scholarly journals Keynote Session: Reducing Racial Disparities in Oncology—Recommendations for Implementing Guideline-Adherent Cancer Care

2021 ◽  
Vol 19 (5.5) ◽  
pp. 598-600
Author(s):  
Shonta Chambers ◽  
Elizabeth Harrington ◽  
Lisa A. Lacasse ◽  
Robert Winn ◽  
moderated by Alyssa A. Schatz
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Racial Disparities ◽  
Policy Change ◽  
Cancer Care ◽  
Working Group ◽  
The United States ◽  
To Receive ◽  
White Patients

Research shows that racial disparities exist in the delivery of guideline-adherent cancer care, and that non-White patients are less likely to receive guideline-concordant care than White patients, leading to worse health outcomes. However, these disparities are not often addressed. The Elevating Cancer Equity initiative aims to address these disparities through policy-change recommendations developed by a working group and informed by data from patients/caregivers and oncologists. The hope is that the results of these surveys and the resultant recommendations will be a step toward cancer care equity in the United States.

scholarly journals Racial disparities in guideline-concordant cancer care and mortality in the United States

2018 ◽  
Vol 3 (3) ◽  
pp. 221-229 ◽  
Author(s):  
Penny Fang ◽  
Weiguo He ◽  
Daniel Gomez ◽  
Karen E. Hoffman ◽  
Benjamin D. Smith ◽  
...  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
Cancer Care ◽  
The United States

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 11 (3) ◽  
pp. 62-66
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

CityHealth

Urban Health ◽  
2019 ◽  
pp. 298-308
Author(s):  
Brian C. Castrucci ◽  
Elizabeth A. Corcoran ◽  
Shelley L. Hearne ◽  
Katie Keith ◽  
Elizabeth Voyles ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Policy Change ◽  
Urban Health ◽  
Urban Areas ◽  
The United States ◽  
Daily Lives ◽  
People’S Daily ◽  
Successes And Challenges ◽  
Policy Solutions

The De Beaumont Foundation CityHealth project aims to provide city leaders in the United States with both an assessment of their communities and with a package of policy solutions that they can use to improve the health of populations in their cities. In so doing, CityHealth serves as a model for efforts to harness science for action toward improving health in cities. With three out of every five Americans living in cities, policy change in the nation’s most populous urban areas has the most tangible opportunity to impact people’s daily lives and health outcomes. This chapter discusses the goals of the CityHealth project and its successes and challenges, and identifies models that can improve urban health worldwide.

scholarly journals Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
J. Matthew Brennan ◽  
Martin B. Leon ◽  
Paige Sheridan ◽  
Isabel J. Boero ◽  
Qinyu Chen ◽  
...  
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Racial Differences ◽  
Valve Replacement ◽  
Aortic Valve Stenosis ◽  
The United States ◽  
Treatment Rate ◽  
To Receive ◽  
White Patients

Background Aortic valve replacement (AVR) is a life‐saving treatment for patients with symptomatic severe aortic valve stenosis. We sought to determine whether transcatheter AVR has resulted in a more equitable treatment rate by race in the United States. Methods and Results A total of 32 853 patients with symptomatic severe aortic valve stenosis were retrospectively identified via Optum’s deidentified electronic health records database (2007–2017). AVR rates in non‐Hispanic Black and White patients were assessed in the year after diagnosis. Multivariate Fine‐Gray hazards models were used to evaluate the likelihood of AVR by race, with adjustment for patient factors and the managing cardiologist. Time‐trend and 1‐year symptomatic severe aortic valve stenosis survival analyses were also performed. From 2011 to 2016, the rate of AVR increased from 20.1% to 37.1%. Overall, Black individuals were less likely than Whites to receive AVR (22.9% versus 31.0%; unadjusted hazard ratio [HR], 0.70; 95% CI, 0.62–0.79; fully adjusted HR, 0.76; 95% CI, 0.67–0.85). Yet, during 2015 to 2016, AVR racial differences were attenuated (29.5% versus 35.2%; adjusted HR, 0.86; 95% CI, 0.74–1.02) because of greater uptake of transcatheter AVR in Blacks than Whites (53.4% of AVRs versus 47.3%; P =0.128). Untreated patients had significantly higher 1‐year mortality than those treated (adjusted HR, 0.57; 95% CI, 0.53–0.61), which was consistent by race (interaction P value=0.52). Conclusions Although transcatheter AVR has increased the use of AVR in the United States, treatment rates remain low. Black patients with symptomatic severe aortic valve stenosis were less likely than White patients to receive AVR, yet these differences have recently narrowed.

Racial disparities in the initial treatment of hepatocellular carcinoma in the population 65+ years in the United States.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 431-431
Author(s):  
Stephanie Costa ◽  
David J. Delgado ◽  
Michael Ross Kaufman ◽  
Brandon George ◽  
Edith P. Mitchell
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
African American ◽  
Racial Disparities ◽  
Initial Treatment ◽  
The United States ◽  
Asian Pacific Islander ◽  
Receive Treatment ◽  
Asian Pacific ◽  
To Receive

431 Background: Insufficient evidence exists regarding the initial management of elderly patients with hepatocellular carcinoma (HCC). The purpose of this study was to describe racial differences in initial treatment of 65+ year old patients with HCC diagnosed in the United States (2004-2014). Methods: A retrospective cohort study was conducted using the 1973-2014 Surveillance, Epidemiology and End Results Program (SEER) database of the National Cancer Institute. Patients with primary hepatocellular carcinoma, diagnosed between 2004 and 2014, and with complete information on race, gender, year of diagnosis, age, marital status, region, tumor status at diagnosis and initial treatment were included. Descriptive statistics were used to compare race with sociodemographic and clinical variables. Univariate and multivariate logistic regressions were performed to describe the association of race with receiving any treatment for HCC (local hepatic therapy and surgical treatment versus no treatment). Results: The sample consisted of 25,499 HCC patients: 70.0% White, 9.1% Black, 19.8% API, 1.0% AI; 68.6% male; 46.8% diagnosed in 2004-2009; 54.8% age 65-74, 45.2% 75 and older; 54.7% married, 7.3% Midwest, 13.8% Northeast, 15.7% Southeast; 81.3% first malignant primary indicator, 13.8% metastasis, 49.3% localized site, and 20.9% receiving initial treatment. After controlling for confounding variables, as compared to White patients, African American patients (OR:0.739 95% CI:0.652, 0.839) had decreased odds of receiving initial treatment; and Asian/Pacific Islander patients (OR:1.490 95% CI:1.371,1.618) had increased odds of receiving initial treatment. Conclusions: Racial disparities exist at the presentation of HCC in the 65+ population. African American patients are less likely to receive treatment and Asian/Pacific Islander patients are more likely to receive treatment. Further research is needed to understand these relationships in subpopulations.

scholarly journals Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003842
Author(s):  
Scarlett Hao ◽  
Rebecca A. Snyder ◽  
William Irish ◽  
Alexander A. Parikh
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Racial Disparities ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Treatment Disparities ◽  
To Receive

Background Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. Conclusions This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

scholarly journals Guideline-concordant lung cancer care and associated health outcomes among elderly patients in the United States

2015 ◽  
Vol 6 (2) ◽  
pp. 101-110 ◽  
Author(s):  
Pramit A. Nadpara ◽  
S. Suresh Madhavan ◽  
Cindy Tworek ◽  
Usha Sambamoorthi ◽  
Michael Hendryx ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Elderly Patients ◽  
Health Outcomes ◽  
Cancer Care ◽  
The United States

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization
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