Removal of the Black race coefficient from the estimated glomerular filtration equation improves transplant eligibility for Black patients at a single center

2021 ◽  
Author(s):  
Melanie P. Hoenig ◽  
Alison Mann ◽  
Martha Pavlakis
Keyword(s):  
Glomerular Filtration ◽  
Single Center ◽  
Filtration Equation ◽  
Black Race ◽  
Black Patients

scholarly journals Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

2021 ◽  
Author(s):  
Matthew J. Czarny ◽  
Rani K. Hasan ◽  
Wendy S. Post ◽  
Matthews Chacko ◽  
Stefano Schena ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Black Race ◽  
Transcatheter Aortic Valve ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P <0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P <0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P =0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P <0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P <0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P =0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.

Abstract 164: Impact of Sex and Race on the Likelihood of Mortality, Cardiology Consultation, and Coronary Angiography Among Hospitalized Patients Evaluated With Cardiac Troponin

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David E Winchester ◽  
Christopher Estel ◽  
Kristopher Kline ◽  
Sean Taasan ◽  
Ki Park ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Black Race ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Risk Of Mortality ◽  
Black Patients ◽  
Highly Sensitive ◽  
Comorbidity Index ◽  
Male Sex ◽  
Cardiovascular Services

Introduction: Serum troponin (Tn) is a highly sensitive test useful in diagnosing acute myocardial infarction. Elevated Tn is associated with higher mortality and greater use of cardiovascular services. The effect of sex and race on these observations has not been well characterized. We hypothesize that sex and race will be independent predictors of cardiology consultation and cardiac catheterization. Methods: We analyzed adult patients hospitalized between 2012 and 2015 who had Tn testing. Patients were compared in 2 cohorts: those with and those without elevation in Tn. We extracted data on demographics, self-reported race, medical history, new inpatient diagnoses, Charlson comorbidity index (CCI), and mortality (up to 3 years). We developed a Cox proportional hazard model for mortality and used logistic regression to determine associations with cardiology consultation and cardiac catheterization. Results: Of the 26,663 included, 22.0% were black, 50.1% were women, 9.8% had diabetes, and 6.4% had pre-existing coronary disease. Cardiac catheterization was performed on 1,800 (6.8%), 3,672 (13.8%) had a cardiology consult, and 4,962 (18.6%) had elevated Tn. Among the variables associated with cardiology consultation were elevated Tn (odds ratio [OR] =3.44, 95% confidence interval [CI] 3.19-3.72, p<0.0001), male sex (OR=1.29, 95% CI 1.20-1.39, p<0.0001) and black race (OR=0.85, 95% CI 0.77-0.93, p=0.0006). Cardiac catheterization was associated with elevated Tn (OR=8.16, 95% CI 7.34-9.06, p<0.0001), male sex (OR=1.45, 95% CI 1.31-1.61, p<0.0001), CCI >4 (OR=0.44, 95% CI 0.35-0.54, p<0.0001), and black race (OR=0.72, 95% CI 0.63-0.82, p<0.0001). A total of 4,697 patients died during follow-up. Elevated Tn (hazard ratio [HR] =2.05, p<0.0001), male sex (HR=1.14, p<0.0001), and CCI >4 (HR=3.33, p<0.0001) were associated with a higher risk of death, while risk among black patients was lower (HR=0.86, p<0.0001). Conclusion: As observed in other investigations, elevated Tn is associated with a higher risk of mortality, cardiac catheterization, and cardiology consultation. We observed that men were more likely to undergo catheterization and consultation, while black patients were less likely to have either. Further investigation into reasons for the observed disparities is warranted.

Racial Disparities in Pediatric Acute Myeloid Leukemia during Induction

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 530-530
Author(s):  
Lena E. Winestone ◽  
Kelly Diringer Getz ◽  
Tamara P. Miller ◽  
Jennifer J. Wilkes ◽  
Leah Sack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Public Insurance ◽  
Black Race ◽  
Black Patients ◽  
Publicly Insured ◽  
Insured Patients ◽  
Acute Myeloid ◽  
White Patients

Abstract Introduction: Black patients with acute myeloid leukemia (AML) have inferior overall survival relative to White patients. Few studies have evaluated differences in induction mortality and none has assessed the contribution of severity of illness at presentation to the disparity in survival. Our primary objectives were to compare induction mortality and acuity of presentation among Black relative to White patients and to assess whether any disparity in induction mortality is the consequence of differences in presentation acuity. In addition, we explored the interaction between Black race and public insurance on induction mortality with use of single referent models. Methods: Using a retrospective cohort of children (ages 0 to 18 years) from 2004 to 2014 with new-onset AML diagnosed and treated at free-standing pediatric hospitals who contribute inpatient information to the Pediatric Health Information System administrative database (PHIS), we evaluated inpatient mortality over two courses of standard induction chemotherapy. We examined race (Black versus White) as the primary exposure and insurance was considered with race using a common reference group. We also considered Intensive Care Unit (ICU)-level resource use during the first 72 hours following the initial AML admission as a surrogate for acuity at presentation and a potential mediator of the association between race and induction mortality. Results: 1,122 patients (183 Black, 939 White) with AML who received standard induction chemotherapy were included. Induction mortality for Blacks was substantially higher than for Whites (cHR= 2.31, 95% CI: 1.01, 5.42). Blacks also had a significantly higher risk of requiring any ICU-level care within the first 72 hours after initial presentation compared with Whites (cHR= 1.52, 95% CI: 1.02, 2.24).The association between race and induction mortality was attenuated following adjustment for ICU-level care within the initial 72 hours after admission, (aHR=1.42, 95% CI: 0.67, 2.99). Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Induction mortality rates for Black and White patients were more similar among the privately insured and were increasingly disparate among the publicly insured. Conclusion: Our findings suggest that Black patients with AML present with more acute illness at initial diagnosis, accounting for up to 63% of the relative excess induction mortality. Identifying factors impacting acuity of illness at presentation and associated with public insurance may help to identify opportunities for intervention and thus narrow the current racial disparities in pediatric AML survival. Table 1. Inpatient Induction Mortality and ICU level Care by Race Outcome, Follow-up Period Overall (N=1122) n (%) Black (n=183) n (%) White (n=939) n (%) cHR (95% CI) aHRa (95% CI) Induction Death 27 (2.4%) 8 (4.4%) 19 (2.0%) 2.31 (1.01, 5.42) 1.42 (0.67, 2.99) Any ICU Level Care in first 72 hrs 135 (12.0%) 31 (16.9%) 104 (11.1%) 1.52 (1.04, 2.24) ICU involving >1 system in first 72 hrs 47 (4.2%) 18 (9.8%) 29 (3.1%) 3.35 (1.84, 6.12) Any ICU Level Care in Induction 237 (21.1%) 48 (26.2%) 189 (20.1%) 1.30 (0.99, 1.71) 1.09 (0.74, 1.61) ICU involving >1 system in Induction 99 (8.8%) 22 (12.0%) 77 (8.2%) 1.42 (0.85, 2.38) 0.92 (0.54, 1.57) a adjusted for ICU acuity score within the first 72 hours of index admission Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Disclosures Wilkes: Alex's Lemonade Stand Foundation: Research Funding; Healthcare Research and Quality: Research Funding. Fisher:Merck: Research Funding; Pfizer: Research Funding. Epstein:Medicus Economics: Consultancy. Aplenc:Sigma Tau: Consultancy.

scholarly journals Delays in presentation and mortality among Black patients with mechanical thrombectomy after large-vessel stroke at a US hospital

2021 ◽  
Vol 51 (1) ◽  
pp. E9
Author(s):  
Joshua S. Catapano ◽  
Kavelin Rumalla ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Dara S. Farhadi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Stroke Onset ◽  
Hospital Length Of Stay ◽  
Multivariable Logistic Regression Analysis ◽  
Delayed Presentation ◽  
Black Race ◽  
Risk Of Death ◽  
Black Patients ◽  
Increased Risk

OBJECTIVE The incidence and severity of stroke are disproportionately greater among Black patients. In this study, the authors sought to examine clinical outcomes among Black versus White patients after mechanical thrombectomy for stroke at a single US institution. METHODS All patients who underwent mechanical thrombectomy at a single center from January 1, 2014, through March 31, 2020, were retrospectively analyzed. Patients were grouped based on race, and demographic characteristics, preexisting conditions, clinical presentation, treatment, and stroke outcomes were compared. The association of race with mortality was analyzed in multivariable logistic regression analysis adjusted for potential confounders. RESULTS In total, 401 patients (233 males) with a reported race of Black (n = 28) or White (n = 373) underwent mechanical thrombectomy during the study period. Tobacco use was more prevalent among Black patients (43% vs 24%, p = 0.04), but there were no significant differences between the groups with respect to insurance, coronary artery disease, diabetes, illicit drug use, hypertension, or hyperlipidemia. The mean time from stroke onset to hospital presentation was significantly greater among Black patients (604.6 vs 333.4 minutes) (p = 0.007). There were no differences in fluoroscopy time, procedural success (Thrombolysis in Cerebral Infarction grade 2b or 3), hospital length of stay, or prevalence of hemicraniectomy. In multivariable analysis, Black race was strongly associated with higher mortality (32.1% vs 14.5%, p = 0.01). The disparity in mortality rates resolved after adjusting for the average time from stroke onset to presentation (p = 0.14). CONCLUSIONS Black race was associated with an increased risk of death after mechanical thrombectomy for stroke. The increased risk may be associated with access-related factors, including delayed presentation to stroke centers.

scholarly journals Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

2020 ◽  
Author(s):  
Giselle Alexandra Suero Abreu ◽  
Aris Karatasakis ◽  
Sana Rashid ◽  
Maciej Tysarowski ◽  
Analise Y Douglas ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Statin Treatment ◽  
Blood Cholesterol ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Clinic ◽  
Black Race ◽  
Black Patients ◽  
Hispanic Patients ◽  
Ascvd Risk

Introduction: Appropriate lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice in an underserved population, with a focus on statin treatment. Methods: We reviewed the records of 1,042 consecutive patients seen between August 2018 and August 2019 in an outpatient academic primary care clinic. Eligibility for statin and other lipid-lowering therapies was determined based on the 2018 American Heart Association and American College of Cardiology (AHA/ACC) guideline on the management of blood cholesterol. Results: Among 464 statin-eligible patients, age was 61.1 +/- 10.4 years and 53.9% were female. Most patients were Black (47.2%), followed by Hispanic (45.7%), and White (5.0%). Overall, 82.1% of patients were prescribed a statin. Statin-eligible patients who qualified based only on a 10-year ASCVD risk > 7.5% were less likely to be prescribed a statin (32.8%, p<0.001). After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age > 55 years (OR = 4.59 [95% CI 1.09 - 16.66], p = 0.026), hypertension (OR = 2.38 [95% CI 1.29 - 4.38], p = 0.005) and chronic kidney disease (OR = 3.95 [95% CI 1.42 - 14.30], p = 0.017). Factors independently associated with statin undertreatment were Black race (OR = 0.42 [95% CI 0.23 - 0.77], p = 0.005), and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 [95% CI 0.07 - 0.25], p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to Black patients (86.8% vs 77.2%). Conclusion: Statin underprescription is seen in approximately one out of five eligible patients, and is independently associated with Black race, younger age, fewer comorbidities, and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to Black patients.

Abstract TP186: High Hospital Mortality Among Non-black Stroke Patients with Metabolic Syndrome

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Digvijaya D Navalkele ◽  
Amelia K Boehme ◽  
Kelly Harmon ◽  
Laurie Schluter ◽  
Melissa Freeman ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Hospital Mortality ◽  
Scale Score ◽  
Prior History ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Black Race ◽  
Black Patients ◽  
History Of

Introduction: Limited information is available on race based stroke outcomes among patients with metabolic syndrome. Methods: We conducted a retrospective review of acute ischemic stroke patients between 2008 and 2015 who were admitted to stroke service at a comprehensive stroke center. Patients were categorized to have metabolic syndrome if they have three of the four criteria (history of hypertension or diabetes or triglycerides ≥ 150 mg/dl or high density lipoprotein (HDL) < 50 mg/dl for women or < 40 mg/dl for men). Patients with metabolic syndrome were grouped based on their race. Primary outcome was modified Rankin Scale score at discharge. Secondary outcomes measures were neurological worsening, hospital mortality, in-hospital complications, discharge stroke scale, and length of stay. Results: Total 659 patients were found to have metabolic syndrome. Among these patients, 206 (31%) were non-black and 453 (69%) were of black race. Compared to non-black patients with metabolic syndrome, black patients were more likely to be women (56% vs. 35%, p<0.0001) and have a prior history of stroke (55% vs. 35%, p<0.0001). Median admission diastolic blood pressure was higher among blacks compared to non-blacks (92 vs. 87mmHg, p = 0.0093). Higher proportion of black patients were on anti-platelets (67% vs. 56%, p = 0.01), statins (83% vs. 71%; p =0.001), and anti-hypertensive medications at home (90% vs. 81%, p = 0.001). Non-blacks had higher triglycerides (188 vs. 132 mg/dl, p<0.0001) and lower HDL levels (36 vs. 44 mg/dl, p< 0.0001). There was no difference in discharge modified Rankin Scale score among the groups. In-hospital myocardial infarction was significantly more frequent among non-blacks (9% vs. 4%, p = 0.03). In-hospital mortality was significantly higher in the non-black group (11% vs. 6%, p = 0.02). Conclusion: Non-black race was associated with higher in-hospital mortality among patients with metabolic syndrome admitted for stroke. Further exploration of higher mortality among this group of patients is warranted to improve stroke outcomes.

scholarly journals Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 361
Author(s):  
Giselle Alexandra Suero-Abreu ◽  
Aris Karatasakis ◽  
Sana Rashid ◽  
Maciej Tysarowski ◽  
Analise Douglas ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Medical Center ◽  
Statin Treatment ◽  
Population Based ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Black Race ◽  
Black Patients ◽  
Hispanic Patients ◽  
Ascvd Risk

Lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09–16.66), p = 0.026), hypertension (OR = 2.38 (95% CI 1.29–4.38), p = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42–14.30), p = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23–0.77), p = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07–0.25), p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). Statin underprescription is seen in approximately one out of five eligible patients and is independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to black patients.

scholarly journals Racial Disparities in Incidence and Survival for Patients with Multiple Myeloma in the United States

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4508-4508
Author(s):  
Lakshmi Radhakrishnan ◽  
Sagar Lonial ◽  
Ajay K. Nooka
Keyword(s):  
Overall Survival ◽  
Black Males ◽  
Research Funding ◽  
The United States ◽  
Incidence Rates ◽  
P Value ◽  
Independent Factor ◽  
Black Race ◽  
Black Patients ◽  
Adjusted Incidence

Abstract Background: Over the past two decades the incidence of myeloma has been gradually increasing in the United States. The incidence rates are higher in men than women, and higher in blacks than whites. Similar to the differential incidence, overall survival rate between blacks and whites are also dissimilar; a difference that is not completely explained and may be attributable to genetic variations between the two groups. Methods: Using data from 18 SEER registries, we examined differences in incidence, mortality and survival from 1973-2012 for 89,867 myeloma patients (68,701 white, 16,364 black and 4,802 others) by race, gender and age-stratification. ICD-O-3 and morphologic (9732/3) codes were used to identify cases. Age-adjusted incidence and mortality rates, regression analysis and survival curves were calculated by race. Statistics were computed using the National Cancer Institute SEER*Stat software, version 8.2.0. and SAS software, version 9.4 (SAS Institute Inc, Cary, NC). Results: Median age at diagnosis was 70 years (range 20-100 years) for the overall population (blacks: 66 years; whites: 71 years, and others: 69 years (P<0.01). The age-adjusted incidence rates per 100,000 populations were: blacks- 11.9 (95% CI 11.6, 12.1, P-value<0.05); whites- 5.1 (95% CI 5.0, 5.2) and others- 3.7 (95% CI 3.6, 3.9). The incidence rates were higher for black males, 14.2 (95% CI 14, 14.7) followed by black females, 10.3 (95% CI 10, 10.6, P-value<0.05). Using white male as reference, incidence rate ratios for black males and females are 2.20 (95% CI 2.12, 2.28) and 1.60 (95% CI 1.54, 1.65) respectively. The 2-year relative survival rates (RSR) for the study population were: whites- 60.4%, blacks: 64.1% and others: 68.4%, respectively. The 5-year RSR by race and gender are included in figure 1. On the survival analysis, black race is an independent factor to have improved survival (HR=0.884, P-value<0.0001). This was corroborated on regression analysis, showing decreased hazard ratios for blacks (HR 0.856 95% CI 0.834, 0.878) compared to whites (P-value<0.001). Conclusions: Black patients are diagnosed younger than whites and other races. The IRRs for black males are twice compared to white males. While the 5-year RSRs are improving for all races and genders, black race is an independent factor to have improved survival. Further population-based studies focused on the exploring the underlying biological mechanisms of disease may explain the earlier presentation with disease and better overall survival among black patients. Figure 1. Figure 1. Disclosures Lonial: Novartis: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Onyx: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding. Nooka:Onyx Pharmaceuticals: Consultancy; Spectrum Pharmaceuticals: Consultancy.

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