Race-specific Rates Research Articles

Investigating the Black Birth Experience: A Race-Stratified Analysis of Preterm Birth Risk and Exposure to Metropolitan Statistical Area-Level Police-Related Deaths, US 2018–2019

Police-related violence may be a source of chronic stress underlying entrenched racial inequities in reproductive health in the USA. Using publicly available data on police-related fatalities, we estimated total and victim race-specific rates of police-related fatalities (deaths per 100,000 population) in 2018–2019 for Metropolitan Statistical Areas (MSA) and counties within MSAs in the USA. Rates were linked to data on live births by maternal MSA and county of residence. We fit adjusted log-Poisson models with generalized estimating equations and cluster-robust standard errors to estimate the relative risk of preterm birth associated with the middle and highest tertiles of police-related fatalities compared to the lowest tertile. We included a test for heterogeneity by maternal race/ethnicity and additionally fit race/ethnicity-stratified models for associations with victim race/ethnicity-specific police-related fatality rates. Fully adjusted models indicated significant adverse associations between police-related fatality rates and relative risk of preterm birth for the total population, non-Hispanic Black, and non-Hispanic White groups separately. Results confirm the role of fatal police violence as a social determinant of population health outcomes and inequities, including preterm birth.

Disproportionate burden of violence: Explaining racial and ethnic disparities in potential years of life lost among homicide victims, suicide decedents, and homicide-suicide perpetrators.

Research indicates that the burden of violent death in the United States is disproportionate across racial and ethnic groups. Yet documented disparities in rates of violent death do not capture the full extent of this inequity. Recent studies examining race-specific rates of potential years of life lost-a summary measure of premature mortality-indicate that persons of color may die at younger ages than their counterparts, leading to increased trauma among surviving family members, friends, and communities. This study examines racial and ethnic disparities in potential years of life lost among people who died by homicide and suicide. We calculated potential years of life lost using life expectancy values specific to each racial and ethnic group, thereby isolating racial differences in potential years of life lost due to violence. Findings indicated that persons of color were disproportionately impacted by violence. Non-Hispanic African American homicide victims, suicide decedents, and homicide-suicide perpetrators died eleven or more years earlier than their non-Hispanic White counterparts. Similar disparities were observed for non-Hispanic Asian or Pacific Islander decedents. Less pronounced differences were observed for Hispanic and non-Hispanic American Indian or Alaska Native decedents. These racial and ethnic disparities were partly accounted for by a broad array of individual differences, incident characteristics, and contextual factors. The results suggest that homicide and suicide exact a high societal cost, and the burden of that cost is disproportionately high among persons of color.

Fentanyl-driven acceleration of racial, gender and geographical disparities in drug overdose deaths in the United States.

We examine trends in drug overdose deaths by race, gender, and geography in the United States during the period 2013-2020. Race and gender specific crude rates were extracted from the final National Vital Statistics System multiple cause-of-death mortality files for several jurisdictions and used to calculate the male-to-female ratios of crude rates between 2013 and 2020. We established 2013-2019 temporal trends for four major drug types: psychostimulants with addiction potential (T43.6, such as methamphetamines); heroin (T40.1); natural and semi-synthetic opioids (T40.2, such as those contained in prescription pain-killers); synthetic opioids (T40.4, such as fentanyl and its derivatives) through a quadratic regression and determined whether changes in the pandemic year 2020 were statistically significant. We also identified which race, gender and states were most impacted by drug overdose deaths. Nationwide, the year 2020 saw statistically significant increases in overdose deaths from all drug categories except heroin, surpassing predictions based on 2013-2019 trends. Crude rates for Black individuals of both genders surpassed those for White individuals for fentanyl and psychostimulants in 2018, creating a gap that widened through 2020. In some regions, mortality among White persons decreased while overdose deaths for Black persons kept rising. The largest 2020 mortality statistic is for Black males in the District of Columbia, with a record 134 overdose deaths per 100,000 due to fentanyl, 9.4 times more than the fatality rate among White males. Male overdose crude rates in 2020 remain larger than those of females for all drug categories except in Idaho, Utah and Arkansas where crude rates of overdose deaths by natural and semisynthetic opioids for females exceeded those of males. Drug prevention, mitigation and no-harm strategies should include racial, geographical and gender-specific efforts, to better identify and serve at-risk groups.

County-level geographic disparities in cardiovascular disease mortality among US breast cancer survivors, 2000-2018.

Disparities in cardiovascular disease mortality among breast cancer survivors are documented, but geographic factors by county-level socioeconomic status (SES) and rurality are not well described. We analyzed 724 518 women diagnosed with localized or regional stage breast cancer between 2000 and 2017 within Surveillance, Epidemiology, and End Results Program-18 with follow-up until 2018. We calculated relative risks (RRs) of cardiovascular disease mortality using Poisson regression, accounting for age- and race-specific rates in the general population, according to county-level quintiles of SES (measured by Yost index), median income, and rurality at breast cancer diagnosis. We also calculated 10-year cumulative mortality risk of cardiovascular disease accounting for competing risks. Cardiovascular disease mortality was 41% higher among breast cancer survivors living in the lowest SES (RR = 1.41, 95% confidence interval [CI] = 1.36 to 1.46, Ptrend < .001) and poorest (RR = 1.41, 95% CI = 1.36 to 1.47, Ptrend < .001) counties compared with the highest SES and wealthiest counties, and 24% higher for most rural relative to most urban counties (RR = 1.24, 95% CI = 1.17 to 1.30, Ptrend < .001). Disparities for the lowest SES relative to highest SES counties were greatest among younger women aged 18-49 years (RR = 2.32, 95% CI = 1.90 to 2.83) and aged 50-59 years (RR = 2.01, 95% CI = 1.77 to 2.28) and within the first 5 years of breast cancer diagnosis (RR = 1.53, 95% CI = 1.44 to 1.64). In absolute terms, however, disparities were widest for women aged 60+ years, with approximately 2% higher 10-year cumulative cardiovascular disease mortality risk in the poorest compared with wealthiest counties. Geographic factors at breast cancer diagnosis were associated with increased cardiovascular disease mortality risk. Studies with individual- and county-level information are needed to inform public health interventions and reduce disparities among breast cancer survivors.

Examining COVID-19 mortality rates by race and ethnicity among incarcerated people in 11 U.S. state prisons (March–October 2021)

BackgroundPopulations who are incarcerated have experienced disproportionately high coronavirus disease 2019 (COVID-2019) mortality rates compared to the general population. However, mortality rates by race/ethnicity from federal, state, and local carceral settings are largely unavailable due to unregulated reporting; therefore, racial/ethnic inequities have yet to be examined. We aimed to estimate coronavirus disease 2019 (COVID-19) mortality rates among individuals incarcerated in U.S. state prisons by race and ethnicity (RE). MethodsPublic records requests to state Departments of Corrections were used to identify deaths from COVID-19 among incarcerated adults occurring from March 1-October 1, 2020. We requested race, ethnicity, and age specific data on deaths and custody populations; sufficient data to calculate age-adjusted rates were obtained for 11 state systems. Race and ethnic specific unadjusted deaths rates per 100,000 persons were calculated overall and by state, based on March 1, 2020 custody populations. Rate ratios (RR) and 95% confidence intervals (95%CI) compared aggregated age-adjusted death rates by race and ethnicity, with White individuals as the reference group. ResultsOf all COVID-related deaths in U.S. prisons through October 2020, 23.35% (272 of 1165) were captured in our analyses. The average age at COVID-19 death was 63 years (SD = 10 years) and was significantly lower among Black (60 years, SD = 11 years) compared to White adults (66 years, SD = 10 years; p < 0.001). In age-standardized analysis, COVID-19 death rates were significantly higher among Black (RR = 1.93, 95% CI: 1.25–2.99), Hispanic (RR = 1.81, 95% CI: 1.10–2.96) and those of Other racial and ethnic groups (RR = 2.60, 95% CI: 1.01–6.67) when compared to White individuals. ConclusionsAge-standardized death rates were higher among incarcerated Black, Hispanic and those of Other racial and ethnic groups compared to their White counterparts. Greater data transparency from all carceral systems is needed to better understand populations at disproportionate risk of COVID-19 morbidity and mortality.

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 (&amp;gt;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.

Race-Specific Trends in Prostate Cancer Screening and Presentation before and after the 2012 United States Preventive Services Task Force Statement.

Our goal was to assess temporal changes in the race-specific rates of prostate specific antigen (PSA) screening, prostate biopsy, overall prostate cancer detection and metastatic cancer at presentation among screen-eligible men in Kaiser Permanente Northern California before and after the 2012 United States Preventive Services Task Force Prostate Cancer Screening Statement. This was a retrospective study spanning the years 2006 to 2017 in screen-eligible Kaiser Permanente Northern California members (Black men ages 45-69, all other men ages 50-69) with no history of prostate cancer. We compared the race-specific biennial rates of PSA testing, prostate biopsy, overall prostate cancer incidence and metastatic cancer at presentation. A total of 422,664 to 567,660 men per biennial period were evaluated (72% White, 8% Black, 20% Asian). Following the 2012 United States Preventive Services Task Force statement, all races experienced similar declines in screening (22%-25%), biopsy (47%-57%) and overall cancer detection (34%-48%) rates. We found an increase in metastatic rates (39%-105%). Following the 2012 United States Preventive Services Task Force Statement, in men under the age of 70, PSA screening, biopsy and overall prostate cancer detection rates significantly decreased in a similar fashion across all races, while rates of metastatic disease significantly increased in all races.

Abstract PS7-40: Triple negative breast cancer in New Orleans, part deux

Abstract Version 7/7/2020 with edit Triple-Negative Breast Cancer in New Orleans – part deaux Objectives: To update our previously reported findings with more current data from SEER 18 registries to compare race-specific incidence rates of triple-negative breast cancer (TNBC) in New Orleans (NO) and Louisiana (LA) with other SEER metro areas and identify the predictors of TNBC. Background: We previously reported significantly increased incidence rates of TNBC in black women (BW) in NO and LA than other SEER metro areas. Methods: We analyzed tumor characteristics of invasive female breast cancers diagnosed from 2011-2017 from SEER 18 for BW and white women (WW). We compared LA data with SEER 18 and metropolitan areas (Atlanta, Detroit, Los Angeles and San Francisco) as we did with our previous data set. Predictors of TNBC in NO and LA were identified in multivariate logistic regression adjusting for age, BMI, poverty, insurance, tumor size, Bloom-Richardson grade and AJCC stage. Results: The overall incidence rate of TNBC in BW was again significantly higher in NO (29.8 per 100,000) than any metro area and the SEER metro areas combined (23.9 per 100,000). Detroit again had the second highest rate (27.2) followed by San Francisco/Oakland (23.8) Los Angeles (22.3) and Atlanta (22.1). The multivariable analysis showed that younger age, large tumor size, high grade were associated with increased risk of TNBC in BW. Conclusions: The incidence rates of TNBC in BW in NO continue to be consistently higher compared to LA and other SEER 18 metro areas. This data reiterates the importance of ongoing translational research to broaden the understanding and optimize the treatment of this aggressive disease, especially in this vulnerable population. Citation Format: Michelle M Loch, Mei-Chin Hsieh, Thomas Reske, Vivien Chen, Xiao-Cheng Wu. Triple negative breast cancer in New Orleans, part deux [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-40.

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&amp;gt;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.

Five years later, but centuries in the making

Five years later, but centuries in the making

Abstract P209: Trends in Presenting Symptoms Among Acute Myocardial Infarction Patients in Community Surveillance: the Atherosclerosis Risk in Communities Study

Introduction: Recent research shows changing incidence rates of AMI by subtype (ST segment elevation [STEMI] and non-ST segment elevation [NSTEMI]), anatomical location, and severity. However, trends in AMI symptom presentation are less well examined. Not all AMI patients present with classic chest pain of cardiac origin. Presentation without cardiac chest pain has been associated with delayed hospital arrival, lower likelihood of receiving medical therapies and cardiac procedures, and higher mortality, as well as female sex, black race/ethnicity, and diabetes. Objective: We examined trends in symptom presentation in subsets of STEMI and NSTEMI by sex and race in the community surveillance of the ARIC Study from 2005 to 2014. Methods: Poisson regression was used to estimate sex- and race-specific event rates for AMI with and without classic chest pain of cardiac origin stratified by NSTEMI and STEMI. Events were defined as definite or probable MI with an assigned NSTEMI or STEMI subtype. Event rates were age-standardized to the US 2010 Census population. We examined average annual percent change in event rates over time, and compared comorbidities, in-hospital complications, and 28-day case-fatality of CHD death by symptom presentation, sex, and race, evaluating heterogeneity between sex and race via interaction terms. All analyses were weighted using ARIC sampling fractions. Results: Between 2005 and 2014, we observed 12,184 AMI events without classic chest pain and 39,512 events with classic chest pain. Events without chest pain were more often NSTEMI vs. STEMI (22% vs. 13%). The decline in event rates over time was similar among NSTEMI patients regardless of presentation symptoms; however, this decline was greater among STEMI patients without classic cardiac pain (-8.03, 95% CI: -10.12, -5.89) than among STEMI patients presenting with classic cardiac pain (-3.02, 95% CI: -4.83, -1.18). The average annual percent decline in event rates differed by race for STEMI but not NSTEMI. Presentation without classic cardiac chest pain was associated with comorbidities such as diabetes, as well as in-hospital complications in both NSTEMI and STEMI patients. Twenty-eight-day case fatality was greater among STEMI patients presenting without classic cardiac chest pain (9.4%, 95% CI: 5.8, 12.9) compared to those with classic cardiac chest pain (4.8%, 95% CI: 3.7, 5.9). Conclusion: AMI without classic chest pain comprised a larger percent of NSTEMI than STEMI events, and while event rates declined over 2005 to 2014, AMI without classic cardiac chest pain was associated with greater 28-day case fatality and in-hospital complications. Future research should explore care pathways and other reasons why these outcomes may differ by cardiac pain presentation.

Cascade testing of men with prostate cancer in families with a spectrum of inherited cancers: Importance of attention to race.

75 Background: Prostate cancer (PCa) is increasingly recognized as a part of hereditary cancer syndromes (HCS) with implications for cascade genetic testing (CGT) of men with PCa in these families. However, race-specific rates of HCS in probands presenting for inherited cancer assessment who report a family history (FHx) of PCa is not known has implications for CGT of men with PCa. Methods: A prospectively maintained genetic testing database at a tertiary care cancer genetics program was queried for all probands reporting a PCa FHx. Pedigrees were analyzed for three HCS linked with PCa: hereditary breast and ovarian syndrome (HBOC), classic Hereditary PCa (HPC), and Lynch syndrome (LS). Associations between HCS and race were evaluated using Fisher’s exact test. Each HCS was evaluated for potential genetic link to the male relative with PCa and associations with race were tested using Fisher’s exact test. Results: 345 probands met inclusion criteria: 53 African-American (AA), 292 Caucasian (Wh), 74.5% female. Proband cancer diagnoses included breast (43.2%), prostate (12.8%), pancreatic (3.8%), ovarian (3.2%), and colorectal (2.9%). Overall, 63.8% of probands met criteria for ≥ 1 HCS based on personal and FHx. Male relatives with PCa in these families with potential genetic link to HCS were found in 75.5% AA families and 61.6% Wh families. HBOC was identified in a higher percentage of AA families with a potentially-linked male relative with PCa compared to Wh families (69.8% vs. 52.4%, respectively; p=0.051). Among probands with HCS potentially linked to PCa (n = 169), 19.5% were found to carry a genetic mutation in a cancer risk gene (17.9% AA and 19.9% Wh). BRCA1/2 mutations accounted for all mutations identified in AA probands and 66.7% of Wh probands. Conclusions: A significant percentage of patients who present for inherited cancer assessment report a FHx of PCa potentially linked with a HCS. Importantly, AA probands with a PCa FHx have comparable rates of HCS as Wh probands, with potentially higher rates of HBOC in AA families accounted for by BRCA mutations. Cascade testing of men with PCa in families with HCS is crucial with a need to address any race-specific barriers.

Age-associated changes of resting energy expenditure, body composition and fat distribution in Chinese Han males.

Age‐related alterations in whole body composition, particularly, reduced fat free mass (FFM) and increased fat mass (FM), lead to a progressive decline in resting energy expenditure (REE). Similarly, regional body composition and fat distribution changes with age might also contribute to an overall lower REE. This study investigated the influence of age on REE, regional body composition and fat distribution, including subcutaneous fat (SF) and visceral fat (VF), in a Chinese Han population as well as their contributions to age‐related changes in REE. One hundred and two males aged 31–83 years old underwent dual‐energy X‐ray absorptiometry (DXA) which measured whole body and regional FM and FFM. SF and VF were measured by magnetic resonance imaging (MRI) and REE by indirect calorimetry. Age was significantly negatively correlated with REE (r = −0.37), total FFM (r = −0.25), upper limbs FFM (r = −0.32), lower limbs FFM (r = −0.34) and showed positive association with trunk FFM (β=0.926). FM, SF and VF decreased in older age groups after an initial rise up to 55–65 years. REE correlated positively to FM, FFM, SF, VF and showed significant association with age (β = −0.254) independent of age‐associated changes in body composition. The regional alterations in body composition with age were explained by changes in trunk FFM (β = 0.926). Age‐related decline in REE were not solely due to alterations in FM and FFM. Therefore, the changes in regional body composition, fat distribution and REE which occur during aging could be explained by disparities in race, ethnicity, diet, physical activity, and lower specific metabolic rates of FFM components.

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.

Endometrial Cancer Trends by Race and Histology in the USA: Projecting the Number of New Cases from 2015 to 2040.

The aim of this study is to explore incidence and incidence-based mortality trends for endometrial cancer in the USA and project future incident cases, accounting for differences by race and histological subtype. Data on age-adjusted and age-specific incidence and mortality rates of endometrial cancer were obtained from the Surveillance, Epidemiology, and End Results 18 registries. Trends in rates were analyzed using Joinpoint regression, and average annual percent change (AAPC) in recent years (2006-2011) was computed for histological subtypes by race. Age, histological, and race-specific rates were applied to US Census Bureau population census estimates to project new cases from 2015 to 2040, accounting for observed AAPC trends, which were progressively attenuated for the future years. The annual number of cases is projected to increase substantially from 2015 to 2040 across all racial groups. Considerable variation in incidence and mortality trends was observed both between and within racial groups when considering histology. As the US population undergoes demographic changes, incidence of endometrial cancer is projected to rise. The increase will occur in all racial groups, but larger increases will be seen in aggressive histology subtypes that disproportionately affect black women.

Abstract C42: Investigating racial inequalities in rates of premenopausal bilateral oophorectomy using claims-based data, North Carolina 2011-2012

Abstract Background: Surgical menopause, or removal of both ovaries in premenopausal women, is associated with decreased incidence of and mortality from ovarian and breast cancer. As a result, racial differences in surgical menopause rates could unintentionally contribute to cancer disparities. Unfortunately, self-reported data on surgical menopause underestimate rates by 36%, and nationally representative clinical data exclude outpatient surgeries. Therefore, there are no reliable data on racial inequalities in surgical menopause. Aims: This study estimated age- and race-specific rates of surgical menopause using claims-based data on every surgery conducted in North Carolina in 2011 and 2012. Methods: Using data from North Carolina's Hospital Discharge Data and Ambulatory Surgery Visit Data, we enumerated, respectively, all inpatient and outpatient surgeries conducted in the state. We restricted the data to bilateral oophorectomies conducted among women aged 20-44 years who were not being treated for cancer. Claims-based procedure codes were used to identify oophorectomies. Diagnostic codes were used to exclude surgeries for malignant conditions. Census data represented the at-risk population. Deviance-adjusted Poisson models assessed whether rates differed by age or race. Results: Oophorectomy rates were 15.0 per 10,000 women aged 20-44 years (n=4,904). The majority of surgeries, 71.3% (n=3,495) were conducted in outpatient settings. Rates increased with age (p&amp;lt;0.01), ranging from 1.2 per 10,000 for 20-24 year-olds to 33.2 for 40-44 year-olds. Rates were higher among non-Hispanic White (17.4 per 10,000) than non-Hispanic Black (13.3) women (p&amp;lt;0.01). In a sensitivity analysis including surgeries with unclear oophorectomy coding, rates were as high as 30.1 and 23.7 for White women and Black women, respectively. Conclusions: In the first population-representative study to use clinical data and include outpatient surgeries, we show that surgical menopause rates are higher than previously reported. Additionally, today, these surgeries are primarily conducted in outpatient settings. Finally, rates are greater among non-Hispanic White versus Black women. Impact: While overall rates of breast and ovarian cancer incidence decreased since 2000, Black-White racial inequalities worsened. Rates decreased among White women while remaining steady or increasing among Black women. Lower rates of surgical menopause among Black women may have the unintentional consequence of contributing to worsening racial inequalities in breast and ovarian cancer incidence and mortality. Citation Format: Whitney R. Robinson, Mariah M. Cheng, Kemi M. Doll. Investigating racial inequalities in rates of premenopausal bilateral oophorectomy using claims-based data, North Carolina 2011-2012. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C42.

Determining optimal prostate-specific antigen thresholds to identify an increased 4-year risk of prostate cancer development: an analysis within the Veterans Affairs Health Care System.

To assess the prostate-specific antigen (PSA) threshold value that optimally predicts future risk of prostate cancer (overall and by race) for a dispersed US population. This was a retrospective analysis of men in the Veterans Affairs (VA) Health Care System database. Men≥40years with a baseline PSA≤4.0ng/mL, not receiving 5-alpha reductase inhibitors, and without a prostate cancer diagnosis prior to baseline PSA date were included and followed for 4years. Patients diagnosed with prostate cancer within 6months of baseline were excluded. The optimal PSA threshold value for future 4-year prostate cancer risk was determined by maximizing Youden's index. The eligible population for the final analysis included 41,250 Caucasian (n=24,518; 59.4%) and African American (n=16,732; 40.6%) patients. The 4-year prostate cancer rate was 3.08% overall, and race-specific rates were 3.02 and 3.17% for Caucasian and African American men, respectively. Mean time to prostate cancer diagnosis was 2.01years across all patients. Race-specific PSA thresholds that optimally predicted future prostate cancer were 2.5ng/mL [area under the curve (AUC)=80.3%] in Caucasians and a 1.9ng/mL (AUC=85.4%) in African Americans; across all patients, a 2.4ng/mL threshold was optimal (AUC=82.5%). In the VA population, a relatively low PSA threshold of ~2.5ng/mL was optimal in predicting prostate cancer within 4years overall and for Caucasian men, but an even lower threshold of 1.9ng/mL was applicable for African American men.

Community Disadvantage and Race-Specific Rates of Violent Crime: An Investigation into the “Racial Invariance” Hypothesis in the United Kingdom

Research into how structural disadvantage affects violent crime among racial groups has produced mixed results. In the United States, however, black and white community-level disadvantage distributions only partially overlap, precluding critical tests of the “racial invariance” hypothesis. We examine the relationship between race, violent crime, and disadvantage in the United Kingdom, where disadvantage distributions for race-groups have greater comparability. Using London borough-level data, we observe racial-invariance at comparably low/high disadvantage. However, at extreme disadvantage the effect increases significantly for black communities but not white or South Asian. This conflicts with studies demonstrating either racial invariance or weaker effects among blacks.

Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973-2010: An Age-Period-Cohort Analysis.

Against the backdrop of late 20th century declines in heart disease mortality in the United States, race-specific rates diverged because of slower declines among blacks compared with whites. To characterize the temporal dynamics of emerging black-white racial disparities in heart disease mortality, we decomposed race-sex-specific trends in an age-period-cohort (APC) analysis of US mortality data for all diseases of the heart among adults aged ≥35 years from 1973 to 2010. The black-white gap was largest among adults aged 35-59 years (rate ratios ranged from 1.2 to 2.7 for men and from 2.3 to 4.0 for women) and widened with successive birth cohorts, particularly for men. APC model estimates suggested strong independent trends across generations ("cohort effects") but only modest period changes. Among men, cohort-specific black-white racial differences emerged in the 1920-1960 birth cohorts. The apparent strength of the cohort trends raises questions about life-course inequalities in the social and health environments experienced by blacks and whites which could have affected their biomedical and behavioral risk factors for heart disease. The APC results suggest that the genesis of racial disparities is neither static nor restricted to a single time scale such as age or period, and they support the importance of equity in life-course exposures for reducing racial disparities in heart disease.

Mammography Screening Among the Elderly: A Research Challenge

BackgroundRandomized trials demonstrate clear benefits of mammography screening in women through age 74 years. We explored age- and race-specific rates of mammography screening and breast cancer mortality among women aged 69 to 84 years. MethodsWe analyzed Medicare claims data for women residing within Surveillance, Epidemiology and End Results geographic areas from 1995 to 2009 from 64,384 non-Hispanic women (4886 black and 59,498 white) and ascertained all primary breast cancer cases diagnosed between ages 69 and 84 years. The exposure was annual or biennial screening mammography during the 4 years immediately preceding diagnosis. The outcome was breast cancer mortality during the 10 years immediately after diagnosis. ResultsAfter adjustment for stage at diagnosis, radiation therapy, chemotherapy, comorbid conditions, and contextual socioeconomic status, hazard ratios (and 95% confidence intervals) for breast cancer mortality relative to no/irregular mammography at 10 years for women aged 69 to 84 years at diagnosis were 0.31 (0.29-0.33) for annual mammography and 0.47 (0.44-0.51) for biennial mammography among whites and 0.36 (0.29-0.44) for annual mammography and 0.47 (0.37-0.58) for biennial mammography among blacks. Trends were similar at 5 years overall and stratified by ages 69 to 74 years, 75 to 78 years, and 79 to 84 years. ConclusionsIn these Medicare claims and Surveillance, Epidemiology and End Results data, elderly non-Hispanic women who self-selected for annual mammography had lower 10-year breast cancer mortality than corresponding women who self-selected for biennial or no/irregular mammography. These findings were similar among black and white women. The data highlight the evidentiary limitations of data used for current screening mammography recommendations.