scholarly journals Racial Differences in Multiple Myeloma Survival and Treatment Using Pooled Clinical Trial and Real-World Electronic Medical Record Data

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-9
Author(s):  
Emelly Rusli ◽  
Lihong Diao ◽  
Cynthia Liu ◽  
Mona A Kelkar ◽  
Lisa Ensign ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Median Number ◽  
Research Network ◽  
Racial Groups ◽  
Publicly Traded ◽  
Black And White ◽  
Line Therapy ◽  
Black Patients ◽  
Ct Data ◽  
White Patients

Background: Past studies have indicated a potential racial disparity in Multiple Myeloma (MM) survival between black and white patients (Costa et al., 2017; Marinac et al., 2020), an issue compounded by minority underrepresentation in clinical trials (Ailawadhi et al., 2018). To better understand how racial disparities affect both MM survival and access to treatment, we performed an analysis of pooled clinical trial (CT) and Real-World EMR Data (RWD). Methods: Eligible Phase II and III open-label MM clinical trials were identified from the Medidata Enterprise Data Store, which comprises over 22,000 historical clinical trials, for de-identified aggregate analyses. De-identified Oncology RWD was sourced from the Guardian Research Network of integrated delivery systems from 2016 to 2020. Baseline characteristics were analyzed in both cohorts. Race was categorized as black, white, or other. Overall Survival (OS) was assessed using Kaplan-Meier analysis. In the RWD, therapy utilization was assessed by race. Results: The RWD contained 5871 patients, with 17.5% black, 78.3% white, and 4.2% other race. Median age in years at diagnosis was 69 for blacks, 72 for whites, and 70 for other races. The gender breakdown was 54.2% female in blacks, 46.0% in whites, 45.9% in those of other races respectively. Median number of prior regimens was 2, with no differences between racial groups. The CT data contained 851 patients, with 1.4% black, 93.5% white, and 5.1% other race. Median age in years at diagnosis was 62 for blacks, 58 for whites, and 55 for other races. The gender breakdown was 33.3% female in blacks, 43.5% in whites, and 46.7% in those of other races respectively. Median number of prior regimens was 5, with no differences between racial groups. There was no statistically significant difference in OS between racial groups in either dataset. In the CT data with median follow-up of 7.8 years, survival from date of diagnosis to last visit or date of death was 25% for blacks and 18% for whites. Currently, in the RWD, 3-year survival comparing blacks to whites is 85% to 83%. The proportion of treated RWD patients appears to be similar between black and white patient groups, with 56% of white and 53% of black patients receiving 1st line therapy, and 33% and 31% receiving 2nd line therapy, respectively. Among newer therapy modalities, white patients had a higher utilization of targeted antibody agent daratumumab (8.7% utilization among whites, 5.2% in blacks, p<0.001), and although not statistically different, proteasome inhibitor carfilzomib use was also higher among whites compared to blacks (6.5% versus 5.5%). Mono daratumumab and ixazomib were used as 1st-line therapy in white patients, while these agents were administered in combination with other treatments in black patients. Adjusting for age and novel therapy use, there was also a suggestion that treatment initiation after diagnosis occurred earlier in whites than blacks (median 1.1 years vs. 1.6 years, p=0.3). Conclusions: Though there were no demonstrated differences in survival between racial groups in either dataset, the RWD suggested differences in treatment utilization, with underutilization of novel therapies like proteasome inhibitors and targeted antibody therapy and later treatment initiation in blacks. Previous studies (Fiala et al., 2017) have noted similar trends, which suggest that therapeutic advances may not be equitably available to all racial groups. This observation could not be replicated in CT data, but merits further exploration. Despite black patients making up 17.5% of patients in the RWD, a racial distribution consistent with published literature (Rosenberg et al., 2015), black patients made up only 1.3% of patients in the CT data. Furthermore, in the CT data, the median age of black patients was older than that of the white and other race groups (62 years compared to 58 and 55, respectively). This observation is magnified by evidence in both the RWD and other datasets (Fillmore et al., 2019) that shows a younger age of onset in black MM patients. Given the strong correlation between age and poorer outcomes in MM (Ludwig et al.,2008), it is possible that these clinical trials are not capturing a representative black patient population, and results may not be generalizable to other groups. Recruitment of black patients should remain a priority in clinical studies in order to effectively assess racial disparities in MM treatment access and survival. Disclosures Rusli: Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company. Diao:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Liu:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Kelkar:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Ensign:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company. Watson:Guardian Research Network, Inc.: Current Employment. Galaznik:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company.

Utilization of glucocorticoids among White and Black patients with systemic lupus erythematosus: Observations from the enrollment visit of a prospective registry

Lupus ◽  
2021 ◽  
pp. 096120332110558
Author(s):  
James K Sullivan ◽  
Emily A Littlejohn
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Health Outcomes ◽  
Lupus Erythematosus ◽  
Cleveland Clinic ◽  
Systemic Lupus ◽  
Black And White ◽  
Black Patients ◽  
White Patients

Background Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to quantify chronic glucocorticoid use among Black and White patients with SLE within a prospective registry. Methods Using enrollment data from a registry at a large academic institution, we compared glucocorticoid use among Black and White patients with SLE. Multivariable logistic regression of race and glucocorticoid use was performed, adjusting for covariates exhibiting a bivariate association with glucocorticoids at significance level p < 0.10. Results 114 White participants (mean age 45; standard deviation (SD) 15) and 59 Black participants (mean age 42; SD 14) were analyzed. White participants had mean SLEDAI-2K score of 3.7 (SD 5.2). Black participants had mean SLEDAI-2K scores of 6.3 (SD 6.0). Among Black participants, 43 (72%) utilized glucocorticoids compared to White participants 39 (34%) (unadjusted odds ratio (OR) 5.17; 95% confidence interval (CI) 2.59–10.33). We did not observe differences between unadjusted hydroxychloroquine (OR 0.69; 95% CI 0.28–1.65) or conventional disease-modifying anti-rheumatic drug (cDMARD) (OR 1.07; 95% CI 0.57–2.01) utilization among Black and White participants. SLEDAI-2K, disability, recent hospitalization, and past or present hydroxychloroquine or cDMARD use were included in a logistic regression model. Adjusting for covariates, Black participants were more likely to be on glucocorticoids (adjusted OR 5.69; 95% CI 2.17–14.96); p = 0.0004). Conclusion Adjusting for disease activity and other medications, Black patients had more exposure to chronic glucocorticoids than White patients in the Cleveland Clinic SLE registry. These patients may face increased glucocorticoid-related morbidity, which could contribute significantly to long-term health outcomes and utilization of health care resources. Future research in larger, more diverse registries should be conducted to further characterize patterns of glucocorticoid use.

Abstract 17673: The Effectiveness of Improved ICD Programming by Race: A MADIT-RIT Sub-study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Larry R Jackson ◽  
Kevin L Thomas ◽  
Wojciech Zareba ◽  
Marc Lahiri ◽  
Samir Saba ◽  
...  
Keyword(s):  
High Rate ◽  
Limited Data ◽  
Icd Therapy ◽  
Black And White ◽  
Black Patients ◽  
Inappropriate Icd Therapy ◽  
Relevant Covariates ◽  
White Patients

Introduction: There are limited data on the risk of inappropriate and appropriate ICD therapy and on the efficacy of different ICD programing strategies as a function of race. Methods: In MADIT-RIT, we evaluated the risk of inappropriate and appropriate ICD therapy by self identified race, and assessed the efficacy of improved ICD programming with either a high rate cut-off VT zone ≥ 200 bpm (Arm B), or long 60 sec delay in the VT zone 170-190 bpm (Arm C), as compared to conventional ICD programming with 2.5 sec delay beginning at 170 bpm (Arm A) among black and white patients. Results: MADIT-RIT enrolled 272 (20%) black and 1119 (80%) white patients. Black patients were younger, more often females, they more often had non-ischemic etiology of cardiomyopathy, a narrower QRS and they were less often implanted with CRT-D. The risk of inappropriate ICD therapy was similar among black and white patients (HR 1.25, 95% CI 0.82-1.93, P=0.30) after adjustment for relevant covariates. High rate cut-off or delayed VT therapy was associated with significant reductions in inappropriate ICD therapy among white patients (Arm B vs. Arm A, HR 0.15, P<0 .0001, Arm C vs. Arm A, HR 0.19, P 0.10). However, delayed VT therapy (Arm C) when compared to Arm A, was associated with greater reduction in appropriate ICD therapy in black patients (HR 0.08, P<0.0001), as compared to white patients (HR 0.27, P<0.0001, P interaction=0.07). There were no appropriate ICD therapies in the 170-200 bpm range in Arm C with delayed VT therapy programming in black patients, and a further reduction in appropriate ICD therapy ≥ 200 bpm (Arm C vs. Arm A, HR=0.16, p<0.001). Conclusion: In MADIT-RIT, there were similar reductions in inappropriate ICD therapy among black and white patients with improved ICD programming. However, black patients derived more benefit from delayed VT zone programming with greater reduction in appropriate ICD therapy compared to whites, due to a higher rate of self-terminating VT events.

A Comparison of Peritoneal Dialysis-Related Infections in Black and White Patients

1993 ◽  
Vol 13 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Jean L. Holley ◽  
Judith Bernardini ◽  
Beth Piraino
Keyword(s):  
Peritoneal Dialysis ◽  
Outcome Data ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Black And White ◽  
Black Patients ◽  
Insulin Dependence ◽  
White Control ◽  
White Patients

Objective To determine if black patients in our peritoneal dialysis (PD) program had higher rates of PD-related infections. The outcomes of black patients versus white patients were also reviewed. Design A review of prospectively collected patient demographic and PD-related infection data and out comes, from 1979 to 1991. Patients The 68 black patients in our PD program were matched with white control patients for age, sex, insulin dependence, time on dialysis, and mode of dialysis (CAPD or CCPD). The infection, demographic, and outcome data from the two groups were compared. Results Black patients had higher peritonitis rates (1.10 vs 0.82 episodeslyear, p=0.001) and exit-site infection rates (1.13 vs 0.95 episodeslyear, p=0.02) than the white control patients. Tunnel infection rates were 0.21 episodeslyear in both groups. S. epidermidis peritonitis was more common in black patients (48% of episodes vs 21% of episodes in whites, p=0.005), and S. aureus peritonitis was more common in white patients (29% vs 11% in blacks, p=0.005). The subset of black patients (n=13) on a disconnect system (Y-set) had a peritonitis rate similar to their white controls on the Y-set (0.41 vs 0.74 episodes/year, p=0.27). There were no episodes of S. epidermidis peritonitis in this subset of black patients. Black patients had fewer S. aureus exit-site infections than white patients (21% vs 41%, p=0.005). Peritonitis was the leading cause of transfer to hemodialysis in the black patients but not in the white patients. Conclusion The susceptibility to S. aureus and S. epidermidis infections differs in black and white patients on peritoneal dialysis for unclear reasons. Peritonitis rates in black patients can be reduced to that of white patients if a disconnect system is used.

The Veterans Health Administration Provides Equal Access to Autologous Hematopoietic Stem Cell Transplantation for Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2629-2629
Author(s):  
Cesar O. Freytes ◽  
Natalie S Callander ◽  
Stacey A Goodman ◽  
Suhong Luo ◽  
Juan J. Toro ◽  
...  
Keyword(s):  
Household Income ◽  
Research Funding ◽  
Equal Access ◽  
Racial Groups ◽  
Veterans Health ◽  
Health Administration ◽  
Hematopoietic Stem ◽  
Black And White ◽  
Black Patients ◽  
Income Quartile

Abstract Autologous hematopoietic stem cell transplantation (AHSCT) remains an integral part of multiple myeloma (MM) therapy. Previous studies have documented disparities in the utilization of AHSCT, with black MM patients receiving AHSCT less frequently than white patients. Among the factors that may influence AHSCT utilization is the availability and quality of health insurance. A previous analysis of black and white MM patients who underwent AHSCT in an equal access health care system, demonstrated comparable survival between black and white patients following AHSCT in MM. Unfortunately, this study did not provide information regarding potential race-based differences in AHSCT utilization. In an effort to understand the relationship between race and AHSCT utilization in an equal access healthcare system, we evaluated AHSCT utilization in a cohort of MM patients from the Veterans Health Administration (VHA) central cancer registry. Patients diagnosed with MM at any VHA medical center between September 1, 1999 and September 30, 2009 using International Classification of Diseases for Oncology, third revision, code 9732/3. Patients who did not receive treatment within 6 months of diagnosis were excluded in order to remove patients with monoclonal gammopathy or smoldering myeloma miscoded as MM (n=1,002). This resulted in a cohort of 2,968 patients. AHSCT was identified by ICD-9 procedure codes (410.4, 410.7, 410.0, 410.1, 410.9) or use of high-dose melphalan. Household income was estimated based upon zip code of residence, linked to census data on median household income by zip code. Of the 2,968 patients, 2,040 (68.7%) were white, 850 (28.6%) were black, 40 (0.1%) from other racial groups, and 38 (0.1%) were from unknown racial groups. The proportion of patients who underwent AHSCT was similar: 270 of 2118 white/other MM patients underwent AHSCT compared to 94 black patients (12.8% vs. 11%, respectively, p = 0.2). Demographics of the patients who received AHSCT are presented in table 1. Comparison of socioeconomic status demonstrated that across the entire cohort of 2,698 patients, black patients were significantly more likely to be from the lowest income quartile compared to white/other patients (38.2% vs. 18.4%, p < 0.001). Among the patients who received transplant, black patients again were more likely to come from the lowest income quartile (29.8% vs. 18.2%, p = 0.07). We conclude that the proportion of white and black patients who undergo AHSCT for MM is similar in the VHA, a finding that was present despite significant differences in estimated household income. Our finding is in contrast to previous registry studies that have shown limited access to transplantation for black MM patients. This suggests that in the VHA, utilization of high-cost interventions such as AHSCT is equal, despite differences in race and socioeconomic status. Table- Demographic and clinical characteristics by race among transplanted MM patients diagnosed 1999 to 2009 Demographic clinical characteristics Overall (N=364) White or other (n=270) Black (n=94) p-value Age (mean / range) 57.5 (27-73) 58 (27-73) 56.1 (30 - 71) 0.02 Sex (Male %) 96.7 97.4 94.7 0.2 Comorbidities (mean Charlson score) 1.4 1.3 1.6 0.09 BMI (%) <18.5 1.1 0.7 2.1 18.5-<25 22 22.2 21.3 25-<30 44.8 41.5 54.3 >=30 32.1 35.6 22.3 0.1 Estimated Household Income (%) Quartile 1 21.2 18.2 29.8 Quartile 2 23.4 23.7 22.3 Quartile 3 25.6 27 21.3 Quartile 4 27.5 28.2 25.5 Unknown 2.5 3 1.1 0.07 Hemoglobin (mean) 11 11.2 10.3 < 0.001 Creatinine (mean) 1.8 1.9 1.5 0.03 Albumin (mean) 3.3 3.4 3.3 0.3 Time(months) between Dx and transplant (mean/range) 12.8 (3.4-87.7) 12.3 (3.4-55.5) 14.1 (3.6-87.7) 0.15 Disclosures Freytes: Merck: Research Funding; Otsuka: Consultancy, Research Funding; Sanofi: Speakers Bureau. Carson:Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Millennium: Consultancy, Research Funding.

Racial Differences in Molecular Cytogenetic Abnormalities in Black and White Patients with Multiple Myeloma (MM): A Single-Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1767-1767
Author(s):  
Ying S Zou ◽  
Yi Huang ◽  
Zhou Feng ◽  
Sin Chan ◽  
Shweta Shukla ◽  
...  
Keyword(s):  
Categorical Variables ◽  
P Value ◽  
Total N ◽  
Cytogenetic Abnormalities ◽  
Molecular Cytogenetic ◽  
Black And White ◽  
Black Patients ◽  
Relationship Of ◽  
Lower Frequencies ◽  
White Patients

Abstract Background: The incidence of MM is 2 to 3 fold higher in blacks than in whites; they present at a younger age and have better overall survival. The biological bases for these disparities remain unclear. Outcome of MM is linked to cytogenetic and molecular changes, both primary (hyperdiploidy and heavy chain (IgH) translocations) and secondary (rearrangements of MYC, activating mutations of NRAS, KRAS or BRAF, and deletions of 17p). Methods: Cytogenomic alterations in consecutive MM patients were assessed using integration of metaphase chromosome analysis by GTG-banding and interphase fluorescence in situ hybridization (iFISH) in CD138-positive cells isolated from fresh BM samples using a protocol of magnetic-activated cell sorting. Changes evaluated included monosomy 13/del(13q), monosomy 17/del(17p), gain of 1q21, and rearrangements of the IGH gene including t(4;14), t(11;14) and t(14;16). Results: Samples from 218 consecutive MM patients were analyzed (Table 1). 108 were from black and 110 were from white patients. Median age for blacks was 59 years (range: 36 - 82) and for whites, 63 years (range: 39 - 83) (p=0.008). Fewer black men than whites were observed (46.3% versus 64.6%, p=0.007). Overall, blacks had fewer abnormal karyotypes compared to whites (18.1% versus 31.8%; p=0.02). Black patients had a lower frequency of non-hyperdiploid karyotypes (8.5% versus 20.6%; p=0.01) and had a trend toward lower frequencies of rearrangements of IGH (30.8% versus 43.5%; p=0.055) than white patients. Most notably, they had significantly lower frequencies of monosomy 17/del(17p) (5.6% versus 18.5%; p=0.003) and monosomy 13/del(13q) (28.9% versus 46.3%; p=0.008). After stratification by age (Figure 1), younger patients showed significantly higher frequencies of the monosomy 17/del(17p) abnormality (p=0.001) and the t(4;14) (p=0.04) than older patients, with the difference more significant in white patients. The associations among molecular cytogenetic abnormalities (Figure 2) showed a different association pattern for black and white patients. White patients with t(11;14) were more likely to have monosomy 13/del(13q) (p=0.003) and gain of 1q21 (p=0.02), while this association was not observed in black patients. Conclusion: Black MM patients had significantly different cytogenetic profiles detected by iFISH on CD-138 selected malignant cells, compared to whites. Black MM patients had a more favorable profile, including lower frequencies of non-hyperdiploid karyotype and of IGH rearrangements. This study supports a biological basis for previously described outcome disparities between black and white patients with MM. Further studies will focus on identifying specific molecular targets and their impact on therapy and on overall outcome. Table 1. Demographics and cytogenetic abnormalities of the MM patients Demographics Black White P-value# Total, n 108 110 Gender, n (%) =0.007* Male 50 (46.30%) 71 (64.55%) Female 58 (53.70%) 39 (35.45%) Age (median) 59 63 =0.008* Chromosome (karyotype) =0.022* Normal 86 (81.90%) 73 (68.22%) Abnormal 19 (18.10%) 34 (31.78%) Hyperdiploidy 8 (7.6%) 8 (7.4%) Non-hyperdiploidy 9 (8.5%) 22 (20.6%) =0.013* 11;14 translocation 2 (1.9%) 4 (3.7%) FISH abnormality -13/del(13q) 31 (28.97%) 50 (46.30%) =0.008* Gain of 1q21 35 (32.71%) 47 (43.52%) =0.103 -17/del(17p) 6 (5.61%) 20 (18.52%) =0.003* IGH rearrangements 33 (30.84%) 47 (43.52%) =0.055^ t(4;14) 7 (6.54%) 13 (12.38%) =0.146 t(11;14) 15 (20.55%) 15 (19.48%) =0.870 t(14;16) 2 (3.85%) 6 (10.71%) =0.175 others 16 (14.95%) 15 (13.89%) =0.824 *means statistical significant (p-value < 0.05), where ^ means marginal significant (0.05 < p-value < 0.10). #p-values come from the Cochran-Mantel-Haenszel tests for categorical variables, and t tests for continuous variables. Associations among eight molecular cytogenetic abnormalities. Each solid black line indicates one abnormality is statistically significantly associated with another abnormality. Figure 1. Distributions of cytogenetic abnormalities by age and race Figure 1. Distributions of cytogenetic abnormalities by age and race Figure 2. Relationship of various cytogenetic abnormalities in the MM patients Figure 2. Relationship of various cytogenetic abnormalities in the MM patients Disclosures No relevant conflicts of interest to declare.

scholarly journals Racial Differences in Pain Treatment and Empathy in a Canadian Sample

2012 ◽  
Vol 17 (6) ◽  
pp. 381-384 ◽  
Author(s):  
Kimberley A Kaseweter ◽  
Brian B Drwecki ◽  
Kenneth M Prkachin
Keyword(s):  
Racial Differences ◽  
Facial Expressions ◽  
Undergraduate Students ◽  
Pain Treatment ◽  
Black And White ◽  
Racial Biases ◽  
Patient Race ◽  
Black Patients ◽  
Treatment Bias ◽  
White Patients

BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain.OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity.METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient.RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment.CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

scholarly journals Racial and Age-Related Differences in Impacts of High-Risk Cytogenetic Abnormalities on Survival in Multiple Myeloma in a Nationwide Electronic Health Record-Derived Database

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4121-4121
Author(s):  
Gregory S Calip ◽  
Mustafa S Ascha ◽  
Xiaoliang Wang ◽  
Amy E Pierre ◽  
Kathleen Maignan ◽  
...  
Keyword(s):  
High Risk ◽  
Board Of Directors ◽  
Research Funding ◽  
Publicly Traded ◽  
Advisory Committees ◽  
Cytogenetic Abnormalities ◽  
Age Related ◽  
Black Patients ◽  
Double Hit ◽  
White Patients

Abstract Background: The incidence of multiple myeloma (MM) and enrichment of cytogenetic abnormalities differ significantly between racial/ethnic groups in the US, and their significance in determining myeloma progression and survival is not well understood. Whole genome sequencing has identified unique mutational signatures in MM, including an age-related process common in hyperdiploid myeloma. Our purpose was to describe racial and age-related differences in the impact of high-risk cytogenetic abnormalities (HRCAs) on survival in MM. Methods: We conducted a retrospective cohort study of adult MM patients starting first-line therapy between January 2011 and May 2021 using the nationwide Flatiron Health electronic health record-derived de-identified database. Patient-level demographic and clinical characteristics were ascertained using structured and unstructured data, curated via technology-enabled abstraction. Patients who had documented fluorescence in situ hybridization testing within 30 days prior to or 90 days following the start of first-line treatment were included. HRCAs, including gain or amplification 1q21, deletion 17p, t(4;14), t(14;16) and t(14;20), were identified and categorized as 0, 1, or 2+ HRCAs. Our outcomes of interest were real world progression free survival (rwPFS) and overall survival (rwOS). Cox proportional hazards models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI), adjusted for demographic and clinical characteristics and treatment including time-dependent receipt of autologous stem cell transplantation. Results: From a cohort of 4889 MM patients, there were 790 (16%) Black and 2995 (61%) White patients with median ages at diagnosis of 68 and 70 years, respectively. Compared to White patients, a higher proportion of Black patients had IgG M-protein (61% vs 55%) and a lower proportion had 1+ HRCAs identified (31% vs 34%). Among all racial groups, compared to patients aged &lt;65 years (N=1771), a higher proportion of patients aged 65+ years (N=3118) had IgA M-protein (21% vs 17%) and 1+ HRCAs identified (35% vs 33%). Multivariable models showed evidence of significant statistical interaction between age and prevalence of HRCA for rwPFS (P-int: 0.02). Among White patients, having 2+ HRCAs ("double-hit MM") compared to no HRCAs was associated with worse rwPFS in both younger and older patients (&lt;65 years: HR 2.88, 95% CI 1.93-4.32, P&lt;0.01; 65+ years: HR 1.51, 95% CI 1.18-1.94, P&lt;0.01). Among Black patients, associations between double-hit MM and rwPFS were attenuated and not statistically significant regardless of age (&lt;65 years: HR 1.81, 95% CI 0.69-4.74, P=0.23; 65+ years: HR 1.61, 95% CI 0.92-2.81, P=0.09). Similarly, we also found evidence of statistical interaction between age and prevalence of HRCA for rwOS (P-int: 0.02). Among White patients, double-hit MM was significantly associated with worse rwOS but the magnitude of increased risk differed for younger (HR 3.39, 95% CI 2.24-5.14, P&lt;0.01) and older (HR 1.61, 95% CI 1.27-2.05, P&lt;0.01) patients. Double-hit MM was significantly associated with worse rwOS among older Black patients (HR 1.78, 95% CI 1.03-3.06, P=0.04), but not younger Black patients (HR 1.60, 95% CI 0.58-4.40, P=0.36). Conclusions: In this cohort of newly diagnosed MM patients treated in routine practice, having double-hit MM was differentially predictive of poor survival across age groups. Double-hit MM was associated with worse rwPFS and rwOS among White patients, but these trends were less consistent among Black patients. Our current understanding of cytogenetic risk stratification of MM requires further study and additional data for identifying low- and high-risk subsets of patients across different ages and racial groups. Figure. Kaplan-Meier survivor functions for rwPFS in White (Panel A) and Black (Panel B) patients by age group and number of HRCAs Figure 1 Figure 1. Disclosures Calip: Flatiron Health: Current Employment; Roche: Current equity holder in publicly-traded company; Pfizer: Research Funding. Ascha: Flatiron Health: Current Employment; Roche: Current equity holder in publicly-traded company. Wang: Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Pierre: Flatiron Health, Inc: Current Employment; Roche: Current holder of stock options in a privately-held company. Maignan: Flatiron Health: Current Employment; Roche: Current equity holder in publicly-traded company. Wadé: Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Leng: Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Seymour: Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Current equity holder in publicly-traded company; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Flatiron Health Inc: Current Employment. Patel: Janssen: Consultancy; Amgen: Consultancy; Celgene: Consultancy. Neparidze: Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline: Research Funding; Janssen: Research Funding.

scholarly journals Disease Expression and Outcomes in Black and White Adults With Hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Milla E. Arabadjian ◽  
Gary Yu ◽  
Mark V. Sherrid ◽  
Victoria Vaughan Dickson
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Chart Review ◽  
Cardiac Fibrosis ◽  
Black African ◽  
Disease Expression ◽  
Black And White ◽  
Black Patients ◽  
Black Populations ◽  
White Adults ◽  
White Patients

Background There is limited research on hypertrophic cardiomyopathy (HCM), which is the most common inherited cardiac disorder, in diverse populations, including Black individuals. Current literature lacks comprehensive data on HCM disease expression, comorbidities, and outcomes in this historically disadvantaged group. The purpose of this study was to examine structural HCM characteristics, comorbidities, and outcomes in a Black and White cohort with HCM. Methods and Results The study was a subgroup analysis from a longitudinal, prospective study on HCM, with supplemental chart review. The sample included adults (≥18 years) with a clinical diagnosis of HCM, who self‐identified as Black/African American or White. The study sample comprised 434 individuals; 57 (13.1%) were Black, and 180 (41.5%) were women. Black patients were younger than White patients, 54.6 (13.4) versus 62.5 (14.8) years, P =0.001. Black patients were more likely to have sub‐basal and diffuse hypertrophy, 22 (38.6%) versus 56 (14.9%), P <0.001, 6 (10.5%) versus 15 (4%), P =0.017, mid‐LV obstruction, 7 (12.3%) versus 21 (5.5%), P =0.025, and cardiac fibrosis ≥15%, 10 (22.2%) versus 19 (8.8%), P =0.009, than White patients. Black patients were more likely to experience appropriate implantable cardioverter defibrillator interventions, 5 (38.5) versus 5 (6.8), P <0.001 and were more likely to have ≥2 sudden death risk factors. Comorbidities were largely similar between groups, though more Black participants had Class II obesity, 12 (21.8) versus 30 (8.1), P <0.001. Both groups had similar rates of genetic testing usage. Conclusions This study underscores the need for continued research of HCM in Black populations, including tailored approaches to diagnosis and precise evaluation of cardiac anatomy.

scholarly journals Evaluation for Racial Disparities in Patients Presenting for Sports Medicine Knee Surgery

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0045
Author(s):  
Christa Wentt ◽  
Morgan Jones ◽  
Greg Strnad ◽  
Isaac Briskin ◽  
Kurt Spindler ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Disease Severity ◽  
Sports Medicine ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Knee Surgery ◽  
Black And White ◽  
Black Patients ◽  
Patient Reported ◽  
White Patients

Objectives: Several clinical studies have outlined differences in clinical outcomes and access to care when controlling for race. No published clinical study has ever investigated healthcare disparities between Black and White patients presenting for sports medicine knee surgery. The purpose of this study is to determine if the racial disparities described in the literature for total joint arthroplasty and spine surgery are also preset in patients presenting for sports medicine knee surgery. Our first hypothesis is that Black patients presenting for sports medicine knee surgery have worse baseline patient-reported quality of life scores, pain, and function compared to White patients. Our second hypothesis is that Black patients have more disease severity at the time of surgery compared to their White counterparts. Methods: We prospectively collected patient-reported outcomes (PROs), disease severity, and treatment utilizing the [BLINDED DATABASE]. Patient race, body mass index (BMI) and insurance were retrospectively collected from the electronic medical record (EMR). We included consecutive patients undergoing both knee arthroscopy (partial meniscectomy) and anterior cruciate ligament (ACL) reconstruction surgery. We excluded patients undergoing other chondral replacement or complex ligamentous procedures (e.g. MPFL reconstruction, multiligamentous knee surgery, etc). Univariate ("unadjusted") analysis was utilized to compare differences between groups with ANOVA, Kruskal Wallis Testing and Pearson’s Chi-square testing. Subsequently, a multivariate analysis model was constructed to control for confounding variables within Black patients vs White patients in order to evaluate for racial disparities in baseline PROs and disease severity. All testing was considered significant at the 5% level. Results: We enrolled a total of 4,557 patients for this study. In the arthroscopy group (APM) we enrolled 3086 total patients. In this group there were 2593 White patients and 408 Black patients. Eighty-five patients identified as “Other”. In the ACL reconstruction (ACLR) group there were 1471 patients. In this group 1197 patients identified as White, 202 patients identified as Black and 72 patients identified as “Other”. Univariate analysis in the APM group demonstrated racial disparities in certain key metrics. BMI was worse in Black patients (32.4) compared to White patients (30.3) (p < 0.001). Both KOOS pain (41.7 versus 47.2; p < 0.001) and KOOS function (51.5 versus 58.0; p < 0.001) were worse in Black patients compared to White patients. A larger portion of Black patients were current smokers compared to White patients (16.% versus 10%; p < 0.001). Baseline VR12 scores were also lower in Black versus White patients (48.4 versus 55.9, p 0.001). Multivariate analysis revealed no racial disparities for any baseline patient-reported outcome measure (pain, function, or quality of life). This is a result of Black patients being more likely to present with higher BMI, current smoker status, fewer years of formal education, and Medicaid insurance. No significant differences between Black and White patients were noted with respect to disease severity (intraoperative pathology; i.e. worse chondral grade, compartments involved, meniscus tear severity). Our ACLR group demonstrated similar findings on univariate analysis with Black patients more likely to have Medicare/Medicaid than commercial insurance, a higher BMI, smoking history and a lower VR12 score compared to White patients. Linear regression analysis demonstrates that age, gender (female worse), BMI, years of education, smoking status and insurance are all significant drivers of outcome for KOOS pain. With respect to additional intra-articular pathology at the time of ACL tear, female sex and increasing years of education were at an increased odds of having a complete meniscal tear. Neither race or insurance status were significant drivers of concomitant intra-articular findings in ACL tear patients. Conclusions: There is no statistically significant racial disparity in baseline patient reported outcomes with respect to patients presenting for sports medicine knee surgery when controlling for important covariates. Black patients did present with worse subjective KOOS knee pain and functional scores, however, when possible confounding variables were controlled for in a multivariable analysis, there was no difference between the White and Black cohorts. The results of this study show that there may be modifiable risk factors that affect outcomes of patients irrespective of racial background. Addressing factors such as BMI, smoking status and healthcare literacy may help to improve outcomes for patients. Further research into interventions to correct these risk factors is needed.

Abstract 12667: Racial Disparities in Emergency Care of Patients With Suspected ACS Undergoing Cardiac CT Angiography: Insights From Romicat II and ACRIN-PA

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Christopher L Schlett ◽  
Thomas Mayrhofer ◽  
Travis Hallett ◽  
Judd Hollander ◽  
Maros Ferencik ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Ct Angiography ◽  
Emergency Care ◽  
Cardiac Ct ◽  
Computer Assisted ◽  
Black And White ◽  
Coronary Syndrome ◽  
Cardiac Ct Angiography ◽  
Black Patients ◽  
White Patients

Introduction: A disparity in health outcomes between black and white patients with coronary artery disease (CAD) has also been reported with pathophysiological differences in CAD and racial disparities in providing health care as potential explanations. Hypothesis: To determine racial disparity in emergency care of patients with suspected acute coronary syndrome (ACS) undergoing cardiac CT angiography (cCTA), which provides knowledge of underlying CAD status. Methods: We combined patient level data of the ACRIN-PA 4005 (American College of Radiology Imaging Network, Pennsylvania) and ROMICAT II (Rule Out Myocardial Infarction using Computer Assisted Tomography) trials, which enrolled patients presenting with suspicion of ACS who were randomized to cCTA as a first diagnostic test at 14 US sites. Sample was restricted to subjects with known CAD status based on cCTA. Self-reported race while the race ‘Black’ were defined as “a person having origins in any of the black racial groups of Africa” and the race ‘white’ as “a person having origins in any of the original peoples of Europe, the Middle East, or North Africa”. Results: We included 1,191 patients (53% white, 47% black). Pretest probability for ACS was similar (TIMI score, p=0.77) between black and white patients, while black patients had lower presence and extent of CAD (calcium score: 39.3±189.3 vs. 88.2±292.1, p<0.001; obstructive CAD 8.3% vs. 17.5%, p<0.001) and ACS (4.0% vs 6.9%, p=0.03). After accounting for the underlying CAD, black patients were more likely admitted to the hospital (β: 0.29 [95%CI: 0.05-0.54-]) and were more likely to undergo additional testing (β: 0.47 [95%CI: 0.09-0.85]) while remaining management showed no significant differences. Conclusions: After adjustment for underlying CAD, among patients in the ED with suspicion of ACS, those who are black received more downstream testing and were more frequently admitted to hospital than white patients.

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