Potential Disparities Research Articles

Racial Disparities in the Utilization of Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability in the United States

Background: Previous studies have reported on the impact of race and ethnicity on access to orthopaedic procedures in the United States. However, there are few studies evaluating racial disparities in elective foot and ankle surgeries. Recognizing and addressing disparities in the access of health resources are steps to improve care rationing. Our study specifically investigated potential racial disparities with utilization and perioperative metrics of lateral ankle ligament reconstruction. Methods: A retrospective study was performed using the National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology ( CPT) code 27698 was used to identify patients who underwent LALR from 2011 to 2020. Sixty-one percent of these patients had available race/ethnicity data and were included in the study. Designations of race and ethnicity were standardized as White non-Hispanic, Black non-Hispanic, Hispanic, Asian American and Pacific Islander, and Other. Race/ethnicity stratifications of NSQIP patients were compared to 2010 and 2020 census data from the United States (US) Census Bureau. Thirty-day postoperative complications and total length of hospital stay, for all complications, were also compared between White patients and all other patients combined. Independent t tests, χ2, and Fisher exact tests were performed to compare differences including age, gender, and postoperative complications. Results: Overall, 1295 patients were included in the study. White non-Hispanic patients underwent 3.3 times more LALR than all other patients during the study period. This finding shows a higher prevalence of surgery on White non-Hispanic patients than all others reported in the US Census Bureau data for 2010 and 2020, where the ratio of White non-Hispanic vs all others were 1.9 and 1.5-fold, respectively. White patients were marginally older with a mean age of 38 years, compared with 36 years for Black patients ( P < .05). There were no differences in 30-day complication rates or total length of hospital stay based on race and ethnicity. Conclusion: Our study found that there was increased utilization of LALR for White non-Hispanic patients compared with all other racial/ethnic groups. These numbers do not mimic the current population trends based on the national census data. Despite this discrepancy, no differences in postoperative complications and length of stay were found based on race and ethnicity. These results suggest that there may be barriers for patients who are not White non-Hispanic to undergo care for LALR. Level of Evidence: Level III, retrospective cohort study.

Gender Differences in Electronic Health Record Usage Among Surgeons.

Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being. To investigate gender differences in EHR usage patterns. This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024. Surgeon's gender. The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables. This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours. This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.

Frailty, Specialized Care, and Sociodemographic Factors: Disparities in Oral Pharmacotherapy Class Utilization Among Medicare Part D Beneficiaries With Overactive Bladder in the United States

ObjectivesTo describe the prevalence of frailty among Medicare beneficiaries with overactive bladder (OAB), analyze oral therapy patterns, and examine potential disparities in treatment. MethodsThis retrospective cohort study utilized the 20% Research Identifiable File Medicare Part D prescription claims dataset (2013-2018). Using the Claims-Based Frailty Index (CFI), Medicare beneficiaries ≥65 years old with OAB were categorized as not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), and frail (CFI >0.25). Logistic regression models assessed associations between frailty and pharmacotherapy utilization. ResultsAmong 111,761 patients (15.8% of the OAB cohort) receiving oral pharmacotherapy (anticholinergic oral medications or mirabegron), 71% were women, 83% were White, and 11.9% were frail. After controlling for age, co-payments and dual eligibility status, frail status (OR 1.16; 95% CI [1.09 - 1.24]), urology (OR 2.05 (95% CI [1.94 - 2.16]) or gynecology (OR 1.74; 95% CI [1.6 - 1.9]) prescribers and residing in the Southern United States (OR 1.53; CI [1.49 - 1.61]) were associated with higher likelihood of mirabegron utilization. Black (OR 0.79; 95% CI ([0.74 - 0.85]) and American Indian/Alaska Native (OR 0.54, 95% CI ([0.39 - 0.74]) patients were less likely to utilize mirabegron than White beneficiaries. ConclusionFrail beneficiaries and those with urology and gynecology prescribers showed higher likelihoods of beta-3 agonist utilization. Despite adjustments, Black and AI/AN patients were less likely to fill mirabegron prescriptions, suggesting disparities in treatment. Our findings highlight the need for policies, interventions, and initiatives to promote equitable OAB oral therapy utilization in vulnerable populations.

Pediatric femoral shaft fractures: the American Academy of Orthopaedic Surgeons clinical practice guidelines versus actual management in a teaching hospital.

In 2009, the clinical practice guidelines (CPG) were released by the American Academy of Orthopaedic Surgeons (AAOS), which outline an age-based approach for treating pediatric femoral shaft fractures (PFSF), both nonoperatively and operatively. The aim of the current study was to investigate potential disparities between the recommended treatments for PFSF based on the AAOS-CPG and the actual treatments administered in The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A retrospective review was conducted on the medical charts and radiographs of all PFSF treated at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2014 to January 2022. We identified 445 children who met our inclusion criteria and evaluated their treatments according to the AAOS-CPG. Actual treatments were then compared with the treatments recommended by the AAOS-CPG. Binomial and multivariate logistic regression was used to examine whether different factors could predict the choice between operative and nonoperative management. Operative treatments were undertaken in 102 of 215 (47.4%) fractures in children younger than 6 years, in 102 of 122 (83.6%) fractures in those between 6 and 12 years of age, and in 107 of 108 (99.1%) fractures in those older than 12 years. Nonoperative management was conducted in 113 of 215 (52.6%) fractures in children younger than 6 years, in 20 of 122 (16.4%) fractures in those between 6 and 12 years of age, and in 1 of 108 (0.9%) fractures in those older than 12 years of age. Surgeon decisions for non-surgery were in agreement with the CPG 52.6% of the time, whereas agreement reached 90.9% for surgical choices. Predictors of actual operative management were age (P=0.01), patient weight (P<0.001), fracture pattern (P<0.001), presence of other orthopedic injuries requiring surgery (P=0.002), and polytrauma (P=0.02). There was limited concordance between actual treatments and CPG recommendations, particularly for the nonoperative management of fractures in children under 6 years old. Age, patient weight, fracture pattern, presence of other orthopedic injuries requiring surgery, and polytrauma were the main predictors of our operative decision-making process.

Gender Disparities in Pro-Environmental Attitudes: Implications for Sustainable Business Practices in Croatia

Objective – This research aimed to investigate potential disparities between genders in Croatia regarding their pro-environmental attitudes and mindsets, focusing on understanding how gender influences individuals' environmental consciousness and support for sustainable practices. This paper presents an empirical study utilizing survey data to examine gender differences in environmental attitudes and behaviors. Methodology – It contributes to the field of environmental sociology by exploring the role of gender in shaping individuals' responses to environmental challenges, with implications for policy development and sustainability initiatives. By employing an online survey via snowball sampling, a total of 263 adult participants from Croatia were recruited for the study. Closed-ended questions on a Likert scale measured respondents' attitudes towards recycling, waste sorting, environmental protection urgency, and health impacts of environmental issues. Findings – The findings in this research indicate that gender plays a role in influencing individuals' environmental attitudes and behaviors, with significant gender-based variations in environmental consciousness. Women exhibit higher levels of concern for environmental issues, stronger support for recycling policies, and a more positive outlook on the health implications of ecological problems. This study provides valuable insights into the connection between gender and environmentalism in Croatia, making significant contributions to existing literature. Moreover, it offers implications for the development of policies targeting environmental management and recognizing the need to influence the environmental behavior of each gender. By focusing on gender disparities in pro-environmental behaviors, the study offers new insights into the connection between gender and environmentalism, emphasizing the need for gender-sensitive approaches to environmental policymaking and intervention. Novelty – The research aims to deepen our understanding of the intersection between gender and environmental attitudes, highlighting the importance of incorporating gender-specific perspectives into efforts to promote sustainable behaviors, address environmental challenges, and foster more environmentally conscious societies in Croatia and beyond. Type of Paper: Empirical JEL Classification: F64, J16, Q54, Q56 Keywords: environmental attitudes, sustainability, eco-awareness, environmental behavior Reference to this paper should be made as follows: Mandarić, D; Hunjet, S.A. (2024). Gender Disparities in Pro-Environmental Attitudes: Implications for Sustainable Business Practices in Croatia, J. Bus. Econ. Review, 9(1), 73–84. https://doi.org/10.35609/jber.2024.9.1(4)

Association of Area Deprivation Index with Adherence to Proposed Regimen in Patients with Sarcoidosis in Detroit, Michigan.

Social predictors affect severity of sarcoidosis, with Black patients, older individuals, those with lower income, and those without insurance having greater severity. This study aimed to explore potential disparities affecting access to care in sarcoidosis patients with a primary focus on metrics such as area deprivation index (ADI) and its association with adherence to the proposed regimen. A retrospective chart review study of all patients seen in pulmonary clinics at a large urban tertiary care center over 2 years with sarcoidosis patients identified with International Classification of Diseases diagnosis code D86. Data collected included age, race, sex, ADI, insurance, online patient portal usage, chest x-rays, pulmonary function tests, missed visits, hospitalizations, positive biopsy, communication and visits around bronchoscopy. Categorical variables were described using frequency and percentage. Numerical variables were described using median, mean and standard deviation. Statistical analysis included chi-square test, two-sample T-test and Wilcoxon rank sum test. Multivariate logistic regression analysis was performed to model independent association with 12 month no-show occurrence as a metric of adherence to the proposed regimen. Among sarcoidosis patients (N = 788), univariate models showed the presence of active online patient portal use among younger patients (58.6 years with portal vs. 65.1 years without portal, p < 0.001), those with lower ADI (73 with portal vs. 92 without portal, p < 0.001) and with commercial insurance (48.5% with portal vs. 20.7% without portal, p < 0.001); more x-rays (45.6% with x-rays vs. 36.6% without x-rays, p = 0.018) and hospitalizations (50.3% with hospitalizations vs. 36.2% without hospitalizations, p < 0.001) in Medicare patients. Sarcoidosis patients with positive biopsies on file from 2013-2023 were more likely to be male (44.19% with positive biopsy vs. 33.91% without positive biopsy, p = 0.006), White (36.29% with positive biopsy vs. 22.9% without positive biopsy, p < 0.001) or other races (3.23% with positive biopsy vs. 2.25% without positive biopsy, p < 0.001), younger (55.8 years with positive biopsy vs. 61.7 years without positive biopsy, p < 0.001) and belonged to lower national ADI ranks (73 with positive biopsy vs. 80 without biopsy, p = 0.041). A multivariate analysis was done with those variables found to be significant in the univariate analyses, which revealed that higher ADI national was associated with failure to adhere to the proposed regimen. We identified intricate patterns of sociodemographic variables affecting access to care in sarcoidosis patients, especially higher ADI national associated with failure to adhere to the proposed regimen, raising concerns for potential healthcare barriers. Understanding these barriers is vital for equitable high-quality care, assisting in timely and efficient management of the patient's disease.

Racial difference in receiving computed tomography for head injury patients in emergency departments

Study objectivePrior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. MethodsPatients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. ResultsAmong 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06–2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. ConclusionsAsian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.

Transferability of new methods for health technology assessment in the field of diabetes between early and late adopters’ countries

This study aimed to investigate the transferability of novel artificial intelligence (AI) methods for prediction modelling of diabetes based on real-world data (RWD) between early and late adopters of emerging health technologies from the perspective of developers and health technology assessment (HTA) experts. A two-step approach was used. Developers of the new AI methods within HTx consortium completed a survey about the benefits, usability, barriers associated with implementing the new prediction models in routine HTA practices. Then, HTA experts from Central and Eastern European (CEE) countries participated in a focus group discussion. Developers generally expressed optimism regarding the transferability of the methods, while acknowledging potential disparities across CEE countries. Key benefits that were identified included enhanced understanding of diabetes, improved cost-effectiveness modelling, and refined patient stratification, all of which could contribute to clinical and reimbursement decisions across various jurisdictions. The focus group underscored the value of real-world data for diabetes prediction modelling, serving as a beneficial resource for both clinicians and HTA agencies. However, there was a recognized need to clarify the processes of integrating randomized clinical trial data with real-world data. For the other stakeholders, the advancement of the methodology will improve the diagnosis and therapy during the process of decision making. Experts from CEE countries recognized the potential of artificial intelligence-based methods employing real-world data for diabetes modelling. These methods are seen as instrumental in elucidating the heterogeneous nature of the disease, supporting clinician decision-making and holding promises for HTA purposes.

Abstract PO-033: Unveiling the complexity of HIV-associated plasmablastic lymphoma: A case report of anal cavity presentation with unconventional immunohistochemical profile

Abstract Introduction: HIV-associated Plasmablastic Lymphoma (PBL) stands as a rare subset of Diffuse Large B-cell Lymphoma (DLBCL), marked as an AIDS-defining malignancy. The primary presentation site is the oral cavity. Although extra-oral PBLs have been reported, these are considered to be very rare. Despite its scarcity, understanding its pathogenesis, diagnosis, and management remains paramount. Herein, we elucidate a distinctive case of HIV-associated PBL manifesting in the anal cavity, an infrequent site, accompanied by an intriguing immunohistochemical signature. Clinical Course: A 30-year-old male presented with symptoms indicative of an anal mass, ultimately diagnosed as Plasmablastic Lymphoma. Further evaluation disclosed a pulmonary nodule and a substantial anal-perineum mass. Given the concurrent HIV infection, initiation of retroviral therapy was crucial alongside lymphoma-directed treatment. Notably, immunohistochemical analysis revealed an unusual profile, encompassing positive expression for CD45, CD38, MYC, OCT2, and MUM1, alongside a heightened Ki-67 proliferation index. Conversely, markers such as CD20, PAX5, Pankeratin, CK7, CK20, MART1, CD30, HHV8 CD138 and P63 exhibited negativity. Epstein-Barr virus (EBV) presence was detected. Treatment initiation comprised HyperCVAD chemotherapy, supplemented by intrathecal chemotherapy and methotrexate. Discussion: Immunophenotypically, PBL conventionally lacks CD45, CD20, and CD79a expression while expressing CD38, CD138, and MUM1. However, our case deviated with positive CD45 expression and negative CD138. Treatment paradigms for HIV-associated PBL encompass intensive regimens such as CHOP-alike regimens with other intensive alternatives such as CODOX-M/IVAC, DA-EPOCH or Hyper-CVAD therapy, with limited intrathecal agent utilization to avert central nervous system involvement. Despite aggressive therapeutic measures, prognosis remains guarded. The progression free survival rates range between 6 and 7 months, with median overall survival falling within the 11 to 13 month range. Long-term survivors predominantly emerge among pediatric patients, underscoring potential disparities in disease biology and treatment response. Conclusion: This case epitomizes the heterogeneity and intricacy inherent in HIV-associated Plasmablastic Lymphoma. The unconventional presentation in the anal cavity, coupled with an atypical immunohistochemical profile, poses challenges to diagnostic and therapeutic strategies. Collaborative efforts with specialized centers are imperative for optimal disease management, accentuating the imperative for sustained research endeavors to enhance outcomes in this aggressive lymphoma variant. Citation Format: Aliya M Khan, Mehmet Hepgur, Sophia Navajas. Unveiling the complexity of HIV-associated plasmablastic lymphoma: A case report of anal cavity presentation with unconventional immunohistochemical profile [abstract]. In: Proceedings of the Fourth AACR International Meeting on Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2024 Jun 19-22; Philadelphia, PA. Philadelphia (PA): AACR; Blood Cancer Discov 2024;5(3_Suppl):Abstract nr PO-033.

Disparities in cause-specific mortality by health insurance type and premium: evidence from Korean NHIS-HEALS cohort study, 2002–2019

BackgroundAlthough one’s socioeconomic status affects health outcomes, limited research explored how South Korea’s National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality.MethodsBased on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002–2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality.ResultsThe SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10–1.15] for men and 1.18 [1.15–1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types.ConclusionThis nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level.Trial registrationThis study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975).

Bridging the Gap: Understanding Appalachian Patient Satisfaction in Cosmetic Rhinoplasty.

Rhinoplasty is a surgical procedure aimed at correcting both functional and aesthetic nasal deformities, addressing issues such as trauma-induced disfigurements and patient dissatisfaction with nasal appearance. Patient satisfaction is a critical outcome measure in rhinoplasty, reflecting the success of the procedure and the quality of care provided. This study investigates factors influencing patient satisfaction among Appalachian patients undergoing rhinoplasty for aesthetic reasons, considering the unique healthcare challenges faced by rural populations. A modified Rhinoplasty Outcome Evaluation questionnaire was utilized to assess patient satisfaction. Descriptive statistics and regression analyses were performed to analyze demographic characteristics, complications, re-operations, and satisfaction scores among rural and urban participants. While no significant differences were found in demographic characteristics, trends in satisfaction scores suggest potential disparities between rural and urban populations. Rural patients exhibited marginally lower satisfaction scores and higher rates of complications and re-operations, highlighting the need for targeted interventions in rural healthcare settings. Addressing geographic barriers, enhancing preoperative education and postoperative support, and fostering interdisciplinary collaboration are essential strategies to improve patient satisfaction and outcomes in rhinoplasty procedures, particularly in rural communities. Further research with larger sample sizes and qualitative methods is warranted to explore the underlying factors contributing to patient satisfaction disparities and to inform evidence-based interventions aimed at narrowing healthcare disparities and advancing health equity in rhinoplasty care.

Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations.

The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes. Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions. Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (β = -5.49, SE = 0.71) and Hispanic participants (β = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (β = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs. Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations.

Genomic profiles of Japanese patients with vulvar squamous cell carcinoma

The incidence of vulvar carcinoma varies by race; however, it is a rare disease, and its genomic profiles remain largely unknown. This study examined the characteristics of vulvar squamous cell carcinoma (VSCC) in Japanese patients, focusing on genomic profiles and potential racial disparities. The study included two Japanese groups: the National Cancer Center Hospital (NCCH) group comprised 19 patients diagnosed between 2015 and 2023, and the Center for Cancer Genomics and Advanced Therapeutics group comprised 29 patients diagnosed between 2019 and 2022. Somatic mutations were identified by targeted or panel sequencing, and TP53 was identified as the most common mutation (52–81%), followed by HRAS (7–26%), CDKN2A (21–24%), and PIK3CA (5–10%). The mutation frequencies, except for TP53, were similar to those of Caucasian cohorts. In the NCCH group, 16 patients of HPV-independent tumors were identified by immunohistochemistry and genotyping. Univariate analysis revealed that TP53-mutated patients were associated with a poor prognosis (log-rank test, P = 0.089). Japanese VSCC mutations resembled those of Caucasian vulvar carcinomas, and TP53 mutations predicted prognosis regardless of ethnicity. The present findings suggest potential molecular-targeted therapies for select VSCC patients.

Factors influencing hospital charges for tonsillectomy to treat obstructive sleep apnea in children.

This study investigates the impact of patient characteristics and demographics on hospital charges for tonsillectomy as a treatment for pediatric obstructive sleep apnea (OSA). The aim is to identify potential disparities in hospital charges and contribute to efforts for equitable access to care. Data from the 2016 Healthcare Cost and Utilization Project (HCUP) Kid Inpatient Database (KID) was analyzed. The sample included 3,304 pediatric patients undergoing tonsillectomy ± adenoidectomy for OSA. Variables such as age, race, length of stay, hospital region, residential location, payer information, and median household income were collected. The primary outcome variable was hospital charge. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were conducted. Among 3,304 pediatric patients undergoing tonsillectomy for OSA. The average total charges for tonsillectomy were $26,400, with a mean length of stay of 1.70 days. Significant differences in charges were observed based on patient race, hospital region, and payer information. No significant differences were found based on gender, discharge quarter, residential location, or median household income. Multiple linear regression showed race, hospital region, and residential location were significant predictors of total hospital charges. This study highlights the influence of patient demographics and regional factors on hospital charges for pediatric tonsillectomy in OSA cases. These findings underscore the importance of addressing potential disparities in healthcare access and resource allocation to ensure equitable care for children with OSA. Efforts should be made to promote fair and affordable treatment for all pediatric OSA patients, regardless of their demographic backgrounds.

Suboptimal Imaging on Obstetric Ultrasound Should Prompt Early Referral for Fetal Echocardiography.

Recent studies suggest that suboptimal cardiac imaging on routine obstetric anatomy ultrasound (OB-scan) is not associated with a higher risk for congenital heart disease (CHD) and, therefore, should not be an indication for fetal echocardiography (F-echo). We aim to determine the incidence of CHD in patients referred for suboptimal imaging in a large catchment area, including regions that are geographically distant from a tertiary care center. We conducted a retrospective chart review of patients referred to Seattle Children's Hospital (SCH) and SCH Regional Cardiology sites (SCH-RC) from 2011 to 2021 for F-echo with the indication of suboptimal cardiac imaging by OB-scan. Of 454 patients referred for suboptimal imaging, 21 (5%) of patients were diagnosed with CHD confirmed on postnatal echo. 10 patients (2%) required intervention by age one. Mean GA at F-echo was significantly later for suboptimal imaging compared to all other referral indications (27.5 ± 3.9 vs 25.2 ± 5.2weeks, p < 0.01). Mean GA at F-echo was also significantly later at SCH-RC compared to SCH (29.2 ± 4.6 vs 24.2 ± 2.9weeks; p < 0.01). In our experience, CHD in patients referred for suboptimal imaging is higher (5%) than previously described, suggesting that routine referral for is warranted. Furthermore, while suboptimal imaging was associated with a delayed F-echo compared to other indications, this delay was most striking for those seen at regional sites. This demonstrates a potential disparity for these patients and highlights opportunities for targeted education in cardiac assessment for primary providers in these regions.

Executive function and spatial abilities in physically active children: an explorative study

BackgroundRegular physical activity has consistently shown promise in improving cognitive functioning among children. However, there is a shortage of comprehensive studies that delve into these benefits across various cognitive domains. This preliminary investigation aimed to discern potential disparities in cognitive performance between active and sedentary children, with a specific focus on inhibitory control, cognitive flexibility, and visuo-spatial working memory abilities.MethodsThe study employed a cross-sectional design encompassing 26 children (mean age 9.53 ± 2.20 years), categorized into two groups: Active and Sedentary. Executive functions were assessed using the NEPSY-II, while visuo-spatial working memory abilities were evaluated through the table version of the Radial Arm Maze (table-RAM) task. All outputs were analyzed with One-way ANOVAS or Kruskal–Wallis Tests to assess differences between Active and Sedentary children in both executive functioning and visuo-spatial working memory processes.ResultsThe findings revealed that the Active group outperformed the sedentary group in inhibitory control (F1,23 = 4.99, p = 0.03*), cognitive flexibility (F1,23 = 5.77, p = 0.02*), spatial span (F1,23 = 4.40, p = 0.04*), and working memory errors (F1,23 = 8.59, p = 0.01**). Both spatial span and working memory errors are parameters closely associated with visuo-spatial working memory abilities.ConclusionsAlthough preliminary, these results offer evidence of a positive link between physical activity and cognitive functioning in children. This indicates the importance of promoting active behaviors, especially within educational environments.

Sex Disparities in the Use and Outcomes of Septal Reduction Therapies for Obstructive Hypertrophic Cardiomyopathy

BackgroundData are limited that examine potential sex-based disparities in the utilization and complications of septal reduction therapy (SRT) in patients with obstructive hypertrophic cardiomyopathy. Our aim was to assess the use and in-hospital outcomes of SRT, according to sex. We performed a retrospective cohort study using the 2017-2019 National Inpatient Sample database. Adult patients with obstructive hypertrophic cardiomyopathy were identified. MethodsWe assessed the use of SRT (surgical septal myectomy and alcohol septal ablation), according to sex. In those who underwent SRT, rates of in-hospital mortality, pacemaker implantation, implantable cardioverter defibrillator (ICD) implantation, ischemic stroke, major bleeding, and pericardial complication were assessed. All outcomes were compared between groups using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidity burden, and hospital characteristics. ResultsIn total, 72,680 weighted hospitalizations (median age: 67 years [range: 57-77]; 61% female patients) were included, and only 5.9% of patients underwent SRT. After IPTW adjustment, female patients were more likely to undergo SRT (adjusted risk ratio [aRR] 1.18, 95% confidence interval [95% CI] 1.03-1.36) and alcohol septal ablation (aRR 1.38, 95% CI 1.04-1.83). Likewise, female patients received pacemaker implantation more often (aRR 1.96, 95% CI 1.10-3.50) and ICD implantation (aRR 0.58, 95% CI 0.34-0.99) less frequently, compared with male patients. No differences were present in rates of surgical septal myectomy, in-hospital mortality, ischemic stroke, major bleeding, and pericardial complication between groups. ConclusionsOur results suggest that female patients were slightly more likely to undergo SRT, especially alcohol septal ablation. In-hospital mortality and postprocedural complications were similar between the sexes, but women received more pacemaker implantation and less ICD implantation.

Utilization and Potential Disparities in Access to Physical Therapy for Spine Pain in the Long-Term Care Population

ObjectiveTo determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DesignSecondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SettingNot applicable. ParticipantsMedicare fee-for-service LTC residents aged ≥65 years. InterventionsNot applicable. Main Outcome MeasuresReceiving PT services. ResultsOf the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. ConclusionsAlthough nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.

Impact of obesity on breast cancer clinicopathological characteristics in underserved community dweller women of Chicagoland: An experience from a US safety-net hospital.

e22519 Background: Breast cancer (BC) continues to pose a significant public health challenge, with its incidence and disproportionate impact on underserved populations in the United States. The relationship between obesity and clinicopathological characteristics at presentation remains a critical area of investigation. Safety-net hospitals catering to diverse, underserved, and often marginalized communities provide a unique setting to explore these associations, shedding light on potential disparities and informing targeted interventions. This study seeks to address a critical gap in knowledge on obesity and BC characteristics in underserved populations in the United States. Methods: In this retrospective study, 927 BC patients were included. Analysis was conducted to assess the association between body mass index (BMI), age of diagnosis, tumor clinicopathologic characteristics, and molecular types. The analysis was stratified by menopausal status at diagnosis. Results: The average age at diagnosis was 57.52 ± 12.40 years; 60.2% were postmenopausal women. Patients were categorized based on BMI into underweight/normal, overweight, and obese categories. One-way ANOVA analysis revealed no significant difference in mean age at presentation between BMI groups (p = 0.08). A significant association was found between BMI and menopausal status (p &lt; 0.05). Disease stage at presentation was significantly associated with BMI (p &lt; 0.05). Further investigation into BMI categories and tumor characteristics revealed a significant correlation in postmenopausal women, with obesity linked to tumor size and lymph node status (p &lt; 0.05). No significant associations were observed between HER-2 status, ER/PR status, and obesity in either premenopausal or postmenopausal groups. In the subgroup analysis focusing on ethnic groups, African American patients (with an average BMI of 32.8 ± 8.2 kg/m2) demonstrated a higher prevalence of obesity at BC diagnosis in both pre and post-menopausal females compared to other ethnic groups (p &lt; 0.05). Conclusions: Obesity was associated with the disease stage and menopause status at diagnosis. In postmenopausal patients, obesity was associated with tumor size and lymph node disease status. Additionally, ethnic variations were evident, with African American patients displaying a higher prevalence of obesity. We need further investigations to tailor interventions addressing diverse demographic factors in BC management.

Sex-based disparities in patients with lung cancer undergoing lobectomy via robotic-assisted thoracoscopic surgery.

e20005 Background: The 2023 report from the World Health Organization(WHO) ranked lung cancer (LC) as the top cause of cancer-related fatalities worldwide. Recently, minimally invasive procedures such as robotic-assisted thoracoscopic surgery (RATS) have been introduced as part of the treatment of some LC cases. Our study aims to bridge the understanding of potential sex-based disparities among LC patients undergoing lobectomy via RATS. Methods: We analyzed the 2016-2020 National Inpatient Sample (NIS) for adult lung cancer(malignant or carcinoma in situ) patients with a principal procedure code of lobectomy with RATS. Cases with underlying mycoses, mycobacterial infection, and pulmonary abscesses were excluded based on recommendations from prior studies. Multivariate regression models helped evaluate sex-based differences in several complications. Results: An estimated 26385 lung cancer patients underwent lobectomy via RATS, consisting of 56.68% females (14955 cases) and 43.32% males (11430 cases). Age differences were noted as females were younger (mean age 67.80 years vs. 69.14 years, p &lt; 0.01). We also found that females were less likely to report several complications, such as acute kidney injury (AKI) (3% vs. 6.6%, aOR 0.538, p &lt; 0.001), pneumonia (2.8% vs. 4.3%, aOR 0.725, p &lt; 0.001), post-procedural air leak (9.2% vs. 11.2%, aOR 0.797, p &lt; 0.001), post-procedural cardiac arrest (0.6 % vs. 1.6%, aOR 0.349, p &lt; 0.001), pulmonary embolism (0.2% vs. 0.5%, aOR 0.345, p &lt; 0.001), deep vein thrombosis (DVT)(1.5% vs. 2.2%, aOR 0.742, p: 0.003), atrial fibrillation (AF)(13% vs 21.7%, aOR 0.564, p &lt; 0.001), acute myocardial infarction (AMI) (0.2% vs. 0.5%, aOR 0.58, p:0.027), and death (0.3% vs. 0.9%, aOR 0.505, p &lt; 0.001). Notably, females were more likely to have an open procedure conversion (0.2% vs 0.1%, aOR 2.235, p:0.017). However, there is no significant difference between the two sexes regarding post-procedural pneumothorax and respiratory failure, atelectasis, supraventricular tachycardia, and events of acute ischemic stroke. Conclusions: Our most recent analysis confirms that among LC patients undergoing lobectomy via RATS, males were more prone to several complications than females. However, we also found that females were more likely to necessitate an open procedure conversion. We, therefore, advocate for further research to enhance our understanding of such disparities and strategies to address them effectively.