scholarly journals Racial Disparity in Mortality Rates Among Black and White Americans with Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 5009-5009
Author(s):  
Oluwasegun Austine Akinyemi ◽  
Oluwaseun B Ogunbona ◽  
Faith O Abodunrin ◽  
Olanrewaju Oni
Keyword(s):  
Multiple Myeloma ◽  
Racial Disparity ◽  
Hematologic Malignancy ◽  
Private Insurance ◽  
The United States ◽  
Mortality Rates ◽  
Survival Outcomes ◽  
Control Group ◽  
Median Income ◽  
Income Quartile

Abstract Background: In the United States, Multiple myeloma (MM) is the second most common hematologic malignancy and the most common hematologic malignancy in blacks. It is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. Different studies have highlighted a racial disparity in survival outcomes between Blacks and Whites patients' population with MM. However, the reason for the observed racial disparity in survival outcomes is not clearly understood. Aim: To explore the role of socioeconomic variables including access to insurance and, median Income on the racial disparity in outcome among patients with MM. Method: We conducted a retrospective analysis of all hospitalizations associated with the primary diagnosis of MM in the National Inpatient Sample (NIS 2008-2014) database using the relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study outcome was the mortality rates between black patients and a propensity score matched control group of white patients with MM. Result: There were 185,000 MM associated hospitalization in the NIS (2008-2014). Among the study population, 66.7% were whites, 20.8% were blacks, and 7.7% were Hispanics. The mean age was 66.5 years for blacks and 70.2years for whites. Among the Black population, 21.6% had private insurance compared to 25.1% of their White counterparts. Also, 45.6% of Black participants were in the lowest income quartile compared to only 19.6% of Whites. Only 13.5% of Blacks were in the highest income quartile compared to 28.7% of Whites. 73.4% of Blacks were on public insurance compared to 70.9% of Whites. There was no difference in the mortality rate between blacks and a control group of whites matched for insurance, median income, sex and age (49.4% vs 50.6%, p =0.42). Conclusion: Multiple myeloma may not be more deadly in Blacks compared to Whites, and the observed disparity in outcomes in the literature are likely due to the effects of social determinants of health such as income and access to insurance. Disclosures No relevant conflicts of interest to declare.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

Progress and trends in the utilization and adoption of palliative care in patients with terminal gynecologic cancer in the United States: A study of 4,264 women.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11606-11606
Author(s):  
Anthony Milki ◽  
Amandeep Kaur Mann ◽  
Daniel Stuart Kapp ◽  
John K. Chan
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Private Insurance ◽  
Gynecologic Cancer ◽  
The United States ◽  
Cancer Type ◽  
Median Income ◽  
Logistic Regression Models ◽  
Lower Socioeconomic ◽  
Chi Squared

11606 Background: To determine the factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were extracted from the National Inpatient Sample (NIS) database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were employed for statistical analyses. Results: Of 4264 women with gynecologic cancer, 983 (23.0%) utilized PC (median age: 66 years). 2633 (61.8%), 1034 (24.3%), and 597 (14.0%) patients had ovarian, uterine, and cervical cancer, respectively. The majority were white (57.9%), and the remainder were black (12.6%), Hispanic (7.8%), and Asian (3.1%). 24.9, 23.9, 23.6, and 25.2% were low, low-middle, middle-high, and high with respect to median income. Medicare, Medicaid, and private insurance was found in 46.7, 10.8, and 37.6% of patients. 36.9, 21.0, 18.0, and 24.1% of patients were treated in hospitals in the South, West, Midwest, and Northeast. 11.3, 23.9, and 64.2% of patients were treated in small, medium, and large hospitals, designated as teaching (53.1%) and nonteaching (46.3%) institutions. The utilization of PC increased from 5.2% in 2005 to 30.4% in 2011. Older age (OR: 1.34; 95% CI: 1.10-1.64; P = 0.01), high SES (OR: 1.37; 95% CI: 1.09-1.72; P = 0.01), privately insured (OR: 1.81; 95% CI: 1.46-2.24; P < 0.001), treatment at Western (OR: 1.94; 95% CI: 1.56-2.41; P < 0.001) and Midwestern hospitals (OR: 1.43; 95% CI: 1.15-1.77; P = 0.001), and depression (OR: 1.34; 95% CI: 1.00-1.80; P = 0.05) were associated with higher PC use. However, race, cancer type, hospital teaching status, and hospital location were not associated with PC use. Conclusions: The use of inpatient palliative care has increased significantly over the study period. The lower utilization of palliative care for terminal illness associated with younger, lower socioeconomic status, Southern and smaller volume hospitals warrants further attention.

scholarly journals Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

2017 ◽  
Vol 33 (10) ◽  
pp. 551-556 ◽  
Author(s):  
Barret Rush ◽  
Katie Wiskar ◽  
Leo Anthony Celi ◽  
Keith R. Walley ◽  
James A. Russell ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Hospital Mortality ◽  
Low Socioeconomic Status ◽  
Household Income ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
The United States ◽  
Median Income ◽  
Risk Of Mortality ◽  
Income Quartile

Objective: Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States. Methods: Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed. Results: A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99-1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97-1.01, P = .40) quartiles compared to the highest. Conclusion: After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES.

Racial and socioeconomic disparities in overall survival in colorectal cancer (CRC) at West Cancer Center & Research Institute (WCCRI), Memphis, TN.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16122-e16122
Author(s):  
Vanessa Wookey ◽  
Gabriella Bufalino ◽  
Gregory A. Vidal ◽  
Bradley G. Somer ◽  
Lee S. Schwartzberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Private Insurance ◽  
Socioeconomic Disparities ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Median Income ◽  
Entire Cohort ◽  
Stage 4

e16122 Background: WCCRI, a comprehensive regional community oncology center in Memphis, Tennessee and the Mid-South region, serves a racially, geographically and socioeconomically diverse patient cohort. We sought to evaluate disparity of outcomes in survival by race and socioeconomic status, in addition to patient and tumor characteristics. Methods: All consecutive patients referred to and treated at WCCRI with colorectal adenocarcinoma from 2007-2013 were included. Individual chart review was performed to verify diagnosis, stage, and date and cause of death. Kaplan-Meier Overall Survival curves were generated for the entire cohort and by race, sex, tumor location and income derived from zip code. WCCRI survival data were compared to SEER data. Results: From 2007-2013, 1,176 patients were included in the analysis: 405 blacks, 757 whites, 14 others. Median age at diagnosis: Blacks 58 yrs, whites 61 yrs. Stage distribution at diagnosis: stage 1: 100, stage 2: 275, stage 3: 425, stage 4: 376. All stages combined, blacks trended towards shorter OS vs whites (5-year OS: 52.8% vs 58.3%; median survival 71.0 mos vs 98.6 mos; p= 0.095). Blacks presented at later stages (71.4% at stage 3 or 4 vs 66.3% for whites) but no statistically significant OS differences were seen when compared by stage. Patients at or below the median income of $39,590 for WCC had worse 5-year OS (51.6% vs. 61.1%; p= 0.006), as did patients without private insurance (5-year OS: uninsured: 48.0%, Medicare/Medicaid: 50.0%, private: 62.0%; p< 0.001). Adjusted for stage, 5-year OS was statistically significant for stage 4 (private: 18.0%, Medicare/Medicaid: 9.4%, uninsured: 8.3%; p= 0.020). A higher proportion of blacks were below the median income (69% vs 39%) but no statistically significant OS differences were seen when adjusted by race. Overall, cancer survival outcomes were similar to SEER results. Conclusions: At WCCRI, black patients with CRC presented at a later stage than whites, however, adjusted for stage, no significant racial difference in OS was found. Income and insurance status influenced survival outcomes. Overall, our results reveal racial and socioeconomic disparities in colorectal cancer in a diverse US population and further detailed multivariate data analyses are underway.

Racial and socioeconomic disparities in overall survival in colorectal cancer (CRC) at West Cancer Center (WCC), Memphis, TN.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 80-80
Author(s):  
Vanessa Wookey ◽  
Gabriella Bufalino ◽  
Gregory A. Vidal ◽  
Bradley G. Somer ◽  
Lee S. Schwartzberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Private Insurance ◽  
Socioeconomic Disparities ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Median Income ◽  
Entire Cohort ◽  
Stage 4

80 Background: WCC, a comprehensive regional community oncology center in Memphis, Tennessee and the Mid-South region, serves a racially, geographically and socioeconomically diverse patient cohort. We sought to evaluate disparity of outcomes in survival by race and socioeconomic status, in addition to patient and tumor characteristics. Methods: All consecutive patients referred to and treated at WCC with colorectal adenocarcinoma from 2007-2013 were included. Individual chart review was performed to verify diagnosis, stage, and date and cause of death. Kaplan-Meier Overall Survival curves were generated for the entire cohort and by race, sex, tumor location and income derived from zip code. WCC survival data were compared to SEER data. Results: From 2007-2013, 1,176 patients were included in the analysis: 405 blacks, 757 whites, 14 others. Median age at diagnosis: Blacks 58 yrs, whites 61 yrs. Stage distribution at diagnosis: stage 1: 100, stage 2: 275, stage 3: 425, stage 4: 376. All stages combined, blacks trended towards shorter OS vs whites (5-year OS: 52.8% vs 58.3%; median survival 71.0 mos vs 98.6 mos; p= 0.095). Blacks presented at later stages (71.4% at stage 3 or 4 vs 66.3% for whites) but no statistically significant OS differences were seen when compared by stage. Patients at or below the median income of $39,590 for WCC had worse 5-year OS (51.6% vs. 61.1%; p= 0.006), as did patients without private insurance (5-year OS: uninsured: 48.0%, Medicare/Medicaid: 50.0%, private: 62.0%; p< 0.001). Adjusted for stage, 5-year OS was statistically significant for stage 4 (private: 18.0%, Medicare/Medicaid: 9.4%, uninsured: 8.3%; p= 0.020). A higher proportion of blacks were below the median income (69% vs 39%) but no statistically significant OS differences were seen when adjusted by race. Overall, cancer survival outcomes were similar to SEER results. Conclusions: At WCC, black patients with CRC presented at a later stage than whites, however, adjusted for stage, no significant racial difference in OS was found. Income and insurance status affected survival outcomes. Overall, our results reveal racial and socioeconomic disparities in colorectal cancer in a diverse US population.

scholarly journals Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876335 ◽  
Author(s):  
Miranda J. Rogers ◽  
Ian Penvose ◽  
Emily J. Curry ◽  
Anthony DeGiacomo ◽  
Xinning Li
Keyword(s):  
Health Insurance ◽  
Acl Reconstruction ◽  
Metropolitan Area ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Median Income ◽  
Insurance Type ◽  
Insured Patients ◽  
Privately Insured

Background: In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation. Purpose: To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act. Study Design: Cross-sectional study. Methods: Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located. Results: Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients ( P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted. Conclusion: The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

Survival outcomes for multiple myeloma over three decades: A Surveillance, Epidemiology, and End Results (SEER) analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8019-8019 ◽  
Author(s):  
I. Jawed ◽  
C. M. Lee ◽  
J. D. Tward ◽  
O. K. Macdonald ◽  
D. Martincic ◽  
...  
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Cox Regression ◽  
Patient Characteristics ◽  
The United States ◽  
Survival Outcomes ◽  
Cox Regression Analysis ◽  
Black Race ◽  
Younger Age ◽  
End Results

8019 Background: There is limited data regarding survival outcomes for multiple myeloma in the literature. The purpose of this study was to analyze how patient characteristics and decade of treatment affect overall survival (OS) and cause-specific survival (CSS) for patients within a large United States (US) population database. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) of the US National Cancer Institute for the years 1973–2003. Patient characteristics (gender, race, age) and year of diagnosis were analyzed by multivariate Cox regression analysis for both OS and CSS endpoints. Results: 40,538 patients were included in the analysis. The mean age at diagnosis was 68.3 (median 69) years. Mean survival for the entire cohort was 41 (median 24) months. Females had better OS than males, hazard ratio (HR) 0.91 (CI 0.89–0.93, P = 0.0001), and CSS, HR 0.96 (CI 0.93–0.98, P = 0.004). There were no significant differences in OS between white and black race (P = 0.34), but black race was associated with improved CSS, HR 0.89 (CI 0.86–0.93, P = 0.0001). Younger age (age <40, 41–60, 61–70, and 71–80) was associated with improved OS and CSS (all P = 0.0001). Early treatment decade (1973–1985) was associated with diminished OS and CSS on multivariate analysis with HR 1.11 (CI 1.08–1.14, P = 0.0001) and HR 1.12 (CI 1.08–1.16, P = 0.001), respectively. Conclusions: This is the largest reported population analysis of survival outcomes for multiple myeloma. It covers three decades of care in the United States. This study reveals that improved OS and CSS are associated with younger age, female gender, and recent decade of treatment. We believe that survival improvement in recent treatment decades may be due to advances in supportive care and/or earlier diagnosis as the standard treatment for myeloma did not significantly change during this time period. Follow up studies may show dramatic improvements in survival outcomes due to modern myeloma therapies in this decade. No significant financial relationships to disclose. [Table: see text]

Demographic characteristics of smoldering multiple myeloma patients: A hospital-based study including 11,643 patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13064-e13064
Author(s):  
Kamal Chamoun ◽  
Ravi Kumar Kyasaram ◽  
Leland L. Metheny ◽  
Molly Gallogly ◽  
Paolo Fabrizio Caimi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Temporal Dynamics ◽  
Private Insurance ◽  
Standard Of Care ◽  
Epidemiologic Studies ◽  
National Cancer Data Base ◽  
Medium Size ◽  
Median Income ◽  
Cancer Data ◽  
Screening Strategies

e13064 Background: SMM is the requisite asymptomatic phase that precedes Multiple Myeloma (MM). Observation until progression to MM has been the standard of care. However, the improvement in risk assessment and utility of chemoprevention strategies stemmed from large trials (e.g. QUIREDEX and E3A06) is beginning to shift the paradigm toward early detection of SMM by implementing screening strategies (e.g., PROMIS study). Lack of specific ICD code for SMM has been a major problem in epidemiologic studies aiming at characterizing the demographics and temporal dynamics of SMM. Here, we used the National Cancer Data Base (NCDB), which covers more than 70% of cancer pts in the USA, for this purpose. Methods: NCDB data from year 2010 to 2014 was analyzed. We defined SMM as pts with ICD-O 9732 that were placed on active surveillance or did not receive any therapy in the first 3 months (m) after diagnosis (Ravindran et al. Blood Cancer J. 2016). Institution size was categorized as small, medium and large if they reported < 10, 10-50, and > 50 cases per year, respectively. Results: Out of a total of 68234 MM pts, we identified 11643 (17%) with SMM. Median follow up was 32 m (0 - 85). Median age was 65 years (26 - 90), 52% were males, 71% were white and 24% were black. Median survival was 77.7 and 49.8 m for pts with SMM and MM, respectively ( p= 0.001). Median age at diagnosis of SMM was 62 and 66 years in blacks and whites, respectively ( p= 0.01). Over 87% of pts were diagnosed in small and medium size institutions (38% and 49%, respectively). Medicare was the main insurance payer (57%), followed by private insurance (32%) and Medicaid (5%), and 3% were not insured. The majority of pts (59.5%) lived in areas where the median income is less than $46K/year. Median distance traveled to treatment facility was 8.5 miles. During the first two years from diagnosis 18% needed treatment which is compatible with known estimated 10% per year risk of progression from SMM to MM. Conclusions: This large study of over 11,000 SMM pts highlights the national demographics of SMM diagnosed between years 2010 and 2014. Our results indicate that targeting small and medium size facilities should be an essential part of SMM screening strategies.

Sign in / Sign up

Export Citation Format

Share Document