scholarly journals Racial Differences in Disease Presentation and Management of Intracranial Meningioma

2018 ◽  
Vol 80 (06) ◽  
pp. 555-561
Author(s):  
C. Lane Anzalone ◽  
Amy E. Glasgow ◽  
Jamie J. Van Gompel ◽  
Matthew L. Carlson
Keyword(s):  
United States ◽  
Overall Survival ◽  
Racial Differences ◽  
Tumor Size ◽  
The United States ◽  
Intracranial Meningioma ◽  
Multivariable Model ◽  
Asian Populations ◽  
Hispanic Patients ◽  
The Impact

Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported “other-unspecified” or “other-unknown.” The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations (p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors (p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.

scholarly journals Geographical Differences in Intracranial Meningioma Management: Examining 65,973 Patients across the United States

2018 ◽  
Vol 80 (06) ◽  
pp. 547-554
Author(s):  
Charles Lane Anzalone ◽  
Amy Glasgow ◽  
Elizabeth Habermann ◽  
Brandon R. Grossard ◽  
Jamie J. Van Gompel ◽  
...  
Keyword(s):  
United States ◽  
New Mexico ◽  
Tumor Size ◽  
Multivariable Analysis ◽  
The United States ◽  
Patient Treatment ◽  
Treatment Preferences ◽  
Intracranial Meningioma ◽  
Geographical Differences ◽  
The Impact

Background Age, tumor size and location, overall health, and patient preference are primary considerations driving treatment decision-making for intracranial meningiomas. However, even for the same individual patient, treatment recommendations may vary between centers and providers. Objective To study associations between geography, disease presentation, and management of intracranial meningioma in the United States. Methods The population-based Surveillance, Epidemiology, and End Results(SEER) data were queried between 2004 and 2014 for cases of intracranial meningioma. Results A total of 65,808 patients with intracranial meningioma were identified. Univariate analyses demonstrated strong associations between geographic location, age, and size of tumor at presentation. The mean age for all registries was 64.2 years, with a range from 62.0 (Utah registry) to 66.6 (Detroit registry). The greatest proportion of small tumors (<1 cm) were identified in the Utah registry (13.9% of tumors), while the greatest proportion of large tumors (> 4cm) were noted in the Hawaii registry (30.7% of tumors). Multivariable analysis demonstrated that the impact of geography on treatment selection was just as important as other established variables. For example, the distribution in tumor size between New Mexico and Greater California registries is nearly identical; however, the odds ratio for surgery was 1.5 times greater for the New Mexico population. Conclusion These data suggest that disease presentation and treatment are significantly influenced by regional referral patterns, provider or institutional treatment preferences, and regional availability of subspecialty expertise. Understanding such biases is important for patients, referring physicians, and treatment providers in an effort to provide balanced counseling and treatment.

Impact of the extent of resection on primary breast angiosarcoma survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 521-521
Author(s):  
Timur Mitin ◽  
Shearwood McClelland ◽  
Jess Hatfield ◽  
Catherine Degnin ◽  
Yiyi Chen
Keyword(s):  
United States ◽  
Surgical Resection ◽  
Tumor Size ◽  
Extent Of Resection ◽  
The United States ◽  
Adjuvant Radiation ◽  
Cancer Data ◽  
Surgical Modality ◽  
The Impact ◽  
Related Mortality

521 Background: The widely accepted standard of care in treating primary breast angiosarcoma involves surgical resection, often followed by adjuvant therapy (radiation and/or chemotherapy). The rarity of this disease has precluded large-scale analyses. The question regarding the impact of resection extent on survival has yet to be examined on a nationwide scale. Methods: The National Cancer Data Base (NCDB) from 2004-2014 identified primary breast angiosarcoma patients throughout the United States having undergone surgical resection. The extent of resection (mastectomy versus lumpectomy) was adjusted for several variables (including patient age, race, income, primary payer for care, tumor size, adjuvant therapies, and medical comorbidities) to assess its impact on breast angiosarcoma-related mortality. Results: Over this eleven-year span, 826 resected primary breast angiosarcoma patients were identified in the United States. Mastectomy was by far the most common surgical modality for primary breast angiosarcoma (86% of patients). Increasing tumor size was predictive for mastectomy over lumpectomy (p < 0.0001), and for involvement of adjuvant radiation therapy (p = 0.001). The extent of surgical resection was inversely predictive of radiation usage (p = 0.017). However, surgical modality was not significantly predictive of breast angiosarcoma-related mortality. Conclusions: Despite the frequent preference of mastectomy for primary breast angiosarcoma treatment (more than 6 of every 7 patients), there is no survival benefit of mastectomy versus lumpectomy. This lack of benefit should be discussed with patients, given the reduced operative morbidity of lumpectomy versus mastectomy. The Class IIB evidence provided from this analysis represents the highest level of evidence to-date governing management of this disease.

Race, Structural Predictors, and Police Shootings: Are There Differences Across Official and “Unofficial” Accounts of Lethal Force?

2018 ◽  
Vol 65 (1) ◽  
pp. 26-45 ◽  
Author(s):  
Andrew C. Gray ◽  
Karen F. Parker
Keyword(s):  
United States ◽  
Racial Differences ◽  
The United States ◽  
Police Violence ◽  
Lethal Force ◽  
Police Shootings ◽  
Future Work ◽  
The Impact ◽  
Official Records ◽  
Official Data

Police shootings have received considerable attention recently. While official data have often been used to capture police use of lethal force, “unofficial” databases have been developed to document lethal force patterns throughout the United States. Thus, it is now possible to systematically compare databases, exploring racial differences and potential causes, which is important given longstanding criticisms of official records. Here, we examine police shootings using Mapping Police Violence and Supplemental Homicide Reports data and investigate the impact of commonly used structural predictors on race-specific police shootings. Significant differences are revealed across official and unofficial databases, particularly by race. We conclude that the data used to estimate police shootings matter, which has key implications for future work on this important topic.

scholarly journals The impact of race and ethnicity on outcomes in 19,584 adults hospitalized with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254809
Author(s):  
Ann M. Navar ◽  
Stacey N. Purinton ◽  
Qingjiang Hou ◽  
Robert J. Taylor ◽  
Eric D. Peterson
Keyword(s):  
United States ◽  
Race And Ethnicity ◽  
The United States ◽  
Lower Mortality ◽  
Real World Data ◽  
Black Adults ◽  
Increased Risk ◽  
Hispanic Patients ◽  
The Impact ◽  
White Patients

Introduction At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear. Methods Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression. Results Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02–1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01–1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93–1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40–0.48), fully adjusted OR 0.71 (95% CI 0.59–0.86)]. Discussion In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.

Racial differences in tumor biology and treatment of gastric cancer in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 174-174
Author(s):  
Joshua Tseng ◽  
James Miller ◽  
Xiaoxi Feng ◽  
Alexandra Gangi ◽  
Jun Gong ◽  
...  
Keyword(s):  
United States ◽  
Gastric Cancer ◽  
Overall Survival ◽  
Racial Differences ◽  
Survival Benefit ◽  
Tumor Biology ◽  
The United States ◽  
Patient Demographics ◽  
Asian Patients ◽  
To Receive

174 Background: Racial disparities for gastric cancer are often identified in the literature. Although patients in Asia consistently demonstrate a survival benefit compared to those in the West, Asian patients in the US still retain this advantage, which suggests that tumor biology may be a major factor. The goal of our study is to identify racial differences in patient demographics, tumor biology and treatment for gastric cancer in the United States. Methods: The National Cancer Database was queried from 2006-2016 for patients with a diagnosis of gastric adenocarcinoma. Patient demographics, tumor characteristics, and treatment patterns were compared by patient ethnicity (White, Black, Hispanic, and Asian) with Kruskal-Wallis test and Pearson’s chi-squared test. Kaplan-Meier survival curves used to assess overall survival, and cox regression used to identify independent prognostic factors for survival. Results: 116,717 patients with gastric cancer identified; 78,066 were White, 17,486 were Black, 8,494 were Asian, and 12,671 were Hispanic. White patients were most likely to be older than 70 and have proximal tumors, and least likely to have diffuse type adenocarcinoma. Hispanic and Black patients were most likely to present with metastases. Asian patients were most likely to receive surgery and least likely to receive chemotherapy or radiotherapy. Stage for stage, Asians had the longest median survival, followed by Hispanic, Black, and White patients. Prognostic factors associated with a survival benefit include Asian ethnicity (HR 0.72, 95% CI 0.68-0.74), Hispanic ethnicity (HR 0.76, 95% CI 0.73-0.79), Black ethnicity (HR 0.95, 95% CI 0.93-0.98), private insurance (HR 0.91, 95% CI 0.87-0.96), higher income (HR 0.85, 95% CI 0.82-0.88), treatment at academic center (HR 0.87, 95% CI 0.83-0.91), higher-volume centers (HR 0.90, 95% CI 0.87-0.93), receiving surgery (HR 0.42, 95% CI 0.41-0.43), chemotherapy (HR 0.56, 95% CI 0.55-0.57), and radiation (HR 0.96, 95% CI 0.93-0.98). Conclusions: Treatment differences between Eastern and Western countries for gastric cancer persist between ethnic groups within the United States, with Asian patients retaining a survival benefit. Black and Hispanic patients present with aggressive disease and unfavorable socioeconomic factors that are detrimental to overall survival.

scholarly journals Racial Impact on Cytogenetic Variations and Outcome in Chronic Lymphocytic Leukemia Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3209-3209
Author(s):  
Yaser Alkhatib ◽  
Shahzaib Nabi ◽  
Edward Peres
Keyword(s):  
Overall Survival ◽  
African Americans ◽  
Chronic Lymphocytic Leukemia ◽  
Racial Differences ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Recent Analysis ◽  
Genetic Mutations ◽  
Time Of Presentation ◽  
The Impact

Abstract INTRODUCTION Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the United States with a higher incidence in Caucasians compared to African Americans (AA). Few studies have looked into the impact of race on the outcome of patients with CLL, with some reporting a more aggressive nature of disease in AA compared to Caucasians and others reporting no difference in outcome between the two groups. In addition, variation in genetic mutations in different races is not well studied in patients with CLL. Hence, we performed a study to evaluate the racial differences in genetic mutations and outcome in patients with CLL. METHODS We reviewed the charts of patients with CLL treated in our institution between 2004 and 2014. We collected data on age, gender, race, genetic mutations, rai stage, time to first treatment (TTFT), and time to second treatment (TTST). Both conventional cytogenetics and florescence in-situ hybridization (FISH) analysis were done for all patients. Only Caucasian and African American patients were included in our analysis. We used Fisher's exact test to assess the statistical significance of any difference. P-values <0.05 were considered significant. RESULTS A total of 177 patients with CLL were analyzed, of which 112 patients were Caucasians and 65 patients were AA. For patients with favorable cytogenetics, deletion 13q14 was seen more often in Caucasian patients compared to AA (41.9% versus 18.4%, p= .001), while trisomy 12 was observed more often in AA patients compared to Caucasians (35% versus 17%, p= .009). There was no difference in patients harboring normal cytogenetics between the two groups. For unfavorable cytogenetics, there was no difference between Caucasian and AA patients in deletion 11q23 (8.9% versus 10.9%, p= .68), or deletion 17p/p53 abnormality (11.6% and 9%, p =.62). There was no difference in Rai stage at the time of diagnosis between Caucasians and AA (Rai stage ≤2: 86.6% versus 76.9%, and Rai >2: 13.4% versus 23.1%, p= .1). No difference was observed between the two groups in regards to TTFT (mean TTFT for Caucasians was 32.2 months versus 32.3 months in AA) or TTST (mean TTST for Caucasians was 50.1 months versus 50.6 months in AA). DISCUSSION Racial differences in CLL including genetic mutations and outcome are poorly studied. Falchi et al has reported that AA patients tended to have a higher risk feature profile at the time of presentation, with an overall worse overall survival. In a SEER database analysis reported by Shenoy et al, authors found that AA had an inferior overall survival compared to non-African Americans. In our analysis, we aimed to assess for any difference in the incidence of prognostic cytogenetics between Caucasians and AA. We also evaluated the difference in outcome in terms of TTFT and TTST. We found that despite the presence of some differences in the favorable cytogenetic profile at time of diagnosis between both races, it did not translate into a difference in rai stage at time of presentation or the overall outcome as measured by TTFT and TTST. Our results confirm the most recent analysis by Nabhan et al, which utilized the Mayo Clinic CLL database, and found no difference in the outcome to either AA or Caucasian CLL patients when treated similarly. Conclusion Based on our analysis, a possible difference in some prognostic cytogenetics might be present between different races which did not affect the overall outcome. Hence, racial difference should not be taken into account when treating patients with newly diagnosed CLL, since there is no evidence that outcomes are different when treated with conventional therapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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