Racial Disparities In Access Research Articles

A Fare Share: A Proposed Solution to Address the Racial Disparity in Access to Public Transportation Funding in America

Black American households are up to six times less likely to own a car than white families and are four times more likely to rely on public transportation to meet their daily needs. Despite this, communities of color have seen consistent disinvestment in their transit infrastructure. Four hundred years of continued housing segregation combined with post-recession austerity policies and ongoing pro-automobile bias has exacerbated this disparity. This Note proposes a straightforward legislative tool to begin to combat this inequity. The proposed legislation would require that urbanized areas spend their public transit dollars according to the population density of the communities a given project would serve, create reporting requirements related to the racial and economic impact of transit projects, and establish a private right of action. In proposing this legislation, this Note evaluates the state of civil rights litigation as it pertains to transportation racism and draws lessons from other areas such as environmental law in order to put forth a simple solution that would have tangible effects across the country in both the short and long term.

Regional, Racial, and Mortality Disparities Associated With Neurosurgeon Staffing at Level I Trauma Centers.

Traumatic brain injury (TBI) occurs in approximately 30% of trauma patients. Because neurosurgeons hold expertise in treating TBI, increased neurosurgical staffing may improve patient outcomes. We hypothesized that TBI patients treated at level I trauma centers (L1TCs) with ≥3 neurosurgeons have a decreased risk of mortality vs. those treated at L1TCs with <3 neurosurgeons. The Trauma Quality Improvement Program database (2010-2016) was queried for patients ≥18 years with TBI. Patient characteristics and mortality were compared between ≥3 and <3 neurosurgeon-staffed L1TCs. A multivariable logistic regression analysis was used to identify risk factors associated with mortality. Traumatic brain injury occurred in 243438 patients with 5188 (2%) presenting to L1TCs with <3 neurosurgeons and 238250 (98%) to L1TCs with ≥3 neurosurgeons. Median injury severity score (ISS) was similar between both groups (17, P = .09). There were more Black (37% vs. 12%, P < .001) and Hispanic (18% vs. 12%, P < .001) patients in the <3 neurosurgeon group. Nearly 60% of L1TCs with <3 neurosurgeons are found in the South. Mortality was higher in the <3 vs. the ≥3 group (12% vs. 10%, P < .001). Patients treated in the <3 neurosurgeon group had a higher risk for mortality than those treated in the ≥3 neurosurgeon group (odds ratio (OR) 1.13, 95% confidence intervals (CI) 1.01-1.26, P = .028). There exists a significant racial disparity in access to neurosurgeon staffing with additional disparities in outcomes based on staffing. Future efforts are needed to improve this chasm of care that exists for trauma patients of color.

Racial Disparities in Access to and Utilization of Jail- and Community-Based Mental Health Treatment in 8 US Midwestern Jails in 2017.

Objectives. To examine the dual disproportionality that individuals with serious mental illness and people of color (PoC) occupy in the criminal-legal system.Methods. This study follows a cohort of 623 individuals who screened positive for mental health issues at booking in 8 Midwestern jails in 2017. We followed individuals through the jails' practices of jail-based mental health treatment, and we used Medicaid billing data to assess community-based behavioral health treatment engagement in the postyear period after jail release. The aim was to examine if an individual's race/ethnicity was associated with their access to jail- and community-based mental health treatment.Results. We did not find any racial disparities in jail-based treatment, although 3 community-based outcomes significantly differed. Compared with PoC, White people had 1.9 times greater odds of receiving community-based mental health and substance use treatment and 4.5 times greater odds of receiving co-occurring disorder treatment.Conclusions. Barriers that individuals released from jail face adversely affect PoC, resulting in reduced access to treatment. Critical race theory can expose the assumptions and functions of systems of care and the possible reproduction of implicit bias in potential solutions.

What's Important: Take a Knee: Our Collective Responsibility to Dismantle Systemic Racism.

What's Important: Take a Knee: Our Collective Responsibility to Dismantle Systemic Racism.

United States Medicaid home and community-based services for people with intellectual and developmental disabilities: A scoping review.

Emerging research tests the impact of United States Medicaid home and community-based (HCBS) waiver policy on outcomes for people with intellectual and developmental disabilities; however, this body of work has yet to be synthesized. We conducted a scoping review to establish what is known about the impact of Medicaid HCBS policy on the lives of people with intellectual and developmental disabilities. Seven studies met final inclusion criteria. Their findings contribute to preliminary evidence that Medicaid HCBS waivers provide economic benefit at the state and federal level, reduce unmet healthcare needs, increase the likelihood that parents will be able to continue working, and reduce racial disparities in access to care. Additional work should compare HCBS waiver programmes, and their causal pathways, as well as draw international comparisons to similar programming, to determine essential infrastructure needed for a successful HCBS programme.

Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has created a devastating public health crisis, posing significant challenges for health care delivery in the US. The changes that the health care system implemented and the changes in the provision of social services have impacted efforts to address the ongoing opioid epidemic, and may worsen existing racial/ethnic and socioeconomic disparities in access to treatment for opioid use disorder (OUD). Pre-COVID-19, research overlooked and the media excluded from its coverage the racial disparities in access to medications for OUD (MOUD) and the increasing rates of opioid overdoses in Black communities surrounding the opioid epidemic (James & Jordan, 2018).

The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction.

IntroductionAfter having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act’s expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI.MethodsQuasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010–2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18–64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality.ResultsA total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality.ConclusionsThe Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.

Geographic Disparities of Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Patients in Virginia

Introduction: Hematopoietic cell transplantation (HCT) is a standard therapy for patients with intermediate to high-risk acute myelogenous leukemia (AML), associated with improved long-term disease-free survival. Virginia is a diverse state, with rural and urban areas, including wealthy and disadvantaged counties. In this study, we compared HCT rates among different regions in the state of Virginia, and analyzed the impact of race/ethnicity, urban vs rural location, primary insurance payor, and socioeconomic status on access to HCT. Methods: We conducted a retrospective, cohort study of patients age 18-75 diagnosed with AML in Virginia from 2013-2017 as reported to the Virginia Cancer Registry (VCR); the VCR was further linked with the Center for International Blood and Marrow Transplant Research (CIBMTR) database for identification of patients who had undergone HCT within two years of diagnosis. Socioeconomic data were generated from the VCR and the American Community Survey (ACS). Univariate and multivariable logistic regression models were used to examine several socioeconomic factors of interest, including patient-level information such as sex, age, race, marital status, primary insurance payor, and distance to closest transplant center as well as factors associated with geography, including specific regions (see Figure 1) and percentage of African Americans residing in the region (see Figure 2). Results: There were 818 patients diagnosed with AML in Virginia from 2013-2017, and of these, 168 (21%) underwent HCT within two years of diagnosis. Median age was lower in the HCT cohort vs. the non-HCT cohort, 55 vs. 64 (p=&amp;lt;0.0001). There was a higher proportion of married patients in the HCT cohort vs. the non-HCT cohort, 67% vs. 53% (p=0.005). The rate of HCT varied by geographic region (p=0.004; see Figure 1). The univariate and multivariate analyses (see Table 1) showed decreased likelihood of HCT with increasing age (OR: 0.96; 95% CI: 0.95-0.98). Patients from regions which had greater than 25% African American population were 42% less likely to undergo HCT (OR: 0.58; 95% CI: 0.38-0.89) (see Figure 2). Patients who were not married were less likely to undergo HCT compared to married patients (OR 0.56; 95% CI: 0.38-0.92). Patients with government insurance as primary payor were less likely to undergo HCT compared to patients with private insurance (OR 0.49; 95% CI: 0.32-0.77). Patients living in areas (by zip code) with a greater percentage of population with a college/graduate degree were more likely to undergo transplant than the patients living in areas with a lower percentage of college/graduate degree (OR: 1.02; 95% CI: 1.00-1.03). Conclusion: From 2013-2017, only 21% of patients with AML in Virginia underwent HCT within two years of diagnosis. We found that the likelihood of undergoing HCT is associated with age, percent of African Americans residing in the region, marital status, primary insurance payor, and percent of population with a bachelor or graduate degree. Our findings suggest geographic and socioeconomic factors are likely barriers to access to HCT. The decreased rate of HCT in regions with a higher percent of African-Americans may reflect structural racism, both due to factors outside and within the medical community. Resources should be devoted to specific interventions addressing disadvantaged populations, including early human leukocyte antigen (HLA) typing, caregiving resources, increased diversity of donor pool, and improved insurance coverage. Future studies will evaluate access to HCT after referral to HCT centers as well as racial disparity in access to HCT across the United States. Disclosures Balkrishnan: Merck and Co.: Consultancy. Devine:Magenta Therapeutics: Consultancy.

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

Although hospice use is increasing and patients in the US are increasingly dying at home, racial disparities in treatment intensity at the end of life, including hospice use, remain. To examine differences between Black and White patients in end-of-life care in a population sample with well-characterized causes of death. This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing population-based cohort study with enrollment between January 25, 2003, and October 3, 2007, with linkage to Medicare claims data. Multivariable logistic regression models were used to examine racial and regional differences in end-of-life outcomes and in stroke mortality among 1212 participants with fee-for-service Medicare who died between January 1, 2013, and December 31, 2015, owing to natural causes and excluding sudden death, with oversampling of Black individuals and residents of Southeastern states in the United States. Initial analyses were conducted in March 2019, and final primary analyses were conducted in February 2020. The primary outcomes of interest were hospice use of 3 or more days in the last 6 months of life derived from Medicare claims files. Other outcomes included multiple hospitalizations, emergency department visits, and use of intensive procedures in the last 6 months of life. Cause of death was adjudicated by an expert panel of clinicians using death certificates, proxy interviews, autopsy reports, and medical records. The sample consisted of 1212 participants (630 men [52.0%]; 378 Black individuals [31.2%]; mean [SD] age at death, 81.0 [8.6] years) of 2542 total deaths. Black decedents were less likely than White decedents to use hospice for 3 or more days (132 of 378 [34.9%] vs 385 of 834 [46.2%]; P < .001). After stratification by cause of death, substantial racial differences in treatment intensity and service use were found among persons who died of cardiovascular disease but not among patients who died of cancer. In analyses adjusted for cause of death (dementia, cancer, cardiovascular disease, and other) and clinical and demographic variables, Black decedents were significantly less likely to use 3 or more days of hospice (odds ratio [OR], 0.72; 95% CI, 0.54-0.96) and were more likely to have multiple emergency department visits (OR, 1.35; 95% CI, 1.01-1.80) and hospitalizations (OR, 1.39; 95% CI, 1.02-1.89) and undergo intensive treatment (OR, 1.94; 95% CI, 1.40-2.70) in the last 6 months of life compared with White decedents. Despite the increase in the use of hospice care in recent decades, racial disparities in the use of hospice remain, especially for noncancer deaths. More research is required to better understand racial disparities in access to and quality of end-of-life care.

Racial Disparities in Outcomes After Common Abdominal Surgical Procedures—The Impact of Access to a Minimally Invasive Approach

BackgroundIt is presently considered the standard of care to perform many routine intra-abdominal operations using a minimally invasive approach. The authors recently identified a racial disparity in access to a laparoscopic approach to inguinal hernia repair, cholecystectomy, appendectomy, and colectomy. The present study further evaluates this patient cohort to assess the relationship between the race and postoperative complications and test the mediating effect of the selected surgical approach. MethodsAfter institutional review board approval, patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent inguinal hernia repair, cholecystectomy, appendectomy, or colectomy in 2016 were identified. Patient demographics, including the self-reported race and ethnicity, as well as clinical, operative, and postoperative variables were recorded. After the exclusion of cases associated with diagnoses of cancer, a 4:1 propensity score matching algorithm generated a clinically balanced cohort of patients of white and black self-reported race. The mediating effect of an open approach to surgery on the relationship between black self-reported race and postoperative complications was evaluated via a series of regressions. ResultsThere were 41,340 unilateral inguinal hernia repairs, 3182 bilateral inguinal hernia repairs, 60,444 cholecystectomies, 50,523 appendectomies, and 58,012 colectomies included in the database in 2017. Exclusion of cases associated with cancer and subsequent propensity score matching returned 17,540 unilateral hernia repairs, 890 bilateral hernia repairs, 23,865 cholecystectomies, 11,660 appendectomies, and 12,320 colectomies. On mediation analysis, any complication, severe complication, and death were significant when regressed on black self-reported race (any: odds ratio [OR] = 1.210, 95% confidence interval [CI] = 1.132-1.291, P < 0.001; severe: OR = 1.352, 95% CI = 1.245-1.466, P < 0.001; death: OR = 1.358, 95% CI = 1.000-1.818, P = 0.044), and open surgery was a significant mediator in the incidence of any complication and severe complication (any: OR = 1.180, 95% CI = 1.105-1.260, P < 0.001 and severe: OR = 1.307, 95% CI = 1.203-1.418, P < 0.001). ConclusionsThese findings underscore the importance of access to a minimally invasive approach to surgery. However, other factors may contribute to racial disparities in postoperative complications after common abdominal operations.

Association between race and treatment patterns and survival outcomes in multiple myeloma: A Connect MM Registry analysis.

BackgroundStudies have reported racial disparities in access to and use of multiple myeloma (MM) treatments between African American (AA) and White patients. Although AA patients demonstrate longer disease‐specific survival, this has not uniformly translated into improved survival over time. The association between race and treatment patterns and survival outcomes was analyzed using data from the Connect MM Registry.MethodsThe Connect MM Registry is a large US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Patients who received first‐line (1L) stem cell transplantation (SCT) or who did not receive SCT (non‐SCT or non–stem cell transplantation [NSCT]) were grouped by raceEffects of race and transplantation status on the use of triplet treatment were estimated using logistic regression.ResultsTreatment patterns in 1L (types and duration of induction, posttransplantation maintenance) were similar between AA and White patients. SCT rates in 1L (32% vs 36%) and triplet treatment use (AA: 44% for NSCT patients and 72% for SCT patients; and White: 48% for NSCT patients and 72% for SCT patients) during first induction were similar. No significant effect of race or transplantation status on 1L triplet treatment use was observed. Race was not found to be associated with survival outcomes among patients who underwent NSCT; however, AA patients who received SCT had significantly longer overall survival compared with White patients who underwent SCT (not reached vs 88.2 months; hazard ratio, 0.56; 95% CI, 0.35‐0.89 [P = .0141]).ConclusionsAA and White patients were found to have similar treatment patterns in the Connect MM Registry, suggesting that both groups had equal access to health care. In this real‐world setting, AA patients received standard‐of‐care treatment, which might have contributed to better MM‐specific survival compared with White patients.

Racial Disparities in Functional Outcomes after Mechanical Thrombectomy for Acute Ischemic Stroke

Background Previous studies have shown racial disparities in access to treatment and outcomes in ischemic stroke patients. We set out to describe racial disparities in functional outcomes among ischemic stroke patients receiving mechanical thrombectomy. Methods We performed a retrospective review of patients in our institution's prospectively collected stroke patient registry from 08/2015 to 08/2019 at 3 comprehensive stroke centers. We reviewed patients aged 18 and older who received mechanical thrombectomy including only patients with race/ethnicity data belonging to the 3 largest race/ethnic groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic (HIS). We compared baseline characteristics and evaluated differences in 90-day modified Rankin score (mRS) as the primary outcome. Results We identified 793 patients who received mechanical thrombectomy. Among 685 eligible patients, 49% were NHW, 31% were NHB, and 20% were HIS. NHB and HIS patients were younger than NHW (average age NHB 62; HIS 64; and NHW 70; p Conclusion Despite differences in risk factor profile and in ED to Groin Puncture time, we did not find any race/ethnic disparities in functional outcomes in NHB and HIS patients. However, the data shows difference in treatment metrics, LOS, and a trend toward worse outcomes in the HIS population which necessitate further study.

3:45 PM Abstract No. 57 Racial disparity in access to endoscopy and transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding in the United States

3:45 PM Abstract No. 57 Racial disparity in access to endoscopy and transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding in the United States

Black and White: Access to Capital Among Minority-Owned Startups

We use confidential and restricted-access data from the Kauffman Firm Survey and matched administrative data on credit scores to explore racial disparities in access to capital for new business ventures. The novel results on racial inequality in startup financing indicate that black-owned startups start smaller and stay smaller over the entire first eight years of their existence. Black startups face more difficulty in raising external capital, especially external debt. We find that disparities in credit-worthiness constrain black entreprenuers, but perceptions of treatment by banks also hold them back. Black entrepreneurs apply for loans less often than white entrepreneurs largely because they expect to be denied credit, even when they have a good credit history and in settings where strong local banks favor new business development.

Enhanced Advocacy and Health Systems Training Through Patient Navigation Increases Access to Living-donor Kidney Transplantation.

To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham. We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program. There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P < 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P < 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians. These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.

Race and Length of Time Pursuing Pregnancy Among Women Who Utilized Medical Help to Get Pregnant

Objective: The evaluation of racial disparities in access to and use of infertility services in the U.S. has been documented. The aims of this study were to: 1) investigate racial differences in length of time women report attempting to become pregnant until seeking medical help; and 2) determine the predictors of seeking medical help to achieve pregnancy. Materials and methods: The National Survey of Family Growth 2011-2015 was used to analyze the duration women attempted to get pregnant among those who sought medical help. Results: 563 women reported seeking medical help to achieve pregnancy. The majority 422 (81%) were white. Multiple linear regression showed that age (β = .93; p = .00), having less than high school education (β = 14.64; p = .01), and higher body mass index (β = .59; p = .00) are significantly associated with an increased length of time for seeking medical help to get pregnant. Religions other than Catholic or Protestant (β = -8.63; p = .04) is significantly associated with a decreased length of time for seeking medical help to get pregnant. Race was not associated with a significant difference in the length of time attempting to become pregnant (β = -1.80; p = .44). Conclusion: Age, education attainment, religious affiliation, and body mass index are significantly associated with the length of time pursuing pregnancy. Once women have utilized medical resources, racial differences in the length of time pursuing pregnancy are not apparent.

Exploring the Needs and Priorities of Black Patients with Lymphoma: A Qualitative Study

Background: Across lymphoma subtypes, disparities have been uncovered in age of onset, stage, treatment, and outcomes by socioeconomic status, insurance status, and race. For several lymphoma subtypes, Black patients present at a mean age approximately 10 years younger than White patients and have worse survival. Racial disparities in access to care and clinical trial enrollment have been described across cancers and contribute to these differences in survival. We sought to clarify patients' perceptions of the needs and priorities for care during diagnosis, treatment, and survivorship. Objective: We conducted qualitative research with Black lymphoma patients in order to determine their perceptions and understanding regarding treatment and research, barriers to care, and future research priorities. Methods: Semi-structured phone interviews were conducted with 12 Black patients with lymphoma who had received treatment in Georgia. Participants were recruited from patients who were previously agreed to be contacted about research when identified through the state cancer registry and a current research participant pool at a university research hospital in Atlanta, Georgia. Interviews were recorded and transcribed verbatim. MAXQDA software (version 18.0.8) was used for coding and identifying themes and grounded theory processes were used to generate codes. Thematic analysis will be used to generate further themes and create a constant-comparative coding process. Results: Emerging themes from this ongoing data collection include endurance, lack of information surrounding diagnosis, trust in medical staff, and willingness to participate in research. Several participants described their cancer journey as simply another hurdle to overcome. They did not consider the emotional toll of their diagnosis and instead focused on positivity, refusing to feel sorry for themselves. A lack of information during the process of care was the most significant barrier for patients. The majority of patients felt that they were not given enough information regarding their diagnosis, with some stating that they had never heard of lymphoma before they were diagnosed with it. Others felt that this lack of information continued into their treatment with some patients being unaware of their cancer status or not being informed about procedures before they occurred. This gap in information left participants feeling disconnected from their own treatment process and uninvolved in their care. Despite this, patients expressed great trust in medical staff. Nearly all participants stated that they trusted their doctor most in their clinical care team and were therefore more willing to proceed with treatments and procedures at their doctor's recommendation. Those with a weaker connection to their doctor and care team reported feeling less satisfied with their care experience. Patients were also very willing to participate in research. Most expressed interest to participate in order to help others that may be diagnosed in the future. Some stated specific factors that would deter them from enrolling in a study, with one participant referencing the Tuskegee Syphilis Study as her reason for avoiding drug trials. Participants expressed interest in a wide range of topics for future research, with several focused on the origins of lymphoma. These participants assumed that they may have been exposed to hazardous materials while serving in the military or through an environmental contaminant and wanted more knowledge in this area. Conclusions: These preliminary findings suggest that the Black population in Georgia has specific needs that are unaddressed by current scientific and medical communities. A lack of information leaves patients feeling uninvolved with their care and potentially disconnected from their care team. This study presents the opportunity for clinicians and research personnel to collaborate with patients to develop communication tools and strategies that keep this population informed during their treatment. Clinicians and medical providers can utilize these data to improve support for this population. Disclosures Flowers: TG Therapeutics: Research Funding; Karyopharm: Consultancy; Gilead: Consultancy, Research Funding; National Cancer Institute: Research Funding; BeiGene: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Denovo Biopharma: Consultancy; Genentech, Inc./F. Hoffmann-La Roche Ltd: Consultancy, Research Funding; Spectrum: Consultancy; Pharmacyclics/Janssen: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Acerta: Research Funding; Bayer: Consultancy; V Foundation: Research Funding; AstraZeneca: Consultancy; Millenium/Takeda: Research Funding; Optimum Rx: Consultancy; Eastern Cooperative Oncology Group: Research Funding; Burroughs Wellcome Fund: Research Funding.

REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

Medicaid Expansion Reduced Racial Disparities in Access to Treatment

Medicaid Expansion Reduced Racial Disparities in Access to Treatment

Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

LBA1 Background: Racial disparities in cancer outcomes remain a societal challenge. The ACA sought to improve equity in healthcare access and outcomes by permitting states to expand Medicaid and providing subsidies for purchase of private insurance. We assessed the impact of Medicaid expansions on racial disparities in time to treatment among patients (pts) with advanced cancer. Methods: We selected pts ages 18-64 years with advanced or metastatic cancer (NSCLC, breast, urothelial, gastric, colorectal, renal cell, prostate, and melanoma), diagnosed between Jan 1, 2011 and Dec 31, 2018, from the nationwide Flatiron Health electronic health record-derived database. We assigned expansion status based on whether the pts’ state of residence had expanded Medicaid as of the diagnosis date. We estimated Medicaid expansion-related changes in the rate of “timely treatment,” an outcome defined as first-line treatment start within 30 days of advanced or metastatic diagnosis. Regression model covariates included race (White, African American, Asian, and Other race), age, sex, practice type, cancer type, stage, and unemployment rate, using time and state fixed-effects. Regression results present predictive margins. Results: The study included 34,067 pts (median age 57 years; 12% African American). Racial disparities were observed pre-expansion: African American pts were 4.9 percentage points (%pt) less likely to receive timely treatment (Table). Regardless of race, Medicaid expansion trended toward an increase in timely treatment overall (p = 0.05). Expansion was associated with a differential benefit for African American vs white pts (6.9 %pt and 1.8 %pt). Prior racial disparities were no longer observed after Medicaid expansion. Conclusions: Implementation of Medicaid expansions as part of the ACA differentially improved African American cancer pts’ receipt of timely treatment, reducing racial disparities in access to care.[Table: see text]