Racial Disparities In Treatment Research Articles

Racial disparities in early-stage NSCLC treatment: A Call for Action.

Non-small cell lung cancer (NSCLC) is associated with a 5-year survival rate of only 28%, however, when caught at an early stage, it can be cured with surgery or stereotactic body radiotherapy (SBRT). Unfortunately, racial disparities may result in limited access to care for some patients. Liu et al. analyzed 64,999 cases of early-stage NSCLC treated between 2005 and 2017 from the Florida cancer registry and showed that Black patients had 36% lower odds of receiving curative-intent surgery compared to their White counterparts. This study highlights significant racial disparities in treatment patterns that must be addressed urgently.

Abstract 4820: Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system

Abstract Introduction: In the U.S., Black patients with papillary thyroid cancer (PTC) are less likely to receive treatment than non-Hispanic White patients. Access to care and insurance status may be related to these disparities. We aimed to compare Black and White patients in receipt of cancer care for PTC in the equal access Military Health System. Materials and Methods: We used the MilCanEpi database to identify a cohort of men and women aged 18 or older who were diagnosed with PTC between January 1, 1998 and December 31, 2014. Patients were assessed for treatment by surgery (e.g., lobectomy, thyroidectomy), adjuvant radioactive iodine (RAI), or active surveillance. Treatment appropriate for risk status (low-risk or high-risk) was compared between non-Hispanic White and Black patients using multivariable logistic regression and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: Among 3,511 patients with PTC, 65.0% White and 65.5% Black received surgical treatment (aOR 0.97, 95% CI 0.80-1.18 for Black vs. White). For patients with low-risk PTC, overall receipt of either surgery or active surveillance (aOR 0.86, 95% CI 0.67-1.10 for Black vs. White) was similar between races. For patients with high-risk PTC, overall receipt of surgery (aOR 1.19, 95% CI 0.71-2.01) or adjuvant RAI (aOR 1.44, 95% CI 0.60-3.44) was similar for Black compared to White patients. Conclusions: In an equal access health system, there were no overall racial differences in receipt of surgical treatment for PTC. Further, in analysis by risk status, there were no significant racial differences in receipt of active surveillance for low-risk PTC nor receipt of adjuvant RAI for high-risk PTC. This suggests the role of access to care in reducing racial disparities in treatment for PTC observed in the general U.S. population. Funding and Acknowledgement: The authors thank the Joint Pathology Center (JPC) for providing the DoD cancer registry data and the Defense Health Agency (DHA) for providing the MHS data repository (MDR) data. This project was supported by the Murtha Cancer Center Research Program (MCCRP) of the Department of Surgery, Uniformed Services University of the Health Sciences (USUHS) under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF, Inc.), grant numbers HHU0001-16-2-0014 and HU0001-18-2-0032 awarded to C.S. Disclaimer: The contents of this abstract are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions, or policies of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. Citation Format: Yvonne L. Eaglehouse, Sarah Darmon, Craig D. Shriver, Kangmin Zhu. Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system [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 4820.

Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty

BackgroundAfrican Americans have the highest prevalence of chronic Hepatitis C virus (HCV) infection. Racial disparities in outcome are observed after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study sought to identify if disparities in treatments and outcomes exist between Black and White patients who have HCV prior to elective THA and TKA. MethodsPatient demographics, comorbidities, HCV characteristics, perioperative variables, in-hospital outcomes, and postoperative complications at 1-year follow-up were collected and compared between the 2 races. Patients who have preoperative positive viral load (PVL) and undetectable viral load were identified. Chi-square and Fisher’s exact tests were used to compare categorical variables, while 2-tailed Student’s Kruskal-Wallis t-tests were used for continuous variables. A P value of less than .05 was statistically significant. ResultsThe liver function parameters, including aspartate aminotransferase and model for end-stage liver disease scores, were all higher preoperatively in Black patients undergoing THA (P = .01; P < .001) and TKA (P = .03; P = .003), respectively. Black patients were more likely to undergo THA (65.8% versus 35.6%; P = .002) and TKA (72.1% versus 37.3%; 0.009) without receiving prior treatment for HCV. Consequently, Black patients had higher rates of preoperative PVL compared to White patients in both THA (66% versus 38%, P = .006) and TKA (72% versus 37%, P < .001) groups. Black patients had a longer length of stay for both THA (3.7 versus 3.3; P = .008) and TKA (4.1 versus 3.0; P = .02). ConclusionsThe HCV treatment prior to THA and TKA with undetectable viral load has been shown to be a key factor in mitigating postoperative complications, including joint infection. We noted that Black patients were more likely to undergo joint arthroplasty who did not receive treatment and with a PVL. While PVL rates decreased over time for both races, a significant gap persists for Black patients.

Early-stage breast cancer treatment disparities in the Midsouth: Has anything changed?

BackgroundWe sought to determine if racial disparities in treatment and survival persist among patients with breast cancer in the Midsouth. MethodsPatients with early-stage breast cancer were identified in the tumor registry of a large healthcare system in the Midsouth. Regression analyses were performed to determine how race was associated with receipt of treatment and mortality. ResultsAmong 4605 patients, 38.8% were Black. Black patients were less likely to undergo surgery (OR = 0.71; 95%CI 0.53–0.97) and receive hormone therapy (OR = 0.81; 95%CI 0.69–0.95) than White patients, but more likely to receive radiation (OR = 1.20; 95%CI 1.08–1.40) and chemotherapy (OR = 1.36; 95%CI 1.16–1.61). Among Black patients, the risk of mortality was lower among those who underwent partial (OR = 0.25; 95%CI 0.12–0.51) or total (OR = 0.35; 95%CI 0.16–0.76) mastectomy and among those who received hormone therapy (OR = 0.62; 95%CI 0.40–0.97). ConclusionThere remains room for improvement in providing treatments that optimize survival among this patient population.

Racial disparities in treatment and outcomes of pediatric hepatoblastoma.

10062 Background: Hepatoblastoma is the most common malignant liver tumor which affects pediatric patients. However, the incidence is rare with 100 cases reported per year.1 Current management consists of surgery and adjuvant cisplatin chemotherapy and radiation depending on tumor histology, resectability, and metastasis.2 However, due to its rarity, optimal treatment protocol remains unclear. The 5-year overall survival rate in the US is approximately 57-69%1. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with hepatoblastoma from 2004 to 2020 using the histology codes 8970 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, and ANOVA tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: This study identified 1215 patients with hepatoblastoma. Black patients had a significantly lower median survival rate compared to White and other race patients (126.2 months vs 165.4 months vs 166.1 months; all p&lt;0.05). Black patients were more likely to be from low-income households than White patients (29.6% vs 17.3%; p&lt;0.05). The mean age of diagnosis was higher for Black patients compared to White patients (2.42 vs 1.99; p&lt;0.05). Black patients were less likely to receive surgery (63.5% vs. 75.4%; p&lt;0.05). Black patients on average had shorter distances to travel from their residence to the hospital (30.61 vs. 59.52 miles; p&lt;0.05). Black patients had longer mean stay times compared to white patients (16.7 days vs 11.2 days; p&lt;0.05). There was no significant difference in survival across incomes. When comparing Black and White patients there was no significant difference in insurance type, surgical margins, grade, stage, size of tumor, regional lymph nodes and time of diagnosis to treatment. No significant difference was shown between adjuvant therapies including chemotherapy and radiation. Conclusions: This study showed Black patients experienced inferior overall survival when diagnosed and treated for hepatoblastoma compared to White patients. This population was less likely to receive surgery, older when diagnosed, and had longer hospital stays. Poorer outcomes suggest a disparity in hepatoblastoma treatment.

Evaluating root causes contributing to real-world disparities in ovarian cancer care: Insights from an implementation science initiative utilizing tethered patient-provider surveys and chart reviews.

e18665 Background: Quality ovarian cancer care is significantly impeded by racial disparities in treatment and survival outcomes for black women with ovarian cancer. In this implementation science (IS) initiative, we evaluated root causes for disparities in care among patients with ovarian cancer at 3 diverse health systems and implemented focused action plans to facilitate improved care quality and promote health equity. Methods: Between 11/2020 and 3/2021, we surveyed oncology team members (n = 53) and ovarian cancer patients (N = 41), and performed randomized and retrospective baseline chart audits (N = 100) at 3 health systems to assess current practices, challenges/barriers, and areas for improvement in equitable care of ovarian cancer patients. Providers then participated in audit/feedback (AF) educational sessions and developed and implemented action plans to address identified gaps. Follow-up chart audits measured practice change following the educational initiative. Results: Significant differences were found between Black and non-Black patients in chart documentation patterns and self-reported survey responses. For example, Black patients were significantly less likely to have chart-documented practices of biomarker testing (BRCA testing 47% of Black patients, and 70% on non-Black patients), assessments for treatment-related adverse events and supportive care (40% vs 70%), fertility counseling (4% vs 17%) and shared decision-making (57% vs. 81%). Patient survey and data suggest racial/cultural differences in the emphasis placed on different treatment decision-making factors, as well as differences in the time/extent to which treatment risks and benefits are discussed with patients. Oncology team members participating in AF sessions developed action plans to improve equitable ovarian cancer care, including increasing education and patient counseling, increasing use of patient navigators, and improving documentation. After implementing action plans, follow-up chart audits showed improvement in the provision of patient education, shared decision-making, biomarker testing, and supportive care for both Black and non-Black patients with ovarian cancer. Conclusions: These findings reveal important factors contributing to racial disparities in ovarian cancer outcomes. The identified gaps may inform future IS initiatives and represent key opportunities for improvement in equitable ovarian cancer patient care. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, GlaxoSmithKline, and Merck &amp; Co. Inc., who had no role in the study design, execution, analysis, or reporting.

Epidemiology and survival trends of lung carcinoids in the veteran population.

e21049 Background: Lung carcinoids (LC) continue to increase in prevalence and existing data shows a female predominance of these tumors, but relevant epidemiologic data for heterogeneous populations is limited. In this study, we describe the epidemiology of LC in the United States (US) Veteran population. Methods: In this retrospective study, we searched Veteran Affairs Cancer Cube Registry (VACCR) for LC cases diagnosed between 2000 and 2017 and their baseline characteristics. Survival rates were analyzed across all baseline characteristics to identify important prognostic factors and results were compared with Surveillance, Epidemiology, and End Results cancer database (SEER). Data was analyzed via chi-square and Fischer exact probability tests (level of significance at &lt; 0.05). Results: We identified 846 LC cases in VACCR (91% males), and 8,851 LC cases in SEER (32% males). Compared to SEER, VACCR data had more black patients (12% vs 8%), less cases with loco-regional disease (56% vs 84% in SEER) and same proportion of lower lobe tumors (40%). The annual incidence rate of LC among all lung cancers in Veterans tripled from 2000 to 2017 (0.3% to 0.9%). No racial disparities in treatment were noted among the Veterans. Male-specific 5-year survival rate was 18% lower in VACCR compared to SEER (61% vs 79%). Univariate analysis of both databases showed a statistically significant association of survival with age, primary tumor site and gender (p &lt; 0.05 for all) (Table 1), with advanced age, upper lobe LC and male gender associated with worse survival. SEER subgroup analyses also showed lower 5-year survival rates for males across all baseline characteristics. Overall, black race appeared to be associated with worse prognosis, but the results did not reach statistical significance for VACCR data. Conclusions: Our study showed that US Veteran population, consisting of older males with more comorbidities, LC have lower survival rates than SEER population with more female LC cases. Advanced age, upper lobe predominant disease, and advanced stage were associated with worse survival. Both SEER and VACCR data suggest that male sex is a poor prognostic factor for LC. [Table: see text]

White psychodrama

White psychodrama

Measuring geographic variation in quality and equity of breast cancer care.

139 Background: Persistent higher breast cancer mortality among Black Americans is partly due to treatment disparities. There is a paucity of surveillance data quantifying racial disparities at local levels, and the relationship of geography to racial disparities in treatment is poorly understood. We sought to develop and apply a claims-based set of breast cancer quality measures, stratified by race, across regions of North Carolina. Methods: We created a retrospective cohort (n = 37,021) of stage I-III breast cancers from 2004-2017 using linked cancer registry and multi-payer claims data. We assessed 4 quality measures derived from ASCO/NCCN and Commission on Cancer including chemotherapy (CT) for hormone receptor negative disease, radiation (RT) after breast conserving surgery (BCS), RT for N2-3 disease, and adjuvant endocrine therapy (ET). Each measure was limited to the ages and tumor features eligible by the ASCO/NCCN/CoC guideline. We estimated age-adjusted overall performance (%) on each measure, and the Black-White gap, at the state level and across 9 geographic sub-regions. We used multivariable Poisson regression to estimate Risk Ratios (RR) comparing quality performance for Black vs. White patients overall and across regions. Exploratory analyses adjusted for patient- and neighborhood-level social determinants of health (SDOH). Results: Median age of the cohort was 68 years and 19% of patients were Black. At the state level, the % of eligible patients meeting quality measures ranged from 73% for adjuvant ET to 95% for RT after BCS. There was significant inter-region variation on all 4 measures. Black patients were less likely to receive adjuvant CT (RR = 0.92, CI 0.87-0.96), post-BCS RT (RR = 0.98, CI 0.97-0.99) and ET (RR = 0.95, CI 0.93-0.98). There was no racial disparity in RT for N2-3 disease. Both overall performance and the magnitude of disparity varied widely across regions and geographic patterns were not consistent across measures. For example, the Charlotte region had the top quality performance for RT for N+ (90%), but worst for ET (70%). Similarly, the Wake region had no racial disparities in CT or RT, but the largest disparity of any region for ET (RR = 0.90, CI 0.84-0.96). Adjustment for SDOH modestly attenuated the relationship between race and quality performance, but significant disparities persisted in the regions with the largest racial gaps. Conclusions: Racial disparities persist in breast cancer care delivery, but with non-uniformity of performance across measures and varying local patterns of disparities. Our findings suggest that cross-cutting interventions spanning the care continuum, and/or interventions adapted to local challenges, may be needed to effectively address racial disparities. The contributions of local resources, structural, and institutional barriers to these patterns remain to be explored. Community-engaged work to share and interpret these findings is ongoing.

Racial disparities in treatment of ruptured abdominal aortic aneurysms

ObjectiveThe Society for Vascular Surgery has recommended immediate transfer of patients with ruptured abdominal aortic aneurysms (rAAAs) to a regional center when feasible. However, Black patients might be less likely to be transferred and more likely to be turned down for repair. We, therefore, examined the transfer rates, turndown rates, and outcomes for Black vs White patients presenting with rAAAs in two large databases. MethodsWe examined all rAAA repairs in the Vascular Quality Initiative from 2003 to 2020 to evaluate the transfer rates and outcomes for Black vs White patients. We used the National Inpatient Sample from 2004 to 2015 to examine the turndown rates. Mixed effects logistic regression, Cox regression, and marginal effects modeling were used to study the interaction between race, insurance status, surgery type (open repair vs endovascular aortic aneurysm repair), and hospital volume. ResultsWe identified 4935 patients with rAAAs in the Vascular Quality Initiative (6.2% Black) and 48,489 in the National Inpatient Sample (6.0% Black). The rates of transfer were high; however, Black patients were significantly less likely to undergo transfer before repair compared with White patients (49% Black vs 62% White; P = .002). The result was consistent in both crude and adjusted analyses when considering only stable patients and was not modified by insurance status, surgery type, or hospital volume. No significant differences were found in perioperative mortality (22% vs 26%; P = .098) or complications (52% vs 52%; P = .64). However, Black patients were significantly more likely to be turned down for repair (37% vs 28%; odds ratio, 1.5; 95% confidence interval, 1.2-1.9; P < .001). A significant interaction was found between race and insurance status with respect to turndown. Patients with private insurance had undergone surgery at a similar rate, regardless of race. However, among patients with Medicare or Medicaid/self-pay, Black patients were less likely than were White patients to undergo repair (Medicare, 64% vs 72%; P = .001; Medicaid/self-pay, 43% vs 61%; P = .031). Patients with Medicaid/self-pay were also less likely to undergo repair than were patients of the same race with either Medicare or private insurance (P < .05). ConclusionsWe found that Black patients with rAAAs are poorly served by the current systems of interhospital transfer in the United States, because they less often undergo transfer before repair. Although the postoperative outcomes appeared similar, this finding could be falsely optimistic, because Black patients, especially the underinsured, were turned down for repair more often even after adjustment. Significant work is needed to better understand the reasons underlying these disparities and identify the targets to improve the care of Black patients with rAAAs.

Cancer treatment and survivorship statistics, 2022.

The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.

164 Racial Disparities in Surgical Recommendations for Primary Central Nervous System Tumors

INTRODUCTION: Racial disparities in treatment and outcomes disproportionately affect patients of color in many surgical fields. There is limited research on these disparities within the field of neurosurgery and most studies report solely on outcomes, not management, of populations at a single institution. METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results database (1971-2015) was used to collect demographic and clinical variables on patients with meningioma (n = 63674), glioblastoma (n = 35258), pituitary adenoma (n = 27506), vestibular schwannoma (n = 11525), astrocytoma (n = 5402), or oligodendroglioma (n = 3977). Univariate and multivariate logistic regression were performed to identify factors independently associated with recommendation against surgical resection. RESULTS: Independent of age at diagnosis, sex, tumor histology, grade, and size, Black patients with meningioma (OR 1.20, 95% CI 1.12-1.27, p &lt; 0.001), glioblastoma (OR 1.15, 95% CI 1.02-1.30, p = 0.023), pituitary adenoma (OR 1.19, 95% CI 1.11-1.28, p &lt; 0.001), and vestibular schwannoma (OR 1.56, 95% CI 1.26-1.93, p &lt; 0.001) were more likely to be recommended against surgical resection compared to White patients. Results were consistent after accounting for patient insurance status and rural-urban continuum code for the county of treatment. CONCLUSION: On review of the NCI SEER database, Black patients were more likely to be recommended against surgery compared to White patients for a number of primary CNS neoplasms, independent of clinical and demographic factors. Further research is needed to identify specific contributions to this inequity.

The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer.

Black patients and underinsured patients with colorectal cancer (CRC) present with more advanced disease and experience worse outcomes. The study aim was to evaluate the interaction of health insurance status and race with treatment and survival in metastatic CRC. Patients diagnosed with metastatic CRC within NCDB from 2006-2016 were included. Primary outcomes included receipt of chemotherapy and 3-year all-cause mortality. Multivariable logistic regression and Cox-regression (MVR) including a two-way interaction term of race and insurance were performed to evaluate the differential association of race and insurance with receipt of chemotherapy and mortality, respectively. 128,031 patients were identified; 70.6% White, 14.4% Black, 5.7% Hispanic, and 9.3% Other race. Chemotherapy use was higher among White compared to Black patients. 3-year mortality rate was higher for Blacks and lower for Hispanics, in comparison with White patients. By MVR, Black patients were less likely to receive chemotherapy. When stratified by insurance status, Black patients with private and Medicare insurance were less likely to receive chemotherapy than White patients. All-cause mortality was higher in Black patients and lower in Hispanic patients, and these differences persisted after controlling for insurance and receipt of chemotherapy. Black patients and uninsured or under-insured patients with metastatic CRC are less likely to receive chemotherapy and have increased mortality. The effect of health insurance among Blacks and Whites differs, however, and improving insurance alone does not appear to fully mitigate racial disparities in treatment and outcomes.

Disparities in Lung Cancer Treatment.

Despite an overall reduction in lung cancer incidence and mortality rates worldwide, Blacks still have higher mortality rates compared to Whites. There are many factors that contribute to this difference. This review seeks to highlight racial disparities in treatment and the possible reasons for these disparities. Factors attributing to racial disparities in lung cancer treatment include social determinants of health, differences in the administration of guideline-concordant therapy as well as molecular testing that is essential for most NSCLC patients. One way to circumvent disparities in lung cancer survivorship is to ensure equal representation of race in research at all levels that will provide insight on interventions that will address social determinants of health, differences in treatment patterns, molecular testing, and clinical trial involvement.

Racial Disparities in Treatment and Outcome of Non-Small Cell Lung Cancer (NSCLC) Patients Across Different Facility Types

<h3>Purpose/Objective(s)</h3> We hypothesize that differential disparities exist in diagnosis, treatment and outcome among NSCLC patients of different races across different types and locations of treatment facilities. <h3>Materials/Methods</h3> The National Cancer Database was queried for cases of lung cancer from 2004-2016. Patients with invasive lung cancer were included. Exclusion criteria were unknown treatment status and unknown tumor size. Multivariate logistic and Cox model were used to assess effects of age, sex, race, facility type, facility location, insurance, education and income on stage, receipt of any treatment, time to receive treatment and outcome. <h3>Results</h3> Among 457,236 patients, 149,772 (32.8%), 241,471(52.9%) and 65,330 (14.3%) were treated at academic, community and integrated centers, respectively. After adjusting for co-founders, as shown in Table 1, Black (B) and Asian (A) race was associated with later stage but better outcomes. B race was associated with less treatment and delayed treatment. In academic facilities, B and A race had later stage, less and delayed treatment but better outcomes. In integrated facilities, B race had similar outcome as White (W) race. When compared to patients from Central facility location, those from West Coast and Mountain facility locations received less treatment (OR, 0.70 and 0.78, respectively, <i>P</i> < 0.001) and later treatment (HR, 0.83 and 0.91, respectively, <i>P</i> < 0.001); patients from Mountain facility locations had better outcomes (HR, 0.89, <i>P</i> < 0.001). <h3>Conclusion</h3> B and A patients were diagnosed at later stage and had less and delayed treatment. However, they had better outcomes stage for stage when compared to W patients. The reverse racial disparity between B and W patients was less in integrated facilities. Efforts to investigate these reverse racial disparities are warranted. Patients from Mountain facility locations had better outcomes than those from Central facility locations, despite less and later treatment. Investigation regarding the effects of facility location on outcome is warranted.

Racial disparities in treatments and mortality among a large population-based cohort of older men and women with colorectal cancer

BackgroundThere were racial disparities in treatment and mortality among patients with colorectal cancer, but few studies incorporated information on hypertension and diabetes and their treatment status. Patients and methodsThe study identified 101,250 patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in the United States who were diagnosed with colorectal cancer at age ≥65 years between 2007 and 2015 with follow-up to December 2016. ResultsThere were substantial racial and ethnic disparities in the prevalence of hypertension and diabetes in patients with colorectal cancer, in receiving chemotherapy and radiation therapy, and in receiving antihypertensive and antidiabetic treatment. Racial disparities in receiving these therapies remained significant in this large cohort of Medicare beneficiaries after stratifications by private health insurance status at the time of cancer diagnosis and by tumor stage. Non-Hispanic black patients had a significantly higher risk of all-cause mortality (hazard ratio: 1.07, 95% CI: 1.04–1.10), which remained significantly higher (1.05, 1.02–1.08) after adjusting for patient sociodemographics, tumor factors, comorbidity and treatments as compared to non-Hispanic white patients. The adjusted risk of colorectal cancer-specific mortality was also significantly higher (1.08, 1.04–1.12) between black and white patients. ConclusionsThere were substantial racial disparities in prevalence of hypertension and diabetes in men and women diagnosed with colorectal cancer and in receipt of chemotherapy, radiation therapy, antihypertensive and antidiabetic treatment. Black patients with colorectal cancer had a significantly higher risk of all-cause mortality and colorectal cancer-specific mortality than whites, even after adjusting for sociodemographic characteristics, tumor factors, comorbidity scores, and treatments.

Disparities in esophageal cancer care based on race: a National Cancer Database analysis

Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR-1.64 [95% confidence interval 1.53-1.76], Hispanic OR-1.19 [1.08-1.32], Asian OR-1.78 [1.55-2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR-1.13 [1.10-1.16] and HR-1.04 [1.02-1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

Racial disparity in treatment of gastroesophageal reflux disease in children with food allergy

Racial disparity in the treatment of gastroesophageal reflux (GER) disease in children with IgE-mediated food allergy (FA) is a life-threatening condition that afflicts more than 8% of US children.1 Unfortunately, the health-related outcomes of FA reach beyond food reactions and can result in anxiety, diminished quality of life (QoL), and impaired psychosocial development.2,3 Food allergy may also be associated with gastrointestinal conditions such as GER disease.4 Gastroesophageal reflux is reported in 2% to 8.2% of children of different ages and can lead to poor weight gain and malnutrition affecting children’s health and QoL.

Racial Disparities in Treatment of Ruptured Abdominal Aortic Aneurysms

The Society for Vascular Surgery recommends immediate transfer of patients with ruptured abdominal aortic aneurysm (rAAA) to a regional center when feasible. However, black patients may be less likely to be transferred, and more likely to be turned down for repair. We therefore examined transfer rates, turndown rates, and outcomes in black vs white patients presenting with rAAA in two large databases.

26984 iPLEDGE pharmacy deserts exist across major metropolitan cities in the United States

Early treatment for acne is crucial to prevent long-term consequences; however, racial disparities in treatment and maldistribution of dermatologists hinders access to care. A study in the District of Columbia demonstrated limited access to iPLEDGE pharmacies in regions with low income and high nonwhite population. This study expands the evaluation of iPLEDGE pharmacy distribution. Twenty cities with a population greater than 500,000 were randomly selected; 4 cities per region. A list of pharmacies was obtained from the Board of Pharmacy and public sources and verified for iPLEDGE enrollment. The association between iPLEDGE pharmacy and demographic data obtained from the 2013-2017 American Community Survey Estimates was evaluated using Poisson regression. Of the 708 ZIP codes surveyed, 5237 total pharmacies were identified of which 2847 were registered in iPLEDGE. For every $1000 increase in median household income, rate ratio of iPLEDGE pharmacies increased by 10% and 12% in the Midwest and West, respectively. Overall, for every percentage increase in nonwhite individuals, rate ratio of iPLEDGE pharmacies decreased by 9%; the most prevalent decrease was in the Southwest by 30%. The rate ratio of iPLEDGE pharmacies decreased by 22% for every percentage increase in individuals below the poverty line; the most prevalent decrease was in the Southwest by 30%. For every unit increase in dermatologist density, iPLEDGE pharmacy density increased by 0.66 units. The administrative burden of processing isotretinoin may be discouraging pharmacies from registering in iPLEDGE. Restricted access to iPLEDGE pharmacies may contribute to the racial and socioeconomic differences in isotretinoin treatment.