Bhav Jain
MD Student with Scholarly Concentration in Health Services & Policy Research / Surgery, expected graduation Spring 2028
Bio
Bhav Jain is pursuing an MD at the Stanford School of Medicine as a Knight-Hennessy Scholar, Harry S. Truman Scholar, and Samvid Scholar. He graduated from the Massachusetts Institute of Technology (MIT) with a bachelor’s degree in computer science and brain and cognitive sciences. At MIT, he was a Legatum Fellow and received the 40 Under 40 in Cancer Award.
His research on healthcare delivery, social determinants of health, and value-based care has been published in outlets such as Nature Medicine, The Lancet Digital Health, JAMA Oncology, Journal of the National Cancer Institute, American Journal of Public Health, Cancer, Journal of the American College of Surgeons, Journal of General Internal Medicine, and American Journal of Managed Care. While at MIT, he launched The Connected Foundation, which forges intergenerational connections between youth and seniors, and Compass, an SMS platform that streamlines patient intake and scheduling. Most recently, he served as a Fellow at the Boston Public Health Commission to implement interventions aimed at curbing substance abuse and homelessness. As a physician-policymaker, Bhav aspires to create high-value, evidence-based healthcare systems that transform clinical care globally. In particular, he seeks to innovate at both public- and private-sector organizations during his career to improve the quality of and lower the cost of patient care.
Contact
https://orcid.org/0000-0003-2648-4894All Publications
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National Cancer System Characteristics and Global Pan-Cancer Outcomes.
JAMA oncology
2025
Abstract
Approximately 29.9 million cancer cases and 15.3 million deaths are anticipated by 2040 globally, necessitating cancer system strengthening. A greater understanding of health system factors that can be leveraged to improve cancer control may guide health system planning.To evaluate predictors of improved cancer outcomes globally.This pan-cancer ecological study used the most recent available national health system metrics and cancer statistics, spanning the breadth of global income levels across 185 countries. Estimates of age-standardized mortality to incidence ratios were derived from GLOBOCAN 2022 for patients with cancer of all ages. The analysis took place on November 27, 2024.Health spending as a percent of gross domestic product (GDP), physicians per 1000 population, nurses and midwives per 1000 population, surgical workforce per 1000 population, GDP per capita, Universal Health Coverage (UHC) service coverage index, availability of pathology services, human development index, gender inequality index (GII), radiotherapy centers per 1000 population, and out-of-pocket expenditure as percentage of current health expenditure were collected. The association between the mortality to incidence ratio (MIR) and each metric was evaluated using univariable linear regressions (α = .0045), which were used to construct multivariable models (α = .05). Variation inflation factor allowed exclusion of variables with significant multicollinearity. R2 measured goodness of fit.On univariable analysis, all metrics were significantly associated with MIR of cancer (P < .001 for all), including UHC index (β, -0.0076 [95% CI, -0.0083 to -0.0068]), GDP per capita (β, -5.10 × 10-6 [95% CI, -5.75 × 10-6 to -4.46 × 10-6]), clinical and workforce capacity, radiotherapy capacity (β, -88.25 [95% CI, -100.43 to -76.06]), and gender inequality index (β, 0.63 [95% CI, 0.57-0.70]). After including metrics significant on univariable analysis and correcting for multicollinearity, on multivariable analysis, greater UHC index and GDP per capita were independently associated with lower (improved) MIR for cancer. The multivariable model had R2 of 0.87. On multivariable analysis stratified by sex, greater UHC index and greater GDP per capita were independently associated with improved MIR for all cancers. R2 for the multivariable models was 0.87 for females and 0.85 for males.This study found that global health system metrics related to progress toward universal health care, greater health care spending and GDP per capita, strengthened clinical workforce and capacity, and increased gender equity were associated with improved pan-cancer outcomes at a population level on univariable analysis. The degree of UHC and GDP per capita were independently associated with improved cancer outcomes in multivariable models with good explanatory power. These exploratory findings merit further validation and may guide health system planning and prioritization.
View details for DOI 10.1001/jamaoncol.2025.0473
View details for PubMedID 40208599
View details for PubMedCentralID PMC11986824
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Depolarizing Health Policy Through Intergenerational Conversations.
American journal of public health
2025; 115 (4): 489-491
View details for DOI 10.2105/AJPH.2024.307971
View details for PubMedID 40073352
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Treatment Noncompletion and Shorter Radiation Regimens Among US Patients With Prostate Cancer: A Focus on Asian American and Pacific Islander Patients.
The Prostate
2025
Abstract
Higher rates of radiation therapy (RT) noncompletion may be associated with certain demographic groups in patients with prostate cancer (PC). We examined disparities in noncompletion and receipt of shorter RT regimens among disaggregated Asian American and Pacific Islander groups in the US.We performed a retrospective cohort analysis of all patients diagnosed with localized PC (2004-2017) in the National Cancer Database who identified as White, East Asian, Southeast Asian, Pacific Islander, or South Asian who were treated with definitive RT. The two primary outcomes were 1) treatment noncompletion and 2) receiving shorter RT regimens. Regression models were adjusted for relevant sociodemographic and clinical factors.The analytic cohort was comprised of 143,379 patients [White, n = 140,656 (98.10%); East Asian, n = 1,150 (0.80%); Southeast Asian, n = 925 (0.65%); Pacific Islander, n = 195 (0.14%); South Asian, n = 453 (0.32%)]. On multivariable analysis, Southeast Asian patients were associated with increased rate of noncompletion compared to White patients (Southeast Asian vs. White; OR: 1.55 [95% CI: 1.29-1.86], p < 0.001). Geographic region of the treatment facility within the United States also was significant, as patients from the South Atlantic (OR: 1.32 [95% CI: 1.24-1.41], p < 0.001), East North Central (OR: 1.09 [95% CI: 1.03-1.17], p = 0.007), East South Central (OR: 1.54 [95% CI: 1.41-1.68], p < 0.001), and West South Central (OR: 1.14 [95% CI: 1.04-1.24], p = 0.005) regions all had higher rates of noncompletion in comparison to patients from New England. Distance from treatment facility, presence of comorbidities, and education attainment rates significantly impacted treatment noncompletion as well. Additionally, our study reports disparities in receipt of short course RT. Pacific Islander patients had substantially higher rates of SBRT (OR: 2.60 [95% CI: 1.10-6.16], p = 0.030) compared to White patients, while Hispanic patients had lower rates of SBRT (OR: 0.48 [95% CI: 0.40-0.57], p < 0.001). Furthermore, receiving treatment in urban (OR: 0.68 [95% CI: 0.61-0.76], p < 0.001) and metro (OR: 0.50 [95% CI: 0.39-0.65], p < 0.001) facilities was associated with reduced access to SBRT than facilities in rural areas. Patients who received treatment in the Middle Atlantic (OR: 3.28 [95% CI: 2.91-3.68], p < 0.001), South Atlantic (OR: 2.72 [95% CI: 2.40-3.09], p < 0.001), East North Central (OR: 1.53 [95% CI: 1.34-1.75], p < 0.001), East South Central (OR: 3.07 [95% CI: 2.61-3.63], p < 0.001), West North Central (OR: 2.35 [95% CI: 2.02-2.75], p < 0.001), and Mountain (OR: 2.45 [95% CI: 2.01-2.97], p < 0.001) regions of the United States had significantly higher rates of SBRT compared to patients from New England.This analysis found that Southeast Asian patients had higher rates of RT noncompletion in comparison to White patients. Additionally, disparities in SBRT access-a shorter course of RT as compared to traditional therapies-were found based on race/ethnicity and geographical factors. Our findings emphasize heterogeneous differences amongst diverse Asian American and Pacific Islander groups and support the need for further disaggregated cancer disparities research to inform targeted interventions.
View details for DOI 10.1002/pros.24887
View details for PubMedID 40165019
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ASO Visual Abstract: Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients with Breast Cancer.
Annals of surgical oncology
2025
View details for DOI 10.1245/s10434-025-17133-y
View details for PubMedID 40128396
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Disparities in Refusal of Adjuvant Radiation for Breast-Conserving Therapy in the USA.
Annals of surgical oncology
2025
Abstract
Breast-conserving therapy (BCT) with lumpectomy and adjuvant radiation offers equivalent outcomes to mastectomy among many patients with early-stage (T1-2N0) breast cancer. Nevertheless, certain populations may experience barriers to receiving BCT and may refuse radiation therapy (RT). We utilized the National Cancer Database (NCDB) to assess factors associated with refusal of adjuvant RT among patients receiving lumpectomy.We performed a retrospective cohort analysis of women ≥ 18 years old diagnosed with cT1-2N0M0 disease in the NCDB from 2004 to 2017 who underwent lumpectomy for removal of the primary tumor. Multivariable logistic regression was used to calculate the adjusted odds ratios (ORs) of refusing RT despite physician recommendation in association with relevant sociodemographic variables. All statistical testing was two sided, and the results were deemed statistically significant at p < 0.05.Of the 580,192 women who underwent lumpectomy, 29,527 (5.09%) refused recommended RT. In the adjusted analysis, Black (OR 1.07 [95% confidence intervals (CI) 1.02-1.12], p = 0.006) and Native Hawaiian or Pacific Islander (OR 1.35 [95% CI 1.04-1.74], p = 0.025) women were more likely to refuse RT than White women. Older age, higher educational attainment, greater distance from treatment facility, uninsured status, greater comorbidity burden, and higher clinical stage were also associated with refusal of RT (all p < 0.05).Disparities persist in the refusal of recommended adjuvant RT among patients with early-stage breast cancer. Efforts are needed to further understand underlying reasons for treatment refusal, to promote patient education informed by cultural humility, and to reduce barriers to RT access.
View details for DOI 10.1245/s10434-025-17152-9
View details for PubMedID 40119190
View details for PubMedCentralID 8100916
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The health impacts of political unrest in Bangladesh and steps forward.
Medicine, conflict, and survival
2025: 1-5
View details for DOI 10.1080/13623699.2025.2471733
View details for PubMedID 40038054
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Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients with Breast Cancer.
Annals of surgical oncology
2025
Abstract
Cancer is the leading cause of death among Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) populations, who are among the most diverse and rapidly growing racial/ethnic groups in the United States. Despite this population's diverse socioeconomic, cultural, and immigration backgrounds, little is known about the within-group disparities in breast cancer stages at diagnosis. This study aims to identify AA&NHPI subgroups at heightened risk for advanced breast cancer by analyzing detailed incidence rates and diagnostic stages across these diverse subgroups.Patient data spanning from 2004 to 2020 were extracted from the National Cancer Database, focusing on individuals newly diagnosed with breast cancer. Individuals were disaggregated into specific AA&NHPI subgroups by self-reported country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs). Higher adjusted odds ratios signify more advanced stage diagnoses.Of 3,001,173 patients with breast cancer, 99,128 (3.30%) identified as AA&NHPI. Compared with NHW patients, AA&NHPI patients were younger (median age, NHW: 62 years versus AA&NHPI: 57 years, p < 0.001) and more likely to be uninsured (NHW: 1.50% vs. AA&NHPI: 2.60%, p < 0.001). The largest AA&NHPI subgroups were Filipino (n = 21,666, 21.9% of AA&NHPI), Chinese (n = 21,303, 21.5%), Indian/Pakistani (n = 20,295, 20.5%), Vietnamese (n = 6680, 6.74%), and Korean (n = 7776, 7.84%). In aggregate, AA&NHPI patients were less likely to present with advanced stage at diagnosis relative to NHW patients (AOR 0.89, 95% confidence interval [CI] 0.88-0.90, p < 0.001). However, AA&NHPI disaggregation demonstrated that Hawaiian (AOR 1.15, 95% CI 1.09-1.22, p < 0.001), Hmong (AOR 1.70, 95% CI 1.28-2.27, p < 0.001), Laotian (AOR 1.37, 95% CI 1.17-1.61, p < 0.001), and Pacific Islander patients (AOR 1.24, 95% CI 1.17-1.32, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the reference AA&NHPI group), all AA&NHPI ethnic groups had higher odds of advanced-stage diagnosis with the highest odds in Hmong (AOR 2.41, 95% CI 1.81-3.20, p < 0.001), Laotian (AOR 1.89, 95% CI 1.61-2.20, p < 0.001), Pacific Islander (AOR 1.71, 95% CI 1.60-1.82, p < 0.001), and Hawaiian (AOR 1.57, 95% CI 1.48-1.67, p < 0.001) patients.Our study characterizes disparities in the stage of breast cancer at presentation across disaggregated AA&NHPI groups, with notably advanced diagnoses in patients of Hmong, Laotian, Pacific Islander, Hawaiian, and Kampuchean descent. These findings underscore the need for disaggregated research exploring both risk factors and barriers to early diagnosis, as well as culturally tailored interventions that involve community leaders and leverage cultural norms to improve cancer screening and diagnosis.
View details for DOI 10.1245/s10434-025-16974-x
View details for PubMedID 40025362
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Cancer incidence and mortality estimates in 2022 in southeast Asia: a comparative analysis.
The Lancet. Oncology
2025
Abstract
Cancer is a leading cause of morbidity and mortality in southeast Asia. We aimed to present and interpret cancer incidence and mortality statistics in the 11 constituent countries of Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, and Viet Nam to inform research priorities, health services, and cancer policy.The number of new incident cases and deaths for all cancers combined and for leading cancers were extracted from the GLOBOCAN 2022 database developed by the International Agency for Research on Cancer for the 11 countries in southeast Asia. For comparison, we extracted estimates from China, India, Japan, Pakistan, South Korea, and the USA. We estimated age-standardised incidence rates (ASIRs) and age-standardised mortality rates (ASMRs) per 100 000 person-years; projections to 2050 were also estimated by multiplying ASIR and ASMR estimates for 2022 by the expected population for 2050. Data on race or ethnicity were not collected.Data were extracted on Dec 5, 2024. For the 11 countries in southeast Asia for all cancers combined, 545 725 (47·6%) of a total of 1 146 810 incident cases were estimated in men and 601 085 (52·4%) incident cases were estimated in women in 2022. In the same period, 385 430 (53·8%) of a total of 716 116 deaths were estimated in men and 330 686 (46·2%) deaths were estimated in women. The total cancer ASIR in men and women was highest in Singapore (235·89 per 100 000 and 231·01 per 100 000 respectively), while the corresponding ASMR was greatest in Laos for men (132·91 per 100 000) and Brunei for women (104·20 per 100 000). Breast cancer was the most common cancer among women in all countries (highest ASIRs in Singapore [72·61 per 100 000] and the Philippines [60·34 per 100 000]), and the most common cause of cancer mortality among women in the Philippines (ASMR 21·47 per 100 000), Malaysia (19·30 per 100 000), Singapore (17·82 per 100 000), Viet Nam (14·67 per 100 000), Indonesia (14·35 per 100 000), and Timor-Leste (10·24 per 100 000). Among men, lung cancer was the most frequently diagnosed cancer in the Philippines (ASIR 37·66 per 100 000), Malaysia (23·23 per 100 000), Myanmar (21·59 per 100 000), and Indonesia (21·30 per 100 000), and the leading cause of death due to cancer in the Philippines (ASMR 33·59 per 100 000), Singapore (31·94 per 100 000), Brunei (23·84 per 100 000), Malaysia (20·42 per 100 000), Myanmar (19·91 per 100 000), Indonesia (18·96 per 100 000), and Timor-Leste (12·95 per 100 000). Liver cancer contributed the greatest incidence and mortality in men in Cambodia, Laos, Viet Nam, and Thailand, and was also the leading cause of death due to cancer among women in Laos (ASMR 13·49 per 100 000), Cambodia (13·34 per 100 000), and Thailand (12·14 per 100 000). Cervical cancer was the leading cause of death due to cancer in women in Myanmar (ASMR 13·37 per 100 000); colorectal cancer was the most common cancer in men in Singapore (ASIR 39·41 per 100 00) and Brunei (37·70 per 100 000). By 2050, 2·03 million new cases of cancer are anticipated in southeast Asia annually, an 89·2% increase in men and a 65·6% increase in women, relative to 2022.The current patterns of cancer incidence and mortality in southeast Asia are primarily driven by breast cancer in women and lung cancer in men, but infection-related cancers (liver and cervix) are common in some countries. Regional collaborations must be strengthened to improve cancer prevention, diagnosis, care, and research in southeast Asia.National Cancer Institute and the Prostate Cancer Foundation.
View details for DOI 10.1016/S1470-2045(25)00017-8
View details for PubMedID 40024257
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Association Between Medicaid Expansion and Insurance Status, Risk Group, Receipt, and Refusal of Treatment Among Men with Prostate Cancer.
Cancers
2025; 17 (3)
Abstract
Background: Although the Patient Protection and Affordable Care Act (ACA) has been associated with increased Medicaid coverage among prostate cancer patients, the association between Medicaid expansion with risk group at diagnosis, time to treatment initiation (TTI), and the refusal of locoregional treatment (LT) among patients requires further exploration. Methods: Using the National Cancer Database, we performed a retrospective cohort analysis of all patients aged 40 to 64 years diagnosed with localized prostate cancer from 2011 to 2016. Difference-in-difference (DID) analysis was used to compare changes in insurance status, risk group at diagnosis, TTI, and the refusal of LT among patients residing in Medicaid expansion versus non-expansion states. In a secondary analysis, we used DID to compare changes in the above outcomes among racial minorities versus White patients living in expansion states. Results: Of the 112,434 patients with prostate cancer in our analysis, 50,958 patients lived in Medicaid expansion states, and 61,476 patients lived in non-expansion states. In the adjusted analysis, we found that the proportion of uninsured patients (adjusted DID: -0.87%; 95% confidence interval [95% CI]: -1.28 to -0.46) and patients who refused radiation therapy (adjusted DID: -0.71%; 95% CI: -0.95 to -0.47) decreased more in expansion states compared to non-expansion states. Similarly, we observed that the racial disparity of select outcomes in expansion states narrowed, as racial minorities experienced larger absolute decreases in uninsured status and the refusal of radiation therapy (RT) regimens than White patients following ACA implementation (p < 0.01 for all). However, residence in a Medicaid expansion state was not associated with changes in risk group at diagnosis, TTI, nor the refusal of LT (p > 0.01 for all); racial disparities in TTI were also exacerbated in expansion states following ACA implementation. Conclusions: The association between Medicaid expansion and prostate cancer outcomes and disparities remains unclear. While ACA implementation was associated with increased insurance coverage and decreased refusal of RT, there was no significant association with earlier risk group at diagnosis, TTI within 180 days, or refusal of LT. Similarly, racial minorities in expansion states had larger decreases in uninsured status and the refusal of RT regimens, as well as smaller increases in intermediate-/high-risk disease at presentation than White patients following ACA implementation, but experienced no significant changes in TTI. More research is needed to understand how Medicaid expansion affects cancer outcomes and whether these effects are borne equitably among different populations.
View details for DOI 10.3390/cancers17030547
View details for PubMedID 39941913
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Limitations of Intraoperative Neuromonitoring for Detection of Cerebral Ischemia.
Journal of cardiothoracic and vascular anesthesia
2024
View details for DOI 10.1053/j.jvca.2024.12.032
View details for PubMedID 39779427
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The Burden of Hematologic Malignancies in Southeast Asia from 1990 to 2021: Estimates from the Global Burden of Disease Study
ELSEVIER. 2024: 7755-7756
View details for DOI 10.1182/blood-2024-202702
View details for Web of Science ID 001412527300020
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Trends in Location of Death for Individuals With Primary Bone Tumors in the United States
ORTHOPEDICS
2024: 1-7
Abstract
Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate trends in use of dedicated end-of-life care settings and investigate sociodemographic disparities in location of death among individuals with primary bone cancer.A retrospective, population-based review of patients who died of primary bone cancer-related causes was performed using the Underlying Cause of Death public use record from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) database for the years 2003 through 2019. A total of 24,557 patients were included.Over the study period, the proportion of primary bone cancer-related deaths occurring at home and in hospice increased, whereas those occurring in hospital, nursing home, and outpatient medical facility/emergency department settings decreased. Several sociodemographic factors were found to be associated with location of death, including age, marital status, and level of education. Moreover, patients of racial and ethnic minority groups were at significantly lower risk of experiencing death at home or in outpatient medical facility/emergency department settings relative to a hospital compared with White patients.Although rates of in-hospital death from primary bone cancer are decreasing, marked racial and ethnic disparities in use of dedicated end-of-life care settings exist. These gaps must be addressed to ensure all patients with primary bone cancer have equitable access to high-quality end-of-life care regardless of racial, ethnic, or socioeconomic status. [Orthopedics. 202x;4x(x):xx-xx.].
View details for DOI 10.3928/01477447-20241028-02
View details for Web of Science ID 001348676100001
View details for PubMedID 39495157
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Understanding and training for the impact of large language models and artificial intelligence in healthcare practice: a narrative review.
BMC medical education
2024; 24 (1): 1096
Abstract
Reports of Large Language Models (LLMs) passing board examinations have spurred medical enthusiasm for their clinical integration. Through a narrative review, we reflect upon the skill shifts necessary for clinicians to succeed in an LLM-enabled world, achieving benefits while minimizing risks. We suggest how medical education must evolve to prepare clinicians capable of navigating human-AI systems.
View details for DOI 10.1186/s12909-024-06048-z
View details for PubMedID 39375721
View details for PubMedCentralID PMC11459854
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Trends in Location of Death for Individuals With Pediatric Cancer.
JAMA pediatrics
2024
View details for DOI 10.1001/jamapediatrics.2024.3102
View details for PubMedID 39312252
View details for PubMedCentralID PMC11420816
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Fetal Personhood Laws and Their Implications for Health Care.
JAMA
2024
View details for DOI 10.1001/jama.2024.14739
View details for PubMedID 39283620
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Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.
American journal of obstetrics and gynecology
2024
Abstract
Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the AANHPI community, prior studies in cervical cancer have considered this group in aggregate.We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated AANHPI groups.Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer was retrospectively analyzed. AANHPI patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus non-metastatic disease at diagnosis.Out of 122,926 patients with cervical cancer, 5,142 (4.2%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients presented at lower stages of cancer (NHW: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Filipino Americans (n=1051, 20.4% of AANHPI), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. AANHPI disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (aOR 1.58, 95% CI 1.21-2.06, p = 0.001) relative to non-Hispanic White patients. Conversely, Chinese American (aOR 0.47, 95% CI 0.37-0.59, p < 0.001), Vietnamese American (aOR 0.54, 95% CI 0.41-0.70, p < 0.001), Hmong American (aOR 0.46, 95% CI 0.22-0.97, p = 0.040), and Indian/Pakistani American (aOR 0.76, 95% CI 0.61-0.94, p = 0.013) patients were less likely to present with metastatic disease. Compared to the largest AANHPI group (Chinese American), nine other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (aOR 3.44, 95% CI 2.41-4.91, p < 0.001), Thai American (aOR 2.79, 95% CI 1.41-5.53, p = 0.003), Kampuchean American (aOR 2.39, 95% CI 1.29-4.42, p = 0.006), Native Hawaiian American (aOR 2.23, 95% CI 1.37-3.63, p = 0.001), and Laotian American (aOR 2.02, 95% CI 1.13-3.61, p = 0.017). In contrast, Vietnamese American (aOR 1.20, 95% CI 0.85-1.71, p = 0.303) and Hmong American (aOR 1.09, 95% CI 0.50-2.37, p = 0.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population - including Pacific Islander American and Thai American patients - may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.
View details for DOI 10.1016/j.ajog.2024.08.027
View details for PubMedID 39179090
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Risk factors and operative risk of large vessel occlusion and stroke during cardiac surgery.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2024; 33 (11): 107958
Abstract
Perioperative Large Vessel Occlusions (LVOs) occurring during and following surgery are of immense clinical importance. As such, we aim to present risk factors and test if the Society of Thoracic Surgery (STS) mortality and stroke risk scores can be used to assess operative risk.Using data containing 7 index cardiac operations at a single tertiary referral center from 2010 to 2022, logistic and multivariate regression analysis was performed to identify factors that correlate to higher operative LVO and stroke rate. Odds ratios and confidence intervals were also obtained to test if the STS-Predicted Risk of Mortality (PROM) and -Predicted Risk of Stroke (PROS) scores were positively correlated to operative LVO and stroke rate.Multivariate modeling showed primary risk factors for an operative LVO were diabetes (OR: 1.727 [95 % CI: 1.060-2.815]), intracranial or extracranial carotid stenosis (OR: 3.661 [95 % CI: 2.126-6.305]), and heart failure as defined by NYHA class (Class 4, OR: 3.951 [95 % CI: 2.092-7.461]; compared to Class 1). As the STS-PROM increased, the relative rate of LVO occurrence increased (very high risk, OR: 6.576 [95 % CI: 2.92-14.812], high risk, OR: 2.667 [1.125-6.322], medium risk, OR: 2.858 [1.594-5.125]; all compared to low risk). STS-PROS quartiles showed a similar relation with LVO risk (quartile 4, OR: 7.768 [95 % CI: 2.740-22.027], quartile 3, OR: 5.249 [1.800-15.306], quartile 2, OR:2.980 [0.960-9.248]; all compared to quartile 1).Patients with diabetes, carotid disease and heart failure are at high risk for operative LVO. Both STS-PROM and -PROS can be useful metrics for preoperative measuring of LVO risks.
View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.107958
View details for PubMedID 39159904
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Cancer burden across the South Asian Association for Regional Cooperation in 2022.
BMJ oncology
2024; 3 (1): e000466
Abstract
The objective of this study is to present a cross-sectional analysis of cancer burden in the South Asian Association for Regional Cooperation (SAARC) region and explain unique characteristics of its cancer burden as compared with the rest of the world.Using publicly available data from the Global Cancer Observatory (GCO) and the World Bank, we collected cancer statistics and population statistics for Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka from 2017 to 2022.The number of newly diagnosed cases in the region was 1 846 963, representing 9.3% of the incidence worldwide. As defined by the GCO, the crude incidence rate (CIR) (per 100 000) of cancer in SAARC was 97.3 compared with the worldwide rate of 235.5. The crude mortality rate (per 100 000) in SAARC was 63.4, compared with 123.6 globally. However, the mortality to incidence ratio (MIR) (per 100 000) was 0.65, compared with 0.49 globally.Our research highlights SAARC's unique cancer landscape with low incidence (CIR) and mortality (CMR) but elevated MIR compared with global figures. These findings underscore the need for a united, contextually relevant approach to addressing the burden of cancer in SAARC. In particular, investment in collaborative, tailored cancer care programmes will build the SAARC region's capacity to address the growing cancer challenge.
View details for DOI 10.1136/bmjonc-2024-000466
View details for PubMedID 39886156
View details for PubMedCentralID PMC11347699
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Trends in location of death for individuals with acute myeloid leukemia in the United States.
Leukemia & lymphoma
2024: 1-4
View details for DOI 10.1080/10428194.2024.2382330
View details for PubMedID 39066785
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Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2024; 32 (8): 494
Abstract
Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer.We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates.Among 775,289 individuals diagnosed with cancer (median age: 68 years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001).Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.
View details for DOI 10.1007/s00520-024-08633-w
View details for PubMedID 38977496
View details for PubMedCentralID 9949565
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Contemporary Patterns of Financial Toxicity Among Patients With Rheumatologic Disease in the United States.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
2024
Abstract
Rheumatologic diseases encompass a group of disabling conditions that often require expensive clinical treatments and limit an individual's ability to work and maintain a steady income. The purpose of this study was to evaluate contemporary patterns of financial toxicity among patients with rheumatologic disease and assess for any associated demographic factors.The cross-sectional National Health Interview Survey was queried from 2013 to 2018 for patients with rheumatologic disease. Patient demographics and self-reported financial metrics were collected or calculated including financial hardship from medical bills, financial distress, food insecurity, and cost-related medication (CRM) nonadherence. Multivariable logistic regressions were used to assess for factors associated with increased financial hardship.During the study period, 20.2% of 41,502 patients with rheumatologic disease faced some degree of financial hardship due to medical bills, 55.0% of whom could not pay those bills. Rheumatologic disease was associated with higher odds of financial hardship from medical bills (adjusted odds ratio, 1.29; 95% confidence interval, 1.22-1.36; p < 0.001) with similar trends for patients suffering from financial distress, food insecurity, and CRM nonadherence (p < 0.001 for all). Financial hardship among patients with rheumatologic disease was associated with being younger, male, Black, and uninsured (p < 0.001 for all).In this nationally representative study, we found that a substantial proportion of adults with rheumatologic disease in the United States struggled with paying their medical bills and suffered from food insecurity and CRM nonadherence. National health care efforts and guided public policy should be pursued to help ease the burden of financial hardship for these patients.
View details for DOI 10.1097/RHU.0000000000002110
View details for PubMedID 38976618
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Dying with dignity: how can we deliver values-concordant end-of-life care for immigrant patients in the United States?
Lancet regional health. Americas
2024; 35: 100776
View details for DOI 10.1016/j.lana.2024.100776
View details for PubMedID 38803546
View details for PubMedCentralID PMC11128497
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Culturally Tailored Strategies to Enhance Type 2 Diabetes Care for South Asians in the United States.
Journal of general internal medicine
2024
Abstract
South Asian immigrants in the United States face an elevated risk of developing type 2 diabetes (T2DM). This phenomenon has been linked to lifestyle factors and social determinants of health (SDOH) such as high-carbohydrate diet, limited physical activity, and stress from assimilation and other life challenges. Unfortunately, barriers stemming from language discordance, low health literacy, and certain cultural practices can hinder effective clinical management of T2DM among South Asian immigrants. In this perspective, we address these sociocultural barriers and propose culturally informed recommendations to improve healthcare delivery for South Asian groups and empower South Asian patients to self-manage T2DM. Our recommendations include (1) considerations and support for SDOH in South Asian communities, (2) culturally tailored healthcare delivery for South Asians, (3) mHealth technologies for T2DM education and self-management; and (4) enhanced epidemiological and South Asian-centric research.
View details for DOI 10.1007/s11606-024-08902-8
View details for PubMedID 38943015
View details for PubMedCentralID 4026332
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Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557402805
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Disparities in stage at presentation for disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups with breast cancer
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557400226
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Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557401381
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Cancer burden across South Asia in 2020: A global cancer observatory analysis.
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557405679
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Disparities in incidence and mortality of hematologic cancers in Southeast Asia: A 2020 analysis.
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557405678
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Trends in location of death for individuals with pediatric cancer in the United States
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557400316
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INCREASING ACCESS TO TELEHEALTH BY ENROLLING PATIENTS IN THE AFFORDABLE CONNECTIVITY PROGRAM
SPRINGER. 2024: S520
View details for Web of Science ID 001433572701275
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HEALTHCARE UNPLUGGED: DISPARITIES IN BROADBAND INTERNET AND HEALTH FACILITY ACCESS AMONG US COUNTIES
SPRINGER. 2024: S782-S783
View details for Web of Science ID 001433572702175
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THE DIGITAL DIVIDE: COUNTY-LEVEL DISPARITIES IN ACCESS TO BROADBAND AND MEDICAL PROVIDERS IN THE UNITED STATES
SPRINGER. 2024: S753-S754
View details for Web of Science ID 001433572702113
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Reported Political Participation by Physicians vs Nonphysicians.
JAMA
2024
Abstract
This study uses survey data to compare rates of political participation between US physicians and nonphysicians from 2017 to 2021.
View details for DOI 10.1001/jama.2024.1996
View details for PubMedID 38573625
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Arts Participation Amongst Healthcare Professionals: An Analysis of US Census Data.
Journal of general internal medicine
2024
View details for DOI 10.1007/s11606-024-08711-z
View details for PubMedID 38530615
View details for PubMedCentralID 9685483
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Addressing cultural and political drivers of vaccine hesitancy: Considerations for the African and Asian contexts.
Vaccine
2024
View details for DOI 10.1016/j.vaccine.2024.02.013
View details for PubMedID 38326129
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Surgical Resection Delays among Patients with Stage 1 Lung Cancer: A Study with Disaggregated Ethnic Groups.
Annals of surgical oncology
2024
View details for DOI 10.1245/s10434-024-14952-3
View details for PubMedID 38282026
View details for PubMedCentralID 3735462
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Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States.
JCO oncology practice
2024: OP2300474
Abstract
PURPOSE: Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals.METHODS: Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC.RESULTS: Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001).CONCLUSION: Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.
View details for DOI 10.1200/OP.23.00474
View details for PubMedID 38252900
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Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery.
Journal of cardiovascular development and disease
2024; 11 (1)
Abstract
Perioperative transient ischemic attacks (PTIAs) are associated with significantly increased rates of postoperative complications such as low cardiac output, atrial fibrillation, and significantly higher mortality in cardiac procedures. The current literature on PTIAs is sparse and understudied. Therefore, we aim to understand the effects of PTIA on hospital utilization, readmission, and morbidity. Using data on all the cardiac procedures at the University of Pittsburgh Medical Center from 2011 to 2019, fine and gray analysis was performed to identify whether PTIAs and covariables correlate with increased hospital utilization, stroke, all-cause readmission, Major Adverse Cardiac and Cerebrovascular Events (MACCE), MI, and all-cause mortality. Logistic regression for longer hospitalization showed that PTIA (HR: 2.199 [95% CI: 1.416-3.416] increased utilization rates. Fine and gray modeling indicated that PTIA (HR: 1.444 [95% CI: 1.096-1.902], p < 0.01) increased the rates of follow-up all-cause readmission. However, PTIA (HR: 1.643 [95% CI: 0.913-2.956] was not statistically significant for stroke readmission modeling. Multivariate modeling for MACCE events within 30 days of surgery (HR: 0.524 [95% CI: 0.171-1.605], p > 0.25) and anytime during the follow-up period (HR: 1.116 [95% CI: 0.825-1.509], p > 0.45) showed no significant correlation with PTIA. As a result of PTIA's significant burden on the healthcare system due to increased utilization, it is critical to better define and recognize PTIA for timely management to improve perioperative outcomes.
View details for DOI 10.3390/jcdd11010027
View details for PubMedID 38248897
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Cost-benefit analysis of intraoperative neuromonitoring for cardiac surgery.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2024; 33 (3): 107576
Abstract
Intraoperative neuromonitoring (IONM) can detect large vessel occlusion (LVO) in real-time during surgery. The aim of this study was to conduct a cost-benefit analysis of utilizing IONM among patients undergoing cardiac surgery.A decision-analysis tree with terminal Markov nodes was constructed to model functional outcome, as measured via the modified Rankin Scale (mRS), among 65-year-old patients undergoing cardiac surgery. Our cost-benefit analysis compares the use of IONM (electroencephalography and somatosensory evoked potential) against no IONM in preventing neurological complications from perioperative LVO during cardiac surgery. The study was performed over a lifetime horizon from a societal perspective in the United States. Base case and one-way probabilistic sensitivity analyses were performed.At a baseline LVO rate of 0.31%, the mean attributable lifetime expenditure for IONM-monitored cardiac surgeries relative to unmonitored cardiac surgeries was $1047.41 (95% CI, $742.12 - $1445.10). At a critical LVO rate of approximately 3.67%, the costs of both monitored and unmonitored cardiac surgeries were the same. Above this critical rate, implementing IONM became cost-saving. On one-way sensitivity analysis, variation in LVO rate from 0% - 10% caused lifetime costs attributable to receiving IONM to range from $1150.47 - $29404.61; variations in IONM cost, percentage of intervenable LVOs, IONM sensitivity, and mechanical thrombectomy cost exerted comparably minimal influence over lifetime costs.We find considerable cost savings favoring the use of IONM under certain parameters corresponding to high-risk patients. This study will provide financial perspective to policymakers, clinicians, and patients alike on the appropriate use of IONM during cardiac surgery.
View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.107576
View details for PubMedID 38232584
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The digital divide in access to broadband internet and mental healthcare
NATURE MENTAL HEALTH
2024; 2 (1)
View details for DOI 10.1038/s44220-023-00176-z
View details for Web of Science ID 001390103900005
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An introduction to digital determinants of health.
PLOS digital health
2024; 3 (1): e0000346
Abstract
In recent years, technology has been increasingly incorporated within healthcare for the provision of safe and efficient delivery of services. Although this can be attributed to the benefits that can be harnessed, digital technology has the potential to exacerbate and reinforce preexisting health disparities. Previous work has highlighted how sociodemographic, economic, and political factors affect individuals' interactions with digital health systems and are termed social determinants of health [SDOH]. But, there is a paucity of literature addressing how the intrinsic design, implementation, and use of technology interact with SDOH to influence health outcomes. Such interactions are termed digital determinants of health [DDOH]. This paper will, for the first time, propose a definition of DDOH and provide a conceptual model characterizing its influence on healthcare outcomes. Specifically, DDOH is implicit in the design of artificial intelligence systems, mobile phone applications, telemedicine, digital health literacy [DHL], and other forms of digital technology. A better appreciation of DDOH by the various stakeholders at the individual and societal levels can be channeled towards policies that are more digitally inclusive. In tandem with ongoing work to minimize the digital divide caused by existing SDOH, further work is necessary to recognize digital determinants as an important and distinct entity.
View details for DOI 10.1371/journal.pdig.0000346
View details for PubMedID 38175828
View details for PubMedCentralID PMC10766177
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Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting.
Clinical oncology (Royal College of Radiologists (Great Britain))
2023
Abstract
AIMS: For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT.MATERIALS AND METHODS: Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted.RESULTS: Of the 125228 women in our study, 115576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT.CONCLUSIONS: In this analysis of over 120000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.
View details for DOI 10.1016/j.clon.2023.12.002
View details for PubMedID 38184401
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Trends in Utilization and Medicare Spending on Short-Course Radiotherapy for Breast and Prostate Cancer: An Episode-Based Analysis from 2015-2019.
International journal of radiation oncology, biology, physics
2023
Abstract
Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiotherapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC.We performed a retrospective cohort analysis of all external beam episodes RT (EBRT) for BC and PC from 2015-2019 to assess predictors of short-course RT (SCRT) utilization and calculate spending differences. Multivariable logistic regression defined adjusted odds ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, age, year of diagnosis, type of practice, as well as the interaction between year and treatment setting. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to the covariables above.Of 143,729 BC episodes and 114,214 PC episodes, 80,106 (55.73%) and 25,955 (22.72%) were SCRT regimens, respectively. Median total spending for SCRT regimens among BC episodes was $9,418 (IQR, $7,966-$10,982) vs. $13,601 (IQR, $11,814-$15,499) for LCRT. Among PC episodes, median total spending was $6,924 (IQR, $4,509-$12,905) for SBRT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes, as well as treatment at hospital-affiliated over freestanding sites (p<0.001 for all).In this evaluation of BC and PC RT episodes from 2015-2019, we found that shorter-course RT resulted in lower costs vs. longer-course RT. SCRT was also more common in hospital-affiliated sites. Future research focusing on potential payment incentives encouraging SCRT when clinically appropriate and applicable in the two most common cancers treated with RT will be valuable as the field continues to prospectively evaluate cost-effective hypofractionation in other disease sites.
View details for DOI 10.1016/j.ijrobp.2023.11.043
View details for PubMedID 38072324
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Access and barriers to genomic classifiers for breast cancer and prostate cancer in India.
International journal of cancer
2023
Abstract
The incidence of cancer in general, including breast and prostate cancer specifically, is increasing in India. Breast and prostate cancers have genomic classifiers developed to guide therapy decisions. However, these genomic classifiers are often inaccessible in India due to high cost. These classifiers may also be less suitable to the Indian population, as data primarily from patients in wealthy Western countries were used in developing these genomic classifiers. In addition to the limitations in using these existing genomic classifiers, developing and validating new genomic classifiers for breast and prostate cancer in India is challenging due to the heterogeneity in the Indian population. However, there are steps that can be taken to address the various barriers that currently exist for accurate, accessible genomic classifiers for cancer in India.
View details for DOI 10.1002/ijc.34784
View details for PubMedID 37962056
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Trends in Location of Death for Individuals With Ovarian Cancer in the United States.
Obstetrics and gynecology
2023
Abstract
Using the publicly available Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database from 2003 to 2019, we evaluated associations between decedent characteristics and location of death for patients with ovarian malignancy. We found that Black, Native American, Asian American, and Hispanic patients were more likely to die in hospitals than White patients, despite an overall reduction in hospital deaths and an overall increase in hospice facility deaths. Additionally, patients with lesser educational attainment were more likely to die in nursing facilities and less likely to die in hospice facilities. Although there may be some contribution from cultural preferences, these findings may represent disparities in access to palliative care affecting people with cancer from racial and ethnic minoritized groups.
View details for DOI 10.1097/AOG.0000000000005439
View details for PubMedID 37944156
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Trends and Determinants of Location of Death Due to Colorectal Cancer in the United States : A Nationwide Study.
Annals of surgical oncology
2023
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US); however, there are limited data on location of death in patients who die from CRC. We examined the trends in location of death and determinants in patients dying from CRC in the US.We utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to extract nationwide data on underlying cause of death as CRC. A multinomial logistic regression was performed to assess associations between clinico-sociodemographic characteristics and location of death.There were 850,750 deaths due to CRC from 2003 to 2019. There was a gradual decrease in deaths in hospital, nursing home, or outpatient facility/emergency department over time and an increase in deaths at home and in hospice. Relative to White decedents, Black, Asian, and American Indian/Alaska Native decedents were less likely to die at home and in hospice compared with hospitals. Individuals with lower educational status also had a lower risk of dying at home or in hospice compared with in hospitals.The gradual shift in location of death of patients who die of CRC from institutionalized settings to home and hospice is a promising trend and reflects the prioritization of patient goals for end-of-life care by healthcare providers. However, there are existing sociodemographic disparities in access to deaths at home and in hospice, which emphasizes the need for policy interventions to reduce health inequity in end-of-life care for CRC.
View details for DOI 10.1245/s10434-023-14337-y
View details for PubMedID 37907701
View details for PubMedCentralID 4192888
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ASO Visual Abstract: Trends and Determinants of Location of Death Due to Colorectal Cancer in the USA: A Nationwide Study.
Annals of surgical oncology
2023
View details for DOI 10.1245/s10434-023-14380-9
View details for PubMedID 37899416
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Delays in Time to Surgery Among Asian and Pacific Islander Women with Breast Cancer.
Annals of surgical oncology
2023; 30 (9): 5337-5340
View details for DOI 10.1245/s10434-023-13806-8
View details for PubMedID 37365415
View details for PubMedCentralID 4788555
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Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.
Annals of surgical oncology
2023; 30 (9): 5495-5505
Abstract
Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients.We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors.Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups.Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
View details for DOI 10.1245/s10434-023-13339-0
View details for PubMedID 37017832
View details for PubMedCentralID PMC10075171
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ASO Author Reflections: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders.
Annals of surgical oncology
2023; 30 (9): 5506-5508
View details for DOI 10.1245/s10434-023-13560-x
View details for PubMedID 37120487
View details for PubMedCentralID 9069392
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Revamping Public Health Systems: Lessons Learned from the "Triple-demic".
American journal of preventive medicine
2023
View details for DOI 10.1016/j.amepre.2023.08.013
View details for PubMedID 37598983
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A holistic framework to integrate HIV and cardiovascular disease care in sub-Saharan Africa
AIDS
2023; 37 (10): 1497-1502
View details for DOI 10.1097/QAD.0000000000003604
View details for Web of Science ID 001032025700002
View details for PubMedID 37199570
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Disparities in Breast-Conserving Therapy Versus Mastectomy Among Asian American and Pacific Islander Women.
Annals of surgical oncology
2023; 30 (7): 3894-3897
View details for DOI 10.1245/s10434-023-13315-8
View details for PubMedID 37014557
View details for PubMedCentralID PMC10431949
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Trends in location of death for individuals with metastatic lung cancer in the United States.
American journal of surgery
2023; 226 (1): 135-137
View details for DOI 10.1016/j.amjsurg.2023.02.017
View details for PubMedID 36907745
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A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2023; 31 (7): 420
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
View details for DOI 10.1007/s00520-023-07886-1
View details for PubMedID 37354234
View details for PubMedCentralID 3705700
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Disparities in Receipt of Mental Health Services and Mental Distress Among Patients with Chronic Obstructive Pulmonary Disease
JOURNAL OF GENERAL INTERNAL MEDICINE
2023
View details for DOI 10.1007/s11606-023-08273-6
View details for Web of Science ID 001019285600001
View details for PubMedID 37349638
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Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men.
Prostate cancer and prostatic diseases
2023; 26 (2): 309-316
Abstract
Despite great heterogeneity amongst Hispanic groups, prostate cancer studies often report Hispanic patients in aggregate. We sought to identify differences in prostate cancer risk group at presentation and treatment status among Hispanic subgroup populations.Patients with localized prostate adenocarcinoma diagnosed from 2004-2017 were identified in the National Cancer Database (NCDB) and disaggregated by racial subgroup and Hispanic country of origin. Ordinal logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment with intermediate-unfavorable or high-risk disease.In our sample (n = 895,087), Hispanic men had greater odds of presenting with higher-risk localized prostate cancer compared with non-Hispanic White men (AOR = 1.18 95% CI 1.16-1.21, p < 0.001). Additionally, Hispanic Black men were less likely to present with higher-risk disease than non-Hispanic Black men. Disparities also existed when disaggregated by country of origin, particularly for Mexican men. Amongst men with unfavorable-risk disease, Hispanic men were less likely to receive treatment than non-Hispanic White men (95% CI 0.57-0.67, p < 0.001). The odds of Hispanic Black patients receiving treatment was 2.00 times the odds (95% CI 1.17-3.41 p = 0.011) of non-Hispanic Black patients receiving treatment. Upon disaggregation by country of origin, disparities persisted, particularly for Mexican men.We found marked heterogeneity when risk group at presentation and treatment for higher-risk disease were disaggregated by racial subgroup and country of origin. Our findings support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.
View details for DOI 10.1038/s41391-022-00526-5
View details for PubMedID 35306541
View details for PubMedCentralID 6547116
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Crossing Borders: Improving Mental Health Outcomes in Asian American Immigrants With Cancer.
JCO oncology practice
2023; 19 (5): 234-237
View details for DOI 10.1200/OP.22.00740
View details for PubMedID 36821806
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The impact of commercial health datasets on medical research and health-care algorithms
LANCET DIGITAL HEALTH
2023; 5 (5)
View details for Web of Science ID 001030852600001
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The impact of commercial health datasets on medical research and health-care algorithms.
The Lancet. Digital health
2023; 5 (5): e288-e294
Abstract
As the health-care industry emerges into a new era of digital health driven by cloud data storage, distributed computing, and machine learning, health-care data have become a premium commodity with value for private and public entities. Current frameworks of health data collection and distribution, whether from industry, academia, or government institutions, are imperfect and do not allow researchers to leverage the full potential of downstream analytical efforts. In this Health Policy paper, we review the current landscape of commercial health data vendors, with special emphasis on the sources of their data, challenges associated with data reproducibility and generalisability, and ethical considerations for data vending. We argue for sustainable approaches to curating open-source health data to enable global populations to be included in the biomedical research community. However, to fully implement these approaches, key stakeholders should come together to make health-care datasets increasingly accessible, inclusive, and representative, while balancing the privacy and rights of individuals whose data are being collected.
View details for DOI 10.1016/S2589-7500(23)00025-0
View details for PubMedID 37100543
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Epistemic equity in oncology: Opportunities to leverage patient-centric implementation in clinical trial design.
Cancer
2023; 129 (9): 1313-1315
View details for DOI 10.1002/cncr.34674
View details for PubMedID 36755299
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Spending It Forward: Integrated Public Health Investments Are Vital to the Pandemic Response.
Journal of public health management and practice : JPHMP
2023; 29 (4): 430-432
View details for DOI 10.1097/PHH.0000000000001739
View details for PubMedID 37071037
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China Needs Evidence-Based COVID Vaccines, and Its Government Now Has a Political Opening to Provide Them.
Journal of public health management and practice : JPHMP
2023; 29 (3): 281-283
View details for DOI 10.1097/PHH.0000000000001731
View details for PubMedID 36867518
View details for PubMedCentralID PMC10042742
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Total Joint Arthroplasty Utilization After Orthopaedic Surgery Referral: Identifying Disparities Along the Care Pathway.
The Journal of arthroplasty
2023; 38 (3): 424-430
Abstract
Although racial and ethnic disparities in total joint arthroplasty (TJA) have been thoroughly described, only a few studies have sought to determine exactly where along the care pathway these disparities are perpetuated. The purpose of this study was to investigate disparities in TJA utilization occurring after patients who had diagnosed hip or knee osteoarthritis were referred to a group of orthopaedic providers within an integrated academic institution.A retrospective, multi-institutional study evaluating patients with diagnosed hip or knee osteoarthritis was conducted between 2015 and 2019. Information pertaining to patient demographics, timing of clinic visits, and subsequent surgical intervention was collected. Utilization rates and time to surgery from the initial clinic visit were calculated by race, and logistic regressions were performed to control for various demographic as well as health related variables.White patients diagnosed with knee osteoarthritis were significantly more likely to receive total knee arthroplasty (TKA) than Black and Hispanic patients, even after adjusting for various demographic variables (Black patients: odds ratio [OR] = 0.63, 95% CI = 0.55-0.72, P = .002; Hispanic patients: OR = 0.69, 95% CI = 0.57-0.83, P = .039). Similar disparities were found among patients diagnosed with hip osteoarthritis who underwent total hip arthroplasty (THA; Black patients: OR = 0.73, 95% CI = 0.60-0.89, P = <.001; Hispanic patients: OR = 0.72, 95% CI = 0.53-0.98, P <.001). There were no differences in time to surgery between races (P > .05 for all).In this study, racial and ethnic disparities in TJA utilization were found to exist even after referral to an orthopaedic surgeon, highlighting a critical point along the care pathway during which inequalities in TJA care can emerge. Similar time to surgery between White, Black, and Hispanic patients suggest that these disparities in TJA utilization may largely be perpetuated before surgical planning while patients are deciding whether to undergo surgery. Further studies are needed to better elucidate which patient and provider-specific factors may be preventing these patients from pursuing surgery during this part of the care pathway.Level IV.
View details for DOI 10.1016/j.arth.2022.09.020
View details for PubMedID 36150431
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The Enhancing Oncology Model: Leveraging improvement science to increase health equity in value-based care.
Journal of the National Cancer Institute
2023; 115 (2): 125-130
Abstract
The Oncology Care Model (OCM), launched in 2016 by the Centers for Medicare and Medicaid Services, was the first demonstration of value-based payment in oncology. Although the OCM delivered mixed results in terms of quality of care and total episode costs, the model had no statistically significant impact on remediating racial, ethnic, and socioeconomic disparities among beneficiaries. These deficits have been prominent in other aspects of US healthcare, and as a result, the Institute for Healthcare Improvement has advocated for stakeholders to leverage improvement science, an applied science that focuses on implementing rapid cycles for change, to identify and overcome barriers to health equity. With the announcement of the new Enhancing Oncology Model, a continuation of the OCM's efforts in introducing value to cancer care for episodes surrounding chemotherapy administration, both policymakers and providers must apply tenets of improvement science and make eliminating disparities in alternative payment models a forefront objective. In this commentary, we discuss previous inequities in alternative payment models, the role that improvement science plays in addressing health-care disparities, and steps that stakeholders can take to maximize equitable outcomes in the Enhancing Oncology Model.
View details for DOI 10.1093/jnci/djac194
View details for PubMedID 36245086
View details for PubMedCentralID PMC9905958
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The implications of rising alcohol-associated cancer burden: Considerations for the Indian context.
Asia-Pacific journal of clinical oncology
2023; 19 (1): 275-276
View details for DOI 10.1111/ajco.13750
View details for PubMedID 35098671
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Corporate Social Responsibility Framework: An Innovative Solution to Social Determinants of Health in the USA.
Journal of racial and ethnic health disparities
2023
Abstract
Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare system has struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes the CSR construct, there is a paucity of research on SDOH integration with the CSR framework.We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA.Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage.Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.
View details for DOI 10.1007/s40615-022-01493-2
View details for PubMedID 36689122
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Fragile X Syndrome Patient-Derived Neurons Developing in the Mouse Brain Show FMR1-Dependent Phenotypes.
Biological psychiatry
2023; 93 (1): 71-81
Abstract
Fragile X syndrome (FXS) is characterized by physical abnormalities, anxiety, intellectual disability, hyperactivity, autistic behaviors, and seizures. Abnormal neuronal development in FXS is poorly understood. Data on patients with FXS remain scarce, and FXS animal models have failed to yield successful therapies. In vitro models do not fully recapitulate the morphology and function of human neurons.To mimic human neuron development in vivo, we coinjected neural precursor cells derived from FXS patient-derived induced pluripotent stem cells and neural precursor cells derived from corrected isogenic control induced pluripotent stem cells into the brain of neonatal immune-deprived mice.The transplanted cells populated the brain and a proportion differentiated into neurons and glial cells. Immunofluorescence and single and bulk RNA sequencing analyses showed accelerated maturation of FXS neurons after an initial delay. Additionally, we found increased percentages of Arc- and Egr-1-positive FXS neurons and wider dendritic protrusions of mature FXS striatal medium spiny neurons.This transplantation approach provides new insights into the alterations of neuronal development in FXS by facilitating physiological development of cells in a 3-dimensional context.
View details for DOI 10.1016/j.biopsych.2022.08.020
View details for PubMedID 36372569
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Community Paramedicine: An Innovative Model for Value-Based Care Delivery.
Journal of public health management and practice : JPHMP
2022; 29 (2): E65-E68
View details for DOI 10.1097/PHH.0000000000001683
View details for PubMedID 36580427
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Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2022; 30 (11): 8905-8917
Abstract
There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity.Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18-45 vs. 46-64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term.Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants' family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income.A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients' family members and to design interventions to mitigate healthcare cost-related coping mechanisms.
View details for DOI 10.1007/s00520-022-07234-9
View details for PubMedID 35877007
View details for PubMedCentralID 3107566
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Racial disparities in treatment delay among younger men with prostate cancer.
Prostate cancer and prostatic diseases
2022; 25 (3): 590-592
Abstract
Young men (≤55 years) with prostate cancer (PC) may experience treatment delays despite clinical consequences of delays beyond six months. Using the United States National Cancer Database (2004-2017), we employed multivariable logistic regression analysis to retrospectively examine racial disparities in localized PC treatment delays >6 months since diagnosis. Of the 89,196 men ≤55 years included, young Black men experienced treatment delays beyond six months more frequently than young White men (7.39% vs. 3.96%; AOR 1.95, 95% CI 1.81-2.09, p < 0.001), a disparity that was greater than that among men ages 56-64 (pinteraction < 0.001). This result persisted upon restricting the sample to men with private insurance/managed care. The finding that Black men with localized PC experienced treatment delays almost twice as frequently as White men underscores access barriers that may go beyond the direct costs of care.
View details for DOI 10.1038/s41391-021-00479-1
View details for PubMedID 35190652
View details for PubMedCentralID 4191828
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The Novel Adenovirus: A Call for Advances in Health Infrastructure and Pandemic Preparedness.
Journal of public health management and practice : JPHMP
2022; 28 (6): 603-606
View details for DOI 10.1097/PHH.0000000000001620
View details for PubMedID 36070580
View details for PubMedCentralID PMC9555589
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Assessment of Compliance With Centers for Medicare & Medicaid Services Price Transparency Final Rule.
JAMA oncology
2022; 8 (8): 1212-1213
Abstract
This cross-sectional study assesses disclosures of commercial payer-negotiated rates in compliance with Centers for Medicare & Medicaid Services new final ruling effective January 1, 2022.
View details for DOI 10.1001/jamaoncol.2022.1783
View details for PubMedID 35679019
View details for PubMedCentralID PMC9185506
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Disparities in timely treatment among young women with breast cancer.
American journal of surgery
2022; 224 (2): 811-815
Abstract
Although evidence suggests worse breast cancer-specific survival associated with treatment delay beyond 90 days, little is known regarding the sociodemographic predictors of delays in cancer-directed surgery among young women with breast cancer. This is particularly notable, given that 5-10% of new diagnoses occur in younger women aged <40 years, commonly with more aggressive features than in older women.We used the National Cancer Database (2004-2017) to assess sociodemographic disparities in delay of upfront surgery beyond 90 days among young women with non-metastatic breast cancer, using multivariable logistic regression and predictive marginal modeling.Black women experienced treatment delays more frequently than white women (aOR: 1.93 [95% CI: 1.76-2.11], p < 0.001). Adjusted rates of treatment delay were 4.91% [95% CI: 4.51%-5.30%] and 2.60% [95% CI: 2.47%-2.74%] for Black and white women, respectively, and 2.97% [95% CI: 2.83%-3.12%], 2.36% [95% CI: 2.03%-2.68%], and 1.18% [95% CI: 0.54%-1.81%] for women from metro, urban, and rural areas, respectively.These results suggest that improving access to timely treatment may be leveraged as a means through which to lessen the breast cancer disparities experienced by Black women.
View details for DOI 10.1016/j.amjsurg.2022.01.019
View details for PubMedID 35090684
View details for PubMedCentralID PMC9304449
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Integrated practice units present an opportunity over siloed survivorship care settings.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2022; 30 (8): 6375-6379
Abstract
Given the rapidly rising cancer burden in the USA, the need to innovate survivorship care for oncology patients is rising rapidly. The current body of empirical evidence in survivorship care has focused on care provided by general practitioners (GP) and specialists/surgeons (SS). In particular, current evaluations address cost of care, cancer recurrence, quality of life, and overall survival of patients, with results indicating no statistically significant differences in GP- and SS-led care models and little emphasis on the broader characteristics of care settings. We fill this gap in survivorship care by introducing a perspective on the potential for holistic care delivery with a multidisciplinary team approach at integrated practice units (IPUs). Additionally, we propose a comprehensive examination of survivorship care across GP-, SS-, and IPU-led settings to provide researchers and practitioners with solid ground to determine the optimal survivorship care model, considering four key characteristics: (1) operating mode and skills, (2) cost and accountability of care, (3) health outcome measurement, and (4) workflow and scheduling.
View details for DOI 10.1007/s00520-022-06964-0
View details for PubMedID 35290514
View details for PubMedCentralID 4709150
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Trends in location of death for individuals with primary brain tumors in the United States.
Neuro-oncology
2022; 24 (8): 1400-1401
View details for DOI 10.1093/neuonc/noac075
View details for PubMedID 35472173
View details for PubMedCentralID PMC9340612
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Payer-Negotiated Prices for Breast Cancer Treatment at NCI-Designated Cancer Treatment Centers.
Annals of surgical oncology
2022; 29 (6): 3381-3383
View details for DOI 10.1245/s10434-022-11349-y
View details for PubMedID 35094186
View details for PubMedCentralID PMC9479750
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ASO Research Letter: Trends in Location of Death for Individuals with Pancreatic Cancer in the United States.
Annals of surgical oncology
2022; 29 (5): 2766-2768
View details for DOI 10.1245/s10434-021-11058-y
View details for PubMedID 34748124
View details for PubMedCentralID 6704737
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Orthogeriatric co-management care models: The need for integrated practice units.
The Lancet regional health. Western Pacific
2022; 21: 100416
View details for DOI 10.1016/j.lanwpc.2022.100416
View details for PubMedID 35310900
View details for PubMedCentralID PMC8928085
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Racial disparities in senior healthcare: System-level interventions.
Journal of the American Geriatrics Society
2022; 70 (4): 1292-1296
View details for DOI 10.1111/jgs.17658
View details for PubMedID 35006606
View details for PubMedCentralID PMC8986603
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Socioeconomic disparities in healthcare utilization for atherosclerotic cardiovascular disease.
American heart journal
2022; 246: 161-165
Abstract
The impact of the social determinants of health on healthcare utilization for patients with atherosclerotic cardiovascular disease (ASCVD) remains incompletely characterized.We queried the National Health Interview Survey from 2000-2018 to examine disparities in healthcare utilization metrics by education, income-to-poverty ratio, and health insurance coverage for adults with self-reported ASCVD.We show that, while education and income-to-poverty ratios demonstrated significant disparities for provider visits and preventive screenings, the largest disparities were noted for health insurance coverage.These trends suggest that efforts to expand private or government insurance to improve coverage for patients with ASCVD may address healthcare utilization-based disparities.
View details for DOI 10.1016/j.ahj.2022.01.011
View details for PubMedID 35093303
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Weight gain after in vitro fertilization: a potential consequence of controlled ovarian stimulation.
Journal of assisted reproduction and genetics
2022; 39 (4): 973-976
Abstract
In the USA, 42% of adult women were estimated to have obesity, and 13% of women of childbearing age similarly have impaired fecundity. Obesity is associated with infertility such that patients with obesity often seek out in vitro fertilization (IVF) services. Here, we report on the case of a woman with childhood-onset class II obesity who had been undergoing treatment with phentermine and topiramate prior to undergoing 3 cycles of IVF. With each cycle, the patient temporarily gained 13-15 lbs. during controlled ovarian stimulation (COS). Weight gain from COS may be clinically relevant and merits further study to optimize weight status across women's reproductive life and to better assist women who gain weight secondary to IVF. Incorporating weight monitoring into IVF protocols may also help better characterize the scope of weight gain from COS.
View details for DOI 10.1007/s10815-022-02444-w
View details for PubMedID 35218460
View details for PubMedCentralID PMC9051006
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Overcoming congressional inertia on obesity requires better literacy in obesity science.
Obesity (Silver Spring, Md.)
2022; 30 (4): 799-801
Abstract
Obesity-focused health policies, including the landmark Treat and Reduce Obesity Act, have stalled at the federal level over the past decade. Congressional inaction on obesity reflects both misconceptions of obesity as a lifestyle choice and limited awareness for the burden obesity imposes on our health care system. Given these challenges, we argue that health professionals must bolster their efforts to partner with public figures with obesity and to directly educate the public. These strategies may help destigmatize obesity and build awareness of obesity as a disease. Furthermore, we suggest that these strategies may empower patients to flex their unrealized political muscle and demand more from their elected leaders. A bold, multilevel approach that elicits a public demand for change can propel obesity policy into the 21st century.
View details for DOI 10.1002/oby.23405
View details for PubMedID 35244978
View details for PubMedCentralID PMC8957554
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Randomized clinical trials of weight loss: Pragmatic and digital strategies and innovations.
Contemporary clinical trials
2022; 114: 106687
Abstract
During the COVID-19 pandemic, digital strategies and decentralized approaches allowed for the continuation of weight loss clinical trials despite in-person engagement coming to a halt. In particular, trials leveraged remote mediums to measure data in real-time across a broad array of metrics while testing novel strategies to streamline patient care. Such approaches may address longstanding challenges with traditional trials, including attrition and underrepresentation of racial and ethnic minorities. Ultimately, emerging data from trials utilizing both digital and in-person strategies may indicate the promise of a hybrid approach in incorporating a robust virtual component for continuous patient monitoring and an in-person component for patient adherence and data standardization. In this commentary, we provide an overview of the most innovative digital approaches in clinical trials of weight loss during the COVID-19 era, as well as identify opportunities and challenges for these modes of research going forward.
View details for DOI 10.1016/j.cct.2022.106687
View details for PubMedID 35085830
View details for PubMedCentralID PMC8785263
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Rural-Urban Differences in Influenza Vaccination Among Adults in the United States, 2018-2019.
American journal of public health
2022; 112 (2): 304-307
Abstract
Objectives. To provide adjusted rates of self-reported receipt of the influenza vaccine in the 2018-2019 flu season among adults in large metropolitan, medium and small metropolitan, and nonmetropolitan areas of the United States by age group, gender, and race. Methods. We queried the 2019 National Health Interview Survey for respondents aged 18 years and older. To provide national estimates of influenza vaccination coverage, we performed sample-weighted multivariable logistic regressions and predicted marginal modeling while adjusting for age, gender, race/ethnicity, and urban-rural household designation. Results. After weighting, 48.1%, 46.2%, and 43.6% of adults from large metropolitan, small and medium metropolitan, and nonmetropolitan areas, respectively, received the influenza vaccine. Additionally, there was a trend toward declining influenza vaccination status from large metropolitan to rural areas in all age groups, both genders, and multiple racial/ethnic groups. Conclusions. Self-reported influenza vaccination rates were lower in rural than in urban areas among adults of all age groups and both genders. Using community leaders for health promotion, augmentation of the community health care workforce, and provision of incentives for providers to integrate influenza vaccination in regular visits may expand influenza vaccine coverage. (Am J Public Health. 2022;112(2):304-307. https://doi.org/10.2105/AJPH.2021.306575).
View details for DOI 10.2105/AJPH.2021.306575
View details for PubMedID 35080958
View details for PubMedCentralID PMC8802596
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All Infrastructure Is Health Infrastructure
AMERICAN JOURNAL OF PUBLIC HEALTH
2022; 112 (1): 24-26
View details for DOI 10.2105/AJPH.2021.306595
View details for Web of Science ID 000819836600016
View details for PubMedID 34936427
View details for PubMedCentralID PMC8713619
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Global health responsibilities in a Taliban-led Afghanistan.
Nature medicine
2021
View details for DOI 10.1038/s41591-021-01547-8
View details for PubMedID 34750556
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Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups.
JCO oncology practice
2021: OP2100412
Abstract
We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors.We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors.Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients.Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.
View details for DOI 10.1200/OP.21.00412
View details for PubMedID 34709962
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Whether the weather will help us weather the COVID-19 pandemic: Using machine learning to measure twitter users' perceptions.
International journal of medical informatics
2021; 145: 104340
Abstract
The potential ability for weather to affect SARS-CoV-2 transmission has been an area of controversial discussion during the COVID-19 pandemic. Individuals' perceptions of the impact of weather can inform their adherence to public health guidelines; however, there is no measure of their perceptions. We quantified Twitter users' perceptions of the effect of weather and analyzed how they evolved with respect to real-world events and time.We collected 166,005 English tweets posted between January 23 and June 22, 2020 and employed machine learning/natural language processing techniques to filter for relevant tweets, classify them by the type of effect they claimed, and identify topics of discussion.We identified 28,555 relevant tweets and estimate that 40.4 % indicate uncertainty about weather's impact, 33.5 % indicate no effect, and 26.1 % indicate some effect. We tracked changes in these proportions over time. Topic modeling revealed major latent areas of discussion.There is no consensus among the public for weather's potential impact. Earlier months were characterized by tweets that were uncertain of weather's effect or claimed no effect; later, the portion of tweets claiming some effect of weather increased. Tweets claiming no effect of weather comprised the largest class by June. Major topics of discussion included comparisons to influenza's seasonality, President Trump's comments on weather's effect, and social distancing.We exhibit a research approach that is effective in measuring population perceptions and identifying misconceptions, which can inform public health communications.
View details for DOI 10.1016/j.ijmedinf.2020.104340
View details for PubMedID 33242762
View details for PubMedCentralID PMC7654388