Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Abstract Background In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. Methods Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008–2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. Results In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. Conclusion Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

Download Full-text

Colorectal Cancer Disparities: A Systematic Review and Meta-Analysis

10.1101/2021.07.01.21259880 ◽

2021 ◽

Author(s):

Solomiya Syvyk ◽

Chris Wirtalla ◽

Rachel Rapaport Kelz ◽

Sanford Roberts ◽

Caitlin Finn

Keyword(s):

Colorectal Cancer ◽

Vulnerable Populations ◽

Surgical Outcomes ◽

English Language ◽

Cancer Disparities ◽

Cancer Site ◽

Colorectal Cancer Surgery ◽

Black Patients ◽

The Impact ◽

White Patients

IMPORTANCE Colorectal Cancer (CRC) disparities continue to mostly impact vulnerable populations. Across the CRC continuum, most focus has been attributed to interventions in prevention, detection, and diagnosis. Varying surgical outcomes has emerged as an important contributing factor to CRC disparities. OBJECTIVE To evaluate the distribution of publications across the CRC care continuum, examine interventional studies related to CRC Surgery, and synthesize findings in studies evaluating CRC disparities in Surgery. DATA SOURCES We searched PubMed for prospective or retrospective studies reporting data on colorectal cancer disparities. STUDY SELECTION Studies were selected if: (1) articles used US-sourced data (2) articles were published in the English language (3) Subjects included humans only or data. MAIN OUTCOMES AND MEASURES Odds ratios for receipt of surgery for black vs. white patients were pooled from studies that performed multivariate analysis. Subgroup analysis was performed per procedure type. RESULTS No publications regarding interventions associated with improvements in colorectal cancer surgery were found. Of the 1600 articles identified, an analysis was conducted from 18 publications. It included 89,214 black patients and 646,990 white patients. Black patients were significantly less likely to receive surgical treatment for CRC than white patients. This was confirmed in the sensitivity analysis by cancer site (colon vs rectum). CONCLUSIONS AND RELEVANCE Based on the results, the majority of studies on CRC disparities have focused on access to prevention, diagnosis and screening. Considering the impact of varying surgical outcomes on vulnerable populations, it should be considered to shift research focus from process-oriented interventions to outcomes.

Download Full-text

Abstract 14: Disparities in Cardiovascular Disease Outcomes Among Pregnant Females

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.14 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Mohamed M Gad ◽

Islam Y Elgendy ◽

Ahmed M Mahmoud ◽

Anas M Saad ◽

Hani Jneid ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

African American ◽

African Americans ◽

Hospital Mortality ◽

Pregnant Women ◽

Racial Disparities ◽

The United States ◽

Median Income ◽

White Patients

Introduction: The incidence of cardiovascular (CV) disease among pregnant women is rising in the United States (US). Data on racial disparities for the major CV events during pregnancy are limited. Methods: Pregnant women hospitalized from January 2007 to September 2015 were identified in the Nationwide Inpatient Sample. Outcomes of interest were mortality, myocardial infarction (MI), stroke, and pulmonary embolism (PE). Multivariate regression analysis was used for Odds Ratio (OR) and 95% Confidence Interval (CI). Results: Among 37,524,315 pregnant women, 17,159,400 (45.7%) were White, 4,921,574 (13.1%) were African American, and 7,111,216 (19.0%) were Hispanic. Following 2010, trends of mortality and stroke declinedsignificantly in African Americans, however, were stable in Whites (Figure). In-hospital mortality was 13.52 per 100,000 hospitalizations. The incidence of in-hospital mortality was highest among AfricanAmericans followed by White, then Hispanic patients; 29.63, 10.61, and 9.73 per 100,000 hospitalizations, respectively. The majority of African Americans (61.9%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of African American patients were below-median income (70.54%) while nearly half of the White patients were above the median income (47%). Compared to Whites, African Americans had the highest mortality with OR of 2.79, 95% CI (2.61-2.99), myocardial infarction with OR of 2.178, 95% CI (2.01-2.36), stroke with OR of 2.04, 95% CI (1.96-2.13), and pulmonary embolism with OR of 1.95, 95% CI (1.82-2.08). Conclusions: Significant racial disparities exist in the major CV events among pregnant women. Further efforts are needed to minimize these differences.

Download Full-text

The impact of marital status on racial disparities in esophageal cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4056 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4056-4056

Author(s):

Alan Paniagua Cruz ◽

Karlie L. Haug ◽

Lili Zhao ◽

Priya Wadhera ◽

Rishinda Reddy

Keyword(s):

Esophageal Cancer ◽

African American ◽

Marital Status ◽

Racial Disparities ◽

Secondary Analysis ◽

Fold Increase ◽

Categorical Variables ◽

Continuous Variables ◽

Surgery Rates ◽

The Impact

4056 Background: It is well known that racial disparities exist in cancer treatment and outcomes. The present study examined the impact of marital status as a surrogate for social support on esophageal cancer (EsC) care. Methods: We performed a secondary analysis of data collected from a state cancer registry. We included individuals with an EsC diagnosis between January 1, 2000 and December 31, 2013. A Chi-square test and Fisher’s exact test was used to analyze categorical variables and two-sample t-tests to compare continuous variables. Results: 8754 patients (Caucasian (C) or African American (AA) only) were included, with 88.4% C and 11.6% AA. Staging at diagnosis in C and AA patients revealed that 30.6% vs 28.6% had localized disease, followed by 33.8% vs 32.0% with regional, and 35.6% vs 40.0% with metastatic, respectively (p = .0155). Rates of chemotherapy (53.6% vs 53.5%) and radiation therapy (54.1% vs 56.2%) administration were found to be similar between C and AA patients. In contrast, surgery rates were significantly different between the two groups, with 29.7% of C undergoing surgical resection in comparison to only 12.0% of AA patients (p < .0001). When evaluating marital status, 63.3% of C were married, compared to 33.4% of AA patients (p < .0001). In the AA group, 20.1% of married patients underwent surgery in contrast to only 7.6% of single AAs (p < .0001). Similarly, in the C group, married patients underwent surgery at a rate of 34.5%, while single patients went to surgery at a rate of 22.2% (p < .0001). Surgery contraindication (CI) rates were found to be similar across all groups (5.6% married Cs, 5.2% married AAs, 6.6% single Cs, and 6.5% single AAs) along with surgery refusal rates (1.56% single Cs vs 2.68% married Cs (p = .052), and 1.04% single AAs vs 2.81% married AAs (p = .210)). Conclusions: African American patients receive chemotherapy and radiotherapy at comparable rates to Caucasian patients, but the rates of surgery are significantly lower. Being married was associated with an almost three-fold increase in surgery rates for AA patients, and cause a significant increase in Caucasians too.

Download Full-text

Racial disparities in performance status among cancer patients at a community oncology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.132 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 132-132

Author(s):

Joanne S. Buzaglo ◽

Alexander Musallam ◽

Edward Stepanski ◽

Craig White ◽

Mary Joiner ◽

...

Keyword(s):

African American ◽

Racial Disparities ◽

Cancer Patients ◽

Performance Status ◽

Daily Activities ◽

Cancer Type ◽

Community Oncology ◽

Black Patients ◽

Oncology Practice ◽

White Patients

132 Background: Performance status is used to characterize patient ability to tolerate chemotherapy and as a selection criterion for clinical research. Poor performance status can exclude patients from clinical trial participation. Further, African American cancer patients are underrepresented in cancer clinical trials. The study purpose was to document performance status at the initial patient visit to a community oncology practice and to explore racial disparities between White and Black patients. Methods: This study used a retrospective, observational design with ePRO collected via the Patient Care Monitor™ (PCM). All study data were collected as part of routine clinical care at a community oncology practice during 1/2019–11/2019. An Eastern Cooperative Oncology Group (ECOG) score was automatically calculated after patients at an initial clinic visit completed a 1-item question that assessed performance status via e-tablet. Results: 6,613 patients completed the PCM survey (mean age 59; 33% male/67% female; 55.4% White, 38% Black). Cancer type was known for a subset of patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). The average ECOG score for the total sample was 0.97. 50% indicated they were able to complete their normal daily activities without any restriction; 26.9% were able to complete their normal daily activities and some light work. In contrast, 10.3% indicated they could take care of themselves, but could not work and are in bed/chair less than half the day. 10.3% could take care of themselves sometimes but could not work and are in bed/chair more than half the day. 4.5% indicated they could not take care of themselves and were in bed/chair almost always. When assessing racial differences between those self-identifying as White or Black/African American, average ECOG score was higher in Black patients [Mean(SD) = 1.03(1.24)] when compared to White patients [Mean(SD) = 0.93(1.14)] (p = 0.003). We observed a higher percentage of Black patients reported not being able to take care of themselves (51.9% Black v. 41.0% White). In contrast, a higher percentage of White patients reported being able to complete all daily activities without restriction (38.3% Black v. 54.5% White). Conclusions: This study shows significant racial disparities in performance status among patients seen at a community oncology practice with Black patients exhibiting significant worse performance status than White patients. These findings have implications for disparities in treatment outcomes and racially biased access to clinic trials.

Download Full-text

THE IMPACT OF ALIVIADO DEMENTIA CARE HOSPICE EDITION TRAINING PROGRAM ON HOSPICE STAFF’S DEMENTIA SYMPTOM KNOWLEDGE

Innovation in Aging ◽

10.1093/geroni/igz038.3130 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S851-S851

Author(s):

Catherine E Schneider ◽

Alycia A Bristol ◽

Ariel Ford ◽

Shih-Yin Lin ◽

Abraham A Brody

Keyword(s):

Psychological Symptoms ◽

Daily Practice ◽

Dementia Care ◽

Interdisciplinary Teams ◽

Practice Change ◽

P Value ◽

Evidence Based ◽

Improvement Program ◽

Team Members ◽

The Impact

Abstract A lack of high quality dementia training for healthcare workers is a key barrier to effective care for persons with dementia (PWD), a vulnerable and increasing population across the care continuum. Hospice agencies in particular are underprepared to care for this population, although annually about 17% of hospice patients have a primary diagnosis of dementia and an additional 28% as a comorbidity. Aliviado Dementia Care-Hospice Edition is an interdisciplinary, evidence-based quality improvement program developed to assist hospice interdisciplinary teams in caring for PWD and their caregivers. Interdisciplinary hospice team members in two agencies were enrolled in online training modules, which addressed multiple areas including pain, behavioral and psychological symptoms of dementia (BPSD), and working with caregivers. They were also provided a toolkit to integrate training in daily practice. Changes in knowledge, confidence and attitudes were tested before and after training and paired t-tests were utilized to evaluate the program’s effect. Thirty-five individuals completed the program and pre/post tests. Paired t-tests showed clinically and statistically significant increases in knowledge, attitudes and confidence in five of 10 domains including depression knowledge and confidence and BPSD knowledge, confidence and interventions. The greatest increase was in using BPSD interventions (18.5% increase, p-value: 0.0002), depression confidence (15.9% increase, p-value: 0.006) and BPSD confidence (12.6% increase, p-value: 0.02). Aliviado is an evidence-based, systems-level intervention shown to improve clinical knowledge, attitudes and confidence in treating pain and BPSD in PWD. This training could be used to produce systems-level practice change for hospice interdisciplinary team members serving PWD.

Download Full-text

Characteristics and Outcomes of Latinx Patients With COVID-19 in Comparison With Other Ethnic and Racial Groups

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa401 ◽

2020 ◽

Vol 7 (10) ◽

Cited By ~ 2

Author(s):

Saef Izzy ◽

Zabreen Tahir ◽

David J Cote ◽

Ali Al Jarrah ◽

Matthew Blake Roberts ◽

...

Keyword(s):

African American ◽

African Americans ◽

Asian American ◽

Age Groups ◽

Racial Groups ◽

Icu Admission ◽

Younger Age ◽

Multivariable Regression ◽

The Impact ◽

White Patients

Abstract Background There is a limited understanding of the impact of coronavirus disease 2019 (COVID-19) on the Latinx population. We hypothesized that Latinx patients would be more likely to be hospitalized and admitted to the intensive care unit (ICU) than White patients. Methods We analyzed all patients with COVID-19 in 12 Massachusetts hospitals between February 1 and April 14, 2020. We examined the association between race, ethnicity, age, reported comorbidities, and hospitalization and ICU admission using multivariable regression. Results Of 5190 COVID-19 patients, 29% were hospitalized; 33% required the ICU, and 4.3% died. Forty-six percent of patients were White, 25% Latinx, 14% African American, and 3% Asian American. Ethnicity and race were significantly associated with hospitalization. More Latinx and African American patients in the younger age groups were hospitalized than whites. Latinxs and African Americans disproportionally required the ICU, with 39% of hospitalized Latinx patients requiring the ICU compared with 33% of African Americans, 24% of Asian Americans, and 30% of Whites (P < .007). Within each ethnic and racial group, age and male gender were independently predictive of hospitalization. Previously reported preexisting comorbidities contributed to the need for hospitalization in all racial and ethnic groups (P < .05). However, the observed disparities were less likely related to reported comorbidities, with Latinx and African American patients being admitted at twice the rate of Whites, regardless of such comorbidities. Conclusions Latinx and African American patients with COVID-19 have higher rates of hospitalization and ICU admission than White patients. The etiologies of such disparities are likely multifactorial and cannot be explained only by reported comorbidities.

Download Full-text

Association Between Marital Status and Racial Disparities in Esophageal Cancer Care

JCO Oncology Practice ◽

10.1200/jop.19.00561 ◽

2020 ◽

Vol 16 (6) ◽

pp. e498-e506

Author(s):

Alan Paniagua Cruz ◽

Karlie L. Haug ◽

Lili Zhao ◽

Rishindra M. Reddy

Keyword(s):

Esophageal Cancer ◽

Marital Status ◽

Racial Disparities ◽

Cancer Care ◽

Statistical Significance ◽

Secondary Analysis ◽

Eligibility Criteria ◽

Significant Difference ◽

The Impact ◽

White Patients

PURPOSE: This study was designed to examine the impact of marital status on racial disparities in esophageal cancer care. PATIENTS AND METHODS: We performed a secondary analysis of data collected from the state cancer registry maintained by the Michigan Department of Health and Human Services. We identified patients with an esophageal cancer diagnosis between January 1, 2000, and December 31, 2013. χ2 test and logistics regression were used to analyze 6,809 patients who met our eligibility criteria. Statistical significance was defined as P ≤ .05. RESULTS: Approximately 88.4% of our patients were White and 11.6% were Black. A significantly higher number of White patients were married when compared with Blacks (62.9% v 31.8%, respectively; P < .0001). There was no significant difference in cancer staging between the 2 groups ( P = .0671). Married Blacks had similar rates of esophagectomy, chemotherapy, and radiation as married Whites. Both single groups had lower rates of esophagectomy and chemotherapy than married Whites, but single Blacks were the least likely to undergo esophagectomy. Single patients were more likely to refuse treatment. CONCLUSION: Marital status differs significantly in Black and White patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.

Download Full-text

Surgical Outcomes of Distal Pancreatectomy in Elderly Patients

The American Surgeon ◽

10.1177/0003134820982574 ◽

2020 ◽

pp. 000313482098257

Author(s):

Derek Tessman ◽

Jesse Chou ◽

Saad Shebrain ◽

Gitonga Munene

Keyword(s):

Distal Pancreatectomy ◽

Surgical Outcomes ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Improvement Program ◽

Postoperative Myocardial Infarction ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Background The extent to which age impacts surgical outcomes remains poorly characterized. This study aims to evaluate the impact of age on 30-day outcomes in patients after distal pancreatectomy. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), distal pancreatectomy patients were identified and age-stratified, groups A (≤75 years) and B (>75 years). Outcomes included 30-day mortality, morbidity, readmissions, operative time (min), and hospital length of stay (LOS, days). Results Of 3042 total patients identified, 1686 (55.4%) were women. A total of 2649 patients (87.1%) were in group A. Overall, both groups had similar baseline characteristics with the exception of the following: diabetes mellitus (24.8% vs. 30.0%, P = .03), smoking (19.3% vs. 4.8%, P < .001), congestive heart failure (.5% vs. 1.8%, P = .010), hypertension (HTN) (47.9% vs. 72.5%, P < .001), bleeding disorders (3.1% vs. 5.3%, P = .036), the American Society of Anesthesiologists (ASA) (III-V) scores (67.6% vs. 85.5%, P < .001), and body mass index (29.2 [±6.7] vs. 27.4 [±5.6], P = .001). Deep surgical site infection was higher in group A (12.1% vs. 6.6%, P = .001), while acute renal failure (ARF) and postoperative myocardial infarction (MI) were higher in group B. 30-day readmissions were higher in group A (17.4% vs. 12.2%, P = .011) despite no statistically significant difference in LOS (7.10 [±6.36] vs. 7.30 [±4.93] days, P = .553) or overall morbidity (29.4% vs. 28.8%, P = .859). Conclusion(s) Those undergoing distal pancreatectomy experienced similar overall morbidity and mortality outcomes regardless of age. However, those older than 75 years had more cardiovascular risk factors, which may have contributed to their higher rates of postoperative ARF and MI.

Download Full-text

Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.18_suppl.lba1 ◽

2019 ◽

Vol 37 (18_suppl) ◽

pp. LBA1-LBA1 ◽

Cited By ~ 6

Author(s):

Blythe J.S. Adamson ◽

Aaron B. Cohen ◽

Melissa Estevez ◽

Kelly Magee ◽

Erin Williams ◽

...

Keyword(s):

African American ◽

Racial Disparities ◽

Fixed Effects ◽

Metastatic Cancer ◽

Private Insurance ◽

Cancer Type ◽

Medicaid Expansion ◽

The Impact ◽

Medicaid Expansions ◽

Timely Treatment

LBA1 Background: Racial disparities in cancer outcomes remain a societal challenge. The ACA sought to improve equity in healthcare access and outcomes by permitting states to expand Medicaid and providing subsidies for purchase of private insurance. We assessed the impact of Medicaid expansions on racial disparities in time to treatment among patients (pts) with advanced cancer. Methods: We selected pts ages 18-64 years with advanced or metastatic cancer (NSCLC, breast, urothelial, gastric, colorectal, renal cell, prostate, and melanoma), diagnosed between Jan 1, 2011 and Dec 31, 2018, from the nationwide Flatiron Health electronic health record-derived database. We assigned expansion status based on whether the pts’ state of residence had expanded Medicaid as of the diagnosis date. We estimated Medicaid expansion-related changes in the rate of “timely treatment,” an outcome defined as first-line treatment start within 30 days of advanced or metastatic diagnosis. Regression model covariates included race (White, African American, Asian, and Other race), age, sex, practice type, cancer type, stage, and unemployment rate, using time and state fixed-effects. Regression results present predictive margins. Results: The study included 34,067 pts (median age 57 years; 12% African American). Racial disparities were observed pre-expansion: African American pts were 4.9 percentage points (%pt) less likely to receive timely treatment (Table). Regardless of race, Medicaid expansion trended toward an increase in timely treatment overall (p = 0.05). Expansion was associated with a differential benefit for African American vs white pts (6.9 %pt and 1.8 %pt). Prior racial disparities were no longer observed after Medicaid expansion. Conclusions: Implementation of Medicaid expansions as part of the ACA differentially improved African American cancer pts’ receipt of timely treatment, reducing racial disparities in access to care.[Table: see text]

Download Full-text