Social Determinants of Health and Health Care Utilization among Hispanic and Non-Hispanic Black Men at Risk for Hypertension.

Background: Non-Hispanic Black (NHB) men experience cardiovascular disparities, including high prevalence of hypertension and high morbidity and mortality due to cardiovascular disease (CVD). Less is known about CVD risk among Afro-Latin (AL) men, who are an understudied population overall. The Hispanic/Latin population is the largest and fastest growing ethnic minority group in the United States, as well as one of the most heterogeneous. However, CVD in this population is often examined in aggregate, or by country of origin, and is most often compared to Non-Hispanic White individuals, not only limiting understanding of CVD risk but also potential avenues for intervention. Objective: To describe CVD risk, healthcare utilization and social determinants of health among a sample of AL and NHB men. Methods and Results: We present preliminary data from the Community-to-Clinic Linkage Program (CLIP) study, a community-based cluster randomized trial testing barbershop facilitation to prevent hypertension in normotensive Black men. The study is set in Staten Island (SI), New York City. Approximately 10% of SI residents identify as Black, of which ~ 90% live in 6 zip codes with the highest prevalence of hypertension in the borough. Within the cohort (N=243), AL men (N=88) and NHB men (N=155) had similar blood pressure, but AL men were younger and had lower BMI compared to NHB men, age mean (SD), 35.1 (11.8) years versus 39.2 (12.1) years, p=0.007, BMI 25.6 (4.2) versus 27.2 (5.2) BMI, p=0.01. While diet was similar, AL men had higher levels of weekly physical activity, 5662 (4927) minutes versus 3461 (2453) minutes among NHB men, p<0.001. Both groups had a similar rate of smoking tobacco and there were no differences related to sleep quality or sleep duration. AL men were more likely to have seen a healthcare provider in the last 5 years compared to NHB men and used the emergency room for care more than NHB men, 70.5% versus 47.6%, p=0.02, and 20.4% versus 9.2%, p=0.02, respectively. More AL men delayed medical care because of costs in the last year than NHB men, 8.2% versus 2.3%, p=0.03. Fewer AL men reported having a primary care provider, 19.4% versus 29.3%, p=0.03 compared to NHB men. Both groups reported similar rates of depressive symptoms and social support, but NHB men had higher perceives stress (PSS-4 scores), 6.0 (2.9) versus 4.4 (3.4), p<0.001 than AL men. More AL men were born abroad, 69.4% versus 96.6%, p<0.001 than NHB men. Education attainment was similar between both groups; AL men were more likely to be employed full-time than NHB men, 57.1% versus 51.7%, p=0.04. Income data was limited as approximately a third of men declined to respond. Conclusion: Understanding CVD risk and patterns of healthcare utilization among Afro-Latin and Non-Hispanic Black men will help inform strategies for intervention to improve cardiovascular health and reduce CVD disparities.

5013 Background: Black men have been underrepresented in large-scale molecular prostate cancer (PC) surveys, despite having higher PC incidence and mortality. Since molecular profiling to guide the use of targeted agents is increasingly important in mCRPC, we compared precision medicine data and utilization in a cohort of black and white men with mCRPC. Methods: The PROMISE precision medicine database is an academic collaboration to compile clinical and genomic data from men with PC. All patients have had germline and/or somatic genetic testing performed. Eligibility criteria for this analysis included a diagnosis of mCRPC with available race and biomarker data. The primary outcome was the proportion of non-Hispanic black (NHB) and non-Hispanic white (NHW) men with actionable molecular data, defined as the presence of mismatch repair deficiency (MMRd/MSI-H), homologous recombination repair deficiency (HRRd), tumor mutational burden (TMB) ≥ 10 mut/MB, or AR-V7. Secondary outcomes included the proportion of NHB and NHW men with other alterations, the type and timing of genomic testing performed, and the use of targeted therapy. Results: A total of 962 mCRPC patients (21.2% NHB; 78.8% NHW) met inclusion criteria of 1619 in the overall database. Median age (NHB/NHW) was 61/63; 77.5/68.8% had Gleason 8-10; 52.5/56.7% presented with de novo metastatic disease (33.8/29.9% LN, 36.2/32.2% bone and 8.3/6.1% viscera). The median time from diagnosis to first molecular result was 56.3 mo for NHB v 58.7 mo for NHW (p = 0.45). Use of blood-based molecular testing was more common in NHB men (48.7% v 36.4%, p < 0.001). Overall, 32.8% of NHB men harbored actionable molecular data compared to 30.3% of NHW men (Table). MMRd/MSI-H was more common in NHB men (9.1 v 4.9%, p = 0.04). Other than PTEN (12.7/23.8% NHB/NHW, p = 0.0001), no significant differences were seen in the 15 most frequently mutated genes, including TP53, AR, CDK12, RB1, and PIK3CA. Tumor suppressor co-mutations (PTEN/TP53/RB1) were found in 13.1% of NHB and 18.0% NHW (p = 0.13). Delivery of targeted therapy was reported in 19.6% of NHB and 23.7% of NHW men (p = 0.25) after a median of 2 CRPC lines. Median OS from development of mCRPC was 41.5 mo (95% CI, 34.7-51.3) and 44.7 mo (95% CI, 41.1-51.5) for NHB and NHW men, respectively (p = 0.14). Conclusions: In a real-world mCRPC molecular profiling cohort, we found similar overall rates of actionable molecular alterations in NHB and NHW men, but higher rates of MMRd/MSI-H and lower frequency of PTEN alterations in NHB men. We did not find differences in delivery of targeted therapy. [Table: see text]

BACKGROUND:Cardiovascular disease (CVD) is a leading cause of death in men with prostate cancer. In addition, non-Hispanic Black (NHB) men experience worse CVD-related mortality compared to their non-Hispanic White (NHW) counterparts, although the reason for this racial disparity remains unclear. Notably, vascular endothelial dysfunction often precedes the emergence of overt CVD. Indeed, conduit-vessel dysfunction, micro-vascular dysfunction, and arterial stiffness are independent predictors of CVD risk. Thus, the purpose of this study was to comprehensively assess vascular health in recently diagnosed NHB and NHW men with prostate cancer. Methods: Twenty-eight men (10 NHW, 18 NHB) with a new clinical diagnosis of prostate cancer (within 3 months) participated in this study. Flow-mediated dilation (FMD) was performed to represent conduit-vessel vascular endothelial function. Cutaneous post occlusive reactive hyperemia (PORH) with local thermal heating (LTH) and iontophoresis of acetylcholine were performed to represent various mechanisms regulating microvascular function. Lastly, pulse wave velocity (PWV) and pulse wave analysis (PWA) were performed to assess central and aortic stiffness, respectively. Data are reported as mean ± SD. Results: A 4-year age difference ( p=0.131) was observed between NHB (65±7 years) and NHW (69±6 years) men. No differences in BMI or clinical laboratory values were observed between NHB and NHW patients (all p>0.05). NHB men exhibited significantly lower microvascular function compared to NHW men, including PORH (NHB: 117±44 PU vs NHW: 207±47 PU; p<0.001), LTH (NHB: 180±73 PU vs NHW: 281±65 PU; p=0.003), and iontophoresis (NHB: 67±28 PU vs NHW: 136±38 PU; p<0.001). No differences in FMD ( p=0.596), PWV ( p=0.695), or PWA ( p=0.883) were observed between groups. CONCLUSION: The results of the current study provide compelling evidence that microvascular dysfunction is present in NHB men who are recently diagnosed with prostate cancer compared to their NHW counterparts. Given that NHB men were 4 years younger, these data support that the microvascular dysfunction may accelerate vascular aging and contribute to the racial disparity in CVD following prostate cancer diagnosis. Supported by: AHA SFRN 863621 (RAH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999–2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24–1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.

Non-Hispanic Black (NHB) men are at higher risk both for incidence and mortality from prostate cancer (PCa) compared to Non-Hispanic White (NHW) men, but these findings arise from biopsy-detected PCa reports. We aimed to compare the incidence, subsequent management and cancer-specific mortality (CSM) of incidental PCa among NHB and NHW men, using two different North American cohorts. The Surveillance, Epidemiology and End-Result (SEER: 2004-2017) and our institutional Henry Ford Health (HFH: 1995-2022) databases were queried to identify men diagnosed with incidental PCa. Cumulative incidence estimates were used to calculate CSM differences between NHB and NHW men. Competing-risk multivariable regression analysis tested the impact of race on CSM, after accounting for all available covariates. A total of 418 and 6,124 incidental PCa cases were recorded in HFH and SEER database respectively. No pathological differences were observed between NHB and NHW men in both the cohorts, except for prostate-specific antigen (PSA) value at diagnosis, which was higher in NHB men. At 10-years, the CSM rates were 5.5% vs 7.2% in our cohort and 8.6% vs 10.3% in the SEER cohort for NHW and NHB men, respectively (all Gray's test p-value > 0.05). At multivariable, race was not an independent predictor of CSM in our HFH cohort (HR: 1.46, 95% CI: 0.57-3.71, p = 0.6). In the SEER cohort, NHB men were 34% less likely to die from PCa from 1 year to the next (95% CI: 0.49-0.90, p = 0.008), when compared with NHW men. In the comparison of incidental PCa findings between NHB and NHW men, both groups had similar pathological characteristic and survival outcomes. These findings are different from the 'conventional' screening-detected PCa and suggest that racial differences have minimal to no adverse effects on PCa-specific mortality after incidental diagnosis.

No data exist comparing racial differences in bone microstructure or mechanical competence using HR-pQCT and micro-finite element analysis (μFEA) in elderly Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) men. These modalities were utilized to investigate skeletal health in 255 elderly men (age ≥ 65) from a population-based study in New York City: 40.0% Caribbean Hispanic (CH), 35.3% NHW, and 24.7% NHB. Covariate-adjusted (age, BMI, calcium consumption, smoking, diabetes, liver disease, and HIV) results are shown. We also explored the effect of socioeconomic (SE) factors. At the distal tibia, CH men had lower trabecular indices with 9% lower stiffness and failure load (both p < .05) compared to NHW. CH men had smaller cortical area (Ct.Ar) and lower thickness (Ct.Th) compared to NHB, with 11% (p < .05) lower stiffness and failure load. After adjusting for SE, differences in stiffness and failure load between CH and NHW were no longer significant. Comparing NHB to NHW men at the tibia, NHB had lower trabecular indices but greater Ct.Ar, Ct. volumetric bone density (Ct.vBMD) and Ct.Th, with no differences in stiffness and failure load. At the diaphyseal tibia, Ct.Ar and Ct.Th were lower in CH compared to both NHW and NHB men, with 11% and 17% lower stiffness and failure load compared to NHW and NHB (all p < .05). Radial μFEA indices were not different. In conclusion, CH elderly men have lower mechanical competence at the tibia compared to NHW and NHB men, which could result in a greater risk of incident fracture in CH men. Some differences between CH and NHW may be related to modifiable SE factors. Studies assessing HR-pQCT’s ability to predict incident fracture and how SE factors affect fracture risk are needed in men of races and ethnicities historically underrepresented in skeletal research.

Non-Hispanic black (NHB) men have higher rates of chronic disease than men in other racial/ethnic groups. Poor diet quality is one risk factor for chronic disease, but research on the diet quality and nutrient intake of NHB men is sparse. The objective of this study was to describe and compare the diet quality and nutrient intake of NHB and non-Hispanic white (NHW) men in the United States. We analyzed cross-sectional data on 5050 men (31.3% NHB, 68.7% NHW) who participated in the National Health and Nutrition Examination Survey (NHANES) during 2007-2012. To assess diet quality, we calculated Healthy Eating Index (HEI)-2010 scores from each participant's 24-hour recall data. We used logistic regression models to determine if NHB men had lower odds of meeting dietary recommendations for nutrient intake than NHW men. We used linear regression models to identify significant differences in HEI-2010 scores between NHB and NHW men. After adjusting for sociodemographic measures, NHB and NHW men had similar diet quality (P = .59). Compared with NHW men, NHB men had lower odds of meeting recommendations for dietary fiber and cholesterol intake and higher odds of meeting recommendations for saturated fat and sodium intake. Differences between NHB and NHW men in the intake of certain nutrients may be related to chronic disease disparities. Future research should consider racial/ethnic differences in dietary intake among men and the impact these differences have on men's health.

Although men have greater societal and economic privileges, men have higher all-cause mortality rates than women, even after controlling for education. Further, racial/ethnic mortality disparities exist among men with varying levels of education. Few studies have explored the independent effects of education and all-cause mortality between non-Hispanic Black and non-Hispanic White men with the same level of education. Our purpose was to identify trends in racial differences in all-cause mortality between non-Hispanic White and non-Hispanic Black men with the same level of education. Data for the study came from the National Health Interview Surveys 2000–2011 linked to the 2000–2009 Mortality Files. The Student’s t and chi-square tests were used to assess the mean and proportional differences between non-Hispanic White and non-Hispanic Black men (≥18 years of age) across a range of demographic and health-related factors. Cox proportional hazard models were specified to examine the association between level of education and all-cause mortality adjusting for the demographic and health characteristics. Except for men who did not complete high school, statistically significant differences in all-cause mortality are present between non-Hispanic Black and non-Hispanic White men with the same level of education. The findings reveal the importance of understanding the level of education on differences in all-cause mortality between non-Hispanic Whites and non-Hispanic Blacks.

High allostatic load (AL), a measure of physiological dysregulation, has been linked with premature morbidity and mortality. There is a paucity of research assessing AL among non-Hispanic Black (NHB) and non-Hispanic White (NHW) American men of various age groups. This study investigated racial differences in AL among NHB and NHW adult men and assessed whether racial differences in AL varied by age. Data were drawn from NHB (n = 232) and NHW (n = 246) men in the Nashville Stress and Health Study. AL was based on the sum of 10 biomarkers that was dichotomized as high AL (four or more high-risk biomarkers) or low AL (fewer than four high-risk biomarkers). Modified Poisson regression models were estimated to assess race differences in AL, adjusting for age, socioeconomic status (SES), and health behaviors. Interactions assessed whether racial differences in AL varied between young (22-49 years) and older (50-69) men. NHB men had a higher prevalence of being in the high AL group (prevalence ratio [PR] = 1.54, confidence interval [CI] = [1.09, 2.18]), relative to NHW men in the total sample. Among young men ages 22 to 49 years, NHB men had a higher prevalence of being in the high AL group (PR = 2.09, CI = [1.25, 3.49]), relative to NHW men. Among older men ages 50 to 69 years, there were no racial differences in AL. Findings underscore the importance of identifying factors that are associated with high AL, which is critical to mitigate premature morbidity and mortality, among NHB men.

Introduction: Recent studies have highlighted the cardiotoxic effects of novel androgen deprivation therapy for prostate cancer. The association of demographic and geographic background on cardiovascular disease (CVD)-related mortality in patients with prostate cancer is unclear. Goals: We aimed to analyze the trends in CVD mortality among patients with prostate cancer in the United States (US) from 1999-2022, with stratification by age, race, census region, rural-urban status, place of death, and specific CVD types. Methods: The age-adjusted mortality rates (AAMR) per 100,000 people were extracted using the Centers for Disease Control and Prevention WONDER database from 1999-2022. Joinpoint regression was utilized to calculate annual percentage change (APC) with 95% confidence intervals to assess for significant differences in change in AAMR over time. Results: A total of 440,318 deaths occurred due to CVD in patients with prostate cancer in the US in the last 20 years. The AAMR declined from 1999 to 2016 (APC -3.0 [-3.3, -2.8]) and rose till 2022 (APC 4.6 [3.4, 6.2]). AAMRs were stable in recent years for Non-Hispanic (NH) Asian or Pacific Islanders (2018-2020; APC (11.7 [-0.9, 17.9]) and NH American Indian or Alaska Native men (1999-2022, APC (-0.6 [-1.6, 0.3]). NH Black, NH White, and Hispanic men had a significant increase in AAMR from 2017 (APC 4.9), 2016 (APC 5.1), and 2018 (APC 7.0) to 2022, respectively, after an initial decline. NH Black men had the highest AAMR across all census regions. Mississippi, the District of Columbia, Nebraska, and California had the greatest overall AAMRs. The AAMRs were higher in rural than urban areas (5.9 vs 5.3/100000 people). Most deaths occurred in the decedent's home (35.3%) and in men aged &gt;85 years. Ischemic heart disease (AAMR 2.0), hypertensive disease (AAMR 1.7), and cardiac arrest (AAMR 1.4) were the top 3 causes of CVD-related mortality among patients with prostate cancer. Conclusion: CVD mortality in prostate cancer patients has increased in recent years with the greatest AAMR in NH Black and elderly men, and those living in rural areas. Identifying the causes and creating policies to reduce disparities requires further research.

National guidelines recommend next-generation sequencing (NGS) of tumors in patients diagnosed with metastatic prostate cancer (mPCa) to identify potential actionable alterations. Non-Hispanic Black men are poorly represented in precision oncology cohorts, and therefore differences in alterations frequencies between non-Hispanic Black and White men remain poorly characterized. To describe the spectrum and frequency of alterations in PCa-related genes and pathways, as well as associations with self-identified race and ethnicity and overall survival in US veterans. This retrospective cohort study compared alteration frequencies between non-Hispanic Black and White men who underwent NGS testing from January 23, 2019, to November 2, 2023, adjusted by NGS analyte and clinicopathologic covariates. The analytic data file was locked on December 8, 2023. NGS testing was performed through the Department of Veterans Affairs (VA) National Precision Oncology Program, part of the largest near-equal access integrated health care system in the US. Pathogenic alterations identified by NGS testing with a commercially available NGS platform. The primary outcome consisted of alteration frequencies in individual genes, actionable targets, and canonical prostate cancer pathways. Associations between alteration frequency and race and ethnicity as well as survival were also examined. A total of 5015 veterans with mPCa who underwent NGS were included (1784 non-Hispanic Black [35.6%] and 3231 non-Hispanic White [64.4%]; mean [SD] age, 67.4 [9.0] years). Non-Hispanic Black veterans were younger, had higher prostate-specific antigen levels at diagnosis, were less likely to report Agent Orange exposure, and resided in more deprived neighborhoods compared with non-Hispanic White veterans. Nine of the top 10 most commonly altered genes were the same in non-Hispanic Black and non-Hispanic White veterans; however, the frequencies of alterations varied by race and ethnicity. Non-Hispanic Black race and ethnicity was associated with higher odds of genomic alterations in SPOP (odds ratio [OR], 1.7; 95% CI, 1.2-2.6) as well as immunotherapy targets (OR, 1.7; 95% CI, 1.1-2.5) including high microsatellite instability status (OR, 3.1; 95% CI, 1.1-9.4). Furthermore, non-Hispanic Black race and ethnicity was associated with lower odds of genomic alterations in the AKT/PI3K pathway (OR, 0.6; 95% CI, 0.4-0.7), androgen receptor axis (OR, 0.7; 95% CI, 0.5-0.9), and tumor suppressor genes (OR, 0.7; 95% CI, 0.5-0.8). Cox proportional hazards modeling stratified by race and ethnicity found that alterations in tumor suppressor genes, including TP53, were associated with shorter overall survival in both non-Hispanic Black (hazards ratio [HR], 1.54; 95% CI, 1.13-2.11) and non-Hispanic White (HR, 1.52; 95% CI, 1.25-1.85) veterans. This retrospective clinical genomic profiling cohort study with a large total and proportional representation of non-Hispanic Black men with mPCa reported significant differences in alteration frequencies from key oncogenic pathways but similar survival rates in the near equal-access VA health care setting. This analysis suggests the utility of genomic testing for identifying candidates irrespective of race and ethnicity for precision oncology treatments, which could contribute to equitable outcomes in patients with mPCa.

Non-Hispanic black (NHB) men experience higher risk of prostate cancer than other racial/ethnic groups, and it is possible that socioenvironmental (SE) adversity and resulting stress may contribute to this disparity. Data from the Southern Community Cohort Study were used to evaluate associations between SE adversity and perceived stress in relation to prostate cancer risk, overall and by race/ethnicity and grade. Between 2002 and 2009, 26,741 men completed a questionnaire, from which an 8-item SE adversity composite was created (covering socioeconomic status, residential environment, and social support/buffers). Two items from the Perceived Stress Scale were assessed. With follow-up through 2011, 527 prostate cancer cases were diagnosed. In multivariable models, each one-unit increase in the SE adversity composite was associated with increased prostate cancer risk among non-Hispanic white (NHW) men (HR 1.23; 95% CI 1.02-1.48) and reduced risk among NHB men (HR 0.89; 95% CI 0.82-0.95) (p interaction: 0.001). This pattern held for low grade, but not high grade, cancers although power was limited for the latter. Perceived stress variables were associated with increased risk of prostate cancer among NHW men, but not among NHB men. Results do not support the hypothesis that SE adversity my underlay the racial disparity in prostate cancer, over and above that of covariates, including healthcare utilization.

Concerns persist that low-risk prostate cancer in non-Hispanic Black (NHB) men may be more aggressive, with clinicians uncertain if active-surveillance (AS) should be used in this population. Using the SEER Prostate Cancer Specialized Database (2010-2020), we analyzed 106,486 men with low-risk prostate cancer, of whom 16.6% were NHB. AS or watchful waiting (AS/WW) was less frequently used in NHB men compared to non-Hispanic White (NHW) men (32.9% vs 37.5%), NHB men showed consistently lower utilization of AS/WW over the years (aOR = 0.91, 95%CI: 0.86, 0.95), with absolute differences ranging from 3.4% to 8.5%. In multivariable competing risks analysis, 10-year PCSM did not significantly differ by race (SHR = 1.03, 95% CI: 0.66-1.60). These findings suggest AS/WW is a safe option for NHB men and its use may be underutilized in this group despite comparable long-term cancer-specific outcomes.

Hispanic and Non-Hispanic (NH) Black adults, particularly men, disproportionately experience significant smoking-related health disparities, including cancer. Thus, identifying factors that explicate sex, racial, and ethnic differences in cigarette use is critical for developing tailored interventions to prevent smoking-related diseases among these groups. While sociodemographic characteristics and other social determinants of health (SDOH) are identified as key correlates of cigarette use, little is known about how these factors intersect with sex, race, and ethnicity to influence cigarette use. This study examined data from 15,695 Hispanic and Non-Hispanic (NH) Black participants of the National Institutes of Health All of Us Research Program to examine the role of sociodemographic characteristics and SDOH on cigarette use at the intersection of sex, race, and ethnicity. Using Horn's parallel analysis, we created a composite variable corresponding to cigarette use intensity and duration (CSID). Then, linear regressions and relative importance analyses identified the differential and relative associations among sociodemographic factors and SDOH on CSID across Hispanic men, Hispanic women, NH Black men, and NH Black women. Older age and lower educational level were the factors that were most strongly associated with higher CSID across the four groups. While housing insecurity was the third highest negative correlate for Hispanic men and women, religious service attendance, and being married ranked as third most important for NH Black women and men, respectively. These findings highlight specific factors to incorporate in smoking cessation and prevention programs uniquely designed for these populations.

PD20-06 RACE-BASED TRENDS IN THE PROPORTION OF METASTATIC PROSTATE CANCER AT DIAGNOSIS BETWEEN 2005 AND 2020: FINDINGS FROM THE NATIONAL CANCER DATABASE