Papers by Eric Adjei Boakye
Prevention Research: Prevention Behaviors
The Journal of Maternal-Fetal & Neonatal Medicine
Abstract Background: For women who suffer from abruption in the first pregnancy, the extent to wh... more Abstract Background: For women who suffer from abruption in the first pregnancy, the extent to which birth spacing has an impact on maternal and fetal outcomes in a second pregnancy remains unclear. Objectives: To examine the effect of interpregnancy interval (IPI) after a first pregnancy complicated by placental abruption, on adverse maternal and fetal outcomes in a subsequent pregnancy. Study design: This was a population-based retrospective cohort study using maternally-linked Missouri birth registry from 1989 to 2005 (n = 2069). Exposure of interest was IPI and outcomes were placental abruption, preeclampsia, preterm birth, small for gestational age, cesarean delivery, and neonatal plus fetal deaths (neofetal death) in a second pregnancy. Logistic regressions were used to assess the association between IPI and the outcomes. Results: Compared with women with an IPI of 1–2 years, those with short IPI (<1 year) were more likely to experience preterm birth (aOR 3.01, 95% CI 1.71–5.28) and neonatal death (aOR 3.52, 95% CI 1.24–10.02) in their subsequent pregnancy. No significant associations between IPI and recurrent placental abruption or preeclampsia were detected. Conclusions: Women who become pregnant in less than a year’s time of an initial placental abruption are at increased risk for preterm birth and neofetal death in a subsequent pregnancy. Other ischemic placental disease conditions are also shown to have serious health implications for a woman’s next pregnancy.
Head & Neck, 2021
Privately insured patients with head and neck cancer (HNC) typically have better outcomes; howeve... more Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid.
Journal of Epidemiology and Global Health, 2018
Central American immigrants to the United States are a growing population with rates of food inse... more Central American immigrants to the United States are a growing population with rates of food insecurity that exceed national averages. We analyzed multiple years of data from the Center for System Peace and the Current Population Survey, Food Security Survey Module, from 1998 to 2015. We used ordered probit and probit regressions to quantify associations between premigration residence in a country exposed to armed conflict in Central America and the food insecurity of immigrants in the United States. The study sample included 5682 females and 5801 males between the ages of 19 and 69 years who were born in Central America and migrated to the United States. The mean age of individuals included in the study sample was 38.2 years for females (standard deviation, 11.0) and 36.8 years for males (standard deviation, 10.6). Premigration armed conflict was associated with a 10.7% point increase in postmigration food insecurity among females (95% confidence interval, 6.8–14.5), and a 9.5% poi...
Journal of the National Cancer Institute, 2021
BACKGROUND While Medicaid expansion is associated with decreased uninsured rates and earlier canc... more BACKGROUND While Medicaid expansion is associated with decreased uninsured rates and earlier cancer diagnoses, no study has demonstrated an association between Medicaid expansion and cancer mortality. Our primary objective was to quantify the relationship between early Medicaid expansion and changes in cancer mortality rates. METHODS We obtained county-level data from the National Center for Health Statistics for adults ages 20-64 who died from cancer from 2007-2009 (pre-expansion) and 2012-2016 (post-expansion). We compared changes in cancer mortality rates in early Medicaid expansion states (CA, CT, DC, MN, NJ, and WA) vs. non-expansion states through a difference-in-differences (DID) analysis using hierarchical Bayesian regression. An exploratory analysis of cancer mortality changes associated with the larger-scale 2014 Medicaid expansions was also performed. RESULTS In adjusted DID analyses, we observed a statistically significant decrease of 3.07 (95% credible interval = 2.19 t...
Archives of Sexual Behavior
We examined the association between sexual orientation and human papillomavirus (HPV)-related ris... more We examined the association between sexual orientation and human papillomavirus (HPV)-related risky sexual behaviors among high school students in the U.S. We used the 2015 Youth Risk Behavior Survey, a three-stage cluster sample, nationally representative, cross-sectional study. Participants were sexually active students (Grades 9-12) in public, private, and Catholic schools in 50 states and the District of Columbia (n = 5,958). Sexual orientation dimensions were: sexual self-identity (heterosexual, gay, lesbian, bisexual, and not sure) and sex of sexual contacts. HPV-associated risky sexual risk behaviors selected a priori were early sexual debut (≤ 12 or ≥ 13 years old) and number of lifetime partners (≥ 2 or ≥ 4). Separate multiple logistic regression analyses estimated association between sexual orientation and sex of sexual contacts, and HPV-associated risky sexual behaviors. Among the 5,958 high school students, a quarter had ≥ 4, and two-thirds had ≥ 2 sexual partners. Students who self-identified as bisexual (aOR = 2.43, 99% CI 1.19-4.98) or "not sure" (aOR = 4.56, 99% CI 2.54-8.17) were more likely to have sexual debut before 13 years. Similarly, students whose sexual contacts were adolescent females who had sex with females and males were more likely to have sexual debut before they turned 13 years of age (aOR = 3.46, 99% CI 1.83-6.48), or had ≥ 4 sexual partners (aOR = 2.66, 99% CI 1.74-4.08), or had ≥ 2 sexual partners (aOR = 3.09, 99% CI 1.91-5.00). In conclusion, HPV-associated risky sexual behavior is prevalent among high school students, especially sexual minorities. Interventions tailored to this population could increase HPV vaccine uptake and prevent future HPV-associated cancers and other negative outcomes.
Poster Presentations - Proffered Abstracts
Objective: Access to care is an important issue for head and neck cancer (HNC) patients as HNC is... more Objective: Access to care is an important issue for head and neck cancer (HNC) patients as HNC is one of the most expensive cancers, particularly for late stage disease. While some data show increased insurance coverage with Medicaid expansion, evidence is limited for impacts on socioeconomic disparities in insurance or on stage at diagnoses. This study aimed to quantify the impact of state Medicaid expansion status on insurance status and stage at diagnosis in HNC patients. Methods: Using a quasi-experimental design, the 2011-2015 Surveillance, Epidemiology, and End Results database was queried for adults with HNC in the United States. Changes in insurance coverage and stage at diagnosis after 2014 in states that expanded Medicaid (EXP) were compared to changes in states that did not expand Medicaid (NEXP). Difference-in-differences analyses were used to assess changes in the percentage of Medicaid coverage, uninsured, and early stage diagnoses in EXP relative to NEXP states. Results: A total of 26,330 HNC cases were identified. In difference-in-difference analyses, we observed an increase in Medicaid insurance in expansion relative to non-expansion states (3.36 percentage points (PP), 95% CI = 1.32, 5.41, p=.001), especially for residents of low income and education counties. We also observed a reduction in uninsured status among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p=.002). Additionally, we found significant increases among young adults age 18-34 years (17.2 PP, 95% CI – 1.34, 33.10, p=0.034), females (7.54 PP, 95% CI = 2.00, 13.10, p=0.008), unmarried patients (3.83 PP, 95% CI = 0.30, 7.35, p=0.033), and patients with cancer of the lip (13.5 PP, 95% CI = 2.67, 24.30, p=0.015). There was some evidence for greater expansion-associated increases in early stage diagnoses for non-Hispanic blacks (8.53 PP) and other races (20.4 PP) relative to white HNC patients (p=.025). Conclusions: Medicaid expansion is associated with improved insurance coverage for HNC patients, particularly those with low income, and increased early stage diagnoses for young adults and for racial/ethnic minorities. Thus, Medicaid expansion may improve access to care for patients with HNC. Our findings are particularly relevant at a time when there is debate in the United States about healthcare financing, Medicaid, and the Affordable Care Act. Citation Format: Nosayaba Osazuwa-Peters, Justin M Barnes, Eric Adjei Boakye, Matthew E Gaubatz, Kenton J Johnston, Neelima Panth, Rosh KV Sethi, Uchechukwu Megwalu, Mark A Varvares. Effect of state Medicaid expansion status on insurance coverage and stage at diagnosis in head and neck cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A121.
Human Vaccines & Immunotherapeutics
ABSTRACT Objectives We compared HPV vaccine initiation and completion of heterosexual with lesbia... more ABSTRACT Objectives We compared HPV vaccine initiation and completion of heterosexual with lesbian and bisexual (LB) women. Methods We aggregated National Health and Nutrition Examination Survey data from 2009 to 2016 for 3,017 women aged 18 to 34 y in the United States. HPV vaccine initiation was defined as reported receipt of ≥1 dose of the vaccine and completion as receipt of the three recommended doses. Weighted percentages and multivariable logistic regression models were used to examine differences in HPV vaccine initiation and completion between heterosexual and LB women. Results Approximately 12% of respondents self-identified as LB women. Overall, a higher percentage of respondents (26%) had initiated the HPV vaccine than completed the three vaccine doses (17%). In the bivariate analysis, LB women had higher initiation ([35% of LB women versus 25% heterosexual]; p = .0012) and completion rates ([24% of LB women versus 17% heterosexual]; p = .0052) than heterosexual women. After adjusting for covariates, compared to heterosexual women, LB women were 60% (aOR = 1.60, 95% CI: 1.16–2.19) more likely to initiate and 63% (aOR = 1.63, 95% CI: 1.12–2.37) more likely to complete the HPV vaccine. Conclusions Although LB women had higher likelihood of HPV vaccine initiation and completion compared with heterosexual women, their HPV vaccine uptake was well below the Healthy People 2020 target (80%). Understanding differences in the drivers of vaccine uptake in the LB population may inform strategies that would further increase HPV vaccine uptake toward achieving the 80% completion target.
Cancer Causes & Control
Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexu... more Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24–0.73 and aOR = 0.79; 95% = 0.72–0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80–0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41–0.94) than heterosexuals, and there were no differences for breast screening. We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.
Journal of Clinical Oncology
7035 Background: Medicaid expansion has been associated with increased access to care and earlier... more 7035 Background: Medicaid expansion has been associated with increased access to care and earlier stage at diagnosis among patients with head and neck cancer (HNC). However, it is unclear whether Medicaid expansion has impacted HNC mortality rates. We examined the associations between early Medicaid expansions (2010-2011) with mortality rates for HNC in the United States. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat was utilized to obtain mortality rates for early expansion (CA, CT, DC, MN, NJ, and WA) and non-early expansion states (all others) in the year ranges as available in SEER: 2005-2007 (pre-expansion) and 2012-2016 (post-expansion). Deaths in 2008-2011 were excluded as a phase-in/washout period. Difference-in-differences analyses were utilized to compare mortality rates pre- and post-early expansion in early expansion vs. non-early expansion states. The parallel trends assumption was tested comparing changes in ...
Head & Neck, Apr 22, 2020
Journal of Cancer Research and Clinical Oncology
Purpose As the number of cancer survivors in the United States increases, quantifying the risks a... more Purpose As the number of cancer survivors in the United States increases, quantifying the risks and burden of second primary cancers (SPCs) among cancer survivors will help develop long-term prevention and surveillance strategies. We describe the risk of developing a SPC among survivors of 10 cancer sites with the highest survival rates in the United States. Methods Adult patients diagnosed with an index smoking-related (urinary bladder, kidney and renal pelvis, uterine cervix, oral cavity and pharynx, and colon and rectum) and index non-smoking-related (prostate, thyroid, breast, corpus and uterus, and non-Hodgkin lymphoma) cancers were identified from Surveillance, Epidemiology, and End Results (2000–2015). SPC risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Results A cohort of 2,903,241 patients was identified and 259,685 (8.9%) developed SPC (7.6% of women and 10.3% of men). All index cancer sites (except prostate) were associated with a significant increase in SPC risk for women and men. Patients diagnosed with smoking-related index cancers (SIR range 1.20–2.16 for women and 1.12–1.91 for men) had a higher increased risk of SPC than patients with non-smoking-related index cancers (SIR range 1.08–1.39 for women and 1.23–1.38 for men) relative to the general population. Conclusion We found that 1-in-11 cancer survivors developed a SPC. Given the increasing number of cancer survivors and the importance of SPC as a cause of cancer death, there is a need for increased screening for and prevention of SPC.
American Journal of Clinical Oncology
Objectives: Thirty-day (30-day) mortality, a common posttreatment quality metric, is yet to be de... more Objectives: Thirty-day (30-day) mortality, a common posttreatment quality metric, is yet to be described following surgery for head and neck squamous cell carcinoma (HNSCC). This study aimed to measure 30-day postoperative mortality in HNSCC and describe clinical/nonclinical factors associated with 30-day mortality. Methods: In this retrospective cohort study, the National Cancer Database (2004 to 2013) was queried for eligible cases of HNSCC (n=91,858). Adult patients were included who were treated surgically with curative intent for the primary HNSCC, not missing first treatment, survival, and follow-up information. The outcome of interest was all-cause mortality within 30 days of definitive surgery. Clinical and nonclinical factors associated with all-cause 30-day postoperative mortality were estimated using a fully adjusted, multivariable logistic regression, which accounted for time-varying nature of adjuvant therapy. Results: A total of 775 patients died within 30 days of definitive surgery for HNSCC (30-day mortality rate of 0.84%). Thirty-day mortality rate was however up to 2.33% (95% confidence interval [CI], 1.91%-2.75%) depending on comorbidity. In the fully adjusted model, increasing severity of comorbidity was associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: adjusted odds ratio [aOR], 1.43; 95% CI, 1.21-1.69, and of 2+ aOR, 2.55; 95% CI, 2.07-3.14). Odds of 30-day mortality were greater among Medicaid patients (aOR, 1.77; 95% CI, 1.30-2.41), and in patients in neighborhoods with little education (≥ 29% missing high school diploma: aOR, 1.35; 95% CI, 1.02-1.78). Conclusions: Patients with higher 30-day mortality were those with a greater burden of comorbidities, with little education, and covered by Medicaid.
Journal of Clinical Oncology
106 Background: Cost-related medication non-compliance (CRN), which is associated with access-to-... more 106 Background: Cost-related medication non-compliance (CRN), which is associated with access-to-care barriers and poorer health outcomes, is more prevalent among cancer survivors than other adults. While CRN in survivors has been decreasing recently, evidence for a change driven by the Affordable Care Act (ACA) is limited. We aimed to quantify the impact of the ACA on CRN in non-elderly cancer survivors using population-based data and a quasi-experimental design. Methods: We utilized 2011-2017 National Health Interview Survey data. CRN was defined as not being able to afford medication or taking less than prescribed, skipping doses, or delaying prescription filling due to cost. Linear probability models applied to difference-in-difference analyses were used to compare CRN changes after the ACA in non-elderly ( < 65 years) cancer survivors relative to control groups expected to be impacted less by ACA provisions--non-elderly adults without a cancer history, elderly survivors, and...
The Laryngoscope
To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from... more To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)‐related head and neck squamous cell carcinoma (HNSCC) and HPV‐unrelated HNSCC and to 2) compare overall survival between those with HPV‐related and HPV‐unrelated index HNSCC among patients who develop SPM.
Journal of Clinical Oncology
181 Background: Suicide rate is among cancer survivors double that of the general United States p... more 181 Background: Suicide rate is among cancer survivors double that of the general United States population, and risk is significantly greater among males than females. Meanwhile, being married confers survival advantage across the cancer continuum, with males benefitting more than females. This study was aimed at determining whether marital status mitigated the risk of suicide among male cancer patients with advanced stage disease. Methods: Male patients with stage IV cancer of nine common cancer sites (prostate, lung/bronchus, colon/rectum, urinary bladder, melanoma of the skin, kidney/renal pelvis, non-Hodgkin lymphoma, head and neck cancer, liver/intrahepatic bile duct) diagnosed from 2007-2015 from the Surveillance, Epidemiology, and End Results 18 database were included. A multivariate competing risks proportional hazards model determined the impact of marital status on suicide while controlling for covariates (age, county-level poverty percentage, insurance status, race/ethnic...
Health Economics, Outcomes, and Policy Research
Introduction: Although there are currently more than 430,000 head and neck cancer (HNC) survivors... more Introduction: Although there are currently more than 430,000 head and neck cancer (HNC) survivors in the United States, it is accepted that many more patients would have survived longer if they presented at an earlier stage. Less than half of all head and neck cancer patients present with early-stage disease. One of the factors implicated in late stage of presentation for head and neck cancer patients is access to care, driven by health insurance status. While individuals with health insurance are known to present earlier, less is known about outcome differences for patients who are uninsured or who have Medicaid insurance. We have observed many head and neck cancer patients initially present without insurance despite qualifying for Medicaid, and so are assisted with obtaining insurance before discharge. This process blurs the line between uninsured and Medicaid patients. The aim of this study was to determine whether there are disparities in survival outcomes for HNC patients based on whether they are insured, uninsured, or have Medicaid insurance. Methods: A cohort of 49,524 patients aged 18-64 years with first primary HNC from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed from 2007-2014 was included. Actuarial survival curves stratified by insurance status (insured, Medicaid, and uninsured) were created to determine HNC-specific survival differences between the groups with a log-rank test. Patient characteristics including insurance, race/ethnicity, sex, county-level poverty, surgery, marital status, tumor site, stage, year of diagnosis, and age at diagnosis were utilized in a Fine and Gray competing risk proportional hazard model to compute adjusted hazard ratios (aHR) for cause-specific death from HNC. Multinomial logistic regression was also performed to determine characteristics of patients with each type of insurance by adjusted odds ratios (aOR). Results: The cohort was mostly male (75.6%) and insured (73.6%), with 18.6% on Medicaid and 7.8% uninsured. At the end of the 7-year follow-up period, HNC-specific survival rate was significantly lower for patients on Medicaid (49.5%) than uninsured (54.8%) and insured patients (74.2%) (log-rank p Conclusion: While patients with health insurance had better survival outcome in general, our study showed that patients with Medicaid did not have a better survival outcome than those without any insurance after adjusting for all other prognostic factors, including stage of presentation and treatment modality. Medicaid patients, in fact, had worse outcome than uninsured HNC patients. It could be that despite having insurance, Medicaid patients did not have adequate access to care and thus had delayed presentations. Our findings highlight the need to bridge the health insurance gap for HNC patients to increase survivorship. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Sean T. Massa, Eric Adjei Boakye, Lauren M. Cass, Sai Deepika Challapalli, Rebecca L. Rohde, Mark A. Varvares. Survival outcomes for head and neck patients with Medicaid: A health insurance paradox [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C54.
Cancer Control
Objectives Human papillomavirus (HPV)-associated cancers account for about 9% of the cancer morta... more Objectives Human papillomavirus (HPV)-associated cancers account for about 9% of the cancer mortality burden in the United States; however, survival differs among sociodemographic factors. We determine sociodemographic and clinical variables associated with HPV-associated cancer survival. Methods Data derived from the Surveillance, Epidemiology, and End Results 18 cancer registry were analyzed for a cohort of adult patients diagnosed with a first primary HPV-associated cancer (anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers), between 2007 and 2015. Multivariable Fine and Gray proportional hazards regression models stratified by anatomic site estimated the association of sociodemographic and clinical variables and cancer-specific survival. Results A total of 77 774 adults were included (11 216 anal, 27 098 cervical, 30 451 oropharyngeal, 2221 penile, 1176 vaginal, 5612 vulvar; average age = 57.2 years). The most common HPV-associated cancer was cervical carcinoma (...
Poster Presentations - Proffered Abstracts
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Papers by Eric Adjei Boakye