Racial Differences In Outcomes Research Articles

Gender disparity in chimeric antigen receptor T-cell therapy utilization and outcomes in the United States.

2556 Background: Chimeric antigen receptor T-cell [CART] therapy has marked a new era in the treatment of relapsed/refractory hematological malignancies since its approval in 2017. Racial disparity was studies previously but not gender. Current study aimed to evaluate gender disparity in CART therapy utilization and outcomes. Methods: This cross sectional study was done using National Inpatient Sample [NIS], the largest database available in the US. Inpatient admissions of adults who received CART therapy for various indications during year 2020 were included. Results: A total of 6915 patients were admitted to hospital for CART therapy in 2020 with an overall inpatient mortality rate of 1%. Mean age of the patients was 57yr. Majority were White [64%], with a higher median household income, admitted to urban and large sized hospitals and predominantly covered by Medicare or private insurance [~80%]. Study population was divided into males and females and outcomes were compared. Females were significantly younger with lower Charlson comorbidity index and higher utilization of CART therapy [81% vs 19%] compared to males. Females had 86% lesser odds of mortality compared to males (Odds Ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.47; p value 0.001). Females had significantly lesser hospitalization charges [mean decrease $471,193; p value 0.000] and length of stay [mean decrease 8 days; p value 0.000] compared to males after adjusting for confounders. Racial differences in outcome were compared after multiple imputation was used to correct for 4% missing data in the race category in NIS 2020. There was no statistically significant difference in mortality, length of stay or hospitalization charges between Whites, Blacks and Hispanic races similar to previous studies. Conclusions: Eligibility criteria for CART therapy includes patients with good performance status and organ function with less comorbidities. Our study found that females were younger, healthier and therefore qualified better for CART therapy compared to males. Hence they had significantly higher utilization of CART therapy. In addition, among the population receiving CART therapy, females had better outcomes compared to males in terms of mortality, length of stay and hospitalization charges. In general, males have higher incidence and mortality with poorer outcomes in most hematological malignancies where CART therapy is a treatment option. Measures at modifying and improvising CART therapy to cater to more male subjects will not only reduce gender disparity but also improve overall survival and reduce disease burden. [Table: see text]

Impact of race on outcomes to 177Lu-PSMA-617 (LuPSMA) for metastatic castrate-resistant prostate cancer (mCRPC).

27 Background: Prior work suggests that African American (AA) and other minority patients (pts) derive equal benefit from taxane chemotherapy and androgen receptor pathway inhibitors (ARPIs) for mCRPC as white pts. LuPSMA showed an overall survival (OS) benefit in mCRPC pts after prior taxane and ARPI. However, there are no data on racial differences in outcomes to LuPSMA. Methods: We queried an IRB-approved registry of all pts treated with at least 2 cycles of LuPSMA between June 2022 and August 2023 at two academic medical centers in Boston, MA. Clinical data, including self-reported race, was abstracted from the electronic medical record. Pts of AA, Hispanic/Latino and Asian race were categorized as minorities. Outcomes of interest were the proportion of patients with ≥50% decrease in PSA levels during LuPSMA therapy (PSA50) and OS, defined from the date of the first cycle of LuPSMA. PSA50 and OS between races were compared with the Chi-Square and log-rank tests, respectively. Results: A total of 156 pts were included. Median age at LuPSMA initiation was 73 years (range 53-92) and the median number of prior lines of therapy was 5 (range 2-12); all pts had received ≥1 taxane and ≥1 ARPI. 136 (87%), 10 (6%), 6 (4%) and 4 (3%) pts were White, AA, Hispanic/Latino and Asian, respectively. The median number of LuPSMA cycles received in the entire cohort was 4 (range 2-7), and median follow-up was 7.1 months. A numerically higher proportion of minority pts had visceral disease at baseline compared to White pts (50% vs. 31%, (X2 = 2.87, p=0.090). Overall, 86 pts (55%) had a PSA50, with PSA50 of 55% (n=75), 60% (n=6), 67% (n=4) and 25% (n=1) amongst White, AA, Hispanic/Latino and Asian pts, respectively. There was no significant difference in PSA50 between White and minority pts (X2 = 0.00, p=0.990). Median OS in the entire cohort was 12.9 months and was not significantly different between White and minority pts (12.9 months vs. 8.5 months, p=0.533). The Table summarizes outcomes by race. Conclusions: PSA50 and OS were comparable between minority and White pts receiving LuPSMA for mCRPC, despite minority pts tending to present with more visceral disease, a known adverse prognostic factor. Validation of these findings and efforts to widen access to LuPSMA amongst minorities are required, given that pts of all racial backgrounds appear to benefit equally from LuPSMA. [Table: see text]

Evaluating outcome associations with race after mechanical thrombectomy: an analysis of the NVQI-QOD acute ischemic stroke registry

BackgroundMechanical thrombectomy has become the standard of care for acute ischemic stroke due to large vessel occlusions. Racial differences in outcomes after mechanical thrombectomy for acute ischemic stroke have not...

Racial Differences in Outcomes in Children on Maintenance Dialysis Enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

Racial Differences in Outcomes in Children on Maintenance Dialysis Enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

FRI044 Racial Differences In Outcomes Of Hospitalizations For COVID-19 With Morbid Obesity: Insights From The National Inpatient Sample

Abstract Disclosure: R.A. Gajjar: None. D. Ahluwalia: None. M. Kumar: None. S. Rai: None. H. Shaka: None. Introduction: The prevalence of obesity has risen across the globe over the past two decades and has remained high in the United States. In addition, obesity has surfaced as an independent risk factor for severe COVID-19 infection. We sought to investigate the impact of racial differences on hospitalizations for COVID-19 with morbid obesity using a nationally representative sample. Methods: The National Inpatient Sample database for 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of morbid obesity, using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome studied was inpatient mortality, while secondary outcomes included inpatient complications, mean length of stay (LOS), and mean total hospital charge (THC). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and to analyze the outcomes. Results: A total of 130,570 hospitalizations for COVID-19 with morbid obesity were identified, of which 48% were Caucasians, 25% were African Americans, and 19% were Hispanics. Our analysis revealed that Hispanics were associated with significantly higher adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 1.4, [95% CI: 1.23-1.60], p <0.001), increased mean LOS (1.25 days, [95% CI: 0.87-1.64], p <0.001), and higher mean THC ($34,554, [95% CI: 25,316-43,791], p <0.001) as compared to Caucasians; whereas African Americans had significantly lower adjusted odds of inpatient mortality (aOR: 0.85, [95% CI: 0.76-0.96], p=0.011) when compared to Caucasians. Additionally, complications such as sepsis (aOR 1.74, [95% CI: 1.50-2.03], p <0.001), acute respiratory failure (ARF) (aOR: 1.15, [95% CI: 1.05-1.25], p=0.003), need for intubation (aOR: 1.27, [95% CI: 1.22-1.43], p <0.001), mechanical ventilation (aOR: 1.26, [95% CI: 1.13-1.41], p <0.001), requirement of pressor support (aOR: 1.74, [95% CI: 1.32-2.31], p <0.001), the necessity of blood transfusion (aOR: 1.68, [95% CI: 1.40-2.02], p <0.001) were significantly higher in Hispanics when compared to Caucasians. Conclusion: In this retrospective analysis of admissions for COVID-19 with morbid obesity, we discovered that the Hispanic subpopulation had elevated odds of mortality, along with a greater length of hospital stay and increased cost of hospitalization when compared to Caucasians. Additionally, Hispanics had higher odds of inpatient complications such as sepsis, ARF, need for mechanical ventilation/intubation, vasopressors, and blood transfusions. Our study highlights the existence of racial disparities that significantly affect outcomes in admissions for COVID-19 with morbid obesity. Presentation: Friday, June 16, 2023

Racial Difference in Outcomes in Breast Cancer Patients with Residual Nodal Disease after Neoadjuvant Chemotherapy

African Americans (AA) requiring neoadjuvant chemotherapy (NAC) have been associated with worse outcomes. Residual nodal disease (ypN+) after NAC represents a highly unfavorable risk factor. We hypothesized that even within this unfavorable subgroup, that racial differences in outcome would persist. An IRB-approved retrospective review of breast cancer (BC) patients in a multi-institutional study was performed between 2005-2018 to identify ypN+ patients (excluding metastatic or inflammatory BC). Clinico-pathologic parameters stratified by race were collected and analyzed. For molecular subtype analyses, patients were stratified into triple negative (TN), hormone receptor (HR)+/HER2-, and HR+/HER2+, and HR-/HER2+ subtypes. Overall survival (OS), disease free survival (DFS) and recurrence outcomes were obtained, and univariate and multivariate (MVA) logistic regression models were constructed and analyzed. Among 404 ypN+ patients, 107 (26%) were AA, and 297 (74%) were non-AA. Median follow-up for the non-AA group was 3.8 years (y) (IQR 2.4-6.3) and 3.5y (IQR 2.0-6.2) for the AA group. Clinical and pathologic patient characteristics (age, molecular subtypes, BRCA status, histology, grade, smoking status, primary surgery type, axillary/reconstruction surgery rates, margin status, stage) were without significant statistical differences between the non-AA and AA group, except the non-AA group had proportionally more cN3 disease (10.5% vs. 5.1%; p = .01). Despite this, AA demonstrated worse OS and DFS outcomes (Table). AA also had significantly worse local (15% vs. 6.7%, p = .02), regional (11.2% vs. 5.1%, p = .05) and distant recurrences (32.7% vs. 22.6%, p = .05) compared to non-AA. On MVA for OS and DFS, HR+ status, clinical stage, and AA race (HR 2.1 (CI 1.3-3.4), p = .004 and HR 1.7 (CI 1.1-2.6), p = .01 respectively) remained significant. Molecular subtype analysis demonstrated that AA with HR+/HER2- but not the TN subtypes demonstrated significantly worse outcomes (Table). Utilization of endocrine therapy was not different between AA and non-AA patients (94% vs. 97%, p = 0.3) to explain this discrepancy. Worse outcomes in HER2 subtype for AA group was suggested but could not be statistically verified due to insufficient sample size. There was no discernible difference in chemotherapy and radiation therapy regimen or compliance between the AA and non-AA groups. AA patients who fail to achieve nodal clearance with NAC had higher local, regional and distant recurrence, and worse survival compared to non-AA, particularly those with non-TN status. These differences could not be readily explained by therapeutic disparity, or compliance. These hypothesis generating findings suggest need to explore biological implications, and alternative therapeutic strategies for this unfavorable subgroup.

Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure.

The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.

Racial disparities in the outcomes of allogeneic bone marrow transplant: A 5-year nationwide inpatient study.

e19060 Background: Allogeneic bone marrow transplantation (ABMT) is a life-saving procedure in hematological malignancies and bone marrow failure disorders. Despite advances in the field, literature proposes racial disparities in the outcomes of ABMT. This study aims to investigate this difference among distinct racial cohorts. Methods: We identified patients who underwent ABMT for malignant and nonmalignant hematologic diseases from 2016-2020 using the nationwide inpatient sample (NIS) database. We compared the racial differences in outcomes during the hospitalization, including immunologic and hematologic complications, associated infections, length of stay, and mortality rate. Baseline characteristics were compared using a T-test and Chi-Square. Multivariate regression analysis was applied to estimate differences in outcomes. We used STATA Version 17.0 Software for data analysis. The p-value was set at p < 0.05 for statistical significance. Results: A retrospective study was conducted on a cohort of 14,599 adults who underwent ABMT. Out of which 30% (4,379) developed complications. The mean age for ABMT was 54, and the average length of stay was 29 days. In this cohort, 79.5% (11,325) were whites, 4.2% (610) were blacks, 8.3% (1,185) were Hispanics, and 7.8% (1,125) were others. When comparing the outcomes among racial groups, invasive fungal infections 15.5% (95), mucositis 36% (220), septic shock 9% (55), and respiratory failure 14.7% (90) were more common in blacks (p < 0.05). Neutropenia 41.3% (490) and cytomegalovirus (CMV) infection 12.2% (145) were more common in Hispanics (p < 0.05). However, no significant difference was noted in immunologic complications (graft versus host disease (GVHD), bone marrow rejection (BMR), bone marrow failure (BMF)), pancytopenia, clostridium difficile infection (CDI), and mortality (p < 0.05). Conclusions: Our study shows that blacks had a higher prevalence of invasive fungal infections, mucositis, septic shock, and respiratory failure, while Hispanics reported a higher prevalence of neutropenia and CMV infection. However, no significant differences were noted in GVHD, BMR, BMF, pancytopenia, CDI, and mortality rates. Therefore, it can be concluded that while there are some differences in post-ABMT complications among racial groups, overall, the rates of major complications and mortality do not significantly differ.

Racial differences in outcomes of patients with relapsed/refractory multiple myeloma treated with selinexor.

e20016 Background: Multiple Myeloma (MM) is the 2nd most common hematologic malignancy in the US, though survival in patients with MM has improved over the past decade. Survival improvements in African Americans (AAs) have been smaller, which may be due to disparity in access to therapies. There are also key differences in MM biology between races, including higher rates of IgA disease and genetics. Given underrepresentation of minorities in clinical trials, we analyzed whether outcomes were similar between AAs and other races in the phase 2 STORM trial (NCT02336815) of selinexor. Selinexor, an oral, first-in-class selective inhibitor of nuclear export via exportin 1, has proven efficacy for refractory MM. To our knowledge, this is the first race subgroup analysis of selinexor in any clinical trial. Methods: Pts from STORM who received study drug (N = 202) were included. Pts with heavily pretreated MM, including triple-class and penta- refractory MM refractory to the last line of therapy were given selinexor (80mg) + dexamethasone (20mg) twice weekly. We conducted a retrospective racial subgroup analysis. Cox proportional modeling was used to determine the hazard ratio (HR) for MM relapse between races controlling for covariates. Results: AAs represented 17% of pts (35 AAs, 148 White, 2 Asian, 11 other and 6 missing). AAs were younger compared to other races (median age 60.7 vs 65.3) with more females (74.3% vs 40.7%). Cytogenetic abnormalities and R-ISS staging were similar between races. AAs had a median progression free survival (PFS) of 6.5 mos (95% CI 4.7, NR) compared with 3.7 mos (95% CI 2.8, 4.6; p = 0.035) for other races. Overall response rate (ORR) was 25.7% (95% CI 12.5, 43.3) in AA pts vs 23.4% [17.2, 30.5] in other races), clinical benefit rate (37.1% [21.5, 55.1] vs 35.9% [28.7, 43.7]), median duration of response (5.6 mos [2.1, NR] vs 5.3 [3.6, NR]), median duration of treatment (9 wks [IQR 3-22 wks] vs 8 wks [4-16 wks]), and mean dose intensity (117.9 mg/wks [STD 35.1] vs 117.1 [34.7]) were similar between grps. Rates of Adverse Events (AEs) ≥ grade 3 (94.3% vs 95.8%), and AE-related dose reductions (45.7% vs 54.5%), discontinuations (22.9% vs 30.5%), and deaths (5.7% vs 10.8%) were also similar. The adjusted HR for MM relapse in AAs was 0.45 (95% CI 0.22, 0.92; p = 0.028) after controlling for gender, age and prior therapy. Conclusions: This subgroup analysis showed that compared with other races, AAs pts were younger and included a greater percentage of women. Although ORRs were similar, AAs had a longer PFS compared with other races after adjusting for covariates. Despite small sample size, the differences were statistically significant. It is unclear if the better PFS reflects a different biology, pharmacology of selinexor or both. Dose adjustments and tolerability were relatively comparable. These results could assist in the placement of selinexor in the treatment sequence of relapsed refractory MM for AAs.

212 Proof of Concept: An EHR-fueled Risk Surveillance Tool for Managing Care Delivery Equity in Hospitalized African Americans with Congestive Heart Failure

OBJECTIVES/GOALS: 1) Characterize racial differences in congestive heart failure care delivery. 2) Examine the extent to which specific clinical roles were associated with improved care outcomes (i.e., hospitalizations, readmissions, days between readmissions, and charges) of African Americans (AA) with CHF. METHODS/STUDY POPULATION: EMR data was extracted from the Arkansas Clinical Data Repository (AR-CDR) on patients (ages 18-105) who received care between January 1, 2014 and December 31, 2021. Variables included age, sex, race, ethnicity, rurality, clinical diagnosis, morbidities, medical history, medications, heart failure phenotypes, and care delivery team composition. Binomial logistic regression ascertained the effects of these variables on patient’s care outcomes. A Mann Whitney-U test identified racial differences in outcomes. Psychometrically, classical test theory and item response theory assessed items for the risk surveillance tool. RESULTS/ANTICIPATED RESULTS: The study identified 5,962 CHF patients who generated 80,921 care encounters. The results revealed the disproportionate impact of CHF prevalence, hospitalizations, and readmissions on AAs. AAs had a significantly higher number of hospitalizations (i.e., 50% more) than Caucasians. Specific clinical roles (i.e., MDs, RNs, Care Managers) were consistently associated with 30% or greater decrease in odds of hospitalization and readmission, even when stratified by heart failure phenotype. Classical test theory results (e.g., Cronbach’s alpha; 0.88) indicated the set of items on the risk surveillance tool accurately reflect a patient risk for improved outcomes. DISCUSSION/SIGNIFICANCE: The findings stimulate the need for 1) EHR-based tools that manage care delivery equity and 2) investigations of specific clinical roles in risk stratifying and operationalizing the care plans of AAs, advancing formal access-to-care frameworks by ensuring access to clinical roles that are associated with improved outcomes.

MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE Arshia Aalami Harandi, Anjali Kapur, and Jason Kim Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Anjali KapurAnjali Kapur More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) is a common condition with a 12.5% risk of surgical treatment by age 80. Prior studies have shown racial differences in outcomes of surgical treatment of POP in the US. Our study investigates whether there are racial disparities in adverse outcomes following surgical treatment of POP in the American College of Surgeons National Surgical Quality Improvement Program (NSPIQ) database. METHODS: Patients were collected from the NSPIQ database between 2011-2020 with current procedural terminology codes for minimally invasive and open sacrocolpopexy, vaginal vault suspension, anterior colporrhaphy, vaginal repair, enterocele/rectocele repair, and obliterative surgery. Reported complications were aggregated into composite Clavien-Dindo I-II and III-IV classifications. Multivariate logistic regression was utilized to calculate adjusted odds ratios (aOR) for complications. Age, BMI, past medical history, smoking history, surgical treatment, and ASA score were included as covariates in the regression model. RESULTS: Within Clavien Dindo III-IV complications, African Americans had a 35% increased risk (aOR: 1.35, p<.01), while Asians and Hispanics had a 42% (aOR: 0.58, p<.01) and 23% (aOR: 0.77, p<.01) decreased risk, respectively. Asian race was associated with a 19% decreased risk of Clavien-Dindo I-II complications (aOR: 0.81, p<.05) compared to White patients, with all other ethnicities bearing similar risk. Age >65 was associated with a 14% decreased risk of Clavien-Dindo I-II complications (aOR: 0.86, p<.01) and 15% decreased risk of Clavien-Dindo III-IV complications (aOR: 0.85, p<.01). Comorbidities of dyspnea, severe COPD, ascites, CHF, disseminated cancer, open wound/infection, steroids/immunosuppression, smoking history, and BMI >30 were significantly associated with higher odds of Clavien-Dindo III-IV complications (p<.05) (Table 1). CONCLUSIONS: African American women receiving surgical treatment for POP have increased risk of high-grade complications even when adjusted for age, past medical history, smoking status, and type of surgery. Further research is needed to elucidate implicit biases or disparities in healthcare that may contribute to adverse outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e91 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Aalami Harandi More articles by this author Anjali Kapur More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

HSR23-090: Racial Differences in Outcomes of Osimertinib in Patients With EGFR-Positive Non–Small Cell Lung Cancer in a Real World US Population

"HSR23-090: Racial Differences in Outcomes of Osimertinib in Patients With EGFR-Positive Non–Small Cell Lung Cancer in a Real World US Population" published on 31 Mar 2023 by National Comprehensive Cancer Network.

Disparities in Care Among Gunshot Victims: A Nationwide Analysis

IntroductionGiven the well-known healthcare disparities most pronounced in racial and ethnic minorities, trauma healthcare in underrepresented patients should be examined, as in-hospital bias may influence the care rendered to patients. This study seeks to examine racial differences in outcomes and resource utilization among victims of gunshot wounds in the United States. MethodsThis is a retrospective review of the National Trauma Data Bank (NTDB) conducted from 2007 to 2017. The NTDB was queried for patients who suffered a gunshot wound not related to accidental injury or suicide. Patients were stratified according to race. The primary outcome for this study was mortality. Secondary outcomes included racial differences in resource utilization including air transport and discharge to rehabilitation centers. Univariate and multivariate analyses were used to compare differences in outcomes between the groups. ResultsA total of 250,675 patients were included in the analysis. After regression analysis, Black patients were noted to have greater odds of death compared to White patients (odds ratio [OR] 1.14, confidence interval [CI] 1.037-1.244; P = 0.006) and decreased odds of admission to the intensive care unit (ICU) (OR 0.76, CI 0.732-0.794; P < 0.001). Hispanic patients were significantly less likely to be discharged to rehabilitation centers (Hispanic: 0.78, CI 0.715-0.856; P < 0.001). Black patients had the shortest time to death (median time in minutes: White 49 interquartile range [IQR] [9-437] versus Black 24 IQR [7-205] versus Hispanic 39 IQR [8-379] versus Asian 60 [9-753], P < 0.001). ConclusionsAs society carefully examines major institutions for implicit bias, healthcare should not be exempt. Greater mortality among Black patients, along with differences in other important outcome measures, demonstrate disparities that encourage further analysis of causes and solutions to these issues.

Abstract 10060: Racial Differences in Outcomes of Hypertensive Crisis in Women With History of Preeclampsia: A National Sample Study

Objective: Preeclampsia has been shown to put women at an increased risk of developing hypertension later in life. We aimed to determine racial differences in in-hospital outcomes of hypertensive crisis in women with history of preeclampsia in the United States. Methods: The national inpatient sample was retrospectively studied from 2012-2019 to identify hospitalizations for hypertensive crisis aged &gt;18. We further identified history of preeclampsia within each admission using ICD-10 codes. The primary outcome was hospital length of stay (LOS) and inpatient mortality rate. Secondary outcomes were chosen as a 3-point composite development of stroke, myocardial infarction (MI) or congestive heart failure (CHF). Demographic (age, sex, race) information was also recorded. Caucasian patients were chosen as baseline reference to compare other ethnicities with. Data was analyzed with STATA 16.0, and adjusted odds ratios (AOR) were calculated using multivariate logistic regression. Results: There were 531,432 hospitalizations for hypertensive crisis, out of which 11% (58,457) had history of preeclampsia. 65% of this subset was Caucasian, 21% were African American (AA) and 11% Hispanic. Inpatient mortality rate was higher in Hispanic patients with preeclampsia vs Caucasians [6.2% vs 4.3%; AOR: 1.56 (1.49 – 1.61, p&lt;0.001)]. AA patients had a longer LOS vs Caucasians [5.5 vs 3.2; AOR: 1.21 (1.19 – 1.25, p&lt;0.001)]. There was no significant difference in LOS in Hispanic patients (p=0.08). Hispanic women had increased odds of developing stroke while inpatient compared to their Caucasian counterparts (AOR: 2.31, p&lt;0.001). There was no significant difference in development of MI amongst the races (p=0.09). However, AA women with history of preeclampsia were more likely to develop CHF compared to Caucasians (AOR: 1.92, p&lt;0.001). Conclusion: Hispanic women with history of preeclampsia have higher mortality rate and incidence of stroke when admitted with hypertensive crisis. Similarly, African American women with preeclampsia have longer hospital stay when admitted with hypertensive crisis. Further research is needed to understand and alleviate these cardiovascular burdens in ethnic minorities.

Abstract 13402: Racial Differences in Incidence of Acute Kidney Injury in Patients With ST-Elevation Myocardial Infarction

Background: Racial differences in outcomes of STEMI patients continue to persist. Our study aimed to assess the difference in the incidence of acute kidney injury (AKI) post percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), stratified by race into African Americans (AA) vs Caucasians. Methods: All STEMI patients who underwent PCI at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were categorized into two groups depending on a diagnosis of the presence or absence of AKI post PCI. AKI was defined as &gt;0.3mg/dl rise in post PCI creatinine from pre-procedure value. Relative risk of developing AKI depending on race was calculated with the help of a two by two table. Results: Overall, 1847 patients were admitted to our hospital with a STEMI and underwent PCI during the study period. Of these, 267 (15%) developed AKI post PCI. 19% of AA patients developed AKI compared to 13% of Caucasian. Comparison of baseline characteristics amongst patients who developed AKI revealed that AA patients with AKI were younger than their Caucasian counterparts (median age 63 vs 68, p=0.006), but were more likely to having smoking history (52% vs 35%, p=0.014). Upon analyzing the association between race and AKI, AA patients were 48% more likely to develop AKI post PCI compared to Caucasian patients (RR of 1.48, 95% CI 1.17-1.86, p=0.0015). This difference was observed in spite of no significant differences in radial access, contrast dose, or mechanical circulatory support use between the two races. Conclusion: African Americans STEMI patients are almost 50% more likely than Caucasians to develop AKI post PCI. Developing race-specific process measures and further optimization of procedural characteristics may be necessary to improve the outcomes of AA STEMI patients.

Are There Racial Differences in Inpatient Outcomes and Treatment Utilization following Hospitalization for Myasthenia Gravis Exacerbation?

Introduction: Little is known about racial differences in inpatient outcomes following hospitalizations for myasthenia gravis (MG). In this study, we used a claims-based database to assess racial differences in outcomes in hospitalized myasthenics. Methods: The 2006–2014 National Inpatient Sample database was queried using the International Classification of Diseases 9th Edition diagnosis code (358.01) to identify adult patients (age >17 years) undergoing hospitalization for MG. Race was categorized into – white, black/African American (AA), Asian or Pacific Islander, Hispanic, Native American, and other. Complications assessed included urinary tract infections, acute renal failure, cardiac complications, systemic infection, deep venous thrombosis, and pulmonary embolism. Multivariate logistic regression analyses were used to assess whether race was associated with a difference in outcomes, after controlling for baseline demographics, hospital characteristics, and treatment factors. Results: A total of 56,189 patient admissions, using a weighted sample, underwent hospitalization for MG between 2006 and 2014. Black/AA patients had significantly higher odds of experiencing systemic infections (odds ratio [OR] 1.35 [95% confidence intervals [CI] 1.16–1.58]; p < 0.001), deep venous thrombosis (OR 2.11 [95% CI 1.36–3.27]; p = 0.001), and renal failure (OR 1.19 [95% CI 1.05–1.35]; p = 0.005). Black/AA patients were more likely to be intubated (OR 1.09 [95% CI 1.01–1.19]; p = 0.028) and receive noninvasive mechanical ventilation (OR 1.62 [95% CI 1.46–1.79]; p < 0.001), however, were less likely to receive intravenous immunoglobulin (OR 0.77 [95% CI 0.73–0.82]; p < 0.001) and plasmapheresis (OR 0.77 [95% CI 0.72–0.82]; p < 0.001). Black/AA and Hispanic patients had lower mortality (OR 0.74 [95% CI 0.59–0.94; p = 0.012]. Conclusions: Significant racial differences exist in both treatment utilization and inpatient outcomes for patients hospitalized for MG.

Abstract No. 192 Racial differences in outcomes of transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding: the ALTA study

Prior national claims data studies indicate that Black patients experience two-fold higher mortality compared with white patients following transjugular intrahepatic portosystemic shunt (TIPS) creation for gastroesophageal variceal bleeding. Due to absence of lab values in the source population data, it is not known whether this mortality gap persists with adjustment for pre-procedural MELD. The purpose of this study was to: a) compare MELDNa-adjusted post-TIPS mortality by race and b) examine racial differences in pre- and peri-procedural care processes, in a clinical TIPS cohort.

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Abstract 12313: Gender and Racial Differences in Outcomes of Patients With Non-Acute Myocardial Infarction Cardiogenic Shock Receiving Extracorporeal Membrane Oxygenation With or Without Left Ventricular Unloading Devices

Introduction: Cardiogenic shock (CS) is a state of end organ hypo-perfusion due to primary pump failure, 80% of which is due to acute myocardial infarction (AMI). Among patients with AMI-CS, women as well as black and Hispanic males have been found to have worse clinical outcomes with persistent sex disparities after receiving mechanical circulatory support (MCS). However similar differences in outcomes of CS in non-AMI patients with MCS are unknown. Methods: National Inpatient Sample database from years 2015 to 2018 was queried to identify patients admitted with non-AMI-CS. Gender and racial differences in baseline demographics and in-hospital outcomes were compared in patients who received VA-ECMO with or without LV unloading devices. Statistical significance was assigned at p&lt;0.05. Results: 178,605 patients met the criteria for non-AMI-CS out of which 2,190 (1.23%) patients received VA-ECMO alone, 965 (0.54%) received VA-ECMO plus Intra-aortic balloon pump (IABP) and 414 (0.23%) received VA-ECMO plus Impella. Gender and racial distribution of each cohort is shown in figure 1. On multivariate analysis, the in-hospital mortality rates in patients on VA-ECMO only or VA-ECMO plus Impella were non significantly higher for females as compared to males (OR: 1.29 (0.88-1.89), p=0.18), (OR: 1.97 (0.27-14.64), p=0.51) respectively, whereas in patients with VA-ECMO plus IABP they were non-significantly lower than males (OR: 0.74 (0.28-1.99), p=0.55). Furthermore, the in-hospital mortality was non significantly lower in African Americans when compared to Caucasians among patients on VA-ECMO with or without LV unloading devices. Conclusions: In patients admitted with non-AMI-CS requiring VA-ECMO with or without LV unloading devices no statistically significant gender or race-based differences occur in mortality outcomes.

Racial differences in outcomes and utilization after cardiac arrest in the USA: A longitudinal study comparing different geographical regions in the USA from 2006–2018

AimHealthcare disparities can affect access and quality of care among many in the United States (US). In addition to race, we sought to assess if geography affected rates of cardiac arrest, and the subsequent outcomes. MethodsUsing the National Inpatient Sample database from 2006–2018, we assessed rates of cardiac arrest (out of hospital that survived to admission and in-hospital) and cardiac catheterization, and length of stay (LOS) in four regions: Northeast (NE), South (SO) West (W) and Midwest (MW). ResultsCardiac arrest increased from 27,611 (2006) to 43,333 (2018). The proportion of African American (AA) patients experiencing cardiac arrest significantly increased from 11.9% to 18.8%. The mortality decreased from 65.4% to 60.8% in all patients and 70.2% to 61.4% in AA. Mortality in AA remained higher than non-AA (OR, 1.09 [1.08–1.11], p < 0.001). When regions were compared for mortality, MW had a lower risk than NE 0.94[0.92–9.96]; SO 1.05[1.04–1.07] and W 1.11[1.09–1.13] were higher compared to NE. LOS decreased slightly from 9.0 days to 8.7 in all patients. LOS for AA was longer than non-AA (11.3 vs 8.6 days) with the NE having the longest LOS. AA were less likely to receive cardiac catheterization than non-AA (9.5% vs 15%) with the largest racial gap in the MW region. ConclusionThe proportion of AA with cardiac arrests increased over the study period. Mortality and LOS improved significantly in AA from 2006 to 2018 but remain significantly higher than non-AA patients. Future research should identify contributors to these concerning trends.