Racial and ethnic disparities in the survival of adolescents and young adults (AYA) with acute myeloid leukemia (AML).

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 297-297
Author(s):  
Urshila Durani ◽  
Adam C Bartley ◽  
Ronald S. Go
Keyword(s):  
Care Delivery ◽  
Lymphoblastic Leukemia ◽  
Ethnic Disparities ◽  
National Cancer Data Base ◽  
Cancer Data ◽  
The Us ◽  
Ethnic Subgroups ◽  
Race Ethnicity ◽  
Socio Demographic Factors ◽  
Patient Care Delivery

297 Background: Unlike acute lymphoblastic leukemia, no studies have examined the effect of race on survival among AML in AYA using national data. Methods: We studied patients in the US National Cancer Data Base aged 15-39 diagnosed with AML from 2001-2011 (excluding acute promyelocytic leukemia). AMLs harboring inv(16) or t(8;21) were defined as good-risk. We examined overall survival (OS) according to race/ethnicity and survival trends over three time-periods: 2001-2004, 2005-2008, and 2009-2011. Results: We identified 8,986 patients, with a mean follow-up of 37 months. The median OS according to race/ethnicity was 56, 49, 41, and 22 months for Asians/Pacific Islanders (A/PI), Hispanics, Whites, and Blacks respectively (P < 0.001). OS improved over time among Whites only, with respective median OS of 31, 43, and 49 months (P < 0.001). Multivariate analysis adjusting for socio-demographics, travel distance, and AML type, showed that, compared to Whites, Blacks had a significantly worse and Hispanics a significantly better OS (Table). Conclusions: We found significant disparities in OS among racial/ethnic subgroups in AYA with AML despite adjustment for socio-demographic factors. Blacks had the worse and Hispanics the best outcome. In the past decade, OS improved only among the Whites. Further studies should examine provider and patient care delivery factors that may contribute to these disparities. [Table: see text]

Impact of Ethnicity On Incidence and Survival Among Adults with Acute Lymphoblastic Leukemia in the United States; Insights From 2005 SEER Data.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3069-3069
Author(s):  
Casey L O'Connell ◽  
Pedram Razavi ◽  
Roberta McKean-Cowdin ◽  
Malcolm C. Pike
Keyword(s):  
T Cell ◽  
B Cell ◽  
Ethnic Groups ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
Incidence Rates ◽  
The Us ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic

Abstract Abstract 3069 Poster Board III-6 Background Acute lymphoblastic leukemia (ALL) is an aggressive malignancy whose incidence declines through adolescence and then increases steadily with age. Prognosis appears to be inversely related to age among adults. We sought to explore the impact of race/ethnicity on incidence and survival among adults with ALL in the United States (US). Methods We examined trends in incidence and survival among adults with ALL in the US using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program which includes data from 17 SEER registries. We calculated the incidence rates for the most recent time period (2001-2005) because the classification for ALL subtypes was more complete during this time. For the survival analysis we used the data collected between 1975 and 2005. We categorized race/ethnicity into 5 mutually exclusive categories: non-Hispanic whites (NHW), Hispanic whites (HW), African Americans (AA), Asian/Pacific Islanders (API) and American Indians/Native Alaskans (AI/NA). Hispanic ethnicity was defined using SEER's Hispanic-origin variable which is based on the NAACCR Hispanic Identification Algorithm (NHIA); 11 patients dually coded as black and Hispanic were included in the AA group for our analyses. Few ALL cases were identified among AI/NA, so that group is not represented in the final analyses. We included ALL cases coded in the SEER registry using the International Classification of Disease for Oncology (ICD-0-3) as 9827-9829 and 9835-9837. We excluded cases of Burkitt's leukemia (n=228), cases that were not confirmed by microscopic or cytologic tests (n=132), cases that were reported only based on autopsy data (n=3) and cases whose race/ethnicity were unknown (n=20). The average annual incidence rates per 100,000 for 2001-2005, age-adjusted to the 2000 US standard population were calculated using SEER*Stat Version 6.4.4 statistical software. We used multivariate Cox hazard models stratified by SEER registry and age category to estimate the hazard ratios (HR) and 95% confidence intervals (95% CI) for relative survival of adult ALL cases across race/ethnicity, sex and cell of origin (B- or T-cell). All models were adjusted for the diagnosis era, and use of non-CNS radiation. The model also included an interaction term for age and diagnosis era. We performed a separate stratified analysis of the impact of race/ethnicity on survival within age subgroups (20-29, 30-39, 40-59, 60-69, 70+). Results The highest incidence rate (IR) of ALL was observed for HW (IR: 1.60; 95% CI: 1.43-1.79). HW had a significantly higher IR across all age categories as compared to the other racial/ethnic groups, while AA had the lowest IR. In particular, the observed rate of B-cell ALL among HW (IR 0.77; 95% CI 0.69-0.87) was more than twice that of NHW (IR: 0.29; 95% CI: 0.27-0.32) and more than three times the rate observed among AA (IR: 0.20; 95% CI: 0.15-0.26). In contrast, we did not observe statistically significant variability in the rates of T-cell ALL across race/ethnic groups (overall IR: 0.12; 95% CI: 0.11-0.14). Survival was significantly poorer among AA (HR: 1.26; 95% CI: 1.09-1.46), HW (HR: 1.21; 95% CI: 1.09-1.46), and API (HR: 1.18; 95% CI: 1.06-1.32) compared to NHW with all subtypes of ALL. Among adults younger than 40 with B-cell ALL, survival was significantly poorer among AA (HR: 1.60; 95% CI:1.021-2.429) and HW (HR: 1.53; 95% CI:1.204-1.943) with a non-signficant trend among API (HR: 1.22; 95% 0.834-1.755) compared to NHW. Survival differences between the different racial/ethnic groups were no longer statistically significant among adults with B-cell ALL over the age of 40. For T-cell ALL, survival was significantly poorer among AA (HR: 1.61; 95% CI: 1.22-2.10), HW (HR: 1.49; 95% CI: 1.14-1.93) and API (HR: 1.57; 95% CI: 1.13-2.13), as compared to NHW. A similar survival pattern by age (adults above and below age 40 years) was observed for T-cell as described for B-cell, with AA under 40 having a particularly dismal prognosis (HR: 2.89; 95% CI 1.96-4.17) compared to NHW. Conclusions The incidence rate of B-cell ALL among adults in the US is higher among HW than other ethnic groups. Survival is significantly poorer among AA and HW than among NHW under the age of 40 with B-cell ALL. Survival is also significantly poorer among AA, HW and API than among NHW with T-cell ALL in adults under 40. Survival trends appear to converge after the age of 40 among all racial/ethnic groups. Disclosures No relevant conflicts of interest to declare.

Outcomes of multimodality therapy for gallbladder cancer in the United States (US): Analysis of the National Cancer Data Base (NCDB).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 313-313 ◽  
Author(s):  
Fatima Hamid ◽  
Hammad Shafqat ◽  
Kalyan Mantripragada ◽  
Thomas Guerrero ◽  
Ponnandai Somasundar ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Observational Studies ◽  
Locally Advanced ◽  
The United States ◽  
National Cancer Data Base ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Cancer Data ◽  
The Us

313 Background: Management of gallbladder cancer (GBCA) is largely based on small observational studies, and it is unknown how various treatment modalities are applied in the community. The objective of this study was to describe the utilization of surgery (S), chemotherapy (Ct) and chemoradiation (CRT), and associated overall survival (OS) in the US. Methods: We selected adult patients (pts) with GBCA diagnosed in 2004-2012 from the NCDB—a population-wide registry capturing > 70% of incident cancers in the US. We identified pts undergoing S, Ct and concurrent CRT. We assumed adjuvant (Adj) therapy if it was started within 4 months (mo) of S. Stage was grouped as: T1-T3N0, node-positive (N+), T4 (N0 or N+) or metastatic (M1). OS was calculated from diagnosis, with 95% confidence intervals (CI). Results: We identified 22,574 GBCA pts. Median age was 71 years. There were 69% women, 71% white non-Hispanic, 10% white Hispanic, 14% black and 4% Asian pts. Distribution of stage groups was: in situ, 4%; T1N0, 8%; T2N0, 16%; T3N0, 13%; N+, 14%; T4, 3%; M1, 38%; unknown, 4%. Most non-metastatic pts underwent S, but only a minority received Adj Ct or CRT (Table). Among M1 and T4 pts, 44% received Ct, but 29% got no cancer-directed therapy. Median OS for M+ or T4 pts was 4 and 7 mo, respectively. It was 8 and 11 mo, respectively, if Ct was given. Conclusions: These OS estimates provide realistic prognosis for GBCA pts treated with various modalities in the US. Adj therapy is rarely delivered in locally advanced (T3N0 or T1-3N+) GBCA. Survival in T4 and M1 GBCA remains poor even with palliative Ct. Novel therapeutic approaches for GBCA of all stages are needed. [Table: see text]

scholarly journals RTHP-06. IMPACT OF THE AMERICAN TAX PAYER RELIEF ACT ON STEREOTACTIC RADIOSURGERY UTILIZATION IN THE UNITED STATES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi211-vi211
Author(s):  
Shearwood McClelland III ◽  
Catherine Degnin ◽  
Yiyi Chen ◽  
Gordon Watson ◽  
Jerry Jaboin
Keyword(s):  
United States ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
The United States ◽  
National Cancer Data Base ◽  
Federal Law ◽  
Cancer Data ◽  
Whole Brain Radiation ◽  
The Us

Abstract INTRODUCTION For brain metastases, single-fraction stereotactic radiosurgery (SRS) spares appropriately chosen patients from the invasiveness of operative intervention and the permanent cognitive morbidity of whole brain radiation. SRS is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). The implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS The National Cancer Data Base (NCDB) from 2010–2016 identified brain metastases patients from non-small cell lung cancer (NSCLC) throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010–2012) versus after (2013–2016) ATRA implementation. Utilization was adjusted for several variables, including patient demographics and healthcare system characteristics. RESULTS From 2012 to 2013, there was a substantial decrease of LINAC SRS in favor of GKRS overall (37% to 28%) and individually in both academic and non-academic centers. Over the three-year span immediately preceding ATRA implementation, 65.8% received GKRS and the remaining 34.2% receiving LINAC. In the four years immediately following ATRA implementation 68.0% received GKRS compared with 32% receiving LINAC; these differences were not statistically significant. CONCLUSIONS ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a steady decline, similar to rates prior to implementation. These findings are indicative that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US. Such findings should serve as a reminder of the importance and impact of public policy on treatment modality utilization by physicians and hospitals.

scholarly journals POS0023 RACIAL/ETHNIC AND REGIONAL DIFFERENCES IN MULTIMORBIDITY BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS AND COMPARATORS IN A LARGE NATIONWIDE US STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 213.1-214
Author(s):  
H. J. Dykhoff ◽  
E. Myasoedova ◽  
M. Peterson ◽  
J. M. Davis ◽  
V. Kronzer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Logistic Regression ◽  
Regression Models ◽  
Index Date ◽  
Ethnic Disparities ◽  
Logistic Regression Models ◽  
The Us ◽  
Race Ethnicity ◽  
Geographic Regions ◽  
Racial Ethnic

Background:Patients with rheumatoid arthritis (RA) have an increased burden of multimorbidity. Racial/ethnic disparities have also been associated with an increased burden of multimorbidity.Objectives:We aimed to compare multimorbidity among different racial/ethnic groups and geographic regions of the US in patients with RA and comparators without RA.Methods:We used a large longitudinal, real-world data warehouse with de-identified administrative claims for commercial and Medicare Advantage enrollees, to identify cases of RA and matched controls. Cases were defined as patients aged ≥18 years with ≥2 diagnoses of RA in January 1, 2010 - June 30, 2019 and ≥1 prescription fill for methotrexate in the year after the first RA diagnosis. Controls were persons without RA matched 1:1 to RA cases on age, sex, census region, calendar year of index date (corresponding to the date of second diagnosis code for RA), and length of prior medical/pharmacy coverage. Race was classified as non-Hispanic White (White), non-Hispanic Black (Black), Asian, Hispanic, or other/unknown, based on self-report or derived rule sets. Multimorbidity (2 or more comorbidities) was defined using 25 chronic comorbidities from a combination of the Charlson and Elixhauser Comorbidity Indices assessed during the year prior to index date. Rheumatic comorbidities were not included. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).Results:The study included 16,363 cases with RA and 16,363 matched non-RA comparators (mean age 58.2 years, 70.7% female for both cohorts). Geographic regions were the same in both cohorts: 50% South, 26% Midwest, 13% West, and 11% Northeast. Race/ethnicity was not part of the matching criteria and varied slightly between the cohorts: among RA (non-RA) patients, 74% (74%) were White, 11% (9%) Hispanic, 10% (9%) Black, 3% (4%) Asian, and 3% (4%) other/unknown. Patients with RA had more multimorbidity than non-RA subjects (51.3% vs 44.8%). Multimorbidity comparisons across US geographic regions were similar in both cohorts, with comparable multimorbidity levels for patients in the West and Midwest and higher levels for those in the Northeast and South (Figure 1). Among the non-RA patients, 43.5% of Whites experienced multimorbidity, compared to 33.9% of Asians, 46.1% of Hispanics, and 58.4% of Blacks. These associations remained after adjustment for age, sex, and geographic region, with significantly lower multimorbidity among Asians (OR: 0.81; 95%CI: 0.67-0.99) and significantly higher multimorbidity among Hispanics (OR: 1.21; 95%CI: 1.07-1.37) and Blacks (OR: 1.74; 95%CI: 1.54-1.97), compared to Whites in the non-RA cohort. Among the RA patients, racial/ethnic differences were less pronounced; 50.6% of Whites, 42.8% of Asians, 48.8% of Hispanics, and 58.4% of Blacks experienced multimorbidity. Adjusted analyses revealed no significant differences in multimorbidity for Asians (OR: 0.88; 95%CI: 0.70-1.08) and Hispanics (OR: 1.06; 95%CI: 0.95-1.19) and a less pronounced increase in multimorbidity among Blacks (OR: 1.32; 95%CI: 1.17-1.49) compared to Whites in the RA cohort.Conclusion:This large nationwide study showed increased occurrence of multimorbidity in RA versus non-RA patients and in both cohorts for residents of the Northeast and South regions of the US. Racial/ethnic disparities in multimorbidity were more pronounced among patients without RA compared to RA patients. This indicates the effects of RA and race/ethnicity on multimorbidity do not aggregate. The underlying mechanisms for these associations require further investigation.Figure 1.Logistic regression models comparing multimorbidity levels in RA and non-RA cohorts.Disclosure of Interests:Hayley J. Dykhoff: None declared, Elena Myasoedova: None declared, Madeline Peterson: None declared, John M Davis III Grant/research support from: Research grant from Pfizer, Vanessa Kronzer: None declared, Caitrin Coffey: None declared, Tina Gunderson: None declared, Cynthia S. Crowson: None declared.

Barriers for people of color to RD in the US

2018 ◽  
Vol 4 (1) ◽  
pp. 6
Author(s):  
Jill White
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Ethnic Disparities ◽  
Health Care Delivery System ◽  
People Of Color ◽  
Institute Of Medicine ◽  
Unequal Treatment ◽  
Nutrition Programs ◽  
Health Care Practitioners ◽  
The Us

The Healthy People 2010 objective of eliminating health disparities was prompted by the  Institute of Medicine (IOM) report Unequal Treatment; Confronting Racial and Ethnic Disparities in Health Care . The report documented racial inequities within the U.S. health care delivery system, including differential treatment on the basis of race demonstrated by health care practitioners.  Recommendation 5-3 was to Increase the proportion of underrepresented U.S. racial and ethnic minorities among health professionals .Between 2002 and 2008 the number of people of color entering undergraduate Nutrition programs increased by 67 %,  while the number admitted to internships decreased by 11% . Of particular concern is the 58% decrease in African American's admitted into dietetic internships over the past decade.   This paper is a discussion of barriers to RD that have been identified by African Americans in five studies, in hopes of shedding light on how to address and reverse this trend. 

Abstract 50: Persistent Racial/Ethnic Disparities Despite Declining Rates of Ischemic Stroke Hospitalizations Among Medicare Beneficiaries, 2001-2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Tatjana Rundek ◽  
Larry B Goldstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ethnic Groups ◽  
Mixed Model ◽  
Systems Of Care ◽  
Ethnic Disparities ◽  
Fee For Service ◽  
Hospitalization Rates ◽  
The Us ◽  
Race Ethnicity ◽  
Racial Ethnic

Background: Stroke hospitalizations in the US have declined over the last decade, but little is known about whether decreases are similar across racial/ethnic groups. We compared ischemic stroke hospitalization rates and geographic patterns across the US from 2001-2013 for elderly Hispanics, Blacks, Whites, and those of other race/ethnicity. Methods: Ischemic stroke hospitalizations (ICD-9 primary discharge codes 433, 434, 436) were identified among Medicare fee-for-service beneficiaries aged ≥65y in 2001-2003 and 2011-2013. National annualized rates for each period were calculated per 100,000 person-years (PY). A spatial mixed model with a Poisson link function and adjustment for age and sex was fit to calculate and map county-specific risk-standardized stroke hospitalization rates for each racial/ethnic group. Results: National annualized stroke hospitalization rates decreased by 15% between 2001-2003 and 2011-2013 (1298/100,000 PY to 1103/100,000 PY). County-level risk-standardized hospitalization rates varied across the US and among the four racial/ethnic groups (figure). Regardless of time period, Blacks had the highest rates, followed by Whites, Hispanics, and other races. The absolute and relative declines in risk-standardized hospitalization rates were smallest for Hispanics (173/100,000 PY; 15%) and Blacks (196/100,000 PY; 12%) compared to Whites (243/100,000 PY; 19%) and other races (273/100,000 PY; 33%). Conclusions: Although national hospitalization rates for ischemic stroke among those aged ≥65y decreased between 2001 and 2013, the decline varied by race/ethnicity, with persistent disparities between groups. Despite the declines in US stroke hospitalizations, these racial/ethnic differences call for greater prioritization of prevention intervention programs to reduce stroke disparities. AHA/ASA efforts to expand stroke systems of care also need to address these disparities.

Building Data Infrastructure to Evaluate and Improve Quality: The National Cancer Data Base and the Commission on Cancer's Quality Improvement Programs

2015 ◽  
Vol 11 (3) ◽  
pp. 209-212 ◽  
Author(s):  
Lawrence N. Shulman ◽  
Ryan McCabe ◽  
Greer Gay ◽  
Bryan Palis ◽  
Daniel McKellar
Keyword(s):  
Quality Improvement ◽  
Data Base ◽  
Care Delivery ◽  
National Cancer Data Base ◽  
Improve Quality ◽  
Data Infrastructure ◽  
Cancer Data ◽  
Improvement Programs ◽  
Quality Improvement Programs

It is only in the last decade that the quality of cancer care delivery has begun to be seriously measured. The authors focus on efforts by the Commission on Cancer to develop the oncology quality agenda using the National Cancer Data Base.

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