Racial Disparities In Survival Research Articles

Reducing Endometrial Cancer Disparities to Advance Health Equity (REACH Study) [ID 2683434

INTRODUCTION: Racial disparities in endometrial cancer survival have been increasing over the past 10 years. While Black women are diagnosed more often with aggressive histologic subtypes, studies have found tumor characteristics only partially account for their lower rates of survival. The degree to which system factors such as insurance and access to subspecialty care contribute to disparate survival outcomes is unclear. METHODS: This was a retrospective cohort study of individuals diagnosed with endometrial cancer from 2005 to 2021 within a large integrated health care system with high levels of access to gynecologic oncologists. Data were extracted from tumor registry and electronic databases. Multivariable logistic regression was used to evaluate associations between 1- and 5-year survival rates and race. RESULTS: Among 11,249 women, 61.9% identified as White, 15.1% Asian, 7.8% Black, 13.6% Hispanic, and 0.6% mixed or unknown race, with 46.5% having public insurance through Medicare or Medi-Cal. In preliminary analysis, Black women had lower survival compared to White women at 1 year (87.4% versus 92.3%) and 5 years (67% versus 78.7%) (OR 0.57; 95% CI, 0.46–0.71; P<.001). However, when adjusted for histology and stage, survival differences between Black and White women at both 1 year (OR 0.83; 95% CI, 0.65–1.07; P=.15) and 5 years (OR 0.92; 95% CI, 0.73–1.15; P=.45) were no longer significant. CONCLUSION: Among a diverse group of insured individuals receiving care within an integrated health care system, tumor characteristics largely accounted for racial disparities in survival. These findings suggest that disparities in survival not explained by tumor characteristics can be addressed by closing gaps in insurance coverage and access to care.

341 Racial Disparities in Incidence, Treatment, and Survival in Adult Brain Metastases: A 10-Year National Database Analysis

INTRODUCTION: Brain metastases are the most common central nervous system tumors in the United States. It is imperative to understand how prognosis and survival varies demographically to ensure equitable care for vulnerable populations and reduce financial burdens on the healthcare system. METHODS: Using the Surveillance, Epidemiology, and End Result Program (SEER) database, adults with non-primary brain metastases between 2010 and 2019 were identified. The primary outcome measure was all-cause mortality within 5 years. Chi-squared tests of independence and one way analyses of variance were used to compare group differences between White, Black, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native patients. A Cox proportional hazards model was developed to evaluate the risk of death within 5 years. RESULTS: A total of 65,154 patient records were identified following exclusion based on age (>84 years or <18 years), missing race data, and missing survival data. The incidence of brain metastases increased from 2.53 per 100,000 adults in 2010 to 2.71 per 100,000 in 2019. A/PI patients had the highest population-adjusted incidence, highest population proportion of high income, the longest time from diagnosis to treatment, lowest rate of radiation refusal, and highest rate of chemotherapy treatment. Subsequently, A/PI patients had the highest 5-year survival rate compared to White and Black patients (9.05% vs. 4.15% vs. 3.23% respectively, p < 0.001). Chemotherapy (OR = 0.44) and surgery (OR = 0.51) were the strongest protective factors against death while being widowed (OR = 1.15) and having primary lung cancer (OR = 1.14) strongest risk factors. CONCLUSIONS: A/PI patients also have a significant survival advantage compared to White, Black, and AI/AN patients, potentially due to higher rates of radiation and chemotherapy treatment. Patients of other races are recommended treatment at lower rates than A/PI patients, suggesting a discrepancy in services offered to these patients.

Abstract 4845: Evaluating racial disparities in immune checkpoint inhibitor survival and autoimmunity

Abstract Introduction: In recent years, immune checkpoint inhibitors (ICI) have revolutionized the landscape of treatment across a variety of cancers. Potential concerns regarding racial disparities in ICI access and therapeutic efficacy have been well documented. Recent studies have indicated improved ICI access and response outcomes in White patients compared to minority groups with head and neck cancer (HNC) and melanoma patients. In contrast, patients diagnosed with lung cancer have been mixed, with some research suggesting black patients may fare better with ICI therapy. Existing literature is largely limited to retrospective studies with small population sizes, and lacks comparisons of racial disparities across malignancies. We aim to describe and compare racial inequities in ICI outcomes in HNC, melanoma, and lung cancer. Methods: The TriNetX US Collaborative Network database was queried for patients >18 years-old with a diagnosis of head and neck cancer, melanoma or lung cancer that were treated with ICIs. Malignancy cohorts were defined by race: non-Hispanic White (NHW) and Black. Race cohorts were 1:1 propensity score matched (PSM) for comorbidities, oncologic stage, and chemoradiation treatment. Demographic differences in cohorts were evaluated prior to matching. Following PSM, overall survival and rates of autoimmunity were assessed at 5 years. Results: 19,443 NHW and 2,827 Black patients treated with ICI were identified. At a baseline, the Black patient cohorts had significantly higher rates of comorbidies (p<0.02). Across all malignancies, the geographic distribution of NHW patients was more equally distributed compared to Black patients (majority south). With PSM, black HNC patients had significantly lower survival rates compared to NHW [HR: 1.4 (1.2, 1.6), p=0.0002]. In melanoma, the same trend was present, though not significant [HR: 1.3 (0.95, 1.7), p=0.1]. In contrast, in lung cancer, Black patients had significantly higher survival rates compared to NHW patients [HR 0.78 (0.70, 0.86), p<0.0001]. In HN and lung cancer, NHW patients had significantly higher rates of autoimmune conditions after ICI therapy compared to Black [OR: 2.0 (1.4,2.8), 1.2 (1.0, 1.4), respectively]. Conclusion: This study represents the most extensive analysis of racial disparities on ICI outcomes across malignancies. This study found that black patients treated with ICIs had decreased survival rates at 5 years compared to NHW patients in HNC and melanoma, but increased survival rate in lung cancer. This disparity persisted following PSM, matching cohorts for comorbidities, oncologic stage and adjuvant therapy. Black patients also had significantly lower rates of autoimmunity in HN and lung cancer. Noted differences in survival may be a reflection of geographic practice differences, access to care and/or socioeconomic status. Further investigation is required to elucidate the underlying etiologies of these trends. Citation Format: Kathryn L. Nunes, Pablo Llerena, Praneet Kaki, Shreya Mandloi, Annie Moroco, Eric Mastrolonardo, David M. Cognetti, Adam J. Luginbuhl, Joseph M. Curry. Evaluating racial disparities in immune checkpoint inhibitor survival and autoimmunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4845.

Abstract 6121: Racial differences in the intratumoral immune cell infiltrate in luminal breast cancer

Abstract Background: Black women have a higher rate of breast cancer mortality compared with their non-Hispanic White (NHW) counterparts, with an 80% higher likelihood of breast cancer death from axillary node-negative, ER-positive (a.k.a. luminal) tumors (Hoskins et al, JAMA Oncol 2021). Black women are 30% more likely to have ER-positive tumors with a high-risk gene expression profile, indicating a role for tumor biology in this disparity (Hoskins et al, JAMA Oncol 2023). The underlying biological mechanisms responsible are unknown. The aim of this study was to investigate the immune cell infiltrate in ER-positive breast tumors as a potential driver of disproportionately aggressive luminal tumor biology among Black women. Methods: Gene expression data from ER-positive tumors diagnosed in women identified as Black or NHW in The Cancer Genome Atlas (TCGA) were deconvoluted with the CIBERSORT tool to estimate the relative intratumoral proportion of 22 immune cell types within each tumor. Differential analysis of imputed immune cell fractions comparing race was conducted with the Mann-Whitney test. P-values were adjusted for multiple comparisons with the false discovery rate (FDR) method. Linear regression of previously reported ancestry estimates for breast cancer patients in TCGA (Huo, et al, JAMA Oncol 2017) was used to test for association between African ancestry and proportion of regulatory T cells (Tregs) in tumors from Black women. Results: CIBERSORT analysis of tumors found a significantly increased proportion of Tregs in tumors from Black (n=86) than NHW (n=534) patients, with log2 fold-change= 0.74 (FDR-corrected p-value= 0.01). Plasma cells, T follicular helper cells and M0 macrophages were increased in tumors from Black women with uncorrected p-values < 0.05, but racial differences in these cell types were not significant after FDR correction (p >0.1). Ancestry analysis among Black women indicated that African ancestry was not associated with the intratumoral proportion of Tregs (1 SD change in proportion African ancestry was associated with 0.06 standard deviation increase in Tregs, p > 0.3). Confirmation of findings with a racially diverse breast tumor TMA from an independent cohort is ongoing and results will be presented. Conclusions: Increased pro-tumorigenic Treg infiltrate in ER-positive breast tumors from Black women may contribute to a disproportionately aggressive tumor phenotype and racial survival disparity. The findings could have therapeutic implications and suggest that immune checkpoint inhibitors may have increased activity against luminal breast cancer in Black patients. Although this study did not show a statistically significant effect for genetic admixture within African Americans, larger studies are needed to distinguish the contribution of ancestry vs. social context, environmental, and behavioral factors as the driver of this racial difference in tumor biology. Citation Format: Neha Hippalgaonkar, George Chlipala, Dezheng Huo, Garth Rauscher, Naiche Adler, Jan Kitajewski, Kent Hoskins. Racial differences in the intratumoral immune cell infiltrate in luminal breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6121.

Abstract 6124: A comprehensive pan-cancer study nominating NF-κB-mediated TNFA signaling-induced hypoxia as a risk factor in Hispanic cancer progression

Abstract The Hispanic (HA) population is the second largest racial/ethnic group in the United States after non-Hispanic White (NHW). Though the HA population usually has a lower reported incidence of cancers compared to NHW, there are racial disparities exist in the mortality rate of some of the cancers. Factors related to the Social Determinants of Health (SDOH), such as higher poverty rates, less education, and reduced access to health care, are known to increase the risk of diagnosing advanced-stage cancer in HA compared to the NHW population. The contribution of such SDOH in the HA cancer population has been studied in the past years. However, the contribution of biological and genetic mechanisms to HA cancer disparity has not been well understood. Thus, in this study, we performed a comprehensive analysis of different databanks to understand the common genetic and biological factors that contribute to the pan-cancer disparity in the HA population. To identify HA and NHW populations, we used self-reported racial/ethnic information. Analysis of the “All of Us” database suggested a high prevalence of infection-related cancers such as Liver, Stomach, and Cervix Uteri in the HA population compared to the NHW population. SEER database also showed an increased percentage of diagnoses with infection-related cancers and poor survival of the HA population with these cancers compared to the NHW. We then analyzed the TCGA transcriptome data from primary tumors from HA and NHW patients. We only selected cancers with data from at least ten patients in each group. TCGA data confirmed that the tumors from HA cancer patients primarily express high inflammatory and immune-responsive signatures. Specifically, we found a high enrichment of NF-κB induced TNFA signaling in HA tumors. We also observed a significant correlation between TNFA and Hypoxia signature in many HA cancers. Since hypoxia is known to be associated with resistance to radiation and chemotherapy, targeting the increased hypoxia signature in HA tumors may be critical for sensitizing HA patients to cancer therapy. Overall, our pan-cancer analyses suggest an increased prevalence of many infection-related cancers in the HA population. HA tumors are enriched with TNFA, NF-κB, and hypoxic signatures. Specific targeting of these signatures may be critical in managing the HA patients who currently suffer from racial disparity in cancer incidence and survival. Citation Format: Tagari Samanta, Jun Hyoung Park, Benny Abraham Kaipparettu. A comprehensive pan-cancer study nominating NF-κB-mediated TNFA signaling-induced hypoxia as a risk factor in Hispanic cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6124.

Abstract A003: Decomposing racial and ethnic disparities in endometrial cancer survival

Abstract Background: Black-White mortality disparities are well-established and continue to widen over time among women diagnosed with endometrial cancer (EC). Yet, few studies have explored the existence or sources of racial/ethnic disparities in EC survival among Hispanic, American Indian/Alaska Native (AI/AN), Asian, and Native-Hawaiian/Pacific Islander (NH/PI) women. EC survival disparities across racial and ethnic groups have been suggested to be linked to differences in sociodemographic, clinical, and access to care characteristics. We examined how these individual- and area-level factors influence the presence of racial/ethnic disparities among women with EC. Methods: Participants were diagnosed between 2004 and 2019 with stages 1A through 4B endometroid and non-endometroid EC in the National Cancer Database (NCDB). Race was categorized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, Asian, NH/PI, and AI/AN. We performed Oaxaca-Blinder decompositions of the log overall survival (OS) time assuming an accelerated failure time model with Weibull error, which decomposes observed differences in log survival time into parts potentially explained by differences in measured prognostic factors and differences not explained by measured variables. We examined the following classes of prognostic factors: age at diagnosis, zip code-level demographics (educational attainment, average income, and rurality), access to care (insurance status, facility type and location, treatment delay), Charlson comorbidity score, tumor characteristics (stage and histology), and guideline-concordant treatment (GCT). White women were the comparison group in all decompositions. Results: Compared with NHW women (N=121,069; estimated overall survival for average covariates values (eOS)=19.7 years) eOS was significantly shorter among NHB women (N=15,855; eOS=9.9 years); longer among Asian women (N=5,098; eOS=42.7 years); longer among Hispanic women (N=9,671; eOS=25.9 years); and not significantly different in NH/PI (N=536; eOS=24.8 years) or AI/AN women (N=551; eOS=17.0 years). Measured covariates explained 76.7% of the difference for NHB women (p<0.001); 19.7% for Asian women (p<0.001); and did not significantly explain the difference for Hispanic women (8.4%; p=0.14). Factors significantly contributing to the observed differences for NHB women were tumor characteristics (61.5%); access to care (6.6%); zip code-level demographics (5.1%); comorbidity (3.9%); age (-1.8%); and GCT (1.5%). Significant factors for Asian women were age (16.6%); tumor characteristics (-6.0%); zip code-level demographics (4.7%); access to care (3.0%); and comorbidity (1.6%). Significant factors for Hispanic women were age (45.2%); tumor characteristics (-17.9%); access to care (-13.4%); comorbidity (-2.0%); and GCT (-1.0%). Conclusions: Contributors to EC survival disparities vary by race/ethnicity and strongly implicate the need for research to identify how disparities arise to tailor interventions to reduce survival gaps. Citation Format: Jordyn A. Brown, Jennifer A. Sinnott, Ziyu Gao, Caitlin E. Meade, Macarius M. Donneyong, Tasleem J. Padamsee, Ashley S. Felix. Decomposing racial and ethnic disparities in endometrial cancer survival [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A003.

Abstract IA005: New directions in prevention and early detection of endometrial cancers

Abstract Most endometrial cancers and precursor lesions are preceded by postmenopausal bleeding (PMB), offering a window of opportunity for early detection and improved survival. Clinical guidelines recommend prompt evaluation of PMB to rule out endometrial cancer. Current diagnostic approaches including transvaginal ultrasound and endometrial biopsy are invasive and can be associated with discomfort and procedural pain, and we have shown that recommendations may not be consistent with underlying risk of endometrial cancer. Access to these procedures may be challenging for patients who live in rural areas or who experience other barriers to care. Current strategies may also have limited accuracy for detecting non-endometrioid cancers which are clinically aggressive, more common in Black women, and increasing in incidence and mortality in the U.S. Black women experience significant racial disparities in endometrial cancer survival and are more likely to experience diagnostic delays compared to their White counterparts. Because of the anatomical continuity of the lower genital tract, we and others have demonstrated the feasibility of pairing molecular assays with minimally invasive self-sampling approaches, such as vaginal tampons, for the detection of tumor DNA. In a recent study led by our colleagues at the Mayo Clinic, we identified over 28 methylation markers that were tested in self-collected tampon samples that showed good clinical performance for endometrial cancer detection. Such approaches can mitigate cancer disparities by offering an at-home early detection strategy to increase coverage and expand access to care. To date, few endometrial cancer studies have been conducted within diverse clinical populations. To address this gap, we designed the Discovery and Evaluation of Tests for Endometrial Cancer in Tampons (DETECT) study. DETECT is a case control study that includes patients undergoing hysterectomy for endometrial cancer and benign conditions at the University of Alabama at Birmingham (UAB). DETECT has enrolled over 700 patients to date, including over 360 with endometrial cancer (approximately 30% with non-endometrioid tumors). In this study, we collect extensive questionnaire data including information about symptoms, and novel risk factors such as feminine hygiene and hair product use. We obtain clinical information on diagnostic procedures, surgery, and treatment information from electronic medical records, and collect tampon, tissue, and blood samples from enrolled patients. In preliminary analyses, over two-thirds of participants self-collected a vaginal tampon sample, with collection varying by race (57% in Black vs. 76% in White patients). Next steps include pilot testing to compare the performance of biomarkers (somatic mutations and methylation markers) measured from tampon samples to tissue for endometrial cancer detection. Future goals of DETECT include the evaluation of endometrial cancer risk factors, biomarkers, outcomes, and disparities across the cancer continuum. Citation Format: Megan A. Clarke. New directions in prevention and early detection of endometrial cancers [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr IA005.

Progress made toward equitable transplantation in children and young adults with kidney disease.

Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.

Bayesian mediation analysis for time-to-event outcome: Investigating racial disparity in breast cancer survival

Mediation analysis is conducted to make inferences on the effects of mediators that intervene in the relationship between an exposure variable and an outcome. Bayesian mediation analysis (BMA) naturally considers the hierarchical structure of the effects from the exposure variable to mediators and then to the outcome. We propose three BMA methods on survival outcomes, where mediation effects are measured in terms of hazard rate, survival time, or log of survival time respectively. In addition, we allow setting a limited survival time in the time-to-event analysis. The methods are validated by comparing the estimation precision at different scenarios through simulations. The three methods all give effective estimates. Finally, the methods are applied to the Surveillance, Epidemiology, and End Results Program (SEER) supported special studies to explore the racial disparity in breast cancer survival. The included variable completely explained the observed racial disparities. We provide visual aids to help with the result interpretations.

Understanding causes of racial/ethnic survival disparity in 47,178 patients with colorectal cancer: A quantitative evaluation of molecular, socioeconomic, and clinical covariates.

20 Background: A disparity in overall survival (OS) of colorectal cancer (CRC) patients based on self-reported race has been observed. Separately, differing frequencies of driver gene mutations among racial groups have been observed. The contribution of these molecular differences to disparity in outcomes is not well understood. We conducted a systematic investigation of molecular, socioeconomic (SES) and clinical covariates to quantitate the degree to which each influences the OS disparity. Methods: The Foundry software platform was used to query electronic health records to identify CRC patients and extract clinical and molecular data. The relative contribution of each variable to OS disparity was determined using mediation analysis consisting of sequential multivariate Cox regression models. Results: 47,178 patients with CRC diagnosed between 1973 and 2023 with self-reported race were identified. Relative to Non-Hispanic white (NHW), African American (AA) had worse OS (HR=1.16, P= 1.5E-6), while Asians and Hispanics had better OS (HR=0.66, P=4.2E-13 and HR=0.86, P=3.4E-6, respectively). The magnitude of disparity between AA and NHW was greater in metastatic disease (HR 1.2, P=1.7E-4). Among 7,628 patients with clinical molecular testing, five genes differed significantly in mutation frequencies; APC (54% NHW, 62% AA, 57% Hispanics, 46% Asian, FDR= 0.01), KRAS (45%, 58%, 50%, 44%, FDR=8.4E-9), PIK3CA (17%, 23%, 17%, 12%, FDR=0.006) were higher in AA, while BRAF (8%, 3%, 4%, 7%, FDR=2.4E-8), KIT (4%, 1%, 2%, 3%, FDR=0.013) were higher in NHW. In multivariate analysis mutations of BRAF (HR= 1.9, P=1.2E-8), KRAS (HR= 1.39, P=1.7E-7), and APC (HR= 0.81, P= 5E-4) were significantly associated with OS as was national area deprivation index (HR= 1.07, P=0.004), marital status (HR= 1.16, P=0.03), performance status (HR= 1.42, P= 5.3E-29), disease stage (HR= 1.502, P=4.4E-26), right sided tumors (HR= 1.23, P=0.003), tumor differentiation (HR= 1.22, P=0.004) and MSI-high (HR= 0.37, P=1.8E-7). Mediation analysis identified neighborhood SES as the greatest contributor to disparity (38%), followed by primary tumor side (10%), and molecular characteristics (MSI-status, KRAS and BRAF mutations, 10%). After including all covariates, 39% of disparity remained unaccounted. Conclusions: Systematic evaluation of a large cohort from a single institution confirmed substantial racial disparity in survival and frequencies of driver mutations. SES factors have the largest contribution but account only for forty percent of the disparity, with tumor molecular features also contributing. Molecular characteristics should be incorporated in multicentric studies of racial survival disparity. Future clinical studies should ideally account for genetic ancestry and molecular features when evaluating chemotherapy outcomes.

Racial disparities in breast cancer survival after treatment initiation in Brazil: a nationwide cohort study

Breast cancer is a public health priority in Brazil and ensuring equity in health care is one of the cancer control plan goals. Our aim was to present the first assessment on the influence of race or skin colour on breast cancer survival at the national level. In this nationwide cohort study, data on women who initiated treatment for breast cancer in the public health-care system (Sistema Unico de Saúde), Brazil, were assembled through record linkage of administrative and mortality information systems. The administrative information systems were the Outpatient Information System (data from high complexity procedure authorisations) and the Hospital Information System (data from hospitalisation authorisations). We included women aged 19 years or older who started treatment between Jan 1, 2008, and Nov 30, 2010; self-identified as having White, Black, or Brown race or skin colour; had tumour stage I-IV; and were treated with chemotherapy or radiotherapy, or both. Patients were followed up until Dec 31, 2015. Patients with only hormone therapy records or who underwent only surgery were excluded. The Kaplan-Meier method was used to estimate crude overall survival for race or skin colour by time since treatment initiation, and Cox regression to estimate all-cause mortality hazard ratios (HRs) before and after adjustment for other covariates. We identified 59 811 women treated for stage I-IV breast cancer. 37 318 (62·4%) women identified themselves as White, 18 779 (31·4%) as Brown, and 3714 (6·2%) as Black. 5-year overall survival probability was higher for White women (74% [95% CI 73-74]) than Black women (64% [62-65]; p<0·0001). In adjusted regression models stratified by the absence of hormone therapy, Black women had a 24% (HR 1·24 [95% CI 1·16-1·34]; p<0·0001) higher risk of all-cause death than White women, and in the presence of hormone therapy Black women had a 25% (1·25 [1·14-1·38]; p<0·0001) higher risk of all-cause death than White women. Black skin colour was identified as a statistically significant risk marker for lower 5-year survival probability and higher risk of all-cause death among women treated for breast cancer by the Sistema Unico de Saúde. Actions to understand and mitigate this unfair difference in health results are urgently needed. Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais.

Disparities in esophageal cancer incidence and esophageal adenocarcinoma mortality in the United States over the last 25-40 years.

Esophageal carcinoma presents as 2 types, esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) with the frequency of both changing in the United States (US). To investigate EAC/ESCC incidence time trends among the 3 main US racial groups and investigate trends in US EAC survival by ethnicity. Twenty-five years (1992-2016) of data from SEER 13 program was analyzed to compare incidence trends in EAC and ESCC between non-Hispanic whites (nHW), non-Hispanic Blacks (nHB) and Hispanics (Hisp) using SEERStat®. In addition, SEER 18 data, from 1975-2015, on EAC in the US was analyzed to evaluate racial disparities in incidence and survival using SEERStat® and Ederer II method. In the 3 major US ethnic groups, age-adjusted incidence of ESCC has declined while EAC has continued to rise from 1992-2016. Of note, in Hisp, the EAC incidence rate increased while ESCC decreased from 1992 to 2016, resulting in EAC as the predominant esophageal cancer subtype in this group since 2011, joining nHW. Furthermore, although ESCC remains the predominant tumor in nHB, the difference between ESCC and EAC has narrowed dramatically over 25 years. EAC survival probabilities were worse in all minority groups compared to nHw. Hisp have joined nHW as US ethnic groups more likely to have EAC than ESCC. Of note, EAC incidence in nHB is increasing at the highest rate nationally. Despite lower EAC incidence in all minority groups compared to nHW, these populations have decreased survival compared to nHW.

Differences in Survival between Black and White Patients with Head and Neck Squamous Cell Carcinoma: Comparison of Data from the DOD Central Cancer Registry and SEER.

Barriers to health care access may contribute to the poorer survival of Black patients with head and neck squamous cell carcinoma (HNSCC) than their White counterparts in the U.S. general population. The Department of Defense's (DOD) Military Health System (MHS) provides universal health care access to all beneficiaries with various racial backgrounds. We compared overall survival of patients with HNSCC by race in the MHS and the general population, respectively, to assess whether there were differences in racial disparity between the two populations. The MHS patients were identified from the DOD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the NCI's Surveillance, Epidemiology and End Results (SEER) program. For each cohort, a retrospective study was conducted comparing survival by race. Black and White patients in the CCR cohort had similar survival in multivariable Cox regression models with a HR of 1.04 and 95% confidence interval (95% CI) of 0.81 to 1.33 after adjustment for the potential confounders. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients with an adjusted HR of 1.47 (95% CI = 1.43-1.51). These results remained similar in the subgroup analyses for oropharyngeal and non-oropharyngeal sites, respectively. There was no racial difference in survival among patients with HNSCC in the MHS system, while Black patients had significantly poorer survival than White patients in the general population. Equal access to health care could reduce racial disparity in overall survival among patients with HNSCC.

Abstract B108: Racial disparities in survival among oral cavity and pharynx cancer patients treated with immunotherapy: Insights from the US National Cancer Database (NCDB)

Abstract Purpose: Survival rates for oral cavity and oropharynx cancers vary by race, with Non-Hispanic(NH)-Black patients experiencing relatively lower survival rates compared to NH-White patients. While the potential for improving survival with immunotherapy has been demonstrated in clinical trials, it remains unclear whether racial disparities persist in patients treated with this novel approach. We aimed to evaluate the association between race and all-cause mortality among oral and pharynx cancer patients who received immunotherapy. Methods: This study utilized the National Cancer Database (NCDB) to investigate racial disparities in survival after immunotherapy among patients diagnosed with oral cavity and pharynx cancers between 2013 and 2017. Multivariable Cox proportional hazards models were employed to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. Results: The study cohort included 7,714 patients, consisting of 7,011 NH-White patients and 703 NH-Black patients. During the follow-up period, mortality occurred in 45.5% of NH-White patients and 59.5% of NH-Black patients. After adjusting for sociodemographic, clinical, and treatment factors, NH-Black patients had a higher risk of death compared to NH-White patients (HR: 1.24; 95% CI: 1.11, 1.38). Additionally, the study found no significant differences in the interaction between race and Charlson-Deyo comorbidity score or race and area-level median income. Conclusion: This study suggests that urgent action is needed to address these disparities to improve outcomes for NH-Black patients with oral cavity and pharynx cancers. Citation Format: Danting Yang, Shama Karanth. Racial disparities in survival among oral cavity and pharynx cancer patients treated with immunotherapy: Insights from the US National Cancer Database (NCDB) [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 B108.

Abstract B087: Racial disparities in breast cancer survival: Examining the potential role of neighborhood deprivation and breast adipose tissue inflammation

Abstract Background: Previous studies have found the Black-White disparity in breast cancer survival is greatest among women living in neighborhoods of high socioeconomic status (i.e., low % poverty). This study aimed to examine the association between race and breast cancer mortality according to neighborhood deprivation, a more comprehensive measure of neighborhood socioeconomic status. We also explored the association between neighborhood deprivation and the presence of breast adipose tissue inflammation as a potential biologic mechanism underlying the association. Methods: We examined Black-White disparities in breast cancer mortality overall and stratified by neighborhood deprivation status among 37,369 Black and White women in the Georgia Cancer Registry who were diagnosed with a first primary Stage I-IIIA breast cancer between 2010 and 2017 and followed until December 31, 2019. Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). In a separate analysis, we examined the presence of crown-like structures in breast adipose tissue (CLS-B), detected by CD68 immunohistochemistry, among 342 women with stage I–III breast cancer who underwent mastectomy at Emory University Hospitals in Atlanta, Georgia (2007–2012). Logistic regression models were used to estimate odds ratios (OR) and 95% CIs. For both cohorts of breast cancer patients, neighborhood deprivation was assessed dichotomously using census tract at diagnosis and the neighborhood deprivation index (NDI), which was computed using American Community Survey 5-year estimates for census tracts in Georgia. Results: In Georgia, we found Black women with breast cancer had ~1.8 times higher rate of breast cancer mortality than their White counterparts (age-adj. HR=1.78, 95% CI: 1.63, 1.94). The disparity was attenuated after adjusting for stage and molecular subtype but was not eliminated (multivariable (MV)-adj. HR=1.32, 95% CI: 1.21, 1.45). When stratified by NDI, the disparity was greater among women living in neighborhoods of low deprivation (MV-adj. HR=1.44, 95% CI: 1.26, 1.64) compared to high deprivation (MV-adj. HR=1.17, 95% CI: 1.03, 1.33). Among Emory breast cancer patients, we found high neighborhood deprivation was inversely associated with CLS-B (age- and race-adj. OR=0.48, 95% CI; 0.26, 0.87). We also found Black patients were more likely than their White counterparts to have CLS-B in low deprivation neighborhoods (age-adj. OR=1.79, 95% CI: 0.98, 3.25) but not in high deprivation neighborhoods (age-adj. OR=0.73, 95% CI: 0.24, 2.20), albeit estimates were imprecise. Conclusion: Our study using a population-based cohort of breast cancer patients in Georgia adds to the evidence that racial disparities in breast cancer survival are worse among women living in higher socioeconomic (i.e., low deprivation) neighborhoods. Additionally, we provide evidence of a potential underlying mechanism, finding the prevalence of CLS-B higher for women in low rather than high deprivation neighborhoods, particularly Black women in this group. Citation Format: Maret L. Maliniak, Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Leah Moubadder, Lauren E. McCullough. Racial disparities in breast cancer survival: Examining the potential role of neighborhood deprivation and breast adipose tissue inflammation [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 B087.

Abstract C078: Comprehensive evaluation for contribution of molecular, socioeconomic and disease covariates to colorectal cancer racial survival disparity of 47,178 patients

Abstract Background: Racial disparities in survival of Colorectal cancer (CRC), as well as differing frequency of driver gene mutation, have been observed before. Here we observe that self-reported race is associated with overall survival (OS) in a single institutional cohort of 47,178 patients with CRC. we conducted a systematic investigation of molecular, Socioeconomic (SES) and Disease covariates to quantitate the degree to which each influences OS. Methods: Under an approved IRB protocol, the Palantir-Foundry software system was used to query the MD Anderson (MDA) patient database to identify CRC patients and extract outcomes data and covariates. Genetic mutations that showed significant difference were included with other SES and Disease covariates in Cox-proportional hazard regression model for OS. Preliminary mediation analysis was done to quantify the contribution of each covariate to the OS disparity. Results: 47,178 patients with CRC adenocarcinoma diagnosed between 1973 and 2023 were identified and race (self-reported) was extracted (Asian 1433, 3.0%; African American (AA) 4126, 8.7%; Hispanic 4166, 8.8%; non-Hispanic White (NHW) 37453, 79.4%). Relative to NHW, AA had worse OS (HR=1.22, P= 8.03E-8), while Asians and Hispanics had better OS (HR=0.68, P= 1.06E-8 and HR=0.88, P= 7E-4). Restricting to stage 4 patients, these disparities persisted; AA HR 1.2 (p=1.7E-4) Asian HR 0.67 (p= 1.64E-5), Hispanic HR 0.88 (p= 1.4E-2) relative to NHW. Among 7,628 patients with clinical mutational testing, five genes had significant differences in mutation frequency; APC (45% Asian, 62% AA, 44% NHW, 57% Hispanics, P= 5.83E-3), KRAS (43%, 57%, 44%, 50%, P=3.43E-9), PIK3CA (13%, 23%, 17%, 17%, P=3.37E-3), BRAF (8%, 3%, 8%, 4%, P=1.15E-8), KIT (3%, 2%, 5%, 2%, p=0.046). In multivariate analysis the survival difference between Asians, Hispanics or AA compared to NHW was no longer significant (HR= 0.91, P=0.59, HR= 0.87, P=0.21 and HR=1.14, P= 0.18). In contrast KRAS (HR= 1.5, P=9.22E-9), BRAF (HR= 1.64, P=1E-4) APC mutation (HR= 0.77, P=1E-4) were independently associated with OS, as was higher ECOG (HR= 1.39, P=7.14E-23), higher stage (HR= 1.5, P=3.57E-20), higher national area deprivation index (ADI) quantile (HR=1.08, P= 2.7E-3), being married (HR=1.2, P= 1.52E-2), right side colon tumor (HR=1.22, P= 1.03E-2), poorly differentiated tumors (HR= 1.2, P=1.47E-2), undergoing surgical intervention (HR= 0.47, P=1.54E-29) and MSI-high (HR= 0.41, P=2.16E-6). In our single institution study preliminary mediation analysis showed that ADI, marital status, right sided affection, KRAS mutation, BRAF mutation were the main drivers of the survival disparities in contrast to stage, grade, performance status, surgical intervention and MSI-status. Conclusions: Racial survival disparity is complex and multifactorial. Our single center systematic evaluation showed that SES, driver gene mutations and site of colon affected by the tumor made an important contribution to the racial survival disparity. Further investigation of germline variation, and treatment response is warranted. Citation Format: Mahmoud Yousef, Abdelrahman Yousef, Mohammad Zeineddine, Saikat Chowdhury, Mohammad Fanaeian, Naoko Little-Jackson, Mark Knafl, Kristin Alfaro-Munoz, Abinheet Uppal, Scott Kopetz, Wenyi Wang, Jason Willis, John Paul Shen. Comprehensive evaluation for contribution of molecular, socioeconomic and disease covariates to colorectal cancer racial survival disparity of 47,178 patients [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 C078.

Abstract B102: Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival

Abstract Background: Ovarian cancer is the most lethal gynecologic cancer and the fifth leading cause of cancer-related mortality among women in the US. Racial and ethnic disparities in ovarian cancer outcomes exist, wherein non-Hispanic Black (NHB) women are 40% more likely to die compared with non-Hispanic White (NHW) women. Comorbidity burden is differential by race and ethnicity and has the potential to affect treatment and outcomes. Our objective was to evaluate the association between comorbidities, present at the time of diagnosis, and mortality, and to evaluate if comorbidities contributed to racial and ethnic disparities in mortality. Methods: The KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival) Study includes women diagnosed with invasive ovarian, fallopian, or peritoneal cancer between 2000 and 2018 at KP Northern California, older than 18 years and residing in California at diagnosis. Comorbidities were identified using ICD-9/10 and procedural codes up to five years preceding the ovarian cancer diagnosis. We computed hazard ratios (HRs) and 95% confidence intervals (CIs) associating individual comorbidities and the Charlson Comorbidity Index (CCI) with all-cause mortality, and the racial disparities (Hispanic, non-Hispanic Asian, and NHB vs. NHW) in all-cause mortality by comorbidity, adjusting for age and stage. Results: Of 4,910 ovarian cancer patients in the KP ROCS cohort, 605 (12%) are Hispanic, 672 (13%) are non-Hispanic Asian, 282 (5.5%) are NHB, and 3,321 (74%) are NHW. At diagnosis, NHB and Hispanic ovarian cancer patients were more likely to present with diabetes than non-Hispanic Asian and NHW women (NHB=16%, Hispanic=13% vs non-Hispanic Asian=10%, NHW=8%). Cardiovascular disease was more common among NHB women compared with other racial and ethnic groups (NHB=37% vs. Hispanic=26%, non-Hispanic Asian=19%, NHW=32%). Moreover, the net burden of comorbidities (CCI=3+) was higher among NHB women compared with other racial and ethnic groups (NHB=22% vs non-Hispanic Asian=9%, Hispanic=13%, NHW=13%). In the multivariable-adjusted models, ovarian cancer patients with diabetes (HR=1.16, 95%CI 1.03, 1.31), cardiovascular disease (HR=1.32, 95% CI 1.22, 1.44), hypertension (HR=1.07, 95%CI 0.99, 1.16), or renal disease (HR=1.25, 95%CI, 1.14, 1.38 at the time of their diagnosis were more likely to die than those without the corresponding comorbidity. NHB ovarian cancer patients had an increased hazard of mortality across nearly all comorbid conditions compared with NHW patients, whereas Hispanic women had equivalent mortality rates as NHW patients, and non-Hispanic Asian patients had reduced mortality rates compared with NHW patients across each individual comorbidity. Conclusions: These analyses indicate that the presence of comorbid conditions negatively impacts survival among ovarian cancer patients. Moreover, NHB ovarian cancer patients are more likely to present with comorbidities at the time of their ovarian cancer diagnosis compared with other racial and ethnic groups, which may partially explain the observed disparities. Citation Format: Lindsay J. Collin, Jia Li, Valerie S. Lee, Juraj Kavecansky, Christine Garcia, Carola Sanchez Diaz, Scarlett Lin Gomez, Jennifer A. Doherty, Elisa V. Bandera, Lawrence H. Kushi. Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival [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 B102.

Abstract C084: Quantifying racial disparities in hepatocellular carcinoma: A comprehensive meta-analysis of survival and early presentation

Abstract Background: Hepatocellular carcinoma (HCC) constitutes a significant burden on global cancer mortality, with distinct disparities in survival and early presentation observed across racial and ethnic groups. Despite previous research recognizing race as a critical prognostic factor in HCC, these studies have been limited by inconsistent findings and a lack of comprehensive, multi-population analysis. Given the diverse global demographics affected by HCC and the critical necessity of equitable healthcare, a detailed investigation of these disparities is crucial. Aim: Our study aimed to quantitatively synthesize existing literature on racial disparities in the early presentation and survival of HCC, comparing White patients to Black, Asian, and Hispanic groups. Methods: We searched PubMed, Embase, and Cochrane Library databases for studies published until May 2022 that reported racial disparities in HCC survival and early presentation. For early presentation, we employed relative risk (RR), and for survival outcomes, we utilized the hazard ratio (HR), applying random-effect models in both instances. All statistical analyses were conducted using R software (version 4.0.3) with metafor and meta packages. Results: Our search yielded 16 eligible studies, representing 241962 patients from various racial and ethnic backgrounds (172268 white, 33656 black, 12837 Hispanic, 23201 Asian). The pooled RR for early presentation was 0.89 (95% CI: 0.85-0.93, P&amp;lt;0.01, I2=58%) for Black, 1.01 (95% CI: 0.98-1.03, P=0.39, I2=0%) for Asian, and 0.96 (95% CI: 0.88-1.04, P=0.35, I2=77%) for Hispanic patients compared to White patients. These results suggest a lower rate of early presentation among Black and Hispanic patients, with no significant difference observed in the Asian cohort. The pooled HR for survival was 1.09 (95% CI: 1.06-1.12, P&amp;lt;0.01, I2=30%) for Black, 0.83 (95% CI: 0.75-0.92, P&amp;lt;0.01, I2=78%) for Asian, and 0.93 (95% CI: 0.89-0.98, P=0.02, I2=67%) for Hispanic patients compared to White patients. These findings point towards worse survival outcomes for Black patients and improved survival outcomes for Asian and Hispanic patients. Conclusion: This study underscores the significant racial disparities in HCC outcomes and early presentation, highlighting the need for targeted strategies to enhance health equity in HCC care. Future research should prioritize investigating the factors contributing to lower early presentation rates among Black and Hispanic populations and the varied survival outcomes across racial groups to inform the development of race-specific prevention, early detection, and treatment strategies. Citation Format: Muhammed Khaled Elfaituri, Ala Khaled. Quantifying racial disparities in hepatocellular carcinoma: A comprehensive meta-analysis of survival and early presentation [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 C084.

Abstract B116: Real world treatment patterns and treatment outcomes of neuroendocrine tumors: A single institution study

Abstract Introduction: Neuroendocrine tumors (NET) arising from the gastrointestinal tract are rare heterogenous neoplasms that differ in several characteristics including biological behavior, degree of differentiation as well as prognosis. Given the rarity of the condition, much appears to be learned about clinical characteristics and response to therapy for patients with GI neuroendocrine tumors. African American patients are typically associated with poorer outcomes or survival in a variety of tumors but not as well described in neuroendocrine tumors. Our study aimed to study if racial disparities exist in outcomes for patients with NET’s. Methods: Patients who had a diagnosis of neuroendocrine tumor of any grade, and primary location between 2014 to 2022 were identified from Henry Ford Health (HFH) Cancer Registry. The patients’ demographic (age at diagnosis, sex, and self-reported race and ethnicity) were collected from the HFH Electronic Health Records databases in this retrospective data analysis. Race was determined and stratified as non-Hispanic Caucasian (CA), African American (AA), others, and unknown. Log-rank test was conducted to compare the survival curves between CA and AA groups. Cox proportional hazards model was applied with adjustments for age and sex (if applicable) while comparing racial disparities in overall survival. The CA vs. AA hazard ratio (HR) and p-values were calculated. Results: Of the 736 patients, 56.4% (415) were CA, 32.6% (240) were AA, 6.5% (48) were others with the rest 4.5% (33) being unknown. 57.6% of the patients were over the age of 60 and the distribution of males and females were about equivalent at 49.6% and 50.4% respectively. The mean Charlson co-morbidity index was 2.47 in CA, and 2.08 in AA (p=0.095). The average survival in months from time of diagnosis was 76.93 months in CA and 84.6 months in AA (p=0.05). There was no statistical significance when adjusted for age and sex (HR = 1.18, p=0.33). Black females had an average survival of 85.76 months compared to 83 months in white females (p=0.6). Black males did better with an average survival of 82 months to compared to white males at 70.48 months (p=0.04). When age was adjusted, there was no statistical significance between CA and AA (HR = 1.38, p = 0.18). Both white males and females had more patients diagnosed as metastatic at one year prior to diagnosis n= 28 and n=20 respectively compared to black males (n=10) and females (n=9). However, black females with metastatic disease did worse than white females with average survival of 15.22 months compared to 24.24 months (p=0.8). Conclusion: In our retrospective analysis, white patients seemed to have a worse prognosis in terms of overall survival (OS) compared to black patients. However, when adjusted for age and sex, it did not appear to be statistically significant. Black females did have an overall survival worse than white females. Larger studies across multiple institutions may help us understand if racial disparities do exist and develop methods to help eliminate them. Citation Format: Radhika N. Gutta, Wang-Ting Su, Ruicong She, Gazala Khan. Real world treatment patterns and treatment outcomes of neuroendocrine tumors: A single institution study [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 B116.

Disparities in the Enrollment of Racialized, Ethnic Minority, and Older Adults in Randomized Trials of Acute Myeloid Leukemia: A Systematic Review

Introduction: There are significant racial and ethnic disparities in incidence and survival for patients diagnosed with hematologic malignancies. Understanding discrepancies in enrollment in randomized controlled trials based on race, ethnicity, and age is important to better understand access to care and clinical trial conduct. Objective: To systematically review the literature on enrollment of racialized, ethnic minority, and older adults in randomized controlled trials (RCTs) of acute myeloid leukemia (AML) and to provide enrollment estimates and compare these to population characteristics. Methods: MEDLINE was searched from inception through to June 2023. No restrictions based on language or publication date were used. Pairs of reviewers independently screened titles, abstracts, and full texts of records. Inclusion criteria were phase II and III RCTs of disease modifying therapy for AML in adults (≥18 years) reporting efficacy and safety outcomes. We excluded single arm trials, trials with unpublished results, conference abstracts, follow-up reports, subgroup/post-hoc/exploratory analyses, and supportive care trials, except those evaluating disease-modifying therapies and reporting clinical efficacy. A standardized form was pilot-tested and used to extract data related to trial characteristics. The proportion of trials reporting racial and ethnic subgroups (African American/Black, Asian, American Indian/Alaskan native, Native Hawaiian or other Pacific Islander, White, Hispanic), and age ≥65 were determined. For US trials, we calculated the enrollment incidence ratios (EIRs), the ratio of trial proportions of members of a racial and ethnic subgroup divided by US population-based incidence in the corresponding racial and ethnic subgroup using the Surveillance, Epidemiology, and End Results (SEER 20) database. We conducted a random-effects meta-analysis to pool EIRs. Results: After screening 7,759 titles and abstracts and 157 full texts, we included 90 studies, of which 14 (15%) were US trials. Overall, there were 21 (23.3%) trials that reported race or ethnicity and 26 (28.9%) that reported the enrollment proportion of ≥65 years. Of the trials with data on race or ethnicity, 15 (71.4%) had data on African American/Blacks, 21 (100%) Whites, 14 (66.7%) Asian or Pacific Islanders, 2 (9.52%) American Indian and Alaskan Native, 4 (19.0%) Hispanics. Of trials reporting on race, 176 (3.6%) of participants were African American/Black, 360 (7.2%) Asian or Pacific Islander, 5 (0.1%) American Indian and Alaskan Native, 3,914 (79.6%) White, and 39 (0.8%) Hispanic. Of the 14 US trials, 4 (28.6%) reported race and 4 (28.6%) reported enrolled proportion of older adults. Hispanic patients (EIR 0.20; 95%CI 0.07 to 0.59, I 2=86%), and Asian patients (EIR 0.24; 95%CI 0.07 to 0.86, I 2=77%) were significantly underrepresented while White patients (EIR 1.33, 95%CI 1.07 to 1.66, I 2=99%) were significantly overrepresented. Confidence intervals were wide for EIR of Black patients (EIR 0.96, 95%CI 0.42 to 2.2, I2=91%). Conclusion: Most trials did not report data on race and ethnicity or on enrollment proportion of participants ≥65 years. Only a small proportion of trial participants were from racial and ethnic minority groups. Hispanic and Asian patients were significantly underrepresented while White patients were overrepresented.