Significant Racial Differences Research Articles

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.

Racial and Ethnic Disparities in Perceived Health Status Among Patients With Cardiovascular Disease.

Understanding health outcomes among people with cardiovascular disease (CVD) is crucial for improving treatment strategies and patient quality of life. This study investigated racial and ethnic disparities in perceived health status among non-Hispanic Black, Hispanic, and non-Hispanic White adults with CVD. The study had a retrospective cross-sectional design and used data from the Medical Expenditure Panel Survey spanning 8 calendar years (2014-2021). The study population consisted of adults diagnosed with various CVDs. We used ordinal logistic regression models adjusted for demographic and socioeconomic characteristics, CVD severity, comorbidities, and health care expenditures to assess racial and ethnic differences in perceived health status. Among the 11,715 (weighted frequency, 15,431,283) adults with CVD, we observed significant differences in perceived health status across racial and ethnic cohorts. The unadjusted analysis showed that non-Hispanic Black adults had significantly higher odds than non-Hispanic White adults of perceiving their health as poorer (odds ratio [OR]= 1.89; 95% CI, 1.74-2.07; P < .001), with a similar observation among Hispanic adults (OR = 2.05; 95% CI, 1.85-2.26; P < .001). Although female sex, higher education, and better income had protective effects on perceived health status independent of race, we found significant racial and ethnic differences in the effect of older age, physical and cognitive limitations, and health insurance status on perceived health status. This study revealed substantial racial disparities in perceived health status among adults with CVD, with notable differences in the effects of predictive factors. Addressing these disparities requires targeted interventions to improve health care access and enhance socioeconomic conditions tailored to the needs and experiences of racial and ethnic populations.

Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020.

This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020. Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period. The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate. The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist. · As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..

NCOG-28. SERUM PROTEIN BIOMARKERS LINKED TO NEURODEGENERATIVE PROCESSES ARE ELEVATED IN GLIOMA PATIENTS AND ASSOCIATED WITH SEVERITY OF NEUROLOGIC SYMPTOMS

Abstract BACKGROUND Glioma patients frequently report neurologic symptoms, adding to the complexity of cancer management and negatively impacting quality of life. However, mechanisms associated with the development of neurologic symptoms in glioma patients remain unclear. Pathological changes in the brain of glioma patients might result in elevated peripheral blood levels of proteins previously linked to central nervous system (CNS) damage and neurodegeneration, including neurofilament light chain (NfL), tau, and glial fibrillary acidic protein (GFAP). Here, we tested the hypothesis that the circulating levels of these proteins in blood are elevated in glioma patients and associated with the severity of neurologic symptoms. METHODS Patients (n=73) were enrolled in a natural history study (NCT02851706, PI T. Armstrong). Healthy subjects (n=39) were recruited by the National Institutes of Health Clinical Center Blood Bank. Neurologic symptom severity and walking interference were assessed using MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT). Serum proteins were analyzed using ultrasensitive assays (Meso Scale Discovery). RESULTS Participants were predominantly white (patients 74%, healthy subjects 67%) and male (patients 58%, healthy subjects 54%). The median age was 44 (range=24,74) for patients and 49 (range=19,78) for healthy volunteers. No significant differences in age, sex, or race were observed between patients and healthy subjects. Serum levels of NfL (p&amp;lt;0.0001), GFAP (p&amp;lt;0.0001), and tau (p&amp;lt;0.0001) were higher in glioma patients when compared to healthy subjects. Patients with walking interference had higher levels of GFAP (p=0.003), NfL (p=0.003), and tau (p=0.004), and those who reported numbness had higher levels of GFAP (p=0.012). CONCLUSIONS These findings suggest that serum levels of protein markers of neurodegeneration are elevated in glioma patients and associated with the presence of neurologic symptoms. Blood-based biomarkers have the potential to shed light on the mechanisms underlying symptoms and offer a non-invasive alternative for monitoring CNS damage that impact patient outcomes.

Exploring Associations Between Urban Youth’s Race and Ethnicity, Social–Emotional Well-Being, and Health-Promoting Behaviors

Multiple aspects of social–emotional well-being have been identified as influential factors in adults’ and children’s physical activity and nutrition. However, the associations between social–emotional well-being, race and ethnicity, and health-promoting behaviors among urban youth remain understudied. This cross-sectional pilot study examines the relationships between social–emotional well-being and health-promoting behaviors. The study also explores how race and ethnicity affect physical activity and consumption of nutrient-dense foods among urban youth ages 11–19 ( N = 100) in a small Northeastern city in the United States. The results do not indicate any associations between social–emotional well-being measures and health-promoting behaviors measured as fulfilling physical activity and fruit and vegetable intake guidelines. However, we found significant racial and ethnic differences in health-promoting behaviors. These findings indicate that prevention programs and policies aimed at enhancing urban youth’s engagement in physical activity and consumption of nutrient-rich foods need to be tailored based on racial, ethnic, and cultural contexts.

Trajectories of physiological stress markers over time among Latinx immigrants in the United States: Influences of acculturative stressors and psychosocial resilience

AimsLatinx immigrants are exposed to acculturative stressors as they adapt to the U.S. However, little is known about the impact of acculturative stressors and psychosocial resilience on physiological responses and health over time. The purpose of this study was to examine trajectories of physiological stress markers among Latinx adults over time and examine the influence of acculturative stressors and psychosocial resilience factors on these different trajectories. MethodsA community-based, longitudinal study was conducted with adult Latinx immigrants in North Carolina (N = 391) over a two-year period. Self-reported measures of ten different types of acculturative stressors (e.g., occupational, family, healthcare, discrimination) and psychosocial resilience factors (individual resilience, coping, ethnic pride, familism, and social support) along with urine samples were taken at baseline and 12- and 24-month follow-up periods. Biomarkers of physiological stress (inflammatory cytokines interleukin-6 (IL-6), IL-8 and IL-18 and C-Reactive Protein (CRP)) were measured in urine. Multivariate latent class growth analysis, linear mixed models, and unadjusted bivariate analyses were conducted to address the study aims. ResultsParticipants were an average of 39 years of age (SD = 6.94) and mostly women (68.8%) and Spanish speakers (83%). Three latent classes of physiological stress marker trajectories were identified: resilient, rapidly increasing stress, and chronic elevated stress. These latent classes had significant differences in gender, race, coping styles, ethnic pride, and parental acculturative stressors. ConclusionsThe findings from this study identify specific types of acculturative stressors and psychosocial resilience factors that are important targets for health promotion and disease prevention programs for Latinx immigrants.

A-109 The impact of adjusting circulating calcium levels for changes in albumin

Abstract Background Correcting patients’ circulating calcium to albumin level is a common clinical practice to aid in the evaluation of calcium disorders. More recent studies have called into question the utility of the calculation relative to its ubiquity. The purpose of this study is to re-evaluate the practice of calcium adjustment and thus impact on the interpretation of calcium level. Methods Retrospective calcium and albumin levels performed and reported during May 2022 were retrieved. Reference intervals for both serum calcium and albumin were statistically derived using the Hoffman regression method following removal of outliers. Samples exhibiting hypoalbuminemia had their calcium adjusted using the formula (corrected calcium = (0.8 * (derived mean normal albumin - patient's albumin) + calcium). Patients who had their calcium levels adjusted were then compared to the currently in use reference interval to determine if their initial classification of calcium levels was impacted. Results Reported calcium and albumin results from a total of 1639 patients (712 males and 927 females) were obtained. Male patients, 137 (19%) were found to exhibit hypoalbuminemia and their calcium levels were adjusted with 15 patients (2% of total) had their initial calcium status change. 13 patients were reclassified from a state of hypocalcemia to normocalcemia (average increase in calcium levels was 0.9 mg/dL), while 2 patients were reclassified as being hypercalcemic. Among females, 151 (16%) found to exhibit hypoalbuminemia had their calcium levels adjusted with 12 patients (1.3% of total) having their initial calcium classification changed. 11 were reclassified from a state of hypocalcemia to normocalcemia (average increase in calcium levels was 0.89 mg/dL) and one patient was reclassified as hypercalcemic. There was no gender specific significant difference in the extent of required calcium adjustment (p= 0.92). Among the 474 black patients 88 (19%) exhibited hypoalbuminemia and mean calcium level of 9.51 mg/dL. Of those 88 patients, 4 were reclassified from a state of hypocalcemia to normocalcemia (average calcium increase of 0.96 mg/dL) and one patient status changed from normocalcemia to hypercalcemia. Furthermore, among the 1094 white patients, 191 (17%) exhibited hypoalbuminemia and had a mean calcium level of 9.38 mg/dL. Among the white patients, 21 (2%) changed from a state of hypocalcemia to normocalcemia (average calcium increase of 0.88 mg/dL). One patient changed from a state of normocalcemia to hypercalcemia. There was no significant racial difference in in the extent of required calcium adjustment (p=0.65). Conclusions The practice of adjusting calcium to account for albumin levels lead to changes in patients’ calcium status and thus likely to be of benefit in clinical management. There were no significant gender or racial differences in the relative proportion of changes in calcium status following albumin correction.

Racial and Ethnic Differences in Patient Presentation and Treatments in Head and Neck Dermatofibrosarcoma Protuberans

Head and neck dermatofibrosarcoma protuberans (HNDFSP) is a rare neoplasm with a high rate of local infiltration and local recurrence but a low rate of distant metastasis. Given the limited literature on HNDFSP and existing studies pointing to possible racial and ethnic differences, further research is needed to understand important clinical correlates that may impact treatment and prognosis. The National Cancer Database (NCDB) was queried for all cases of HNDFSP diagnosed from 2004 to 2016. Demographic characteristics of the included patients were compared using chi-squared and t-tests. Kaplan-Meier and Cox multivariable regression analyses were performed to assess survival differences. Of the 778 included patients, 526 (67.6%) patients were white, 113 (14.5%) were black, 33 (4.2%) were Asian, 87 (11.2%) were Hispanic, and 19 (2.4%) were classified as Other. White patients presented at a significantly older age (43.8 years) than did black (38.9 years) and Hispanic patients (37.9 years) (p = 0.02). White patients with HNDFSP had significantly higher income status (p = 0.0001), were more likely to be insured (p = 0.0001), and were more likely to have a high school diploma (p = 0.0001). There were no significant racial differences in 5-year (96.1%) or 10-year (92.0%) overall survival. None of the variables yielded a statistically significant value in Cox analysis. Differences exist in HNDFSP presentation between racial groups. Specifically, differences in income, insurance status, education level, and age of presentation exist between these groups. Future studies focused on morbidity are needed to better understand the consequences of these difference on HNDFSP patients.

Efficacy of a smoking cessation program for patients with lung cancer.

357 Background: Smoking cessation improves overall mortality and cancer-specific mortality in patients with lung cancer. However, cessation is rarely successful without medical assistance, indicating a need for focused intervention in patients with lung cancer. Referrals for formal counseling can facilitate access to smoking cessation resources and serve as an impetus for cessation. In this study, we analyzed the efficacy of the smoking cessation program at our institution’s cancer center and identified opportunities for improvement in patient outreach, education, recruitment, and retention. Methods: A retrospective chart review of patients at our institution's cancer-dedicated smoking cessation center was conducted between January 1, 2022, to August 31, 2023. All referred patients with primary lung cancer or documented lung metastasis were included. Patient demographic and medical information were collected from the electronic medical record. Data was analyzed with descriptive (frequency, mean, median, interquartile ranges (IQR), 95% confidence interval) and inferential (t-test, Chi-Squared/Fisher’s Exact) statistics. P-value &lt;0.05 was deemed significant. Results: 138 patients were referred for smoking cessation counseling, 24 (17.4%) attended counseling, and 14 (58.3%) attended ≥2 visits. Patients had a median time from referral to first session of 14 days (IQR=8.5). All counseled patients were prescribed nicotine replacement therapy (NRT) with 19 receiving multiple modalities. Of the 23 patients actively smoking at first meeting, 19 (82.6%) saw some reduction in packs/day (PPD) compared with 55 (51.9%, n=106) in actively smoking non-counseled patients (p=0.006). Counseled patients saw improvement in packs/day smoking with a mean reduction of 0.66 PPD (p=0.0001, [0.36, 0.95 95% CI]). Patients who attended &gt;2 meetings saw a mean PPD reduction of 1.13 (p=0.004, [0.49, 1.78 95% CI]). In patients who did not attend counseling, 82 (71.9%, n=114) were never successfully contacted. There was no significant difference in age, gender, race, or insurance between patients who attended or did-not-attend counseling. Conclusions: Our smoking cessation program demonstrates effectiveness in facilitating a significant decrease in PPD. However, low utilization presents an opportunity for quality improvement to identify barriers to engagement and improve patient outreach. Proposed interventions include strategies such as patient-portal mediated outreach, provider reminders in the EMR, and utilization of referral and scheduling at initial oncology appointment as quality metrics. Smoking cessation program. Program Efficacy Number of Visits Mean Packs/Day Decrease [95% CI] 1 (n=9) 0.31 [-0.12, 0.73] 2 (n=6)* 0.56 [0.20, 0.91] &gt;2 (n=8)** 1.13 [0.49, 1.78] Total (n=23)*** 0.66 [0.36, 0.95] Attended Counseling n (%) Did Not Attend Counseling n (%) Patients with Any Decrease in Packs/Day* 19 (82.6) 55 (51.9) Patients Attaining Relapse Free Cessation 9 (37.5) 26 (22.8) *p&lt;0.05, **p&lt;0.005, ***p&lt;0.0005.

Disparities in patient-reported distress in head and neck cancer.

257 Background: Distress is common among cancer patients, and impacts morbidity and mortality. Head and neck cancer (HNC) is considered one of the most emotionally distressing of all cancers, and given the stark racial disparities in HNC outcomes, we sought to examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. Methods: We built a retrospective cohort of patients at a semi-urban, academic, National Cancer Institute (NCI)-designated comprehensive cancer center in the Southeastern United States. Cohort included patients with a diagnosis of HNC who received care from the Radiation Oncology department 5 weeks or less of initial diagnosis, from 2017 to 2022. Outcome of interest was clinically meaningful distress, a binary variable defined as a score of ≥4 on the distress thermometer (DT), a validated tool measuring distress, with scores ranging from 0-10. Main independent variables were sociodemographic factors (race/ethnicity, age, sex, marital status, and health insurance status). We further adjusted for clinical variables (stage of presentation, anatomical subsites, smoking and alcohol history), and problem list domain items. Using chi-square tests and multinomial regression analysis, we estimated differences in distress and odds of meaningful distress by sociodemographic factors, adjusting for clinical factors and problem list domains. Results: From a primary sample of 1,167 patients, 507 patients met our inclusion criteria. Nearly half (45.8%) of our sample had clinically meaningful distress, with a median DT score of 3 (IQR, 0-6). Total number of problem list items and physical concerns showed significant racial differences ( p &lt; 0.05); however, in our final models, race was not significantly associated with clinically meaningful distress. Compared to those unmarried, married patients were significantly less likely to report distress (aOR = 0.62; 95% CI: 0.40, 0.95). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR = 2.03; 95% CI: 1.02, 4.08). Other factors associated with significant clinical distress included tobacco history, and reported practical problems. Conclusions: Marital status and reported emotional problems are significantly associated with clinically meaningful distress in patients with HNC. Our study underscores the need for social support in mitigating distress and optimizing mental healthcare in our patient population. Further studies will explore distress trajectories across the HNC continuum and impact on HNC outcomes.

Genomic and Socioeconomic Determinants of Racial Disparities in Breast Cancer Survival: Insights from the All of Us Program.

Background: Breast cancer outcomes are worse among Black women in the U.S. compared to White women. While extensive research has focused on risk factors contributing to breast cancer; the role of genomic elements in health disparities between these racial groups remains unclear. This study aims to identify genomic variants and socioeconomic status (SES) determinants influencing racial disparities in breast cancer survival through multiple mediation analyses. Methods: Our investigation is based on the NIH-supported All of Us (AoU) program and analyzes 7452 female participants with malignant tumors of breast, including 5073 with genomic data. A log-rank test reveals significant racial differences in overall survival time between Black and White participants (p-value = 0.04). Multiple mediation analysis examines the effects of 9481 genetic variables across 23 chromosomes in explaining the racial disparity in survival, adjusting for SES variables. Results: 15 gene mutations, in addition to age, general health, and general quality of life, have significant effects (p-values < 0.001) in explaining the observed racial disparity. Mutations in TMEM132B, NARFL, SALL1, PAD12, RIPK1, ASB14, DCX, GNB1L, ARHGAP32, AL135787.1, WBP11, SLC16A12AS1, AP000345.1, IKBKB, and SUPT20H have significantly different distributions between Black and White participants. The disparity is completely explained by the included variables as the direct effect is insignificant (p-value = 0.73). Conclusions: The combined impact of SES determinants and genetic mutations can explain the observed differences in breast cancer survival among Black and White participants. Future studies will explore pathways and design in vivo and in vitro experiments to validate the functions of these genes.

No Increased Risk of Major Adverse Cardiovascular Events following Nicotinamide Exposure.

Nicotinamide metabolites have recently been implicated in increased risk of major cardiovascular events (MACE). Supportive data about clinical risk of MACE for nicotinamide users is lacking. To determine whether nicotinamide use results in an increase of MACE. Retrospective cohort study of two patient cohorts, Vanderbilt University Medical Center (VUMC) and Military Veteran Program (MVP). The risk of MACE in patients exposed to nicotinamide was compared to the risk of MACE in unexposed patients. In the VUMC cohort, 1228 patients were exposed to nicotinamide based on keyword entry for "nicotinamide" or "niacinamide" and hand-review of charts, while 253 were unexposed but had documented recommendation for use. In the MVP cohort, there were 1594 with exposure to nicotinamide propensity score matched to 2694 without exposure. The primary exposure for the VUMC cohort was a confirmed exposure to nicotinamide in chart review. The primary exposure for the MVP cohort was medication entry for "nicotinamide" or "niacinamide". The primary outcome was development of MACE based on a validated phenotype. Between both cohorts, 6039 patients were included, of whom 5125 were male with a mean age of 63.2 years. Neither cohort had significant differences in mean age, sex, race and ethnicity between the nicotinamide exposed and unexposed groups. In the VUMC cohort, there was no significant association between nicotinamide exposure and the primary outcome of MACE (HR 0.76, 95% CI 0.46 - 1.25, p = 0.28). MACE prior to nicotinamide exposure was strongly associated with subsequent MACE (HR 9.01, 95% CI 5.90 - 13.70, p < 0.001). In the MVP cohort, we adjusted for MACE risk factors as potential confounding variables and saw no significant association between nicotinamide exposure and MACE (HR 1.00 95% CI 0.75 - 1.32), while history of prior MACE remained strongly associated with subsequent MACE (HR 9.50, 95% CI 6.38 - 14.1). In this retrospective cohort study of 6039 adults from two different patient populations, we found no increased risk of MACE in patients with nicotinamide exposure.

An analysis of 105 female-perpetrated mass murders.

Most research on mass murderers to date has focused on perpetrators of male sex, while research on perpetrators of female sex has been relegated to case reports and series. We aimed to more fully examine the phenomenon of female-perpetrated mass murder. We analyzed 1715 worldwide incidents of personal-cause mass murder from 1900 to 2019, identifying 105 (6%) events perpetrated by females. We defined mass murder as any event involving at least three fatalities, not including the perpetrator, using any method. We identified cases of mass murder from English-language databases of mass murder or murder in print or online. There were no significant differences in age and race between female and male perpetrators. Relative to males, female perpetrators were significantly less likely to employ firearms in their mass murders, using them in less than half of cases, compared to over 70% for males. The prevalence of psychotic signs and symptoms among female mass murderers was more than double that among males (25.7% vs. 12.5%, p < 0.01), while the rate of nonpsychotic psychiatric or neurological conditions was also much greater among female perpetrators (29.5% vs. 17.1%, p < 0.01). Over half of female perpetrators took or attempted to take their own lives. More than three-quarters of mass murders by females involved at least one family member as a victim. This study underscores sex-specific differences in the perpetration of mass murder and the need for further research to understand how insights about such dynamics might lead to the development of more effective and informed intervention policies.

Gender, race, and ethnicity in lung cancer clinical trial participation: Analysis of 253,845 patients from 2002 to 2021

BackgroundLung cancer remains the greatest cause of cancer-related death, and multiple large studies have identified persistent racial disparities in lung cancer outcomes. In this study, we used public recording of lung cancer data on clinicaltrials.gov to sample age, gender, racial, and ethnic characteristics of participants in lung cancer clinical trials. MethodsClinicalTrials.gov, a US federal government repository of clinical trials, was queried for the term “lung cancer” and several related terms. A list of all studies matching these criteria was generated, and information regarding age, gender, ethnicity, and racial breakdown of participants was analyzed. Studies that did not report results to ClinicalTrials.gov or had at least one non-US site were excluded. Hypothesis testing was performed with the Student t test and χ2 test. Trends were analyzed using Spearman testing in Python (VSCode). ResultsRates of minority (ie, nonwhite) and female participation in US lung cancer clinical trials have increased significantly (P < .01) over the 20-year period from 2002 to 2021 but still do not represent parity with lung cancer incidence. Subset analysis by intervention offered did not show any significant differences in race, gender, or ethnic participation between studies that offered surgical intervention and those involving noninvasive interventions. National Institutes of Health–funded studies do not appear to have recruited any Hispanic participants, as assessed by reporting on ClinicalTrials.gov. The rates of race and ethnicity reporting also increased significantly over the study period. ConclusionsOur data demonstrate that there are persistent but improving racial and ethnic disparities in lung cancer clinical trials. Limitations of this study include poor reporting of results on clinicaltrials.gov. These findings demonstrate significant progress in the recruitment of minority participation, but also identify a significant role for policy changes to align participation with lung cancer incidence.

Impact of Surgical Team Involvement at the Time of Trauma Activation for Pediatric Patients With Motorized Cycle or All-Terrain Vehicle Injury Mechanism.

At our institution, level 2 trauma (L2T) activations are primarily managed by pediatric emergency medicine (PEM) physicians, whereas level 1 activations are co-managed by pediatric surgery and PEM. Starting in September 2019, the response to L2T activations due to all-terrain vehicles or motorized cycles (ATVs/MCs) changed to include surgical assessment upon patient arrival due to increased likelihood of significant injuries and need for higher level of care. The impact of PEM/surgery co-management of ATV/MC L2T patients on time to an admission decision is unknown. We retrospectively reviewed patients <18 years of age presenting to our American College of Surgeons-verified level 1 pediatric trauma center as L2T activations with ATV/MC mechanism between 1/2016 and 10/2022. Patient demographics, injury characteristics, details of imaging, interventions, and emergency department (ED) course were recorded. The χ 2 and Fisher exact tests were performed. One hundred fifty-five patients met the inclusion criteria prior to augmenting our response to include surgical presence at L2T-ATV/MC activations, and 216 patients were treated after our protocol change. There were no statistically significant differences in age, sex, race, transfer status, vehicle subtype, or Injury Severity Scores between groups. Trauma surgery was involved in the care of 74.8% of L2T-ATV/MC patients before protocol augmentation and 87% after ( P = 0.003). Time to an admission decision significantly decreased by 22.5 minutes (117 minutes [interquartile range, 72-178] vs 94.5 minutes [interquartile range, 60-139]; P = 0.023) after protocol augmentation. There was a trend toward increased completion of mandated postsecondary survey communication huddles after protocol change (84.6% to 91.2%, P = 0.089). The median total ED length of stay did not differ between admitted and discharged patients. Early surgical assessment for pediatric patients with ATV/MC injuries improved time to an admission decision and trauma communication huddle compliance. Next steps include identifying process improvement opportunities to decrease ED total length of stay for patients with ATV/MC injuries.

Temporal Trends in Race and Sex Differences in Cardiac Arrest Mortality in the USA, 1999–2020

BackgroundCardiac arrest (CA) affects over 600,000 patients in the USA annually. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups. MethodsA county-level cross-sectional longitudinal study using death data of patients aged 15 years or more from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. CAs were identified using the International Classification of Diseases, tenth revision, clinical modification codes. ResultsThe CA-related deaths between 1999 and 2020 were 7,710,211 in the entire USA. The annual CA related age-adjusted mortality rates (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents), followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82 % of all deaths and 51 % were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000). ConclusionsCA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of the COVID-19 pandemic. There were also significant racial and sex differences in mortality rates.

A case study of inclusion of rural populations in research: Implications for science and health equity.

Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross-sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non-rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non-rural for our entire sample, and 17.5% rural and 82.5% urban for our state-level sample. There were significant differences in race, sex, and age between rural and non-rural participants and Material Community Deprivation Indices between rural and non-rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

Using the Electronic Health Record to Implement Expedited Partner Therapy in the Pediatric Emergency Department.

Expedited partner therapy (EPT) is a partner treatment strategy for sexually transmitted infections (STIs) including gonorrhea and chlamydia as well as trichomoniasis in some states. The process allows healthcare providers to write prescriptions for STI treatment among partners of infected patients without a previous medical evaluation. The Centers for Disease Control (CDC) has recommended EPT as a useful option to facilitate partner treatment, particularly male partners of women with chlamydia or gonorrhea infections. Our institution implemented EPT in 2016 after Ohio legislation was passed to authorize its use. We aim to describe the implementation process and descriptive outcomes of EPT adoption in a pediatric emergency department. This study describes use of the electronic health record for implementation of EPT in our institution. We conducted a retrospective review of EPT utilization from implementation. Electronic records from the implementation date of January 1, 2017, through December 31, 2021, were reviewed. We describe basic demographics and overall uptake of the intervention. Fisher exact tests were used for categorical variables and two-sample t -tests for continuous variables. There was a total of 3275 positive test results and 739 EPT prescriptions written. Adolescent patients who received prescriptions for EPT were more likely to be female (78.7% of all EPT prescriptions, P = 0.007) and older than other patients (average age 17.7 vs 17.4 years, P = 0.004). There was no significant difference in race, insurance, or ethnicity among adolescent patients receiving and not receiving EPT. The percentage of positive STI tests associated with an EPT prescription ranged between 11.4% and 18.2%. Metronidazole was the most prescribed EPT medication. The use of the electronic health record provides a platform for implementation of EPT. Our study highlights a potential strategy for increasing treatments of STIs through EPT prescribing in the emergency department setting.

Sex Differences in Inflammation-Related Biomarkers Detected with OCT in Patients with Diabetic Macular Edema

PurposeTo investigate sex-based differences in inflammation-related biomarkers on Spectral-Domain Optical Coherence Tomography (SD-OCT). DesignCross-sectional study. ParticipantsPatients with diabetic macular edema (DME) between February 1, 2019, and March 31, 2023, without intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection within the prior six months. MethodsWe reviewed each patient’s medical record for age, biological sex, race and ethnicity, most recent glycated hemoglobin level (HbA1c), visual acuity (VA), and central macular thickness (CMT). OCT biomarkers that have been found in literature to be associated with inflammation, including disorganization of retinal inner layers (DRIL), retinal hyperreflective foci (HRF), hyperreflective choroidal foci (HCF), subfoveal neuroretinal detachment (SND), and perturbation in retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, and inner nuclear layer (INL) thickness were evaluated by graders masked to the clinical characteristics of the patients. We performed multivariable regression analyses with the OCT biomarkers as the outcome variables and sex, age, HbA1c, and CMT as independent variables. Main Outcome MeasuresOCT inflammation-related biomarkers as listed above ResultsFemale patients were on average two years older than male patients (P = 0.041). There were no significant differences in race and ethnicity, HbA1c, VA, or CMT between male and female patients. After controlling for age, HbA1c, and CMT, we found male sex to be associated with more HRF (incidence rate ratio [IRR] = 1.19, 95% confidence interval [CI] = 1.10 – 1.29), more HCF (odds ratio = 2.01, 95% CI = 1.12 – 3.64), and thicker INL (7 μm thicker in males, 95% CI = 2 – 12). Sex was not a significant predictor for either DRIL or SND in the multivariable regression models. Patients with higher HbA1c were more likely to have more HRF (IRR = 1.02 per 1 point increase, 95% CI = 1.00 – 1.04) after controlling for other factors. ConclusionsMale sex was correlated with more inflammation-related biomarkers on OCT including more HRF, more HCF, and thicker INL, after accounting for age, glycemic control, and amount of DME. Further studies are needed to evaluate the potential implications of these sex-based differences for individualized treatment.

Genetic Counseling, Testing, and Family Communication Into Survivorship After Diagnosis of Breast Cancer.

To examine receipt of genetic testing and communication with relatives about results into survivorship after diagnosis of breast cancer. Women age 20-79 years diagnosed with early-stage breast cancer in 2014-2015 and reported to the Georgia and Los Angeles County SEER registries were surveyed approximately 7 months and 6 years after diagnosis (n = 1,412). We asked about genetic counseling, testing, and communication with relatives about results. We categorized women into indications for testing on the basis of clinical guidelines at the time of diagnosis and at the time of the follow-up survey (FUPs). A total of 47.4% had indications for genetic testing at any time: 28.0% at baseline and an additional 19.4% at the time of the FUPs (only); 71.9% (95% CI, 67.4 to 76.4) of those with a baseline indication reported genetic testing versus 53.3% (95% CI, 47.3 to 59.2) with an indication at FUPs only and 35.0% (95% CI, 31.6 to 38.4) with no indication (P < .001). There were no significant racial or ethnic differences in receipt of testing, controlling for age and clinical indications (P = .239); results for genetic counseling were similar. Only 3.4% of survivors had direct-to-consumer genetic testing (DTCt) for cancer. Testers who reported a pathogenic variant (n = 62) were much more likely to have talked to most or all their first-degree adult relatives about genetic testing than those with a variant of unknown significance (n = 49) or a negative finding (n = 419): 62.7% versus 38.8% and 38.0%, respectively (P < .001). Many women with indications for genetic counseling and testing into survivorship do not receive it. But those tested reach out to family members on the basis of the clinical relevance of their results. Very few patients obtained DTCt, which suggests that these tests do not substitute for clinical testing in breast cancer survivors.