African American Research Articles

Racial and Socioeconomic Disparities in Traumatic Brain Injury Outcomes: Insights From a Nationwide Analysis

BACKGROUND AND OBJECTIVES: To examine the effects of racial and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among patients with traumatic brain injury (TBI) stratified by race and socioeconomic status (SES). METHODS: We conducted a retrospective analysis by analyzing the 1995-2015 Nationwide Inpatient Sample database. Adjusted logistic regressions and multinomial logistic regression models with and without propensity score matching were applied to investigate the effects of disparities on clinical outcomes. RESULTS: African American and Hispanic patients with TBI had a lower risk of in-hospital mortality, longer hospital LOS, and lower likelihood of being discharged to rehabilitation compared with White patients. The TBI patients with poor SES (pSES) had lower in-hospital mortality and were more likely to leave against medical advice compared with non-pSES TBI patients. CONCLUSION: Racial and socioeconomic disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital LOS among the TBI population. Our study observed pSES TBI patients had a lower likelihood of in-hospital mortality than non-pSES patients, which may be partially attributed to the fact that most of the pSES TBI patients were hospitalized in urban teaching hospitals and hospitals with large bed size. In effect, our data suggest that the Social Safety Net of the United States is effective in preventing mortality in patients with TBI.

Intracerebral hemorrhage

Background: Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and more severe disability. Asian such as Chinese and Japanese and Mexican Americans, Latin Americans, African Americans, Native Americans have higher incidences than do white Americans. So, ICH is an important cerebrovascular disease in Asia. Summary: ICH accounts for approximately 10-20% of all strokes. The incidence of ICH is higher in low- and middle-income than high-income countries and is estimated 8-15% in western countries like USA, UK and Australia, and 18-24% in Japan, Taiwan and Korea. The ICH incidence increases exponentially with age, and old age especially over 80 years is a major predictor of mortality independent of ICH severity. Females are older at the onset of ICH and have higher clinical severity than males. Modifiable risk factors include blood pressure, smoking, alcohol consumption, lipid profiles, use of anticoagulants, antiplatelet agents and sympathomimetic drugs. Non-modifiable risk factors constitute old age, male gender, Asian ethnicity, cerebral amyloid angiopathy, cerebral microbleed, and chronic kidney disease. Blood pressure is the most important risk factor of ICH. Imaging markers may help predict ICH outcome, which include black hole sign, blend sign, iodine sign, island sign, leakage sign, satellite sign, spot sign, spot-tail sign, swirl sign, and hypodensities. ICH prognostic scoring system such as ICH scoring system and ICH grading scale scoring system in Chinese and Osaka prognostic score and Naples prognostic score has been used to predict ICH outcome. Early minimally invasive removal of ICH can be recommended for lobar ICH of 30–80 mL within 24 hours after onset. Decompressive craniectomy without clot evacuation might benefit ICH patients aged 18–75 years with 30–100 mL at basal ganglia or thalamus. However, clinical studies are needed to investigate the effect of surgery on patients with smaller or larger ICH, ICH in non-lobar locations, and for older patients or patients with preexisting disability. Surgical treatment is usually associated with neurological sequels if survived. For medical treatment, blood pressure lowering should be careful titrated to secure continuous smooth and sustained control and avoid peaks and large variability in systolic blood pressure. Stroke and cancer are the most common causes of death in Asian ICH patients, compared to stroke and cardiac disease in non-Asian patients. Key Messages: The incidence and outcome are different between Asian and non-Asian patients, and more clinical studies are needed to investigate the best management for Asian ICH patients.

Navigating Funding Benchmarks: A Research Note

The Magnolia Project has served a section of “the Northwest Corridor” of Jacksonville, FL, providing reproductive and well-woman care and intensive case management to reduce infant mortality in the African American community for more than a quarter century. As a grantee of the Federal Healthy Start Program, the Magnolia Project must adhere to certain benchmarks concerning women’s health, strengthening families, and promoting system change. As with many U.S. Federal funded initiatives, these benchmarks are known to change over time. In this paper, we examine a snapshot from the 2019 to 2022 grant period to assess how the Magnolia Project fared with the federally required benchmarks.

COVID-19, social determinants, and African American-White disparities: policy response and pathways forward.

COVID-19 translated African Americans' greater social, economic, and health-related risk, reflecting adverse Social Determinants of Health (SDOH), into greater COVID morbidity, hospitalization, and mortality, and it threatened to enlarge the very risks causing greater COVID suffering. However, following a federal policy response injecting trillions of dollars into the US economy, longstanding African American-White disparities ineconomic well-being, insurance coverage, vaccination rates, and evictions declined. On the other hand, troubling and consequential disparities in k-12 academic achievement and college attendance disparities widened. Continuous monitoring and careful research are needed to document and explain trajectories in social determinant disparities and to offer insight into how policy intervention can decrease continuing disparities in economic well-being, health care, and housing stability.

Does Policy Uncertainty Boost Vaccine Hesitancy? Political Controversy, the FDA and COVID-19 Vaccine Hesitancy in Fall 2020.

Vaccine hesitancy is associated with political and institutional distrust, but there is little research on how people's trust responds to political events. We revisit the fall of 2020 when evaluation of new COVID-19 vaccines collided with an impending national election. Drawing on a political Bayesian perspective, we assess abrupt changes in attention to political events and test hypotheses on subpopulation response: (1) partisan, (2) educational, and (3) ethnic and racial. Analysis of daily changes in news reporting and social media use in 2020, combined with detailed analysis of two-large scale surveys fielded at the time, focusing on questions of COVID-19 vaccine hesitancy and safety concerns about COVID-19 vaccines. Vaccine hesitancy in the US spiked from late August to early October 2020. We identify several plausible triggers for this spike, all pertaining to the FDA and electoral politics. Heightened vaccine hesitancy occurred among Democrats, Asian and Black citizens, as well as college-educated respondents. Turbulence mainly affected those who were initially most trusting in government and vaccines. Asian-American vaccine confidence recovered; that of Black Americans did not. Electoral politics may destabilize citizen assumptions about vaccine authorization and boost uncertainty, thereby undermining public willingness to take approved vaccines.

Identification of Non-Coding RNA Biomarkers in Non-Small Cell Lung Cancer to Address Racial Disparities.

Lung cancer significantly impacts mortality, with African Americans (AAs) showing higher rates than White Americans (WAs). Noncoding RNAs (ncRNAs) play a crucial role in lung tumorigenesis. To identify ncRNA biomarkers associated with racial disparities in lung cancer, we used droplet digital PCR to examine 93 lung cancer-associated ncRNAs in plasma and sputum samples from participants with AA and WA, including 118 patients and 92 cancer-free smokers. In the AA population, plasma showed differential expression of ten ncRNAs, while sputum revealed four ncRNAs when comparing lung cancer patients to the control group. In the WA population, the plasma displayed 11 ncRNAs, and the sputum had five ncRNAs showing differential expression between lung cancer patients and the control group. For AAs, we identified a three-ncRNA panel (plasma miRs-147b, 324-3p, 422a) for diagnosing lung cancer in AAs with 86% sensitivity and 89% specificity. For WAs, a four-ncRNA panel comprising sputum miR-34a-5p and plasma miRs-103-3p, 126-3p, and 205-5p was developed, achieving 88% sensitivity and 87% specificity. These panels remained effective across various stages and types of lung tumors, and were validated in an independent cohort of 56 patients and 72 controls. Ethnicity-related ncRNA signatures hold promise as biomarkers for tackling racial disparities in patients with lung cancer.

Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care.

Approximately 1 in 5 adults are diagnosed with depression in their lifetime. However, less than half receive help from a health professional, with the treatment gap being worse for individuals with socioeconomic disadvantage. Computer-assisted cognitive behavioral therapy (CCBT) is an effective and convenient strategy to treat depression; however, its cost-effectiveness in a sociodemographically diverse population remains unknown. To evaluate the cost-effectiveness of clinician-supported CCBT compared with treatment as usual (TAU) in a primary care population with a substantial number of patients with low income, limited computer or internet access, and lack of college education. This economic evaluation was a randomized clinical trial-based cost-effectiveness analysis. The trial was conducted at the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville. Enrollment occurred from June 24, 2016, to May 13, 2019. Participants had mild to moderate depression and were followed up for 6 months after treatment completion. The last follow-up assessment was conducted on January 30, 2020. Statistical analysis was performed from August 2023 to August 2024. CCBT intervention was provided for 12 weeks and included 9 modules ranging from behavioral activation and cognitive restructuring to relapse prevention strategies, supported by telephonic sessions with a clinician, in addition to TAU, which included standard clinical management in primary care. The primary health outcome was quality-adjusted life years (QALYs), estimated using the Short-Form 12 questionnaire (SF-12). The secondary outcome was treatment response, defined as at least 50% improvement in the Patient Health Questionnaire. The intervention cost included sessions with mental health clinicians and the cost of the CCBT software, plus the cost of loaner computer and internet data plan for low-resource households. An incremental cost-effectiveness ratio (ICER) was computed, while adjusting for baseline scores, age, and sex. The cost-effectiveness acceptability curve presented the probability of CCBT being cost-effective for a range of willingness-to-pay values. Among the 175 primary care patients included in this study, 148 (84.5%) were female; 48 (27.4%) were African American, 2 (1.2%) were American Indian or Alaska Native, 4 (2.5%) were Hispanic, 106 (60.5%) were White, and 15 (8.6%) were multiracial; and the mean (SD) age was 47.03 (13.15) years. CCBT was associated with better quality of life and higher chance of treatment response at the posttreatment and 6-month time points, compared with the TAU group. The ICER for CCBT was $37 295 (95% CI, $22 724-$66 546) per QALY, with a probability of 89.4% of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. The ICER per case of treatment response was $3623 (95% CI, $2617-$5377). In this trial-based economic evaluation, CCBT was found to be cost-effective, compared with TAU, in primary care patients with depression. As this study included individuals with low income and with limited internet access who are underrepresented in cost-effectiveness studies, it has important policy implications for addressing unmet needs in sociodemographically diverse populations.

Modeling longitudinal change patterns of self-regulation from early to middle childhood: Methodological innovations and individual differences.

Patterns of change in self-regulation from the ages of 2.5 to 12 years were modeled using repeated measures of self-regulation for a sample of 399 African American (n = 180, 45%) and Latinx (n = 219, 55%) children from families experiencing low income. Measures included both direct assessment and parent report. Results confirmed four components of self-regulation: working memory, inhibitory control, complex response inhibition, and set shifting. Furthermore, these components of self-regulation were more differentiated at younger ages but grew increasingly integrated as children developed. During early childhood, Latinx children displayed greater levels of working memory and higher levels of inhibitory control, and African American children displayed greater complex response inhibition and set shifting, but these ethnic differences reversed by early elementary school. By late middle childhood, ethnic differences in self-regulation had virtually disappeared altogether. Few differences by child gender or family poverty status were identified. Recommendations are provided to facilitate the modeling of self-regulation over extended periods of development including (a) utilizing measures that overlap time points, (b) standardizing the measurement scales, and (c) utilizing a flexible latent variable model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of fasting on cardiovascular risk factors among healthy adult Muslims attending primary care, Kano, Northern Nigerian.

Cardiovascular diseases (CVD) are among the most prevalent and preventable chronic diseases in the 21st century The global burden of disease: 2004 update. The Report in Sections. A person's risk of developing CVD can be reduced by adopting healthy lifestyles, spiritual and religious practices The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. Fasting as a spiritual practice is not exempted from these benefits. Most world's religions recommend a period of fasting. The obligatory Ramadan fasting in Islam may provide an interesting opportunity to reduce food intake and increase physical activity. The main objective of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors on healthy adult Muslims. The study was pre/post-test single arm intervention conducted at the staff clinic of Family Medicine department, AKTH, and Northwest, Nigeria. Kano. The study recruited healthy adults 18yrs and above not on any medications that can affect metabolic profiles consecutively from two weeks before Ramadan fasting of 2018 and the last week of Ramadan of the same year. The questionnaire included information on sociodemographic, clinical parameters and Lifestyle pattern. Thirty healthy volunteers were included in this study, 25 males (83.3%) and 5 females (16.7%). The mean age was 38.23 ± 6.35(SD). Twenty-five participants were married (83.3%) with 4 singles (13.3%) and 1 divorcee (3.3%). During Ramadan fasting, weight reduced (67.90 ± 11.61 versus 66.53 ± 12.13 4th week of Ramadan p-value < 0.002) Body Mass Index (22.89 ± 3.63 versus 4th week of Ramadan 22.38 ± 3.64 p-value < 0.002) and systolic blood pressure (120.33 ± 19.91versus 4th week of Ramadan 115.33 ± 14.32 p-value 0.003) reduced significantly compared to baseline. The waist circumference, pulse rate, fasting blood sugar and cholesterol were reduced but were not statistically significant. The result from this study suggested that Ramadan fasting may be a useful means of reducing burden of cardiovascular diseases, as the improved cardiovascular risk factors associated with fasting may translate into a significant health benefit.

Fidelity of BMI, Waist, and Waist-to-Height Ratio as Adiposity Measures in Normoglycemic Black vs. White American Adults

Abstract Objective To assess ethnic disparities in the association between indirect and direct measures of adiposity in African American (AA) and European American (EA) adults. Methods We analyzed the indirect (weight, body mass index {BMI}, waist circumference {WC}, waist-to-height ratio {WHtR}) and direct (total fat, trunk fat, fat-free mass) adiposity measures in healthy AA and EA adults. Assessments included anthropometry, OGTT, body composition by DXA, and calculation of direct-to-indirect adiposity ratios (total fat/BMI, trunk fat/WC, trunk fat/WHtR, and FFM/weight). Results A total of 314 subjects (167 AA, 147 EA) underwent DXA. All participants (mean age 44.2 ± 10.6 years) had normal fasting and 2-hr glucose values. The BMI (AA vs EA) was 31.2 ± 7.42 kg/m2 vs.28.8 ± 6.78 kg/m2 (P=0.0014); WC 95.3 ± 16.0 cm vs. 92.9 ± 15.0 cm (P=0.15). Significant correlations (P&amp;lt;0.0001) were observed between BMI and total fat (r=0.68), WC and trunk fat (r= 0.61) and WHtR vs. trunk fat (r=0.77) for the combined cohort, with heterogeneity in the strength of association by sex and ethnicity. Fat-free mass was higher in AA vs EA participants (P=0.03). Total fat/BMI was lower in AA vs. EA participants (P=0.0047); trunk fat/WC (P=0.004) and trunk fat/WHtR (P=0.0026) were lower in AA men vs EA men. Conclusion The BMI overestimated body fat in AA participants versus EA participants, and waist circumference overestimated trunk fat in AA men versus EA men. These data indicate ethnic disparities in the fidelity of indirect measures of adiposity and argue for ethnic-specific BMI thresholds for determination overweight/obesity.

Prenatal And Postpartum Care Experiences Among Black Birthing People In The United States: An Integrative Review.

Among Black birthing people, high-quality, respectful care throughout pregnancy and postpartum is hindered by distrust, racial discrimination, and unsatisfactory care. The purpose of this integrative review was to examine prenatal and postpartum care experiences among Black birthing people in the United States. A literature search, spanning from inception through October 6, 2022, across 4 research databases, used a combination of keywords to capture reports on care experiences among Black birthing people. We included quantitative and qualitative studies in the United States with people who self-identified as Black or African American and reported prenatal or postpartum health care experiences. Intrapartum experiences were excluded. All studies were evaluated with the Mixed-Methods Appraisal Tool, National Institutes of Health Study Quality Assessment tool, or Joanna Briggs Institute critical appraisal checklist. Data were analyzed and synthesized using the Joanna Briggs Institute convergent integrated approach to incorporate quantitative and qualitative research. A total of 16 studies published over 27 years met the inclusion criteria. All studies examined the health care experiences of Black birthing people during prenatal or postpartum care. None of the studies focused solely on postpartum care experiences. The 2 most prominent themes were models of care and patient-provider interactions, encompassing both positive and negative experiences. Positive care experiences included collaborative patient-provider interactions, continuity of care, and culturally centered care. Adverse experiences were more frequently noted and involved discriminatory treatment during patient-provider interactions, fragmented care models, and a lack of cultural awareness. Black birthing people in the United States report some positive but more negative health care experiences during pregnancy and postpartum care, which may play an important role in health inequities. Promoting prenatal and postpartum care models that provide continuity and are high-quality, collaborative, and culturally centered were identified as high-priority targets to foster patient safety and improve clinical outcomes.

Large-scale deep proteomic analysis in Alzheimer's disease brain regions across race and ethnicity.

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease, yet our comprehension predominantly relies on studies within non-Hispanic White (NHW) populations. Here we provide an extensive survey of the proteomic landscape of AD across diverse racial/ethnic groups. Two cortical regions, from multiple centers, were harmonized by uniform neuropathological diagnosis. Among 998 unique donors, 273 donors self-identified as African American, 229 as Latino American, and 434 as NHW. While amyloid precursor protein and the microtubule-associated protein tau demonstrated higher abundance in AD brains, no significant race-related differences were observed. Further proteome-wide and focused analyses (specific amyloid beta [Aβ] species and the tau domains) supported the absence of racial differences in these AD pathologies within the brain proteome. Our findings indicate that the racial differences in AD risk and clinical presentation are not underpinned by dramatically divergent patterns in the brain proteome, suggesting that other determinants account for these clinical disparities. We present a large-scale proteome (∼10,000 proteins) of DLPFC (998) and STG (244) across AD cases. About 50% of samples were from racially and ethnically diverse brain donors. Key AD proteins (amyloid and tau) correlated with CERAD and Braak stages. No significant race-related differences in amyloid and tau protein levels were observed in AD brains. AD-associated protein changes showed a strong correlation between the brain proteomes of African American and White individuals. This dataset advances understanding of ethnoracial-specific AD pathways and potential therapies.

Abstract 4125334: Disparities In Clinical And Demographic Outcomes Of Non-Acute Myocardial Infarction-Associated Cardiogenic Shock In African American Vs. Non-African American Patients: An Analysis From The National Inpatient Sample Database

Background: Limited knowledge exists regarding non-acute myocardial infarction-associated cardiogenic shock (nACS-CS) and its associated outcomes within the African American population. Aim: This investigation aimed to examine the clinical outcomes of nACS-CS in the African American population compared to the non-African-American population in the United States. Methods: The National Inpatient Sample (NIS) database was employed to identify hospitalizations with nACS-CS from 2018 to 2020. Patients were categorized as either African Americans or non-African Americans. Statistical analyses, including Chi-square and t-tests, were conducted using STATA version 18. Results: Out of 8,607 nACS-CS hospitalizations, 1,325 (15.4%) involved African Americans between 2018 and 2020 (Figure 1a). African American patients with nACS-CS tended to be younger (60.9±16.6 vs. 65.8±16.7 years; p &lt; 0.05). Moreover, the length of stay for this cohort was notably longer (16.2±0.75 vs. 14.8±0.32 days; p &lt; 0.05). The demographic age group affected by cardiogenic shock exhibited a decreasing trend as time progressed up to 2020 (p-trend&lt;0.05; Figure 1b). The mean hospital charges were also higher for the African American cohort (p&lt;0.05). In-hospital mortality also showed a progressive increase among African Americans over time (p&lt;0.05). Conclusion: Among African American patients with nACS-CS, there is an escalating burden on healthcare, evidenced by a progressively younger demographic being affected over time, coupled with worsening rates of in-hospital mortality. Furthermore, there is a higher mean cost of hospitalization and a prolonged length of stay compared to their non-African American counterparts.

Abstract 4138035: Inclisiran in Routine Clinical Practice: Results from a Nationwide Study of &gt;5,000 Patients

Introduction: Inclisiran is a small interfering RNA drug which inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9). Inclisiran was recently approved for the treatment of hypercholesterolemia and durably lowers LDL levels by around 50% with injections once every six months based on the results of large, randomized controlled trials. However, no nationwide studies have evaluated the use or effectiveness of Inclisiran in routine clinical practice. Goals/Aims: To characterize the use and effectiveness of Inclisiran in routine clinical practice in a large nationwide cohort. Methods/Approach: We used the Truveta healthcare database, a large nationwide database of electronic health records, to study patients who were administered Inclisiran up to September 2023. Patient demographic characteristics and lipid levels before and after treatment were summarized. Means and 95% confidence intervals were estimated using t-tests. Results/Data: A total of 5,256 patients (median age 71, first quartile 65, third quartile 76) were prescribed Inclisiran, of whom 2,919 (55.5%) were Female. In terms of race, most of the patients identified as White (81.0%), and a smaller proportion as African American (7.3%), Asian (2.1%), or American Indian/Alaska Native (0.5%); 7.3% of patients identified as more than one race or did not provide race data. Mean LDL and HDL levels (mg/dL) before Inclisiran were 125 (95% CI 123-127) and 51 (95% CI 51-52) respectively and after Inclisiran were 88 (95% CI 85-90) and 50 (95% CI 49-51) respectively. The mean difference in LDL after treatment was -39 (95% CI -42 to -37) mg/Dl for a mean percent change of -22% (95% CI -25% to -19%). Effects of Inclisiran on LDL levels are shown in Figure 1. At the conference, we will compare effects of Inclisiran to those of Alirocumab and Evolocumab (two older monoclonal antibodies against PCSK9) using a propensity score overlap weighting design. Conclusions: In a large cohort of patients administered Inclisiran in routine clinical practice, Inclisiran use was associated with substantial decreases in LDL levels, but those decreases were nonetheless smaller than the effects seen in randomized controlled trials of the drug.

Abstract 4145840: Hypertensive Cardiorenal Disease with Cardiorenal Failure vs. Hypertensive Renal Disease with Renal Failure: Racial Mortality Trends from 1999 to 2020 in the United States

Introduction: High levels of blood pressure (BP) are responsible for 7.6 million deaths each year worldwide, more than any other risk factor. The diagnosis of hypertension is associated with a significant increase in the risk of kidney or cardiovascular events, with no prior history of these events. Our study aims to analyze trends in hypertensive heart disease and hypertensive heart and kidney disease-related mortality in the United States, focusing on different races. Method: We retrieved death certificate data from the CDC-WONDER database for adults aged ≥25 years. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Temporal trends were examined using the average annual percent change (AAPC) determined by joinpoint regression. Result: From 1999 to 2020, a total of 100,705 people died from hypertensive heart and renal disease in the USA. The overall AAMR of 1.4 per 100,000 displayed a trend during this period (AAPC: 4.8, 95% CI [3.3–6.2]). Total deaths from hypertensive heart disease and renal disease associated with heart failure were 5,274, showing an increasing trend from 1999 to 2020. The AAMR for hypertensive heart and renal disease with heart failure was 0.1 (AAPC: 5.2, 95% CI [3.8–6.7]). Black or African Americans have the highest AAMR (0.1, 95% CI [0.1–0.1]). Total deaths from hypertensive heart disease and renal disease associated with renal failure were 34,519, showing an increasing trend from 1999 to 2020. The AAMR for hypertensive heart and renal disease with renal failure was 0.4 (AAPC: 3.9, 95% CI [2.6–5.1]). Black or African American has the highest AAMR (1.6, 95% CI [1.5–1.6]), followed by American Indian or Alaska Native (0.5, 95% CI [0.4–0.5]), Asians and Pacific Islanders (0.4, 95% CI [0.4–0.4]), and White (0.4, 95% CI [0.3–0.4]). Conclusion: African Americans and other identified high-risk races should get targeted therapies to reduce the burden of hypertensive-related morbidity and mortality; those with renal impairment should receive special attention. The goals of these interventions ought to be to increase access to healthcare, raise public knowledge of hypertension, and support lifestyle changes.

Abstract 4140149: Differences in Interventional Treatment Outcomes of Peripheral Arterial Disease between African American Females, African American Males, and Caucasian Females

Introduction: Several recent publications demonstrated worse outcomes of interventional treatment of peripheral arterial disease (PAD) in patients of African American (AA) descent compared to Caucasians (C), and in female patients compared to male patients. However, studies addressing sex differences in outcomes, included predominantly white female patients. To our knowledge, there are no published studies specifically addressing outcomes of interventional treatment of PAD in female patients of African American descent. Aims: 1. To determine if the outcomes of interventional treatment of PAD in female patients of African American (FAA) descent differ from male African American patients (MAA), and Caucasian female patients (FC). If such differences exist, to identify factors associated with it. Methods: This study has a cross-sectional design with systematically retrospective data collection by the National Vascular Quality Initiative. Included in this study was data on patients treated with endovascular and open surgical options for symptomatic PAD. Statistical analysis was done using IBM Statistic SPSS V25. Results: 447,263 unique cases containing required data were available in the VQI database. Among them, 171,250 were female patients, of which 32,966 were FAA, 126,519 FC, and 39,461 MAA. This race and gender distribution is not significantly different from the US population structure (US Census Bureau 2023). 1 However, female to male ratio was higher in AA (0.83) compared to C (0.58, p&lt;0.0001). FAA were younger (65.143+/-9.59) compared to FC (69.16+/-10.32, P&lt;0.00001). Comparison of comorbidities, smoking rates, pre-interventional medications and post-interventional outcomes are listed in Table 1. Multivariate analysis confirmed higher amputation rate among FAA compared to FC and to MAA and showed no significant difference in mortality. Conclusions: FAA patients who require interventional treatment for PAD have significantly higher rate of hypertension and diabetes compared to FC and MAA patients and have higher amputation rates. It appears that differences in clinical outcomes of PAD treatment in FAA are related mostly if not entirely to poorly managed comorbidities existed prior to intervention.

Abstract 4127909: Smartphone-enabled, home-based exercise in patients with symptomatic peripheral arterial disease: the Smart Step Grady randomized trial

Introduction: About 10% of peripheral artery disease (PAD) patients develop claudication, with African Americans at higher risk and more severe symptoms. While supervised exercise therapy (SET) is a primary treatment, its uptake is low. We assessed the feasibility and effectiveness of smartphone-delivered home-based exercise therapy (HBET) in improving functional capacity and PAD symptoms in low-resource settings lacking SET. Methods: We conducted an interim analysis of Smart Step, a pilot randomized trial (1:1 ratio) comparing smartphone-enabled HBET to usual care (UC) in symptomatic PAD patients at Grady Memorial Hospital, a public safety net hospital in Atlanta, GA, from August 2018 to March 2024. The HBET group received virtual exercise coaching, app-based education, messaging, and reminders for 12 weeks. The primary outcome was the change in 6-minute walking distance (6MWD) at 12 weeks. Secondary outcomes included changes in the Walking Impairment Questionnaire (WIQ) and Short Form 36 (SF-36) scores. Data were analyzed using intention-to-treat, with mixed model repeated measures regression assessing the association between 6MWD and treatment. Results: We screened 102 patients and enrolled 46. To date, 26 (56%) participants have completed the study, 6 (13%) dropped out, and 14 (30%) are pending completion. The mean [SD] age was 63 [12] years, with 50% female and 90% African American. After 12 weeks, the mean 6MWD increased by 15.7 m from a baseline of 336.0 m in the HBET arm (n=13) and decreased by 6.6 from a baseline of 310.2 m in the UC arm (n=13). The between-group difference was 22.4 [95% CI -11.8 – 56.6] m; p=0.19). The WIQ stair climbing score changed by -10.9 in the UC arm vs. 7.1 in the HBET arm (between group difference 17.9 [95% CI 1.1-34.8]; p=0.04), while the other WIQ sub-scores were more similar between groups. The 12-week changes in SF-36 scores were not different by group. Conclusion: In this preliminary analysis, the HBET arm showed within-group improvements in 6MWD and symptoms after 12 weeks, but most changes were not significantly different when comparing them with the UC arm. Future analyses are pending and will provide the necessary statistical power for a more precise measure of the treatment effects.

Abstract 4119327: Tyrosine Kinase Inhibitor and Their Cardiotoxic Profile in the African American Population at a Community Safety Net Hospital

Intro: Tyrosine Kinase inhibitors (TKI) have been an effective treatment option for multiple cancer types. Unfortunately, TKIs have shown to have off-target Kinase binding to cardiac tissue. The examination of these cardiotoxic side effects have not been sufficiently explored in minority populations and studies such as DASISION and ENESTnd with high NAA homogeneous demographics reflect this issue. AA tend to have higher rates of HTN and HF at baseline, so further evaluation of TKI cardiotoxicity in this population is warranted. Methods: A total of 181 patients (pts) charts were reviewed in this study, who were exposed to either Ibrutinib, Imatinib and Sorafenib. First, Patients’ demographic data, such as age, gender, race, malignancy type were obtained along with their corresponding exposure to TKIs discussed above. Next, each patient (pt) chart was examined for any cardiotoxic etiologies after starting a TKI, such as arrhythmias, new- onset heart failure (nOHF) , cardiac arrest (CA), and Myocardial infarction (MI). Echocardiography reports were examined for Ejection fraction ( EF). In summary, this is an observational study looking at Cardiotoxicity secondary to TKI use in the AA population. Results: This study's demographics consisted of 149 AA and 32 NAA (non- african american), with the average age of 64.2, and had 128 males and 53 females. A total of 89 pts were on imatinib, 57 on Ibrutinib, 35 on sorafenib. In our population, 64 pts received cardiac echography while on TKIs, with 9 of them demonstrating nOHF. In terms of cardiac arrhythmias, a total of 67 pts experienced this while on TKI, with about 34% (51/149) of AA compared to 50% (16/32) of NAA. A total of 18 pts in the study required hospital management as a sequelae of their cardiotoxicity. Conclusion: There were a few trends that diverged from most studies regarding cardiotoxicity associated with TKIs in our study. When looking at individual items, such as rate of Atrial Fibrillation (AF), seen commonly in patients on Ibrutinib, our rate seen is 4.6% which is lower compared to earlier pooled homogenous population studies (6-7%). Earlier clinical trials of Sorafenib had a 2 % rate of HF in mostly homogenous NAA populations, and our study had 0% rate in total. Overall, several cardiotoxicity trends seen with the TKIs in this observational study warrant need for future studies to enable improved cardiac surveillance strategies post treatment in heterogeneous populations.

Abstract 4131486: Cardiovascular Mortality in Children and Young Adults: Trends and Demographic Differences in the United States, 1999 to 2021

Background: Cardiovascular disease (CVD) mortality in the U.S. younger population is on the rise. However, limited data is available on CVD-related mortality trends in this population. Aim: This study aimed to assess the temporal trends and demographic differences in CVD-related mortality among the U.S. youth. Methods: The CDC WONDER dataset was analyzed from 1999-2021 for CVD-related mortality in children and young adults (age &lt;25 years). Socio-demographic data including gender, race/ethnicity, urbanization status and census region was acquired. Age adjusted mortality rates (AAMR) per 100,000 persons and annual percent changes (APCs) with 95% confidence interval (CIs) were calculated. Results: Between 1999-2021, a total 54,283 CVD-related deaths occurred among the youth in the U.S. The overall AAMR declined from 1999-2008 (APC, -1.15 [-3.4 to 0.53]), followed by sharp decrease from 2008-2012 (APC, -3.28 [-4.68 to 0.86]). The AAMR continued to decrease steadily from 2012 to 2019 (APC: -1.20, [-3.76 to -0.06]), followed by a sharp increase in from 2019 to 2021, (APC, 3.03 [-0.66 to 5.12]). Males consistently had higher AAMRs than females from 1999 (AAMR males: 2.99 vs females: 2.3) to 2021 (AAMR males: 2.39 vs females: 1.74). Non-Hispanic (NH) Black or African Americans had the highest AAMR in 2020 (3.68), followed by NH Whites (1.71), Hispanic or Latinos (1.59), and Asian and Pacific Islanders (1.2). AAMRs also showed significant variations across different regions (overall AAMR West 1.81; Northeast 1.93; Midwest 2.3; South 2.69). Metropolitan areas (2.23) consistently had lower mortality rates than nonmetropolitan areas (2.59). Conclusion: Our analysis revealed that CVD-related mortality in the youth declined from 1999-2019, followed by an increase in 2020 to 2021. Highest mortality rates were seen in males, Black or African Americans, Western region of the U.S, and nonmetropolitan areas. Tailored interventions are necessitated to decrease the burden of CVD-related mortality in these demographics among children and young adults in the United States.

Abstract 4134560: Sex Differences in Repolarization Abnormalities Associated with Ventricular Arrhythmia in Mitral Valve Prolapse

Background: Compared to men, women with mitral valve prolapse (MVP) are more likely to present with sudden death, and most women who die suddenly are premenopausal. Repolarization abnormalities are common in patients with MVP-attributed sudden death. However, differences in repolarization between men and women with MVP are not known. Hypothesis: Repolarization abnormalities are associated with ventricular arrhythmia and are more common in women than men with MVP. Aims: To investigate associations of ECG repolarization abnormalities with sex and ventricular arrhythmia in MVP. Methods: We reviewed 12-lead ECGs from 272 adults with MVP for T-wave inversion, ST segment elevation, ST depression, QTc and QT dispersion. Patients were excluded if they had prior MI, coronary artery disease, mitral valve surgery, moderate or severe LVH, heart failure, reduced left ventricular ejection fraction, atrial fibrillation or QRS duration &gt;120ms. Transthoracic echocardiograms were reviewed for mitral regurgitation, mitral annular disjunction, bi-leaflet or myxomatous MVP. Ambulatory ECGs (n=94) were assessed for NSVT or PVCs (&gt; 1% burden) and ECGs for &gt;1 PVC on any 10 second tracing. Associations were evaluated using Fisher’s exact test, Wilcoxon rank-sum test or multiple linear regression. Results: Among 272 patients, median (IQR) age was 58 (47-67) years, 162 (59.6%) were women, 46 (16.9%) were African American, and 34 (12.5%) had frequent ventricular ectopy. Women and men had similar rates of NSVT (15/66 [22.7%] vs 4/28 [14.3%], p=0.41) and frequent ventricular ectopy (25/162 [15.4%] vs 9/110 [8.1%], p=0.093). The QTc was longer in women (433 [417, 446] vs 423 [406, 442] ms, p=0.023) and in those with NSVT (437 [421, 444] vs 421 [405, 436] ms, p=0.028), but not in those with ventricular ectopy (437 [420, 445] vs 428 [410, 444] ms, p=0.15). There was a trend towards increased QTc in patients with mitral annular disjunction (433 [418, 454] vs 429 [408, 444] ms, p=0.054) and myxomatous MVP (434 [414, 450] vs 427 [408, 444] ms, p=0.076). Female sex was the only independent predictor of QTc (R 2 =0.14, p=0.0032). Conclusion: Among patients with mitral valve prolapse, women have longer QT interval than men, and longer QT interval is associated with nonsustained ventricular tachycardia. Subtle or dynamic delay in repolarization may promote malignant ventricular arrhythmias in women. Understanding these relationships may help identify patients at risk for sudden death.