Increasingly, radiologic imaging is obtained as part of the pathway in diagnosing ventral hernias. Often, radiologists receive incomplete or incorrect clinical information from clinicians. Objective: The aim of the study is to determine if clinical exam findings alter radiological interpretation of ventral hernias on CT.

Abstract Introduction: Racial and ethnic minority breast cancer patients present with later clinical stage at diagnosis, which may be due to lack of access to care due to poor socioeconomic status (SES). Our hypothesis was that the racial gap in clinical stage at breast cancer presentation would be eliminated after adjustment for SES. Methods: Retrospective review was performed of breast cancer (excluding ductal carcinoma in situ) patients from 10 hospitals in Harris County Texas between 2002 and 2011. Demographic and clinical information was recorded. Clinical stage was calculated based on data from the institutional tumor registry and electronic medical record. Zip code-based SES data, including mean household income and percentage of households receiving social support, were downloaded from www.census.gov. A multivariate ordered logistic regression clustered by hospital was used to identify predictors of clinical stage. Results: Of 3084 breast cancer patients, the mean age at diagnosis was 59 ± 14 years. The cohort included 1873 Caucasian (61%), 519 African-Americans (17%), 353 Hispanics (11%), and 339 Asian/others (11%). Age, race, mean household income, and percentage of household receiving social support were predictive of clinical stage at presentation (p<0.05). Ordered Logistic RegressionVariableOdds RatioSEp-value95% CIMean Income0.998.2 e-060.0010.98 - 0.99% Social Support1.010.0020.0021.00 - 1.01Age0.980.0020.0410.97- 0.99Race African-American4.581.220.0002.72 - 7.72Hispanic1.991.260.2730.58 - 6.89Asian/other1.450.760.4730.52 - 4.04Caucasian = referent value for Race, SE = standard error, CI = confidence interval The largest racial gap was observed between African-Americans and Caucasians. African Americans from areas with a mean income up to $180K still had a lower predicted probability of presenting with clinical stage 1a disease than the Caucasians from the poorest mean income areas ( $305K) still had a higher probability of presenting with clinical stage 4 disease as Caucasians from areas with a mean income as low as $100K. Conclusion: Both African-American race and residence in a low SES zip code contribute independently to late clinical stage at presentation among breast cancer patients. Both genetic and social factors may play a role in this disparity. Addressing factors related to just race or low SES status alone is unlikely to improve outcomes for African-Americans from low SES zip codes. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-14.

Uninsured and underinsured patients have reduced access to surgical care which may result in delays in treatment, more complicated disease at presentation, increased hospital encounters and unnecessary imaging. The purpose of this study was to quantify the delays in treatment and overuse of hospital resources associated with laparoscopic cholecystectomy (LC) at a large safety-net hospital.