Abstract PO-210: Healthcare disparities in melanoma overall survival evaluated by race/ethnicity and socioeconomic status and the impact of integrated healthcare on an insured population

Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared

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Exploring the Effect of Disability, Race-Ethnicity, and Socioeconomic Status on Scores on the Self-Determination Inventory: Student Report

Council review ◽

10.1177/0014402918782150 ◽

2018 ◽

Vol 85 (1) ◽

pp. 10-27 ◽

Cited By ~ 18

Author(s):

Karrie A. Shogren ◽

Leslie A. Shaw ◽

Sheida K. Raley ◽

Michael L. Wehmeyer

Keyword(s):

Socioeconomic Status ◽

Best Practices ◽

Interactive Effect ◽

Autism Spectrum ◽

The Self ◽

Self Determination ◽

Future Research ◽

Assessment Development ◽

Race Ethnicity ◽

The Impact

The Self-Determination Inventory: Student Report (SDI:SR) was developed to address a need in the field for tools to assess self-determination that are aligned with current best practices in assessment development and administration, and emerging research and best practices in promoting self-determination. The present study explored patterns of differences in self-determination scores across students with and without disabilities (i.e., no disability, learning disabilities, intellectual disability, autism spectrum disorder, and other health impairments) of varying racial-ethnic backgrounds (i.e., White, African American or Black, Hispanic or Latino[a], and Other) as well as the impact of receiving free and reduced price lunch (as a proxy for socioeconomic status) on self-determination scores in these groups. Findings suggest an interactive effect of disability, race-ethnicity, and free and reduced price lunch status on self-determination scores. Implications for future research and practice are discussed.

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The Impact of Socioeconomic Status and Race-Ethnicity on Dental Health

Sociological Perspectives ◽

10.1525/sop.2007.50.1.7 ◽

2007 ◽

Vol 50 (1) ◽

pp. 7-25 ◽

Cited By ~ 12

Author(s):

Kenneth Hudson ◽

Jean Stockard ◽

Zach Ramberg

Keyword(s):

Socioeconomic Status ◽

Dental Health ◽

Race Ethnicity ◽

The Impact

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Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

10.1101/2021.05.27.21257925 ◽

2021 ◽

Author(s):

Arnab K Ghosh ◽

Orysya Soroka ◽

Mark A Unruh ◽

Martin Shapiro

Keyword(s):

Socioeconomic Status ◽

Length Of Stay ◽

Median Income ◽

Adverse Health Outcomes ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic ◽

Fourth Quartile ◽

Zip Code ◽

Surgical Admission

Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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Impact of Socioeconomic Status & Race/Ethnicity On Survival in Diffuse Large B-Cell Lymphoma (DLBCL): A Population-Based Study.

Blood ◽

10.1182/blood.v114.22.1954.1954 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1954-1954

Author(s):

James M. Foran ◽

Laura A. McClure ◽

Christina A. Clarke ◽

Theresa H. M. Keegan

Keyword(s):

Socioeconomic Status ◽

B Cell Lymphoma ◽

Population Based ◽

Block Group ◽

Census Block ◽

Census Block Group ◽

Risk Of Death ◽

Race Ethnicity ◽

The Impact ◽

Neighborhood Ses

Abstract Abstract 1954 Poster Board I-977 Introduction: Despite advances in treatment and a well-characterized prognostic index, significant heterogeneity remains in DLBCL survival. Preliminary data suggest a potential survival disparity based on race/ethnicity or socioeconomic status (SES). To evaluate the impact of these and other variables on survival we performed an analysis in the ethnically diverse population-based California Cancer Registry (CCR). We utilized Neighborhood SES, an index of 7 census measures of education, income, occupation & cost of living, based on the residential census-block group at diagnosis. Each census-block group comprises ∼1500 residents. Neighborhood SES has been shown to be significantly associated with survival after Follicular Lymphoma (JCO 27:3044, 2009). Methods: All pts with DLBCL (ICD-O-3 codes 9680 & 9684) diagnosed from Jan 1988 to Dec 2007 and reported to CCR were included in the analysis, including n=16,892 diagnosed from 1988-2000, and n=11,916 from 2001-2007 (total study pop'n =28,808). HIV/AIDS pts were excluded, as were n=63 with Mediastinal LBCL & n=10 with primary effusion lymphoma. The mean age was 63 yrs, and the cohort was 53% male. Between time periods, there was a relative increase in Hispanic pts [15.4% (1988-2000) to 20.8% (2001-2007), p<0.001], and a 4% increase in advanced stage from 42% (1988-2000) to 46% (2001-2007) (p<0.001). Neighborhood SES was stratified into quintiles from lowest (SES-1) to highest (SES-5), the pt distribution was: SES-1, 14%; SES-2, 18%; SES-3, 21%; SES-4, 23%; and SES-5, 24%. To evaluate the impact of prognostic factors (particularly diagnosis period, SES, and race/ethnicity) on overall survival (OS) & disease-specific survival (DSS) we used Cox proportional hazards regression to calculate hazard ratios (HR) for death with 95% CI's. Multivariate regression models included variables significant at p<0.15 in univariate models or with a priori hypotheses for inclusion. Results are presented by stage at diagnosis [Localized/Regional (LocReg) vs. Advanced (ADV)]. Results: There was a significant improvement in OS in patients diagnosed after 2001 for both LocReg (HR 0.87, 95%CI 0.82-0.91, p<0.001) and ADV stage (HR 0.69, 95%CI 0.66-0.72, p<0.001), which correlates with the introduction of rituximab into therapy for DLBCL. As expected, age >60 years was associated with a significantly worse OS for LocReg (HR 3.06, 95%CI 2.90-3.24) and ADV stage (2.02, 95%CI 1.93-2.12). Females also had significantly better OS compared with males (Loc-Reg - HR 0.90, 95%CI 0.86-0.94; ADV - HR 0.89, 95%CI 0.85-0.93). There was no significant impact of race/ethnicity on survival with the exception of non-Hispanic Asian/Pacific Islanders (NH A/PI) with ADV stage, for whom OS was significantly inferior compared with whites (HR 1.18, 95%CI 1.09-1.27, p<0.001). Compared with the highest quintile (SES-5), there was a significant effect of lower neighborhood SES on OS and DSS (see Table). Conclusion: There has been a significant improvement in survival after DLBCL since 2001, but patients in the lowest SES-1 quintile have a 34% higher risk of death from any cause and 20% higher risk for death from lymphoma than those in the highest SES-5. In this model, race/ethnicity did not have a significant impact on survival with the exception of NH A/PI with ADV stage. Studies to understand and address these socioeconomic disparities are urgently required in order to extend the improvements in DLBCL survival more effectively. Disclosures: Foran: Genentech: Honoraria, Research Funding.

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The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.217 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 217-217 ◽

Cited By ~ 2

Author(s):

Julie Anna Wolfson ◽

Can-Lan Sun ◽

Heeyoung Kim ◽

Tongjun Kang ◽

Smita Bhatia

Keyword(s):

Overall Survival ◽

Multivariable Analysis ◽

Cancer Center ◽

Insurance Status ◽

Cancer Centers ◽

Risk Of Death ◽

Comprehensive Cancer Centers ◽

Increased Risk ◽

Race Ethnicity ◽

The Impact

217 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21y, impact of site of care on survival for vulnerable AYA subpopulations (race/ethnicity) between 22-39y at diagnosis remains unstudied. Methods: Utilizing a cohort of 10,602 AYAs newly diagnosed between 22-39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the Los Angeles County cancer registry between 1998 and 2008, we aimed to determine the impact of receiving care at NCI Comprehensive Cancer Centers (NCICCC) on overall survival for AYAs, and disparities in survival by race/ethnicity. We further aimed to understand the role of SES and insurance status in accessing care at NCICCC. Multivariable analyses included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model. Results: A total of 904 (9%) patients received treatment at the 3 NCICCC (City of Hope, Jonsson Cancer Center, and Norris Cancer Center) in LA County. Ten-year overall survival (10y OS) was significantly worse for patients treated at non-NCICCC (81%) when compared with those treated at NCICCC (83%, p=0.02). Also, 10y OS was worse for African Americans (AA) (68%) vs. non-Hispanic whites (86%, p<0.0001). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that AA (HR=1.5, p=0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (HR=0.9, p=0.84) was abrogated. However, among patients treated at non-NCICCC, these differences in outcome persisted (HR=1.48, p<0.0001). Independent of SES, insurance and tumor factors, AA (OR=0.44, p<0.001) were less likely to use NCICCC. Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the inferior outcome observed among AA with cancer. AA are less likely to use NCICCC for treatment. Barriers to accessing care at NCICCC are currently being explored.

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Investigation of an ethnic predisposition to developing brain metastases (BM) in Asian patients with colorectal cancer (CRC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15023 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15023-e15023

Author(s):

Kerri McGovern ◽

Teresa Rodriguez ◽

Melissa H Smith ◽

Antonia Maloney ◽

Wasif M. Saif

Keyword(s):

Overall Survival ◽

Molecular Markers ◽

Ethnic Disparities ◽

The United States ◽

Treatment Modalities ◽

Increased Risk ◽

Incidence And Mortality ◽

Race Ethnicity ◽

The Impact ◽

Hispanic White

e15023 Background: CRC, the third most common cancer in the United States, carries racial/ethnic disparities in both incidence and mortality. With availability of effective systemic therapies, the life of CRC patients can be prolonged which thereby increases the risk of metastases at uncommon sites, such as the brain. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients using retrospective data (2010 – 2018) at a single institution. Methods: We retrospectively reviewed patients diagnosed with CRC and collected data on age, race/ethnicity, stage, treatment modalities, metastatic sites, and survival. Race and ethnicity were defined in accordance with federal standards set by the U.S. Census. Following this, race/ethnicity was self-declared and/or based on the primary language declared and categorized as non-Hispanic White, Hispanic White, non–Hispanic Black, Asian, or Unknown/Other. CRC location was classified as right-sided, left-sided or rectal. Results: We identified 264 CRC patients (median age: 61; range: 38 - 99). Among them 123 identified as non-Hispanic white, 28 non-Hispanic black, 26 Hispanic white, and 9 declared Other. There were 76 (29%) who identified as Asian. Of those 76 patients, 5 (7%) developed BM. All 5 patients were male and stage IV at initial diagnosis. BM was a late stage phenomenon with rectal primary and lung metastases seemly associated with an increased risk in the specific cohort. Molecular markers such as KRAS were available in 3 patients without clear association. Median time to development of BM was 29 months (range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery. Conclusions: Our study showed an incidence of BM of 7% in the Asian sub-population compared to the historical control of 0.6 – 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of BM in CRC patients with emphasis on molecular markers. Recognition of BM in CRC patients is clinically relevant secondary to multiple lines of therapy as mentioned earlier and its grave impact on outcome.

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The Role of Psychosocial Processes in Explaining the Gradient Between Socioeconomic Status and Health

Current Directions in Psychological Science ◽

10.1111/1467-8721.01245 ◽

2003 ◽

Vol 12 (4) ◽

pp. 119-123 ◽

Cited By ~ 204

Author(s):

Nancy E. Adler ◽

Alana Conner Snibbe

Keyword(s):

Socioeconomic Status ◽

Allostatic Load ◽

Direction Of Causation ◽

Race Ethnicity ◽

And Gender ◽

Psychosocial Processes ◽

The Life Course ◽

Ethnicity And Gender ◽

The Impact

The gradient between socioeconomic status (SES) and health is well established: Many measures of health show that health increases as SES increases. However, the mechanisms underlying this association are not well understood. Behavioral, cognitive, and affective tendencies that develop in response to the greater psychosocial stress encountered in low-SES environments may partially mediate the impact of SES on health. Although these tendencies might be helpful for coping in the short term, over time they may contribute to the development of allostatic load, which increases vulnerability to disease. Debate remains regarding the direction of causation between SES and health, the impact of income inequality, the interaction of SES with race-ethnicity and gender, and the effects of SES over the life course.

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