Key Findings

• Black patients had longer times from biopsy to surgery than other groups.
• Black patients experienced higher rates of persistent disease post-treatment.
• Survival rates among Black patients improved when adjusted for multiple variables, yet disparities persisted.
• Palliative care referrals were more common for Black patients when adjusted for disease stage and histology.

Endometrial cancer affects demographic groups in the U.S. disproportionately, necessitating a focused investigation into racial disparities in treatment and outcomes. A retrospective study published in the Gynecologic Oncology Reports evaluated patient outcomes within a large urban academic health system. It looked at care patterns and recurrence rates, with particular findings relative to the experiences of Black patients compared to those of other racial groups.

Hospital Site and Treatment Timeliness Emerged as Significant Factors 

Hospital site was found to be a significant factor influencing survival outcomes, indicating that survival rates are not only a product of medical treatment but also of where the treatment is provided. 

Black patients also experienced longer delays from endometrial biopsy (EMB) to surgery compared to their counterparts, with Black women experiencing a delay of 31.5 days versus 24.0 days for other groups. This delay could contribute to the higher rates of advanced disease and lower survival rates observed among Black patients, suggesting a critical area for improving timely access to surgical interventions.

Differential Outcomes in Disease Persistence

All racial groups in the cohort received surgery within the recommended 6 weeks, and Black women completed chemotherapy at significantly higher rates than other groups. However, Black patients had higher rates of persistent disease following primary treatment. This finding points to potential underlying biological differences or variances in how treatments are administered or received. Moreover, the study found that Black patients were more likely to be referred to palliative care after adjusting for stage and histology, highlighting a possibly different trajectory in disease management and end-of-life care planning.

Practical Insights for Clinical Application

The results reinforce the necessity for healthcare providers to consider not only the biological aspects of endometrial cancer but also the socioeconomic and institutional factors that contribute to disparate outcomes. More equitable healthcare policies and consideration of the broader social determinants that affect patient outcomes will help ensure timely and standardized care. Understanding these factors may help improve interventions that not only address the disease but also the social contexts in which these patients live.

Source:

Papatla, K., Orfanelli, T., Stoffels, G., Layne, T. M., Baldwin, E., Leibold, A., Blank, S. V., & Cohen, S. (2024). Mitigating disparity?: Treatment patterns, survival, and recurrence rates by race, ethnicity, and hospital site across a large urban health system. Gynecologic Oncology Reports, 53, 101372. https://doi.org/10.1016/j.gore.2024.101372 

• Socioeconomic factors like poverty and low education levels significantly worsen health outcomes for those with HIV and heart failure.
• Geographic and immigration-related disparities further complicate access to care and overall health status.
• Integrating mental health care and addressing social challenges are necessary for improving patient outcomes.

A narrative review published in the journal Cureus delves into the intricate effects of social determinants of health (SDoH) on individuals suffering from human immunodeficiency virus (HIV) and heart failure (HF). Both conditions exert a heavy socioeconomic burden on societies and healthcare systems globally. 

The review suggests that while medical advancements have been significant, social factors such as socioeconomic status, education, and geographical location continue to play a pivotal role in the health outcomes of patients with these conditions.

Exploring Socioeconomic and Educational Barriers

Lower socioeconomic status is linked to higher rates of HIV transmission and worse outcomes in heart failure management. Education level directly affects health literacy, which in turn influences disease management and patient empowerment. Addressing these disparities requires comprehensive strategies that go beyond clinical care to include social support systems and community-based interventions.

Geographic and Immigration Challenges

Individuals from rural areas or with immigrant status face significant challenges in accessing consistent and effective healthcare. The review points out that rural residents often receive diagnoses later and have less access to healthcare resources, which can lead to worse outcomes. Immigrants may face legal and social barriers that inhibit their access to healthcare services, highlighting the need for healthcare policies that are inclusive of these populations to ensure equitable care.

The Crucial Role of Mental Health Integration

The integration of mental health care is emphasized as a critical factor in managing HIV and HF effectively. Patients with either condition often experience higher rates of mental health disorders, which can adversely affect their overall health and quality of life. The review advocates for the inclusion of mental health services within routine care settings to address these needs comprehensively, which could lead to better health outcomes and improved quality of life.

Conclusions for Clinicians

For healthcare providers, understanding the influence of social determinants on health outcomes is essential for the effective management of HIV and HF. Clinicians are encouraged to consider these factors when developing treatment plans and to advocate for policies that improve access to comprehensive care. Integrating social and psychological support into medical care can help mitigate the adverse effects of these determinants and improve the longevity and quality of life for patients. Implementing strategies that improve access to education and healthcare, especially in underserved populations, may significantly impact the success of treatment regimens and improve patient satisfaction.

Source:

Borkowski, P., & Borkowska, N. (2024). The Impact of social Determinants of Health on outcomes among Individuals with HIV and heart Failure: a literature review. Curēus. https://doi.org/10.7759/cureus.55913 

Both individual- and area-level social determinants of health (SDOH) are associated with atherosclerotic cardiovascular disease (ASCVD) risk, according to a study published online April 26 in JAMA Network Open.

Mengying Xia, M.P.H., from Columbia University in New York City, and colleagues examined the association of SDOH at both individual and area levels with ASCVD risks. The analysis included 26,316 participants (aged 40 to 79 years without a history of ASCVD) from four large U.S. cohort studies, with baseline data collected from 1995 to 2007 and a median follow-up of 13.0 years.

The researchers found that 44.7 percent had at least one adverse individual-level SDOH and 41.5 percent had at least one adverse area-level SDOH. At both the individual and area levels, SDOH, including low education, low income, and unemployment, were associated with an increased risk for ASCVD. Model discrimination did not change by adding area-level SDOH alone to the pooled cohort equations (PCEs) but modestly improved calibration. There were modest improvements in both discrimination and calibration when adding both individual- and area-level SDOH to the PCEs among non-Hispanic Black individuals (change in C index, 0.0051; change in scaled integrated Brier score [IBS], 0.396 percent), as well as improvement in calibration in White individuals (change in scaled IBS, 0.274 percent).

“Both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals,” the authors write.

One author reported owning stock in MedExplain. 

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Rates of dual-energy X-ray absorptiometry (DXA) screening for osteoporosis are lower than expected for Asian American Medicare beneficiaries, according to a study published online March 9 in Skeletal Radiology.

Soterios Gyftopoulos, M.D., from New York University Langone Health in New York City, and colleagues assessed osteoporosis screening utilization rates among Asian American populations. The sanalysis included 80,439 Medicare beneficiaries.

The researchers found that 15.1 percent received osteoporosis screening. For women, the DXA rate was approximately four times greater than the rate for men (19.8 versus 5.0 percent). For Asian American beneficiaries living in ZIP codes with higher mean household income, DXA was significantly more common than for those in lower-income areas (17.6 versus 14.3 percent). DXA was significantly more common among beneficiaries aged younger than 80 years (15.5 percent) versus those aged 80 years and older (14.1 percent). Asian American beneficiaries had significantly lower DXA rates compared with other races and ethnicities, when controlling for years of Medicare eligibility, age, sex, location, and mean income.

“We found lower than expected DXA screening rates for Asian American patients,” the authors write. “A better understanding of the barriers and facilitators to Asian American osteoporosis screening is needed to improve patient care.”

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Global initiatives have significantly enhanced early HIV detection. However, despite the strides, in many parts of the world, late diagnosis and the prevalence of opportunistic infections persist.  

A retrospective study published in Annals of Global Health focused on evaluating the occurrence and types of opportunistic infections (OIs) among newly identified HIV patients in Ghana and the factors influencing them.

Variables That Impact Opportunistic Infections in Ghana’s HIV Patients 

An analysis was carried out using data from 423 patients at the Korle-Bu Teaching Hospital, aged 18 years and older, diagnosed with HIV between July 1, 2018 and December 2019. Through the application of multivariate logistic regression, the study examined the variables associated with the onset of OIs. A p-value of less than 0.05 was considered statistically significant for this study.

The participants’ average age at the time of diagnosis was 40.15 years ± 11.47 years, with a gender distribution of 30.3% male and 69.7% female. 

The investigation revealed a 33.1% prevalence rate of opportunistic infections among newly diagnosed patients (95% confidence interval (CI) 34.6–44.1). Notably, approximately 70% of those affected by OIs were in WHO clinical classification stages III or IV of HIV.

Common Opportunistic Infection Types 

Candidiasis, affecting the oral to esophageal regions, emerged as the most prevalent OI at 36.9%, followed by cerebral toxoplasmosis at 19.9%. The analysis also indicated that women had a 51% lower chance of presenting an OI at diagnosis compared to men. 

Factors Influencing Prevalence 

Factors such as employment status significantly influenced the likelihood of OIs, with employed individuals having 2.5 times higher odds than their unemployed counterparts and self-employed individuals having 3.6 times higher odds. Students were noted to have 3.8 times higher odds of developing an OI.

In addition, those in the later stages of HIV, specifically stages III and IV, were significantly more prone to OIs, with a likelihood 15.88 times greater than those in earlier stages.

The Need for Detection Strategies 

In this study, one-third of patients receiving a new HIV diagnosis also contended with opportunistic infections, with a higher susceptibility noted among men. This highlights a need for enhanced detection strategies, focusing particularly on reaching and testing men, to bridge the awareness and testing gap effectively.

Source: 

Puplampu, P., Asafu-Adjaye, O., Harrison, M., Tetteh, J., & Ganu, V. (2024). Opportunistic Infections among newly diagnosed HIV patients in the largest tertiary facility in Ghana. Annals of Global Health, 90(1). https://doi.org/10.5334/aogh.4149 

Persistent disparities by race/ethnicity are seen in the incidence of tuberculosis (TB), according to a study published online April 2 in the Annals of Internal Medicine.

Yunfei Li, Sc.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues quantified trends in racial/ethnic disparities in TB incidence among U.S.-born persons in a time series analysis of national TB registry data for 2011 to 2021.

The researchers found that compared with non-Hispanic White persons, the incidence rate ratios were as high as 14.2 among American Indian or Alaska Native females in an analysis of TB incidence rates for each racial/ethnic population. Females, younger persons, and those with TB attributed to recent transmission had greater relative disparities. Males had greater absolute disparities. In 2011 to 2021, excess TB cases represented 69 and 62 percent of total cases for females and males, respectively. The investigators found no evidence to suggest a reduction in incidence rate ratios over time; small, statistically nonsignificant increases were seen in most relative disparity measures.

“Reducing barriers to TB prevention activities and ensuring that all persons have access to affordable and effective TB services are essential for accelerating progress toward population-level TB elimination,” the authors write. “Public health action to address disparities requires the collection of evidence to determine the causes of these disparities and the efficiency of interventions to close them.”

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Postmenopausal changes may accelerate coronary artery calcium (CAC) progression in women, according to a study presented at the annual meeting of the American College of Cardiology, held from April 6 to 8 in Atlanta.

Ella Ishaaya, M.D., from Harbor-UCLA Medical Center in Torrance, California, and colleagues compared CAC progression between postmenopausal women and age-matched men with equivalent statin therapy and coronary artery disease risk factors to determine if postmenopausal changes contribute to faster CAC progression. The analysis included 579 postmenopausal women on statin therapy who underwent baseline and follow-up CAC scans at least one year apart, as well as male patients, matched (1:1) for age, race, statin use, hypertension, and diabetes mellitus.

The researchers found that for a baseline CAC level of 1 to 99, women had significantly higher CAC progression versus men (8 versus 4 points). Annualized median CAC change for a baseline CAC of 100 to 399 was 31 versus 16 points for women versus men. When CAC was >400, there was no significant difference observed in annualized progression by gender.

“This is a unique study cohort of only postmenopausal statin users that signals that postmenopausal women may have risk of heart disease that is on par with males,” Ishaaya said in a statement. “Women are underscreened and undertreated, especially postmenopausal women, who have a barrage of new risk factors that many are not aware of. This study raises awareness of what those risk factors are and opens the door to indicating the importance of increased screening for coronary artery calcium.”

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Insulin out-of-pocket (OOP) cost caps are associated with a reduction in insulin OOP costs, but no increase in insulin use, according to a study published online March 26 in the Annals of Internal Medicine.

Laura F. Garabedian, Ph.D., M.P.H., from Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, and colleagues conducted a pre-post study with a control group to examine the effect of state insulin OOP caps on insulin use and OOP costs among patients with diabetes. Data were included from eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021 and 17 control states.

The researchers found that in the overall population, state insulin caps were not associated with changes in insulin use (relative change in fills per month, 1.8 percent). In intervention states, insulin users had a 17.4 percent relative reduction in insulin OOP costs, which was mainly driven by reductions among health savings account (HSA) enrollees; among nonaccount plan members, there were no differences seen in OOP costs. Insulin OOP cost reductions were larger (40.0 percent) in association with more generous ($25 to $30) state insulin OOP caps, which was mainly driven by larger reductions in those with HSA plans.

“Other policies might be needed to improve access to affordable insulin among commercially insured patients with diabetes who have cost-related underuse,” the authors write.

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Pharmacy dispensing patterns for sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP1-RA) medications show lower prescribing for minority patients; and the rate of SGLT2i prescriptions is low among patients with indications for therapy, according to two studies presented at the American Heart Association Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2024 Scientific Sessions, held from March 18 to 21 in Chicago.

Luis A. Rodriguez, Ph.D., M.P.H., from Kaiser Permanente in Oakland, California, and colleagues conducted a retrospective cohort study of adults with type 2 diabetes from six large U.S. care delivery systems to examine pharmacy dispensing of SGLT2i and GLP1-RA medications. The cohort included 681,823 patients, who were followed for a median of six years. The researchers found that from 2014 to 2022, there was an increase in the age-, sex-, and site-adjusted rate of annual pharmacy dispensing of SGLT2i and GLP1-RA medications (from 0.1 to 12.2 and from 0.3 to 3.8 percent, respectively). In the fully adjusted models, SGLT2i and GLP1-RA dispensing was lower for minorities compared with Whites.

Jung-Im Shin, M.D., Ph.D., from Johns Hopkins University in Baltimore, and colleagues characterized SGLT2i prescription patterns by indication for therapy in patients with and without diabetes in 2022 in the United States. A total of 760,337 patients with diabetes and 2,640,077 without diabetes were classified by their indications for SGLT2i therapy. The researchers found that SGLT2i medications were prescribed in 11.2, 11.2, and 7.1 percent with indication present, absent, or unknown, respectively, among those with diabetes, and in 2.5, 0.1, and 0.1 percent, respectively, among those without diabetes.

“Interventions are needed to increase uptake of guideline recommendations for SGLT2i use,” Shin said in a statement.

Several authors from the Rodriguez and Shin studies disclosed ties to the pharmaceutical industry.

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