Racial Differences In Outcomes Research Articles

Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality

The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation. To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort. The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011-2013) with active surveillance for vital status and hospitalizations. Race was determined by self-report and categorized as white, black, or other. Atrial fibrillation (adjudicated using electrocardiograms, hospital discharge codes, and death certificates), stroke, heart failure, CHD, and mortality. After exclusions, 15 080 participants (mean [SD] age, 54.2 [5.8] years; 8290 women [55.5%]; 3831 black individuals [25.4%]) were included in this analysis. During a mean (SD) follow-up of 20.6 (6.2) years, there were 2348 cases of incident AF. The incident rates of AF per 1000 person-years were 8.1 (95% CI, 7.7-8.5) in white individuals and 5.8 (95% CI, 5.2-6.3) in black individuals. The rates of stroke, heart failure, CHD, and mortality were higher in black individuals with AF than white individuals with AF. The association of AF with these outcomes, estimated with rate differences (rate of the end point in those with AF minus the rate in those without AF per 1000 person-years), also differed by race. The rate difference for stroke in individuals with AF was 10.2 (95% CI, 6.6-13.9) in white individuals and 21.4 (95% CI, 10.2-32.6) in black individuals. For heart failure and CHD, the rate differences were 1.5- to 2.0-fold higher in black individuals than white individuals. White individuals with AF had a rate difference of 55.9 (95% CI, 48.1-63.7) for mortality compared with black individuals, who had a rate difference of 106.0 (95% CI, 86.0-125.9). In the prospective ARIC Study, the outcome of AF on the rates of stroke, heart failure, CHD, and mortality was considerably larger in black individuals than white individuals. These results indicate the vulnerability and increased risk in black individuals with AF. Continued investigation of racial differences in AF and its related adverse outcomes are essential to identify and mitigate racial disparities in the treatment of AF.

Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care.

To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals. Simulated data. Through simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality. The minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent. Researchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.

Racial Differences in Outcomes after Acute Ischemic Stroke Hospitalization in the United States

Racial differences in stroke outcomes have major health policy implications. There is paucity of contemporary data on racial differences in clinical outcomes and resource utilization in acute ischemic stroke hospitalizations in the United States. We used the 2011-2012 National Inpatient Sample to identify hospitalizations with a primary diagnosis of acute ischemic stroke. Primary outcomes were in-hospital mortality, utilization of thrombolysis, and endovascular mechanical thrombectomy (EMT). Secondary outcomes were length of stay (LOS) and average inflation-adjusted charges. A total of 173,910 hospitalizations representing 835,811 hospitalizations nationwide were included in the study. Mean age was 70.9 years and 52.3% were women. Blacks (adjusted OR .71, 95% CI .64-.78, P < .001) and Asian or Pacific Islanders (adjusted OR .80, 95% CI .66-.97, P = .02) had a lower in-hospital mortality compared to Whites. Blacks were less likely to be treated with thrombolysis (adjusted OR .84, 95% CI .76-.92, P < .001) and EMT (OR .73, 95% CI .58-.91, P = .01). Average LOS and inflation-adjusted charges were significantly higher for racial minorities compared to Whites. Blacks and Asians hospitalized for ischemic stroke are less likely to die in the hospital compared to Whites. Hospitalization for stroke in Blacks is associated with lower rates of reperfusion therapy, longer lengths of stay, and higher costs compared to Whites.

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates.

African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown. The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis. A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death. SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003). SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.

Race-based socioeconomic and treatment disparities in adolescent and young adults with stage II-III rectal cancer.

714 Background: Stage II-III rectal cancer (CA) requires a multidisciplinary approach to optimize outcomes. This study explores whether treatment disparities account for racial differences in outcomes of AYA (ages 15-39) patients. Methods: AYAs with clinical stage II-III rectal CA were identified in the National Cancer Database. Demographic, clinical, and pathologic features predictive of receipt of adjuvant and surgical therapies were examined as well as factors associated with overall survival (OS). Results: Most of the 3,295 patients were white (72.0%), male (57.5%) and free of comorbidities (93.8%). Income, education levels, and rates of health insurance coverage were higher for whites than for blacks or Hispanics. Clinical stage was balanced by race, but more blacks and Hispanics did not receive radiation (24.5% and 27.1%, respectively, vs 16.5% for whites), surgery (22.4% and 15.3%, vs 12.3%), or chemotherapy (21.5% and 24.1%, vs 16.7%; p &lt; 0.05). Additionally, the average number of days before treatment was 34.0 for blacks and 33.3 for Hispanics, versus 27.5 for whites (p &lt; 0.05). Multivariate analysis showed that receipt of neoadjuvant chemoradiation was less likely when patients were black (OR 0.7, 95%CI 0.5-0.9, p = 0.014), Hispanic (OR 0.6, 95%CI 0.4-0.9, p = 0.012), female (OR 0.8, 95% CI 0.63-0.94, p = 0.011), without insurance (OR 0.5, 95%CI 0.36-0.69, p &lt; 0.001), or treated at a community cancer center (OR 0.5, 95%CI 0.36- 0.74, p &lt; 0.05). Race significantly influenced treatment, regardless of disease stage. Although 5-year OS was lower (p &lt; 0.05) in blacks (59.8±3.3%) and Hispanics (65.9±3.5%) compared to whites (74.9±1.1%), race did not impact mortality on Cox regression. Instead, mortality was associated with male sex (HR 1.5, 95%CI 1.1-2.0, p = 0.009), nodal positivity (HR 2.6, 95%CI 1.9-3.6, p &lt; 0.001), nonsurgical therapy (HR 7.1, 95%CI 2.8-18.2, p &lt; 0.001), no chemotherapy (HR 1.9, 95%CI 1.03-3.6, p = 0.04), poorly differentiated histology (HR 3.0, 95%CI 1.3-6.5, p = 0.007), and no insurance (HR 1.7, 95%CI 1.1-2.7, p = 0.022). Conclusions: Race-based socioeconomic and treatment disparities may contribute to survival differences among AYAs with rectal cancer.

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates

Breast Cancer Mortality in African-American and Non-Hispanic White Women by Molecular Subtype and Stage at Diagnosis: A Population-Based Study.

Higher breast cancer mortality rates for African-American than non-Hispanic White women are well documented; however, it remains uncertain if this disparity occurs in disease subgroups defined by tumor molecular markers and stage at diagnosis. We examined racial differences in outcome according to subtype and stage in a diverse, population-based series of 103,498 patients. We obtained data for all invasive breast cancers diagnosed between January 1, 2005, and December 31, 2012, and followed through December 31, 2012, among 93,760 non-Hispanic White and 9,738 African-American women in California. Molecular subtypes were categorized according to tumor expression of hormone receptor (HR, based on estrogen and progesterone receptors) and human epidermal growth factor receptor 2 (HER2). Cox proportional hazards models were used to calculate relative hazard (RH) and 95% confidence intervals (CI) for breast cancer-specific mortality. After adjustment for patient, tumor, and treatment characteristics, outcomes were comparable by race for stage I or IV cancer regardless of subtype, and HR(+)/HER2(+) or HR(-)/HER2(+) cancer regardless of stage. We found substantially higher hazards of breast cancer death among African-American women with stage II/III HR(+)/HER2(-) (RH, 1.31; 95% CI, 1.03-1.65; and RH, 1.39; 95% CI, 1.10-1.75, respectively) and stage III triple-negative cancers relative to Whites. There are substantial racial/ethnic disparities among patients with stages II/III HR(+)/HER2(-) and stage III triple-negative breast cancers but not for other subtype and stage. These data provide insights to assess barriers to targeted treatment (e.g., trastuzumab or endocrine therapy) of particular subtypes of breast cancer among African-American patients.

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype.

Treatment advances have differed by breast cancer subtype. We examined the impact of race on survival of women with metastatic breast cancer by disease subgroup. Using surveillance, epidemiology, and end results -Medicare data, we included white and black patients aged ≥66 with de novo metastatic breast cancer diagnosed between 1998 and 2009. Using trastuzumab as a proxy for human epidermal growth factor receptor 2 (HER2)-positive status, we defined three disease subgroups: (1) HER2-positive (received trastuzumab), (2) HER2-negative/unknown (never received trastuzumab)/hormone receptor (HR)-positive, and (3) HER2-negative/unknown/HR-negative. Multivariate Cox proportional models assessed the impact of race on overall survival (OS) and breast cancer-specific survival by subgroup. We also examined trastuzumab treatment patterns. Among 4364 women (86% white, 14% black), 9% had HER2-positive, 72% had HER2-negative/unknown/HR-positive, and 18% had HER2-negative/unknown/HR-negative tumors. Patients with HER2-positive disease experienced longer median OS compared with others: 2.4 versus 1.8years for women with HER2-negative/unknown/HR-positive and 0.5years for women with HER2-negative/unknown/HR-negative disease (P<0.001). Racial differences in OS were only observed among patients with HER2-positive tumors: median OS: 1.4 versus 2.7years for black and white women, adjusted hazard ratio 1.45; 95% Confidence interval 1.01-2.08. Results for breast cancer-specific survival were similar. We also observed racial differences in trastuzumab utilization, with longer median time to trastuzumab initiation and lower likelihood of continuation over time for black (vs. white) patients. Among women with de novo metastatic breast cancer, racial differences in survival were only apparent for those with inferred HER2-positive tumors. Further study of how treatment patterns affect outcomes is warranted.

Racial Differences in Outcomes within the National Lung Screening Trial. Implications for Widespread Implementation.

Black individuals with lung cancer (LC) experience higher mortality because they present with more advanced disease and are less likely to undergo curative resection for early-stage disease. The National Lung Screening Trial (NLST) demonstrated improved LC mortality by screening high-risk patients with low-dose computed tomography (LDCT). The benefit of LDCT screening in black individuals is unknown. Examine results of the NLST by race. This was a secondary analysis of a randomized trial (NCT00047385) performed in 33 U.S. centers. Overall and lung cancer-specific mortality were measured. Screening with LDCT reduced LC mortality in all racial groups but more so in black individuals (hazard ratio [HR], 0.61 vs. 0.86). Smoking increased the likelihood of death from LC, and when stratified by race black smokers were twice as likely to die as white smokers (HR, 4.10 vs. 2.25). Adjusting for sociodemographic and behavioral characteristics, black individuals experienced higher all-cause mortality than white individuals (HR, 1.35; 95% confidence interval, 1.22-1.49); however, black individuals screened with LDCT had a reduction in all-cause mortality. Black individuals were younger, were more likely to be current smokers, had more comorbidities, and had fewer years of formal education than white individuals (P < 0.05). Black individuals screened with LDCT had decreased mortality from lung cancer. However, the demographics associated with improved LC survival were less commonly found in black individuals. The overall mortality in the NLST was higher for black individuals than white individuals, but improved in black individuals screened, suggesting that this subgroup may have had improved access to care. To realize the reductions in mortality from LC screening, dissemination efforts need to be tailored to meet the needs of this community.

Abstract 12427: Racial Disparities in Hospitalization for Atrial Fibrillation: The Nationwide Inpatient Sample 2001-09

Introduction: Racial differences in atrial fibrillation (AF) prevalence and disparities in treatment are well established; however, racial differences in outcomes among patients hospitalized with AF are less clear. We assessed racial differences in complications related to AF in a representative sample of AF hospitalization in the United States. Methods: We identified adults (≥ 40 years) with a principal diagnosis of AF and length of stay (LOS) among survivors of 1-30 days using weighted national estimates from the Nationwide Inpatient Sample. We excluded patients undergoing cardiac surgery or with missing covariates. Annual AF hospitalization rates by race were calculated using the total US population obtained from the US Census Bureau. We used multivariable regression models (covariates listed in Table) to examine associations of race with heart failure and hospital mortality among patients admitted with AF. Results: 2,244,036 AF hospitalizations (85% White, 6.7% Black, 5.0% Hispanic and 1.4% Asian/Pacific Islander) were analyzed from 2001-09. Hospitalization and outcome data by year are summarized in the table. Across all studied years, Blacks had lower AF hospitalization rates than Whites. Yet in all study years, mean LOS was longer for Blacks (range 4.2-4.6 days) than Whites (range 3.4-3.6 days). Blacks consistently had increased risk of in-hospital heart failure (Odds Ratio [OR] ranged from 1.5 [1.4, 1.7] to 1.7 [1.6, 1.9] across years) and death (OR, 1.5 [1.1, 2.1] to 2.3 [1.7, 3.0]) compared with Whites after adjustment for comorbidities. Conclusions: Although Blacks have lower incidence of hospitalizations for AF, they experience higher risk of heart failure, longer LOS, and greater mortality compared with Whites hospitalized with AF. Further public health investigation is warranted to examine the causes for disparities in outcomes among Blacks with AF and identify modifiable factors that may improve outcomes of Blacks with AF.

Abstract 11025: Cardiovascular Disease Mortality Among Black and White Women With Ductal Carcinoma in Situ of the Breast

Background: Ductal carcinoma in situ (DCIS) of the breast represents 15-20% of new breast cancer diagnoses in the United States annually and the incidence has been escalating since the 1970s. Long-term competing risks of cardiovascular disease (CVD) mortality, as well as racial differences in outcomes among US women with DCIS are unknown. Methods: Case data from the years 1978-2010 was abstracted using SEER*Stat software available through the National Cancer Institute from the 2010 SEER (Surveillance, Epidemiology and End Reports) registries. We evaluated CVD, breast cancer, and all-cause mortality using cumulative incidence rates and hazard ratios (HRs). Results: A total of 12,173 deaths were observed over a median follow up time of 9.2 years with 33% of deaths due to CVD and 8% due to breast cancer. The cumulative incidences of CVD death at 5, 10, and 20 years of follow up were 2.0% (95% CI 1.8-2.1), 5.1% (CI 4.9-5.3), and 13.2% (CI 12.8-13.7), respectively. The highest incidence of CVD mortality were found in women diagnosed with DCIS between 1978-1983 with 5, 10, and 20 year incidence of 5.0% (CI 3.9-6.1), 10.2% (CI 8.6-11.7), and 21.1% (CI 19.0-23.2), respectively. When stratifying by age at diagnosis, cumulative incidences of CVD death were highest among women diagnosed at age ≥ 70. Compared to white women, black women tended to have higher risk of death, especially among women diagnosed at young age; for those aged 40-49 at diagnosis, the HR for CVD mortality was 9.83 (95% CI 4.56-21.17). Conclusions: Among women diagnosed with DCIS, the risk of dying from CVD was greater than breast cancer at 20 years, with the incidence of CVD most pronounced among women diagnosed in an earlier treatment era (1978-1983) and older age. Black women had greater risks of dying from CVD compared to white women for all years, with this disparity decreasing with advanced age.

Mitigation of Racial Disparities After Simultaneous Pancreas and Kidney Transplantation.

Racial differences in outcomes after simultaneous pancreas and kidney transplantation (SPK) persist even in the modern era of immunosuppression. Studies have shown that inferior outcomes are associated with reduced access to SPK among African Americans (AA). Identification of SPK protocols associated with improved outcomes among AA recipients is of paramount importance to mitigate these disparities. We report the largest single center experience with SPK transplantation in AA. Methods: Long-term outcomes among adult, SPK recipients transplanted at our center between 1997-2012 [n=228; AA=76; Caucasian American (CA) =152]. All patients received anti-thymocyte globulin induction. Maintenance was FK, MMF, and prednisone (steroid-free after 2006). Multivariate Cox proportional hazard regression (aHR), adjusting for recipient age, gender; donor age, BMI, race, gender, terminal creatinine, DGF, serum amylase, lipase. Results: SPK allografts were more often from donors aged 18-34 yrs, CA, BMI<30, terminal creatinine 1.0 mg/dL, amylase 82U/L, lipase 23U/L, and highest blood glucose 205mg/dL. Across recipient race, there were no significant differences in kidney survival or graft loss [1yr: 100% (AA) vs. 99.3% (CA), p>0.05; aHR 0.49, 95%CI 0.10-2.2, p>0.05]. There were no differences in pancreas survival or graft loss across race [1yr: 93.4% (AA) vs. 95.4% (CA), p>0.05; aHR 0.50, 95%CI 0.19-1.31, p>0.05].Table: No Caption available.Figure: No Caption available.Conclusion: These data demonstrate, for the first time, AA SPK recipients achieve similar long-term outcomes compared to their CA counterparts, and lend support to improving access to SPK transplantation for AA. DISCLOSURES:Locke, J.: Speaker's Bureau, Spire Learning, Visiting professor series sponsored by Sanofi.

Race, poverty, and the traffic ticket cycle

Purpose – Through systematic observation of police decision-making behavior, the aim of this paper is to investigate what factors differentiate between citizens who receive a warning vs a ticket from police and whether the influence of those factors varies by race. The paper also explores the context of those decisions for both blacks and whites to further the understanding of the underlying mechanisms of any observed differences in the likelihood of receiving a ticket vs a warning. Design/methodology/approach – Data were collected during police ridealongs conducted in a sample of cities within Cuyahoga County, Ohio. A total of 140 ridealongs were completed, yielding a total of 312 vehicle or citizen stops. Findings – The paper finds that black citizens are more likely to receive a ticket than white citizens. However, the paper also finds important differences in the situational context of traffic stops for blacks and whites and uncover evidence of a cycle of traffic tickets and license suspensions among some black drivers. Research limitations/implications – The study demonstrates the importance of examining the underlying situational context in analyses of decision making in traffic stops. The main limitation of the analyses is that the data were limited to one county in the state of Ohio. Practical implications – The data suggests that one of the causes of the racial disparities in tickets vs warnings involves a cycle of tickets and license suspensions that occurs among some black drivers. These drivers appear to become caught up in a cycle where a compilation of prior tickets from traffic infractions, driving without insurance, or defaulting on child support payments leads to high numbers of points and subsequent license suspensions. The paper discusses some practical implications for addressing this pattern, including specific programs that could be adopted by municipalities that seek to break the cycle of repeated violation of driver's license laws. Originality/value – Beyond identifying the impact of citizen race on the likelihood of receiving a warning vs a ticket during a traffic stop, this study contributes to the existing literature by exploring the situational context of these decisions, and identifying the ways in which variations in situational contexts help explain racial differences in outcomes in traffic stops. The identification of a traffic ticket cycle among some black drivers appears to be an original finding.

Abstract P1-04-16: Multi-center experience with CELLSEARCH® circulating tumor cell kit on patients with metastatic breast cancer

Abstract Background: Clinical studies have shown that circulating tumor cell (CTC) detection via the CELLSEARCH® assay is a validated prognostic marker for the prediction of progression-free survival (PFS) and overall survival (OS) in metastatic breast cancer (mBC) patients. We evaluated the impact of CTC testing on OS using real-world observational data from multiple centers. Material and Methods: Electronic medical records (EMR) were used to identify patients who were: (i) women &amp;gt; 18 years diagnosed with mBC on or after their date of registration, (ii) registered to the EMR system on or after 4/1/2010, and (iii) followed for at least 2 months from the time of metastases. Patients who had CTC testing were required to have at least 1 valid CTC test result. OS among mBC patients with CTC testing was compared to a cohort of patients without CTC testing (non-CTC) using a Cox model controlling for age, race, hormone receptor status, and scanning frequency. Results: CTC patients were treated in 43 centers and grouped into two main sites based on region (N1 = 123, N2 = 240); non-CTC patients were treated in 58 different centers (N = 1,115). Mean (SD) ages of CTC and non-CTC patients were 66 (13) and 65 (14) years, respectively. ER or PR+ patients comprised 77% of the CTC tested and 72% of the non-CTC samples. The majority of patients in both cohorts were Caucasian (83% - CTC, 57% - non-CTC). A Cox model comparing OS between CTC and non-CTC patients did not show a survival benefit due to CTC testing. Comparing CTC testing frequency between the two sites showed that, on average, the 123 patients from site 1 were tested more frequently than the 240 patients in site 2 (0.6 vs. 0.3 CTC tests/month, p-value&amp;lt;0.001). The model that compared OS between CTC patients from site 1 showed a 43% reduction in risk of death (HR = 0.58, p-value = 0.005) compared to the overall cohort of non-CTC patients. Patients from site 2 did not show a reduction in risk of death compared to non-CTC patients, but a significant interaction between CTC testing and race (Caucasian vs. non-Caucasian) (p-value = 0.005) was observed. For Caucasians, CTC patients exhibited a 37% reduction in risk of death compared to non-CTC patients; reduction in risk of death was not observed for non-Caucasians CTC patients. This interaction (p-value = 0.005) was consistent among the subset of ER or PR+ Caucasian patients relative to non-CTC ER or PR+ Caucasian patients (HR = 0.55). For site 1, the subset of ER or PR+ CTC also had a lower risk of dying compared to ER or PR+ non-CTC (HR = 0.47, p-value = 0.004). Discussion: These results suggest that frequent serial testing for CTC may be associated with better prognosis compared to no CTC testing or even infrequent CTC testing. By more frequent monitoring, the assessment of serial CTCs provide clinicians with more frequent information, which in turn can provide a clearer understanding of a patient's cancer progression in a metastatic setting. One limitation of these results is the difficulty in ruling out other potential drivers. Particularly, results regarding the racial differences in outcomes where race might serve as a proxy for a number of factors such as severity of disease which is difficult to derive from a retrospective observational database. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-04-16.

Role of Vitamin D Receptor Activation in Racial Disparities in Kidney Disease Outcomes

African Americans have lower 25-hydroxyvitamin D (25(OH)D) levels compared with whites. African Americans also have a higher risk of developing albuminuria and end-stage renal disease but a lower risk of death once they commence hemodialysis compared with whites. Vitamin D levels have been associated with multiple outcomes including albuminuria, progression to end-stage renal disease, and all-cause and cardiovascular mortality. In this review, we examine the evidence linking 25(OH)D to outcomes and the possibility that differential 25(OH)D may explain certain racial differences in outcomes.

855 Racial Differences in Outcome of Colonoscopy in Young Adults (

Identification and removal of colonic adenomas is the corner stone of our colorectal cancer prevention program. There has been a concern of earlier development of colonic adenomas in adults < 50 years of age especially in high risk ethnic groups. There are very limited studies done to determine the yield of colonoscopy in young minority adults.

Racial differences in outcomes of triple-negative breast cancer

African American (AA) women have a higher incidence of triple-negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor, and HER2 gene amplification) than Caucasian (CA) women, explaining in part their higher breast cancer mortality. However, there have been inconsistent data in the literature regarding survival outcomes of TNBC in AA versus CA women. We performed a retrospective chart review on 493 patients with TNBC first seen at the Washington University Breast Oncology Clinic (WUBOC) between January 2006 and December 2010. Analysis was done on 490 women (30 % AA) for whom follow-up data was available. The median age at diagnosis was 53 (23-98) years and follow-up time was 27.2 months. There was no significant difference between AA and CA women in the age of diagnosis, median time from abnormal imaging to breast biopsy and from biopsy diagnosis to surgery, duration of follow-up, tumor stage, grade, and frequency of receiving neoadjuvant or adjuvant chemotherapy and pathologic complete response rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and CA groups by either univariate or multivariate analysis that included age, race, and stage. The hazard ratio for AA women was 1.19 (CI 0.80-1.78, p = 0.39) and 0.91 (CI 0.62-1.35, p = 0.64) for OS and DFS, respectively. Among the 158 patients who developed recurrence or presented with stage IV disease (AA: n = 36, CA: n = 122), no racial differences in OS were observed. We conclude that race did not significantly affect the clinical presentation and outcome of TNBC in this single center study where patients received similar therapy and follow-up.

Racial differences in outcomes of triple-negative breast cancer.

1048 Background: The incidence and mortality of breast cancer can differ significantly among racial and ethnic groups. African American (AA) women have a lower incidence of breast cancer, but higher mortality compared to other racial groups. Triple negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor and HER2), which is an aggressive type of breast cancer, occurs more frequently in AA women. The few studies addressing whether racial differences exist in the outcomes of patients with TNBC have yielded inconsistent results. Methods: The Washington University Medical Oncology Database captures the clinical information for all new patients (pts) seen at the Breast Oncology Clinic. Most of these pts reside in the St. Louis metropolitan area. Using this database, we performed a retrospective analysis to examine the association of race with the clinical presentation and outcome of TNBC in this geographically defined patient population. Results: Between May 2006 and March 2011, 506 pts with TNBC were entered in the database. Analysis was done on 499 patients for whom follow up data is available. The median follow up (F/U) time was 24.5 months and the median age at diagnosis was 53 (24 to 98) years. Thirty percent of pts were AA. Only 5% presented with stage IV at diagnosis and the majority of tumors (86%) were high grade. Neoadjuvant chemotherapy was administered in 151 pts, 22% of whom achieved a pathologic complete response (pCR). There was no significant difference between races in the age of diagnosis, F/U time, tumor stage, grade, frequency of receiving neo/adjuvant chemotherapy and pCR rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and other racial groups by either univariate or multivariate analysis that took into account tumor stage, grade, patient age and menopausal status. The HR for OS was 1.154 (CI 0.772 – 1.725, p value 0.4860) and for DFS it was 0.947 (CI 0.650 – 1.380, p value 0.7764) in AA compared to other races. In the 92 pts who recurred, there was no racial difference in time from recurrence to death. Conclusions: Race does not significantly affect the clinical presentation or outcome of TNBC in the St. Louis metropolitan area.

Racial Differences in Outcomes of the Evaluation of Potential Live Kidney Donors: A Retrospective Cohort Study

Background: In the USA, the lower rate of live donor kidney transplant among Black transplant candidates may stem from lower rates of donation among potential live donors who are Black. We determined whether outcomes of the evaluation of potential live kidney donors varied according to the potential donors’ demographic characteristics. Methods: We performed a single-center, retrospective observational cohort study of 1,179 potential live kidney donors, who came forward between 2000 and 2007. Potential donors’ intended recipients were first-time transplant recipients who were evaluated between 2000 and 2005. Results: There were 268 (22.7%) potential live kidney donors who were Black, of whom 93.7% were recruited by Black transplant candidates. Donor outcomes included actual donation (38.3%), exclusion due to blood group or crossmatch incompatibility (20.4%), exclusion due to medical contraindication to donation (13.7%), and lack of further donor interest (11.2%). Black (vs. non-Black) potential donors were less likely to actually donate (27.2 vs. 41.6%, p < 0.001). Black potential donors were more likely to stop pursuing live donation (p = 0.047) or be excluded from donation for medical reasons (p = 0.008) or blood group or crossmatch incompatibility (p = 0.01). These racial differences persisted in a multivariable multinomial logistic regression model of factors associated with outcomes of the donor evaluation. Conclusions: Potential live kidney donors who are Black are less likely to actually donate. Future studies should determine whether paired exchange and desensitization programs decrease these racial differences and why Black potential donors appear more likely to stop pursuing live donation.

Abstract 8426: Racial Differences in Heart Transplant Wait-List and Early Post-Transplant Mortality in the United States

Background: Racial differences in long-term outcomes after heart transplant (HT) are well known. However, racial differences in outcomes among those listed for a HT in the United States (US) have not been characterized. We sought to assess racial and ethnic differences in risk factors and in risk of wait-list and early post-transplant mortality among patients (pts) listed for a HT in the US in the current era Methods and Results: We identified all pts ≥18 yrs of age listed for a primary HT in the US during July, 2006- June, 2009 in the Organ Procurement and Transplant Network database. Of 7361 pts analyzed, 69% were white, 20% black, 7% Hispanic and 3% were “other’. Black and Hispanic pts were younger than white pts and were more likely to have blood type O (black 48%, Hispanic 53%, white 42%), dilated cardiomyopathy (71%, 56%, 39%, respectively), pulmonary artery wedge pressure &gt;20 mm Hg (55%, 54%, 47%, respectively), listing status 1A or 1B (68%, 63%, 53%, respectively) and public medical insurance (25%, 26%, 10%, respectively) (P&lt;0.001 for all). Overall, 11.5% of white, 12.5% of black and 14.8% of Hispanic pts listed for a HT died on the wait-list or became too sick to transplant. In an analysis adjusted for age, diagnosis, listing status, pulmonary artery wedge pressure, support variables (inotropes, ventilator, mechanical support, implantable cardioverter defibrillator) and renal function, both black (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.99, 1.43) and Hispanic (HR 1.65, 95% CI 1.25, 2.05) pts were at higher risk of dying on the wait-list or becoming too sick to transplant compared to white pts (P=0.002). These risks remained unchanged after further adjustment for blood type and medical insurance. Compared to white HT recipients, post-transplant in-hospital mortality was higher in black recipients (Odds ratio [OR] 1.47, 95% CI 1.13, 1.91) but was not different in Hispanic recipients (OR 0.87, CI 0.57, 1.32). Conclusions: Black and Hispanic pts listed for a HT in the US appear to be at higher risk of dying on the wait-list or becoming too sick to transplant compared to white pts. Black pts also appear to be at higher risk of early post-transplant mortality. Understanding the mechanisms for these racial differences in outcomes requires further investigation.