Racial Discrepancies Research Articles

Racial discrepancies in initial presentation and diagnosis of patients with endometrial cancer.

89 Background: Endometrial cancer incidence and mortality are increasing, particularly in Black patients who have more aggressive non-endometrioid subtypes. Racial disparities in mortality may be partially contributable to early clinical factors including recognition of symptoms, type of evaluation, and referral timing. We evaluated differences in factors related to symptom appraisal and delays in diagnosis by race and histology. Methods: In this retrospective cohort study, we included patients diagnosed with endometrial cancer from 01/01/2019 to 09/01/2023 at a single institution who were enrolled in the Discovery and Evaluation of Testing for Endometrial Cancer in Tampons (DETECT) study. Demographic characteristics and factors regarding initial presentation and workup were obtained from the electronic medical record. We evaluated patient-reported length and type of symptoms at initial presentation, diagnostic imaging type, and time from initial presentation to time of imaging, tissue sampling, and referral to gynecologic oncology. We assessed differences by race and histology (endometrioid vs. non-endometroid) using chi-square and Kruskal-Wallis tests and analysis of variance. Results: Of the 335 patients included in our analysis, 237 (70.7%) had endometrioid and 98 (29.3%) had non-endometrioid histology. Patients with endometrioid histology were significantly more likely to be younger, White, non-smokers, and have higher obesity levels by body mass index than those with non-endometrioid histology (p=<0.01). The length of symptoms at time of initial presentation was significantly longer in Black patients overall (p=0.01) and in Black patients with endometrioid histology compared to their White counterparts (p=0.04). A similar trend was seen in patients with non-endometrioid histology but was not statistically significant (p=0.15). There was no difference in type of symptoms reported. The type of imaging (p=0.005) differed significantly between endometrioid and non-endometrioid groups. White patients were more likely to have a transvaginal ultrasound performed at initial presentation (p=0.004). Black patients with endometrioid endometrial cancer were more likely to have a longer time period from initial presentation to referral to gynecologic oncology (p=0.04) despite having a shorter time between initial presentation and endometrial sampling (p=0.04). Conclusions: In our cohort, Black patients with endometrial cancer were more likely to have experienced symptoms for a longer time period prior to presentation, less likely to be evaluated with transvaginal ultrasound, and had a longer time period between initial presentation and referral to gynecologic oncology compared to White patients. Raising awareness and targeting these early steps in evaluation and detection of endometrial cancer may help decrease racial disparities in outcomes.

Motor vehicle traffic fatalities by race and ethnicity (2010 – 2021)

Motor vehicle traffic fatalities (MVTFs) are a public health issue that substantially affects the growing Black or African American, Indigenous, and People of Color (BIPOC) population. To further understand the racial discrepancies that exist in MVTFs, data from the Fatality Analysis Reporting System (FARS) and U.S. Census were utilized to explore factors such as rurality, urbanicity, restraint use, and alcohol-impairment. Calculations considered yearly driver and occupant fatality rates per 100,000 population for each race and ethnicity from 2010 through 2021. A Poisson regression model was used to quantify the relationship between the MVTF rates and the factors of interest. Results demonstrated that the American Indian or Alaska Native population was statistically the most overrepresented group in fatality rates across all factors explored. Additionally, the American Indian or Alaska Native population and Black or African American populations were the only groups to have statistically significant increases in fatality rates in recent years when accounting for factors such as unrestrained vehicle driver/occupants and alcohol-impaired fatality rate. In contrast, the Native Hawaiian or Pacific Islander population has consistently experienced one of the largest statistically significant reductions in driver and occupant fatality rates over time. Further analysis is necessary to develop and implement countermeasures that may reduce the increasing fatality rates of the most vulnerable populations while continuing to decrease rates for others as well. Despite limitations of FARS and population data, these results provide a pathway to reducing MVTFs and associated racial inequities that exist in the nation, particularly as the BIPOC population continues to grow.

Undergraduate Students’ Confidence in Scientific Activity and Support Systems Based on Diversity in an Environmental Science Course

Undergraduate student support systems and individual confidence in science courses have been linked to better academic performance among college students. As the topics of diversity and inclusion continue to draw the attention of the collegiate, the problem of equity surrounding supportive learning environments for all races in higher education comes into focus. This paper adds to the literature by highlighting the importance of adequate support for students in collegiate settings. Disparities in student support and confidence with scientific activities among students of color (SOC) and white students in an undergraduate environmental science course had been evaluated. Students (n = 235) were asked to complete a Qualtrics survey containing questions focused on evaluating support from parents, siblings, close relatives, friends, peers, classmates, and professors and confidence regarding self-efficacy in learning and doing scientific activities. The perceived support and confidence in scientific activities in white students and SOC were measured using an independent T-test. The findings demonstrated that white students may have had access to stronger support systems and had higher perceived confidence levels in completing scientific activities based on survey responses. On average, white students had greater perceived support and more confidence. As a result, higher dropout rates, lower performance overall, and alienation of these students in higher education environments could occur. If this trend continues, racial discrepancies suggest that students of color need stronger support networks related to scientific activities in higher education settings. KEYWORDS: Student Support; Student Scientific Confidence; STEM Confidence; Students of Color; Academic Support; Undergraduate Student; Family Support; Student Peers

Large language models to evaluate racial discrepancies in performance status assignment.

1561 Background: Oncologic treatment eligibility relies heavily on “Performance Status” (PS), a subjective gauge of a patient's overall health. Despite frameworks aimed at quantifying PS, these assessments remain prone to potential bias. A systematic evaluation of discrepancies in language between ECOG PS and race has yet to be conducted. Large language models (LLMs) have the ability to synthesize text and may enable an assessment of the relationship between race, note text, and physician-documented PS. We hypothesize that LLMs can quantify these relationships to understand potential inconsistencies in ECOG PS. Methods: In our single-institution cohort study, we examined patients from medical or radiation oncology clinics between January 2012 to December 2023 with documented ECOG PS. PS was extracted from clinical notes and redacted from downstream analyses. Notes were categorized by patient-reported race (Asian, Black, White, Other). 1,500 matched subjective assessments (from oncologist clinical notes) and PS were randomly sampled for each race, except for Black patients, where only 640 entries were available. We divided training and test sets using an 80-20 ratio across each race. Using the training cohort, we trained race-specific models to assign ECOG PS based on subjective assessment, using two LLMs: UCSFBERT (BERT pretrained on UCSF data) and RoBERTa. In the hold-out test sets, we applied each model across all races to assign ECOG PS based on subjective assessments. These were evaluated by micro-F1 (model accuracy) and Multiway ANOVA to compute model-specific p-values. Results: 13.6% of patients had a documented ECOG 2+, with variation across races (Asian: 16.1%, Black: 17.7%, White: 7.7%, Other: 15.3%). Models tended to assign Black patients with ECOG 0-1 with worse performance status (ECOG 2+). Other than RoBERTa models trained on Asian and White cohorts, all models trained on a specific race showed disparate classification results when applied to other races (out-of-domain), highlighting potential biases in LLM models trained where a specific race predominates (Table; ANOVA). Conclusions: This study demonstrates a novel way to use LLM to assess discordance within physician documentation and performance status assignment. It underscores the need for incorporating diverse demographic data when using LLM in medical contexts. This research has potential to dissect how bias may be propagated within physician practice and provide insight into known disparities in clinical trial enrollment and standard of care implementation.[Table: see text]

Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms.

The impact of race on outcomes in the treatment of intracranial aneurysm (IA) remains unclear. We aimed to investigate the relationship between race classified into White, Black, Hispanic, and other and treatment outcomes in patients with ruptured and unruptured IAs. The study population consisted of 2836 patients with IA with endovascular treatment or microsurgical treatment (MST) from 16 centers in the United States and Asia, all participating in the observational "STAR" registry. The primary outcome was a 90-day modified Rankin Scale of 0 to 2. Secondary outcomes included periprocedural cerebral infarction and intracranial hemorrhage, perioperative symptomatic cerebral vasospasm in ruptured IA and mortality, and all causes of mortality within 90 days. One thousand fifty-three patients were White (37.1%), 350 were Black (12.3%), 264 were Hispanic (9.3%), and 1169 were other (41.2%). Compared with White patients, Hispanic patients had a significantly lower proportion of primary outcome (adjusted odds ratio [aOR] 0.36, 95% CI, 0.23-0.56) and higher proportion of the periprocedural cerebral infarction, perioperative mortality, and all causes of mortality (aOR 2.53, 95% CI, 1.40-4.58, aOR 1.84, 95% CI, 1.00-3.38, aOR 1.83, 95% CI, 1.06-3.17, respectively). Outcomes were not significantly different in Black and other patients. The subgroup analysis showed that Hispanic patients with age ≥65 years (aOR 0.19, 95% CI, 0.10-0.38, interaction P = .048), Hunt-Hess grades 0 to 3 (aOR 0.29, 95% CI, 0.19-0.46, interaction P = .03), and MST (aOR 0.24, 95% CI, 0.13-0.44, interaction P = .04) had a significantly low proportion of primary outcome. This study demonstrates that Hispanic patients with IA are more likely to have a poor outcome at 90 days after endovascular treatment or MST than White patients. Physicians have to pay attention to the selection of treatment modalities, especially for Hispanic patients with specific factors to reduce racial discrepancies.

Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review.

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.

Differential preferences in breast aesthetics by self-identified demographics assessed on a national survey

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon’s practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents’ impressions of “breast attractiveness.” Respondents were asked to rate breasts on a Likert scale. Survey responses were analyzed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p<0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R=0.940; p<0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p<0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p<0.001), but not Black or African American individuals (2.7 vs 2.4, p=0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations.

Abstract B064: Racial disparities in bone and soft-tissue sarcomas: An analysis of the Surveillance, Epidemiology, and End Results program

Abstract Introduction Bone and soft-tissue sarcomas comprise a broad yet heterogenous group of malignancies, separately classified into at least 70 different histological diseases. In the United States, approximately 15,000 cases of bone and soft-tissue sarcomas are annually diagnosed, roughly representing 1% of all incident cancer diseases. Health disparities exist for cancer patients of different racial identities, but research on patients with soft-tissue and bone sarcomas is still debatable. This analysis elucidates racial discrepancies in epidemiological measures among patients with such diseases. Methods The Surveillance, Epidemiology, and End Results database was queried between 2000 and 2020 for patients with bone or soft-tissue sarcomas. Metrics, consisting of prevalence, incidence, and incidence-based mortality rates, as well as case-fatality ratios were computed. Multivariate survivorship analyses controlling for age, sex, race, tumor size, stage, and grade were performed to identify independent predictors of survival. Results The most and least frequently diagnosed subtypes of bone and soft-tissue sarcomas were leiomyosarcoma and lymphangiosarcoma with an average of 889.6 and 1.3 cases per year, respectively. Malignancies were all primarily identified in White patients compared to subjects of other races. From 2000 to 2020, the prevalence of fibrosarcoma significantly increased for non-White and non-Black individuals and the prevalence of dermatofibrosarcoma decreased only for White individuals (both, p&amp;lt;0.05). Incident cases of dermatofibrosarcoma decreased for White patients and the general population but increased for Black patients and those of other races (p&amp;lt;0.001). Incident cases of synovial sarcoma, on the other hand, declined only among Black individuals (p&amp;lt;0.001). Incidence-based mortality rates increased significantly among patients with almost all bone and soft-tissue sarcomas but declined among Black individuals with fibrous histiocytoma (both, p&amp;lt;0.001). Multivariate survivorship analysis showed that Black individuals experienced worse survival compared to White individuals with clear cell sarcoma, hemangiosarcoma, leiomyosarcoma, and synovial sarcoma. Individuals of other races with clear cell sarcoma, hemangiosarcoma, and leiomyosarcoma experienced worse survival compared to White patients with these diseases. Conclusion Current literature has not delineated the impact of demographic factors like race and ethnicity on prevalence, incidence, mortality, and survivorship of patients with bone and soft-tissue sarcomas. Racial discrepancies exist among patients with various subtypes of bone and soft-tissue sarcoma. More exploration into social determinants of health is necessary to understand how race plays a role in the epidemiology of these cancers. Citation Format: Marc El Beaino, Rachel Baum, Karim Masrouha, Patrick P. Lin. Racial disparities in bone and soft-tissue sarcomas: An analysis of the Surveillance, Epidemiology, and End Results program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B064.

Racial Discrepancies in the Use of Stigmatizing Language Is Evident in Hematology/Oncology Electronic Medical Records

Healthcare inequities are often attributed to large-scale structural barriers for access to medical care or patient-medical staff interactions. However, the role of the electronic medical record (EMR) in perpetuating hidden biases has been poorly characterized. This passive form of sharing implicit biases with unknown readers may have profound ripple effects asynchronous in place and time from the note writer. This study aims to illustrate racial imbalances in ad hominem patient characterizations as documented by medical staff, regardless of role, in a large metro healthcare system. The use of certain potentially stigmatizing language in emergency department (ED) and inpatient notes for hematology/oncology patients was investigated. Retrospective chart review of four hospitals within a university network in a major metro area between 1/1/2019 - 6/30/2021 was undertaken. Patients ≥22 years old were included with two primary hypotheses in mind: 1) Negative terms are used more frequently for underrepresented minorities, and 2) words with shock value (i.e. curse words) are used more often than more general descriptors of these terms (e.g. “cursing” or “profanity”). Nine positive and twelve negative terms were evaluated, based on the authors' observations of their use in the EMR in past encounters (Table 1). Some were personal descriptors in which the ED or inpatient note writer would be less likely than outpatient providers to have a full sense of outpatient care or social determinants of health (e.g. compliant). Others were behavioral descriptions (e.g. hostile) or words with minimal medical relevance (e.g. curse words). If multiple notes in an encounter included the same word(s), the encounter was only analyzed once for each word to avoid word count inflation, though re-occurrences for the same patient in subsequent encounters were counted. Authors' manual data review using natural language processing software confirmed appropriate use of terms. Generalized estimating equations were used for race-based comparisons to account for same-patient clustered encounters. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for self-reported demographic comparisons with White as the reference category. P≤0.05 was considered significant. A total of 1,059 encounters for 889 hematology/oncology patients were analyzed. Mean age was 61 years (standard deviation 16.7) and 49.4% were female. White race was reported for 80.2% of patients (72% system-wide prevalence during same timeframe) and Black for 11.4% (15.2% system-wide); all others were ≤4% so only White/Black comparisons were included. Positive terms were more prevalent than negative ones (n=535 vs 459). However, negative terms were found more often for Black individuals (OR 2.24, CI 1.41 - 3.56, P&amp;lt;0.001), while the positive terms were less frequently documented in Black patients relative to White patients (OR 0.51, CI 0.33 - 0.77, P=0.001), and neither category was concordant with the overall patient racial demographics. Other significant racial differences existed for the terms “Argumentative”, “Disrespectful”, “Noncompliant”, and “Polite”, all discrepancies which favored White patients (Table 2). Specific curse words were documented nearly as often as “cursing”, “swearing”, or “profanity”, but no racial differences were observed. Some words in the initial search (“Brave”, “Courageous”, “Empathetic”, and “Ambitious”) were not found in hematology/oncology notes in this timeframe. EMR documentation in hospital-based hematology/oncology care demonstrated evidence of racial discrepancies in language that may carry stigma, positively or negatively. Importantly, many of these terms have questionable, if any, medical relevance. The use of stigmatizing terminology in the EMR may reflect implicit biases that extend past the direct patient encounter, passively and subconsciously prejudicing future care from other staff members. Time-saving heuristics and documentation shortcuts like copy-forwarding may further ossify healthcare inequities. This phenomenon is undoubtedly not limited to this hospital system or the hematology/oncology field, but quantitative real-world evidence has been scant. Improved awareness of stigmatizing language in documentation may be one step towards mitigating this contributor to unequal care for hematology/oncology providers and their patients.

S88 Unveiling Racial Discrepancies in the Outcomes of Portal Vein Thrombosis Associated With Pancreatic Cancer in the United States

S88 Unveiling Racial Discrepancies in the Outcomes of Portal Vein Thrombosis Associated With Pancreatic Cancer in the United States

The credit they deserve: contesting predictive practices and the afterlives of red-lining

Racial capitalism depends on the reproduction of an existing racialized economic order. In this article, I argue that the disavowal of past injustice is a central way in which this reproduction is ensured and that market-based forms of knowledge production, such as for-profit predictive practices, play a crucial role in facilitating this disavowal. Recent debates about the fairness of algorithms, data justice, and predictive policing have intensified long-standing controversies, both popular and academic, about the way in which statistical and financial modes of accounting and predicting articulate, represent and produce ascriptive categories of hierarchically ordered social difference, and reproduce unjust social hierarchies and inequalities. These debates have productively problematized the racial lives of seemingly apolitical predictive technologies and demanded the re-politicization of predictive practices. What has been missing from these debates so far, however, is a more explicit engagement with ways in which anti-racist movements and activists themselves have contested the entanglements of prediction and race making. I turn to a recent prominent example, namely the contestation over racial discrepancies in subprime lending to examine how fair lending activists have conceptualized and troubled the reproduction of a racialized economic order through for-profit predictive practices in the decade before the Great Financial Crisis. I situate this particular example in the broader historical and political context of politicizing prediction that first emerged with the ascendancy of a liberal, individualist-proprietary conception of risk, and the political problem space to which this has given rise. My analysis shows that actuarial conceptions of fairness continue to reverberate in anti-racist contestations of for-profit predictive practices, and that they tend to marginalize and undercut more radical strands of critique of the racialization of financial markets. Insofar as these modalities of contestation implicitly reproduce a liberal, proprietary-individualist conception of risk, I argue, they fail to effectively challenge the quasi-alchemical transformation of injustice into personal responsibility, and thus contribute to the disavowal of past injustice.

Editorial: A closer examination of the racial discrepancies in ED cardiac care.

The undercurrent of racial disparities in healthcare is undeniable and remains pervasive despite concerted efforts to mitigate disparities in outcomes. This is well documented in a number of areas including access to care, pain management, as well as the evaluation and management of chest pain. The latest findings from the STOP-CP cohort study call attention yet again to an apparent gap in care between White and non-White patients in the ED evaluation of chest pain. While this is concerning, it also highlights an important question for us as clinicians to reflect upon. How do we interpret and assess disparities in clinical evaluation NOT seemingly associated with downstream disparities in outcomes?

Investigating the association between knee osteoarthritis symptoms with pain catastrophizing domains between Hispanics and non-Hispanic Whites.

Knee osteoarthritis (KOA) is a chronic disease accompanied by debilitating symptoms including pain, stiffness, and limited physical functionality, which have been shown to be associated with pain catastrophizing. Previous studies have revealed racial discrepancies in pain catastrophizing, notably between Hispanics and non-Hispanics while pointing to potential health disparities. Using a conceptual model, this study aimed to investigate racial differences in associations between KOA symptoms with specific pain catastrophizing domains (rumination, magnification, and helplessness). Patients with KOA (n = 253; 147 Hispanics, 106 non-Hispanic Whites) completed a survey that included measures of knee symptoms, pain catastrophizing, and demographic variables. Structural equation modeling revealed that among Hispanics, each pain catastrophizing domain (rumination, magnification, and helplessness) was associated with at least two symptomatic experiences, including pain severity and difficulty in physical function. Specifically, pain severity was associated with (a) rumination: β = 0.48, p < 0.001, (b) magnification: β = 0.31, p = 0.003; and (c) helplessness: β = 0.39, p < 0.001). Additionally, a lower score in physical function was associated with higher magnification (β = 0.26, p = 0.01), and helplessness (β = 0.25, p = 0.01). Among non-Hispanic White patients, pain severity was further associated with two domains of pain catastrophizing, including rumination (β = 0.39, p < 0.001) and helplessness (β = 0.35, p = 0.01). In addition, association pathways for demographic variables revealed that older Hispanics experienced greater challenges with higher pain severity (β = 0.26, p = 0.01) and greater difficulty with physical function (β = 0.31, p < 0.001) while Hispanics females experienced higher pain (β = 0.19, p = 0.03). These findings highlight the importance of designing tailored interventions that consider key demographic factors such as age, and gender, to improve physical function that might alleviate pain catastrophizing among Hispanics with KOA.

Differential Preferences in Breast Aesthetics by Self-identified Racial Demographics Assessed on a National Survey

Abstract Goals/Purpose Breast aesthetics are a highly discussed topic within plastic surgery. However, there is a paucity of literature examining how preferences differ amongst various demographic groups. The objective of this study was to assess how perceptions of the ideal breast differ between respondents stratified by self-identified race. Methods/Technique A cohort of 25 patients from the senior surgeons’ practices presenting for aesthetic or reconstructive breast surgery was assembled. This cohort was selected with the aim of choosing a sample that maximized diversity on the basis of breast size and shape, skin tone, and nipple-areola complex size and position. Pre-operative anteroposterior photographs from these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents’ impressions of “breast attractiveness.” Respondents were asked to rate breasts on a Likert scale of 1 to 5, with 1 being not at all attractive and 5 being most attractive. Survey responses were analyzed for differences in breast aesthetic preferences by race using ANOVA and t-tests where appropriate. Results/Complications A total of 1,021 survey responses were collected. The majority of survey respondents identified as White or Caucasian (73%). A total of 18% of individuals self-identified as Black or African-American, while 5% identified as Asian. The remaining 3% of respondents identified as Other, Native American, or selected multiple categories and groups were too small for cross-group comparison and were thus excluded. On average, individuals in the White or Caucasian group rated any given pair of breasts 8% more attractive than Black or African-American individuals and 14% more attractive than Asian individuals. ANOVA testing revealed significant differences amongst groups (p=0.014). Subgroup comparison revealed a significant difference between ratings of breast attractiveness between White or Caucasian individuals and Asian respondents (2.61 vs 2.25; p=0.002). Comparisons between White or Caucasian respondents and Black or African-American individuals were not significant (2.61 vs 2.40; p=0.06) as was the analysis between Black or African-American respondents and Asian individuals (2.40 vs 2.25; p=0.08). While these intergroup comparisons did not reach significance in the current sample, perhaps with a larger sample size a difference between these groups might be elucidated. Despite these racial discrepancies in breast attractiveness, regression analysis revealed that the ratings amongst each of the groups were highly correlated with one another: White or Caucasian and Black and African-American (R=0.68; R2=0.46; p&amp;lt;0.001), Black or African-American and Asian (R=0.72; R2=0.52; p&amp;lt;0.001), and White or Caucasian and Asian (R=0.86; R2=0.73; p&amp;lt;0.001). Conclusion In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by race. On average, White or Caucasian respondents rated a given pair of breasts as more aesthetically pleasing than Black or African-American and Asian counterparts. While this difference was observed, it is important to note that ratings amongst racial groups were highly correlated with one another across all photographs presented. In other words, while Black or African-American and Asians rated breasts lower than their White or Caucasian counterparts, relative attractiveness for the breasts amongst groups paralleled one another. While self-identified racial groups rated the breasts similar relative to one another, there were distinct differences in numerical ratings that may be reflective of broader, more generalized sentiments and preferences that were not able to be captured by our survey instrument. These findings merit further investigation to understand these trends and observations. Doing so will enable plastic surgeons to have a better understanding of patient preferences and expectations when seeking reconstructive or aesthetic breast surgery and thereby improve patient satisfaction.

MP75-10 SURVIVAL OUTCOMES BY RACE FOLLOWING MINIMALLY INVASIVE SURGICAL TREATMENT FOR UPPER TRACT UROTHELIAL CARCINOMA: AN ANALYSIS OF THE ROBUUST REGISTRY

MP75-10 SURVIVAL OUTCOMES BY RACE FOLLOWING MINIMALLY INVASIVE SURGICAL TREATMENT FOR UPPER TRACT UROTHELIAL CARCINOMA: AN ANALYSIS OF THE ROBUUST REGISTRY

Artificial Intelligence for the Classification of Pigmented Skin Lesions in Populations with Skin of Color: A Systematic Review

Background: While skin cancers are less prevalent in people with skin of color, they are more often diagnosed at later stages and have a poorer prognosis. The use of artificial intelligence (AI) models can potentially improve early detection of skin cancers; however, the lack of skin color diversity in training datasets may only widen the pre-existing racial discrepancies in dermatology. Objective: The aim of this study was to systematically review the technique, quality, accuracy, and implications of studies using AI models trained or tested in populations with skin of color for classification of pigmented skin lesions. Methods: PubMed was used to identify any studies describing AI models for classification of pigmented skin lesions. Only studies that used training datasets with at least 10% of images from people with skin of color were eligible. Outcomes on study population, design of AI model, accuracy, and quality of the studies were reviewed. Results: Twenty-two eligible articles were identified. The majority of studies were trained on datasets obtained from Chinese (7/22), Korean (5/22), and Japanese populations (3/22). Seven studies used diverse datasets containing Fitzpatrick skin type I–III in combination with at least 10% from black Americans, Native Americans, Pacific Islanders, or Fitzpatrick IV–VI. AI models producing binary outcomes (e.g., benign vs. malignant) reported an accuracy ranging from 70% to 99.7%. Accuracy of AI models reporting multiclass outcomes (e.g., specific lesion diagnosis) was lower, ranging from 43% to 93%. Reader studies, where dermatologists’ classification is compared with AI model outcomes, reported similar accuracy in one study, higher AI accuracy in three studies, and higher clinician accuracy in two studies. A quality review revealed that dataset description and variety, benchmarking, public evaluation, and healthcare application were frequently not addressed. Conclusions: While this review provides promising evidence of accurate AI models in populations with skin of color, the majority of the studies reviewed were obtained from East Asian populations and therefore provide insufficient evidence to comment on the overall accuracy of AI models for darker skin types. Large discrepancies remain in the number of AI models developed in populations with skin of color (particularly Fitzpatrick type IV–VI) compared with those of largely European ancestry. A lack of publicly available datasets from diverse populations is likely a contributing factor, as is the inadequate reporting of patient-level metadata relating to skin color in training datasets.

Arteriovenous Graft Failure in the Veterans Health Administration: Outcome Disparities Associated with Race.

Background Vascular access for ongoing hemodialysis often fails, frequently requiring repeated procedures to maintain vascular patency. While research has shown racial discrepancies in multiple aspects of renal failure treatment, there is poor understanding of how these factors might relate to vascular access maintenance procedures after arteriovenous graft (AVG) placement. Purpose To evaluate racial disparities associated with premature vascular access failure after percutaneous access maintenance procedures following AVG placement using a retrospective national cohort from the Veterans Health Administration (VHA). Materials and Methods All hemodialysis vascular maintenance procedures performed at VHA hospitals between October 2016 and March 2020 were identified. To ensure the sample represented patients who consistently used the VHA, patients without AVG placement within 5 years of their first maintenance procedure were excluded. Access failure was defined as a repeat access maintenance procedure or as hemodialysis catheter placement occurring 1-30 days after the index procedure. Multivariable logistic regression analyses were performed to calculate prevalence ratios (PRs) measuring the association between hemodialysis maintenance failure and African American race compared with all other races. Models controlled for vascular access history, patient socioeconomic status, and procedure and facility characteristics. Results In total, 1950 access maintenance procedures in 995 patients (mean age, 69 years ± 9 [SD], 1870 men) with an AVG created in one of 61 VHA facilities were identified. Most procedures involved African American patients (1169 of 1950, 60%) and patients residing in the South (1002 of 1950, 51%). Premature access failure occurred in 215 of 1950 (11%) procedures. When compared with all other races, African American race was associated with premature access site failure (PR, 1.4; 95% CI: 1.07, 1.43; P = .02). Among the 1057 procedures in 30 facilities with interventional radiology resident training programs, there was no evidence of racial disparity in the outcome (PR, 1.1; P = .63). Conclusion African American race was associated with higher risk-adjusted rates of premature arteriovenous graft failure after dialysis maintenance. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Forman and Davis in this issue.

Carnegie and Rockefeller's Philanthropic Legacy: Exclusion of African Americans From Medicine.

In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller's General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller's philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.

Racial and incident discrepancies in news media reporting of sudden unexpected infant death (SUID)

BackgroundRegardless of injury prevention and outreach efforts, there continue to be low rates of adherence with the American Academy of Pediatrics (AAP) safe sleep recommendations. Media is an important tool for parental education and may influence risk perception and caregiver choices. Due to media reports potentially serving as an opportunity for shaping social norms, caregiver education and injury prevention, an evaluation was undertaken to evaluate Georgia local news reporting of sudden unexpected infant death (SUID) as compared to drownings, homicides, and firearm injuries. Our objective was to evaluate incident and racial discrepancies in Georgia news media reporting of SUID as compared to other pediatric injury deaths.ResultsDespite its high incidence, SUID was far less commonly mentioned in the news media, with only 1.9% (10/525) mentioned as compared to 8.1% of drownings (17/211), 11.4% (74/649) of MVC’s, 14.7% (59/402) of homicides between ages 1–18, 20% (11/55) of fire-related deaths and 25% (15/59) of homicides under age one (infant homicides). Across SUID and homicide, deaths of White infants were reported in the news media at 2.5 times the rate of Black infants.ConclusionDespite SUID being a leading cause of infant death, it is infrequently mentioned in the news media. When mentioned, the news media are more likely to highlight the deaths of White infants as compared to Black infants, though the incidence rate of SUID is higher in Black infants as compared to White.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.