Racial Differences In Time Research Articles

Racial differences in time from prostate cancer diagnosis to treatment initiation

Timely delivery of care has been identified by the Institute of Medicine as an indicator for quality health care, and treatment delay is a potentially modifiable obstacle that can contribute to the disparities among African American (AA) and Caucasian patients in prostate cancer recurrence and mortality. Using the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database, we compared time from diagnosis to treatment in AA and Caucasian prostate cancer patients. A total of 2506 AA and 21,454 Caucasian patients diagnosed with localized prostate cancer from 2004 through 2007 and treated within 12 months were included. Linear regression was used to assess potential differences in time to treatment between AA and Caucasian patients, after adjusting for sociodemographic and clinical covariates. Time from diagnosis to definitive (prostatectomy and radiation) treatment was longer for AA patients in all risk groups, and most pronounced in high-risk cancer (96 versus 105 days, P < .001). On multivariate analysis, racial differences to any and definitive treatment persisted (β = 7.3 and 7.6, respectively, for AA patients). Delay to definitive treatment was longer in high-risk (versus low-risk) disease and in more recent years. AA patients with prostate cancer experienced longer time from diagnosis to treatment than Caucasian patients with prostate cancer. AA patients appear to experience disparities across all aspects of this disease process, and together these factors in receipt of care plausibly contribute to the observed differences in rates of recurrence and mortality among AA and Caucasian patients with prostate cancer.

Are there racial differences in colorectal cancer care timeliness among users of the Veterans Affairs Healthcare System?

6555 Background: The Veterans Affairs (VA) healthcare system is the largest integrated healthcare system in the United States. While the quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of literature describing racial differences in timeliness of VA CRC care. The objective of this analysis was to examine potential racial differences in CRC care timeliness. Methods: Data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Included patients must have been Caucasian or African American, diagnosed with non-metastatic CRC between 2003 and 2006, and received definitive CRC surgery. We examined 3 timeliness metrics – time from: 1) surgery to initiation of adjuvant chemotherapy (Stage II-III), 2) surgery to surveillance colonoscopy (Stage I-III), and 3) surgery to death (Stage I-III). Unadjusted analyses used Log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. Results: In adjusted Cox regression there were no racial differences in time to initiation of chemotherapy (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). In adjusted Cox regression, Caucasian race was protective, with shorter time to first surveillance colonoscopy (HR 0.63, p=0.02). The median time to colonoscopy was 367 and 383 days for Caucasian and African American patients respectively. Conclusions: Caucasian patients receive follow-up colonoscopies slightly sooner than African American patients in VA; the difference between median times by race is only 16 days. Though statistically significant, this difference is not clinically meaningful since no scientific evidence suggests differing benefits of surveillance colonoscopy in a small timeframe.

Racial differences in delay of treatment for localized prostate cancer (CaP): A population-based study.

6037 Background: African-Americans (AA) are diagnosed with more advanced CaP than Caucasians (CA) and are more likely to die from CaP. Treatment delay is a potentially modifiable obstacle to care and clinically may be more important in AA patients because of more aggressive cancer at diagnosis. We examined time from diagnosis to curative treatment (surgery or radiation) in AA and CA patients in the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Methods: 21,454 CA and 2,506 AA patients who were diagnosed with non-metastatic CaP from 2004-08 and received treatment within 12 months of diagnosis were included. Linear regression was used to examine factors associated with number of days from diagnosis to treatment initiation, and logistic regression to assess odds of treatment within 6 months of diagnosis. Results: AA patients were more likely to have high-risk CaP than CA patients (39 vs. 35%), and less likely to have low-risk CaP (27 vs. 31%) (p&lt;.001). Time to treatment was significantly prolonged for AA patients in all risk groups of CaP, and the difference was most prominent for high-risk patients (median 105 days for AA vs. 96 days for CA, p=.002). Racial differences in time to treatment persisted in multivariable analysis (Table). Sensitivity analyses examining the proportion of AA and CA patients initiating treatment within 6 months of diagnosis revealed similar results. Conclusions: AA patients, especially those with high-risk CaP, experience longer treatment delays than CA patients. This is the first large-scale study to examine treatment delays in AA and CA patients with CaP. The differences found may contribute to our understanding of racial disparities in CaP treatment outcomes. [Table: see text]

Racial Differences in the Consequences of Childhood Maltreatment for Adolescent and Young Adult Depression, Heavy Drinking, and Violence

This study examined racial differences in the consequences of childhood maltreatment for depression, heavy drinking, and violence during adolescence and young adulthood among black and white young men. Data were obtained from the Pittsburgh Youth Study, a prospective longitudinal study of urban males (N = 971, 56% black). Childhood maltreatment was defined as substantiated physical or sexual abuse, physical neglect, emotional maltreatment, or moral/legal/educational maltreatment, with the first referral before 12 years of age. Self-reports of depressive symptoms and heavy drinking (consuming more than six drinks on a single occasion) and official, parent, and self-reports of violent offending were assessed between 12 and 17 years of age (adolescence) and at 24/25 years of age (young adulthood). Regression analyses were conducted to examine childhood maltreatment and race, as well as maltreatment-by-race interactions, as predictors of the three outcomes. Prevalence of childhood maltreatment was higher for black than for white boys; however, there were no racial differences in timing, type, severity, and chronicity of maltreatment. When socioeconomic status and cohort were controlled, childhood maltreatment significantly predicted depressive symptoms and violence in adolescence but none of the outcomes in young adulthood. Race was a significant predictor of heavy drinking and violence during adolescence, and of all three outcomes in young adulthood. No significant race-by-maltreatment interaction effects were found. Childhood maltreatment has similar negative consequences for black and white male youth during adolescence. Extending intervention efforts through adolescence is important to alleviate these problems among victims.

Testing for Racial Prejudice in the Parole Board Release Process: Theory and Evidence

We develop a model of a Parole Board contemplating whether to grant parole release to a prisoner who has finished serving their minimum sentence. The model implies a simple outcome test for racial prejudice robust to the inframarginality problem. Our test involves running simple regressions of whether a prisoner recidivates on the exposure time to the risk of recidivism and its square, using only the sample of prisoners who are granted parole release strictly between their minimum and maximum sentences and separately by race. If the coefficient estimates on the exposure time term differ by race, then there is evidence of racial prejudice against the racial group with the smaller coefficient estimate. We implement our test for prejudice using data from Pennsylvania from January 1996 to December 31, 2001. Although we find racial differences in time served, we find no evidence for racial prejudice on the part of the Parole Board based on our outcome test.

Testing for Racial Prejudice in the Parole Board Release Process: Theory and Evidence

We develop a model of a Parole Board contemplating whether to grant parole release to a prisoner who has finished serving their minimum sentence. The model implies a simple outcome test for racial prejudice robust to the inframarginality problem. Our test involves running simple regressions of whether a prisoner recidivates on the exposure time to the risk of recidivism and its square, using only the sample of prisoners who are granted parole release strictly between their minimum and maximum sentences and separately by race. If the co- efficient estimates on the exposure time term differ by race, then there is evidence of racial prejudice against the racial group with the smaller coefficient estimate. We implement our test for prejudice using data from Pennsylvania from January 1996 to December 31, 2001. Although we find racial differences in time served, we find no evidence for racial prejudice on the part of the Parole Board based on our outcome test.

Variations in time to receiving first surgical treatment for breast cancer as a function of racial/ethnic background

6566 Background: Multiple studies have shown differences in the type of breast cancer treatment received, related to race/ethnicity or socioeconomic status. This study investigates racial disparities in time to receiving first surgical treatment (i.e., surgical delay) in patients with breast cancer. Methods: Patients admitted at two affiliated hospitals for breast cancer treatment during 2001- 2006 were identified. Time to receiving surgery or surgical delay was defined as the time in days between diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Unadjusted comparisons between racial/ethnic groups were made using the Kruskal-Wallis Test (KW). A multivariate linear regression model was used to predict the natural logarithm of time to receiving surgery by racial/ethnic group. Adjustments were made for several factors including age, diagnosis year, AJCC stage, type of surgery, hospital, number of comorbidities and insurance status. Results: 2,845 patients who were first treated with surgery were identified. Racial background was classified as White, African American, or Asian/Other. Average age was 58.7 years (SD = 13.5). Overall median time to surgery was 16.5 days; 15.5 days in whites, 22.5 and 19.5 days in African Americans and Asian/others, respectively (p = 0.002, by KW). Multivariate linear regression analyses (table) showed that only African Americans, not Asian/others, had significantly increased surgical delay compared to whites (p = 0.001). Surgical delay also significantly increased with older age, more recent diagnosis year (not shown), mastectomy vs. lumpectomy, and for patients without comorbid conditions. Higher AJCC stage was also variably related to surgical delay. No statistically significant relationship to surgical delay was observed for either hospital or insurance status. Conclusions: This study demonstrates racial differences in time to first surgical treatment in a group of ethnically diverse breast cancer patients. Factor Mean or % Beta 95% CI p-value Race group (vs. White) African American 5.4% 0.50 (0.20,0.81) 0.001 Asian/Other 4.5% 0.05 (-0.29,0.38) 0.79 Age (per 10 years) 58.7 0.08 (0.03,0.13) 0.003 AJCC stage: 2 (vs. 0 or 1) 27.7% 0.15 (-0.01,0.32) 0.059 AJCC stage 3+ (vs. 0 or 1) 7.9% 0.28 (0.01,0.55) 0.042 Surgery type (mast. vs. lump.) 37.5% 0.33 (0.18,0.48) <0.001 Insurance (yes vs. no) 96.6% -0.19 (-0.71,0.33) 0.48 At least one comorbidity (vs. none) 31.5% -0.29 (-0.49,-0.09) 0.004 Model includes intercept (not shown) No significant financial relationships to disclose.

Differential delays in breast cancer treatment as a function of racial/ethnic background

17023 Differential delays in breast cancer treatment as a function of racial/ethnic background Background: Multiple studies have identified differences in breast cancer treatment and outcome due to racial/ethnic and socioeconomic factors. The purpose of this study was to investigate treatment disparities, both actual and temporal (i.e. time delay), in patients newly diagnosed with breast cancer as a function of racial/ethnic background. Methods: Patients at two affiliated hospitals newly diagnosed with breast cancer were identified and classified from discharge billing data. Time to treatment was defined as the time in days between biopsy proven diagnosis and initiation of treatment including chemotherapy, radiation therapy, lumpectomy and mastectomy. Nonparametric Analysis of Variance (ANOVA) using the Kruskal-Wallis Test examined differences between race groups based on median time to treatment. Types of treatment were analyzed by the Chi-Square test. Results: A total of 1217 patients were identified over a five-year period. Racial background was classified as White, African American, or Asian/Other. Lumpectomy was performed in 47%, 41%, and 38%, respectively (p = 0.15), while 24%, 23%, and 18% received a mastectomy (p = 0.51). There were no significant differences between the racial groups for types of therapy received. Results from ANOVA (table) showed statistically significant differences between the three race groups in terms of time to mastectomy (p = 0.003) and time to radiation therapy (p=0.043). Results from pairwise comparisons showed that (1) African American patients had a significantly longer time to mastectomy than Whites (p = 0.002), (2) patients in the Asian/Other group had a significantly longer time to radiation than their white counterparts (p = 0.015). Conclusion: This study demonstrates racial differences in time to non-surgical and surgical treatment in a group of ethnically diverse breast cancer patients. [Table: see text] No significant financial relationships to disclose.

291: Racial Differences in Timing of Presentation and Salvage Rates of Acute Testicular Torsion

You have accessJournal of UrologyPodium 8, Sunday, May 20, 2007, 10:00 am - 12:00 pm1 Apr 2007291: Racial Differences in Timing of Presentation and Salvage Rates of Acute Testicular Torsion Ervin Teper and Mark Horowitz Ervin TeperErvin Teper More articles by this author and Mark HorowitzMark Horowitz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30556-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "291: Racial Differences in Timing of Presentation and Salvage Rates of Acute Testicular Torsion." The Journal of Urology, 177(4S), pp. 97–98 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 97-98 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Ervin Teper More articles by this author Mark Horowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

Early Menarche: A Review of Research on Trends in Timing, Racial Differences, Etiology and Psychosocial Consequences

This paper elucidates varying definitions of “early menarche” and reviews evidence in four well-documented areas: (a) A potential trend toward earlier maturation, (b) racial differences in menarcheal timing, (c) etiology of early puberty, and (d) consequences of early puberty. While teachers and physicians perceive menarche as occurring earlier than in the past, mean menarcheal age has remained relatively constant over the past 50 years. Conflicting results concerning racial differences in timing highlight the need for further research to unravel the effects of race and social economic status (SES). Evidence regarding the relative etiological contributions of nutrition, environmental stress, and genetics is evaluated. Maturing earlier than one’s peers has negative consequences for girls, especially when combined with simultaneous stressors. However, the negative psychosocial consequences of early puberty may not last into later adolescence or adulthood. Few studies have investigated early-maturing adolescents’ subjective experience with menarche, particularly those from non-white and non-middle-class backgrounds.

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery. This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year. Inpatient data came from medical record reviews; follow-up data came from telephone interviews at 1, 6, and 12 months after stroke. The study included consecutive acute ischemic or intracerebral hemorrhagic stroke patients from 9 VA medical centers. The main outcome measures were time to initiation of inpatient rehabilitation services and ability to perform activities of daily living. There were no racial differences in receipt of inpatient rehabilitation services (blacks, 76%; whites, 70%) or in the proportion of patients referred within 3 days of admission (blacks, 43.5%; whites, 42.0%). Among patients who experienced delay in initiation of rehabilitation, only low-income blacks experienced worse functional recovery over 12 months. Low-income black stroke patients who experience delay in initiation of inpatient rehabilitation have a worse trajectory of functional recovery in the first year after stroke. Poverty-associated factors in the postdischarge setting may explain this phenomenon.

Racial Differences in Timing and Factors Associated with Retirement

Racial Differences in Timing and Factors Associated with Retirement