Disproportionately higher cardiovascular disease risk and incidence with high fructose corn syrup sweetened beverage intake among black young adults-the CARDIA study.

BACKGROUND: The black/white heart disease mortality disparity began increasing in the early 1980's, coincident with the switch from sucrose to high-fructose-corn-syrup/(HFCS) in the US food supply. There has been more fructose in HFCS than generally-recognized-as-safe/GRAS, which has contributed to unprecedented excess-free-fructose/(unpaired-fructose) in foods/beverages. Average- per-capita excess-free-fructose, from HFCS, began exceeding dosages/(5-10 g) that trigger fructose-malabsorption in the early 1980's. Fructose malabsorption contributes to gut-dysbiosis and gut-in-situ-fructosylation of dietary peptides/incretins/(GLP-1/GIP) which forms atherosclerotic advanced-glycation-end-products. Both dysregulate gut endocrine function and are risk factors for cardiovascular disease/(CVD). Limited research shows that African Americans have higher fructose malabsorption prevalence than others. CVD risk begins early in life. METHODS: Coronary-Artery-Risk-Development-in-Adults/(CARDIA) study data beginning in 1985-86 with 2186 Black and 2277 White participants, aged 18-30 y, were used to test the hypothesis that HFCS sweetened beverage intake increases CVD risk/incidence, more among Black than White young adults, and at lower intakes; while orange juice-a low excess-free-fructose juice with comparable total sugars and total fructose, but a 1:1 fructose-to-glucose-ratio, i.e., low excess-free-fructose, does not. Cox proportional hazards models were used to calculate hazard ratios. RESULTS: HFCS sweetened beverage intake was associated with higher CVD risk (HR = 1.7) than smoking (HR = 1.6). CVD risk was higher at lower HFCS sweetened beverage intake among Black than White participants. Intake, as low as 3 times/wk, was associated with twice the CVD risk vs. less frequent/never, among Black participants only (HR 2.1, 95% CI 1.2-3.7; P = 0.013). Probability of an ordered relationship approached significance. Among Black participants, CVD incidence jumped 62% from 59.8/1000, among ≤ 2-times/wk, to 96.9/1000 among 3-6 times/wk consumers. Among White participants, CVD incidence increased from 37.6/1000, among ≤ 1.5-times/wk, to 41.1/1000, among 2 times/wk-once/d - a 9% increase. Hypertension was highest among Black daily HFCS sweetened beverage consumers. CONCLUSION: The ubiquitous presence of HFCS over-the-past-40 years, at higher fructose-to-glucose ratios than generally-recognized-as-safe, may have contributed to CVD racial disparities, due to higher fructose-malabsorption prevalence among Black individuals, unpaired/excess-free-fructose induced gut dysbiosis and gut fructosylation of dietary peptides/incretins (GLP-1/GIP). These disturbances contribute to atherosclerotic plaque; promote incretin insufficiency/dysregulation/altered satiety/dysglycemia; decrease protective microbiota metabolites; and increase hypertension, CVD morbidity and mortality.

Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.

Continuity of care is important for prostate cancer care due to multiple treatment options, and prolonged disease history. We examined the association between continuity of care and outcomes in Medicare beneficiaries with localized prostate cancer, and the moderating effect of race using Surveillance, Epidemiological, and End Results (SEER) - Medicare data between 2000 and 2016. Continuity of care was measured as visits dispersion (continuity of care index or COCI), and density (usual provider care index or UPCI) in acute survivorship phase. Outcomes were emergency room visits, hospitalizations, and cost during acute survivorship phase and mortality (all-cause and prostate cancer-specific) over follow-up phase. Higher continuity of care was associated with improved outcomes, and interaction between race and continuity of care was significant. Continuity of care during acute survivorship phase may lower the racial disparity in prostate cancer care. Future research can analyze the mechanism of the process.

Alterations in Hemoglobin and Serum 25-hydroxyvitamin D are Related Before and After Weight Loss Independent of African Admixture.

African American (AA) and European American (EA) women often exhibit differences in hemoglobin (Hb) and 25-hydroxyvitamin D [25(OH)D], both of which can be altered by calorie restriction leading to weight loss. Given these known differences, it is of clinical interest to examine the potential for race-specific, adverse responses to weight loss. Sixty-four overweight (BMI 27-29.9 kg/m2), premenopausal women consumed a standardized, very-low calorie diet to reduce BMI < 25 kg/m2. Ancestry informative markers provided estimates of African admixture, an objective mean of expressing race. Blood sampling and anthropometric measures were performed at baseline and upon meeting target BMI. At baseline, in the overweight state, Hb (g/dL) (AA, 11.7 ± 0.9 vs. EA, 12.5 ± 0.8; p < .01) and 25(OH)D (nmol/L) (AA, 35.7 ± 12.9 vs. EA, 57.0 ± 20.0; p < .01) were lower in AAs. After weight loss, Hb decreased (AA, -0.5 ± 0.7 vs. EA, -0.4 ± 0.6; p = .48) to a similar extent among races. Conversely, 25(OH)D increased (AA, 43.4 ± 14.0 vs. EA 68.2 ± 24.3; p < .01) though the magnitude of change (Δ) was not different (AA, +7.8 ± 13.5 vs. EA, +11.2 ± 16.7; p = .37) between races. Multiple linear regression revealed a positive association between ΔHb and Δ25(OH)D (r = .386; p < .01) adjusted for African admixture, Δtestosterone, and Δbody fat%. Path analyses revealed a significant indirect effect of Δbody fat% on ΔHb through Δ25(OH)D, ß =-0.023, CI [-0.06, -0.004]. Following 15% weight loss, participants with the largest increase in serum 25(OH)D exhibited the smallest decrease in Hb. Future research should clarify the optimal degree of calorie restriction to stimulate weight loss while mitigating the potential risk of anemia associated with dieting efforts.

Maternal prepregnancy body mass index and risk of spontaneous preterm birth.

BACKGROUND: Findings from studies examining risk of preterm birth associated with elevated prepregnancy body mass index (BMI) have been inconsistent. METHODS: Within a large population-based cohort, we explored associations between prepregnancy BMI and spontaneous preterm birth across a spectrum of BMI, gestational age, and racial/ethnic categories. We analysed data for 989,687 singleton births in California, 2007-09. Preterm birth was grouped as 20-23, 24-27, 28-31, or 32-36 weeks gestation (compared with 37-41 weeks). BMI was categorised as <18.5 (underweight); 18.5-24.9 (normal); 25.0-29.9 (overweight); 30.0-34.9 (obese I); 35.0-39.9 (obese II); and ≥ 40.0 (obese III). We assessed associations between BMI and spontaneous preterm birth of varying severity among non-Hispanic White, Hispanic, and non-Hispanic Black women. RESULTS: Analyses of mothers without hypertension and diabetes, adjusted for age, education, height, and prenatal care initiation, showed obesity categories I-III to be associated with increased risk of spontaneous preterm birth at 20-23 and 24-27 weeks among those of parity 1 in each race/ethnic group. Relative risks for obese III and preterm birth at 20-23 weeks were 6.29 [95% confidence interval (CI) 3.06, 12.9], 4.34 [95% CI 2.30, 8.16], and 4.45 [95% CI 2.53, 7.82] for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. A similar, but lower risk, pattern was observed for women of parity ≥ 2 and preterm birth at 20-23 weeks. Underweight was associated with modest risks for preterm birth at ≥ 24 weeks among women in each racial/ethnic group regardless of parity. CONCLUSIONS: The association between women's prepregnancy BMI and risk of spontaneous preterm birth is complex and is influenced by race/ethnicity, gestational age, and parity.

National SIDS Trends in the United States From 2000 to 2019: A Population-Based Study on 80 Million Live Births.

Sudden infant death syndrome (SIDS) is the most common cause of death for infants between 1 month and 1 year of age in the United States. The objective was to examine recent trends in SIDS in the United States, over time and by sex and race. A population-based cross-sectional study was conducted on 80 710 348 live births using data from the Center for Disease Control and Prevention's (CDC) "Birth Data" and "Mortality Multiple Cause" files from 2000 to 2019. Logistic regression examined the effects of sex and race on the risk of SIDS and examined temporal changes in risk across sex and race over the study period. Incidence of SIDS decreased from 6.3 to 3.4/10 000 births from 2000 to 2019, with an overall incidence of 4.9/10 000 births (95% confidence interval [CI] = 4.4-5.3). Male infants were at the greatest risk of SIDS as were black and American Indian infants. Although SIDS incidence decreased by sex and race over time, the decline was smaller among Hispanic and American Indian infants.

Racial disparities affect the association between gestational urinary phthalate mixtures and infant genital measures.

Background: Phthalates are ubiquitous anti-androgenic endocrine disrupting chemicals found in personal care products, medications, and many plastics. Studies have shown a racial disparity in phthalates exposure among U.S. women, which may also impact fetal development. Methods: We conducted a prospective cohort study of gestational exposure to a phthalates mixture in a racially-diverse population to determine their association with genital development. Mid-gestation (18-22 weeks) urine was collected from 152 women who self-identified as non-Hispanic Black and 158 women who self-identified as non-Hispanic White in Charleston, South Carolina between 2011 and 2014. We measured eight phthalate monoester metabolites in urine using liquid chromatography tandem-mass spectrometry. Mid-gestational penile dimensions were measured using ultrasound and anogenital distances were measured postnatally. We used Bayesian kernel machine regression to estimate the associations among the mixture of phthalate metabolites and mid-gestation penile dimensions and postnatal anogenital distance measures among singleton male (n = 179) and female (n = 131) infants, adjusted for urinary specific gravity, maternal age, body mass index, education level, cigarette smoking, and gestational age at enrollment or birth weight z-score. Results: We found a stronger association between greater phthalates and decreased anopenile distance among infants born to women who self-identified as Black. Mono (2-ethylhexyl) phthalate (MEHP) was the driving mixture component among Black women, and monobutyl phthalate (MBP) and monoethyl phthalate (MEP) were drivers among White women. We also identified a non-linear association between phthalates and lesser ultrasound penile volume among women who self-identified as Black with monoisobutyl phthalate (MiBP) and MBP being most important. We also found an association between greater phthalates and shorter anoclitoral distance among infants born to women who self-identified as Black, with MEP and monobenzyl phthalate (MBzP) contributing most to this association. Conclusion: Our results suggest a disparity in the association between gestational exposure to a mixture of phthalates and fetal genital development among women who self-identified as Black compared to White.

Changes over time in POLST use and content by race and ethnicity among California nursing home residents.

BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. METHODS: California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content-orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. RESULTS: POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two-thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. CONCLUSIONS: Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative.

Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample.

COVID-19 has brought the disparities in health outcomes for patients to the forefront. Racial and gender identity are associated with prevalent healthcare disparities. In this study, we examine the health disparities in COVID-19 hospitalization outcome from the intersectional lens of racial and gender identity. The Agency for Healthcare Research and Quality (AHRQ) 2020 NIS dataset for hospitalizations from 1 January 2020 to 31 December 2020 was analyzed for primary outcome of in-patient mortality and secondary outcomes of intubation, acute kidney injury (AKI), AKI requiring hemodialysis (HD), cardiac arrest, stroke, and vasopressor use. A multivariate regression model was used to identify associations. A p value of <0.05 was considered significant. Men had higher rates of adverse outcomes. Native American men had the highest risk of in-hospital mortality (aOR 2.0, CI 1.7−2.4) and intubation (aOR 1.8, CI 1.5−2.1), Black men had highest risk of AKI (aOR 2.0, CI 1.9−2.0). Stroke risk was highest in Asian/Pacific Islander women (aOR 1.5, p = 0.001). We note that the intersection of gender and racial identities has a significant impact on outcomes of patients hospitalized for COVID-19 in the United States with Black, Indigenous, and people of color (BIPOC) men have higher risks of adverse outcomes.

Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity.

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.

Geodemographic analysis of pediatric firearm injuries in Miami, FL.

PURPOSE: Firearm injuries (GSW) are a growing public health concern and leading cause of morbidity and mortality among children, yet predictors of injury remain understudied. This study examines the correlates of pediatric GSW within our county. METHODS: We retrospectively queried an urban Level 1 trauma center registry for pediatric (0-18 years) GSW from September 2013 to January 2019, examining demographic, clinical, and injury information. We used a geographic information system to map GSW rates and perform spatial and spatiotemporal cluster analysis to identify zip code "hot spots." RESULTS: 393 cases were identified. The cohort was 877% male, 87% African American, 10% Hispanic, and 22% Caucasian/Other. Injuries were 92% violence-related and 4% accidental, with 63% occurring outside school hours. Mortality was 12%, with 53% of deaths occurring in the resuscitation unit. Zip-level GSW rates ranged from 0 to 9 (per 1000 < 18 years) by incident address and 0-6 by home address. Statistically significant hot spots were in predominantly underserved African American and Hispanic neighborhoods. CONCLUSIONS: Geodemographic analysis of pediatric GSW injuries can be utilized to identify at-risk neighborhoods. This methodology is applicable to other metropolitan areas where targeted interventions can reduce the burden of gun violence among children. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level III.

Racial Disparity in Incidence and Survival for Gastrointestinal Stromal Tumors (GISTs): an Analysis of SEER Database.

BACKGROUND: Gastrointestinal tumors (GISTs) represent the most common mesenchymal tumors of the gastrointestinal tract. There has been limited data on GIST incidence and survival disparities between ethnic groups. AIMS: Assess disparities in incidence and survival among race in the USA in the era of available GIST histologic codes and treatment. METHODS: We queried Surveillance, Epidemiology, and End Results (SEER) database for GIST from 2002 to 2015, with diagnostic code 8936. RESULTS: Of the 7204 patients identified, 4928 (68.4%) were White, 1308 (18.2%) African American (AA), and 968 (13.4%) were classified as "Other" (American Indian/Alaskan Native, Asian/Pacific Islander). The overall incidence rate (IR) was 0.75 per 100,000. IR was highest among AA at 1.37/100,000, but 0.65/100,000 for Whites, 1.10/100,000 for Asians/Pacific Islanders, and 0.28/100,000 for American Indians/Alaskan Natives. The GIST incidence was twice as high for AA as for Whites (rate ratio [RR]: 2.12; 95% CI: 1.98-2.26; p < 0.001). There was higher proportion of Whites than AA, who underwent surgical extirpation. Median overall survival (OS) and GIST specific survival (GSS) were not reached for all race, which indicates more than half of the patients were still alive at end of follow-up period. In multivariate Cox model, belonging to "Other" had better OS (adjusted hazard ratio [aHR]; 0.73, 95% CI: 0.55-0.95, P = 0.021) for GIST, but no difference in prognosis and OS for AA and White [(aHR for whites; 0.84, 95% CI: 0.69-1.02, P = 0.071), AA = reference]. There was no difference in GSS among races. CONCLUSIONS: Significant racial disparity in incidence and overall survival for GIST exists, and efforts should be made to bridge this gap and improve outcomes for all races. The overall incidence rate for GIST was noted to be 7.5 per 1 million, and IR of GIST was twice as high for African Americans as compared to Whites. The "Other" racial group (American Indians/Alaskan Natives, Asians, and Pacific Islanders) had superior OS as compared to African Americans and Whites.

Race Does Not Affect Tumor Control, Adverse Effects, or Quality of Life after Proton Therapy.

PURPOSE: To compare 5-year biochemical control, toxicity, and patient-reported quality of life (QOL) outcomes for African American and White patients treated with proton therapy (PT) for prostate cancer. MATERIALS AND METHODS: We reviewed the medical records of 1,066 men with clinically localized prostate cancer. Patients were treated with definitive PT between 2006 and 2010. Patients received a median radiation dose of 78 Gy (RBE) with conventional fractionation (1.8- 2 Gy [RBE] per fraction). Sixty-eight (6.4%) men self-identified as African American and 998 (93.6%) self-identified as White. Five-year rates of biochemical control, grade 3 genitourinary and gastrointestinal toxicity, and patient-reported QOL are reported and compared between African American and White patients. RESULTS: Median biochemical follow-up was 5.0 years for both African American and White patients. Median follow-up for toxicity was 5.0 and 5.2 years, respectively. On multivariate analysis, race was not a significant predictor for 5-year freedom from biochemical failure (HR 0.8, p=0.55). No significant association was found between race and grade 3 genitourinary toxicity on multivariate analysis at 5 years (HR 2.5, p=0.10). Patient-reported QOL using median EPIC bowel, urinary incontinence, and irritative summaries scores were not significantly different between the groups. African Americans had higher median sexual summary scores at 2 years than White patients (75 vs. 54, p=0.01) but by 5+ years, the sexual summary scores were no longer significantly different (63 vs. 53, p=0.35). CONCLUSION: With a median follow-up of 5 years, there were no racial disparities in biochemical control, grade 3 toxicity, or patient-reported QOL after PT for prostate cancer.

A Vicious Cycle: A Social-Psychological Account of Extreme Racial Disparities in School Discipline.

Can social-psychological theory provide insight into the extreme racial disparities in school disciplinary action in the United States? Disciplinary problems carry enormous consequences for the quality of students' experience in school, opportunities to learn, and ultimate life outcomes. This burden falls disproportionately on students of color. Integrating research on stereotyping and on stigma, we theorized that bias and apprehension about bias can build on one another in school settings in a vicious cycle that undermines teacher-student relationships over time and exacerbates inequality. This approach is more comprehensive than accounts in which the predicaments of either teachers or students are considered alone rather than in tandem, it complements nonpsychological approaches, and it gives rise to novel implications for policy and intervention. It also extends prior research on bias and stigmatization to provide a model for understanding the social-psychological bases of inequality more generally.

Age, Race and Regional Disparities in Colorectal Cancer Incidence Rates in Georgia between 2000 and 2012.

Colorectal cancer (CRC) incidence rates and mortality have been decreasing in the United States. Currently, states in the South have the smallest reduction in CRC mortality. The trends of CRC incidence rates in Georgia in comparison to the United States have not been investigated. We analyzed age-adjusted incidence rates of CRC in Georgia and the United States from 2000 to 2012 using data from SEER 18 registries. Age-adjusted incidence rates (95% CI) were calculated as cases per 100,000 to the 2000 US Standard population. CRC incidence rates were calculated for groupings based on age at time of diagnosis, race, sex, and geographic location within Georgia. Incidence rates were higher in males compared to females in Georgia. In Georgians age 50-64, incidence rates were higher compared to the US, while those ages 65+ displayed lower incidence rates. Black Georgians age 50-64 generally exhibited higher incidence rates of CRC and lower rates of decrease in incidence compared to other races in Georgia. Asian/Pacific Islander females age 50-64 in Georgia exhibited an increasing trend in incidence rate. Whites and blacks Georgians age 50-64 displayed higher incidence rates compared to the US, while Asian/Pacific Islanders displayed lower incidence rates. Greater incidence rates of CRC in rural and Greater Georgia were seen across all races when compared to overall rates in Georgia. Efforts should be made to address disparities in Georgia based on race and geographic location. Increased screening by colonoscopy or fecal occult blood testing, reduction of risk factors and promotion of healthy lifestyles can reduce CRC incidence rates.

Fatal Firearm Injuries in Tennessee: A Comparison Study of Tennessee's Two Most Populous Counties 2009-2012.

Firearm injuries are a leading cause of violent death in Tennessee. This study was designed to compare the demographic and epidemiologic features of fatal firearm injuries in Shelby County and Davidson County, Tennessee between 2009 and 2012. We identified 1081 gunshot fatalities for the study period in these two counties. Shelby County had a higher overall, age-adjusted gunshot mortality rate, a higher male age-adjusted gunshot mortality rate, and a higher age-adjusted gunshot homicide rate than Davidson. Age groups 25-34 years and 35-44 years had higher crude mortality rates for gunshot deaths in Shelby County than Davidson County. Both counties had higher age-adjusted gunshot mortality rates for black males than white males, higher homicide rate for black race than white, and higher suicide rate for white race than black. Homicide was the most common manner of death, and handguns were the most common type of firearm used in both counties.

Racial disparities in olfactory loss among older adults in the United States.

BACKGROUND: Age-related olfactory loss (presbyosmia) substantially decreases quality of life, presages neurodegenerative disease, impairs nutrition, and predicts mortality. We sought to determine how race is associated with olfactory loss in older American adults in order to inform both health care and policy. METHODS: The National Social Life, Health and Aging Project interviewed a cross-sectional nationally representative probability sample of older adults in the United States. African Americans and Hispanics were oversampled, providing power to detect disparities for these subgroups. As part of an omnibus survey of demographic, social, psychological, and biological measures, National Social Life, Health and Aging Project assessed the ability to verbally identify odors by presenting five odor pens. Multivariate ordinal logistic regression quantified racial differences in odor identification, and then tested potential confounders. RESULTS: African Americans and Hispanics had markedly worse olfactory function (controlling for gender and age) compared with whites (p < .001), twice the magnitude of gender differences, and comparable to aging 9 years. Cognition, household assets, and education accounted for the disparity found among Hispanics but not among African Americans. Moreover, other potential confounders, such as physical or mental health, including tobacco and alcohol use, did not account for the African American health disparity, which remained significant (p = .001) after including these factors. CONCLUSIONS: African Americans are more likely to suffer from presbyosmia, a health disparity not explained by gender, education, cognition, physical or mental health, and health behaviors. This novel health disparity may result from lifetime environmental exposures, diet, or genetic susceptibility. Dissecting the interactions among these putative mechanisms will provide insight into ameliorating this decline in critical human sensory function.

Wilms tumor survival in Kenya.

PURPOSE: Survival from Wilms Tumor (WT) exceeds 90% at 5 years in developed nations, whereas at last report, 2-year event-free survival (EFS) in Kenya reached only 35%. To clarify factors linked to these poor outcomes in Kenya, we established a comprehensive web-based WT registry, comprised of patients from the four primary hospitals treating childhood cancers. MATERIALS AND METHODS: WT patients diagnosed between January 2008 and January 2012 were identified. Files were abstracted for demographic characteristics, treatment regimens, and enrollment in the Kenyan National Hospital Insurance Fund (NHIF). Children under 15 years of age having both a primary kidney tumor on imaging and concordant histology consistent with WT were included. RESULTS: Two-year event-free survival (EFS) was 52.7% for all patients (n=133), although loss to follow up (LTFU) was 50%. For the 33 patients who completed all scheduled standard therapy, 2-year EFS was 94%. Patients enrolled in NHIF tended to complete more standard therapy and had a lower hazard of death (Cox 0.192, p < 0.001). CONCLUSION: Survival of Kenyan WT patients has increased slightly since last report. Notably, WT patients completing all phases of standard therapy experienced 2-year survival approaching the benchmarks of developed nations. Efforts in Kenya should be made to enhance compliance with WT treatment through NHIF enrollment.

Racial Disparity in Police Contacts.

Criminologists agree the race disparity in arrests cannot be fully explained by differences in criminal behavior. We examine social environment factors that may lead to racial differences in police contact in early adolescence, including family, peers, school, and community. Data are from 331 8th-grade students. Blacks were almost twice as likely as Whites to report a police contact. Blacks reported more property crime but not more violent crime than Whites. Police contacts were increased by having a parent who had been arrested, a sibling involved in criminal activity, higher observed reward for negative behavior, having school disciplinary actions, and knowing adults who engaged in substance abuse or criminal behavior. Race differences in police contacts were partially attributable to more school discipline.