scholarly journals EPID-19. RACIAL/ETHNIC DISPARITIES IN TREATMENT PATTERN AND TIME TO TREATMENT FOR ADULTS WITH GLIOBLASTOMA IN THE US

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii82-ii82
Author(s):  
Quinn Ostrom ◽  
Nirav Patil ◽  
Gino Cioffi ◽  
Jill S Barnholtz-Sloan
Keyword(s):  
Access To Health Care ◽  
Ethnic Disparities ◽  
Treatment Pattern ◽  
Linear Regression Models ◽  
Time To Treatment ◽  
Survival Difference ◽  
Race Ethnicity ◽  
Receive Treatment ◽  
Asian Pacific ◽  
To Receive

Abstract BACKGROUND Race/ethnicity have been previously shown to significantly affect survival after diagnosis with glioblastoma, but the cause of this survival difference is not known. The aim of this study was to examine variation in treatment pattern and time to treatment by race/ethnicity, and the extent to which this affects survival. METHODS Data were obtained from the National Cancer Database (NCDB) for adults >= 40 with glioblastoma (histologic codes 9440–9442 and topographical codes C71.0–C71.9) from 2004–2016 (N=117,710). Treatment patterns and time to treatment by race/ethnicity were compared using univariable and multivariable logistic and linear regression models, respectively. Models were adjusted for age, sex, insurance status, pre-existing comorbidities, type of treating institution, and distance to institution. RESULTS Black non-Hispanics (BNH) were 17% less likely to receive radiation (p=1.47x10-8) and 32% less likely to receive chemotherapy (p=1.10x10-31) than White non-Hispanics (WNH). Among those that did receive treatment, it took 3.3 additional days on average for BNH to receive radiation (p=2.12x10-11) and 4.6 additional days to receive chemotherapy in comparison to WNH (p=4.14x10-10). Hispanics were 21% less likely to receive radiation (p=4.79x10-12), and 23% less likely to receive chemotherapy (p=7.51x10-14) than WNH. Among those that did receive treatment, it took 3.3 additional days on average for Hispanics to receive radiation (p=4.07x10-9) and 4 additional days to receive chemotherapy in comparison to WNH (p=1.51x10-6). There were no significant differences in time to surgery, or in to treatment for Asian Pacific Islanders or American Indian/Alaska Natives. CONCLUSIONS Both likelihood of receiving treatment and time to radiation and chemotherapy vary significant between BNH and Hispanics as compared to WNH, and this difference is not fully explained by comorbidities or access to health care.

scholarly journals 0377 A Strengths-Based Approach to Examine Obstructive Sleep Apnea in Black and White Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A144-A145
Author(s):  
N J Williams ◽  
M Butler ◽  
J Roseus ◽  
J Blanc ◽  
A Barnes ◽  
...  
Keyword(s):  
Social Support ◽  
Ethnic Differences ◽  
Ethnic Disparities ◽  
Sleep Diary ◽  
Newly Diagnosed ◽  
Linear Regression Models ◽  
Obstructive Sleep ◽  
Falling Asleep ◽  
Race Ethnicity ◽  
Insomnia Complaints

Abstract Introduction The majority of studies on race/ethnic disparities in OSA are derived from a deficit-based perspective (i.e. >BMI, non-adherence to PAP). It would prove useful to identify which aspects are protective to inform potential treatment approaches. We focused on two potential factors: resilience and social support, in patients newly diagnosed with OSA. Given the high prevalence of insomnia complaints in patients with OSA, insomnia was our outcome of interest. Methods 91 patients newly diagnosed with OSA provided demographic and socioeconomic status, sleep measures (Epworth, DBAS), resilience (Connor Davidson Resiliency Scale), social support (MOS Social Support Scale) and completed the Insomnia Severity Index. The cross-sectional associations between ISI, race/ethnicity, resilience, social support and their interaction effects were examined using linear regression models with covariate adjustment for participant age, sex and BMI. We ascertained total ISI score and individual items. Results The sample was 34.1% black (n=31), mean age of 57.6 years, SD=13.6, 64.8% male (n=59), and mean BMI of 32.4, SD=7.04. Mean sleep duration (as reported by sleep diary) was 6.64, SD=1.35. Black, white differences were not observed for sleepiness (M=8.60; 10.43, p=0.11) or DBAS (M=4.61; M=5.04, p=0.30). Blacks, reported clinically significant insomnia (M=15.00, SD=7.17) compared to whites (M=12.02, SD=6.83, p=0.05). On the individual ISI items, blacks were significantly more likely to endorse difficulty falling asleep (M=1.58, SD=1.54; M=0.75, SD=0.93,p=0.002) and waking up too early (M=2.09, SD=1.26; M=1.45, SD=0.93,p=0.021) compared to whites. Resilience (M=30.04, SD=6.42) and social support scores (M=74.13, SD=21.36) did not differ by race/ethnicity. In adjusted linear analysis, resilience had significant effect on ISI score (b=-0.36, SE=0.12, p=0.003) but not social support (b=-0.06, SE=0.08, p=0.31). Conclusion In this study we did not observe race/ethnic differences for sleepiness and dysfunctional beliefs about sleep. With respect to the protective factors, race/ethnic differences were not observed. Resilience, not social support, was related to insomnia complaints. Future studies should examine a variety of factors that may serve black and other racial/ethnic groups with OSA, and help elucidate protective processes. Support K23HL125939

scholarly journals Racial/Ethnic Disparities in Mortality: Contributions and Variations by Rurality in the United States, 2012–2015

2019 ◽  
Vol 16 (3) ◽  
pp. 436 ◽  
Author(s):  
Jeffrey Hall ◽  
Ramal Moonesinghe ◽  
Karen Bouye ◽  
Ana Penman-Aguilar
Keyword(s):  
Rural Areas ◽  
Ethnic Disparities ◽  
The United States ◽  
Mortality Rates ◽  
Malignant Neoplasms ◽  
Ethnic Populations ◽  
Asian Pacific Islanders ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
Racial Ethnic

The value of disaggregating non-metropolitan and metropolitan area deaths in illustrating place-based health effects is evident. However, how place interacts with characteristics such as race/ethnicity has been less firmly established. This study compared socioeconomic characteristics and age-adjusted mortality rates by race/ethnicity in six rurality designations and assessed the contributions of mortality rate disparities between non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in each designation to national disparities. Compared to NHWs, age-adjusted mortality rates for: (1) NHBs were higher for all causes (combined), heart disease, malignant neoplasms, and cerebrovascular disease; (2) American Indian and Alaska Natives were significantly higher for all causes in rural areas; (3) Asian Pacific islanders and Hispanics were either lower or not significantly different in all areas for all causes combined and all leading causes of death examined. The largest contribution to the U.S. disparity in mortality rates between NHBs and NHWs originated from large central metropolitan areas. Place-based variations in mortality rates and disparities may reflect resource, and access inequities that are often greater and have greater health consequences for some racial/ethnic populations than others. Tailored, systems level actions may help eliminate mortality disparities existing at intersections between race/ethnicity and place.

Deploying Street Outreach Workers to Reduce Failure to Appear in Juvenile Court for Youth of Color: A Randomized Study

2017 ◽  
Vol 65 (12) ◽  
pp. 1740-1762 ◽  
Author(s):  
Sarah Cusworth Walker ◽  
Asia Sarah Bishop ◽  
Jovi Catena ◽  
Elizabeth Haumann
Keyword(s):  
Juvenile Court ◽  
Controlled Trial ◽  
Randomized Study ◽  
Ethnic Disparities ◽  
Youth Of Color ◽  
Street Outreach ◽  
Outreach Workers ◽  
Outreach Services ◽  
Race Ethnicity ◽  
To Receive

This study is a randomized controlled trial of a failure to appear (FTA) prevention program involving street outreach workers. Over 2 years, 560 youth were randomized to receive street outreach services or no services based on an FTA risk score. The program was found to significantly and modestly reduce the likelihood of an FTA at the first court hearing following a summons (arraignment) but not subsequent hearings (case setting). No interactions were found for differential effects by race/ethnicity or gender. Although the program prioritized youth of color, the effects were not sufficient to substantially reduce disparities given the dispersed benefits to all youth. Implications of these findings for reducing race and ethnic disparities are discussed.

US Trends in Receipt of Appropriate Diabetes Clinical and Self-care From 2001 to 2010 and Racial/Ethnic Disparities in Care

2014 ◽  
Vol 40 (6) ◽  
pp. 756-766 ◽  
Author(s):  
Roxana Chen ◽  
Allen Cheadle ◽  
Donna Johnson ◽  
Bonnie Duran
Keyword(s):  
Self Care ◽  
Ethnic Disparities ◽  
Self Management ◽  
Self Monitoring ◽  
Recommended Care ◽  
Flu Vaccination ◽  
Race Ethnicity ◽  
To Receive ◽  
Recommended Services ◽  
Racial Ethnic

Purpose The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care. Methods This observational study examined receipt of A1C tests, annual eye and foot exams, flu vaccination, diabetes self-management education (DSME), exercise, self-monitoring of blood glucose (SMBG), and self feet examinations among US adults with diabetes using national survey data from 2001 to 2010. Analyses included estimating proportions for each indicator by year, testing differences in magnitude of change from 2001 to 2010 by race/ethnicity, and regression models to assess changes in care over time and factors associated with care. Results There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, DSME, and SMBG but declines in eye and self feet exams. DSME was positively associated with receipt of several care indicators. However, only half of respondents received DSME. White and black non-Hispanics, respectively, experienced improvements in at least 3 indicators. Hispanics experienced a significant increase in exercise but were consistently less likely than whites to receive or engage in most care. Conclusions While improvements in several indicators were observed, patterns varied by race/ethnicity, with Hispanics falling short on most measures. DSME was strongly associated with most care and demonstrates the potential to improve receipt of recommended care by increasing DSME participation. With the Affordable Care Act (ACA), health professionals have a prime opportunity to leverage ACA provisions to increase access to recommended services, including DSME.

Presenting international prognostic scoring system affects time to treatment: A retrospective single center review.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20058-e20058
Author(s):  
Sierra Sutcliffe ◽  
Indryas Woldie ◽  
Caroline M. Hamm
Keyword(s):  
Retrospective Chart Review ◽  
B Cell Lymphoma ◽  
International Prognostic Scoring System ◽  
Cancer Center ◽  
Wait Times ◽  
Time To Treatment ◽  
Lower Stage ◽  
History Of ◽  
Receive Treatment ◽  
To Receive

e20058 Background: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin’s lymphoma, which requires prompt initiation of chemotherapy to cure, as any delays can result in worse outcomes. A recent study in Japan found that patients with an IPI score ≥3 had a worse prognosis if their diagnosis was delayed, whereas with an IPI score < 3, there was no effect. Methods: This study investigated how long Windsor patients wait to receive chemotherapy after diagnosis, and how this affects relapse status. A retrospective chart review was conducted, looking at all patients diagnosed with DLBCL who underwent treatment at the Windsor Regional Cancer Center from 2007 to 2018 (N = 317). Each chart was reviewed for variables relating to treatment and outcomes. Results: Overall survival within the studied time period was 71% with the median survival time of 11.99 years. The overall relapse rate was 19.24% with a mean relapse-free interval of 4.87 years. A longer time to initial treatment resulted in a decreased risk of relapse (p = 0.038); however, these patients tended to have a lower stage (p = 0.002), no family history of cancer (p < 0.001), and lower IPI scores (p = 0.004). When broken down by IPI score, the mean times to treatment after diagnosis were: IPI 0 = 40 days; IPI 1 = 35 days; IPI 2 = 38 days; IPI 3 = 29 days; IPI 4 = 22 days; IPI 5 = 29 days. Conclusions: These results show that while DLBCL patients with worse prognostic measures are prioritized to receive treatment quicker, there is a large discrepancy in time to treatment between IPI scores. There was an 11-day delay between early and late IPI scores, likely driven by patient symptoms, rather than evidence of safety. The natural history of DLBCL is known to be aggressive, but more granular information is necessary to determine appropriate wait times for presenting IPI score. Further research should focus on identifying delays in the process, and if it can be streamlined to improve wait times for all patients, regardless of IPI score.

scholarly journals Racial and Ethnic Disparities in the Refusal of Surgical Treatment in Women 40 Years and Older With Breast Cancer in the United States Between 2010 and 2017

2022 ◽  
Author(s):  
Pierre Fwelo ◽  
Zenab Yusuf ◽  
Abigail Adjei ◽  
Gabriel Huynh ◽  
Xianglin Du
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Surgical Treatment ◽  
Black Women ◽  
Ethnic Disparities ◽  
Breast Conserving Surgery ◽  
The United States ◽  
Recommended Treatment ◽  
Race Ethnicity ◽  
To Receive

Abstract Purpose Although surgical resection is the main modality of treatment for breast cancer, some patients elect to refuse the recommended surgery. We assessed racial and ethnic differences in women 40 years and older who received or refused to receive surgical treatment for breast cancer in the United States and whether racial disparities in mortality were affected by their differences in the prevalence of refusal for surgical treatmentMethods We studied 277,127 women with breast cancer using the Surveillance, Epidemiology, and End Results (SEER) data and performed multivariable logistic regressions to investigate the association between surgery status of breast cancer and race/ethnicity. Additionally, we performed Cox logistic regression analyses to determine the predictors of mortality outcomes. Results Of 277,127 patients with breast cancer, 1,468 (0.53%) refused to receive the recommended surgical treatment in our cohort. Non-Hispanic Black women were 112% more likely to refuse recommended surgical treatment for breast cancer compared to their non-Hispanic White counterparts [adjusted odds ratio: 2.12, 95% confidence interval (CI)=1.82-2.47]. Women who underwent breast conserving surgery [hazards ratio (HR): 0.15, 95% CI: 0.13-0.16] and mastectomy (HR:0.21, 95% CI: 0.18-0.23) had lower hazard ratios of mortality as compared to women who refused the recommended treatment after adjusting for covariates. Conclusion Race/ethnicity was associated with refusal for recommended surgery, especially among non-Hispanic Black women. Also, surgery refusal was associated with a higher risk of all-cause and breast cancer-related mortality. These disparities stress the need to tailor interventions aimed at raising awareness of the importance of following physician recommendations among minorities.

scholarly journals Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

2022 ◽  
Author(s):  
McKaylee Robertson ◽  
Meghana Shamsunder ◽  
Ellen Brazier ◽  
Mekhala Mantravadi ◽  
Madhura S Rane ◽  
...  
Keyword(s):  
Access To Health Care ◽  
Healthcare Access ◽  
Ethnic Disparities ◽  
Community Based ◽  
Access To Health ◽  
National Cohort ◽  
Barriers To Healthcare ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Disproportionate Burden

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

scholarly journals Disparities in Access to Care and Satisfaction among U.S. Children: The Roles of Race/Ethnicity and Poverty Status

2005 ◽  
Vol 120 (4) ◽  
pp. 431-441 ◽  
Author(s):  
Leiyu Shi ◽  
Gregory D. Stevens
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Medical Care ◽  
Access To Health Care ◽  
Ethnic Disparities ◽  
Access To Health ◽  
Poverty Status ◽  
Quality Of Medical Care ◽  
Race Ethnicity ◽  
Racial Ethnic

Objectives. The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. Methods. Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. Results. Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. Conclusions. Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

Racial disparities in the initial treatment of hepatocellular carcinoma in the population 65+ years in the United States.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 431-431
Author(s):  
Stephanie Costa ◽  
David J. Delgado ◽  
Michael Ross Kaufman ◽  
Brandon George ◽  
Edith P. Mitchell
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
African American ◽  
Racial Disparities ◽  
Initial Treatment ◽  
The United States ◽  
Asian Pacific Islander ◽  
Receive Treatment ◽  
Asian Pacific ◽  
To Receive

431 Background: Insufficient evidence exists regarding the initial management of elderly patients with hepatocellular carcinoma (HCC). The purpose of this study was to describe racial differences in initial treatment of 65+ year old patients with HCC diagnosed in the United States (2004-2014). Methods: A retrospective cohort study was conducted using the 1973-2014 Surveillance, Epidemiology and End Results Program (SEER) database of the National Cancer Institute. Patients with primary hepatocellular carcinoma, diagnosed between 2004 and 2014, and with complete information on race, gender, year of diagnosis, age, marital status, region, tumor status at diagnosis and initial treatment were included. Descriptive statistics were used to compare race with sociodemographic and clinical variables. Univariate and multivariate logistic regressions were performed to describe the association of race with receiving any treatment for HCC (local hepatic therapy and surgical treatment versus no treatment). Results: The sample consisted of 25,499 HCC patients: 70.0% White, 9.1% Black, 19.8% API, 1.0% AI; 68.6% male; 46.8% diagnosed in 2004-2009; 54.8% age 65-74, 45.2% 75 and older; 54.7% married, 7.3% Midwest, 13.8% Northeast, 15.7% Southeast; 81.3% first malignant primary indicator, 13.8% metastasis, 49.3% localized site, and 20.9% receiving initial treatment. After controlling for confounding variables, as compared to White patients, African American patients (OR:0.739 95% CI:0.652, 0.839) had decreased odds of receiving initial treatment; and Asian/Pacific Islander patients (OR:1.490 95% CI:1.371,1.618) had increased odds of receiving initial treatment. Conclusions: Racial disparities exist at the presentation of HCC in the 65+ population. African American patients are less likely to receive treatment and Asian/Pacific Islander patients are more likely to receive treatment. Further research is needed to understand these relationships in subpopulations.

Disparities by Gender and Race/Ethnicity in Child Maltreatment and Memory Performance

2021 ◽  
pp. 088626052110152
Author(s):  
Monique J. Brown ◽  
Yanping Jiang ◽  
Peiyin Hung ◽  
Mohammad Rifat Haider ◽  
Elizabeth Crouch
Keyword(s):  
Sexual Abuse ◽  
Child Maltreatment ◽  
Memory Performance ◽  
Ethnic Disparities ◽  
Public Health Issue ◽  
Adult Health ◽  
Linear Regression Models ◽  
Gender And Race ◽  
Race Ethnicity ◽  
Racial Ethnic

Adverse childhood experiences, which include child maltreatment, are a major public health issue nationally. Child maltreatment has been linked to poorer cognitive functioning, which can start in childhood and persist into adulthood. However, studies examining the potential disparities by gender and race/ethnicity are lacking. The aim of this study was to assess the gender and racial/ethnic disparities in the association between child maltreatment and memory performance. Data were obtained from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health ( N = 11,624). Weighted multiple linear regression models were used to assess the associations between sexual abuse, physical abuse, neglect, and child maltreatment score and memory. Models were stratified by gender, race, and ethnicity. Men who were exposed to sexual abuse, neglect and two or three child maltreatment types scored one to three points lower (β = –1.44; 95% CI: –2.83, –0.06; β = –2.41; 95% CI: –3.75, –1.08; β = –3.35; 95% CI: –5.33, –1.37; β = –2.31; 95% CI: –3.75, –0.86) in memory performance compared to men who did not report sexual abuse, neglect, or child maltreatment, respectively. Black respondents who were exposed to sexual abuse scored two points lower (β = –1.62; 95% CI: –2.80, –0.44) in memory performance compared to Black respondents who did not report sexual abuse. Among Other race and Hispanic respondents, those who reported neglect scored four points lower (β = –4.06; 95% CI: –6.47, –1.66; β = –4.15; 95% CI: –5.99, –2.30) in memory performance, respectively, compared to their counterparts who did not report neglect. Gender- and racial/ethnic-responsive memory performance interventions addressing child maltreatment may be beneficial for affected populations.

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