Disparities in Hepatocellular Carcinoma Incidence, Stage, and Survival: A Large Population-Based Study.

BACKGROUND: Liver cancer is one of the most rapidly increasing cancers in the United States, and hepatocellular carcinoma (HCC) is its most common form. Disease burden and risk factors differ by sex and race/ethnicity, but a comprehensive analysis of disparities by socioeconomic status (SES) is lacking. We examined the relative impact of race/ethnicity, sex, and SES on HCC incidence, stage, and survival. METHODS: We used Surveillance, Epidemiology, and End Results (SEER) 18 data to identify histologically confirmed cases of HCC diagnosed between January 1, 2000 and December 31, 2015. We calculated age-adjusted HCC incidence, stage at diagnosis (local, regional, distant, unstaged), and 5-year survival, by race/ethnicity, SES and sex, using SEER*Stat version 8.3.5. RESULTS: We identified 45,789 cases of HCC. Incidence was highest among low-SES Asian/Pacific Islanders (API; 12.1) and lowest in high-SES Whites (3.2). Incidence was significantly higher among those with low-SES compared with high-SES for each racial/ethnic group (P < 0.001), except American Indian/Alaska Natives (AI/AN). High-SES API had the highest percentage of HCC diagnosed at the local stage. Of all race/ethnicities, Blacks had the highest proportion of distant stage disease in the low- and high-SES groups. Survival was greater in all high-SES racial/ethnic groups compared with low-SES (P < 0.001), except among AI/ANs. Black, low-SES males had the lowest 5-year survival. CONCLUSIONS: With few exceptions, HCC incidence, distant stage at diagnosis, and poor survival were highest among the low-SES groups for all race/ethnicities in this national sample. IMPACT: HCC prevention and control efforts should target low SES populations, in addition to specific racial/ethnic groups.

Disparities in Colorectal Cancer Screening in the United States Before and After Implementation of the Affordable Care Act.

BACKGROUND & AIMS: Colorectal cancer (CRC) is major cause of cancer-related mortality in the United States. Screening, however, is suboptimal and there are disparities in outcomes. After health policy changes and national efforts to increase rates of screening and address inequities, we aimed to examine progress towards eliminating racial and ethnic disparities in CRC screening. METHODS: We conducted a repeated cross-sectional analysis of average-risk adults (age 50-75 years) included in the behavioral risk factors surveillance system survey. The main outcome was CRC screening status. We determined screening rates overall and by race and ethnicity (1 variable) for each survey year from 2008 through 2016 and used Joinpoint analyses to determine significant trends in rates over time by race and ethnicity. We also examined screening modalities used overall and by race and ethnicity. RESULTS: We analyzed data from 1,089,433 respondents. Screening uptake was 61.1% in 2008 and 67.6% in 2016 (P < .001); it was highest among whites and lowest among Hispanics. Only whites, Hispanics, and Asians had significantly higher screening rates in each study year (P < .001). Despite increasing rates among Hispanics, the screening rate disparity between whites and Hispanics was 17% at the end of the study period. Screening rates in blacks did not change with time and were 4.0% lower than the rate in whites in 2016. Other racial and ethnic groups had varying levels of improvement with time. Colonoscopy was the most common modality each year. CONCLUSIONS: In a cross-sectional analysis of average-risk adults, we found that although rates of CRC screening have increased overall since 2008, they have increased disproportionately in each racial and ethnic group, and disparities in screening uptake persist.

Low-Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System.

BACKGROUND: Older adults are particularly vulnerable to complications from proton pump inhibitor (PPI) drugs. We sought to characterize the prevalence of potentially low-value PPI prescriptions among older adults to inform a quality improvement (QI) intervention. METHODS: We created a cohort of patients, aged 65 years or older, receiving primary care at a large academic health system in 2018. We identified patients currently prescribed any PPI using the electronic health record (EHR) medication list (current defined as September 1, 2018). A geriatrician, a gastroenterologist, a QI expert, and two primary care physicians (PCPs) created multidisciplinary PPI appropriateness criteria based on evidenced-based guidelines. Supervised by a gastroenterologist and PCP, two internal medicine residents conducted manual chart reviews in a random sample of 399 patients prescribed PPIs. We considered prescriptions potentially low value if they lacked a guideline-based (1) short-term indication (gastroesophageal reflux disease [GERD]/peptic ulcer disease/Helicobacter pylori gastritis/dyspepsia) or (2) long-term (>8 weeks) indication (severe/refractory GERD/erosive esophagitis/Barrett esophagus/esophageal adenocarcinoma/esophageal stricture/high gastrointestinal bleeding risk/Zollinger-Ellison syndrome). We used the Wilson score method to calculate 95% confidence intervals (CIs) on low-value PPI prescription prevalence. RESULTS: Among 69 352 older adults, 8729 (12.6%) were prescribed a PPI. In the sample of 399 patients prescribed PPIs, 63.9% were female; their mean age was 76.2 years, and they were seen by 169 PCPs. Of the 399 prescriptions, 143 (35.8%; 95% CI = 31.3%-40.7%) were potentially low value-of which 82% began appropriately (eg, GERD) but then continued long term without a guideline-based indication. Among 169 PCPs, 32 (18.9%) contributed to 59.2% of potentially low-value prescriptions. CONCLUSION: One in eight older adults were prescribed a PPI, and over one-third of prescriptions were potentially low-value. Most often, appropriate short-term prescriptions became potentially low value because they lacked long-term indications. With most potentially low-value prescribing concentrated among a small subset of PCPs, interventions targeting them and/or applying EHR-based automatic stopping rules may protect older adults from harm. J Am Geriatr Soc 67:2600-2604, 2019.

Incidence, psychosocial burden, and economic impact of genital warts in Mexico / Incidencia, carga psicosocial e impacto económico de las verrugas genitales en México

Abstract: Objective: To estimate the burden of genital warts (GW) in Mexico. Materials and methods: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. Results: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. Conclusions: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

Resumen: Objetivo: Estimar la carga por verrugas genitales (VG) en México. Material y métodos: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. Resultados: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. Conclusiones: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

Incidence, psychosocial burden, and economic impact of genital warts in Mexico.

OBJECTIVE: To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

OBJETIVO: Estimar la carga por verrugas genitales (VG) en México. MATERIAL Y MÉTODOS: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. RESULTADOS: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. CONCLUSIONES: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

Intellectual developmental disorders in Mexico: a call for programmes promoting independence and inclusion.

This paper describes an innovative institution, Capacitación y Desarrollo Integral AC (CADI - Comprehensive Training and Development), created in Mexico to develop evidence-based interventions grounded in the principles of inclusion, independence, social and health equity that promote the well-being of persons with intellectual developmental disorder older than 14 years.