Up-to-Date Colonoscopy Use in Asian and Hispanic Subgroups in New York City, 2003-2016.

BACKGROUND: Colorectal cancer screening uptake in the United States overall has increased, but racial/ethnic disparities persist and data on colonoscopy uptake by racial/ethnic subgroups are lacking. We sought to better characterize these trends and to identify predictors of colonoscopy uptake, particularly among Asian and Hispanic subgroups. STUDY: We used data from the New York City Community Health Survey to generate estimates of up-to-date colonoscopy use in Asian and Hispanic subgroups across 6 time periods spanning 2003-2016. For each subgroup, we calculated the percent change in colonoscopy uptake over the study period and the difference in uptake compared to non-Hispanic Whites in 2015-2016. We also used multivariable logistic regression to identify predictors of colonoscopy uptake. RESULTS: All racial and ethnic subgroups with reliable estimates saw a net increase in colonoscopy uptake between 2003 and 2016. In 2015-2016, compared with non-Hispanic Whites, Puerto Ricans, Dominicans, and Central/South Americans had higher colonoscopy uptake, whereas Chinese, Asian Indians, and Mexicans had lower uptake. On multivariable analysis, age, marital status, insurance status, primary care provider, receipt of flu vaccine, frequency of exercise, and smoking status were the most consistent predictors of colonoscopy uptake (≥4 time periods). CONCLUSIONS: We found significant variation in colonoscopy uptake among Asian and Hispanic subgroups. We also identified numerous demographic, socioeconomic, and health-related predictors of colonoscopy uptake. These findings highlight the importance of examining health disparities through the lens of disaggregated racial/ethnic subgroups and have the potential to inform future public health interventions.

Diversity protects: The role of school and classroom racial/ethnic diversity on the experience of peer victimization during the middle school years.

The effects of school and classroom racial/ethnic diversity on peer victimization, self-blame, and perceived school safety were examined in a racially/ethnically diverse sample of students followed over the three years of middle school. Sixth grade students (N = 5,991, 52% female; M = 11.63 years) were recruited from 26 urban middle schools that systematically varied in racial/ethnic diversity. Based on student self-report, the sample was 31.6% Latino/Mexican, 19.6% White, 17.4%, Multiethnic/Biracial, 13% East/Southeast Asian, 10.9% Black, and 6.9% Other very small racial/ethnic groups. Each school had a structural diversity score based on the number and size of racial/ethnic groups enrolled. Using a novel method based on course schedules and class rosters, each student's individual exposure to diversity in their classes was assessed to capture dynamic diversity. Latent growth modeling showed that structural school diversity and dynamic classroom diversity were both related to less victimization at the start of middle school and a decrease over time. Dynamic classroom diversity buffered the associations between victimization and self-blame and between victimization and perceiving school as unsafe. Dynamic classroom diversity was more protective than structural school diversity. Implications for practice, intervention and policies to promote school racial/ethnic diversity were discussed.

Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US.

Importance: With the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response to NACT by race and ethnicity and the potential long-term outcomes. Objective: To examine whether there were any racial and ethnic differences in pathologic complete response (pCR) rate following NACT and, if so, whether they varied by molecular subtype and were associated with survival. Design, Setting, and Participants: A retrospective cohort study was conducted including patients with stage I to III breast cancer diagnosed between January 2010 and December 2017 who underwent surgery and received NACT; median follow-up was 5.8 years, and data analysis was conducted from August 2021 to January 2023. Data were obtained from the National Cancer Data Base, a nationwide, facility-based, oncology data set that captures approximately 70% of all newly diagnosed cases of breast cancer in the US. Main Outcomes and Measures: Pathologic complete response, defined as ypT0/Tis ypN0, was modeled using logistic regression. Racial and ethnic differences in survival were analyzed using a Weibull accelerated failure time model. Mediation analysis was conducted to measure whether racial and ethnic differences in the pCR rate affect survival. Results: The study included 107 207 patients (106 587 [99.4%] women), with a mean (SD) age of 53.4 (12.1) years. A total of 5009 patients were Asian or Pacific Islander, 18 417 were non-Hispanic Black, 9724 were Hispanic, and 74 057 were non-Hispanic White. There were significant racial and ethnic differences in pCR rates, but the differences were subtype-specific. In hormone receptor-negative (HR-)/erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-positive (ERBB2+) subtype, Asian and Pacific Islander patients achieved the highest pCR rate (56.8%), followed by Hispanic (55.2%) and non-Hispanic White (52.3%) patients with the lowest pCR rate seen in Black patients (44.8%). In triple-negative breast cancer, Black patients had a lower pCR rate (27.3%) than other racial and ethnic groups (all >30%). In HR+/ERBB2- subtype, Black patients had a higher pCR rate (11.3%) than other racial/ethnic groups (all ≤10%). In mediation analysis, racial and ethnic differences in achieving pCR after NACT could explain approximately 20% to 53% of the subtype-specific survival differences across racial and ethnic groups. Conclusions and Relevance: In this cohort study of patients with breast cancer receiving NACT, Black patients had a lower pCR rate for triple-negative and HR-/ERBB2+ breast cancer but a higher pCR rate for HR+/ERBB2- diseases, whereas Asian and Pacific Islander patients had a higher pCR rate for HR-/ERBB2+ diseases. Tumor grade and ERBB2 copy number could account for some of these within-subtype disparities, but further studies are warranted. Inability to achieve a pCR can mediate in part, but not entirely, the worse survival outcomes experienced by Black patients.

Racial/ethnic disparities in costs, length of stay, and severity of severe maternal morbidity.

BACKGROUND: In contrast to other high-resource countries, the United States has experienced increases in the rates of severe maternal morbidity. In addition, the United States has pronounced racial and ethnic disparities in severe maternal morbidity, especially for non-Hispanic Black people, who have twice the rate as non-Hispanic White people. OBJECTIVE: This study aimed to examine whether the racial and ethnic disparities in severe maternal morbidity extended beyond the rates of these complications to include disparities in maternal costs and lengths of stay, which could indicate differences in the case severity. STUDY DESIGN: This study used California's linkage of birth certificates to inpatient maternal and infant discharge data for 2009 to 2011. Of the 1.5 million linked records, 250,000 were excluded because of incomplete data, for a final sample of 1,262,862. Cost-to-charge ratios were used to estimate costs from charges (including readmissions) after adjusting for inflation to December 2017. Mean diagnosis-related group-specific reimbursement was used to estimate physician payments. We used the Centers for Disease Control and Prevention definition of severe maternal morbidity, including readmissions up to 42 days after delivery. Adjusted Poisson regression models estimated the differential risk of severe maternal morbidity for each racial or ethnic group, compared with the non-Hispanic White group. Generalized linear models estimated the associations of race and ethnicity with costs and length of stay. RESULTS: Asian or Pacific Islander, Non-Hispanic Black, Hispanic, and other race or ethnicity patients all had higher rates of severe maternal morbidity than non-Hispanic White patients. The largest disparity was between non-Hispanic White and non-Hispanic Black patients, with unadjusted overall rates of severe maternal morbidity of 1.34% and 2.62%, respectively (adjusted risk ratio, 1.61; P<.001). Among patients with severe maternal morbidity, the adjusted regression estimates showed that non-Hispanic Black patients had 23% (P<.001) higher costs (marginal effect of $5023) and 24% (P<.001) longer hospital stays (marginal effect of 1.4 days) than non-Hispanic White patients. These effects changed when cases, such as cases where a blood transfusion was the only indication of severe maternal morbidity, were excluded, with 29% higher costs (P<.001) and 15% longer length of stay (P<.001). For other racial and ethnic groups, the increases in costs and length of stay were smaller than those observed for non-Hispanic Black patients, and many were not significantly different from non-Hispanic White patients. Hispanic patients had higher rates of severe maternal morbidity than non-Hispanic White patients; however, Hispanic patients had significantly lower costs and length of stay than non-Hispanic White patients. CONCLUSION: There were racial and ethnic differences in the costs and length of stay among patients with severe maternal morbidity across the groupings that we examined. The differences were especially large for non-Hispanic Black patients compared with non-Hispanic White patients. Non-Hispanic Black patients experienced twice the rate of severe maternal morbidity; in addition, the higher relative costs and longer lengths of stay for non-Hispanic Black patients with severe maternal morbidity support greater case severity in that population. These findings suggest that efforts to address racial and ethnic inequities in maternal health need to consider differences in case severity in addition to the differences in the rates of severe maternal morbidity and that these differences in case severity merit additional investigation.

Larysuicide: an online risk stratification system to identify patients at high risk of suicide after the laryngeal cancer diagnosis.

BACKGROUND: Patients with laryngeal cancer have more than five times the incidence of suicide compared with the general population. In this study, we aimed to develop an online risk stratification system, named Larysuicide, to identify patients at high risk of suicide after the laryngeal cancer diagnosis. METHODS: Forty-two thousand and sixty-six American patients from the SEER-18 database and 4207 Chinese patients from our center were included in this study. We randomly assigned American patients into the training set and validation set at a ratio of 7:3, and all Chinese patients remained as an independent external testing set. LASSO regression model was applied for data dimension reduction, feature selection, and Larysuicide building. The performance of model was evaluated and validated by C-index, AUC, calibration curves, decision curve analysis (DCA), and univariate regression analysis. RESULTS: The Larysuicide developed with seven selected features-age, race, cancer site, pathological subtype, grade, stage at presentation, and radiation. The model showed good discrimination, with a C-index of 0.745 (95% CI 0.723-0.767) in training set, 0.759 (95% CI 0.722-0.800) in validation set, and 0.749 (95% CI 0.730-0.769) in testing set. The AUC was 0.745 in training set, 0.759 in validation set, and 0.749 in testing set. The calibration curves showed good calibration. Decision curve analysis demonstrated that Larysuicide was clinically useful. The univariate regression analysis presented patients in the high-risk group identified by Larysuicide suffered a significantly higher risk of committing suicide after cancer diagnosis. CONCLUSION: We constructed an online risk stratification system which could help health-care professionals efficiently identify patients at high risk of suicide after the laryngeal cancer diagnosis. Larysuicide could be a useful tool for health-care professionals to implement an early and appropriate psychological intervention in context of precision medicine.

Information seeking behaviour differences indicate which US population groups lack information about human papilloma virus and associated cancer risks.

BACKGROUND: The majority of the US population have poor knowledge of cancers related to human papillomavirus (HPV). Identifying best sources for communicating this information can guide strategies to promote HPV vaccination. OBJECTIVES: To assess the relationship between sources of health information and individuals' knowledge of HPV-related cervical and oropharyngeal cancer. METHODS: This study conducts logistic regression on the most recent wave (2019) of the Health Information National Trends Survey. Dependent variables are indicators for self-reported awareness that HPV causes (a) cervical cancer and (b) oropharyngeal cancer. The primary indicator is a variable for different sources of health information: The Internet, professional sources, print materials, friends/family and never looked for health information. RESULTS: Being female, young, non-Hispanic White and having college education is associated with higher odds of knowing about HPV-related cervical cancer. Controlling for demographic factors, individuals using professionals and the Internet are more likely to know that HPV causes cervical cancer (aOR: 2.65, 95% CI: 1.66, 4.25; aOR: 2.47, 95% CI: 1.75, 3.50, respectively) compared to those who have never looked for health information. Similar results were found for HPV-related oropharyngeal cancer. CONCLUSION: Findings provide implications for targeted messaging through effective channels to improve HPV vaccination uptake.