scholarly journals Are Racial and Ethnic Disparities in Mortality from Acute Leukemia Due to Socioeconomic Status Factors? Data from the Surveillance Epidemiology and End Results Database Linked to the National Longitudinal Mortality Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2101-2101
Author(s):  
Manali I. Patel ◽  
Norman Johnson ◽  
Sean Altekruse ◽  
Kim Rhoads
Keyword(s):  
Socioeconomic Status ◽  
Acute Leukemia ◽  
The United States ◽  
Cancer Information ◽  
Insurance Status ◽  
Mortality Study ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Mortality Disparities ◽  
End Results

Abstract Background: Previously, we demonstrated mortality disparities for minorities with Acute Leukemia (AL) despite favorable demographic and genetic prognostic factors. We also showed that differences in treatment by race/ethnicity explained a large component of this disparity. However, due to the limitations of the Surveillance Epidemiology and End Results (SEER) stand-alone database, we could not explore the association between AL mortality and socioeconomic status (SES) factors. The purpose of the current study is to determine how SES impacts racial/ethnic differences in AL mortality using an expanded SEER-SES linked dataset. Because SES may influence the receipt of high quality care, we hypothesize that SES factors will explain some proportion of AL mortality disparities. Methods: Patients with acute lymphocytic (ALL) and acute myeloid (AML) leukemia were identified in SEER and linked to the National Longitudinal Mortality Study (NLMS). The NLMS contains patient-level SES factors collected by in-person and telephone interview surveys for a random sample in the United States Census Bureau Current Population Surveys (CPS) from the years 1979 to 2011. The SEER-NLMS linkage includes detailed cancer information (date of diagnosis, type of cancer, cause of death) and detailed SES factors (marital status, education, income, home ownership, occupation, insurance status) as well as individual demographic factors (age, gender, race/ethnicity). Cox proportional hazard models were built to estimate the hazard of mortality by race/ethnicity after consideration of individual, clinical, and SES factors. Results: A total of 621 patients were diagnosed with ALL and AML during the study period. Thirty-six records were excluded due to missing data leaving 124 (21%) patients with ALL and 461 (79%) with AML in the analysis. ALL: The majority of patients were non-Hispanic white (NHW) (n=73; 59%), followed by Hispanic (n=22; 18%), Asian Pacific Islander (API) (n=8; 6%), non-Hispanic black (NHB) (n=8; 6%) and unspecified/other race (n=13; 10%). Hispanic patients had a 3-fold increase in the hazard of death (HR 3.21; 95% CI (2.00-5.17)) when compared to NHW patients. Education and income decreased the hazard of death for Hispanic compared to NHW patients (HR 2.33 95% CI (1.21-4.48)). Insurance status further reduced this disparity (HR 2.02 95% CI (1.01-4.04)). Further adjustment for occupation and household ownership completely neutralized these disparities (HR 1.14; 95% CI (0.52-2.41)). AML: The sample included 67% NHW (n=311) patients; 7% Hispanic (n =31), 5% NHB (n=22), 6% API (n=29) and 15% patients with unspecified/other race (n=68). Similar to ALL, there was a significant association between Hispanic ethnicity and increase hazard of mortality (HR 1.50; 95% CI (1.06-2.11)). There was a marked decreased hazard of mortality associated with API (HR 0.64 95% CI (0.44-0.91)) compared with NHW patients. The results in models adjusted for select SES factors demonstrated a persistent, unchanged mortality disparity for Hispanic patients. Conclusions: SES factors explain some proportion of disparities in acute leukemia mortality, with the most impact in ALL; however, SES factors do not have as strong of an association in AML. Future interventions should be attentive to the underlying and specific factors that can reduce disparities in these diseases. Disclosures No relevant conflicts of interest to declare.

scholarly journals Racial and Ethnic Enrollment Disparities and Demographic Reporting Requirements in Acute Leukemia Clinical Trials

2021 ◽  
Author(s):  
Andrew Hantel ◽  
Marlise R. Luskin ◽  
Jacqueline S Garcia ◽  
Wendy Stock ◽  
Daniel J DeAngelo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Native American ◽  
Acute Leukemia ◽  
Race And Ethnicity ◽  
Disease Incidence ◽  
The United States ◽  
Reporting Requirements ◽  
Number Of Patients ◽  
Hispanic Patients ◽  
Race Ethnicity

Data regarding racial and ethnic enrollment diversity for acute myeloid (AML) and lymphoid leukemia (ALL) clinical trials in the United States (US) are limited, and little is known about the effect of federal reporting requirements instituted in the late 2000s. We examined demographic data reporting and enrollment diversity for US ALL and AML trials from 2002-2017 as well as changes in reporting and diversity after reporting requirements were instituted. Of 223 AML and 97 ALL trials with results, 68 (30.5%) and 51 (52.6%) reported enrollment by both race and ethnicity. Among trials that reported race and ethnicity (AML N=6,554; ALL N=4,149), non-Hispanic (NH)-Black, NH-Native American, NH-Asian, and Hispanic patients had significantly lower enrollment compared to NH-white patients after adjusting for race-ethnic disease incidence (AML odds: 0.68, 0.31, 0.75, and 0.83; ALL: 0.74, 0.27, 0.67, and 0.64; all p≤0.01). The proportion of trials reporting race increased significantly after the reporting requirements (44.2 to 60.2%; p=0.02), but race-ethnicity reporting did not (34.8 to 38.6%; p=0.57). Reporting proportions by number of patients enrolled increased significantly after the reporting requirements (race: 51.7 to 72.7%, race-ethnicity: 39.5 to 45.4%; both p<0.001), and relative enrollment of NH-Black and Hispanic patients decreased (AML odds: 0.79 and 0.77; ALL: 0.35 and 0.25; both p≤0.01). These data suggest that demographic enrollment reporting for acute leukemia trials is suboptimal, changes in diversity after the reporting requirements may be due to additional enrollment disparities that were previously unreported, and enrollment diversification strategies specific to acute leukemia care delivery are needed.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Jasmine Peters ◽  
Mariel S Bello ◽  
Leigh Spera ◽  
T Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Systematic Review ◽  
Native American ◽  
The United States ◽  
Current Status ◽  
Surgical Trauma ◽  
Insurance Status ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Race Ethnicity ◽  
The Impact

Abstract Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.

164 Hispanic Ethnicity and Socioeconomic Status are Independently Associated with Improved Prognosis in Glioblastoma Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 241-241
Author(s):  
Kevin J Moore ◽  
Angela Richardson ◽  
Tulay Koru-Sengul ◽  
Michael E Ivan
Keyword(s):  
Socioeconomic Status ◽  
Race And Ethnicity ◽  
Cox Regression ◽  
The United States ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Hispanic Ethnicity ◽  
Cancer Data ◽  
Hispanic Patients

Abstract INTRODUCTION Significant racial and social disparities have previously been identified in outcomes from glioblastoma. Although some epidemiologic studies have shown Hispanic ethnicity to be protective, other studies have not replicated this finding. As many studies do not consider race separately from ethnicity, the role of Hispanic ethnicity in glioblastoma survival is not well understood. Florida has one of the largest Hispanic populations in the United States. Using a population-based cancer database, this study examines sociodemographic and survival disparities in glioblastoma patients. METHODS Data from the Florida Cancer Data System (FCDS) and the US Census were linked for adult (>18 yrs) glioblastoma patients to determine disease burden and survival. A multivariable Cox regression model was used to model patient survival adjusting for sociodemographic, tumor, and clinical characteristics. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated for overall sample. All statistical analyses were completed with SAS v.9.4. RESULTS >In total, 16,180 Florida adults were diagnosed with glioblastoma between 1981 and 2013. The majority were male (56.0%) and white (93.0%), and 11.2% of glioblastoma patients identified as Hispanic with 2.4% self-identifying as Cuban. Hispanics had significantly better survival compared to non-Hispanics (aHR 0.84; 95% CI 0.78 0.90). Current smokers fared significantly worse (aHR 1.11; 95% CI 1.04 1.18). Higher socioeconomic status was also associated with increased survival (aHR 0.91, 95% CI 0.84 0.99). Younger age at diagnosis, surgical resection, chemotherapy, radiation therapy, and female sex were also associated with significantly improved outcomes. CONCLUSION This study demonstrates clear sociodemographic and survival disparities for glioblastoma patients. This analysis considers race and ethnicity as two distinct variables and shows improved survival outcomes for Hispanic patients. Additionally patients from neighborhoods with higher socioeconomic status have increased survival. Further analysis is needed to assess the role of histologic and molecular subtypes in these ethnic groups.

Acute Surgical Decision-Making in Abdominal Trauma Is Not Altered by Race or Socioeconomic Status

2018 ◽  
Vol 84 (12) ◽  
pp. 1869-1875 ◽  
Author(s):  
Krista Haines ◽  
Clayton Rust ◽  
Benjamin Pham Nguyen ◽  
Suresh Agarwal
Keyword(s):  
Decision Making ◽  
Socioeconomic Status ◽  
Surgical Site Infection ◽  
Insurance Status ◽  
Site Infection ◽  
Colonic Injury ◽  
Surgical Decision ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Surgical Decision Making

Two main procedures are performed on patients suffering from colonic perforation, diverting colostomy and primary tissue repair. We investigated patient race, ethnicity, and socioeconomic status (SES) that predicted surgical outcomes after blunt or penetrating trauma. A retrospective analysis was performed using data from the National Trauma Data Bank for three years (2013–2015). We identified patients who presented with primary colonic injury and subsequent colon operation (n = 5431). Operations were grouped into three classes: colostomy, ileostomy, and nonostomy. Multiple linear and logistic regressions were performed to assess how race and insurance status are associated with the primary outcome of interest (ostomy formation) and secondary outcomes such as length of stay, time spent in ICU, and surgical site infection. Neither race/ethnicity nor insurance status proved to be reliable predictors for the formation of an ostomy. Patients who received either a colostomy or ileostomy were likely to have longer stays (OR [odds ratio]: 5.28; 95% CI [confidence interval]: 3.88–6.69) (OR: 11.24; 95% CI: 8.53–13.95), more time spent in ICU (2.73; 1.70–3.76) (7.98; 6.10–9.87), and increased risk for surgical site infection (1.32; 1.03–1.68) (2.54; 1.71–3.78). Race/ethnicity and SES were not reliable predictors for surgical decision-making on the formation of an ostomy after blunt and penetrating colonic injury. However, the severity of the injury as calculated by Injury Severity Score and the number of abdominal injuries were both associated with higher rates of colostomy and ileostomy. These data suggest that surgical decision-making is dependent on perioperative patient presentation and, not on race, ethnicity, or SES.

Nursing Research in Community-Based Approaches to Reduce Exposure to Secondhand Smoke

2009 ◽  
Vol 27 (1) ◽  
pp. 365-391 ◽  
Author(s):  
Ellen J. Hahn ◽  
Kristin B. Ashford ◽  
Chizimuzo T. C. Okoli ◽  
Mary Kay Rayens ◽  
S. Lee Ridner ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Indoor Air ◽  
Secondhand Smoke ◽  
The United States ◽  
Population Based ◽  
Emergency Department Visits ◽  
Nursing Research ◽  
Smoke Free Policy ◽  
Shs Exposure ◽  
Race Ethnicity

Secondhand smoke (SHS) is the third leading cause of preventable death in the United States and a major source of indoor air pollution, accounting for an estimated 53,000 deaths per year among nonsmokers. Secondhand smoke exposure varies by gender, race/ethnicity, and socioeconomic status. The most effective public health intervention to reduce SHS exposure is to implement and enforce smoke-free workplace policies that protect entire populations including all workers regardless of occupation, race/ethnicity, gender, age, and socioeconomic status. This chapter summarizes community and population-based nursing research to reduce SHS exposure. Most of the nursing research in this area has been policy outcome studies, documenting improvement in indoor air quality, worker’s health, public opinion, and reduction in Emergency Department visits for asthma, acute myocardial infarction among women, and adult smoking prevalence. These findings suggest a differential health effect by strength of law. Further, smoke-free laws do not harm business or employee turnover, nor are revenues from charitable gaming affected. Additionally, smoke-free laws may eventually have a positive effect on cessation among adults. There is emerging nursing science exploring the link between SHS exposure to nicotine and tobacco dependence, suggesting one reason that SHS reduction is a quit smoking strategy. Other nursing research studies address community readiness for smoke-free policy, and examine factors that build capacity for smoke-free policy. Emerging trends in the field include tobacco free health care and college campuses. A growing body of nursing research provides an excellent opportunity to conduct and participate in community and population-based research to reduce SHS exposure for both vulnerable populations and society at large.

scholarly journals Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study

2008 ◽  
Vol 20 (4) ◽  
pp. 417-435 ◽  
Author(s):  
Limin X. Clegg ◽  
Marsha E. Reichman ◽  
Barry A. Miller ◽  
Benjamin F. Hankey ◽  
Gopal K. Singh ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cancer Incidence ◽  
Stage At Diagnosis ◽  
Mortality Study ◽  
End Results

The Association Between Socioeconomic Status, Renal Cancer Presentation, and Survival in the United States: A Survival, Epidemiology, and End Results Analysis

Urology ◽  
2014 ◽  
Vol 84 (3) ◽  
pp. 583-589 ◽  
Author(s):  
Matthew R. Danzig ◽  
Aaron C. Weinberg ◽  
Rashed A. Ghandour ◽  
Srinath Kotamarti ◽  
James M. McKiernan ◽  
...  
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Renal Cancer ◽  
The United States ◽  
End Results

scholarly journals GERM-04. PRIMARY INTRACRANIAL GERM CELL TUMORS ARE MORE PREVALENT AMONG PEDIATRIC PATIENTS OF ASIAN/PACIFIC ISLANDER RACE/ETHNICITY IN THE UNITED STATES

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i16-i17
Author(s):  
Nayan Lamba ◽  
Bryan Iorgulescu
Keyword(s):  
Pediatric Patients ◽  
Pacific Islander ◽  
Germ Cell Tumors ◽  
The United States ◽  
Asian Pacific Islander ◽  
Intracranial Germ Cell Tumors ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
The U.S

Abstract Introduction Primary intracranial germ cell tumors (GCTs) appear to be more prevalent among pediatric patients in eastern Asia than in the U.S. Herein we use cancer registry data to evaluate whether GCT prevalence differs by race/ethnicity among U.S. pediatric patients. Methods Pediatric patients (age≤14) presenting between 2004–2017 with a primary intracranial GCT were identified by ICD-O-3 histological and topographical coding from the National Cancer Database (comprising >70% of cancers newly-diagnosed cancers in the U.S.), and categorized by NICHD age stages. Patients’ age, sex, race/ethnicity, and overall survival, and tumor location and size were evaluated. Results 889 pediatric patients with primary intracranial GCTs were identified, which were overwhelmingly male (64.8%) and pure germinomas (64.0%). Non-germinomatous (24.5%) and mixed (11.5%) tumor types were in the minority. Overall, primary GCTs comprised 4.9% of intracranial tumors in pediatric males and 2.9% of intracranial tumors in pediatric females. Asian/Pacific Islander pediatric patients in the U.S. had a notably higher prevalence of GCTs: among Asian/Pacific Islander males, 10.6% of all brain tumors were GCTs, compared to only 4.5% in White non-Hispanic patients, 2.8% in Black non-Hispanic patients, and 6.0% in Hispanic patients. Despite the much lower prevalence of GCTs among female patients overall, this predominance also persisted for Asian/Pacific Islander females, among whom 7.5% of brain tumors were GCTs, compared to only 2.5% in White non-Hispanic patients, 2.4% in Black non-Hispanic patients, and 4.1% in Hispanic patients. Overall, 9.4% of pediatric primary intracranial GCTs occurred in patients of Asian/Pacific Islander race/ethnicity, in contrast to 4.0% of diffuse astrocytic/oligodendroglial tumors, 2.8% of other astrocytic tumors, or 4.6% of embryonal tumors. Conclusions Primary intracranial GCTs affect a substantially larger proportion of both male and female pediatric patients of Asian/Pacific Islander race/ethnicity in the United States.

scholarly journals Age-related Differences in Breast Cancer Mortality according to Race/Ethnicity, Insurance, and Socioeconomic Status

2019 ◽  
Author(s):  
Yazmin San Miguel ◽  
Scarlett Lin Gomez ◽  
James D. Murphy ◽  
Richard B. Schwab ◽  
Corinne McDaniels-Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Health Insurance ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Insurance Status ◽  
Younger Patients ◽  
Younger Women ◽  
Health Insurance Status ◽  
Race Ethnicity

Abstract Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.

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