Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry

Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

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Racial, Ethnic, and Socioeconomic Factors Result in Disparities in Outcome Among Children with Acute Lymphoblastic Leukemia Not Fully Attenuated By Disease Prognosticators: A Children's Oncology Group (COG) Study

Blood ◽

10.1182/blood-2021-147386 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 211-211

Author(s):

Sumit Gupta ◽

David T. Teachey ◽

Meenakshi Devidas ◽

Yunfeng Dai ◽

Richard Aplenc ◽

...

Keyword(s):

Lymphoblastic Leukemia ◽

Advisory Committees ◽

Black Patients ◽

Increased Risk ◽

Hispanic Patients ◽

Race Ethnicity ◽

Racial Ethnic ◽

Subsequent Addition ◽

Hispanic White ◽

White Patients

Abstract Introduction: Health disparities are major issue for racial, ethnic, and socioeconomically disadvantaged groups. Though outcomes in childhood acute lymphoblastic leukemia (ALL) have steadily improved, identifying persistent disparities is critical. Prior studies evaluating ALL outcomes by race or ethnicity have noted narrowing disparities or that residual disparities are secondary to differences in leukemia biology or socioeconomic status (SES). We aimed to identify persistent inequities by race/ethnicity and SES in childhood ALL in the largest cohort ever assembled for this purpose. Methods: We identified a cohort of newly-diagnosed patients with ALL, age 0-30.99 years who were enrolled on COG trials between 2004-2019. Race/ethnicity was categorized as non-Hispanic white vs. Hispanic vs. non-Hispanic Black vs. non-Hispanic Asian vs. Non-Hispanic other. SES was proxied by insurance status: United States (US) Medicaid (public health insurance for low-income individuals) vs. US other (predominantly private insurance) vs. non-US patients (mainly jurisdictions with universal health insurance). Event-free and overall survival (EFS, OS) were compared across race/ethnicity and SES. The relative contribution of disease prognosticators (age, sex, white blood cell count, lineage, central nervous system status, cytogenetics, end Induction minimal residual disease) was examined with Cox proportional hazard multivariable models of different combinations of the three constructs of interest (race/ethnicity, SES, disease prognosticators) and examining hazard ratio (HR) attenuation between models. Results: The study cohort included 24,979 children, adolescents, and young adults with ALL. Non-Hispanic White patients were 13,872 (65.6%) of the cohort, followed by 4,354 (20.6%) Hispanic patients and 1,517 (7.2%) non-Hispanic Black patients. Those insured with US Medicaid were 6,944 (27.8%). Five-year EFS (Table 1) was 87.4%±0.3% among non-Hispanic White patients vs. 82.8%±0.6% [HR 1.37, 95 th confidence interval (95CI) 1.26-1.49; p<0.0001] among Hispanic patients and 81.9%±1.2% (HR 1.45, 95CI 1.28-1.56; p<0.0001) among non-Hispanic Black patients. Outcomes for non-Hispanic Asian patients were similar to those of non-Hispanic White patients. US patients on Medicaid had inferior 5-year EFS as compared to other US patients (83.2%±0.5% vs. 86.3%±0.3%, HR 1.21, 95CI 1.12-1.30; p<0.0001) while non-US patients had the best outcomes (5-year EFS 89.0%±0.7%, HR 0.78, 95CI 0.71-0.88; p<0.0001). There was substantial imbalance in traditional disease prognosticators (e.g. T-cell lineage) across both race/ethnicity and SES, and of race/ethnicity by SES. For example, T-lineage ALL accounted for 17.6%, 9.4%, and 6.6% of Non-Hispanic Black, Non-Hispanic White, and Hispanic patients respectively (p<0.0001). Table 2 shows the multivariable models and illustrates different patterns of HR adjustment among specific racial/ethnic and SES groups. Inferior EFS among Hispanic patients was substantially attenuated by the addition of disease prognosticators (HR decreased from 1.37 to 1.17) and further (but not fully) attenuated by the subsequent addition of SES (HR 1.11). In contrast, the increased risk among non-Hispanic Black children was minimally attenuated by both the addition of disease prognosticators and subsequent addition of SES (HR 1.45 to 1.38 to 1.32). Similarly, while the superior EFS of non-US insured patients was substantially attenuated by the addition of race/ethnicity and disease prognosticators (HR 0.79 to 0.94), increased risk among US Medicaid patients was minimally attenuated by the addition of race/ethnicity or disease prognosticators (HR 1.21 to 1.16). OS disparities followed similar patterns but were consistently worse than in EFS, particularly among patients grouped as non-Hispanic other. Conclusions: Substantial disparities in survival outcomes persist by race/ethnicity and SES in the modern era. Our findings suggest that reasons for these disparities vary between specific disadvantaged groups. Additional work is required to identify specific drivers of survival disparities that may be mitigated by targeted interventions. Figure 1 Figure 1. Disclosures Gupta: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Teachey: NeoImmune Tech: Research Funding; Sobi: Consultancy; BEAM Therapeutics: Consultancy, Research Funding; Janssen: Consultancy. Zweidler-McKay: ImmunoGen: Current Employment. Loh: MediSix therapeutics: Membership on an entity's Board of Directors or advisory committees.

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Increased Disease Burden Among Black Children Compared to White Children with Newly Diagnosed Acute Myeloid Leukemia

Blood ◽

10.1182/blood-2018-99-120076 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 369-369

Author(s):

Lena E. Winestone ◽

Kelly D Getz ◽

Yimei Li ◽

Evanette Burrows ◽

Michael Scheurer ◽

...

Keyword(s):

Acute Leukemia ◽

Disease Burden ◽

Vital Signs ◽

Block Group ◽

Black Patients ◽

Hispanic Patients ◽

Race Ethnicity ◽

Racial Ethnic ◽

High Disease Burden ◽

Hispanic White

Abstract Introduction: We previously demonstrated Black patients with acute myeloid leukemia (AML) are more likely to require ICU-level resources at initial presentation. This disparity in acuity at presentation explained 62% of the two-fold racial disparity in early mortality (Winestone Am J Hematol 2017). We sought to expand these findings using a more detailed data source that leverages electronic medical record (EMR) data from two large institutions. We hypothesized that disparities in severity at presentation by race, ethnicity, and socioeconomic status would be identified in granular EMR data for children with acute lymphoblastic leukemia (ALL) and AML. Methods: Acute leukemia patients who were diagnosed at Children's Hospital of Philadelphia or Texas Children's Hospital (2006-2014) were included. Patients who transferred from a referring hospital or whose race was specified as Asian, other, or unknown were excluded. Race and ethnicity were combined into 3 mutually exclusive categories: Hispanic, non-Hispanic White, and non-Hispanic Black. The first set of vital signs (blood pressure, heart rate, respiratory rate, and temperature) and the timing of key diagnostic evaluations were manually abstracted. Patient age, sex, race/ethnicity, residential address, and results of selected laboratory tests from the first 72 hours after admission underwent automated extraction from the EMR. Residential addresses were batch-matched to geo-coordinates linking each patient to a census-derived block group. The following measures of socioeconomic status (SES) were evaluated: median household income, education, unemployment, and crowding. Vital signs were interpreted using age-specific American Heart Association reference ranges. Individual and composite lab-based definitions created a priori were used to identify high disease burden, risk of infection, renal dysfunction, abnormal coagulation (prothrombin time >17 or fibrinogen <100) and liver function (AST/ALT>200 or bilirubin >2.5 or GGT>150). Log-binomial regression was used to compute unadjusted prevalence ratios (PR) and corresponding 95% confidence intervals (CI) comparing incidence of vital sign and laboratory abnormalities by race/ethnicity and block group SES. Stratification by leukemia type (AML vs. ALL) allowed for assessment of heterogeneity in associations of interest. Covariates that were associated with race and thus were potential confounders were also included in multivariable models to obtain adjusted PRs. Results: A total of 899 acute leukemia patients (474 non-Hispanic White, 318 Hispanic, and 107 non-Hispanic Black) were included. Figure 1 shows patient characteristics including patients' geo-coordinates mapped onto census block group median household income. Vital signs at presentation were generally similar across racial/ethnic groups with the exception of heart rate among Hispanic patients (62% vs. 53%, p=0.03). Black patients with AML had an increased prevalence of elevated white blood cell (WBC) count and uric acid and Black patients with ALL demonstrated increased prevalence of coagulopathy compared to White non-Hispanic patients (Table 1). For both AML and ALL, Black patients were more likely to have more than 2 lab abnormalities relative to White non-Hispanic patients. There were no clinically significant differences in time to key diagnostic evaluations by race/ethnicity; median time to CBC was under 2 hours for all racial/ethnic groups, median times to bone marrow biopsy and lumbar puncture ranged from 25-39 hours, and median time to chemotherapy was between 2-3 days. None of the measures of SES were significantly associated with abnormal vital signs, abnormal labs, or prolonged time to key diagnostic evaluations. Conclusions: Black patients with newly diagnosed AML present with increased prevalence of high disease burden as evidenced by elevated WBC and uric acid. Across acute leukemia types, Black patients are more likely to present with more than 2 lab abnormalities; these lab abnormalities likely represent physiologic dysfunction at diagnosis and may compound one another to explain the previously observed racial disparity in ICU-level care requirement. Similar ethnic differences were not observed among Hispanic patients with AML or ALL. We are conducting ongoing investigation into the impact that rurality and distance to the hospital have on initial presentation. Disclosures Fisher: Merck: Research Funding; Pfizer: Research Funding.

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Racial and Ethnic Differences in Health Care Utilization Following Severe Acute Brain Injury in the United States

Journal of Intensive Care Medicine ◽

10.1177/0885066620945911 ◽

2020 ◽

pp. 088506662094591

Author(s):

Rayleen C. Jones ◽

Claire J. Creutzfeldt ◽

Christopher E. Cox ◽

Krista L. Haines ◽

Catherine L. Hough ◽

...

Keyword(s):

Brain Injury ◽

Ethnic Differences ◽

Multivariable Analysis ◽

Acute Brain Injury ◽

Racial And Ethnic Differences ◽

Asian Patients ◽

Black Patients ◽

Increased Risk ◽

Hispanic Patients ◽

Race Ethnicity

Objective: To examine racial and ethnic differences in the utilization of 3 interventions (tracheostomy placement, gastrostomy tube placement, and hospice utilization) among patients with severe acute brain injury (SABI). Design: Retrospective cohort study. Setting: Data from the National Inpatient Sample, from 2002 to 2012. Patients: Adult patients with SABI defined as a primary diagnosis of stroke, traumatic brain injury, or post-cardiac arrest who received greater than 96 hours of mechanical ventilation. Exposure: Race/ethnicity, stratified into 5 categories (white, black, Hispanic, Asian, and other). Measurements and Main Results: Data from 86 246 patients were included in the cohort, with a mean (standard deviation) age of 60 (18) years. In multivariable analysis, compared to white patients, black patients had an 20% increased risk of tracheostomy utilization (relative risk [RR]: 1.20, 95% CI: 1.16-1.24, P < .001), Hispanic patients had a 10% increased risk (RR: 1.10, 95% CI: 1.06-1.14, P < .001), Asian patients had an 8% increased risk (RR: 1.08, 95% CI: 1.01-1.16, P = .02), and other race patients had an 10% increased risk (RR: 1.10, 95% CI: 1.04-1.16, P < .001). A similar relationship was observed for gastrostomy utilization. In multivariable analysis, compared to white patients, black patients had a 25% decreased risk of hospice discharge (RR: 0.75, 95% CI: 0.67-0.85, P < .001), Hispanic patients had a 20% decreased risk (RR: 0.80, 95% CI: 0.69-0.94, P < .01), and Asian patients had a 47% decreased risk (RR: 0.53, 95% CI: 0.39-0.73, P < .001). There was no observed relationship between race/ethnicity and in-hospital mortality. Conclusions: Minority race was associated with increased utilization of tracheostomy and gastrostomy, as well as decreased hospice utilization among patients with SABI. Further research is needed to better understand the mechanisms underlying these race-based differences in critical care.

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Racial and ethnic differences in response to treatment for Marfan syndrome

Cardiology in the Young ◽

10.1017/s104795112100130x ◽

2021 ◽

pp. 1-8

Author(s):

Rachel Ayers ◽

Michael Kelleman ◽

Glen Iannucci ◽

Courtney McCracken ◽

Matthew E. Oster

Keyword(s):

Marfan Syndrome ◽

Ethnic Differences ◽

Aortic Root ◽

Randomised Trial ◽

Z Score ◽

Treatment Groups ◽

Black Patients ◽

Aortic Root Enlargement ◽

Racial Ethnic ◽

Hispanic White

Abstract Objective: To determine whether racial/ethnic differences exist for the treatment of Marfan syndrome aortopathy. The 2014 Pediatric Heart Network randomised trial of losartan versus atenolol in Marfan syndrome paediatric and young adult patients showed no treatment differences in the rate of aortic root growth over 3 years; however, they did not examine racial/ethnic differences, and recent data suggest that angiotensin receptor blockers may have different pharmacologic effects in different racial/ethnic populations. Methods: We performed a secondary analysis of public-use data from the Pediatric Heart Network randomised trial comparing the differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic patients) amongst the treatment groups for the primary outcome of rate of aortic root enlargement by z score and secondary outcome of rate of change of absolute diameter of aortic root, z score and absolute diameter of ascending aorta, and blood pressure changes. Results: For aortic root enlargement by z score amongst on-Hispanic White patients, patients on losartan exhibited an annual z score change of –0.090 ± 0.016, compared to –0.146 ± 0.015 for those on atenolol (p = 0.01), favouring atenolol. For Hispanic and non-Hispanic Black patients, there was no difference in primary or secondary outcomes between treatment groups. Conclusion: Non-Hispanic White patients had a small, but statistically significantly greater decrease in aortic root z score favouring atenolol over losartan. There were no significant differences amongst Hispanic or non-Hispanic Black patients, which may be due to relatively small size numbers. These findings may have important implications for medication selection by race/ethnicity in Marfan syndrome patients, which has not previously been evaluated in studies.

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Characteristics and Factors Associated with COVID-19 Infection, Hospitalization, and Mortality Across Race and Ethnicity

10.1101/2020.10.14.20212803 ◽

2020 ◽

Author(s):

Chengzhen L. Dai ◽

Sergey A. Kornilov ◽

Ryan T. Roper ◽

Hannah Cohen-Cline ◽

Kathleen Jade ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Health System ◽

Alaska Native ◽

Clinical Characteristics ◽

Hospital Death ◽

Increased Risk ◽

Hispanic Patients ◽

Race Ethnicity ◽

Racial Ethnic

BackgroundData on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across the major racial/ethnic groups and assessed their associations with COVID-19 outcomes.MethodsThis retrospective cohort study analyzed patients who were tested for SARS-CoV-2 in a large, integrated health system spanning California, Oregon, and Washington between March 1 and August 30, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression.Findings289,294 patients with known race/ethnicity were tested for SARS-CoV-2 by PCR, of whom 27.5% were non-White minorities. 15,605 persons tested positive, with minorities representing 58.0%. Disparities were widest among Hispanics, who represented 40.5% of infections but 12.8% of those tested. Hispanics were generally younger and had fewer comorbidities except diabetes than White patients. Of the 3,197 patients hospitalized, 58.9% were non-White. 459 patients died, of whom 49.8% were minorities. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increase odds of testing positive and hospitalization were associated with all minority races/ethnicities except American Indian/Alaska Native. Highest odds of testing SARS-CoV-2 positive was for Hispanic patients (OR [95% CI]: 3.68 [3.52-3.84]) and highest odds of COVID-19 hospitalization was for Native Hawaiian/Pacific Islander patients (2.13 [1.48 - 3.06]). Hispanic patients also exhibited increased morbidity including need for mechanical ventilation. In multivariate modeling, Hispanic race/ethnicity was associated with increased odds of hospital mortality (1.75 [1.15-2.67]) among patients over age 70, but hospital mortality was not increased for any race/ethnicity sub-population in the multivariate model.InterpretationMajor healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, and despite younger in age, required excess hospitalization and need for mechanical ventilation compared to their expected demographic proportions. As characteristics of patients varying between race/ethnicity, targeted, culturally-responsive interventions are needed to address the increased risk of poor outcomes among minority populations with COVID-19.FundingBiomedical Advanced Research and Development Authority; National Center for Advancing Translational Sciences

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Racial/ethnicity differences when endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.351 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 351-351

Author(s):

Donna Lynn Berry ◽

Fangxin Hong ◽

Barbara Halpenny ◽

Matthew Epstein ◽

Quoc-Dien Trinh

Keyword(s):

Prostate Cancer ◽

Logistic Regression ◽

Ethnic Differences ◽

Influential Factors ◽

Treatment Choice ◽

Patient Profile ◽

Famous Person ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

351 Background: Race and ethnicity impact the type of treatment received for localized prostate cancer in American men. We hypothesized that there may be differences in men’s influential values and preferences related to treatment decisions. Methods: We analyzed samples from two multicenter, randomized trials of the Patient Profile-Prostate (P3P) decision aid, first comparing the trial groups on demographic and decisional variables using Chi-square tests. Stratified (P3P I vs II) logistic regression was then used to assess the univariate association between race/ethnicity and endorsement of moderate-or-strong influence of 14 lifestyle factors, current or future symptoms, or important others on the decision. A multivariable stratified logistic regression with backward variable selection was used to further estimate the association between influential factors and race/ethnicity. Results: Data from 494 and 392 participants in P3PI and P3PII, respectively, were analyzed for 40 Hispanic, 168 non-Hispanic black, 637 non-Hispanic white, 19 others and 6 missing. Age (p=.0001), education (p<.0001), marital status (p<.0001), income (p<.0001), Internet use for information (p<.0001) and decisional control preference were significantly different across racial/ethnic groups. In adjusted analyses, racial/ethnic differences existed for influence of age (Non Hispanic Black (NHB) vs. Non Hispanic White (NHW) OR: 0.56 95%CI 0.38-0.85p=.002), religion/spirituality (NHB vs. NHW OR: 3.2095%CI1.95-5.26, p<.0001), future bladder function (NHB vs. NHW OR: 0.5795%CI0.35-0.90, p=.04), future ability to engage in recreation (NHB vs. NHW OR: 0.5495%CI 0.34-0.86, p=0.02), and a story of a famous person with prostate cancer (NHB vs. NHW OR: 2,11 95%CI1.30-3.43, p=.007). Conclusions: Our results suggest racial/ethnic differences for influences underlying treatment choice. Better understanding these influences may help us present salient information about treatment options to patients and address disparities.

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Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

Innovation in Aging ◽

10.1093/geroni/igaa057.545 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Chirag Vyas ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Olivia Okereke

Keyword(s):

Native American ◽

Ethnic Differences ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Omega 3 ◽

Late Life Depression ◽

Item Level ◽

Racial Ethnic ◽

Hispanic White

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.

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Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure

Heart ◽

10.1136/heartjnl-2020-318650 ◽

2021 ◽

pp. heartjnl-2020-318650

Author(s):

Robbie Sparrow ◽

Shubrandu Sanjoy ◽

Yun-Hee Choi ◽

Islam Y Elgendy ◽

Hani Jneid ◽

...

Keyword(s):

Primary Outcome ◽

Left Atrial Appendage ◽

Kidney Injury ◽

Complication Rates ◽

Left Atrial Appendage Closure ◽

Black Patients ◽

Comorbidity Burden ◽

Race Ethnicity ◽

Racial Ethnic ◽

Major Adverse Events

ObjectiveThis manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC).MethodsThe US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke.ResultsOf 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and ‘other’ race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of ‘other’ race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles.ConclusionIn this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.

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Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre– and Mid–COVID-19 (Preprint)

10.2196/preprints.33637 ◽

2021 ◽

Author(s):

Ruby Castilla-Puentes ◽

Jacqueline Pesa ◽

Caroline Brethenoux ◽

Patrick Furey ◽

Liliana Gil Valletta ◽

...

Keyword(s):

Health Belief Model ◽

Ethnic Groups ◽

Ethnic Differences ◽

Health Belief ◽

Depression Symptoms ◽

Seeking Help ◽

Key Drivers ◽

Race Ethnicity ◽

Belief Model ◽

Racial Ethnic

BACKGROUND The prevalence of depression symptoms in the United States is >3 times higher mid–COVID-19 versus pre-pandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. OBJECTIVE To describe attitudes, mindsets, key drivers, and barriers related to depression pre– and mid–COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. METHODS Advanced search, data extraction, and AI-powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre– (February 1, 2019-February 29, 2020) and mid–COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. RESULTS Of 2.9 and 1.3 million relevant digital conversations pre– and mid–COVID-19, race/ethnicity was determined among 1.8 million (62%) and 979,000 (75%) conversations pre– and mid–COVID-19, respectively. Pre–COVID-19, 1.3 million conversations about depression occurred among non-Hispanic Whites (NHW), 227,200 among Black Americans (BA), 189,200 among Hispanics, and 86,800 among Asian Americans (AS). Mid–COVID-19, 736,100 conversations about depression occurred among NHW, 131,800 among BA, 78,300 among Hispanics, and 32,800 among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre– to mid–COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoidant mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. CONCLUSIONS Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre– and mid–COVID-19. Generally, COVID-19 has made conversations about depression more negative, and with frequent discussions of barriers to seeking care. These data highlight opportunities for culturally competent and targeted approaches to address areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM.

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Abstract P352: Racial/Ethnic Differences in Cardiovascular Disease Outcomes among Patients with Hypertension or Type 2 Diabetes

Circulation ◽

10.1161/circ.131.suppl_1.p352 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Jia Pu ◽

Sukyung Chung ◽

Beinan Zhao ◽

Vani Nimbal ◽

Elsie J Wang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Asian Indian ◽

Ethnic Differences ◽

Elevated Risk ◽

Stroke Incidence ◽

Men And Women ◽

Hazard Ratios ◽

Race Ethnicity ◽

Racial Ethnic

Background: This study assesses racial/ethnic differences in CVD outcomes among patients with hypertension (HTN) or type 2 diabetes (T2DM) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexican, non-Hispanic black (NHB), and non-Hispanic White (NHW) in a large, mixed payer ambulatory care setting in northern California. Study Design: We estimated the rate of CVD incidence among adult patients with HTN (N=171,864) or T2DM (N=10,570), or both (N=36,589) using electronic health records between 2000-2013. Average follow-up was 4.5 years. CVD, including CHD (410-414), PVD (415, 440.2, 440.3, 443.9, 451, 453), and stroke (430-434), was defined by ICD-9 codes; HTN and T2DM were defined by ICD-9 codes, medication history, or two or more elevated blood pressure measures/abnormal glucose lab test results. Cox proportional hazard models were used to estimate hazard ratios for CHD, PVD, and stroke across race/ethnicity. Results: Among these patients, 10.5% developed CVD by the end of year 2013 (5.4% CHD, 3.4%PVD, 3.6% stroke). There was a gender difference in the risk of incident CHD. Among males, the age-adjusted hazard ratios for CHD were significantly higher for Asian Indians (HR: 1.3, 95% CI: 1.2-1.5) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.8, CI: 0.6-0.9) compared to NHWs. Among females, the age-adjusted hazard ratios for CHD were significantly higher for Mexican (HR: 1.3, CI: 1.1-1.5) and NHBs (HR: 1.7, CI: 1.4-2.0) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.5, CI: 0.4-0.7). NHB men and women also had significantly higher age-adjusted hazard ratios for PVD (men: HR: 1.5, CI: 1.2-1.9; women: HR: 1.6, CI: 1.3-1.9) and stroke (men: HR: 1.3, CI: 1.1-1.7; women: HR: 1.3, CI: 1.1-1.6) compared to NHWs. The age-adjusted hazard ratios for PVD and stroke were lower or equivalent to NHWs for all Asian subgroups and Mexican men and women. Patients with both HTN and T2DM were at elevated risk to develop CVD compared to patients with only one of the two conditions, regardless of their race/ethnicity. Conclusions: Compared to previous studies, we found less racial/ethnic variation in CVD outcomes, in particular stroke, among patients with HTN or T2DM. Our finding suggests the higher stroke incidence rates in several races/ethnicities are likely to be explained by the higher prevalence of HTN and T2DM among these groups. However, Asian Indian men and NHB and Mexican women with HTN or T2DM were at elevated risk for CHD compared to NHWs. Since the majority of patients in the study cohort had health insurance, further studies are needed to better understand the reasons for the observed racial/ethnic differences beyond disparities in access to health care. Special attention needs to be paid to patients with multiple conditions.

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