Proportion Of White Patients Research Articles

Provider care segregation and hospital-region racial disparities for carotid interventions in the USA

BackgroundReasons for racial disparities in the utilization and outcomes of carotid interventions (carotid endarterectomy (CEA) and carotid artery stenting (CAS)) are not well understood, especially segregation of care associated with...

Characteristics and pregnancy outcomes of pregnant women by cancer diagnosis status.

11038 Background: Given the broad exclusion of pregnant patients from clinical trials, limited evidence exists on the impact of cancer diagnoses on pregnancy outcomes. This study aimed to describe patient characteristics and end of pregnancy events among women with and without a cancer diagnosis before pregnancy. Methods: This retrospective claims study used data from the Komodo Research Dataset between 01/01/2016–08/31/2023 to identify adult women with a known gestation of pregnancy record and end of pregnancy outcome. Eligible members needed to be continuously enrolled in medical and prescription drug plans for both 365 days before (baseline) and after the derived pregnancy start (index date). This pregnancy cohort was then stratified according to cancer status, evidenced by any cancer diagnosis during the baseline period, to allow assessment of pregnancy outcomes. Valid pregnancy outcomes included full or preterm live birth and pregnancy loss such as miscarriage, stillbirth, and elective termination. Only the earliest pregnancy observed for each eligible member was analyzed. Results: Among the 1,921,866 pregnant women included in the analyses, only 0.7% (N=12,723) of patients had any cancer diagnosis in the year prior to pregnancy start. Cancer patients were older than non-cancer patients (mean age: 33.8 and 29.2 years, respectively). Commercial medical insurance was more common (67.7% vs. 58.9%) among cancer vs. non-cancer patients and Medicaid enrollment was less common (30.3% vs. 40.6%) upon pregnancy start. The proportion of patients with a live birth was lower among cancer vs. non-cancer patients (59.7% vs. 67.1%), while the proportion with pregnancy loss was higher (31.6% vs. 25.8%). Medicaid enrollment was more common among patients that had a pregnancy loss relative to live birth for both cancer and non-cancer patients (35.5% vs. 27.5% and 45.7% vs. 38.7%, respectively). The proportion of black patients was higher among patients with a pregnancy loss relative to those with live birth in both cohorts (cancer: 11.1% vs. 8.3%; non-cancer: 16.9% vs. 13.7%), while the proportion of white patients was similar for cancer patients with a pregnancy loss vs. live birth (37.4% vs. 37.1%) and the proportion was lower for non-cancer patients (30.4% vs. 34.4%). Conclusions: Preliminary findings suggest pregnancy loss was more common among cancer patients than non-cancer patients. Regardless of cancer status, differences in insurance coverage and race were observed for patients with a live birth relative to patients with pregnancy loss. Additional research should be conducted to identify factors driving differences in pregnancy outcomes, such as in care management by race and ethnicity, particularly among the vulnerable population of cancer patients.

Disparities in cancer care utilization in patients with brain tumors: A nationwide analysis.

e23142 Background: Brain tumors are highly aggressive and are associated with poor prognosis. Minority populations still experience inequities in the delivery of cancer care, despite concerted efforts to reduce such disparities. We studied disparities in receipt of cancer care for patients with primary brain tumor. Methods: National Inpatient Sample 2017-2020 was queried to identify the patients admitted with brain tumor. Results of the study were reported in accordance with the STROBE guidelines. We divided the cases into two groups i.e., the patients undergoing curative cancer care (CC) and palliative care (PC). We performed descriptive analysis and analyzed predictors of getting PC or CC using logistic regression analysis. Results: Among 144,355 patients hospitalized for primary brain tumor, 33,645 (23.3%) received PC. Mean age of PC group was 60±20.1 years, while the CC group had mean age of 52.9±21.3 years ( P < 0.01). Compared to patients < 45 years, the patients with age 46-64 years and ≥65 years were more likely to receive PC (OR = 1.9, 95% CI 1.6-2.4 and OR = 2.23, 95% CI 1.8-2.8, P < 0.01, respectively). The proportion of Black patients in the PC group was more compared to the CC group (10.4% vs 7.6%). However, the proportion of White patients in the PC group was lower than the CC group (74.8% vs 77.9%), P < 0.001. Black patients were more likely to receive PC (OR = 1.5, 95% CI 1.3-1.7, p < 0.01), while no difference was observed in other ethnic or racial groups. Compared to CC group, PC group had a higher percentage of patients with Medicare (50.9% vs 35.9%), Medicaid (14.4% vs 13.8%) and a lower percentage of patients with private insurance (31.9% vs 47.0%) p < 0.01. Patients with private insurance were less likely to receive PC (OR = 0.7, 95% CI 0.6-0.8, p < 0.01). PC group had a higher percentage of low-income group patients compared to the CC group ($1-$49,999: 22.5% vs 20.6% and $50,000-$64,999: 25.3% vs 24.2%, P < 0.01). Patients in teaching hospitals had decreased odds of PC (OR 0.8, 95% CI 0.7-0.9, P = 0.01) compared to non-teaching hospitals. Patients with major depressive disorder (OR 1.3, 95% CI 1.1-1.4, P < 0.01), electrolyte disorders (OR 1.6, 95% CI 1.5-1.8, P < 0.01), and atrial fibrillation (OR 1.3, 95% CI 1.1-1.5, P = 0.01) had increased odds of receiving PC. Conclusions: The patients who underwent PC were older, more likely to be Black, and of low-income groups. Patients in teaching hospital had a decreased likelihood of undergoing PC. The health care disparities should be addressed to achieve a better quality of care across all groups. [Table: see text]

Sex- and Race-Based Differences in the Treatment of Interstitial Lung Diseases in North America and Australasia

Biological sex, gender, and race are important considerations in patients with interstitial lung diseases (ILDs). Does a patient's sex assigned at birth, and race, influence ILD treatment initiation? Patients with ILD from three longitudinal prospective registries were compared in this observational study. ILD-related medications included antifibrotics and immunomodulating medications. Race was dichotomized as "White" vs"non-White." Time to treatment initiation was determined from the date of the initial ILD registry visit to the date of first medication initiation. Proportions of treated patients were compared between groups by χ2 test. Cox proportional analysis was used to determine how sex and race were associated with time to treatment initiation stratified by ILD diagnosis. A total of 4,572 patients were included across all cohorts. The proportion of men who received treatment was higher than for women in the Canadian cohort (47%vs40%; P< .001), and the proportion of White patients who received treatment was also higher compared with non-White patients (46%vs36%; P< .001). In contrast, the proportion of treated men in the Chicago cohort was lower compared with women (56%vs64%; P= .005), and that of White patients was lower compared with non-White patients (56%vs69%; P< .001). No sex- or race-based differences in proportions of patients treated were found in the Australasian cohort. White race was significantly associated with earlier treatment initiation compared with non-White race across diagnoses in the Canadian cohort, whereas the opposite association was found in the Australasian cohort. Sex- and race-based differences exist in the initiation of ILD treatment, with variability across different cohorts in different countries. Reasons for these differences need to be further explored in future studies.

Placebo Response to Oral Administration in Osteoarthritis Clinical Trials and Its Associated Factors

In osteoarthritis (OA) clinical trials, a placebo is often used as control. Therefore, a thorough understanding of the placebo response is important for guiding drug development in OA. To develop an oral placebo response model for OA. PubMed, EMBASE, and Cochrane Library databases were searched systematically from January 1, 1991, to July 2, 2022. Randomized double-blind placebo-controlled trials of patients with primary OA were included. The interventions and placebo were administered orally. A total of 3032 trials were identified; of these, 130 (4.3%) met the inclusion criteria. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, dosage form of the placebo, sample size, proportion of patients who previously used nonsteroidal anti-inflammatory drugs, publication year, intervention categories, Kellgren-Lawrence grades, proportion of White patients, duration of pain, funding source, and risk of bias were extracted. A model-based meta-analysis was used to evaluate the time course of the placebo response in OA treatment and estimate the influencing factors. For subgroup analyses, a meta-analysis with a random-effects model was used to summarize the typical values of the model parameters and their SEs. The primary end point was the time course of the oral placebo response on the WOMAC pain, stiffness, and function subscale scores. The 130 trials selected for analysis included 12 673 participants (mean age, 59.9 years; 68.9% women). The baseline scores of WOMAC pain, stiffness, and function subscales were found to be significantly associated with the placebo response. The placebo response reached 90% of its maximum response between 5 and 7 weeks. The placebo responses on the WOMAC subscales were also associated with the sample size, proportion of patients who had previously used nonsteroidal anti-inflammatory drugs, intervention drugs, and publication year. In this study, an oral placebo response model of OA was developed that may quantitatively describe the placebo response at different baseline levels of symptoms. The findings may provide valuable references for future clinical trial design and decision-making.

Measuring health disparity index in gynecologic oncology (281)

<b>Objectives:</b> A health disparity index (HDI) can be used to regularly assess quality metrics by race and ethnicity. Our objective was to describe the implementation of the HDI for gynecology oncology patients at a tertiary-care academic center. <b>Methods:</b> We systematically collected reportable quality events for gynecologic oncologic patients at a single academic institution over a one-year period, July 2020 - June 2021, who were presented at the department's bimonthly morbidity and mortality quality forum. Reportable events were mainly postoperative complications and were predefined as death within 30 days, transfusion of greater than four units of blood products, hospital stay greater than 15 days, unplanned transfer to the intensive care unit, unanticipated return to the operating room, re-admission within 30 days, venous thromboembolic event, operative injury, surgical site infection, and estimated blood loss greater than 750 mL for benign cases. The calculation below was used to compare events in Black patients compared to White patients. The race was self-reported and extracted from the electronic medical record. For the purposes of this calculation, reportable events were considered binary (i.e., patients either had or did not have a reportable event). A Chi-square test was used to compare the two populations. An HDI of 1 describes equal morbidity in White and Black patients, HDI <1 greater morbidity in White patients, and HDI >1 greater morbidity in Black patients. <b>Results:</b> A total of 458 patients underwent surgery with the gynecologic oncology service from July 2020 to June 2021 at The Hospital of the University of Pennsylvania. Sixty-two percent (<i>n</i>=284) identified as White, 29.7% (<i>n</i>=136) identified as Black, and 8.3% (<i>n</i>=38) identified as a race or ethnicity that was not White or Black. There were 73 reported events captured in the safety net reporting application. Of those 73 events, 33% (<i>n</i>=24) were for Black patients, 60% (<i>n</i>=44) were white patients, while the remaining 7% (<i>n</i>=5) were for all remaining patients. The proportion of Black patients with a reportable event was 17.6% (24/136), with a 95% CI of 11.6-25.1. The proportion of White patients with a reportable event was 15.5% (44/284), with a 95% CI of 11.5-20.2. The HDI presented at individual quality forums ranged from 0.50 to 5.1 over a 12-month period. The mean HDI is 1.14 with a 95% CI of 0.72-1.79 (p=0.57). <b>Conclusions:</b> From July 2020 to June 2021, the HDI was greater than 1 for our gynecologic oncology patients, indicating that a disparity in surgical and medical outcomes was present at a large urban academic institution. The wide range, as well as statistically non-significant p-value, is likely attributable to the small cohort. Using this HDI, our department is undertaking innovative quality improvement efforts to close the health disparity gap seen amongst gynecologic oncology patients.

DID WE NEED THOSE ANTIBIOTICS? OUTCOMES OF PATIENTS WITH COVID-19 TREATED FOR BACTERIAL SUPERINFECTION OF THE LUNGS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic has affected over half a billion people worldwide. Series report that up to 75% of hospitalized patients with COVID-19 receive broad-spectrum antibiotics;however, the incidence of bacterial coinfection is consistently reported to be low. The diagnosis of bacterial superinfection of the lungs (BSL) is clinical, which presents the possibility of overdiagnosis and overutilization of antibiotics. The aim of this study was to describe the outcomes of patients who were treated for a bacterial superinfection of the lungs (BSL) compared to those who were not. METHODS: We conducted a retrospective chart review of all consecutive patients with a diagnosis of COVID-19 hospitalized at our center. We defined BSL as a documented episode of pneumonia treated with antibiotics. We collected information on demographics, comorbidities, and microbiological markers. We compared patients with and without a diagnosis of BSL in terms of intensive care unit (ICU) stay, intubation, length on mechanical ventilation, length of hospital stay (LOS) and 7-day and 30-day mortality. RESULTS: Five hundred eighty-two patients had a diagnosis of COVID-19, of which 105 had BSL. Patients with BSL were older compared to those without BSL (mean age 74 vs 70 years) and more likely to be male (57% vs 47%), but they were similar in proportion of White patients (64 vs 63.6) and Charlson comorbidity index (5 vs 4). Patients with BSL had a higher likelihood of admission to the ICU (63% vs 19%) and higher intubation rates (31% vs 9%). BSL patients had longer mechanical ventilation (9 vs 3 days) and greater length of stay (13 vs 7). Only 17 BSL patients had sputum cultures, of which 10 were positive. None of the BSL patients had a positive Legionella urinary antigen or Streptococcus pneumoniae urinary antigen, and only 6/57 (10.5%) had a positive MRSA nasal screen. Seven-day and 30-day mortality were not statistically different between BSL and non-BSL patients (p=0.18, p=0.65 respectively). Interestingly, Cox proportional hazard analysis adjusted for age, sex, race, CCI and ICU stay yielded a significantly reduced mortality at 7 and 30-day among BSL patients (HR=0.2 CI [.1-0.7], p=.0106, HR=0.5 [CI.3-0.8], p=0.0101, respectively). CONCLUSIONS: Patients with BSL received more intense supportive care, and had a longer ICU stay, yet did not have a greater mortality. When adjusting for age, sex, race, CCI and ICU, there was a significant reduction in mortality. It is tempting to interpret these finding as an effect of antibiotics;however, we did not record COVID-19-specific treatments such as steroids, tocilizumab and remdesivir. It is likely that the BSL patients received more steroids, which have been associated with reduced mortality. In our population, microbiological testing was performed in a minority of patients, and it was therefore not a reliable marker of true infection. It is possible that many patients in the BSL group did not truly have a bacterial infection. CLINICAL IMPLICATIONS: Patients with a diagnosis of BSL were sicker, but we observed no difference in unadjusted mortality. Studies on the outcomes of the BSL among COVID-19 patients should account for the effect of concurrent COVID-19 specific therapy. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Ricardo Arbulu Guerra, source=Web Response No relevant relationships by NIRZARI PANDYA, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Mohamed Yassin, source=Web Response

Associations Between Patient Neighborhood Characteristics and Inappropriate Antimicrobial Use

Background: Antimicrobials are among the most commonly prescribed medications in US hospitals; an estimated 50% of hospitalized patients receive an antimicrobial. Research has shown that antimicrobial prescriptions to vary by patient- and hospital-level factors; however, disparities by patient neighborhood characteristics have not been examined. We evaluated associations between hospital and neighborhood indicators of socioeconomic status (SES) and antimicrobial use (AU) for gram-positive bacterial infections (GPBs), and broad-spectrum use for community-acquired infections (BSCAs) and hospital-onset infections (BSHOs). Methods: This analysis was conducted among 86 acute-care hospitals in California that submitted AU data via the NHSN in 2019. Hospital-level AU was measured as standardized antimicrobial administration ratios (SAARs) calculated by dividing observed antimicrobial use by risk-adjusted predicted antimicrobial use for GPB, BSCA, and BSHO antimicrobial groupings and categorized as binary (&gt;1 or &lt;1); SAARs &gt;1 indicate potential inappropriate prescribing. California Office of Statewide Health Planning and Development 2018 data were used to obtain hospital characteristics and patient age, race or ethnicity, insurance, and comorbidities (defined by Charlson comorbidity index) for hospitalizations where AU may have been indicated, based on International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes. The California Healthy Places Index (HPI) was used to obtain composite neighborhood SES indicators for each patient at the ZIP code level, measured as tertiles. Covariates were aggregated to the hospital level. Poisson regressions were used to evaluate the association between hospital and neighborhood SES indicators and SAAR scores, controlling for potential hospital-level confounders. Results: Among 86 hospitals included in the analysis, the mean patient age for hospitalizations where AU may have been indicated was 66 years, the proportion of white patients was 55%, and the mean proportion of Medi-Cal users was 19%. After adjusting for confounders including age, race or ethnicity, insurance status, comorbidities, and number of hospital beds; higher median values of patient SES had a protective effect against hospitals having GP SAAR scores &gt; 1 (relative risk [RR], 0.68; 95% CI, 0.50–0.93) but was not significantly associated with hospitals having BSCA SAAR scores &gt;1 (RR, 0.79; 95% CI, 0.62–1.02) or BSHO SAAR scores &gt;1 (RR, 0.80; 95% CI, 0.61–1.04). Conclusions: Considering SES in addition to summary antimicrobial use scores such as SAARs may help identify populations potentially at risk for inappropriate AU; however, patient-level information is still necessary to evaluate appropriateness of antimicrobial prescribing.Funding: NoDisclosures: None

A national analysis of untreated stage III non-small cell lung cancer in black and white patients.

e20561 Background: Stage III non-small cell lung cancer (NSCLC) is treatable and potentially curable with surgical resection and/or chemoradiotherapy (CRT). Factors such as medical comorbidities and access to care may impact treatment decisions, including the decision to give no treatment. Using the National Cancer Database (NCDB), we analyzed the clinical presentation and proportion of Black and White Stage III NSCLC patients who received no form of treatment and compared their overall survival to patients who received other forms of management. Methods: Black and White stage III NSCLC’s diagnosed between 2004 and 2015 in the NCDB were included. Cases with multiple tumors and who received surgery were excluded. Patients who received no form of treatment (No-RT-nor-CT) were compared to patients treated with (CRT), RT only (RT), and CT only (CT). Univariate, multivariate, and Kaplan-Meier models were performed. Results: A total of n=22,459 Black and n=138,477 White stage III NSCLC patients were analyzed. Concurrent CRT given within 0-30 days was the most common management for Black (42.3%) and White patients (43.9%). No-RT-nor-CT was the second largest management group among Black (21.2%) and White patients (21.5%). A higher proportion of Black patients (14.2%) had a contraindication to CT than White patients (12.9%), p=0.0016; the same was true for those not managed with RT (6.1% vs. 5.3%, p=0.0051). Among patients managed without CT, the most common reason for not receiving CT among Black (63.31%) and White patients (63.0%) was that CT was not part of the planned 1st treatment course. Among patients managed without RT, the most common reason for not receiving RT among Black (77.0%) and White patients (78.2%) was that RT was not part of the planned 1st treatment course. A higher proportion of White patients versus Black patients did not receive CT (17.4% vs 14.0%, p&lt;0.0001) nor RT (8.8% vs 7.7%, p=0.0013) because it was refused by the patient or guardian. The 2- and 5-year overall survival (OS) rates were lowest among the No-RT-nor-CT cohort of Black (13.9%, 5.4%, respectively) and White (12.1%, 4.6%, respectively) patients versus all other treatments. Median OS with No-RT-nor-CT was 4 months for Black patients and 3 months for White patients (p&lt;0.0001). Conclusions: Concurrent CRT with or without surgery is an established standard of care for stage III NSCLC, but a significant proportion of White and Black patients are not receiving potentially curative therapy. A higher proportion of Black patients had contraindications to CT and RT than a similar cohort of White patients, which may reflect a higher rate of medical comorbidities. A higher proportion of White patients or their guardians refused CT and RT than a similar cohort of Black patients. Assessing and addressing the challenges that affect access to care and the type of care delivered remains an essential component of health care in America and influences survival outcomes.

Demographic Variations in Patient Populations and Regional Distributions Between Male and Female Ophthalmologists in the United States: Cross-Sectional Analysis

ABSTRACT Purpose: To determine if patient demographics differ by ophthalmologist gender. Methods: Demographic data on U.S. ophthalmologists were collected from the 2017 Medicare Physician and Other Supplier National Provider Identifier Aggregate Report. Results: Of the 17,230 ophthalmologists included, female ophthalmologists (23.7%) provided care for a smaller proportion of White patients (77.4% ± 24.9% female, 81.0% ± 22.1% male; p < .001), had younger beneficiaries (73.8 ± 3.2 years old females, 74.8 ± 2.9 years old males; p < .001) and had a higher proportion of female beneficiaries per provider (61.1% ± 4.6% females, 59.6% ± 4.0% males; p < .001). Average age of beneficiaries and number of beneficiaries were correlated with years since medical school (rho = 0.283, rho = 0.148; both p < .001). The number of Medicare beneficiaries, proportion of female beneficiaries, years since medical school and group practice size were independently associated with physician gender (p < .001). Conclusion: Female ophthalmologists saw a larger proportion of ethnically diverse, younger, female patients.

Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes

Background/PurposeOur study aimed to assess the impacts of neighborhood socioeconomic status on mechanical thrombectomy (MT) outcomes for acute ischemic stroke (AIS). MethodsWe conducted a prospective observational study of consecutive adult AIS patients treated with MT at one US comprehensive stroke center from 2012 to 2018. A composite neighborhood socioeconomic score (nSES) was created using patient home address, median household income, percentage of households with interest, dividend, or rental income, median value of housing units, percentage of persons 25 or older with high school degrees, college degrees or holding executive, managerial or professional specialty occupations. Using this score, patients were divided into low, middle and high nSES tertiles. Outcomes included 90-day functional independence, in-hospital mortality, length of hospital stay, discharge location, time to recanalization, successful recanalization, and symptomatic intracranial hemorrhage (sICH). Results328 patients were included. Between the three nSES groups, proportion of White patients, time-to-recanalization and admission NIH stroke scale differed significantly (p<0.05). Patients in the high nSES tertile were more likely to be functionally dependent at 90 days (unadjusted OR, 95% CI, 1.91 [1.10, 3.36]) and were less likely to die in the hospital (unadjusted OR, 95% CI, 0.46, [0.20, 0.98]). Further, patients in the high nSES tertile had decreased times to recanalization (median time in minutes, low=335, mid=368, high=297, p=0.04). However, after adjusting for variance in race and severity of stroke, the differences in clinical outcomes were not significant. ConclusionThis study highlights how unadjusted neighborhood socioeconomic status is significantly associated with functional outcome, mortality, and time-to-recanalization following MT for AIS. Since adjustment modifies the significant association, the socioeconomic differences may be influenced by differences in pre-hospital factors that drive severity of stroke and time to recanalization. Better understanding of the interplay of these factors may lead to timelier evaluation and improvement in patient outcomes.

Thoracic Radiation Oncology Clinical Trial Accrual and Reasons for Nonenrollment: Results of a Large, Prospective, Multiyear Analysis

Clinical trials are considered the gold standard in evidence-based medicine, yet few patients with cancer ultimately enroll. Here we examine patients screened for thoracic radiation oncology clinical trials to better understand enrollment trends. A prospective database tracking screening and enrollment for patients referred for thoracic radiation oncology consultation at our institution from 2016 to 2019 was evaluated. Proportional enrollment rates, patient and disease characteristics, self-reported socioeconomic factors, and reasons for ineligibility or nonenrollment across 17 radiation therapy trials were compared. Enrollment data on 2372 patients were available for analysis. Of these patients, 40.0% (949) were deemed "not eligible" (NE) for any trial or were unwilling to be further screened. Reasons for ineligibility included stage (44%), histology (13%), radiation therapy not indicated (12%), patient decision (7%), and enrollment in a competing medical or surgical oncology trial (5%). The remaining 60.0% (1423) were "potentially eligible" (PE) for one or more trials. Most had non-small cell lung cancer (71%) or esophageal cancer (16%), and there were significantly fewer stage IV PE (29%) versus NE (49%) patients (P < .0001). Of 2372 patients, 281 (11.9%) enrolled. Notable reasons for nonenrollment were inclusion and exclusion criteria (58%), patients declining enrollment (14%), and physician decision (5%). The proportion of white patients was higher in the PE versus NE group (82.5% vs 75.8%; P < .001). Additionally, white race (87.9% vs 81.2%; P = .008), English language preference (96.4% vs 92.9%; P = .032), and non-Hispanic/Latino ethnicity (94.0% vs 90.1%; P = .042) were significantly different in enrolled versus nonenrolled PE patients. Only 12% of patients screened for radiation therapy trials ultimately enrolled, and more than two-thirds had no trial available or were found ineligible. In addition, 19% of potential eligible patients did not enroll because the patient or physician declined. Future trials may benefit from pragmatic designs with more inclusive enrollment criteria and multidisciplinary engagement of referring providers.

Racial Disparities in Diabetes Management Outcomes: Evidence from a Remote Patient Monitoring Program for Type 2 Diabetic Patients.

Introduction: Despite growing documentation of the efficacy of telemedicine in diabetes management, racial disparities in telemedicine-facilitated diabetes management remain underexplored. This study examined disparities in diabetes management outcomes between black and white patients with type 2 diabetes (T2D) in a remote monitoring program. Methods: The analysis sample included 914 white T2D patients and 365 black T2D patients in Nebraska who completed a 3-month remote patient monitoring and coaching after hospital discharge from 2014 to 2017. Ordinary least squares regression was estimated to examine racial differences in hemoglobin A1c (HbA1c), and logistic regression was used to determine the odds of HbA1c > 9% at the end of the program, controlling for demographics, baseline health conditions, and patient activation and engagement with the program. Results: The proportion of white patients with HbA1c > 9% was reduced from 16% at the baseline to 7% at program completion, and the corresponding reduction among black patients was from 30% to 18%. After adjusting for the effects of baseline HbA1c and other covariates, the average HbA1c among black patients at the end of the program was 0.23 points higher than that among white patients (p < 0.01), and the adjusted odds of black patients having HbA1c > 9% was 1.68 times that of white patients (95% confidence interval [1.07-2.63]). Discussion: The remote patient monitoring and coaching program reduced the absolute gap between black and white T2D patients. However, substantial racial disparities in HbA1c still remained at the end of the program and warranted further research.

Abstract TP429: Arcadia versus Other Esus Trials: Comparison of Patient Characteristics

Objective: We hypothesize that ESUS patients enrolled in the ARCADIA study are broadly representative and similar to those randomized in recent ESUS trials that returned negative results. Methods: This study is a qualitative comparison between characteristics of patients in NAVIGATE and RE-SPECT ESUS and those of patients enrolled up to this point in ARCADIA, an ongoing, investigator-initiated, NINDS-funded, multicenter, randomized trial of standard dose apixaban versus aspirin 81 mg daily among consented patients with ESUS and biomarker evidence of atrial cardiopathy. The patients from ARCADIA included all those consented, regardless of biomarker evidence of atrial cardiopathy. Inclusion and exclusion criteria, as well as detailed study protocols, have been previously reported. Results: Age and sex were similar in all three trials (see table). All trials had a similar proportion of white patients, but there were more black patients in ARCADIA and more Asian patients in RE-SPECT and NAVIGATE ESUS. More patients smoked (44%) in ARCADIA than in the other trials (17-20%). In all three trials strokes were clinically mild, with mean NIHSS scores and modified Rankin scores of 1. Further comparisons of patient characteristics are seen in the table below. Conclusions: Many of the characteristics of patients enrolled thus far in ARCADIA are similar to those of patients enrolled in the RE-SPECT ESUS and NAVIGATE ESUS trials, suggesting that the ARCADIA results will be highly generalizable. If positive, the ARCADIA trial results will highlight the importance of identifying a subgroup of ESUS patients likely to benefit from empiric treatment with anticoagulation, namely those with atrial cardiopathy. Important differences were seen between ARCADIA and the other trials, including proportions of patients who smoked and proportions of Black and Asian patients. These differences may be further analyzed upon completion of the trial.

Veterans Aging Cohort Study Index as a Marker of Bone Disease in HIV-Infected Patients.

People living with human immunodeficiency virus (HIV) infection have higher risk of low bone mineral density (BMD) and fragility fracture than general population. The aim of our retrospective study was to explore if HIV-specific Veterans Aging Cohort Study (VACS) Index and its specific components could help identify patients at risk for low BMD. A total of 195 HIV-infected patients with dual-energy X-ray absorptiometry (DXA) scan between 2007 and 2014 were included and DXA scan results were used to classify patients with osteopenia. VACS Index was calculated for all patients using laboratory values closest to the date of DXA scan. Logistic regression was used to assess the association between VACS Index score or individual components of VACS Index with the presence of low BMD after adjusting for confounding variables. A total of 109 (56%) patients were diagnosed with low BMD. VACS Index score was significantly associated with low BMD, with the odds of low BMD increasing 1.21 times for each 10 unit increase in VACS Index score [confidence interval (95% CI) 1.03-1.42; p = .02]. The two groups differed significantly on patient weights, proportion of white patients, and hepatitis C-coinfected patients. After adjusting for white race and weight, hepatitis C coinfection was significantly associated with increased risk of low BMD (odds ratio 24.4; 95% CI 7.45-80.16). VACS Index score, previously demonstrated to be a marker of frailty in HIV-infected patients, is significantly associated with risk of low BMD and could be used to develop a prediction tool to screen for low BMD in resource-limited setting where DXA scans are not easily available.

Abstract WP345: Pre-Intracerebral Hemorrhage Antiplatelet and Anticoagulant Use and Differences in Hospital Course; A Population-Based Study

Objective: Patients on antiplatelet (AP) or anticoagulant (AC) agents cause more alarm when they develop intracerebral hemorrhage (ICH) compared with non-users. This analysis aimed to quantitatively evaluate the differences in the hospital course of ICH patients based on underlying AP and/or AC use, using a population-based cohort. Methods: Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) was a population-based study of spontaneous ICH among residents of the five-county Greater Cincinnati/Northern Kentucky region between July 2008 and December 2012. Baseline demographics, medications, hospital course, and discharge disposition were collected. Initial and subsequent computed tomography (CT) images of the head were reviewed to assess ICH location, volume, and presence of intraventricular hemorrhage (IVH). Change in ICH volume was calculated when repeat CT image was available. Results: There were 1121 cases of ICH during the study period. A higher proportion of white patients were on AP or AC than other races (56.4% vs. 39.7%, p&lt;.0001). The majority of patients with subsequent imaging experienced an increase in ICH size. Patients taking AC pre-ICH had a larger increase in volume despite more frequent use of pro-thrombotic therapy. There was no difference in IVH incidence based on AP or AC use. Length of stay and surgical hematoma evacuation rates were similar among the groups. Inpatient mortality was higher in AC users (44.4% vs. 21.3%, p&lt;.0001), but was virtually the same for AP users as for non-users. Of 272 pre-ICH AP users, 86 (31.6%) were discharged on AP (8 on dual AP). Of 91 pre-ICH AC users, 11 (12%) were discharged on AC. Conclusion: Pre-ICH AC use was associated with greater ICH volume increase and inpatient death. There was no significant difference in number of IVH, rate of surgical treatment, or length of stay. Inpatient mortality did not differ between AP users and non-users.

Bullous Variant of Central Serous Chorioretinopathy: Expansion of Phenotypic Features Using Multimethod Imaging

To define the phenotypic characteristics of the bullous variant of central serous chorioretinopathy (CSC) using multimethod imaging. Retrospective, observational case series. Twenty-one eyes of 14 patients with bullous retinal detachment resulting from CSC (bullous CSC group) and 122 eyes of 84 patients with chronic CSC without bullous retinal detachment (nonbullous CSC group). We performed a retrospective review of clinical and multimethod imaging data of patients who sought treatment from the authors with bullous retinal detachment resulting from CSC between January 2010 and November 2015. Multimethod imaging comprised color photography, fluorescein angiography, fundus autofluorescence, and high-resolution optical coherence tomography. Consecutive cases of chronic CSC without bullous retinal detachment, seen during the same period, comprised a comparative group. Qualitative and quantitative characteristics of the choroid, retinal pigment epithelium, and retina were compared between the 2 groups. Mean age of the bullous CSC group was 53.8 years. There was no difference in age, visual acuity, corticosteroid use, or the proportion of white patients and men between the 2 groups (all P > 0.132). Peripheral nonperfusion occurred only in eyes with bullous retinal detachment (38% of cases). Retinal pigment epithelial tears were seen in 95% of eyes in the bullous group and none of the eyes in the nonbullous CSC group. The bullous CSC group demonstrated a greater number of pigment epithelial detachments (PEDs) and more eyes demonstrated PEDs with internal hyperreflectivity (both P < 0.016). Mean subfoveal choroidal thickness in the bullous CSC group (463.1±83.1 μm) was not different compared with that of the nonbullous CSC group (400.6±100.6 μm; P= 0.993). More eyes in the bullous CSC group demonstrated hyperreflectivity around large choroidal vessels and at the level of the choriocapillaris on OCT (P < 0.001). Retinal folds and subretinal fibrin were identified in a greater proportion of eyes in the bullous CSC group (both P < 0.001). Bullous retinal detachment is a rare manifestation of chronic CSC and is characterized by a unique constellation of phenotypic and multimethod imaging features.

Abstract IA02: Racial and gender-based survival disparities in head and neck cancer

Abstract Background: Racial and gender disparities in the incidence and outcome of head and neck cancers have been known Men are much more likely to develop HNSCC than women (40,220 cases v 14,850 cases in the US in 2014). Racial outcome disparities have been observed in head and neck cancer with black patients consistently reported to have diminished survival compared to whites. Nationally, from 2003-2009, 5 year relative survival for oral cavity and pharyngeal cancer was 67% for whites and 46% for blacks. For laryngeal cancer, the relative survival was 64% for whites and 52 % for blacks (www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/). The etiology of this racial survival disparity appears to be multifactorial in origin. To investigate this further, we performed a retrospective analysis of HNSCC patients treated at the University of Maryland Greenebaum Cancer Center (UMGCC) Methods: We retrospectively analyzed 1318 patients with first primary HNSCC treated at the UMGCC from 2000 to 2010. Demographic and clinical characteristics as well as overall survival (OS) were compared between black and white patients. Results: Of the 1318 patients analyzed, 65.9% were white, 30.7% were black and 3.3% were other races. Striking differences in the distribution of patients by disease site were noted. Black patients were far less likely to present with oral cavity cancer (15.6% of cases) and far more likely to present with laryngeal or hypopharyngeal (65.6% of cases) cancer. White patients were more likely to have early stage (I and II) disease, especially in the oral cavity. In the full cohort, overall survival for black patients was significantly worse than for white patients (median 2.5 years vs. 4.8 years, p&amp;lt;0.0001). Multivariable Cox regression analysis showed black patients had significantly worse survival accounting for age, gender, stage, primary site, tobacco and alcohol consumption. Black patients had worse median OS in both oral cavity (5.7 vs 3.2 years, p&amp;lt;0.0001) and oropharyngeal cancer (4.9 vs.2.1 years p&amp;lt;0.0001). However, multivariable analysis showed that race was only significantly associated with survival in oropharyngeal cancer. There was no difference in OS between races in laryngeal or hypopharyngeal cancer. The difference in survival in oral cavity cancers resulted from the larger proportion of white patients with Stage I or II disease. White patients with oral cavity and oropharyngeal cancer were more likely to have surgery as primary treatment than blacks reflecting the higher prevalence of early stage disease. No difference was noted in the rates of chemoradiotherapy between black and white patients with advanced disease in oropharynx, hypopharynx and larynx. Analysis of HPV associated oropharyngeal cancer over time shows that these cancers are much more common in blacks than in whites, but are increasing for both races. Our data are corroborated by SEER data and other investigators. Interestingly between 1975 and 2007 the incidence of oral cavity cancer as a whole fell by 51%. For black women, the incidence of oral tongue cancer fell by a similar 55% during that time period. The incidence of oral tongue cancer for white women increased by 21% during the same period, driven significantly by a 111% increase in young white women. (Patel 2011, JCO 29: 1488). The etiology of this increase in oral tongue cancer among white women does not appear to be associated with HPV or smoking and its causes are unclear. Conclusion: We observed striking differences in site of disease, stage at presentation and survival comparing black and white patients. The difference in survival between the two groups overall is driven by a large difference specifically in oropharyngeal cancer. This is consistent with previous reports of differences in the incidence of HPV in the two ethnic groups, but likely reflects other factors as well. An emerging gender and racial disparity in the incidence of oral tongue cancer remains unexplained. Citation Format: Kevin Cullen. Racial and gender-based survival disparities in head and neck cancer. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA02.

The efficacy and safety of canagliflozin across racial groups in patients with type 2 diabetes mellitus

Objective:Canagliflozin, a sodium-glucose co-transporter 2 inhibitor, enhances urinary glucose excretion through an insulin-independent mode of action, and improves glycemic control in patients with type 2 diabetes mellitus (T2DM). This study assessed the efficacy and safety of canagliflozin across racial groups.Methods:The efficacy of canagliflozin 100 mg and 300 mg was evaluated by racial group using data pooled from four placebo-controlled phase 3 studies and two placebo-controlled sub-studies of a population of patients with inadequately controlled T2DM (N = 4158). Least-squares mean changes from baseline were calculated for hemoglobin A1c (HbA1c), systolic blood pressure (SBP), body weight (BW), cholesterol, and triglycerides. Safety/tolerability evaluation included reporting of general and prespecified adverse events (AEs).Results:A total of 75% of patients were White, 13% were Asian, 4% were Black/African American, and 8% were ‘Other’ (American Indian, Alaskan Native, mixed race, Native Hawaiian or other Pacific Islander, not reported, and unknown). Baseline demographics were similar for these groups. Dose-related reductions in HbA1c, BW, and SBP were observed with both canagliflozin doses in all racial groups. Canagliflozin was generally safe and well tolerated. Treatment with canagliflozin was associated with an increased rate of genital mycotic infections (GMIs) and urinary tract infections (UTIs) in all racial groups. GMIs were observed more often in Black/African American males and males from the ‘Other’ racial group, whereas UTIs and osmotic diuresis-related AEs were less common in Asians. Key study limitations include the high proportion of White patients compared with other racial groups and the fact that included studies were not powered to evaluate racial differences.Conclusion:Canagliflozin was generally well tolerated and consistently associated with reductions in HbA1c, BW, and SBP in patients with T2DM independent of racial background. (ClinicalTrials.gov numbers: NCT01081834; NCT01106677; NCT01106625; NCT01106690; and NCT01032629.)

Treatment and Management Patterns of Patients with Von Willebrand Disease in the United States

Background: Few data exist regarding patient management strategies for von Willebrand disease (VWD), the most frequently inherited bleeding disorder. The objective of this study was to retrospectively assess patterns of VWD patient management in the United States. Methods: 41 physicians were recruited using the Centers for Disease Control and Prevention’s list of hemophilia treatment centers (HTCs) and the American Medical Association’s physician database (16 HTC-, 25 non-HTC-affiliated). Patient charts were randomly sampled by quota method. Results: Charts of 225 VWD patients treated from 1/2005–12/2007 were reviewed (94/74/57 for VWD types 1/2/3, respectively). The proportion of white patients was higher at non-HTCs than HTCs, and among type 1 than type 2 patients. Females comprised 65% of patients, (77% of type 1, 55% of type 2, and 58% of type 3 patients) However, bleeding episodes requiring treatment occurred in 53% of male but only 36% of female patients. The proportion of patients treated with desmopressin or von Willebrand factor/factor VIII (VWF/FVIII) concentrates for bleeding (148 events) and surgery (140 episodes) within VWD type were: 31% and 47% of type 1, 55% and 36% of type 2, 44% and 39% of type 3 patients, respectively. Of the 140 surgical events requiring desmopressin or VWF/FVIII concentrates, 61% occurred in the non-HTC setting. Conclusion: In addition to revealing interesting disparities in VWD patient demographics, these data indicate VWD patients receive care generally aligned with treatment guidelines, with the exception of the number of surgeries performed outside of the HTC setting, where access to laboratory monitoring of factor levels may be limited.