Medicare at Fifty Years: Impact on Health Care Disparities

Objectives: To review history of legislation to development of Medicare program in the United States To delineate key Medicare milestones To review recent changes in Medicare To define impact on disparities An examination of the history of Medicare and its impact on our ability to deliver patient-centered, interprofessional care. A description of global interprofessional education and practice, highlighting real world examples from the work of Partners In Health in West Africa and Haiti

Medicare at 50: Its Effect on Disparities

This Forum presentation provides an overview of the historical impact of the Medicare with emphasis on key milestones related to reducing health disparities. Recent challenges related to ACA are also discussed. Objectives: Review the history of legislation leading to development of the Medicare program in the U.S Delineate key Medicare milestones Identify recent changes in Medicare Define the impact on disparities and quality of care Presentation: 47:48 Note: PowerPoint slides are at bottom of pag

Associations Between Oncogenic Risk Markers and Clinical Outcomes among Black and White Colorectal Cancer Patients

Introduction: Blacks have a 25% higher incidence of colorectal cancer compared to their white societal counterparts. Additionally, the overall mortality rate among black colorectal cancer patients is 50% higher than that of whites. However, little is known about the biomarkers prevalent among blacks and their possible correlation to treatment response and patient outcomes. Objective: The objective of this study is to explore disease trends that may unveil a correlation between molecular markers and poor clinical outcomes among black colorectal cancer patients. Methods: De-identified patient data was obtained from The Oncology Data Services Department (Cancer Registry) of TJUH. The population cohort included newly diagnosed colorectal cancer patients treated at TJUH from 2000-2019, and included information regarding patient race, sex, age at presentation, stage at presentation, histological code, tumor markers: KRAS, NRAS, BRAF, MS1, treatment received, surgical findings: tumor size, lymph node involvement, presence of distant metastases at first surgery, response to chemotherapy & disease-free survival. Results: Preliminary data on the analyzed population demonstrates that biomarker profiles did not correlate with patient race. Therefore, racial disparities seen among colorectal cancer patients cannot be attributed to these findings. Conclusion: Biomarker trends among newly diagnosed colorectal cancer patients at TJUH do not correlate with racial identity. Additional data is needed regarding possible etiologies for the comparatively higher incidence and mortality rates among black colorectal cancer patients. Health professionals should continue to explore possible etiologies for this racial disparity in future studies

Racial Disparities in Diabetes Mellitus Prevalence in Prostate Cancer Patients on Androgen Deprivation Therapy

Intro/Background Androgen deprivation therapy (ADT) is successfully used in patients with advanced prostate cancer. ADT has show to prolong survival. The use of ADT is associated with many side effects, most notably an increase in diabetes incidence for patients on ADT. African American men have higher prevalence and mortality rates from prostate cancer than White men. It is unclear how prostate cancer treatment such as ADT affects these disparities. This study examines racial differences in the prevalence of diabetes mellitus in prostate cancer patients based on their ADT status in the US.https://jdc.jefferson.edu/medoncposters/1016/thumbnail.jp

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Molecular and Genomic Factors in Colorectal Cancer to Optimize Therapeutic Decisions and Patient Care

Presentation: 34 minute

Navigating the Complex World of Cancer Diagnosis and Care: Minimizing Disparities

Objectives: 1. Discuss the factors associated with cultural competency and disparities. 2. Outline issues implicated in the increased incidence and mortality of cancer in minority adults and the rationale behind them. 3. Formulate approaches to reduce the existing disparities in cancer and its treatment in minority American adults. Presentation: 52 minute

Precision Medicine in Colorectal Cancer: Molecular Factors to Optimize Systemic Therapeutic Decisions and Patient Care

Learning Objectives: To review progress over the past 50 years in the diagnosis and treatment of colorectal cancer To discuss etiology, biology, and emerging use of biomakers To provide an overview of treatment strategies and parameters Presentation: 56 minute

The Long Journey to Health Equity: A Candid Conversation about Public Health in Philadelphia

As the poorest and most diverse of the nation\u27s 10 largest cities, Philadelphia struggles to address an array of issues that affect the health and wellbeing of our community members. There are no easy answers, but there are many of ideas and efforts underway led by dedicated citizens working to make a difference. This Population Health Forum is dedicated to acandid conversation about health equity, moderated by local journalist and media executive Sara Lomax-Reese. Presentation: 58:5