Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Valy Fontil ◽  
Lucia Pacca ◽  
Brandon Bellows ◽  
Elaine Khoong ◽  
Charles McCulloch ◽  
...  
Keyword(s):  
Racial Differences ◽  
San Francisco ◽  
Structural Equation ◽  
Safety Net ◽  
Clinic Visit ◽  
Treatment Intensification ◽  
Missed Opportunities ◽  
Black Patients ◽  
Missed Visits ◽  
Equitable Treatment

Introduction: Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity. Hypothesis: We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities. Methods: We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP<140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes. Results: The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p<0.001) and missed more visits (β=0.37, p<0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure). Conclusion: Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.

scholarly journals Clinical Characteristics and Outcomes Based on Race of Hospitalized Patients With COVID-19 in a New Orleans Cohort

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Victoria Silver ◽  
Andrew G Chapple ◽  
Allison H Feibus ◽  
Jeremy Beckford ◽  
Natalie A Halapin ◽  
...  
Keyword(s):  
New Orleans ◽  
Racial Differences ◽  
Clinical Characteristics ◽  
Safety Net ◽  
Ordinal Scale ◽  
Black Communities ◽  
Symptom Duration ◽  
Black Patients ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities. Methods We conducted a retrospective study of patients admitted to an urban safety net hospital in New Orleans, Louisiana, with reactive SARS-CoV-2 testing from March 9 to 31, 2020. Clinical characteristics of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher exact tests. The relationship between race and outcome was assessed using day 14 status on an ordinal scale. Results This study included 249 patients. The median age was 59, 44% were male, and 86% were age ≥65 years or had ≥1 comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 vs 5.88 days; P = .05) and were more likely to have asthma (P = .008) but less likely to have dementia (P = .002). There were no racial differences in initial respiratory status or laboratory values except for higher lactate dehydrogenase in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio, 0.92; 95% CI, 0.70–1.20), were associated with worse day 14 outcomes. Conclusions Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and day 14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures and transmission in Black communities as one step toward reducing COVID-19-related racial inequities.

scholarly journals 57. clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 in New Orleans, LA: A Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S159-S160
Author(s):  
Victoria Silver ◽  
Andrew Chapple ◽  
Allison H Feibus ◽  
Jeremy Beckford ◽  
Natalie Halapin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
New Orleans ◽  
Racial Differences ◽  
Clinical Characteristics ◽  
Safety Net ◽  
Black Communities ◽  
Oxygen Requirement ◽  
Black Patients ◽  
Initial Oxygen

Abstract Background In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities. Methods We conducted a retrospective cohort study of patients admitted to an urban safety net hospital in New Orleans, LA with reactive SARS-CoV-2 testing from March 9–31, 2020. Clinical characteristics and outcomes of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher’s exact tests. We examined Day-14 status using an ordinal scale to assess race and outcome. Table 1. Demographics and Comorbidities by Race for Patients Hospitalized with COVID-19 Table 2. Clinical Characteristics at Presentation by Race for Patients Hospitalized with COVID-19, March 2020 Results This study included 249 patients. Median age was 59, 44% were male, 86% were age ≥65 years or had ≥1 comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 versus 5.88 days, p=0.05), and were more likely to have asthma (p=0.008), but less likely to have dementia (p=0.002). There were no racial differences in initial respiratory status or laboratory values other than higher initial LDH in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio = 0.92, 95%CI: 0.70–1.20), were associated with worse Day-14 outcomes. Figure 1: Admissions over time by Race Figure 2a: Hospital outcomes by Race over the Follow-up period Figure 2b: Day-14 Outcomes by Race Conclusion Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and Day-14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures in Black communities as one step towards reducing racial inequities related to COVID-19. Figure 3a: Logistic Regression for Initial Oxygen Requirement Figure 3b: Cumulative Logistic Regression for Ordinal Day-14 Outcomes Disclosures Meredith E. Clement, MD, FHI360 (Consultant)Gilead (Research Grant or Support)Janssen (Scientific Research Study Investigator)

scholarly journals Divergent poststroke outcomes for black patients

Neurology ◽  
2019 ◽  
Vol 93 (18) ◽  
pp. e1664-e1674 ◽  
Author(s):  
James F. Burke ◽  
Chunyang Feng ◽  
Lesli E. Skolarus
Keyword(s):  
Racial Differences ◽  
Care Setting ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Fee For Service ◽  
Primary Analysis ◽  
Skilled Nursing ◽  
Black Patients ◽  
Postacute Care ◽  
White Patients

ObjectiveTo explore racial differences in disability at the time of first postdischarge disability assessment.MethodsThis was a retrospective cohort study of all Medicare fee-for-service beneficiaries hospitalized with primary ischemic stroke (ICD-9,433.x1, 434.x1, 436) or intracerebral hemorrhage (431) diagnosed from 2011 to 2014. Racial differences in poststroke disability were measured in the initial postacute care setting (inpatient rehabilitation facility, skilled nursing facility, or home health) with the Pseudo-Functional Independence Measure. Given that assignment into postacute care setting may be nonrandom, patient location during the first year after stroke admission was explored.ResultsA total of 390,251 functional outcome assessments (white = 339,253, 87% vs black = 50,998, 13%) were included in the primary analysis. At the initial functional assessment, black patients with stroke had greater disability than white patients with stroke across all 3 postacute care settings. The difference between white and black patients with stroke was largest in skilled nursing facilities (black patients 1.8 points lower than white patients, 11% lower) compared to the other 2 settings. Conversely, 30-day mortality was greater in white patients with stroke compared to black patients with stroke (18.4% vs 12.6% [p < 0.001]) and a 3 percentage point difference in mortality persisted at 1 year. Black patients with stroke were more likely to be in each postacute care setting at 30 days, but only very small differences existed at 1 year.ConclusionsBlack patients with stroke have 30% lower 30-day mortality than white patients with stroke, but greater short-term disability. The reasons for this disconnect are uncertain, but the pattern of reduced mortality coupled with increased disability suggests that racial differences in care preferences may play a role.

scholarly journals Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention

2020 ◽  
pp. ASN.2020040502
Author(s):  
Joseph Lunyera ◽  
Robert M. Clare ◽  
Karen Chiswell ◽  
Julia J. Scialla ◽  
Patrick H. Pun ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Racial Differences ◽  
Medical Center ◽  
Reference Value ◽  
Coronary Intervention ◽  
Absolute Increase ◽  
Black Patients ◽  
Percutaneous Coronary ◽  
Duke University ◽  
Multiple Domains

BackgroundUndergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure.MethodsWe examined the association of self-reported race (Black, White, or other) and baseline eGFR with AKI incidence among patients who underwent PCI at Duke University Medical Center between January 1, 2003, and December 31, 2013. We defined AKI as a 0.3 mg/dl absolute increase in serum creatinine within 48 hours, or ≥1.5-fold relative elevation within 7 days post-PCI from the reference value ascertained within 30 days before PCI.ResultsOf 9422 patients in the analytic cohort (median age 63 years; 33% female; 75% White, 20% Black, 5% other race), 9% developed AKI overall (14% of Black, 8% of White, 10% of others). After adjustment for demographics, socioeconomic status, comorbidities, predisposing medications, PCI indication, periprocedural AKI prophylaxis, and PCI procedural characteristics, Black race was associated with increased odds for incident AKI compared with White race (odds ratio [OR], 1.79; 95% confidence interval [95% CI], 1.48 to 2.15). Compared with Whites, odds for incident AKI were not significantly higher in other patients (OR, 1.30; 95% CI, 0.93 to 1.83). Low baseline eGFR was associated with graded, higher odds of AKI incidence (P value for trend <0.001); however, there was no interaction between race and baseline eGFR on odds for incident AKI (P value for interaction = 0.75).ConclusionsBlack patients had greater odds of developing AKI after PCI compared with White patients. Future investigations should identify factors, including multiple domains of social determinants, that predispose Black individuals to disparate AKI risk after PCI.

Racial Differences in Occupational Turnover Intent among NCAA Division IA Assistant Football Coaches

2004 ◽  
Vol 21 (1) ◽  
pp. 84-92 ◽  
Author(s):  
George B. Cunningham ◽  
Michael Sagas
Keyword(s):  
Racial Differences ◽  
Ncaa Division I ◽  
Structural Equation ◽  
Career Satisfaction ◽  
Turnover Intentions ◽  
Division I ◽  
Equation Modeling ◽  
Turnover Intent ◽  
Football Coaches ◽  
Intercollegiate Athletic Departments

Whereas previous research has demonstrated racial differences in occupational turnover intent, why such differences exist remains unclear. Therefore, the purpose of this Research Note was to examine perceived opportunity, career satisfaction, and occupational turnover intent of racial-minority and White NCAA Division I-A assistant football coaches (N = 382). Multivariate analysis of variance indicated that racial minorities perceived less career-related opportunity, were less satisfied with their careers, and had greater occupational turnover intentions than their White counterparts. Structural equation modeling indicated that career satisfaction fully mediated the relationship between perceived opportunity and occupational turnover intent. Results highlight the need for a change in the organizational culture of intercollegiate athletic departments such that diversity is valued and embraced.

Abstract 16520: Predictors of Thirty Day Readmission in a Vulnerable and Underserved Urban Heart Failure Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexandra B Steverson ◽  
Paul Marano ◽  
Caren Chen ◽  
Yifei Ma ◽  
Rachel Stern ◽  
...  
Keyword(s):  
Heart Failure ◽  
Substance Use ◽  
San Francisco ◽  
Chart Review ◽  
Safety Net ◽  
Housing Status ◽  
Medical Comorbidities ◽  
Increased Risk ◽  
Safety Net Hospital ◽  
Icd 10

Introduction: Heart failure (HF) readmission quality metrics disproportionately impact reimbursement in safety net hospitals. Prior research has demonstrated the effect of medical comorbidities on readmission, however, there is a paucity of data on predictors of readmission in vulnerable and underserved HF patients. We sought to evaluate the effect of demographics, medical and social comorbidities on risk of 30 day readmission in an academic safety net hospital in San Francisco. Methods: We performed a retrospective chart review from 2018 to 2020. Patients were included if treated for HF while on inpatient cardiology or medicine services and were assigned an ICD-10 discharge code for HF. Patients less than 21 years old were excluded. Demographics and comorbidities were obtained through evaluation of ICD-10 discharge codes and chart review. Multivariate modeling was used to determine predictors of 30 day readmission. Results: The study population included 383 patients in which the mean age was 60±13 years and 73% (n=282) were male. 44% (170) were Black, 23% (88) were Latinx, 33% (127) were not housed, 97% (371) had public insurance, and 21% (81) had a diagnosis of mental illness. 46% (177) had CAD, 76% (291) hypertension, and 36% (177) DM. Substance use was common with 30% (114) using methamphetamines, 36% (138) cocaine, 18% (69) opioids, and 35% (135) alcohol. On multi-variate analysis, EF less than 40% (75%, 285) was the only medical comorbidity associated with an increased risk of readmission (OR 1.86, 1.1-3.1, p= 0.018). Social variables associated with increased risk of readmission included identifying as Black (OR 2.26, 1.03-5.0, p= 0.043) or Latinx (OR 3.43, 1.41-7.59, p= 0.006), homelessness (OR 3.02, 1.76-5.18, p=<0.001), and specific substance use: methamphetamine (OR 2.23, 1.39-3.57, p=0.001), cocaine (OR 1.63, 1.03-2.57, p= 0.037), opioids (OR 1.81, 1.05-3.13, p= 0.033), and alcohol (OR 2.26, 1.43-3.58, p= 0.001). Conclusion: Race, housing status and substance use were more strongly associated with readmission risk than medical comorbidities in a population of urban, vulnerable and underserved HF patients. Interventions to improve HF readmission metrics should consider addressing racial and social disparities in similar populations.

Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6542-6542
Author(s):  
Adrien Bernstein ◽  
Ruchika Talwar ◽  
Elizabeth A. Handorf ◽  
Kaynaat Syed ◽  
Serge Ginzburg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Safety Net ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Gleason Grade ◽  
Grade Group ◽  
Black Patients ◽  
The Impact ◽  
White Patients

6542 Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term. Results: 647 men with untreated non-metastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

Abstract 16247: Methamphetamine Use Predicts Worse Prognosis in a Safety Net Heart Failure Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anjali B Thakkar ◽  
Yifei Ma ◽  
Teresa Wang ◽  
Alexandra Teng ◽  
Rebecca Scherzer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
San Francisco ◽  
Cox Regression ◽  
Bypass Graft ◽  
Safety Net ◽  
High Risk Population ◽  
Age And Gender ◽  
Safety Net Hospital ◽  
And Gender

Background: Methamphetamine (MA) use is rising, and overdose deaths have increased by 500% in San Francisco since 2008. MA use is associated with heart failure (HF); yet, cardiovascular (CV) outcomes in this population have not been described. Methods: We performed a retrospective case-control study of HF patients at a safety net hospital in San Francisco. Between January 2001-June 2019, 1771 HF patients with MA use were matched by age and gender to 3542 HF patients without MA use. We examined age and gender-adjusted associations of MA use with likelihood of index HF admission and 30-day readmission (HF and all-cause), and used demographic-adjusted Cox regression model with competing risks to compare hazard rates associated with MA use over the 18-year study period. Results: At time of HF diagnosis, mean age was 52 years and 77% were male. Patients with MA use were significantly more likely than non-MA users to be black (49.1% vs 33.0%), and to have comorbid conditions including HIV (14.5% vs 4.7%), pulmonary hypertension (11.1% vs 7.7%), hypertension (82.0% vs 77.6%), and cocaine use (58.0% vs 14.7%). Despite similar rates of coronary artery disease, myocardial infarction, and diabetes, HF patients with MA use were less likely to have percutaneous coronary intervention (6.1% vs 8.2%) or coronary artery bypass graft (0.8% vs 1.4%), p<0.05 for all. Compared to HF patients without MA use, HF patients with MA use had higher rates of index HF hospitalizations (36.0% vs 21.7%, adjusted odds ratio 2.04, 95% CI 1.80-2.32, p<0.01), 30-day HF readmission (12.2% vs 6.4%, adjusted hazard ratio (aHR) 1.87, 95% CI 1.31-2.67, p<0.01) and 30-day all cause readmission (20.9% vs 14.3%, aHR 1.46, 95% CI 1.14-1.88, p<0.01). Exposure to MA was associated with higher likelihood of death during the study period, regardless of hospitalizations (22.4% vs 15.1%, aHR=1.17, 95% CI 1.03-1.33, p<0.01). Conclusions: In our study, HF patients with MA use were more likely to be admitted for an index HF admission; subsequently, they were also more likely to be readmitted within 30 days. Regardless of hospitalization risk, individuals with MA use had higher likelihood of death. Further study to understand the clinical and socioeconomic factors driving worse outcomes in this high-risk population is needed.

Sign in / Sign up

Export Citation Format

Share Document