scholarly journals Racial Disparities in the Diagnostic Evaluation of Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4116-4116
Author(s):  
Lucia D Notardonato ◽  
Spencer S Langerman ◽  
Jifang Zhou ◽  
Gregory S Calip ◽  
Brian C-H Chiu ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Relative Difference ◽  
Diagnostic Evaluation ◽  
Diagnostic Workup ◽  
Newly Diagnosed ◽  
Fish Cytogenetics ◽  
Black Patients ◽  
Pet Ct ◽  
Beta 2 Microglobulin ◽  
White Patients

Abstract Introduction: Multiple myeloma (MM) is the most common hematologic malignancy in Black individuals with a 2-to-3-fold higher incidence rate among Black compared to White individuals. While therapeutic advances have led to significant increases in survival rates in MM across races, there still exist racial disparities in outcomes that have been attributed to inferior access to novel therapies and autologous stem cell transplant among Black patients. Risk stratification is an important strategy that allows clinicians to identify high-risk disease and potentially tailor therapy based on staging to try to abrogate its poor prognosis. Current risk stratification schemata in MM, such as the International Staging System (ISS) and Revised ISS (R-ISS), necessitate serum laboratory data and fluorescence in-situ hybridization (FISH) cytogenetic analysis of bone marrow specimens. To the best of our knowledge, it is unknown if discrepancies exist in the initial diagnostic workup of MM between Blacks and Whites, which ultimately may have treatment and outcome implications. We sought to assess the presence of racial disparities in the diagnostic workup of newly diagnosed MM among Black and White patients. Methods: We performed a retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, which includes 16,174 MM patients with patient-level demographics, survival data, and health care claims information. The data included patients ≥ 65 years-old with the diagnosis of MM between 2001-2015. Race was documented by SEER registries. Lab and imaging data were collected from 180 days before and after diagnosis to capture an ample and appropriate allotted time for diagnostic workup. CPT codes were queried to determine the frequency of the diagnostic tests of interest. Data were analyzed through R version 4.0.2. Pearson chi-squared tests were used to compare frequency of diagnostic testing between racial groups. Results: A total of 18,267 MM patients were identified in the SEER-Medicare linked database. Of that, 15,360 MM patients (12,645 White and 2,715 Black) were identified with peripheral blood laboratory, bone marrow, and imaging health care claims data available . The remaining 2,907 patients with a documented race other than White or Black were excluded. Complete blood count and comprehensive metabolic panel serum tests were used to evaluate completeness of CPT codes use, which demonstrated that >89% (13,723/15,360) of individuals had both tests performed. Overall, Black patients had lower frequency of nearly all serum and imaging tests completed relative to White patients (Table 1). Only 61% of White patients underwent the testing components necessary to adequately risk-stratify disease by ISS (e.g., beta-2 microglobulin) compared to 50% of Black patients (relative difference 21%). 30% of White individuals underwent the components to determine R-ISS (e.g., FISH cytogenetics). There were low overall rates of FISH cytogenetics obtained in the study population, with White individuals undergoing FISH cytogenetics at a rate of 30% compared to 25% among Black individuals (relative difference 18%). Magnetic resonance imaging (MRI) of the lumbar spine, the most commonly imaged portion of the spine by MRI, was performed more commonly in White vs Black individuals (33% vs 24%, relative difference 35%). PET/CT was performed in only a small percentage of patients (Whites 9% vs Blacks 5%, relative difference 94%). Conclusions: In a real-world analysis of patients with newly diagnosed MM, we found that Black patients were less likely than White patients to undergo a complete initial diagnostic evaluation. While rates of beta-2 microglobulin and FISH cytogenetics testing were low among all patients, Black patients were less likely to undergo testing needed to complete staging for ISS/R-ISS or proper imaging to assess for extramedullary disease (i.e., PET/CT). Whether these differences between the races in the initial diagnostic workup lead to differences in treatment strategies and survival outcomes deserves additional investigation. Further work is needed to improve access to complete diagnostic evaluation among Black patients with newly diagnosed MM. Figure 1 Figure 1. Disclosures Calip: Pfizer: Research Funding; Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Derman: Sanofi: Membership on an entity's Board of Directors or advisory committees.

Effect of an antiracism intervention on disparities in time to lung cancer surgery.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 101-101
Author(s):  
Jacob Newton Stein ◽  
Samuel Cykert ◽  
Christina Yongue ◽  
Eugenia Eng ◽  
Isabella Kathryn Wood ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Racial Disparities ◽  
Cancer Care ◽  
Retrospective Cohort ◽  
Early Stage ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Early Stage Lung Cancer ◽  
Black Patients ◽  
White Patients

101 Background: Racial disparities are well described in the management of early-stage lung cancer, with Black patients less likely to receive potentially curative surgery than non-Hispanic Whites. A multi-site pragmatic trial entitled Accountability for Cancer Care through Undoing Racism and Equity (ACCURE), designed in collaboration with community partners, eliminated racial disparities in lung cancer surgery through a multi-component intervention. The study involved real-time electronic health record (EHR) monitoring to identify patients not receiving recommended care, a nurse navigator who reviewed and addressed EHR alerts daily, and race-specific feedback provided to clinical teams. Timeliness of cancer care is an important quality metric. Delays can lead to disease progression, upstaging, and worse survival, and Black patients are more likely to experience longer wait times to lung cancer surgery. Yet interventions to reduce racial disparities in timely delivery of lung cancer surgery have not been well studied. We evaluated the effect of ACCURE on timely receipt of lung cancer surgery. Methods: We analyzed data of a retrospective cohort at five cancer centers gathered prior to the ACCURE intervention and compared results with prospective data collected during the intervention. We calculated mean time from clinical suspicion of lung cancer to surgery and evaluated the proportion of patients who received surgery within 60 days stratified by race. We performed a t-test to compare mean days to surgery and chi2 for the delivery of surgery within 60 days. Results: 1320 patients underwent surgery in the retrospective arm, 160 were Black. 254 patients received surgery in the intervention arm, 85 were Black. Results are summarized in Table. Mean time to surgery in the retrospective cohort was 41.8 days, compared with 25.5 days in the intervention cohort (p<0.01). In the retrospective cohort, 68.8% of Black patients received surgery within 60 days versus 78.9% of White patients (p<0.01). In the intervention, the difference between Blacks and Whites with respect to surgery within 60 days was no longer significant (89.41% of Black patients vs 94.67% of White patients, p=0.12). Conclusions: Racial disparities exist in the delivery of timely lung cancer surgery. The ACCURE intervention improved time to surgery and timeliness of surgery for Black and White patients with early-stage lung cancer. A combination of real-time EHR monitoring, nurse navigation, and race-based feedback markedly reduced racial disparities in timely lung cancer care. [Table: see text]

Racial disparities in biomarker testing and clinical trial enrollment in non-small cell lung cancer (NSCLC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9005-9005
Author(s):  
Debora S. Bruno ◽  
Lisa M. Hess ◽  
Xiaohong Li ◽  
Eric Wen Su ◽  
Yajun Emily Zhu ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Racial Disparities ◽  
Trial Participation ◽  
First Line ◽  
Metastatic Nsclc ◽  
Black Patients ◽  
Biomarker Testing ◽  
Clinical Trial Enrollment ◽  
White Patients

9005 Background: Cancer racial disparities may exist at many levels in the health care system, from screening to timely diagnosis and treatments received, as well as clinical trial enrollment. This study investigated differences in black versus white race among patients with NSCLC undergoing biomarker testing and clinical trial enrollment in the US. Methods: This retrospective observational study utilized the Flatiron Health database, which includes longitudinal data of patients with advanced/metastatic NSCLC. Patients were eligible if they had evidence of systemic therapy in the database from 1/1/2017 through 10/30/2020. Descriptive analyses summarized differences by race in biomarker testing and trial enrollment. Multivariable regression examined the relationship between these factors. Results: A total of 14,768 patients were eligible: 9,793 (66.3%) were white and 1,288 (8.7%) were black. 76.4% of white patients and 73.6% of black patients underwent at least one single molecular test or comprehensive genomic analysis (p = 0.03). Next-generation sequencing (NGS) was performed among 50.1% of white patients and 39.8% of black patients (p < 0.0001. Trial participation was observed among 3.9% of white and 1.9% of black patients (p = 0.0002). There was a statistically significant association between race (white vs black) and both biomarker testing (ever vs never) and trial participation (yes vs no) (both p < 0.001, unadjusted chi square). Differences in NGS testing, baseline biomarker testing, and race were retained as statistically significant (p < 0.01) in adjusted regression analyses. The receipt of first-line targeted therapy was comparable between white and black patients (10.2% and 9.2%, respectively, p = 0.24); however, this summary did not consider biomarker test results. First line use of pembrolizumab+carboplatin+pemetrexed was observed among 19.8% of white and 22.6% of black patients; carboplatin+paclitaxel was observed among 16.5% and 18.6%, and single-agent pembrolizumab was observed among 14.8% and 11.5%, respectively. Conclusions: The use of NGS-based testing, which is recommended by the National Comprehensive Cancer Network Clinical Guidelines in Oncology for patients with advanced/metastatic NSCLC, is the most notable disparity among black patients, with more than a 10 percentage-point difference in receipt of this testing versus white counterparts. This may in part contribute to the more than double the rate of participation in clinical trials observed among white patients, as many second line and beyond trials utilize molecular targets as inclusion criteria. While multiple factors are known to impact health care disparities, access to and receipt of appropriate biomarker testing may be an attenable goal in order to ensure equal access to quality care.

Racial Disparities in Invasive Management for Patients With Acute Myocardial Infarction With Chronic Kidney Disease

2021 ◽  
Author(s):  
Jennifer A. Rymer ◽  
Shuang Li ◽  
Patrick H. Pun ◽  
Laine Thomas ◽  
Tracy Y. Wang
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Racial Disparities ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Logistic Regression Models ◽  
Black Patients ◽  
Invasive Management ◽  
White Patients

Background: Due to increased risks of contrast nephropathy, chronic kidney disease (CKD) can deter consideration of invasive management for patients with myocardial infarction (MI). Black patients have a higher prevalence of CKD. Whether racial disparities exist in the use of invasive MI management for patients with CKD presenting with MI is unknown. Methods: We examined 717 012 White and 99 882 Black patients with MI treated from 2008 to 2017 at 914 hospitals in the National Cardiovascular Data Registry Chest Pain—MI Registry. CKD status was defined as estimated glomerular filtration rate (eGFR) ≥90 mL/(min·1.73 m 2 ; no CKD), eGFR <90 but ≥60 (mild), eGFR <60 but ≥30 (moderate), and eGFR <30 or dialysis (severe). We used multivariable logistic regression models to examine the interaction of race and CKD severity in invasive MI management. Results: Among those with MI, Black patients were more likely than White patients to have CKD (eGFR <90; 61.4% versus 58.5%; P <0.001). Among those with MI and CKD, Black patients were more likely than White patients to have severe CKD (21.2% versus 12.4%; P <0.001). Patients with CKD were more likely than those without CKD to have diabetes or heart failure; Black patients with CKD were more likely to have these comorbidities when compared with White patients with CKD (all P <0.0001). Black race and CKD were associated with a lower likelihood of invasive management (adjusted odds ratio, 0.78 [95% CI, 0.75–0.81]; adjusted odds ratio, 0.72 [95% CI, 0.70–0.74]; P <0.001 for both). At eGFR levels ≥10, Black patients were significantly less likely than White patients to undergo invasive management. Conclusions: Black patients with MI and mild or moderate CKD were less likely to undergo invasive management compared with White patients with similar CKD severity. National efforts are needed to address racial disparities that may remain in the invasive management of MI.

scholarly journals Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer

2008 ◽  
Vol 26 (30) ◽  
pp. 4891-4898 ◽  
Author(s):  
Shaheenah Dawood ◽  
Kristine Broglio ◽  
Ana M. Gonzalez-Angulo ◽  
Aman U. Buzdar ◽  
Gabriel N. Hortobagyi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stage Iv ◽  
The United States ◽  
Breast Cancer Specific Survival ◽  
Newly Diagnosed ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Black Patients ◽  
Stage Iv Breast Cancer ◽  
White Patients

Purpose Overall, breast cancer mortality has been declining in the United States, but survival studies of patients with stage IV disease are limited. The aim of this study was to evaluate trends in and factors affecting survival in a large population-based cohort of patients with newly diagnosed stage IV breast cancer. Patients and Methods We searched the Surveillance, Epidemiology, and End Results registry to identify female patients with stage IV breast cancer diagnosed between 1988 and 2003. Patients were divided into three groups according to year of diagnosis (1988 to 1993, 1994 to 1998, and 1999 to 2003). Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics independently associated with survival. Results We identified 15,438 patients. Median age was 62 years. Median follow-up was 16 months, 18 months, and 11 months in periods 1988 to 1993, 1994 to 1998, and 1999 to 2003, respectively. Median breast cancer–specific survival was 23 months. In the multivariate model, earlier year of diagnosis, grade 3 disease, increasing age, being unmarried, hormone receptor–negative disease, and no surgery were all independently associated with worse overall and breast cancer–specific survival. With each successive year of diagnosis, black patients had an increasingly greater risk of death compared with white patients (hazard ratio, 1.03; 95% CI, 1.00 to 1.06; P = .031). Conclusion The survival of patients with newly diagnosed stage IV breast cancer has modestly improved over time, but these data suggest that the disparity in survival between black and white patients has increased.

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.

Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients

2005 ◽  
Vol 23 (3) ◽  
pp. 510-517 ◽  
Author(s):  
Ewout W. Steyerberg ◽  
Craig C. Earle ◽  
Bridget A. Neville ◽  
Jane C. Weeks
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Racial Disparities ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Curative Surgery ◽  
Black Patients ◽  
Surgical Evaluation ◽  
White Patients

Purpose We investigated racial disparities in access to surgical evaluation, receipt of surgery, and survival among elderly patients with locoregional esophageal cancer. Methods We selected 2,946 white patients and 367 black patients who were older than 65 years and had clinically locoregional esophageal cancer in the Surveillance, Epidemiology, and End Results (SEER) registry (1991 to 1999). Treatment and outcome data were obtained from the linked SEER-Medicare databases. We used logistic regression analysis to estimate odds ratios (ORs) for being seen by a surgeon and for undergoing surgery. Cox proportional hazards analyses were performed to estimate hazard ratios (HRs) for survival adjusted for medical, nonmedical, and treatment characteristics. Results The rate of surgery for black patients was half that of white patients (25% v 46%; OR, 0.38; P < .001), which was caused by both a lower rate of seeing a surgeon (70% v 78%; OR, 0.66; P < .001) and a lower rate of surgery once seen (35% v 59%; OR, 0.38; P < .001). These racial disparities were only partly explained by differences in patient and cancer characteristics, and not by nonmedical factors, such as socioeconomic status. The 2-year survival rate was lower for black patients (18% v 25%; HR, 1.18; P = .004), but this racial difference disappeared when corrected for treatment received (adjusted HR, 1.02; P = .80). Conclusion Underuse of potentially curative surgery is an important potential explanation for the poorer survival of black patients with locoregional esophageal cancer. Barriers to surgical evaluation and treatment need to be reduced, whether related to patient or healthcare system factors.

Abstract 184: Racial Disparities in Out-Of-Hospital Cardiac Arrest Interventions and Survival in the Pragmatic Airway Resuscitation Trial

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Joshua R Lupton ◽  
Robert Schmicker ◽  
Jestin Carlson ◽  
Clifton W Callaway ◽  
Heather Herren ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Racial Disparities ◽  
Secondary Analysis ◽  
Laryngeal Tube ◽  
Advanced Airway ◽  
Black Patients ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest ◽  
White Patients

Background: Prior studies have reported racial disparities in survival from out-of-hospital cardiac arrest (OHCA). However, these studies did not evaluate how emergency medical services (EMS) provider assessment of race impacts OHCA interventions and survival. Our objective was to evaluate racial disparities in OHCA airway management and patient outcomes in the multicenter Pragmatic Airway Resuscitation Trial (PART). Methods: We conducted a secondary analysis of adult OHCA patients enrolled in PART. Trial subjects were randomized to initial advanced airway management with laryngeal tube or endotracheal intubation. The primary independent variable was patient race (categorized by EMS as white, black, and other). We used general estimating equations (GEE) to examine the association of race (white or black) with airway attempt success, 72-hour survival, and survival to hospital discharge, adjusting for sex, age, witness status, bystander CPR, initial rhythm, arrest location, and randomization cluster. Results: Of 3002 patients, race was 1537 white, 860 black, and 605 other. Median times (min [interquartile range]) from dispatch to arrival (5.4 [2.8] vs. 5.0 [2.3]), arrival to CPR (2.2 [2.7] vs. 2.0 [2.7]), and arrival to airway attempt (12.2 [7.6] vs. 11.0 [7.4]) were longer for black compared to white patients, respectively. Black patients had lower unadjusted odds of shockable rhythms (OR 0.59; 95% CI 0.47, 0.74), bystander CPR (0.47; 0.39, 0.56), and survival to discharge (0.68; 0.50, 0.92) than white patients. After adjustment for confounders, black race was not associated with airway success (OR 1.13; 95% CI 0.9, 1.41), 72-hr survival (1.06; 0.81, 1.30), or survival to discharge (0.82; 0.57, 1.19). Conclusions: Although black patients had lower odds of shockable rhythms and bystander CPR, airway success and survival odds were similar to white patients. Further studies are needed to better understand disparities in survival from OHCA.

Measuring disparities in quality of oncology care across oncology practices.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6533-6533
Author(s):  
Nancy Lynn Keating ◽  
Mary Beth Landrum ◽  
Alan Zaslavsky ◽  
Cleo A. Samuel ◽  
Anna Sinaiko ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Quality Measures ◽  
Care Quality ◽  
Fee For Service ◽  
Practice Level ◽  
Black And White ◽  
Percentage Points ◽  
Black Patients ◽  
Ed Visits ◽  
White Patients

6533 Background: Equity is now recognized as an essential aspect of health care quality. Racial inequities in clinical performance diminish overall system performance. We assessed the feasibility and reliability of practice-level measures of racial disparities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Methods: Using fee-for-service Medicare data, we identified 1,196,970 Black or White fee-for-service Medicare beneficiaries with cancer receiving chemotherapy in 2016-2019, who were attributed to 5511 oncology practices that treated at least 1 Black and 1 White beneficiary (96.4% of all beneficiaries). We studied two CMS quality measures: chemotherapy associated ED visits and chemotherapy associated hospitalizations. For each outcome, we estimated multi-level models with separate practice-level random intercepts for Black and White patients to quantify practice-level Black-White disparities in adjusted rates of these measures and assess the associations of these rates with the proportion of Black patients in the practice. Results: Overall, 108,177 Black and 966,381 White beneficiaries with cancer were treated at 1321 practices with reliable estimates (reliability ≥70%) of Black-White differences in rates of chemotherapy-associated ED visits; 101,411 Black and 915,895 White beneficiaries were treated at 1,012 practices with reliable estimates of chemotherapy-associated hospitalizations. These practices treated 80% or more of all Black and White beneficiaries; 10% of these practices treated 75% of Black beneficiaries. The median adjusted Black-White rate difference across practices was +8.9% [interquartile interval (IQI) +5.0%, +12.8%; 5th, 95th percentile -1.8 to +19.2%] for chemotherapy associated ED visits and +4.4% [IQI +1.3%, +7.7%; 5th, 95th percentile -3.5% to +13.5%] for chemotherapy associated hospitalizations. Chemotherapy-associated ED visit rates were 3.2 percentage points higher for Black vs White patients (P <.001) at the practice with the mean % of Black patients, but the difference was smaller in practices with more Black patients (0.4 percentage points less for each 10% increase in Black share, P <.001). Chemotherapy-associated hospitalization rates were 0.6 percentage points lower for Black vs White patients (P =.01) but did not vary by practice racial composition. Conclusions: Using data from more than 1000 practices over 4 years, we calculated reliable estimates of practice-level racial disparities in chemotherapy-associated ED visits and hospitalizations. Practice-level performance for these quality measures was generally lower for Black versus White beneficiaries. Measuring and providing feedback on practice-level Black-White disparities in oncology performance measures may be one effective tool for advancing racial equity in care quality for cancer patients receiving chemotherapy.

Racial disparities in performance status among cancer patients at a community oncology practice.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 132-132
Author(s):  
Joanne S. Buzaglo ◽  
Alexander Musallam ◽  
Edward Stepanski ◽  
Craig White ◽  
Mary Joiner ◽  
...  
Keyword(s):  
African American ◽  
Racial Disparities ◽  
Cancer Patients ◽  
Performance Status ◽  
Daily Activities ◽  
Cancer Type ◽  
Community Oncology ◽  
Black Patients ◽  
Oncology Practice ◽  
White Patients

132 Background: Performance status is used to characterize patient ability to tolerate chemotherapy and as a selection criterion for clinical research. Poor performance status can exclude patients from clinical trial participation. Further, African American cancer patients are underrepresented in cancer clinical trials. The study purpose was to document performance status at the initial patient visit to a community oncology practice and to explore racial disparities between White and Black patients. Methods: This study used a retrospective, observational design with ePRO collected via the Patient Care Monitor™ (PCM). All study data were collected as part of routine clinical care at a community oncology practice during 1/2019–11/2019. An Eastern Cooperative Oncology Group (ECOG) score was automatically calculated after patients at an initial clinic visit completed a 1-item question that assessed performance status via e-tablet. Results: 6,613 patients completed the PCM survey (mean age 59; 33% male/67% female; 55.4% White, 38% Black). Cancer type was known for a subset of patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). The average ECOG score for the total sample was 0.97. 50% indicated they were able to complete their normal daily activities without any restriction; 26.9% were able to complete their normal daily activities and some light work. In contrast, 10.3% indicated they could take care of themselves, but could not work and are in bed/chair less than half the day. 10.3% could take care of themselves sometimes but could not work and are in bed/chair more than half the day. 4.5% indicated they could not take care of themselves and were in bed/chair almost always. When assessing racial differences between those self-identifying as White or Black/African American, average ECOG score was higher in Black patients [Mean(SD) = 1.03(1.24)] when compared to White patients [Mean(SD) = 0.93(1.14)] (p = 0.003). We observed a higher percentage of Black patients reported not being able to take care of themselves (51.9% Black v. 41.0% White). In contrast, a higher percentage of White patients reported being able to complete all daily activities without restriction (38.3% Black v. 54.5% White). Conclusions: This study shows significant racial disparities in performance status among patients seen at a community oncology practice with Black patients exhibiting significant worse performance status than White patients. These findings have implications for disparities in treatment outcomes and racially biased access to clinic trials.

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