Age-adjusted Prevalence Research Articles

Prevalence of Trachoma after Implementation of Trachoma Elimination Interventions in Oromia Regional State, Ethiopia: Results of Impact Surveys in 131 Evaluation Units Covering 139 Districts

ABSTRACT Purpose To determine the prevalence of trachomatous inflammation—follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. Methodology A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. Results A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1–9 years ranged from 0.15% (95% confidence interval [CI]: 0.0–0.4) to 37.5% (95% CI: 31.1–43.7). The TF prevalence was <5% in 73/131 (56%) EUs. The EU-level age- and gender-adjusted prevalence of TT unknown to the health system among people aged ≥15 years ranged from 0.001% (95% CI: 0.00–0.02) to 2.2% (95% CI: 1.1–3.1) with 37/131 (28%) EUs having a prevalence <0.2%. Only 48% of all households surveyed had access to improved water sources for drinking. Approximately 96% of households did not have an improved latrine. Conclusion Oromia is on the path towards elimination of trachoma as a public health problem.

Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018−2020

ABSTRACT Purpose Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation—follicular (TF) prevalence in 1–9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. Method We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. Result Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1−9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. Conclusion Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.

Epidemiology and Burden of NMOSD, MS, and MOGAD in Thailand: a Population-Based Study

Objective To determine cumulative incidence and point prevalence of neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Thailand using population-based data of Chumphon province. Background CNS inflammatory demyelinating diseases (CNSIDDs) have a great interracial heterogeneity. The epidemiology of CNSIDDs in Thailand, a Mainland Southeast Asian country, is unknown. Design/Methods Searching for CNSIDD patients at a public secondary care hospital in Chumphon from January 2016 to December 2021 was performed using relevant ICD-10-CM codes. All neurology patients were systematically referred to this hospital as it was the only hospital in the province with a neurologist. Diagnoses were individually ascertained by retrospective chart review. Cumulative incidence over 2016-2021, point prevalence on December 31st, 2021, attack rate, mortality rate, and disability-adjusted life years (DALYs) were calculated. Population data were obtained from the National Statistical Office of Thailand. As of December 31st, 2021, the population census of Chumphon was 509,479. Results NMOSD was the most prevalent CNSIDD in adult Thai population at 3.33 per 100,000 persons (crude prevalence 2.55). The age-adjusted prevalence of aquaporin-4 antibody-positive NMOSD alone was 3.08 per 100,000 persons. Age-adjusted incidence rate of NMOSD was 1.65 per 100,000 persons/year (crude incidence rate 0.20). Age-adjusted prevalence of MS followed at 0.77 and MOGAD at 0.51 per 100,000 persons (crude prevalence 0.59 and 0.39, respectively). Although most had a fair recovery, disability was worst among NMOSD with a DALY of 3.47 years per 100,000 persons. Mortality and attack rates were highest in NMOSD as well. No increase in incidence or attack rate were observed during the COVID-19 pandemic. Conclusions CNSIDDs are rare diseases in Thailand. The prevalence is comparable to that of East Asian countries. NMOSD caused the highest DALYs among CNSIDDs.

EPH126 Sex- and Age-Adjusted Incidence and Prevalence Population-Based Estimation for Acute Myeloid Leukemia in Korea From 2011 to 2019

EPH126 Sex- and Age-Adjusted Incidence and Prevalence Population-Based Estimation for Acute Myeloid Leukemia in Korea From 2011 to 2019

Increasing clinical awareness of obesity as a serious, chronic, relapsing, and treatable disease

The American Medical Association recognized obesity as a disease in 2013. Obesity is influenced by genetic, environmental, physiologic, behavioral, and sleep factors and is associated with approximately 200 health conditions. Assessed using body mass index, body composition, and evaluation of weight-related complications, obesity is treated with lifestyle interventions, anti-obesity medications, and metabolic and bariatric surgery. The age-adjusted prevalence of overweight and obesity in US adults has increased substantially in the 21st century, from an estimated 56% in 1988-1994 to approximately 73.1% in 2017-2018. Nevertheless, there are substantial barriers to successful obesity treatment in the United States, including inadequate treatment coverage; a lack of acceptance by providers, patients, and employers that obesity is a disease; the perception that treatment is ineffective; and the belief that obesity is a behavioral concern related to a lack of willpower. Obesity is a serious, chronic, relapsing, and treatable disease associated with many related conditions; it requires long-term medical management and multimodal care strategies.

Patient-Centered Access to IBD Care: A Qualitative Study.

Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with IBD with a focus on accessing health care. Using a qualitative descriptive approach, patients diagnosed with IBD (≥18 years of age) were purposively sampled from rural and urban gastroenterology clinics and communities across Canada. Co-facilitated by a researcher and patient research partner, 14 focus groups were recorded, transcribed, and coded for themes. Thematic analysis was used to ascertain the congruence or discordance of IBD specialty care access experiences. A total of 63 individuals participated in the study. The majority of participants were female (41/63, 65%) and from urban/suburban regions (33/63, 52%), with a mean age of 48.39 (range 16-77 years). The analysis generated three main themes: (1) need for patient to be partner, (2) adapting IBD care access to individual context, and (3) patient-defined care priorities should guide access to IBD care. The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the impact of these factors on accessing care. Using a patient-centered exploration of barriers and facilitators, IBD specialty care access in Canada can be better understood and improved on provincial and national levels.

A population-based serological study of post-COVID syndrome prevalence and risk factors in children and adolescents

Post-COVID syndrome remains poorly studied in children and adolescents. Here, we aimed to investigate the prevalence and risk factors of pediatric post-COVID in a population-based sample, stratifying by serological status. Children from the SEROCoV-KIDS cohort study (State of Geneva, Switzerland), aged 6 months to 17 years, were tested for anti-SARS-CoV-2 N antibodies (December 2021-February 2022) and parents filled in a questionnaire on persistent symptoms in their children (lasting over 12 weeks) compatible with post-COVID. Of 1034 children tested, 570 (55.1%) were seropositive. The sex- and age-adjusted prevalence of persistent symptoms among seropositive children was 9.1% (95%CI: 6.7;11.8) and 5.0% (95%CI: 3.0;7.1) among seronegatives, with an adjusted prevalence difference (ΔaPrev) of 4.1% (95%CI: 1.1;7.3). Stratifying per age group, only adolescents displayed a substantial risk of having post-COVID symptoms (ΔaPrev = 8.3%, 95%CI: 3.5;13.5). Identified risk factors for post-COVID syndrome were older age, having a lower socioeconomic status and suffering from chronic health conditions, especially asthma. Our findings show that a significant proportion of seropositive children, particularly adolescents, experienced persistent COVID symptoms. While there is a need for further investigations, growing evidence of pediatric post-COVID urges early screening and primary care management.

Annual prevalence of non-communicable diseases and identification of vulnerable populations following the Fukushima disaster and COVID-19 pandemic

Disasters, pandemics, and their response measures can have secondary effects on the physical and psychological health of affected populations. Using health insurance receipt data from 2009 to 2020, we assessed changes in the prevalence of major non-communicable diseases (NCDs), including hypertension, hyperlipidemia, diabetes, and mental disorders, among affected populations before and after the Fukushima disaster and coronavirus disease (COVID-19) outbreak in Japan. Furthermore, age and sex groups with the largest increases in prevalence after these events were identified. The participants of this study were employees of large companies and their dependent family members who were insured by health insurance societies (HIS). The dataset was provided by JMDC Inc. The annual age-adjusted prevalence of each disease belonging to the HIS scheme was used to calculate the ratio of disease prevalence before and after the events. After the Fukushima disaster, hypertension, hyperlipidemia, and diabetes generally increased over a 9-year period in Fukushima Prefecture. The increase in the prevalence rate of these three NCDs and mental disorders was the highest among females aged 40–74 years compared to males and the other age groups. The prevalence of all four diseases increased after the COVID-19 outbreak in Japan, with a marked increase in males aged 0–39 years. Changes in prevalence ratios of NCDs after the COVID-19 outbreak among the areas affected by the Fukushima disaster were lower than in the whole of Japan. It is important to provide tailor-made public health support among populations in accordance with the type of disasters and pandemic.

Rising Prediabetes, Undiagnosed Diabetes, and Risk Factors in Young Women

Women of reproductive age are less prone to cardiovascular disease than men. However, diabetes mellitus negates this female advantage. The prevalence change of prediabetes (prediabetes mellitus) and diabetes mellitus and diabetes mellitus‒associated cardiovascular risk factors have not been clearly described in women before menopause. Using National Health and Nutrition Examination Survey data (1999-2018), this study estimated the age-adjusted prevalence of prediabetes mellitus (2005-2018), diagnosed diabetes mellitus, and undiagnosed diabetes mellitus in premenopausal women. Logistic regression was used to examine cardiovascular risk factors, including obesity, central obesity, hypercholesterolemia, hypertension, and hypertriglyceridemia, associated with prediabetes mellitus, diagnosed diabetes mellitus, or undiagnosed diabetes mellitus in premenopausal women. The magnitude of the association among age-matched men and postmenopausal women was compared. The analysis was conducted in 2022. Premenopausal women experienced an increased prevalence of prediabetes mellitus and undiagnosed diabetes mellitus, contrasting with steady trends in all U.S. adults over the last 2 decades. Premenopausal women with prediabetes mellitus or diabetes mellitus (versus those with normoglycemia) have significant obesity risk, and the risk is equivalent to that among age-matched men and higher than that among postmenopausal women. The association between prediabetes mellitus and hypercholesterolemia or hypertriglyceridemia was significant in premenopausal women only. Hypercholesterolemia and hypertension associated with undiagnosed diabetes mellitus were significant in premenopausal women and men of the same age, respectively. Diagnosed and undiagnosed diabetes mellitus was associated with hypertriglyceridemia in men and postmenopausal women, respectively. Premenopausal women had increased prediabetes mellitus and undiagnosed diabetes mellitus in the past 2 decades. They face a considerable cardiovascular risk burden associated with prediabetes mellitus and diabetes mellitus. Cardiometabolic risk screening and patient education should be improved in young and early middle-aged adults, particularly in women.

Prevalence of Hypertension, Diabetes, and Other Cardiovascular Disease Risk Factors in Two Indigenous Municipalities in Rural Guatemala: A Population-Representative Survey.

Nearly 50% of Guatemalans are Indigenous Maya, yet few studies have examined the prevalence of modifiable cardiovascular disease (CVD) risk factors in Indigenous Maya populations. Therefore, we sought to estimate the prevalence of modifiable CVD risk factors in two Indigenous Maya areas in Guatemala. We conducted, between June 2018 and October 2019, a population-representative survey of adults aged 18 years and older in two rural Indigenous Maya municipalities in Guatemala. Our primary outcomes were five modifiable CVD risk factors: diabetes, hypertension, obesity, smoking, and alcohol use. We estimated the crude and age-standardized prevalence of each outcome. We also constructed multivariable logistic regression models to assess prevalence over covariates including age, sex, education level, ethnicity, and poverty. Sampling weights adjusted for nonresponse, and appropriate survey commands were used in all analyses. The crude prevalence of diabetes was 12.5% (95% confidence Interval [CI] 9.6% to 16.1%), hypertension 20.3% (95% CI 17.1% to 23.9%), obesity 23.7% (95% CI 19.4% to 28.6%), smoking 10.7% (95% CI 7.8% to 14.5%), and high alcohol use 0.9% (95% CI 0.5% to 1.6%). Age-standardized prevalence of each outcome was similar to the crude prevalence. The prevalence of multiple CVD risk factors increased between the age groups 18-29 years and 50-59 years before decreasing among older age groups. Men had twenty-fold higher smoking prevalence than women (20.5% vs. 1.2%, respectively) and women had nearly double the age-adjusted prevalence of obesity as men (30.1% vs. 17.0%, respectively). There is a substantial prevalence of modifiable CVD risk factors in rural, Indigenous populations in Guatemala, in particular hypertension, diabetes, obesity (among women), and smoking (among men). These findings can help catalyze policy and clinical investments to improve the prevention, management, and control of CVD risk factors in these historically marginalized communities.

Variation in the Immune Tumor Microenvironment in Relation to Self-Reported Race in Individuals with Multiple Myeloma

Introduction: Black/African American (AA) patients have the highest incidence and death rate of any racial group in the U.S. for most cancers, including multiple myeloma (MM). The causes of this health disparity are likely multifactorial resulting from a complex interplay of socioeconomic, environmental, and biological factors. MM is the most common blood cancer in AA individuals. The age-adjusted prevalence and incidence of the pre-malignant plasma cell condition, monoclonal gammopathy of undetermined significance (MGUS) and MM are ~2-3-fold higher among AA compared to non-Hispanic White (NHW) individuals. The reason for the increased risk of MM among AA individuals remains poorly defined. Emerging evidence indicates that tumor-extrinsic factors, including the bone marrow immune tumor microenvironment (iTME), influences the development of MM, response to therapy and overall disease survival. However, no studies to date have examined MM iTME composition in AA patients. AA patients are significantly underrepresented in most research studies and clinical trials limiting our understanding of disease in this underserved population. Since differences in the iTME have been identified in breast, colon and prostate cancer in association with African ancestry, we sought to evaluate the composition of the iTME in AA and NHW patients with MGUS/SMM or MM using multi-parameter time of flight mass cytometry (CyTOF). Methods: The iTME was characterized in 51 viably frozen whole bone marrow (BM) aspirates obtained from 21 AA and 30 NHW individuals. Of the 21 BM samples from AA individuals, 15 had MM, 2 had SMM and 4 had MGUS. Of the 30 BM samples from NHW individuals, 24 had MM, 1 had SMM and 5 had MGUS. The frozen specimens were thawed, washed using warmed cell culture media containing benzonase nuclease, stained using the Maxper Direct Immune Profiling Assay Kit (Fluidigm), fixed, and washed according to the manufacturer's guidelines. Data were acquired with a Helios mass cytometer. A total of 32 immune cell populations were analyzed by the Cytobank software. All statistical analyses were performed using GraphPad Prism and BlueSky Statistics. A Student's t-test/Mann-Whitney U test was used to compare two independent groups. All tests were two-tailed and an FDR-adjusted p<0.05 was considered significant. Results: Of the 32 immune cell populations analyzed, significant differences in the abundance of 13 immune populations between AA (median age 61 yrs) and NHW (median age 66 yrs) individuals with MM were identified. In relation to the CD45+CD66b- lymphocyte population, we found greater total mean CD3+ T cells (AA 52.3% vs. NHW 37.9%, p<0.001) including a greater mean CD4+ T cells (AA 24.0% vs. NHW 18.9%, p<0.05) and a greater mean CD8+ T cells (AA 22.7% vs. NHW 14.4%, p<0.05), CD4+ terminal effector cells (AA 7.0% vs. NHW 3.7%, p<0.001) and a greater mean CD8+ terminal effector cells (AA 13.8% vs. NHW 7.1%, p<0.05), CD4+ naïve (AA 2.4% vs. NHW 4.3%, p<0.05) and effector memory (AA 8.1% vs. NHW 5.3%, p<0.05), Th1-like (AA 0.7% vs. NHW 0.3%, p<0.05) and gamma delta T cells (AA 1.1% vs. NHW 0.5%, p<0.05) in AA compared to NHW patients with MM. Significant reductions in the mean basophils (AA 0.1% vs. NHW 0.3%, p<0.05) and monocytes (AA 18.4% vs. NHW 29.8%, p<0.01) were also observed in AA compared to NHW patients with MM. Since CD8+ T cell-mediated anti-myeloma response has been demonstrated in mouse models, which suggested a critical role for CD8+ T cells as dominant effectors of MM cell death, we focused our analysis on the CD8+ T cell population. Of the CD8+ terminal effector T cells, we observed an enrichment of CD28-CD57+ CD8+ "senescent T cells", a highly cytotoxic but terminally differentiated T cell state, with diminished proliferative capacity in AA compared to NHW patients (AA 43.6% vs. NHW 25.5%, p<0.05). Conversely, AA patients also had decreased CD28+CD57- CD8+ T cells (AA 30.3% vs. NHW 44.2%, p<0.05). Further, MM patients with high senescent CD8+ T cells (>30%) had a favorable overall survival compared to patients with low senescent CD8+ T cells (<30%) (HR 0.26, 95% CI 0.07-1, p-value 0.037). Conclusion: The T cell lineage displays the most significant difference in the immune cell composition between AA and NHW patients with MM. Additional studies are necessary to determine whether the increased cytotoxic T cells, which may have expanded in response to tumor antigens, explain the improved outcomes of AA patients with MM.

Hypercalcemia in Individuals with Monoclonal Gammopathy of Undetermined Significance: Results from the Istopmm Study

Introduction Multiple myeloma (MM) is a malignancy of bone marrow plasma cells, characterized by monoclonal immunoglobulins in the blood or urine and associated organ dysfunction encapsulated in the CRAB criteria (hypercalcemia, renal impairment, anemia, and bone lesions). MM is always preceded by monoclonal gammopathy of undetermined significance (MGUS), an asymptomatic premalignant stage. MGUS is relatively common in the general population, with an age-adjusted prevalence of 3-6%, dependent on gender and race. No treatment is recommended for MGUS, but a regular follow-up to detect progression to MM is advised. This includes regular measurements of serum calcium to capture MM-associated hypercalcemia. Hypercalcemia in the general population is most commonly caused by hyperparathyroidism or non-MM malignancy. We are unaware of any systemic study designed to guide physicians on how to react to hypercalcemia in individuals with MGUS. The aim of this study was to examine the underlying causes of hypercalcemia in individuals with MGUS and which diagnostic factors along with hypercalcemia are indicative of MM in order to guide the approach to hypercalcemia in individuals with MGUS in the clinic. Methods The ongoing Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study is a population-based screening study for MGUS and a randomized trial of follow-up strategies. In total, 80,759 Icelanders aged 40 years and above enrolled in the study, and 75,422 were screened for MGUS using serum protein electrophoresis (SPEP) and a free light chain assay. Two-thirds of those who screened positive for MGUS were randomized to active follow-up at the study´s clinical research center. Participants who were in active follow-up in the study between April 1. 2017, and March 1. 2022, and had albumin-corrected serum calcium levels ≥ 2.55 mmol/L or serum ionized calcium levels ≥ 1.40 mmol/L were identified. The medical records of the participants were reviewed in collaboration with a senior endocrinologist to establish the persistence of hypercalcemia and underlying diagnosis. If MM was found as the cause of the hypercalcemia, then other CRAB features present at diagnosis were also recorded. In addition, the characteristics of the study cohort were compared with individuals without hypercalcemia who were in active follow-up in iStopMM using Student's t-test and Fisher exact test. Results Of the 2,546 individuals with MGUS in active follow-up, 191 (7.5%) had at least one elevated serum calcium measurement, of whom 93 had persistent hypercalcemia (48.7%) (Figure 1A). Thus, more than half had transient hypercalcemia. Individuals with hypercalcemia were more likely to be female (68% vs. 45%; p < 0.001) and were older than those without hypercalcemia (median age 73 vs. 70 years; p < 0.001). Primary hyperparathyroidism was found to be the most common cause of persistent hypercalcemia (56%), with malignancies other than MM following as the second most common cause (16%). In 18 cases (19%), the cause of hypercalcemia was not identified (Figure 1B). However, MM was ruled out in every case according to iStopMM protocols. MM was found in 3 participants with persistent hypercalcemia (3%); all had bone lesions and other concurrent CRAB features. Conclusion In this nationwide screening study, based on 75,422 individuals, we examined hypercalcemia in 2,546 individuals with MGUS and found that it was rarely associated with MM. Additionally, we found no cases of isolated hypercalcemia in MM. Importantly, more than half of hypercalcemia cases were transient, and when persistent, the underlying causes among individuals with MGUS were similar to those in the general population. Based on these results, we conclude that hypercalcemia, particularly isolated hypercalcemia, is not a strong indicator of MGUS progression and is most often caused by other underlying diseases. Thus, in the absence of other CRAB features, hypercalcemia in MGUS should be approached in the same way as in patients without MGUS. Measurements of serum calcium should be repeated, and hyperparathyroidism should be ruled out before undertaking further assessments for possible malignancy, including MM. These findings contribute to a more evidence- and value-based approach to the care of individuals with MGUS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

High Incidence of Clonal Hematopoiesis in Transfusion-Dependent Thalassemia Patients

Introduction: Despite improvement in survival in patients with transfusion-dependent thalassemia (TDT), patients experience significant morbidities, including iron overload, malignancies, thromboembolic events and stroke, and cardiac complications like heart failure and arrhythmias. It is established that global chain imbalance and excess iron leads to significant oxygen stress and to the formation of oxygen free radicals resulting in an increased risk of mutations. Clonal Hematopoiesis of Indeterminate Potential (CHIP) is characterized by the presence of somatic variants in the peripheral blood with a variant allele frequency (VAF) ≥2% in genes associated with hematologic malignancies. These variants occur more frequently with advanced age (~ 10% at age> 65 years). That said, recent data show that young patients with CHIP are at increased risk for developing not only hematological malignancies, but also coronary heart disease, cardiovascular events and stroke. In this study we explored if TDT patients have an increased risk of clonal hematopoiesis and if this observation correlates with their underlying cardiovascular status, thromboembolic complications and history of malignancy. Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from ninety five patients with TDT just before their regular transfusion schedule (43 men and 52 women, mean age 39 years old, range 4-55 years ). 40 patients had a history of splenectomy, 32 patients had a history of cardiac disorder (13 patients with atrial fibrillation or other arrhythmias, 19 patients with valvular dysfunction). Genomic DNA was isolated from PBMCs from all patients and Next-Generation Sequencing analysis (NGS) was performed for the mutational status of 58 recurrently mutated genes in myeloid malignancies using a custom-designed Illumina sequencing panel (Illumina, San Diego, CA). Identification of mutations with a VAF ≥2% were reported after bioinformatics analysis and variant interpretation using the Varsome, ClinVar (v.2021) and Franklin databases. Results: Fifteen of 95 patients analyzed (15.8%) displayed mutations in the genes implicated in CHIP. The age-adjusted prevalence of clonal hematopoiesis in patients with TDT vs the reported in the general population is significantly higher. Overall, 22 somatic variants were identified in 15 patients with a median VAF of 40% (range 2.5%-52%): variants were detected in various genes including ATM, FLT3, ASXL1, MPL, SF3B1, BRAF, BTK, TP53, JAK2, RUNX1, ETV6 and EZH2. Four patients carried variants in 4 different genes (TP53, TET2, CEBPA, NPM1) with a mean VAF of 3% (range 2,45% - 4,14%). The patient carrying the TP53 variant is a 44-year old male with a history of splenectomy and arrhythmia (ectopic atrial tachycardia). The patient carrying the TET2 mutation is 55-year old female with a history of colon cancer ten years ago, but no evidence of malignancy relapse as of today. A 5-year old male patient carried a clone in the NPM1 gene with VAF of 2.7%, with no history of splenectomy or cardiac complications. Finally, a 20 year-old male patient carried a clone in the CEBPA gene (VAF 2.7%) along with a clone in the ATM gene (VAF 50.3%). No history of splenectomy, or thromboembolic complications were noted in this patient. Bioinformatics analysis revealed 18 variants in 11 patients with a VAF frequency within the germline range (VAF range 47-52%); germline DNA analysis is ongoing. Seventy TDT patients (73,7%) carried the FLT3 C680T variant that is higher than the incidence reported in gnomAD exome for the European population (60.7%). Ninety three patients carried the ASXL1 T2444C variant, comparable to the observed frequency in the general population. The TET2 C100T variant was observed in 3,1% of the analyzed population compared to the 1.5% reported in the general population. Further analysis revealed that none of the patients had a history of stroke and only two patients had a history of mitral valve regurgitation. Conclusion: We report for the first time that patients with TDT display a significantly higher frequency of variants in genes associated with myeloid malignancies. Life-long stress in the hematopoiesis in these patients may contribute to the increased risk of clonal mutations observed, however further analysis is required to better understand the impact of these observations.

Obesity and Race As Determinates of Plasma Von Willebrand and Factor VIII Levels

Introduction: Obesity has emerged as a significant public health problem in all ages in the United States. The age-adjusted prevalence of obesity and severe obesity were 42.2% and 9.2% respectively among adults aged 20 or older from 2017-2018. Overall, non-Hispanic black and Hispanic adults and youth had a higher prevalence of obesity compared with other race and Hispanic-origin groups. Obesity prevalence was lower among non-Hispanic Asian men and women compared with other race and Hispanic-origin groups based on National Center for Health Sciences- Center for Disease Control. Factor VIII (FVIII) and von Willebrand factor (vWF) are both coagulation factors that are acute phase reactants. Obesity has been associated with metabolic syndrome and resultant chronic inflammation. Obesity has previously been linked to increasing FVIII levels, however, studies have not been able to confirm a linkage between VWF and body mass index (BMI). Methods: This is a secondary analysis of a single-site retrospective review of the electronic health record of patients that had von Willebrand profiles [VWF:Antigen (Ag), VWF:Activity (Act), and/or FVIII activity] obtained within 24 hours of a hemoglobin level who had no bleeding disorder diagnosis. BMI was recorded when available in the electronic medical record at the time of laboratory testing and correlation between BMI and FVIII/vWF levels was assessed. Data was retrieved from January 1, 2012, through June 1, 2021. Results: We identified 4552 individuals who had VWF profile testing that had an associated hemoglobin level in a 24-hour period and did not carry a diagnosis of VWD. Among all subjects, a total of 2152 subjects were found to have BMI measurements, 1294 subjects <85th percentile, 379 subjects ≥85th - 95th percentile and 479 subjects ≥ 95th percentile. Demographics for the cohort with BMI measurements were White (N=1,673; mean BMI percentile 67.4±29.4), Black (N=377; mean BMI percentile 72±27.3), Asian (N=46, mean BMI percentile 48.0±33.9). There was a statistically significant difference in BMI by race (P<0.001). VWF antigen (P<0.005) and FVIII level (P<0.005) were significantly and positively correlated with increased BMI levels. Similarly, VWF activity/antigen ratio was negatively correlated (P<0.005) with increasing BMI. Further statistical modelling was performed, controlling for hemoglobin, BMI percentile, race, and age. BMI percentile remained a determinant for VWF antigen and FVIII levels. VWF antigen levels were statistically different in those with BMI <85th and ≥ 95th percentile (P<0.0001) and ≤85th-95th and ≥ 95th percentile (P<0.01). FVIII levels were significant between BMI ≤85th and ≥ 95th percentile (P<0.0001). We also examined the cohort for potential differences in VWF and FVIII levels based on race. Black race was found to be associated with higher VWF antigen levels among all races and found to be statistically significant when compared to White race (P<0.0001). Black race was also associated with a higher FVIII level versus White race (P<0.0001). Further statistical modeling was also done for race, controlling for BMI, hemoglobin, and age. VWF antigen levels were statistically significant among races (P<0.0001) with Black race having the highest mean level. Similarly, Race was a significant factor for VWF activity/antigen ratio (P<0.0001) with White race having the highest and Black race the lowest mean ratio. Race was also statistically significant (P<0.0001) for FVIII levels, with Black race having the highest levels and lowest levels in the all-other race category. Conclusions: BMI and race were independently found to be determinants of VWF:Ag and FVIII levels. As patients presenting for a bleeding disorder evaluation may be overweight or obese, the confounding effect of increased BMI should be considered during the diagnostic evaluation. We also observed racial differences in VWF antigen and FVIII levels. As this was antigen testing, it should not be affected by the known racial differences in sensitivity to ristocetin cofactor testing. Further studies to confirm these findings and the potential confounding effect of BMI are needed.

Racial disparities and prevalence of cardiovascular disease risk factors, cardiometabolic risk factors, and cardiovascular health metrics among US adults: NHANES 2011–2018

This study estimated the prevalence of cardiovascular disease (CVD) risk factors, cardiometabolic (CM) risk factors, and cardiovascular health metrics (CVHMs) among US adults and across race/ethnicity groups. The study comprised 8370 US adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2011–2018, free of coronary heart disease/heart failure, angina/angina pectoris, heart attack, and stroke, who provided complete data for the outcome variables of interest. Age-adjusted prevalence of CVD and CM risk factors, and CVHMs were computed for all adults and across race/ethnicity groups. All analyses accounted for the complex, multi-stage survey sampling design of the NHANES. Hypertension (45.0%), obesity (40.0%), fasting plasma glucose ≥ 100 mg/dL or hypoglycemic medication (51.0%), ideal physical activity (59.2%) and ideal smoking status (56.9%) were most prevalent for the whole sample. Mexican Americans and non-Hispanic Blacks had elevated risk for some, but not all, CVD and CM risk factors compared to non-Hispanic Whites and non-Hispanic Asians. Reducing further health disparities and persisting differences among racial and ethnic groups is vital to achieving the American Heart Association vision of all people having ideal cardiovascular health, living healthier and longer.

Health Care Access and Use Among Adults With and Without Vision Impairment: Behavioral Risk Factor Surveillance System, 2018.

Adults with vision impairment may have unique needs when accessing health care to maintain good health. Our study examined the relationship between vision status and access to and use of health care. We analyzed data on adults aged 18 years or older who participated in the 2018 Behavioral Risk Factor Surveillance System. Vision impairment was identified by a yes response to the question "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" Survey questions assessed health care access over the past year (having health insurance coverage, a usual health care provider, or unmet health care needs because of cost) and use of health care during that period (routine checkup and dental visit). We estimated age-adjusted prevalence of our outcomes of interest and used bivariate analyses to compare estimates of the outcomes by vision impairment status. The prevalence of self-reported vision impairment was 5.3%. Compared with adults without impaired vision, adults with vision impairment had a lower prevalence of having health insurance coverage (80.6% vs 87.6%), a usual health care provider (71.9% vs 75.7%), or a dental visit in the past year (52.9% vs 67.2%) and a higher prevalence of having an unmet health care need in the past year because of cost (29.2% vs 12.6%). Adults with vision impairment reported lower access to and use of health care than those without. Further research can better identify and understand barriers to care to improve access to and use of health care among this population.

Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry

Introduction: Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in &gt;1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature (&lt;65 years) PVD in a large integrated healthcare system. Methods: Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes. Results: We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% &amp; 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any &amp; premature PVD was higher with worse ADI groups ( Table ). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5 th ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories &amp; 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood). Conclusion: Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.

Abstract 13513: Favorable Neighborhood Walkability is Associated With Lower Burden of CV Risk Factors Among Patients Within an Integrated Health System: Houston Methodist CVD Learning Health System Registry

Background: Optimizing modifiable cardiovascular risk factors is critical to achieving AHA’s 2020 Strategic Impact Goals. Neighborhood and urban factors with a supportive walkable environment can enhance physical activity and hence impact CVH across a wide range of populations. We assessed whether a more walkable environment is associated with CV risk factor burden irrespective of CVD burden among a large diverse population within an integrated health system. Methods: Cross-sectional study using data from 1.01 million patients aged 18+ years in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2021). Individuals lacking NW (177,674) &amp; BMI &lt;18.5 kg/m 2 (27,065) were excluded. Neighborhood walkability (NW) was defined using 2019 Walk Score. Patients were assigned to 1 of 4 NW categories ( Figure ). Study participants were classified as poor (&gt;3 CV risk factors), average (1-2 CV risk factors) or optimal (0 CV risk factors). Results: We included 901,860 patients (mean age 51.88, female 59%, NHB 15%, and 16% Hispanics), most of these (86%) resided in the 2 least walkable neighborhoods. Age-adjusted prevalence of CV risk factors was significantly lower among participants in most favorable walkable neighborhoods irrespective of CVD status ( Figure ). In adjusted analysis, favorable NW (somewhat/very walkable) vs unfavorable NW (car dependent) was associated with 2-fold odds for optimal vs poor CVD risk (OR 2.07 95%CI: 2.01-2.12) among those without CVD. Similar results were found in those with CVD (OR 1.58 95% CI:1.41-1.77). Conclusions: Our findings demonstrate favorable association between neighborhood walkability and the CVD risk factors burden in large population of about 1 million individuals. These robust findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating growing burden of modifiable CV risk factors.

Abstract 13517: Simple Noninvasive FIB-4 Index is Associated With Increased Risk for Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist CVD Learning Health System Registry

Introduction: Non-alcoholic fatty liver disease and liver fibrosis (LF) are associated with atherosclerotic cardiovascular disease (ASCVD). In this study, we aim to assess if the Fibrosis-4 index (FIB-4), a surrogate marker for liver fibrosis that is easily calculated from information within electronic medical records, is associated with composite and subgroups of ASCVD across a wide range of demographics and risk profile in a large integrated healthcare system. Methods: This cross-sectional study analyzed data on 606,056 individuals (&gt;18 years old) from the Houston Methodist Cardiovascular Disease Learning Health System Registry (June 2016-April 2022). We implemented the FIB-4 score for patients based on simultaneous presence of 4 variables (age, AST, ALT, and platelet count). LF risk was categorized according to previously described cutoffs: Low (&lt;1.3), Intermediate (1.3-2.67), and High (&gt;2.67). ASCVD (CAD, PAD, and Stroke) were identified using ICD-10-CM codes. Results: In the final study population (mean age: 54 years, 60% females, 16% Non-Hispanic Black, and 16% Hispanic adults), 27% of individuals were at moderate-risk and 8% at high-risk for LF based on the FIB-4 index. Moderate-high risk LF is associated with higher age-adjusted prevalence of both composite and subcategories of ASCVD (CAD, PAD, Stroke). Accounting for demographics, CV risk factors, and ASA/statin use, moderate and high-risk LF was associated with a 1.32 (95% CI 1.30-1.35) and 1.67 (95% CI 1.62-1.72) odds of prevalent composite ASCVD, respectively, compared to low-risk LF. Similar associations were noted for increasing LF risk and prevalence of ASCVD subcategories. Conclusions: In a large integrated health system, a moderate-high risk of liver fibrosis (based on FIB-4 index) is significantly associated with a spectrum of ASCVD conditions. FIB-4 index based early identification and management of these high-risk individuals need to be evaluated in further implementation studies.

Prevalence, trends, and outcomes of cardiovascular diseases in pregnant patients in the USA: 2010-19.

Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVDs) in pregnant patients are limited. This study aimed to analyse the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the USA. This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from 1 January 2010, to 31 December 2019. Data analyses were conducted from January to February 2022. Pregnancy-associated hospitalizations were identified. The main outcomes were the prevalence and trend of CVD in pregnant patients. 39 212 104 hospitalized pregnant patients were identified: 4 409 924 with CVD (11.3%) and 34 802 180 without CVD (88.8%). The annual age-adjusted CVD prevalence increased from 9.2% in 2010 to 14.8% in 2019 (P < 0.001). Hypertensive disorder of pregnancy (1069/10 000) was the most common, and aortic dissection (0.1/10 000) was the least common CVD. The trends of all CVD subtypes increased; however, the trend of valvular heart disease decreased. Age-adjusted in-hospital all-cause mortality was 8.2/10 000 in CVD, but its trend decreased from 8.1/10 000 in 2010 to 6.5/10 000 in 2019 (P < 0.001). CVD was associated with 15.51 times higher odds of in-hospital all-cause mortality compared with non-CVD patients [odds ratio (OR): 15.51, 95% confidence interval (CI)13.22-18.20, P < 0.001]. CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI: 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94)(P < 0.001 for all). There is an increasing age-adjusted trend in overall CVD and its subtypes among pregnant patients in the USA from 2010 to 2019. Pregnant patients with CVD had higher odds of in-hospital mortality than those without CVD. However, in-hospital all-cause mortality among patients with and without CVD has decreased over the past 10 years. CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke rates.