was performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type. Among 12 422 hospitalizations, a cohort of 6211 patients with cannabis use disorder (median age, 53 years [IQR, 44-59 years]; 3498 [56.32%] male) were matched with 6211 patients without cannabis use disorder for analysis. Cannabis use disorder was associated with an increased risk of perioperative morbidity and mortality compared with hospitalizations without cannabis use disorder in adjusted analysis (adjusted odds ratio, 1.19; 95% CI, 1.04-1.37; P = .01). The outcome occurred more frequently in the group with cannabis use disorder (480 [7.73%]) compared with the unexposed group (408 [6.57%]). In this cohort study, cannabis use disorder was associated with a modest increased risk of perioperative morbidity and mortality after major elective, inpatient, noncardiac surgery. In the context of increasing cannabis use rates, our findings support preoperative screening for cannabis use disorder as a component of perioperative risk stratification. However, further research is needed to quantify the perioperative impact of cannabis use by route and dosage and to inform recommendations for preoperative cannabis cessation.

Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia.

According to current estimates, there are 665,723 people in Ethiopia who have human immunodeficiency syndrome. As Ethiopia inches closer to attaining the 95/95/95 targets for treatment coverage and reaching epidemic control, however, attrition from anti-retroviral treatment is still one of the key programmatic challenges. To assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District. A 6-year (June 28, 2015 to June 27, 2021) institution-based retrospective cohort study was used to recruit 540 study participants by using simple random sampling. Data were obtained from chart review, coded, entered into Epi Data, and exported to Stata 14.2 software for analysis. At least 1 month missed appointment is considered as attrition and the predictors of attrition were identified using bivariable and multivariable Cox proportional hazard models and an adjusted hazard ratio (AHR). Bivariate and multivariate analyses were conducted to find predictors of attrition, p-value < 0.05 was considered statistically significant. From the total 540 study participant, 158 (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years .Being WHO clinical stage III or IV (AHR = 1.96,), non-practice of Appointment spacing model (AHR = 3.98), poor or fair ART adherence level (AHR = 6.47), age groups (15-24) years (AHR = 1.73) and Others ART linkage points[index case testing, tuberculosis clinic and referral from private/public health institutions] (AHR = 1.76) were significantly associated. The study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient sociodemographic, clinical, and treatment-related factors were significantly associated with patients on ART.

Peaceful acceptance of illness among older adults with cancer.

12045 Background: Greater illness acceptance is associated with lower levels of psychological distress and higher rates of completion of advance care planning in adults with advanced cancer. However, studies on factors associated with illness acceptance among older adults with advanced cancer are limited and historically have not explored its relationship with caregiver or physician characteristics, despite the important role caregivers and oncologists play in patient illness acceptance. We aimed to evaluate the associations of patient, caregiver, and physician-related factors with illness acceptance among older adults with cancer. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (NCT 02054741; PI: Mohile; funding NCI UG1CA189961). We recruited patients aged 70 years or over with stage III or IV incurable solid tumors or lymphoma and at least one geriatric assessment domain impairment as well as their caregivers. Illness acceptance was assessed using the 5-item Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire (range 5-20). Higher PEACE score indicates greater illness acceptance. Multiple linear regression was used to assess the associations of patient, caregiver, and physician-related variables with PEACE. Variables included patient sociodemographic factors, geriatric assessment variables, and estimated life expectancy; caregiver sociodemographic variables, anxiety, depression, and physical function; and oncologist years in practice and comfort with geriatrics. Results: We included 333 patient-caregiver dyads; mean age (SD) of patients and caregivers, respectively, were 76.8 (5.4) and 66.6 (12.1). Approximately 27%, 26%, and 16% of patients had lung, gastrointestinal, and genitourinary cancers, respectively. Mean PEACE score was 17.4 (2.5), indicating relatively high illness acceptance (Table). On regression analysis, patient psychological impairment domain (including both anxiety and depression) (B=-0.89; p&gt;0.01), patient’s lower estimated life expectancy (≤1 vs. &gt;5 years, B=-1.19, p=0.02), and lower caregiver education attainment (≤high school vs. college; B=-0.86; p&lt;0.01) were associated with a lower illness acceptance. No physician variables were associated with PEACE. Conclusions: A better understanding of illness acceptance and its associated factors can facilitate patient-caregiver dyadic interventions to improve illness acceptance. [Table: see text]

Inequities in Thyroid Cancer Care: Populations Most at Risk for Delays in Diagnosis and Treatment.

Background: Delays in treatment for thyroid cancer (TC) have been associated with higher overall mortality rates. However, few studies have explored the impact of health disparities on delayed presentation and treatment for TC. This study aims to investigate what patient sociodemographic factors contribute to delays in presentation and treatment of TC. Methods: Using the National Cancer Database, we identified patients diagnosed with well-differentiated TC between 2004 and 2016 who underwent thyroidectomy. Multivariable regression analyses were conducted to examine the impact of race, insurance status, income, and distance from treatment facility on time to surgical treatment, stage, the presence of distant metastases, and tumor size. Results: We identified 89,105 patients diagnosed with well-differentiated TC who underwent thyroidectomy. Nonwhite patients who were uninsured or had Medicare or Medicaid insurance were more likely to experience delays in care, present with higher stages at diagnosis, and have distant metastases and larger tumors at presentation. Distance from treatment facility was associated with delays in surgical treatment and higher stage at presentation. Conclusion: Delays in TC presentation and surgical treatment vary by race, insurance status, and patient location. Health care policies should focus on targeting at-risk individuals to reduce health care disparities in this disease.

P098 Changes in Analgesic Prescribing in Patients with Inflammatory Arthritis in England: An Observational Study in CPRD Aurum

Abstract Background/Aims Pain is a common symptom experienced by patients with inflammatory arthritis (IA). Emerging data indicate IA pain treatment focuses on prescribing analgesics despite an absence of evidence for long-term efficacy. Delivering optimal, equitable IA pain care in England requires understanding current practice. To address this, we evaluated analgesic prescribing in patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (SpA) contributing data to the Clinical Practice Research Datalink Aurum, a primary care electronic health record database covering 20% of England. Methods Cross-sectional analyses (2004-2020) evaluated the annual prevalence of analgesic prescriptions in patients with RA/PsA/axial SpA. These were reported stratified by age, gender, ethnicity, deprivation, and geographical region. Analgesic prescriptions were classified using Bedson et al’s hierarchical system with an additional gabapentinoid group. Joinpoint regression models evaluated time-points when a significant change in the trends of prescription annual prevalence occurred. Results Although declining over time, the annual prevalence of analgesic prescriptions remained high (84.2% [95% CI 83.9, 84.5] in 2004; 64.5% [95% CI 64.2, 64.8] in 2020). In 2004, oral NSAIDs were the commonest analgesic (prevalence 56.1% [95% CI 55.8, 56.5]). By 2020, this fell to 22.3% (95% CI 22.1, 22.6) with opioids being the commonest analgesic (prevalence 39.0% [95% CI 38.7, 39.2]). Most opioid prescriptions were “strong/very strong” and long-term. Annual prevalence of non-NSAID analgesic prescriptions was highest in RA and of NSAIDs was highest in axial SpA. The annual prevalence of all analgesic types except NSAIDs differed by age, sex, deprivation, ethnicity, and region. Annual prevalence of non-NSAID analgesic prescriptions increased with age and deprivation, were higher in females than males, and higher in Northern than Southern England. The opposite pattern was seen with age for oral NSAIDs. NSAIDs were more commonly prescribed in males than females. Very little difference was seen in NSAID prescribing by deprivation, ethnicity, and region. There was a significant change in the trend of opioid prescription annual prevalence in 2015 (year of Public Health England’s “Opioid Aware” release) when the rate of decline increased, and at 2013 and 2018 for gabapentinoids when the annual prevalence increase slowed then declined (years of NHS England’s release of information on gabapentinoid risks, and their reclassification as controlled substances). Conclusion Whilst overall national analgesic prescribing in IA has fallen over 17 years - with interventions to deliver safer opioid/gabapentinoid prescribing potentially contributing - it remains common. This is at variance with evidence of analgesic efficacy and risks. The differences in prescribing of some analgesic types by patient sociodemographic factors and regions suggest unwarranted variation. Interventions are needed to improve the delivery of effective, equitable IA pain treatment. Disclosure I.C. Scott: None. R. Whittle: None. J. Bailey: None. H. Twohig: None. S.L. Hider: None. C.D. Mallen: None. S. Muller: None. K.P. Jordan: None.