Explaining Racial/Ethnic Disparities in Use of High-Volume Hospitals

5584 Background: Population-based studies of women with advanced ovarian cancer report racial/ethnic disparities in access to high volume centers (HVCs), surgical outcomes after primary debulking surgery (PDS), and overall survival (OS). However, there is evidence that with equal utilization of expert ovarian cancer care, differences in survival dissipate. The objective of this study is to evaluate patients (pts) with advanced ovarian cancer who had PDS at a HVC to determine whether racial/ethnic disparities persist in surgical outcome and survival. Methods: With IRB approval, all pts with stages IIIB to IV high-grade ovarian cancer who underwent PDS from 1/2001-12/2013 were identified. Pts self-identified race/ethnicity as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Asian (A), or Hispanic (H) in the medical record. The main outcome measures were PDS <1cm residual and OS. A Cox proportional hazards model was used to compare OS by race/ethnicity. Pt and clinical factors, including age, income, BRCA status, BMI, ASA, grade, carcinomatosis, bulky abdominal disease, were adjusted for in the multivariate analysis. Results: 963 pts were identified: 851 NHW (88%); 43 A (4%), 34 H (4%), 28 NHB (3%), 7 Other (0.7%). Asian pts were younger at diagnosis (p<0.0001); there were no differences in other demographic or clinical characteristics among racial/ethnic groups. After adjusting for pt and clinical factors, the likelihood of PDS to residual <1cm was similar among NHB and H compared to NHW pts; Asian pts were more likely than NHW to have >1cm residual (OR 2.32, 95%CI 1.1-4.9, p=.03). Median OS was 55.1 mos (95%CI: 51.8-58.5) for the entire cohort. On both univariate and multivariate analysis, there was no disparity in OS among racial or ethnic groups (p=0.615). Conclusions: Racial and ethnic disparities in overall survival and surgical outcomes in women with advanced ovarian cancer can be reduced by treatment at a HVC. Additional research is needed to determine what factors are associated with receiving treatment at HVCs, and what interventions could increase the diversity of patients treated at HVCs.

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Treatment at a high volume academic research program mitigates racial/ethnic disparities in pancreatic adenocarcinoma

HPB ◽

10.1016/j.hpb.2020.04.542 ◽

2020 ◽

Vol 22 ◽

pp. S74

Author(s):

Q. Chu ◽

Y. Chu ◽

M. Hsieh ◽

T. Lagraff ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Research Program ◽

Academic Research ◽

Ethnic Disparities ◽

High Volume ◽

Racial Ethnic

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Study finds racial/ethnic disparities in depressive trajectories among middle-aged or older adults

PsycEXTRA Dataset ◽

10.1037/e531082012-003 ◽

2012 ◽

Author(s):

J. Liang ◽

X. Xu ◽

A. R. Quinones ◽

J. M. Bennett ◽

W. Ye

Keyword(s):

Older Adults ◽

Ethnic Disparities ◽

Middle Aged ◽

Racial Ethnic

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1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States

Diabetes ◽

10.2337/db20-1489-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1489-P

Author(s):

SHARON SHAYDAH ◽

GIUSEPPINA IMPERATORE ◽

CARLA MERCADO ◽

KAI M. BULLARD ◽

STEPHEN R. BENOIT

Keyword(s):

United States ◽

Ethnic Disparities ◽

Diabetic Coma ◽

Racial Ethnic

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Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.2807 ◽

2017 ◽

Vol 35 (1) ◽

pp. 86-95 ◽

Cited By ~ 35

Author(s):

Albert J. Farias ◽

Xianglin L. Du

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Ethnic Disparities ◽

Medication Possession Ratio ◽

Adjuvant Endocrine Therapy ◽

Hormone Receptor Positive ◽

Medication Costs ◽

Poverty Status ◽

Racial Ethnic ◽

Out Of Pocket Costs

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

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Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?

International Journal of Health Geographics ◽

10.1186/1476-072x-10-24 ◽

2011 ◽

Vol 10 (1) ◽

pp. 24 ◽

Cited By ~ 21

Author(s):

Nancy Tian ◽

J Gaines Wilson ◽

F Benjamin Zhan

Keyword(s):

Breast Cancer ◽

Late Stage ◽

Spatial Association ◽

Ethnic Disparities ◽

Female Breast Cancer ◽

Female Breast ◽

Late Stage Diagnosis ◽

Racial Ethnic

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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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Physical Activity as a Mediator in the Relationship Between Race or Ethnicity and Changes in Multimorbidity

Innovation in Aging ◽

10.1093/geroni/igaa057.1098 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 342-342

Author(s):

Jason Newsom ◽

Emily Denning ◽

Ana Quinones ◽

Miriam Elman ◽

Anda Botoseneanu ◽

...

Keyword(s):

Physical Activity ◽

Sex Education ◽

Chronic Conditions ◽

Structural Equation ◽

Insurance Coverage ◽

Ethnic Disparities ◽

Later Life ◽

Equation Modeling ◽

The Relationship ◽

Racial Ethnic

Abstract Racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time have been established. Studies report differences in physical activity across racial/ethnic groups. We investigated whether racial/ethnic differences in accumulation of multimorbidity over a 10-year period (2004-2014) were mediated by physical activity using data from the Health and Retirement Study (N = 10,724, mean age = 63.5 years). Structural equation modeling was used to estimate a latent growth curve model of changes in the number of self-reported chronic conditions (of nine) and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) to change in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, personal wealth, and insurance coverage. Results indicated that Blacks engaged in significantly lower levels of physical activity than Whites (b = -.171, □ = -.153, p < .001), but there were no differences between Hispanics and Whites (b = -.010, □ = -.008, ns). Physical activity also significantly predicted both lower initial levels of multimorbidity (b = -1.437, □ = -.420, p < .001) and greater decline in multimorbidity (b = -.039, □ = -.075, p < .001). The indirect (mediational) effect for the Black vs. White comparison was significant (b = .007, □ = .011, 95% CI [.004,.010]). These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in middle and later life, suggesting greater need to reduce sedentary behavior and increase activity.

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