Racial Trends Research Articles

Racial, ethnic, and geographical differences in testicular cancer mortality trends in the United States.

409 Background: Incidence rates of Testicular cancer (TC) have been slowly increasing in the United States in recent decades. Prior research has identified racial disparities in mortality; however, these trends have not been extensively evaluated. Given that TC has a diverse presentation, this study was undertaken to establish racial, ethnic, geographical differences in longitudinal mortality trends. Methods: Age-adjusted cancer mortality rates for TC were obtained for men in the United States from the CDC Wide-ranging Online Data for Epidemiologic Research database. Testicular cancer-specific mortality (TCSM) rates from 1999-2019 were calculated using linear regression. Trends in mortality by race (White versus Black), ethnicity (Hispanic versus non-Hispanic), urbanization, and census region were analyzed using SAS 9.4. TCSM rates were compared by F-test. A two-sided hypothesis test was performed for p-values, where values < 0.05 were considered statistically significant. Results: From 1999-2019, overall age-adjusted TCSM has been slowly, but not significantly, increasing per year (Table). There was worsening TCSM rates for Hispanics (+)0.0019 per 100,000 compared to non-Hispanics (-)0.003; p=0.010. Black men had slightly improved TCSM rates/year (-0.0007) compared to white men (+0.0006); p=0.049. Significant geographical differences in mortality rates were observed, with a decreasing TCSM rate of (-)0.00092 the Northeast and an increasing rate of (+)0.00086 in the West (p = 0.032 for difference between slopes). Among urbanization categories, TCSM rates in Large Central Metros regions (central counties in metro areas with population > 1 million) and Small Metro regions (counties with population 50,000-249,999) were significantly different [(-)0.0004 and (+)0.0022 respectively; p =0.048]. All other comparisons were not significant. Conclusions: Using comprehensive, contemporary data on TCSM over 2 decades, we found significant differences in TCSM rates. Mortality rates from TC have been increasing, particularly among Hispanics. Understanding racial, ethnic, and geographical trends in TCSM rates is important in treating men with the disease and, ultimately, reducing deaths caused by TC.[Table: see text]

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action.

The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce.In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations. This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported. Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trendsand the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030. There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.

Gender and Racial Disparity among Addiction Psychiatry Fellows in the United States.

The United States (US) has a culturally diverse population. However, the percentage of underrepresented minorities (URMs) and women in healthcare does not fully reflect their current and future demographics. Our objective was to explore and forecast the gender and racial trends in the US addiction psychiatry fellowship programs. A retrospective analysis was performed using data from Accreditation Council for Graduate Medical Education (ACGME) Resource Books which encompassed US addiction psychiatry fellows from 2007 to 2020. Simple linear and multiple regression were used to predict the 2030 addiction psychiatry workforce. White (Non-Hispanic) and Asian/Pacific Islander had a relative change of -2.8% and -26.1% from 2011 to 2020, respectively. Black (non-Hispanic) had a relative change of + 5.2%. Hispanic and Native American/Alaskan had no relative change during this time. From 2007 to 2020, women's representation relatively decreased by 10.9%. Statistically, these dynamic trends of the addiction psychiatry workforce will continue to exist in 2030. Women and URM addiction psychiatrists play an effective role in addressing substance use disorders (SUD). Unfortunately, the current gender and racial disparities in addiction psychiatry will exist in the future. Understanding the continued gender and racial bias in addiction psychiatry fellowships and devising appropriate recommendations can help mitigate the existing disparities.

National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011-2018.

Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011-2018), we examined recent trends in racial and ethnic differences in awareness and antihypertensive medication use, and their association with racial and ethnic differences in hypertension control. Between 2011 and 2018, age-adjusted hypertension awareness declined for Black, Hispanic, and White individuals, but the 3 outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals had a similar awareness (odds ratio, 1.20 [0.96-1.45]) and overall treatment rates (1.04 [0.84-1.25]), and received more intensive antihypertensive medication if treated (1.41 [1.27-1.56]), but had a lower control rate (0.72 [0.61-0.83]). Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52-0.85] and 0.74 [0.59-0.89]), overall treatment rates (0.72 [0.57-0.88] and 0.69 [0.55-0.82]), received less intensive medication if treated (0.60 [0.50-0.72] and 0.86 [0.75-0.96]), and had lower control rates (0.66 [0.54-0.79] and 0.69 [0.57-0.81]). The racial and ethnic differences in awareness, treatment, and control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were significantly associated with lower control in Asian and Hispanic individuals (P<0.01 for all) but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

Regional and Racial Trends in US Colorectal Cancer Screening

Objective: Colorectal cancer screening is proven to reduce cancer burden and mortality. Despite several well-established screening methods, colorectal cancer still has the third-highest cancer mortality rate in the United States. Methods: We examine the self-reports of individuals ever having a colonoscopy or fecal occult blood test (FOBT) from the Behavioral Risk Factor Surveillance System questionnaire to determine if screening rates differed by race and year while controlling for state and other variables. Results: Colonoscopy rates increased between years while FOBT rates decreased. Blacks had higher colonoscopy rates than Whites and other racial minorities had lower rates. Blacks also had higher FOBT rates, as did American Indians/Alaska Natives (AI/ ANs), Native Hawaiian/Pacific Islanders (NH/PIs), and the multiracial category (MR). Whites and Asians saw a rise in colonoscopy rates between 2014 and 2018, whereas AI/ANs, NH/PIs, MR, and the other category (Other) saw a rise in FOBT rates. State-level screening rates were not associated with state-level incidence or mortality rates. Conclusions: Racial disparities still exist in self-reported colorectal screening patterns, though some are trending in the right direction, and there is a gap between screening rates and incidence rates by state that depend on further factors.

Trends in Racial, Ethnic, and Sex Representation Among Surgical Faculty Members and Medical Students in the US, 2011-2020

Trends in Racial, Ethnic, and Sex Representation Among Surgical Faculty Members and Medical Students in the US, 2011-2020

Sticky Floor, Broken Ladder, and Glass Ceiling: Gender and Racial Trends Among Neurosurgery Residents.

IntroductionDiversity and equity in academic medicine are critically important in improving healthcare standards and patient-related outcomes. Gender and racial disparities are some major challenges faced by the health system. This article reviews the gender and racial trends among residents of neurosurgery in the United States (US).MethodsWe retrospectively analyzed the data extracted from the Accreditation Council for Graduate Medical Education (ACGME)’s annual Data Resource Books from 2007 to 2019. ACGME cataloged gender as men and women and race/ethnicity was categorized as White/non-Hispanic, Asian or Pacific Island, Hispanic, Black/non-Hispanic, Native American/Alaskan, others, and unknown. Counts, proportions, relative, and absolute percentage changes were calculated to highlight trends in resident appointments over time and across the specialty of neurosurgery.ResultsThe number of female residents increased steadily from 10.6% in 2007 to 19.3% in 2019; with an absolute increase of 8.74%, a relative increase of 63.9%, and a simultaneous decrease in male residents. When averaged across the nine-year study period, 51% of the study sample was White (non-Hispanic), followed by Asian/Pacific Islanders at 15.2%. The representation of Hispanics was 4.3%, Black/African Americans were 4.5%, Native Americans/Alaskans were 0.2%, and others were 8% of the total study population.ConclusionOur study concludes that gender and racial disparity persist within the neurosurgery residency training programs in the US. Concrete efforts at all academic levels are needed to provide greater support for the females and for the careers of underrepresented minority (URM) trainees to ensure their increased representation in neurosurgery.

Gender and Racial Trends Among Vascular Neurology Fellowship Programs: By Design or By Default.

IntroductionBenefits of increasing diversity in teams include the addition of different perspectives leading to increased innovation and creativity, faster problem solving, improved workforce morale, and reduced burnout leading to improved patient outcomes. This article reviewed the trend of gender and racial disparity in vascular neurology fellowship programs.MethodsWe retrospectively analyzed the data extracted from the Accreditation Council for Graduate Medical Education (ACGME)’s annual Data Resource Books from 2007 to 2019. ACGME cataloged gender as men and women and race/ethnicity was categorized as White/Non-Hispanic, Asian or Pacific Island, Hispanic, Black/Non-Hispanic, Native American/Alaskan, others, and unknown. Counts, proportions, relative, and absolute percentage changes were calculated to highlight trends in resident appointments over time and across the specialty of vascular neurology.ResultsThe representation of females increased steadily; with a relative increase of 11.78% from the year 2007 to 2019. Race/ethnicity was reported starting from the year 2011. When averaged across the nine-year study period, 35% of the study sample was White (Non-Hispanic), followed by Asian/Pacific Islanders at 25%. The representation of Hispanics was 4.8%, Black/African Americans were 3%, Native Americans/ Alaskans were 0.23% and Others were 13% of the total study population. For 17.7% of the fellows, racial data were not known and was categorized as Unknown racial distribution.ConclusionOur study concludes that gender and racial disparity persists within the fellowship programs of vascular neurology. Effective strategies at individual, administrative, and national levels are needed to engage women and under-represented minorities in vascular neurology as a career choice.

Adapting to Racial Trends in the U.S. Population.

Nurse leaders call for more diversity in nursing school students and faculty.

Changing trends in Black-White racial differences in surgical menopause: a population-based study

Bilateral oophorectomy before menopause, or surgical menopause, is associated with negative health outcomes, including an increased risk for stroke and other cardiovascular outcomes; however, surgical menopause also dramatically reduces ovarian cancer incidence and mortality rates. Because there are competing positive and negative sequelae associated with surgical menopause, clinical guidelines have not been definitive. Previous research indicates that White women have higher rates of surgical menopause than other racial groups. However, previous studies may have underestimated the rates of surgical menopause among Black women. Furthermore, clinical practice has changed dramatically in the past 15 years, and there are no population-based studies in which more recent data were used. Tracking actual racial differences among women with surgical menopause is important for ensuring equity in gynecologic care. This population-based surveillance study evaluated racial differences in the rates of surgical menopause in all inpatient and outpatient settings in a large, racially diverse US state with historically high rates of hysterectomy. We evaluated all inpatient and outpatient surgeries in North Carolina from 2011 to 2014 for patients aged between 20 and 44 years. Surgical menopause was defined as a bilateral oophorectomy, with or without an accompanying hysterectomy, among North Carolina residents. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify inpatient and outpatient procedures, respectively, and diagnostic indications. We estimated age-, race-, and ethnicity-specific rates of surgical menopause using county-specific population estimates based on the 2010 United States census. We used Poisson regression with deviance-adjusted residuals to estimate the incidence rate ratios in the entire state population. We tested changes in surgery rates over time (reference year, 2011), differences by setting (reference, inpatient), and differences by race and ethnicity (reference, non-Hispanic White). We then described the surgery rates between non-Hispanic White and non-Hispanic Black patients. Between 2011 and 2014, 11,502 surgical menopause procedures for benign indications were performed in North Carolina among reproductive-aged residents. Most (95%) of these surgeries occurred concomitant with a hysterectomy. Over the 4-year study period, there was a 39% reduction in inpatient surgeries (incidence rate ratio, 0.61) and a 100% increase in outpatient surgeries (incidence rate ratio, 2.0). Restricting the analysis to surgeries among non-Hispanic White and Black patients, the increase in outpatient surgeries was significantly higher among non-Hispanic Black women (P<.01) for year-race interaction (reference, 2011 and non-Hispanic White). The overall rates of bilateral oophorectomy for non-Hispanic Black women rose more quickly than for non-Hispanic White women (P<.01). In 2011, the rate of surgical menopause was greater among White women than among Black women (17.7 vs 13.2 per 10,000 women). By 2014, the racial trends were reversed (rate, 24.8 per 10,000 for non-Hispanic White women and 28.4 per 10,000 for non-Hispanic Black women). Our findings suggest that the rates of surgical menopause increased in North Carolina in the early 2010s, especially among non-Hispanic Black women. By 2014, the rates of surgical menopause among non-Hispanic Black women had surpassed that of non-Hispanic White women. Given the long-term health consequences associated with surgical menopause, we propose potential drivers for the racially-patterned increases in the application of bilateral oophorectomy before the age of 45 years.

Updated Evaluation of RhD Status Among Women of Child-Bearing Age in Detroit, Michigan.

The Rh blood group system is one of the most important and immunogenic blood group systems after the ABO blood group system and, like other blood group antigens, it follows ethnic and racial trends. However, when it comes to D variants-partial D and weak D-most of the cohorts studied in the literature have been of European descent. This study aimed to discover the variant D trends in Detroit, Michigan, with an emphasis on Black communities. From 2016 to 2018, there were 102 patients (women of childbearing potential: < 50 years) at Henry Ford Hospital that had serologic D discrepant testing. These patients were sent out for molecular RHD determination. In total, 12.7% of patients were characterized as RhD positive and 87.3% of patients were characterized as RhD variants (nominated as RhD negative at our institution). Our predominantly Black cohort sheds light on the diversity of the RhD antigen. The majority of Blacks were classified as RhD variants (RhD negative nomination at our institution). Therefore, molecular testing for this patient population with serologic RhD discrepancies is paramount to properly manage their obstetric care.

Racial differences and trends in pathologic complete response following neoadjuvant chemotherapy for breast cancer.

575 Background: Given improvements in systemic therapy, pathologic complete response (pCR) rates following neoadjuvant chemotherapy were over 60% in breast cancer patients in recent clinical trials, especially in human epidermal growth factor receptor 2 (HER2)-positive and triple negative cases. While racial minority groups were associated with worse survival outcomes despite receiving standard of care in prospective studies, they were under-represented in clinical trials. To address this knowledge gap, we performed an observational cohort study to evaluate pCR and survival outcomes stratified by racial and ethnic groups. Methods: The National Cancer Database (NCDB) was queried for female patients with stage I-III breast cancer diagnosed between 2010 and 2017 treated with neoadjuvant chemotherapy followed by surgery. Cochran-Armitage test was used to analyze the trend of pCR over time. Logistic multivariable analysis (MVA) was used to identify variables associated with pCR defined as ypT0/isN0. Cox MVA was used to analyze the overall survival (OS) benefit. Results: A total of 105,804 patients (n = 72,631 for non-Hispanic white [NHW], n = 7,632 for Hispanic white [HW], n = 19,505 for black, n = 4,393 for Asian or Pacific Islander [API], n = 1,643 for other race) were included for analysis. Median follow up was 49.2 months (interquartile range 32.7-71.3). Overall pCR rate increased from 15.1% in 2010 to 27.2% in 2017, largely driven by API women (15.7% to 31.6%) and hormone receptor (HR)-HER2+ tumors (28.6% to 53.1%; all trend p &lt; 0.001). On logistic MVA, when compared to NHW women, HW women were more likely to have pCR for HR-HER2+ (adjusted odds ratio [aOR] 1.18, p = 0.02) and HR+HER2+ tumors (aOR 1.29, p = 0.005), while black women were more likely to have pCR for HR+HER2- tumors (aOR 1.13, p = 0.01) and less likely for HR-HER2+ (aOR 0.80, p &lt; 0.001) and triple negative tumors (aOR 0.82, p &lt; 0.001). API women were more likely to have pCR for HR-HER2+ tumors compared to NHW women (aOR 1.17, p = 0.04). On Cox MVA, when compared to NHW women, HW (ypT+N0: adjusted hazards ratio [aHR] 0.75, p &lt; 0.001; ypN+: aHR 0.79, p &lt; 0.001) and API women (ypT0/isN0: aHR 0.52, p = 0.005; ypT+N0: aHR 0.63, p &lt; 0.001; ypN+: aHR 0.86, p = 0.03) were associated with improved OS, while black women were associated with worse OS for ypN+ only (aHR 1.18, p &lt; 0.001). Conclusions: To our knowledge, this is the largest study using a nationwide oncology database suggesting the improving trend of pCR rate over time for all racial cohorts. In our study, when compared to NHW, HW and API women were more likely to have pCR for select HER2+ tumors, while black women were less likely to have pCR for HR-HER2+ and triple negative tumors but not for HR+HER2- tumors. HW and API women were associated with improved survival in the setting of any residual disease compared to NHW women, while black women were associated with worse survival only for residual nodal disease.

Racial and ethnic representation trends in United States oncology training programs.

6519 Background: Utilizing race and ethnicity data from the Accreditation Council for Graduate Medical Education (ACGME), this study aims to assess representation trends across American Society of Clinical Oncology (ASCO) participant specialties from the past five academic years in order to characterize current needs and effectively address these needs moving forward. Methods: Self-reported ethnicity/race data from the ACGME database books were collected from academic years 2015-16 to 2019-2020 for the following oncologic training programs: hematology and medical oncology, medical oncology, gynecologic oncology, pediatric hematology and oncology, radiation oncology, complex general surgical oncology. Summary statistics and chi-square analysis were conducted to compare underrepresented minority (URM) trends across programs. URM groups were cross-referenced with definitions provided by the AAMC and included those who identify as Hispanic, Latino or of Spanish origin, Black or African American, and Native American or Alaskan. Results: Over the study period, only 1,250 (9.0%) of 13,853 oncology trainees identified as URM. Chi-square analysis demonstrated no significant change in URM representation in all oncology specialties combined between 2015-16 and 2019-20 (8.9% [95% CI, 7.8%-10.0%] vs. 9.7% [95% CI, 8.7%-10.8%]; P=.31). Between 2015-16 and 2019-20, Hematology and oncology (+1.3%), pediatric hematology and oncology (+0.3%) all demonstrated insignificant increasing trends in representation while radiation oncology (-0.3%), complex general surgical oncology (-4.0%) had statistically insignificant decreasing trends in representation. Gynecologic oncology (+6.0%) demonstrated a significant increasing trend in representation. Conclusions: This is the first study to characterize the vast disparities in representation in oncologic training programs in the United States. There is a demonstrated lack of representation across all oncology training programs and a lack of significant improvement over the study period. A multiprong approach is needed to improve diversity and representation across the spectrum of the oncology workforce in the United States.

Abstract SS1-03: Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery

Abstract BACKGROUND: Breast Conservation Surgery (BCS) includes either partial mastectomy or oncoplastic surgery, of which oncoplastic surgery has become increasingly prevalent. Previous studies have examined BCS rates and post-operative complications, however, no known study has analyzed racial disparity in BCS utilization rates. Understanding racial disparity is crucial to addressing health equality and access to care. Therefore, our study aims to examine racial differences in BCS utilization rates within an 11-year period to determine how these rates have changed over time. METHODS: This retrospective cohort analysis utilized the NSQIP (National Surgical Quality Improvement Program) database to identify women who underwent BCS procedures between 2008-2018. All patients were diagnosed with ductal carcinoma in situ or invasive breast cancer. BCS was further sub-divided into partial mastectomy and oncoplastic surgery. Patient demographics were recorded, and racial utilization trends were analyzed using a Cochran- Armitage test and Index of Disparity analysis, which is a method for summarizing proportional changes within a group’s population and its subgroups. RESULTS: In the 11-year period, 180,700 women underwent a breast cancer resection, of which 46% underwent BCS. Within BCS, 92% underwent a partial mastectomy and 8% received oncoplastic procedures. For both BCS subgroups, Caucasian women held the highest sample size (82%), followed by African Americans (12%), and Asian Americans (5%). Within the total sample size, BCS utilization increased from 38% in 2008 to 53% in 2018. Within the BCS subgroup, the proportion of patients having oncoplastics increased from 3.5% in 2008 to 10% in 2018, leading to a declining proportion of partial mastectomies: 96.5% to 90.0% (all p&amp;lt;0.01). When stratified by race, oncoplastic utilization between 2008 and 2018 increased from 4% to 10% in Asian and Caucasian patients, and 1% to 10% in African American patients (p&amp;lt;0.01). Overall, the racial index of disparity for BCS patients decreased from 17.1% to 9.7%. Interestingly, the index of disparity has remained relatively unchanged for partial mastectomies (1.2% to 0.2%), but significantly decreased in oncoplastics (35% to 1.6%) suggesting an improvement in racial disparities for this surgical option. CONCLUSION: As breast conservation surgery becomes the mainstay for early-staged breast cancer interventions, it is crucial to understand the potential for novel procedures to worsen healthcare inequalities. This study demonstrates promising progress within the field of breast conservation surgery with a decreasing index of disparity among races especially in oncoplastic surgery. Citation Format: Jolie Jean, Michael M. Jonczyk, Christopher Homsy, Stephen Naber, Abhishek Chatterjee. Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS1-03.

Gender and Racial Disparities among US Psychiatry Residents: A Review of Trends

Diversity provides better patient outcomes, reduces physician burnout, and therefore lessens the burden of the healthcare system. In this study, we explore the gender and racial trends in the recruitment of medical graduates into US psychiatry residency programs. Retrospective data analysis was performed utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME) Data's annual Resource Books from the year 2007 to 2018. Demographic data, including gender and race, were extracted for psychiatry residents. Gender was categorized as Male, Female, and Not Reported. Race/ethnicity was categorized as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black/African-American (Non-Hispanic), Native American/Alaskan, Others (not in the aforementioned categories), and Unknown. Female psychiatry residents relatively decreased by 2.6% whereas male psychiatry residents relatively increased by 15.5% from 2007 to 2018. Between the years 2011 and 2018, there was a relative increase in African American/Black and Native American/Alaskan psychiatry residents by 5.5% and 1%, respectively, whereas the Asian/Pacific Islanders, White (Non-Hispanic), and Hispanic/Latino psychiatry residents relatively decreased by 5.1%, 2.3%, and 1.7%, respectively. Despite the overall increase of women and ethnic minorities in US medical schools, women and racial minorities remain significantly under-represented in psychiatry residency programs in the US.

Gender and racial trends among neurology residents: an overview

Diversification of academic medicine improves healthcare standards and patient outcomes. Gender and racial inequalities are major challenges faced by the healthcare system. This article reviews the trends of gender and...

Visual Symbols and Military Culture in Britain’s West African Colonial Army (c.1900–60)

Abstract Visual symbols like uniforms, emblems and ceremonies became central in inventing British military culture among West African forces reflecting orientalist and ornamentalist interpretations of empire. While uniforms fostered military identity, the versions devised for West African soldiers reproduced racial stereotypes and military fashion trends. Granting insignia and Colours to West African units transformed them from simplistic paramilitaries to honoured members of the British imperial milieu. Colours served as ritual objects enabling West African forces to recreate pivotal cultural events of the British regimental system. The public presence of uniformed West African soldiers promoted a sense of imperial majesty that reinforced British rule. Travelling to Britain, West African troops participated in parades and exhibitions initially displaying the epic scale of the empire, but eventually these military visitors became symbols of colonial reform. With independence, Britain’s former colonies in West Africa retained Western-style military symbols altered to highlight republicanism and modernist aspirations.

Racial Differences in Substance Use Patterns During Pregnancy [23C

INTRODUCTION: Substance use during pregnancy remains a significant public health problem. Studies have reported racial differences in substance use, however this has not been addressed in the pregnant population. This study describes associations between maternal race and substance use patterns in pregnancy. METHODS: A retrospective study of singleton births from August 2013 through December 2014 was conducted using universal urine drug screen (UDS) collected at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. The data is shown by frequency of substance use (no use, any use, use of specific substances) and maternal race (Caucasian, African American, Asian). RESULTS: 2,270 patients met study criteria. There were 1,030 (45%) Caucasians, 802 (35%) African Americans, and 117 (5%) Asians identified. Caucasian and African Americans had approximately the same rates of substance use, 30.0% and 32.5% respectively. It is notable that 93.1% of African Americans with a positive UDS were positive for only THC, compared to 63.8% of Caucasians. Polysubstance use was much higher in Caucasians than any other racial group, with 31.7% of Caucasian users positive for opiates, 12.0% for benzos, and 5.8% for cocaine. No Asians had a positive UDS. CONCLUSION: Our study addresses the racial differences of substance use during pregnancy, specifically detailing the substances used. Our study strongly suggests the need for local and state initiatives to better understand the racial trends for substance use in pregnancy in order to tailor prenatal care interventions that optimize pregnancy outcomes.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.