(Press-News.org) COLUMBUS, Ohio - Older minority cancer patients with poor social determinants of health are significantly more likely to experience negative surgical outcomes compared to white patients with similar risk factors, according to a new study published by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James).
A new retrospective analysis of more than 200,000 patients conducted by researchers with the OSUCCC - James suggests that minority patients living in high socially vulnerable neighborhoods had a 40% increased risk of a complication and 23% increased risk of 90-day mortality compared with white patients for neighborhoods with low social vulnerability. The U.S. Centers for Disease Control (CDC) defines social vulnerability as "potential negative effects on communities caused by external stresses on human health."
Study results were published online ahead of print in the Journal of the American College of Surgeons Jan. 25, 2021, and were highlighted in the 2020 Southern Surgical Association Program.
"This study speaks to how health care and health outcomes extend beyond the doors of the hospital and even beyond the specifics of the disease the patient may have. Ultimately, the resources in the patient's community may be as important to a patient's health as what goes on in the hospital," said Timothy Pawlik, MD, senior author of the study and holder of the Urban Meyer III and Shelley Meyer Chair for Cancer Research at the OSUCCC - James. Pawlik serves as surgeon-in-chief at the Ohio State Wexner Medical Center and as chair of the Department of Surgery in the Ohio State College of Medicine.
"This issue is not new, but the data strongly suggests we could significantly improve surgical outcomes by intentionally integrating vulnerability assessments into our national standard of care models. By doing so, we could help identify the most vulnerable among us - upfront - and provide additional supports as patients move through treatment and recovery," Pawlik added. "The data emphasize how efforts to improve outcomes for cancer patients need to extend beyond the hospital and address systemic health-related disparities within the communities in which patients live."
Study Method and Results
For this retrospective study, researchers used a novel risk stratification tool called the social vulnerability index (SVI), a composite measure of 15 social and economic factors. Although the CDC created the SVI using census data to identify communities needing greater support during disasters, researchers recently have applied it to medical studies.
Researchers identified 203,800 patients age 65 or older from the 2016-2017 Medicare inpatient claims files who underwent an operation for one of three common cancers--lung, colon and rectal--or for cancer of the esophagus between 2013-2017. The investigators merged the Medicare information with the CDC's SVI for each patient's county of residence. The SVI includes county-level data such as unemployment rates, racial distribution, prevalence of people with disabilities, vehicle access and overcrowded community living. A high SVI score indicates greater social vulnerability.
Researchers found that minority patients with high SVI scores had a 47% increased chance of an extended length-of-stay, 40% increased odds of a surgical complication and 23% increased odds of 90-day mortality. When comparing white to non-white patients with a similar social vulnerability risk factor score, non-white patients fared worse in overall recovery.
Additionally, researchers noted that older patients who underwent a cancer operation and resided in areas with high social vulnerability were less likely to achieve a "textbook outcome" as a result of their procedures. A "textbook outcome" means that these patients did not have in-hospital complications, an extended hospitalization or a readmission within three months, and that they were alive 90 days after surgery.
Differences Noted by Race
As social vulnerability increased, the outcomes differences by race became more pronounced, Pawlik said.
"Especially for Black and Hispanic individuals, the impact of residing in a socially vulnerable community was much more pronounced," he added. "They had much greater risk of having adverse outcomes than white patients."
Even when the researchers matched patients' characteristics, such as age and cancer type, they found that Blacks and Hispanic patients from high-SVI counties had 26% lower odds of receiving a textbook outcome compared to whites from a low-SVI county.
In general, the differences in textbook outcomes were driven by complications and prolonged hospitalization, according to Pawlik.
"Patients from socially vulnerable communities had the most difficulty achieving a postoperative course without a complication, and they were the most likely to have an extended length of stay. These patients are in double and triple jeopardy," Pawlik said. "Our data clearly showed a disparity in health, as defined by textbook outcome, with poorer outcomes if a patient was a minority, or from a highly socially vulnerable community or, in particular, both."
Recommendations Based on Findings
Pawlik cautioned that, because the SVI is population-based, it is not a useful tool to calculate risk at the individual level. Instead, he says, health care providers should ask about patients' home situations and address their potential lack of resources/support as a routine step in standard of care across all health care systems.
"Make sure patients have the necessary support in the community they are going back into, with access to such things as food, basic services, transportation, home health care and wound care," Pawlik said. "Strong, individualized discharge planning and partnering with community leaders to ensure a smoother transition from the hospital back into the community are key."
INFORMATION:
Collaborators in this study include J. Madison Hyer, MS, Diamantis I. Tsilimigras, MD, Adrian Diaz, MD, Rosevine A. Azap, Jordan Cloyd, MD, FACS, Mary Dillhoff, MD, FACS, Aslam Ejaz, MD, FACS, and Allan Tsung, MD, FACS, all from The Ohio State University; and Rayyan S. Mirdad of the Royal College of Surgeons, Dublin, Ireland.
CHAMPAIGN, Ill. -- Absent a widely available vaccine, mitigation measures such as stay-at-home mandates, lockdowns or shelter-in-place orders have been the major public health policies deployed by state governments to curb the spread of COVID-19.
But given the uncertain duration of such policies, questions have been raised about the potential negative mental health consequences of extended lockdowns with indefinite end dates. But according to new research co-written by a team of University of Illinois Urbana-Champaign experts who study the intersection of health care and public policy, the negative mental health effects of ...
ITHACA, N.Y. - Researchers from Cornell University and the National Park Service have pinpointed and confirmed the location of the remnants of a wooden fort in Alaska - the Tlingit people's last physical bulwark against Russian colonization forces in 1804 - by using geophysical imaging techniques and ground-penetrating radar.
The fort was the last physical barrier to fall before Russia's six-decade occupation of Alaska, which ended when the United States purchased Alaska in 1867 for $7 million.
The Tlingit built what they called Shiskinoow - the "sapling fort" - on a peninsula in modern-day Sitka, Alaska, ...
During epileptic seizures, a large number of nerve cells in the brain fire excessively and in synchrony. This hyperactivity may lead to uncontrolled shaking of the body and involve periods of loss of consciousness. While about two thirds of patients respond to anti-epileptic medication, the remainder is refractory to medical treatment and shows drug-resistance. These patients are in urgent need for new therapeutic strategies.
Together with colleagues in Japan, Prof. Dr. Christine Rose and her doctoral student Jan Meyer from the Institute of Neurobiology at HHU have performed a study to address the cellular mechanisms that promote the development of epilepsy. While up to now, most studies and anti-epileptic drugs targeted nerve cells (neurons), ...
Findings of a new study published by researchers from Trinity College Dublin and St James's Hospital outline the health impacts faced by older people while cocooning during the Covid-19 pandemic. The findings are published in the Quarterly Journal of Medicine here: https://bit.ly/3qGKJoI.
Cocooning involves staying at home and reducing face-to-face interaction with other people and is an important part of the response to the COVID-19 pandemic, with an overall aim to prevent transmission to vulnerable older people. However, concerns exist regarding the long-term adverse effects ...
A new study from Indiana University researchers finds that most high-school age youth are willing to wear masks to help prevent the spread of the COVID-19 virus, but that more education is needed on how to wear masks properly and on the importance of consistent commitment to public health guidelines.
The study, published today in the Journal of Adolescent Health looked at 1,152 youth's mask wearing and social distancing behaviors during five, in-person live-streamed high school graduations from one U.S. public school district in early July 2020. These broadcasts allowed the researchers to systematically document social-distancing behaviors throughout the ceremonies and mask-wearing as students crossed the graduation stage ...
Coconut oil has increasingly found its way into German kitchens in recent years, although its alleged health benefits are controversial. Scientists at the University of Bonn have now been able to show how it is metabolized in the liver. Their findings could also have implications for the treatment of certain diarrheal diseases. The results are published in the journal Molecular Metabolism.
Coconut oil differs from rapeseed or olive oil in the fatty acids it contains. Fatty acids consist of carbon atoms bonded together, usually 18 in number. In coconut oil, however, most of these chains are much shorter and contain only ...
Research from North Carolina State University shows that extreme weather events, such as hurricanes and increased precipitation, affect both the amount and the composition of picophytoplankton in the Neuse River Estuary. The work is a first step in determining how a wetter climate may affect the estuarine ecosystem.
Picophytoplankton are defined as any phytoplankton measuring less than three micrometers in size. Although well studied as part of the oceanic ecosystem and food web, picophytoplankton are understudied in estuarine systems, even though they occur in significant numbers within these environments.
"Picophytoplankton are important primary producers in aquatic ecosystems," says Ryan Paerl, assistant professor of ...
DALLAS - Jan. 25, 2021 - Small cell lung cancer (SCLC) cells are missing a surface protein that triggers an immune response, allowing them to hide from one of the body's key cancer defenses, a new study led by UT Southwestern researchers suggests. The findings, reported online today in Cancer Research, a journal of the American Association for Cancer Research, could lead to new treatments for SCLC, which has no effective therapies.
Despite decades of study, SCLC - a subset of lung cancer that makes up about 13 percent of lung cancer diagnoses - has a very poor prognosis, with only about 6 percent of patients surviving five years after ...
Massive earthquakes are, fortunately, rare events. But that scarcity of information blinds us in some ways to their risks, especially when it comes to determining the risk for a specific location or structure.
"We haven't observed most of the possible events that could cause large damage," explained Kevin Milner, a computer scientist and seismology researcher at the Southern California Earthquake Center (SCEC) at the University of Southern California. "Using Southern California as an example, we haven't had a truly big earthquake since 1857 -- that was the last time the southern San Andreas broke into a massive magnitude ...
Scientists at Tokyo Institute of Technology (Tokyo Tech), Imperial and High Energy Accelerator Research Organization (KEK) Institute of Materials Structure Science, discover new Ba7Nb4MoO20-based materials with high oxygen-ion (oxide-ion O2-) conductivities--"the hexagonal perovskite-related oxides"--and shed light on the underlying mechanisms responsible for their conductivity. Their findings lead the way to uncovering other similar materials, furthering research on developing low-cost and scalable renewable energy technologies.
Over the past few years, fuel cells have become a focal point of research in eco-friendly technology because of their ...
