Centers For Control Research Articles

Unpacking WHO and CDC Bottle Bioassay Methods: A Comprehensive Literature Review and Protocol Analysis Revealing Key Outcome Predictors

Background Resistance monitoring is a key element in controlling vector-borne diseases. The World Health Organization (WHO) and Centres for Disease Control and Prevention (CDC) have each developed bottle bioassay methods for determining insecticide susceptibility in mosquito vectors which are used globally. Methods This study aimed to identify variations in bottle bioassay methodologies and assess the potential impact on the data that is generated. Our approach involved a systematic examination of existing literature and protocols from WHO and CDC, with a focus on the specifics of reported methodologies, variation between versions, and reported outcomes. Building on this, we experimentally evaluated the impact of several variables on bioassay results. Results Our literature review exposed a significant inconsistency in the how bioassay methods are reported, hindering reliable interpretation of data and the ability to compare results between studies. The experimental research provided further insight by specifically identifying two key factors that influence the outcomes of bioassays: mosquito dry weight and relative humidity (RH). This finding not only advances our comprehension of these assays but also underscores the importance of establishing precisely defined methodologies for resistance monitoring. The study also demonstrates the importance of controlling bioassay variables, noting the significant influence of wing length, as an indicator of mosquito size, on mortality rates in standardized bioassays. Conclusions Generating data with improved protocol consistency and precision will not only deepen our understanding of resistance patterns but also better inform vector control measures. We call for continued research and collaboration to refine and build consensus on bioassay techniques, to help bolster the global effort against vector-borne diseases like malaria.

Clinical Outcomes After Admission of Patients With COVID-19 to Skilled Nursing Facilities

During the COVID-19 pandemic, stabilized COVID-19-positive patients were discharged to skilled nursing facilities (SNFs) to alleviate hospital crowding. These discharges generated controversy due to fears of seeding outbreaks, but there is little empirical evidence to inform policy. To assess the association between the admission to SNFs of COVID-19-positive patients and subsequent COVID-19 cases and death rates among residents. This cohort study analyzed survey data from the National Healthcare Safety Network of the Centers for Disease Control and Prevention. The cohort included SNFs in the US from June 2020 to March 2021. Exposed facilities (ie, with initial admission of COVID-19-positive patients) were matched to control facilities (ie, without initial admission of COVID-19-positive patients) in the same county and with similar preadmission case counts. Data were analyzed from June 2023 to February 2024. The week of the first observable admission of COVID-19-positive patients (defined as those previously diagnosed with COVID-19 and continued to require transmission-based precautions) during the study period. Weekly counts of new cases of COVID-19, COVID-19-related deaths, and all-cause deaths per 100 residents in the week prior to the initial admission. A stacked difference-in-differences approach was used to compare outcomes for 10 weeks before and 15 weeks after the first admission. Additional analyses examined whether outcomes differed in facilities with staff or personal protective equipment (PPE) shortages. A matched group of 264 exposed facilities and 518 control facilities was identified. Over the 15-week follow-up period, exposed SNFs had a cumulative increase of 6.94 (95% CI, 2.91-10.98) additional COVID-19 cases per 100 residents compared with control SNFs, a 31.3% increase compared with the sample mean (SD) of 22.2 (26.4). Exposed facilities experienced 2.31 (95% CI, 1.39-3.24) additional cumulative COVID-19-related deaths per 100 residents compared with control facilities, representing a 72.4% increase compared with the sample mean (SD) of 3.19 (5.5). Exposed facilities experiencing potential staff shortage and PPE shortage had larger increases in COVID-19 cases per 100 residents (additional 10.97 [95% CI, 2.76-19.19] cases and additional 14.81 [95% CI, 2.38-27.25] cases, respectively) compared with those without such shortages. This cohort study suggests that admission of COVID-19-positive patients into SNFs early in the pandemic was associated with preventable COVID-19 cases and mortality among residents, particularly in facilities with potential staff and PPE shortages. The findings speak to the importance of equipping SNFs to adhere to infection-control best practices as they continue to face COVID-19 strains and other respiratory diseases.

Screening Accuracy of BMI for Adiposity Among 8- to 19-Year-Olds.

Although the limitations of BMI have long been recognized, there are recent concerns that it is not a good screening tool for adiposity. We therefore examined the cross-sectional relation of BMI to adiposity among 6923 8- to 19-year-olds in the National Health and Nutrition Survey from 2011 through 2018. Participants were scanned with dual-energy x-ray absorptiometry. Adiposity was expressed as fat mass index (FMI, fat mass kg ÷ m2) and percentage of body fat (%fat). Lean mass was expressed as lean mass index (LMI, lean mass ÷ m2). Regression models and 2 × 2 tables were used to assess the relation of BMI to FMI, %fat, and LMI. Age and BMI accounted (R2) for 90% to 94% of the variability of FMI and LMI in each sex. Associations with %fat were weaker (R2s ∼0.70). We also examined the screening abilities of a BMI ≥ Centers for Disease Control and Prevention 95th percentile for high levels of adiposity and LMI. Cut points were chosen so that prevalences of high values of these variables would be similar to that for high BMI. Of participants with a high BMI, 88% had a high FMI, and 76% had a high %fat. Participants with a high BMI were 29 times more likely to have a high FMI than those with lower BMIs; comparable relative risks were 12 for high %fat and 14 for high LMI. Despite its limitations, a high BMI is a very good screening tool for identifying children and adolescents with elevated adiposity.

Prevalence and associated Factors of Anemia in Diabetic Patients

Introduction: Diabetes presents a significant global health challenge due to its association with a range of pathological changes, such as metabolic, cellular, and blood disturbances, that lead to long-term microvascular and macrovascular complications. Healthcare providers often underestimate anemia as a co-morbidity in diabetes, despite the wide range of prevalence estimates reported in the literature. Addressing anemia in diabetes patients early can reduce the incidence of these complications, as has been demonstrated. Aim of the study: The study aimed to estimate the prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus (T2DM). Methods: This is a cross-sectional prospective study with a retrospective review of diabetic patient medical records attending family medicine clinics at four military hospitals (King Hussien Medical Center, Prince Rashed Military Hospital, Queen Aliah Military Hospital, and Prince Hashem Military Hospital) at Royal Medical Services. Adult patients over the age of 18 diagnosed with type 2 diabetes mellitus for more than one year will be included in the study. However, those patients with diseases (such as thalassemia and leukemia) or other systemic disorders (such as infectious diseases) that could result in anemia, those with acute conditions such as acute hemorrhage, those who received blood transfusions in the last three months, pregnant women, or type 1 diabetes will be excluded. Anemia will be defined as hemoglobin level < 13 g/dl in men and 12g/dl in females (Harrison TR, 2011). Type 2 DM will be defined glycated hemoglobin (HbA1c > 6.5%), fasting blood glucose (FBG > 126 mg/dl), random blood glucose (RBG > 200 mg/dl) (American Diabetes Association, 2012). Patients’ medical records will be reviewed for patient medications, duration of diabetes, diabetic complications, and glycemic control. Furthermore, to exclude any patients who have one or more of the aforementioned conditions reported in the exclusion criteria. Meanwhile, researcher will collect the following data in the clinic after patients’ agreement to participate in the study which include: age, sex, marital status, smoking status, comorbidities, anthropometric measurements including weight, height and body mass index (BMI). Moreover, patient will ask to withdraw complete blood count (CBC) blood sample which include hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) for diagnosing anemia if its present. Patients will be divided into two groups based on the presence of anemia; anemic group and non-anemic group. Regarding study variables. Glycemic control will be classified into two categories based on HbA1c result (controlled diabetic group comprised those whose HbA1c level was equal to or <7.5% and poorly controlled diabetic group comprised those whose HbA1c level was >7.5%). Body mass index will classify according to Center of Disease Control (CDC) as follow: BMI score < 18.5 Kg/m2 is underweight, 18.5–24.9 Kg/m2 is normal, 25–29.9 Kg/m2 is overweight and BMI ≥ 30 Kg/m2 is obese. The sample size will be calculated based on Cohran’s sample size formula as: n=Z2 pq /e2. Here, p will be the anticipation of anemia prevalence in the diabetic population, q=1 - p; e is an acceptable error (5%); and Z= 1.96. A simple random sampling (systematic procedure) will be used to choose patients with type 2 diabetes in order to reduce the possibility of selection bias. With this technique, we randomly choose the first subject and then select the next subjects in a periodic manner according to K (interval). K will be determined based on the sampling frame prepared by researchers divided by n. Descriptive analysis will be used with the mean (standard deviation) for normally distributed variables and the median (inter-quartile range) for highly skewed distributions. The t-test and the Mann-Whitney test will be used to compare the baseline characteristics of quantitative variables between anemic and non-anemic groups for variables with a normal and highly skewed distribution, respectively. Categorical variables will be compared between the groups using the chi-square test. Logistic regression analyses will be employed to find out how these variables are associated with anemia. The results will be given as odds ratios (ORs) with a 95% confidence interval (CI). We will select only covariates with a p-value <0.20 in the univariate analysis to enter the logistic analysis.

Zika Virus Infection Knowledge and Communication Preferences Among Women of Reproductive Age in Central Brooklyn, New York: A Thematic Analysis.

The 2016 outbreak of Zika virus (ZIKV) infected millions and resulted in thousands of infants born with malformations. Though the clusters of severe birth defects resulting from this outbreak have subsided, ZIKV continues to be a concern throughout much of Latin America and the Caribbean. Travel and sexual intercourse remain the dominant transmission risk factors for women of reproductive age and their partners. This is particularly true for communities in Brooklyn, New York, that comprise large immigrant and foreign-born populations. Practitioners of public health understand little about how women at risk for ZIKV are most likely to receive information about the virus or who they trust most to provide that information. In the context of five focus group discussions, this study explored the knowledge and communication preferences of 20 women of reproductive age in Central Brooklyn. Results derived from a thematic analysis suggest that while most women are familiar with mosquitos as ZIKV vectors, knowledge of sexual transmission is considerably lower. Many respondents believe that only women who are pregnant or trying to become pregnant are at risk, and public health agencies, such as the U.S. Centers for Disease Control and Prevention, remain the most trusted sources of information. These findings can support more effective communication about the risks of ZIKV infection and other vector-borne diseases to women in New York City and similar urban communities.

Esophageal cancer in the United States: A 21-year mortality analysis (1999-2020).

e23258 Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first five years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends that are undergoing substantial transformations on a global scale, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. Methods: The mortality trends among adults with EC were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where EC was presented as a contributing or the underlying cause of death. Code C15 “Malignant Neoplasms of Esophagus” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Results: Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999-2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). CMRs also increased with advancing age and were greatest in individuals over the age of 85 years. AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and non-metropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile. Conclusions: Over the last two decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Enhancements to the National HIV Surveillance System, United States, 2013-2023.

HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services' Ending the HIV Epidemic in the United States initiative, the White House's National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains.

A Research Note on Community Resilience Estimates: New U.S. Census Bureau Data With an Application to Excess Deaths From COVID-19.

In this research note, we describe the results of the first validation study of the U.S. Census Bureau's new Community Resilience Estimates (CRE), which uses Census microdata to develop a tract-level vulnerability index for the United States. By employing administrative microdata to link Social Security Administration mortality records to CRE, we show that CRE quartiles provide more stable predictions of COVID-19 excess deaths than single demographic categorizations such as race or age, as well as other vulnerability measures including the U.S. Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and the Federal Emergency Management Agency's National Risk Index (NRI). We also use machine learning techniques to show that CRE provides more predictive power of COVID-19 excess deaths than standard socioeconomic predictors of vulnerability such as poverty and unemployment, as well as SVI and NRI. We find that a 10-percentage-point increase in a key CRE risk measure is associated with one additional death per neighborhood during the initial outbreak of COVID-19 in the United States. We conclude that, compared with alternative measures, CRE provides a more accurate predictor of community vulnerability to a disaster such as a pandemic.

Association of Symptoms and Viral Culture Positivity for SARS‐CoV‐2—Tennessee, April–July 2020

ABSTRACTBackgroundUnderstanding how symptoms are associated with SARS‐CoV‐2 culture positivity is important for isolation and transmission control guidelines.MethodsIndividuals acutely infected with SARS‐CoV‐2 in Tennessee and their household contacts were recruited into a prospective study. All participants self‐collected nasal swabs daily for 14 days and completed symptom diaries from the day of illness onset through day 14 postenrollment. Nasal specimens were tested for SARS‐CoV‐2 using RT‐qPCR. Positive specimens with cycle threshold values < 40 were sent to the Centers for Disease Control and Prevention (CDC) for viral culture. First, we modeled the association between symptoms and the risk of culture positivity using an age‐adjusted generalized additive model (GAM) accounting for repeated measurements within participants and a symptom‐day spline. Next, we investigated how timing of symptom resolution was associated with the timing of culture resolution.ResultsIn a GAM restricted to follow‐up days after symptoms began, the odds of a specimen being culture positive was significantly increased on days when wheezing, loss of taste or smell, runny nose, nasal congestion, sore throat, fever, or any symptom were reported. For all symptoms except sore throat, it was more common for participants to have culture resolution before symptom resolution than for culture to resolve after or on the same day as symptom resolution.ConclusionsOverall, symptomatic individuals were more likely to be SARS‐CoV‐2 viral culture positive. For most symptoms, culture positivity was more likely to end before symptoms resolved. However, a proportion of individuals remained culture positive after symptom resolved, across all symptoms.

Age of Juice Introduction and Cardiometabolic Outcomes in Middle Childhood

BackgroundThe American Academy of Pediatrics recommends juice introduction after 12 mo of age. Juice consumption has been linked to childhood obesity and cardiometabolic risk. We examined the prospective relationship between the age of juice introduction and primary and secondary cardiometabolic outcomes in middle childhood. Objectives. MethodsParents reported the age of juice introduction on Upstate KIDS questionnaires completed between 4 and 18 mo. The quantity and type of juice introduced were not measured. Anthropometry, blood pressure (BP), and arterial stiffness by pulse wave velocity (PWV) were measured for 524 children (age, 8–10 y) at study visits (2017–2019). Age- and gender-adjusted z-scores were calculated using the Centers for Disease Control and Prevention reference for anthropometrics. Plasma lipids, hemoglobin A1c (HbA1c), and C-reactive protein (CRP) in a subset of children were also measured (n = 248). Associations between age at juice introduction (categorized as <6, 6 to <12, ≥12 mo), and outcomes were estimated using mean differences and odds ratios, applying generalized estimating equations to account for correlations between twins. ResultsApproximately 18% of children were introduced to juice at <6 mo, 52% between 6 and <12 mo, and 30% ≥ 12 mo of age. Children who were introduced to juice before 6 mo had higher systolic BP (3.13 mmHg; 95% confidence interval [CI]: 0.52, 5.74), heart rate (4.46 bpm; 95% CI: 1.05, 7.87), and mean arterial pressure (2.08 mmHg; 95% CI: 0.15, 4.00) compared with those introduced ≥12 mo after covariate adjustment including sociodemographic factors and maternal prepregnancy body mass index. No adjusted differences in anthropometry, lipids, HbA1c, and CRP levels were found. ConclusionsEarly juice introduction during infancy was associated with higher systolic BP, heart rate, and mean arterial pressure in middle childhood.This trial was registered at clinicaltrials.gov as NCT03106493 (https://clinicaltrials.gov/study/NCT03106493?term=upstate%20KIDS&rank=1).

Rural-urban disparities in colorectal cancer-related mortality changes in the United States.

e13714 Background: Colorectal cancer is the second leading cause of cancer-related death in the world. The incidence of colorectal cancer rates is higher in rural areas compared to urban populations which is attributed to obesity, and lower adherence to screening. It is hence vital to identify large population-based data on rural and urban disparities in colorectal cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years:1999-2020) for patients aged 15 years and above, with malignant neoplasm of colorectum (ICD-10: C18.9, C19, C20) listed as underlying cause of death. We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban- Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 810,577 colorectal cancer-related deaths were retrieved, amongst which 418,744 (51.6%), were in the large metropolitan, 249,933 (30.8%) were in the small/medium metropolitan, and 141,900 (17.5%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas. However, the decline in AAMR was significantly higher among large metropolitan areas as compared to rural areas (AAPCD: -1.0043, 95% CI -1.64, -0.35, p=0.0022). There was no statistically significant difference in decline in AAMR when large metropolitan areas were compared to small/medium metropolitan (AAPCD: -0.4517, 95% CI -0.90, -0.002, p=0.051) and when small/medium metropolitan were compared to rural areas (AAPCD: -0.5526, 95% CI -1.16, -0.05, p=0.07). Conclusions: We identified discrepancies in the decline in colorectal cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the large metropolitan counterparts. This raises the concern for poor access to cancer care in this population group. Our results emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity in rural areas. [Table: see text]

Investigating predictors of protein intake in an adult population utilising the National Health and Nutrition Examination (NHANES) Survey in the United States

It is widely accepted that meeting recommended protein intake is protective of muscle mass(1). Insufficient intake is related to accelerated sarcopenia and impaired physical function, contributing to increased mortality and morbidity. The recommended target set by the American dietary guidelines is 0.8 g of protein per kg of body weight, based on data collated by the National Academies published in 2005(2). Currently approximately 50% of women and 30% of men do not meet these targets(3). It is of public interest to analyse current patterns of intake to allow for improved strategy through awareness of factors that impact protein intake.To investigate the factors which determine an individual’s protein intake and how they can be used to predict daily intake.A secondary data analysis of longitudinal data collected in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2020 has been carried out(4). Data was accessed from the public domain on the Centers for Disease Control and Prevention (CDC) website. The study protocol received approval from the research ethics review board of the National Center for Health Statistics (NCHS) of the CDC. Average protein intake has been calculated and participant demographics reported. STATA software has been used to carry out a bivariate regression of factors associated with protein intake, an adjusted multivariate regression analysis and a parsimonious model.19601 participants (52.4% women) aged 20 and over had valid protein data. Adjusted regression analysis generated three model fits, with the parsimonious model excluding BMI categories and household income had a statistically insignificant impact on protein intake. Men consumed 23.99g more protein per day compared to women (p&lt;0.001: 95% CI 23.09 to 24.89). Individuals over 65 consumed 13.92g less protein per day compared to those aged 20-35 years old (p&lt;0.001: 95% CI − 15.25 to −12.59). Mexican American individuals consumed 7.47g more protein than Non-Hispanic White individuals (p&lt;0.001: 95% CI 5.89 to 9.04) and Non-Hispanic White individuals consumed 2.95g more protein compared to non-Hispanic Black individuals (p&lt;0.001: 95% CI 4.13 to 1.77). Those with the lowest educational attainment consumed 10.77g less protein compared to individuals with a college degree (p&lt;0.001: 95% CI −12.79 to −8.74). From 2011 to 2020, there was a gradual decline in protein intake which is statistically significant when comparing 2011/12 with 2015/16 and 2017/2020.Protein intake can be predicted by an individual’s gender, age, ethnicity, level of education attainment and time period. This study informs policymakers that individuals aged 65 and above are at risk of insufficient protein intake and there has been a general decrease in protein consumption over time. This provides evidence to support initiatives focused on this age category to maximise change and reduce rates of sarcopenia.

Navigating disparities: Insights from a colorectal cancer screening program in federally qualified community healthcare centers.

1537 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in Georgia. Despite evidence for the effectiveness of CRC screening, disparities in access are prevalent in underserved populations. Georgia’s Federally Qualified Health Centers (FQHCs) struggle with low screening rates (42.8%), partly due to Georgia’s lack of Medicaid expansion, poor access to health services in rural areas, and deficiencies in coordinated strategies. The Georgia Colorectal Cancer Control Program (GCRCCP) was funded by the Centers for Disease Control and Prevention to implement evidence-based interventions (EBIs) in qualifying FQHCs across South Georgia. Here, we assess the program's impact on clinic-level screening rates (SR). Methods: Fourteen clinics with 12,159 CRC-eligible patients (ages 50-75) were enrolled from East Georgia Healthcare Center (EGHC) and Albany Area Primary Health Center (AAPHC). FQHC clinics had to have a SR below 60% to participate in the program. In addition to the EBIs (provider assessment and feedback, provider reminders, patient reminders, reducing structural barriers), the GCRCCP integrated provider education using the ECHO Model and navigation through a nationally recognized, evidence-based patient navigation program. We compared baseline (2020 and 2021) and follow-up data (2022) to determine the average change in SR over time, overall, and by demographic sub-groups. Results: The overall change in SR for the 14 clinics was +6.7%, from a baseline average of 45.3% to 52% in 2022. The average change in SR for EGHC clinics (n=9) was +11.5% (from 32.2 to 43.7%). Women had a higher SR (44.9%) than men (41.8%), but both realized an increase in SR, +10.5% and +9.1%. Non-Hispanic Black Americans (NHBA) experienced a higher increase in SR, +13.7% (from 37.2 to 50.9%) than their Non-Hispanic White (NHW) counterparts (+7.5% (from 29.8 to 37.3%)). The uninsured vs. insured followed a similar pattern (+15.3% (from 17.8 to 33.1%)) vs. +2.1 (from 45.9 to 48%). The average change in SR for AAPHC clinics (n=5) was +1.8% (from 58.4 to 60.2%). There was a decline in SR for men, -8.6% (from 64 to 55.4%), and an increase for women, +3.8% (from 58.2 to 62%). NHBA had a decrease in SR, -0.8% (from 61.2 to 61%), while NHW Americans had an increase in SR, +0.2% (from 53.8 to 54.2%). The uninsured and insured groups realized minimal increases of +0.6% (from 46 to 46.6%) and +0.8% (from 62 to 62.8%), respectively. Conclusions: The implementation of EBIs and patient navigation show varied potential to reduce disparities in accessing CRC screening in underserved populations. FQHC clinics that sustain implementation activities and workflow processes can benefit communities long-term and improve health equity.

The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020.

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related fatalities despite early diagnosis and treatment progress, creating a significant public health issue in the United States. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate HCC mortality patterns and death locations from 1999 to 2020. The objective was to analyze trends in HCC mortality across different population groups, considering the impact of urbanicity. In this study, death certificate data obtained from the CDC WONDER database were utilized to investigate the trends in HCC mortality and location of death between 1999 and 2020. The annual percent change (APC) method was applied to estimate the average annual rate of change during the specified timeframe for the relevant health outcome. Furthermore, including data on the location of death and geographic areas allowed us to gain deeper insights into the patterns and characteristics of HCC and its impact on different regions. Between 1999 and 2020, there were 184,073 reported deaths attributed to HCC, and data on the location of death were available for all cases. Most deaths occurred during inpatient admissions (34.93%) or at home (41.19%). The study also found that the highest age-adjusted mortality rate (AAMR) for HCC was observed among male patients, particularly among those identified as Asian or Pacific Islander. Variations in AAMR were determined based on the level of urbanization or rurality of the area, with higher rates observed in more densely populated and urbanized regions. In contrast, less urbanized and populated areas experienced a profound increase in AAMR over the past two decades. The HCC-related AAMRs have worsened over time for most ethnic groups, except for Asian or Pacific Islanders, which showed a reduction in APC despite having the worst AAMR. Although rural and less densely populated areas have substantially increased AAMR over the past two decades, more urbanized areas continued to have higher AAMR rates.

MmpR5 protein truncation and bedaquiline resistance in Mycobacterium tuberculosis isolates from South Africa: a genomic analysis

The antibiotic bedaquiline is a key component of new WHO regimens for drug-resistant tuberculosis; however, predicting bedaquiline resistance from bacterial genotypes remains challenging. We aimed to understand the genetic mechanisms of bedaquiline resistance by analysing Mycobacterium tuberculosis isolates from South Africa. For this genomic analysis, we conducted whole-genome sequencing of Mycobacterium tuberculosis samples collected at two referral laboratories in Cape Town and Johannesburg, covering regions of South Africa with a high prevalence of tuberculosis. We used the tool ARIBA to measure the status of predefined genes that are associated with bedaquiline resistance. To produce a broad genetic landscape of M tuberculosis in South Africa, we extended our analysis to include all publicly available isolates from the European Nucleotide Archive, including isolates obtained by the CRyPTIC consortium, for which minimum inhibitory concentrations of bedaquiline were available. Between Jan 10, 2019, and July, 22, 2020, we sequenced 505 M tuberculosis isolates from 461 patients. Of the 64 isolates with mutations within the mmpR5 regulatory gene, we found 53 (83%) had independent acquisition of 31different mutations, with a particular enrichment of truncated MmpR5 in bedaquiline-resistant isolates resulting from either frameshift mutations or the introduction of an insertion element. Truncation occurred across three Mtuberculosis lineages, and were present in 66% of bedaquiline-resistant isolates. Although the distributions overlapped, the median minimum inhibitory concentration of bedaquiline was 0·25 mg/L (IQR 0·12-0·25) in mmpR5-disrupted isolates, compared with 0·06 mg/L (0·03-0·06) in wild-type M tuberculosis. Reduction in the susceptibility of M tuberculosis to bedaquiline has evolved repeatedly across the phylogeny. In our data, we see no evidence that this reduction has led to the spread of a successful strain in South Africa. Binary phenotyping based on the bedaquiline breakpoint might be inappropriate to monitor resistance to this drug. We recommend the use of minimum inhibitory concentrations in addition to MmpR5 truncation screening to identify moderate increases in resistance to bedaquiline. US Centers for Disease Control and Prevention.

High ankle-brachial index participants experienced similar long-term mortality as peripheral artery disease in a national sample of community-dwelling adults

BackgroundOnly a few small studies have shown the association between high ankle-brachial pressure index (ABI >1.4) and adverse cardiovascular (CV) events and mortality. Although there is abundant literature depicting the association between ABI and overall systemic atherosclerosis, it typically focuses on low ABI. Furthermore, historically, many studies focusing on peripheral artery disease have excluded high ABI participants. We aimed to study the mortality outcomes of persons with high ABI in the National Health and Nutrition Examination Survey (NHANES). MethodsWe obtained ABI from participants aged ≥40 years for survey years 1999 to 2004. We defined low a ABI as ≤0.9, normal ABI as 0.9 to 1.4, and high ABI as >1.4 or if the ankle pressures were >245 mm Hg. Demographics, various comorbidities, and laboratory test results were obtained at the time of the survey interview. Multivariable adjusted hazard ratios (HRs) along with 95% confidence intervals (CIs) were calculated for CV and all-cause mortality via Cox proportional hazards regression. Mortality was linked to all NHANES participants for follow-up through December 31, 2019, by the Centers for Disease Control and Prevention. ResultsWe identified 7639 NHANES participants with available ABI. Of these, 6787 (89%) had a normal ABI, 646 (8%) had a low ABI, and 206 (3%) had elevated ABI. Of participants with high ABI, 50% were men, 15% were African Americans, 10% were current smokers, 56% had hypertension, 33% had diabetes, 15% had chronic kidney disease (CKD), and 18% had concomitant coronary artery disease (CAD). Diabetes (odds ratio [OR], 2.4; 95% CI, 1.7-3.2), CAD (OR, 1.6; 95% CI, 1.0-2.4), and CKD (OR, 1.5; 95% CI, 1.0-2.3) at baseline were associated with having a high ABI, respectively. A high ABI was associated independently with elevated CV (HR, 2.6; 95% CI, 2.1-3.1; P < .0001) and all-cause mortality (HR, 2.5; 95% CI, 2.2-2.8; P < .0001) after adjusting for covariates, including diabetes, CKD, CAD, current smoking, cancer, and hypertension. ConclusionsA high ABI is associated with an elevated CV and all-cause mortality, similar to patients with PAD. High ABI participants should receive the same attention and aggressive medical therapies as patients with PAD.

Trends in hospice utilization and place of death preferences in multiple myeloma-related deaths from 2003 to 2020: Analysis of CDC Wonder database.

e24039 Background: Multiple myeloma (MM) is an incurable hematological malignancy of plasma cells with high disease-related morbidity and mortality. Modern treatment has revolutionized the care of MM patients. However, a significant proportion of patients will eventually succumb to the disease. Place of Death (POD) is an important determinant of patient and caregiver preference, access to home-based supportive care, and cost of caregiving at EOL. We evaluate trends in POD for patients and hospice utilization with MM in the U.S. from 2003 to 2020. Methods: We analyzed data using the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database. The data for deaths due to MM was pooled using the International Classification of Diseases-10th Revision code C 90.0. We included adult patients (age &gt; 18 years), diagnosed with MM during 2003-2020. The demographic data was obtained to calculate descriptive statistics using age, gender, place of death, census region, and utilization of hospice mortality. Annual percentage change (APC) in mortality was calculated using the joinpoint model. Results: There were 205,472 deaths in MM patients in the era 2003-2020, of which 88,245 (42.95%) deaths were in the decedent home and hospice facility (H&amp;H) and107,275 (52.12%) deaths were reported in medical facilities and nursing homes. There was a significant increase in the trend of H&amp;H [29% to 58%, average annual percentage (AAPC) 4.6404, p &lt; 0.001] and a decline in medical facility/nursing home (M&amp;N) deaths [64.9% to 37.7%, AAPC-2.1059, p &lt; 0.001]. When stratified by census regions, all regions in the US depicted significantly increased utilization of H&amp;H (p &lt; 0.001), with the highest H&amp;H utilization in the West region (CENS-R4) of 47.97%, while the highest M&amp;N mortality of 60.4% was observed in North-East region. There is a significant increase in H&amp;H utilization reported in the age group 45-64 years (AAPC 3.544) and age group 65+ (AAPC 5.0277) with p &lt; 0.0001 for both groups. The younger patients (Age &lt; 45) tend to use hospice less, but the number of deaths in the group was small. Furthermore, we saw increased H&amp;H utilization in both genders, with female AAPC at 4.0951 and male AAPC at 5.1393, p &lt; 0.0001 With regards to race, the highest H&amp;H utilization was seen in whites (44.66%), then American Indian or Alaska Native (40.12%), Asian or Pacific Islander (36.76%), and African American (36.05%). However, the trend analysis from 2003-2020 depicts the highest AAPC change in AAPI (8.8409). Conclusions: Over the past two decades, there has been a trend in increased utilization of hospice facilities in end-of-life care among MM patients. However, there is still opportunities to expand its utility especially in the North-East and among African American patients to reduce the psychological and cost of end-of-life care.

Trends in location of death for individuals with pediatric cancer in the United States.

1591 Background: Children and adolescents with cancer face unique symptomatic, psychosocial, and existential challenges at the end of life (EOL). Premature death alongside severe pain and complex symptoms is distressing for the patients and families. Location of death is an important clinical and psychosocial decision for many patients. Therefore, we explored differences in location of death amongst pediatric patients with cancer using a large, national US database. Methods: We performed multinomial logistic regressions and analyzed trends in place of death for children and adolescents (ages 0 to 19) diagnosed with cancer from 2003-2019 using the Centers for Disease Control and Prevention Wide-Range Online Data for Epidemiologic Research database (CDC WONDER). We studied associations in place of death with essential decedent characteristics (age, sex, and race) for ICD10 codes C00-C96 and D00-D49, which encompass the most common causes of cancer death in children and adolescents. Results: Of 1,910 pediatric oncology decedents, 910 died in a hospital, 794 died at home, 12 died in nursing facilities, 59 in hospice, and 135 in outpatient facilities. Over time, death at home decreased by 50%. Death in the hospital increased by 64% and death in hospice increased by 200%. Children 10-19 years-of-age were more likely to die in hospice than children younger than 4 and children between 5-9 years-of-age. Additionally, they were less likely to die in outpatient medical facilities and ED. 1,388 decedents were White, 411 were Black, 18 were American Indian, and 93 were Asian. Children of racial and ethnic minorities were significantly more likely to die in hospitals than White children with cancer (Black: 1.81 [1.44-2.28], Asian: 1.57 [1.03-2.41], and Hispanic: 1.60 [1.26-2.04]). Black children with cancer were also more likely (1.67 [1.11-2.53]) to die in outpatient facilities compared to White children. Asian children &amp; Black children were less likely to die at home (0.48[0.38-0.61] and 0.55 [0.35-0.86] respectively). Conclusions: In contrast to the adult population that has demonstrated steady increases in deaths at home, for children with cancer, relative rates of death at home decreased while death in the hospital increased, with distinct differences among race/ethnic groups. Adequate education and support are needed to facilitate both autonomy and symptom palliation at EOL. Future work must explore underlying reasons for differences in place of death across time and demographic groups, so as to identify and alleviate any potential barriers, and to promote equitable access to a good death for each individual.

Updated vaccination and screening recommendations for hepatitis B: Implications for pharmacists

The number of new infections of hepatitis B is rising and a large number of cases are undiagnosed. These factors are contributing to hepatitis B-related liver complications, including liver cancer, and deaths that could be prevented. The Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention recently updated vaccination and screening/testing recommendations for hepatitis B. The updated recommendations remove the need for risk assessment before screening or vaccination. Pharmacists will play a key role in a concerted national effort to implement these updated recommendations. A multistakeholder advisory council convened by the Hepatitis B Foundation identified key barriers to screening and vaccination. The council also formulated strategies to optimize implementation of the updated recommendations. These strategies include educating pharmacists about the new recommendations and how they will help to reduce the burden of hepatitis B and liver cancer. Pharmacists could explore establishing pharmacy-provider collaborative practice agreements and potentially leverage capacity built with COVID-19 vaccine implementation. Hospital systems and other clinic settings could update their electronic health records to include prompts for hepatitis B vaccination and screening. Pharmacy systems can implement different reminder options to help patients complete the hepatitis B vaccine series. To address a lack of vaccine confidence, pharmacists can emphasize the cancer prevention benefit of hepatitis B screening and vaccination and engage with patients on an individual level to understand their concerns, assess vaccine status, and discuss vaccine recommendations. Effective implementation of the new recommendations will help achieve national and global goals of eliminating hepatitis B as a public health threat by 2030.

CDC's New Hepatitis C Virus Testing Recommendations for Perinatally Exposed Infants and Children: A Step Towards Hepatitis C Elimination.

New U.S. Centers for Disease Control and Prevention (CDC) guidelines for hepatitis C virus (HCV) testing of perinatally exposed infants and children released in 2023 recommend a nucleic acid test (NAT) for detection of HCV ribonucleic acid (i.e., NAT for HCV RNA) at 2-6 months of age to facilitate early identification and linkage to care for children with perinatally acquired HCV infection. Untreated hepatitis C can lead to cirrhosis, liver cancer, and premature death and is caused by HCV, a blood-borne virus transmitted most often among adults through injection drug use in the United States. Perinatal exposure from a birth parent with HCV infection is the most frequent mode of HCV transmission among infants and children. New HCV infections have been increasing since 2010, with the highest rates of infection among people aged 20-39 years, leading to an increasing prevalence of HCV infection during pregnancy. In 2020, the CDC recommended one-time HCV screening for all adults aged 18 years and older and for all pregnant persons during each pregnancy. Detecting HCV infection during pregnancy is key for the identification of pregnant persons, linkage to care for postpartum treatment, and identification of infants with perinatal exposure for HCV testing. It was previously recommended that children who were exposed to HCV during pregnancy receive an antibody to HCV (anti-HCV) test at 18 months of age; however, most children were lost to follow-up before testing occurred, leaving children with perinatal infection undiagnosed. The new strategy of testing perinatally exposed children at age 2-6 months was found to be cost-effective in increasing the identification of infants who might develop chronic hepatitis C. This report describes the current perinatal HCV testing recommendations and how they advance national hepatitis C elimination efforts by improving the health of pregnant and postpartum people and their children.