Geographic Variations of Racial/Ethnic Disparities in Late-Stage Diagnosis of Childhood Cancer in Texas

143 Background: Childhood cancer survival varies by race/ethnicity in the United States. This study evaluated the impact of potentially modifiable characteristics - health insurance and area-level social deprivation - on racial/ethnic disparities in childhood cancer survival nationwide. Methods: We identified 65,113 childhood cancer patients aged < 18 years newly diagnosed with any of 10 common cancer types (e.g. central nervous system (CNS) neoplasms, acute lymphoblastic leukemia (ALL), Hodgkin lymphoma) from the 2004-2014 National Cancer Database. Cox proportional hazard models were used to compare survival probabilities by race and ethnicity (non-Hispanic white (NHW) vs non-Hispanic black (NHB), Hispanic, and non-Hispanic other (NH other)) for each cancer type. We conducted mediation analyses by the mma R package to evaluate the racial/ethnic survival disparities mediated by health insurance (private, Medicaid, and uninsured) and social deprivation index (SDI) quartile. SDI is a composite measure of deprivation based on seven characteristics (e.g. income, education, employment). Results: Compared to NHW, worse survival were observed for NHB (HR (hazard ratio): 1.4, 95% CI: 1.3-1.5), Hispanic (HR: 1.2, 95% CI: 1.1-1.2), and NH other (HR: 1.2, 95% CI: 1.1-1.3) for all cancer sites combined after adjusting for sociodemographic characteristics other than health insurance and SDI. Health insurance explained 20% of the survival disparities and SDI explained 19% of the disparity between NHB vs NHW; health insurance explained 48% of the survival disparities and SDI explained 45% of the disparity between Hispanic vs NHW. For ALL, health insurance significantly explained 15% and 18% of the survival disparities between NHB and Hispanic vs NHW, respectively. SDI significantly explained 19% and 31% of the disparities, respectively. Conclusions: Health insurance and SDI mediated racial/ethnic survival disparities for several childhood cancers. Expanding insurance coverage and improving healthcare access in disadvantaged areas may effectively reduce disparities for these cancer sites.

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Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors

The Journal of Rural Health ◽

10.1111/jrh.12179 ◽

2016 ◽

Vol 33 (2) ◽

pp. 146-157 ◽

Cited By ~ 17

Author(s):

Yan Lin ◽

Michael C. Wimberly

Keyword(s):

Breast Cancer ◽

Late Stage ◽

Geographic Variations ◽

Late Stage Diagnosis ◽

Neighborhood Level

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Racial Disparities in Use of Chiropractic Services by Medicare Beneficiaries Aged 65 to 99 in Los Angeles County, California

Journal of Evidence-Based Complementary & Alternative Medicine ◽

10.1177/2156587215604784 ◽

2015 ◽

Vol 21 (2) ◽

pp. 131-137 ◽

Cited By ~ 2

Author(s):

James M. Whedon ◽

Melissa N. Kimura ◽

Reed B. Phillips

Keyword(s):

Los Angeles ◽

Racial Disparities ◽

Los Angeles County ◽

Local Level ◽

Ethnic Disparities ◽

State Level ◽

Chiropractic Care ◽

Geographic Variations ◽

Racial Ethnic ◽

Zip Code

Racial and ethnic disparities in utilization of chiropractic services have been described at the state level, but little is known about such local disparities. We analyzed Medicare data for the year 2008 to evaluate by ZIP code for utilization of chiropractic services among older adults in Los Angeles County, California. We evaluated for availability and use of chiropractic services by racial/ethnic category, quantified geographic variations by coefficient of variation, and mapped utilization by selected racial/ethnic categories. Among 7502 beneficiaries who used chiropractic services, 72% were white, 12% Asian, 1% black, 1% Hispanic, and 14% other/unknown. Variation in the number of beneficiaries per ZIP code who used chiropractic services was highest among Hispanics, blacks, and Asians. We found evidence of racial disparities in use of chiropractic services at the local level in Los Angeles County. Older blacks and Hispanics in Los Angeles County may be underserved with regard to chiropractic care.

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Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.741334 ◽

2021 ◽

Vol 9 ◽

Author(s):

Tegan J. Reeves ◽

Taylor J. Mathis ◽

Hailey E. Bauer ◽

Melissa M. Hudson ◽

Leslie L. Robison ◽

...

Keyword(s):

Health Disparities ◽

Health Outcomes ◽

Childhood Cancer ◽

Ethnic Disparities ◽

Childhood Cancer Survivors ◽

Individual Level ◽

Family Level ◽

Race Ethnicity ◽

Racial Ethnic ◽

Neighborhood Level

The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

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Racial/ethnic disparities in oropharyngeal cancer outcomes among males in the United States (2005-2016): A population-based retrospective cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18576 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18576-e18576

Author(s):

Seiichi Villalona ◽

Antoinette Stroup ◽

Satsuki Villalona ◽

Jeanne Ferrante

Keyword(s):

Late Stage ◽

The United States ◽

Population Based ◽

The Past ◽

Hpv Status ◽

Late Stage Diagnosis ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Race Ethnicity ◽

Racial Ethnic

e18576 Background: The incidence of male oropharyngeal cancers (OPCa) has increased rapidly during the past two decades in the United States. Little is known regarding differences in OPCa incidence and outcomes by race/ethnicity and human papillomavirus (HPV) status. Methods: Population-based retrospective cohort study of 175,843 males diagnosed in U.S. with OPCa from 2005-2016 in the North American Association of Central Cancer Registries. Outcomes included: incidence trends of OPCa by race/ethnicity [Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Other] and histology-based HPV status; late-stage diagnosis; 5-year cumulative and mean survival; and mortality (cause-specific, all cause). Results: The majority of male OPCa were HPV-related (92.2%) and in NHW (83.6%), with marked increase in late-stage HPV-related OPCa among NHW. No difference in late-stage diagnosis was observed between NHW, NHB (aOR, 0.99, 95% CI, 0.94-1.04), and Hispanics (aOR, 0.98, 95% CI, 0.92-1.04), while other race had lower odds of late-stage diagnosis (aOR 0.87, 95% CI, 0.79-1.01). HPV-related cancers (aOR, 3.47, 95% CI, 3.33-3.62), Medicaid (aOR, 1.37, 95% CI, 1.28-1.46) and no insurance (aOR, 1.44, 95% CI, 1.32-1.56) were independent predictors of late-stage diagnosis. NHB (69.72 months, 95% CI, 68.14-71.31) and Hispanics (91.89 months, 95% CI, 89.87-93.91) had lower unadjusted mean survival in HPV-related OPCa relative to NHW (99.63 months, 95% CI, 99.18-100.07; p < 0.01). Higher cancer-specific mortality was observed among NHB (aHR, 1.79, 95% CI, 1.71-1.86), Hispanics (aHR, 1.07, 95% CI, 1.01-1.14), HPV-related OPCa (aHR, 1.17, 95% CI, 1.11-1.24), age > 54 years, insurances other than private, residence in counties with higher poverty, and geographic regions other than the Northeast. Adjusting for treatment attenuated associations but did not eliminate the observed cancer-specific mortality, except in Hispanics and residence in the South. Conclusions: There has been a sharp increase in HPV-related late-stage OPCa among NHW males over the past decade. Despite no racial/ethnic differences in late-stage diagnosis, NHB had highest mortality that was not explained by treatment. HPV vaccination and possibly, oral cancer screening should be promoted, especially in NHW males. Further research is needed to elucidate comorbidities and possible biologic mechanisms responsible for the higher OPCa mortality among NHB males.

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