The Role of a Monoclonal Gammopathy of Undetermined Significance Diagnosis in Healthcare Utilization

Background Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the United States. This dissertation was designed to: (1) Describe the trajectories of serum biomarkers over time in patients with an MGUS diagnosis, (2) Determine if an MGUS diagnosis is associated with changes in healthcare service utilization, and (3) explore the patient- and provider-level drivers of healthcare utilization in patients with MGUS. Methods Data sources include health claims and electronic health records from a community-based population of patients seeking care in central Massachusetts and primary qualitative data collected from providers and patients’ interviews. The analyses included descriptive statistics, group-based trajectory modeling, conditional Poisson regression, and qualitative data analyses. Results (1) Three distinct multi-trajectory groups of creatinine and hemoglobin were identified. (2) The rates of emergency room, hospital, and outpatient visits were higher for patients with MGUS than patients without MGUS. (3) Patients have a basic understanding of MGUS; however, some patients feel anxiety, which may affect other aspects of their lives. Patients primarily see hematologists for follow-up care; other providers have less knowledge about MGUS. Conclusions Biomarker trajectories characterize specific subpopulations of patients with MGUS over time. We found that an MGUS diagnosis is associated with higher healthcare utilization, especially during the months surrounding the diagnosis date. Finally, our study suggests that some patients with MGUS may need psychosocial support services and identifies a gap in knowledge around caring for MGUS patients among primary care providers

English language proficiency, complete tooth loss, and recent dental visits among older adults in the United States

Objectives: This study sought to provide population-based estimates of complete tooth loss and recent dental visits among older adults in the United States by English language proficiency. Methods: We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants 50 years of age (n = 10,452, weighted to represent 111,895,290 persons). Five categories of language proficiency were created based on self-reported English language ability and language spoken at home (Spanish, Other). Results: The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%, English only: 12.0%). Complete tooth loss was less common among participants for whom Spanish was their primary language, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42-0.76). Among those without complete tooth loss, dental visits in the past year were less common among participants with primary language other than English as compared to those who only speak English. Conclusions: Complete tooth loss varied by English language proficiency among adults aged 50 years in the United States. Suboptimal adherence to annual dental visits was common, more so in those with complete tooth loss, and varied by English language proficiency

Sex differences in risk factors for oral and pharyngeal cancer among Puerto Rican adults

Background: Oral and pharyngeal cancer (OPC) is a frequent type of cancer in Puerto Rico, with the risk being higher in men relative to women. We assessed differences in OPC risk factors implicated in these sex disparities. Methods: We analyzed data of 740 adult participants (40-65 years) from the San Juan Overweight Adults Longitudinal Study (SOALS). A comprehensive questionnaire was administered to collect information on sociodemographic characteristics, cigarette smoking, binge drinking, oral high-risk HPV infection, fruit and vegetable consumption, sexual behavior, and oral hygiene practices. A full-mouth periodontal examination was also performed. Sixteen OPC known and potential risk factors were evaluated. Crude and adjusted prevalence ratio (PR) estimates for individual OPC risk factors, by sex, were calculated using log-binomial regression. Results: Compared to women, men had significantly increased prevalence of several OPC risk factors including current smoking (PR: 1.91, 95% Confidence interval [CI]: 1.35-2.70), binge drinking (PR: 1.92, 95% CI: 1.31-2.84), and severe periodontitis (PR: 2.05, 95% CI: 1.47-2.85). Conclusions: Men were significantly more likely than women to have risk factors for OPC. Cancer prevention and control efforts should focus on sex-specific interventions that help reduce this disparity

Differences in survival among multiple myeloma patients in the United States SEER population by neighborhood socioeconomic status and race/ethnicity

PURPOSE: We examined the combined influences of race/ethnicity and neighborhood socioeconomic status (SES) on long-term survival among patients with multiple myeloma (MM). METHODS: Data from the 2000-2015 NCI Surveillance, Epidemiology, and End Results Program (SEER-18) were used. Census tract-level SES index was assessed in tertiles (low, medium, high SES). Competing-risk modeling was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CIs) for SES tertile adjusted for sex and age at diagnosis and stratified by race/ethnicity. RESULTS: Overall, living in a low SES neighborhood was associated with worse MM survival. However, we observed some variation in the association by racial/ethnic group. Living in a low versus a high SES neighborhood was associated with a 35% (95% CI = 1.16-1.57) increase in MM-specific mortality risk among Asian/Pacific Islander cases, a 17% (95% CI = 1.12-1.22) increase among White cases, a 14% (95% CI = 1.04-1.23) increase among Black cases, and a 7% (95% CI = 0.96-1.19) increase among Hispanic cases. CONCLUSION: These results suggest that the influence of both SES and race/ethnicity should be considered when considering interventions to remedy disparities in MM survival

Variation in Colorectal Cancer Screening Practices According to Cardiovascular Disease Status and Race/Ethnicity

PURPOSE: To assess current estimates of colorectal cancer (CRC) screening practices in relation to cardiovascular disease (CVD) status and whether this association varies by race/ethnicity. METHODS: Cross-sectional analysis of the Behavioral Risk Factor Surveillance System data from 2012, 2014, 2016, and 2018 among US adults aged 50-75 years (n = 807,937). Participants\u27 self-reported CRC screening practices were categorized as being up-to-date, not up-to-date, or never screened. Multinomial logistic regression was used to assess whether self-reported prevalent CVD was associated with CRC screening practices after adjusting for several potentially confounding variables; additional analyses were stratified by race/ethnicity. RESULTS: One-quarter of US adults had never been screened for CRC, while 67.0% reported being up-to-date with CRC screening. The proportion of Hispanics who had never been screened (35.3%) was higher than non-Hispanic Whites (23.5%) and Blacks (20.6%). Adults with CVD were less likely to never have been screened (adjusted odds ratio (aOR), 0.92; 95% confidence interval (CI), 0.88-0.95) or not to be up-to-date (aOR, 0.90; 95% CI, 0.86-0.94) on CRC screening than those without CVD. CONCLUSION: The presence of CVD is associated with better adherence to CRC screening guidelines. Poor CRC screening utilization in Hispanics should be a priority for further investigation and intervention