Racial Disparities In Time Research Articles

Racial Disparities in Time to Huntington Disease Diagnosis in North America

Racial Disparities in Time to Huntington Disease Diagnosis in North America

Payer Status and Racial Disparities in Time to Surgery for Emergent Orthopaedic Procedures.

Delay in surgical management for orthopaedic emergencies and severe fracture types can result in notable morbidity and even mortality for patients. Disparities in various facets of orthopaedic care have been identified based on race/ethnicity, socioeconomic status, and payer status, but disparities in time to surgery have been poorly explored. The purpose of this study was, therefore, to investigate whether disparities exist in time to emergent orthopaedic surgery. Patients who underwent surgery for hip fracture, femur fracture, pelvic fracture, septic knee, septic hip, or cauda equina syndrome over 2012 to 2020 were identified using national data. Multivariable linear regression models were constructed, controlling for age, sex, race/ethnicity, payer status, socioeconomic status, hospital setting, and comorbidities to examine the effect of payer status and race/ethnicity, on time to surgery. Over 2012 to 2020, 247,370 patients underwent surgery for hip fracture, 64,827 for femur fracture, 14,130 for pelvic fracture, 14,979 for septic knee, 3,205 for septic hip, and 4,730 for cauda equina syndrome. On multivariable analysis, patients with Medicaid experienced significantly longer time to surgery for hip fracture, femur fracture, pelvic fracture, septic knee, and cauda equina syndrome ( P < 0.05 all). Black patients experienced longer time to surgery for hip fracture, femur fracture, septic knee, septic hip, and cauda equina syndrome, and Hispanic patients experienced longer time to surgery for hip fracture, femur fracture, pelvic fracture, and cauda equina syndrome ( P < 0.05 all). The results of this study demonstrate that Medicaid-insured patients, and often minority patients, experience longer delays to surgery than privately insured and White patients. Future work should endeavor to identify causes of these disparities to promote creation of policies aimed at improving timely access to care for Medicaid-insured and minority patients. III.

Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis

Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than White patients. This study aims to investigate potential racial disparities in time to surgical decompression in patients with CCS. The National Trauma Data Bank was queried from 2017 to 2019 for patients who underwent surgery for CCS. The primary outcome was time from hospital admission to surgery. Student's t-test and Pearson's chi-squared test were used to evaluate differences in categorical and continuous variables, respectively. An uncensored Cox proportional hazards regression model was developed to assess the effect of race on surgical timing while adjusting for potential confounders. 1076 patients with CCS resulting in cervical spinal cord surgery were included in the analysis. Regression analysis results showed that Black patients (HR=0.85, p=0.03), female patients (HR=0.81, p<0.01), and patients treated at community hospitals (HR=0.82, p=0.01) were less likely to receive early surgery. Though the advantages of early surgical decompression in the setting of CCS have been detailed in medical literature, Black and female patients experience lower rates of prompt surgery following hospital admission and higher rates of adverse outcomes. This disproportionately increased time to intervention exemplifies demographic disparities in the timely provision of treatment to patients with spinal cord injuries.

Racial disparities in time to laparoscopic cholecystectomy for acute cholecystitis

BackgroundDisparities in healthcare exist, yet few data are available on racial differences in time from admission to surgery. This study aimed to compare time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. MethodsPatients who underwent laparoscopic cholecystectomy for acute cholecystitis from 2010 to 2020 were identified using NSQIP. Time to surgery and additional preoperative, operative, and postoperative variables were analyzed. ResultsIn the univariate analysis, 19.4% of Black patients experienced a time to surgery >1 day compared with 13.4% of White patients (p < 0.0001). In the multivariable analysis, controlling for potential confounding factors, Black patients were found to be more likely than White patients to experience a time to surgery >1 day (OR 1.23, 95% CI 1.17–1.30, p < 0.0001). ConclusionsFurther investigation is indicated to better define the nature and significance of gender, race, and other biases in surgical care. Surgeons should be aware that biases may adversely impact patient care and should strive to identify and proactively address them to promote health equity in surgery.

Impact of Race on Outcomes of Advanced Stage Non-Small Cell Lung Cancer Patients Receiving Immunotherapy.

The impact of race in advanced stage non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) is conflicting. Our study sought to examine racial disparities in time to treatment initiation (TTI), overall survival (OS), and progression-free survival (PFS) using a population that was almost equally black and white. This was a retrospective cohort study of stage IV NSCLC patients > 18 years receiving immunotherapy at our center between 2014 and 2021. Kaplan-Meier curves and the multivariate Cox proportional hazards model determined the predictors of OS and PFS. Analyses were undertaken using IBM PSAW (SPSS v.28). Out of 194 patients who met the inclusion criteria, 42.3% were black (n = 82). In the multivariate analysis, there was no difference in PFS (HR: 0.96; 95% CI: 0.66,1.40; p = 0.846) or OS (HR: 0.99; 95% CI: 0.66, 1.48; p = 0.966). No difference in treatment selection was observed between white and black patients (p = 0.363), nor was there a difference observed in median time to overall treatment initiation (p = 0.201). No difference was observed in OS and PFS in black and white patients. Black patients' reception of timelier immunotherapy was an unanticipated finding. Future studies are necessary to better understand how race impacts patient outcomes.

Evaluation of racial disparities in time to presentation, diagnosis, and gynecologic oncology referral in women with serous endometrial cancer (431)

<b>Objectives:</b> The frequency and mortality of endometrial cancer (EC) continue to increase in the United States; this is most striking for aggressive EC subtypes, such as serous tumors. Black women have higher rates of serous EC and lower survival rates compared to White women. We aimed to delineate racial differences in diagnosis and referral between Black and White women with serous EC treated at a quaternary academic medical center as contributing factors to this disparity. <b>Methods:</b> We extracted the following from the electronic medical record of women with confirmed serous EC seen at our center from 2001-2019: demographics, presenting symptoms including duration, details of evaluation and diagnosis, dates of initial visit with gynecologic oncology, and stage of cancer at presentation. We categorized the time from symptom onset to initial evaluation, from presentation to diagnosis, and from diagnosis to visit with gynecologic oncology. Chi-square tests were used to compare these times across racial categories. <b>Results:</b> Data from the medical records of 248 women were analyzed (106 Black women and 142 White women). The median age was 68 years. Presenting symptoms were similar between Black and White women, with abnormal bleeding being the most common (82.8% of Black women, 82.3% of White women, p=0.84). A trend toward presentation at a higher stage was identified for Black women (41.2% Black women with stage III and IV disease, 33.1% White women with stage III and IV disease; p=0.26). Black women had a longer duration of symptoms prior to presentation: 36.4% of Black women presented after >3 months (mos) of symptoms, while 18% of White women presented after >3mo of symptoms (p=0.01). Black women trended toward longer times to diagnosis after the presentation: 45.9% of Black women were diagnosed >3mos after the presentation compared to 33.3% of White women (p=0.14). The mode of diagnosis was similar between Black and White women, with endometrial biopsy being the most common (66% of Black women, 54% of White women, p=0.06). There was no significant difference among these groups in time to see a gynecologic oncologist after a diagnosis was made: 94% of Black women were seen within one mo as compared to 92% of White women (p=0.38). <b>Conclusions:</b> We identified racial disparities in the presentation and diagnosis of serous EC, including a longer duration of symptoms prior to presentation for Black compared to White women. Statistical significance was not reached with regard to the difference in time to diagnosis after the presentation, but a trend was identified in this duration being longer for Black versus White women. No differences were noted in time to referral to gynecologic oncology after diagnosis between Black and White women. Future work should focus on outreach strategies to ensure timely workup for the signs and symptoms of EC among Black women.

ASO Author Reflections: Racial Disparities in Time to Breast Cancer Treatment—A Call to Action

ASO Author Reflections: Racial Disparities in Time to Breast Cancer Treatment—A Call to Action

ASO Visual Abstract: Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center.

ASO Visual Abstract: Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center.

ASO Author Reflections on "Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center".

ASO Author Reflections on "Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center".

Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center.

Racial disparities in breast cancer care have been linked to treatment delays. We explored whether receiving care at a comprehensive breast center could mitigate disparities in time to treatment. Retrospective chart review identified breast cancer patients who underwent surgery from 2012 to 2018 at a comprehensive breast center. Time-to-treatment intervals were compared among self-identified racial and ethnic groups by negative binomial regression models. Overall, 2094 women met the inclusion criteria: 1242 (59%) White, 262 (13%) Black, 302 (14%) Hispanic, 105 (5%) Asian, and 183 (9%) other race or ethnicity. Black and Hispanic patients more often had Medicaid insurance, higher American Society of Anesthesiologists (ASA) scores, advanced-stage breast cancer, mastectomy, and additional imaging after breast center presentation (p<0.05). After controlling for other variables, racial or ethnic minority groups had consistently longer intervals to treatment, with Black women experiencing the greatest disparity (incidence rate ratio 1.42). Time from initial comprehensive breast center visit to treatment was also significantly shorter in White patients versus non-White patients (p<0.0001). Black race, Medicaid insurance/being uninsured, older age, earlier stage, higher ASA score, undergoing mastectomy, having reconstruction, and requiring additional pretreatment work-up were associated with a longer time from initial visit at the comprehensive breast center to treatment on multivariable analysis (p<0.05). Racial or ethnic minority groups have significant delays in treatment even when receiving care at a comprehensive breast center. Influential factors include insurance delays and necessity of additional pretreatment work-up. Specific policies are needed to address system barriers in treatment access.

Impact of socioeconomic and medical factors on racial disparities in time to treatment initiation and survival in breast cancer patients.

e18583 Background: Delays in breast cancer treatment have been associated with adverse outcomes. Previously, we observed longer time to treatment initiation (TTT) and inferior overall survival (OS) among Black versus White patients with breast cancer. We aim to examine the extent to which social, and medical factors influence these outcomes. Methods: Women over age 18 who identified as Black or White and diagnosed with stage I-IV breast cancer between 2015 and 2020 at the Cleveland Clinic were identified. Variables included were age, race, type of insurance, receptor status, hypertension, type 2 diabetes, CKD stage 3/4, obesity, and tobacco use. Characteristics according to race were analyzed by the Chi-squared test for categorical variables and the Wilcoxon rank sum test for continuous variables. The primary outcomes were TTT and OS. TTT was analyzed using multivariable linear regression and OS was analyzed using multivariable Cox regression. Results: Patient characteristics by race are shown in Table. Black patients were older, more frequently had triple-negative (TN) receptor status and comorbidities, and less frequently had private insurance. On multivariable linear regression Black race and increased age were associated with longer TTT (both p &lt; 0.001) whereas TN vs HR+/HER2- was associated with shorter TTT (p = 0.007). On multivariable Cox regression Black race (HR 1.39; p = 0.009), increased age (HR 1.02; p &lt; 0.001), Medicaid/Medicare (HR 1.91) or other insurance (HR 1.68) vs private insurance (p &lt; 0.001), type 2 diabetes (HR 1.55; p = 0.001), CKD stage 3/4 (HR 1.93; p &lt; 0.001), and HER2+ (HR 1.44) or TN (HR 2.41) vs HR+/HER2- (p &lt; 0.001) were associated with increased hazard of death .Obesity (HR 0.73; p &lt;0.025) was associated with decreased hazard of death. Conclusions: Our study highlights racial disparities in breast cancer outcomes including the potential contribution of medical and socioeconomic factors. Further investigation will identify the relative contribution of patient related factors on TTT and OS and explore their impact on breast cancer recurrence. It is critically important for providers to attempt to understand factors contributing to disparities in order to implement interventions that can attempt to limit them.[Table: see text]

Racial disparities in receipt of guideline-concordant care for early-onset colorectal cancer in the U.S.

6544 Background: Early-onset colorectal cancer patients who are Black are less likely to survive than white patients, even for early-stage disease, possibly due to differences in receipt of guideline-concordant care. This study evaluated racial disparities in receipt of timely and guideline-concordant colon and rectal cancer care in a large nationwide sample. Methods: Non-Hispanic Black and white individuals aged 20-49 years newly diagnosed with colorectal cancer during 2004-2019 were selected from the National Cancer Database. Patients who received all care recommended by the National Comprehensive Cancer Network (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) for which they were eligible according to cancer subsite and clinical and pathological TNM stage were considered guideline concordant. Demographic characteristics (age and sex), comorbidities, and health insurance coverage type were added sequentially to a series of multivariable models to estimate contribution to racial disparities in receipt of guideline-concordant care. Racial disparities in time from diagnosis date (among rectal cancer patients eligible for neoadjuvant chemotherapy) and surgery date (among colon cancer patients eligible for adjuvant chemotherapy) to date of chemotherapy initiation was evaluated using restricted mean survival time. Results: Of the 84,728 colon and 62,483 rectal cancer patients, 20.8% and 14.5% were Black, respectively. Black patients were less likely to receive guideline concordant care than white patients diagnosed with colon and rectal cancer, respectively (Table). Demographic characteristics and comorbidities combined explained less than 5% of the disparity, while health insurance coverage type explained 28.6% and 19.4% of the disparity among colon and rectal cancer patients, respectively. Restricted mean time to chemotherapy was statistically significantly longer among Black than white patients for colon (54.0 vs 48.7 days, p &lt;.001) and rectal cancers (49.6 vs 40.9 days, p &lt;.001), respectively. Conclusions: Black patients diagnosed with early-onset colorectal cancer receive worse and less timely care than their white counterparts. Differences in health insurance coverage type, a modifiable factor, were the largest identified contributor to the racial disparities in receipt of guideline-concordant care, suggesting that improved access to care could help mitigate disparities in cancer outcomes. [Table: see text]

Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery.

Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non-small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. A total of 2,363 patients with stage I and II non-small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group (P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group (P < .01) and 64.9% of Black patients and 73.2% of White patients (P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.

Racial Disparities in Time to Start of Definitive Radiation Treatment for Patients With Locally Advanced Cervical Cancer

<h3>Purpose/Objective(s)</h3> Chemoradiation (CRT) is the curative standard for patients with locally advanced cervical cancer (LACC). The impact of time to start of definitive treatment has not been well defined. To further elucidate quality improvement metrics, we investigated factors that may influence start time to CRT or radiation (RT) and its impact on recurrence and survival outcomes. <h3>Materials/Methods</h3> Patients with LACC treated with definitive CRT or RT at our institution between 2015 and 2020 were retrospectively identified. Time to treatment initiation (TTI) was defined as the number of days from date of diagnosis (via biopsy) to start date of RT treatment. The cohort was stratified by the median TTI - within 75 (early) or ≥ 75 days (delayed). Multivariable logistic regression was conducted to examine factors associated with delayed TTI. Secondary endpoints of locoregional failure (LRF), overall survival (OS), and distant failure (DF) were evaluated in multivariable Cox and Fine-Gray models. <h3>Results</h3> We identified 143 patients with LACC who underwent definitive CRT or RT with a median follow up of 18 months. 71 (49.7%) patients had TTI < 75 days (median 53, range 2-74 days) and 72 (50.3%) patients had TTI ≥ 75 days (median 91, range 75-472 days). The delayed cohort had a higher proportion of Hispanic patients (51.4% vs 31.0%, <i>P</i> = 0.04). Both cohorts had similar distributions of other patient, tumor, and treatment related variables. In multivariable logistic regression examining the sociodemographic and clinical factors associated with delayed TTI, only race was a significant predictor as Hispanic women were 2.62 times more likely to undergo delayed TTI (OR 95% CI 1.14-6.00, <i>P</i> = 0.03) than non-Hispanic White women. Non-Hispanic women of other races (Black, Asian, mixed) comprised 18.2% of our cohort and had similar odds (<i>P</i> = 0.58) of undergoing delayed TTI as non-Hispanic White women. In multivariable models, delayed TTI was not associated with inferior LRF, OS, or DF. Similarly, Hispanic race was not associated with inferior outcomes on these endpoints. <h3>Conclusion</h3> In our study, patients with LACC were more likely to receive delayed definitive treatment of ≥ 75 days if they were Hispanic. This disproportionate delay in treatment at a high volume, academic cancer center represents an opportunity for exploration of patient-, physician-, and system-centered factors in order to counteract this disparity. Further studies examining the presence of similar disparities in delay to definitive treatment for locally advanced cervical cancer at other institutions and settings are warranted.

Analysis of racial disparities in time to treatment initiation and survival among patients with advanced cancers.

127 Background: Racial disparities in cancer care have received increased attention in recent years. One previously identified disparity is in the time to treatment initiation (TTI) – a factor closely associated with outcomes. While most research in the US to date has focused on the Medicaid and Medicare populations, this study examined disparities between different racial/ethnic groups in TTI and overall survival (OS) among patients with cancer managed in the community setting. Methods: Using the Flatiron Health electronic health record database, patients diagnosed with advanced non-small cell lung cancer (aNSCLC), metastatic colorectal cancer (mCRC), metastatic breast cancer (mBC), multiple myeloma (MM), advanced gastroesophageal cancer (aGastric), advanced urothelial cancer (aUL), metastatic renal cell carcinoma (mRCC) or advanced melanoma (aMel) and treated with first-line (1L) therapy, with ≥1 month of follow-up during 2014-2019, were included. Patient characteristics, TTI and outcomes were compared across race/ethnicity groups classified as White, Black, Asian and Hispanic/Latino/Other (Other). Results: A total of 81,543 patients were evaluated (37% aNSCLC, 19% mCRC, 15% mBC, 8% MM, 6% aGastric, 5.2% aUL, 5.0% mRCC and 4.1% aMel); 67% were White, 9% Black, 3% Asian and 11% Other. Overall, TTI was similar across race/ethnicity groups (median range 1.1–1.2 months), and 44% of all patients received treatment ≤30 days post-diagnosis. Overall Survival (months). Median OS varied by tumor and race/ethnicity groups (Table). However, multivariate Cox proportional hazards analysis showed that Asian patients had better OS than Black patients in many cancers (hazard ratio [HR] 0.8 aNSCLC, 0.75 mBC, 0.63 aGastric, 0.59 aUL, 0.81 mCRC, 0.68 mRCC), while White patients had better survival than Black patients in mBC (HR 0.8) and aGastric (HR 0.87). Conclusions: In this real-word analysis, TTI did not differ by race/ethnicity group for any of the cancers examined. However, some differences in OS emerged on multivariate analysis – this was longer in Asian than Black patients in aNSCLC, mBC, mCRC, aGastric, aUL and mRCC, and longer in White than Black patients in mBC and aGastric. Given the small sample size in some groups, further analyses are needed to determine the influence of race/ethnicity on cancer care and outcomes.[Table: see text]

Reducing racial disparities in time to breast cancer diagnosis: Impact of immediate screening mammogram reads during the COVID pandemic.

6508 Background: During the COVID-19 pandemic, barriers to access screening mammography along with goals to reduce visits supported immediate reading of screening mammograms. Typically, screening mammograms are reported after patients have left the facility. If imaging is abnormal, then an additional visit is needed for diagnostic imaging, introducing delays and potential disparities .Thus, we implemented an immediate-read screening mammography program and measured its impact on racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram. Methods: Responding to the COVID-19 pandemic, we implemented an immediate read screening program in late May 2020. Patients were provided imaging results before discharge and if the exam was abnormal, efforts were made to perform diagnostic imaging during that visit. We identified consecutive screening mammograms performed weekdays 8:00am-4:30pm and Saturdays 9:00am-4:00pm pre-implementation (6/1/19-10/31/19) and post-implementation (6/1/2020-10/31/2020). Exams left unread while awaiting comparison studies, due to technical factors, or for more than 10 days were excluded. Patient demographics and time from screening exam completion to report finalized were obtained from the electronic medical record. Cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive value (PPV) were calculated. Multivariable linear and logistic regression models were used to compare time from screening exam to report, same-day diagnostic imaging, and screening performance metrics pre- and post-implementation overall and by patient subgroups. Results: After 963 exams met exclusion criteria, a total of 8,222 pre- and 7,235 post-implementation exams were included. Median time to report finalization decreased from 61minutes (interquartile range [IQR]:24, 152) to 4 minutes (IQR:2, 7) for pre- and post-implementation periods (p &lt; 0.001). During the pre-implementation period, non-white patients had lower odds of having same-day diagnostic imaging after an abnormal screening exam (age-adjusted odds ratio: 0.28; 95% CI: 0.10, 0.78 p = 0.015). There was no evidence of this disparity post-implementation. AIR was higher in the pre- versus post-implementation period (6.3% versus 5.0%; p &lt; 0.001). There was no evidence of a difference in CDR (5.8 versus 4.2 cancers/1,000 exams) and PPV (9.2% versus 8.4%) for pre- versus post-implementation periods. Conclusions: An immediate read screening mammography program reduces racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram, thus promoting equity in access to care.[Table: see text]

Abstract SS1-10: Impact of Medicaid expansion on racial disparities in time to adjuvant chemotherapy administration among breast cancer (BC) patients

Abstract BACKGROUND: Delays in adjuvant chemotherapy initiation have a detrimental effect in outcomes and are more frequently seen among racial/ethnic minorities, uninsured patients and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study we evaluate the impact of Medicaid expansion on racial disparities in time to adjuvant chemotherapy administration in a large cohort of BC patients.METHODS: Women (aged 40-64) diagnosed with primary invasive BC (stage I-III) between 01/01/2007 and 12/31/2016 were identified in the National Cancer Database. All patients underwent surgery as initial treatment modality and received adjuvant chemotherapy within 6 months of surgery. Chemotherapy delay was defined as &amp;gt;60 days from surgery to the first dose of chemotherapy. The cohort was limited to those residing in states that underwent Medicaid expansion in 2014 (KY, NV, CO, OR, NM, WV, AR, RI, AZ, MD, MA, ND, OH, IA, IL, VT, HI, NY, DE). For comparison purposes, 2007-2013 was considered the pre-expansion period and 2014-2016 the post-expansion period. We calculated difference-in-difference (DID) estimates using multivariable linear regression models. Results are presented as adjusted differences (in % points) between race/ethnicity groups in the pre and post-expansion periods, and as adjusted DID with 95% CI. A negative DID estimate indicates that Medicaid expansion reduces the racial/ethnic disparity in chemotherapy administration delay. The parallel trend assumption was tested. Variables in the final model included age, comorbidities, BC subtype, insurance status, distance to treatment facility, region, education, household income, facility type and facility case volume. RESULTS: 105,385 patients were included (median age 53), of them 75,663 (71.8%) were diagnosed in the pre- and 29,722 (28.2%) in the post-expansion period. 77.5% of the patients were White, 11.7% Black and 4.9% Hispanic. The proportion of patients experiencing chemotherapy initiation delays was greater among Blacks and Hispanics in both study periods compared to Whites. The proportion of chemotherapy delays decreased for all races between the pre and the post-expansion period. We observed a statistically significant decrease in the chemotherapy initiation racial disparity. The adjusted DID was -2% (95%CI -3.8 to -0.3, P=0.02) between Whites and Blacks was and -3% (95%CI -5.5 to -0.5, P=0.02) between Whites and Hispanics. In a subgroup analysis among 10,777 Medicaid patients the parallel trend assumption was not valid, therefore we estimated the DID between Whites and Blacks using a propensity-score based weight sample, identifying a reduction in the racial disparity of even greater magnitude (DID -9.1% [-14.4 to -3.8, P&amp;lt;0.001]). CONCLUSIONS: We demonstrate that Medicaid expansion reduced racial disparities by decreasing the proportion of Blacks and Hispanics experiencing delays in adjuvant chemotherapy initiation and decreasing the gap that exists when compared to Whites. These important results highlight the positive impact of policies aimed at improving equity and increasing access to health care. Pre-ExpansionPost-ExpansionRaceNAdjusted Rate of Delayed Chemo &amp;gt; 60 daysAdjusted Difference Between White Race (% points)NAdjusted Rate of Delayed Chemo &amp;gt; 60 daysAdjusted Difference Between White Race, (%points)Adjusted DID (95% CI), Percentage PointsPWhite5930527.202232524.20RefRefBlack856036.18.9372031.16.9-2.0 (-3.8 to -0.3)0.02Hispanic343232.35.1170426.32.1-3.0 (-5.5 to -0.5)0.02 Citation Format: Mariana Chavez-MacGregor, Xiudong Lei, Hui Zhao, Tina Shih, Sharon H Giordano. Impact of Medicaid expansion on racial disparities in time to adjuvant chemotherapy administration among breast cancer (BC) patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS1-10.

Racial Disparities in Time to Treatment Initiation for Stage IV Non-Small Cell Lung Cancer Patients Receiving Immunotherapy

Racial Disparities in Time to Treatment Initiation for Stage IV Non-Small Cell Lung Cancer Patients Receiving Immunotherapy

Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma.

Although cure rates for early stage anal squamous cell cancer (ASCC) are overall high, there may be racial disparities in receipt of treatment and outcome precluding favorable outcomes across all patient demographics. Therefore, the authors aimed to assess the time to treatment initiation and overall survival (OS) in Black and White patients receiving definitive chemoradiation for early stage ASCC. The authors identified patients diagnosed with early stage (stage I-II) ASCC and treated with chemoradiation diagnosed between 2004 and 2016 in the National Cancer Database. Clinical and treatment variables were compared by race using the χ test, and OS assessed through Cox regression with 1:1 nearest neighbor propensity score matching. Among 9331 patients, 90.6% were White. Black patients had longer median time to treatment initiation as compared with White patients (47 vs. 36 d, P<0.001), and on multivariable analysis, the Black race was associated with higher odds of >6 weeks of time to treatment initiation (hazard ratio, 1.78; 95% confidence interval, 1.53-2.08; P<0.001). Furthermore, Black patients had worse OS (5-year survival 71% vs. 77%; P<0.001), which persisted after propensity score matching (P=0.007). Black patients had a longer time to treatment initiation and worse OS as compared with White patients with early stage ASCC treated with chemoradiation. Further research is needed to better elucidate the etiologies of these disparities.

Abstract D071: Impact of racial differences in financial burden on time to treatment

Abstract Background Racial disparities in time-to-treatment exist among cancer patients, with patients of color being more likely to experience treatment delays. Such racial differences in treatment initiation are likely on the causal pathway to inequities in treatment outcomes. Emerging research has documented racial differences in financial burden, but little is known about the contribution of financial burden to disparities in treatment delays. In this study, we evaluated whether financial burden partly accounted for racial disparities in time to treatment initiation among a cohort of cancer survivors. Methods We used cross-sectional data of patients enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC) between 2010 and 2016. The sample for this study was limited to cancer patients and survivors who identified as non-Hispanic White or Black, received a diagnosis for breast, genitourinary, gastrointestinal, or head or neck cancer, and completed a questionnaire at least 30 days following their diagnosis (N=2,123). Time to treatment was measured in number of days from diagnosis to start of first course of treatment, ascertained from the medical record. Initial treatment was either surgery, chemotherapy, radiation, or hormonal therapy, depending on the clinical indication. Financial burden was assessed using the Patient Satisfaction Questionairre-18 on the self-reported satisfaction with the financial aspects of care (&amp;gt;3.5 is satisfied; &amp;lt;=3.5 is unsatisfied). To assess racial differences in time to treatment, we conducted both unadjusted and adjusted OLS regression analysis. Results In the first model predicting time to treatment as a function of race and clinical factors only, Black race was associated with a 11.4 day increase in the number of days between diagnosis and treatment (p&amp;lt; 0.001). In a second model adjusting for race, clinical factors and financial burden, the absence of financial burden was associated with a decrease in the number of days between diagnosis and treatment (\beta=-3.2, p= 0.042). Results were similar in the final fully adjusted model accounting for the above covariates in addition to sociodemographic factors, with the absence of financial burden being associated with a minor decrease in the time to treatment initiation (\beta= -3.0, p= 0.044). There was only a minor attenuation in the Black-White disparity in the fully adjusted model, with Black race being associated with an increase of 10.6 days between diagnosis and treatment initiation (p=0.001). Conclusions In Black patients and patients who report experiencing financial burden a greater number of days elapse between diagnosis and treatment initiation. Decreases in the time from diagnosis to first treatment is a modifiable factor in treatment inequities whether both for related to financial burden and race. Citation Format: Wendi Elkins, Olive Mbah, Jeannette T Benson, Laura Farnan, Neda Padilla, Sam Cykert, Bryce B Reeve, Giselle Corbie-Smith, Cleo A. Samuel. Impact of racial differences in financial burden on time to treatment [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D071.