Centers For Disease Control Research Articles

Bacterial metallothionein, PmtA, a novel stress protein found on the bacterial surface of Pseudomonas aeruginosa and involved in management of oxidative stress and phagocytosis.

The pathogen Pseudomonas aeruginosa is a highly problematic multidrug-resistant (MDR) pathogen with complex virulence networks. MDR P. aeruginosa infections have been associated with increased clinical visits, very poor healthcare outcomes, and these infections are ranked as critical on priority lists of both the Centers for Disease Control and Prevention and the World Health Organization. Known P. aeruginosa virulence factors have been extensively studied and are implicated in counteracting host defenses, causing direct damage to the host tissues, and increased microbial competitiveness. Targeting virulence factors has emerged as a new line of defense in the battle against MDR P. aeruginosa strains. Bacterial metallothionein is a newly recognized virulence factor that enables evasion of the host immune response. The studies described here identify mechanisms in which bacterial metallothionein (PmtA) plays a part in P. aeruginosa pathogenicity and identifies PmtA as a potential therapeutic target.

HIV Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA.

There are significant disparities in HIV acquisition, with Black individuals facing disproportionately more new diagnoses. Per Centers for Disease Control and Prevention (CDC), all people aged 13-64 should be tested at least once in their lifetime, and men at increased risk (e.g., those who have male sexual contact, multiple partners, have partners with multiple partners, or share drug injection equipment) should be tested annually. The study included young Black men who have sex with women (MSW), aged 15-26, and who live in New Orleans, LA. Survey data was used to elicit the frequency and factors associated with three self-reported outcomes: (1) history of ever HIV testing, (2) HIV screening in the last year among those who were recommended per CDC, and (3) HIV positivity. Of the 1321 men included, 694/1321 men (52.5%) reported ever having been HIV tested. There were 708/1321 (54.2%) men who met the recommendation for annual screening and 321/708 (45.3%) of these eligible men reported being tested in the previous year. Of those ever tested, 44/694 (6.3%) self-reported testing positive. In logistic regression analysis, older age (OR: 1.27, p < 0.001), prior STI testing (OR: 6.45, p < 0.001), and prior incarceration (OR:1.70, p = 0.006) were positively associated with having ever received an HIV test, and ever having a male partner (OR: 3.63, p = 0.014) was associated with HIV positivity. Initiatives to improve HIV testing rates among young Black men who have sex with women are needed to reduce the burden of HIV and help the End the Epidemic initiative.

Increasing Restorative Sleep Among Adults With Depressive Symptoms: A Quality Improvement Project.

The Centers for Disease Control and Prevention estimates that 34.8% of adults in the United States experience non-restorative sleep. The restorative theory of sleep is based on sleep as a means for the restoration of cellular function that is needed for activities when awake. Non-restorative sleep leads to awakening feeling unrefreshed and not ready for the activities of the day three or more times weekly. Aims: The aim of this quality improvement project was to increase restorative sleep by increasing the average amount of sleep over units of 24 h, decreasing perceived insufficient sleep, and decreasing episodes of unintended daytime sleep among patients with depressive symptoms ages 18 to 80 years in an outpatient mental health clinic. Methods: Ten patients with depressive symptoms and reporting non-restorative sleep volunteered to participate in the project. Participants kept a sleep diary and followed principles of healthy sleep such as limiting time in bed and going to bed at the same time nightly. The change in and the average amount of sleep over 24 h and daytime sleepiness were evaluated using the Behavioral Risk Factor Surveillance System. Results: All participants achieved at least one more day of restorative sleep, with nine increasing restorative sleep by at least 30 min per day, and nine having no episodes of unintentionally falling asleep.

Challenges of COVID-19 Case Forecasting in the US, 2020-2021.

During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19 Forecast Hub (https://covid19forecasthub.org). We evaluated approximately 9.7 million forecasts of weekly state-level COVID-19 cases for predictions 1-4 weeks into the future submitted by 24 teams from August 2020 to December 2021. We assessed coverage of central prediction intervals and weighted interval scores (WIS), adjusting for missing forecasts relative to a baseline forecast, and used a Gaussian generalized estimating equation (GEE) model to evaluate differences in skill across epidemic phases that were defined by the effective reproduction number. Overall, we found high variation in skill across individual models, with ensemble-based forecasts outperforming other approaches. Forecast skill relative to the baseline was generally higher for larger jurisdictions (e.g., states compared to counties). Over time, forecasts generally performed worst in periods of rapid changes in reported cases (either in increasing or decreasing epidemic phases) with 95% prediction interval coverage dropping below 50% during the growth phases of the winter 2020, Delta, and Omicron waves. Ideally, case forecasts could serve as a leading indicator of changes in transmission dynamics. However, while most COVID-19 case forecasts outperformed a naïve baseline model, even the most accurate case forecasts were unreliable in key phases. Further research could improve forecasts of leading indicators, like COVID-19 cases, by leveraging additional real-time data, addressing performance across phases, improving the characterization of forecast confidence, and ensuring that forecasts were coherent across spatial scales. In the meantime, it is critical for forecast users to appreciate current limitations and use a broad set of indicators to inform pandemic-related decision making.

Reported Impact of COVID-19 Workload and Stressors on School Nurses' Provision of Care During the 2021-2022 School Year: A Secondary Analysis of U.S. School Nurse Survey Data.

Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021-2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021-2022 school year.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth.

Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.

The Establishment Of Shelters as A New Paradigm Towards Struggling With Violence Against Women: A Literature Review

Objective: Shelters are an important part of a full response to survivors, as stated in many international conventions, such as the 1995 Beijing Declaration and Platform for Action (BDPfA). This study aims to provide a comprehensive perspective on the establishment of shelters for women survivors of violence. Materials and methods: This narrative review was conducted based on the Scale for the Assessment of Narrative Review Articles (SANRA). The MEDLINE, SCOPUS, Web of Science, Embase, Ovid, and EBSCO databases in English and Magiran and Scientific Information Database (SID) in Persian were searched for related documents. Also, WHO, the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Centers for Disease Control and Prevention (CDC), and the United Nations Population Fund's (UNFPA) guidelines and instructions for shelter services for women and girls who have been subjected were searched up to July 31, 2023. A qualitative synthesis was carried out on the 28 eligible articles and instructions out of the 420 retrieved documents. Results: "A "shelter" describes emergency and temporary "safe accommodation for women and children who have been subjected to or are at risk of (typically male) domestic abuse. Types of shelters include emergency shelters or safe homes, second-stage or transitional housing facilities, third-stage housing, and alternative accommodation during (and occasionally after) the period of residence. The shelter delivers a wide range of services, including health services, socio-economic services, and legal services. These principles consisted of a comprehensive perspective, quality of service, organization, funding, and the right issues. Conclusion: Women who are survivors need holistic, interdisciplinary, and specialist care that focuses on safety and needs. The adoption of regulations with robust enforcement guarantees and the facilitation of approvals for the construction of non-governmental shelters and safe houses should be on the agenda setting.

Police killings of unarmed Black persons and suicides among Black youth in the US: A national time-series analysis.

Suicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. We obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. Suicides among Black youth increase by ~1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p >0.05; exposure lag 1 coefficient = -0.70, p >0.05; exposure lag 2 coefficient = -0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p< 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p< 0.05).

Can incorporating molecular testing improve the accuracy of newborn screening for congenital adrenal hyperplasia?

Single-tier newborn screening (NBS) for CAH using 17-hydroxyprogesterone (17OHP) measured by fluoroimmunoassay (FIA) in samples collected at 24-48 hours produces a high false-positive rate (FPR). 2nd tier steroid testing can reduce the FPR and has been widely implemented. We investigated the accuracy of an alternative multi-tier CAH NBS protocol that incorporates molecular testing of the CYP21A2 gene and reduces the 1st tier 17OHP cutoff to minimize missed cases. Created a Minnesota-specific CYP21A2 pathogenic variants panel; develop a rapid, high-throughput multiplex, allele-specific-primer-extension assay; perform 1-year retrospective analysis of Minnesota NBS results comparing metrics between a conventional steroid-based two-tier protocol and a molecular-based multi-tier NBS protocol, applied post-hoc. CYP21A2 gene sequencing of 103 Minnesota families resulted in a Minnesota-specific panel of 21 pathogenic variants. Centers for Disease Control and Prevention (CDC) created a molecular assay with 100% accuracy and reproducibility. Two-tier steroid-based screening of 68,659 live births during 2015 resulted in 2 false negatives (FNs), 91 FPs, and 1 true positive (TP). A three-tier protocol with a lower 1st-tier steroid cutoff, 2nd-tier 21-variant CYP21A2 panel and 3rd-tier CYP21A2 sequencing would have resulted in 0 FNs, 52 FPs and 3 TPs. Incorporation of molecular testing could improve the accuracy of CAH NBS, although some distinct challenges of molecular testing may need to be considered before implementation by NBS programs.

Infectious mediastinitis: A retrospective cohort study

Abstract Objective This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients diagnosed with mediastinitis according to the criteria defined by the Centers for Disease Control and prevention, who were treated in Strasbourg University Hospital, France between January 1st, 2010 and December 31st, 2020. Results We investigated 151 cases, including 63 post-sternotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). Mean age was 63 ± 14.5 years old and 109/151 were male. Microbiological documentation varied according to the origin of the infection. When documented, cases with PSM were mostly monomicrobial (36/53, 67.9%) and involved staphylococci (36/53, 67.9%), whereas cases with MEP and DNM were mostly plurimicrobial (38/48, 79.2% and 8/12, 66.7%, respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range: 21–56), and 122/151 (80.8%) patients benefited from early surgical management. The overall 1-year survival was estimated to be 64.8% (95% CI; 56.6%–74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusion Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.

Antibiotic discovery with artificial intelligence for the treatment of Acinetobacter baumannii infections.

Acinetobacter baumannii presents a severe global health threat, with alarming levels of antimicrobial resistance rates resulting in significant morbidity and mortality in the USA, ranging from 26% to 68%, as reported by the Centers for Disease Control and Prevention (CDC). To address this threat, novel strategies beyond traditional antibiotics are imperative. Computational approaches, such as QSAR models leverage molecular structures to predict biological effects, expediting drug discovery. We identified OmpW as a potential therapeutic target in A. baumannii and screened 11,648 natural compounds. We employed QSAR models from a ChEMBL bioactivity data set and conducted structure-based virtual screening against OmpW. Demethoxycurcumin, a lead compound, exhibited promising antibacterial activity against A. baumannii, including multidrug-resistant strains. Additionally, demethoxycurcumin demonstrated anti-virulence properties by reducing A. baumannii interaction with host cells. The findings highlight the potential of artificial intelligence in discovering curcuminoids as effective antimicrobial agents against A. baumannii infections, offering a promising strategy to address antibiotic resistance.

Characterization of Post-COVID-19 Definitions and Clinical Coding Practices: Longitudinal Study.

Post-COVID-19 condition (colloquially known as "long COVID-19") characterized as postacute sequelae of SARS-CoV-2 has no universal clinical case definition. Recent efforts have focused on understanding long COVID-19 symptoms, and electronic health record (EHR) data provide a unique resource for understanding this condition. The introduction of the International Classification of Diseases, Tenth Revision (ICD-10) code U09.9 for "Post COVID-19 condition, unspecified" to identify patients with long COVID-19 has provided a method of evaluating this condition in EHRs; however, the accuracy of this code is unclear. This study aimed to characterize the utility and accuracy of the U09.9 code across 3 health care systems-the Veterans Health Administration, the Beth Israel Deaconess Medical Center, and the University of Pittsburgh Medical Center-against patients identified with long COVID-19 via a chart review by operationalizing the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) definitions. Patients who were COVID-19 positive with either a U07.1 ICD-10 code or positive polymerase chain reaction test within these health care systems were identified for chart review. Among this cohort, we sampled patients based on two approaches: (1) with a U09.9 code and (2) without a U09.9 code but with a new onset long COVID-19-related ICD-10 code, which allows us to assess the sensitivity of the U09.9 code. To operationalize the long COVID-19 definition based on health agency guidelines, symptoms were grouped into a "core" cluster of 11 commonly reported symptoms among patients with long COVID-19 and an extended cluster that captured all other symptoms by disease domain. Patients having ≥2 symptoms persisting for ≥60 days that were new onset after their COVID-19 infection, with ≥1 symptom in the core cluster, were labeled as having long COVID-19 per chart review. The code's performance was compared across 3 health care systems and across different time periods of the pandemic. Overall, 900 patient charts were reviewed across 3 health care systems. The prevalence of long COVID-19 among the cohort with the U09.9 ICD-10 code based on the operationalized WHO definition was between 23.2% and 62.4% across these health care systems. We also evaluated a less stringent version of the WHO definition and the CDC definition and observed an increase in the prevalence of long COVID-19 at all 3 health care systems. This is one of the first studies to evaluate the U09.9 code against a clinical case definition for long COVID-19, as well as the first to apply this definition to EHR data using a chart review approach on a nationwide cohort across multiple health care systems. This chart review approach can be implemented at other EHR systems to further evaluate the utility and performance of the U09.9 code.

Impact of an innovative bundled payment to TB health care providers in China: an economic simulation analysis

BackgroundTuberculosis is the second most deadly infectious disease after COVID-19 and the 13th leading cause of death worldwide. Among the 30 countries with a high burden of TB, China ranks third in the estimated number of TB cases. China is in the top four of 75 countries with a deficit in funding for TB strategic plans. To reduce costs and improve the effectiveness of TB treatment in China, the NHSA developed an innovative BP method. This study aimed to simulate the effects of this payment approach on different stakeholders, reduce the economic burden on TB patients, improve the quality of medical services, facilitate policy optimization, and offer a model for health care payment reforms that can be referenced by other regions throughout the world.MethodsWe developed a simulation model based on a decision tree analysis to project the expected effects of the payment method on the potential financial impacts on different stakeholders. Our analysis mainly focused on comparing changes in health care costs before and after receiving BPs for TB patients with Medicare in the pilot areas. The data that were used for the analysis included the TB service claim records for 2019–2021 from the health insurance agency, TB prevalence data from the local Centre for Disease Control, and health care facilities’ revenue and expenditure data from the Statistic Yearbook. A Monte Carlo randomized simulation model was used to estimate the results.ResultsAfter adopting the innovative BP method, for each TB patient per year, the total annual expenditure was estimated to decrease from $2,523.28 to $2,088.89, which is a reduction of $434.39 (17.22%). The TB patient out-of-pocket expenditure was expected to decrease from $1,249.02 to $1,034.00, which is a reduction of $215.02 (17.22%). The health care provider’s revenue decreased from $2,523.28 to $2,308.26, but the health care provider/institution’s revenue-expenditure ratio increased from -6.09% to 9.50%.ConclusionsThis study highlights the potential of BPs to improve medical outcomes and control the costs associated with TB treatment. It demonstrates its feasibility and advantages in enhancing the coordination and sustainability of medical services, thus offering valuable insights for global health care payment reform.

Abstract PO3-10-07: Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort

Abstract Introduction: Data from the Centers for Disease Control and Prevention (CDC) labels each US state based on its 5-Year Relative Survival of Breast Cancer (BC) patients (pts). Data is categorized into four “survival groups'', each representing a range of 5-year survival percentages. Using real-world data, this study characterized the populations in each survival group, examining pt knowledge and education about their disease as well as preferences and factors influencing their decision to explore clinical trial (CT) opportunities. Methods: Leal is an AI-based platform that employs self-reported medical profiles to match cancer pts with CTs. This study involved a diverse cohort of 14,509 BC pts who completed the questionnaire. The geographic distribution of pts across US states was analyzed, taking into account the state’s 5-year BC survival %. Four groups were defined as follows: Group A (86.4 - 89.4%), Group B (89.4 - 90.4%), Group C (90.4 - 91.5%), and Group D (92.0 - 95.0%). Parameters such as race, willingness to travel, insurance coverage, performance of genetic testing, and biomarker knowledge were considered in the analysis. Results: We found significant variations in registration rates on the Leal platform across groups. The Highest registration rate was recorded for Group D which has the highest 5-year survival rate (p&amp;lt; 0.0001). Group A which has the lowest 5-year relative survival had a significantly higher proportion of African Americans compared to group D (14% vs 4%, p &amp;lt; 0.0001). Moreover, while there was no difference in the percentage of pts undergoing Next-Generation Sequencing (NGS) in both groups, a larger proportion of pts in Group D demonstrated proficiency in interpreting the test reports (p = 0.05). Although no significant differences were found in the proportion of pts who were aware of their treatment (tx) history between the two groups, whites in both groups exhibited greater knowledge of their tx (p = 0.001). Additionally, pts in Group D showed a significantly higher willingness to travel longer distances to participate in CTs (p=0.001), and a larger percentage of them had insurance coverage. Conclusions: This study used data from CDC that categorized US states into four groups based on BC pts’ 5-Year Survival. CT participation is associated with better clinical outcomes, especially for pts with poorer prognosis. In agreement, we show a higher signup rate to the Leal platform in States with higher 5-year relative survival, possibly pointing to higher CT education and knowledge among pts in those states. This is further supported by higher proficiency in interpreting NGS reports, resulting in better-optimized CT options on the Leal platform. Group A was also characterized by a reduced willingness to travel for a CT and a larger proportion of pts without health insurance. Those are significant barriers for CT enrollment, and ultimately limit access to optimal care and may impact outcomes. Gaps in knowledge of key disease parameters such as tx history were observed for African Americans, regardless of geographic location, highlighting the need to focus on minority populations even in states where the survival rate is relatively high. In agreement, the proportion of African Americans in group A was markedly higher, correlating with current disparities in access to tx and poorer outcomes. AI-based platforms are optimized for the exact identification of barriers to access to care and for enabling relevant healthcare and support organizations to effectively address individual patient issues, consequently increasing access to CTs, particularly among different racial and ethnic populations. Citation Format: Michal Safran, Yelena Lapidot, Tzvia Bader, Avital Gaziel. Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-07.

Abstract PO2-25-11: Incidence of Breast Cancer in Louisiana Compared to the United States

Abstract Aside from skin cancer, breast cancer is the most common cancer in American women. More specifically, one in eight women will develop breast cancer during their lifetime. Breast cancer is classified into subtypes defined by immunohistochemistry (IHC) expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). ER+/PR+/HER2- tumors are the most common form of breast cancer and are typically associated with risk factors including older age, nulliparity, obesity following menopause, alcohol and tobacco use, sedentary lifestyle, and hormone therapy. ER-/PR-/HER2+ tumors comprise approximately 15-20% of breast cancers and are caused by overexpression of the HER2 gene. These tumors have similar risk factors to ER+/PR+/HER2- tumors, except for age. Women with HER2+ breast cancer are likely to be younger compared to ER+PR+/HER2-. Tumors lacking hormone receptors are classified as ER-/PR-/HER2-, otherwise known as triple-negative breast cancer (TNBC). TNBC represents 10%-20% of breast cancers and carries a poorer prognosis, shorter survival, and unresponsiveness to hormone therapy compared to other forms of breast cancer. TNBC has been associated with African American race, socioeconomically deprived population, younger age at diagnosis (most frequently in women ages 40-50), more advanced disease stage, higher grade, high mitotic indices, family history of breast cancer and BRCA1 mutations. The primary aim of this study is to compare incidence of ER+/PR+/HER2-, ER-/PR-/HER2+, and ER-/PR-/HER2- (TNBC) in Louisiana to the national population. The Louisiana Tumor Registry (LTR) was utilized to obtain state and national level data. The LTR is a participant of the National Cancer Institute’s Surveillance, Epidemiology and End Results Program, and the Centers for Disease Control and Prevention’s National Program of Cancer Registries. Our study evaluated women in Louisiana diagnosed with ER+/PR+/HER2-, ER-/PR-/HER2+, and ER-/PR-/HER2- from 2010-2019. The populations were subdivided by age at time of diagnosis. Data was subdivided into ages 0-49, and &amp;gt;50. Rates were calculated per 100,00 and age-adjusted to the 2000 United States Standard Population (19 age groups - Census P25-1130). A p-value of &amp;lt; 0.05 indicates a significantly different rate in Louisiana comparative to the United States (SEER). Our results are as follows. Unexpectedly, Louisiana has a significantly lower rate of ER+/PR+/HER2- cancer in women ages 0-49 and ages &amp;gt;50 compared to the United States. Based on epidemiological risk factors, Louisiana should have a much higher rate of ER+/PR+/HER2- comparative to the United States population. Louisiana has a significantly higher rate of ER-/PR-/HER2+ cancer in women ages &amp;gt;50 and ER-/PR-/HER2- (TNBC) in women ages 0-49 and ages &amp;gt;50 compared to the United States. These findings are discordant with traditional epidemiologic studies regarding breast cancer and require further investigation. Breast Cancer Incidence Rates1 by Age from 2010-2019 in Louisiana and the United States Table 1: Breast Cancer Incidence Rates in women ages 0-49 and ages &amp;gt;50 from 2010-2019 in Louisiana Compared to the United States. Citation Format: Avery Daily, Julie Cupp, Krystle Trosclair. Incidence of Breast Cancer in Louisiana Compared to the United States [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-25-11.

Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy.

Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention. To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories. We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas. Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.

Should Blood Cultures Be Drawn Through an Indwelling Catheter?

Abstract There is no practical way to definitively diagnose a catheter-related bloodstream infection in situ if blood cultures are only obtained percutaneously unless there is the rare occurrence of purulent drainage from a central venous catheter insertion site. That is why the IDSA guidelines for diagnosis and management of catheter-related bloodstream infections and IDSA guidelines for evaluation of fever in critically ill patients both recommend drawing blood cultures from a central venous catheter (CVC) and percutaneously if the catheter is a suspected source of infection. However, CVC-drawn blood cultures may be more likely to be positive reflecting catheter hub, connector, or intraluminal colonization and many hospitals in the US discourage blood culture collection from catheters in an effort to reduce reporting of central-line associated bloodstream infections to the Centers for Disease Control and Prevention. As such, clinical decisions are made regarding catheter removal or other therapeutic interventions based on incomplete and potentially inaccurate data. We urge clinicians to obtain catheter-drawn blood cultures when the catheter may be the source of suspected infection.

Trend analysis and age-period-cohort effects on morbidity and mortality of liver cancer from 2010 to 2020 in Guangzhou, China

IntroductionLiver cancer is one of the most common malignant gastrointestinal tumors worldwide. This study intends to provide insight into the epidemiological characteristics and development trends of liver cancer incidence and mortality from 2010 to 2020 in Guangzhou, China.MethodsData were collected from the Cancer Registry and Reporting Office of Guangzhou Center for Disease Control and Prevention. Cross-sectional study, Joinpoint regression (JPR) model, and Age-Period-Cohort (APC) model were conducted to analyze the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trend of liver cancer among the entire study period.ResultsThe age-standardized incidence and mortality of liver cancer in Guangzhou showed an overall decreasing trend. The disparity in risk of morbidity and mortality between the two sexes for liver cancer is increasing. The cohort effect was the most significant among those born in 1965~1969, and the risk of liver cancer incidence and mortality in the total population increased and then decreased with the birth cohort. Compared with the birth cohort born in 1950~1954 (the reference cohort), the risk of liver cancer incidence and mortality in the males born in 1995~1999 decreased by 32% and 41%, respectively, while the risk in the females decreased by 31% and 32%, respectively.ConclusionsThe early detection, prevention, clinical diagnosis, and treatment of liver cancer in Guangzhou have made remarkable achievements in recent years. However, the risk of liver cancer in the elderly and the middle-aged males is still at a high level. Therefore, the publicity of knowledge related to the prevention and treatment of liver cancer among the relevant population groups should be actively carried out to enhance the rate of early diagnosis and treatment of liver cancer and to advocate a healthier lifestyle.

Abstract PS18-03: The Association between Food Deserts, Food Swamps, and Postmenopausal Breast Cancer Mortality in the United States

Abstract Purpose: Breast cancer (BRCA), the 4th leading cause of cancer death in the United States (U.S.), is one of 13 obesity-related cancers. Healthy food consumption is a protective factor shown to decrease obesity risk and postmenopausal BRCA mortality, respectively. However, residing in geographical areas with no access to healthy food options (food deserts) or unhealthy food options (food swamps) reduces access to healthy foods and has been severely understudied. We examined the relationship between residing in food swamps and deserts with postmenopausal BRCA mortality. Methods: We conducted an ecological analysis utilizing 2010 – 2020 Center for Disease Control and Prevention postmenopausal BRCA mortality data (restricted to 45+ years old) and aggregated 2012 – 2020 data from the U.S. Department of Agriculture Food Environment Atlas data. Food swamp score (FS) was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer’s markets. Food desert score (FD) was calculated as the proportion of residents living more than one mile (urban) or 10 miles (rural) from a grocery store and household income ≤ 200% of the federal poverty threshold. We categorized FD and FS to low, moderate, or high; higher scores indicated counties with poorer healthy food resources. Multilevel generalized mixed effects models were used to estimate the mentioned association. Results: 2,280 counties/county equivalents with high postmenopausal BRCA mortality rates had higher percentage of non-Hispanic (NH)-Black population (5.80 vs. 2.08), poverty rates (17.2 vs. 14.2), and high food swamp scored areas (39.0 vs. 24.5) versus counties/county equivalents with low postmenopausal BRCA mortality rates (p-value &amp;lt; 0.0001). After adjusting for age, percentage of NH-Blacks per county, and poverty rate, we found 42% increased odds of having high postmenopausal BRCA mortality rates among U.S. counties/county equivalents with high food swamp scores (adjusted odds ratio [AOR] = 1.42; 95% CI: 1.14 – 1.78). Conclusions: Sampled U.S. counties with the poorest food swamp environment had significantly increased odds of postmenopausal BRCA mortality. We suggest that local policymakers and community stakeholders should employ sustainable approaches at combating obesity and BRCA by increasing healthier accessible food sources (e.g. creating more walkable neighborhoods and community gardens). Citation Format: Malcolm Bevel, Meng-Han Tsai, April Parham, Sydney Andrzejak, Samantha Jones, Justin Moore. The Association between Food Deserts, Food Swamps, and Postmenopausal Breast Cancer Mortality in the United States [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS18-03.

Improving Antibiotic Overuse in Primary Care: A Multimodal Quality Improvement Project.

Antibiotic overuse has increased over time related to provider knowledge gaps about best practices, provider perception of patient expectations on receiving an antibiotic, possible pressure to see patients in a timely fashion, and concerns about decreased patient satisfaction when an antibiotic is not prescribed. The Centers for Disease Control and Prevention estimates that up to 30% of antibiotics are inappropriately prescribed in the outpatient setting. This quality improvement project consisted of a multimodal approach to decrease inappropriate antibiotic prescribing for viral upper respiratory infections (URIs) by using provider education, passive patient education, and clinical decision support tools based on Centers for Disease Control and Prevention recommendations and the Be Antibiotic Aware tool. Following implementation, there was an 11% decrease in viral URI antibiotic prescribing, from a rate of 29.33% to 18.33% following the multimodal implementation. The use of evidence-based education and treatment guidelines was found to decrease inappropriate antibiotic prescribing for patients diagnosed with viral URIs.