Difference In Age Of Diagnosis Research Articles

Sex and intelligence quotient differences in age of diagnosis among youth with attention‐deficit hyperactivity disorder

AbstractObjectivesAttention‐deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental condition and is characterized by inattention, hyperactivity, and impulsivity. Research suggests that some populations, such as females and individuals with high intelligence quotients may be a risk for late ADHD diagnosis and subsequent treatment. Our goal is to advance our understanding of ADHD diagnosis, by examining (1) how child sex and cognitive abilities together are related to the age of diagnosis and (2) whether symptom presentation, current internalizing and externalizing symptoms, and demographic factors are related to age of diagnosis.MethodsOur analyses contained children who completed the required tests (N = 568) from a pre‐existing dataset of 1380 children with ADHD from the Province of Ontario Neurodevelopmental Disorders (POND) Network (pond‐network.ca). First, we conducted a moderation analysis with sex as the predictor, cognitive abilities as the moderator, and age of diagnosis as the outcome. Second, we conducted correlation analyses examining how symptom presentation, current internalizing and externalizing symptoms, and demographic factors are related to age of diagnosis.ResultsHigher IQ was related to a later age of diagnosis. Higher hyperactive–impulsive symptoms and externalizing symptoms were related to an earlier age of diagnosis. Internalizing symptoms were trend associated with a later age of diagnosis in girls. Higher socioeconomic status and non‐White maternal ethnicity were related to later age of diagnosis.ConclusionsIQ, sex, ADHD symptomology, internalizing symptoms, externalizing symptoms, and socio‐demographic factors affect the age of diagnosis.

Smoking and pathogenic germline variants in patients with lung cancer.

8040 Background: Few studies have investigated the correlation of smoking history with pathogenic germline variants (PGVs) in patients diagnosed with lung cancer. With emerging opportunities for PGVs in DNA damage-repair (DDR) genes to inform precision therapies, we investigated the prevalence of PGVs in patients with lung cancer, stratified by smoking status. Methods: Germline genetic testing (GGT) (Invitae Corp.) and insurance claims (Komodo Healthcare MapTM) data were reviewed for 14,317 patients with an ICD code for lung cancer from 2015-2023 and hereditary cancer GGT of ≥ 10 genes. PGV rates were assessed overall, in DDR genes and in lung cancer related genes. Smoking history was defined by ICD codes. Number of genes tested varied per ordering clinician preference. Clinically actionable PGVs were defined as those associated with clinical management recommendations or trial eligibility per current standard of care guidelines. Chi-square tests were used with significance set to p < 0.05. Results: The cohort was predominantly female (70.9%), white (65.7%), and over half had a history of smoking (57.1%). PGVs in 73 known cancer-risk genes were identified in 1,804/14,317 (12.6%) patients. Frequencies of PGV were 12.6% (1,026/8,175) in patients with smoking history compared to 12.7% (778/6,142) in those with no reported smoking history. There was no statistically significant difference in DDR gene, TP53, or EGFR PGV rates for patients with or without smoking history (p > 0.05). Mean (SD) age of lung cancer diagnosis was significantly younger for patients with a history of smoking and DDR PGVs (61 (11)) compared to those with negative results (62 (12), p = 0.005). There was no significant difference in age of diagnosis between patients with no smoking history and DDR PGVs (60 (12)) and those with negative results (59 (13), p = 0.888). PGV rates by clinician-reported ancestry: Black/African-American, 9%; Asian or Pacific Islander, 11%; Hispanic, 12%; White, 13%. Among genes with > 1,000 patients tested, PGVs were most common in BRCA2 (2.2%), CHEK2 (2.0%), ATM (1.6%), SPINK1 (1.6%), and BRCA1 (1.2%). Conclusions: In 14,317 patients with lung cancer, 12.6% had PGVs. There was no significant difference in enrichment of PGVs in DDR genes when patients were stratified by reported smoking history, suggesting the enrichment of these genes is independently associated with lung cancer. The age of onset for patients with DDR gene PGVs varied with smoking history, suggesting that risk conferred by these PGVs could be additive to smoking risk. These data reinforce prior studies supporting consideration of GGT for all patients with lung cancer, independent of age or reported smoking history.

Bone Marrow Failure and Inborn Errors of Immunity: An Immunogenomic Crossroad

Autoimmunity and immunodeficiency can coexist in a paradox fashion. Inborn errors of immunity (IEI) are a heterogeneous group of inherited disorders in which the immune system is disturbed, not only predisposing to infection, but also triggering autoimmunity. While investigating the presence of germline variants implicated in IEI in patients with T-LGL leukemia (Abstract #182344), we serendipitously found that these congenital defects were indeed more frequently encountered in cases with immune cytopenias and, specifically, with BMF. This finding motivated us to expand our investigation towards AA and PNH. With the advent of NGS, an increasing number of adult-onset IEI has been identified. As compared to classic IEI, autosomal dominant (AD) traits, with non-canonical, less-deleterious-effect variants, and mono-allelic defects for recessive (AR) diseases may occur in these cases, leading to incomplete penetrance and delayed, subclinical or even atypical expressivity. Few reports have described AA as an unusual manifestation of IEI and, more recently, complement factor H variants have been linked to PNH. 1 Here we hypothesized that rare germline variants predisposing to IEI may contribute to the pathogenesis of AA and its evolution to PNH. To comprehensively study the presence of IEI traits in such setting, we identified 398 AA/PNH patients, in 57 of whom we performed WGS. We assessed the presence of rare germline variants in rationally selected 120 IEI genes, spanning different immune defects. A stringent variant calling and categorization algorithm to avoid false positives was devised. We excluded variants defined by frequency >1% across genome resources. For the purpose of this study, we selected all pathogenic/likely pathogenic (P/LP) and variants of uncertain significance (VUS) overrepresented in our cohort (significant p value for Obs. vs. Exp. frequencies after multiple-testing correction). We identified 100 rare variants, 60 of which, involving 36 genes and carried by 37 patients, were significantly overrepresented. The combined allelic burden for these variants was 53% ( vs the expected 3% in normal genomes). All variants were heterozygous (median mutations/patient: 1, IQR: 1-2), and 23 and 37 defects involved genes linked to AD and AR traits, respectively. Overall, 11/60 variants, carried by 10/57 patients (18%), were classified as P/LP, and 10 were in 6 genes linked to AD traits, constituting sufficient basis for immune imbalance leading to disease. According to the immune pathway, 5 variants involved 3 IEI genes previously associated with BMF ( TERT, TINF2, DKC1), but most of them clustered in alternative IEI categories marked by T- or B-cell defects, autoimmunity, and innate or complement system defects ( FigA). A total of 4/6 genes with at least one P/LP were recurrently mutated ( TERT, AIRE, PRF1, BLK) including loci not previously related to BMF. Remarkably, 3 patients had alterations in a mutational hotspot in the gene AIRE linked to autoimmunity through dominant-negative effects. 2 We also studied genotype-phenotype correlations according to: 1) pathogenicity/inheritance pattern, and 2) immune pathway. Carriers of P/LP and AD defects (since VUS in AD vs AR genes are more likely to be of clinical relevance) had a higher proportion of autoimmunity (35 vs. 8% in non-carriers, p= .02) ( FigB). Despite there were no differences in age of diagnosis, severity of cytopenias or PNH clone presence, suboptimal response to immunosuppression was more frequently registered in carriers (63 vs. 37% in non-carriers, p= .04). Of note, variants associated with innate/complement system were more frequent in PNH (28 vs. 6% in AA, p= .04). Moreover, in patients with initial AA diagnosis, adjusting by sex, age, and PNH clone, innate/complement variants were associated with a higher risk of PNH evolution (aOR: 24, p= .02). Our study suggests that: 1) variants predisposing to immunodeficiency are overrepresented in BMF; 2) cryptic IEI traits may result in aberrant/incomplete response to otherwise easily cleared antigens, so that immune BMF may eventually arise in these cases from failed compensatory feedback mechanisms; and 3) different pathways are asymmetrically distributed between AA and PNH. We provide new insights on the immunogenomic crossroads between immunodeficiency and autoimmunity, and open the horizon of the IEI spectrum towards the fields of BMF and clonal hematological disorders.

Abstract 17344: Risk Factors for Disease Severity in Cardiac Laminopathy

Introduction: Disease-causative variants in LMNA -encoded lamin A/C cause a penetrant dilated cardiomyopathy associated with conduction disease (CD) and ventricular arrhythmias (VA). Prior studies show conflicting results regarding the effect of sex, variant type, and CD on severity and sudden death risk in cardiac laminopathy. Methods: In this retrospective study, we utilized a single-center genetic arrhythmogenic cardiomyopathy registry (N=432) to identify patients with ultra-rare LMNA variants and ascertain the effect of sex, mutation type, and clinical presentation on disease severity. Advanced heart failure (AHF) events were defined as ventricular assist device placement or cardiac transplantation whereas VA events were defined as sudden cardiac arrest, sustained ventricular arrhythmia, or appropriate implantable cardioverter-defibrillator shock. Results: The LMNA variant-positive cohort (N=83) had an age of diagnosis of 36 ± 10 years with 80% showing a cardiac phenotype. No difference in the age at diagnosis (37 vs. 34 years; p=0.3) or prevalence of AHF events (14% vs. 18%; p=0.8) and VA events (34% vs. 36%; p=0.9) was observed between females (N=50) and males (N=33). Furthermore, there was no difference in age of diagnosis (37 vs. 33 years; p=0.1) or prevalence of AHF (14% vs. 12%; p=0.9) and VA events (33% vs. 34%; p=0.9) between individuals with missense (N=42) or frameshift (N=32) variants. Interestingly, in comparison to individuals that presented with isolated CD (N=11) those that first presented with left ventricular dysfunction or arrhythmias (atrial or ventricular) (N=41) were more likely to have VA events (9% vs. 53%; p=0.01) and AHF events (0% vs 29%; p=0.05). In addition, those with structural/arrhythmic presentation had earlier time to VA events (15 years vs. 22 years; p=0.04) and AHF events (23 vs undefined; p=0.09) than those with CD. Conclusions: Contrary to prior studies, in this large single-center cardiac laminopathy study, sex and mutation type were not associated with increased risk of AHF or VA events. However, patients presenting with isolated CD had a lower risk of AHF and VA events. Contemporary multi-center studies are needed to better ascertain risk factors associated with AHF and VA events in cardiac laminopathy.

Sex Differences in Age of Diagnosis, HLA Genotype, and Autoantibody Profile in Children With Type 1 Diabetes.

To examine sex differences in children with newly diagnosed type 1 diabetes (T1D) with respect to age at diagnosis, presence of autoantibodies (GAD antibody [GADA], insulinoma-associated protein 2 [IA-2A], insulin autoantibody [IAA], and zinc transporter 8 autoantibody), and HLA risk. A population-based nationwide sample of 3,645 Swedish children at T1D diagnosis was used. Girls were younger at T1D diagnosis (9.53 vs. 10.23 years; P < 0.001), more likely to be autoantibody-positive (94.7% vs. 92.0%; P = 0.002), more often positive for multiple autoantibodies (P < 0.001), more likely to be positive for GADA (64.9% vs. 49.0%; P < 0.001), and less likely to be positive for IAA (32.3% vs. 33.8%; P = 0.016). Small sex differences in HLA risk were found in children <9 years of age. The disease mechanisms leading to T1D may influence the immune system differently in girls and boys.

Sex differences in age of diagnosis of autism spectrum disorder: Preliminary evidence from Uganda.

This study was performed to determine (a) the age at which autism spectrum disorder (ASD) is first diagnosed in Ugandan children receiving mental health services, (b) whether age at diagnosis varies by sex and clinical presentation, and (c) the average age of ASD diagnosis in children manifesting comorbid conditions. A retrospective chart review was performed and demographic as well as clinical data were collected from children with ASD diagnoses who attended two mental health clinics in Uganda between 2014 and 2019. Descriptive statistics such as percentages, means, and standard deviations were used to summarize the data. Independent t-test was also performed to determine differences in the mean age of diagnosis between males and females. Two hundred and thirty-seven (156 males, 81 females) children with ASD were identified. The average age of ASD diagnosis was (6.9 ± 4.0) years. A statistically significant difference in age of ASD diagnosis was found between males and females (t=-2.106, p=0.036), such that on average females received a diagnosis at least 1 year later than males. Of the 237 participants, 53.6% were identified with ASD only, 16.0% had ASD and ADHD, 10.5% were diagnosed with ASD and epilepsy, and 7.2% had a diagnosis of complex ASD. The results confirm delays in access to ASD diagnosis and suggest that females are more likely to receive a ASD diagnosis later than males within the Ugandan context. ASD awareness should be intensified to improve public or professional knowledge about ASD to enhance early identification in Uganda.

P105 EOSINOPHILIC ESOPHAGITIS SYMPTOMS, DIAGNOSIS, AND TREATMENT IN HISTORICALLY UNDERREPRESENTED POPULATIONS

Phenotypic differences in age of diagnosis, symptoms, and eosinophil count have been reported among different racial/ethnic groups of eosinophilic esophagitis (EoE) patients. Our objective was to further characterize minority EoE patients in order to identify any health disparities.

P633 Clinical epidemiology of Inflammatory Bowel Disease in Lbanon

Abstract Background The worldwide epidemiology of Inflammatory Bowel Disease (IBD) is changing. Increasing Crohn’s disease (CD) and Ulcerative Colitis (UC) incidence and prevalence have been recorded. In Lebanon, the current status of IBD is not well known. Methods The aim is to report patients’ characteristics newly diagnosed with IBD in Lebanon based on Montreal classification and to report the prevalence and the incidence of IBD in the Lebanese population during a period of 20 years. This is a retrospective study conducted in collaboration with the National Institute of Pathology, from January 2001 till December 2020 were reviewed. Patients were characterized based on: sex, age at diagnosis, year of diagnosis, location and extension of the disease. Results A total of 3101 new IBD cases were identified (1504 UC, 1597 CD), mean age for UC and CD was 41.05 years and 36.5 years, respectively. sex ratio (M/F) of 1.15 and 1.29 in UC and CD, respectively. In UC, the 3 age groups distribution, ≤ 16 years, 17–40 years and &amp;gt; 40 years were 5.72%, 47.83% and 40.45%, respectively. Regarding the location distribution, E3 was the most prevalent (55.6%), followed by E1 (24.6%) and E2 (19.8%); with no difference between male and female. Similar pattern of location distribution was noted in the 3 age groups. There was no difference in age of diagnosis but a significant increase of E3 from 40% (2001–2010) to 60% (2011–2020) was noted. In CD, 5.54%, 58.93% and 35.53% of patients were aged ≤ 16 years, 17–40 years and &amp;gt; 40 years, respectively. L1, L2, L3 and L4 represented 57.8%, 16.72%, 23.42% and 1.88% of the location distribution, respectively; without difference between male and female. L1 is significantly higher in the young age groups (≤ 16 years: 68.75% and 17–40 years: 67.72%) compared to the older age group (&amp;gt; 40 years: 39.06%) whereas L2 and L3 were higher in the older age group. When divided into two 10-year periods, there was a significant increase of L1 (63%) in the last 10 years (2010–2020) compared to the 10 years before (40%) and an increase of the disease incidence in the age group 17–40 years. Based on all these data, we calculated the incidence of UC and CD and their progression during this period of 20 years. We noted a progressive increase of the incidence of IBD, especially for CD in the last 3 years. The cumulative incidence of UC and CD were 4.686 and 4.582, respectively. The prevalence of UC and CD were 69.9 par 100000 and 68.35 per 100000, respectively. Conclusion The mean age of IBD in Lebanon is higher than that described in Europe and North America. Pancolitis in UC and ileal involvement in CD remain the most common forms found. There was an increase of the incidence of IBD during the last 20 years and especially of CD during the last 3 years

34P Sex and age differences in primary lung cancer in Morocco: An epidemiologic study

Background: Lung cancer is a leading cause of death worldwide. In Morocco, it is the most commonly occurring cancer in men. The aim of this study is to determine the epidemiological and histological profile of primary lung cancer in Rabat (capital of Morocco) over a 4-year period, from 2014 to 2017, by sex and age. Methods: This is a descriptive retrospective study of all patients with primary lung cancer diagnosed and treated at Ibn Sina University Hospital Center in Rabat during the period from January 2014 to December 2017. The data were collected from medical records for each patient. Statistical analysis was performed using Epi InfoTM7. Results: During the period of study, 574 new cases of primary lung cancer were diagnosed. Of these, 87.5% were men and 12.5% were women, giving a male-female ratio of 7. The average age of patients at diagnosis was 58.4 years (range 21–85 years). There was no significant gender difference in average age. The age distribution show that 19.9% of patients were aged less than 50 years, 29.7% were in the 50–59-year age group, 33.8% were aged between 60 and 69 years and 16.5% were aged 70 years and older. According to the results, 7.3% of lung cancers were small cell lung cancer (SCLC) and 90.9% were non-small cell lung cancer (NSCLC). Adenocarcinoma was the most frequent cell type of lung cancer, with 60.45%, followed by squamous cell carcinoma, with 23%. According to gender, adenocarcinoma was more common in women (70.8%) than in men (58.4%), while squamous cell carcinoma was relatively frequent in men (24.7%) than in women (11.1%). There was no significant difference in age of diagnosis, by histological type of lung cancer. Conclusions: Lung cancer is a serious and potentially deadly disease in Morocco. It is important to develop strategies that take into account the current trends in lung cancer and target particularly groups at risk. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Cholesteatoma and family history: An international survey.

To explore the relative frequency of a family history of cholesteatoma in patients with known cholesteatoma, and whether bilateral disease or earlier diagnosis is more likely in those with a family history. Associations between cleft lip or palate and bilateral disease and age of diagnosis were also explored. An online survey of patients with diagnosed cholesteatoma was conducted between October 2017 and April 2019. The sample consisted of patients recruited from two UK clinics and self-selected respondents recruited internationally via social media. Side of cholesteatoma, whether respondents had any family history of cholesteatoma, age of diagnosis and personal or family history of cleft lip or palate were recorded. Of 857 respondents, 89 (10.4%) reported a positive family history of cholesteatoma. Respondents with a family history of cholesteatoma were more likely to have bilateral cholesteatoma (P=.001, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.35-3.43), but there was no difference in the age of diagnosis (P=.23). Those with a history of cleft lip or palate were not more likely to have bilateral disease (P=.051, OR 2.71, CI 1.00-7.38), and there was no difference in age of diagnosis (P=.11). The relatively high proportion of respondents that reported a family history of cholesteatoma offers supporting evidence of heritability in cholesteatoma. The use of social media to recruit respondents to this survey means that the results cannot be generalised to other populations with cholesteatoma. Further population-based research is suggested to determine the heritability of cholesteatoma.

Retinal hemangioblastomas in Von Hippel‐Lindau germline mutation carriers: progression, complications and treatment outcome

AbstractPurposeEvaluating the phenotype, complications and treatment outcome of retinal hemangioblastomas (RH) and correlating this features with the genotype of Von Hippel‐Lindau (VHL) germline mutation carriers.MethodsRetrospective analysis of the medical and genetic records of 21 individuals with a VHL germline mutation and a diagnosis of RH. Germline mutation status was correlated to phenotype, complications, treatment methods and outcomes. Mutations were categorized in two genotypic categories: the truncating mutation (TM) group and the missense mutation (MM) group.ResultsFrom the 36 VHL germline mutation carriers, 21 VHL patients developed RH. Prevalence of RH in VHL disease was higher in TM carriers (15 of 21, 68.2%) vs. 40% of the MM carriers (6 of 15). The mean age of diagnosis of RH was 25.7 years. There was no significant difference in age of diagnosis of RH between genotypic categories (P = 0.931). Mean follow‐up duration was 16.3 years and did not differ significantly between the mutation groups (P = 0.383). Bilateral involvement was observed in 66.7% of the patients. Missense mutation (MM) carriers (n = 6) developed more RH (more than 5 RH: 50.0% vs. 38.5%), had a larger extent of peripheral retinal involvement of ocular VHL disease (66.7% vs. 35.7% all quadrants involved) and developed more progression‐related complications compared to TM carriers (n = 15) (100% vs. 46.7%). Complete tumor regression at last recorded visit was achieved in fifteen patients (71.4%). Moderate (VA 20/80 to 20/200) to severe (less than VA 20/200) visual impairment was observed in 53.3% of the eyes of MM carriers and 28.1% of the eyes of TM carriers at last recorded visit.ConclusionsGermline mutation status might play a role in the course of progression of RH in VHL disease. In our observational study, VHL missense mutation carriers had a more complicated progression of RH than carriers of a truncating mutation.

761 Increased Risk of Preeclampsia in Women With Inflammatory Bowel Disease on Anti-TNF Therapy

INTRODUCTION: Women with inflammatory bowel disease (IBD) are at an increased risk of adverse pregnancy outcomes. Some observational studies have demonstrated a possible association between IBD and the risk preeclampsia. There is evidence of immune dysregulation in preeclampsia; in particular, upregulation of TNF-α. Our hypothesis was that anti-TNF therapy in pregnancy may decrease the risk of preeclampsia in women with IBD. METHODS: We identified cases of preeclampsia from among patients with IBD followed at a tertiary care center. We selected two random controls with a normotensive pregnancy for each case, matched only on disease type (ulcerative colitis vs. Crohn's). We collected data on age, race, pre-pregnancy hypertension, diabetes, smoking, medication use and disease activity. RESULTS: We identified 9 women with preeclampsia and 18 controls as reported during patient interviews. Demographic and clinical characteristics are shown in Table 1. There was no significant difference in age of diagnosis of IBD, previous diagnoses of hypertension or diabetes, tobacco use, age at delivery, or nulliparity. The majority of women (8/9) stopped their anti-TNFα therapy in the third trimester. Women who developed preeclampsia were more likely to be on thiopurine or biologic therapy during pregnancy (100% vs. 39%, P &lt; 0.01). Other pregnancy complications included preterm delivery in 6 participants (3 in each group) and 1 participant with each of the following: Clostridium difficile colitis, small bowel obstruction, post-partum hemorrhage and intrauterine growth restriction. There was no significant difference between cases and controls in regard to the number of flares during pregnancy. Using univariate logistic regression, we found a significant increase in the odds of having preeclampsia in women on anti-TNF therapy as compared to women not on anti- TNF therapy (OR 6.25; 95% CI 1.09-43.7). CONCLUSION: Women with inflammatory bowel disease on anti-TNF therapy are at an increased risk of developing preeclampsia. This finding suggests that the risk of preeclampsia in IBD may be associated with the severity of the underlying disease and degree of inflammation necessitating the biologic therapy. Despite therapy targeting TNFα, a possible pathologic actor in preeclampsia, women on anti- TNF therapy remain at an increased risk of preeclampsia, though this may be in part due to the fact that most women discontinue anti-TNF therapy in the third trimester.

Abstract 5047: Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015

Abstract Introduction: Human papillomavirus (HPV) is the most common etiology of oropharyngeal squamous cell carcinoma (OPSCC), causing 70-90% of cases, and has continued to increase in incidence. While HPV-associated OPSCC has been associated with younger age at diagnosis compared to other head and neck cancers, research studies suggest that age of diagnosis might have increased in the last decade. There is currently no long-term, population-based estimate of age of diagnosis of oropharyngeal cancer, or differences in age of diagnosis based on race and gender. This study aimed to describe the change if any in the age of diagnosis of OPSCC in the last four decades. Methods: The mean age at diagnosis of OPSCC patients from the Surveillance, Epidemiology, and End Results (SEER) 9 database diagnosed from 1975-2015 was computed for each year (n = 30,320). An independent samples t-test compared mean age at diagnosis by sex (female, male), and analysis of variance compared mean age at diagnosis by race/ethnicity (Hispanic, non-Hispanic (NH) white, NH black, NH other). Joinpoint regression estimated yearly increases/decreases in mean age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Results: OPSCC patients were predominantly NH white (80.0%) and male (76.8%) with a mean age at diagnosis of 60.3 years (standard deviation = 10.9 years). Females had a significantly higher mean age at diagnosis than males (62.4 versus 59.7, p &amp;lt; 0.01). Hispanic (mean = 59.2) and NH black patients (mean = 57.3) had a significantly lower mean age at diagnosis than NH white patients (mean = 60.8). Overall, mean age at diagnosis remained stable from 1975-1996 (APC = 0.00, p &amp;gt; 0.05), significantly decreased from 1996-2002 (APC=-0.86, p &amp;lt; 0.01), and significantly increased from 2002-2015 (APC = 0.35, p &amp;lt; 0.01). However, the overall AAPC showed a stable trend in age of diagnosis from 1975-2015 (AAPC = -0.02, p &amp;gt; 0.05). The AAPCs in age of diagnosis for gender (males and females) and race/ethnicity also both remained stable from 1975-2015 (p &amp;gt; 0.05), except for NH blacks, with an estimated 0.13% yearly increase in age of diagnosis from 1975-2015 (AAPC = 0.13, p &amp;lt; 0.01). Conclusions: The overall age at diagnosis for OPSCC has remained stable in the United States between 1975 and 2015. The younger age at diagnosis among NH blacks and Hispanics is important in prevention, early detection, and surveillance of OPSCC in the United States Citation Format: Brittany J. Cline, Matthew C. Simpson, Aleksandr R. Bukatko, Eric Adjei Boakye, Kahee A. Mohammed, Nosayaba Osazuwa-Peters. Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5047.

Service Preferences of Parents of Children With Mild Bilateral or Unilateral Hearing Loss: A Conjoint Analysis Study

Universal newborn hearing screening results in substantially more children with mild bilateral and unilateral hearing loss identified in the early years of life. While intervention services for children with moderate loss and greater are generally well-established, considerable uncertainty and variation surrounds the need for intervention services for children with milder losses. This study was undertaken with parents of young children with permanent mild bilateral and unilateral hearing loss to examine their preferences for characteristics associated with intervention services. Conjoint analysis, a preference-based technique, was employed to study parents' strength of preferences. Using a cross-sectional survey that consisted of eight hypothetical clinic scenarios, we invited parents to make a discrete choice (to select one of two or more different services) between available services with different characteristics. The survey was informed by qualitative interviews conducted for this purpose. The questionnaire was administered to parents receiving intervention services in the province of Ontario, Canada, who were enrolled in a mixed-methods longitudinal study examining outcomes in early-identified children with mild bilateral/unilateral hearing loss. Data were analyzed using a generalized linear model (probit link) to identify attributes of interest for the respondents. Characteristics of the children were entered into the model to control for differences in age of diagnosis, sex, laterality of hearing loss, and hearing aid use. A total of 51 of 62 invited parents completed the questionnaire. All four attributes of care that were included in the survey were found to be statistically significant, that is, parents valued support for amplification, support for speech-language development, emotional support, and communication from professionals. Analysis showed greater preference for enhanced levels relating to support for speech-language development than for support for amplification. Preference for attributes relating to emotional support and communication were also greater than for support for amplification use. Conjoint analysis was used to quantify parents' preferences for service attributes. Parents' values provide insights into the aspects of a service model that should receive consideration in the development of intervention programs for young children with mild bilateral or unilateral hearing loss and their families. Although parents of young children with mild bilateral or unilateral hearing loss valued several components of care, they indicated a clear preference for speech-language support compared with support for amplification use.

Epidemiologic, prognostic, and treatment factors in sinonasal diffuse large B -cell lymphoma.

To further characterize the epidemiology, prognostic disease-specific factors, and treatment outcomes-including newly available chemotherapy data-for patients with sinonasal diffuse large B-cell lymphoma (DLBCL). The Surveillance, Epidemiology, and End Results registry was queried from 1973 to 2015 for patients with DLBCL of the nasal cavity and paranasal sinuses. Demographic and disease parameters were collected. Prognostic disease-specific survival and overall survival factors were evaluated with univariate Kaplan-Meier analysis. Significant variables were analyzed with multivariate Cox regression analysis. A total of 1,273 cases of DLBCL of the sinonasal tract were identified. Significant differences in age of diagnosis between men (65.3) and women (71.1) existed (P < .01). Most common primary sites of DLBCL were maxillary sinus (36.1%) and nasal cavity (34.5%), with nasal cavity more common among Asian/Pacific Islands (43.4%) and maxillary sinus more common for Caucasians (36.3%) and African Americans (42.1%). Overall survival was 70% at 2 years, 54% at 5 years, and 38% at 10 years. Disease-specific survival was 81%, 73%, and 67%, respectively. Chemotherapy (hazard ratio [HR]: 0.551; P < .001) and radiation therapy (HR: 0.818; P = .012) were associated with improved prognosis, whereas higher Ann Arbor stage worsened prognosis (HR: 1.21; P < .001). Surgical intervention did not significantly impact survival. This is the first study to include chemoradiation therapy in population-based analysis of sinonasal DLBCL. Chemotherapy and radiation therapy use significantly improve survival in these patients, whereas Ann Arbor staging is significantly associated with poorer outcomes. The mainstay of treatment for DLBCL should remain combination chemoradiation. NA Laryngoscope, 129:1259-1264, 2019.

Laryngomalacia in Patients With Craniosynostosis.

To characterize differences in the clinical presentation and treatment outcomes of laryngomalacia in patients with and without craniosynostosis. A retrospective cohort study was performed comparing all patients with concomitant laryngomalacia and craniosynostosis seen at a tertiary care children's hospital between 2000 and 2016 with a control group of patients with isolated laryngomalacia. Thirty-two patients with craniosynostosis (59% male) and 68 control patients (56% male) were included. There were no significant differences in age of diagnosis or incidence of prematurity. Symptom presentation, disease severity, swallowing function, comorbidities, treatment modalities, and outcomes were examined using logistic regression. Patients with craniosynostosis had increased odds of presenting with stertor (odds ratio [OR] = 3.41, P = .022), increased work of breathing (OR = 18.8, P = .007), obstructive sleep apnea (OR = 8.48, P = .003), dysphagia (OR = 3.40, P = .008), and aspiration (OR = 40.2, P < .001) and decreased odds of presenting with stridor (OR = 0.0804, P < .001) compared with controls. Patients with craniosynostosis had increased odds of severe laryngomalacia (OR = 5.00, P = .031) and other airway anomalies such as tracheomalacia (OR = 5.73, P = .004), bronchomalacia (OR = 15.5, P = .013), and subglottic stenosis (OR = 2.75, P = .028). Treatment of patients with craniosynostosis was more likely to include tracheostomy (OR = 24.8, P < .001) and gastrostomy tube (OR = 88.4, P < .001). There were no significant differences in rates of supraglottoplasty. Clinical presentations, comorbidities, and treatments of laryngomalacia are significantly different in the context of craniosynostosis.

Hepatocellular carcinoma in South America: Evaluation of risk factors, demographics and therapy.

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Most studies addressing the epidemiology of HCC originate from developed countries. This study reports the preliminary findings of a multinational approach to characterize HCC in South America. We evaluated 1336 HCC patients seen at 14 centres in six South American countries using a retrospective study design with participating centres completing a template chart of patient characteristics. The diagnosis of HCC was made radiographically or histologically for all cases according to institutional standards. Methodology of surveillance for each centre was following AASLD or EASL recommendations. Sixty-eight percent of individuals were male with a median age of 64years at time of diagnosis. The most common risk factor for HCC was hepatitis C infection (HCV, 48%), followed by alcoholic cirrhosis (22%), Hepatitis B infection (HBV, 14%) and NAFLD (9%). We found that among individuals with HBV-related HCC, 38% were diagnosed before age 50. The most commonly provided therapy was transarterial chemoembolization (35% of HCCs) with few individuals being considered for liver transplant (<20%). Only 47% of HCCs were diagnosed during surveillance, and there was no difference in age of diagnosis between those diagnosed incidentally vs by surveillance. Nonetheless, being diagnosed during surveillance was associated with improved overall survival (P=.01). Our study represents the largest cohort to date reporting characteristics and outcomes of HCC across South America. We found an important number of HCCs diagnosed outside of surveillance programmes, with associated increased mortality in those patients.

Histological features and survival in NSCLC patients treated with surgery with curative intention.

e20080 Background: New classification of adenocarcinomas and better typing of histological characteristics of lung tumors leads us to wonder if these histological data could have a prognostic repercussion in the NSCLC who were into curative intent surgery Methods: We followed 95 patients with stage I-III NSCLC underwent surgery in a 4 year period (2010-2013), until August 2016. Most patients were male (82%), smokers (90%, 44% exsmokers and 56% active , median age at diagnosis was 64 years, 47% had a previous COPD, and 52% were diagnosed of NSCLC without any symptom of lung cancer. 79% patients had lobectomy or sleeve resection, and 21% pneumonectomy. 47% patients had adjuvant chemotherapy (CT) Results: We found no significant differences in age of diagnosis between men (64.95 y) and women (58.65 y) (p = 0.066) nor in survival time. Median disease-free survival (DFS) is 15 months and overall survival (OS) is 49 months. If we analyze DFS from surgery to the first relapse, most happen at first 2 years (80%). By stage, OS at 5 years is 73% in stage IA, 58% stage IB, 46% stage IIA, 36% stage IIB, 24% for stage IIIA and 9% in IIIB. We had 49% adenocarcinomas (most frequent, 53%, acinar subtype), and 51% squamous, and we found no significant difference between histologies, nor between subtypes. But there was a significant difference between DFS, favorable for mild lymphoid response (20 months) with respect to moderate or intense response (11 months) Conclusions: We found that we are underusing adjuvant CT. In our group there is no difference in survival for tumor size, linfovascular invasion, histological grade or histology, but we found a better DFS for mild lymphoid response vs moderate-intense pattern. This finding may be related to the antitumor activity of the immune system, and we want to validate it prospectively, and its relationship with subsequent immune therapy response.

Are males and females with autism spectrum disorder more similar than we thought?

Differences in behavioral and cognitive profiles have been suggested to potentially impact the presentation of social and communication symptoms in females with autism spectrum disorder. This study examined gender differences in age of diagnosis, cognitive profiles, social communication symptomatology, and autism spectrum disorder symptom severity in a community-based sample of 566 males and 113 females with autism spectrum disorder ranging in age from 1 year, 9 months to 56 years, 4 months. Results suggest either very small or no gender differences in age at diagnosis, intelligence quotient, cognitive profiles, or autism spectrum disorder symptom severity. This is a departure from clinical lore that females with autism spectrum disorder are more likely to have lower intelligence quotient and more severe impairments. There is a slight difference in symptom severity with females having higher average total Childhood Autism Rating Scale scores, but this difference is likely of minimal clinical significance. In contrast, on the Autism Diagnostic Observation Schedule-Generic, females were found to receive lower scores than males particularly on modules 2 and 3. Across males and females, individuals with stronger verbal problem-solving skills were found to receive lower Autism Diagnostic Observation Schedule-Generic module 3 scores. Given the language demands of this module, additional attention may be warranted when evaluating older children and adolescents for autism spectrum disorder.

Factors That Affect Age of Identification of Children With an Autism Spectrum Disorder

This study explored factors associated with age of identification of autism spectrum disorder (ASD). Results of a one-way ANOVA indicated differences in age of diagnosis among the four regions in the United States, F(3, 650) = 7.618, p = .01. Tukey’s post hoc comparisons of the groups indicated that the mean age of diagnosis in the Midwest ( M = 38.9 months or 3 years, 3 months) was significantly later than in the Northeast ( M = 32.75 months or 2 years, 9 months, p = .000) and South ( M = 33.26 months or 2 years, 9 months, p = .000). Results of a Pearson correlation indicated a significant negative correlation ( r = −.409, n = 654, p = .000) between date of birth and age of diagnosis, with more recent birthdays associated with lower age of diagnosis. Regression results were statistically significant, F(25, 620) = 7.549, p &lt; .001, R2 = .233, with some factors predicting earlier age of diagnosis and some factors predicting later diagnosis.