Years For Whites Research Articles

Presence of hyperdiploidy and history of tobacco use in African American patients with SMM.

8062 Background: Smoldering multiple myeloma (SMM) has a clinically variable course in progression to active myeloma (MM). Accurate risk stratification is essential in identifying which patients may benefit from early therapeutic intervention. Current models do not account for the potential impact of race on risk of progression to SMM. Here, we seek to identify independent risk factors for progression in African American (AA) versus white patients in a real-world single institutional database of SMM patients. Methods: We retrospectively identified 224 patients (pts) with untreated SMM from 2007 to 2021 treated at our institution. Patient demographics and disease characteristics were obtained from our IRB-approved myeloma database. TTP was defined as the time from diagnosis of SMM to diagnosis of active MM, estimated by Kaplan-Meier and compared by log-rank test. Univariate analyses were performed using Cox proportional hazard models for TTP. Results: A total of 224 pts (AA 35%, white 47%, other/unknown 17%) were identified with median age 62y (range 32-82). Median follow-up was 4.3y in Whites and 5y in AA pts. Notable characteristics include M/F 45%/54%, IgG/IgA/FLC 76%/17%/6%, 30% current/past smoker (median 15 pack-years), 12% alcohol use (≥10 drinks/wk), 45% with BMI > 30. Multiple cytogenetic abnormalities were defined as presence of ≥2 of the following: t(4;14), t(14;16), gain(1q21), del(1p), del(13), or del(17p). The median TTP (mTTP) was 6.8 [95% CI (3.7, 8.2)] years in whites and 5.6 [95% CI (4.6, 11.8)] years in AA. On univariate analysis, M-spike > 1.5, involved K/L ratio > 12, and bone marrow PC > 20% were associated with increased risk of progression for both AA and whites (all p < 0.05). As expected, gain of 1q21 was associated with increased risk of progression for both groups, though more pronounced in AA (HR 2.94, p = 0.025) versus whites (HR 2.33, p = 0.013). Hyperdiploidy was associated with shorter mTTP in AA (HR 3.03, p = 0.004) compared to whites (HR 1.39, p = 0.3). Multiple cytogenetic abnormalities was associated with shorter mTTP in whites (HR 2.63, p = 0.004) but was not statistically significant in AA (HR 2.63, p = 0.104). Interestingly, tobacco use was associated with shorter mTTP in Blacks (HR 2.94, p = 0.005) but not in whites (HR 0.96, p = 0.85). Conclusions: Understanding the potential impact of racial background on progression from SMM to MM is critical in the appropriate management of all patients with SMM. In this database, with a large proportion of AA patients, hyperdiploidy and +1q portend high risk of progression in AA patients. Further study is needed to better classify these potential differences to ensure risk stratification models are applicable to all patients.

Perceived change in age after functional upper blepharoplasty

ABSTRACT Purpose To evaluate the perceived age of patients before and after functional upper blepharoplasty. Methods Retrospective chart review of patients who underwent upper blepharoplasty by a single surgeon at an academic center. The inclusion criterion was having external photographs before and after blepharoplasty. Exclusion criteria included any other concurrent eyelid or facial surgery. Primary endpoint: perceived change in age after surgery as judged by the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) surgeons. Results Sixty-seven patients (14 men, 53 women) were included. Mean pre-operative age was 66.9 years (range 37.8–89.4) and mean post-operative age was 67.4 years (range 38.6–89). The mean perceived age pre-operatively was 68.9 years, and the mean perceived age post-operatively was 67.1 years, a change of 1.8 years (p = 0.0001 by two-tailed paired T-test). Inter-rater reliability of the observers was measured by intraclass correlation coefficient of 0.77 for pre-operative and 0.75 for post-operative photos. The decreased perceived age was 1.9 years for women, 1.4 years for men, 0.3 years for Asians, 1.2 years for Hispanics, and 2.1 years for whites. Discussion Functional upper blepharoplasty by an experienced ASOPRS surgeon was shown to reduce the perceived age of a patient by an average of 1.8 years.

Abstract B104: Assessing disparities in social determinants of health between African Americans/Black and Whites

Abstract According to the 2020 census, the African American (AA) population reached almost 47 million habitants, comprising 14% of the total United States (U.S) population. Data has shown that amongst all racial and ethnic groups in the U.S, AA men have the highest incidences of cancer, and AA men and women have the highest death rate and worst survival for most malignancies. Historically, AAs face worse outcomes and illness compared to Whites. AAs have higher rates of lung cancer (LC), yet, are less likely to fulfill LC screening eligibility criteria. Black women, on the other hand, are almost twice as likely as White to die from breast cancer. Social determinants of health (SDH) heavily impact the health outcomes in this population. We sought to explore the differences in SDH between African Americans/Black and Whites. Survey data were obtained from the AAMC biannual Consumer Survey of Health Care Access. There were 53,523 subjects included from 2010to 2019. A chi-square comparison was conducted between Black, Hispanic, White, and other races with subsequent multivariate analysis. Numerical values were summarized as mean plus standard deviation and compared using ANOVA. A total of 5,245 participants self-identified as African American or Black. The largest group of AA participants were 25-34 years (21.7% ) versus ≥ 65 years for whites (23.3%). Most AA respondents were female, single, college graduates, employed full time and had private insurance. During the most recent medical care visit, AA reported higher rates than Whites for concerns about housing stability OR 2.37(1.52,3.69) and food insecurity OR 1.70 (1.08,2.69). Compared with Whites, AA reported significantly higher experiences of unfair treatment due to age OR 1.15 (1.01,1.30), race OR 1.62 (1.42,1.87), language OR 1.39 (1.20,1.59), culture OR 1.29 (1.11,1.50), and religion OR 1.47 (1.26,1.71). Disparities in social determinants of health have a quantifiable impact on the experiences within health care of the AA population. Perceived racial discrimination by the AA communities can negatively impact this vulnerable population's cancer diagnosis and care, widening disparities that have been present for decades. Citation Format: Coral Olazagasti, Idalid Franco, Fay Osman, Narjust Duma. Assessing disparities in social determinants of health between African Americans/Black and Whites [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B104.

Worsening premature death burden gap from systemic sclerosis in men and black persons: A US nationwide population-based study.

Male sex and black race incur poor prognosis in systemic sclerosis (SSc). There is no nationwide population-based assessment of premature SSc death burden by sex and race. This is a population-based study comprising all recorded SSc deaths across the United States. We constructed histograms depicting the number of SSc deaths for each age by sex and race, and calculated the cumulative percent death at each age and the median age of death. We determined the odds ratios for the risk of premature death from SSc by sex and race. We then calculated the percent of total SSc deaths for different age groups by sex and race from 1970 to 2015. We performed chi-square test with Yates's correction and quantified the odds ratio (OR) with 95% confidence interval (CI). The median age of SSc death was 63 years in males versus 68 years in females, and 57 years in blacks versus 70 years in whites. The odds for SSc death before 65 years age was 1.8 (95% CI, 1.6-2.0) for males compared with females and 5.1 (95% CI, 4.4-6.0) for blacks compared with whites. The higher odds for premature death in males than in females was similar for both races. Differences in the proportions of premature deaths from 1970 to 2015 increased between males and females (-5% to 17%) and between blacks and whites (14% to 36%). Males and black persons die of SSc at younger ages. The worsening premature death burden gap between the two sexes and races over the last five decades is troublesome.

P886: AFRICAN AMERICAN PATIENTS WITH SMOLDERING MULTIPLE MYELOMA MAY HAVE A LOWER RISK OF PROGRESSION COMPARED TO WHITE PATIENTS

Background: The incidence of multiple myeloma (MM) and its precursor stages is two to threefold higher in African Americans (AAs) compared to whites when adjusted for socioeconomic status, age, and sex. However, there is limited information on whether racial background affects the risk of progression from smoldering MM (SMM) to MM. Aims: To assess the effect of race on the progression from SMM to MM. Methods: Patients with SMM presenting to Memorial Sloan Kettering Cancer Center between the years 2000 and 2019 and who identified as either AA or white were included in this retrospective study. Baseline patient and disease characteristics were collected at the time of diagnosis including laboratory, imaging, and pathology reports. Differences in distributions of continuous and discrete characteristics were assessed by Kruskal-Wallis and chi-square tests. Time to progression (TTP) was assessed using the Kaplan-Meier method with log-rank test for comparisons. Univariate and multivariate Cox proportional hazard models were used to estimate effects of risk factors on TTP with hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 576 patients were included (70 were AA, 12%). Median follow-up time was 3 years in AAs and 4 years in whites. Differences in baseline characteristics between AAs and whites included median age (60 years in AAs [IQR 51-67] vs 64 years in whites [IQR 56-72], p = 0.01), median hemoglobin level (12.3g/dL in AA [IQR 11.8-13] vs 12.8g/dL in whites [IQR 11.8-13.9], p = 0.02), and immunoparesis including 1 or 2 uninvolved immunoglobulins (31% and 10% in AAs vs 56% and 27% in whites, p = 0.002). There was no difference in bone marrow plasma cell percentage (BMPC), M-spike, free light chain ratio, or Mayo-2018 SMM risk score. AA race was associated with a significantly decreased risk of progression in the univariate model (HR 0.57, CI 0.34-0.94). In the multivariate model adjusting for age, sex, and variables associated with an increased risk of progression in the univariate model (BMPC, M-spike, free light chain ratio, immunoparesis and low albumin), AA race remained associated with a decreased risk of progression (HR 0.39, CI 0.16-0.95). Overall, AA patients with SMM had a significantly (p = 0.027) longer median TTP (9.7 vs 6.2 years), and a lower 2-year (12.6% vs 20.1%) and 5-year (34% vs 44.6%) progression rate than whites. Because AA patients were younger at diagnosis, we stratified patients by age group, < 65 vs ≥65 years. In patients < 65 years, there was no difference in progression rate. In patients aged ≥65 years, AA patients continued to have a longer TTP than whites (9.8 vs 5.2 years, p = 0.02). Image:Summary/Conclusion: In our retrospective single institution experience, AA patients with SMM had a lower risk of progression to MM compared to whites. Both groups had similar Mayo-2018 risk scores, however, AA patients had a lower degree of immunoparesis at baseline. Future studies are needed to better understand if these differences are explained by differences in disease biology including genomic mechanisms, immune microenvironment, and systemic immune response.

African American patients with smoldering multiple myeloma may have a lower risk of progression compared to White patients.

8045 Background: The incidence of multiple myeloma (MM) is two to threefold higher in African Americans (AAs) compared to whites when adjusted for socioeconomics, age, and sex. However, there is limited information on whether racial background affects the risk of progression from smoldering MM (SMM) to MM. Methods: Patients with SMM presenting to Memorial Sloan Kettering Cancer Center between the years 2000 and 2019 and who identified as either AA or white were included in the study. Baseline characteristics were collected at the time of diagnosis including laboratory, imaging, and pathology reports. Differences in distributions of continuous and discrete characteristics were assessed by Kruskal-Wallis and chi-square tests. Time to progression (TTP) was assessed using the Kaplan-Meier method with log-rank test for comparisons. Univariate and multivariate Cox proportional hazard models were used to estimate effects of risk factors on TTP with hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 576 patients were included (70 were AA, 12%). Median follow-up time was 3 years in AAs and 4 years in whites. Differences in baseline characteristics between AAs and whites included median age (60 years in AAs vs 64 years in whites, p = 0.01), median hemoglobin level (12.3g/dL in AA vs 12.8g/dL in whites, p = 0.02), and immunoparesis including 1 or 2 uninvolved immunoglobulins (31% and 10% in AAs vs 56% and 27% in whites, p = 0.002). There was no difference in bone marrow plasma cells, M-spike, free light chain ratio, or Mayo-2018 SMM risk score. AA race was associated with a significantly decreased risk of progression in the univariate model (HR 0.57, CI 0.34-0.94). In the multivariate model adjusting for age, sex, and variables associated with an increased risk of progression in the univariate model (bone marrow plasma cells, M-spike, free light chain ratio, immunoparesis and low albumin), AA race remained associated with a decreased risk of progression (HR 0.39, CI 0.16-0.95). Overall, AA patients with SMM had a significantly (p = 0.027) longer median TTP (9.7 vs 6.2 years), and a lower 2-year (12.6% vs 20.1%) and 5-year (34% vs 44.6%) progression rate than whites. Because AA patients were younger at diagnosis, we stratified patients by age group, &lt; 65 vs ≥65 years. In patients &lt; 65 years, there was no difference in progression rate. In patients aged ≥65 years, AA patients continued to have a longer TTP than whites (9.8 vs 5.2 years, p = 0.02). Conclusions: In our retrospective single institution experience, AA patients with SMM had a lower risk of progression to MM compared to whites. Both groups had similar Mayo-2018 risk scores, however, AA patients had a lower degree of immunoparesis at baseline. Future studies are needed to better understand if these differences are explained by differences in disease biology including genomic mechanisms, immune microenvironment, and systemic immune response.

Racial Disparity in Mortality Rates Among Black and White Americans with Multiple Myeloma

Background: In the United States, Multiple myeloma (MM) is the second most common hematologic malignancy and the most common hematologic malignancy in blacks. It is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. Different studies have highlighted a racial disparity in survival outcomes between Blacks and Whites patients' population with MM. However, the reason for the observed racial disparity in survival outcomes is not clearly understood.Aim: To explore the role of socioeconomic variables including access to insurance and, median Income on the racial disparity in outcome among patients with MM.Method: We conducted a retrospective analysis of all hospitalizations associated with the primary diagnosis of MM in the National Inpatient Sample (NIS 2008-2014) database using the relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study outcome was the mortality rates between black patients and a propensity score matched control group of white patients with MM.Result: There were 185,000 MM associated hospitalization in the NIS (2008-2014). Among the study population, 66.7% were whites, 20.8% were blacks, and 7.7% were Hispanics. The mean age was 66.5 years for blacks and 70.2years for whites. Among the Black population, 21.6% had private insurance compared to 25.1% of their White counterparts. Also, 45.6% of Black participants were in the lowest income quartile compared to only 19.6% of Whites. Only 13.5% of Blacks were in the highest income quartile compared to 28.7% of Whites. 73.4% of Blacks were on public insurance compared to 70.9% of Whites. There was no difference in the mortality rate between blacks and a control group of whites matched for insurance, median income, sex and age (49.4% vs 50.6%, p =0.42).Conclusion: Multiple myeloma may not be more deadly in Blacks compared to Whites, and the observed disparity in outcomes in the literature are likely due to the effects of social determinants of health such as income and access to insurance. DisclosuresNo relevant conflicts of interest to declare.

Determinants of Adherence to ADA Type II Diabetes Mellitus Guidelines: Implications for Longevity

The aim of this study was to identify the differences in terms of demographics, socioeconomic status and overall levels of morbidity-related health burden between population strata characterized by high levels of adherence to American Diabetes Association screening guidelines and their low-adherence counterparts. Factor analysis was used to create a single continuous measure of adherence which was stratified and analyzed using the Cox proportional hazards model to identify adherence levels associated with protective effects for mortality. Based on the results, the entire population of Health and Retirement Study respondents newly diagnosed with diabetes mellitus, type II was then stratified into four levels of adherence – excellent, sufficient, insufficient, poor – based on the strength of the protective effect associated with that level of the adherence factor and compared. Mortality in the group associated with excellent adherence was 41 to 57 percentage points lower than among their counterparts. High levels of adherence were associated with White and Hispanic race, low morbidity burden, high education and economic status, and low levels of functioning limitations. Based on race-specific survival function estimates we found that the life expectancy at age 65 of an individual newly diagnosed with type II diabetes mellitus could be improved from 14.97 to 19.64 years for whites, 13.36 to 19.58 years for African Americans and 14.92 to 21.28 for Hispanics if average adherence levels are increased to the highest levels observed in our study. Finally, we found that adherence levels were improving over the 1991-2015 period suggesting successful diabetes awareness efforts.

Abstract 14157: Racial Differences in Outcomes of Ischemic Stroke and Mortality With Left Atrial Appendage Closure With Watchman Device in Medicare Population

Introduction: Left atrial appendage closure by Watchman implantation is a novel non-pharmacological alternative for stroke prevention in non-valvular atrial fibrillation (AF) patients who are deemed unable to take long term anticoagulation. Blacks and Hispanics were under-represented in the clinical trials for Watchman device and therefore more outcome data is needed in these populations. Hypothesis: We sought to study racial differences in outcomes of mortality and ischemic stroke in Medicare beneficiaries who received a Watchman device Methods: Medicare claims were used to identify 13,598 patients with AF who underwent Watchman implantation during January 2015 to November 2017. Patient demographics including race and comorbid conditions were identified based on the hospital discharge record. Death and readmission rate for ischemic strokes and transient ischemic attacks (TIA’s) were assessed. Primary readmission diagnoses were classified using the AHRQ Clinical Classification Software. Results: The mean age of patients was 78±6.3 years and 40.3% were female. There were 11,955 whites (88%), 453 blacks (3.3%) and 523 Hispanic patients (3.8%). Mean CHAD 2 S 2 VASc score was 4.7 in blacks, 4.6 in Hispanics and 4.5 in whites. One year mortality after watchman implantation was 6.8% in blacks, 8% in Hispanics and 7.69% in whites. After risk adjustment, compared to whites, the Hazard Ratio for death was 0.82 in blacks (p=0.31) and 0.96 in Hispanics (p=0.82). The rate of ischemic stroke and TIA following Watchman implantation was highest at 4.75 per 100 patient years in blacks followed by 2.87 per 100 patient years in Hispanics and 2.37 per 100 patient years in whites. After risk adjustment, blacks continued to have higher risk for ischemic stroke (HR 1.87, p = 0.01) compared to whites, while Hispanics had a similar risk (HR 1.19, p=0.51). Conclusions: In the Medicare population undergoing Watchman implantation, after risk adjustment, one year mortality following the procedure was similar in whites, Hispanics and blacks. However, the rate of ischemic stroke was significantly higher in blacks compared to whites even after risk adjustment. Further studies are needed in the real world to monitor the outcomes associated with watchman device in minority population.

1255. Comparison in AIDS-Related Mortality Between African Americans and Whites with Human Immunodeficiency Virus During the HAART Era

BackgroundHigher death rates have been reported in African American (AA) compared with non-Hispanic whites with HIV infection. However, there are no published studies of attributable mortality by racial and ethnic groups. We evaluated differences in attributable mortality between AA and whites.MethodsWe conducted a retrospective review of all persons with HIV infection who received care at the University of Cincinnati Medical Center whose deaths were between 1996 and 2017. We abstracted chart data using a standard data tool and identified all deaths reported to the social security national database. Probable cause of death was assigned using the EuroSida CoDe methodology. Primary endpoint was to compare AIDS vs. non-AIDS-related deaths between AA and whites.ResultsInitial analysis of 588 deaths are reported through 2007 (44% AA and 53% white). The median age at the time of HIV diagnosis was 37 years for AA patients and 36 years for white patients, while median age at the time of death was 43 years for AA and 42 years for whites (P = ns). 16.9% of AA were women, 2.6% were transgender; 10.3% of whites were women and 1% were transgender (P < 0.02). Risk factors for HIV acquisition included: MSM, 61.3% of whites vs. 46.0% AA; heterosexual contact, 11.7% of whites vs. 13.4% for AA; and injection drug use 16.9% white vs. 18.3% AA (P < 0.0001). African Americans had both lower median CD4 counts at the time of diagnosis and within 3–6 months prior to death (167 and 68 cells/mm3, respectively) as compared with whites (214 and 103 cells/mm3, respectively) (P < 0.0001 for both). There was no statistical significance of having AIDS at entry into the practice between AA and whites (P = 0.79). AIDS-related deaths accounted for a larger percentage of overall deaths within white patients (51%) compared with AA patients (40%) (P = 0.03).ConclusionOur data show that while a greater percent of AIDS-related deaths were found in whites vs. AA in the early HAART era, AA patients typically have lower CD4 counts at the time of diagnosis and within 3–6 months prior to death. Future analyses will examine specific attributable mortality, HIV viremia and changes in causes of death over later HAART era. Understanding factors associated with mortality may inform care models to prevent or delay future deaths.Disclosures All authors: No reported disclosures.

Lifetime Risk of Lower-Extremity Peripheral Artery Disease Defined by Ankle-Brachial Index in the United States.

BackgroundThere are no available lifetime risk estimates of lower‐extremity peripheral artery disease (PAD).Methods and ResultsUsing data from 6 US community‐based cohorts and the vital statistics, we estimated the prevalence and incidence of PAD, defined as an ankle‐brachial index < 0.90, at each year of age from birth to 80 years for white, black, and Hispanic men and women. Then, we used Markov Monte Carlo simulations in a simulated cohort of 100 000 individuals to estimate lifetime risk of PAD. On the basis of odds ratios of PAD for traditional atherosclerotic risk factors (eg, diabetes mellitus and smoking), we developed a calculator providing residual lifetime risk of PAD. In an 80‐year horizon, lifetime risks of PAD were 30.0% in black men and 27.6% in black women, but ≈19% in white men and women and ≈22% in Hispanic men and women. From another perspective, 9% of blacks were estimated to develop PAD by 60 years of age, while the same proportion was seen at ≈70 years for whites and Hispanics. The residual lifetime risk within the same race/ethnicity varied by 3.5‐ to 5‐fold according to risk factors (eg, residual lifetime risk in 45‐year‐old black men was 19.9% when current smoking, diabetes mellitus, and history of cardiovascular disease were absent versus 70.4% when all were present).ConclusionsIn the United States, ≈30% of blacks are estimated to develop PAD during their lifetime, whereas the corresponding estimate is ≈20% for whites and Hispanics. The residual lifetime risk within the same race/ethnicity substantially varies according to traditional risk factors.

Ethnic differences in patients with Brugada syndrome and arrhythmic events: New insights from Survey on Arrhythmic Events in Brugada Syndrome

There is limited information on ethnic differences between patients with Brugada syndrome (BrS) and arrhythmic events (AEs). The purpose of this study was to compare clinical, electrocardiographic (ECG), electrophysiological, and genetic characteristics between white and Asian patients with BrS and AEs. The Survey on Arrhythmic Events in Brugada Syndrome is a multicenter survey from Western and Asian countries, gathering 678 patients with BrS and first documented AE. After excluding patients with other (n = 14 [2.1%]) or unknown (n = 30 [4.4%]) ethnicity, 364 (53.7%) whites and 270 (39.8%) Asians comprised the study group. There was no difference in AE age onset (41.3 ± 16.1 years in whites vs 43.3 ± 12.3 years in Asians; P = .285). Higher proportions of whites were observed in pediatric and elderly populations. Asians were predominantly men (98.1% vs 85.7% in whites; P < .001) and frequently presented with aborted cardiac arrest (71.1% vs 56%; P < .001). Asians tended to display more spontaneous type 1 BrS-ECG pattern (71.5% vs 64.3%; P = .068). A family history of sudden cardiac death was noted more in whites (29.1% vs 11.5%; P < .001), with a higher rate of SCN5A mutation carriers (40.1% vs 13.2% in Asians; P < .001), as well as more fever-related AEs (8.5% vs 2.9%; P = .011). No difference was observed between the 2 groups regarding history of syncope and ventricular arrhythmia inducibility. There are important differences between Asian and white patients with BrS. Asian patients present almost exclusively as male adults, more often with aborted cardiac arrest and spontaneous type 1 BrS-ECG. However, they have less family history of sudden cardiac death and markedly lower SCN5A mutation rates. The striking difference in SCN5A mutation rates should be tested in future studies.

Abstract 18743: Lack of Evidence of Higher 30-day All-cause Readmission Among Older African American (vs. White) Medicare Beneficiaries Hospitalized for Heart Failure

Background: A recent study using administrative data suggested that older African American heart failure (HF) patients may have higher 30-day readmissions than whites do (PMC3332042). However, to what extent these associations are intrinsic remains unclear. Methods: Of the 8042 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 1994 were African American and 6048 were white. Using propensity scores for being an African American, we assembled a matched cohort of 1799 pairs of African American and white patients balanced on 33 baseline characteristics. Results: Matched patients (N=3598) had a mean age of 74 (±11) years with no racial difference (p=0.599). 30-day all-cause readmission occurred in 20% and 22% of matched African Americans and whites, respectively (HR, 0.89; 95% CI, 0.77-1.03; p=0.110; Figure, left panel). In the pre-match cohort (N=8042), African Americans were younger (77 v 72 years for whites; p&lt;0.001) and had similar unadjusted 30-day all-cause readmission (20% v. 20% for whites; p=0.075), but had significantly lower risk when adjusted for age and sex (HR, 0.87; 95% CI, 0.77-0.98; p=0.018; Figure, right panel) but not for propensity scores (HR, 0.90; 95% CI, 0.80-1.02; p=0.101). Among matched patients, race had no association with 30-day HF readmission or all-cause mortality. Conclusions: Findings from our propensity-matched study suggest that in a cohort of hospitalized African American and white HF patients who were balanced on 33 baseline characteristics, race had no independent association with 30-day all-cause or HF readmissions or all-cause mortality.

Abstract 12978: Incident Atrial Fibrillation is Similar in Blacks and Whites With Congestive Heart Failure

Introduction: Clinical studies have demonstrated that blacks have a lower prevalence and incidence of atrial fibrillation (AF) compared with whites. Given the strong biologic associations between AF and congestive heart failure (CHF), we hypothesized that the racial disparity for incident AF is attenuated in CHF patients. Methods: The University of Pennsylvania Atrial Fibrillation Free-Congestive Heart Failure (PAFF-CHF) Cohort is a large, multi-hospital retrospective cohort of individuals with clinical CHF and without AF at index visit. Baseline demographic and clinical parameters were obtained, and medical records were queried for incident outcomes. The primary outcome was incident AF, which was defined as a clinical or ECG diagnosis of AF on any follow up encounter. Results: Of 5,131 patients in PAFF-CHF, there were 2,037 blacks (40%) and 3,094 whites (60%). Median follow up time was 4.5 years (1.8, 5.9), with blacks having significantly longer follow up (4.7 v 4.2 yr, p &lt; 0.001). During this follow-up, 851 subjects (16%) developed AF, with rates of 5.1 per 100 person years in whites and 4.9 per 100 person years in blacks (p = 0.8). Time independent risk factors for developing AF included male gender (OR 1.42 [95% CI 1.22 - 1.65], p &lt; 0.001); LBBB on index ECG (1.32 [1.01 - 1.72], p = 0.04); and black race (OR 1.31 [1.13 - 1.52], p &lt; 0.001). In a regression model of traditional risk factors for AF including age, gender, hypertension, coronary artery disease, diabetes, and renal insufficiency, black race remained an independent risk factor for AF (OR 1.45 [1.23 - 1.70], p &lt; 0.001). Finally, time to event analysis showed no difference in freedom from AF and no difference in freedom from AF or death (Figure). Conclusions: In a large cohort of HF patients, incident AF was similar in blacks and whites. Although prior studies have indicated a low prevalence and incidence of AF in blacks compared with whites, the development of AF appears to be a common finding in both races after a diagnosis of CHF.

MP78-19 RACIAL DISPARITIES IN ONCOLOGIC OUTCOMES AFTER RADICAL PROSTATECTOMY: LONG-TERM FOLLOW-UP

MP78-19 RACIAL DISPARITIES IN ONCOLOGIC OUTCOMES AFTER RADICAL PROSTATECTOMY: LONG-TERM FOLLOW-UP

A prospective study of statin use and mortality among 67,385 blacks and whites in the Southeastern United States

PurposeThe primary objective of this study is to examine the race-specific associations between statin use and overall mortality, as well as cardiovascular and cancer mortality, among blacks and whites in the Southeastern United States (US). Little is known about these associations in blacks.Patients and methodsThe Southern Community Cohort Study is an ongoing, prospective cohort study, which enrolled from 2002 through 2009 nearly 86,000 participants aged 40–79 years. We used Cox regression models to estimate race-specific hazard ratios (HRs) and 95% confidence intervals (CI) for overall and cause-specific mortality associated with statin use based on self-reported hypercholesterolemia and treatment at cohort entry. Mean age at cohort entry was 51.4 years in blacks (n=48,825) and 53.5 years in whites (n=18,560). Sixty-one percent of participants were women. Whites were more likely to have self-reported hypercholesterolemia (40% versus 27%, P<0.001), and to report being treated with either statins (52% versus 47%, P<0.001) or combination lipid therapy (9% versus 4%, P<0.001) compared with blacks, regardless of sex. During follow-up (median: 5.6 years) 5,199 participants died. Compared with untreated hypercholesterolemic individuals, statin use was associated with reduced all-cause mortality (adjusted HR [aHR] 0.86; 95% CI 0.77–0.95) and cardiovascular disease mortality overall (aHR 0.75; 95% CI 0.64–0.89) and among whites (aHR 0.67; 95% CI 0.50–0.90), blacks (aHR, 0.80; 95% CI 0.65–0.98), men (aHR 0.70; 95% CI 0.55–0.90), and women (aHR 0.79; 95% CI 0.63–0.99) (P>0.05 for race and sex interaction). Statin use was not associated with cancer mortality overall or in subgroup analyses.ConclusionRegardless of race or sex, self-reported statin use was linked to reduced all-cause and cardiovascular disease mortality. However, factors contributing to the modestly lower statin use and markedly lower prevalence of self-reported hypercholesterolemia among blacks remain to be determined.

Mortality by Race Among Low-Income Adults With Early-Onset Insulin-Treated Diabetes

OBJECTIVETo determine if long-term mortality rates in early-onset insulin-treated diabetes differ by race among adults of similar socioeconomic status.RESEARCH DESIGN AND METHODSA total of 391 (299 African Americans, 92 whites) mostly low-income adults 40–79 years of age with insulin-treated diabetes diagnosed before 30 years of age were recruited from community health centers in the southeast U.S. Cox models were used to estimate hazard ratios (HRs) of all-cause mortality among African Americans compared with whites. Additionally, standardized mortality ratios (SMRs) were used to compare the mortality experience of the individuals with diabetes with both national and general community health center sex- and race-specific population norms.RESULTSMean age at diabetes diagnosis and cohort entry, respectively, was 21 and 50 years in African Americans and 19 and 51 years in whites. During an average of 6.7 years of follow-up, 29% of African Americans and 35% of whites died. In multivariable analysis, no significant mortality difference was observed among African Americans compared with whites (HR 0.83 [95% CI 0.53–1.30]; P = 0.51). Compared with the race-specific U.S. general population, SMRs for those with diabetes were 5.7 in African Americans and 11.7 in whites. However, when compared with the same source population (i.e., the community health center population), SMRs were 3.5 and 3.7 in African Americans and whites, respectively.CONCLUSIONSElevated mortality persists in men and women with long duration of early-onset insulin-treated diabetes, but given survival to 40 years of age and similarly low economic status and access to health care, our data do not suggest a racial disparity in mortality.

Examining racial differences in diffuse large B-cell lymphoma presentation and survival

We performed a retrospective cohort analysis of 701 (533 white and 144 black) patients with diffuse large B-cell lymphoma (DLBCL) treated at two referral centers in southern United States between 1981 and 2010. Median age of diagnosis for blacks was 50 years vs. 57 years for whites (p < 0.001). A greater percentage of blacks presented with elevated lactate dehydrogenase levels, B-symptoms and performance status ≥ 2. More whites (8%) than blacks (3%) had a positive family history of lymphoma (p = 0.048). There were no racial differences in the use of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; 52% black vs. 47% white, p = 0.73). While black race predicted worse survival among patients treated with CHOP (hazard ratio [HR] 1.8, p < 0.001), treatment with R-CHOP was associated with improved survival irrespective of race (HR 0.61, p = 0.01). Future studies should examine biological differences that may underlie the observed racial differences in presentation and outcome.

Prehypertension: To Treat or Not To Treat Should No Longer Be the Question

To the Editor: We read with great interest the article by Selassie et al1 that progression from prehypertension to full-blown hypertension occurs more rapidly in blacks, with 50% transitioning to hypertension within 1.7 years compared with 2.7 years in whites. Although the authors highlight the importance of controlling prehypertension, we feel that …

Temporal and geographic variations of Waldenstrom macroglobulinemia incidence

Waldenstrom macroglobulinemia (WM) is a non-Hodgkin lymphoma (NHL) subtype. Little is known about the incidence and trends for this disease in the United States. Twenty-year data from the Surveillance, Epidemiology, and End Results (SEER) program were used for this study. SEER*Stat was used for data analysis. Of the 95,797 cases of NHL diagnosed between 1988 and 2007 in 9 SEER registries, 1835 (1.9%) were new cases of WM. Median age at diagnosis of WM was 73 years. The overall annual age-adjusted incidence was 0.38 per 100,000 persons per year, which increased with age, ranging from 0.03 in patients aged <50 years to 2.85 in patients aged ≥80 years. The incidence of WM was higher in men (0.54) than in women (0.27; P < .001) and was higher in whites (0.41) than in African Americans (0.18) or other races (0.21; P < .05). The annual percentage change for the whole population was 1.01% (P > .05). The annual percentage change was 1.21% for whites (P < .05) and 0.80% (P > .05) for nonwhites. Significant annual percentage change increases were seen in the group aged 70 to 79 years (1.24%; P < .05) and in 3 geographic registries (P < .001). Although the overall incidence of WM remained steady over time, significant increases in incidence were seen over the past 20 years in whites, in those aged 70 to 79 years, and in 3 geographic registry areas.