Racial Differences In Time Research Articles

Assessing racial differences in time to subsequent treatment following androgen deprivation therapy among Veterans with prostate cancer.

Background For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1L) systemic treatment for improved outcomes. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite significant racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1L ADT. Methods We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients adjusted for baseline covariates. Results From 2001-2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3,402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95%CI = 0.80-0.85) compared to NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88-0.98) and Other men (HR = 0.91, 95%CI = 0.84-0.98), also had lower subsequent treatment rates. Conclusions All races examined had significantly lower rates of subsequent treatment after 1L ADT relative to NHW. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.

886. Impact of Race on the Early Diagnosis and Treatment of Lyme Disease

Abstract Background Previous studies using single-state and Medicare surveillance data found that Black patients with Lyme Disease (LD) are more likely to present outside of the typical summer months and have higher rates of disseminated disease at diagnosis. We further explored differences in clinical presentation and early treatment of Lyme Disease by self-reported race among a large cohort of patients at an academic research clinic. Methods We abstracted data from all patients with untreated or post-treatment LD seen at the Johns Hopkins Lyme Disease Research Center (LDRC)—either for clinical care or research participation. Patients self-reported their demographics, and clinical information regarding their initial Lyme presentation was either recorded at the time of diagnosis or was abstracted from prior, external medical records. We examined the distribution of race across initial LD clinical presentations—categorized as 1) erythema migrans (EM) rash only, 2) disseminated disease, or 3) non-specific symptoms only—using chi-squared or Fisher’s exact test and fit logistic regression models. We compared racial differences in time to appropriate treatment using a one-sided Mann-Whitney test. Results Of 1363 individuals seen at the LDRC, 93% were white, 3% were Black, 2% were Asian, and 3% self-identified as either ‘other’ or more than one race. Compared to white patients, Black patients were less likely to present with erythema migrans (EM) rash (p < 0.0001) and more likely to present with disseminated disease or non-specific symptoms (p=0.009, p=0.019, respectively). Black patients were more likely to have received a course of inappropriate antibiotic therapy ( 16.7% vs 8.0 %, p= 0.058). Also, Black patients with EM rash experienced longer time to appropriate treatment (16.3 days vs 4.0, p=0.062). Number of asterisks indicates degree of statistical significance. N/S means "non-significant" Conclusion We identified several racial disparities in the early detection and treatment of Lyme Disease, highlighting the need for increased awareness of Lyme and its early manifestations among patients of color and the front-line clinicians who care for them. Because darker skin tones are generally under-represented in medical textbooks and patient education materials, we include several examples of EM rashes from Black patients seen at the LDRC (Figure 2). Disclosures John Aucott, MD, Pfizer, Inc.: Advisor/Consultant

10583 Racial Differences in Time to Diagnosis of Endometriosis

10583 Racial Differences in Time to Diagnosis of Endometriosis

Assessing racial differences in time to treatment escalation following androgen-deprivation therapy among veterans with prostate cancer.

5078 Background: Androgen deprivation therapy (ADT) is standard care first-line (1L) systemic treatment for advanced and metastatic prostate cancer (PC). Currently, there are no population-level studies assessing the duration of 1L ADT and time to treatment escalation (chemotherapy [CT], novel hormonal therapy [NHT], or non-steroidal antiandrogen [NSAA]). Methods: We performed a retrospective population-level analysis to assess the association between race and time to treatment escalation after ADT in the Veterans Affairs Health Care System. From 2001-2021, 164,477 patients (pt) diagnosed with PC and treated with ADT alone were identified. Baseline demographic and clinical characteristics were sorted by race: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Other and compared among groups using chi square tests for categorical variables and Kruskal-Wallis tests for continuous variables. The primary outcome was time from ADT to treatment escalation, defined as receipt of NHT, NSAA, or CT. Men with no evidence of treatment escalation were censored at time of death or most recent visit. We estimated 5-year event rates by race using Kaplan-Meier (KM) analyses. Univariable and multivariable Cox proportional hazards models were used to test the association between race and time to treatment escalation with time of ADT as time zero. Multivariable models were adjusted for age, year, time from PC diagnosis to ADT, Charlson Comorbidity Index and BMI at ADT start along with PSA, testosterone level, and receipt of radiation therapy (RT) prior to ADT. Results: NHB were youngest (p<0.001), started ADT in more recent years (p<0.001), had the highest pre-ADT PSA (p<0.001) and testosterone levels (p<0.001), the most comorbidities (p<0.001), and the highest rate of RT prior to ADT (p<0.001) relative to other groups. During a median (Q1, Q3) follow-up of 55.2 (25.0, 102.4) months, 31,288 pt (19%) had treatment escalation, of which 12,093 (39%) were NHTs, 14,842 (47%) were NSAAs, 3,895 (12%) were CT and 458 (2%) were other 2nd line therapies. Compared to NHW, NHB had significantly lower rate of treatment escalation in univariable (HR=0.89, 95% CI=0.87-0.92) and multivariable analysis (HR=0.82, 95% CI=0.80-0.84). KM estimates at 5-year for the percent free from escalation was 80.5 (80.2-80.8%) in NHW vs. 83.0 (82.6-83.4%) in NHB. Rate of treatment escalation was similar for Hispanics and other races compared to NHW, with 5-year KM estimates of 81.0 (80.3-81.7%) and 81.0 (80.0-82.0%) for Hispanics and other races, respectively. Conclusions: This study assessing racial differences in time to treatment escalation of men receiving 1L ADT found that NHB had a significantly lower rate of treatment escalation. Whether this decreased rate of treatment escalation among NHB men represents improved outcomes (i.e. lower risk of progression) or undertreatment requires further study.

Racial disparities in time to laparoscopic cholecystectomy for acute cholecystitis

BackgroundDisparities in healthcare exist, yet few data are available on racial differences in time from admission to surgery. This study aimed to compare time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. MethodsPatients who underwent laparoscopic cholecystectomy for acute cholecystitis from 2010 to 2020 were identified using NSQIP. Time to surgery and additional preoperative, operative, and postoperative variables were analyzed. ResultsIn the univariate analysis, 19.4% of Black patients experienced a time to surgery >1 day compared with 13.4% of White patients (p < 0.0001). In the multivariable analysis, controlling for potential confounding factors, Black patients were found to be more likely than White patients to experience a time to surgery >1 day (OR 1.23, 95% CI 1.17–1.30, p < 0.0001). ConclusionsFurther investigation is indicated to better define the nature and significance of gender, race, and other biases in surgical care. Surgeons should be aware that biases may adversely impact patient care and should strive to identify and proactively address them to promote health equity in surgery.

Investigation of Factors Contributing to Racial Differences in Sport-Related Concussion Outcomes

Following sport-related concussion (SRC), early studies have demonstrated racial differences in time to clinical recovery; however, these differences have not been fully explained. We sought to further explore these associations by considering possible mediating/moderating factors. Data from patients aged 12-18 years diagnosed with SRC from November 2017 to October 2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded. The exposure of interest was race, dichotomized as Black/White. The primary outcome was time to clinical recovery (days from injury until the patient was either deemed recovered by an SRC provider or symptom score returned to baseline or zero.) RESULTS: A total of 389 (82%) White and 87 (18%) Black athletes with SRC were included. Black athletes more frequently reported no SRC history (83% vs. 67%, P= 0.006) and lower symptom burden at presentation (median total Post-Concussion Symptom Scale 11 vs. 23, P < 0.001) than White athletes. Black athletes achieved earlier clinical recovery (hazard ratio [HR]= 1.35, 95% CI 1.03-1.77, P=0.030), which remained significant (HR= 1.32, 95% CI 1.002-1.73, P= 0.048) after adjusting for confounders associated with recovery but not race. A third model adding the initial Post-Concussion Symptom Scale score nullified the association between race/recovery (HR=1.12, 95% CI 0.85-1.48, P= 0.410). Adding prior concussion history further reduced the association between race/recovery (HR= 1.01, 95% CI 0.77-1.34, P= 0.925). Overall, Black athletes initially presented with fewer concussion symptoms than White athletes, despite no difference in time to clinic. Black athletes achieved earlier clinical recovery following SRC, a difference explained by differences in initial symptom burden and self-reported concussion history. These crucial differences may stem from cultural/psychologic/organic factors.

Racial differences in time to blood pressure control of aneurysmal subarachnoid hemorrhage patients: A single-institution study.

Aneurysmal subarachnoid hemorrhage occurs in approximately 30,000 patients annually in the United States. Uncontrolled blood pressure is a major risk factor for aneurysmal subarachnoid hemorrhage. Clinical guidelines recommend maintaining blood pressure control until definitive aneurysm securement occurs. It is unknown whether racial differences exist regarding blood pressure control and outcomes (HLOS, discharge disposition) in aneurysmal subarachnoid hemorrhage. Here, we aim to assess whether racial differences exist in 1) presentation, 2) clinical course, and 3) outcomes, including time to blood pressure stabilization, for aSAH patients at a large tertiary care medical center. We conducted a retrospective review of adult aneurysmal subarachnoid hemorrhage cases from 2013 to 2019 at a single large tertiary medical center. Data extracted from the medical record included sex, age, race, insurance status, aneurysm location, aneurysm treatment, initial systolic and diastolic blood pressure, Hunt Hess grade, modified Fisher score, time to blood pressure control (defined as time in minutes from first blood pressure measurement to the first of three consecutive systolic blood pressure measurements under 140mmHg), hospital length of stay, and final discharge disposition. 194 patients met inclusion criteria; 140 (72%) White and 54 (28%) Black. While White patients were more likely than Black patients to be privately insured (62.1% versus 33.3%, p < 0.001), Black patients were more likely than White patients to have Medicaid (55.6% versus 15.0%, p < 0.001). Compared to White patients, Black patients presented with a higher median systolic (165 mmHg versus 148 mmHg, p = 0.004) and diastolic (93 mmHg versus 84 mmHg, p = 0.02) blood pressure. Black patients had a longer median time to blood pressure control than White patients (200 minutes versus 90 minutes, p = 0.001). Black patients had a shorter median hospital length of stay than White patients (15 days versus 18 days, p < 0.031). There was a small but statistically significant difference in modified Fisher score between black and white patients (3.48 versus 3.17, p = 0.04).There were no significant racial differences present in sex, Hunt Hess grade, discharge disposition, complications, or need for further interventions. Black race was associated with higher blood pressure at presentation, longer time to blood pressure control, but shorter hospital length of stay. No racial differences were present in aneurysmal subarachnoid hemorrhage associated complications or interventions.

Reply to “Racial Differences in Time at Work Not Working” by William A. Darity Jr. et al.

Reply to “Racial Differences in Time at Work Not Working” by William A. Darity Jr. et al.

Racial Differences in Time at Work Not Working

Racial differences in effort at work, if they exist, can potentially explain race-based wage/earnings disparities in the labor market. The authors estimate specifications of time spent on non-work activities at work by Black and White males and females with data from the American Time Use Survey. Estimates reveal that trivially small differences occur between non-Hispanic Black and non-Hispanic White males in time spent not working while on the job that disappear entirely when correcting for non-response errors. The findings imply that Black–White male differences in the fraction of the workday spent not working are either not large enough to partially explain the Black–White wage gap, or simply do not exist at all.

Racial differences in timing of food allergen introduction

Food allergy (FA) impacts 8% of children in the United States,1 with disease prevalence varying by race and highest rates observed among Black children.2,3 However, it is unclear what factors may underlie racial differences in prevalence. Racial differences in timing of food allergen introduction during infancy may influence FA development and disease manifestation. The National Institute of Allergy and Infectious Diseases released the Addendum Guidelines for the Prevention of Peanut Allergy in the United States in 2017 (PPA guidelines).

Kawasaki Disease and Clinical Outcome Disparities Among Black Children

ObjectiveTo determine whether Black children with Kawasaki disease exhibit disparities in prevalence, sequelae, and response to intravenous gamma globulin (IVIG) treatment.Study designInternational Classification of Diseases codes were used to identify children with Kawasaki disease admitted to a tertiary center in the southeastern US. Subjects diagnosed and treated according to American Heart Association criteria were included. Demographic, laboratory, clinical, and echocardiographic data from the electronic medical record (2000-2015) were compared between Blacks and Whites.ResultsData from 369 subjects (52% Whites and 48% Blacks) were included in our analysis. No significant differences related to timely admission, IVIG treatment, or coronary artery (CA) abnormalities during hospitalization were observed. Blacks showed lower IVIG response rates than Whites for patients administered IVIG within 10 days of fever onset (86.6% vs 95.6%; P = .007). Blacks received more ancillary drugs (9.6% vs 2.6%; P = .003), and endured longer hospitalizations (mean, 5 ± 3.9 days vs 3.4 ± 2.2 days; P = .001). Blacks presented with higher C-reactive protein level and erythrocyte sedimentation rate and lower hemoglobin, albumin, and sodium levels. Blacks had a higher proportion of persistent CA abnormalities than Whites at second follow-up echocardiogram (14.5% vs 6.3%; P = .03), and at third follow-up echocardiogram (21.2% vs 6.9%; P = .01).ConclusionsCompared with White children, Black children with Kawasaki disease had higher IVIG refractory prevalence, more severe inflammation, more ancillary treatments, and longer hospitalizations. Despite no racial differences in time to diagnosis or initial treatment, there was greater CA abnormality persistence among Black children at follow-up.

Abstract D071: Impact of racial differences in financial burden on time to treatment

Abstract Background Racial disparities in time-to-treatment exist among cancer patients, with patients of color being more likely to experience treatment delays. Such racial differences in treatment initiation are likely on the causal pathway to inequities in treatment outcomes. Emerging research has documented racial differences in financial burden, but little is known about the contribution of financial burden to disparities in treatment delays. In this study, we evaluated whether financial burden partly accounted for racial disparities in time to treatment initiation among a cohort of cancer survivors. Methods We used cross-sectional data of patients enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC) between 2010 and 2016. The sample for this study was limited to cancer patients and survivors who identified as non-Hispanic White or Black, received a diagnosis for breast, genitourinary, gastrointestinal, or head or neck cancer, and completed a questionnaire at least 30 days following their diagnosis (N=2,123). Time to treatment was measured in number of days from diagnosis to start of first course of treatment, ascertained from the medical record. Initial treatment was either surgery, chemotherapy, radiation, or hormonal therapy, depending on the clinical indication. Financial burden was assessed using the Patient Satisfaction Questionairre-18 on the self-reported satisfaction with the financial aspects of care (&amp;gt;3.5 is satisfied; &amp;lt;=3.5 is unsatisfied). To assess racial differences in time to treatment, we conducted both unadjusted and adjusted OLS regression analysis. Results In the first model predicting time to treatment as a function of race and clinical factors only, Black race was associated with a 11.4 day increase in the number of days between diagnosis and treatment (p&amp;lt; 0.001). In a second model adjusting for race, clinical factors and financial burden, the absence of financial burden was associated with a decrease in the number of days between diagnosis and treatment (\beta=-3.2, p= 0.042). Results were similar in the final fully adjusted model accounting for the above covariates in addition to sociodemographic factors, with the absence of financial burden being associated with a minor decrease in the time to treatment initiation (\beta= -3.0, p= 0.044). There was only a minor attenuation in the Black-White disparity in the fully adjusted model, with Black race being associated with an increase of 10.6 days between diagnosis and treatment initiation (p=0.001). Conclusions In Black patients and patients who report experiencing financial burden a greater number of days elapse between diagnosis and treatment initiation. Decreases in the time from diagnosis to first treatment is a modifiable factor in treatment inequities whether both for related to financial burden and race. Citation Format: Wendi Elkins, Olive Mbah, Jeannette T Benson, Laura Farnan, Neda Padilla, Sam Cykert, Bryce B Reeve, Giselle Corbie-Smith, Cleo A. Samuel. Impact of racial differences in financial burden on time to treatment [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 D071.

Racial differences in time to treatment for melanoma

BackgroundLonger time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although black patients present with later-stage melanoma and have worse survival than non-Hispanic white patients, the association between race and TTDS is unknown.ObjectiveTo investigate racial differences in time to melanoma treatment.MethodsRetrospective review of the National Cancer Database (2004-2015). Multivariable logistic regression was used to evaluate the association of race with TTDS, controlling for sociodemographic/disease characteristics.ResultsOf the 233,982 patients with melanoma identified, 1221 (0.52%) were black. Black patients had longer TTDS for stage I to III melanoma (P < .001) and time to immunotherapy (P = .01), but not for TTDS for stage IV melanoma or time to chemotherapy (P > .05 for both). When sociodemographic characteristics were controlled for, black patients had over twice the odds of having a TTDS between 41 and 60 days, over 3 times the odds of having a TTDS between 61 and 90 days, and over 5 times the odds of having a TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean, 60.4 days), and those with private insurance had the shortest TTDS (mean, 44.6 days; P < .001 for both).ConclusionsTargeted approaches to improve TTDS for black patients are integral in reducing racial disparities in melanoma outcomes.

RACIAL DIFFERENCES IN PHYSICAL ACTIVITY IN NURSING HOME RESIDENTS WITH COGNITIVE IMPAIRMENT

INTRODUCTION: Nursing home residents with moderate to severe cognitive impairment are mostly sedentary. It is more likely that African-American (AA) older adults tend to be more sedentary than their white counterparts. The purpose of this study was to examine racial differences in overall time spent in physical activity (PA), time in sedentary, light intensity, and moderate levels of PA, and participation in activities of daily living (ADLs) among cognitively impaired nursing home residents. METHODS: This was a secondary data analysis from the Function and Behavior Focused Care Intervention study. The sample included 336 cognitively impaired residents from 12 nursing homes. RESULTS: The mean age of the residents was 86.2 (SD=10.1) with an average MMSE score of 7.8 (SD=5.0) where 41% were AA and 59% white. White and AA participants engaged in only 51.2 and 46.1 minutes of light and 1.5 and 1.1 minutes of moderate level PA, respectively. There was a significant difference in time spent in light-intensity PA with whites spending more time in this level of activity [F(4, 242) = 3.360, p = .01]. Conversely, AAs had better functional ability than white residents [F(4, 242) = 4.754, p < .001]. There were no significant racial differences in time in sedentary, or moderate level PA. DISCUSSION: These findings are consistent with prior research showing that AAs had lower PA levels compared to their white counterparts. Future research should focus on increasing PA among nursing home residents and consider specific interventions to increase activity among AA residents.

Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System

Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models. This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.

Race, Socioeconomic Status, and Time to Transplantation in Multiple Myeloma

Race, Socioeconomic Status, and Time to Transplantation in Multiple MyelomaBackground: Multiple myeloma is the most common hematologic malignancy in blacks. Previous studies have found that black patients undergo autologous stem cell transplant (ASCT) less frequently than their white counterparts, though the reasons for this have not been fully elucidated. To identify whether racial differences in timing of referrals to transplant centers and transplantation may play a role in this observed disparity, we analyzed data from transplants undergone at The Mount Sinai Hospital between 2011 and 2016.Methods: We retrospectively analyzed 416 black and white patients who received their first autologous stem cell transplant for multiple myeloma at The Mount Sinai Hospital between 2011 and 2016. We compared the time from initial diagnosis to stem cell harvest and the time from harvest to transplant between the two groups while controlling for age, socioeconomic status, and functional status.Results: In total, 264 white patients and 152 black patients were identified as receiving their first transplant between 2011 and 2016. Data regarding each patient's demographic, date of diagnosis, date of harvest and transplant, and functional status were available. Age, socioeconomic status (as assessed through census data of median income of the patients' zip code), and functional status were considered possible confounders. Linear regression analysis was used to assess differences in transplant timing between races while controlling for these factors. We found that between racial groups, neither the time from diagnosis to harvest (528 days vs. 406 days respectively, p=.95) nor the time from harvest to transplant (113 days vs. 150 days respectively, p=.31) was significantly different. Age and socioeconomic status also did not significantly affect either time point, although patients with higher socioeconomic status had a decreased time from diagnosis to harvest which approached significance (p=0.07) regardless of their race. Finally, better functional status was associated with a shorter time from diagnosis to harvest (p=0.003).Conclusion: Based on these findings, race and socioeconomic status did not significantly affect expediency of referral to and completion of transplantation following initial disease diagnosis. Further studies are needed to clarify the factors contributing to observed differences in ASCT utilization between blacks and whites. DisclosuresNo relevant conflicts of interest to declare.

Do you see what I see? A character analysis of health risk behaviors in television shows popular with Black adolescents in the US

ABSTRACTAdolescents spend many hours per day watching television, and there are racial differences in time spent watching television and in show preferences. Prior research suggests there are also differential associations in how exposure to media content affects adolescent behavior. This study examines the demographic representation of main characters and health risk behaviors (i.e., sex, alcohol use, violence, bullying, and their combinations) portrayed in television content popular with Black and non-Black adolescents. A content analysis of television show characters (n = 377) from the 2014–2015 season was conducted on shows popular with 14–17-year old adolescent audiences in the United States. Group popularity was determined by Nielsen ratings segmented by Black and non-Black (primarily White) adolescents. Results suggest that character representation varies by whether shows were popular with Blacks or others, and that risk portrayals are common in all popular content with few group differences. Implications for adolescent behavior are discussed.

Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence

BackgroundPrior studies on treatment for alcohol-related problems have yielded mixed results with respect to gender and race/ethnicity disparities. Additionally, little is known about gender and racial differences in time to first alcohol-related service contact amongst persons with alcohol dependence. This study explored gender and race/ethnicity differences for first alcohol-related service utilization in a population-based sample. MethodsPrimary analyses were restricted to Blacks, Whites and Hispanics, ages 18–44, with lifetime alcohol dependence (n=3311) in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions. We compared time to service use among men and women within and across race/ethnicity strata using multivariable Cox proportional hazard methods. ResultsIn the sample of individuals age <45 with alcohol dependence, only 19.5% reported alcohol-related service use. Overall, women were less likely than men to receive alcohol-related services in their lifetime. However, women who did receive treatment were younger at first service utilization and had a shorter interval between drinking onset and service use than men. Gender differences were consistent across racial/ethnic groups but only statistically significant for Whites. There were no appreciable race/ethnicity differences in hazard ratios for alcohol-related service use or time from drinking initiation to first service contact. Results of sensitivity analyses for persons ≥45 years old are discussed. ConclusionsThere are important gender differences in receipt of and time from drinking initiation to service utilization among persons with alcohol dependence. Increased recognition of these differences may promote investigation of factors underlying differences and identification of barriers to services.

An Examination of Racial Differences in Process and Outcome of Colorectal Cancer Care Quality Among Users of the Veterans Affairs Health Care System

BackgroundVeterans Affairs (VA) manages the largest US integrated health care system. Although quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of research examining racial differences in this care. This study examines racial differences in 2 dimensions of quality of VA CRC care: processes (time to treatment) and outcomes (survival). Patients and MethodsRetrospective data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Study patients were white and African American men diagnosed with nonmetastatic CRC between 2003 and 2006 who received definitive CRC surgery. We examined 3 quality indicators: time from (1) surgery to initiation of adjuvant chemotherapy (stages II-III disease), (2) surgery to surveillance colonoscopy (stages I-III disease), and (3) surgery to death (stages I-III disease). Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. ResultsIn unadjusted analyses, there was no evidence of racial differences across the 3 quality measures. In adjusted Cox regression, there were no racial differences in time to initiation of chemotherapy (hazard ratio [HR], 0.82; P = .61) or surgery to death (HR, 0.94; P = .49). In adjusted Cox regression, among those receiving colonoscopy within 7 to 18 months after surgery, white patients experienced slightly shorter median times to surveillance colonoscopy than did African American patients (367 vs. 383 days; HR, 0.63; P = .02). ConclusionOther than a small racial difference in timing of surveillance colonoscopy, there was little evidence of racial differences in quality of CRC care among VA health care system users.

The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer

BackgroundNon-small cell lung cancer is the leading cause of cancer-related mortality in the United States. Patients with late-stage disease (stage 3/4) have five-year survival rates of 2%–15%. Care quality may be measured as time to receiving recommended care and, ultimately, survival. This study examined the association between race and receipt of timely non-small cell lung cancer care and survival among Veterans Affairs health care system patients.MethodsData were from the External Peer Review Program, a nationwide Veterans Affairs quality-monitoring program. We included Caucasian or African American patients with pathologically confirmed late-stage non-small cell lung cancer in 2006 and 2007. We examined three quality measures: time from diagnosis to (1) treatment initiation, (2) palliative care or hospice referral, and (3) death. Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.ResultsAfter controlling for patient and disease characteristics using Cox regression, there were no racial differences in time to initiation of treatment (72 days for African American versus 65 days for Caucasian patients, hazard ratio 1.04, P = 0.80) or palliative care or hospice referral (129 days versus 116 days, hazard ratio 1.10, P = 0.34). However, the adjusted model found longer survival for African American patients than for Caucasian patients (133 days versus 117 days, hazard ratio 0.31, P < 0.01).ConclusionFor process measures of care quality (eg, time to initiation of treatment and referral to supportive care) the Veterans Affairs health care system provides racially equitable care. The small racial difference in survival time of approximately 2 weeks is not clinically meaningful. Future work should validate this possible trend prospectively, with longer periods of follow-up, in other veteran groups.