Race-specific Mortality Research Articles

Oncogenic alteration rates, race, and prostate cancer specific mortality in Veterans with metastatic prostate cancer undergoing somatic tumor next generation sequencing.

Oncogenic alteration rates, race, and prostate cancer specific mortality in Veterans with metastatic prostate cancer undergoing somatic tumor next generation sequencing.

S579 Race-Specific Mortality from Esophageal Cancer in the United States

S579 Race-Specific Mortality from Esophageal Cancer in the United States

Heterogenous Effects of Local Government Spending on Mortality Across Racial Groups Among Working-Age Adults in the U.S.

Mortality among working-age adults has been rising, but the underlying reasons are not fully known. Given the relationship between higher levels of public spending and better health outcomes, it is possible that differences in public spending may explain some of this trend. This study examined the association between county government spending and overall and race-specific mortality among working-age adults over time. Hybrid random effects models, which specified separate within- and between-county effects, were used to assess the relationship between per capita county spending and overall and race-specific mortality rates from 1980 to 2019. All models controlled for median age, percentage of the population with at least a bachelor's degree, unemployment rate, and poverty rate. In the overall population, counties with higher k-12 education, library, and police spending were significantly associated with higher mortality rates. Among Black adults, counties with lower corrections spending, lower waste management spending, and higher highway spending had significantly higher Black mortality. Among White adults, counties with lower natural resource spending and higher police spending had higher White mortality. This study showed that differences in public spending may explain the geographic and racial differences in mortality among working-age adults. Local governments should consider public spending as a tool to improve overall population health and address racial health inequalities in their jurisdictions.

Race-Specific Mortality from Multiple Myeloma: A CDC Database Population Study in the United States between 2000 and 2020

Background: Multiple myeloma is the second most prevalent hematologic cancer, following lymphoma, with a median overall survival of 5 to 10 years. Multiple myeloma prognosis has markedly changed over time. Despite that, there are significant racial inequalities in the incidence and overall survival of all different types and stages of the disease. Interestingly, it is twice as prevalent and fatal among African-Americans as White. In the lack of studies examining racial disparities in racial subgroups, we conducted a retrospective study to assess mortality trends across all racial groups in the United States between 2000 and 2020. Method: We performed a retrospective study utilizing the Centers for Disease Control and Prevention (CDC) database. Employing the multiple cause of death database (ICD-10 revision codes), we identified all patients who died of Multiple Myeloma (C90.0.x listed as the underlying cause of death) of all races (White, Black, Asian or Pacific Islander, and American Indian or Alaska Native) between 2000 and 2020 in the United States regardless of Hispanic origin and gender. Age-adjusted mortality rates were calculated per 1000,000 persons (PMP), standardized to the US census data from 2000, and stratified by race. Result: Between 2000 and 2020, a total of 237,496 multiple myeloma deaths were identified in all races, with an overall age-adjusted mortality of 33.4 PMP. We identified a total of 189,964 deaths, 41,823 deaths, 4,558 deaths, and 1,151 deaths in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations respectively. The overall age-adjusted mortalities were 31.1 PMP, 62.1 PMP, 16 PMP, and 22.7 PMP in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations respectively. Furthermore, over the 20 years, the age-adjusted mortality decreased by 26 % in Black (from 74.5 PMP in 2000 to 54.8 PMP in 2020), 22 % in White (from 35.2 PMP in 2000 to 27.5 PMP in 2020), 12 % in Asian or Pacific Islander (from 16.3 PMP in 2000 to 14.4 PMP in 2020), and 52 % in American Indian or Alaska Native (from 28.8 PMP in 2000 to 13.9 PMP in 2020). Conclusion: This comprehensive population-based study demonstrates that there are racial disparities in multiple myeloma mortality. Within the past two decades, the mortality was highest among African Americans and lowest among Asians and Pacific Islanders. Moreover, all racial groups had a decrease in mortality trends. American Indian Alaskans had the highest rate of decrease, which was double that of blacks. Multiple factors can contribute to the disparities including but not limited to the interplay between disease biology, risk factors, treatment response, and unequal access to innovative therapies. Further studies are needed to investigate the causes of the racial disparities and identify strategies to minimize the racial gap.

S54 Trends in Race-Specific Mortality From Pancreatic Cancer in the United States Between 2000 and 2020

S54 Trends in Race-Specific Mortality From Pancreatic Cancer in the United States Between 2000 and 2020

Abstract 3672: Area-level drivers of the breast cancer mortality race disparity in Georgia

Abstract In the US, breast cancer mortality is 40% greater among Black than White women. The mortality disparity varies geographically and has persisted despite improvements in survival. Georgia is one of six states where breast cancer recently surpassed lung cancer as the leading cause of cancer death among Black but not White women, is a large and diverse state, and thus, an ideal setting to study race disparities. Our work in the Atlanta Metro area has shown that the mortality disparity is pronounced among patients with clinically favorable subtypes, low Oncotype DX® recurrence scores, guideline-concordant care, and similar access to surgical facilities. The disparity also persists among patients with private insurance and those living in areas of low poverty, suggesting clinical and sociodemographic differences do not fully account for the observed disparity. Recent evidence suggests area-level factors may contribute to the disparity. Our group reported that neighborhood-level redlining (i.e., mortgage denial based on place) is associated with an increase in breast cancer mortality while neighborhood-level lending bias (i.e., mortgage denial based on race) is associated with a decrease in breast cancer mortality. In Atlanta, Black patients are more likely to live in redlined areas and less likely to live in areas with lending bias, than White patients, further suggesting place is an important driver of disparities. We investigated the role of other area-level factors on race-specific mortality in Georgia. Race-specific standardized mortality ratios were computed for each county in Georgia. Observed breast cancer deaths among non-Hispanic White (NHW) and non-Hispanic Black (NHB) women within 5 years of a stage I-III breast cancer diagnosis (2005-2013) were obtained from the Georgia Cancer Registry. County-level characteristics were derived from the American Community Survey and Georgia Department of Public Health. A Bayesian model-based approach was used to stabilize local estimates and estimate associations with area-level factors. Smoothed estimates of relative disparity ranged from 1.2 to 1.7, with pronounced disparity for counties surrounding the Atlanta and Savannah metropolitan areas and least pronounced disparity in Metro Albany counties. Among NHB women, living in a rural (versus non-rural) county was associated with a nearly 20% increase in breast cancer mortality (RR=1.19, 95% credible interval (CI): 0.96, 1.48); an association not observed in NHW patients (RR=0.93, 95% CI: 0.79, 1.07). In contrast, a 10-point increase in the percent of adults with ≤high school education was associated with a 10% increase (95% CI: 1.05, 1.17) in mortality for NHW patients only. The race disparity in Georgia is not evenly distributed across counties. We identified area-level characteristics associated with race-specific mortality. Identifying other area-level drivers of breast cancer mortality is an important area of inquiry. Citation Format: Rebecca Nash, Lindsay J. Collin, Jeffrey Switchenko, Lauren E. McCullough. Area-level drivers of the breast cancer mortality race disparity in Georgia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3672.

Abstract PO-173: Spatial heterogeneity and rural-urban differences in the Black-White breast cancer mortality disparity in Georgia

Abstract Introduction: Breast cancer mortality in the US is 40% higher among Black than White women. Even among patients with prognostically favorable tumors, disparities persist, suggesting clinical features do not fully account for mortality differences. Area-level factors (e.g., rurality) influence health outcomes and may explain spatial variation in mortality disparities. Rurality can impact access to and quality of care, and socioeconomic status. Georgia is an ideal place to study spatial heterogeneity in race disparities because of the diverse population (>30% Black), large number of counties (159), and pronounced disparities in breast cancer mortality in the Atlanta area. Methods: Race-specific standardized mortality ratios (SMRs) were calculated for each county in Georgia to account for sparsely populated areas and areas with high residential segregation. Observed deaths among women diagnosed with localized or regional breast cancer between 2005 and 2013 were obtained from the Georgia Cancer Registry. To ensure equal follow-up, only deaths within five years of diagnosis were included. Expected deaths were estimated using race-specific population counts, race-specific breast cancer incidence rates, and the pooled (Black and White) mortality rate among Georgia women, with indirect age adjustment (20–44, 45–54, 55+ years). Spatial smoothing methods, including adding neighboring data to meet a threshold and Bayesian models with conditionally autoregressive priors, were used to stabilize local estimates. Counties were classified by 2013 RUC codes (urban: 1–3, rural: 4–9). Results: A total of 3,235 breast cancer deaths were observed during the study period, with 42% among Black women. The median SMR was lower for White (0.8, IQR: 0.7, 1.1) than Black women (1.4, IQR: 1.1, 2.0). Among Black women only, median SMR was greater in rural (1.7, IQR: 1.1, 2.5) than urban counties (1.3, IQR: 1.1, 1.6). After sequentially adding neighboring data to meet a race-specific threshold of 30 observed deaths, smoothed median SMRs were 0.9 (IQR: 0.8, 0.9) and 1.4 (IQR: 1.2, 1.6) for White and Black women, respectively. For Black women, median SMR was attenuated in rural counties (1.4, IQR: 1.2, 1.7) but unchanged in urban counties (1.3, IQR: 1.2, 1.5). The greatest SMRs for Black women were observed in urban counties comprising the Atlanta area and rural southeast Georgia. For example, Fulton County SMRs were 1.6 and 0.7, for Black and White women, respectively. Highest SMRs for White women were observed in southwest Georgia, but were similar to SMRs among Black women in this region. The spatial distribution of SMRs using same neighbor smoothing and Bayesian models were similar. Conclusion: Breast cancer mortality race disparities vary widely across Georgia. These results highlight specific areas for public health intervention, especially among Black women. This work presents a potential mechanism to monitor trends in small area cancer mortality race disparities over time. Future work will model the impact of area-level factors on the disparity magnitude. Citation Format: Rebecca J. Nash, Lauren E. McCullough, T.J. Pierce, Lindsay J. Collin, Anne H. Gaglioti, Kevin C. Ward, Michael Kramer, Jeffrey Switchenko. Spatial heterogeneity and rural-urban differences in the Black-White breast cancer mortality disparity in Georgia [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-173.

Influenza and Pneumonia Mortality Across the 30 Biggest U.S. Cities: Assessment of Overall Trends and Racial Inequities.

Influenza and pneumonia account for substantial morbidity in the United States and show a demonstrated racial inequity. Detailed race-specific analysis at the city level can be used to guide targeted prevention efforts within the most at-risk communities. The purpose of this study is to analyze city-level data of influenza/pneumonia mortality rates and racial disparities across the 30 biggest U.S. cities over time. We assess racial inequities in influenza/pneumonia mortality in the 30 biggest cities and compare city-level trends overtime through age-adjusted overall and race-specific mortality rates calculated from public death records for the years 2008–2017. The national influenza/pneumonia mortality rate significantly decreased as did 45% of the cities included in the study. Nationally, the Black mortality rate was 16% higher than White mortality rate, and a significant disparity was seen within about one-third of the biggest cities. Over half (56%) of the cities showed reductions in both Black and White mortality; however, there was no overall trend in racial equity with some cities reducing the inequities between the Blacks and Whites and others increasing the inequities. Elevated mortality rates in communities of color can be traced to structural racism, social factors, and access to treatment and prevention services. We recommend an approach utilizing community outreach administered through localized public health organizations and supported by data at the city level.

Abstract 15312: Racial Disparities in Trends in Mortality From Cardiac Arrests in the United States

Background: African Americans are at increased risk of fatal cardiac arrests, but population-based studies exploring contemporary epidemiology are not available. We sought to identify the trend in race-specific mortality from cardiac arrest in the United States. Methods: Using the multiple cause of death database, we identified all patients (Caucasians or African Americans) who died of cardiac arrest (International Classification of Diseases, 10th revision code I46.x listed as underlying cause of death) between 1999 and 2018. Age-adjusted mortality rates were standardized to the 2000 US census data, and stratified by age group (<35 years, 35-64 years, and ≥ 65 years). Results: A total of 311,065 cardiac arrest deaths were identified, with an overall age-adjusted mortality of 53.6 per million (Caucasian: 49.1 per million, African American: 90.6 per million). Overall, age-adjusted mortality decreased from 80.1 per million persons (1999) to 44.3 per million persons (2012), followed by 8.8% increase to 48.2 (2018). Between 2012 and 2018, African Americans had higher rates of increase (10.9%) compared with Caucasians (6.9%). Largest disparities in relative changes between 2012 and 2018 occurred in patients younger than 35 years (African American: 35%, Caucasians -11%), and patients ≥ 65 years (African Americans: 8%, Caucasians 4%), figure. Conclusions: Although the mortality due to cardiac arrest has declined in the US between 1999 and 2012, a recent increase has been noted between 2012 and 2018, particularly among younger African Americans. Studies should focus on identifying causes of disparities and identifying methods to reduce the racial gap.

Abstract B137: Colorectal cancer mortality and disparities in America’s 30 most populous cities

Abstract Background: In the U.S., colorectal cancer (CRC) is the 2nd leading cause of cancer deaths and Blacks have a 40% higher CRC mortality rate compared to Whites. Reduction in CRC mortality and racial disparities may be achieved, in part, by addressing modifiable factors (e.g. smoking, overweight/obesity, cancer screening availability/uptake, treatment access) and coordinating efforts by civil societies, policy makers, and community leaders. Implementing programs and policy changes at the city level may be the most effective strategy for the U.S. because over 80% of invasive cancer cases occur within urban areas. The purpose of the present analysis is to calculate (and rank) overall and race-specific CRC mortality rates as well as measures of disparities for the 30 biggest U.S. cities. Methods: The 2013-2017 National Center for Health Statistics mortality data and 2013-2017 American Community Survey 5-year population estimates were used to compute the overall, non-Hispanic (nH) Black, and nH White average annual CRC mortality rates for the U.S. and the 30 most populous cities. The rates were age-adjusted using the 2000 standard U.S. population. The Black and White CRC mortality rates were used to calculate rate ratios (RR) and rate differences (RD) and their respective 95% confidence intervals (CIs). In addition, the number of excess deaths due to the racial disparity in CRC mortality was ascertained. Results: The estimated annual CRC mortality rate for the U.S. was 14.3 per 100,000 total population. The city-level rates ranged from a low of 10.6 (San Jose) to a high of 31.1 (Las Vegas). Nationally, the Black rate was 43% higher than the White rate (95% CI: 1.41-1.44) with a RD of 6.27 per 100,000 population. Racial disparities were found in 25 of the 30 cities. Among those with a disparity, Philadelphia had the lowest level (RR=1.21; 95% CI 1.08-1.35, RD=3.55; 95% CI: 1.46-5.63) while Washington DC had the highest (RR=2.60; 95% CI 2.04-3.30, RD=13.65; 95% CI: 10.76-16.54). In the U.S., the yearly number of excess Black CRC deaths was 2,252. Across the 25 cities with a disparity, Seattle and Portland fared the best while Chicago fared the worst in terms of excess deaths (3 versus 96, respectively). Even among the 12 cities with a lower CRC mortality rate than that of the U.S., 7 had a greater level of disparity (RR>1.43) than the nation. However, some cities like San Diego, New York, Boston, and Oklahoma City fared well in terms of the overall CRC mortality rates and level of disparity. Conclusion: To our knowledge, this study is the first to illustrate the substantial variability in CRC mortality disparities across a sample of urban cities. Local level data helps identify cities that may need the most support and offers examples of model cities. City-level information can be used to assist city officials, public health professionals, cancer control agencies, and other organizations to make real, evidence-based changes in policies, services, and funding. Citation Format: Abigail Silva, Nazia Sayad, Fernando De Maio, Maureen Benjamins. Colorectal cancer mortality and disparities in America’s 30 most populous cities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B137.

Blurred lines: racial misclassification in death certificates in Brazil.

To analyze the agreement between self-reported race and race reported on death certificates for older (≥ 60years) residents of São Paulo, Brazil (from 2000 to 2016) and to estimate weights to correct mortality data by race. We used data from the Health, Well-Being and Aging Study (SABE) and from Brazil's Mortality Information System. Misclassification was identified by comparing individual self-reported race with the corresponding race on the death certificate (n = 1012). Racial agreement was analyzed by performing sensitivity and Cohen's Kappa tests. Multinomial logistic regressions were adjusted to identify characteristics associated with misclassification. Correction weights were applied to race-specific mortality rates. Total racial misclassification was 17.3% (13.1% corresponded to whitening, and 4.2% to blackening). Racial misclassification was higher for self-reported pardos/mixed (63.5%), followed by blacks (42.6%). Official vital statistics suggest highest elderly mortality rates for whites, but after applying correction weights, black individuals had the highest rate (45.85/1000 population), followed by pardos/mixed (42.30/1000 population) and whites (37.91/1000 population). Official Brazilian data on race-specific mortality rates may be severely misclassified, resulting in biased estimates of racial inequalities.

Drug Overdose Trends among Black Indiana Residents: 2013-2017

ObjectiveTo understand trends in race-specific mortality rates between blacks and whites to discover any racial inequalities that might exist for drug overdose deaths. To delve into the types of drugs that are prominently involved in black drug overdose deaths from 2013-2017 in the state of Indiana.IntroductionBlack Hoosiers, the largest minority population in Indiana, make up almost 10% of the state’s population, and accounted for 8% of the total resident drug overdose deaths from 2013-2017 compared to whites at 91%. However, a closer look at race-specific mortality rates might reveal racial inequalities. Therefore, the purpose of this project was to analyze drug overdose morality rates among white and black Hoosiers to discover possible racial inequalities and to discover trends in drug involvement in overdose deaths among blacks.MethodsDrug overdose deaths that occurred in Indiana between 2013 and 2017 were identified using the underlying and contributing cause of death ICD-10 codes and abstracted from the Indiana State Department of Health’s annual finalized mortality dataset. Race-specific drug overdose death rates were calculated and compared among racial groups. Drug overdose deaths in blacks were examined for trends over time and by the types of drugs involved.ResultsBetween 2013 and 2017, drug overdose mortality rates for whites increased from 17.05 to 27.28 per 100,000. Blacks saw a higher rate increase during this same time frame: from 10.74 to 30.62 per 100,000, surpassing the mortality rate of whites by the end of 2017. Drug overdose deaths in blacks increased 197% from 2013-2017 and drug specific mortality rate increases were seen across all drug category’s. Opioids, which were involved in 61% of the 2017 drug overdose deaths among blacks, had a rate increase from 3.05 to 18.62 per 100,000 between 2013 and 2017. Drug specific overdose mortality rate increases were also seen for overdoses involving cocaine (1.76 to 10.62 per 100,000), benzodiazepines (0.32 to 3.08 per 100,000), and psychostimulants other than cocaine (0.16 to 1.69 per 100,000) such as amphetamines.ConclusionsWhile white Hoosiers had higher drug overdose mortality rates between 2013 and 2016, black Hoosiers had a greater mortality rate increase and surpassed the mortality rate in whites in 2017. Opioids, the most frequently involved substance in overdose deaths among blacks from 2013-2017, showed increasing rates during this time period. However, increases in drug specific overdose mortality rates for cocaine, benzodiazepines, and psychostimulants other than cocaine also call for public health attention. These results promote the inclusion of minority health experts in drug overdose prevention efforts and issue a call for future prevention efforts to be targeted toward the state’s largest minority population.

Characteristics of persistently unhealthy counties: A comparison of white and black mortality over time

This research examines differences in white and black persistence of mortality in the United States over a period of nearly 50 years. Using data from the National Center for Health Statistics Compressed Mortality File, we calculated race-specific, all-cause age-adjusted mortality rates for ten time periods from 1968 to 2015. Counties ranking in the top 20% of mortality in at least half of the time periods are classified as persistently unhealthy. Race-specific mortality persistence is mapped illustrating geographic disparities in the clustering of unhealthy places. Persistence of white mortality is clustered in several distinct Southern regions, while black persistent mortality is evenly distributed geographically. Socioeconomic characteristics of white and black persistently unhealthy places are also examined, with a focus on rural–urban differences.

Comparing Microvascular Decompression with Gamma Knife Radiosurgery for Trigeminal Neuralgia. A Cost-Effectiveness Analysis

Both microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS) are time-tested treatment modalities for trigeminal neuralgia (TN). There is little evidence in the literature studying these modalities head to head in a cost-effectiveness comparison. To evaluate the cost-effectiveness of MVD compared with GKRS for treating patients with TN. We developed a Markov cost-effectiveness model for the U.S. health care system to account for all costs related to MVD and GKRS as treatment modalities for TN, from the health care system perspective, over a patient lifetime horizon. A base case was estimated using data from previous studies, from our own GKRS experience, and from a current data analysis of patients undergoing MVD. We derived model inputs, including health care costs, survival, and utility estimates, from the literature. We used age-specific, sex-specific, and race-specific mortality from national registries. Costs studied included those for MVD, for GKRS, for treating complications from either procedure, and for medications throughout patient lifetimes. We performed multiple 1-way, 2-way, and probabilistic sensitivity analyses to confirm the robustness of model assumptions and results. The incremental cost-effectiveness ratio (ICER), with a threshold of $50,000 per quality-adjusted life-year (QALY) gained, defined cost-effectiveness. The base case had an ICER of $12,154 per QALY for MVD compared with GKRS. Probabilistic sensitivity (Monte Carlo) analysis showed that MVD was cost-effective in 70% of model iterations. GKRS was favored when the willingness to pay threshold was <$12,000 per QALY gained. In patients medically eligible for either procedure, we found MVD to be the most cost-effective modality to treat TN, primarily because of its reported greater durability. MVD remained the most cost-effective strategy across a broad range of model input values in sensitivity analyses.

The Veterans Affairs Disparity Paradox: Racial Disparities Among a Cohort of American Military Veterans with Prostate Cancer

Black men with prostate cancer have historically been found to have worse outcomes compared to other racial/ethnic groups. This finding has primarily been attributed to differences in genetics, health care access, and socioeconomic status. We sought to validate this relationship between race and prostate cancer specific mortality (PCSM) in a large national cohort of American veterans. We used a nationwide database of the Veterans Health Administration (VHA) by means of the VA Informatics and Computing Infrastructure (VINCI). Our initial query captured 82,886 patients who were diagnosed with prostate cancer from 2000 to 2015 and had received radiation therapy as part of their initial treatment. To control for possible confounders, patients who received brachytherapy, surgery, or had metastatic disease at diagnosis were excluded. Covariates included age at diagnosis, T stage, Gleason score, PSA at diagnosis, administration of ADT, Charlson Comorbidity Index (CCI) score, tobacco/alcohol history, marital status, employment status, and median income. Patients who lacked data for covariates were excluded. We compared baseline characteristics between blacks and other racial/ethnic groups with Pearson’s chi-squared and Mann-Whitney U tests. We compared PCSM and non-prostate cancer mortality (NPCM) between groups using multivariable Cox proportional hazards models. Our final study cohort included 27,753 patients, of which 8,453 (30.5%) were black. At time of diagnosis, blacks were younger (64 vs 67, p<0.001), had a higher PSA (12.6 vs 10.2, p<0.001), and were more likely to have a CCI score of 2+ (24.5% vs 19.8%, p<0.001). Additionally, they were more likely to have T1 disease (72.6% vs 62.3%, p<0.0001) and slightly more likely to receive ADT (47.5% vs 46.1%, p=0.037). Blacks were less likely to have Gleason 8+ disease (20.6% vs 22.5%, p<0.001). Controlling for potential confounders, we found improved PCSM among blacks (HR 0.86, 95% CI 0.77 to 0.97, p=0.012). Increasing age, PSA, T stage, Gleason score, and CCI score were associated with worse PCSM. In addition to improved PCSM, we also found that black patients had improved NPCM compared to other racial/ethnic groups (HR 0.812, 95% CI 0.76 to 0.87, p<0.0001). Our discovery of improved prostate cancer specific mortality and non-prostate cancer mortality among black veterans demonstrates a unique racial disparity paradox that has not been seen in the general population. Further research is required to determine if our results are driven by systematic differences in the cohort or in VHA care delivery.

The differential effects of rural health care access on race-specific mortality

We examined the relationship between race-specific rural mortality and the health infrastructure of rural counties in light of America’s recent emergence of a rural mortality penalty. Using the Compressed Mortality File from National Center for Health Statistics (2008–2012) and county-level demographic, socioeconomic, and health care indicators from the Area Health Resource File and the US Census, we created a rural public health infrastructure index which encompasses four types of health care access (public health employees, critical access hospital/rural referral centers, rural health clinics, and emergency departments) within counties. We found that each unit increase in the index is associated with a decline in rural Black mortality, but is associated with an increase in rural White mortality. Policymakers could benefit from focusing on the declining rate of mortality improvement in many rural regions, specifically by trying to better understand how decisions concerning public health spending may influence mortality differently for Black and White residents.

Concordance in the relative mortality rates for prostate cancer and gastric cancer in African Americans.

270 Background: The racial disparity in outcomes for prostate cancer, gastric cancer, and multiple myeloma is demonstrated by these malignancies having the highest age-adjusted mortality rate ratio for black Americans versus white Americans. A variety of factors have been identified as contributing to this disparity, leading to our hypothesis that there would not be concordance, in respect to the mean, when the county-level age-adjusted black: white mortality rate ratio for a malignancy was compared to the other two malignancies. Methods: Publically available information from cancerrates.gov was used to obtain county-level data in regards to race-specific age-adjusted mortality rates for prostate cancer, gastric cancer, and multiple myeloma. Counties with potentially unstable age-adjusted mortality rates were excluded. A malignancy’s age-adjusted mortality rate for blacks was divided by the complementary rate for whites to determine the black: white mortality rate ratio. Across a county, malignancies were compared for concordance in mortality rate ratios relative to the mean ratio for that malignancy. After a preliminary inspection noted that all New Jersey counties had a markedly lower black: white mortality ratio for gastric cancer than other counties in the data set, the New Jersey counties were excluded from analysis and odds ratios for concordance were calculated. Results: All counties (n = 68) had a black: white age-adjusted mortality ratio of &gt; 1 for each malignancy. In the analyzed counties (n = 52), there was a statistically significant concordance in black: white mortality rate ratios for prostate cancer and gastric cancer (OR = 3.26, p = 0.046). The black: white mortality rate ratios for neither prostate cancer (OR = 1.17, p = 0.78) nor gastric cancer (OR = 1.17, p = 0.78) demonstrated a statistically significant concordance with multiple myeloma. Conclusions: The concordance in the black: white mortality rate ratios for prostate cancer and gastric cancer in this dataset indicate that these two malignancies may share common clinical, environmental, or genetic factors in African-Americans. Future research is needed into what common factors may contribute to disparities in these two malignancies.

Long-Term Trends in Black and White Mortality in the Rural United States: Evidence of a Race-Specific Rural Mortality Penalty.

The rural mortality penalty-growing disparities in rural-urban macro-level mortality rates-has persisted in the United States since the mid 1980s. Substantial intrarural differences exist: rural places of modest population size, close to urban areas, experience a greater mortality burden than the most rural locales. This research builds on recent findings by examining whether a race-specific rural mortality penalty exists; that is, are some rural areas more detrimental to black and/or white mortality than others? Using data from the Compressed Mortality File from 1968 to 2012, we calculate annual age-adjusted, race-specific mortality rates for all rural-urban regions designated by the Rural-Urban Continuum Codes. Indicators for population, socioeconomic status, and health infrastructure, as a proxy for access to care, are used as predictors of race-specific mortality in multivariable regression models. Three important results emerge from this analysis: (1) there is a substantial mortality disadvantage for both black and white rural Americans, (2) the most advantageous regions of mortality for blacks exhibit higher mortality than the most disadvantageous regions for whites, and (3) access to health care is a much stronger predictor of white mortality than black mortality. The rural mortality penalty is evident in race-specific mortality trends over time, with an added disadvantage in black mortality. The rate of mortality improvement for rural blacks and whites lags behind their same-race, urban counterparts, creating a diverging gap in race-specific mortality trends in rural America.

Age and Race Specific Trends and Mortality for Dementia Hospitalization in the US

Objective: To explore ethnoracial and gender specific mortality associated with dementia hospitalizations from 1997 to 2008, using a nationally representative database. Design: Cross-sectional. Participants: 354,949,163 from the Nationwide Inpatient Sample (NIS) database using appropriate ICD-9 and procedure codes. Measurements: Descriptive, univariate and multivariable analysis (Linear, Cox) adjusting for comorbidity, hospital factors and socio-demographics were used. Results: Mortality was higher for dementia hospitalizations for all age groups (35-64 years and ≥ 65 years) vs. non-dementia hospitalizations (2.7% vs. 1.5% and 5.5% vs. 4.5%). For individuals aged 35-64 years, dementia hospitalizations were more common among males vs. females (53.8% vs. 46.2%). Crude in-hospital mortality was higher among Whites and males for all age groups and overall mortality declined from 1999 to 2008. Adjusted relative risk of mortality was higher among men as compared to women of all age groups (RR 2.87, 95% CI 2.82-2.92) and also higher among Hispanics and African Americans as compared to Whites (African Americans: RR 2.35, 95% CI 2.21-2.51; Hispanics: RR 2.15, 95% CI 2.06-2.23). Conclusion: African Americans, Hispanics and men bear a disproportionate burden from dementia in the hospital setting. Interventions to improve care outcomes in these populations are important.

Economic Opportunity, Health Behaviors, and Mortality in the United States.

We assessed whether economic opportunity was independently associated with health behaviors and outcomes in the United States. Using newly available, cross-sectional, county-level data from the Equality of Opportunity Project Database and vital statistics, we estimated associations between all-cause mortality rates (averaged over 2000-2012) and economic opportunity, adjusting for socioeconomic, demographic, and health system covariates. Our measure of economic opportunity was the county-average rank in the national income distribution attained by individuals born to families in the bottom income quartile. Secondary outcomes included rates of age- and race-specific mortality, smoking, obesity, hypertension, and diabetes. An increase in economic opportunity from the lowest to the highest quintile was associated with a 16.7% decrease in mortality. The magnitudes of association were largest for working-age adults and African Americans. Greater economic opportunity was also associated with health behaviors and risk factors. Economic opportunity is a robust, independent predictor of health. Future work should investigate underlying causal links and mechanisms.