Potential Disparities Research Articles

Differences in Pertussis Incidence by Race and Ethnicity in the United States, 2010-2017.

An increased pertussis burden has been demonstrated among Hispanic or Latino and American Indian or Alaska Native (AI/AN) infants. However, data on potential disparities among other age and racial groups are limited. We analyzed pertussis cases reported through Enhanced Pertussis Surveillance from 2010 to 2017. Pertussis and severe pertussis incidence were calculated by race (White, Black or African American, AI/AN, and Asian or Pacific Islanders), ethnicity (Hispanic or Latino and non-Hispanic or non-Latino), and age. Compared with White persons, overall incidence was lower among Black or African American (incidence rate ratio [IRR], .57; 95% confidence interval [CI], .53-.61), AI/AN (IRR, 0.65; 95% CI, .58-.72), and Asian or Pacific Islander persons (IRR, 0.39; 95% CI, .35-.43). Overall incidence of pertussis was higher (1.5-fold; 95% CI, 1.37-1.60) among Hispanic or Latino compared with non-Hispanic or non-Latino adults, potentially related to household size or lower pertussis vaccine uptake among adult Hispanic or Latino cases. Severe pertussis incidence was similar among Black or African American and AI/AN persons compared with White persons. Among infants, severe pertussis incidence was 1.4-fold higher (95% CI, 1.03-1.82) among Black or African American infants than among White infants, and 2.1-fold higher (95% CI, 1.67-2.57) among Hispanic or Latino infants than non-Hispanic or non-Latino infants. The contrast between lower reported incidence but similar or higher severe pertussis incidence among Black or African American and AI/AN persons compared with White persons warrants further investigation and may reflect underdiagnosis or underreporting of mild disease.

Making end-of-life health disparities in the U.S. visible through family bereavement narratives

ObjectiveEnd-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care. MethodsSemi-structured interviews with 25 bereaved individuals were conducted regarding their experiences with the terminal illness and death of an immediate family member. Using a framework of family bereavement narratives, a cross-case data analysis demonstrated qualitative patterns between (in)access to end-of-life care and how participants framed bereavement stories. ResultsFour themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond. InnovationThis innovative qualitative connection between family members' bereavement stories and end-of-life care emphasizes the importance of employing a health equity lens within hospice and palliative care, especially in addressing the important aim of comprehensively supporting families even when illness ends. This study demonstrates that access to, quality of, and imagining beyond current structures for EOL may be vital factors for facilitating effective sense-making for the dying and their family systems. ConclusionThese findings illustrate the potential interconnections between (in)access to end-of-life care, sense-making, and communication for individuals and families experiencing terminal illness and bereavement.

Estimation of Prevalence of Hyperacusis in High School Students of Mysore District.

Hyperacusis, characterized by an abnormal sensitivity to everyday sounds, is a condition associated with subjective distress and physiological changes in the auditory system. Prevalence rates have varied significantly worldwide, emphasizing the need for standardized criteria. This study aimed to determine the prevalence of hyperacusis among high school students in Mysore district and explore gender differences. A diverse cohort of 597 high school students participated in this cross-sectional study. The Modified Khalfa Hyperacusis Questionnaire assessed hyperacusis symptoms. Demographic data included age, gender, and educational status. A cut-off score of 28 on the questionnaire identified hyperacusis cases. Data were analyzed descriptively. The study revealed a substantial hyperacusis prevalence of 17.25% among high school students in the Mysore district. Out of 103 identified cases, 43.69% were females, and 56.31% were males. These results suggest a potential gender disparity in hyperacusis prevalence. The study's findings highlight the high prevalence of hyperacusis among Indian high school students, emphasizing the need for attention to this issue in adolescent health. Gender differences observed in this study align with previous research, indicating a higher prevalence among males. Hyperacusis is a prevalent condition among Indian high school students, warranting further research on its causes and co-occurrence across different age groups. These findings underscore the significance of addressing hyperacusis as a critical health concern among adolescents and emphasize the need for tailored interventions and increased awareness.

Abstract 1313: Racial disparities in colorectal cancer incidence across US ethnic groups: A comprehensive analysis

Abstract Colorectal cancer (CRC) ranks as the third most prevalent global cancer and the fourth leading cause of cancer-related deaths. Racial disparities in CRC within the United States pose a significant public health concern, affecting incidence, mortality rates, and screening rates. This study investigates the impact of racial disparities on CRC incidence across various US states, utilizing CRC data from the National Cancer Institute (NCI) at the Centers for Disease Control and Prevention (CDC). Analysis with GraphPad Prism 5 software and Student's t-test reveals a consistent trend of higher CRC incidence in males compared to females, irrespective of ethnicity. Notably, the Black and American Indian ethnic groups demonstrate the highest CRC incidences among all races, especially in individuals aged 65 and above. Certain states, including Iowa and Mississippi for Black populations, and Alaska, Minnesota, Montana, Oklahoma, and South Dakota for American Indian populations, exhibit significantly elevated CRC incidences compared to the national average. County-specific analysis in Alabama reveals varying CRC incidence rates across ethnic groups, with higher rates in specific counties, such as Clarke County for Black males. Limited reports for American Indian, Asian Pacific, and Hispanic ethnic groups indicate potential disparities in access to testing, awareness, and funding for CRC detection and prevention. This study concludes that Black and American Indian males and females experience a higher incidence of colorectal cancer, possibly influenced by genetic factors or other variables contributing to CRC development. The observed disparities are multifaceted, arising from a combination of social, economic, and healthcare system factors. Addressing these complexities is crucial for mitigating CRC disparities and promoting equitable healthcare access and outcomes. Additional research, including molecular screening studies, is essential to substantiate disparities in cancer-related health and enhance public health and cancer awareness within the community. Key Words: Cancer, Colorectal Cancer, Health Care, Racial Disparities Citation Format: Anathbandhu Chaudhuri, Rosianna Gray. Racial disparities in colorectal cancer incidence across US ethnic groups: A comprehensive analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1313.

Chronic Disease Multimorbidity Among Transgender People Living With HIV in North America

Despite the growing importance of HIV clinical care and research, scarce research has investigated multimorbidity among transgender populations. This study investigated multimorbidity burden for transgender people living with HIV using data from a large longitudinal cohort collaboration representative of HIV care-engaged adults in North America with cisgender (cis) comparators. Multivariable Poisson regression estimated chronic disease multimorbidity (HIV and ≥1 of chronic kidney disease, liver fibrosis, type two diabetes mellitus, hypertension, hyperlipidemia, and anxiety/depression) prevalence and incidence rate ratios by gender identity from January 2000 through December 2016 among adults (≥18 years old) engaged in HIV care in the United States and Canada among the North American TRAnsgender Cohort Collaboration, nested within the North American AIDS Cohort Collaboration on Research and Design. The total study sample included 301 transgender women (TW), 26 transgender men (TM), 11,504 cis women (CW), and 51,029 cis men (CM). At study entry, TW and TM were younger and more TW and TM were Black compared with CM. The prevalence and incidence of chronic disease multimorbidity were elevated for transgender PWLH, though without consistent statistically significant effects. Suggestive evidence of elevated multimorbidity and potential disparity among TW and TM compared with CW and CM in the current study highlights the importance of future studies with improved gender ascertainment and the ability to recruit larger transgender samples. Attention to intervenable chronic disease risk factors including smoking, and potentially unique vulnerabilities for TW vs TM, is also warranted.

Abstract 4816: Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients

Abstract Background: Beyond its well-known lethality, pancreatic cancer (PC) is associated with a wide variety of physical and psychological complications. These complications collectively lead to an increase in symptom burden experienced by patients with PC, as compared to other cancer types, leading to lower health-related quality of life (HRQoL) and worsened clinical outcomes. Reducing symptom burden is often achieved through the use of supportive care medications (SCM). Racial disparities have been described in the use of pain and psychiatric medications but limited research has explored potential disparities in access to and utilization of other SCM among diverse racial and ethnic groups. The goal of this study was to illustrate the presence of racial/ethnic disparities in the treatment patterns of supportive care medications in end-of-life care of PC patients Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database from 2005 to 2017. Participants were identified using ICD9 and ICD10 diagnostic codes. Patients diagnosed with PC and have died in 2005-2007 with more than 1 year of Medicare enrollment before death were included. Logistic regression models to assess the association between use of supportive care medications and race, adjusting for covariates (sex, race, age, marital status, education, income, residence, CCI, year of diagnosis of PC, cancer stage). Results: After the application of the inclusion/exclusion criteria, 74,309 patients were included in the final analysis (White: 72.53%, Black 11.01%, Hispanic 9.60%, Asian/Pacific Islander 6.58%) Racial and ethnic disparities in the use of multiple SCM drug classes were identified. The results are summarized in Table 1. Conclusion: Disparities in the use of SCM were found in patients with PC. Minorities had significantly less use of sleep aids and headache aids, and increased use of cognitive aids and appetite stimulants. AAs also had lower uses of anti-emetics. AA Hispanic Asian SCM Drug Class aOR 95% CI aOR 95% CI aOR 95% CI Anti-emetics 0.77 (0.73, 0.81) 0.98 (0.93, 1.03) 1.01 (0.95, 1.08) Appetite stimulants 1.06 (1.01, 1.11) 1.01 (0.96, 1.06) 1.28 (1.20, 1.36) Cognitive aids 1.38 (1.25, 1.53) 1.04 (0.93, 1.17) 1.11 (0.97, 1.26) Headache aids 0.68 (0.63, 0.74) 0.81 (0.74, 0.87) 0.85 (0.77, 0.93) Sleep aids 0.71 (0.67, 0.75) 0.87 (0.82, 0.92) 0.87 (0.81, 0.93) Citation Format: Olga M. Trejos Kweyete, Yi Guo, Sherise C. Rogers, Lisa Scarton, David L. DeRemer, Chardae L. Whitner, Diana J. Wilkie, John M. Allen. Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4816.

In-vivo 3-dimensional spine and lower body gait symmetry analysis in healthy individuals

BackgroundNumerous research studies have delved into the biomechanics of walking, focusing on the spine and lower extremities. However, understanding the symmetry of walking in individuals without health issues poses a challenge, as those with normal mobility may exhibit uneven movement patterns due to inherent functional differences between their left and right limbs. The goal of this study is to examine the three-dimensional kinematics of gait symmetry in the spine and lower body during both typical and brisk overground walking in healthy individuals. The analysis will utilize statistical methods and symmetry index approaches. Furthermore, the research aims to investigate whether factors such as gender and walking speed influence gait symmetry. MethodsSixty young adults in good health, comprising 30 males and 30 females, underwent motion capture recordings while engaging in both normal and fast overground walking. The analysis focused on interlimb comparisons and corresponding assessments of side-specific spine and pelvis motions. ResultsStatistical Parametric Mapping (SPM) predominantly revealed gait symmetries between corresponding left and right motions in the spine, pelvis, hip, knee, and ankle during both normal and fast overground walking. Notably, both genders exhibited asymmetric pelvis left-right obliquity, with women and men showing an average degree of asymmetry between sides of 0.9 ± 0.1° and 1.5 ± 0.1°, respectively. Furthermore, the analysis suggested that neither sex nor walking speed appeared to exert influence on the 3D kinematic symmetry of the spine, pelvis, and lower body in healthy individuals during gait. While the maximum normalized symmetry index (SInorm) values for the lower thorax, upper lumbar, lower lumbar, pelvis, hip, knee, and ankle displayed significant differences between sexes and walking speeds for specific motions, no interaction between sex and walking speed was observed. SignificanceThe findings underscore the potential disparities in data interpretations between the two approaches. While SPM discerns temporal variations in movement, these results offer valuable insights that may enhance our comprehension of gait symmetry in healthy individuals, surpassing the limitations of straightforward discrete parameters like the maximum SInorm. The information gleaned from this study could serve as reference indicators for diagnosing and evaluating abnormal gait function.

Abstract 3817: Real-world clinical outcomes in patients with advanced ROS1+non-small cell lung cancer in the US

Abstract Introduction: ROS1 rearrangements define a rare molecular subtype of non-small cell lung cancer (NSCLC), occurring in 1-2% of patients (pts) with advanced NSCLC (aNSCLC). Crizotinib and entrectinib received US approval for ROS1+ aNSCLC in March 2016 and August 2019, respectively. Few studies have addressed temporal trends in first-line (1L) utilization since these drugs’ approval. This study describes treatment patterns and clinical outcomes in pts with ROS1+ aNSCLC in the US. Methods: This retrospective study used the nationwide Flatiron Health (FH) electronic health record-derived de-identified database and included adult pts with ROS1+ aNSCLC who received 1L (index) therapy between March 2015 and December 2022. Pts were followed until March 31, 2023, and had ≥ 3 months of follow-up post-index date. Treatment-related (sequence, time to treatment discontinuation [TTD], time to next treatment [TTNT]) and clinical (real-world progression-free survival [rwPFS], overall survival [OS]) outcomes of 1L therapy were assessed using descriptive statistics and Kaplan-Meier methods. Results: In the FH database, 87,784 pts had aNSCLC, and 242 were ROS1+. The median age was 65 years; most were female (64%), White (67%), non-squamous (91%) and had a history of smoking (52%), with most pts having ECOG performance status 0 (31%) or 1 (35%). 19% had brain metastases prior to or up to 30 days post-index. Median follow-up time was 14.2 months. In 1L treatment, only 59% received ROS1-sensitive TKI monotherapy (i.e. crizotinib, entrectinib, ceritinib), with 97 (40%) and 40 (17%) treated with crizotinib and entrectinib monotherapy, respectively. Median TTD and TTNT for 1L was 6.4 (95% CI: 5.0, 7.6) and 7.6 (95% CI: 6.5, 9.4) months, respectively. Among 1L crizotinib pts, 51% had 2L treatments and 57% of those initiated another ROS1-sensitive TKI (16% entrectinib). Among 1L entrectinib pts, 43% had 2L therapy; of these, 82% initiated another ROS1-sensitive TKI. Median rwPFS was 7.5 (95% CI: 6.2, 9.3) months (1L crizotinib, 8.6 [95% CI: 5.3, 13.0] months; 1L entrectinib, 8.0 [95% CI: 5.3, 13.6] months). Median OS was 29.0 (95% CI: 19.4, 35.9) months (1L crizotinib, 31 [95% CI: 19.4, not estimable [NE]] months; 1L entrectinib, NE). Patients initiated ROS1-sensitive TKIs (crizotinib, entrectinib or ceritinib) in 1L across each year of the study (2015: 67%, 2016: 58%, 2017: 51%, 2018: 47%, 2019: 63%, 2020: 81%, 2021: 52%, 2022: 68%). Overall, 5% received checkpoint-inhibitor (CPI) only, 17% chemotherapy alone, and 7% a chemotherapy/CPI combination. Conclusion: Compared to relevant clinical trials, ROS1+ aNSCLC pts in this real-world study were older, had greater smoking exposure, and worse overall survival. Only 59% of pts initiated 1L ROS1-sensitive TKI monotherapy. These results highlight potential disparities in the diagnosis and treatment of ROS1+ NSCLC and opportunities for improving clinical outcomes. Citation Format: Reginald Villacorta, Saurabh Ray, Yong Yuan, Sushupta Vijapur, Sonia Kim, Haiyan Sun, Sky Myers, Vincent Lam. Real-world clinical outcomes in patients with advanced ROS1+non-small cell lung cancer in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3817.

Abstract 6374: Socio-demographic predictors of recruitment in neuroblastoma therapeutic clinical trials

Abstract The generalizability of clinical trial outcomes hinges upon the equitable access and enrollment of diverse patient populations. Yet, disparities persist that may influence enrollment patterns. In neuroblastoma, the impact of ethnicity, socioeconomic status (SES), distance to care, and age at diagnosis on enrollment in therapeutic trials remains underexplored. We aimed to investigate these factors in neuroblastoma patients to identify potential disparities in clinical trial participation. We utilized the Childhood Cancer Research Network data, selecting neuroblastoma cases from 2008-2015, excluding those >21 years old or with incomplete data. We focused on factors influencing enrollment in therapeutic trials (ANBL0032, ANBL0421, ANBL0531, ANBL0532, ANBL0621, ANBL0931, ANBL1021, ANBL1221, ANBL1232). Key predictors examined were ethnicity, age at diagnosis, SES (via Yost Index), and distance to care from home to treatment hospital. We employed Poisson regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals for trial participation. Analyzing 3,148 neuroblastoma cases from the CCRN registry, the ethnic composition was as follows: 68% were non-Hispanic White, 14% Hispanic, and 10% NH Black and SES distribution was even across quintiles. Age at diagnosis was a significant factor in trial enrollment: children >2 years were 94% more likely to enroll than those under 2 years (p < 0.001). Race, ethnicity, SES, and distance to care showed no significant effect on enrollment, all with non-significant p-values. In CCRN, neuroblastoma patient's age at diagnosis was a determinant in therapeutic trial enrollment, providing insight into design strategies to encourage trial participation. While common barriers like race, ethnicity, SES, and distance to care did not impact enrollment in our cohort, the significant role of age highlights an area where focused efforts can ensure that all age groups have equitable access to the potential benefits of therapeutic trials. Category N aRR (95% CI) p-value Race and Ethnicity Non-Hispanic (NH) White 2139 ref Hispanic (All races) 436 0.93 (0.81, 1.08) 0.36 NH Black 320 1.07 (0.93, 1.23) 0.33 NH Asian/Pacific Islander 98 1.14 (0.89, 1.47) 0.30 NH American Indian/Alaska Native 17 0.95 (0.48, 1.88) 0.89 Other 138 0.94 (0.75, 1.17) 0.55 SES (Yost Index) Quintile 1 493 0.88 (0.75, 1.02) 0.09 Quintile 2 524 0.95 (0.83, 1.10) 0.53 Quintile 3 606 0.98 (0.86, 1.11) 0.71 Quintile 4 554 0.92 (0.80, 1.06) 0.24 Quintile 5 563 ref Age at Diagnosis <2 year 1790 ref >2 years 1354 1.94 (1.76, 2.12) <0.001 Distance to Care 0-25 miles 1520 ref >25-50 miles 535 1.05 (0.93, 1.18) 0.36 >50-100 miles 412 0.97 (0.85, 1.11) 0.91 >100-250 miles 239 0.99 (0.87, 1.13) 0.60 >250 miles 82 0.99 (0.77, 1.28) 0.97 Citation Format: DeVon Hunter-Schlichting, Jeannette Sample, Kate Knowles, David Van Riper, Logan Spector, Erin Marcotte. Socio-demographic predictors of recruitment in neuroblastoma therapeutic clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6374.

Temporal Considerations in Brain Metastases Radiation Therapy: The Intersection of Chronobiology and Patient Profiles.

The circadian system, a vital temporal regulator influencing physiological processes, has implications for cancer development and treatment response. Our study assessed circadian timing's impact on whole-brain radiotherapy outcomes in brain metastases for personalized cancer therapy insights. The aim of the study was to evaluate circadian influence on radiation treatment timing and its correlation with clinical outcomes and to identify patient populations benefiting from interventions synchronizing circadian rhythms, considering subgroup differences and potential disparities. An IRB-approved retrospective analysis of 237 patients undergoing whole-brain radiotherapy for brain metastases (2017-2021), receiving over 80% of treatments in the morning or afternoon, was performed. Survival analyses utilized Kaplan-Meier curves. This was a single-institution study involving patients receiving whole-brain radiotherapy. Demographic, disease, and socioeconomic parameters from electronic medical records were collected. Morning treatment (n = 158) showed a trend toward improved overall survival vs. afternoon (n = 79); the median survival was 158 vs. 79 days (p = 0.20, HR = 0.84, CI95% 0.84-0.91). Subgroup benefits for morning treatment in females (p = 0.04) and trends in controlled primary disease (p = 0.11) and breast cancer metastases (p = 0.08) were observed. Black patients exhibited diminished circadian influence. The present study emphasized chronobiological factors' relevance in brain metastases radiation therapy. Morning treatment correlated with improved survival, particularly in specific subgroups. Potential circadian influence disparities were identified, laying a foundation for personalized cancer therapy and interventions synchronizing circadian rhythms for enhanced treatment efficacy.

Presenting Off-Hours, Door-to-Balloon Time, and Clinical Results in Patients Primary Percutaneous Coronary Intervention

Background: The timely management of ST-segment elevation myocardial infarction (STEMI) through primary percutaneous coronary intervention (PCI) significantly impacts patient outcomes. However, the influence of off-hours presentation (nights, weekends, and holidays) on door-to-balloon (D2B) time and clinical outcomes remains a pivotal concern, as it potentially affects the efficiency of care and patient prognosis. Objective: This study aims to evaluate the association between off-hours presentation, D2B time, and clinical outcomes in patients undergoing primary PCI for STEMI, to identify potential disparities in treatment efficacy and to inform strategies for improving cardiovascular emergency care. Methods: Conducting a retrospective cross-sectional analysis, this study included 90 patients admitted with STEMI who underwent primary PCI at a tertiary care center between March 2022 and March 2023. Patients were stratified into two groups based on the timing of hospital presentation: off-hours and regular hours. Primary outcomes assessed were D2B time, mortality rates, and incidences of cardiogenic shock and heart failure. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and multivariable logistic regression to adjust for potential confounders. Results: The mean D2B time for patients presenting during off-hours was significantly longer (96.4 ± 12.3 minutes) compared to those presenting during regular hours (84.6 ± 9.8 minutes, p<0.001). No statistically significant differences were observed in mortality rates (off-hours 4.4% vs. regular hours 6.7%, p=0.155), cardiogenic shock (off-hours 6.7% vs. regular hours 4.4%, p=0.351), or heart failure (off-hours 8.9% vs. regular hours 6.7%, p=0.214). Multivariable analysis confirmed off-hours presentation as an independent predictor of prolonged D2B time (coefficient 11.8, 95% CI 8.2-15.5). Conclusion: Off-hours presentation is associated with significantly longer D2B times in STEMI patients undergoing primary PCI, underscoring the need for healthcare systems to address the disparities in care delivery during off-hours. However, no significant differences in short-term clinical outcomes were observed, suggesting that factors beyond D2B time contribute to patient prognosis. Further studies are warranted to explore comprehensive strategies to optimize care irrespective of presentation time.

“You matter”: patients perceptions and disparities about cancer care and telehealth during and after COVID-19 pandemic

PurposeDisparities in cancer care have been exacerbated by the COVID-19 pandemic. The aim of this study is to establish how telehealth mitigated the effect of COVID-19 on the healthcare sector and to identify potential disparities in perception and experience with telehealth in cancer care during and after the pandemic.MethodsWe identified individuals with an established cancer diagnosis who received treatment at a comprehensive academic cancer center with a diverse patient population between 2019 and 2021, during the COVID-19 pandemic. Participants were asked to complete a self-administrated survey intended to collect patient-reported outcomes on socioeconomic and mental health challenges incurred during the pandemic as well as participants’ experience with telehealth. The assessment was adapted from a 21-question-based survey applied for mental health. Descriptive statistics were used to summarize participant characteristics and the response to the survey items. Multivariable logistic regression was performed to assess and analyze the contributing factors to the survey responses.ResultsA total of N = 136 participants were included in this analysis. The majority of participants (60.6%) reported increased anxiety, stress, or experience of distress as a direct result of COVID-19. However, among 54.1% of survey responders participated in a telehealth appointment and 84.4% agreed it was an easy and effective experience.ConclusionElderly, male, and black participants reported the worst impact related to the pandemic. The majority of patients had a positive experience with telehealth. The results of the study suggest that telehealth services can serve as a tool for patients with cancer during and beyond active treatment to access supportive services.

Abstract P247: Rural-Urban Disparities in In-Hospital Stroke Mortality in North Carolina

Introduction/Hypothesis: Stroke remains a significant public health concern. North Carolina (NC) has the 11 th highest stroke mortality in the United States and an increasingly diverse population with respect to rurality and race-ethnicity. We assessed the hypothesis that rural stroke patients have higher in-hospital mortality than urban stroke patients in NC. We also explored the interaction between rurality and race-ethnicity on stroke mortality. Methods: We conducted a retrospective study of stroke hospitalizations at 115 NC hospitals from January 2019-September 2020. Data were obtained from an inpatient database of patient demographics, county of residence, insurance, admission date, and discharge disposition and diagnoses. Eligible patients included adults with principal discharge diagnosis codes for stroke (ICD-10-CM I60.xx-I63.xx) and were classified by rurality defined by the NC Office of Rural Health. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) comparing in-hospital mortality in rural versus urban patients, overall and stratified by race-ethnicity subgroups. Results: Among 32,808 patients, 37% resided in rural counties. Patients were mean 69 years old, 50% female, 30% Black, and 3% Hispanic. Unadjusted in-hospital mortality was lower in rural versus urban patients (4.2% and 5.0%, respectively). Adjusted model found a weak, non-significant association between rurality and stroke mortality (OR 1.06, 95% CI 0.95-1.19; Table 1). In race-ethnicity subgroups, rural-urban ORs were not statistically significant although the point estimates suggest modestly greater differences among racial/ethnic minorities compared to White patients. Conclusions: We found minimal, adjusted rural-urban differences in in-hospital stroke mortality in NC statewide and within race-ethnicity subgroups. Further research is needed to investigate potential disparities in long-term stroke mortality and morbidity and their underlying determinants.

Comparative statistical analysis of pitting in Two 2205 duplex stainless steel variants

The inherent variability of pitting poses challenges in accurately evaluating the pitting resistance due to potential disparities in test results. This study compares the pitting resistance of two commercial 2205 duplex stainless steels. Counterintuitively, the variant with higher Pitting Resistance Equivalent Number, exhibits a lower Critical Pitting Temperature. Through the potentiostatic pulse test and potentiostatic polarization, this variant is observed to have a greater number of pitting initiation sites. Further investigation, using SEM inclusion statistics, reveals an increased presence of inclusions rich in calcium oxides as the underlying cause of this unexpected phenomenon.

Evaluation of a Structured Review Process for Emergency Department Return Visits with Admission

Review of emergency department (ED) revisits with admission allows the identification of improvement opportunities. Applying a health equity lens to revisits may highlight potential disparities in care transitions. Universal definitions or practicable frameworks for these assessments are lacking. The authors aimed to develop a structured methodology for this quality assurance (QA) process, with a layered equity analysis. The authors developed a classification instrument to identify potentially preventable 72-hour returns with admission (PPRA-72), accounting for directed, unrelated, unanticipated, or disease progression returns. A second review team assessed the instrument reliability. A self-reported race/ethnicity (R/E) and language algorithm was developed to minimize uncategorizable data. Disposition distribution, return rates, and PPRA-72 classifications were analyzed for disparities using Pearson chi-square and Fisher's exact tests. The PPRA-72 rate was 4.8% for 2022 ED return visits requiring admission. Review teams achieved 93% agreement (κ = 0.51) for the binary determination of PPRA-72 vs. nonpreventable returns. There were significant differences between R/E and language in ED dispositions (p < 0.001), with more frequent admissions for the R/E White at the index visit and Other at the 72-hour return visit. Rates of return visits within 72 hours differed significantly by R/E (p < 0.001) but not by language (p = 0.156), with the R/E Black most frequent to have a 72-hour return. There were no differences between R/E (p = 0.446) or language (p = 0.248) in PPRA-72 rates. The initiative led to system improvements through informatics optimizations, triage protocols, provider feedback, and education. The authors developed a review methodology for identifying improvement opportunities across ED 72-hour returns. This QA process enabled the identification of areas of disparity, with the continuous aim to develop next steps in ensuring health equity in care transitions.

Recommendations for the assessment of sexual and gender minority status in serious mental illness research and clinical care.

Sexual and gender minority (SGM) groups experience exposure to minority stress, including discrimination, prejudice, microaggressions, and internalized stigma. Despite the sizable portion of the United States' population that identifies as SGM, relatively little research has been done to comprehensively understand the mental health consequences of SGM stress-particularly as they relate to serious mental illnesses (SMIs)-and SGM status is rarely reported in published studies. This article provides an overview of SGM research among people with SMIs as well as other relevant disorders. Findings show that sizable gaps remain in our knowledge of whether SGM groups experience higher rates or greater severity of SMIs, including schizophrenia-spectrum and bipolar disorders, though findings related to depressive and trauma-related disorders may be able to inform research and treatment for those with SMIs. To increase our understanding of potential mental health disparities for those with SMIs, researchers are encouraged to include measures to assess SGM identity, report upon this demographic information within their manuscripts, and examine differences in rates and severity of SMIs between these groups. Clinicians are encouraged to incorporate demographic questions into their standard intake batteries and initiate discussion of SGM status and minority stressors early on in treatment to promote more positive outcomes for this group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Collapsing glomerulopathy is likely a major contributing factor for worse allograft survival in patients receiving kidney transplants from black donors.

Although a few registry-based studies have shown associations between receiving kidney allografts from Black donors and shorter allograft survival, detailed, large, single-center studies accounting for common confounding factors are lacking. Furthermore, pathologic alterations underlying this potential disparity have not been systematically studied. We performed a retrospective clinical-pathological study of kidney transplant recipients who received kidney allografts from either Black (n = 407) or White (n = 1,494) donors at Columbia University Irving Medical Center from 2005 to 2018, with median follow-up of 4.5 years post-transplantation. Black donor race was independently associated with allograft failure (adjusted HR = 1.34, p = 0.02) and recipients of kidney allografts from Black donors had a higher incidence of collapsing glomerulopathy [7.4% vs. 1.9%, OR = 4.17, p < 0.001]. When causes of allograft failure were examined, only allograft failure following development of collapsing glomerulopathy was more frequent in recipients of allografts from Black donors [15% vs. 5%, OR = 3.16, p = 0.004]. Notably, when patients who developed collapsing glomerulopathy were excluded from analysis, receiving kidney allografts from Black donors was not independently associated with allograft failure (adjusted HR = 1.24, p = 0.10). These findings revealed that, compared with recipients of kidney allografts from White donors, recipients of kidneys from Black donors have modestly shorter allograft survival and a higher probability of developing collapsing glomerulopathy, which negatively impacts allograft outcome. Identification of collapsing glomerulopathy risk factors may help decrease this complication and improve allograft survival, which optimally may reduce racial disparities post-transplantation.

THE IMPACT OF DIGITAL EDUCATION ON MALAYSIAN STUDENTS: A SIGNIFICANT REVIEW

This scoping article investigates the profound implications of digital education on Malaysian students, aiming to provide a comprehensive overview of its impact. The introduction delineates the evolving landscape of education in the digital age and underscores the increasing reliance on technology for learning. The problem statement identifies key challenges faced by Malaysian students in adapting to digital education, such as technological disparities, access limitations, and potential disparities in the quality of online education. Employing a mixed-methods approach, the methodology combines quantitative surveys to gauge the extent of digital education adoption and qualitative interviews to explore the nuanced experiences and perceptions of students. The expected results anticipate a multifaceted impact, including enhanced accessibility, potential disparities, and varying degrees of adaptability. This study envisions contributing valuable insights to policymakers, educators, and stakeholders in refining digital education strategies tailored to the Malaysian context. In conclusion, the article discusses the broader implications of the findings, emphasizing the need for equitable digital infrastructure and pedagogical innovations to ensure a positive and inclusive educational transformation in Malaysia.

On the equity of the x-minute city from the perspective of walkability

Walkability and equity in transport are crucial aspects of sustainable mobility and social well-being. The x-minute city concept emphasizes the importance of walkability, by fostering the design of a city where people can easily access their daily needs aiming to reduce reliance on private cars. However, such approaches, which generally rely on the idea of an “average resident” can ignore inequalities amongst people and fail to achieve the goal of building urban environments where everyone can participate in city life regardless of their socio-economic characteristics and vulnerability. In this study we propose an approach to assess the equity of the x-minute city, highlighting the limitations of the current application of the concept. The approach includes the computation of x-minute thresholds based on the walkability of pedestrian paths and considering different users’ needs. Home to school trips and social trips are taken as a reference; equity metrics such as the Lorenz Curve and Gini Index are used to assess how the x-minute city concurs with the transport equity of a city. The results of the assessment can help identify potential disparities in access to key destinations among different user groups, and support evidence-based policy recommendations to promote equitable transportation options. The case study of Bari, Italy, is used to illustrate the application of the method; however, the proposed approach can be replicated in different contexts, contributing to the ongoing discourse on walkability and equity in transport.

Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data.

The purpose of this study was to characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database. Merative MarketScan insurance claims (n = 12,394,902) were used to identify youth (6-17 years of age) newly diagnosed with narcolepsy (International Classification of Diseases, 10th revision codes). Narcolepsy diagnosis and care 1 year postdiagnosis included polysomnography with Multiple Sleep Latency Test, pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only). The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black vs White youth with Medicaid. Two thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had polysomnography with Multiple Sleep Latency Test (± 1 year postdiagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have polysomnography with Multiple Sleep Latency Test. Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black vs White children with Medicaid. Only half overall had evidence of a diagnostically required polysomnography with Multiple Sleep Latency Test, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management. Tang SH, Min J, Zhang X, etal. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med. 2024;20(7):1141-1151.