Racial Trends Research Articles

974 Racial Trends in Opioid Use Disorder (OUD) at Delivery Hospitalization in the U.S. (2010-2020)

974 Racial Trends in Opioid Use Disorder (OUD) at Delivery Hospitalization in the U.S. (2010-2020)

975 Racial Trends in Severe Maternal Morbidity Among Parturients With Opioid use disorder in the U.S.

975 Racial Trends in Severe Maternal Morbidity Among Parturients With Opioid use disorder in the U.S.

National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020

Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention. To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD. This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023. Self-reported race and ethnicity. Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications. The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively. In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.

Rural-Urban and Racial Trends in Survival of Patients with Multiple Myeloma: 1975-2019 Surveillance, Epidemiology, and End Results (SEER) Analysis

Introduction Although five-year survival rates for multiple myeloma (MM) in the US have continued to steadily improve in recent decades, these advances have not accrued equally to all segments of the population. Sub-groups of patients differentiated by race, socioeconomic status, ethnicity, and geographic location continue to experience inferior survival rates of MM. Little is known about the interacting effects of rural-urban differences and race on the outcomes of patients with MM. The objective of this study is to examine national rural-urban trends in 5-year myeloma-specific survival and overall survival (OS) for patients with MM in a diverse sample of racial groups. Methods This cross-sectional study used SEER data from 1975-2019 to include patients diagnosed with MM. Patients who were 18 years or younger, had missing information regarding rural or urban designation, and had missing follow-up time were excluded. Rural-urban designation was determined using the 2013 Rural Urban Continuum Codes (RUCC). Patients in counties with codes 1 to 3 were classified as urban, while all counties with codes 4 to 9 were rural. SEER coded race and ethnicity data was used. OS was calculated as the time from diagnosis to death from any cause or censored if the patient was still alive. Myeloma-specific survival was calculated as the time from diagnosis to myeloma-related death or censored if the patient was still alive; deaths due to non-myeloma causes were censored at the date of death. These patients were excluded from analysis: missing or unknown cause of death; Non-Hispanic American Indian/Alaska Native, Non-Hispanic Asian or Pacific Islander, and Non-Hispanic Unknown Race. Kaplan-Meier methods were used to estimate 5-year survival rates. Cox proportional hazards regression was used for multivariable modeling of survival data. All survival analyses were completed using SAS 9.4. For all p-values in the model, the 0.05 alpha level was used. Results From 1975 to 2019, there were 40,435 MM cases, with 55.9% between ages 60 and 79 years (Table). Overall, there were 18,680 (46.2%) female, 2,815 (7%) Hispanic (all races), 6,100 (15.1%) Non-Hispanic Black (NHB), and 31,510 (77.9%) Non-Hispanic White (NHW) patients. The majority of patients were classified as urban (84.7%). Rural patients were more likely to be NHW (92.2%). Very few (1.3%) NHB patients were from rural counties. Additionally, 23,180 (57.3%) patients were diagnosed between 2000 and 2019. The 5-year OS and myeloma-specific survival rates increased substantially from 1975 to 2019 across all races (Figure). During the study period, the 5-year myeloma-specific survival rate increased from 28.1% to 62.8% for urban patients and from 26.5% to 56% for rural patients. In the multivariable model (data available after January 1, 1990) younger age, urban home address, later year of diagnosis and NHB race were significantly associated with superior myeloma-specific survival (p&amp;lt;0.01). Compared with NHW, NHB patients had significantly improved myeloma-specific survival (HR=0.928, 95% CI: 0.889-0.969, p=0.0007). There was no significant interaction between rurality and race (p&amp;gt;0.05). In multivariable model for OS, younger age, later year of diagnosis, female sex and urban home address were associated with superior OS (p&amp;lt;0.01), but race/ethnicity was no longer a significant predictor. Conclusions Over 4+ decade study period, 5-year OS and myeloma-specific survival rate increased in all racial groups regardless of rural-urban location. The survival of rural patients was consistently lower than urban patients for NHW and Hispanics. Due to the small sample size, we did not analyze this relationship for NHB patients. Although the annual percent change for myeloma-specific survival was greater for NHW than NHB patients, the latter exhibited better outcomes compared with NHW patients even after adjusting for all other factors including age, sex, year of diagnosis and rural or urban home location. We plan to expand our analyses to include SEER-Medicare linked database to understand if differences in treatment variables, demographics and socioeconomic status can explain the disparities in survival.

Abstract 18888: Demographic and Racial Trends of Ischemic Heart Disease Related Mortality in Patients With Cancer

Introduction: We aim to assess the demographic and racial trends of mortality associated with Ischemic heart disease in patients diagnosed with neoplasia, between 1999 and 2020. Methods: A cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for the Epidemiological Research database (CDC-WONDER) was conducted to investigate the trends in mortality associated with Ischemic heart disease (ICDcodes - I20-I25) in patients with diagnosis of neoplasm or cancer during the time of death (ICD codes C00-D48). The study calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals, using jointpoint regression analysis. Demographic and racial trends were evaluated. Results: 359,383 Ischemic heart disease-related deaths occurred in cancer patients from 1999 to2020. Annual trends show that the AAMR decreased from 8.3 (95% CI 8.2-8.4) in 1999 to 3.3(95% CI 3.3-3.4) in 2020. The overall AAMR from 1999-2020 had an Annual PercentageChange (APC) decrease of -5 (95% CI: -5.3 to -4.7). When stratified by sex, males had a worseAAMR at 7.6 (95% CI: 0.6-0.6), and females were found to have an AAMR of 3.1 (95% CI: 0.5-0.5). When stratified by ethnicity, AAMR was highest among African Americans at 5.4 (95% CI:5.3-5.4), followed by white at 4.9 (95% CI 4.9-5.0), followed by American Indian or Alaskan Native at 2.7 (95% CI 2.6-2.9), followed by Asian or PacificIslander at 2.5 (95 % CI 2.5-2.6). Conclusions: In the United States, there has been a general decrease in IHD-associated Mortality in cancer patients from 1999 to 2020. Similar to the IHD-related mortality in the general population. Our data shows that the AAMR is worse in men, black population. In the setting of worse AAMR in specific populations, further research is needed to identify the causes and potential strategies to improve AAMR in cancer patients.

Abstract 18793: Demographic and Regional Trends in Mortality From Cardiac Arrest in the USA From 1999-2020

Introduction: Cardiac Arrest (CA) is a major public health problem associated with high mortality. We aim to assess the demographic and racial trends of mortality associated with CA between 1999 and 2020. Methods: A cross-sectional analysis of the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research database (CDC-WONDER) was conducted to investigate the trends in mortality associated with CA (ICD codes -I46.0, I46, I46.9, and I49.0). Using Joinpoint regression analysis, the study calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals. Demographic and racial trends were evaluated. Results: 394,021 CA-related deaths occurred from 1999 to 2020. Annual trends show that the AAMR reduced from 8.3 (95% CI 8.2-8.4) in 1999 to 4.7(95% CI 4.6-4.8) in 2020. The overall AAMR from 1999-2018 had an Annual Percentage Change (APC) decrease of -2.0 (95% CI: -2.4 to -1.6). From 2012 to 2020, the APC was 0.4(95% CI: -0.3 to 1). When stratified by sex, males had a worse AAMR at 6.4 (95% CI: 6.4-6.4), and women were found to have an AAMR of 4.5 (95% CI: 4.4-4.5). When stratified by ethnicity, AAMR was highest among African Americans at 9.3 (95% CI: 9.2-9.3), followed by White at 5.0 (95% CI 5.0-5.0), followed by Asian or Pacific Islanders at 3.6(95% CI 3.5-3.7) and American Indian or Alaska Native patients at 3.0 (95% CI2.9-3.2). When stratified by geographical area, Non-metro, rural areas had worse AAMR than urban areas. Conclusions: There has been a general decrease in CA-associated mortality from 1999 to 2012 in the United States. However, since 2012, the mortality has been stable and not improving. Our data shows that the AAMR is worse in men, African Americans, and rural populations. In the setting of no improvement of AAMR since 2012, further research is needed to identify the causes and potential strategies to improve AAMR.

TCT-305 Demographic, Regional, Gender-Based, and Racial Trends in Peripheral Artery Disease Hospitalization in the United States (2008–2020)

TCT-305 Demographic, Regional, Gender-Based, and Racial Trends in Peripheral Artery Disease Hospitalization in the United States (2008–2020)

Temporal and Racial Trends in Prostate Specific Antigen Screening for US Men With Family History of Prostate Cancer.

Limited data exists on trends in prostate-specific antigen (PSA) screening in men with family history of prostate cancer (PCa). 1) to study age-stratified temporal trends in PSA screening from 2000-2018 for men with a family history of PCa and black men with family history of PCa; and 2) identify determinants associated with receipt of PSA screening in aforementioned groups. We identified men aged ≥40 without prior history of PCa using data from National Health Institution Survey (NHIS) 2000-2018 who self-reported PSA testing in the last 12 months. Age-stratified temporal trends and weighted multivariable logistic regression analyses were assessed. PSA screening increased for men with a family history of prostate cancer between NHIS 2000 (28.9%) and 2005 (41.9%), with stable rates for the following years. Black men with family history of PCa showed no significant change in PSA screening rates regardless of age. Controlling for socio-demographics and access to healthcare provider, younger age (40-54) and later survey years (2013-2018) were associated with a lower likelihood of PSA screening overall and for black men, but not for those with positive family history. Data from nationally representative study of US men indicated that the annual PSA screening rates for men with a family history of PCa was higher than reported for the overall male population. We believe this represents the first study on trends and determinants of PSA screening in US men with a family history of PCa.

64-OR: Trends in Racial, Ethnic, and Socioeconomic Inequalities in Diagnosed Diabetes Prevalence and Incidence among U.S. Adults, 2008–2021

We examined national trends in racial, ethnic, and socioeconomic status (SES) inequalities for diagnosed diabetes prevalence and incidence. Self-reported data were from adults aged ≥18 years in the National Health Interview Survey 2008-2021. Annual prevalence and incidence estimates were age-standardized to the 2010 U.S. Census population. Absolute measures of inequality in diagnosed diabetes prevalence and incidence included between-group variance (BGV) for race and ethnicity (nominal categories) and the slope index of inequality (SII) for SES (educational attainment and family poverty-to-income ratio (PIR) ordinal categories). We calculated BGV and SII for each year along with the average annual percent change (AAPC) to assess trends in inequalities over time. PIR inequalities in diabetes prevalence increased (AAPC for SII: -1.7%, p=.010) while racial and ethnic (AAPC for BGV: -10.9%, p=.010) and education (AAPC for SII: 5.8%, p=.001) inequalities in diabetes incidence decreased over time (Figure). From 2008-2021, racial, ethnic, and education inequalities in diagnosed diabetes incidence improved but persisted. Income-related inequalities in diagnosed diabetes prevalence worsened over time. To close these gaps, future research could focus on identifying factors driving these trends including the contribution of morbidity and mortality. Disclosure R.Saelee: None. I.A.Hora: None. M.E.Pavkov: None. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. K.M.Bullard: None.

Trends in Racial, Ethnic, and Gender Diversity in Orthopaedic Surgery Adult Reconstruction Fellowships From 2007 to 2021

BackgroundOrthopaedic surgery has seen improvement in its representation of women, whereas the representation of racial/ethnic minorities has remained stagnant over the past decade. Overall, the surgical field lags behind other specialties in sex and racial/ethnic parity. Although demographic disparities within orthopaedics have been analyzed for both residents and faculty members, information for adult reconstruction fellows remains limited. MethodsSex and race/ethnicity demographics for adult reconstruction orthopaedic fellowship matriculants were collected via a database published by the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021. Statistical analyses, including descriptive statistics and significance testing, were performed. ResultsDuring the 14-year time frame, men trainees remained high with an overall average percentage of 88% and demonstrated increasing representation (P trend = .012). White non-Hispanics, Asians, Blacks, and Hispanics represented on average 54%, 11%, 3%, and 4%, respectively. White non-Hispanics (P trend = .039) and Asians (P trend = .030) saw increasing and decreasing representation, respectively. Women, Blacks, and Hispanics remained relatively stagnant throughout the observation period as no trends were appreciable (P trend >.05, each). ConclusionUsing publicly available demographic data from the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021, we found relatively limited progress in the representation of women and those from traditionally marginalized groups seeking additional training in adult reconstruction. Our findings mark an initial step in measuring the demographic diversity among adult reconstruction fellows. Further research is needed to ascertain specific factors likely to attract and retain members from minoritized groups into orthopaedics.

Trends in Racial, Ethnic, and Gender Diversity Among Hand Surgery Fellows From 2007 to 2021

There is a paucity of research on the demographic trends of orthopedic and plastic hand surgery fellows. The purpose of this study was to ascertain the current state of racial and gender demographic trends in hand surgery fellowship from 2007 to2021. We analyzed fellowship demographic data from the Accreditation Council for Graduate Medical Education public database from 2007-2008 through 2020-2021. The gender of hand surgery fellows was categorized as male, female, or not reported and their race/ethnicity as White, Non-Hispanic; Asian or Pacific Islander, Hispanic; Black, Non-Hispanic; American Indian or Alaskan Native; other; or unknown. We extracted the number of fellows per year for each category and calculated the percentage equivalents and average percentages. We performed the chi-square test for trend (Cochran-Armitage test) to identify any significant changes in the percentages of gender and race/ethnicity between 2007 and2021. There was a significant increase in the percentage of hand surgery fellows who are women (20.7% to 30.7%) and Asian or Pacific Islander (13.3% to 25.3%). There was no significant change in the percentage of Hispanic or Black, Non-Hispanic fellows. Although there have been some increases, hand surgery fellows continue to be underrepresented by women and minorities, consistent with the demographic of orthopedic and plastic surgery residents. There have been increasing trends in the number of women and minorities in medical schools, which leaves room for improvement from the downstream prospective applicant pool. The physician-patient relationship can potentially be strengthened by race and gender concordance; however, many minority and female hand surgery patients do not have physicians who are women or of the same ethnic background. Patient satisfaction, trust, and potential health outcomes may be improved with a physician workforce that reflects the diversity of their patients.

Socioeconomic and Racial Trends in Human Papillomavirus Vaccination: A 10-Year Retrospective Review [ID: 1366482

INTRODUCTION: Human papillomavirus (HPV) vaccination in the United States is low, and lack of vaccination disproportionately affects minority patients and those of a lower socioeconomic status. We sought to assess the effect of race and ethnicity and socioeconomic factors on HPV vaccine adoption over the last decade. METHODS: An analysis was conducted on data from the National Health Nutrition Examination Survey from 2009 to 2018 of individuals aged 12–26 years. Sociodemographic and vaccination history was gathered via self-report. Logistic regression models assessed relationships between HPV vaccination and variables of interest. RESULTS: Data from 8,120 individuals were included in the analysis. Vaccine initiation among females rose from 30.5% (95% CI 25.7–35.8) in 2009–2010 to 55.1% (95% CI 50.0–60.0) in 2017–2018 and from 8.3% (95% CI 6.2–10.9) in 2011–2012 to 36.4% (95% CI 31.2–41.9) in 2017–2018 for males. Individuals with insurance coverage were 2.0 times more likely to report being vaccinated (95% CI 1.8–2.6). Independent of insurance coverage, having a routine place to seek health care was associated with a 1.9 times increase (95% CI 1.5–2.3) in HPV vaccination. Independent of insurance and access to care, Mexican American and non-Hispanic Black individuals were 1.7 times (95% CI 1.3–2.2) and 1.4 times (95% CI 1.1–1.9) less likely to complete the vaccine series compared to non-Hispanic White individuals. CONCLUSION: Human papillomavirus vaccination initiation has increased in the United States over the past 10 years; however, vaccination has plateaued among women with only half of females vaccinated and nearly a fifth initiating but not completing the series. Access to care appears to be a significant predictor of HPV vaccination.

B-59 | Cardiovascular Outcomes and Racial Trends of Transcatheter Aortic Valve Replacement Among Octogenarians With Kidney Disease: A Subgroup Analysis

Limited data is available regarding in-hospital outcomes of TAVR in the octogenarian population with CKD stage. We used the National Inpatient Sample (NIS) database to compare CKD stage I-III (CKD-LG) and CKD stage IV-V (CKD-HG) among octogenarians. We included a total of 89,090 octogenarian patients with CKD (TAVR CKD-LG n= 69,105; TAVR CKD-HG n= 19,985). The median age in TAVR CKD-LG and TAVR CKD-HG were 85 and 86, respectively. TAVR CKD-LG had a higher percentage of in-hospital mortality (2.0% vs 1.4%, p=0.04) compared to TAVR CKD-HG. TAVR CKD-LG had a lower percentage of AKI (16.7% vs 25.3%, p<0.001) and major bleeding (1.6% vs 2.2%, p=0.04) compared to TAVR CKD-HG. There was no significant difference between groups in cerebrovascular accidents (CVA), post-procedural stroke, sudden cardiac arrest (SCA), transfusion, cardiogenic shock (CS), and mechanical circulatory support (MCS). The median length of stay in TAVR CKD-LG and TAVR CKD-HG were 2 days and 3 days, and the median adjusted total charges for TAVR CKD-LG and TAVR CKD-HG were $197,978 and $198,821, respectively. Octogenarians with CKD stage I-III had a higher percentage of in-hospital mortality compared to CKD stage IV-V but were associated with a lower percentage of AKI and major bleeding. CVA, post-procedural stroke, SCA, transfusion, CS, and MCS showed no statistically significant difference.

Trends in Racial, Ethnic, and Gender Diversity in Orthopaedic Surgery Spine Fellowships from 2007-2021.

Descriptive. To analyze trends in racial, ethnic, and gender diversity in orthopaedic spine surgery fellowship trainees. Orthopaedic surgery has consistently been labeled as one of the least diverse fields in Medicine. While some effort has been made to combat this in recent years at the residency level, it is uncertain if spine fellowships have had any changes in fellow demographics. Fellowship demographic data was collected through the Accreditation Council for Graduate Medical Education (ACGME). Data collected included gender (Male, Female, Not reported), and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007-2008 to 2020-2021. A χ2 test for trend (Cochran-Armitage test) was done to determine if there was a significant change in percentages of each race and gender during the study period. Results were considered statistically significant at P<0.05. White, Non-Hispanic males represent the largest proportion of orthopaedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in representation of any race or gender of orthopaedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be underrepresented in orthopaedic spine fellowship. Orthopaedics spine surgery fellowship programs have not made substantial progress in diversifying its population. To see progression of diversity, more attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field. 1.

Her Cold War: Women in the U.S. Military 1945–1980 by Tanya L. Roth

<i>Her Cold War: Women in the U.S. Military 1945–1980</i> by Tanya L. Roth

Regional and Racial Trends in US Prostate Cancer Screening

Objective: In this study, we examined whether self-reported prostate cancer screening rates differed by ethnicity. Methods: We used 2014 and 2018 data from the Behavioral Risk Factor Surveillance System (BRFSS) to determine if self-reported screening rates differed by ethnicity and year, while we controlled for geographic, demographic, and health factors. We also investigated factors that may influence screening rates. Results: Self-reported screening rates decreased between 2014 and 2018, both overall and by each ethnicity. Blacks had significantly higher odds of reporting a PSA test than Whites (OR = 1.13 ± 0.01 in 2014; 1.14 ± 0.01 in 2018); all other group had lower odds than Whites. By ethnicity, only Blacks and Native Hawaiians/Pacific Islanders had higher odds of being asked the questions than Whites; all other groups had lower odds. Overall screening rates were positively correlated with prostate cancer incidence rates by state but not for any racial group individually. Conclusions: Self-reported PSA test rates are declining, are associated with PSA test knowledge, are less likely in non-black minorities, and may be influenced by healthcare discussions and state-level incidence rates

Contemporary trends in the incidence of spontaneous coronary artery dissection (SCAD) – ethnic and household income disparities

ABSTRACT Objectives Spontaneous coronary artery dissection (SCAD) may contribute to 35% of acute coronary syndrome among women ≤50 years of age. We aimed to investigate the overall incidence, as well as the trends of SCAD incidence based on race, household income, and the U.S. census regions utilizing the National Inpatient Sample. Methods In this retrospective cohort study the discharge data were extracted from the NIS using 9th and 10th revisions of the International Classification Disease for SCAD. Results We found that the incidence of SCAD is rising in all U.S. census regions, and patients were predominantly females. Overall crude incidence of SCAD per 1,000,000 discharges per year was found to be 4.95 (2010), 5.73 (2011), 5.34 (2012), 6.18 (2013), 7.64 (2014), 8.11 (2015), 14.58 (2016), and 14.81 (2017). There was a higher incidence of SCAD in white population and higher-income groups. Among U.S. census regions, West has had the highest incidence followed by the Northeast, Midwest, and South. Statistically significant differences were observed in year-to-year SCAD incidence among racial groups, household income quintiles, and U.S. census regions (P < 0.0001). Conclusion Recent trends indicate that the incidence is highest among White race, highest household income quintile, and in U.S. CENS-R4 (Census Region 4: West). These findings defy classic racial trends in cardiovascular disease burden which need further discovery.

Racial trends in clinical preventive services use, chronic disease prevalence, and lack of insurance before and after the Affordable Care Act.

To compare the relative change in the use of clinical preventive services, prevalence of chronic disease, and share uninsured among White, Black, and Hispanic adults before and after the introduction of the Affordable Care Act (ACA). Retrospective analysis using the Medical Expenditure Panel Survey of adults aged 18 to 64 years. The regression relies on a fully interacted set of indicator variables of each racial group by 3 time periods: 2005-2009, 2010-2013, and 2014-2018. Outcomes included indicators of mammography, colonoscopy, and lipid panel use. Several chronic conditions were examined, including diabetes, hyperlipidemia, hypertension, coronary heart disease, and mental health status. The final outcome variables examined health insurance (uninsured or not) and out-of-pocket spending as a share of family income. Regression models were used controlling for patient characteristics (age, income, education) and for a set of fully interacted indicator variables of race and time period. We tested for relative changes in White adults vs minority adults for each outcome variable. We used the Wald test (test command in Stata) to test for relative changes over time. We found reductions in baseline (pre-ACA) disparities over time in several of the measures between minority adults and White adults. This included greater growth in the use of mammograms and colonoscopies among minority populations. The results also saw relative reductions in hypertension, coronary heart disease, and fair or poor mental health. Finally, the share uninsured among Hispanic adults decreased at a faster rate than among White adults pre-ACA compared with the ACA period examined. The ACA is associated with a reduction in baseline differences in the use of some clinical preventive services, chronic disease prevalence, health insurance coverage, and out-of-pocket spending. Continued efforts to promote prevention and further expansions of coverage would appear to pay dividends.

Racial Trends in Peyronie's Disease Treatments: Analysis of the Veterans Health Administration

ABSTRACT Introduction Racial disparities are known to affect urologic care. Settings such as the Veterans Affairs (VA) health system, where access to care is more equitable, have noted reductions in racial disparities for certain diseases. Previous studies of Peyronie's Disease (PD) have investigated responses to treatment by race, but not treatment rates themselves. Frequently, racial disparities in healthcare are attributed to differences in income or decreased insurance rates among people of color. For this reason, we aimed to investigate racial disparities in PD treatments by evaluating the VA Informatics and Computing Infrastructure (VINCI), which contains data from the VA. As veterans are insured and able to obtain treatment for PD through the VHA, this population allows us to study the effects of race on treatment rates when insurance does not serve as a barrier. Objective To evaluate the treatment rates for Peyronie's Disease within the VA by race in order to determine whether racial disparities exist when insurance access is equitable. Methods We queried VINCI to obtain data for a cohort of men that have a recorded diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We then used the following CPT codes to identify which patients had procedures known to be therapeutic for PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). We evaluated treatment rates among patients with race/ethnicity information recorded. We reported results as frequencies and used the chi-square test to evaluate significant differences in treatment rates when comparing racial groups to Whites, with statistical significance reported at p&amp;lt;.05. Results We obtained data for 17,022 patients with diagnoses of PD. Within the total population of patients diagnosed with PD, 71.4% were White (Non-Hispanic), 25.4% were Black, 5.8% were Hispanic or Latino, 0.3% were Asian or Pacific Islander (API), and 1.6% were Native American (NA), and 5.4% were unknown. Among this cohort, 13.6% of all patients, 13.6% of Whites, 14.3% of Blacks (p=0.2985), 13.5% of Hispanics (p=0.9205), 9.1% of API (p=0.3319), 16.7% of NA (p=0.1406), and 9.6% of unknown (p=0.0041) were treated. Conclusions Within the VHA population, which is not limited by access to health insurance, all patients with recorded race information were treated at similar rates for PD to Whites. Only those without racial information recorded were treated at a significantly lower rate. This study demonstrates the potential for equitable insurance and access to healthcare to reduce racial disparities. Further investigation is required to evaluate whether these treatment patterns are similar within the general population. Disclosure No

Gender and Racial Disparity Among US Forensic Psychiatry Fellows: Broken System by Default.

Diversity enhances the performance of the healthcare system by providing better patient outcomes and reducing physician burnout. In this study, we explored the gender and racial trends in the recruitment of women and racial minorities into forensic psychiatry fellowship programs in the US. Retrospective data analysis was performed by utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from the year 2007 to 2021. Demographic data, including gender and race, were extracted for forensic psychiatry fellows. The number of female trainees increased significantly to become a majority, i.e., 58.8% of all forensic psychiatry trainees in 2020-2021 were female compared to 27.78% of women forensic psychiatry fellows in 2007-08. Between 2011-12 and 2020-2021, there was a relative increase in White (Non-Hispanic), Asian/Pacific Islander and Black (Non-Hispanic) forensic psychiatry fellows, by 54.75%, 114.4%, and 0.36% respectively. Despite the overall increase in the numbers of ethnic minorities in US psychiatry residency and fellowship programs, racial minorities remain significantly under-represented in forensic psychiatry fellowship programs. We need to revise policies to promote underrepresented minorities in medicine (URMM) in forensic psychiatry.