Racial Disparities In Outcomes Research Articles

Abstract PO2-09-06: Interaction of racial disparities on outcomes and toxicities associated with treatment of HER2+Breast Cancer- a TrinetX Database study

Abstract Objective: Investigate the interaction of racial disparities on outcomes and toxicities associated with treatment of HER2+BrCa (Breast Cancer)- a TrinetX Database study Background: HER2+BrCa is an aggressive subtype accounting for about 1/3rd of all BrCa, for which Trastuzumab based therapy remains the mainstay of treatment. While we are starting to understand the breadth of racial disparities in BrCa , the knowledge about outcomes and toxicities in relation to treatment of HER2+ BrCa is still limited. Design/Methods: In this propensity score-matched cohort study we used the TriNetX Research Network, a multi-health care organization de-identified electronic health record (EHR) database, to compare the 1-, 3-, and 5-year mortality of HER2+BrCa non-Hispanic African American (NHAA) women to a corresponding non-Hispanic White cohort (NHW). Qualification into the two race based HER2+BrCa cohorts required the presence of a C50 ICD-10-CM diagnosis code and at least one proxy for HER2 positivity such as Trastuzumab administration (index event). Cohorts were matched for age, BMI, comorbidities (HTN, DM ), and lab values using 1:1 matching with a greedy nearest neighbor search. Toxicity outcomes of interest such as cardiomyopathy, neuropathy, diarrhea, rashes, leg swelling/edema, and fatigue as well as the frequency of emergency room visits were also compared between the cohorts. The associations of observed outcome frequencies in the two cohorts were tested for significance using the chi-square test. The odds ratios and p-values, corrected for multiple hypothesis testing using the Benjamini-Hochberg procedure, are reported as an effect size and significance estimation. Results: 15983 patients met the inclusion criteria for HER2+BrCa (13611-NHW and 2372-NHAA). The mean age at the index event was 55.6 ± 12.6 years for NHAA and 57.2 ± 13.3 years for NHW. After matching the two sub-cohorts, 2303 patients remained in each. NHAA women were found to have significantly increased odds of neuropathy and cardiomyopathy for 1, 3, and 5-year time intervals after the HER2+BrCa index date, as compared to the reference NHW women (abbreviated results given in Table 1). In addition, the odds of an emergency room visit (for any reason) was found to be increased by as much as 79% in NHAA women as compared to the NHW women. The odds of experiencing fatigue/malaise, diarrhea/nausea, and rash, were reduced for NHAA women across all time intervals investigated. Odds ratios for mortality and leg swelling did not meet the significance threshold (p-value < 0.05). Conclusion: This study, which examined racial disparities in outcomes and toxicities associated with HER2+BrCa, revealed significant findings. NHAA women with HER2+BrCa treated with Trastuzumab based therapy demonstrated increased odds of experiencing neuropathy and cardiomyopathy compared to their NHW counterparts. Additionally, NHAA women had a higher likelihood of emergency room visits for any reason. Conversely, NHAA women exhibited decreased odds of fatigue/malaise, diarrhea/nausea, and rash. These findings underscore the importance of considering the impact of race on HER2+BrCa outcomes and treatment toxicities and suggest the need for further research and targeted interventions to address disparities and thus enhance treatment outcomes in diverse populations. Table 1: Representative significant Odds ratios and corrected p-values for outcomes comparing the NHAA and NHW cohorts. Citation Format: Monali Vasekar, Justin Petucci, Avnish Katoch, Vasant Honavar. Interaction of racial disparities on outcomes and toxicities associated with treatment of HER2+Breast Cancer- a TrinetX Database study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-06.

Racial Disparities in Outcomes Following Surgical Fixation of Traumatic Thoracolumbar Fractures: A National Database Analysis

This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with white patients. The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with white patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. African American patients experienced longer operative times compared to Asian American and white patients (3.74 ± 1.87 hours versus 3.04 ± 1.71 hours and 3.48 ± 1.81 hours, p<0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to white patients (30.7 % and 25.6% versus 19.9%, p<0.001). African American and Asian American patients had a higher risk of postoperative complications than white patients (22.4% and 20% versus 19.7%, p<0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11 - 1.28, p<0.001). African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with white patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications.

6300163 Racial disparities in outcome in a diverse district general hospital obstetric unit

6300163 Racial disparities in outcome in a diverse district general hospital obstetric unit

Racial disparities in outcomes of patients with stage I-III triple-negative breast cancer after adjuvant chemotherapy: a post-hoc analysis of the E5103 randomized trial.

Breast cancer mortality is higher in Black women than other racial groups. This difference has been partially attributed to a higher proportion of triple-negative breast cancer (TNBC). However, it is uncertain if survival disparities exist in racially diverse TNBC patients receiving similar treatments. Here, we examine racial differences in disease-related outcomes in TNBC patients treated on the E5103 clinical trial. From 2007 to 2011, 4,994 patients with stage I-III HER2-negative breast cancer were randomized to adjuvant chemotherapy with or without bevacizumab. This analysis was limited to the subset of 1,742 TNBC patients with known self-reported race. Unadjusted Kaplan-Meier curves and adjusted Cox-Proportional Hazards models were used to determine breast cancer events and survival outcomes. Of the analysis population, 51 (2.9%) were Asian, 269 (15.4%) Black, and 1422 (81.6%) White. Median age was 51 years. Patient characteristics, treatment arm, and local therapies were similar across racial groups. White women were more commonly node-negative (56% vs. 49% and 44% in Asian and Black women, respectively; p < 0.01). At a median follow-up of 46 months, unadjusted Kaplan-Meier locoregional and distant recurrence, and disease-free and overall survival, did not differ significantly by race. In Cox models adjusted for patient and tumor characteristics and treatment arm, race was not associated with any disease event. Larger tumor size and nodal involvement were consistently associated with breast cancer events. This clinical trial population of similarly treated TNBC patients showed no racial differences in breast cancer outcomes. Disease extent, rather than race, was associated with disease events.

Availability of Primary Care Physicians and Racial Disparities in Colorectal Cancer-Related Mortality in the United States.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States (US), however racial disparities in outcomes persist. We sought to assess the correlation of availability of primary care physicians (PCPs) and racial disparities in CRC-related mortality. We studied the correlation between age-adjusted incidence and mortality rates of CRC among all 50 states and the District of Columbia (D.C.) from the Center for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) with the number of actively practicing PCPs in all 50 states and D.C. from the Association of American Medical Colleges (AAMC) State Physician Workforce Data Report. Pearson's coefficient was used to study correlations and the two-sample t test was used for comparing state-level PCP/CRC ratios between the two groups. Statistical analysis was performed using VassarStats. The mean AAMR per 100,000 population for CRC was significantly higher among AA versus White populations (t = 5.79, p < 0.001). Higher state-wide PCP per CRC case ratio correlated with lower state-wide CRCrelated mortality (r = -0.36, p = 0.011). The mean PCP per CRC case ratio was significantly lower among AA compared to White populations (t = -15.95, p < 0.0001). Higher PCP per CRC case ratio correlated with lower CRC-related mortality among both White (r = -0.64, p < 0.0001) and AA (r = -0.57, p = 0.0002) populations. These findings suggest that racial disparities in CRC-related mortality may at least in part be related to lower availability of PCPs. Efforts focused on the development of strategies focused on improving access to primary care may help bridge racial disparities in CRC-related outcomes.

Racial Disparities in Outcomes of Delivery and Cardiac Complications Among Pregnant Women with Congenital Heart Disease.

Advances in cardiology have led to improved survival among patients with congenital heart disease (CHD). Racial disparities in cardiovascular and maternal outcomes are well known and are likely to be more profound among pregnant women with CHD. Using the 2001 to 2018 National Inpatient Sample, we identified all hospitalizations for delivery among women ≥ 18years of age with CHD. Unadjusted and adjusted between-race differences in adverse maternal cardiovascular, obstetric, and fetal events were assessed using logistic regression models. During the study period, we identified 52,711 hospitalizations for delivery among women with concomitant CHD. Of these, 66%, 11%, and 16% were White, Black, and Hispanic, respectively. Obstetric complications and fetal adverse events were higher among Blacks compared to Whites and Hispanics (44% vs. 33% vs. 37%, p < .001; 36% vs. 28% vs. 30%, p < .001), respectively. No between-race differences were observed in overall cardiovascular adverse events (27% vs. 24% vs. 23%, p < .21). However, heart failure was significantly higher among Black women (3.6% vs. 1.7% vs. 2.2%, p = 0.001). While a lower income quartile was associated with higher rates of adverse outcomes, adjustment for income did not attenuate the adverse impact of race. Black females with CHD diagnoses were more likely to experience adverse obstetric, fetal events, and heart failure compared to White and Hispanic women irrespective of their income status. Further research is needed to identify causes and devise interventions to mitigate racial disparities in the care of pregnant women with CHD.

Racial disparities in outcomes after liver transplantation in the UK: registry analysis.

Racial disparities in outcomes after liver transplantation in the UK: registry analysis.

Letter to the Editor. Potential confounding variables when assessing racial disparities in outcomes after MVD for TN.

Letter to the Editor. Potential confounding variables when assessing racial disparities in outcomes after MVD for TN.

Disparities in Outcomes of Cutaneous T-Cell Lymphoma in US Patients Aged < 40 Years Compared to Older Population

Background A rapid increase in the incidence of cutaneous T-cell lymphoma in young patients (&amp;lt; 40 years) was recently reported. 1 However, there is a lack of data on the disease outcomes in this age group. We examined the characteristics and outcomes of CTCL patients aged &amp;lt;40 years compared to an older population to improve our understanding of the disease in the different age groups. Methods Cases of CTCL were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program from 2000 to 2020. Statistical analyses were conducted with SPSS® version 25. Patients' characteristics were reported in frequencies and compared with the Chi-squared test between patients &amp;lt;40 years and an older population (40+ years). The Kaplan-Meier method was used to estimate median overall survival (OS). Cox Regression was done to determine predictors of survival. Results 16,923 cases of CTCL were identified during the study period. As shown in Table 1, gender distribution was similar among both age groups. Younger patients were more likely to be non-Whites. Mycosis fungoides was the most common subtype seen in both populations, with a higher frequency in the younger. The disease was localized in more than half of younger people but more advanced in older patients. 5- and 10-year overall survival (OS) were higher in the younger age group. There was no significant difference in sex, rates of chemotherapy use, and surgery between older and younger patients. Table 2 shows the predictors of survival of CTCL. Being male conferred a poor prognosis in older but not younger patients. Hispanics had a worse prognosis in the younger age group, while Asians and American Indians, compared to Whites, had poorer survival in older patients. Survival was worse in both age groups in Blacks. The most aggressive CTCL sub-type in the younger age group was extranodal NK-/T-cell lymphoma, nasal type but adult T-cell leukemia/lymphoma in older patients. Beam radiation was the only form of radiotherapy associated with improved survival in only younger patients, unlike in older patients who received survival benefits from all forms of radiotherapy. Chemotherapy was associated with poorer survival in both age groups. The diagnosis period was a predictor of improved survival in both age groups. Conclusion The racial distribution of CTCL between the age groups is consistent with a previous US study, though the ages were higher than the cut-off used in our research. 2 The poorer survival outcome in older patients is likely related to a more advanced stage of the disease, as shown in our study. Key findings in our study include the age-related poor prognosis of the disease in some races: outcomes were poor for Hispanics in younger patients but not in older patients. At the same time, in Asians and American Indians, the reverse was the case. The reason for this is unclear to us. Chemotherapy seems to worsen outcomes in both age groups, consistent with a recent study. 3 Also, beam radiation treatment (less used in younger patients compared to older people in our study) appears to offer some improvement in survival in younger people; probably, this should be used more in carefully selected young patients while balancing the risks with the benefits. The prognosis of CTCL has improved in recent years. Advances in treatment or earlier diagnosis may explain this. Prospective studies are needed to examine the reasons for the racial disparities in outcomes.

Are There Racial Differences in the Rate of Surgical Site Infection Based on Surgical Subspecialty?

Background: Surgical site infection (SSI) is a common, morbid post-operative complication. We hypothesized the presence of racial differences in SSI rates, comparing black/African American (BAA) to white non-Hispanic (WNH) patients. Patients and Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), BAA and WNH surgery patients across 10 surgical specialties were identified: general surgery (GS), vascular surgery (VS), cardiac surgery (CS), thoracic surgery (TS), orthopedics (OS), neurosurgery (NS), urology (US), otolaryngology (ENT), plastic surgery (PS), and gynecology (GYN). The primary outcome was SSI rate (superficial, deep incisional, or organ/space). The secondary outcome was rate of non-surgical infection. Pearson χ2 and Fisher exact tests were used to test group differences of categorical variables. Continuous variables were tested with the Student t-test, or Mann-Whitney U test, with statistical significance set at a value of p < 0.05. Multivariable logistic regression models were conducted to analyze the association between race/ethnicity and the infection outcomes. Results: A total of 740,144 patients were included: 99,425 (13.4%) BAA and 640,749 (86.6%) WNH, distributed as follows; 32,2976 GS, 17,6175 OS, 44,383 VS, 2,227 CS, 9,645 TS, 42,298 NS, 42,726 US, 18,518 ENT, 20,709 PS, and 60,517 GYN cases. Surgical site infection rates were higher among WNH in GS (4.4% vs. 4.1%; p = 0.003) and TS (3.1% vs. 1.7%; p = 0.015); lower in VS (3.2% vs. 4.4%; p < 0.001), OS (1.2% vs.1.6%; p < 0.001), and GYN (2.4% vs. 3%; p < 0.001); and similar between WNH and BAA in ENT (1.8% vs 1.8%; p = 0.76), and US (1.9% vs. 1.9%; p = 0.90). Non-surgical infection was higher in BAA in NS (3.2% vs. 2.5%; p = 0.003), and higher in WNH in GYN (2.6% vs. 2%; p < 0.001), OS (1.7% vs. 1.1%; p < 0.001), US (4.4% vs. 3.6%; p = 0.014), and VS (3.4% vs. 2.6%; p < 0.001). Conclusions: Variation exists in SSI rates between WNH and BAA patients among surgical subspecialties. Further research is required to understand these differences and address racial disparities in outcomes.

Pathogenic germline variants in patients with endometrial cancer of diverse ancestry.

Racial disparities in outcomes exist in endometrial cancer (EC). The contribution of ancestry-based variations in germline pathogenic variants (gPVs) is unknown. Germline assessment of ≥76 cancer predisposition genes was performed in patients with EC undergoing tumor-normal Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets sequencing from January 1, 2015 through June 30, 2021. Self-reported race/ethnicity and Ashkenazi Jewish ancestry data classified patients into groups. Genetic ancestry was inferred from Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets. Rates of gPV and genetic counseling were compared by ancestry. Among 1625 patients with EC, 216 (13%) had gPVs; 15 had >1 gPV. Rates of gPV varied by self-reported ancestry (Ashkenazi Jewish, 40/202 [20%]; Asian, 15/124 [12%]; Black/African American (AA), 12/171 [7.0%]; Hispanic, 15/124 [12%]; non-Hispanic (NH) White, 129/927 [14%]; missing, 5/77 [6.5%]; p=.009], with similar findings by genetic ancestry (p<.001). We observed a lower likelihood of gPVs in patients of Black/AA (odds ratio [OR], 0.44; 95% CI, 0.22-0.81) and African (AFR) ancestry (OR, 0.42; 95% CI, 0.18-0.85) and a higher likelihood in patients of Ashkenazi Jewish genetic ancestry (OR, 1.62; 95% CI; 1.11-2.34) compared with patients of non-Hispanic White/European ancestry, even after adjustment for age and molecular subtype. Somatic landscape influenced gPVs with lower rates of microsatellite instability-high tumors in patients of Black/AA and AFR ancestry. Among those with newly identified gPVs (n=114), 102 (89%) were seen for genetic counseling, with lowest rates among Black/AA (75%) and AFR patients (67%). In those with EC, gPV and genetic counseling varied by ancestry, with lowest rates among Black/AA and AFR patients, potentially contributing to disparities in outcomes given implications for treatment and cancer prevention. Black women with endometrial cancer do worse than White women, and there are many reasons for this disparity. Certain genetic changes from birth (mutations) can increase the risk of cancer, and it is unknown if rates of these changes are different between different ancestry groups. Genetic mutations in 1625 diverse women with endometrial cancer were studied and the lowest rates of mutations and genetic counseling were found in Black and African ancestry women. This could affect their treatment options as well as their families and may make disparities worse.

Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study.

Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.

Racial disparities in outcomes of primary squamous cell cancer of the vagina: A population-based analysis of treatment and survival (1149)

Racial disparities in outcomes of primary squamous cell cancer of the vagina: A population-based analysis of treatment and survival (1149)

Abstract P143: Racial Disparities In Acute Renal Failure Incidence Amidst Hypertensive Emergencies

Introduction: Persons from diverse backgrounds are disproportionately affected by adverse outcomes related to hypertension. We aimed to examine the likelihood of requiring hemodialysis during hospitalization in patients admitted for hypertensive emergency by race. Methods: We analyzed the 2020 National Inpatient Sample data to evaluate patients primarily admitted for hypertensive emergencies and acutely required hemodialysis. Patients who were already on hemodialysis were excluded. To assess for correlations, we applied logistic and linear regression analyses, taking into account potential confounders. The threshold for statistical significance was established at a 2-tailed p-value &lt;0.05. Results: In 2020, of 1,221,535 hypertensive emergency hospital admissions, 128,095 (10.5%) necessitated hemodialysis due to acute renal failure. After controlling for age, gender, hospital characteristics, insurance status, income, and Elixhauser comorbidities, we found that Black, Hispanic, Asian/Pacific Islander, and Native American patients had higher likelihoods of requiring hemodialysis compared to White patients, with aORs of 1.88 (95% CI 1.79-1.96), 2.96 (95% CI 2.74-3.19), 3.29 (95% CI 2.99-3.62), and 2.57 (95% CI 2.18-3.04) respectively (Figure 1). Conclusion: This analysis was unable to account for the degree of hypertension control prior to admission, a significant limitation. Further investigation is needed to discern what factors preceding or during hospital admission increase the risk of acute renal failure, in order to address these observed racial disparities in outcomes for patients with hypertensive emergencies.

Racial and Ethnic Disparities Among Patients Hospitalized for Acute Cholangitis in the United States.

We sought to determine whether race/ethnicity is associated with hospitalization outcomes among patients admitted with acute cholangitis. Few studies have evaluated the association between race and outcomes in patients with acute cholangitis. We analyzed United States hospitalizations from 2009 to 2018 using the Nationwide Inpatient Sample (NIS). We included patients 18 years old or above admitted with an ICD9/10 diagnosis of cholangitis. Race/ethnicity was categorized as White, Black, Hispanic, or Other. We used multivariable regression to determine the association between race/ethnicity and in-hospital outcomes of interest, including endoscopic retrograde cholangiopancreatography (ERCP), early ERCP (<48h from admission), length of stay (LOS), and in-hospital mortality. Of 116,889 hospitalizations for acute cholangitis, 70% identified as White, 10% identified as Black, 11% identified as Hispanic, and 9% identified as Other. The proportion of non-White patients increased over time. On multivariate analysis controlling for clinical and sociodemographic variables, compared with White patients, Black patients had higher in-hospital mortality (adjusted odds ratio: 1.4, 95% confidence interval: 1.2-1.6, P <0.001). Black patients were also less likely to undergo ERCP, more likely to undergo delayed ERCP, and had longer LOS ( P <0.001 for all). In this contemporary cohort of hospitalized patients with cholangitis, Black race was independently associated with fewer and delayed ERCP procedures, longer LOS, and higher mortality rates. Future studies with more granular social determinants of health data should further explore the underlying reasons for these disparities to develop interventions aimed at reducing racial disparities in outcomes among patients with acute cholangitis.

Racial disparities in hospitalization outcomes among patients with cholangiocarcinoma.

6631 Background: Studies have reported on the rising incidence and mortality outcomes among patients diagnosed with cholangiocarcinoma (CCA) but racial disparities in outcomes among inpatients have not been explored in this population. We examined the racial disparities in outcomes among adult hospitalized patients with a diagnosis of CCA. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic and linear regression models were used to examine the association between race/ethnicity and patient disposition, length of stay, elective admissions, and total hospital charges. Results: In the adjusted analyses, while Black patients had 14% higher odds (95% Confidence Interval (CI): 1.04–1.25) of being discharged to a facility/home with home health care versus routine discharge when compared to their White counterparts, Hispanics had 14% lower odds (95% CI: 0.79–0.95). Black patients had 39% higher risk (95% CI: 1.19–1.63) of death versus routine discharge relative to the White patients. Compared to White patients, Blacks (AOR: 1.23; 95% CI: 1.13–1.34), Hispanics (AOR: 1.15; 1.06–1.25) and other race/ethnicities (AOR: 1.20; 1.10–1.31) were more likely to have a length of hospital stay greater than 5 days relative to 5 days or less. Hispanics (β: $16,789; 95% CI: $11,480–$22,099) were found to have higher total hospital charges when compared to the White CCA patients. Additionally, Black (AOR: 0.68; 95% CI: 0.60–0.78) and Hispanic patients (AOR: 0.87; 95% CI: 0.77–0.99) were less likely to be admitted electively to the hospital. Conclusions: Despite advances made in treatment of patients with CCA, the prognosis remains poor. We report disparities in various hospitalization outcomes among adult patients with a diagnosis of CCA. Health care providers need to be aware that these disparities exist and health policies should be implemented to narrow the gap in existing disparities. [Table: see text]

Hip &amp; Pelvis

The June 2023 Hip &amp; Pelvis Roundup360 looks at: Machine learning to identify surgical candidates for hip and knee arthroplasty: a viable option?; Poor outcome after debridement and implant retention; Can you cement polyethylene liners into well-fixed acetabular shells in hip revision?; Revision stem in primary arthroplasties: the Exeter 44/0 125 mm stem; Depression and anxiety: could they be linked to infection?; Does where you live affect your outcomes after hip and knee arthroplasties?; Racial disparities in outcomes after total hip arthroplasty and total knee arthroplasty are substantially mediated by socioeconomic disadvantage both in black and white patients.

Correlation of cardiovascular disease with racial disparities in endometrial cancer outcomes.

5602 Background: Survival for Black women with endometrial cancer (EC) is shorter than that for non-Hispanic White (NHW) women, with a rate ratio for mortality of 1.98 per the American Cancer Society. Cardiovascular risk factors and disease are also more prevalent in Black women than NHW women. In women with breast cancer, Black patients received less optimal management of comorbidities and experienced increased cardiovascular disease (CVD)-related mortality as compared to White women. Similar to breast cancer, we hypothesize that CVD contributes to EC mortality disparities for Black women. Methods: In this retrospective cohort study, SEER and institutional data were utilized to investigate the contribution of CVD to outcomes for Black EC patients. The primary outcome was the contribution of cardiovascular mortality to the overall survival of Black patients. Secondary outcomes included identifying rates of new cardiovascular diagnoses, renal dysfunction, and adequacy of blood pressure control. The SEER cohort was defined using SEER*Stat 8.4.0.1. Uterine cancer patients were identified from the 2020 SEER Research Data. Survival by cause of death and proportion of deaths by cause of death were analyzed. Raw and adjusted hazard ratios for cardiovascular mortality were calculated. Next, institutional data was used to investigate survival, CVD diagnoses, renal dysfunction, and HTN in EC patients. Results: The SEER cohort contained 192,465 patients. Of these, 153,878 (80.8%) were White and 19,906 (10.3%) were Black. Black race was associated with decreased survival among patients who died of cardiovascular causes (HR 1.51, 95% CI 1.4 - 1.63, p &lt; 2*10-16). When adjusted for age, stage, and histology, the hazard for decreased survival remained elevated for Black patients who died of cardiovascular causes (adjusted HR 1.65, 95% CI 1.52-1.77, p &lt; 2*10-16). Our institutional cohort included 1491 patients, 1263 (84.7%) White and 151 (10.0%) Black. Black patients had a relative risk of death of 1.92 (95% CI 1.38 - 2.61) compared with White patients. Among patients with CVD, the hazard for death was 2.02 (95% CI 1.39 - 2.80). Black patients had significantly higher blood pressure, creatinine, and eGFR measurements. Conclusions: Racial outcome disparities in EC are multifactorial. CVD management will become increasingly important with the use of targeted therapies including lenvatinib and trastuzumab. Our study highlights an additional area of disparity and suggests possible interventions.

Sex and Racial Disparity in Outcome of Aneurysmal Subarachnoid Hemorrhage in the United States: A 20-Year Analysis

Aneurysmal subarachnoid hemorrhage is associated with high rate of morbidity and mortality. We aimed to assess prognostic impact of sex, race, and ethnicity in these patients. Nationwide Inpatient Sample (2000-2019) was used to identify patients presenting with aneurysmal subarachnoid hemorrhage as primary diagnosis. Patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities, type of the hospital, and treatment modality used for aneurysm repair were extracted. The previously validated Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale was used to estimate the clinical severity. Discharge destination and in-hospital mortality was used as outcome measured. The impact of race/ethnicity and sex on clinical outcome was analyzed using multivariate regression models. A total of 161 086 patients with aneurysmal subarachnoid hemorrhage were identified. Mean age was 55.0±13.8 years. Sixty-nine percent of the patients were female, 60% White patients, and 17% Black patients. There was no difference in the Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale score between the 2 sexes. Women had significantly lower odds of good clinical outcome (defined as discharge to home or acute rehabilitation facility; RR, 0.83 [95% CI, 0.74-0.94]; P=0.004). Hispanic patients (RR, 1.12 [95% CI, 1.07-1.17]; P<0.001) had higher odds of excellent clinical outcome compared with White patients, and lower risk of mortality were observed in Black patients (RR, 0.73 [95% CI, 0.66-0.81]) and Hispanic patients (RR, 0.78 [95% CI, 0.70-0.86]) compared with the White patients. In this nationally representative study, women were less likely to have excellent outcomes following aneurysmal subarachnoid hemorrhage, and White patients had disproportionately higher likelihood of worse clinical outcomes. Lower rates of mortality were seen among Black and Hispanic patients.

Explaining racial disparities in surgical survival: a tapered match analysis of patient and hospital factors

ObjectivesEvaluate whether hospital factors, including nurse resources, explain racial differences in Medicare black and white patient surgical outcomes and whether disparities changed over time.DesignRetrospective tapered-match.Setting571 hospitals at two time points...