scholarly journals 1256. Contemporary Evaluation of Racial/Ethnic Disparities in Survival and Disease Progression among People with HIV in the US Midwest

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S451-S452
Author(s):  
Rohan Khazanchi ◽  
Harlan R Sayles ◽  
Sara H Bares ◽  
Susan Swindells ◽  
Jasmine R Marcelin ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Progression ◽  
Ethnic Disparities ◽  
Hiv Viral Load ◽  
Risk Status ◽  
Cd4 Counts ◽  
Patient Demographics ◽  
Significant Difference ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Background Combating HIV-related disparities is a major goal of the 2020 National HIV/AIDS Strategy. However, research on HIV disparities has primarily been conducted in urban settings. A 1997–2007 study of people with HIV (PWH) at our clinic noted significantly increased mortality among high-risk non-Hispanic (NH) Black PWH (73%) compared with NH Whites (88%). This study evaluated demographic disparities in survival and disease progression in a large Midwest clinical cohort. Methods We retrospectively reviewed records of 1,396 PWH receiving treatment at an HIV Clinic in Omaha, Nebraska from 2012 through 2017. We included patients over 19 years old with diagnosed HIV, a minimum of two visits, and no lapse in care >2 years. Patients were stratified into low-risk (CD4 >100 cells/mm3 and HIV viral load <250,000 copies/mL) and high-risk (all others) groups. Cox proportional hazard models and Kaplan–Meier curves with log-rank tests compared patient demographics and mortality. Generalized estimating equations modeled change in CD4 count over time. Results No significant difference in mortality was noted across race/ethnicity categories (P = 0.286). Several clinical and demographic characteristics, including CD4 counts <500 cells/mm3, were significantly associated with increased mortality (Figure 1). Compared with NH Whites, mean CD4 counts (Figure 2) were significantly lower for NH Blacks (P = 0.001), Hispanics (P = 0.006), and Others (P = 0.013). High-risk status was associated with mortality (P < 0.001), but no significant differences in mortality were noted across race/ethnicity categories after stratifying for patient risk status (Figures 3 and 4). Conclusion Significant racial/ethnic disparities in HIV disease progression among PWH at a Midwest HIV Clinic persist. However, in contrast to the 1997–2007 study, disparities in survival were not observed among high-risk PWH. As our patient demographics are essentially the same, the reduction of this disparity suggests needed investigation of whether these changes are the result of better antiretroviral efficacy or if social determinants of health in the region have improved. Systems-level interventions are needed to ensure all PWH benefit from continuing advances in HIV research and care. Disclosures All authors: No reported disclosures.

Racial and ethnic disparities in risk and survival in children with neuroblastoma: An updated analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10036-10036
Author(s):  
Caileigh Pudela ◽  
Mark A. Applebaum ◽  
Sang Mee Lee ◽  
Arlene Naranjo ◽  
Julie R. Park ◽  
...  
Keyword(s):  
Native American ◽  
High Risk ◽  
Ethnic Groups ◽  
Proportional Hazards ◽  
Ethnic Disparities ◽  
Cox Proportional Hazards ◽  
Black And White ◽  
High Risk Disease ◽  
Significant Difference ◽  
Racial Ethnic

10036 Background: Biologic and socioeconomic factors contribute to health disparities among patients with pediatric cancer. In an analysis of Children’s Oncology Group (COG) neuroblastoma (NBL) patients (pts) diagnosed between 2001-2009, non-Hispanic Black (Black) pts were previously shown to have a higher prevalence of high-risk disease and worse event-free survival (EFS) compared to non-Hispanic White (White) pts. Here, we analyzed data in the International Neuroblastoma Risk Group Data Commons (INRGdc) to validate these findings. Methods: Three-year EFS and overall survival (OS) of COG pts diagnosed between 2001-2009 (Cohort 1; n = 4,358) and 2010-2016 (Cohort 2; n = 3,689) in the INRGdc with known race and ethnicity were estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to evaluate differences in EFS and OS between racial/ethnic groups. The association of clinical characteristics and tumor biomarkers with racial/ethnic groups were analyzed using Chi-square tests. Results: The distribution of race/ethnicity for pts in Cohort 1 and Cohort 2 was as follows, respectively: White: 72% (n = 3,136) and 70% (n = 2,575); Black: 11.4% (n = 495) and 10.7% (n = 397); Hispanic: 12.2% (n = 532) and 14.1% (n = 522); Asian and Hawaiian: 4% (n = 178) and 4.6% (n = 172); Native American: 0.4% (n = 17) and 0.6% (n = 23). In both cohorts, a higher proportion of Black pts had INSS stage 4 disease, age ≥ 18mo, and unfavorable histology tumors when compared to White pts (Cohort 1: p = 0.003; p < 0.001; p < 0.001, respectively vs Cohort 2: p = 0.014; p < 0.001; p < 0.001, respectively). No significant differences in the proportion of pts with MYCN amplified or diploid tumors were detected between Black and White pts in either cohort. Black pts had a higher prevalence of high-risk disease compared to White pts in both Cohorts 1 and 2 (p < 0.001 and p < 0.001, respectively). Among all pts in Cohort 1, EFS was 73% and OS was 83%. In Cohort 1, Black pts had worse EFS (68% vs 73%; HR = 1.31, 95%CI 1.11-1.55, p = 0.002) and OS (78% vs 84%; HR = 1.41, 95% CI 1.16-1.70, p = 0.001) compared to White pts. Among all pts in Cohort 2, EFS was 81% and OS was 88%. Black pts in Cohort 2 also had worse EFS compared to White pts (76% vs 82%; HR = 1.35, 95% CI = 1.03-1.76, p = 0.027), although no significant difference in OS was observed (p = 0.21). In analyses restricted to high-risk pts, no statistically significant difference in EFS and OS in Black vs White pts was detected in either cohort. Conclusions: In the modern treatment era, Black NBL pts continue to have a higher prevalence of high-risk disease and inferior 3-year EFS compared to White pts. The lack of significant difference in survival among high-risk NBL pts by race suggests that Black and White pts are receiving comparable treatments and responding similarly. The socioeconomic and/or genomic factors contributing to the higher proportion of Black pts with high-risk disease requires further investigation.

scholarly journals Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

2021 ◽  
Vol 18 (6) ◽  
pp. 2921
Author(s):  
Jay J. Xu ◽  
Jarvis T. Chen ◽  
Thomas R. Belin ◽  
Ronald S. Brookmeyer ◽  
Marc A. Suchard ◽  
...  
Keyword(s):  
United States ◽  
District Of Columbia ◽  
Ethnic Disparities ◽  
The United States ◽  
Attributable Mortality ◽  
Race Ethnicity ◽  
Using Data ◽  
Rate Ratios ◽  
Degree Of Association ◽  
Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

scholarly journals Racial/Ethnic Disparities in Influenza Vaccination Coverage Among US Adolescents, 2010-2016

2018 ◽  
Vol 133 (6) ◽  
pp. 667-676 ◽  
Author(s):  
Noah S. Webb ◽  
Benjamin Dowd-Arrow ◽  
Miles G. Taylor ◽  
Amy M. Burdette
Keyword(s):  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Black Adolescents ◽  
Ethnic Disparities ◽  
White Adolescents ◽  
Hispanic Adolescents ◽  
Vaccination Rates ◽  
Targeted Interventions ◽  
Race Ethnicity ◽  
Racial Ethnic

Objective: Although research suggests racial/ethnic disparities in influenza vaccination and mortality rates, few studies have examined racial/ethnic trends among US adolescents. We used national cross-sectional data to determine (1) trends in influenza vaccination rates among non-Hispanic white (hereinafter, white), non-Hispanic black (hereinafter, black), and Hispanic adolescents over time and (2) whether influenza vaccination rates among adolescents varied by race/ethnicity. Methods: We analyzed provider-reported vaccination histories for 2010-2016 from the National Immunization Survey–Teen. We used binary logistic regression models to determine trends in influenza vaccination rates by race/ethnicity for 117 273 adolescents, adjusted for sex, age, health insurance, physician visit in the previous 12 months, vaccination facility type, poverty status, maternal education level, children in the household, maternal marital status, maternal age, and census region of residence. We calculated adjusted probabilities for influenza vaccination for each racial/ethnic group, adjusted for the same demographic characteristics. Results: Compared with white adolescents, Hispanic adolescents had higher odds (adjusted odds ratio [aOR] = 1.11; 95% confidence interval [CI], 1.06-1.16) and black adolescents had lower odds (aOR = 0.95; 95% CI, 0.90-1.00) of vaccination. Compared with white adolescents, Hispanic adolescents had significantly higher adjusted probabilities of vaccination for 2011-2013 (2011: 0.22, P < .001; 2012: 0.23, P < .001; 2013: 0.26, P < .001). Compared with white adolescents, black adolescents had significantly lower probabilities of vaccination for 2016 (2016: 0.21, P < .001). Conclusions: Targeted interventions are needed to improve adolescent influenza vaccination rates and reduce racial/ethnic disparities in adolescent vaccination coverage.

Trends in breast cancer survival by race-ethnicity in Florida.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18556-e18556
Author(s):  
Robert Brooks Hines ◽  
Asal Johnson ◽  
Eunkyung Lee ◽  
Stephanie Erickson ◽  
Saleh M.M. Rahman
Keyword(s):  
Breast Cancer ◽  
Ethnic Disparities ◽  
Cancer Death ◽  
Cancer Outcomes ◽  
Subdistribution Hazard ◽  
Breast Cancer Death ◽  
Breast Cancer Outcomes ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

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.

scholarly journals Racial/Ethnic Disparities in Mammogram Frequency Among Women With Intellectual Disability

2019 ◽  
Vol 57 (3) ◽  
pp. 177-187 ◽  
Author(s):  
Evelyn Arana ◽  
Amy Carroll-Scott ◽  
Philip M. Massey ◽  
Nora L. Lee ◽  
Ann C. Klassen ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Black Women ◽  
Medical Record ◽  
Ethnic Groups ◽  
White Women ◽  
Ethnic Disparities ◽  
Medical Record Data ◽  
Record Data ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Little information exists on the associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. This study collected survey and medical record data to examine this relationship. Results indicated that Hispanic and Black women with ID were more likely than White women with ID to have mammograms every 2 years. Participants who live in a state-funded residence, were aged 50+, and had a mild or moderate level of ID impairment were more likely to undergo mammography compared to participants living with family or alone, were &lt;50, and had severe ID impairment. Further research is needed to understand the mechanisms explaining disparities in mammograms between these racial/ethnic groups.

Infant Mortality among Adolescent Mothers in the United States: A 5-Year Analysis of Racial and Ethnic Disparities

2020 ◽  
Author(s):  
Matthew D. Moore ◽  
Anne E. Brisendine ◽  
Martha S. Wingate
Keyword(s):  
United States ◽  
Preterm Birth ◽  
Infant Mortality ◽  
Ethnic Disparities ◽  
The United States ◽  
Racial And Ethnic Disparities ◽  
Postneonatal Mortality ◽  
Maternal Characteristics ◽  
Race Ethnicity ◽  
Racial Ethnic

Objective This study was aimed to examine differences in infant mortality outcomes across maternal age subgroups less than 20 years in the United States with a specific focus on racial and ethnic disparities. Study Design Using National Center for Health Statistics cohort-linked live birth–infant death files (2009-2013) in this cross-sectional study, we calculated descriptive statistics by age (<15, 15–17, and 18–19 years) and racial/ethnic subgroups (non-Hispanic white [NHW], non-Hispanic black [NHB], and Hispanic) for infant, neonatal, and postneonatal mortality. Adjusted odds ratios (aOR) were calculated by race/ethnicity and age. Preterm birth and other maternal characteristics were included as covariates. Results Disparities were greatest for mothers <15 and NHB mothers. The risk of infant mortality among mothers <15 years compared to 18 to 19 years was higher regardless of race/ethnicity (NHW: aOR = 1.40, 95% confidence interval [CI]: 1.06–1.85; NHB: aOR = 1.28, 95% CI: 1.04–1.56; Hispanic: aOR = 1.36, 95%CI: 1.07–1.74). Compared to NHW mothers, NHB mothers had a consistently higher risk of infant mortality (15–17 years: aOR = 1.12, 95% CI: 1.03–1.21; 18–19 years: aOR = 1.21, 95% CI: 1.15–1.27), while Hispanic mothers had a consistently lower risk (15–17 years: aOR = 0.72, 95% CI: 0.66–0.78; 18–19 years: aOR = 0.74, 95% CI: 0.70–0.78). Adjusting for preterm birth had a greater influence than maternal characteristics on observed group differences in mortality. For neonatal and postneonatal mortality, patterns of disparities based on age and race/ethnicity differed from those of overall infant mortality. Conclusion Although infants born to younger mothers were at increased risk of mortality, variations by race/ethnicity and timing of death existed. When adjusted for preterm birth, differences in risk across age subgroups declined and, for some racial/ethnic groups, disappeared. Key Points

scholarly journals Maternal Age Patterns of Preterm Birth: Exploring the Moderating Roles of Chronic Stress and Race/Ethnicity

2020 ◽  
Vol 54 (9) ◽  
pp. 653-664 ◽  
Author(s):  
Sangmi Kim ◽  
Eun-Ok Im ◽  
Jianghong Liu ◽  
Connie Ulrich
Keyword(s):  
Preterm Birth ◽  
Black Women ◽  
Chronic Stress ◽  
Maternal Age ◽  
Ethnic Disparities ◽  
Birth Certificates ◽  
Future Research ◽  
Age Related ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Background Despite the suggested contribution of cumulative chronic stress to the racial/ethnic disparities in preterm birth (PTB), it is unclear how chronic stress, maternal age, and race/ethnicity are linked underlying PTB. Purpose We investigated the moderating effect of chronic stress on the maternal age–PTB association among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women. Methods We analyzed the Washington State’s Pregnancy Risk Assessment Monitoring System data linked with birth certificates. The sample included women aged 18 years or older who birthed the first, singleton baby without birth defects. Chronic stress was measured by race/ethnicity-specific chronic stress indices. A maternal age–chronic stress interaction was modeled to predict PTB by logistic regression stratified by race/ethnicity. In subanalysis, the moderating role of racism was investigated in the maternal age–chronic stress interaction among three minority groups combined. Results Women’s maternal age trajectory of PTB varied by their race/ethnicity and chronic stress level. N-H White and N-H Black women showed a steeper maternal age-related increase in PTB (weathering) under higher chronic stress, indicating a chronic stress’ cumulative effect with maternal age. Besides, the extent of weathering was amplified by racism on top of chronic stress, particularly among N-H Black women. Conclusions These results show that both chronic stress and racism may develop accelerated PTB risk among minority women. Future research should use more objective and accurate chronic stress measures to ascertain the complex relationships among chronic stress, racial discrimination, and maternal age underlying the racial/ethnic differentials in PTB.

An Examination of Racial/Ethnic Disparities in Truancy Court

2019 ◽  
Vol 66 (1) ◽  
pp. 33-58
Author(s):  
Laura L. Rubino ◽  
Valerie R. Anderson ◽  
Christina A. Campbell
Keyword(s):  
Regression Models ◽  
Ethnic Disparities ◽  
Initial Contact ◽  
White Youth ◽  
School To Prison Pipeline ◽  
Status Offense ◽  
Race Ethnicity ◽  
Racial Ethnic

The purpose of this study was to examine the effect of race/ethnicity on recidivism outcomes with a sample of juveniles involved with a truancy court. Three regression models were conducted to examine the influence of race/ethnicity on receiving any new court petition ( N = 1,206), including petitions for delinquency offenses or any new status offense petition within 2 years of their initial contact with the court. Results suggest that racial/ethnic disparities exist for juveniles involved in truancy court, especially with regard to new delinquency petitions. These findings are important to take into consideration to understand how truancy courts may facilitate the school-to-prison pipeline for non-White youth.

scholarly journals Striking Racial/Ethnic Disparities in Liver Cancer Incidence Rates and Temporal Trends in California, 1988–2012

2018 ◽  
Vol 110 (11) ◽  
pp. 1259-1269 ◽  
Author(s):  
Christopher Pham ◽  
Tse-Ling Fong ◽  
Juanjuan Zhang ◽  
Lihua Liu
Keyword(s):  
Asian American ◽  
Temporal Trends ◽  
Ethnic Disparities ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Percent Change ◽  
Southeast Asians ◽  
Ethnic Populations ◽  
Race Ethnicity ◽  
Racial Ethnic

AbstractBackgroundHepatocellular carcinoma (HCC) is characterized by disparate risk patterns by race/ethnicity. We examined HCC incidence patterns and temporal trends among detailed racial/ethnic populations, including disaggregated Asian-American subgroups.MethodsUsing data from the population-based California Cancer Registry, we identified 41 929 invasive HCC cases diagnosed during 1988–2012. Patients were grouped into mutually exclusive racial/ethnic groups of non-Hispanic (NH) white, NH black, Hispanic, and NH Asian/Pacific Islander (API), as well as Asian subgroups of Chinese, Filipino, Japanese, Korean, Vietnamese, Cambodian, Laotian, and South Asian. Age-adjusted and age-specific incidence rates by sex, race/ethnicity, and time period were calculated. The average annual percent change (AAPC) in incidence rates was estimated using joinpoint regression. All estimates were provided with the 95% confidence intervals (CIs).ResultsAggregated NH API had higher HCC risk than NH whites, NH blacks, and Hispanics. When disaggregated, Southeast Asians (Vietnamese, Cambodians, and Laotians) had overall HCC incidence rates eight to nine times higher than NH whites and more than twice that of other ethnic Asians. Statistically significant rising temporal trends of HCC were found in NH whites, NH blacks, and Hispanics, especially those older than age 50 years. Overall HCC risk declined in Chinese males (AAPC = –1.3%, 95% CI = –2.0 to –0.6), but rose in Filipino (AAPC = +1.2%, 95% CI = 0.3 to 2.1) and Japanese males (AAPC = +3.0%, 95% CI = 0.4 to 5.6) and Vietnamese (AAPC = +4.5%, 95% CI = 0.7 to 8.5) and Laotian (+3.4%, 95% CI = 0.1 to 6.8) females.ConclusionsOur findings provide valuable information for the identification of at-risk ethnic subgroups of Asian Americans while underscoring the importance of disaggregating ethnic populations in cancer research.

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