Stevens, Maria

Objective: To evaluate the relationship between race and social determinants of health and receipt of hysterectomy versus uterine-preserving fibroid treatment. Methods: A retrospective cohort study using deidentified claims and longitudinal health data from OptumLabs ® Data Warehouse. Patients aged 15–55 years with newly diagnosed fibroids between 2010 and 2023 were included. Menopausal individuals and those with gynecological cancer were excluded. The primary outcome was hysterectomy by any route versus uterine-preserving fibroid surgery within 180 days of fibroid diagnosis. We used logistic regression to assess associations between socioeconomic factors and receipt of hysterectomy after adjusting for pertinent covariates. Results: A total of 73,479 individuals were included; 50,645 received hysterectomy, 22,834 received a uterine-preserving treatment. Race, income, education level, and rurality were independently associated with the probability of hysterectomy. Odds of hysterectomy were lower for all people of color compared with White individuals (Asian odds ratio [OR] 0.61 [95% confidence interval (CI): 0.56–0.66], Black OR: 0.70 [95% CI: 0.67–0.73], and Hispanic OR: 0.90 [95% CI: 0.86–0.95]). Individuals with household income <$40,000, less than high school education, and rural address were more likely to undergo hysterectomy compared with those with income >$124,999 (OR: 1.15, 95% CI: 1.09–1.21), bachelor’s degree or higher (OR: 2.55, 95% CI: 1.78–3.65), and metropolitan address (OR: 1.70, 95% CI: 1.44–2.01). All associations were significant at p < 0.05. Conclusion: People with fewer socioeconomic advantages, such as lower household income, lower educational attainment, and rural address were more likely to receive hysterectomy rather than uterine-preserving fibroid treatment. After controlling for age, surgery year, and socioeconomic factors, people of color were less likely to receive hysterectomy rather than uterine-preserving fibroid treatment.

Abstract Objectives Multimorbidity is burdensome for people with RA. We investigated differences in multimorbidity and comorbidities by sex and age in the RA population. Methods This cross-sectional analysis used national administrative claims (OptumLabs® Data Warehouse) from people with RA and non-RA comparators (matched on age, sex, race, census region, index year and length of baseline insurance coverage) from 2010–2019. RA was determined using a validated algorithm. Multimorbidity was defined as ≥2 (MM2+) or ≥5 (MM5+) comorbidities from a validated set of 44 chronic conditions. We used logistic regression to assess associations between characteristics and multimorbidity. Results The sample included 154 391 RA patients and 154 391 non-RA comparators. For people aged 18–50 years, RA women (vs RA men) had 7.5 and 4.4 (vs 3.2 and 0.9 in non-RA women vs non-RA men) percentage point increases for MM2+ and MM5+, respectively. For people aged 51+ years, RA women (vs RA men) had 2.1 and 2.5 (vs 1.2 and 0.3 in non-RA women vs non-RA men) percentage point increases for MM2+ and MM5+, respectively. Interactions revealed that differences in multimorbidity between women and men were exacerbated by RA (vs non-RA) (P &lt; 0.05), with more pronounced effects in people aged 18–50. Men had more cardiovascular-related conditions, whereas RA women had more psychological, neurological and general musculoskeletal conditions. Other comorbidities varied by sex and age. Conclusion Multimorbidity disproportionately impacts women with RA. Research, clinical and policy agendas for rheumatic diseases should acknowledge and support the variation in care needs by sex and gender across the lifespan.

AbstractBackgroundOpioid overdose deaths have disproportionately impacted Black and Hispanic populations, in part due to disparities in treatment access. Emergency departments (EDs) serve as a resource for patients with opioid use disorder (OUD), many of whom have difficulty accessing outpatient addiction programs. However, inequities in ED treatment for OUD remain poorly understood.MethodsThis secondary analysis examined racial and ethnic differences in buprenorphine access using data from EMBED, a study of 21 EDs across five health care systems evaluating a clinical decision support system for initiating ED buprenorphine. The primary outcome was receipt of buprenorphine, ED administered or prescribed. Hospital type (academic vs. community) was evaluated as an effect modifier. Hierarchical models with cluster effects for site and clinician were used to assess buprenorphine receipt by race and ethnicity.ResultsBlack patients were less likely to receive buprenorphine (6.4% [51/801] vs. White patients 8.5% [268/3154], odds ratio [OR] 0.59, 95% confidence interval [CI] 0.45–0.78). This association persisted after adjusting for age, insurance, gender, clinician X‐waiver, hospital type, and urbanicity (adjusted OR [aOR] 0.64, 95% CI 0.48–0.84) but not when discharge diagnosis was included (aOR 0.75, 95% CI 0.56–1.02). Hispanic patients were more likely to receive buprenorphine (14.8% [122/822] vs. non‐Hispanic patients, 11.6% [475/4098]) in unadjusted (OR 1.57, 95% CI 1.09–1.83) and adjusted models (aOR 1.41, 95% CI 1.08–1.83) but not including discharge diagnosis (aOR 1.32, 95% CI 0.99–1.77). Odds of buprenorphine were similar in academic and community EDs by race (interaction p = 0.97) and ethnicity (interaction p = 0.64).ConclusionsBlack patients with OUD were less likely to receive buprenorphine whereas Hispanic patients were more likely to receive buprenorphine in academic and community EDs. Differences were attenuated with discharge diagnosis, as fewer Black and non‐Hispanic patients were diagnosed with opioid withdrawal. Barriers to medication treatment are heterogenous among patients with OUD; research must continue to address the multiple drivers of health inequities at the patient, clinician, and community level.

ObjectiveTo identify differences in multimorbidity and individual comorbidities among individuals with rheumatoid arthritis (RA), separated by race and ethnicity.MethodsThis case–control study within OptumLabs Data Warehouse from 2010 to 2019 matched RA cases (defined by 2 codes plus prescription of an RA drug) to non‐RA controls 1:1 on age, sex, race and ethnicity, region, index date of RA, and insurance coverage duration. We defined multimorbidity as the presence of ≥2 or ≥5 validated comorbidities. Logistic regression models calculated adjusted odds of multimorbidity with 95% confidence intervals (95% CIs) within each race and ethnicity.ResultsWe identified 154,391 RA cases and 154,391 controls (mean age 59.6, 76% female). Black enrollees had the most multimorbidity ≥2/≥5 (73.1%, 34.3%); Asian enrollees had the least (52.4%, 17.3%). Adjusted odds of multimorbidity ≥2 and ≥5 in RA cases versus controls was 2.19 (95% CI 2.16–2.23) and 2.06 (95% CI 2.02–2.09), respectively. This increase was similar across race and ethnicity. However, we observed elevated occurrence of certain comorbidities by race and ethnicity versus controls (P < 0.001), including renal disease in White enrollees (4.7% versus 3.2%) and valvular heart disease in Black and White enrollees (3.2% and 2.8% versus 2.6% and 2.2%).ConclusionMultimorbidity is a problem for all RA patients. Targeted identification of certain comorbidities by race and ethnicity may be a helpful approach to mitigate multimorbidity.

Background. Despite extensive evaluation processes to determine candidacy for kidney transplantation, variability in graft failure exists. The role of patient socioeconomic status (SES) in transplantation outcomes is poorly understood because of limitations of conventional SES measures. Methods. This population-based retrospective cohort study assessed whether a validated objective and individual-level housing-based SES index (HOUSES) would serve as a predictive tool for graft failure in patients (n = 181) who received a kidney transplant in Olmsted County, MN (January 1, 1998 to December 8, 2016). Associations were assessed between HOUSES (quartiles: Q1 [lowest] to Q4 [highest]) and graft failure until last follow-up date (December 31, 2016) using Cox proportional hazards. The mean age (SD) was 46.1 (17.2) years, 109 (60.2%) were male, 113 (62.4%) received a living kidney donor transplant, and 40 (22.1%) had a graft failure event. Results. Compared with Q1, patients with higher HOUSES (Q2–Q4) had significantly lower graft failure rates (adjusted hazard ratio, 0.47; 95% confidence interval, 0.24-0.92; P < 0.029), controlling for age, sex, race, previous kidney transplantation, and donor type. Conclusions. Although criteria for kidney transplant recipients are selective, patients with higher HOUSES had lower graft failure rates. Thus, HOUSES may enable transplantation programs to identify a target group for improving kidney transplantation outcomes.

Abstract Background Immunosuppressant therapeutic drug monitoring (TDM) usually requires outpatient travel to hospitals or phlebotomy sites for venous blood collection; however Mitra® Microsampling Device (MSD) sampling could allow self-collection and shipping of samples to a laboratory for analysis. This study examined the feasibility of using volumetric microsampling by MSD for TDM of tacrolimus (TaC) and cyclosporin A (CsA) in transplant patients, along with their feedback on the process. Methods MSD was used to collect TaC and CsA from venous (VB) or capillary (CB) blood. The MSDs were rehydrated, extracted, and analyzed using on-line solid phase extraction coupled to tandem mass spectrometry (SPE-MS/MS). We report an abbreviated method validation of the MSD including: accuracy, precision, linearity, carry-over, and stability using residual venous whole blood (VB) samples. Subsequent clinical validation compared serially collected MSD + CB against VB (200 µL) from transplant patients. Results Accuracy comparing VB vs. MSD+VB showed high clinical concordance (TaC = 89% and CsA = 98%). Inter- and intra-precision was ≤11.5 %CV for TaC and CsA. Samples were stable for up to 7 days at room temperature with an average difference of &lt;10%. Clinical validation with MSD+CB correlated well with VB for CsA (slope = 0.95, r2 = 0.88, n = 47) and TaC (slope = 0.98, r2 = 0.82, n = 49). CB vs. VB gave concordance of 94% for CsA and 79% for TaC. A satisfaction survey showed 82% of patients preferred having the capillary collection option. Conclusion Transplant patients favored having the ability to collect capillary samples at home for TaC/CsA monitoring. Our results demonstrate good concordance between MSD+CB and VB for TaC and CsA TDM, but additional studies are warranted.

Abstract Introduction: Family reinforcement (praise, reminders) may influence health behaviors and affect cancer knowledge, including risk factors. There has been insufficient research on the influence of familial factors in cancer prevention, especially for individuals with a family history of pancreatic cancer (PC). Objectives were to assess: 1) associations between family history of PC and familial reinforcement of cancer prevention with PC knowledge, and 2) interaction between family history of PC and familial reinforcement of cancer prevention on PC knowledge. Methods: A sample of 778 unaffected relatives with ≥1 affected first (FDR) or second degree relatives (SDR) were ascertained from Mayo Clinic’s Biospecimen Resource for Pancreas Research, a familial PC registry, along with 685 primary care controls. Participants with a personal history of cancer were excluded with the exception of non-melanoma skin cancer. Participants completed health/behavior questionnaires (June 2008 to June 2018). Items were summed to create factor scores for familial reinforcement of cancer prevention and PC knowledge. PC family history was categorized by number of relatives with PC: 1) none, 2) 1 FDR and/or ≥1 SDR, and 3) ≥2 FDRs. We employed linear models utilizing generalized estimating equations to assess the association between PC family history and familial reinforcement with PC knowledge, and the interaction based on PC family history, adjusting for age, sex, and education, and accounting for familial relatedness. Estimates of the linear coefficient β and 95% confidence intervals (CI) are reported, and p-values &lt; 0.05 were considered significant. Analyses were conducted using SAS 9.4 (SAS Institute, Cary, NC). Results: There was a significant association between PC family history and PC knowledge such that those with 1 FDR and/or ≥1 SDR (β=3.0; 95% CI: 2.5-3.4; p&lt;0.0001) or ≥2 FDRs (β=4.4; 95% CI: 3.7-5.0; p&lt;0.0001) with PC had increased PC knowledge after adjusting for age, sex, and education. There was a significant association between familial reinforcement and PC knowledge such that individuals with increased familial reinforcement (β=0.1; 95% CI: 0.03-0.12; p=0.0026) had higher PC knowledge after adjusting for pertinent covariates. The interaction between PC family history and familial reinforcement was significant such that increased familial reinforcement was associated with higher PC knowledge in individuals with ≥2 FDRs with PC compared to controls (β=0.2; 95% CI: 0.09-0.34; p=0.001); however, this relationship was not significant in individuals with 1 FDR and/or ≥1 SDR. Conclusions: Individuals with a stronger family history of PC may benefit from increased familial reinforcement of cancer prevention to enhance knowledge about PC. Further efforts should be targeted toward incorporating the family in cancer care to raise familial awareness about PC. Citation Format: Maria Stevens, Dalia Mikhail, Amanda Toledo Hernandez, Sarah Fagan, Kari Chaffee, Gloria M. Petersen. Familial reinforcement and family history interact to influence knowledge about pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2426.