Journal articles: 'Therapy with Hispanics'

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Martinez, Steve R., Steven L. Chen, and Anton J. Bilchik. "Treatment Disparities in Hispanic Rectal Cancer Patients: A SEER Database Study." American Surgeon 72, no. 10 (October 2006): 906–8. http://dx.doi.org/10.1177/000313480607201014.

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Although Hispanics demonstrate a low overall incidence of rectal cancer, mortality rates have not decreased relative to non-Hispanic whites. To determine if this was in part due to racial disparities in care, we compared rates of neoadjuvant therapy and sphincter-preserving surgery between Hispanics and non-Hispanic whites diagnosed with rectal cancer using the Surveillance, Epidemiology, and End Results (SEER) database. The study population was comprised of 2,573 Hispanics (55.4% male) and 28,395 non-Hispanic whites (56.6% male). Rates of neoadjuvant radiation were 13.5 per cent for Hispanics compared with 10.4 per cent for non-Hispanic whites (P < 0.001). In a Cox proportional hazards model adjusting for nodal status, tumor size, and T stage, non-Hispanic whites were significantly less likely to have received neoadjuvant therapy (hazard ratio, 0.72; P < 0.001; 95% confidence interval 0.63–0.83). Rates of sphincter preservation were 67 per cent for Hispanics and 70 per cent for non-Hispanic whites (P = 0.003). Non-Hispanic whites were significantly more likely to have received a sphincter-preserving operation than Hispanics (hazard ratio, 1.076; P = 0.019; 95% confidence interval 1.02–1.27). We conclude that Hispanics are significantly more likely to receive neoadjuvant therapy but are less likely to receive sphincter-sparing operations for rectal cancer compared with non-Hispanic whites. Further studies are required to assess the impact of these treatment disparities on patient outcome.

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Lo, Joan Chia-Mei, Malini Chandra, Jeanne A. Darbinian, Rita L. Hui, and Nancy P. Gordon. "Ethnicity, Ethnic Language, and Fracture Risk Conditions in Women Initiating Osteoporosis Therapy." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A245. http://dx.doi.org/10.1210/jendso/bvab048.498.

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Abstract Introduction: The ethnic diversity of women with osteoporosis has increased, but data on acculturation and health remain limited. Having a primary language (PL) other than English may reflect acculturation level and/or immigration as an adult. We used electronic health record (EHR) data from a large US health plan to examine the association of baseline clinical risk conditions and PL among US Chinese and US Hispanic women who initiated osteoporosis therapy. Methods: We identified women age 65-74y who initiated osteoporosis therapy in 2002–2014, excluding those with skeletal disorders, advanced kidney disease and metastatic cancer. PL was ascertained from the EHR. The study included 1676 Chinese women with English-PL (50%) vs Chinese-PL (50%); 3453 Hispanic women with English-PL (72%) vs Spanish-PL (28%); and 20,289 non-Hispanic White (White) women with English-PL. Clinical conditions assessed included: current smoking; BMI <19 kg/m2; Charlson-Deyo Comorbidity Index (CCI); diabetes (DM) based on diagnosis with treatment; rheumatoid arthritis (RA) based on 2 diagnoses; and fracture diagnosis in the prior 5 years. Language subgroups (* denotes significant difference by PL, p<.05) and ethnic groups (all ethnic differences cited are significant at p<.05) were compared using chi-square tests. Results: Mean age was (69±3y) for Chinese, Hispanics, Whites, and PL subgroups. Prior fracture was lower in Chinese (12.8%) and Hispanics (25.6%) vs Whites (29.7%), with Chinese lower than Hispanics. Smoking was lower in Chinese (1.6%) and Hispanics (6.7%) vs Whites (11.3%). CCI score ≥3 was lower in Chinese (5.2%) and higher in Hispanics (13.0%) vs Whites (10.4%). RA was low overall and lowest in Chinese, especially Chinese-PL. More Chinese (4.2%) and fewer Hispanics (0.8%) had a BMI <19 vs Whites (2.2%). DM was higher in Hispanics (14.8%) and Chinese (8.2%) compared to Whites (5.7%). Significant and non-significant differences by PL were observed for current smoking (0.8%* vs 2.4% for Chinese-PL vs English-PL; 4.0% vs 7.8% for Spanish-PL vs English-PL), prior fracture (11.4%* vs 14.2% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) and DM (10.5%* vs 5.8% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) in Chinese and Hispanic women. Conclusion: Among older women initiating osteoporosis therapy, US Chinese women have lower comorbidity but a higher DM prevalence compared to white women, especially those with Chinese-PL. Hispanic women have higher comorbidity and higher DM prevalence than White women, with no differences by PL. Variation in prior fracture, low BMI, RA, and smoking were also seen. These findings highlight ethnic differences in women receiving osteoporosis care, including differences by primary language in Chinese women. Future studies should examine fracture risk factors and outcomes in US immigrant populations, especially Asians.

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Rodriguez, Rodrigo, Melissa Gonzalez, Bridget N. Fahy, Anita Kinney, and Ashwani Rajput. "Disparities in stage at presentation and treatment of colorectal cancer among Hispanic and non-Hispanic white patients." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 433. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.433.

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433 Background: Although incidence rates for colorectal cancer (CRC) for Hispanics are similar to non-Hispanic whites (NHW) in New Mexico, the cause-specific mortality is higher among the Hispanic population. Hispanics have also been shown to be less likely to be current with colorectal cancer screening guidelines as compared to NHW. The purpose of this study was to determine if there was a difference between Hispanics and NHW in stage at presentation and if the care provided was concordant with NCCN guidelines at our NCI designated cancer center. Methods: A prospective data base of all patients who presented with colorectal cancer between June 2009 and July 2013 was queried. A total of 197 patients were identified. Data was extracted that included: demographics, stage of CRC at first diagnosis, treatments given, and pathology results. Frequencies of stage at presentation and NCCN guideline concordance (meeting the 12 lymph node metric, receipt of adjuvant therapy for stage III disease and radiation therapy for locally advanced rectal cancer) were recorded. Results: The Table shows the results. There were 107 (55%) males. There was not a statistical difference in the stage of presentation for Hispanics and NHW for patients with colon cancer. Hispanic patients with rectal cancer, however, presented with more advanced stage of disease as compared to NHW (p<0.05). There was no statistically significant difference in concordance with NCCN guidelines for the three metrics analyzed. Conclusions: Hispanics and NHW with colon cancer presented with similar stage of disease and were concordant with NCCN guideline metrics. Hispanics with rectal cancer, however, presented at a more advanced stage of disease as compare to NHW patients. The reason for this disparity remains to be elucidated. Future studies to include outreach, education, screening and molecular profiling of these disparate populations are planned. [Table: see text]

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Bosse, Dominick, Wanling Xie, Connor Wells, Aly-Khan A. Lalani, Frede Donskov, Alisha Bent, Hao-Wen Sim, et al. "Clinical outcomes according to ethnicity in patients with metastatic renal cell carcinoma (mRCC) treated with VEGF-targeted therapy (TT)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e16065-e16065. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e16065.

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e16065 Background: Discrepancies in clinical outcomes between different ethnic groups are well known in cancer patients. Differences in mRCC patients receiving VEGF-TT are less well characterized. We thought to report on baseline characteristics and treatment outcomes in African-Americans (AA) and Hispanic patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Methods: Caucasians, AA and Hispanics with mRCC treated with 1stline VEGF-TT were identified from the IMDC. We created 2 matched cohorts: 1) AA vs. Caucasians and 2) Hispanics vs. Caucasians, both matched for age (<50; 50-59; 60-69; <70-year-old), gender, years of treatment (2003-07; 2008-12; 2013-16) and geography (Canada, USA, Europe). Weighted Cox and logistic regressions were used to compare OS, time-to-treatment failure (TTF) and best response, adjusted for nephrectomy status, IMDC risk groups, number of metastatic sites (1 v. >1) and histology (clear-cell vs. else). Results: 73 AA and 71 Hispanics met eligibility criteria and were matched with 1236 and 901 eligible Caucasians, respectively. AA had more non-clear cell histology (26% v. 11%), time from diagnosis to therapy<1 year (67% v. 55%) and anemia (75% v. 54%) vs. Caucasians. Differences were not significant for Hispanics. Clinical outcomes are presented in Table. Conclusions: Adjusted for clinical prognostic factors, Hispanics with mRCC have statistically shorter TTF and survival than Caucasians. AA had a trend toward shorter TTF (not significant) but similar survival than Caucasians. Underlying genetic/biological differences, along with potential cultural variations, may impact survival in Hispanic mRCC patients. [Table: see text]

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Ailawadhi, Sikander, Kejal Parikh, Safiya Abouzaid, Zhou Zhou, Wenxi Tang, Zoe Clancy, Claudia Cheung, Zheng-Yi Zhou, and Jipan Xie. "Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: a SEER-Medicare analysis." Blood Advances 3, no. 20 (October 17, 2019): 2986–94. http://dx.doi.org/10.1182/bloodadvances.2019000308.

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Abstract The objective of the study was to assess racial disparities in the treatment and outcomes among white, African American, and Hispanic patients with multiple myeloma (MM). Patients with an MM diagnosis from the Surveillance Epidemiology and End Results (SEER)–Medicare (2007-2013) database were included. Continuous Medicare enrollment for 6 months before (baseline) and after MM diagnosis was required unless death occurred. Time from MM diagnosis to novel therapy initiation and autologous stem cell transplant (ASCT), overall survival (OS), and MM-specific survival (MSS) was evaluated. Unadjusted and multivariable regressions compared African Americans and Hispanics vs whites. Trends of novel therapy and ASCT use across MM diagnosis years were assessed using linear regression models. The study included 3504 whites, 858 African Americans, and 468 Hispanics. African Americans and Hispanics had a longer time from MM diagnosis to novel therapy initiation vs whites (median: 5.2 and 4.6 vs 2.7 months, respectively). All cohorts had an increasing trend of novel therapy initiation within 6 months of MM diagnosis, particularly whites (all P < .05). Median MSS was significantly longer for African Americans (5.4 years) than whites (4.5 years; P < .05), and was comparable for Hispanics and whites. Median OS was similar overall (2.6-2.8 years). ASCT rate within 1 year of MM diagnosis rose among whites and African Americans (P < .05), but not Hispanics, who were less likely to receive ASCT vs whites. Significant variations in novel therapy and ASCT use were observed among different racial/ethnic groups with MM. Although OS was similar, both African Americans and Hispanics may not be fully benefitting from the introduction of novel therapies, as they receive them later than whites.

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Ricardo, Juan, Jorge Conte, Talal Alkayali, Ahmed Salem, Jamie Huston, Ravi Shridhar, and Kenneth L. Meredith. "Esophageal cancer in Hispanic patients: A demographic analysis of the National Cancer Database." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6561. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6561.

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6561 Background: Hispanics are the fastest-growing minority accounting for 18% of the US population. The National Cancer Institute estimated 17,290 new cases of esophageal cancer (EC) in the US in 2018. Hispanics are reported to have lower EC prevalence. We sought to interrogate the demographic patterns of EC in Hispanics. Secondary objective was to examine evidence of socioeconomic disparities and differential therapy. Methods: We queried the National Cancer Database to identify patients with EC between 2005–2015. Patients were divided into two groups, Hispanic vs Non-Hispanic (NH). Demographics compared were age, sex, tumor data, surgical intervention, type of treatment, insurance status, income, residence area, and Charlson/Deyo score. Pearson’s Chi-square test was used to compare categorical variables. Groups were matched by propensity score-matched analysis (PSM). Survival analysis was estimated by the Kaplan-Meier method and associated log-rank test. P-value ≤0.05 was considered significant. Results: We identified 85,004 patients with EC; 3,205 were Hispanic (3.8%). In this US population we identified significant disparities between the Hispanic and NH groups. Statistically significant differences among Hispanics included higher prevalence of squamous EC (24.7% vs 19.6%), higher likelihood of stage IV cancer diagnosis (40.7% vs. 34.8%), younger age, higher uninsured status (10.4% vs 3%) with income < $38,000 (26.4% vs 15.9%), and Charlson/Deyo score 0 (72.3% vs 70.7%) when compared to NH. However, Hispanics were less likely to have surgical intervention (29% vs 36.3) and overall less likely to receive any type of treatment (30.1% vs 26.1%). PSM showed that any treatment, insurance status and lower income were predictors of survival. Treated Hispanics survived longer than NH (median survival 17 vs 15 months). Overall survival at 5 years was 22% vs 17%, respectively, p < 0.05. Conclusions: Despite lower prevalence of EC in Hispanics compared to NH, there is a disproportionately higher number of metastatic and untreated cases among Hispanics. This disparity may be explained by Hispanics' limited access to medical care exacerbated by their socioeconomic and insurance status. Further clinical and epidemiologic research is warranted to reveal other factors impacting these health disparities.

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Qiao, Yanru, Christina A. Spivey, Junling Wang, Ya-Chen Tina Shih, Jim Y. Wan, Julie Kuhle, Samuel Dagogo-Jack, William C. Cushman, and Marie A. Chisholm-Burns. "Higher Predictive Value Positive for MMA Than ACA MTM Eligibility Criteria Among Racial and Ethnic Minorities: An Observational Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 2018): 004695801879574. http://dx.doi.org/10.1177/0046958018795749.

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The objective of this study was to examine positive predictive value (PPV) of medication therapy management (MTM) eligibility criteria under Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial and ethnic groups. The study analyzed Medicare data (2012-2013) for 2 213 594 beneficiaries. Medication utilization issues were determined based on medication utilization measures mostly developed by Pharmacy Quality Alliance. MMA was associated with higher PPV than ACA in identifying individuals with medication utilization issues among non-Hispanic blacks (blacks) and Hispanics than non-Hispanic whites (whites). For example, odds ratio for having medication utilization issues to whites when examining MMA in 2013 and ACA were 1.09 (95% confidence interval [CI] = 1.04-1.15) among blacks, and 1.17 (95% CI = 1.10-1.24) among Hispanics, in the main analysis. Therefore, MMA was associated with 9% and 17% higher PPV than ACA in identifying patients with medication utilization issues among blacks and Hispanics, respectively, than whites.

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Demeke, Hanna B., Qingwei Luo, Ruth E. Luna-Gierke, Mabel Padilla, Gladys Girona-Lozada, Sandra Miranda-De León, John Weiser, and Linda Beer. "HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015–2018, Medical Monitoring Project." International Journal of Environmental Research and Public Health 17, no. 1 (December 25, 2019): 171. http://dx.doi.org/10.3390/ijerph17010171.

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Relocation from one’s birthplace may affect human immunodeficiency virus (HIV) outcomes, but national estimates of HIV outcomes among Hispanics/Latinos by place of birth are limited. We analyzed Medical Monitoring Project data collected in 2015–2018 from 2564 HIV-positive Hispanic/Latino adults and compared clinical outcomes between mainland US-born (referent group), Puerto Rican (PR-born), and those born outside the United States (non-US-born). We reported weighted percentages of characteristics and used logistic regression with predicted marginal means to examine differences between groups (p < 0.05). PR-born Hispanics/Latinos were more likely to be prescribed antiretroviral therapy (ART) (94%) and retained in care (94%) than mainland-US-born (79% and 77%, respectively) and non-US-born (91% and 87%, respectively) Hispanics/Latinos. PR-born Hispanics/Latinos were more likely to have sustained viral suppression (75%) than mainland-US-born Hispanics/Latinos (57%). Non-US-born Hispanics/Latinos were more likely to be prescribed ART (91% vs. 79%), retained in care (87% vs. 77%), and have sustained viral suppression (74% vs. 57%) than mainland-US-born Hispanics/Latinos. Greater Ryan White HIV/AIDS-funded facility usage among PR-born, better mental health among non-US-born, and less drug use among PR-born and non-US-born Hispanics/Latinos may have contributed to better HIV outcomes. Expanding programs with comprehensive HIV/AIDS services, including for mental health and substance use, may reduce HIV outcome disparities among Hispanics/Latinos.

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Romero, Tomás, Pablo Velez, Dale Glaser, and Camila X. Romero. "Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?" Cardiology Research and Practice 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/975393.

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Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics.Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables,2×2chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained.Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n=387). Hispanics had less private insurance than NHW (31.4% versus 56.3%,P<0.001); no significant differences were found according to gender.Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings.

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Ortiz, Blanca I., Kelly M. Shields, Kevin A. Clauson, and Patrick G. Clay. "Complementary and Alternative Medicine Use Among Hispanics in the United States." Annals of Pharmacotherapy 41, no. 6 (June 2007): 994–1004. http://dx.doi.org/10.1345/aph.1h600.

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OBJECTIVE: To review the use of complementary and alternative medicine (CAM) in Hispanics in the US and highlight the modalities most likely to be unfamiliar to healthcare practitioners. DATA SOURCES: A search of the literature published in English and a subsequent bibliographic search were conducted using MEDLINE, International Pharmaceutical Abstracts, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and Manual Alternative and Natural Therapy Index System (1980– March 2007). Primary search terms included, but were not limited to, Hispanic, Latino, complementary and alternative medicine, and dietary supplements. Studies that assessed or evaluated the use of CAM in the Hispanic population were reviewed. Articles that included both Hispanics and non-Hispanics were also included. STUDY SELECTION AND DATA EXTRACTION: The literature search yielded 42 articles focused on the use of CAM by Hispanics. Survey was the most common method used in these studies, although some hybrid interviews were also conducted. DATA SYNTHESIS: Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. Some trials examined overall CAM use, whereas others looked at specific dietary supplements and herbs. Most reports found a higher than expected rate of CAM use in Hispanics (50–90%). A number of products potentially unfamiliar to healthcare practitioners, such as linden, sapodilla, and star anise, were reported as commonly used in several studies. Many studies were limited by the sample size or use of only one Hispanic subgroup. CONCLUSIONS: Hispanics use a wide range of CAM therapies, including several that may be unfamiliar to healthcare practitioners. Understanding the rationale, motivations, and history of Hispanics' use of CAM will enhance the cultural competence of healthcare professionals and help address these patients' medical needs. TRASFONDO: El uso de terapias de medicina complementaria y alternativa (CAM) es común entre los pacientes y se cree que la etnicidad influye en la frecuencia y extensión de su uso. Los pacientes de origen Hispano son una sub-población en rápido crecimiento. Con el fin de proveer efectivamente cuidado a este grupo de pacientes, es importante entender el papel de las terapias CAM en los tratamientos de esta población.

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Deshpande, Aditya, Maria Monica Gramatges, Ghadir S. Sasa, Philip J. Lupo, Rachel E. Rau, Michele S. Redell, Terzah M. Horton, Michael E. Scheurer, and Karen R. Rabin. "Poorer Relapse-Free Survival in Hispanic Children Diagnosed with Acute Myeloid Leukemia Compared with Non-Hispanics: A Texas Single Institution Experience." Blood 126, no. 23 (December 3, 2015): 1312. http://dx.doi.org/10.1182/blood.v126.23.1312.1312.

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Abstract Introduction: Acute myeloid leukemia (AML) comprises about 18% of childhood leukemias, with an incidence of 7.7 cases per million in the United States. The evidence for variation in disease distribution by race and ethnicity is limited, although there is a slight increased risk for the promyelocytic subtype in Hispanics (Puumala et al, Pediatr Blood Cancer, 2014). In earlier treatment eras (pre-2002), the Children's Cancer Group reported Hispanics with AML to have inferior overall survival (OS) when compared with non-Hispanics (Lange et al, Blood, 2008; Aplenc et al, Blood, 2006), but their event-free survival did not differ significantly. According to recent SEER data, both Hispanic children and adults with AML demonstrated similar OS disparities (Hossain et al, Cancer Epidemiol, 2015; Patel et al, Am J of Clin Oncol, 2015), despite the fact that age at presentation and cytogenetic features were more favorable in Hispanics compared with non-Hispanics. In order to better understand the impact of Hispanic ethnicity upon AML outcomes, we examined relapse-free survival (RFS) and OS in children diagnosed with AML at Texas Children's Hospital (TCH), which has a large Hispanic population, and compared host, disease, and treatment factors that may have affected outcomes. Methods: We retrospectively reviewed medical records from children (age 0-21 years) with newly diagnosed AML treated at TCH between 1998 and 2015. Subjects with acute promyelocytic leukemia or therapy-related AML were excluded. Self-reported race and ethnicity were used to categorize the study population into Hispanics (of any race) and non-Hispanics. Differences in proportions of host, disease, and treatment characteristics between the two groups were compared using Pearson's X2 test. The Kaplan-Meier method was applied to estimate RFS and OS. We then used the Wilcoxon-Breslow-Gehan test to determine if survival functions (RFS and OS) were statistically different by ethnicity, adjusting for treatment era (pre-vs, post 2002). RFS was defined as time from the date of diagnosis until date of relapse. Patients without an event were censored at the date of last known contact. Research was performed under a local Institutional Review Board-approved protocol and in accord with the Declaration of Helsinki. Results: Of the 99 AML cases with available clinical information, 37 (37%) self-identified as Hispanic. Host, disease, and treatment factors in Hispanic and non-Hispanic subjects with AML did not differ according to prognostic factors such as age at diagnosis or favorable cytogenetic features (Table 1). Additionally, Hispanics and non-Hispanics did not differ significantly in cause of death (disease-related or other). The groups did not differ significantly in OS, but Hispanics had significantly poorer RFS (p=0.03) (Figure 1). Conclusions: Despite no significant differences in frequency of known AML risk factors, the TCH Hispanic population was both significantly more likely to relapse and had an earlier time to relapse than did non-Hispanics. This effect was even more surprising given that this population was twice as likely to have AML characterized by favorable cytogenetic features, although this enrichment did not reach significance. Of note, the RFS difference we observed is unlikely to be related to treatment compliance or socioeconomic factors, as all AML patients were hospitalized throughout treatment. Further study is needed to confirm this finding in a larger pediatric AML cohort, and to identify host factors related to Hispanic ancestry that may be responsible for the differences observed in RFS. Figure 1. Patient characteristics *Number of subjects in each category is shown in parentheses unless otherwise specified. SD=Standard deviation, CBF = core binding factor, MRD = minimal residual disease, BMT = bone marrow transplant Figure 1. Patient characteristics. / *Number of subjects in each category is shown in parentheses unless otherwise specified. / SD=Standard deviation, CBF = core binding factor, MRD = minimal residual disease, BMT = bone marrow transplant Figure 2. Comparison of AML relapse-free survival in Hispanics vs. non-Hispanics, adjusted for treatment era Figure 2. Comparison of AML relapse-free survival in Hispanics vs. non-Hispanics, adjusted for treatment era Disclosures No relevant conflicts of interest to declare.

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Powers, Benjamin Daniel, Maureen Patricia Daly, and Alliric Isaac Willis. "Predictors of quality radiation therapy completion after breast-conserving surgery." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 210. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.210.

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210 Background: Quality radiation therapy completion (QRTC) is critical to quality breast conserving treatment (BCT). Our aim was to identify predictors of QRTC after BCT in an urban setting. Methods: Hospital Tumor Registry Data was collected for female BCT patients Stage I and II. Radiation therapy completion (RTC) was defined as 35 days or more of breast radiation. QRTC was defined as RTC of 35-49 days. Statistical analyses were performed with SPSS. Results: 346 patients were analyzed. Demographic data: Ethnicity: Black n=230 (66.5%), White n=63 (18.2%), Hispanic n=53 (15.3%); Age: < 50 years n=74 (21.4%), 50 – 64 years n=152 (43.9%), > 64 years n=120 (34.7%); Insurance: Medicare n=131 (37.9%), Private n=94 (27.2%), Medicaid n=121 (35.0%). Hispanics (60.4%) were more likely to have Medicaid versus blacks (33%) and whites (20.6%), p<0.001. Majority (52%) of patients live within 3 miles of treatment. More blacks (66.5%) live <3.0 miles than whites (7.9%) or Hispanics (41.5%), p<0.001. There was no significant difference in mean days of RTC by ethnicity (black 46.8, white 46.4, and Hispanic 48.1 days; p=0.75) or total RTC % (black 88.2%, white 97.9%, Hispanic 93.3%; p=0.09). However, a substantial difference was seen in QRTC % by ethnicity (black 51.8%, white 79.2%, Hispanic 57.8%; p=0.03) Multivariate logistic regression of failure to achieve QRTC found associations with black race (OR=2.67), Medicare (OR= 3.46), Medicaid (OR=2.19), and age <50 years (OR=4.13). Conclusions: This study demonstrates high overall % RTC; however, it identifies significant disparities in successful QRTC. Those at greatest risk of unsuccessful QRTC were younger, Medicare or Medicaid insured, and black ethnicity. Distance was not a significant factor in this urban population. Further studies should investigate the specific barriers that may contribute to disparities in QRCT among those at risk groups. [Table: see text]

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Guzman, Alberto, and Noam Ostrander. "Hispanics' Awareness of Assistive Technology." Assistive Technology 21, no. 1 (June 17, 2009): 28–34. http://dx.doi.org/10.1080/10400430902945868.

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Mejia, Alex V. "Outcomes of Hispanic Patients with Advanced Hematological Malignancies Participating in Early Phase Clinical Trials." Blood 124, no. 21 (December 6, 2014): 2634. http://dx.doi.org/10.1182/blood.v124.21.2634.2634.

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BACKGROUND: Participating in early phase clinical trials is encouraged among patients who have exhausted standard treatment options. There is continued focus at the federal level to develop programs addressing racial disparities. Data on disparities in solid tumors such as lung, breast, and colorectal cancers is vast. However, racial and ethnically based outcomes in hematologic malignancies, early phase clinical trial participation and observed clinical outcomes from these trials have received much less attention. AIM: To describe, evaluate and compare the clinical outcomes and characteristics of a cohort of consecutive Hispanic and Non-Hispanics patients with advanced hematologic malignancies enrolled on early phase clinical trials at the Cancer Therapy and Research Center, (CTRC) from 2000 to 2013. METHODS: We retrospectively reviewed records of patients with advanced hematological malignancies treated within phase I/II clinical trials at the CTRC and report descriptive statistics used to summarize patients' baseline characteristics on demographics, response, toxicities and survival based on ethnicity. Categorical data were described with contingency tables including counts. The t- and chi square tests were used to compare the differences in survival (PFS and OS) and toxicity between ethnicities. This report constitutes the preliminary findings of the first 106 patients out of a larger cohort of patients currently under study. RESULTS: One hundred and six patients were treated. The median number of prior systemic therapies was 3 for both Hispanics (range 0-5) and Non-Hispanics (range 0-12). The median age of Hispanic patients was 52 years and for non-Hispanics was 64 years, with a male/female ratio of 29/22 for Hispanics and of 27/24 for non-Hispanics respectively. (Table1) Among 53 Hispanic patients, the mean progression free (PFS) and overall survival (OS) were 3.6 and 5.3 months respectively [95% CI for PFS 2.45-4.6 months and for OS 3.5–7.1 months]. Among 53 Non-Hispanic patients, the mean PFS and OS were 3.9 and 5.2 months respectively [95% CI for PFS 2.4-5.2 months and for OS 2.7–7.7 months]. There were no statistically significant differences in outcome between ethnicities. (p=0.73 for PFS and p=0.97 for OS). The derived clinical benefit rate (CBR=SD+CR+PR) was 26% for Hispanics and 22% for Non-Hispanic patients. Significant difference was observed in the rates of G3/G4 toxicities. (figure1) Sixteen Hispanic patients (30%) vs. 11 non-Hispanic patients (21%) developed grade 3 or 4 toxicity (p=0.02). CONCLUSION:Our preliminary clinical outcome and safety data suggests that early phase clinical trials may offer similar potential clinical benefit for Hispanic patients with advanced hematological malignancies when compared with those of non-Hispanic origin. It appears that there was a slight increased risk of grade 3 and 4 toxicities when compared with patients of non-Hispanic origin. Further analysis is ongoing to determine prognostic indicators in this population. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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Yang, J., P. Mauldin, M. Ebeling, T. Hulsey, M. B. Thomas, and N. F. Esnaola. "Racial/ethnic differences in use of surgery and adjuvant chemotherapy for nonmetastatic colon cancer: Where's the rub?" Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 529. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.529.

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529 Background: Disparities in receipt of recommended medical therapy for colon cancer have been reported. The objective of this study was to determine the independent effect of black race and Hispanic ethnicity on use of surgery/adjuvant therapy in patients (pts) with nonmetastatic colon cancer, controlling for surgical/medical oncology consultation Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 26,946 pts aged 66 and older with resected stage I-III colon cancer diagnosed between 1999-2004. Surgical/medical oncology consultation and receipt of chemotherapy were ascertained from Medicare claims. The relationships between patient/tumor characteristics, surgical/medical oncology consultation, and use of surgery/adjuvant therapy were analyzed using chi square tests. Odds ratios (OR) of receipt of surgery/chemotherapy were calculated using logistic regression analysis. Results: We identified 23,834 white, 2,022 black, and 1,090 Hispanic pts with stage I (7,088 pts), stage II (9,510 pts), and stage III (7,236 pts) colon cancer. Blacks and Hispanics were more likely to be younger, less educated, of lower income, and have greater comorbidity compared to whites. Rates of surgical resection were lower among blacks than Hispanics (86.6% vs. 88.8% vs. 92.0% in whites, all p < 0.001). Blacks with stage III colon cancer (but not Hispanics) were also less likely to receive adjuvant chemotherapy (48.2% vs. 54.7% in whites, p < 0.001). After controlling for socioeconomic status, comorbidity, and surgical/medical oncology consultation, black race (but not Hispanic ethnicity) was independently associated with underuse of surgery (adjusted OR, 0.68; 95% confidence interval [CI], 0.51-0.89) and adjuvant chemotherapy (adjusted OR, 0.71; 95% CI, 0.60-0.85). Conclusions: Black race, but not Hispanic ethnicity, is a powerful, independent predictor of underuse of surgery and adjuvant chemotherapy in pts with nonmetastatic colon cancer. Qualitative studies are needed to determine whether patient misperceptions about colon cancer surgery/chemotherapy or suboptimal physician-patient interactions may underlie these observations. No significant financial relationships to disclose.

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Doll, Marie, Steven Gale Roshon, Elizabeth Rodriguez Stone, and Robert Sam Butler. "Evaluation of art therapy on mood, anxiety, and pain levels in patients with cancer undergoing chemotherapy treatment." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e21713-e21713. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e21713.

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e21713 Background: Art therapy is a mental health modality that uses art-making to improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. The primary purpose of the trial is to assess the effect of art therapy on cancer patients' mood, anxiety, and pain levels. Secondary endpoints include exploring difference in response to art therapy by specific patient characteristics. Methods: Trial enrolled 50 cancer patients receiving chemotherapy. They participated in an hour long art therapy session with Art Therapist. Patients completed four visual analog scales (VAS) at three different time points: pre-treatment, post treatment (immediately after session) and 48-72 hours after session. Primary end points are pre and post session changes in the VAS for distress, depression, anxiety and pain. Secondary endpoints include differences in VAS scores by ethnic groups (Hispanic vs non-Hispanic), race (white vs non-white), age, gender, and marital status. Analysis was performed using repeated measures, mixed models, and pairwise means comparisons for the four measurements using the Tukey-Kramer adjustments for multiple comparisons. Results: Study revealed a statistically significant difference between pre treatment and post treatment as well as pre-treatment and follow up across distress, depression, anxiety and pain. There was no statistically significant difference between post treatment and follow up. The only significant correlation seen among patient characteristics was that Hispanic patients had higher depression scores at all time points vs non-Hispanics. Conclusions: Art therapy improved mood, anxiety and pain among all patients. Benefits were seen immediately after session and persisted at least 48-72 hours across all groups equally. Hispanic patients had higher depression scores compared to non-Hispanics. Clinical trial information: NCT02659345. [Table: see text]

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Calfa, C. J., M. Escalon, S. Zafar, E. Lopez, V. Patel, S. Patel, L. Feun, and L. E. Raez. "Beyond race: The impact of ethnicity on the treatment outcome of locally advanced head and neck cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 16500. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.16500.

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16500 Background: Self identified racial groups share an unequal burden of head and neck cancer . Recent evidence suggests that outcome among races is different and the causes are multifactorial. Nonetheless, differences among ethnic groups have not been reported. Herein, we decided to analyze differences in treatment response and outcome among our white and Hispanic patient population treated for locally advanced head and neck cancer. Methods: Patients were identified using the tumor registry. We reviewed retrospectively the data from medical records. 100 white Hispanics (WH) and 50 white non-Hispanics (WNH) diagnosed with locally advanced head and neck cancer and treated at our institution from 2004 to 2005, were eligible for the study. Standard statistical analysis, including Kaplan-Meier survival curve and Cox proportional hazard models were used. P value of <0.05 was considered for statistical significance. Results: Preliminary results reveal that, in our study population, median age at diagnosis, gender, performance status (ECOG 0–2) and squamous cell histology did not differ significantly between the two groups. Stage 4 at diagnosis was more commonly observed in Hispanics as opposed to WNH (85.7% vs 68.6%) (P = 0.1). Surgery was more commonly used as an initial treatment option in Hispanics than WNH (42.8% vs 28.6%) (P = 0.18) while chemotherapy was less likely to be used (78.6% vs. 91.4%) (P = 0.15). Hispanics were more likely to smoke than WNH (P = 0.0003) and were equally exposed to chronic alcohol use. Patients from the Hispanic group were more likely to respond to therapy than whites by Chi-squared analysis but this difference was not statistically significant (P = 0.09). No differences were seen in disease free survival. Kaplan-Meier estimate of median overall survival was 16 months for Hispanics vs. 25 months for whites but this difference did not reach statistical significance (P = 0.26). Final analysis will be available at the time of the annual meeting. Conclusion: In our experience, a trend for decrease overall survival was noted in the Hispanic ethnic group. This may be in part due to more advanced stage at presentation. Nonetheless, in order to definitively answer this question, further research is warranted. No significant financial relationships to disclose.

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Farias, Albert J., and Xianglin L. Du. "Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer." Journal of Clinical Oncology 35, no. 1 (January 1, 2017): 86–95. http://dx.doi.org/10.1200/jco.2016.68.2807.

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Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

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Ailawadhi, Sikander, Ryan D. Frank, Nicolette T. Chimato, Zahara Meghji, Raj Patel, Prachi Jani, Tanya S. Kakar, et al. "Factors Determining Utilization of Stem Cell Transplant (SCT) for Initial Therapy of Multiple Myeloma (MM) By Patient Race: Exploring Intra-Racial Healthcare Disparities." Blood 130, Suppl_1 (December 7, 2017): 860. http://dx.doi.org/10.1182/blood.v130.suppl_1.860.860.

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Abstract Background: SCT is a standard therapeutic approach for patients with MM and has contributed to improved outcomes. While SCT utilization in MM has increased for all racial-ethnic subgroups over time, population-based studies have repeatedly shown that racial minorities are less likely to receive it. We explored factors that determine SCT utilization among patients within a given race to understand intra-racial disparities and how to address them in order to maximize the use of this imperative treatment among eligible patients. Methods: The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004-2013 was studied. Cases without information on the selected patient or facility characteristics evaluated in this analysis, including SCT use, race, median income, insurance status or facility type of initial MM diagnosis and/or treatment were excluded. The association between utilization of SCT as part of initial therapy of MM and socio-demographic factors was studied stratifying patients into mutually exclusive racial-ethnic subgroups non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, non-Hispanic Asians (NHA) and others using multivariate GEE logistic regression analysis (clustered on facility ID). Interactions between race and patient/facility characteristics and SCT utilization were tested using similar methods but including all races. Results: Of the 123480 unique MM patients in NCDB diagnosed between 2004-2013, 111799 met the inclusion criteria. Of these, 15021 patients (13.4%) received SCT as part of initial MM therapy. Of those who received SCT, 77.5% were NHW (14.4% of all NHW), 15.1% NHB (10.3% of all NHB), 5.2% Hispanics (13.2% of all Hispanics), 2% NHA (15.5% of all NHA) and <1% others. There was no difference by gender but significantly reduced odds of receiving SCT were noted for every 10-year increase in age at diagnosis for all racial subgroups. NHA were the only subgroup not to have a significant year-wise increase over time in odds of receiving SCT between 2004-2013. A significant increase in SCT utilization was seen with increasing median income (quartiles; 2008-2012 data), for NHW and Hispanics but not for NHB and NHA, while increased education (% population with high-school degree; 2008-2012 data) was associated with a significant increase in SCT use for NHW and NHB, but not among Hispanics or NHA. An increase in great circle distance (GCD) from the treating facility as well as a lower Charlson-Deyo comorbidity index (CCI) was associated with significantly increased odds of receiving SCT for all racial groups. Insurancepayer status significantly affected odds of receiving SCT among all races with those having private insurance to be most likely to receive SCT among NHW, NHB and Hispanics while those with "other government" insurance payer type being most likely among NHA. Among treating facility characteristics, patients of all races were more likely to receive SCT if treated at an academic/researchfacility (including NCI-designated centers) or centers with highest quartile of patientvolume seen. For analysis by geographicalregion, NHW and NHA had the highest odds of receiving SCT in mountain region but there was no impact of geography on SCT for NHB or Hispanics. Odds ratio (OR) of receiving SCT as part of initial MM therapy by socio-demographic and facility characteristics for patients of individual racial subgroups are shown in Table 1. A significant interaction between odds of receiving SCT and various racial subgroups was noted for patient age at diagnosis (p<.001, decreased odds among NHW and NHA), GCD from treating facility (p=0.013, increased odds among NHB and NHA), CCI (p=0.043, decreased odds among NHA) and treatment facility volumes (p=0.046, increased odds among NHA and Hispanics). Conclusions: In the largest analysis exploring socio-demographic factors affecting SCT utilization in MM we note a significant disparity within races for who gets SCT as a part of initial MM management and who does not. While some of these factors are non-modifiable, others including access to healthcare, income, insurance and literacy levels, proximity to treatment center, treating facility type as well as volumes are modifiable and appear to be barriers to SCT among in some races, while not in others. These must be addressed to minimize disparities within racial subgroups, especially the minorities and realize maximal benefit of SCT for MM. Disclosures Ailawadhi: Novartis: Consultancy, Honoraria; Pharmacyclics: Research Funding; Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Sher: LAM Therapeutics, Inc: Research Funding.

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Plaisance, Eric P., Larrell L. Wilkinson, Kelsey E. Miller, and Luke S. Mahan. "Factors Influencing the Accumulation of Recommended Physical Activity among Latinos in the Deep South of the United States (Factores que Influyen en la Acumulación de Actividad Física Recomendada entre Latinos en el Extremo Sur de los Estados Unidos)." Retos, no. 27 (March 5, 2015): 213–17. http://dx.doi.org/10.47197/retos.v0i27.34381.

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Less than 40% of the U.S. population achieves the recommended amount of leisure-time physical activity (LTPA) recommended by the American College of Sports Medicine [ACSM (>150 minutes/week of moderate-intensity or equivalent vigorous-intensity LTPA)]. The number of Hispanic/Latino men and women who report being physically inactive is disproportionately higher than non-Hispanic/Latinos. The purpose of this investigation is to evaluate factors which influence the achievement of meeting ACSM recommendations for LTPA among adults with Hispanic/Latino ethnicity and whites (non-Hispanic/Latino) in the southern United States. Self-reported data collected as part of the Behavioral Risk Factor Surveillance System (BRFSS) was analyzed in male and female Hispanic/Latinos and non-Hispanic/Latino whites using the Andersen Model and Chi Square Analysis to examine the association between variables. Hispanic/Latino men/women were significantly less likely to meet the ACSM recommendations (> 150 minutes/week) compared to non-Hispanic/Latinos. Lower amounts of income, education, and access to health care were all significant factors of whether Hispanic/Latinos in the Deep South achieved the ACSM recommendations for LTPA. Although the percentage of overweight Hispanic/Latinos was considerably higher than White (non-Hispanic/Latino), reported obesity was highest among Whites (non-Hispanic/Latino). LTPA between the two groups differed significantly, suggesting that not achieving the physical activity recommendations is associated with being overweight, but other factors may also contribute to being overweight and obesity.Key words. physical activity, Hispanics, leisure, obesity, overweight, disease.Resumen. Menos del 40% de la población de los Estados Unidos cumple con la cantidad de actividad física de tiempo libre (AFTL) recomendada por el Colegio Americano de Medicina Deportiva [ACSM (> 150 minutos/semana de AFTL de intensidad moderada o su equivalente de intensidad vigorosa)]. La cantidad de hombres y mujeres hispanos o latinos que reportan ser físicamente inactivos es desproporcionadamente mayor que quienes no lo son. El propósito de esta investigación es evaluar los factores que pueden influir en alcanzar las recomendaciones del ACSM para AFTL en adultos de origen étnico hispano o latino y en caucásicos (que no son hispanos o latinos) en la región Sur de los Estados Unidos. Se recolectaron datos de cuestionarios autoadministrados que son parte del Sistema de Vigilancia de Factores de Riesgo del Comportamiento (Behavioral Risk Factor Surveillance System, BRFSS), los cuales se analizaron en hombres y mujeres hispanos o latinos y en caucásicos que no lo eran, por medio del Modelo de Andersen y pruebas de Chi cuadrado para examinar la asociación entre variables. Se encontró que los hombres y las mujeres latinos tenían una menor probabilidad de cumplir con las recomendaciones del ACSM (> 150 minutos/semana) en comparación con quienes no eran hispanos o latinos. Menores ingresos económicos, educación y acceso a los servicios de salud fueron factores significativos que condicionaban si los hispanos o latinos en el extremo Sur lograban las recomendaciones del ACSM para AFTL. Aunque el porcentaje de hispanos o latinos con sobrepeso fue considerablemente mayor que los caucásicos (no hispanos o latinos), la obesidad reportada fue mayor entre los caucásicos (no hispanos o latinos). La AFTL entre los dos grupos fue estadísticamente diferente, lo cual sugiere que no alcanzar las recomendaciones de actividad física se asocia con tener sobrepeso; sin embargo, otros factores también pueden contribuir en tener sobrepeso y obesidad.Palabras claves. actividad física, hispanos, ocio, obesidad, sobrepeso, enfermedad.

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Naeem, Fouzia, Mohammad Nael Mhaissen, James McCarty, and Chokechai Rongkavilit. "Disseminated Coccidioidomycosis Among Children in Central California: A Retrospective Review." Open Forum Infectious Diseases 4, suppl_1 (2017): S82. http://dx.doi.org/10.1093/ofid/ofx163.027.

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Abstract Background The burden of coccidioidomycosis in central California is significant among children. Yet, the literature on such infection is limited, particularly on disseminated coccidioidomycosis (DC) in children. Objectives Review the natural history, treatment and outcomes of DC in a tertiary children’s hospital. Methods Retrospective review of patients ≤21 years old with DC seen at our facility during 1/1/07–12/31/16. Results Eighty cases were identified. Median age was 8.5 years (IQR 4.3–14.6); majority was hispanic (66%) and without comorbid conditions (85%). Pulmonary disease with other organ involvement occurred in 69%; 19% had meningitis. Overall, 82% had resolved and/or stable disease (RS), whereas 14% experienced relapse and/or progressive disease (RP). Meningitis more commonly seen in older age group (14.3 vs. 6.9 years, P = 0.04) and had low eosinophil’s (0.8 vs. 2.1%, P < 0.01). More organ involvement (64% vs. 35%, P = 0.03) and RP disease (22% vs. 5%, P = 0.04) commonly seen in children 10 years or older. Non-Hispanics also found to be older than Hispanics (12.2 vs. 7.4 years, P < .01); received multiple drug therapy (48% vs. 18%, P = 0.02). Although not significant, Non-Hispanics were more likely to have meningitis (30% vs. 13%, P = 0.07), coccidioidal complement fixation (CF) titers ≥ 32 (92% vs. 73%, P = 0.07), and RP disease (24% vs. 7%, P = 0.06) than Hispanics. No significant association was found between gender and age, CF titers, and/or outcomes. Higher CF titers were seen with >1 organ involvement (1:256 vs. 1;64, P < 0.01) and more antifungal therapy (1:256 vs. 1:32, P < 0.01). Coccidioides EIA antibody was positive in 50% of cases and 48% with negative/indeterminate results were positive by Immunodiffusion. On multivariate analysis, age remained independently associated with RP (OR = 1.2, 95% CI 1.0–1.5, P = 0.02); age (OR = 1.1, 95% CI 1.0–1.3, P = 0.01) and more antifungal therapy (OR = 3.7, 95% CI 1.4–9.5, P < 0.01) with non-Hispanics. Conclusion To our knowledge this is the largest series for pediatric DC. We identify older age group, non-Hispanics and higher CF titers as potential risk factors for DC, which require early intervention. Prospective studies are needed to identify predictors for adverse outcomes in pediatric DC. Disclosures All authors: No reported disclosures.

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Dennis, Michael, Diana Cirstea, Asaf Maoz, Adam Lerner, Ami K. Patel, and Shayna Sarosiek. "Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital." Blood 132, Supplement 1 (November 29, 2018): 4864. http://dx.doi.org/10.1182/blood-2018-99-118472.

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Abstract Background: Outcomes in multiple myeloma (MM) have improved in recent years, but disparities among racial-ethnic groups persist (Costa, 2017; Ailawadhi, 2012; Waxman, 2010). Differences in disease biology, treatment modalities, and access to care are likely explanations for these disparities. Currently the preferred induction therapy for MM is a three-drug regimen, such as bortezomib/cyclophosphamide/dexamethasone (VCD), bortezomib/lenalidomide/dexamethasone (VRD) or carfilzomib/pomalidomide/dexamethasone (KPd). This is often followed by high-dose melphalan with autologous stem cell transplant (HDM/SCT) and maintenance therapy. Older or frail adults may not tolerate this three-drug approach or HDM/SCT. Two-drug regimens without HDM/SCT are acceptable options in these groups. This retrospective study was designed to explore the utilization of preferred induction therapy and HDM/SCT across racial-ethnic groups at Boston Medical Center. Results: One hundred sixty-eight patients with MM were treated at our institution between 2004 and 2017. Sixty-six percent were non-Hispanic Black (NHB), 20% were non-Hispanic White (NHW), and 14% were Hispanic. The average age was 63 years and 56% of the population was male. There was no significant difference in age or sex between the NHB, NHW, and Hispanic groups. Only 83 patients (49%) received a three-drug induction regimen. Forty-six (51%) were < 65 years old, while 37 (48%) were ≥ 65 years old. The utilization of standard induction therapy was significantly different among racial-ethnic groups < 65 years old. Thirteen NHW patients (76%) received triplet induction therapy, compared to only 10 Hispanics (63%) and 23 NHB patients (40%) (p=0.02). A similar trend was observed in regards to treatment with HDM/SCT within the first year after diagnosis for patients age < 65 years and triplet therapy in patients undergoing HDM/SCT (any age), although these trends did not reach statistical significance (47% NHWs, 31% Hispanics, and 28% NHBs, p=0.31 and 91% NHWs, 78% Hispanics, and 58% NHBs, p=0.11 respectively). There were no significant differences among groups age ≥ 65 years in regards to triplet induction therapy, HDM/SCT within the first year, or HDM/SCT any time after diagnosis. The median time to HDM/SCT and overall survival were not significantly different between racial-ethnic groups, regardless of age above or below 65 years. Conclusion: NHB and Hispanic patients less than 65 years old are less likely to receive a standard three-drug induction regimen. There is also a trend towards fewer patients receiving HDM/SCT in the first year after diagnosis among these groups compared to NHW patients. Our study did not confirm a survival benefit in NHB patients under age 65, which has been reported in prior studies (Fillmore, 2018; Waxman, 2010). The lack of benefit seen in this study could be related to lower rates of three-drug induction therapy and HDM/SCT in the NHB group. Further research is needed to explore patient co-morbidities, socioeconomic factors, and physician biases to determine why minority groups have less utilization of standard therapies. Table. Table. Disclosures No relevant conflicts of interest to declare.

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Yang, Jun, Heng Xu, Cheng Cheng, Meenakshi Devidas, Deqing Pei, Yiping Fan, Wenjian Yang, et al. "ARID5B Genetic Polymorphisms Contribute to Racial Disparities In Childhood Acute Lymphoblastic Leukemia: A Children's Oncology Group Study." Blood 116, no. 21 (November 19, 2010): 8. http://dx.doi.org/10.1182/blood.v116.21.8.8.

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Abstract Abstract 8 Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children. Substantial racial differences exist not only in the risk of developing childhood ALL, but also in the outcome of ALL therapy, e.g. children with Hispanic ethnic background exhibit the highest incidence of ALL and the lowest survival rate among major racial/ethnic groups in the US. Although both genetic and non-genetic factors are thought to be important, the exact cause(s) of such racial disparities remains largely unknown. Taking a genome-wide approach, we previously identified single nucleotide polymorphisms (SNPs) in the ARID5B gene that are strongly associated with ALL risk in whites (e.g. rs10821936, P=1.4×10-15, Nat. Genet. 2009, 41:1001), which was independently replicated in several studies (Nat. Genet. 2009, 41:1006; Blood 2010 115:1765). Interestingly, the ALL risk allele (allele C) at the ARID5B SNP is also associated with ALL risk in black children, but is much less prevalent in blacks than whites (allele C frequency, 18% in blacks and 34% in whites), providing a genetic basis for the lower risk of ALL in black children (Leukemia 2010 24:894). In this study, we evaluated the contribution of ARID5B genetic variations to the disparities in ALL incidence and outcome between Hispanic and white children. To identify genetic variations associated with ALL in each population, we first compared genotype frequencies at 51 ARID5B SNPs between ALL cases and ancestry-matched controls, i.e., between 330 Hispanic children with ALL and 134 Hispanic controls; and between 978 white children with ALL and 1,046 white controls. After adjusting genetic ancestry to control for population stratification, we observed that 10 of 51 ARID5B SNPs were significantly associated with ALL in both populations, and 6 and 10 SNPs were significant only in whites and Hispanics, respectively. In both race groups, the strongest association was observed at rs10821936 (P= 8.3×10-20 in whites and P=3.7×10-8 in Hispanics). Interestingly, the frequency of the ALL risk allele (allele C) at rs10821936 was higher in Hispanics (43%) than in whites (33%), consistent with the higher incidence of ALL in Hispanics. In fact, for all 10 SNPs significant in both populations, the risk alleles were consistently more common in Hispanics than whites and conferred greater risk of ALL (higher odds ratios in Hispanics than whites). Additionally, we performed forward selection-based multivariate analyses in each population in which ARID5B SNPs compete against each other on the basis of independent associations with ALL. In whites, rs10821936 was the first and only SNP that entered the multivariate model, suggesting a single causal variant at the ARID5B locus tagged by this SNP. In contrast, in Hispanics, 3 ARID5B SNPs were independently associated with ALL in the multivariate model even after adjusting for genotype at rs10821936. Moreover, these 3 ARID5B SNPs were located in linkage disequilibrium blocks distinct from that tagged by rs10821936, arguing for multiple possible causal variants in the ARID5B gene in Hispanics. Finally, we tested whether ARID5B polymorphisms are related to treatment outcome in 1,605 children enrolled on the COG P9904 and P9905 studies. Of 26 ARID5B SNPs associated with ALL risk, 5 were also associated ALL relapse (P<0.05), with the alleles related to disease risk always linked to poorer treatment outcomes. For instance, the T allele at rs6479778 was more frequent in ALL cases than in healthy controls (P=0.0029 in whites and P=0.0031 in Hispanics), and patients carrying the T allele also exhibited an increased risk of ALL relapse (P=1.3×10-4). Because the T allele is more common in Hispanics (24%) than whites (14%), this polymorphism is likely to contribute to the racial differences in both disease risk and treatment outcome of ALL. In conclusion, our results indicate that genetic polymorphisms in the ARID5B gene are important determinants of racial disparities in childhood ALL. Disclosures: Relling: St. Jude Children's Research Hospital: Employment, Patents & Royalties; Enzon Pharmaceuticals: Research Funding.

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Okoh, Alexis K., Olivia Chan, Molly Schultheis, Setri Fugar, Nathan Kang, Sari Kaplon, Ravindra Karanam, Mark Russo, Mark Zucker, and Margarita Camacho. "Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 14, no. 3 (May 3, 2019): 236–42. http://dx.doi.org/10.1177/1556984519836862.

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Objective We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race. Methods Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race: Caucasian, African American (AA), and Hispanic. Postoperative outcomes including complications, discharge disposition, and survival at defined time points were compared. Cox proportional hazards were used to identify factors associated with 1-year all-cause survival. Results A total of 158 patients who had LVADs as BTT ( n = 63) and DT ( n = 95) were studied. Of these, 56% ( n = 89) were Caucasians, 35% ( n = 55) were AA, and 9% ( n = 14) were Hispanics. AA patients had higher BMI and lower socioeconomic status and educational level, and were more likely to be single or divorced. Operative outcomes were similar among all 3 groups. Unadjusted 30-day, 6-month, 1-year, and 2-year survival rates for Caucasians versus AA versus Hispanics were 82% versus 89% versus 93%, P = 0.339; 74% versus 80% versus 71%, P = 0.596; 67% versus 76% versus 71%, P = 0.511; and 56% versus 62% versus 68%, P = 0.797. On multivariate analysis, device-related infection, malfunction, and abnormal rhythm were factors associated with overall all-cause mortality. Conclusion AA patients who undergo LVAD implantation as BTT or DT have lower socioeconomic status and educational level compared to their Caucasian or Hispanic counterparts. These differences, however, do not translate into postimplant survival outcomes.

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Hess, Brian, Matthew Siegel, Tulio E. Rodriguez, Shams Bakhos, Maria Theodorou, Michael Tallarico, Scott E. Smith, Aileen Go, and Patrick Stiff. "Correlation of Ethnicity, Socioeconomic Status, and Co-Morbidity with Outcome After Allogeneic Hematopoietic Stem Cell Transplantation." Blood 120, no. 21 (November 16, 2012): 3102. http://dx.doi.org/10.1182/blood.v120.21.3102.3102.

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Abstract Abstract 3102 Identifying the optimal patients and timing for allogeneic hematopoietic stem cell transplant (HSCT) is an ongoing challenge for transplant centers that requires assessment of more than just the disease status and stage. Pre-existing co-morbidities also independently impact both 100 day and 1 year non-relapse mortality (NRM) as well as long term overall survival. Additionally, the CIBMTR has also shown that Hispanic patients have an inferior survival after allogeneic HSCT, although why ethnicity is linked to a higher mortality, e.g. is it higher risk/timing of transplant, lower socioeconomic status, increased co-morbidities, etc. however, is still undetermined. A survival analysis of allogeneic HCT outcomes that includes ethnicity, co-morbidity, insurance payor, as well as traditional risk factors such as age, disease risk at transplant, and remission status would be helpful to clarify the outcome disparities found in different ethnic subgroups and more importantly lead to strategies to minimize the effect. Methods: We performed a retrospective analysis of the outcome of 363 consecutive adult allogeneic transplants at Loyola University Hospital of whom approximately 10% were Hispanics (34) from January 1, 2003 to June 30, 2010. We use a focused approach to optimize care of non-English speaking Hispanics which involves native speakers at all levels, written materials in Spanish, and an IRB approved method to permit all non-English speaking patients to enroll in all clinical trials is present. Traditional prognostic data as well as the Sorror co-morbidity index and socioeconomic and ethnicity status were determined for each patient. The surrogate we used for socioeconomic status was insurance payor (i.e. indigent + Medicaid vs. third party insurance/Medicare). Survival analysis was calculated using Kaplan Meier plots considering each patient at 100 days, 1 year, and 3 years. Results: The median age for the 363 patients was 47.1 years with 48.7% being in the High Risk CIBMTR category, and 74.1% being in remission at transplant. The median co-morbidity index was 2.0. No differences were seen in remission status or the co-morbidity index for Hispanic vs. non-Hispanic patients, while fewer Hispanic patients were in the High CIBMTR Risk group (27.3 vs. 50.9%; p = .048). Survival for Hispanics (34) vs. non-Hispanics (329) showed no difference in overall survival at three years (42.1 vs. 42.8%). Based on payors, we found no statistical difference in 100 day overall mortality after HSCT for those with Medicaid (n = 35) vs. non-Medicaid (n = 328) payors with Hispanic non-Medicaid and non-Hispanic non-Medicaid survivals at 100 days of 82.8 and 87.9%. However despite the relatively small number, both the non-Hispanic and Hispanic patients with Medicaid showed a significantly decreased survival after 100 days with 3 year survivals of 20.0 and 30.0% for Hispanic and non-Hispanic Medicaid patients vs. 51.7 and 56.7% of the Hispanic and non-Hispanic non-Medicaid groups respectively (p = .002). Conclusions: Unlike prior reports, and perhaps by using a focused approach for our non-English speaking Hispanic patients, we found no difference in survival between Hispanics and non-Hispanics in our series of 363 consecutive allografts at 100 days, 1, or 3 years, although they may have been predicted to have had a slightly better prognosis based on a better Risk Group status. We did however find that payor was an important prognostic variable for outcome after the first 100 days regardless of ethnicity. Whether this is simply due to the financial toll of such a chronic illness and therapy remains to be seen, but this suggests that closer follow-up after day 100 may be of significant benefit for this subgroup of patents which may grow due to health care reform. Disclosures: No relevant conflicts of interest to declare.

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Gao, Yong, and Weimo Zhu. "DIF Detection of Activity Items across Non-Hispanic Whites and Hispanics in NHANES Physical Activity Questionnaire." Medicine & Science in Sports & Exercise 40, Supplement (May 2008): S200. http://dx.doi.org/10.1249/01.mss.0000322323.32556.e5.

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Solanki, A. A., G. F. Liu, M. C. Ranck, A. Kolokythas, L. Feldman, A. R. Howard, and M. T. Spiotto. "Similar Outcomes in Hispanics and Non-Hispanics After Radiation Therapy for Head and Neck Squamous Cell Carcinoma." International Journal of Radiation Oncology*Biology*Physics 87, no. 2 (October 2013): S464. http://dx.doi.org/10.1016/j.ijrobp.2013.06.1228.

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Diaz-Abad, Montserrat, Wissam Chatila, Matthew R. Lammi, Irene Swift, Gilbert E. D’Alonzo, and Samuel L. Krachman. "Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea." Sleep Disorders 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/878213.

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Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA).Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study.Results. Seventy-nine patients (26 males;53±11 yrs; body mass index(BMI)=45±9 kg/m2) with apnea-hypopnea index (AHI)33±30events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006), income level (P<0.001), and employment status (P=0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03,P=0.004, andP=0.001, resp.), as well as in Hispanics (P=0.02,P=0.02,P=0.03, resp.).Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.

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Hursting, Marcie J., and Ik-Kyung Jang. "Dosing Patterns and Outcomes in African American, Asian, and Hispanic Patients with Heparin-Induced Thrombocytopenia Treated with Argatroban." Blood 112, no. 11 (November 16, 2008): 3403. http://dx.doi.org/10.1182/blood.v112.11.3403.3403.

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Abstract Nonwhites, as compared with whites, have increased risk for thromboembolic complications in heparin-induced thrombocytopenia (HIT) (Lewis et al, Chest 2006). To better characterize the risk in nonwhite patients, we retrospectively evaluated dosing patterns and clinical outcomes in African American, Asian, and Hispanic patients administered argatroban therapy for clinically diagnosed HIT. Patients were from previously reported, multicenter, prospective studies of argatroban therapy (2 mcg/kg/min, adjusted to achieve aPTTs 1.5–3 times baseline) in HIT (defined as an otherwise unexplained platelet count <100 x109/L, or 50% reduction in platelet count, following heparin therapy). For African American (n=52), Asian (n=13), and Hispanic (n=14) patient groups, baseline characteristics, therapeutic argatroban dose and duration, aPTTs during therapy, and clinical outcomes (death, including death due to thrombosis; amputation, including amputation secondary to ischemic complications of HIT; new thrombosis; and major bleeding within a 37-day period) were summarized and compared. Among groups, no differences were detected in demographic or baseline features, excepting weight (median values: 62, 77 and 85 kg, respectively, for Asians, African Americans, and Hispanics). Median baseline platelet counts were 45–71 x109/L, and approximately 50% of patients in each group had HIT-related thrombosis before argatroban was initiated. Each group received a similar duration of argatroban therapy (4.0–5.5 days), yet Asians needed a lesser dose (1.0 mcg/kg/ min, versus 1.9 mcg/kg/min in other groups) to achieve comparable aPTTs (61–69 s). New thrombosis occurred most often in African Americans (21%, versus 7–8% in other groups) and when baseline HIT-related thrombosis was present (9/13 events, 69%). Amputation occurred most often in Hispanics (21%, versus 0–12% in other groups) and when diabetes was present (6/9 events, 67%). Mortality was 21–31%, and mortality due to thrombosis was 0–7%. Asians had the lowest frequency of any thrombotic-related outcome (composite of death due to thrombosis, amputation secondary to ischemic complications of HIT, or new thrombosis: 8%, versus 27–29% in other groups). Two patients, each African American, experienced major bleeding (gastrointestinal), for an overall major bleeding rate of 2.5% and by-group rates of 0–4%. Although limited by small group sizes, our study is among the first to characterize outcomes in minority patients administered nonheparin therapy for HIT. Our findings suggest that, despite achieving comparable levels of anticoagulation with argatroban, African Americans and Hispanics are higher risk patients than Asians for poor outcomes in HIT and also that in minority patients with adverse outcomes, baseline HIT-related thrombosis or diabetes is often present.

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Cholankeril, Michelle, and Keia Smith. "A single institution study on the demographics and response rates of Hispanic women with HER2+ disease." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19069-e19069. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19069.

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e19069 Background: Hispanics have 20% lower incidence of breast cancer than the general US population. Despite this, breast cancer is the leading neoplasm seen in Hispanics and is a significant cause of their mortality. Our study reports the incidence and outcome of HER2 breast cancer, use of a neoadjuvant regimen, and surgery type in the Hispanic population at our urban institution. Methods: This study reports on 37 women that were diagnosed with HER2+, non-metastatic breast cancer from 2015-2019. We report this as a single institution, community program that provides equal access healthcare and delivery. Our data was investigated and compiled using our facility’s cancer registry. The patient sample included 20(54%) Hispanics, 13(35%) African Americans, 3(8.0%) Caucasians and 1(3%) Asian. Of the 20 Hispanic women, 85% were Estrogen Receptor (ER) positive and 48% were Progesterone Receptor (PR) positive. Eleven (55%) of the 20 Hispanic patients(pts) received neoadjuvant chemotherapy (NAC), which included regimens containing Trastuzamab (H) with or without Pertuzumab(P). Our remaining 9 pts receiving adjuvant therapy were investigated for response as well. Results: Our Hispanic pts receiving NAC had an overall complete response rate of 45% and a partial response rate of 55%. There appeared to be no significant difference in response rate in Hispanic women between the HP group versus H. NAC pts had fewer partial mastectomies performed than those not receiving NAC. Hispanic NAC patients were found to have significantly more sentinel lymph node dissections (SLND) 7(88%) versus axillary lymph node dissections 1(16%) compared to other ethnicities receiving NAC. Non NAC Hispanic patients had 56% sentinel lymph node dissections, compared to 44% complete axillary dissections. Conclusions: The results indicate that there is a significant Hispanic population at our facility that harbor the HER2 oncogene. These pts seem to have a promising response to the NAC regimen in regards to SLND. We hope to have a larger patient sample through a multi-institution study, with statistical analysis to support our current findings. More studies should be performed on Hispanic women with HER2 disease, as data with this subset of population is lacking. The NAC regimen should be greatly considered and implemented in the treatment in those looking to downstage axillary disease. We hope to further investigate treatment options for Hispanic pts to gain greater pathological responses, leading to improved progression free and disease free survival that match that of other ethnic groups.

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Guzman, Alberto. "Learning about Assistive Technology: Hispanics and a National Sample." Assistive Technology 20, no. 1 (March 31, 2008): 48–54. http://dx.doi.org/10.1080/10400435.2008.10131931.

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Tariq, Muhammad Junaid, Muhammad Usman Almani, Syed Ali Amir Sherazi, Muhammad Usman, Abdul Wahab Arif, Barbara Yim, and Shweta Gupta. "Anxiety due to COVID-19 and impact on patients receiving chemotherapy in an inner-city minority population." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 108. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.108.

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108 Background: Cook County Health (CCH) is one of the largest public safety net hospitals in the United States. COVID-19 pandemic significantly affected patient care. Although hospitals took measures to keep patients safe, there is a general level of anxiety in patients about coming to the hospital. This study was undertaken to see the impact of COVID-19 and anxiety in patients actively receiving infusional therapy at our institution. Methods: All patients coming to our Infusion Center were offered an anonymous written questionnaire. The survey was given for 10 calendar days in June 2020 after Chicago moved into Phase-3 of re-opening that indicated significant control of COVID-19. The survey was offered in English, Spanish and Polish. It also included the GAD scale for anxiety assessment. Statistics were done using the t-test and z-test. Results: A total of 107 patients completed the survey. About 55% were women with 67% patients over 50 years old. Of the 90 people that specified their race, 44% were black and 42% were Hispanic, 9% whites, and 5% others. Overall 68% had high school or less level of education with Hispanics having significantly lower education than blacks. About 30% had testing for COVID-19 with 81% being negative. Treatment interruption occurred in 39% patients. Despite 75% finding our infusion center extremely or very safe for treatments 28% still felt moderately or severely anxious on the GAD scale. Blacks had similar levels of anxiety compared to Hispanics in March 2020 but no significant change over the months compared to Hispanics who had a significant reduction in anxiety over time. Blacks also had significantly higher rates of moderate to severe anxiety on the GAD scale (33%), while no Hispanic had severe anxiety and 18% had moderate anxiety. Despite a higher level of anxiety, blacks were less likely to have treatment interruptions compared to Hispanics (Table). Conclusions: Despite low levels of anxiety, Hispanics were more likely to have treatment interruptions during the COVID pandemic compared to blacks who had a higher level of anxiety but lower levels of treatment interruptions. The cause of this may be the level of education and awareness between the groups. However, overall there is still a significant amount of anxiety in the inner-city minority population regarding COVID-19. [Table: see text]

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Moore, Kevin J., Angela Richardson, Tulay Koru-Sengul, and Michael E. Ivan. "164 Hispanic Ethnicity and Socioeconomic Status are Independently Associated with Improved Prognosis in Glioblastoma Patients." Neurosurgery 64, CN_suppl_1 (August 24, 2017): 241. http://dx.doi.org/10.1093/neuros/nyx417.164.

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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.

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Ortiz, Victor R., Carmen A. Padro, Juan Lopez-Taylor, Juan L. Martinez, Jose A. Martin, Claude Bouchard, and Miguel A. Rivera. "Kcnj11 Gene Polymorphism And Endurance Performance Status In Hispanics." Medicine & Science in Sports & Exercise 37, Supplement (May 2005): S165. http://dx.doi.org/10.1249/00005768-200505001-00874.

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Ortiz, Victor R., Carmen A. Padro, Juan Lopez-Taylor, Juan L. Martinez, Jose A. Martin, Claude Bouchard, and Miguel A. Rivera. "Kcnj11 Gene Polymorphism And Endurance Performance Status In Hispanics." Medicine & Science in Sports & Exercise 37, Supplement (May 2005): S165. http://dx.doi.org/10.1097/00005768-200505001-00874.

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Gershon, Richard C., Rina S. Fox, Jennifer J. Manly, Dan M. Mungas, Cindy J. Nowinski, Ellen M. Roney, and Jerry Slotkin. "The NIH Toolbox: Overview of Development for Use with Hispanic Populations." Journal of the International Neuropsychological Society 26, no. 6 (February 17, 2020): 567–75. http://dx.doi.org/10.1017/s1355617720000028.

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AbstractObjective:Hispanics/Latinos are the largest and fastest-growing minority population in the United States. To facilitate appropriate outcome assessment of this expanding population, the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIH Toolbox®) was developed with particular attention paid to the cultural and linguistic needs of English- and Spanish-speaking Hispanics/Latinos.Methods:A Cultural Working Group ensured that all included measures were appropriate for use with Hispanics/Latinos in both English and Spanish. In addition, a Spanish Language Working Group assessed all English-language NIH Toolbox measures for translatability.Results:Measures were translated following the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology for instances where language interpretation could impact scores, or a modified version thereof for more simplified translations. The Spanish versions of the NIH Toolbox Cognition Battery language measures (i.e., Picture Vocabulary Test, Oral Reading Recognition Test) were developed independently of their English counterparts.Conclusions:The Spanish-language version of the NIH Toolbox provides a much-needed set of tools that can be selected as appropriate to complement existing protocols being conducted with the growing Hispanic/Latino population in the United States.

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Laffer, Cheryl L., and Fernando Elijovich. "Essential Hypertension of Caribbean Hispanics: Sodium, Renin, and Response to Therapy." Journal of Clinical Hypertension 4, no. 4 (July 2002): 266–73. http://dx.doi.org/10.1111/j.1524-6175.2002.00973.x.

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Vyas, Ojas Harihar, Marcela Mazo- Canola, Juan Francisco Garza, Ruchi Hamal, Lashandra Royster, Ellen Johnson, Leyla Bohanini, and Virginia G. Kaklamani. "Toxicity disparities between Hispanics and non-Hispanics enrolled in clinical trials in south Texas." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18089-e18089. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18089.

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e18089 Background: The U.S. Hispanic (H) population is estimated to increase from 55 million in 2014 to 119 million in 2060, growing from 17% to 29% of the total population. H are underrepresented in cancer trials. A review of practice-changing oncology trials showed only 3.9% of included patients were H. Disparities have been identified in time to diagnosis, treatment and outcomes in H patients, including those on clinical trials, despite uniform stage, treatment, and follow-up. Given our institution’s history of strong H accrual, we aimed to look at the rate of enrollment and toxicity in our early phase cancer trials of H compared with non-Hispanic whites (NHW). Methods: We retrospectively reviewed charts of patients enrolled in Phase I trials at UTHSCSA to assess rates of selected toxicities, death, hospitalizations and reasons for withdrawal from phase 1 trials. The following toxicities were recorded: anemia, neutropenia, neuropathy, nausea, vomiting, and fatigue. All H patients were compared to randomly selected statistical controls. Patients who were on multiple trials were excluded. Results: Of the 520 patients reviewed, 376 (72.3%) self-identified as H, 123(23.7%) as NHW, and 448 (86.2%) of patients had a solid tumor diagnosis. H and NHW with solid tumors are compared in the Table. They were similarly matched for sex, but H were noted to be older and more likely to receive cytotoxic therapy. Rates of patients experiencing any grade 3/4 toxicity or hospitalization were similar as shown. H were more likely to withdraw from trial due to disease progression. Conclusions: This retrospective analysis shows H patients did not experience significantly more toxicities in early phase clinical trials at an academic center in a minority-majority community. Prospective data collection is needed to provide more detailed information in the disparities that exist in toxicity and outcomes in H compared with NHW in cancer trials. [Table: see text]

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Nahleh, Zeina A., Brian Hobbs, Elizabeth Elimimian, Wei (Auston) Wei, Annie Gupta, and Cassann N. Blake. "Patterns of systemic treatment utilization in ER+/PgR+/HER2+, early-stage breast cancer (BC): An analysis of the National Cancer Database." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 547. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.547.

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547 Background: The preferences and trends of treatment utilization of adjuvant endocrine therapy (ET) versus chemotherapy (CH) for small node-negative triple positive (TP) BC are unclear. We sought to determine these preferences and assess the impact on outcome. Methods: This is a retrospective study from the National Cancer Database including patients with TP stage I BC, 2004-2015. Treatment selection was evaluated for association with patient clinical and demographic characteristics using logistic regression. Overall survival (OS) was estimated using the Kaplan-Meier method and compared among patient and treatment cohorts by log-rank test and Cox regression. Results: Of 37,777 patients analyzed, 79% were White (Non-Hispanics), 10% African Americans, and 5% Hispanic/Latinos. 57% were 50-70 years old. 86% received adjuvant endocrine therapy versus 14% CH first. Around 40 % of all patients received anti-Her2 therapy. Patients younger than 70 years, with male BC, diagnosed with poorly differentiated BC, African Americans and Hispanics were more likely to be treated with chemotherapy. OS rate at 5-year was 92.3% (95% CI: 0.918-0.928). In multivariate analysis for patients with survival data, an increased rate of death was associated with: treatment in community versus academic/research centers, CH first versus ET, no treatment with anti-Her2 therapy, government versus private /no insurance, Native American ethnicity. A slight but statistically significant reduction in the in the risk of death at 5 years was evident for patients receiving anti-Her2 therapy plus ET therapy, 5-year OS 93.5% (CI: 89.2-98%), when compared to patients receiving anti-Her2 therapy plus CH 92.7 % (CI: 89.4-96). Conclusions: This study provides real world data of common practices in the US . The majority of patients with node negative Stage I, ER+/PR+/Her2+ BC received adjuvant ET and anti-Her2 therapy, not chemotherapy. These patients had a similar to slightly improved 5 year- survival when compared to anti-Her2 therapy plus CH, supporting the use ET plus anti-Her2 therapy in this setting. Future studies should focus on better selecting patients with hormone receptor positive and Her 2 + early stage BC who would benefit from adjuvant CH. Disparity in outcome also warrants further evaluation. [Table: see text]

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Carmona, E. T., S. M. Nouraie, J. P. Bakker, C. J. Stitt, M. S. Aloia, and S. R. Patel. "0357 CPAP Adherence is Lower in Minority Neighborhoods." Sleep 43, Supplement_1 (April 2020): A136. http://dx.doi.org/10.1093/sleep/zsaa056.354.

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Abstract Introduction The effectiveness of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) is limited by adherence. Small, single-center studies have reported CPAP adherence is lower in racial minorities suggesting disparities in OSA care. We used nationally representative data to assess racial differences in CPAP adherence at a neighborhood level. Methods Telemonitoring data were obtained from a therapy database maintained by a CPAP manufacturer. Usage over the first 90 days in patients initiated on CPAP between 11/01/2015 and 10/31/2018 who had at least one usage session, age 18-90 years, and valid U.S. zip code were mapped to a zip code tabulation area (ZCTA). Age- and sex-adjusted CPAP usage was calculated for each ZCTA with greater than 10 CPAP users. Ecologic analyses were performed to model the association of the proportion of blacks and Hispanics in each ZCTA (obtained from the 2013-2017 American Community Survey) on CPAP usage controlling for proportion of adults with bachelor’s degree and proportion of adults with household income below the poverty line. Results Our analysis included 13,118 ZCTAs averaging data over 737,274 patients. In adjusted analyses, each 10% increase in the proportion of blacks and Hispanics was associated with a 0.12 (95% CI 0.11-0.12) hour and 0.14 (95% CI 0.14-0.15) hour decrease in nightly CPAP use, respectively. Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% blacks were 4.96, 4.81, 4.67, 4.56, and 4.14 hours respectively (p<0.001). Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% Hispanics were 4.87, 4.86, 4.75, 4.50, and 4.10 hours respectively (p<0.001). Conclusion CPAP adherence is lower in neighborhoods with higher proportions of black and Hispanic residents independent of differences in education or poverty. These differences lead to lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities. Support Philips Respironics, NIH R25HL130600 and K24HL127307.

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Alattar, M., K. Hahn, and C. J. Wray. "Stage at presentation for medically underserved gastric cancer patients." Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 26. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.26.

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26 Background: Survival disparities in the United States exist for nearly all malignancies. The relationship between stage at presentation and outcome is not well understood. Our hypothesis is that medically un- and underinsured gastric cancer (GC) patients present at advanced stage leading to worse outcomes. Methods: Institutional review board approved review of the departmental gastrointestinal cancer database from 04/08/2000 to 11/18/2008. All patients diagnosed with gastric adenocarcinoma were included; clinicopathologic, treatment and outcome data was recorded. Statistical analysis was performed using STATA 10. Results: A total of 185 patients (108 male, 77 female) were included in this study. Mean age at diagnosis for all patients was 55.3 yrs. The mean age at diagnosis was lower for Hispanics (52.4 years) when compared to other races (ANOVA p = 0.00). The majority of Hispanic patients presented with stage IV disease (55%, chi square p = 0.01). The age range and minimum age at diagnosis was different for Hispanics. Median survival for the entire cohort was 12.3 mo. Although not significant (log rank p = NS), median survival was lowest for African Americans (AA) and Asians. Cox proportional hazards model demonstrated surgical resection and adjuvant therapy (chemoradiation) to be independent predictors of survival. Conclusions: Hispanic patients in medically un- and underinsured populations showed significantly younger age at presentation and more advanced stage of GC. However, median survival for Hispanic GC patients was not significantly shortened compared to other races in this cohort. Survival for AA and Asian patients in a public safety net hospital remains poor and investigation into factors contributing to such disparities is ongoing. [Table: see text] No significant financial relationships to disclose.

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Kurian, Allison W., Elisha Hughes, Ryan Bernhisel, Braden Probst, Jerry Lanchbury, Susanne Wagner, Alexander Gutin, et al. "Performance of the IBIS/Tyrer-Cuzick (TC) Model by race/ethnicity in the Women’s Health Initiative." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 1503. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.1503.

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1503 Background: The TC model, a breast cancer (BC) risk assessment tool based on family cancer history, reproductive and lifestyle factors is used to guide BC screening and prevention. TC was developed and validated largely in non-Hispanic White (NHW) women. We evaluated the calibration and discrimination of TC version 7.02 among racially/ethnically diverse post-menopausal women enrolled in the Women’s Health Initiative (WHI) clinical trials or observational study. Methods: WHI enrolled post-menopausal women from 1993-1998 and followed them prospectively for BC incidence. We included women aged ≤80 years at enrollment with no prior BC or mastectomy and with data required for TC, including weight, height, ages at menarche, first birth and menopause, menopausal hormone therapy use and family history of breast or ovarian cancer in first or second-degree relatives. Calibration was assessed by the ratio of observed BC cases to the number expected by TC (O/E), with expected cases calculated as the sum of cumulative hazards. We tested for differential discrimination by race/ethnicity (NHW, African American, Hispanic, Asian/Pacific Islander, Native American, other) using Cox regression. Time to BC was modeled using age, race/ethnicity, TC estimate (transformed by log of relative lifetime risk), and a term for interaction between race/ethnicity and TC estimate. Results: During the follow-up period (median 18.9 years, maximum 23.4 years), 6,836 new BC cases were diagnosed among 91,893 women. TC was well-calibrated overall (O/E 0.95) in NHW and African Americans, but over-estimated risk for Hispanics (O/E 0.75, Table). Results suggested good calibration for Asian/Pacific Islanders and Native Americans, but sample sizes were small. Discrimination did not differ significantly by race/ethnicity (two-sided p-value for interaction = 0.33). Conclusions: TC provided similar risk discrimination among post-menopausal women of different racial/ethnic groups over nearly 20 years of follow-up; however, it overestimated risk for Hispanics. Future studies in diverse populations are warranted, with need for a more accurate breast cancer risk assessment tool for Hispanics. [Table: see text]

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Yu, Stanley, Jeffrey Douglass, Clifford Qualls, Sanjeev Arora, and Jeffrey C. Dunkelberg. "S1003 Response to Therapy with Pegylated Interferon and Ribavirin in Hispanics with Hepatitis C Compared to Non-Hispanic Whites." Gastroenterology 134, no. 4 (April 2008): A—772—A—773. http://dx.doi.org/10.1016/s0016-5085(08)63608-2.

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Yu, Stanley, Jeffrey M. Douglass, Clifford Qualls, Sanjeev Arora, and Jeffrey C. Dunkelberg. "Response to Therapy With Pegylated Interferon and Ribavirin for Chronic Hepatitis C in Hispanics Compared to Non-Hispanic Whites." American Journal of Gastroenterology 104, no. 7 (May 12, 2009): 1686–92. http://dx.doi.org/10.1038/ajg.2009.173.

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Kruse-Jarres, Rebecca, Nick M. Pajewski, and Cindy A. Leissinger. "The Role of Race and Ethnicity in the Clinical Outcomes of Severe Hemophilia A Patients with Inhibitors." Blood 110, no. 11 (November 16, 2007): 1163. http://dx.doi.org/10.1182/blood.v110.11.1163.1163.

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Abstract Background: Repeatedly, it has been observed that inhibitors to factor VIII are more frequent in African American (AA) and Hispanic (H) patients with severe congenital hemophilia A than in Caucasian (C) patients. Large retrospective reviews have shown that the mortality rates between African American and Caucasian patients with hemophilia have been similar, although non-whites had significantly more bleeding complications, need for hospitalizations and joint limitations. One possible explanation suggested that whites were more likely to receive aggressive treatment strategies such as home infusion. In none of the above reviews were patients stratified by inhibitor status. Few non-white patients have been included in large studies of inhibitor development and natural history. The purpose of this study was to evaluate the impact of race and ethnicity on the clinical characteristics and outcomes of inhibitors in patients with severe hemophilia A. Methods: This is a retrospective review of the repository database of the Hemophilia and Thrombosis Research Society (HTRS). Due to skewed distributions, non-parametric Kruskal-Wallis tests were used to test for racial differences. Results: The HTRS database captured data from 658 hemophilia patients since January 2000. Within the HTRS registry, there were 562 patients with severe hemophilia A: 68.1% (n=383) Caucasian, 21.0% (n=118) African American, and 10.9% (n=61) Hispanic. In comparison to Caucasians, Hispanics had a higher age at hemophilia diagnosis (p-value <0.01), while there was not a significant difference with African-Americans (p-value =0.53). Amongst those subjects with a prior history of inhibitors, African-Americans and Hispanics had a higher family history of inhibitor development: 13.7% of C, 26.3% of AA (pwhite = 0.02), and 41.2% of H (pwhite = <0.01). In patients with a history of inhibitors, Caucasians reported the lowest prevalence of a history of Intracranial Hemorrhage (ICH): 15.8% of C, 29.8% of AA (pwhite = 0.03), and 20.6% of H (pwhite = 0.52). African-Americans reported the lowest rate of receiving ITT (64.9%), followed 76.5% in Hispanics and 84.9% in Caucasians. African-Americans also had the lowest success rate of ITT, 30.4% as compared to 35.3% in Hispanics and 60.3% in Caucasians. In comparison to African-Americans, Caucasians did not have a significantly higher rate of unrestricted function (p=0.13), while the rate was significantly higher in Hispanics (p=0.02). Conclusion: While the HTRS database did not assess overall bleeding complications, it did show a significantly higher incidence of ICH in African-Americans versus Caucasian inhibitor patients, which could not be confirmed in non-inhibitor patients. It also appears, that fewer African-Americans and Hispanics are receiving immune tolerance therapy and that they have a lower success rate than Caucasians. However, there were insufficient patients studied to reach statistically significant conclusions. Hispanics did report significantly higher level of function. However, the HTRS survey does not use a very intricate, detailed tool to assess function. The above data proposes further investigation of bleeding risk across race/ethnicity in inhibitor vs. non-inhibitor populations. It also prompts us to look at larger databases to assess use and outcome of immune tolerance across races. Thirdly, it poses the question, whether there is a racial/ethnic difference in functional status and whether there could be variation in severity and outcome of bleeds.

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Lasser, Karen E., David U. Himmelstein, Steffie J. Woolhandler, Danny McCormick, and David H. Bor. "Do Minorities in the United States Receive Fewer Mental Health Services Than Whites?" International Journal of Health Services 32, no. 3 (July 2002): 567–78. http://dx.doi.org/10.2190/uexw-rarl-u46v-fu4p.

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Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The authors calculated visit rates per 1,000 population to either primary care or psychiatric providers for mental health counseling, psychotherapy, and psychiatric drug therapy. In the primary care setting, Hispanics and blacks had lower visit rates (per 1,000 population) for drug therapy than whites (48.3 and 73.7 vs. 109.0; P < .0001 and P < .01, respectively). Blacks also had a lower visit rate for talk therapy (mental health counseling or psychotherapy) than whites (23.6 vs. 42.5; P < .01). In the psychiatric setting, Hispanics and blacks had lower visit rates than whites for talk therapy (38.4 and 33.6 vs. 85.1; P < .0001 for both comparisons) and drug therapy (38.3 and 29.1 vs. 71.8; P < .0001 for both comparisons). These results indicate that minorities receive about half as much outpatient mental health care as whites.

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Colon, Elsa Orellano. "Gender Differences in the Adoption and Use of Assistive Technology (AT) Among Hispanics." American Journal of Occupational Therapy 73, no. 4_Supplement_1 (August 1, 2019): 7311505192p1. http://dx.doi.org/10.5014/ajot.2019.73s1-po7032.

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Bhatia, Smita, Wendy Landier, Muyun Shangguan, Lindsey Hageman, Wendy Leisenring, Nancy Kornegay, Mary V. Relling, and F. Lennie Wong. "Non-Adherence to Oral 6-Mercaptopurine (6MP) Explains Ethnic Differences In Disease-Free Survival In Children with Acute Lymphoblastic Leukemia (ALL) – a Children's Oncology Group (COG) Study (AALL03N1)." Blood 116, no. 21 (November 19, 2010): 7. http://dx.doi.org/10.1182/blood.v116.21.7.7.

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Abstract Abstract 7 Background: Hispanic children with ALL have a significantly inferior outcome compared with non-Hispanic whites (Blood, 2002). Low systemic exposure to 6MP adversely affects prognosis (N Engl J Med 1990), and red cell (RBC) levels of its metabolite (thioguanine nucleotide [TGN]) correlate with survival (Blood, 1999). Significant inter-patient variability in RBC TGN levels exists due either to inherited difference in thiopurine methyltransferase (TPMT) activity, or failure to adhere to prescribed 6MP. Non-adherence to 6MP has been reported, and could be related to differences in cultural beliefs, possibly accounting for ethnic differences in ALL survival. Methods: We tested this hypothesis in Hispanic and non-Hispanic white children with ALL diagnosed at age ≤21 yrs, and receiving maintenance therapy at 78 participating COG institutions. 6MP adherence was measured over 6 months using Medication Event Management System (MEMS) and RBC TGN. Electronic MEMS cap collected real-time data on dates/ times when the 6MP bottle was opened. Whether the bottle opening was followed by ingestion of 6MP was assessed by monthly (6 assessments/ patient) measurement of TGN. TPMT activity was also measured. Self-reported sociodemographics and reasons for non-adherence were also collected. MEMS-based adherence (outcome of interest) was defined as the ratio of days that 6MP bottle was opened to days 6MP doses were prescribed, reported as a percentage: “% adherence”. All prescribed doses were reviewed for each patient, and the period of time when 6MP was withheld by the prescriber due to toxicity/ illness taken into account. Longitudinal analysis was performed using Generalized Estimating Equations. Results: 333 patients (173 Hispanics; 160 non-Hispanic whites) contributed 54,193 person-days of observation for 6MP adherence. Median age at study participation was 6 yrs (2-20); 67% were males; 38% presented with high-risk disease per NCI criteria. While age, sex and disease characteristics did not differ by ethnicity, Hispanics were significantly more likely to report indices of lower SES (Table). Mean % adherence over the 6 month study period was significantly lower among Hispanics (86±20%) compared with non-Hispanic whites (93±9%, p<0.0001). Multivariate longitudinal analysis identified the following at risk for lower adherence: Hispanic ethnicity (p<0.0001, Fig A); age ≥12 yrs at study entry (p=0.004, Fig B); single mothers as caregivers (p=0.003, Fig C); and time on study (p<0.0001). Reasons for missing 6MP doses included forgetfulness (55%), disruption of usual routine (22%), logistical barriers (15%), and side effects (5%). With a median follow-up of 4.5 yrs, disease-free survival (DFS) was significantly inferior for Hispanics (81±5% at 6 yrs) compared with non-Hispanic whites (94±2%, p=0.01, Fig D). After adjusting for sex, NCI risk, TPMT activity, and 6MP dose-intensity, each 1% decrease in adherence was associated with a 3% increase in risk of relapse (p=0.01). Most importantly, in the multivariate model without adherence, Hispanic ethnicity was associated with a significantly increased risk of relapse (HR=3.2, p=0.01); however upon inclusion of adherence in the model (p=0.01), the association between ethnicity and recurrence diminished in magnitude and significance (HR=2.1, p=0.18). A cutpoint in adherence at 85% was accompanied by a statistical separation in DFS (DFS: 92±2.2% vs. 77.0±5.1%, p<0.0001, Fig E), as well as a large separation in TGN levels (198 vs. 174, p=0.07), making 85% a clinically relevant level of adherence. Conclusion: Non-adherence to 6MP is prevalent in children with ALL. Hispanic children are more likely to be non-adherent, even after adjusting for sociodemographic variables. Non-adherence is associated with significantly inferior DFS. Non-adherence explains the ethnic differences in DFS. This study has informed a targeted intervention to reduce non-adherence to oral chemotherapy, with the goal to reduce disparities in ALL outcome. Disclosures: Relling: St. Jude Children's Research Hospital: Employment, Patents & Royalties; Enzon Pharmaceuticals: Research Funding.

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Mora, Pablo F., Jason Chao, Aramesh Saremi, Terry A. Dex, Michelle Roberts, and Guillermo E. Umpierrez. "EFFICACY AND SAFETY OF IGLARLIXI IN HISPANICS AND NON-HISPANIC WHITES WITH TYPE 2 DIABETES." Endocrine Practice 25, no. 11 (November 2019): 1091–100. http://dx.doi.org/10.4158/ep-2018-0615.

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Objective: Type 2 diabetes (T2D) is more common in Hispanic than non-Hispanic white (NHW) populations worldwide, and ethnicity, among other factors, may affect response to therapy. The efficacy and safety of insulin glargine 100 units/mL (iGlar) and the fixed-ratio combination of iGlar and the glucagon-like peptide 1 receptor agonist lixisenatide (iGlarLixi) was assessed in Hispanic and NHW patients with T2D from 25 countries. Methods: In this post hoc analysis, data from two 30-week randomized controlled trials comparing iGlar and iGlarLixi in patients with T2D uncontrolled on basal insulin ± oral antidiabetes drugs (OADs; LixiLan-L: NCT02058160) or uncontrolled on metformin ± OADs (LixiLan-O: NCT02058147) were evaluated. Results: Of the 1,512 patients included across trials, 301 were Hispanic and 1,211 NHW. Compared with iGlar, iGlarLixi resulted in greater reductions in glycated hemoglobin (A1C) and 2-hour postprandial glucose and a higher proportion of patients at target A1C <7.0% (<53 mmol/mol), regardless of ethnicity. Among NHWs from the LixiLan-L trial, documented symptomatic hypoglycemia (plasma glucose ≤70 mg/dL) rates were higher with iGlar compared with iGlarLixi ( P = .06), whereas this trend was reversed among Hispanics ( P = .07). Nevertheless, in both trials, a greater proportion of patients taking iGlarLixi than iGlar reached the composite efficacy endpoints of target A1C without hypoglycemia and target A1C without weight gain, regardless of ethnicity. Conclusion: These results indicate that iGlarLixi is a viable therapeutic option for both Hispanic and NHW patients with T2D, as it is efficacious without a significant increase in hypoglycemia, irrespective of ethnicity. Abbreviations: A1C = glycated hemoglobin; BMI = body mass index; FPG = fasting plasma glucose; FRC = fixed-ratio combination; GLP-1 RA = glucagon-like peptide 1 receptor agonist; HDL-C = high-density-lipoprotein cholesterol; iGlar = insulin glargine; iGlarLixi = insulin glargine + lixisenatide; LDL-C = low-density-lipoprotein cholesterol; NHW = non-Hispanic white; OAD = oral antidiabetes drug; PPG = postprandial glucose; T2D = type 2 diabetes

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Hernandez-Suarez, Dagmar F., Kyle Melin, Frances Marin-Maldonado, Hector J. Nunez, Ariel F. Gonzalez, Lorena Gonzalez-Sepulveda, Sona Rivas-Tumanyan, et al. "Implementing a pharmacogenetic-driven algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics: protocol for a non-randomised clinical trial." BMJ Open 10, no. 8 (August 2020): e038936. http://dx.doi.org/10.1136/bmjopen-2020-038936.

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IntroductionMinority populations in the USA are disproportionately affected by cardiovascular conditions. Reduced responsiveness to clopidogrel among carriers of CYP2C19 variants has been reported in patients with either coronary artery disease (CAD) or acute coronary syndrome (ACS) after the percutaneous coronary intervention (PCI). Previous studies have evaluated CYP2C19 genotyping-guided antiplatelet therapy in selected populations; however, this has yet to be tested among Hispanics. Given the paucity of clinical research on CYP2C19 and antiplatelet clinical outcomes in Hispanics, our study will test the safety and efficacy of a genetic-driven treatment algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics.Methods and analysisThis is a multicentre, prospective, non-randomised clinical trial that proposes an assessment of pharmacogenomic-guided DAPT in post-PCI Caribbean Hispanic patients with ACS or CAD. We will recruit 250 patients to be compared with a matched non-concurrent cohort of 250 clopidogrel-treated patients (standard-of-care). Major adverse cardiovascular events (MACEs) such as all-cause death, myocardial infarction (MI), stroke, coronary revascularisation, stent thrombosis and bleedings over 6 months will be the study endpoints. Among the recruited, high-risk patients will be escalated to ticagrelor and low-risk patients will remain on clopidogrel. The primary objective is to determine whether genetic-guided therapy is superior to standard of care. The secondary objective will determine if clopidogrel treatment in low-risk patients is not associated with a higher rate of MACEs compared with escalated antiplatelet therapy in high-risk patients. Patients will be enrolled up to the group’s completion.Ethics and disseminationApproval was obtained from the Institutional Review Board of the University of Puerto Rico Medical Sciences Campus (protocol # A4070417). The study will be carried out in compliance with the Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice Guidelines. Findings will be published in a peer-reviewed journal and controlled access to experimental data will be available.Trial registration numberNCT03419325; Pre-results.

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Journal articles on the topic 'Therapy with Hispanics'

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