Mediators of racial disparity in the use of prostate MRI.

6554 Background: Evidence of racial disparity in the use of prostate MRI presents new obstacles to closing recognized gaps in treatment and outcome for black men with prostate cancer. To anticipate strategies for improving equity in cancer care, we examined mediators of racial disparity in the use of prostate MRI surrounding the diagnosis of prostate cancer. Methods: We conducted a multiple mediation analysis among patients with localized prostate cancer in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between January 2008 and December 2015. We assessed claims for prostate MRI within the six-month period preceding or following diagnosis. We first identified candidate clinical and sociodemographic meditators based on their association with both race and prostate MRI, including the Index of Concentrations at the Extremes (ICE), a measure of racialized residential segregation calculated at the zip code or census tract level. We used non-linear Multiple Additive Regression Trees (MART) models to estimate the direct and indirect relative effects of mediators. Results: We identified 71,597 eligible patients. Black patients with prostate cancer were less likely (5.3%) to receive a prostate MRI when compared with white patients (7.0%; unadjusted odds ratio 0.75, 95% CI 0.67-0.84, p < 0.001). 33.1% (95% CI 20.6-44.9) of the racial disparity in prostate MRI use was attributable to variation in SEER region, 22.5% (95% CI 13.0-30.2) to residence in a high poverty area, 17.2% to residential segregation (ICE group 17.2%, 95% CI 8.1-27.9%), and 13.2% to dual eligibility for Medicaid (95% CI 8.6-20.2%). Clinical and pathologic factors were not significant mediators. After accounting for the mediators, the direct effects of race accounted for 6.2% of the observed disparity in prostate MRI use. Conclusions: Sociodemographic factors including geographic region, and area-level measures of income and residential segregation explain the majority of the observed racial disparity in the use of prostate MRI among older Americans with prostate cancer. The findings underscore that measurable structural factors can be readily identified that underlie racial disparity in access to emerging diagnostic tools for patients with cancer.

Racial, Ethnic, and Socioeconomic Discrepancies in Opioid Prescriptions Among Older Patients With Cancer

PURPOSE: Minority race and lower socioeconomic status are associated with lower rates of opioid prescription and undertreatment of pain in multiple noncancer healthcare settings. It is not known whether these differences in opioid prescribing exist among patients undergoing cancer treatment. METHODS AND MATERIALS: This observational cohort study involved 33,872 opioid-naive patients of age > 65 years undergoing definitive cancer treatment. We compared rates of new opioid prescriptions by race or ethnicity and socioeconomic status controlling for differences in baseline patient, cancer, and treatment factors. To evaluate downstream impacts of opioid prescribing and pain management, we also compared rates of persistent opioid use and pain-related emergency department (ED) visits. RESULTS: Compared with non-Hispanic White patients, the covariate-adjusted odds of receiving an opioid prescription were 24.9% (95% CI, 16.0 to 33.9, P < .001) lower for non-Hispanic Blacks, 115.0% (84.7 to 150.3, P < .001) higher for Asian–Pacific Islanders, and not statistically different for Hispanics (−1.0 to 14.0, P = .06). There was no significant association between race or ethnicity and persistent opioid use or pain-related ED visits. Patients living in a high-poverty area had higher odds (53.9% [25.4 to 88.8, P < .001]) of developing persistent use and having a pain-related ED visit (39.4% [16.4 to 66.9, P < .001]). CONCLUSION: For older patients with cancer, rates of opioid prescriptions and pain-related outcomes significantly differed by race and area-level poverty. Non-Hispanic Black patients were associated with a significantly decreased likelihood of receiving an opioid prescription. Patients from high-poverty areas were more likely to develop persistent opioid use and have a pain-related ED visit.

Implementation of the No Poverty Sustainable Development Goal (SDG) in Visegrad Group (V4)

This presented study discusses problems related to the implementation of the Sustainable Development Goal 1: No Poverty, aimed at eliminating poverty, based on the example of the Visegrad Group (V4) countries. The introduction addresses the general characteristics of the V4 and attempts to define the concept of sustainable development, with particular emphasis on its complex nature and importance for future generations. The purpose of the research was to assess the diversity within the Visegrad Group countries in the years 2005–2018 in terms of poverty and sustainable development level in the No Poverty area and also to identify the impact of the socioeconomic development level in the studied countries on sustainable development in the No Poverty area. Taking into account the analysis of poverty indicators in the Visegrad Group countries, the best results were recorded for Czechia. The second part of the conducted analyzed allowed us to conclude that Czechia definitely presents the highest level of sustainable development, followed by Slovakia. The highest average dynamics of changes occur in Poland and Hungary, which result in the gradual elimination of the existing disproportions. Among other research results, it is worth highlighting that the V4 countries show significant, however, decreasing differences regarding the indicators describing poverty in relation to sustainable development.

EFFECT OF ELEVATION AND SLOPE ON FOOD AVAILABILITY IN THE POVERTY AREA IN LEBAK REGENCY, BANTEN PROVINCE

<p><span lang="IN"><span style="font-size: medium;">The availability of food <span>in</span> a region is the most important thing for human development. Food is a major problem in <span>poor families</span>. Lebak Regency is a pocket of poverty located in Banten Province. The objectives of the study analyzed (1) spatial pattern of food availability level in Lebak Regency; (2) the relationship between elevation and slope to the area of food availability in Lebak Regency; (3) the relationship of food <span>available</span> to <span>poor families</span>. The method of analysis used in this study is spatial analysis <span> </span>and statistical analysis (<span>Chi-Square</span>). The results conclusion that: first, the high availability of food surplus area <span>spread</span> outside the capital of Lebak Regency. <span>Second, the elevation and slope had no effect on food availability; Third, the poor rural families are concentrated in the southern part of Lebak Regency, while urban poor located in the northern part, especially in the capital of Lebak Regency; Fourth, the relationship between food availability and the percentage of poor families is not significant at α = 0.05</span></span></span><span lang="IN">.</span></p>

Area-Based Socioeconomic Status and Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Outcomes: A CIBMTR Analysis

Introduction: Outcome disparities related to race and area-based socioeconomic status (SES) following allogeneic hematopoietic stem cell transplantation (allo-HCT) have been identified in adult patients [Baker et al. 2009]. The relationship between SES and outcomes in pediatric allo-HCT has not been previously described. Among a large cohort of pediatric allo-HCT recipients we sought to determine the impact of area-based poverty on 5-year outcomes of overall survival (OS), acute and chronic graft-versus-host-disease (aGVHD, cGVHD); as well as the short-term outcome of infection through day 100 . Methods: We utilized the Center for International Blood and Marrow Transplant Research (CIBMTR) database to examine the association of sociodemographic variables with outcomes in two cohorts of pediatric transplant recipients aged <=18 years who received allo-HCT at U.S. centers between 2006-2015. Cohort 1 (malignant) included 2053 children who received myeloablative conditioning for any malignancy. Cohort 2 (non-malignant) included 1696 children who received myeloablative or reduced-intensity conditioning for any non-malignant disease. Zip codes of child's residence were categorized as high-poverty area (>=20% households living below 100% federal poverty level (FPL)) versus low-poverty area (<20% households below 100% FPL) by linkage to U.S. Census data [Krieger et al. 2002]. Individual-level sociodemographic variables including insurance (Medicaid-only vs Other), race (Caucasian vs Black vs Other) and ethnicity (non-Hispanic vs Hispanic) were included as covariates. Cox regression was used to examine the effect of patient-related (age, performance status, insurance, race, and ethnicity), disease-related (disease type and status), and HCT-related (donor/graft type, CMV status, stem cell source, HLA match, donor age and gender, conditioning regimen and intensity, GVHD prophylaxis, year of HCT) variables on the outcomes of interest between the two area-based poverty groups. Results: Fifteen percent (N=299) of children in Cohort 1 lived in a high-poverty area; 35% (N=711) were insured by Medicaid-only; 11% (N=227) were African-American and 20% (N=417) Hispanic. Median follow-up of survivors was 74 months. In multivariable analysis, there was no association between area-based poverty and OS; however, OS was inferior in children with Medicaid-only insurance compared to those with private insurance (HR 1.22 (95% CI 1.06-1.40), p=0.0037) and in Black children compared to Caucasian (HR 2.02 (95% CI 1.10-3.73), p=0.0234). For the secondary outcomes of aGVHD, cGVHD or infection through day 100, there were no associations between area-based poverty, insurance, race, or ethnicity in multivariable analysis. To further explore the independent association of insurance with OS, we performed an ad hoc univariate analysis that demonstrated that insurance-related differences in OS for malignant disease appear to be driven by differences in treatment-related mortality (TRM) (5-year TRM: Medicaid-only 25% (95% CI 22-28) versus 18% (95% CI 16-21) other). Thirteen percent (N=228) of children in Cohort 2 lived in a high-poverty zip code; 35% were insured by Medicaid-only (N=597); 20% (N=332) were African-American and 20% (N=344) Hispanic. Median follow-up of survivors was 74 months. In multivariable analyses, there was no association between area-based poverty, insurance, race or ethnicity and any outcome. Conclusion: Area-based poverty is not associated with disparate outcomes in pediatric allo-HCT for malignant or non-malignant disease. In the setting of malignant disease, insurance-a household-level measure of socioeconomic status-and Black race are independently associated with inferior OS. These results suggest that future prospective investigation of more refined measures of household-level socioeconomic status may identify risk-factors for treatment-related mortality in this population. Disclosures No relevant conflicts of interest to declare.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil

Introduction The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim To investigate the influence of socioeconomic status (SES) and maternal education on infants’ language, motor and cognitive development. Methods The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants’ families. Results A positive association was found between SES and infants’ performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.