Racial Disparities In Outcomes Research Articles

Comparison of Enhanced Recovery After Surgery (ERAS) metrics by race among gynecologic oncology patients: Ensuring equitable outcomes

ObjectivesRace and ethnicity are not routinely audited in Enhanced Recovery After Surgery (ERAS) pathways. Given known racial disparities in outcomes in gynecologic oncology, the purpose of this study was to compare differences in ERAS implementation and outcomes by race. MethodsA cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to December 2021. Compliance with ERAS metrics, postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and readmissions within 30 days were compared by race. ResultsOf 1083 patients (17.0% non-white), non-white women were younger (54.2 years ±13.1 vs. 60.7 years ±13.6, p < 0.001) and proportionally fewer spoke English (75.0% vs. 97.8%, p < 0.001). Fewer non-white women received preadmission ERAS education (73.4% vs. 79.9%, p = 0.05). There were no differences in ERAS implementation by race, including similar rates of preoperative nutritional assessment, carbohydrate loading, antibiotic and thrombosis prophylaxis, and unplanned surgeries by race. There were no differences in complications, reoperations, ICU transfers, or readmissions by race on univariate and multivariate analysis. Four non-white (2.2%) and two white women (0.2%, p = 0.009) died within 30 days of surgery. ConclusionsFewer non-white women received preadmission education, possibly due to language barriers. ERAS compliance, postoperative complications, readmissions, reoperations, and ICU transfers did not differ by race. There were two additional deaths within 30 days postoperatively among non-white women compared to white women - which is difficult to interpret given the rarity of perioperative mortality - but appeared unlikely to be related to differences in ERAS protocol implementation. ERAS programs should ensure educational materials are translated into various languages and audit metrics by race to ensure equitable outcomes.

Abstract WP145: Racial Disparity In Outcomes Of Acute Ischemic Stroke In The United States: A 20-year Analysis Of The National Inpatient Sample From 2000-2019

Background: Acute ischemic stroke (AIS) is associated with a high rate of morbidity and mortality. We aimed to characterize racial disparities in patients with AIS over a 20 year period and examine the prognostic impact of race on functional outcomes. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Discharge location was used as a surrogate for functional outcome. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of &lt;0.001. All analysis performed in R version 4.1.3. Results: A total of 10,415,286 patients with AIS were identified. Mean Age was 70.91±13.8 years. Patients were 61% White, 14.3 % Black, 6.6% Hispanic, and 2.4% Asian. Average NIH Stroke Scale differed significantly among the groups, with Asian patients having more severe disease than White, Black, or Hispanic patients (p&lt;0.001). After multivariate analysis, Black patients had worse odds for discharge home than white patients (AOR 0.8, 95%CI: 0.77-0.83, p&lt;0.001) with a higher likelihood of discharge to nursing/long-term care facilities (AOR 1.3, 95%CI: 1.26-1.34, p&lt;0.001). In hospital mortality was less in Black (AOR 0.64, 95%CI: 0.58-0.7) and Hispanic (AOR 0.78, 95% CI: 0.69-0.87) patients (p&lt;0.001). Conclusions: This 20 year nationally representative analysis of racial disparities in patients with AIS shows that while Black patients have worse odds of discharge home, they are less likely than White patients to die in the hospital. White patients make up the majority of cases, but their percentage of total AIS cases decreased while Black patients increased over the twenty year study period.

Structural racism in clinical research limits its validity and applicability

The current sociocultural pressures to re-examine structural racism in society and in medicine have inspired researchers to question the assumptions that underpin clinical research and to more deliberately ask questions about the disparities in cancer outcomes based on race or ethnicity with a more intersectional lens.1 Sumit Gupta and colleagues2 present a provocative study on racial and ethnic disparities in survival outcomes in children with acute lymphocytic leukaemia who participated in Children's Oncology Group clinical trials between 2004 and 2019, showing that racial disparities in the outcome of acute lymphocytic leukaemia persist, despite overall advances in its management.

Racial Disparity in Outcomes Among Prostate Cancer Patients in the Post-Affordable Care Act Period.

Our objective was to assess whether Medicaid expansion is associated with reduced racial disparity in quality of care measured as 30-day mortality, 90-day mortality, and 30-day readmission in prostate cancer patients receiving surgery. We used the National Cancer Database to extract a cohort of African American and White men diagnosed with prostate cancer between 2004 and 2015 and surgically treated. We used 2004-2009 data to observe preexisting racial disparity in outcomes. We used 2010-2015 data to assess racial disparity in outcomes and the interaction of race and Medicaid expansion status. Between 2004 and 2009, 179,762 men met our criteria. In this period, African American patients reported higher hazard of 30- and 90-day mortality and higher odds of 30-day readmission compared to White patients. Between 2010 and 2015, 174,985 men met our criteria. Of these 84% were White and 16% were African American. Main effects models showed that compared to White men, African American men had higher odds of 30-day mortality (OR=1.96, 95% CI = 1.46, 2.67), 90-day mortality (OR=1.40, 95% CI = 1.11, 1.77), and 30-day readmission (OR=1.28, 95% CI = 1.19, 1.38).The interactions between race and Medicaid expansion were not significant (P = .1306, .9499, and .5080, respectively). Improved access to care via Medicaid expansion may not translate into reduced racial disparity in quality-of-care outcomes in prostate cancer patients treated surgically. System-level factors such as availability of and referrals to care, and complex socioeconomic structure may also play a role in improving quality of care and reducing disparities.

Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem Inflammatory Syndrome in Children vs COVID-19

Multisystem inflammatory syndrome in children (MIS-C) causes severe inflammation of multiple organ systems after SARS-CoV-2 infection. During the pandemic, surveillance reporting of MIS-C was voluntary, with likely underreporting. For a rare syndrome like MIS-C, numerous data are needed to explore the disease in greater detail. To use large all-payer billing data and the new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) code for MIS-C to compare outcomes across MIS-C and COVID-19 over all 4057 hospitals in 31 states. A retrospective cross-sectional study of all COVID-19 and MIS-C hospitalizations in individuals younger than 21 years from 31 states was conducted, using Agency for Healthcare Research and Quality 2021 Healthcare Cost and Utilization Project data. Analyses were conducted from February 1 to October 20, 2022. Fifty complications, adverse medication events, costs, and the Social Vulnerability Index. There were 4107 individuals with MIS-C (median age, 9 [IQR, 5-13] years; 2443 [59.5%] male; 1384 [38.1%] White) and 23 686 individuals with COVID-19 without MIS-C (median age, 15 [IQR, 5-18] years; 12 878 [54.4%] female; 4605 [44.1%] White), with 1.48 (95% CI, 1.35-1.62) MIS-C hospitalizations per 100 000 children per month, ranging from 0.97 hospitalizations per 100 children for White and 1.99 hospitalizations per 100 children for Black children. Outcomes worsened as the number of organ system dysfunctions increased from 2 to 8 organs. Deaths associated with MIS-C increased from less than 1% to 5.8% (95% CI, 3.3%-8.4%) and from less than 1% to 17.2% (95% CI, 11.7%-22.7%) for COVID-19 (P = .001). Adverse medication events associated with MIS-C increased from 4.9% (95% CI, 3.8%-6.0%) to 17.8% (95% CI, 13.7%-22.0%) and from 1.2% (95% CI, 1.0%-1.3%) to 13.4% (95% CI, 8.4%-18.3%) for COVID-19. The median length of stay for MIS-C increased from 4 (IQR, 2-5) to 8 (IQR, 5-12) days and from 3 (IQR, 2-5) to 16 (IQR, 7-23) days for COVID-19. Median costs for MIS-C increased from $16 225 (IQR, $9244-$26 822) to $53 359 (IQR, $35 920-$86 882) and from $6474 (IQR, $3741-$12 103) to $98 643 (IQR, $30 675-$204 956) for COVID-19. The percentage of MIS-C cases that were in Black children doubled from 16.2% to 31.7% (P = .001) as organ dysfunction increased, remaining unchanged with COVID-19. Hospital stays for MIS-C increased by 1 day (P = .01) for Black patients compared with White patients, with Black patients moving from the bottom to top quartile of socioeconomic vulnerability, with no disparity with COVID-19. In this cross-sectional study, MIS-C was more common and severe than previously reported, with more racial disparities in outcomes than were seen in patients with COVID-19. The findings of this study suggest that relying on mean outcomes for MIS-C from past studies can be misleading, since outcomes and disparities varied widely with the number of multiorgan dysfunctions.

Abstract B106: Racial differences in baseline financial distress, basic needs, social support, and symptom distress among women receiving early-stage breast cancer chemotherapy

Abstract Little is known about how baseline financial health for patients with breast cancer (BC) influences racial disparity in outcomes. Thus, this study sought to: 1) describe financial hardship in women prior to chemotherapy for early-stage breast cancer (baseline) and how that varies by race; 2) examine associations between baseline financial health, perceived stress, symptom distress and social support Methods: This analysis employed a descriptive correlational comparative design using data from the baseline time point of SEMOARS: The Symptom Experience, Management and Outcomes According to Race and Social Determinants of Health a multi-site, repeated measures, mixed-methods study comparing the symptom experience of Black and White women with BC. Inclusion criteria were female, Black or White race, 18 years of age or older, prescribed chemotherapy for a diagnosis of stages 1–3 BC. Measures included demographic characteristics, self-reported race, and basic needs assessment of food, housing, utilities, and health. Economic Hardship, the 17-item Psychological Sense of Economic Hardship includes 4 subscales reflecting recent economic strain. The Interpersonal Support Evaluation List (ISEL) assesses the perceived availability of social support, and the Symptom Distress Scale (SDS) evaluates the current symptom experiences of 11 symptoms. Descriptive, comparative and correlational statistics were used. Results: A total of 248 women were included in this cross-sectional analysis. Participants had a mean age of 52.99±12.31 years; were 58.9% White and 41.1% Black, 54% partnered, 57.3% employed, and 70.8% had some college education. Almost all participants (98%) had some form of insurance. Almost one fifth (18.5%) of patients reported inadequate household income to meet their basic needs and 41.5% reported somewhat or extreme difficulty in paying for their basic needs. Compared to White patients, Black patients reported significantly higher (worse) levels of economic hardship (1.17±2.95 vs. -0.70±2.36; p&amp;lt;.001) and reported inadequate income to meet basic needs (30.5% vs. 10.5%; p&amp;lt;.001), and somewhat or extreme difficulty in paying for their basic needs (50.5% vs. 27.6%; 9.5% vs. 3.9%, ps&amp;lt;.001 respectively). Economic hardship had significant weak to moderate correlations with symptom distress (r=0.389, p&amp;lt;.001) and social support subscales (r= -0.333 to -0.445, all p&amp;lt;.001), in the expected directions. Black race was associated with worse economic hardship, its subscales, and inadequate current household income (rs= -0.208 to -0.334; all ps &amp;lt;.001). Using multiple linear regression, 34% of the variance in economic hardship was explained for this cohort (F(6, 169)=19.81, p&amp;lt;0.001). Of the predictor variables, Black race was significantly associated with economic hardship (Beta= -0.239, p&amp;lt;0.001, 95% CI: -2.10 to -0.58). Discussion: Black patients begin BC chemotherapy with greater financial distress, less social support, and higher physical symptoms than White patients. This holds implications for racial differences in the ability to tolerate chemotherapy Citation Format: Margaret Q. Rosenzweig, Catherine Bender, Susan Sereika, Mary Connolly, Hiba Abujaradeh, Susan Mazanec. Racial differences in baseline financial distress, basic needs, social support, and symptom distress among women receiving early-stage breast cancer chemotherapy [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B106.

Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures.

Introduction Femoral shaft fractures are a common pediatric injury that can require non-operative or operative management. Several studies have shown that race impacts pain management and a number of emergency department visits in the pediatric femur fracture population. This study aimed to investigate any association between pediatric patient race and number of comorbidities, 30-day postoperative outcomes, and length of stay following open surgical treatment of femoral shaft fractures. Methods Pediatric patients who underwent open treatment of femoral shaft fracture were identified in the National Surgical Quality Improvement Program-Pediatric database from 2012-2019. Patients were categorized into two cohorts: White and underrepresented minority (URM). URM groups included Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Demographics, comorbidities, and postoperative complications were compared using bivariate and multivariable regression analyses. Results Of the 5,284 pediatric patients who underwent open treatment of femoral shaft fracture, 3,650 (69.1%) were White, and 1,634 (30.9%) were URM. Compared to White patients, URM patients were more likely to have a higher American Society of Anesthesiologists score (p=0.012), more likely to have pulmonary comorbidities (p=0.005), require preoperative blood transfusion (p=0.006), and have an increased risk of prolonged hospital stay (OR 2.36; p=0.007). Conclusion Pediatric URM patients undergoing open treatment of femoral shaft fractures have an increased risk of extended hospital stay postoperatively compared to White patients. As the racial and ethnic constitution of the pediatric population changes, understanding racial and ethnic health disparities will be crucial to providing equitable care to all patients.

Are Lymph Node Metastases Associated With Survival in Black Patients With Pancreatic Cancer?

IntroductionDespite aggressive surgical care and systemic therapy, patients with pancreatic ductal adenocarcinoma (PDAC) have a poor prognosis. Recent studies show that racial disparities in outcome also exist. We sought to investigate the association lymph node (LN) metastases had with survival between Black and White patients with PDAC after resection. MethodsRetrospective analysis of 226 PDAC patients who underwent resection at a single institution from 2010 to 2018 was performed with attention to LN metastasis and patient race. The number of patients who received chemotherapy was also evaluated. ResultsOne Hundred Seventy Five (77.4%) PDAC patients were White and 51 (22.6%) were Black. 130 (59.3%) patients had LN metastasis (LN+). LN+ and LN- groups were similar in race (P = 0.93), sex (P = 0.10) and age at the time of diagnosis (P = 0.45). Patients with LN + disease were more likely to present with larger tumors (3.4 versus 2.8 cm, P = 0.02) and higher T status (P = 0.001). White and Black patients had similar rates of LN metastasis (59% versus 58.8%, P = 1.0). The median survival for LN- Black and White patients were similar (43.2 versus 30.2 mo, P = 0.82). LN + Black patients trended towards receiving more systemic therapy than White LN + patients (55% versus 42%, P = 0.10). The median survival for LN + Black patients was significantly less than LN + White patients (17.5 versus 24.6 mo, P = 0.04). ConclusionsBlack LN + PDAC patients have an inferior survival rate after resection when compared to their White counterparts. Our disparity in outcome cannot be solely explained by a difference in systemic treatment. Further investigation is warranted to determine racial differences in tumor biology or response to chemotherapy.

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

BackgroundHealth disparities disproportionately affect minority groups across the United States with respect to care access, quality, and outcomes. The aim of this study is to examine existing disparities between white and African American (AA) patients regarding postoperative outcomes following total joint arthroplasty and provide insight into disparity trends over a 9-year period. MethodsA retrospective review of 16,779 total joint arthroplasty patients at a single institution between January 2013 and December 2021 was performed. Patients were grouped by race as AA or white. Outcomes of interest included length of stay (LOS), home discharge, 30-day emergency department return, and 30-day readmission. Univariate statistics and multivariate regressions were utilized to analyze results. ResultsSignificant improvements in LOS and rates of home discharge occurred for both white and AA patients at our institution over a 9-year period, while rates of 30-day emergency department returns and readmissions demonstrated a downward but non–statistically significant trend. Despite these trends, AA patients continued to experience longer lengths of stay, less likelihood of 0- or 1-day LOS, and higher risk of nonhome discharge for most years examined. However, after controlling for demographic and comorbidity differences, the differences between groups narrowed over time resulting in no significant differences in the aforementioned 3 measures by 2021. ConclusionsAlthough racial disparities in outcomes are still apparent, over time, the differences in resource utilization between AA and white patients have narrowed. Initiatives aimed at creating healthier communities with increased access to care and the ultimate goal of equitable care must continue to be pursued.

Abstract 13828: Improvement in Racial Disparities in Heart Transplantation Following the Heart Allocation Policy Change

Objectives Heart allocation policy (HAP) in the US was changed in October 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods: The United Network for Organ Sharing (UNOS) registry was used to identify adult patients undergoing isolated HT between 2010-2021. Patients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or Other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on mortality. Results A total of 27,403 patients underwent HT in 143 centers during the study period. The proportion of non-whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p&lt;0.001). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22-1.41; p&lt;0.001) but not in the post-HAP era (HR 1.12, 95% CI 0.03-1.34; p=0.222) compared to White recipients. Other non-white recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre- and post-HAP eras. Conclusions: Under the new heart allocation system, a higher percentage of recipients are non-white. In addition, racial disparities in outcomes have improved with Black recipients no longer having an increased adjusted risk of mortality following HT.

Geographic disparities in peripartum cardiomyopathy outcomes

BACKGROUNDCardiomyopathy causes more than a third of late postpartum pregnancy–related deaths in the United States, and racial disparities in outcomes among pregnant individuals with cardiomyopathy exist. Underlying community factors may contribute to disparities in peripartum cardiomyopathy outcomes. OBJECTIVEThis study aimed to identify the geographic distribution of and disparities in peripartum cardiomyopathy outcomes, hypothesizing that patients living in communities with higher social vulnerability may have worse outcomes. STUDY DESIGNThis was a retrospective cohort study of patients with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 at a single center, excluding those with a post office box address as a post office box address may not reflect the census tract in which a patient resides. Severe peripartum cardiomyopathy (vs less severe peripartum cardiomyopathy) was defined as ejection fraction <30%, death, intensive care unit admission, left ventricular assist device or implantable cardioverter defibrillator placement, or transplant. The US census tract for the patient's address was linked to the Centers for Disease Control and Prevention Social Vulnerability Index, a 0 to 1 scale of a community's vulnerability to external stresses on health, with higher values indicating greater vulnerability. The Social Vulnerability Index includes social factors divided into socioeconomic, household composition, minority status, and housing type and transportation themes. The Social Vulnerability Index and Social Vulnerability Index components were compared among patients by peripartum cardiomyopathy severity. RESULTSOf 95 patients in the original cohort, 5 were excluded because of the use of a post office box address. Of the remaining 90 patients, 56 met severe peripartum cardiomyopathy criteria. At baseline, individuals with and without severe peripartum cardiomyopathy had similar ages, marital status, payor type, tobacco use, gestational age at delivery, and mode of delivery; however, individuals with severe peripartum cardiomyopathy were more likely to be Black (vs White) (59% vs 29%; P<.007) and less likely to recover ejection fraction (EF) to ≥55% by 12 months (36% vs 62%; P=.02) than individuals with less severe peripartum cardiomyopathy. Patients with severe peripartum cardiomyopathy were more likely to live in areas with a higher Social Vulnerability Index (0.51 vs 0.31; P=.002) and with more residents who were unemployed, impoverished, without a high school diploma, in single-parent households, of minority status, without a vehicle, and in institutionalized group quarters than patients with less severe peripartum cardiomyopathy. The median income was lower in communities of individuals with severe peripartum cardiomyopathy than in communities of individuals with less severe peripartum cardiomyopathy. CONCLUSIONPatients with severe peripartum cardiomyopathy outcomes were more likely to live in communities with greater social vulnerability than patients with less severe peripartum cardiomyopathy outcomes. To reduce disparities and maternal mortality rates, resources may need to be directed to socially vulnerable communities.

CORR Insights®: Racial Disparities in Outcomes After THA and TKA Are Substantially Mediated by Socioeconomic Disadvantage Both in Black and White Patients.

DIVERSITY & DISPARITIES IN MUSCULOSKELETAL CARE, WORKFORCE, AND EDUCATION GUEST EDITORS KIMBERLY J. TEMPLETON MD AND KRIS RADCLIFF MD

Racial disparities in outcomes for extracorporeal membrane oxygenation in the United States

BackgroundRacial disparities in extracorporeal membrane oxygenation (ECMO) outcomes in patients with a broad set of indications are not well documented. MethodsAdults requiring ECMO were identified in the 2016–2019 National Inpatient Sample. Patient and hospital characteristics, including mortality, clinical outcomes, and resource utilization were analyzed using multivariable regressions. ResultsOf 43,190 adult ECMO patients, 67.8% were classified as White, 18.1% Black, and 10.4% Hispanic. Although mortality for Whites declined from 47.5 to 41.0% (P = 0.002), it remained steady for others. Compared to White, Asian/Pacific Islander (PI) race was linked to increased odds of mortalty (AOR = 1.4, 95% CI = 1.1–2.0). Black race was associated with increased odds of acute kidney injury (AOR = 1.4, 95%-CI: 1.2–1.7), while Hispanic race was linked to neurologic complications (AOR 21.6; 95% CI 1.2–2.3). Black and Hispanic race were also associated with increased incremental costs. ConclusionsRace-based disparities in ECMO outcomes persist in the United States. Further work should aim to understand and mitigate the underlying reasons for such findings.

Racial Disparities in Outcomes After THA and TKA Are Substantially Mediated by Socioeconomic Disadvantage Both in Black and White Patients.

Racial Disparities in Outcomes After THA and TKA Are Substantially Mediated by Socioeconomic Disadvantage Both in Black and White Patients.

32782 Skin of color associated with worse outcomes and lower probability of treatment in cutaneous squamous cell carcinoma: A case-control study

Morbidity and mortality of skin cancer are disproportionately higher in Blacks, Hispanics, and people of low socioeconomic status. Racial disparities in outcomes for common cancers, including melanoma, have been studied, but no case control studies have examined disparities of cutaneous squamous cell carcinoma (cSCC) in skin of color (SOC). We conducted a retrospective case-control study comparing patient demographics, tumor characteristics and disease outcomes between SOC (n = 95) and non-Hispanic White (NHW; n = 487) patients with SCC.

Comparison of Enhanced Recovery After Surgery (ERAS) metrics by race among gynecologic oncology patients: Ensuring equitable outcomes (006)

Objectives: Race and ethnicity data are not routinely reported in the auditing of Enhanced recovery after surgery (ERAS) pathways. Given known racial disparities in outcomes among gynecologic oncology patients, the purpose of this study was to compare differences in ERAS metrics by race. Methods: A cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to July 2021. Demographic factors and compliance with preoperative, intraoperative, and postoperative ERAS metrics were compared by race using t-test and Chi-square analyses. Postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and re-admission within 30 days were also compared by race using Chi-square and multivariate logistic regressions (adjusted for age, body mass index, and diagnosis). Results: Of 1015 patients identified (83.9% White, 16.1% non-White), 94.2% underwent laparotomy. Non-White women were younger (54.3 years ± 13.5 vs 60.8 years ± 13.3, p<0.001) and less likely to speak English (76.1% vs 97.1%, p<0.001). Fewer non-White women had ovarian cancer than White women (45.4% vs 58.6%, p<0.002). Fewer non-White women received preadmission ERAS education (71.2% vs 79.8%, p=0.014) and fewer received oral bowel preparation (33.1% vs 47.1%) compared to White women. However, there were no differences in rates of preoperative nutritional assessment, carbohydrate loading, antibiotic prophylaxis prior to incision, or thrombosis prophylaxis by race. Intraoperative and postoperative metrics did not differ by race, including surgical approach, blood loss, length of incision, core body temperature, intravenous crystalloid and blood products given, length of operation, length of stay, resection site drainage, use of a nasogastric tube, and mobilization on the day of surgery. A higher percentage of non-White patients experienced complications during their primary stay than White patients (34.4% vs 26.5%, p=0.041, see Table 1). When analyzed by complication type, non-White women had more anesthesia complications (5.5% vs 1.8%, p=0.004), hypotension (5.5% vs 1.2%, p<0.001), and surgical complications (11.7% vs 7.0%, p=0.044) compared to White women. However, no differences were noted in complications after the primary stay, 30-day survival, reoperation, ICU transfer, or readmission. On multivariate logistic regression, non-White women were more likely to experience complications during the primary stay (OR: 1.8, 95% CI: 1.2-2.6, p=0.007) after adjusting for confounders. Objectives: Race and ethnicity data are not routinely reported in the auditing of Enhanced recovery after surgery (ERAS) pathways. Given known racial disparities in outcomes among gynecologic oncology patients, the purpose of this study was to compare differences in ERAS metrics by race. Methods: A cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to July 2021. Demographic factors and compliance with preoperative, intraoperative, and postoperative ERAS metrics were compared by race using t-test and Chi-square analyses. Postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and re-admission within 30 days were also compared by race using Chi-square and multivariate logistic regressions (adjusted for age, body mass index, and diagnosis). Results: Of 1015 patients identified (83.9% White, 16.1% non-White), 94.2% underwent laparotomy. Non-White women were younger (54.3 years ± 13.5 vs 60.8 years ± 13.3, p<0.001) and less likely to speak English (76.1% vs 97.1%, p<0.001). Fewer non-White women had ovarian cancer than White women (45.4% vs 58.6%, p<0.002). Fewer non-White women received preadmission ERAS education (71.2% vs 79.8%, p=0.014) and fewer received oral bowel preparation (33.1% vs 47.1%) compared to White women. However, there were no differences in rates of preoperative nutritional assessment, carbohydrate loading, antibiotic prophylaxis prior to incision, or thrombosis prophylaxis by race. Intraoperative and postoperative metrics did not differ by race, including surgical approach, blood loss, length of incision, core body temperature, intravenous crystalloid and blood products given, length of operation, length of stay, resection site drainage, use of a nasogastric tube, and mobilization on the day of surgery. A higher percentage of non-White patients experienced complications during their primary stay than White patients (34.4% vs 26.5%, p=0.041, see Table 1). When analyzed by complication type, non-White women had more anesthesia complications (5.5% vs 1.8%, p=0.004), hypotension (5.5% vs 1.2%, p<0.001), and surgical complications (11.7% vs 7.0%, p=0.044) compared to White women. However, no differences were noted in complications after the primary stay, 30-day survival, reoperation, ICU transfer, or readmission. On multivariate logistic regression, non-White women were more likely to experience complications during the primary stay (OR: 1.8, 95% CI: 1.2-2.6, p=0.007) after adjusting for confounders.

Markers of graft injury and the conundrum of racial disparities in outcomes after heart transplantation: Early insights for long term outcomes

Resolving inequity in health care is one of the most important challenges of 21st century medical care. Ensuring that all patients have equal access to and benefit from the myriad medical advances seen in the last few decades is paramount. Advanced heart failure treatment remains an area where much work has gone into understanding barriers to equitable care, but where differences in outcomes are still evident. Heart transplantation (HT) remains the gold standard therapy for patients with advanced heart failure and improvements in medical care have resulted in better long-term survival on average.

Racial disparity in distant recurrence-free survival in patients with localized breast cancer: A pooled analysis of National Surgical Adjuvant Breast and Bowel Project trials.

Black race is associated with worse outcome in patients with breast cancer. The distant relapse-free survival (DRFS) between Black and White women with localized breast cancer who participated in National Cancer Institute-sponsored clinical trial was evaluated. Pooled data were analyzed from 8 National Surgical Adjuvant Breast and Bowel Project (NSABP) trials including 9702 women with localized breast cancer treated with adjuvant chemotherapy (AC, n = 7485) or neoadjuvant chemotherapy (NAC, n = 2217), who self-reported as Black (n = 1070) or White (n = 8632) race. The association between race and DRFS was analyzed using log-rank tests and multivariate Cox regression. After adjustment for covariates including age, tumor size, nodal status, body mass index and taxane use, and treatment (AC vs NAC), Black race was associated with an inferior DRFS in estrogen receptor-positive (ER+; hazard ratio [HR], 1.24; 95% CI, 1.05-1.46; P = .01), but not in ER- disease (HR, 0.97; 95% CI, 0.83-1.14; P = .73), and significant interaction between race and ER status was observed (P = .03). There was no racial disparity in DRFS among patients with pathologic complete response (pCR) (log-rank P = .8). For patients without pCR, Black race was associated with worse DRFS in ER+ (HR, 1.67; 95% CI, 1.14-2.45; P = .01), but not in ER- disease (HR, 0.91; 95% CI, 0.65-1.28; P = .59). Black race was associated with significantly inferior DRFS in ER+ localized breast cancer treated with AC or NAC, but not in ER- disease. In the NAC group, racial disparity was also observed in patients with residual ER+ breast cancer at surgery, but not in those who had pCR. Black women with breast cancer have worse outcomes compared with White women. We investigated if this held true in the context of clinical trials that provide controlled treatment setting. Black women with cancer expressing estrogen receptors (ERs) had worse outcome than White women. If breast cancers did not express ERs, there was no racial disparity in outcome. We also observed racial disparity in women who received chemotherapy before their cancer was removed, but only if they had cancer expressing ERs and residual disease on completion of treatment. If the cancer disappeared with presurgical chemotherapy, there was no racial disparity.

Harm-to-Benefit of Three Decades of Prostate Cancer Screening in Black Men

BackgroundProstate-specific antigen screening has profoundly affected the epidemiology of prostate cancer in the United States. Persistent racial disparities in outcomes for Black men warrant re-examination of the harms of screening relative to its cancer-specific mortality benefits in this population.MethodsWe estimated overdiagnoses and overtreatment of prostate cancer for men of all races and for Black men 50 to 84 years of age until 2016, the most recent year with treatment data available, using excess incidence relative to 1986 based on the Surveillance, Epidemiology, and End Results registry and U.S. Census data as well as an established microsimulation model of prostate cancer natural history. Combining estimates with plausible mortality benefit, we calculated numbers needed to diagnose (NND) and treat (NNT) to prevent one prostate cancer death.ResultsFor men of all races, we estimated 1.5 to 1.9 million (range between estimation approaches) overdiagnosed and 0.9 to 1.5 million overtreated prostate cancers by 2016. Assuming that half of the 270,000 prostate cancer deaths avoided by 2016 were attributable to screening, the NND and the NNT would be 11 to 14 and 7 to 11 for men of all races and 8 to 12 and 5 to 9 for Black men, respectively. Alternative estimates incorporating a lag between incidence and mortality resulted in a NND and a NNT for Black men that reached well into the low single digits.ConclusionsComplementary approaches to quantifying overdiagnosis indicate a harm-benefit tradeoff of prostate-specific antigen screening that is more favorable for Black men than for men of all races considered together. Our findings highlight the need to account for the increased value of screening in Black men in clinical guidelines. (Funded by the Patient-Centered Outcomes Research Institute, the National Cancer Institute, the Bristol Myers Squibb Foundation, and the Damon Runyon Cancer Research Foundation.)

Race and Outcomes in Patients with Congenital Cardiac Disease in an Enhanced Recovery Program

Disparities in perioperative outcomes exist. In addition to patient and socioeconomic factors, racial disparities in outcome measures may be related to issues at the provider and institutional levels. Recognizing a potential role of standardized care in mitigating provider bias, this study aims to compare the perioperative sedation and pain management and consequent outcomes in Enhanced Recovery After Surgery (ERAS) cardiac patients of different races undergoing congenital heart surgery at a single quaternary children's hospital. A retrospective study. A single quaternary pediatric hospital. Patients, infants to adults, undergoing elective congenital cardiac surgery and enrolled in the ERAS protocol from October 2018 to December 2020. None. Of the patients, 872 were reviewed and 606 with race information were analyzed. There was no significant difference in intraoperative and postoperative oral morphine equivalent, perioperative sedatives, and regional blockade in Asian or African American patients when compared to White patients. Postoperative pain scores and outcomes among African American and Asian races were also not statistically different when compared to White patients. Racial disparity in perioperative management and outcomes in patients with standardized ERAS protocols does not exist at the authors' institution. Future comparative studies of ERAS noncardiac patients may provide additional information on the role of standardization in reducing implicit bias.