Disparities in access to surgery for glioblastoma multiforme at high-volume Commission on Cancer–accredited hospitals in the United States

2021 ◽  
pp. 1-10
Author(s):  
Anshit Goyal ◽  
Jad Zreik ◽  
Desmond A. Brown ◽  
Panagiotis Kerezoudis ◽  
Elizabeth B. Habermann ◽  
...  
Keyword(s):  
United States ◽  
Surgical Intervention ◽  
Residential Location ◽  
High Volume ◽  
The United States ◽  
National Cancer Database ◽  
Subgroup Analyses ◽  
Access To Surgery ◽  
Hispanic White ◽  
White Patients

OBJECTIVE Although it has been shown that surgery for glioblastoma (GBM) at high-volume facilities (HVFs) may be associated with better postoperative outcomes, the use of such hospitals may not be equally distributed. The authors aimed to evaluate racial and socioeconomic differences in access to surgery for GBM at high-volume Commission on Cancer (CoC)–accredited hospitals. METHODS The National Cancer Database was queried for patients with GBM that was newly diagnosed between 2004 and 2015. Patients who received no surgical intervention or those who received surgical intervention at a site other than the reporting facility were excluded. Annual surgical case volume was calculated for each hospital, with volume ≥ 90th percentile defined as an HVF. Multivariable logistic regression was performed to identify patient-level predictors for undergoing surgery at an HVF. Furthermore, multiple subgroup analyses were performed to determine the adjusted odds ratio of the likelihood of undergoing surgery at an HVF in 2016 as compared to 2004 for each patient subpopulation (by age, race, sex, educational group, etc.). RESULTS A total of 51,859 patients were included, with 10.7% (n = 5562) undergoing surgery at an HVF. On multivariable analysis, Hispanic White patients (OR 0.58, 95% CI 0.49–0.69, p < 0.001) were found to have significantly lower odds of undergoing surgery at an HVF (reference = non-Hispanic White). In addition, patients from a rural residential location (OR 0.55, 95% CI 0.41–0.72, p < 0.001; reference = metropolitan); patients with nonprivate insurance status (Medicare [OR 0.78, 95% CI 0.71–0.86, p < 0.001], Medicaid [OR 0.68, 95% CI 0.60–0.78, p < 0001], other government insurance [OR 0.68, 95% CI 0.52–0.86, p = 0.002], or who were uninsured [OR 0.61, 95% CI 0.51–0.72, p < 0.001]); and lower-income patients ($50,354–$63,332 [OR 0.68, 95% CI 0.63–0.74, p < 0.001], $40,227–$50,353 [OR 0.84, 95% CI 0.76–0.92, p < 0.001]; reference = ≥ $63,333) were also found to be significantly associated with a lower likelihood of surgery at an HVF. Subgroup analyses revealed that elderly patients (age ≥ 65 years), both male and female patients and non-Hispanic White patients, and those with private insurance, Medicare, metropolitan residential location, median zip code–level household income in the first and second quartiles, and educational attainment in the first and third quartiles had increased odds of undergoing surgery at an HVF in 2016 compared to 2004 (all p ≤ 0.05). On the other hand, patients with other governmental insurance, patients with a rural residence, and those from a non-White racial category did not show a significant difference in odds of surgery at an HVF over time (all p > 0.05). CONCLUSIONS The present analysis from the National Cancer Database revealed significant disparities in access to surgery at an HVF for GBM within the United States. Furthermore, there was evidence that these racial and socioeconomic disparities may have widened between 2004 and 2016. The findings should assist health policy makers in the development of strategies for improving access to HVFs for racially and socioeconomically disadvantaged populations.

scholarly journals Lung Adenocarcinoma Biomarker Incidence in Hispanic Versus Non-Hispanic White Patients

2013 ◽  
Vol 138 (3) ◽  
pp. 390-394 ◽  
Author(s):  
Elizabeth McQuitty ◽  
Wei Zhang ◽  
Heather Hendrickson ◽  
Fermin O. Tio ◽  
Jaishree Jagirdar ◽  
...  
Keyword(s):  
United States ◽  
Lung Adenocarcinoma ◽  
The United States ◽  
Smoking History ◽  
Genetic Changes ◽  
Mutational Frequency ◽  
Hispanic Patients ◽  
Biomarker Testing ◽  
Hispanic White ◽  
White Patients

Context.—Lung cancer is the leading cause of cancer deaths in the United States and worldwide. Biomarker testing is critical to personalized therapy in lung adenocarcinoma and has been extensively investigated in non-Hispanic whites, Asians, and African Americans. However, little information addresses the underlying genetic changes in lung adenocarcinoma among Hispanic patients in the United States. Objective.—To identify targetable biomarkers other than EGFR and EML4-ALK in Hispanic patients with lung adenocarcinoma. Design.—We tested DNA extracted from 85 lung adenocarcinoma specimens collected from 40 Hispanic and 43 non-Hispanic white patients for previously reported mutations in KRAS, MET, BRAF, mTOR, STAT3, JAK2, PIK3CA, AKT1 through AKT3, and PTEN with a custom Sequenom massARRAY assay (Sequenom, San Diego, California). Results.—Mutations in KRAS were identified in 11 cases (13%; 6 Hispanic [7%], 5 non-Hispanic white [6%]) and had no correlation with sex, age, or smoking history. Mutations in PIK3CA were identified in 2 of the 40 Hispanic patients (5%), including one patient (2.5%) with a concurrent KRAS mutation. The tumors were wild type for all other genes tested. Conclusions.—Targetable biomarkers other than EGFR and EML4-ALK were identified in 7 of the 40 Hispanic patients (18%) and 5 of the 43 non-Hispanic white patients (12%), suggesting a similar mutational frequency. Our highly multiplexed genotyping assay detected actionable mutations in 14% (12 of 83) more patients than would have been identified by EGFR and EML4-ALK testing alone.

Acral melanocytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients

2016 ◽  
Vol 74 (4) ◽  
pp. 724-730.e1 ◽  
Author(s):  
Reshmi Madankumar ◽  
Priyanka V. Gumaste ◽  
Kathryn Martires ◽  
Panta R. Schaffer ◽  
Sonal Choudhary ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Melanocytic Lesions ◽  
Hispanic White ◽  
White Patients

scholarly journals SARS-CoV-2 Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey

2021 ◽  
pp. ASN.2021010104
Author(s):  
Pablo Garcia ◽  
Maria E. Montez-Rath ◽  
Heather Moore ◽  
Johnie Flotte ◽  
Chris Fults ◽  
...  
Keyword(s):  
United States ◽  
Native American ◽  
Side Effects ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Vaccine Acceptability ◽  
Increased Risk ◽  
Hispanic White ◽  
White Patients

BackgroundPatients on dialysis are at increased risk for COVID-19–related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination.MethodsWith the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons.ResultsA total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18–44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18–44 years versus those 45–64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders’ main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively).ConclusionsA substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects.

Shale, Quakes, and High Stakes: Regulating Fracking-Induced Seismicity in Oklahoma, USA and Lancashire, UK

2019 ◽  
Vol 3 (1) ◽  
pp. 1-14
Author(s):  
Miriam R. Aczel ◽  
Karen E. Makuch
Keyword(s):  
United States ◽  
Hydraulic Fracturing ◽  
Shale Gas ◽  
Seismic Activity ◽  
Oil And Gas ◽  
Oil And Gas Industry ◽  
High Volume ◽  
The United States ◽  
Horizontal Drilling ◽  
Induced Seismic Activity

High-volume hydraulic fracturing combined with horizontal drilling has “revolutionized” the United States’ oil and gas industry by allowing extraction of previously inaccessible oil and gas trapped in shale rock [1]. Although the United States has extracted shale gas in different states for several decades, the United Kingdom is in the early stages of developing its domestic shale gas resources, in the hopes of replicating the United States’ commercial success with the technologies [2, 3]. However, the extraction of shale gas using hydraulic fracturing and horizontal drilling poses potential risks to the environment and natural resources, human health, and communities and local livelihoods. Risks include contamination of water resources, air pollution, and induced seismic activity near shale gas operation sites. This paper examines the regulation of potential induced seismic activity in Oklahoma, USA, and Lancashire, UK, and concludes with recommendations for strengthening these protections.

A survey of Instagram users with asthma to evaluate the acceptability of a planned clinical trial intervention (Preprint)

2020 ◽  
Author(s):  
Kerry Spitzer ◽  
Brent Heineman ◽  
Marcella Jewell ◽  
Michael Moran ◽  
Peter Lindenauer
Keyword(s):  
United States ◽  
Social Media ◽  
Health Care Providers ◽  
College Education ◽  
The United States ◽  
Survey Study ◽  
Care Providers ◽  
Healthy Behaviors ◽  
Social Media Platforms ◽  
Hispanic White

BACKGROUND Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. There is a need for more research into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. OBJECTIVE In this study, we assess the willingness of Instagram users with poorly controlled asthma to participate in a pilot study that uses Instagram as a means of providing social and informational support. In addition, we explore the potential for adapting photovoice and digital storytelling to social media. METHODS A survey study of Instagram users living with asthma in the United States, between the ages of 18 to 40. RESULTS Over 3 weeks of recruitment, 457 individuals completed the pre-survey screener; 347 were excluded. Of the 110 people who were eligible and agreed to participate in the study, 82 completed the study survey. Respondents mean age was 21(SD = 5.3). Respondents were 56% female (n=46), 65% (n=53) non-Hispanic white, and 72% (n=59) had at least some college education. The majority of respondents (n = 66, 81%) indicated that they would be willing to participate in the study. CONCLUSIONS Among young-adult Instagram users with asthma there is substantial interest in participating in a study that uses Instagram to connect participants with peers and a health coach in order to share information about self-management of asthma and build social connection.

scholarly journals Efficacy and safety of fremanezumab in patients with migraine and inadequate response to prior preventive treatment: subgroup analyses by country of a randomized, placebo-controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Egilius L. H. Spierings ◽  
Mikko Kärppä ◽  
Xiaoping Ning ◽  
Joshua M. Cohen ◽  
Verena Ramirez Campos ◽  
...  
Keyword(s):  
United States ◽  
Czech Republic ◽  
Adverse Events ◽  
Least Squares ◽  
The United States ◽  
Inadequate Response ◽  
Double Blind ◽  
Monthly Average ◽  
Preventive Medication ◽  
Subgroup Analyses

Abstract Background The FOCUS study evaluated the efficacy of migraine preventive medications across different countries within the same patient population, particularly for patients with difficult-to-treat migraine. These prespecified subgroup analyses evaluated efficacy by country in the FOCUS study of fremanezumab in adults with episodic migraine or chronic migraine and documented inadequate response to 2 to 4 migraine preventive medication classes. Methods Overall, 838 participants were enrolled in the FOCUS study, a randomized, double-blind, placebo-controlled, parallel-group, phase 3b study performed at 104 sites. For 12 weeks of double-blind treatment, patients were randomized (1:1:1) to quarterly fremanezumab, monthly fremanezumab, or matched placebo. The primary efficacy endpoint was the mean change from baseline in monthly average migraine days over 12 weeks of double-blind treatment, evaluated by country in these subgroup analyses. Results Of 14 countries contributing data, the Czech Republic (n = 188/838; 22%), the United States (n = 120/838; 14%), and Finland (n = 85/838; 10%) enrolled the most patients. Changes from baseline in monthly average migraine days over 12 weeks were significantly greater with fremanezumab versus placebo for patients in these countries: Czech Republic (least-squares mean difference versus placebo [95% confidence interval]: quarterly fremanezumab, − 1.9 [− 3.25, − 0.47]; P = 0.009; monthly fremanezumab, − 3.0 [− 4.39, − 1.59]; P < 0.001), the United States (quarterly fremanezumab, − 3.7 [− 5.77, − 1.58]; P < 0.001; monthly fremanezumab, − 4.2 [− 6.23, − 2.13]; P < 0.001), and Finland (quarterly fremanezumab, − 3.0 [− 5.32, − 0.63]; P = 0.014; monthly fremanezumab, − 3.9 [− 6.27, − 1.44]; P = 0.002). Results were comparable for the remaining 9 countries, with the least-squares mean difference versus placebo ranging from – 5.6 to – 2.4 with quarterly fremanezumab and from − 5.3 to − 1.5 with monthly fremanezumab. Incidences of serious adverse events and adverse events leading to discontinuation were low and comparable across countries and treatment groups. Conclusions Monthly and quarterly fremanezumab significantly reduced the monthly average number of migraine days versus placebo regardless of country and continent (North America versus Europe) in migraine patients with documented inadequate response to 2 to 4 migraine preventive medication classes. Trial registration ClinicalTrials.gov Identifier: NCT03308968.

scholarly journals Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 671
Author(s):  
Dylan T. Wolff ◽  
Thomas F. Monaghan ◽  
Danielle J. Gordon ◽  
Kyle P. Michelson ◽  
Tashzna Jones ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Bladder Cancer ◽  
Kidney Cancer ◽  
The United States ◽  
Coverage Rate ◽  
National Cancer Database ◽  
Genitourinary Cancer ◽  
Coverage Rates ◽  
Capture Rates

Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.

scholarly journals 1068. Large-Scale Migration and the Changing Viral Hepatitis Prevalences in North America: A modeling approach

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S563-S563
Author(s):  
Kenneth A Valles ◽  
Lewis R Roberts
Keyword(s):  
United States ◽  
Viral Hepatitis ◽  
Large Scale ◽  
Country Of Origin ◽  
Human Movement ◽  
High Volume ◽  
The United States ◽  
The Philippines ◽  
Outcome Data ◽  
Treatment Programs

Abstract Background Infection by hepatitis B and C viruses causes inflammation of the liver and can lead to cirrhosis, liver failure, and hepatocellular carcinoma. The WHO’s ambition to eliminate viral hepatitis by 2030 requires strategies specific to the dynamic disease profiles each nation faces. Large-scale human movement from high-prevalence nations to the United States and Canada have altered the disease landscape, likely warranting adjustments to present elimination approaches. However, the nature and magnitude of the new disease burden remains unknown. This study aims to generate a modeled estimate of recent HBV and HCV prevalence changes to the United States and Canada due to migration. Methods Total migrant populations from 2010-2019 were obtained from United Nations Migrant Stock database. Country-of-origin HBV and HCV prevalences were obtained for the select 40 country-of-origin nations from the Polaris Observatory and systematic reviews. A standard pivot table was used to evaluate the disease contribution from and to each nation. Disease progression estimates were generated using the American Association for the Study of the Liver guidelines and outcome data. Results Between 2010 and 2019, 7,676,937 documented migrants arrived in US and Canada from the selected high-volume nations. Primary migrant source regions were East Asia and Latin America. Combined, an estimated 878,995 migrants were HBV positive, and 226,428 HCV positive. The majority of both migrants (6,477,506) and new viral hepatitis cases (HBV=840,315 and HCV=215,359) were found in the United States. The largest source of HBV cases stemmed from the Philippines, and HCV cases from El Salvador. Conclusion Massive human movement has significantly changed HBV and HCV disease burdens in both the US and Canada over the past decade and the long-term outcomes of cirrhosis and HCC are also expected to increase. These increases are likely to disproportionally impact individuals of the migrant and refugee communities and screening and treatment programs must be strategically adjusted in order to reduce morbidity, mortality, and healthcare expenses. Disclosures All Authors: No reported disclosures

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