Trends In Disparities Research Articles

Trends in life expectancy and life disparity in Turkiye before and during the Covid-19 period

Objective: This descriptive study examines Turkiye's life expectancy trends from 2013 to 2022, encompassing the COVID-19 period. Methods: This study used the Turkish Statistical Institute (TURKSTAT) cause of death data and explored trends in life expectancy and life disparity by using the line-integral decomposition model. Results: According to results, before the pandemic, increased male life expectancy and reduced disparity resulted from improved outcomes in unintentional injuries and malignant neoplasms during adulthood. Female life expectancy gains were driven by declining cardiovascular diseases in old age. However, during COVID-19, males experienced a greater loss of life expectancy than females in youth and adulthood, while females faced higher mortality rates in old age than males. The pandemic has exacerbated the female-male gap in life expectancy and disparity, with all causes of death increasing except for an improvement in malignant neoplasms among males. Conclusion: The study suggests prioritizing policies that address the health challenges faced by elderly females and young/adult males to mitigate the pandemic's impact on public health.

Racial and Regional Disparities in Trends in NICM-Related Mortality in the U.S. From 1999 to 2020

Racial and Regional Disparities in Trends in NICM-Related Mortality in the U.S. From 1999 to 2020

Description of census-tract-level social determinants of health in cancer surveillance data.

Disparities in cancer incidence, stage at diagnosis, and mortality persist by race, ethnicity, and many other social determinants, such as census-tract-level socioeconomic status (SES), poverty, and rurality. Census-tract-level measures of these determinants are useful for analyzing trends in cancer disparities. The purpose of this paper was to demonstrate the availability of the Surveillance, Epidemiology, and End Results Program's specialized census-tract-level dataset and provide basic descriptive cancer incidence, stage at diagnosis, and survival for 8 cancer sites, which can be screened regularly or associated with infectious agents. We present these analyses according to several census-tract-level measures, including the newly available persistent poverty as well as SES quintile, rurality, and race and ethnicity. Census tracts with persistent poverty and low SES had higher cancer incidence rates (except for breast and prostate cancer), higher percentages of cases diagnosed with regional or distant-stage disease, and lower survival than non-persistent-poverty and higher-SES tracts. Outcomes varied by cancer site when analyzing based on rurality as well as race and ethnicity. Analyses stratified by multiple determinants showed unique patterns of outcomes, which bear further investigation. This article introduces the Surveillance, Epidemiology, and End Results specialized dataset, which contains census-tract-level social determinants measures, including persistent poverty, rurality, SES quintile, and race and ethnicity. We demonstrate the capacity of these variables for use in producing trends and analyses focusing on cancer health disparities. Analyses may inform interventions and policy changes that improve cancer outcomes among populations living in disadvantaged areas, such as persistent-poverty tracts.

Trends in Diverticular Disease Hospitalizations and Racial Disparities in Outcomes Across the United States.

Objective This study evaluated trends and racial disparities in hospitalization, clinical outcomes, and resource utilization for diverticular disease (DD) between 2017 and 2020. Methods We performed a retrospective analysis using the NISdatabase from 1 January 2017 to 31 December2020to study hospitalizations for DD (CCSRcode: DIG013). Our primary outcomes were hospitalization rates, all-cause mortality, total charges, and length of stay. Secondary outcomes included in-hospital complicationsand discharge status. Outcomes were stratified by race and ethnicity (White, Black, Hispanic, Asian or Pacific Islanders and Native Americans). Data were weighted and adjusted for clustering, stratification, and other relevant factors. The normality of the continuous data distribution was confirmed usingKolmogorov-Smirnov, and descriptive statistics were used to summarizevariables. Demographic characteristics were compared usingχ² and Student's t-test, with significance set at P<0.05. We usedstepwise multivariable logistic regressionto estimateadjusted odds ratios for studyoutcomes by race and ethnicity, controlling for demographic and clinical factorsand correcting for multicollinearity. Missing data were treated with multiple imputations, trend analyses were performed using Jonckheere-Terpstra tests, and costs were adjusted for inflation using the GDPprice index. Analyses were conducted with Stata 17MP. Results A total of 1,266,539 hospitalizations for DD were included for analysis. Approximately953,220 (75.3%) were White patients and 313,319 (24.7) did not belong to the White race. Atotal of 747,868 (59%) were women compared to 518,671 (41%) men. Compared to patients who were not of the White race, White patients were younger(63.5 vs. 66.8 years; p<0.001). Hospitalizations for DD increased by 1.2% from 323,764 to 327,770 hospitalizations (2017-2019) and decreased by 11.8% from 327,770 to 289,245 admissions in 2020. Mortality rates were higher among White patients than in those not of the White race (16,205 (1.7%) vs 5,013 (1.6%)).However, no significant difference was observed in mortality odds between both sets of patients (aOR, 0.953; 95% CI 0.881-1.032; P=0.237).Mortality rates showed an uptrend over the study period (4,850 (1.5%) in 2017 to 5,630 (1.9%) in 2020; Ptrend<0.001).DD accounted for 7,016,718 hospital days, 2,102,749 procedures, and US$ 6.8 billion in hospital costs. Mean hospital costs increased from US$54,705 to US$72,564 over the study period (P<0.000). Patients who were not of the White race incurred higher mean hospital charges than White patients ($67,635 ± $6,700 vs $59,103 ± $3,850; P<0.001). Black race correlated with lower odds of bowel perforation, routine home discharge, and bowel resection (P<0.001). Conclusion During the study period, hospitalization and mortality rates and resource utilization for DD increased. Patients from other racesincurred higher hospital costs than White patients. White Americans were more likely to be discharged to skilled nursing, intermediate care, and other facilities. Additionally, White patients were less likely to develop bowel abscesses compared to patients who were not White. Compared to White American patients, Black patients had fewer DD hospitalizations complicated by bowel perforations or requiring bowel resections. In contrast, DD admissions among Hispanic patients were more likely to require bowel resections than those among White American patients.

Demographic changes in COVID-19 mortality during the pandemic: analysis of trends in disparities among workers using California’s mortality surveillance system

BackgroundThere is limited information on the extent and patterns of disparities in COVID-19 mortality throughout the pandemic. We aimed to examine trends in disparities by demographics over variants in the pre- and post-vaccine availability period among Californian workers using a social determinants of health lens.MethodsUsing death certificates, we identified all COVID-19 deaths that occurred between January 2020 and May 2022 among workers aged 18–64 years in California (CA). We derived estimates for at-risk worker populations using the Current Population Survey. The waves of COVID-19 mortality in the pre-vaccine availability period were March 2020-June 2020 (wave 1), and July 2020-November 2020 (wave 2), and in the post-vaccine availability period: December 2020-May 2021 (wave 3), June 2021-January 2022 (wave 4), and February 2022-May 2022 (wave 5). Poisson regression models with robust standard errors were used to determine wave-specific mortality rate ratios (MRRs). We examined the change in MRR across waves by including an interaction term between each demographic characteristic and wave period in different models. The role of potential misclassification of Race/ethnicity on death certificates was examined using probabilistic quantitative bias analysis as sensitivity analysis.ResultsAmong the 24.1 million working age CA population included in the study, there were 26,068 COVID-19 deaths in the period between January 2020 and May 2022. Compared with their respective reference groups, workers who were 50–64 years old, male, Native Hawaiian, Latino, or African American, foreign-born; individuals who had lower education; and unmarried were disproportionately affected by COVID-19 mortality. While disparities by sex, race/ethnicity and foreign-born status narrowed in later waves (post-vaccine availability), disparities by age, education level and marital status did not change substantially across waves.ConclusionDemographic disparities in COVID-19 mortality narrowed in the post-vaccine availability waves. However, the existence of disparities across all waves of the pandemic, even in an era of widespread vaccine coverage, could indicate remaining gaps in prevention and differential vulnerability. Addressing the underlying social, structural, and occupational factors that contribute to these disparities is critical for achieving health equity.

Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003–2020

Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003–2020. Descriptive analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in prevalence data during 2003–2020; and prevalence ratios were estimated by year to detect any reduction in disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with other North American studies, we found that relative differences between sexual minority and heterosexual groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the need to better understand mechanisms bolstering sexual orientation health disparities.

Trends in life expectancy and life disparity in the older population in China by regions, 1981–2020

This paper examines the trends in life expectancy and life disparity among the older population in China and its sub-national regions based on China National Population Census data from 1981 to 2020, using the life disparity indicator developed by Zhang and Vaupel. It is shown that, first, the life expectancy of the older population in both China and its sub-national regions has experienced a significant upward trend; however, the growth is uneven across regions. Second, life disparities due to deaths among the elderly in China and its sub-national regions followed a downward trend, but life disparities due to deaths among the elderly as a ratio of total life disparities increased, indicating an increasing importance of deaths among the elderly in life disparities amid overall mortality improvements. Third, multiple linear regression models indicate that variations in life expectancy and life disparity among the older population across regions in China may stem from uneven development in the health transition process and resulting disparities. The eastern region of China has experienced a faster health transition compared to the western region, as evidenced by the greater impact of investments in medical facilities and economic development levels on increasing old-age life expectancy and reducing old-age life disparities in the eastern region. This paper reveals that the life expectancy and life disparity of China's older population has improved considerably over the past four decades, and its relatively lagging improvement compared to that of developed countries over the same period may be related to the relatively lagging health transition in the western region of the country.

Exploring age-standardized cancer incidence rates and regional disparities: A retrospective cohort study of 8 major cancers in South Korea

BackgroundWe analyzed trends in cancer incidence and regional disparities of eight major types of cancer in Korea. MethodsThis retrospective cohort study used the data of 17 cities/provinces from the Korea Central Cancer Registry (1999–2020) in South Korea. Age-standardized incidence rates (per 100,000 person-years), between-group variance (per 100,000 person-years)2, and annual percentage changes ( %) were calculated for the eight most common malignancies. Joinpoint regression was utilized to identify the points at which significant changes occur in cancer incidence or regional disparity trends over time to characterize these trends. ResultsThe incidence of stomach cancer decreased as regional disparity decreased and that of colorectal cancer initially increased but recently declined, showing fluctuations in regional disparity. The incidence and regional disparity in liver cancer decreased. The incidence of lung cancer remained stable, with reduced regional disparities. The incidence of breast cancer rose with increasing regional disparity, whereas the incidence of cervical cancer decreased, accompanied by decreased regional disparity. A significant increase in prostate cancer was found, with initially reduced regional disparities but later showed a resurgence. The incidence of thyroid cancer fluctuated alongside variations in regional disparities. ConclusionThis study revealed cancer incidence and regional variations in each cancer type in Korea. More studies are needed to understand the underlying factors and potential interventions for reducing cancer incidence and addressing regional disparity.

Disparities in trends in bladder cancer mortality between urban and rural patients: A 2000-2020 analysis.

4583 Background: Patients in rural areas in the US often have worse healthcare outcomes due to socioeconomic deprivation, higher rates of smoking, and limited access to medical care. Despite a general decline in bladder cancer mortality over the past two decades, comprehensive studies comparing these trends between urban and rural mortality are scarce. Methods: Utilizing the CDC WONDER database, we extracted mortality data for bladder cancer from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons were standardized to the Year 2000 US standard population. Data segmentation by urbanity utilized the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. The National Cancer Institute's Joinpoint Regression Program was employed to calculate average annual percent changes (AAPCs) and annual percent changes (APCs). Results: In our analysis, we identified a total of 306,750 bladder cancer death cases from 2000 to 2020. Significant improvements in bladder cancer mortality were observed in urban areas, with large central metros experiencing the most pronounced decrease (AAPC -1.0%, p&lt;0.001). This decline was moderate between 2000 and 2016 (APC -0.3, p&lt; 0.001) but accelerated between 2016 and 2020 (APC -3.8%, p&lt;0.001). Large fringe and medium metros also saw comparatively smaller but significant declines (AAPC -0.6%, P&lt;0.05) and also accelerated between 2016-2020. In contrast, small metro and rural areas (micropolitan and noncore) showed no significant improvement, with mortality rates remaining stable between 2000 and 2020 (AAPC 0.2%, P=0.099). Conclusions: This analysis, the largest to date comparing urban and rural mortality trends in bladder cancer, highlights significant disparities in outcomes between large urban and rural areas. The marked improvement in urban areas, especially noted around the time novel agents such as immunotherapy were introduced, underscores the potential impact of advanced treatments. However, the stable mortality rates in rural areas suggest that access to advanced care, environmental influences, socioeconomic status, and slower adaptation of new guidelines in rural settings may play critical roles. These findings underline the urgent need for strategies to close the urban-rural gap. [Table: see text]

A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada.

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

Trends in Racial Disparities in the Treatment and Management of Ruptured Abdominal Aortic Aneurysms

Trends in Racial Disparities in the Treatment and Management of Ruptured Abdominal Aortic Aneurysms

Study on spatial distribution, regional differences and dynamic evolution of rural financial risk in China.

Based on panel data from 2009 to 2021, covering 30 provinces in China, we have been constructed the Rural Financial Risk Index using the objective entropy weighting method to study rural financial risk in China systematically from the perspective of spatial distribution. Specifically, we discuss the spatial distribution, regional differences and dynamic evolution of rural financial risk across Chinese four different regions divided into the Northeast, East, Central and West. It's found that Local government debt and Land transfer income are the two primary determinants influencing the level of rural financial risk in China. Furthermore, we conclude the ranking value of rural financial risk across four regions that the central exhibits the highest level, followed by the West, the East, and finally the Northeast, where the reasons for such ranking results as follows. Firstly, although the highest level of risk among provinces in the West is equivalent to that in the Central, there exists a smaller minimum rural financial risk in the former compared to the latter. Then, it should be noted that there's a low-low agglomeration of rural financial risk in the Northeast, while it demonstrates a high-high agglomeration in the Central according to the Moran Index test analysis. Again, there's a declining trend in rural financial risk disparity within the region and an upward trend is observed when comparing different regions (except the East vs West), especially increase largely between the Northeast and Central in past two years after analyzing the decomposition of Dagum Gini coefficient. Moreover, we study the absolute differences and dynamic evolution in different four regions through three-dimensional diagram of kernel density estimation, and it's found that the change of rural financial risk in four regions moved to the right as a whole, while the tail distribution remains inconspicuous. The absolute difference is diminishing in the Northeast, and the two-level differentiation characteristics tend to weaken as a whole in the Central, with a disordered wave peak height observed in both the East and West. Finally, the article presents pertinent policy implications but limitations according to the research findings.

New records of early Paleocene (earliest Torrejonian) plesiadapiforms from northeastern Montana, USA, provide a window into the diversification of stem primates

Plesiadapiforms (putative stem primates) appear in the fossil record shortly after the Cretaceous/Paleogene boundary and subsequently radiated throughout the Paleocene into a taxonomically and ecomorphologically diverse group. The oldest known plesiadapiforms come from early Puercan (the oldest North American Land Mammal ‘age’ [NALMA] of the Cenozoic) deposits in northeastern Montana, and all records of Puercan plesiadapiforms are taxonomically restricted to members of the Purgatoriidae and the enigmatic genus Pandemonium. Plesiadapiform diversity substantially increased in the following Torrejonian NALMA, but the sparse record of faunas between the Puercan and the well-known middle and late Torrejonian has hampered our understanding of this important interval in early primate evolution. Here we report new plesiadapiform dental fossils from early Torrejonian (To1) deposits from the Tullock Member of the Fort Union Formation in northeastern Montana that record several poorly known taxa including members of the Purgatoriidae, Paromomyidae and Pandemonium, and that document the largest and most diverse assemblage of To1 plesiadapiforms known. We describe a new species of the purgatoriid Ursolestes (Ursolestes blissorum, sp. nov.) that represents the largest plesiadapiform known from the early Paleocene and, among other taxa, provides additional evidence that the temporal range of purgatoriids extended into the Torrejonian. Large sample sizes of the oldest known paromomyid, Paromomys farrandi, allowed us to document intraspecific variability and one undescribed tooth locus. Our observations illuminate changes in dental morphology of some taxa that occurred in To1 and may inform the acquisition of certain diagnostic plesiadapiform dental characters. We evaluate plesiadapiform species richness, mean body mass and body-mass disparity through the Paleocene and reveal unrecognized levels of richness in To1 and a general trend of stable body mass and body-mass disparity. Our findings contribute to documented patterns of plesiadapiform provincialism in the early Paleocene and shed light on the early stages of their Torrejonian radiation.

Abstract PO2-04-02: Trends in Disparities and Transitions of target therapy in Patients With ERBB2 Positive Early Breast Cancer in China and the US, 2011 to 2021

Abstract Background. Diagnosis and treatment of breast cancer have been profoundly improved in China recently. However, trends in disparities and transitions of target treatment in early stage with ERBB2 positive between China and United States are not well known. Methods. This cross-sectional study used Chinese Society of clinical oncology breast cancer (CSCO BC) database from hospitals in 13 provinces of China and Flatiron database from more than 280 US community oncology clinics. Patients with ERBB2 positive and diagnosed as stage I to III breast cancer from 2011 to 2021 were collected. The distribution of target therapy was examined overall and by years. Results. A total of 10245 early-stage breast cancer with ERBB2 positive diagnosed from 2011 to 2021 were screened from the CSCO BC database(n=8446) and the Flatiron Database(n=1799). The median age at diagnosis for Chinese and US was 47 years old and 63 years old. For neoadjuvant therapy, the annual rate of trastuzumab-therapy increased from 0.4% in 2011 to 33% in 2021 in CSCO BC database, while rate of trastuzumab and pertuzumab therapy increased from 0.6% in 2016 to 42% in 2021. The proportion of trastuzumab therapy in Flatiron database decreased from 50% in 2011 to 23% in 2021, while the proportion of dual target therapy increased from 11% in 2013 to 67% in 2021. In adjuvant setting, the trastuzumab therapy increased from 6.8% in 2011 to 37% in 2021 in CSCO BC database, with highest proportion of 65% in 2018. Only 0.1% of patients received dual target therapy in 2018, the proportion increased to 32% in 2021. In Flatiron database, the trastuzumab therapy decreased from 60% in 2011 to 50% in 2021, while rate of trastuzumab and pertuzumab therapy increased from 5% in 2015 to 10% in 2021. Further follow-up is needed for survival data from two databases. Conclusions. Although significant differences were found between the China and US in target therapy, the disparities have been gradually narrowed. Use of trastuzumab in China has overtaken that in US since 2017 attributed to the effort of China's health reform in medical insurance and the promotion of guidelines. Citation Format: Jianbin Li, Jifang Zhou, Haibo Wang, Zhenzhen liu, Zhimin Fan, Yinhua Liu, Cuizhi Geng, Zefei Jiang. Trends in Disparities and Transitions of target therapy in Patients With ERBB2 Positive Early Breast Cancer in China and the US, 2011 to 2021 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-04-02.

Abstract PO2-10-03: Clinical characteristics and survival trends of male breast cancer in the United States: A propensity score matched analysis

Abstract Introduction Male breast cancer (MBC) is extremely rare and represents less than 1% of breast cancer (BC). There are limited studies investigating clinical outcomes of MBC. Although the survival of female breast cancer (FBC) has increased over the years; there is a substantial knowledge gap regarding survival trends of MBC. Given the rarity of MBC, recommendations on the treatment of MBC are scarce and mainly extrapolated from the data from FBC. We aim to analyze the clinical characteristics and annual trend in the survival of MBC compared to FBC. Methods We queried the National Cancer Database for BC patients (pts) diagnosed during 2004-2020. The demographic, clinicopathological and treatment characteristics were summarized by sex. An inverse-propensity weighted cox regression model was used to assess the association between sex and overall survival. Propensity weights were based on age, race, insurance, T, N, M-stages, subtype, grade, chemotherapy (CT), radiation (RT), hormone therapy (HT), and time to definitive treatment. To compare survival trends over time, year of diagnosis and its interaction with sex were included in the model. All analyses were performed at a significance level of 0.05. Results A total of 24, 055 MBC and 2,532,470 FBC pts were identified. MBC pts were older (mean age: 65.6 vs 61.4 years), Blacks (12.8 vs 11.2%) and had more government insurance (55.7% vs 45.8%) compared to FBC (all p&amp;lt; 0.001). Compared with FBC, more MBC pts had stage IV (7% vs 4.7%), fewer pts had stage I (33.4% vs 44.8%), more pts had larger tumors (cT4: 6% vs 3.7%), and node positive disease (18.5% vs 15.5%) (all p&amp;lt; 0.001). MBC were more likely estrogen (ER) (88.5% vs 78.5%) and progesterone receptor (PR) (79.6% vs 68%) positive and less likely HER2 receptor positive (7.9% vs 9.3%) or triple negative (2.8% vs 7.6%) compared to FBC (all p &amp;lt; 0.001). Male pts with BC received less CT (38.7% vs 41.2%), RT (32% vs 52.6%), HT (59.8% vs 62.5%) compared to females with BC (p &amp;lt; 0.001). The overall survival (OS) rates were lower in MBC compared to FBC (5-year: 73% vs 83%; 10-year: 54% vs 70%, p &amp;lt; 0.001). In the propensity weighted cox-regression model, males had higher mortality compared to females with BC (HR 2.8, 95% CI 2.88 - 2.9, p &amp;lt; 0.001). This difference in OS was observed in TNBC (HR 1.2, 95% CI 1.21 - 1.24) and HER2+ (HR 2, 95% CI 1.9 - 2.0), but not in ER/PR+ HER2- BC (HR 0.78, 95% CI 0.78 - 0.79), all p &amp;lt; 0.001. The 5-year and 10-year OS of early-stage MBC and advanced MBC was lower compared to FBC (Early-stage:- 5-year: 77% vs 86%, 10-year: 57% vs 72%, HR 2.9, 95% CI 2.9-2.92; Advanced: 5-year: 23% vs 28%, 10-year: 8% vs 13%, HR 1.14, 95% CI 1.14 – 1.2, both p &amp;lt; 0.001) The 5-year OS rates increased steadily for FBC from 2004-2015; however, the survival rates were not improved for MBC (Table 1) (p-value for interaction of sex and year of diagnosis was 0.02). Conclusion MBC pts have higher mortality rates and poor clinical outcomes compared to FBC pts. We demonstrate that the survival of MBC pts has not improved over the last decade, even after adjusting for clinicopathological and treatment characteristics. These findings suggest the need to investigate personalized treatment interventions for male breast cancer pts, especially given the disparate trends in survival among male and female BC over a period of time. Table 1: Survival trend by sex - overall BC cohort Citation Format: Arya Mariam Roy, Anthony George, Archit Patel, Malak Alharbi, Kristopher Attwood, Shipra Gandhi. Clinical characteristics and survival trends of male breast cancer in the United States: A propensity score matched analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-03.

Abstract PO1-09-05: Reversing Rural Disparity Through Increased Access to Breast Care Using Model of Academic-Community Collaboration

Abstract Background: Rural disparity in Breast Cancer (BC) often relates to poor geographic access. We are small county in rural North Carolina with historically poor outcomes, including more advanced stages of BC at presentation, higher mastectomy rates, and higher BC-specific mortality rates than elsewhere. Beginning in 2002 we increased access to care by construction of a 19-bed Critical Access Hospital. With a higher median age population (10 years older), and cancer as the number one cause of death (30% of all deaths), we began to increase access to services with focus on cancer. Two decades later, we still do not provide all aspects of care locally, but through a model of collaboration we have increased access to all aspects of cancer care. Breast Cancer is the most common, and this report details the reversal in disparity seen rurally based on our model of collaboration with both a regional community cancer program and academic cancer program. Methods: We partnered with academic and community cancer centers in nearby counties to increase access to imaging, cancer specialists, radiation therapy and chemotherapy services, and support services for breast care. When we could not provide these services locally, we helped navigate patients to these other facilities to improve access. We invited dedicated breast surgeon from community cancer program to attend clinic weekly in our area. We created virtual breast-specific tumor boards to discuss 100% of cases prospectively, with improved access to pathologists, geneticists, fellowship-trained imaging specialists, breast surgeons and other multi-disciplinary care members (reconstructive surgery, PT/OT, integrative medicine, GYN). We became cancer accredited with both COC and NAPBC. We compare metrics pre/post-improvements. Results: Baseline: 1. Mortality rates: (2002-2006) 5-year BC mortality rates in our region averaged 32.3/100,000 population which was in the top quartile for the state, 30% higher than the state average. 2. Stages at presentation: 47% of BC stages were early (stages 0/1) in our service region compared to 62% elsewhere (NCDB data). Stage IV represented 6% in our region versus 4% elsewhere. 2500 mammograms/year at hospital at baseline. 3. Surgery/Radiation Therapy: Mastectomy rates averaged &amp;gt;50% in region, with correspondingly lower breast conserving rates than elsewhere due to lack of access to breast surgeons and radiation therapy services locally. Closest RT facility 80 miles. 4. Distances to high quality breast care averaged 150 miles. Closest Academic/Community Cancer Program 2-hour drive (one way). Post Collaboration: 1. Mortality rates: (2015-2019), 5-year BC mortality rates in our region averaged 16.3/100,000 population which is in the lowest quartile, 20% lower than the state average. 2. Stages at presentation: 74% of BC stages are early (stages 0/I) in our region versus 68% elsewhere. Stage IV now below parity with 3% locally versus 4% nationally. More than 5100 mammograms/year done currently at local hospital. 3. Surgery/Radiation Therapy: Mastectomy rates average 21%, with partial mastectomy rates of 79% in our area versus 70% elsewhere (NAPBC data) with RT services available locally. 4. Distances to quality breast care average 20 miles, and we are nationally accredited program in breast care as a critical access hospital. Analytic case load is now triple baseline numbers. Conclusion: We reversed the trend in rural disparity in breast cancer outcomes through model of collaboration. We increased screening rates locally, doubling the number of screening/diagnostic exams, increased the percentage of early stage at diagnosis, halved our mastectomy rates, and reduced BC-specific mortality 50% relative to baseline (and now 20% lower than state). We are now at parity with most BC-specific quality metrics reflecting a huge shift in rural disparity, which could only be achieved rurally through collaboration. Reversing Rural Disparity Through Increased Access to Breast Care Using Model of Academic-Community Collaboration This table depicts the changes in our region over time, which have brought us to parity with Breast Care nationally. Citation Format: Charles Shelton, Antonio Ruiz. Reversing Rural Disparity Through Increased Access to Breast Care Using Model of Academic-Community Collaboration [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-05.

Temporal trends of health disparity in the utilization of curative-intent treatments for hepatocellular carcinoma: are we making progress?

BACKGROUNDLiver-directed treatments: ablative therapy (AT), surgical resection (SR), liver transplantation (LT), as well Trans-Arterial Chemoembolization (TACE) improve OS for early-stage HCC. While racial and socioeconomic disparities impact access to liver-directed therapies, their temporal trends for the curative-intent treatment of HCC remain to be elucidated. METHODSWe performed chi-square, logistic regression, and temporal trends analyses on data from the Nationwide Inpatient Sample from 2011-2019. The outcome of interest was the rate of AT, SR, LT (curative-intent treatments), and TACE utilization, and the primary predictors were racial/ethnic group, and SES (insurance status). RESULTSAfrican-American and Hispanic patients had lower odds of receiving AT – (African-American: OR=0.78, p<0.001), (Hispanic: OR=0.84, p=0.005); and SR – (African-American: OR=0.71, p<0.001), (Hispanics: OR=0.64, p<0.001) compared with white patients. The odds of LT was lower for African-American (OR=0.76, p<0.001) but higher for Hispanic patients (OR=1.25, p=0.001) compared to white patients. Low SES had worse odds of AT (OR=0.79, p=0.001), SR (OR=0.66, p<0.001), and LT (OR=0.84, p=0.028) compared to high SES. While curative-intent treatments showed significant upward temporal trends among White (10.6% to 13.9%, p<0.001), and API/Other patients (14.4% to 15.7%, p=0.007), there were non-significant trends among African-American (10.9% to 10.1%, p=0.825) or Hispanic patients (12.2% to 13.7%, p=0.056). CONCLUSIONS:Our study demonstrates concerning disparities in the utilization of curative-intent treatment for HCC based on race/ethnicity, and socioeconomic status. Moreover, racial/ethnic disparities have widened rather than improved over time.

Diversity in enrollment to clinical trials for cataract medicine and surgery: meta-analysis.

To investigate sex, racial, and ethnic disparities in patient enrollment across cataract trials registered in the United States. Participants enrolled in high-quality (reduced risk of bias), U.S.-registered (on ClinicalTrials.gov ), cataract-related randomized controlled trials (RCTs). RCTs must be completed, have used double or greater masking, and have published results through the registry or a scholarly journal. Cross-sectional database study. Trial (study sponsor country, study site location, trial initiation year, study phase, and study masking) and demographic data (sex, race, and ethnicity according to U.S. reporting guidelines) were collected. The Global Burden of Disease database provided sex-based cataract disease burdens. Pooled participation-to-prevalence ratios (PPRs) with 95% CIs were calculated for female sex, with values between 0.8 and 1.2 constituting sufficient study enrollment. Kruskal-Wallis tests (α = 0.05) with subsequent post hoc comparisons were used to evaluate demographic representations stratified by trial characteristics. From 864 records, 100 clinical trials (N = 67 874) were identified, of which 97 (N = 67 697) reported sex demographics with a pooled female PPR of 0.89 (95% CI, 0.85-0.94). Of the 67 697 total participants, the absolute female enrollment was 19 062 (28.16%). Ethnicity and race were reported in 9 (N = 1792) and 26 trials (N = 23 181), respectively. Among trials that reported race, most were White (N = 19 574; 84.44%). High-quality, U.S.-registered, cataract trials enrolled acceptable proportions of women. However, the absolute number of female and racialized participants was low. Race and ethnicity were underreported. Disparity trends predominately held across secondary variables. To promote generalizability, future trials should pursue equitable demographic enrollment.

Atherosclerotic cardiovascular disease landscape in Singapore.

Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for over one-third of all deaths in Singapore. An analysis of age-standardized mortality rates (ASMR) for CVD in Singapore revealed a deceleration in the initial rapid decline in ASMR. A decrease in smoking prevalence may have contributed to the initial rapid decline in ASMR. Furthermore, other major risk factors, such as diabetes mellitus, hypertension, elevated low-density lipoprotein levels, and obesity, are steadily rising. Singapore's CVD economic burden is estimated to be 8.1 billion USD (11.5 billion SGD). The burden of CVD can only be reduced using individual and population-based approaches. Prevention programs must also be developed based on an understanding of risk trends. Therefore, this article attempts to capture the burden of CVD, trends in risk factor control, preventive care, disparities, and current unmet needs, particularly in atherosclerotic cardiovascular disease management in Singapore.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019.

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.