Sources Of Disparities Research Articles

Insurance remains a major source of disparity for patients with testicular cancer: call for advocacy.

To evaluate the effects of socioeconomic factors, including insurance status, on treatment and survival for patients with testicular cancer. We extracted a retrospective cohort from the National Cancer Database that included patients diagnosed with testicular cancer 2004-2020. Competing-risks and Cox regression multivariate models including demographic, pathological, and socioeconomic covariates were constructed to evaluate receipt of treatment and death, respectively. A total of 95 955 patients with testicular cancer were identified. Compared with private insurance, Medicaid (sub-distribution hazard ratio [SHR] 0.70, P < 0.001), Medicare (SHR 0.73, P < 0.001), and uninsured (SHR 0.72, P < 0.001) patients were associated with decreased likelihood of receiving chemotherapy. Compared with private insurance, Medicaid (SHR 0.55, P < 0.001), Medicare (SHR 0.76, P-value <0.001), uninsured (SHR 0.63, P-value < 0.001), and other government insurance (SHR 0.71, P = 0.010) was associated with decreased likelihood of receiving radiation. Medicaid insurance status (reference private, HR 2.60, P < 0.001) conferred the second largest hazard of death, behind having Stage III disease (reference Stage 0). Compared with private insurance, Medicare (HR 2.20, P < 0.001), no insurance (HR 2.32, P < 0.001), and other government insurance (HR 1.53, P = 0.027) statuses had higher risk of death. Patients diagnosed in Medicaid-expansion states had lower all-cause mortality (11.4% vs 13.6%, P < 0.001). Testicular cancer care relies on early diagnosis and treatment. It is critically important to have a healthcare system where individuals have access to insurance and are served equitably.

Social determinants of health and surgical outcomes of minimally invasive radical prostatectomy: a national population-based study.

Socioeconomic determinants of health (SDOH) are often unvalued during surgery risk stratification; hence, they might be a major source of disparity that can jeopardize outcomes related to urological surgery. The aim of our study is to evaluate the impact of SDOH on postoperative outcomes following minimally invasive radical prostatectomy (MIRP). Patients who underwent MIRP between 2011 and 2021 were retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify patient's characteristics, postoperative complications and SDOH. Outcomes were compared using multivariable regression models. Overall, 100,035 patients (mean age = 63.24 ± 7.07) underwent MIRP. The 60-day postoperative complication rate was 18%. Approximately 6% of patients reported at least one SDOH at baseline. SDOH were associated with higher odds of 60-day postoperative complications (OR:1.24, 95% CI:1.15-1.34), including urinary tract infection (OR:1.32, 95% CI:1.20-1.45) and acute kidney injury (OR:1.31, 95% CI:1.00-1.39). Postoperative urethral stricture (OR:1.37, 95% CI:0.92-1.98) did not reach statistical significance at multivariable analysis. Patients with SDOH have a significantly higher risk of postoperative complications following MIRP, especially urinary infection and acute kidney injury. These findings are multifactorial and should prompt identifying measures that might help prevent this large-scale phenomenon.

Dynamic assessment and pathway optimization of agricultural modernization in China under the sustainability framework: An empirical study based on dynamic QCA analysis

Accelerating agricultural modernization is vital for achieving sustainable agricultural development and ensuring food security. This paper uses the comprehensive evaluation model to measure the level of agricultural modernization in 30 provinces of China from 2012 to 2022. It inspects analyzes the spatial-temporal characteristics and regional differences through the Moran Index and Dagum Gini coefficient. Lastly, based on the configuration perspective, the dynamic qualitative comparative analysis method (QCA) is used to clarify the multiple improvement paths of China's agricultural modernization. The results indicate the following. First, China's agricultural modernization level is not high but has the potential for rapid growth. Regarding spatial distribution, the eastern region has the highest agricultural modernization level, followed by the central region, while the western region has the lowest level, showing a “high-high-low-low” clustering characteristic. Second, the overall disparity in China's agricultural modernization level is fluctuating and declining, with regional differences being the primary source of the overall disparity. The largest difference is between the eastern and western regions. Within regions, the western region has the largest internal disparity, but this disparity is gradually decreasing, whereas the gap in agricultural modernization level within the eastern region is continuously expanding. Third, the paths to improve China's agricultural modernization consist of multiple antecedent conditions. From the configuration perspective, there are four paths to enhance China's agricultural modernization level. These include the dual-strategy approach of “technology and policy,” the comprehensive tri-strategy model of “technology, market, and policy,” the synergistic enhancement model combining “technology and market,” and the multi-faceted core-driven approach.

Who feels they contribute to U.S. society? Helping behaviors and social class disparities in perceived contributions.

Americans in lower (vs. higher) social class contexts are less likely to believe they contribute to society. Helping others by giving one's time is an important way of contributing to others that also varies with social class. Five studies (N = 7,326) investigated whether one source of the social class disparity in perceived contributions is a default model that considers helping distant others (i.e., bridging help, e.g., volunteering) as more of a contribution than helping close others (i.e., bonding help, e.g., caring for family members). In Study 1, Americans in lower (vs. higher) social class contexts perceived they contribute less to society (i.e., self-perceived contributions, Part A) and believed others perceive them as contributing less (i.e., metaperceived contributions, Part B). Studies 2-4 provide evidence for a default model of social good: Americans across social class contexts and even helpers themselves perceived bridging help as more of a contribution than bonding help, in part, because bridging help is perceived as reflecting more choice to help. With a representative sample (Midlife Development in the United States), Study 5 finds that Americans in lower (vs. higher) social class contexts engaged in relatively less bridging help and more bonding help. However, bridging help served as a stronger pathway to feelings of contributing than bonding help did. Together, these studies suggest that people in lower social class contexts may experience a psychological inequality, in part, because some of the forms of help that are most accessible, familiar, and practiced are widely perceived as less of a contribution. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Who Shortlists? Evidence on Gender Disparities in Hiring Outcomes

A substantial body of research examines the relevance of hiring as a source of gender disparities in organizations. However, there is limited evidence on how different sets of key organizational decision makers contribute to gender disparities in hiring outcomes. To address this research gap, we exploit the staggered adoption of a new hiring process in a multinational corporation, which transferred from hiring managers to HR departments the task of shortlisting: narrowing a large pool of candidates to a more manageable set before final decision making. Using a difference-in-differences design, we find that the transfer of shortlisting responsibility increased the share of newly hired women. Additional tests based on quantitative and qualitative data are largely consistent with our finding that the transfer of shortlisting from hiring managers to HR departments led to fewer gender disparities in hiring outcomes given the increased expert knowledge in evaluating candidates and reduced opportunity costs for conducting such evaluations. Our setting offers a unique opportunity to help isolate key organizational decision makers’ role in contributing to gender disparities in hiring outcomes, and our findings have implications for how to alleviate gender disparities in employment.

Abstract C168: Developing lung adenocarcinoma cell lines to mitigate lung cancer health disparities

Abstract Lung cancer continues to be the number one cause of cancer-related deaths worldwide and remains a prominent source of cancer health disparities. Black/African American (B/AA) males exhibit a 12% higher lung cancer incidence rate and a 15% higher lung cancer death rate when compared to white males. Lung adenocarcinoma (LUAD) is the most common histological subtype of lung cancer in all ethnic/racial groups, including B/AAs. To further examine this phenomenon, we want to create a collection of lung cancer cell lines that would be useful for molecular studies of lung cancer development, progression, development of new targeted therapies, and pre-clinical drug testing. After reviewing the literature (Leon et al. 2023, Frontiers in Oncology, Vol. 13, p. 1187585, 2023), we identified only 30 unique B/AA cell lines out of ∼800, the majority of which are derived from White and Asian patients. Moreover, only 6 of the 30 cell lines are derived from patients with LUAD. We are in the process of deriving more LUAD cell lines from B/AA patients as well as alveolar epithelial cell lines in order to study the development of LUAD. In addition, we are creating a collection of multiple independent isogenic cell line variants from an existing lung cancer cell line NCI-H23. NCI-H23 was derived from a B/AA male LUAD patient and harbors a KRASG12C heterozygous mutation. G12C is the most common KRAS mutation in LUAD (∼40% of KRAS mutations) followed by G12V (∼20%), G12D (∼15%), G12A (∼10%), and G13C (∼6%). We used CRISPR/Cas-9 genome- based editing to replace the KRASG12C mutation with KRASG12V, KRASG12D, KRASG12A, and KRASG13C. We have derived multiple independent cell lines for most mutations. We are in the process of performing whole genome sequencing of these cell lines to exclude any off-target effects that may have arisen from the CRISPR/Cas-9 engineering. In addition, we will carry out whole genome RNA sequencing to assess the effect of the engineering and/or KRAS mutation switching. As a control, we are also sequencing the genomes and transcriptomes of three monoclonal cell lines we derived from NCI-H23 cells, to determine what variability ensues with the derivation of monoclonal lines, since that is required to obtain the CRISPR/Cas9-edited cells. We will use this collection of cell lines to study the efficacy of polyisoprenylated cysteinyl amide inhibitors (PCAIs) and other drugs on cell lines bearing these KRAS mutations. PCAIs were developed to target cells carrying mutant KRAS. Our efforts will provide new cell lines to study lung adenocarcinoma in B/AA subjects, addressing a key shortcoming and disparity in the lung cancer research toolkit. Citation Format: Sofia A. Lugo, Christopher Leon, Matthew A. Gladstone, Chunli Yan, Daniel J. Mullen, Pablo E. Puente, Kweku Ofosu-Asante, Justin K. Mensah-Mamfo, Kyle R. Phillips, Yong Huang, Nazarius S. Lamango, Ite A. Offringa. Developing lung adenocarcinoma cell lines to mitigate lung cancer health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C168.

Racial and ethnic differences in transfusion rates in adolescent scoliosis surgery: Preoperative anemia as a mediator of disparity

AbstractBackgroundPediatric patients from minoritized racial and ethnic groups receive red blood cell (RBC) transfusions more frequently while undergoing major surgical procedures. Our objective was to identify the contribution of preoperative anemia to racial and ethnic differences in RBC transfusion rates in adolescent spine surgery.Study Design and MethodsThis is a multicenter, retrospective cohort study of the National Surgical Quality Improvement Program Pediatric database, 2016 to 2021 for patients in the United States and Canada.ResultsAdolescents identifying as non‐Hispanic Black, Hispanic, and other race/ethnicity presented with higher rates of preoperative anemia than non‐Hispanic White adolescents (16.3%, 10.6%, and 9.9%, vs. 7.8%, respectively; p &lt; .0001) and were transfused at higher rates (14.4%, 11.9%, 16.5%, vs. 10.0%, respectively; p &lt; .0001). Minoritized groups demonstrated higher adjusted odds of RBC transfusion compared with non‐Hispanic Whites (non‐Hispanic Black: aOR 1.45 95% CI 1.26–1.65, Hispanic: aOR 1.17 95% CI 0.96–1.41, other race/ethnicity: aOR 1.63 95% CI 1.26–2.09). Of the total effect of minoritized race and/or ethnicity on RBC transfusion, 13.9% was attributed to the indirect effect through preoperative anemia.DiscussionIn this cohort study, patients from minoritized racial and ethnic groups received RBC transfusions at a higher rate than non‐Hispanic White patients, and the difference was partially mediated by preoperative anemia. Future efforts to minimize transfusions and improve health equity should target this modifiable risk factor alongside other sources of disparity and discrimination.

The Challenges of Measuring Socioeconomic Inequality in Pharmacoepidemiology Studies.

Social conditions like socioeconomic status (SES) are critical sources of health disparities. In pharmacoepidemiology research, our ability to measure SES in retrospective, real world clinical data remains challenged by a lack of patient-reported data. Some broadly accepted concepts can be measured at the individual level, such as income, poverty, and education. Community-level measures such as the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) also exist. After reflecting on these existing measures and discussing the challenges for leveraging them with real world data, we offer three recommendations that we believe could improve the ability of pharmacoepidemiologists to better measure and interrogate the effect of SES in their own research. These recommendations include a greater collection of patient-reported metrics, reduced reliance on ZIP Codes and ZIP Code Tabulation Areas for creating community-level measures of deprivation, and the inclusion of GIS and demography specialists within pharmacoepidemiology teams.

Examining Financial Strain and Subjective Social Status in Terms of Behavioral Health Among Latinx Adults in a Federally Qualified Health Center.

There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status-two common and clinically important SDoH factors-on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; Mage = 40.02years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.

Racial differences in odds of asthma exacerbations among Aspergillus fumigatus–sensitized adults with asthma

BackgroundAllergic sensitization to mold is a risk factor for poor asthma outcomes, but whether it accounts for disparities in asthma outcomes according to race or socioeconomic status is not well-studied. ObjectiveTo identify factors associated with allergic sensitization to molds and evaluate associations of sensitization to molds with asthma exacerbations after stratifying by race. MethodsWe conducted a retrospective cohort study of adults with asthma who had an outpatient visit to a large health system between January 1, 2017 and June 30, 2023 and received aeroallergen testing to Aspergillus fumigatus, Penicillium, Alternaria, and Cladosporium. We used logistic regression models to evaluate factors associated with mold sensitization and the effect of mold sensitization on asthma exacerbations in the 12 months before testing, overall and then stratified by race. ResultsA total of 2732 patients met the inclusion criteria. Sensitization to each mold was negatively associated with being a woman (odds ratios [ORs] ≤ 0.59, P ≤ .001 in 5 models) and positively associated with the Black race (ORs ≥ 2.16 vs White, P < .0005 in 5 models). In the full cohort, sensitization to molds was not associated with asthma exacerbations (ORs = 0.95-1.40, P ≥ .003 in 5 models and all above the corrected P value threshold). Among 1032 Black patients, sensitization to A fumigatus, but not to other molds, was associated with increased odds of asthma exacerbations (OR = 2.04, P < .0005). ConclusionBeing a man and Black race were associated with allergic sensitization to molds. Sensitization to A fumigatus was associated with asthma exacerbations among Black patients but not the overall cohort, suggesting that A fumigatus allergy is a source of disparities in asthma outcomes according to race.

Racial disparities in functional outcomes following mechanical thrombectomy in a cohort of patients with ischemic stroke

BackgroundNon-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following...

Assessment of Green Innovation Efficiency in Chinese Industrial Enterprises Based on an Improved Relational Two-Stage DEA Approach: Regional Disparities and Convergence Analysis

Industrial enterprises are characterized by significant energy consumption and high emissions. Therefore, the implementation of green innovation by these enterprises is beneficial for promoting sustainable economic development and safeguarding the ecological environment. In this study, a relational two-stage DEA model containing shared inputs and undesired outputs is constructed to evaluate and decompose the green innovation efficiency (GIE) of Chinese industrial enterprises across 30 provinces from 2012 to 2021. Since the objective function of this model is nonlinear, a heuristic search method is employed for its resolution. On the basis of efficiency evaluation, the Gini coefficient, kernel density estimation, and convergence analysis are further employed to investigate the regional disparities and convergence properties in the two-stage efficiency of green innovation. Our findings are as follows: (1) The average GIE of Chinese industrial enterprises demonstrates a fluctuating upward trajectory, with significant regional disparities observed between provinces. (2) Regional disparities in R&amp;D efficiency (RDE) and achievement conversion efficiency (ACE) have diminished in all regions. Super-variable density and interregional differences serve as the primary sources of regional disparities in RDE and ACE, respectively. (3) The presence of absolute and conditional convergence in RDE and ACE is observed across all regions. To improve the GIE of Chinese industrial enterprises, it is imperative to emphasize the heterogeneous impact of economic levels, industrial structure, and the degree of openness across various regions and stages of green innovation.

Empty chairs at the dinner table: Black-white disparities in exposure to household member deaths

As a result of Black–White inequities in life expectancy, recent research has indicated that Black individuals are disproportionately exposed to the deaths of multiple family members compared to White individuals. Black individuals are also more likely to live in coresident households—that is, households that extend beyond the nuclear family. However, it is unclear the degree to which this population may be disproportionately exposed to the loss of deaths marked by the geographic closeness of the household. In this study, I use data from the Panel Study of Income Dynamics to provide the first nationally representative estimates of Black-White disparities in exposure to household member deaths. I find that Black people are significantly more likely than White individuals to have experienced the death of a household member. Based on these findings, I argue the dual inequities of racial disparities in life expectancy and racial disparities in coresidence are an overlooked, salient source of racial disparities in exposure to death. By illuminating a broader range of network sources that contribute to racial inequities in exposure to death, this study sets forth a new conceptual unit of analysis—that of the household—to investigate the intergenerational reproduction of inequality in health and socioeconomic status due to exposure to death.

Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). University degrees were associated with lower incidence (aNIR=0.253, 95% confidence interval [CI]=[0.221 to 0.289], p<0.001), while black participants had a higher incidence (aNIR=1.995, [1.858 to 2.141], p<0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Neighborhood Racial Composition and Unequal Exposure to Violent Crime in Everyday Contexts.

Exposure to violence is a critical aspect of contemporary racial inequality in the United States. While extensive research has examined variations in violent crime rates across neighborhoods, less attention has been given to understanding individuals' everyday exposure to violent crimes. This study investigates patterns of exposure to violent crimes among neighborhood residents using cell phone mobility data and violent crime reports from Chicago. The analysis reveals a positive association between the proportion of Black residents in a neighborhood and the level of exposure to violent crimes experienced by residents. Controlling for a neighborhood's level of residential disadvantage and other neighborhood characteristics did not substantially diminish the relationship between racial composition and exposure to violent crimes in everyday life. Even after controlling for violence within residents' neighborhoods, individuals residing in Black neighborhoods continue to experience significantly higher levels of violence in their day-to-day contexts compared to those living in White neighborhoods. This suggests that racial segregation in everyday exposures, rather than residential segregation, plays a central role in racial inequality in exposure to violence. Additionally, the analysis suggests that neighborhoods with more Hispanic and Asian residents are exposed to less and more violent crime, respectively, compared to neighborhoods with more White residents. However, this is only observed when not adjusting for the volume of visits points of interest receive; otherwise, the finding is reversed. This study offers valuable insights into potentially novel sources of racial disparities in exposure to violent crimes in everyday contexts, highlighting the need for further investigation.

Sex-based disparities with cost-related medication adherence issues in patients with hypertension, ischemic heart disease, and heart failure.

Identifying sources of sex-based disparities is the first step in improving clinical outcomes for female patients. Using All of Us data, we examined the association of biological sex with cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities. Retrospective data collection identified the following patients: 18 and older, completing personal medical history surveys, having hypertension (HTN), ischemic heart disease (IHD), or heart failure (HF) with medication use history consistent with these diagnoses. Implementing univariable and adjusted logistic regression, we assessed the influence of biological sex on 7 different patient-reported CRMA outcomes within HTN, IHD, and HF patients. Our study created cohorts of HTN (n = 3891), IHD (n = 5373), and HF (n = 2151) patients having CRMA outcomes data. Within each cohort, females were significantly more likely to report various cost-related medication issues: being unable to afford medications (HTN hazards ratio [HR]: 1.68, confidence interval [CI]: 1.33-2.13; IHD HR: 2.33, CI: 1.72-3.16; HF HR: 1.82, CI: 1.22-2.71), skipping doses (HTN HR: 1.76, CI: 1.30-2.39; IHD HR: 2.37, CI: 1.69-3.64; HF HR: 3.15, CI: 1.87-5.31), taking less medication (HTN HR: 1.86, CI: 1.37-2.45; IHD HR: 2.22, CI: 1.53-3.22; HF HR: 2.99, CI: 1.78-5.02), delaying filling prescriptions (HTN HR: 1.83, CI: 1.43-2.39; IHD HR: 2.02, CI: 1.48-2.77; HF HR: 2.99, CI: 1.79-5.03), and asking for lower cost medications (HTN HR: 1.41, CI: 1.16-1.72; IHD HR: 1.75, CI: 1.37-2.22; HF HR: 1.61, CI: 1.14-2.27). Our results clearly demonstrate CRMA issues disproportionately affect female patients with cardiovascular comorbidities, which may contribute to the larger sex-based disparities in cardiovascular care. These findings call for targeted interventions and strategies to address these disparities and ensure equitable access to cardiovascular medications and care for all patients.

Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies.

Efforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist. Analyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.9% pre-AC and 23.3% post-AC). Fine-Gray competing risk models highlighted that candidates with low BSA had a lower likelihood of LT both pre-AC (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.92-0.95) and post-AC (HR 0.96; 95% CI, 0.94-0.98), with minimal improvement in waitlist mortality/dropout risk from pre-AC (HR 1.15; 95% CI, 1.09-1.21) to post-AC (HR 1.13; 95% CI, 1.06-1.19). Findings were mostly reaffirmed by Cox regression models incorporating the trajectory of Model for End-stage Liver Disease (MELD) scores as time-dependent covariates. Regions 3, 5, and 7 showed notable LT waitlist disparities among low BSA patients post-AC policy. Causal mediation analysis revealed that low BSA and the difference between MELD-sodium and MELD 3.0 (MELD_D, as a proxy for the potential impact of the introduction of MELD 3.0) largely explained the sex disparity in AC allocation (percent mediated 90.4). LT waitlist disparities for female candidates persist, largely mediated by small body size. Although MELD 3.0 may reduce some disparities, further body size adjustments for in allocation models are justified.

Place-based policies and geographical inequalities

Abstract Place-based programmes have become an important form of government intervention with the potential to profoundly affect the location of economic activity, along with the wages, employment, and industry mix of communities and regions. The enormous social costs of concentrated poverty and unemployment suggest that forms of policy intervention that can reduce concentrated poverty and unemployment have enormous upsides. At the same time, place-based policies involve important trade-offs. The main source of the trade-offs stems from the fact that place-based policies seek to shift investments, jobs, and incomes from the most productive areas of a country towards the least productive areas. This can result in economically meaningful efficiency losses. Setting socially optimal place-based policies crucially depends on understanding the sources of geographical disparities and the trade-offs involved.

P-168 Both artificial intelligence and manual embryo selection methods show sex-bias, favouring male embryos – insights from the largest embryo sex study using time-lapse and PGT-A

Abstract Study question Do AI-based and manual embryo selection strategies based on morphological and kinetic evaluation favour male over female embryos? Could the differences enable sex selection? Summary answer Male embryos receive higher-quality scores using both AI-based models and manual grading, but not using deep-learning approaches. The differences, although present, preclude reliable sex selection. What is known already A key aspect of IVF, embryo selection, involves methods executed manually via direct embryo morphological assessment, or by artificial intelligence algorithms which assess parameters such as tPNf, t2, t3, t4, t5, t8, tB and ICM and TE grades using time-lapse imaging. However, all current embryo selection models do not take embryo sex into account despite reported differences in developmental timings between XX and XY embryos. If the predictions of embryo selection algorithms themselves are affected by embryo sex, their accuracy and fairness may be impacted, leading to sex disparities in populations heavily reliant on IVF. Study design, size, duration A retrospective study was conducted on 1411 embryos with known sex information following PGT-A, at a single centre between 2018-202, making this the largest study to date interrogating morphological and morphokinetic sex differences using time-lapse and PGT-A data. Three embryo assessment methods were interrogated: manual morphological grading (Gardener system), KIDScore D3 (VitroLife) and CHLOE (Fairtility). These algorithms are representative of the current embryo grading landscape, encompassing manual selection, traditional machine-learning and modern deep-learning approaches, respectively. Participants/materials, setting, methods Kinetic parameters were annotated using CHLOE on incubator time-lapses. KIDScore computation was implemented according to Petersen et al.,2016 making use of kinetic annotations from CHLOE. Manual morphological grading was done at the blastocyst stage using a modified Gardner system. Mann-Whitney U and chi-squared tests compared XX and XY gradings, with detailed analyses on morphokinetics (tPNf,t2-t9+,cc2,cc3,tM,tSB-tEB,ICM and TE grades). To evaluate the ability of morphokinetic differences to predict embryo sex, four machine learning models were built. Main results and the role of chance Overall, XY embryos (4.182 ± 1.353, N = 692) were more likely to be assigned higher scores than XX embryos (4.022 ± 1.420, N = 642) by the machine learning-based KIDScore (U = 207604, p = 0.0182). Similarly, XY (462/668) blastocysts were more likely to receive good grades than XX (351/614) blastocysts under manual morphological grading (χ2 =19.843, df = 1, p &amp;lt; 0.00001). We pinpoint the source of sex disparities in conventional morphological grading to variations in trophectoderm morphology (male embryos receiving higher TE grades). Nevertheless, the observed differences, although present, were of marginal magnitude, and the overlap between the sexes substantial enough to preclude reliable sex selection. No significant difference was found in the scores assigned by more advanced deep learning methods such as CHLOE EQ scores between XX (0.787 ± 0.276, N = 628) and XY (0.802 ± 0.254, N = 679) embryos (U = 204621, p = 0.208). Limitations, reasons for caution This retrospective, single-centre study encounters limitations such as selection bias and constrained generalisability beyond the specific centre. It focuses on blastocyst-stage sex analysis, which, while statistically-powerful, may not fully represent the societal implications of embryo selection on sex ratios. The use of automated kinetic annotations, while efficient, might introduce inaccuracies. Wider implications of the findings Our findings raise significant questions surrounding the fairness of widely-used embryo assessment methods. We highlight the urgent need for the reproductive health community to recognise and address algorithmic bias, ensuring equitable and ethical treatment of all embryos, especially in the context of increasing global reliance on assisted reproduction. Trial registration number not applicable

Disparities in Telehealth Offer and Use among U.S. Adults: 2022 Health Information National Trends Survey.

Objective: Understanding the sources of telehealth disparities can inform efforts to ensure equity. This study examines disparities in telehealth offer and use to understand the role of health care providers in increasing telehealth access. Methods: This cross-sectional analysis of the 2022 Health Information National Trends Survey (n = 5,295) used survey-weighted proportions to characterize telehealth use and multivariable logistic regressions to test associations of sociodemographic and social determinants with (1) telehealth offer and (2) use among those offered the option. Results: Among U.S. adults, 57% were offered telehealth, 80% of whom used it. Technology difficulties and privacy concerns were barriers for 15%-20% of U.S. adults. Compared to telehealth users, most nonusers preferred in-person care (25% versus 84%). Age, education, geographic location, and broadband internet access were related to telehealth offer, whereas no significant disparities emerged in telehealth use. Conclusions: Telehealth use is widespread, but structural and provider-level engagement are needed to achieve equity.