Background Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia mediated by IgM autoantibodies that trigger hemolysis via classical complement pathway. Increased incidence of thrombotic events (TEs) has been reported in patients with other forms of hemolysis. The incidence of TEs in patients with CAD is unknown. Objective Evaluate TE risk in patients with CAD. Patients/Methods This is a matched cohort comparison study evaluating the risk of TEs in patients with CAD and without CAD over a 10‐year period. A total of 608 patients with CAD were identified in the Optum Claims–Clinical data set by reviewing clinical notes for CAD terms and matched with up to 10 patients without CAD (N = 5873). TEs were defined as the first medical claim for a TE using International Classification of Diseases, Ninth and Tenth Revision codes. Cox regression models were used to estimate time to first TE. Sensitivity analyses were conducted to estimate TE risk among patients with primary CAD. Results At least 1 TE occurred in 29.6% of patients with CAD and 17.6% of patients without CAD. The proportion of patients experiencing venous, arterial, and cerebral TEs were each higher among CAD patients. The overall risk of having TEs was higher in patients with CAD (adjusted hazard ratio [aHR], 1.94; 95% confidence interval [CI], 1.64‐2.30). Patients with presumed primary CAD also demonstrated an increased risk of TEs (aHR, 1.80; 95% CI, 1.46‐2.22). Patients with CAD with the fewest comorbidities had 2.44‐fold higher risk of having a TE (95% CI, 1.70‐3.52). Conclusions Patients with CAD have an increased risk of TEs when compared with a matched non‐CAD population.

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Key Points This study demonstrates the severity of anemia and relapsing nature of CAD over time, even after administration of multiple therapies. The majority of CAD patients will at some point in their disease course manifest severe disease necessitating transfusion.

Despite a large number of included studies, many had low COSMIN ratings. We recommend additional rigorous studies to explore the psychometric properties of these instruments. Furthermore, the development of a core outcome set for total hip arthroplasty clinical trials is needed.

Background Discrimination and trust are known barriers to accessing health care. Despite well‐documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case‐control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom‐specific duration), and it controlled for access‐to‐care covariates and potential confounders. Results Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1‐unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22‐2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66‐1.11). Conclusions Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.

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BACKGROUND The clinical landscape has moved toward less aggressive end‐of‐life care for women with ovarian cancer. However, whether there has been a decline in the use of aggressive end‐of‐life services is unknown. The authors evaluated current national trends and racial disparities in end‐of‐life care among women with ovarian cancer using the Surveillance, Epidemiology, and End Results‐Medicare–linked data set. METHODS In total, 7756 Medicare beneficiaries aged >66 years with ovarian cancer who died between 2007 and 2016 were identified. The authors examined trends and racial disparities in late hospice or no hospice use, >1 emergency department (ED) visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life‐extending procedures using multivariable logistic regression. RESULTS The median hospice length of stay did not change over time; however, women were increasingly admitted to the intensive care unit and had multiple ED visits in the last month of life (P < .001). Not enrolling in hospice at the end of life and terminal hospitalizations decreased over time (P < .001). Non‐White women were more likely to receive aggressive end‐of‐life care, particularly for hospital‐related utilization and life‐extending procedures, whereas non‐Hispanic Black women were more likely to have >1 ED visit (odds ratio, 2.04; 95% CI, 1.57‐2.64) or life‐extending procedures (odds ratio, 1.89; 95% CI, 1.45‐2.48) compared with non‐Hispanic White women. CONCLUSIONS Despite clinical guidelines and increasing emphasis on reducing aggressive end‐of‐life care, the use of aggressive end‐of‐life care for women with ovarian cancer persists, and care is most aggressive for non‐White women.

Background Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods REGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors. Results Among 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23). Conclusions Our results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.