Community-based Population Research Articles

An inquisitive exploration on perceived dysphagia, cognition and health-related quality of life in geriatrics

The increasing aging population worldwide is one of the main issues of today. According to the 2011 census, there were 103 million senior citizen i.e about 8.6% of the India’s population. According to data from the U. N Department of Economic and Social Affairs (UNDESA), the proportion of people over 60 will increase from 7.5% in 2010 to 11.1% in 2025. The NSSO 2002 report, the old population is expected to increase to 158.7 million by 2025, rising at a rate that is roughly twice as fast as the general population associated with Perceived Dysphagia, Cognition and Health-Related Quality of Life in Geriatrics populations.Dysphagia is becomes an important common problem for the geriatric population. While Presbyphagia is a term that refers to the distinctive age-related changes that occur in the swallowing mechanism of otherwise healthy older adults. It is well defined that in acutely ill elderly populations, the prevalence and quality-of-life changes associated with dysphagia remain unstable poor health conditions. The present study attempt “To investigate an Inquisitive Exploration on Perceived Dysphagia, Cognition and Health-Related Quality of Life in Geriatrics”.A total of 300 participants were included in the study. The participants within the study were all inhabitants of Pondicherry. The individual with geriatric inclusion was 70 years old and above at the time of participation. Two validated questionnaires were used namely the M.D. Anderson Dysphagia Inventory (MDADI) and the general health Short Form-12 survey (SF-12v2) was administered to assess the impact of dysphagia-age related aspects on overall health. Both the questionnaires were self-administered and widely used in assessing cognitive function among the elderly, it includes orientation, attention, memory, language, and visuospatial skills.The study outcome concluded that there is a relatively high prevalence of dysphagia in the community-based geriatric population; significant quality-of-life impairment is a frequent finding. General health measures do not appear to be sensitive to swallowing-related quality of life but finally, individuals may inaccurately ascribe swallowing problems to normal aging, supporting the role of community education about dysphagia in the elderly.

An innovative model for predicting coronary heart disease using triglyceride-glucose index: a machine learning-based cohort study

BackgroundVarious predictive models have been developed for predicting the incidence of coronary heart disease (CHD), but none of them has had optimal predictive value. Although these models consider diabetes as an important CHD risk factor, they do not consider insulin resistance or triglyceride (TG). The unsatisfactory performance of these prediction models may be attributed to the ignoring of these factors despite their proven effects on CHD. We decided to modify standard CHD predictive models through machine learning to determine whether the triglyceride-glucose index (TyG-index, a logarithmized combination of fasting blood sugar (FBS) and TG that demonstrates insulin resistance) functions better than diabetes as a CHD predictor.MethodsTwo-thousand participants of a community-based Iranian population, aged 20–74 years, were investigated with a mean follow-up of 9.9 years (range: 7.6–12.2). The association between the TyG-index and CHD was investigated using multivariate Cox proportional hazard models. By selecting common components of previously validated CHD risk scores, we developed machine learning models for predicting CHD. The TyG-index was substituted for diabetes in CHD prediction models. All components of machine learning models were explained in terms of how they affect CHD prediction. CHD-predicting TyG-index cut-off points were calculated.ResultsThe incidence of CHD was 14.5%. Compared to the lowest quartile of the TyG-index, the fourth quartile had a fully adjusted hazard ratio of 2.32 (confidence interval [CI] 1.16–4.68, p-trend 0.04). A TyG-index > 8.42 had the highest negative predictive value for CHD. The TyG-index-based support vector machine (SVM) performed significantly better than diabetes-based SVM for predicting CHD. The TyG-index was not only more important than diabetes in predicting CHD; it was the most important factor after age in machine learning models.ConclusionWe recommend using the TyG-index in clinical practice and predictive models to identify individuals at risk of developing CHD and to aid in its prevention.

Glucose Metabolism Indices and the Development of Chronic Kidney Disease: A Cohort Study of Middle-Aged and Elderly Chinese Persons.

Chronic kidney disease (CKD) has become a major global health issue, and abnormalities of glucose metabolism are a risk factor responsible for development of CKD. We aimed to investigate associations between glucose metabolism indices and CKD in a Chinese population and determine which index is superior for predicting incident CKD. We performed a community-based population on 5232 subjects aged ≥40 years without baseline CKD. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. We examined the associations of glucose metabolism indices, including fasting plasma glucose (FPG), 2-hour (2 h) oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-β and the development of CKD. With an average follow-up of 3.6 years, 6.4% of the subjects developed CKD. Pearson's correlation analysis revealed that FPG, HbA1c, fasting insulin, and HOMA-IR were all significantly correlated with UACR and eGFR. The association persisted in multivariate linear regression analysis adjusted for age and sex. Compared with other glucose indices, HOMA-IR exhibited the strongest associations with CKD in COX multivariate regression analysis (HR = 1.17, 95% CI: 1.04-1.31). HOMA-IR is superior to other routine indices of glucose metabolism for predicting the development of CKD in middle-aged Chinese persons. Screening with HOMA-IR may help prevent the development of CKD in the general population.

Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality.

ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits. The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex. Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex. In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.

Association between serum LDL-C concentrations and risk of diabetes: A prospective cohort study.

Low-density lipoprotein cholesterol (LDL-C) and diabetes mellitus are both modifiable risk factors for cardiovascular disease; however, whether elevated LDL-C levels confer a risk for diabetes remains unclear. We aimed to examine the association between serum LDL-C concentrations at baseline and the risk of developing diabetes at follow-up in the general population of Chinese adults. This study included 5274 adults aged ≥ 40 years from a community cohort who were without diabetes and followed for a median of 4.4 years. A standard 75-g oral glucose tolerance test was conducted at baseline and follow-up visits to diagnose diabetes. Logistic regression models and a restricted cubic spline were used to examine the association between baseline serum LDL-C levels and the risk of diabetes development. Subgroup analyses were conducted stratifying on age, sex, body mass index, hypertension, family history of diabetes, and LDL-C levels. A total of 652 participants (12%) developed diabetes during the follow-up period. Compared to quartile 1 of serum LDL-C, quartiles 2, 3, and 4 were associated with a 30%, 33%, and 30% significantly higher risk of diabetes, respectively after adjustment for confounders including homeostatic model assessment for insulin resistance. The linear relationship between baseline LDL-C down to 30.1 mg/dL and incident diabetes was demonstrated by restricted cubic spline analysis, and each 1-SD increase in LDL-C concentration (28.5 mg/dL) was associated with a 12% increase in the risk of diabetes (odds ratio 1.12, 95% confidence interval 1.03-1.22). In this community-based general population, higher serum LDL-C levels were linearly associated with an elevated risk of incident diabetes.

Additive effect between homocysteine and low-density-lipoprotein cholesterol upon incidence of novel carotid plaque formation: data from a Chinese community-based cohort

ObjectiveHomocysteine (HCY) has been associated with carotid plaque in cross-sectional studies, but the prospective relationship between HCY and incident carotid plaque has not been well established. The purpose of this study was to investigate the association between HCY and incidence of novel carotid plaque in a Chinese community-based population without pre-existing carotid atherosclerosis and to assess the additive effect of HCY and low-density lipoprotein cholesterol (LDL-C) on the incidence of novel plaque. Methods: At baseline, we measured HCY and other risk factors in subjects aged ≥ 40 years. All participants underwent carotid ultrasound examinations at baseline and after an average of 6.8 years of follow-up. Incidence of plaque was identified if plaque was absent at baseline, but plaque was detected at the end of follow-up. A total of 474 subjects were included in the analysis. Results: The incidence of novel carotid plaque was 24.47%. Multivariate regression analyses showed that HCY was independently associated with a 1.05-fold-higher likelihood for incident novel plaque (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.01–1.09, P = 0.008). Using tertile 1 and tertile 2 for reference, the top HCY tertile (T3) showed a 2.28-fold-higher likelihood for incident plaque (adjusted OR = 2.28, 95%CI: 1.33–3.93, P = 0.002). The combination of HCY T3 and LDL-C ≥ 3.4 mmol/L had the highest risk for novel plaque formation (adjusted OR = 3.63, 95%CI: 1.67–7.85, P = 0.001) compared to those without either condition. In the LDL-C ≥ 3.4 mmol/L subgroup, HCY was significantly associated with incidence of plaque (adjusted OR = 1.16, 95%CI: 1.04–1.28, P = 0.005, P-interaction = 0.023). Conclusion: In the Chinese community-based population, HCY was independently associated with the incidence of novel carotid plaque. There were additive effect between HCY and LDL-C on the incidence of plaque, the highest risk was observed in individuals with both high HCY levels and LDL-C ≥ 3.4 mmol/L. Our findings suggest that HCY may be a potential target for preventing the incidence of carotid plaque, particularly in individuals with elevated LDL-C levels.

Association of intracranial atherosclerosis with cerebral small vessel disease in a community-based population.

The purpose of this study was to explore the relationship between intracranial atherosclerosis and cerebral small vessel disease (CSVD). Community-dwelling residents of Lishui, China in the PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study were involved. Intracranial atherosclerosis was grouped by the severity of intracranial artery plaques with stenosis and burden. Four imaging markers including lacunes, white matter hyperintensity (WMH), cerebral microbleeds (CMBs), and perivascular spaces (PVS) as well as the CSVD burden scores were assessed. Logistic regression or ordinal logistic regression models with odds ratio (OR) or common OR (cOR) were used to estimate the relationship between intracranial atherosclerosis and CSVD markers and burdens. The mean age was 61.20 ± 6.68 years, and 1424 (46.52%) were men among 3061 participants included at baseline. Intracranial atherosclerotic burden was associated with the severity of the lacunes (OR = 4.18, 95% confidence interval [CI] = 1.83-9.58), modified WMH burden (cOR = 1.94, 95% CI = 1.01-3.71), presence of CMBs (OR = 2.28, 95% CI = 1.05-4.94), and CMB burden (OR = 2.23, 95% CI = 1.03-4.80). However, it was not associated with the WMH burden and PVS. Intracranial atherosclerotic burden was associated with CSVD burden (Wardlaw: cOR = 2.73, 95% CI = 1.48-5.05; Rothwell: cOR = 2.70, 95% CI = 1.47-4.95). The association between intracranial atherosclerosis and CSVD was obvious in participants with both anterior and posterior circulation artery stenosis. Based on a Chinese community population, there may be an association between intracranial atherosclerosis and CSVD, but its mechanism in relation to vascular risk factors still needs to be clarified.

608-P: Association of Neck Circumference and Sarcopenic Obesity in a Cohort of Chinese Community-Based Individuals

Aims: Neck circumference (NC) is a simple and reliable anthropometric measurement for estimating obesity. Sarcopenic obesity is a distinct condition of sarcopenia in the context of obesity, with the cumulative health risks of both phenotypes. This study was aimed to explore the association between NC and sarcopenic obesity in a Shanghai community population. Methods: The study included 1542 participants (622 men and 920 women) with mean age of 58.1 ± 7.06 years who underwent complete examinations at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index was calculated using the BIA equation from Janssen et al. The abdominal fat distribution, including visceral fat area (VFA), was assessed by magnetic resonance imaging. Elevated NC was defined as NC ≥ 38.5 cm in men and NC ≥ 34.5 cm in women. The definition of sarcopenic obesity combined low muscle mass (skeletal muscle mass index of 1 SD below the sex-specific mean value) with obesity which defined according to overall adiposity or fat distribution as body mass index (BMI) ≥ 25 kg/m2, fat% ≥ 25% in men and 30% in women, or VFA ≥ 80cm2, respectively. Results: Subjects with elevated NC had a higher incidence of sarcopenic obesity in both men and women regardless of adiposity status assessed by BMI, fat%, or VFA (all P &amp;lt; 0.001). During the follow up, higher cumulative incidence of sarcopenic obesity was found in those with elevated NC (all P &amp;lt; 0.001). For each 1 cm increase in NC, multivariable-adjusted hazard ratios of sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; besides, the association assessed by high fat% or high VFA remained in both men and women. Conclusion: NC was closely associated with the incidence of sarcopenic obesity, which suggested that it could be helpful to screening sarcopenic obesity in a community-based population. Disclosure Y.Xu: None. T.Hu: None. Y.Shen: None. Y.Wang: None. X.Ma: None. Y.Bao: None.

Programmed cell death ligand 1 (PD-L1) expression landscape and its relationship with tumor mutational burden (TMB) in a community-based cancer center patient population in rural central Nebraska.

e15141 Background: PD-L1 and TMB are the most widely used immunotherapy biomarkers to identify populations who would benefit from immunotherapy, with the higher values predicting better therapeutic efficacy. We sought to explore the occurrence and correlation of these two biomarkers in a community based cancer center patient population in rural central Nebraska. Methods: One hundred sixty consecutive cancer patients(pts) diagnosed and treated between 2018-2022 at Morrison Cancer Center were evaluated. Malignant tumor tissue specimens were analyzed for PD-L1expression and TMB (Foundation test). PD-L1 expression was classified as low ( &lt; 1%), intermediate (1% ≥ PD-L1 &lt; 50%), high (≥ 50%), and TMB classified as low [1–5 mutations/Megabase (muts/Mb)], intermediate (6–19 muts/Mb), high (≥ 20 muts/Mb)]. PD-L1 and TMB values were treated as continuous variables to calculate a Pearson correlation coefficient and p value. Results: Mean age at diagnosis was 64 years (range 33-89). Malignant histology diagnoses included 55 pts with lung, 18 colorectal, 12 breast, 15 unknown primary, 15 pancreas, 10 renal, 3 melanoma, 1 thyroid, 6 ovary, 5 uterus, 5 head and neck, 5 prostate, 5 biliary, and 1 vulvar. Fifty four percent (86/160) of pts had low, 33% (53/160) had intermediate, and 13% (21/160) had high PD-L1 expression score with a mean PD-L1 value of 13.8% (range 0-100). Sixty six percent (106/160) of pts had low, 30% (48/160) had intermediate, and 4% had high TMB with a mean TMB value of 5.6 muts/Mb (range 0-66). A marginal linear correlation between PD-L1 expression and TMB was observed (Pearson Correlation Coefficient = 0.172, P = 0.0270). Conclusions: PD-L1 and TMB are both important biomarkers for immunotherapy. Increasing availability and use of both PD-L1 and TMB testing in the community oncology practice beseeches the question of frequency of these two biomarkers in various cancers in the community oncology patient population as well as any association between them. The results of our study gives a glimpse of the distribution landscape of these two biomarkers for community oncology patients and suggest that PD-L1 and TMB may be independent markers with a weak association. PD-L1 and TMB may each inform use of immunotherapy by different mechanisms. [Table: see text]

The atherogenic index of plasma and carotid atherosclerosis in a community population: a population-based cohort study in China

BackgroundThe atherogenic index of plasma (AIP) is an important alternative metabolic biomarker of atherosclerosis and cardiovascular diseases. Nevertheless, the correlation between the AIP and carotid atherosclerosis is unknown among the general population.MethodsA total of 52,380 community residents, aged ≥ 40 years who underwentcervical vascular ultrasound from December 2017 to December 2020 in Hunan China, were selected for retrospective analysis. The AIP was calculated as a logarithmically converted ratio of triglycerides (TG) to high-density lipoprotein-cholesterol (HDL-C). The participants were divided into AIP quartile groups (Q1-Q4). Logistic regression models and restricted cubic spline analyses were used to examine the association of the AIP with carotid atherosclerosis. Stratified analyses were applied to control for confounding factors. The incremental predictive value of the AIP was further assessed.ResultsAfter adjusting for traditional risk factors, an increased AIP was associated with a higher rate of carotid atherosclerosis (CA), increased carotid intima-media thickness (CIMT), and plaques [odds ratio, OR (95% confidence interval, CI): 1.06 (1.04, 1.08), 1.07 (1.05, 1.09), and 1.04 (1.02, 1.06) per 1-SD increase in the AIP, respectively]. Compared with those participants in the quartile 1 group, those in the quartile 4 group had a greater risk of CA [OR 1.18, 95% CI (1.12, 1.25)], increased CIMT [OR 1.20, 95% CI (1.13, 1.26)], and plaques [OR 1.13, 95% CI (1.06, 1.19)]. However, we did not observe an association between the AIP and stenosis [0.97 (0.77, 1.23), p for trend = 0.758]. Restricted cubic spline analyses also showed a cumulative increase in the risk of CA, increased CIMT, and plaques but not stenosis severity (> 50%) with an increase of the AIP. Subgroup analyses showed that a more significant association between the AIP and the prevalence of increased CA was detected in younger subjects (aged < 60 years) with a body mass index (BMI) of ≥ 24 and fewer comorbidities. Additionally, the AIP provided incremental predictive capacity over established risk factors for CA, as shown by an improvement in the net reclassification index (NRI) and integrated discrimination index (IDI) (all P < 0.05).ConclusionsAn elevated AIP in a community-based population is associated with a higher rate of CA. the AIP could serve as a potential biomarker for CA risk assessment.

Normative cut-offs for polycystic ovary syndrome diagnostic features in adolescents using cluster analysis.

The diagnosis of polycystic ovary syndrome (PCOS) remains challenging with international guidelines prioritising accurate cut-offs for individual diagnostic features. These diagnostic cut-offs are currently based on arbitrary percentiles, often from poorly characterised cohorts, and are dependent on variable laboratory ranges defined by assay manufacturers, limiting diagnostic accuracy. Cluster analysis is the recommended approach for defining normative cut-offs within populations for clinical syndromes. Few PCOS adult studies have applied cluster analysis, with no studies in adolescents. We aimed to define normative cut-offs for individual PCOS diagnostic features in a community-based population of adolescents using cluster analysis. This analysis utilised data from the Menstruation in Teenagers Study, a subgroup of the Raine Study, which is a population based prospective cohort of 244 adolescents whose mean age at PCOS assessment was 15.2 years. K-means cluster analysis and receiver operating characteristics curves were used to define normative cut-offs for modified Ferriman-Gallwey (mFG) score, free testosterone (free T), free androgen index (FAI), and menstrual cycle length. Normative cut-offs for mFG, free T, FAI, and menstrual cycle lengths were 1.0, 23.4 pmol/L, 3.6, and 29 days, respectively. These corresponded to the 65th, 71st, 70th, and 59th population percentiles, respectively. In this novel study, we define the normative diagnostic criteria cut-offs in this unselected adolescent population and show that these cut-offs correspond to lower percentiles than conventional cut-offs. These findings highlight the pertinent need to re-define PCOS diagnostic cut-offs in adolescents. Validation is required in larger, multi-ethnic, and well-characterised adolescent cohorts.

Characteristics of idiopathic pulmonary fibrosis -associated cough. a case-control study

BackgroundMost patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study was to compare chronic cough in early stage IPF patients to cough in subjects with chronic cough from a community-based sample and, especially, to investigate whether cough in IPF is less productive than chronic cough in a community-based sample.MethodsThe IPF cough population consisted of 46 biopsy-confirmed patients who complained of chronic cough. Control population consisted of subjects with chronic cough, gathered by a community-based email survey sent to public service employees and the Finnish Pensioners’ Federation. A case-control setting was applied by having four age, gender, and smoking-status matched subjects from the community sample for each IPF cough patient. A cough specific quality of life questionnaire (Leicester Cough Questionnaire (LCQ)) was filled in by all subjects. The LCQ questionnaire contains 19 questions, each question is scored from 1 to 7 and total score from 3 to 21 with a smaller value indicating more severe impairment.ResultsThe sputum production frequency, as assessed by LCQ question 2, was 5.0 (3.0-6.0) in the IPF chronic cough population and 5.0 (3.0–6.0) in the community-based chronic cough population (median and interquartile range p= 0.72). The LCQ total score was 14.8 (11.5-18.1) in the IPF chronic cough population and 15.4 (13.0–17.5) in the community-based chronic cough population (p=0.76). The domain impact scores were physical, 4.9 (3.9–6.1) vs. 5.1 (4.5–5.6) (p=0.80); psychological, 4.6 (3.7–5.9) vs. 4.7 (3.9–5.7) (p=0.90); and social, 5.5 (3.7–6.5) vs. 5.5 (4.5–6.3) (p=0.84), respectively. Furthermore, cough response to paint or fumes, cough disturbing sleep, and cough frequency per day did not differ between the groups.ConclusionCough in early stage IPF patients was not distinguishable from chronic cough in the community-based population by LCQ. Especially, there was no difference in the self-reported frequency of cough-associated sputum production.

Increased arterial stiffness elevates the risk of heart failure in diabetic patients

BackgroundPrevious studies have shown that arterial stiffness (AS) was a risk factor for heart failure (HF) in nondiabetic patients. We aimed to analyze this impact in a community-based diabetic population. MethodsOur study excluded those who had HF before brachial-ankle pulse wave velocity (baPWV) measurement and included 9041 participants finally. Subjects were divided into the normal (<14 m/s), intermediate (14–18 m/s), and elevated baPWV groups (>18 m/s) based on baPWV values. Multivariate Cox proportional hazard model was used to analyze the effect of AS on HF risk. ResultsDuring the median follow-up of 4.19 years, 213 patients had HF. The results of Cox model showed that HF risk in the elevated baPWV group was 2.25 times higher than that in the normal baPWV group (95% confidence interval [CI]: 1.24–4.11). HF risk increased by 18% (95% CI:1.03–1.35) for every 1 additional standard deviation(SD)of baPWV. Restricted cubic spline results showed statistically significant overall and non-linear associations between AS and HF risk (P < 0.05). The subgroup analysis and sensitivity analysis were consistent with that of total population. ConclusionsAS is an independent risk factor for developing HF in the diabetic population, and AS exhibits a dose-response relationship with HF risk.

Effect of Helicobacter pylori Eradication Therapy on the Incidence of Noncardia Gastric Adenocarcinoma in a Large Diverse Population in the United States

High-quality data regarding the effect of Helicobacter pylori eradication on the risk of noncardia gastric adenocarcinoma (NCGA) remain limited in the United States. We investigated the incidence of NCGA after H pylori eradication therapy in a large, community-based US population. We performed a retrospective cohort study of Kaiser Permanente Northern California members who underwent testing and/or treatment for H pylori between 1997 and 2015 and were followed through December 31, 2018. The risk of NCGA was evaluated using the Fine-Gray subdistribution hazard model and standardized incidence ratios. Among 716,567 individuals with a history of H pylori testing and/or treatment, the adjusted subdistribution hazard ratios and 95% confidence intervals of NCGA for H pylori-positive/untreated and H pylori-positive/treated individuals were 6.07 (4.20-8.76) and 2.68 (1.86-3.86), respectively, compared with H pylori-negative individuals. When compared directly with H pylori-positive/untreated individuals, subdistribution hazard ratios for NCGA in H pylori-positive/treated were 0.95 (0.47-1.92) at <8 years and 0.37 (0.14-0.97) ≥8 years of follow-up. Compared with the Kaiser Permanente Northern California general population, standardized incidence ratios (95% confidence interval) of NCGA steadily decreased after H pylori treatment: 2.00 (1.79-2.24) ≥1 year, 1.01 (0.85-1.19) ≥4 years, 0.68 (0.54-0.85) ≥7 years, and 0.51 (0.38-0.68) ≥10 years. In a large, diverse, community-based population, H pylori eradication therapy was associated with a significantly reduced incidence of NCGA after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7 to 10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the United States through H pylori eradication.

White Matter and Gray Matter Changes Related to Cognition in Community populations (P12-6.008)

<h3>Objective:</h3> To investigate the global and topographic changes of white matter integrity and cortical structure related to cognitive impairments in a community-based population. <h3>Background:</h3> Further studies in associations of cortical and subcortical changes with cognitive function would better explain the pathology of cognitive impairment. <h3>Design/Methods:</h3> A cross-sectional analysis was performed based on 995 subjects (aged 56.8±9.1 years, 34.8% males) from the Shunyi study, a community-dwelling cohort. Cognitive status was accessed by a series of neurocognitive tests including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), category Verbal Fluency Test (VFT), Digit Span Test (DST), and Trail Making Tests A and B (TMT-A and TMT-B). Structural and diffusional MRI data were acquired. White matter integrity was assessed using fractional anisotropy (FA), mean diffusivity (MD), and peak width of skeletonized mean diffusivity (PSMD). Cortical surface area, thickness, and volume were measured using Freesurfer. Probabilistic tractography was further conducted to track the white matter fibers connecting to the cortical regions related to cognition. General linear models were used to investigate the association between brain structure and cognition. <h3>Results:</h3> Global mean FA and MD were associated with VFT performances (FA, β=0.119, p&lt;0.001; MD, β=−0.128, p&lt;0.001). Global cortical surface area, thickness, and volume were not related to cognitive scores. In tract-based spatial statistics, disrupted white matter integrity was related to cognitive impairment mainly in visuomotor processing speed and executive function (TMT-A and VFT), rather than short-term memory (DST). In the whole brain vertex-wise analysis, surface area in the left orbitofrontal cortex and left central sulcus were positively associated with MMSE and MoCA scores. These associations were independent of the connecting white matter tract. <h3>Conclusions:</h3> Disrupted white matter integrity and regional cortical surface area were related to cognition in community-dwelling populations. The associations of cortical surface area and cognition were independent of the connecting white matter tract. <b>Disclosure:</b> Mrs. Li has nothing to disclose. Jing Yuan has nothing to disclose. Fei Han has nothing to disclose. Lixin Zhou has nothing to disclose. Jun Ni has nothing to disclose. Ming Yao has nothing to disclose. Shuyang Zhang has nothing to disclose. Zhengyu Jin has nothing to disclose. Liying Cui has nothing to disclose. Feifei Zhai has nothing to disclose. Yi-Cheng Zhu has nothing to disclose.

P095 Fibromyalgia correlates with neurodivergent traits in a self-selected community population

Abstract Background/Aims Chronic musculoskeletal pain is now a common feature among younger women. Many such women exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. Methods The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. Results Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 65%, 40% and 44% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was strongly associated with autistic traits, with dysautonomia a better predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. Conclusion This is the first community study to provide evidence for a direct association between fibromyalgia and neurodivergent traits. Although self-selected, the findings in our predominantly young population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile. Those who self-identify as non-binary or trans appear at particular risk of developing features of fibromyalgia. Disclosure L. Ryan: None. H. Beer: None. E. Thomson: None. E. Philcox: None. C. Kelly: None.

Risk Factors for Mortality From Aortic Aneurysm and Dissection: Results From a 26-Year Follow-Up of a Community-Based Population.

Background Aortic aneurysm rupture and acute aortic dissection are life-threatening conditions and represent an ever-growing public health challenge. Comprehensive epidemiologic investigations for their risk factors are scant. We aimed to investigate risk factors associated with mortality from aortic diseases through analysis of a community-based Japanese cohort. Methods and Results IPHS (Ibaraki Prefectural Health Study) comprises 95 723 participants who took part in municipal health checkups in 1993. Factors considered for analysis included age, sex, body mass index, blood pressure, serum lipids (high-density lipoprotein [HDL] cholesterol, non-HDL cholesterol, and triglycerides), diabetes, antihypertensive and lipid-lowering drug use, and smoking and drinking habits. Cox proportional hazards models were applied to evaluate the associations between these variables and mortality from aortic diseases. During the median 26-year follow-up, 190 participants died of aortic aneurysm rupture, and 188 died of aortic dissection. An increased multivariable hazard ratio (HR) for mortality from total aortic diseases was observed for high systolic blood pressure (1.61 [1.00-2.59]), diastolic blood pressure (2.95 [1.95-4.48]), high non-HDL cholesterol (1.63 [1.19-2.24]), low HDL cholesterol (1.86 [1.29-2.68]), and heavy (>20 cigarettes/day) smoking habit (2.46 [1.66-3.63]). A lower multivariable HR was observed for diabetes (0.50 [0.28-0.89]). Conclusions Smoking habit, higher systolic blood pressure and diastolic blood pressure levels, higher non-HDL, and lower HDL cholesterol levels were positively associated with mortality from total aortic diseases, whereas diabetes was inversely associated.

Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial

This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC). Extended follow-up of the Zhongshan Angle-Closure Prevention Study. Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS. Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit. Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC. During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI. Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

MP54-04 EXAMINING THE INFLUENCE OF RACE AND PELVIC FLOOR DISORDER SEVERITY ON HEALTH-RELATED SOCIAL NEEDS AMONG MINORITY WOMEN

You have accessJournal of UrologyCME1 Apr 2023MP54-04 EXAMINING THE INFLUENCE OF RACE AND PELVIC FLOOR DISORDER SEVERITY ON HEALTH-RELATED SOCIAL NEEDS AMONG MINORITY WOMEN Jasmine Kannikal, Sanjana Satish, Aaron Gurayah, Erin Kobetz, Katherine Amin, Ekene Enemchukwu, and Raveen Syan Jasmine KannikalJasmine Kannikal More articles by this author , Sanjana SatishSanjana Satish More articles by this author , Aaron GurayahAaron Gurayah More articles by this author , Erin KobetzErin Kobetz More articles by this author , Katherine AminKatherine Amin More articles by this author , Ekene EnemchukwuEkene Enemchukwu More articles by this author , and Raveen SyanRaveen Syan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic floor disorders (PFD) affect 25% of American women 20 years or older and continues to increase in prevalence. While studies have explored racial disparities in PFD knowledge and treatment, few have analyzed the impact of health-related social needs (HRSN). This study aims to characterize unmet HRSN among minority women, as well as assess the impact of race and PFD severity. METHODS: Our IRB-approved, ongoing prospective study began recruitment in June 2022 from private urogynecology clinics; a general urology clinic at the public safety net hospital (SNH); and a community outreach mobile clinic (MC). The standardized Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and Female Genitourinary Pain Index (GUPI) were used to identify PFDs. PFDs exceeding the 33.3 (UDI) or third quartile (POPDI, GUPI) thresholds were characterized as severe. Unmet HRSN were based on the Centers for Medicare & Medicaid Services Accountable Health Communities HRSN Screening Tool: mild and severe represented <8 and >8 unmet HSRN, respectively. Chi-squared tests for PFD presence and severity by race and location were conducted using R. RESULTS: The study cohort (n=107) had a median age of 53 years [IQR 24]. 53 (49.5%) women identified as Hispanic, 38 (35.5%) as Black, and 16 (15%) as Other. Unmet HRSN ranged from 1 to 18. Private clinic participants were 20% less likely to report unmet social needs, compared to MC participants (p=0.020). No statistically significant differences in reported unmet HRSN between SNH and MC, or between racial groups, were observed. Upon chi-squared analysis, no association was found between participants with severe unmet HRSN and those scoring higher on UDI, POPDI, and GUPI (p>0.05). CONCLUSIONS: Community mobile clinic participants were more likely to report severe unmet HRSN, compared to private clinic participants. Black women have a higher prevalence of unmet HRSN, however this did not reach statistical significance with our sample size. This study contributes to an understanding of the role of social determinants of health in disease severity and access to care. This study is ongoing, with a focus on increasing our community-based participant population to better understand health determinants among underserved minorities in non-hospital settings. Source of Funding: Urology Care Foundation Research Scholar Award 2021 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e754 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmine Kannikal More articles by this author Sanjana Satish More articles by this author Aaron Gurayah More articles by this author Erin Kobetz More articles by this author Katherine Amin More articles by this author Ekene Enemchukwu More articles by this author Raveen Syan More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk of suicide after a diagnosis of sleep apnea: A nationwide longitudinal study

Previous studies have presented evidence on the association between sleep apnea and suicidal ideation and planning, but the relationship between a clinical diagnosis of sleep apnea and suicide attempts remains unknown. We investigated the risk of suicide after a diagnosis with sleep apnea using data from a nationwide community-based population database, i.e., the Taiwan National Health Insurance Research Database. We recruited 7,095 adults with sleep apnea and 28,380 age-, sex-, and comorbidity-matched controls between 1998 and 2010 and followed them up until the end of 2011. Individuals who exhibited any (once or repeated) suicide attempts were identified during the follow-up period. The E value was calculated for unmeasured bias. Sensitivity analysis was conducted. Patients with sleep apnea were more likely to carry out any suicide attempt (hazard ratio: 4.53; 95% confidence interval: 3.48–5.88) during the follow-up period than the controls after adjusting for demographic data, mental disorders, and physical comorbidities. The hazard ratio remained significant after excluding individuals with mental disorders (4.23; 3.03–5.92). The hazard ratio was 4.82 (3.55–6.56) for male patients and 3.86 (2.33–6.38) for female patients. Consistent findings of increased risk of repeated suicide attempt were found among patients with sleep apnea. No association was found between continuous positive airway pressure treatment and suicide risk. The calculated E values support suicide risk after the diagnosis of sleep apnea. The risk of suicide was 4.53-fold higher in patients diagnosed with sleep apnea than in their counterparts without sleep apnea.