scholarly journals Short-Term Incidence of Sequelae of HCV Infection Among Medicaid Beneficiaries in Oregon

2018 ◽  
Vol 134 (1) ◽  
pp. 81-88
Author(s):  
Kazuaki Jindai ◽  
Courtney Crawford ◽  
Ann R. Thomas
Keyword(s):  
Cox Regression ◽  
Practical Method ◽  
Pacific Islanders ◽  
Hcv Infection ◽  
Incidence Density ◽  
High Morbidity ◽  
Hazard Ratios ◽  
Asian Pacific Islanders ◽  
Medicaid Beneficiaries ◽  
Asian Pacific

Objectives: Given the known high morbidity and mortality of hepatitis C virus (HCV) infection in Oregon, we sought to develop a practical method of estimating the severe sequelae of HCV infection among Medicaid beneficiaries in Oregon. Methods: We assembled a retrospective cohort that identified all Oregon Medicaid beneficiaries with HCV infection enrolled for at least 1 year during 2009-2013. We linked this cohort to 3 data sets to identify HCV-related deaths, cases of hepatocellular carcinoma (HCC), and first hospitalizations for advanced liver disease (ALD). We calculated incidence density rates and used multivariable Cox regression modeling to calculate adjusted hazard ratios (aHRs) to evaluate the association between demographic characteristics (birth year, sex, race, ethnicity) and these 3 outcomes. Results: Of 11 790 Oregon Medicaid beneficiaries with HCV infection, 474 (4.0%) had an HCV-related death, 156 (1.3%) had HCC, and 596 (5.1%) had a first hospitalization for ALD. Adjusted hazard ratios for deaths were 2.2 (95% confidence interval [CI], 1.6-2.8) among persons born in 1945 through 1965 (vs persons born after 1965), 2.1 (95% CI, 1.7-2.5) among males (vs females), and 1.9 (95% CI, 1.2-2.9) among Asian/Pacific Islanders and 2.2 (95% CI, 1.5-3.2) among American Indian/Alaska Natives (vs white persons). The same risk groups had significant aHRs for first hospitalizations for ALD. Persons born before 1945 (aHR = 17.0; 95% CI, 5.2-55.8) and in 1945 through 1965 (aHR = 12.8; 95% CI, 4.1-40.3) vs born after 1965, males (aHR = 3.3; 95% CI, 2.3-4.8) vs females, and Asian/Pacific Islanders (aHR = 3.9; 95% CI, 2.3-6.7) vs white persons had higher risks for HCC. Conclusions: Continued assessments using the methods piloted in this study will allow Oregon to monitor trends in severe sequelae of HCV infection over time.

scholarly journals SUN-426 The Impact from AJCC 8Th Edition Staging System on Thyroid Cancer Outcomes by Race And Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Antonio Santamaria-Barria ◽  
Amanda N Graff-Baker ◽  
Shu-Ching Chang ◽  
Adam Khader ◽  
Anthony J Scholer ◽  
...  
Keyword(s):  
Native American ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
Staging System ◽  
Cox Proportional Hazards ◽  
Pacific Islanders ◽  
Asian Pacific Islanders ◽  
Asian Pacific ◽  
The Impact ◽  
8Th Edition

Abstract Background. Previous studies have demonstrated racial and ethnic outcome disparities among differentiated thyroid cancer (DTC) patients. However, the impact of the 8th edition of the American Joint Committee on Cancer staging system (AJCC8) on these disparities is unknown. Methods. DTC patients with sufficient tumor and survival data were identified in the National Cancer Database from 2004-2013. The 7th edition of the staging system (AJCC7) and AJCC8 criteria were compared. Multivariable logistic regression was used to evaluate the association between AJCC7 to AJCC8 staging change and race and ethnicity. Cox-proportional hazards regression was then used to evaluate the association between AJCC7 to AJCC8 staging change and overall survival. Results. Of 33,323 DTC patients, 76.7% were White/Non-Hispanics, 7.6% Blacks, 6.7% Hispanics, 5.4% Asian/Pacific-Islanders, and 3.6% Native-American/Other. Most were female (77%) with papillary DTC (90%). After adjusting for demographic, tumor, and treatment characteristics, Hispanics and Asian/Pacific-Islanders were 27% and 12% less likely to be AJCC7 to AJCC8 downstaged than White/Non-Hispanics (OR=0.73, 95%CI: 0.66-0.81; and OR=0.88, 95%CI: 0.79-0.99, respectively); Blacks had no significant downstaging difference compared to White/Non-Hispanics (OR=0.99, 95% CI: 0.90-1.09, p=0.79). Although AJCC8 was a better survival prognosticator than AJCC7, Cox-proportional hazards regression showed that all AJCC7 to AJCC8 downstaged patients had an increased risk of death compared to patients with unchanged staging, regardless of race and ethnicity: White/Non-Hispanics (HR=2.64, 95%CI: 2.34-2.98), Blacks (HR=1.77, 95%CI: 1.23-2.54), Hispanic (HR=3.27, 95%CI: 2.05-5.22), Asian/Pacific-Islanders (HR=2.31, 95%CI: 1.35-3.98), and Native-American/Other (HR=5.26, 95%CI: 2.10-13.19). However, based on two way interaction, the magnitude of negative change in survival from downstaging was only different between White/Non-Hispanics and Blacks (HR=2.64 vs. HR=1.77, respectively; p=0.04). Conclusions. Racial and ethnic outcome disparities persist with AJCC8. The proportion of downstaged DTC patients with AJCC8 varies by race and ethnicity, with the least impact found in Hispanics and Asian/Pacific-Islanders. Downstaged patients across all racial and ethnic groups had a decreased survival than those with unchanged stage, with the least impact in Blacks. These disparities should be taken into account when counseling patients about their prognosis with the new AJCC8.

scholarly journals OTHR-10. THE NATIONAL DISTRIBUTION OF NEWLY-DIAGNOSED BRAIN METASTASES IN ADULTS VARIES WIDELY BY PATIENT DEMOGRAPHICS

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i20-i20
Author(s):  
Vasileios Kavouridis ◽  
Matthew Torre ◽  
Maya Harary ◽  
Timothy Smith ◽  
Bryan Iorgulescu
Keyword(s):  
Brain Metastases ◽  
Pacific Islanders ◽  
Prior History ◽  
National Cancer Database ◽  
Newly Diagnosed ◽  
Patient Demographics ◽  
Asian Pacific Islanders ◽  
History Of ◽  
Asian Pacific ◽  
History Of Cancer

Abstract INTRODUCTION: Metastases are oft-cited as comprising approximately half of all adult intracranial neoplasms, and their national composition remains unclear. METHODS: The patient demographics and histologic distribution of newly-diagnosed brain metastasis (BM) patients aged > 18yo without a prior history of cancer (2010–2015) were evaluated using the National Cancer Database, which comprises > 70% of all newly-diagnosed cancers in the U.S. RESULTS: 91,686 adults presented with a newly-diagnosed BM between 2010–2015. The most common sites of brain metastases overall were lung (82% of metastatic cases), breast (4.1%), melanoma (3.2%), kidney (2.9%), and colorectal (1.8%). The overall 1-year and 5-year OS rates for all BMs were 27.0% (95% CI [26.7%-27.3%]) and 5.3% (95% CI [5.1%-5.5%]), respectively. The distribution of primary sites for newly-diagnosed BMs varied by sex, age, and race. Compared to males, more females had BMs from breast (8.4% versus 0.8%) and fewer had BMs from kidney (1.9% versus 3.8%), melanoma (1.9% versus 4.5%), and esophagus (0.3% versus 2.0%). In young adults, particularly those 20-29yo, BMs were more likely from melanoma, genitourinary (in males), and soft tissue than adults in middle and advanced age. Lung carcinomas comprised fewer BMs in Hispanics (66%) compared to Whites (82%), Blacks (83%), and Asian/Pacific Islanders (85%). BMs from kidney and genitourinary primaries were higher in Hispanics (7.3% and 2.4% of BMs, respectively) than in Whites (2.8% and 0.3%, respectively), Blacks (1.8% and 0.1%, respectively), and Asian/Pacific Islanders (2.6% and 0.2%, respectively). Melanoma was more frequent in Whites (3.8% of BMs) and Hispanics (2.5%) compared to Blacks (0.3%) and Asian/Pacific Islanders (0.6%). CONCLUSION: Our results illustrate the national distribution of newly-diagnosed BMs and investigates how the distribution varies by patient demographics.

Racial disparities in the presentation of hepatocellular carcinoma in the population 65+ years in the United States.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 249-249
Author(s):  
Michael Ross Kaufman ◽  
David J. Delgado ◽  
Stephanie Costa ◽  
Brandon George ◽  
Edith P. Mitchell
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Racial Disparities ◽  
Late Stage ◽  
The United States ◽  
Pacific Islanders ◽  
Stage Iii ◽  
Ajcc Stage ◽  
Asian Pacific Islanders ◽  
Asian Pacific

249 Background: Insufficient evidence exists regarding the presentation and management of elderly patients with hepatocellular carcinoma (HCC). The purpose of this study was to describe racial differences in cancer staging of elderly (65+) patients with HCC diagnosed in the United States. Methods: A retrospective cohort study was conducted using the 1973-2014 Surveillance, Epidemiology and End Results Program (SEER) database of the National Cancer Institute. Patients with primary hepatocellular carcinoma, diagnosed between 2004 and 2014, and with complete information on race, gender, year of diagnosis, age, marital status, region and stage at diagnosis (Derived SEER Summary Stage 2000, and Derived American Joint Committee on Cancer (AJCC) Stage Group, 6th Edition) were included. Descriptive statistics were used to compare sociodemographic and clinical variables with race. Univariate and multivariate logistic regressions were preformed to describe the association of race with the diagnosis of late stage HCC (Regional/Distant vs Localized Stage for SEER Summary Stage, and Stage III/IV vs Stage I/II for AJCC Stage Group). Results: The sample consisted of 19,902 HCC patients: 69.7% White, 9.2% Black, 20.2% API, 1.0% AI; 69.1% male; 45.1% diagnosed in 2004-2009; 56.2% age 65-74, 35.6% 75-84, and 8.2% 85 and older; 58.3% married; 7.4% Midwest, 12.4% Northeast, 17.0% Southeast, 63.2% Pacific West; 44.9% Regional/Distant Stage (SEER Summary Stage) and 41.2% Stage III/IV (AJCC Stage Group). After controlling for confounding variables, Asian/Pacific Islanders had a decreased odds of presenting with late stage disease relative to whites in both the SEER Summary Stage (OR: 0.867, CI:0.805-0.934) and AJCC Stage Group (OR: 0.904, CI:0.838-0.975). Conclusions: Racial disparities exist at the presentation of HCC in the 65+ population. Asian/Pacific Islanders are less likely to be diagnosed with late stage HCC compared to whites. There is a need to study further these relationships in subpopulations.

scholarly journals Problem Gambling Knowledge and Perceived Community Impact Among Asian-Pacific Islanders and Non Asian-Pacific Islanders

2009 ◽  
Vol 12 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Timothy Fong ◽  
Michael Campos ◽  
Richard Rosenthal ◽  
Mary-Lynn Brecht ◽  
Bryan Schwartz ◽  
...  
Keyword(s):  
Problem Gambling ◽  
Pacific Islanders ◽  
Community Impact ◽  
Asian Pacific Islanders ◽  
Asian Pacific

scholarly journals Combined Hepatocellular Cholangiocarcinomas; Analysis of a Large Database

2008 ◽  
Vol 1 ◽  
pp. CPath.S500 ◽  
Author(s):  
Mitchell S. Wachtel ◽  
Yan Zhang ◽  
Tom Xu ◽  
Maurizio Chiriva-Internati ◽  
Eldo E Frezza
Keyword(s):  
Confidence Intervals ◽  
Cox Regression ◽  
Large Database ◽  
Combined Tumor ◽  
Point Estimates ◽  
Hazard Ratios ◽  
Asian Pacific ◽  
Survival Patterns ◽  
Distant Spread ◽  
Combined Tumors

Aim Combined hepatocellular cholangiocarcinoma (combined tumor) has been described as either a variant of hepatoma or a variant of cholangiocarcinoma. Prior studies evaluated fewer than 50 patients with combined tumors, precluding multivariate analyses. Posited was the notion that analysis of a large database would yield more definite answers. Methods This study used SEER (Surveillance, Epidemiology, and End Results Program of the National Cancer Institute) to analyze 282 combined tumors, 2,035 intrahepatic cholangiocarcinomas, and 19,336 hepatomas between the years 1973-2003. Multinomial logit regression calculated point estimates and 95% confidence intervals (c.i.) for relative risk (rr). Cox regression calculated point estimates and 95% confidence intervals (c.i.) for hazard ratios (ĥ). Results Men less often had cholangiocarcinomas than they had combined tumors (rr = 0.63, c.i. = 0.49-0.81). Hepatomas less often than combined tumors presented with distant spread (rr = 0.56, c.i. = 0.43-0.72). Men (rr = 1.50, c.i. = 1.17-1.93) and patients with a known Asian or Pacific birthplace (rr = 2.36, c.i. = 1.56-3.56) more often had hepatomas than they had combined tumors. Among patients not known to have an Asian/Pacific birthplace, a diagnosis of cholangiocarcinoma (ĥ = 0.72, c.i. = 0.63-0.82) or hepatoma (ĥ = 0.75, c.i. = 0.66-0.86) provided a better prognosis than did a diagnosis of combined tumor. Conclusion Combined tumors differ from hepatomas and cholangiocarcinomas in terms of distribution and survival patterns in the population; they should be considered neither cholangiocarcinomas nor hepatomas.

scholarly journals Vascular Risk Factor Prevalence and Trends in Native Americans With Ischemic Stroke - A National Inpatient Sample Analysis

2020 ◽  
Author(s):  
Dinesh V. Jillella ◽  
Sara Crawford ◽  
Rocio Lopez ◽  
Atif Zafar ◽  
Anne S. Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Native Americans ◽  
Ethnic Groups ◽  
Pacific Islanders ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Trend Slope ◽  
Asian Pacific Islanders ◽  
Asian Pacific

AbstractIntroductionNative Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the prevalence of vascular risk factors among Native Americans with ischemic stroke over the last two decades along with a comparison to the other race-ethnic groups.MethodsNational/Nationwide Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized ischemic stroke patients during 2000 - 2016. Ischemic stroke and risk factors of interest were identified using validated ICD-9/10 codes. The race-ethnic groups of interest were Native American, White, Black, Hispanic, Asian/Pacific Islanders, and others. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods: 2000-02, 2003-05, 2006-08, 2009-11, 2012-14, and 2015-16. We explored linear trends over the defined time periods using linear regression models, with differences in trends between the Native American group and each of the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data.ResultsOf the 1,278,784 ischemic stroke patients that were included in the analysis, Native Americans constituted 5472. The age-and-sex-standardized prevalence of hypertension (trend slope = 2.24, p < 0.001), hyperlipidemia (trend slope = 6.29, p < 0.001), diabetes (trend slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope = 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased during these time periods among Native Americans, while coronary artery disease prevalence remained unchanged. Similar upward trends of several risk factors were noted across other race-ethnic groups with Native Americans showing larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all the race-ethnic groups.ConclusionThe prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans and other race-ethnic groups over the last two decades. Significantly larger increases in the prevalence of hypertension and smoking were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.

The prevalence of birth defects among non‐Hispanic Asian/Pacific Islanders and American Indians/Alaska Natives in Texas, 1999–2015

2019 ◽  
Vol 111 (18) ◽  
pp. 1380-1388 ◽  
Author(s):  
Mimi T. Le ◽  
Charlie J. Shumate ◽  
Adrienne T. Hoyt ◽  
Anna V. Wilkinson ◽  
Mark A. Canfield
Keyword(s):  
American Indians ◽  
Birth Defects ◽  
Alaska Natives ◽  
Pacific Islanders ◽  
Asian Pacific Islanders ◽  
Asian Pacific
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