African American Ethnicity Research Articles

Risk and prognostic factors in patients with colon cancer with liver metastasis.

The most common site of metastasis in patients with colon cancer is the liver. This study aimed to identify patients with colon cancer at high risk of developing liver metastasis and to explore their prognosis. The clinical characteristics, treatment methods and survival outcomes of patients diagnosed with colon cancer from 2010 to 2015 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Patients were divided into two groups according to the presence of liver metastasis, and multivariate logistic and Cox regression models were used to identify risk and prognostic factors. A total of 60,018 patients with colon cancer were selected from the SEER database. The incidence of liver metastasis was 9.2%. African American ethnicity, poor differentiation, higher tumor stage, higher lymph node ratio, and lung metastases were common factors associated with both liver metastasis risk and prognosis. Metastasectomy might improve survival among patients with colon cancer with resectable liver metastasis lesions and no other organ involvement.

O-009 The Role of Ethnicity and Polycystic Ovary Syndrome on Pregnancy Complications. An Analysis of a Population Database

Abstract Study question The goal of this study was to determine the independent effect of ethnicity on adverse obstetrical outcomes in women with Polycystic Ovary Syndrome (PCOS). Summary answer Among women with PCOS, African Americans, Hispanic and Asians are at an increased risk of certain adverse obstetrics outcomes, whereas Caucasians have fewer pregnancy complications. What is known already Polycystic ovarian syndrome is associated with an increased risk of pregnancy complications possibly due to the insulin resistance inherent in this syndrome. Variable ethnicities demonstrate different magnitudes of insulin resistance and in non-PCOS populations are known to be at modified pregnancy complication risks. Different ethnicities may have different phenotypes of PCOS, possibly further modifying outcomes. The role of ethnicity in women with PCOS and its effect on pregnancy complications has not been well studied. Study design, size, duration This retrospective population-based study utilized data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), over 11 years from 2004 to 2014. The data are representative of 20% of admissions to US hospitals and geographically represent over 96% of the American population. Clinical modification ICD9-CM codes were used to identify women with PCOS and group them according to maternal ethnicity. In 2015 codes were changed to ICD-10 which are not comparable. Participants/materials, setting, methods All women with PCOS(n = 12782) were grouped according to maternal ethnicity: Caucasian(9107), African American(1098), Hispanic(1288), Asian(741), and other. Pregnancy, delivery, and neonatal outcomes were collected per group and compared to the rest. Chi-square tests were used to compare the baseline characteristics between the cohorts. Logistic regression analyses were conducted to explore associations between ethnicity and pregnancy outcomes through the estimation of odds ratio (OR) and 95% confidence intervals (CI) while controlling for confounding effects. Main results and the role of chance PCOS was found in 12,782 patients with included ethnicity results. Asian women had a higher prevalence of gestational diabetes(GDM) (aOR1.96, 95%CI 1.49-2.58, p < 0.001), chorioamnionitis (aOR3.41, 95%CI 2.12-5.47, p < 0.0001), operative vaginal delivery (aOR2.42, 95%CI 1.65-3.56, p < 0.001), postpartum hemorrhage(PPH) (aOR2.07, 95%CI 1.25-3.43, p = 0.004) and maternal infection (aOR2.84, 95%CI 1.80-4.49, p < 0.001). African Americans had a higher risk of pregnancy-induced hypertension (aOR1.38, 95% CI 1.06-1.80, p = 0.02), preeclampsia (aOR1.68, 95% CI 1.15-2.45, p = 0.007), preterm premature rupture of membrane (aOR2.75, 95%CI 1.58-4.78, p < 0.001), chorioamnionitis (aOR1.83, 95%CI 1.12-2.98, p = 0.016) and cesarean sections (aOR1.69, 95%CI 1.32-2.15, p < 0.001) and lower risk of operative vaginal delivery (aOR0.53, 95%CI 0.31-0.93, p = 0.03), spontaneous vaginal delivery (aOR0.67, 95%CI 0.52-0.85, p < 0.001), and maternal infection (aOR1.91, 95%CI 1.21-3.00, p = 0.005). The risk of GDM (aOR1.36, 95%CI 1.06-1.73, p < 0.014) and PPH (aOR1.58, 95%CI 1.01-2.47, p = 0.045) was increased among Hispanic patients. Caucasian patients were at lower risk of GDM(aOR0.67, 95%CI 0.57-0.79, p < 0.0001), chorioamnionitis (aOR0.39, 95%CI 0.28-0.55, p < 0.0001), casarean section (aOR0.83, 95%CI 0.73-0.95, p < 0.008), spontaneous vaginal deliveries (aOR1.25, 95% CI1.10-1.43, p < 0.001), PPH (aOR0.70, 95% CI0.50-0.98, p < 0.035), blood transfusion (aOR0.49, 95%CI 0.29-0.83, p < 0.007), maternal infection (aOR0.34, 95% CI 0.27-0.51, p < 0.0001) and small for gestational age infants (aOR0.64, 95%CI 0.44-0.93, p < 0.018). Rates of other pregnancy outcomes were similar for the groups. Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relied on the accuracy and consistency of the individuals coding the data. There are known limitations to how accurately hospital coding is able to capture perinatal conditions and complications. Wider implications of the findings Our study demonstrated that among women with PCOS, specific ethnicities are at an increased risk of adverse obstetric outcomes. This underlines the importance of screening for certain pregnancy complications in PCOS women of African American, Hispanic, and Asian ethnicity. Studies should evaluate the role of insulin resistance in these outcomes. Trial registration number not applicable - This study used publicly accessible, anonymized data; therefore, according to articles 2.2, 2.4 of Tri-Council Policy Statement (2010), institutional review board approval was not required.

Uveitis as a Manifestation of Celiac Disease: A Population-Based Study

Introduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease. Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease. Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis. Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory process prior to diagnosing uveitis as idiopathic. Conclusion: In conclusion, we established that patients with celiac disease are at increased risk of developing uveitis after excluding and controlling for any confounding variables. In further studies, it could be interesting to investigate the impact of gluten-free diet in patients with celiac disease on the risk of developing uveitis.

Impact of ethnicity and insurance on adverse effects and treatment outcomes related to immune checkpoint inhibitors at a safety net hospital.

e18538 Background: Clinical trials have shown efficacy and safety of immune checkpoint inhibitors (ICI) in the treatment of various malignancies. However, trial populations often do not adequately represent patient populations in the real-world. We report immune related adverse effects (IRAEs) among patients with various malignancies, diverse ethnicities, and government sponsored insurance or uninsured, as well as treatment outcomes of ICIs in metastatic non-small cell lung cancer (mNSCLC). Methods: A retrospective study of adult patients with malignancy, who received ICI or ICI plus chemotherapy from January 1, 2015 to January 1, 2020 was conducted at a safety net hospital. Data was collected from electronic medical records with IRB approval. IRAEs were identified and categorized according to CTCAE v5.0. 1-year overall survival (OS) and median duration of ICI therapy (mDT) were calculated for mNSCLC patients. Results: We reviewed 121 patients: 49% were African American (AA), 40% were white and 11% were other ethnicities. Medicaid/Medicare (M/M) was the primary insurance for 83% of patients, 6% had commercial insurance and 11% were uninsured. The median duration of follow-up was two years. IRAEs occurred in 37% of patients; hypothyroidism was the most common (7.5%), and none led to death. The incidence of grade 2 or higher IRAEs was lower in AA (25.4%) compared to in whites (32.6%), with treatment discontinuation rates of 5% in AA versus 16% in whites. Among mNSCLC patients, AA and other ethnicities had a decreased 1-year OS of 37% and 22% respectively, compared to 48% in whites. The mDT was 8.3 months for AA and 3 months for other ethnicities, compared to 13.2 months for whites. 40% of M/M patients with mNSCLC were alive at 1 year; none of the uninsured patients were alive at 1 year. The mDT was higher in M/M patients (6 months) than uninsured patients (3.5 months). Conclusions: Ethnicity and insurance coverage may influence the incidence of IRAEs and treatment outcomes with ICI. AA had a lower incidence of IRAEs compared to whites. However, minority populations with mNSCLC had decreased survival compared to whites. mNSCLC patients with M/M had better OS than uninsured patients. Minorities and uninsured patients spent less time on ICI compared to other patients. IRAEs are a significant burden and further study of the use of ICIs in diverse populations is warranted.[Table: see text]

Abstract P6-08-06: Uncovering gaps in patient-provider perceptions of triple-negative breast cancer care: Addressing disparities through education-advocacy partnerships

Abstract Background: Providers and patients alike are unaware of the racial disparities that exist in triple-negative breast cancer (TNBC), which occurs at twice the rate in women of the African Diaspora (WAD) compared to White American women. WAD tend to be diagnosed at a more advanced stage, use under-resourced health care settings or encounter bias in their care, and experience higher rates of TNBC-related mortality. An historically difficult-to-treat breast cancer subtype, the TNBC landscape is changing with an influx of clinical data and newly approved treatments. An educational initiative was designed to heighten awareness of new therapies, including antibody drug conjugates, empower patients in their care, and to align on addressing disparities in TNBC care. Methods: Two, 1-hour online, interactive, video-based programs were designed for patients and providers. The patient/caregiver program was hosted on CancerCoachLive in April, 2022 and the provider program on OMedLive in May, 2022 and remains on-demand until May 2023. With a focus on addressing disparities in care, 78% of patients/caregivers attending the patient program were of African descent. The initiative was conducted in collaboration with TOUCH, the Black Breast Cancer Alliance and the National Breast Cancer Foundation. Four real-world patient accounts of TNBC navigation and management were embedded in the patient program; and represented women of Caucasian, African, and Native American ethnicity. While practice and knowledge gaps among HCPs, and knowledge gaps of patients were assessed, we report on the analysis of ‘tethered’, behavioral, practice pattern, and perception questions assessed across the patient and provider programs. Results: As of June 2022, 200 providers and 29,389 patients/caregivers participated in the ongoing activities. Post education, participants in the provider program anticipated the education would positively impact practice behavior (86%) while patients/caregivers reported greater confidence in discussions with their treatment team (92%). Pre- and post-evaluation of strategies addressing disparities revealed improvements in ‘ensuring access to care through integration of care coordinators or social worker as part of the healthcare team.’ Provider assessment of barriers to enrollment in clinical trials uncovered the top barrier as ‘lack of trials at my institution’ (33%) and the top barrier to integration of new therapies as ‘lack of knowledge regarding evidence-based strategies’ (44%). Misalignments in patient-provider perceptions were observed. ‘Patient lack of interest’ was a provider-identified barrier to clinical trials, yet 60% of patients/caregivers reported that they were ‘very likely’ to participate in a clinical trial if eligible. Similarly, differences were seen in the ranking of topics of highest interest regarding treatment decisions. Lastly, patient- vs provider-identified care challenges were not aligned. Themes from the real-world patient accounts provided greater context for the misalignments observed. Conclusions: Assessment and alignment of patient-provider care perceptions has potential to impact clinical practice behaviors, patient/caregiver communication and confidence, and treatment/clinical trial knowledge for effective TNBC management. This educational partnership facilitated assessment of attitudes, perceptions, and barriers to care that can further guide how disparities in care for patients with TNBC are addressed. This ‘tethered’ approach to education was successful in empowering patients in shared decision-making, initializing changes in clinical practice, and gaining patient-provider insights in TNBC management. This activity was supported by an educational grant from Gilead Sciences, Inc Citation Format: Tariqa Ackbarali, Ricki Fairley, Tiffany A. Traina. Uncovering gaps in patient-provider perceptions of triple-negative breast cancer care: Addressing disparities through education-advocacy partnerships [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-06.

Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis.

Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS. Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1; T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved. We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death; OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening. The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population. The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463).

Disparities in colorectal cancer: Trends of reduced screening among minority populations.

18 Background: Studies have shown that African Americans (AA) are at increased risk for Colorectal Cancer (CRC) compared to other groups. Despite advancements in CRC screening modalities, few studies have investigated disparities in CRC screening among this vulnerable population. Methods: We performed a retrospective review of patients of age 45 or older who were seen in Family Medicine (FM), Internal Medicine (IM), or Gastroenterology (GI) between January 1, 2015 and December 31, 2021 at the Mayo Clinic. Information was collected regarding patient characteristics (age, sex, Charlson comorbidity score, race), and outcomes (whether a Cologuard test was ordered on the same day as the initial appointment, and whether the patient underwent a colonoscopy within 1 year after the initial appointment). Categorical variables were summarized with number and percentage of patients. Outcomes were compared between race groups (Caucasian, AA, Asian, Other) using unadjusted and multivariable logistic regression models. Multivariable models were adjusted for age, sex, and Charlson comorbidity score. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. P-values <0.05 were considered as statistically significant, and all statistical tests were two-sided. Results: Overall, 558,078 were included for analysis and 14,607 (2.6%) were AA. Overall, AA patients for less likely to have Cologuard ordered compared to Caucasians (OR=0.62, p<0.001), notably driven by patient seen in the FM group (OR=0.54, p<0.001) and no statistically significant difference was observed in the IM and GI groups (p=0.055 and p=0.43, respectively). Notably, compared to Caucasian patients, Asian patients were overall more likely to have Cologuard ordered (OR=1.23, p=0.003). In multivariable analysis assessing the likelihood of having a colonoscopy performed within 1 year of the initial appointment, the likelihood of a colonoscopy within 1 year of initial clinic visit was significantly lower for AA compared to Caucasian patients (OR=0.50, p=0.028). This difference was strongest in FM patients (OR=0.26, p=0.022) and was not significant for IM (OR=0.67, p=0.37) or GI (OR=2.31, p=0.25). Conclusions: In this study, we found that AA ethnicity is associated with reduced likelihood of having Cologuard ordered compared to Caucasian patients. Furthermore, AA patients were less likely to have colonoscopy ordered within 1 year of initial visit clinic visit among the overall cohort, highlighting important disparities in CRC screening among this vulnerable patient population notably for those seen in the FM group. Future studies are needed to assess other barriers for CRC screening in this population.

Abstract TMP28: Prevalence Of Dementia In Stroke And Its Effect On Prognosis: A National Database Analysis

Background: Stroke has been extensively studied to cause vascular dementia leading to cognitive dysfunction. However, Alzheimer’s dementia and dementia with Lewy bodies (DLB) need to be further explored. Our goal was to describe the prevalence and prognosis of different dementias in stroke. Methods: A retrospective analysis was conducted with National Inpatient Sample 2016-2019. Prevalence and demographics of dementia in stroke were characterized and prognosis was studied in terms of mortality. Independent predictors of mortality were also described. Multivariate logistic regression analysis was used. Results: 3,412,614 patients were diagnosed with stroke within the population of 142,420,122 patients, establishing a prevalence of 2.4%. Among these patients with stroke, 398,685 patients had concomitant diagnosis of dementia (prevalence 11.7%). Stratified analysis illustrated that within this stroke population, Alzheimer’s dementia had the highest prevalence (2.4%, 81,234 patients), followed by vascular dementia (prevalence 1.65%, 56,195 patients) and DLB (prevalence 0.14%, 4770 patients). Mean age for patients with stroke and dementia was 81.4 years, 59% were females, 41% were males, and 70% were white. In terms of prognosis, dementia is associated with 129% increase in mortality (OR 2.29), vascular dementia with 67% increased odds of mortality (OR 1.67), Alzheimer’s dementia with 100% (OR 2.0) and DLB with 86% increased mortality (OR 1.86). Among patients with stroke and dementia, independent predictors of mortality are heart failure (OR 1.15), ischemic heart disease (OR 1.08), atrial fibrillation (OR 1.32), pulmonary embolism (OR 1.95) and pneumonia (OR 2.19). African-American ethnicity was independently associated with decreased mortality (OR 0.8, p=0.00). Conclusions: 11.7% stroke patients had dementia. Alzheimer’s dementia has the highest prevalence in stroke followed by vascular dementia and DLB. Heart failure, ischemic heart disease, atrial fibrillation, pulmonary embolism and pneumonia are independently associated with higher mortality in this patient population.

Understanding How Community Health Workers Build Trust with Low-Income Women of Color At-Risk for Maternal Child Health Disparities: A Grounded Theory Study

ABSTRACT This article examines how Community Health Workers (CHWs) build trust with low-income women of color who have a historical distrust of the healthcare system, and are at risk for maternal-child health disparities. This qualitative study used a grounded theory methodology guided by Charmaz’s inductive social constructivist approach. Data were collected using open-ended semi-structured interviews and focus groups with CHWs who worked in community-based and hospital-based programs in California, Oregon, Illinois, Texas, South Carolina, New York, and Maine. Thirty-two CHWs participated, with 95% of participants being of Latinx and African American ethnicity. They served women from Latinx, African American, and Migrant communities. The CHW communication strategies represent aspects of respect and client-centered care and are applied in the development of a theoretical framework. CHWs were able to build and sustain trust at the initial encounter through these specific strategies: 1) addressing immediate needs related to social determinants of health; 2) embodying mannerisms and dress; 3) speaking appropriately to the client’s age, culture, and knowledge; 4) easing client’s fears through locus of control, and 5) allowing for time flexibility. These findings have implications for practice through interventions to train healthcare providers to build trust with low-income women of color who have a historical distrust of the healthcare system and who are at risk for maternal-child health disparities. Future research is recommended to explore how the communication trust-building constructs also benefit all other groups at similar risk, including those with mental health disorders and infectious diseases. The findings indicate specific communication strategies through which trust can be built, beginning at the initial encounter with low-income women at risk for maternal-child health disparities and who have a historical distrust of the healthcare system.

Diversity of medical dosimetry applicants and graduates.

Diversity is a critical component in the advancement of human endeavor in science. Students who complete their education and training at diverse schools can serve patients from a wide range of ethnic backgrounds and promote cross-cultural competence. However, developing a diverse environment of professionals is a long-term effort which often takes generations to complete. Increasing awareness of underrepresented genders and/or minorities helps to establish goals for building a future of improved diversity. Specific to radiation oncology, professions such as medical physicists and radiation oncology physicians have reported underrepresented females and minorities. The problem is that there is a paucity of literature regarding diversity of medical dosimetry professionals. The professional organization does not track diversity data for those members currently working in the profession. Therefore, the purpose of this research was to present aggregate data demonstrating the diversity of medical dosimetry applicants and graduates. The methodology involved quantitative data collection from medical dosimetry program directors which answered the research question, what is the diversity of medical dosimetry applicants and graduates? In comparison to the U.S. population, there were less applicant and accepted students of Hispanic/Latino and African American ethnicities whereas the Asian population was higher. While the U.S. population data reveals 3% more females, there were 35% more female than male applicant and accepted students in this study. However, the results differ significantly from medical physics and radiation oncology physicians with only 30% female clinicians.

An overview of inflammatory breast cancer

Inflammatory breast cancer is an uncommon and severe malignancy that frequently goes undiagnosed at first because it presents similarly to more benign breast diseases like mastitis, resulting in delayed treatment. Inflammatory breast cancer affects 1% to 5% of all occurrences of breast cancer and accounts for 8% to 10% of all breast cancer-related deaths. Erythema, skin abnormalities, nipple inversion, edema, and warmth of the affected breast are all signs of inflammatory breast cancer. Recognized risk factors for inflammatory breast cancer include young age at the time of diagnosis, obesity and African American ethnicity. Rapid onset within 3 months and pathologic evidence of invasive carcinoma leads to diagnosis of disease further including erythema occupying at least one-third of the breast, tumour may or may not be present in this case. Chemotherapy, surgery, and radiation make up the trimodal therapy used to treat inflammatory breast cancer. A modified radical mastectomy performed as part of an aggressive surgical strategy improves survival rates. Although patients with inflammatory breast cancer have worse outcomes than those with noninflammatory breast cancer, those who complete trimodal therapy have a positive locoregional control rate, highlighting the significance of an early diagnosis. Physicians must be aware and examine any clinical manifestation of inflammatory breast cancer if present to make a prompt diagnosis and refer patient for expert care timely also awareness and cancer screening can help in prevention of disease. The purpose of this research is to review the available information about an overview of inflammatory breast cancer.

AMPLIFYING COMMUNITY ENGAGEMENT TO INCREASE REPRESENTATION AND APPLICABILITY OF CAREGIVING RESEARCH

Abstract Alzheimer’s disease and related diseases (ADRD) disproportionately affect persons of African American ethnicity, yet persons who identify as Black/African American are consistently and markedly underrepresented in Alzheimer’s research. Prior research suggests that a complex array of factors, from mistrust in medical research to non-inclusive recruitment approaches, have led to the disparity. With the growing rates of ADRD among racial/ethnic groups in the US, it is imperative that research scientists develop interventions and clinical research that are culturally informed and meaningful to the lives of diverse caregivers. The goal of our research is to demonstrate the importance of community engagement and culturally informed interventions, and to offer best practices to advance the science of caregiver recruitment, which may ultimately improve overall representation across racial/ethnic caregiver groups. Research findings will highlight the variety of recruitment strategies used to build trust and more sustainable relationships with diverse communities often underrepresented in research.

Prescribed opioid use is associated with increased all-purpose emergency department visits and hospitalizations in community-dwelling older adults in the United States.

The geriatric and health characteristics of older adults make them more susceptible to the effects of opioids than younger groups. The number of older adults in the United States visiting the emergency department (ED) and overusing opioids has increased in recent years. Research examining their relationship is, however, limited. Using information from the 2020 National Health Interview Survey (NHIS), we included older adults aged 65 and older. To investigate the relationship between prescribed opioid use and 12-months ED visits and hospitalizations, linear regression and logistic regression models were built while adjusting for age, sex, ethnicity, education, employment, general health status, history of depression, and living arrangement. Our study population consisted of 8,631 participants (mean age 74.3). Most of them were females (58.3%) and Caucasian (81.6%). About 16% of the participants used prescribed opioids over the past 12 months. Of the participants with prescribed opioid use, 65.1% of them did so to treat chronic pain. The adjusted regression models revealed that prescribed opioid use was independently and positively associated with 12-months ED visits (β = 0.22, 95% confidence interval [CI] 0.18, 0.26) and hospitalizations (Odds ratio [OR] = 3.78, 95% CI 3.29, 4.35). Other risk factors for 12-months ED visits and/or hospitalizations included advanced age, male gender, unemployment/retirement, African American ethnicity, living alone, fair or poor general health status, and history of depression. Clinicians should screen older adults at high risk for ED visits and hospitalizations and explore multimodal pain management with them to help them reduce/stop using opioids. These efforts may decrease their chronic pain, opioid use, opioid use-related adverse health outcomes, ED visits, as well as hospitalizations.

Ethnic Disparities in Ileal Pouch Anal Anastomosis Outcomes: An ACS-NSQIP Study

IntroductionIleal pouch-anal anastomosis (IPAA) has become the gold standard operation performed for patients with ulcerative colitis (UC) who require colectomy for medically refractory disease or colitis-associated neoplasia. This study aims to evaluate whether differences in surgical outcomes following IPAA creation is associated with minority ethnicity using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical outcomes database. MethodsThe ACS-NSQIP proctectomy-targeted data files (2016-2019) were reviewed to identify patients who underwent an IPAA creation (Current Procedural Terminology codes: 44157, 44158, 44211, and 45113). Demographic, comorbidity, perioperative characteristics, and postoperative outcomes, particularly total-morbidity, surgical site infection, and anastomotic leak, were compared for White, African–American, Hispanic, and Asian patients. Separate multivariable logistic regressions were calculated for each outcome of interest. Certain postoperative outcomes required collation to be analyzed due to low numbers, such as combining all surgical site infections (SSIs), anastomotic leak, and septic complications as “infection complications”. For each regression, a P value of <0.05 was considered to be significant. ResultsA total of 1462 patients were identified who underwent an IPAA creation. There were 1290 (88.2%) Caucasian, 66 (4.5%) African–American, 49 (3.4%) Hispanic, and 57 (3.9%) Asian patients. Minority race or ethnicity was not associated with higher odds of total morbidity, readmission, reoperation, the development of any SSI, anastomotic leak, or other septic complications as compared to White patients. African–American ethnicity was associated with higher odds of developing postoperative bleeding complications (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.15-5.21; P = 0.020) and postoperative renal dysfunction (OR 4.32, CI 1.43-13.07; P = 0.010) as compared to White patients. Elevated body mass index (BMI) was associated with higher odds of developing an SSI (OR 1.03, CI 1.00-1.06; P = 0.045), or an “infection” complication (OR 1.04, CI 1.01-1.07; P = 0.012), but was protective against bleeding complications (OR 0.94, CI 0.9-0.98; P = 0.004). Smoking was associated with higher odds of developing an SSI, anastomotic leak, or septic complications in the combined “infection” regression analysis (OR 2.02, CI 1.25-3.26; P = 0.004). In the analysis of total-morbidity, both hypertension (OR 1.64, CI 1.11-2.42; P = 0.013) and an ASA Class score >3 (OR 1.36, CI 1.03-1.79; P = 0.029) were associated with increased odds of complications. ConclusionsThis analysis of the ACS-NSQIP national database data suggests that ethnicity is not associated with disparities in surgical outcomes following IPAA surgery. African–American ethnicity was however associated with higher odds of developing postoperative bleeding complications and renal dysfunction as compared to White patients. Elevated BMI and smoking history are associated with an increased risk of SSI, anastomotic leak and septic complications.

Abstract 12263: Lack of Diversity in Aortic Stenosis Progression Cohorts: A Systematic Review

Introduction: Aortic stenosis (AS) is characterized by highly variable progression rates. Differential rates of AS progression have been proposed to explain apparent disparities in the treatment of severe AS. However, the evidence supporting this claim is uncertain. Methods: We conducted a systematic review of MEDLINE and EMBASE from 1989 to 2022 to identify prospective cohort studies of AS hemodynamic progression. We evaluated the pooled patient demographics, AS severity, baseline and mean annual changes in echocardiographic markers, and prognostic factors. Results: We identified 32 prospective cohort studies. Overall, 11,432 patients were followed for 27 +/- 15 months on average. The average age was 67 +/- 8 years. The average percent female was 36 +/- 14%. Race was reported in only 4 (13%) cohorts; the average proportion of white patients was 93.9 +/- 6.1%. The average baseline hemodynamic severity was consistent with aortic sclerosis, mild AS, moderate AS, and severe AS in 3 (9.4%), 8 (25.0%), 19 (59.3%), and 2 (6.3%) studies, respectively. Overall, average baseline and annual changes in echocardiographic values were: peak aortic jet velocity (Vmax) 3.21 +/- 0.61 m/s (0.20 +/- 0.09 m/s/yr); aortic valve area (AVA) 1.23 +/- 0.31 cm2 (-0.09 +/- 0.05 cm2/yr); and mean aortic valve gradient (MG) 26.2 +/- 7.6 mmHg (3.9 +/- 1.6 mmHg/yr). Age, sex, coronary artery disease, hypertension, diabetes, hyperlipidemia, and smoking were not associated with AS progression in &gt;75% cohorts. Baseline Vmax and MG were associated with greater AS progression in 6 cohorts (75%). Baseline aortic valve calcification (AVC) and AVA were consistently associated with greater AS progression in 9 cohorts (100%). One cohort found that women have a greater ΔMG for a given level of AVC. A univariate analysis of race in one cohort showed that African American ethnicity was associated with lower risk of progression from normal aortic valves to incident AS. Conclusion: There is limited representation of women and ethnic minorities in prospective AS progression cohorts. Active recruitment of diverse populations in these cohorts is needed. The available clinical evidence provides limited support for claims of differential progression as the cause of racial disparities in AS treatment.

Rosai-Dorfman-Destombes Disease in the Pediatric Head and Neck.

Rosai-Dorfman-Destombes disease (RDD), or sinus histiocytosis with massive lymphadenopathy, is a rare form of non-Langerhans cells histiocytosis. It has a wide-ranging variability in presentation since first described in 1969 but much of its characteristics in children remain unknown. A retrospective chart review of children diagnosed with RDD at a tertiary care children's hospital was conducted from 2000 to 2021. Twelve RDD patients were identified, with an average age of 7 years (SD 4.3). Males comprised 58% of the cohort, and African American ethnicity was most common (42%). Nodal RDD was found in 7 patients (58%). Nine patients (75%) presented RDD within the head and neck, 6 of whom had nodal RDD. The most common presentation was cervical lymphadenopathy, which most often involved levels V (67%), II (56%), III (44%), and I (11%), in order of frequency. Recurrence and persistence of disease after initial treatment was common, with 5 (42%) being disease free at the time of the last follow up. Fifty-eight percent (7/12) developed recurrence or had persistent disease and 4 required adjuvant systemic treatment with corticosteroids and/or chemotherapy. One patient succumbed after developing treatment related acute myelodysplastic leukemia (t-AML) from chemotherapy used to treat recurrent RDD. Pediatric RDD presents at a young age and most commonly involving cervical lymphadenopathy. Ongoing surveillance in the setting of persistence or recurrence without clearly defined prognostic risk factors is important.

Prolonged Opioid Use After Lumbar Fusion Surgery: A Meta-Analysis of Prevalence and Risk Factors

Persistent opioid utilization after spine surgery is a rising complication among both preoperatively opioid-naïve and opioid-tolerant patients. To our knowledge, this is the first meta-analysis to determine the prevalence and characterize the risk factors that predispose patients to prolonged opioid use (≥3months) after lumbar fusion. Studies were identified through searches in PubMed and EMBASE from each database's earliest records to February 1, 2022. We included observational studies examining the risk factors and rates of prolonged opioid use following lumbar fusion. Pooled odds ratios (ORs) or standardized mean differences with corresponding 95% confidence intervals (CI) were estimated using inverse-variance methods. In this meta-analysis of 12 studies encompassing 80,935 patients, 40.2% of patients continued to fill opioid prescriptions ≥3months after lumbar fusion. Significant sociodemographic predictors included Medicare or Medicaid insurance (OR=1.60, 95% CI 1.36-1.88), African-American ethnicity (OR=1.29, 95% CI 1.18-1.41), being from the Southern United States (OR=1.18, 95% CI 1.11-1.25), or women (OR=1.10, 95% CI 1.01-1.20). Being from the Midwestern United States (OR=0.80, 95% CI 0.75-0.85) was found to be a protective factor. Comorbidities associated with increased risk of prolonged opioid use were preoperative opioid use (OR=5.76, 95% CI 3.52-9.41), drug abuse (OR=3.11, 95% CI 2.37-4.08), alcohol abuse (OR=2.37, 95% CI 2.14-2.64), psychiatric disorders (OR=2.29, 95% CI 1.94-2.70), smoking history (OR=1.81, 95% CI 1.23-2.66), arthritis (OR=1.35, 95% CI 1.29-1.40), and higher American Society of Anesthesiologists score (standardized mean difference=0.72, 95% CI 0.61-0.82). The high prevalence of prolonged opioid use after lumbar fusion underscores the importance of screening patients for comorbidities and implementing targeted strategies to minimize opioid misuse.

Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant.

Introduction Pediatric liver transplant recipients have demonstrated excellent long-term survival. The purpose of this analysis is to investigate factors associated with 20-year survival to identify areas for improvement in patient care. Methods Kaplan–Meier with log-rank test as well as univariate and multivariate logistic regression methods were used to retrospectively analyze 4,312 liver transplant recipients under the age of 18 between September 30, 1987 and March 9, 1998. Our primary endpoint was 20-year survival among one-year survival. Results Logistic regression analysis identified recipient age as a significant risk factor, with recipients below 5 years old having a higher 20-year survival rate (p < 0.001). A preoperative primary diagnosis of a metabolic dysfunction was found to be protective compared to other diagnoses (OR 1.64, CI 1.20–2.25). African-American ethnicity (OR 0.71, CI 0.58–0.87) was also found to be a risk factor for mortality. Technical variant allografts (neither living donor nor cadaveric) were not associated with increased or decreased rates of 20-year survival. Conclusions Our analysis suggests that long-term survival is inversely correlated with recipient age following pediatric liver transplant. If validated with further studies, this conclusion may have profound implications on the timing of pediatric liver transplantation.

Social support and food insecurity among older Brazilians in São Paulo

Food insecurity is a growing problem in Brazil, especially among older adults; however, the related sociodemographic factors remain unclear. This study aimed to analyze the relationship between social support dimensions and food insecurity among community-dwelling older adult Brazilians in São Paulo. This cross-sectional study was conducted in three cities in Sao Paulo state, Brazil. The analysis included 598 community-dwelling individuals aged ≥60-years-old, and multiple logistic regression models were used to estimate the associations between the dimensions of social support and food insecurity after adjusting for sociodemographic characteristics. We found that 42.3% of participants were food insecure. In the bivariate analysis, the higher scores in the affective, material, positive social interaction, and informational social support dimensions were statistically associated with the lower odds of food insecurity. In the multiple regression analysis, older adults who had a higher score of positive social interaction were less likely to have food insecurity, whereas the African American ethnicity and those older adults with a total family income ≤2 times of the minimum wage were more likely to have food insecurity. The results indicate that the positive social interaction emerges as an important factor associated with food insecurity among older adults, beyond that of other well-known social factors associated with food insecurity, highlighting the importance of screening for food insecurity and social support in primary care to avoid potential adverse health outcomes among older adults.

Dietary Exposure to United States Food and Drug Administration-Approved Synthetic Food Colors in Children, Pregnant Women, and Women of Childbearing Age Living in the United States.

The Food and Drug Administration (FDA) regulates artificial food colors (AFCs) in the United States. Exposure to AFCs has raised concerns about adverse behavioral effects in children. We quantified AFC exposure in women of childbearing age, pregnant women, and children and compared them to FDA and World Health Organization acceptable daily intakes (ADIs). We estimated the “typical” and “high” single-day and two-day average dietary exposure to each AFC (mg/kg/day) based on laboratory measurements and food consumption data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). We also examined whether AFC intake differed by income, education, and ethnicity. Exposure tended to be higher in children and the highest AFC exposure was found for Red No. 40. Children’s mean and 95th percentile FD&C Red No. 3 estimated intakes exceeded the ADIs in some instances. Juice drinks, soft drinks, icings, and ice cream cones were major foods contributing to children’s (<16 years old) AFC exposure. AFC intake was higher in participants with lower incomes and education and of African American ethnicity. The findings indicate widespread AFC exposure including in very young children. Research is needed on the sociodemographic determinants of exposure and AFC toxicokinetics to better describe the absorption and organ-specific exposure.