scholarly journals 374. Need to Improve Minority Representation through COVID-19 Community Research Partnership

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S289-S289
Author(s):  
Keerti Dantuluri ◽  
Whitney Rossman ◽  
Lauren C Lu ◽  
Connell O Dunn ◽  
Anna M Harris ◽  
...  

Abstract Background Minorities are often unrepresented in research, which limits equity in healthcare advances. The racial and ethnic disparities in outcomes of individuals infected with COVID-19 highlight the importance of inclusivity in research to improve public health measures. Methods We performed a descriptive analysis of the racial and ethnic distribution of children enrolled in our COVID-19 Community Research Partnership (CRP) study, a syndromic and serological surveillance study of children aged 2 – 17 years receiving care at three healthcare systems spanning North and South Carolina. Syndromic surveillance involved daily symptom reporting using a web-based monitoring application. Participants consenting to serological surveillance were mailed at-home tests sampling finger prick capillary blood. In-person and electronic recruitment efforts were conducted in English and Spanish. At one of the study sites, we compared the racial/ethnic distribution of enrolled children to the racial/ethnic distribution of all children who received care at the same site during the same timeframe. We compared the racial/ethnic distribution of participants who ultimately submitted samples for serological testing compared to those who consented to serologic testing. Results At total of1630 children were enrolled from April 2, 2021 – June 8, 2021. Most children were > 5 years old, 50.2% were female, and 88.5% were from mostly urban counties (Table 1). Of enrolled children, 4.2% were Hispanic, 8.2% were black, and 81.6% were white (Table 2). Among 135,355 unique children who received care at the institution during the same time, 12.4% were Hispanic, 23.0% were black, and 63.1% were white. Of 1552 participants who consented to serologic testing, 4.4% were Hispanic, 8.1% were black, and 81.8% were white (Table 3). To date, 242 children submitted serologic samples; 4.1% were Hispanic, 5.0% were black, and 85.5% were white. Table 1. Characteristics of enrolled children in COVID-19 surveillance study Table 2. Racial and Ethnic distribution of children enrolled in the study compared to target population Table 3. Racial and ethnic distribution of children who participated in serology testing Conclusion Despite efforts to recruit a diverse group of children, the proportion of minorities enrolled in our COVID-19 surveillance study underrepresents the targeted population. Ongoing efforts will work to identify barriers and facilitators to research participation among minority families. Disclosures Amina Ahmed, MD, Nothing to disclose

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 395-395
Author(s):  
Dana Stafkey-Mailey ◽  
Charles Bennett ◽  
Michael Dickson

Abstract Abstract 395 Background: Racial/ethnic variations in utilization of cancer care services and outcomes are well documented with African Americans (AAs) almost uniformly shown to have lower utilization rates than Whites. This issue is especially important with respect to use of the supportive care agents, erythropoiesis stimulating agents (ESAs) during time-periods where ESAs were perceived as being associated with high benefit-risk ratios as well as with low benefit-risk ratios. We evaluated ESA utilization among Medicaid patients in South Carolina with anemia and lung cancer (LC), non-Hodgkins lymphoma (NHL) or breast cancer (BC). Three time-points were selected; 2002 nearly 10 years after epoetin alfa received an indication for anemia associated with chemotherapy and the first full year following the approval of darbepoetin, 2006 the year prior to ESA safety notifications and 2009 the most recent full year of data following the implementation of a black box warning. Methods: The analysis utilizes South Carolina Medicaid fee-for-service paid claims. AA and White patients diagnosed with LC=162.xx; NHL=201.xx and 202.xx; or females with BC=174.xx plus anemia (ICD-9-CM=284.xx, 285.xx) were evaluated. Utilization rates were calculated annually as a percent of patients within each racial group with at least one prescription claim or procedure code for an ESA (i.e. epoetin/darbepoetin). Fisher's exact test was used to test for utilization rate differences. Results: The number of SC Medicaid patients diagnosed with anemia and one of the three cancers ranged from 442 to 655 annually. The average age of the study population in 2002 (55.6 years), 2006 (55.3 years) and 2009 (57.7 years) did not vary significantly between AAs and Whites. Among all cancer patients, ESA utilization increased from 2002 peaking in 2006 (prior to safety notifications and CMS National Coverage Decision). Following publication of the black box warning, utilization rates decreased 60% for AAs and 67% for Whites, in 2009. Initially (2002) utilization rates were 15% lower among AAs than Whites. However, by 2006 utilization rates were 13% higher in AAs compared to Whites. Following the black box warning, utilization rates were 30% greater in AAs versus Whites among all cancer patients (LC, BC or NHL). More specifically, ESA utilization rates were 47% greater among AAs compared to Whites with BC, and 280% greater among AA versus White patients with NHL. In contrast, ESA utilization rates were 9% lower in AAs compared to Whites with LC. (Table) Conclusions: Following the approval of darbepoetin in 2002, utilization of ESAs were lower among AA patients with LC, BC or NHL compared to Whites. However, by 2006 when these agents were perceived to have high benefit-risk profiles utilization rates were greater among anemic AA versus White cancer patients. The utilization rates remained higher for AAs during 2009 when ESAs were perceived to have lower benefit-risk profile. Our findings indicate that disparities in the utilization of ESA changed overtime. Counter to results reported in prior studies of racial/ethnic disparities, among the insured poor in South Carolina in recent years, rates of ESA utilization were greater for AAs versus Whites. Additional analyses will evaluate if these differences were associated with differences in outcomes and toxicity. Disclosures: Bennett: Pfizer: Consultancy.


2012 ◽  
Author(s):  
J. Liang ◽  
X. Xu ◽  
A. R. Quinones ◽  
J. M. Bennett ◽  
W. Ye

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1489-P
Author(s):  
SHARON SHAYDAH ◽  
GIUSEPPINA IMPERATORE ◽  
CARLA MERCADO ◽  
KAI M. BULLARD ◽  
STEPHEN R. BENOIT

2017 ◽  
Vol 35 (1) ◽  
pp. 86-95 ◽  
Author(s):  
Albert J. Farias ◽  
Xianglin L. Du

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Chirag Vyas ◽  
Charles Reynolds ◽  
David Mischoulon ◽  
Grace Chang ◽  
Olivia Okereke

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 342-342
Author(s):  
Jason Newsom ◽  
Emily Denning ◽  
Ana Quinones ◽  
Miriam Elman ◽  
Anda Botoseneanu ◽  
...  

Abstract Racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time have been established. Studies report differences in physical activity across racial/ethnic groups. We investigated whether racial/ethnic differences in accumulation of multimorbidity over a 10-year period (2004-2014) were mediated by physical activity using data from the Health and Retirement Study (N = 10,724, mean age = 63.5 years). Structural equation modeling was used to estimate a latent growth curve model of changes in the number of self-reported chronic conditions (of nine) and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) to change in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, personal wealth, and insurance coverage. Results indicated that Blacks engaged in significantly lower levels of physical activity than Whites (b = -.171, □ = -.153, p &lt; .001), but there were no differences between Hispanics and Whites (b = -.010, □ = -.008, ns). Physical activity also significantly predicted both lower initial levels of multimorbidity (b = -1.437, □ = -.420, p &lt; .001) and greater decline in multimorbidity (b = -.039, □ = -.075, p &lt; .001). The indirect (mediational) effect for the Black vs. White comparison was significant (b = .007, □ = .011, 95% CI [.004,.010]). These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in middle and later life, suggesting greater need to reduce sedentary behavior and increase activity.


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048006
Author(s):  
Zhaoying Xian ◽  
Anshul Saxena ◽  
Zulqarnain Javed ◽  
John E Jordan ◽  
Safa Alkarawi ◽  
...  

ObjectiveTo evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA.MethodsPublicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM.ResultsThe Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%–200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%–100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%–66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state.ConclusionsThere are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.


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