Adjustment For Sociodemographic Characteristics Research Articles

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

To evaluate whether hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are associated with cognitive decline later in life among U.S. Hispanic/Latina individuals. The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a prospective population-based study of Hispanic/Latino individuals aged 18-74 years from four U.S. communities. This analysis included parous individuals aged 45 years or older who participated in the HCHS/SOL clinic study visit 1 (2008-2011) neurocognitive assessment and subsequently completed a repeat neurocognitive assessment as part of the Study of Latinos-Investigation of Neurocognitive Aging ancillary study visit 2 (2015-2018). Hypertensive disorders of pregnancy were assessed retrospectively by self-report of any gestational hypertension, preeclampsia, or eclampsia. Cognitive functioning was measured at both study visits with the Brief Spanish-English Verbal Learning Test, Digit Symbol Substitution, and Word Fluency. A regression-based approach was used to define cognitive decline at visit 2 as a function of cognition at visit 1 after adjustment for age, education, and follow-up time. Linear regression models were used to determine whether hypertensive disorders of pregnancy or their component diagnoses were associated with standardized cognitive decline after adjustment for sociodemographic characteristics, clinical and behavioral risk factors, and follow-up time. Among 3,554 individuals included in analysis, the mean age was 56.2 years, and 467 of individuals (13.4%) reported at least one hypertensive disorder of pregnancy. Individuals with hypertensive disorders of pregnancy compared with those without were more likely to have higher mean systolic blood pressure, fasting glucose, and body mass index. After an average of 7 years of follow-up, in fully adjusted models, gestational hypertension was associated with a 0.17-SD relative decline in Digit Symbol Substitution scores (95% CI, -0.31 to -0.04) but not other cognitive domains (Brief Spanish-English Verbal Learning Test or Word Fluency). Neither preeclampsia nor eclampsia was associated with neurocognitive differences. The presence of preeclampsia or eclampsia was not associated with interval neurocognitive decline. In this cohort of U.S. Hispanic/Latina individuals, gestational hypertension alone was associated with decreased processing speed and executive functioning later in life.

Abstract 2214: Impacts of habitual and recent alcohol intake on gut microbiome diversity and composition among Black Americans

Abstract Background: Alcohol intake can alter the gut microbiome, which may play a role in the development of cancer and other chronic diseases. However, there have been limited population-based studies investigating the associations of habitual and recent alcohol intake with the gut microbiome, particularly among Black Americans. Methods: We investigated the association of alcohol intake with the gut microbiome among 538 Black American participants of the Southern Community Cohort Study (150 men and 388 women). Habitual and recent alcohol intake was assessed at cohort baseline (2002-2009) and stool collection (2018-2021), respectively. DNA was extracted from fecal samples for gut microbiome profiling using shotgun metagenomic sequencing. Generalized linear models were employed to evaluate the associations between alcohol intake and gut microbiome diversity and composition, with adjustments for sociodemographic characteristics, other lifestyle factors, and comorbidities. False discovery rate (FDR)<0.1 was considered statistically significant. Results: The mean age at enrollment was 53.2 ± 7.7 years, with a mean interval of 13.8 years (range: 9.0-18.1 years) between baseline and stool collection. Neither habitual nor recent alcohol intake was associated with microbiome diversity indices, and recent alcohol intake was not associated with microbial taxa abundance either. However, habitual alcohol intake, both total amount and subtypes, showed significant associations with microbial taxa abundance primarily in men, including Actinobacteria, Proteobacteria, Firmicutes, and classes Bacilli and Clostridia within these phyla (all FDR<0.1). Specifically, total alcohol and red wine intakes were inversely associated with genus MGYG-HGUT-02719 in class Clostridia; beer consumption was inversely associated with genus Anaerostipes; white wine intake showed negative associations with order RF32 and genus Eubacterium and a positive association with genus Paenibacillus. Most of these associations remained significant after adjusting for BMI and history of cardiometabolic diseases or cancer. Conclusion: We identified gut microbiome taxa associated with habitual alcohol intake among Black American men, including several with anti- or pro-gastrointestinal-cancer properties. However, the magnitudes of these associations were generally small. Further research is needed to determine if these bacteria play a mediating or modifying role in alcohol-disease relationships. Citation Format: Lili Liu, Sang Nguyen, Qiuyin Cai, Martha Shrubsole, Wei Zheng, Danxia Yu. Impacts of habitual and recent alcohol intake on gut microbiome diversity and composition among Black Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2214.

Loneliness, Living Alone, and Risk of Cardiovascular Disease Among Older Adults in China.

Older adults are prone to live alone and feel lonely. The main objective of this study was to assess the associations of loneliness and living alone with cardiovascular disease (CVD) among community-dwelling older individuals in China. We conducted a longitudinal analysis on 3661 participants aged older than 65 years from the latest 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards models were used to assess the associations of loneliness and living alone with CVD risk, with adjustment for confounding factors. A total of 616 incident CVD cases were identified during follow-up. Participants who reported feeling lonely experienced a 28% increased risk of developing CVD after adjustment for sociodemographic characteristics, lifestyle factors, and baseline health status (adjusted hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.01-1.62; ptrend = .046). In contrast, no significant association was observed between living alone and CVD risk. Subgroup analyses showed that among those individuals who lived alone, often feeling lonely doubled the risk of CVD compared to never being lonely (HR: 2.17, 95% CI: 1.20-3.93; ptrend = .007). Loneliness was an independent risk factor for CVD among Chinese older adults. Our findings underscore the importance of addressing loneliness in the prevention of CVD among older individuals, especially those who live alone.

Psychotic-like experiences predict the perceived intent to seek treatment: A network perspective

We aimed to investigate as to whether psychotic-like experiences (PLEs) predict the perceived intent to seek treatment. Our secondary aim was to explore which PLEs predict the perceived need to seek treatment using a network analysis. The study was based on a community sample of individuals with a negative history of psychiatric treatment. At baseline, they completed questionnaires recording the presence of PLEs, depressive, and anxiety symptoms. After 6–7 months, they were reassessed with respect to the perceived intent to seek treatment. A total of 1100 individuals were assessed at baseline (aged 27.1 ± 5.1 years, 48.6 % males). The follow-up assessment was completed by 581 individuals (52.8 %). Higher baseline levels of PLEs were associated with a greater intent to seek treatment at the follow-up before (Beta = 0.289, p < 0.001) and after adjustment for sociodemographic characteristics, depressive and anxiety symptoms (Beta = 0.128, p = 0.004). A network analysis demonstrated that the intent to seek treatment was connected to five nodes of PLEs including “déjà vu experiences” (weight = 0.046), “problems in differentiating reality and imagination” (weight = 0.103), “a lack of control over own ideas or thoughts” (weight = 0.077), “being distracted by distant sounds” (weight = 0.105), and “paranoid thoughts” (weight = 0.145). Findings from the present study indicate that PLEs might contribute to help-seeking behaviors regardless of co-occurring depressive and anxiety symptoms. However, specific PLEs may differ with respect to their effects on the perceived intent to seek treatment.

Associations of regular consumption of breakfast, lunch and dinner with Body Mass Index during adolescence: longitudinal findings by weight status among the Eating and Activity over Time 2010-2018 cohort.

To examine how the associations between meal consumption and BMI over 8 years differ by weight status in a sample of adolescents. Longitudinal, population-based study. Breakfast, lunch and dinner consumption and BMI were self-reported. Linear regressions were used to examine how the associations between meal consumption and BMI differed by weight status. Adolescents in the Minneapolis/St. Paul metropolitan area. Adolescents (n 1,471) were surveyed as part of the EAT 2010-2018 in 2009-2010 (Mage = 14·3 years) and 2017-2018 (Mage = 22·0 years). The prevalence of regular breakfast, lunch and dinner consumption (≥ 5 times/week) ranged from 45 to 65 %, 75 to 89 % and 76 to 94 %, respectively, depending on weight status category. Among adolescents with a sex- and age-specific BMI < 15th percentile, regular consumptions of breakfast, lunch and dinner during adolescence were positively associated with BMI in emerging adulthood compared with irregular consumption of breakfast, lunch and dinner (<5 times/week) after adjustment for socio-demographic characteristics (β = 5·43, β = 5·39 and β = 6·46, respectively; all P-values <0·01). Among adolescents in the BMI 15-85th and 85-95th percentiles, regular consumptions of breakfast, lunch and dinner were positively associated with BMI but to a lesser extent (P-values <0·01). For participants with a BMI ≥ 95th percentile, regular consumptions of breakfast, lunch and dinner were positively associated with BMI, but the associations were not statistically significant (P-values > 0·05). The relationship between meal consumption during adolescence and BMI in emerging adulthood differs by adolescent weight status. Future studies should investigate underlying factors related to meal consumption routines and BMI.

Dyslipidemia in the Russian Federation: population data, associations with risk factors

Aim. To study the prevalence of dyslipidemias and their association with various risk factors in the Russian population of men and women aged 35-74 years in 2020-2022.Material and methods. This work was carried out as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The sample included 28731 men and women aged 35-74 years living in 15 Russian regions. Hypercholesterolemia (HC) was diagnosed with total cholesterol (TC) ≥5,0 mmol/l, while elevated low-density lipoprotein cholesterol (LDL-C) was considered ≥3,0 mmol/l, hypertriglyceridemia — with triglyceride levels ≥1,7 mmol/l, reduced high-density lipoprotein cholesterol (HDL-C) &lt;1,0 mmol/l in men and &lt;1,2 mmol/l in women. Associations were assessed using logistic regression after adjustment for socio-demographic characteristics, drinking status, presence of hypertension (HTN) and stroke.Results. The prevalence of hypertriglyceridemia in the Russian Federation in 2020-2022 was 58,8%, hypertriglyceridemia — 32,2%. The incidence of lipid-lowering therapy increased with age from 1% in the group of 35-44 years to 16% in the group of 65-74 years. On average, only 7,6% of study participants received lipid-lowering therapy. Significant associations of HC with HTN, obesity and alcohol abuse were identified. Similar results were obtained for elevated LDL-C levels, with the exception of alcohol abuse. In turn, a reduced HDL-C level was significantly associated with the lack of higher education, marriage, physical activity, smoking and the presence of diseases.Conclusion. The prevalence of lipid disorders in the Russian Federation in 2020-2022 remained at a high level. These disorders occurred more often in women, and they were better informed about their cholesterol levels and more often received lipid-lowering therapy. HTN, obesity, and some behavioral and social risk factors were associated with dyslipidemia.

Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function

Cannabis use is increasing among reproductive-age individuals and the risks associated with cannabis exposure during pregnancy remain uncertain. To evaluate the association between maternal cannabis use and adverse pregnancy outcomes known to be related to placental function. Ancillary analysis of nulliparous individuals treated at 8 US medical centers with stored urine samples and abstracted pregnancy outcome data available. Participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort were recruited from 2010 through 2013; the drug assays and analyses for this ancillary project were completed from June 2020 through April 2023. Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol using frozen stored urine samples from study visits during the pregnancy gestational age windows of 6 weeks and 0 days to 13 weeks and 6 days (visit 1); 16 weeks and 0 days to 21 weeks and 6 days (visit 2); and 22 weeks and 0 days to 29 weeks and 6 days (visit 3). Positive results were confirmed with liquid chromatography tandem mass spectrometry. The timing of cannabis exposure was defined as only during the first trimester or ongoing exposure beyond the first trimester. The dichotomous primary composite outcome included small-for-gestational-age birth, medically indicated preterm birth, stillbirth, or hypertensive disorders of pregnancy ascertained by medical record abstraction by trained perinatal research staff with adjudication of outcomes by site investigators. Of 10 038 participants, 9257 were eligible for this analysis. Of the 610 participants (6.6%) with cannabis use, 32.4% (n = 197) had cannabis exposure only during the first trimester and 67.6% (n = 413) had ongoing exposure beyond the first trimester. Cannabis exposure was associated with the primary composite outcome (25.9% in the cannabis exposure group vs 17.4% in the no exposure group; adjusted relative risk, 1.27 [95% CI, 1.07-1.49]) in the propensity score-weighted analyses after adjustment for sociodemographic characteristics, body mass index, medical comorbidities, and active nicotine use ascertained via urine cotinine assays. In a 3-category cannabis exposure model (no exposure, exposure only during the first trimester, or ongoing exposure), cannabis use during the first trimester only was not associated with the primary composite outcome; however, ongoing cannabis use was associated with the primary composite outcome (adjusted relative risk, 1.32 [95% CI, 1.09-1.60]). In this multicenter cohort, maternal cannabis use ascertained by biological sampling was associated with adverse pregnancy outcomes related to placental dysfunction.

Frequency of breakfast consumption and its associations with food consumption by degree of industrial processing and with indicators of overweight in Brazilian adolescents (EVA-JF Study)

ObjectiveThe aim of this study was to investigate the frequency of breakfast consumption and estimate its associations with the consumption of food at different degrees of industrial processing and with overweight indicators in Brazilian adolescents. MethodsThis cross-sectional study involved a probabilistic sample of 14- to 19-y-old adolescents enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 805). The frequency of breakfast consumption was evaluated via a questionnaire (classified into "do not consume", "sometimes consume", and "regularly consume"). The evaluation of food consumption involved two 24-h dietary recalls, the items of which were analyzed according to the NOVA classification system. Overweight indicators (waist circumference, body mass index for age (BMI-for-age), and body fat percentage) were evaluated according to a standard protocol. Linear regression models were performed, first without and then with adjustments for sociodemographic characteristics. ResultsWe found that 20% of adolescents skipped breakfast, and ∼46% of the caloric intake came from ultra-processed foods. Breakfast omission was associated with a mean increase of 3.02% (95% confidence interval [CI], 0.52–5.53) in energy intake from ultra-processed foods, in addition to a mean increase of 0.28 z-score (95% CI, 0.05– 0.52) of BMI-for-age and of 1.64% (95% CI, 0.21–3.08) in body fat. ConclusionsWe verified that the omission of breakfast was associated with higher consumption of ultra-processed foods, as well as a higher BMI-for-age and higher percentage of body fat, reinforcing the importance of actions to encourage the consumption of this meal and the adoption of healthy eating practices in adolescents.

0240 Greenspace in Relation to Sleep Health among a Racially and Ethnically Diverse Cohort of US Women

Abstract Introduction Exposure to greenspace has been associated with better sleep health by potentially supporting salubrious activities (e.g., physical activity), buffering noise, improving air quality, and promoting mental health. However, most prior studies have included few sleep dimensions or lacked racial/ethnic diversity. Further, access to greenspace is not equitably distributed across racial/ethnic groups due to structural racism, including environmental justice issues. Methods To investigate cross-sectional associations between greenspace with sleep health, overall and by race/ethnicity, we used data collected at enrollment (2003-2009) from women in the Sister Study (n=1,575 Hispanic/Latina, n=4,421 non-Hispanic (NH)-Black, and n=41,628 NH-White). Participants’ home addresses (X-Y coordinates) were linked to NASA’s Moderate Resolution Imaging Spectroradiometer Normalized Difference Vegetation Index data (250m resolution) during July of the year of enrollment to capture tertiles of proximity to greenspace. Participants reported multiple sleep dimensions including short sleep duration (&amp;lt; 7 hours), insomnia symptoms, frequent napping, and sleep debt (≥2-hour difference between average longest and shortest sleep duration during a week). Adjusting for both individual- and neighborhood-level sociodemographic characteristics, log Poisson regression with robust variance estimated prevalence ratios (PRs) for low/moderate vs. high greenspace associated with poor sleep, overall and by race/ethnicity. Results Among participants (mean±SD age=55.7±9.0 years), Hispanic/Latina and NH-Black participants comprised 8% of the population with high greenspace, 15% with low/moderate greenspace, and reported shorter sleep duration and poorer sleep quality compared to NH-White participants. After adjustment for sociodemographic characteristics, neighborhood disadvantage, and population density, low/moderate vs. high greenspace was associated with an 8% higher prevalence of frequent napping (PR=1.08 [95% CI:1.02-1.15]). Low/moderate greenspace was also marginally associated with a higher prevalence of short sleep duration (PR=1.01 [0.98-1.05]), insomnia symptoms (PR=1.03 [0.99-1.07]), and comorbid short sleep with insomnia symptoms (PR=1.04 [0.99-1.10]) but was not associated with sleep debt. Associations did not vary by race/ethnicity. Conclusion Low or moderate greenspace was marginally associated with poorer sleep across racial/ethnic groups, supporting greenspace as beneficial for all. Although replication with longitudinal data and objective sleep measures is warranted, greenspace interventions may improve population sleep health; equitable access may help address racial/ethnic sleep disparities. Support (if any) NIEHS (Z1AES103325[CLJ] and Z01ES044005[DPS]):

Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study

The risk of type 2 diabetes among women with glucose intolerance during pregnancy that does not meet gestational diabetes criteria requires further investigation. We aimed to explore the associations between various degrees of gestational glucose intolerance and the risk of type 2 diabetes in young adulthood. For this population-based cohort study, the national Israeli conscription database was linked to Maccabi Healthcare Services (MHS), the second-largest state-mandated health provider in Israel. We included 177 241 women who underwent a pre-recruitment evaluation at adolescence (age 16-20 years), 1 year before mandatory military service, and later underwent, from Jan 1, 2001, to Dec 31, 2019, two-step gestational diabetes screening with a 50 g glucose challenge test (GCT) based on a threshold of 140 mg/dL (7·8 mmol/L), followed as needed by a 100 g oral glucose tolerance test (OGTT). Abnormal OGTT values were defined according to the Carpenter-Coustan thresholds: 95 mg/dL (5·3 mmol/L) or higher in the fasting state; 180 mg/dL (10·0 mmol/L) or higher at 1 h; 155 mg/dL (8·6 mmol/L) or higher at 2 h; and 140 mg/dL (7·8 mmol/L) or higher at 3 h. The primary outcome was incident type 2 diabetes in the MHS diabetes registry. Cox proportional hazards models were applied to estimate adjusted hazard ratios (HRs) with 95% CIs for incident type 2 diabetes. During a cumulative follow-up of 1 882 647 person-years, and with a median follow-up of 10·8 (IQR 5·2-16·4) years, 1262 women were diagnosed with type 2 diabetes. Crude incidence rates of type 2 diabetes were 2·6 (95% CI 2·4-2·9) per 10 000 person-years in women with gestational normoglycaemia, 8·9 (7·4-10·6) per 10 000 person-years in women with an abnormal GCT and normal OGTT, 26·1 (22·4-30·1) per 10 000 person-years in women with one abnormal OGTT value (in the fasting state or 1 h, 2 h, or 3 h post-challenge), and 71·9 (66·0-78·3) per 10 000 person-years in women with gestational diabetes. After adjustment for sociodemographic characteristics, adolescent BMI, and age at gestational screening, the risk of type 2 diabetes was higher, compared to the gestational normoglycaemia group, in women with an abnormal GCT and normal OGTT (adjusted hazard ratio [HR] 3·39 [95% CI 2·77-4·16]; p<0·0001), in women with one abnormal OGTT value (9·11 [7·64-10·86]; p<0·0001), and in women with gestational diabetes (24·84 [21·78-28·34]; p<0·0001). The risk of type 2 diabetes was modestly increased in women with isolated elevated fasting glucose (adjusted HR 11·81 [95% CI 8·58-16·25]; p<0·0001), and in women with gestational diabetes and an abnormal fasting glucose (38·02 [32·41-44·61]; p<0·0001). Gestational glucose intolerance, including conditions not meeting gestational diabetes criteria of the two-step strategy, confers a high risk of type 2 diabetes in young adulthood. These conditions should be recognised as risk factors for type 2 diabetes, especially among women with abnormal fasting glucose concentrations during pregnancy. None.

Labor Income Losses Associated With Heart Disease and Stroke From the 2019 Panel Study of Income Dynamics

Current estimates of productivity losses associated with heart disease and stroke in the US include income losses from premature mortality but do not include income losses from morbidity. To estimate labor income losses associated with morbidity of heart disease and stroke in the US due to missed or lower labor force participation. This cross-sectional study used 2019 Panel Study of Income Dynamics data to estimate labor income losses associated with heart disease and stroke by comparing labor income between persons with and without heart disease or stroke, after controlling for sociodemographic characteristics and other chronic conditions and considering the situation of zero labor income (eg, withdrawal from the labor market). The study sample included individuals aged 18 to 64 years who were reference persons or spouses or partners. Data analysis was conducted from June 2021 to October 2022. The key exposure was heart disease or stroke. The main outcome was labor income, measured for the year 2018. Covariates included sociodemographic characteristics and other chronic conditions. Labor income losses associated with heart disease and stroke were estimated using the 2-part model, in which part 1 is to model the probability that labor income is greater than zero and part 2 is to regress positive labor income, with both parts having the same set of explanatory variables. In the study sample consisting of 12 166 individuals (6721 [52.4%] females) representing a weighted mean income of $48 299 (95% CI, $45 712-$50 885), the prevalence of heart disease was 3.7% and the prevalence of stroke was 1.7%, and there were 1610 Hispanic persons (17.3%), 220 non-Hispanic Asian or Pacific Islander persons (6.0%), 3963 non-Hispanic Black persons (11.0%), and 5688 non-Hispanic White persons (60.2%). The age distribution was largely even, from 21.9% for the age 25 to 34 years group to 25.8% for the age 55 to 64 years group, except for young adults (age 18-24 years), who made up 4.4% of the sample. After adjustment for sociodemographic characteristics and other chronic conditions, persons with heart disease would receive an estimated $13 463 (95% CI, $6993-$19 933) less in annual labor income than those without heart disease (P < .001), and persons with stroke would receive an estimated $18 716 (95% CI, $10 356-$27 077) less in annual labor income than those without stroke (P < .001). Total labor income losses associated with morbidity were estimated at $203.3 billion for heart disease and $63.6 billion for stroke. These findings suggest that total labor income losses associated with morbidity of heart disease and stroke were far greater than those from premature mortality. Comprehensive estimation of total costs of CVD may assist decision-makers in assessing benefits from averted premature mortality and morbidity and allocating resources to the prevention, management, and control of CVD.

Exposure to dogs and cats and risk of asthma: A retrospective study.

Findings on the relationship between pet exposure and asthma in western countries are inconsistent. This retrospective study examined the association of owning a dog or cat with the onset of asthma in Japanese people. We also investigated whether there is a critical window during which exposure to dogs and cats can reduce the risk of asthma by stratifying the analysis by the age at which pet ownership began. We analyzed data collected in an internet survey conducted by the Japan Pet Food Association in 2021. Valid data were obtained from 4290 participants for analysis of dog ownership and 4308 participants for analysis of cat ownership. In these respective groups, 41.2% had owned a dog and 26.5% had owned a cat. During the follow-up period, 5.7% of dog owners and 14.8% of non-dog owners developed asthma, as did 5.6% of cat owners and 13.5% of non-cat owners. On binomial logistic regression analysis, participants who had not owned a dog had an odds ratio (OR) of 2.01 (95% confidence interval (CI): 1.45-2.78) of developing asthma compared to those who had owned a dog after adjustment for sociodemographic characteristics. The corresponding OR of asthma onset among participants who had not owned a cat was 2.24 (95%CI: 1.56-3.23). Stratified analysis showed that while younger participants who had not owned a dog had higher ORs of developing asthma, those who had not owned a cat had similar ORs of asthma onset across all age categories. These results suggest that while there may be a critical window in early life during which exposure to dogs can prevent asthma onset, the protective effect of cat exposure is constant across all ages in Japan.

Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study

Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease. The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders. Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence. Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.

Elevated Serum Neurofilament Light Chain Levels Are Associated With All-Cause Mortality: Evidence From National Health and Nutrition Examination Survey.

Several studies have reported the association between blood neurofilament light chain (NfL) levels and all-cause mortality. However, the generalizability of these findings in general adults remains unclear. The study aimed to examine the association between serum NfL and all-cause mortality in a nationally representative population. Longitudinal data were obtained from 2071 participants aged 20-75years in the National Health and Nutrition Examination Survey 2013-14 cycle. Serum NfL levels were measured by using a novel, high-throughput acridinium-ester immunoassay. Kaplan-Meier curves, multivariate Cox regression analysis, and restricted cubic spline regression were employed to investigate the association between serum NfL and all-cause mortality. Over a median follow-up of 73 (interquartile range=12) months, 85 (3.50%) participants died. After adjustment for sociodemographic characteristics, lifestyle variables, comorbidity, body mass index, and estimated glomerular filtration rate, elevated serum NfL levels were still significantly associated with a higher risk of all-cause mortality (hazard ratio=2.45, 95% confidence interval=1.89-3.18 for per lnNfL increase) in a linear manner. Our findings suggest that circulating levels of NfL may serve as a biomarker of mortality risk in a nationally representative population.

Association of Sociodemographic Characteristics With 1-Year Hospital Readmission Among Adults Aged 18 to 55 Years With Acute Myocardial Infarction

Among younger adults, the association between Black race and postdischarge readmission after hospitalization for acute myocardial infarction (AMI) is insufficiently described. To examine whether racial differences exist in all-cause 1-year hospital readmission among younger adults hospitalized for AMI and whether that difference retains significance after adjustment for cardiac factors and social determinants of health (SDOHs). The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study was an observational cohort study of younger adults (aged 18-55 years) hospitalized for AMI with a 2:1 female-to-male ratio across 103 US hospitals from January 1, 2008, to December 31, 2012. Data analysis was performed from August 1 to December 31, 2021. The primary outcome was all-cause readmission, defined as any hospital or observation stay greater than 24 hours within 1 year of discharge, identified through medical record abstraction and clinician adjudication. Logistic regression with sequential adjustment evaluated racial differences and potential moderation by sex and SDOHs. The Blinder-Oaxaca decomposition quantified how much of any racial difference was explained and not explained by covariates. This study included 2822 participants (median [IQR] age, 48 [44-52] years; 1910 [67.7%] female; 2289 [81.1%] White and 533 [18.9%] Black; 868 [30.8%] readmitted). Black individuals had a higher rate of readmission than White individuals (210 [39.4%] vs 658 [28.8%], P < .001), particularly Black women (179 of 425 [42.1%]). After adjustment for sociodemographic characteristics, cardiac factors, and SDOHs, the odds of readmission were 34% higher among Black individuals (odds ratio [OR], 1.34; 95% CI, 1.06-1.68). The association between Black race and 1-year readmission was positively moderated by unemployment (OR, 1.68; 95% CI, 1.09- 2.59; P for interaction = .02) and fewer number of working hours per week (OR, 1.01; 95% CI, 1.00-1.02; P for interaction = .01) but not by sex. Decomposition indicates that 79% of the racial difference in risk of readmission went unexplained by the included covariates. In this multicenter study of younger adults hospitalized for AMI, Black individuals were more often readmitted in the year following discharge than White individuals. Although interventions to address SDOHs and employment may help decrease racial differences in 1-year readmission, more study is needed on the 79% of the racial difference not explained by the included covariates.

Association of Smokeless Tobacco Use With Incident Peripheral Artery Disease: Results From the Atherosclerotic Risk in Communities Study

Cigarette smoking is associated with an increased risk for peripheral artery disease. It is unknown whether smokeless tobacco, a noncombustible form of tobacco exposure, is also associated with increased peripheral artery disease risk. Using data from the Atherosclerosis Risk in Communities study, we tested the hypothesis that the use of smokeless tobacco is associated with a higher risk of developing peripheral artery disease. Participants with peripheral artery disease at baseline were excluded. Smokeless tobacco use was assessed 3 times from 1987 to 1995, and peripheral artery disease events accrued from 1987 to 2018. Smokeless tobacco was modeled as a time-dependent exposure in Cox regression models. Analyses were completed in 2021. This study included 14,344 participants with a baseline mean (SD) age of 54.1 (5.7) years; 54.8% were female, and 26.4% were Black. There were 635 incident peripheral artery disease events over a median follow-up of 27.6 years (maximum of 32.1 years). The peripheral artery disease incidence rate was 4.44 per 1,000 person-years among those who used smokeless tobacco compared with 1.74 per 1,000 person-years for those who did not. The hazard ratio for current versus never smokeless tobacco use was 1.94 (95% CI=1.31, 2.88) after adjustment for sociodemographic characteristics and cigarette smoking. Peripheral artery disease incidence rate among those currently using smokeless tobacco was similar to that of those who currently smoke cigarette (3.39 per 1,000 person-years). Current smokeless tobacco use was associated with high rates of peripheral artery disease, similar to cigarette smoking. Future research should evaluate the effect of cessation of noncombustible tobacco on incident peripheral artery disease.

The association between denture use and cardiovascular diseases. The United States National Health and Nutrition Examination Survey 2009-2018.

Poor dental health is associated with cardiovascular diseases (CVD). However, the relationship between CVD and denture use is currently unknown. This study aimed to investigate whether denture use is associated with CVD among American adults. 10,246 non-pregnant subjects aged 30-59 years from five cycles (2009-2018) of the United States National Health and Nutrition Examination Survey (NHANES) were included in this study. Participants who were observed by a dental examiner wearing denture/partial denture/plates were defined as denture users. CVD was defined as self-reported coronary heart disease, myocardial infarction, angina pectoris, stroke, and congestive heart failure. The association between denture use and CVD was analyzed using logistic regression with adjustment for potential cofounders. 4.4% (95% CI, 3.9-5.0) participants had CVD, and 3.5% (95% CI, 2.8-4.5) participants were denture users. Denture use was associated with CVD [OR = 4.26, 95% CI (2.90-6.28), P < 0.01], which remained significant [adjusted OR = 1.82, 95% CI (1.15-2.88), P < 0.01] after adjustments for sociodemographic characteristics, smoking, alcohol use, drug addiction, body mass index (BMI), and abnormal medical conditions including gum problem, hypertension, diabetes, and hyperlipidemia. Women with dentures had significantly higher odds of CVD [adjusted OR = 2.13, 95% CI (1.10-4.11), P = 0.025]. In this nationally representative survey, denture use was associated with CVD. Denture use may be an unconventional risk factor for assessing CVD risks, especially in women. Future studies are required to investigate whether CVD and denture use is causally related.

Association between pneumonia hospitalisation and long-term risk of cardiovascular disease in Chinese adults: Aprospective cohort study.

Lower respiratory tract infections, including pneumonia, have been associated with short-term increased risk of cardiovascular disease (CVD). However, there is only limited evidence about the long-term impact of pneumonia on the cardiovascular system beyond one year. We conducted a prospective matched cohort study based on data from the China Kadoorie Biobank study of 482,017 adults who were enrolled between June 25, 2004, and July 15, 2008, and were free of CVD at baseline and before pneumonia hospitalization. A total of 24,060 patients hospitalised with pneumonia were identified until December 31, 2018, and were matched on age, sex, urban or rural areas, and decile of the frailty index to 223,875 controls. We used the piecewise Cox proportional hazards model to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for pre-specified incident CVD outcomes, including ischaemic heart disease (IHD), arrhythmia, heart failure (HF), ischaemic stroke (IS), and hemorrhagic stroke (HS), at various time intervals through 10 years after pneumonia hospitalization. Of the 247,935 pneumonia cases and controls included, the mean age (standard deviation) was 53.5 (10.4), and 40.8% (101,159) were men. During follow-up, 2389 (9.9%) pneumonia cases developed IHD, 489 (2.0%) cases developed arrhythmia, 545 (2.3%) cases developed HF, 1764 (7.3%) cases developed IS, and 348 (1.4%) cases developed HS. After adjustment for sociodemographic characteristics, lifestyle factors, health status and medication, underlying conditions, and family history of CVD, the elevated CVD risk was highest within the first 30 days after pneumonia hospitalisation, with subsequent risk reductions varying by subtypes. The elevated risk remained until the eighth year after pneumonia hospitalisation for IHD, arrhythmia, and HF, with HRs (95% CIs) of 1.48 (1.13-1.93), 2.69 (1.70-4.25), and 4.36 (2.86-6.64), respectively. The risk of stroke associated with pneumonia hospitalisation remained elevated until the seventh year for IS (HR=1.30; 95% CI: 1.04-1.63), and until the second year for HS (1.39; 1.07-1.80). The above associations were consistently observed across various characteristics of the participants. In middle-aged and older Chinese adults, pneumonia hospitalisation was associated with short- and long-term CVD risk, with the elevated risk of certain CVD outcomes persisting for up to 8 years. National Natural Science Foundation of China, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, the Kadoorie Charitable Foundation in Hong Kong, the UK Wellcome Trust.

Abstract A018: Geographic disparities in aggressive prostate cancer varies by region-specific environmental and sociodemographic characteristics: A statewide analysis

Abstract Background: Although the overall 5-year survival rate for prostate cancer (PCa) is relatively high, there are substantial differences in survival by stage at diagnosis. In contrast to men diagnosed with localized or regional stage PCa, both of which have a 5-year survival rate of nearly 100%, only 31% of patients survive five years after being diagnosed with distant or metastatic disease. Given PCa remains the second leading cause of cancer death among U.S. men, targeted PCa screening interventions centered on early detection for men at risk for more aggressive PCa subtypes appear warranted. Under a Precision Public Health approach, the application of geospatial analysis to cancer surveillance data can help to identify and “narrow down” geographic areas where rates of aggressive PCa are higher than expected to target for intervention. Thus, the primary objective of this study was to conduct a geospatial scan to identify clusters of aggressive PCa in a State-wide analysis. Given well-known racial disparities and associations between socioeconomic status and PCa stage at diagnosis and survival, the secondary objective was to evaluate geographic variation, or changes in aggressive PCa clusters, by area-level sociodemographics and environmental exposures. Methods: The study population included 82,580 patients diagnosed with incident PCa from the Pennsylvania (PA) State Registry from 2005-2015. Patient addresses were geocoded. Patient clinical data from the registry (age, race/ethnicity, insurance status) were linked via geocodes to area-level sociodemographic measures generated from the US Census Bureau at the census tract level, and to Environmental Quality Indices (Air, water, soil) from the Environmental Protection Agency (EPA) at the county level. Aggressive PCa was evaluated using 3 separate definitions based on TNM staging and/or Gleason grade. A Bayesian geoadditive modeling approach identified census tract clusters with higher than expected rates of aggressive PCa, adjusted for individual-level factors (age, race, diagnosis year) (Baseline model). The baseline model was then compared to models that included sociodemographic and/or environmental measures by evaluating changes in model fit (DIC), cluster size, and relative risk (RR). Results: We identified 3 main clusters in PA where rates of aggressive PCa were higher than expected near Philadelphia, Altoona, and Pittsburgh. Clusters of aggressive PCa in Philadelphia were eliminated and could be fully explained after adjustment for sociodemographic characteristics (insurance, poverty, etc), but not environmental measures. In contract, clusters of aggressive PCa in Pittsburgh were only reduced after adjustment for environmental variables, particularly water quality. Conclusion: PCa screening interventions could be prioritized in high risk cluster areas. Results are novel in that they preliminarily suggest that the type of intervention and focus of future etiologic studies in aggressive PCa might vary by geographic location, even within a single State. Citation Format: Daniel Wiese, Kevin A. Henry, Carolyn Fang, Adam Reese, Mary Daly, Camille Ragin, Shannon M. Lynch. Geographic disparities in aggressive prostate cancer varies by region-specific environmental and sociodemographic characteristics: A statewide analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A018.

Association of plasma cystatin C with all-cause and cause-specific mortality among middle-aged and elderly individuals: a prospective community-based cohort study

We investigated the associations of plasma cystatin C with all-cause and cause-specific mortality risk and identified potential modifying factors affecting these associations in middle-aged and elderly people (≥ 50 years). This community-based prospective cohort study included 13,913 individuals aged ≥ 50 years from the Health and Retirement Study. Cox proportional hazard models were used to estimate the associations between cystatin C concentrations and the risk of all-cause and cardiovascular and cancer mortality after adjustment for sociodemographic characteristics, lifestyle factors, self-reported medical history, and other potential confounding factors. During a total of 71,988 person-years of follow-up (median: 5.8 years; interquartile range 3.3–7.6 years), 1893 all-cause deaths were documented, including 714 cardiovascular-related and 406 cancer-related deaths. The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) cystatin C concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.92 (1.62–2.28) for all-cause mortality, 1.98 (1.48–2.65) for cardiovascular mortality, and 1.62 (1.13–2.32) for cancer mortality. The associations of cystatin C concentrations with all-cause, cardiovascular and cancer mortality did not differ substantially when participants were stratified by sex, age, BMI, current smoking status, current alcohol consumption, and regular exercise (all P for interactions > 0.05). Our study indicates that an elevated plasma cystatin C concentration is associated with an increased risk of all-cause, cardiovascular and cancer mortality both men and women among the middle-aged and elderly individuals.