Differences In Distribution Of Risk Factors Research Articles

Etiology and Risk Factors of Ischemic Stroke in Young Adults: A Mongolian Two-Center Study

Introduction: Young adults experiencing ischemic stroke often present with distinct risk factors and underlying causes that are less prevalent or different compared to older individuals. However, the existing classifications may not fully capture the unique risk and etiological factors specific to young adults. In this study, we utilized a modified risk factor categorization derived from the International Pediatric Stroke Study (IPSS) to analyze the risk factor profiles of Mongolian young patients diagnosed with ischemic stroke. Methods: This study is a retrospective analysis conducted at two medical centers. We included patients between the ages of 18 and 49 years who were admitted to the First and Third Central Hospitals of Ulaanbaatar for their first-ever ischemic stroke during the period from 2018 to 2021. The study aimed to consecutively collect and analyze the risk factors of these patients, which were subsequently categorized into 10 groups based on the modified IPSS criteria. We also examined the potential differences in risk factor distribution based on both sex and age, thereby exploring any notable variations among these patient subgroups. Results: The study included a total of 306 patients, with a median age of 42 years, and 60.5% of the participants were men. Among all patients, at least one IPSS risk factor category was identified in 91.5% of the cases. The most common IPSS subtype observed was atherosclerosis-related risk factors, accounting for 81% of the cases followed by cardiac disorders (16%), chronic systemic conditions (13.1%), arteriopathy (11.4%), and chronic head and neck disorders (6.2%). The prevalence of chronic systemic conditions was higher in patients aged below 35 years (16.7% vs. 11.4%) and in women (21.5% vs. 7.6%, p < 0.05). Atherosclerosis-related risk factors were more dominant in patients aged 35 years and older (87.1% vs. 67.7%, p < 0.0001) and in men (93.0% vs. 62.8%, p < 0.0001). Conclusions: The IPSS classification has the potential to serve as an effective tool in identifying the risk factors associated with ischemic stroke in young adults

Association of Multiple High-Risk Factors on Observed Outcomes in Real-World Patients With Advanced Ovarian Cancer Treated With First-Line Therapy.

To identify risk factors for disease progression or death and assess outcomes by risk categories in real-world patients with advanced ovarian cancer. This retrospective study included adult patients from a nationwide electronic health record-derived deidentified database with stage III/IV ovarian cancer who received first-line therapy and had ≥12 weeks of follow-up after index date (end of first-line therapy). Factors predictive of time to next treatment and overall survival (OS) were assessed. Patients were grouped according to the cumulative number of high-risk factors present (stage IV disease, no debulking surgery or neoadjuvant therapy and interval debulking surgery, visible residual disease after surgery, and breast cancer gene [BRCA] wild-type disease/unknown BRCA status), and time to next treatment and OS were assessed. Region of residence, disease stage, histology, BRCA status, surgery modality, and visible residual disease were significant predictors of time to next treatment; age, Eastern Cooperative Oncology Group performance status, disease stage, BRCA status, surgery modality, visible residual disease, and platelet levels were significant predictors of OS (N = 1,920). Overall, 96.4%, 74.1%, and 40.3% of patients had at least 1, 2, or 3 high-risk factors, respectively; 15.7% of patients had all four high-risk factors. Observed median time to next treatment was 26.4 months (95% CI, 17.1 to 49.2) in patients with no high-risk factors and 4.6 months (95% CI, 4.1 to 5.7) in patients with four high-risk factors. Observed median OS was shorter among patients with more high-risk factors. These results underscore the complexity of risk assessment and demonstrate the importance of assessing a patient's cumulative risk profile rather than the impact of individual high-risk factors. They also highlight the potential for bias in cross-trial comparisons of median progression-free survival because of differences in risk-factor distribution among patient populations.

P81 IMPACT OF CORONAROGRAPHY AND CORONARY ANGIOPLASTY ON MORTALITY IN A COHORT OF PATIENTS WITH NEW–ONSET HEART FAILURE IN ITALY

Abstract Background Although myocardial ischemia and coronary artery disease play a crucial role in the pathophysiology of new–onset heart failure (HF), the impact of coronary angiography and percutaneous coronary angioplasty (PCI) revascularization on HF mortality is not well clarified. Objective To evaluate the efficacy of performing coronary angiography and PCI in reducing medium–term outcomes in a cohort of patients hospitalized with new–onset HF in Italy. Methods Retrospective cohort study enrolling all patients aged 18–100 years hospitalized for new–onset heart failure in an Italian accredited public or private hospital in the years 2015–2019 and survived 30 days after index hospitalization. Patients with a prior diagnosis of CAD were excluded from the analysis. The enrolled patients were classified into: patients not undergoing coronary angiography (No CVG); patients undergoing coronary angiography without PCI (CORO) and patients undergoing coronary angiography and PCI (PCI). The primary outcome measure of the study was all–cause mortality 1 year after the index hospitalization. A multivariate Cox model estimated through a stepwise procedure was used to compare the study groups taking into account the different distribution of risk factors. Results 342,090 hospitalizations for new–onset HF were recorded in Italy during the study period. Of these, 32,240 (9.42%) patients underwent coronary angiography without PCI and only 5,890 (1.72%) underwent PCI as well. Patients undergoing an invasive procedure were on average younger (mean age =80.7 in No CVG, 69.0 in CORO and 72.3 in PCI), with a lower percentage of women (58.8% in No CVG, 37.0% in CORO and 27.6% in PCI) and with fewer comorbidities than untreated. After adjusting for gender, age, and comorbidities, coronary angiography was protective versus no treatment whether performed alone (HR=0.57; p<0.0001) or followed by PCI (HR=0.67; p<0.0001). 0.0001). Conclusions In this cohort of consecutive patients with new–onset HF, coronary angiography and/or PCI was associated with a significant reduction in 1–year mortality.

Cancer burden in adolescents and young adults in Europe

Cancer epidemiology is unique in adolescents and young adults (AYAs; aged 15-39 years). The European Society for Medical Oncology/European Society for Paediatric Oncology (ESMO/SIOPE) AYA Working Group aims to describe the burden of cancers in AYAs in Europe and across European Union (EU) countries. We used data available on the Global Cancer Observatory. We retrieved crude and age-standardised (World Standard Population) incidence and mortality rates. We reported about AYA cancer burden in Europe and between 28 EU member states. We described incidence and mortality for all cancers and for the 13 cancers most relevant to the AYA population. Incidence and mortality varied widely between countries with the highest mortality observed in Eastern EU countries. Cancers of the female breast, thyroid and male testis were the most common cancers across countries followed by melanoma of skin and cancers of the cervix. Variations in cancer incidence rates across different populations may reflect different distribution of risk factors, variations in the implementation or uptake of screening as well as overdiagnosis. AYA cancer mortality disparities may be due to variation in early-stage diagnoses, different public education and awareness of cancer symptoms, different degrees of access or availability of treatment. Our results highlight the future health care needs and requirements for AYA-specialised services to ensure a homogeneous treatment across different countries as well as the urgency for preventive initiatives that can mitigate the increasing burden.

Multiple third‐variable analysis for competing risk data—With an application to explore racial disparity in breast cancer recurrence

There are many racial and ethnic disparities in cancer outcomes. Through special studies supported by CDC, we found that compared with Caucasians, African‐American women with breast cancer were more likely to have cancer recurrences. We are interested in exploring this racial disparity by identifying risk factors that contribute to the disparity and quantify their effects. Cancer may recur after a disease‐free (cancer cannot be detected) period. In exploring cancer recurrences, it is important to take into account competing events, for example, a patient died of cancer but never had a disease‐free period. We propose the use of the Fine‐Gray model in the multiple third‐variable analysis to explore the racial disparity. The challenges were that we have to deal with left‐truncated and right‐censored data and use different weights in the third‐variable analysis when exploring different distributions of risk factors among different racial populations. We propose an algorithm for the analysis and apply the method to explore the racial disparity in cancer recurrence on breast cancer patients diagnosed in 2011 in Louisiana. The racial disparity in breast cancer recurrence was partially explained by the tumour characteristics at the time of diagnosis, cancer subtypes and treatment, and the patients' residential environmental conditions. We are able to explain 50% of the disparity. The method is implemented in the R package mma.

Incidence of malignancies in patients with multiple sclerosis versus a healthy matched cohort: A population-based cohort study in the Netherlands using the PHARMO Database Network

This study estimated the incidence of malignancy in patients with multiple sclerosis (MS) versus a matched general population cohort in the Netherlands. Adults with a diagnosis of MS between 2006 and 2014 in the General Practitioner (GP) Database of the PHARMO Database Network with ≥ 1 year of patient history were matched to four non-MS individuals based on year of birth, sex, and GP practice. Patients were followed-up until the earliest malignancy diagnosis, death, or end of data collection. Age-adjusted incidence rates (IR) were measured overall and by cancer type. Standardized incidence ratios (SIR) were calculated as the ratio of stratification-specific IRs in the MS and non-MS cohorts. A total of 1,692 MS patients were matched to 6,768 non-MS patients. Age-adjusted IR of any malignancy, excluding non-melanoma skin cancer (n = 27), in the MS cohort was 48.3 (95%CI:30.1–66.5) per 10,000 PY. An increased incidence of any malignancy was observed in the MS cohort versus the non-MS cohort (SIR 1.8 [95%CI:1.1–2.5]). The most commonly observed malignancies in the MS cohort were breast cancer (n = 8; IR 20.4 [95%CI:6.3–34.5] per 10,000 PY) and melanoma (n = 6; IR 14.8 [95%CI:3.0–26.7] per 10,000 PY). The corresponding SIR observed between cohorts was 1.4 (95%CI:0.4–2.4) and 3.4 (95%CI:0.7–6.2), respectively. While the small increased incidence of malignancy in the MS cohort could be an artefact created by a different distribution of risk factors, an increased incidence of malignancy in MS patients in the Netherlands cannot be excluded.

Breast Cancer Population Attributable Risk Proportions Associated with Body Mass Index and Breast Density by Race/Ethnicity and Menopausal Status.

Overweight/obesity and dense breasts are strong breast cancer risk factors whose prevalences vary by race/ethnicity. The breast cancer population attributable risk proportions (PARP) explained by these factors across racial/ethnic groups are unknown. We analyzed data collected from 3,786,802 mammography examinations (1,071,653 women) in the Breast Cancer Surveillance Consortium, associated with 21,253 invasive breast cancers during a median of 5.2 years follow-up. HRs for body mass index (BMI) and breast density, adjusted for age and registry were estimated using separate Cox regression models by race/ethnicity (White, Black, Hispanic, Asian) and menopausal status. HRs were combined with observed risk-factor proportions to calculate PARPs for shifting overweight/obese to normal BMI and shifting heterogeneously/extremely dense to scattered fibroglandular densities. The prevalences and HRs for overweight/obesity and heterogeneously/extremely dense breasts varied across races/ethnicities and menopausal status. BMI PARPs were larger for postmenopausal versus premenopausal women (12.0%-28.3% vs. 1.0%-9.9%) and nearly double among postmenopausal Black women (28.3%) than other races/ethnicities (12.0%-15.4%). Breast density PARPs were larger for premenopausal versus postmenopausal women (23.9%-35.0% vs. 13.0%-16.7%) and lower among premenopausal Black women (23.9%) than other races/ethnicities (30.4%-35.0%). Postmenopausal density PARPs were similar across races/ethnicities (13.0%-16.7%). Overweight/obesity and dense breasts account for large proportions of breast cancers in White, Black, Hispanic, and Asian women despite large differences in risk-factor distributions. Risk prediction models should consider how race/ethnicity interacts with BMI and breast density. Efforts to reduce BMI could have a large impact on breast cancer risk reduction, particularly among postmenopausal Black women.

The Role of Gender in the Importance of Risk Factors for Coronary Artery Disease.

Identification of risk factors and their importance in different genders is essential in order to prevent, diagnose, and manage coronary artery disease (CAD) properly. The present study aims to investigate the role of gender in the distribution of different risk factors in ischemic heart disease. This study is a cross-sectional study. More than one thousand (N = 1012) patients referring to the Nuclear Medicine Department in Namazi Hospital, Shiraz, Iran, from March 2017 to March 2018 were studied. The patients' demographic data and their clinical history were collected. The results of the myocardial perfusion scan were recorded and compared between groups. Statistical analysis was implemented by SPSS version 18.0, and P values below 0.05 were considered statistically significant. Out of the 1012 patients participating in this study, 698 (69%) were female and 314 (31%) were male. Ischemic heart disease (IHD) was significantly higher in men compared to women (19.1% versus 14.2%). The higher levels of systolic and diastolic blood pressures, along with older age, were a significant risk factor in women (P < 0.05). Previous myocardial infarction (MI), diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HLP) had a strong correlation with IHD in our female population. Regarding the male subjects, previous MI and HLP had a lower correlation with IHD. Based on our logistic regression models, investigation of the simultaneous effects of risk factors on IHD showed that previous MI is the most effective risk factor in females (OR = 3.93) mostly in terms of residual ischemia in the infarcted myocardium. In the male population, on the other hand, HTN was identified as the most effective risk factor for IHD (OR = 2). In conclusion, we found that older age, higher blood pressure, DM, previous MI, HTN, and HLP have a significant association with IHD in the female population, whereas older age, DM, and HTN were significant risk factors for IHD in males. Also, the most effective factor for women was previous MI, while it was HTN for the male population.

Reproductive factors and risk of breast cancer by tumor subtypes among Ghanaian women: A population-based case-control study.

Higher proportions of early-onset and estrogen receptor (ER) negative cancers are observed in women of African ancestry than in women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status may explain this disparity. We analyzed data from 1,126 cases (aged 18-74 years) with invasive breast cancer and 2,106 controls recruited from a population-based case-control study in Ghana. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for menstrual and reproductive factors using polytomous logistic regression models adjusted for potential confounders. Among controls, medians for age at menarche, parity, age at first birth, and breastfeeding/pregnancy were 15 years, 4 births, 20 years and 18 months, respectively. For women ≥50 years, parity and extended breastfeeding were associated with decreased risks: >5 births vs. nulliparous, OR 0.40 (95% CI 0.20-0.83) and 0.71 (95% CI 0.51-0.98) for ≥19 vs. <13 breastfeeding months/pregnancy, which did not differ by ER. In contrast, for earlier onset cases (<50 years) parity was associated with increased risk for ER-negative tumors (p-heterogeneity by ER = 0.02), which was offset by extended breastfeeding. Similar associations were observed by intrinsic-like subtypes. Less consistent relationships were observed with ages at menarche and first birth. Reproductive risk factor distributions are different from European populations but exhibited etiologic heterogeneity by age at diagnosis and ER status similar to other populations. Differences in reproductive patterns and subtype heterogeneity are consistent with racial disparities in subtype distributions.

A regional equity profile to assess the impact of social inequalities on determinants and health outcomes in the population residing in Sicily Region (Southern Italy)

to build an equity profile for assessing the impact of socioeconomic inequalities on the determinants and health outcome in Sicily (Southern Italy). descriptive study aimed to define an equity profile in Sicily by using a rich list of indicators of structure of the resident population and of distribution of determinants and health outcome, derived from the integration of available information and scientific evidence at regional level with high local detail. the equity profile collects available information on the health status of the population in Sicily, on the determinants, and on the use of health and social services. The characteristics of people or population groups have been explored and can produce inequalities on health which included individual and context socioeconomic status. using available information sources and study results have explored the effects of the disadvantage on health in the region: mortality, morbidity, oncological incidence, reproductive health, and some of their determinants. the Sicilian population tends to aging. Migration flows tend to compensate the reduction in births in Sicily and it increases the proportion of younger people and women in childbearing age. The proportion of large families tends to get smaller, whereas the proportion of single-component ones increases; the population groups with low education, unemployment, poverty, and income increases. Starting from the first thousand days of life, to continue in the other classes of the population, the different distribution of risk factors on health was identified according to different levels of deprivation. the Sicilian equity profile has systematized and consolidated previous experiences on the effects of disadvantage on health. Prevention interventions, oriented towards equity, should be based on the results of this study and should take care of the general aspects of actions and, at the same time, focus on vulnerable population groups.

Reproductive Factors and Risk of Breast Cancer by Tumour Subtypes Among Ghanaian Women: A Population-Based Case-Control Study

Background: Women of African ancestry have a higher proportion of early-onset and oestrogen receptor (ER) negative cancers compared to women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status might explain this disparity. Methods: We analysed data from 1,126 women with invasive breast cancer and 2,106 population controls aged 18-74 years recruited from three hospitals in Ghana from 2013-2015. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for menstrual and reproductive factors using polytomous logistic regression models adjusted for potential confounders. Findings: Among controls, the medians for age at menarche, parity, age at first birth and breastfeeding/pregnancy were 15 years, 4 births, 20 years, and 18 months, respectively. For women >50 years, parity and extended breastfeeding were associated with decreased risks: >5 births vs. nulliparous, OR 0·40 (95% CI 0·20-0·83), and 0·71 (95% CI 0·51-0·98) for >19 vs. <13 breastfeeding months/pregnancy, which did not differ by ER. In contrast, for earlier onset cases (<50 years) parity was associated with increased risk for ER-negative tumours (p-heterogeneity by ER=0·02), which was offset by extended breastfeeding. Similar associations were observed by intrinsic-like subtypes. Less consistent relations were observed with ages at menarche and first birth. Interpretation: Reproductive risk factor distributions were different from European populations, but exhibited aetiologic heterogeneity by age at diagnosis and ER status similar to other populations. Differences in reproductive patterns and subtype heterogeneity are consistent with racial disparities in subtype distributions. Funding: Intramural program of the National Cancer Institute. Declaration of Interest: Authors have no conflicts of interest to declare. Ethical Approval: The study was approved by the Special Studies Institutional Review Board of the National Cancer Institute (Rockville, MD, USA), the Ghana Heath Service Ethical Review Committee and institutional review boards at the Noguchi Memorial Institute for Medical Research (Accra, Ghana), the Kwame Nkrumah University of Science and Technology (Kumasi, Ghana), the School of Medical Sciences at Komfo Anokye Teaching Hospital (Kumasi, Ghana), and Westat (Rockville, MD, USA). All participants provided written informed consent.

Cardiovascular and other risk factors among people who live in slums in Buenos Aires, Argentina

ObjectivesEffective planning of health policies requires the availability of accurate data, representing the burden of disease and risks to the diverse components of society. In Argentina, health information comes from the national risk factors survey (NRFS), which characterises the distribution of different risk factors. However, the NRFS has never collected information from residents living in slums, despite slums representing 10% of the population. The objective of this survey was to characterise the prevalence of cardiovascular and other risk factors among the inhabitants of one of the largest slums in Buenos Aires (Villa 31) and compare it to data from the NRFS. Study designThis was a cross-sectional study. MethodsA cross-sectional study was carried out in 400 slum households, using the same data structure as the NRFS. The survey obtained information about economic aspects, reproductive health, addictions and risk factors. All participants had their blood pressure, weight and height measured. A total of 406 people were interviewed and their data were compared with data from 32,365 people in the NRFS. All comparisons were made on the basis of age group. ResultsA fair/poor self-perceived level of health (odds ratio [OR] 3.19, 95% confidence interval [CI]: 2.60–3.91), anxiety and moderate to severe depression (OR 5.44, 95% CI: 4.43–6.69), problem drinking (OR 10.01, 95% CI 8.08–12.40), self-reported hypertension (OR 1.26, 95% CI: 1.01–1.57), overweight (OR 1.26, 95% CI: 1.03–1.55) and obesity (OR 1.72, 95% CI: 1.38–2.15) were significantly higher in the slum population. In people aged 18–24 years, the prevalence of diabetes was triple the national average (OR 3.17, 95% CI: 1.26–7.98). For all evaluated conditions in this study, the inhabitants of the slum received significantly less treatment compared with participants from the NRFS. ConclusionsThe prevalence of cardiovascular and other risk factors in the slum population has a different distribution to that reported in the NRFS. These data suggest the need to establish specific policies for slum populations.

UK experience of herpes zoster vaccination can inform varicella zoster virus policies

UK experience of herpes zoster vaccination can inform varicella zoster virus policies

Measuring the impact of differences in risk factor distributions on cross-population differences in disease occurrence: a causal approach

In cross-population comparisons of disease occurrence (prevalence, incidence), a common public health question is the extent to which variations in the distribution of risk factors for the disease explain observed differences. Limited work has been done on formalizing this problem, which is conceptually tantamount to quantifying the degree of confounding for the 'population effect' induced by different factors. A common approach is to compare 'unadjusted' and 'adjusted' regression-based estimates of that parameter, but the interpretation of the resulting 'contribution' measures may be hindered by other confounding sources and non-collapsibility issues. Interactions also raise interpretational challenges. We formalized this problem using directed acyclic graphs and the potential outcomes framework, on the basis of which we defined a series of estimands that address specific questions and are identifiable under certain causal assumptions. We subsequently determined possible estimators. A study of regional differences in egg allergy prevalence in 1-year-olds was used for illustration. The main estimands defined were: the change in the prevalence or incidence difference induced by compositional variations in measured risk factors, all at once and individually, relative to a reference population; and the proportion of the crude difference that remains unexplained by measured factors. Standardization (g-computation), inverse probability weighted (IPW) and doubly robust IPW estimators of these estimands were considered. This work provides a causal theoretical basis for studying disease occurrence differences between populations. The proposed measures can be used to answer the questions that arise in this context under a set of clearly stated assumptions.

Head and Neck Cancers in North-East Iran: A 25 year Survey.

Cancers are among the worst noncommunicable diseases around the world. Head and neck cancers are ranked as the fifth most common cancers worldwide. As there are different distributions of risk factors around the world, the incidence of these cancers varies from one place to another. We conducted a descriptive analytic cross-sectional study, based on census-based records from the private oncology clinic in Mashhad, Iran. Data from 1,075 patients with head and neck cancers were analyzed from 1986 to 2010. We categorized the duration of study into five periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010. Head and neck cancers refers to cancers originating from seven sites in the head and neck including the nasal cavity, oral cavity, pharynx, larynx, salivary glands, paranasal sinuses, and thyroid. Data of 1,075 patients were analyzed. 66.2% were male. Mean ± standard deviation (SD) age at the time of diagnosis was 55.37±15.55 years. The most frequent type of head and neck cancer was larynx cancer (36%), followed by pharynx (28.5%), oral (17.5%), thyroid (6.8%), sinus (6.4%), salivary gland (4.10%), and nasal cancer (0.70%). although larynx cancer was the most frequent cancer over the whole study duration, there was a significant (P=0.04) difference in the relative frequency of these cancers across the five time periods. There was a significant difference in mean age between cancer categories (P<0.001). The only cancer with a different mean age at different time periods was pharynx cancer (P=0.02). There was a significant difference between sex and cancer categories (P<0.001). Laryngeal cancer was the most common head and neck cancer over the whole duration of this study. The differences in the patterns of other head and neck cancers could be due to geographical differences and also different risk factors and lifestyles all over the world. Further investigations in these fields are suggested in future studies.

Italian cancer figures--Report 2015: The burden of rare cancers in Italy.

Italian cancer figures--Report 2015: The burden of rare cancers in Italy.

Abstract 875: Risk factors for hepatocellular carcinoma (HCC) by race/ ethnicity in the United States

Abstract Background: Primary liver cancer is the sixth most common cancer worldwide, with HCC representing the majority of the cases. In the U.S., HCC rates are higher among Hispanics, Asians and blacks than among whites. Whether the higher risks are due to different distributions of risk factors is not clear. Thus, we conducted an analysis of HCC risk factors by race/ethnicity in the SEER-Medicare database for the years 2000-2009. Methods: HCC cases (n = 8,116), identified by ICD-O morphology codes 8170-8175, were compared to a 5% random sample of cancer-free persons in the SEER areas (n = 313,525). Risk factors examined included type II diabetes (DM II), obesity, hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol-related disorders. Multivariate logistic regression analyses, which adjusted for age, location, gender, income and date of diagnosis as well as the other risk factors were used to compare risk factors by racial/ethnic group. Results: Risk factors by race/ethnicity Risk factorWhiteBlackAsiansHispanicsN 6,120N 668N 971N 357%OR (95% CI)%OR (95% CI)%OR (95% CI)%OR (95% CI)Obesity6.31.06 (0.9-1.2)5.51.0 (0.7-1.5)0.70.2 (0.1-0.8)7.81.2 (0.7-1.9)DM II44.52.9 (2.8-3.1)41.81.3 (1.1-1.6)38.11.8 (1.5-2.1)54.62.0 (1.5-2.7)HBV1.83.8 (2.6-5.7)3.61.6 (0.7-3.7)17.717.1 (11.8-25.0)2.01.4 (0.2-11.1)HCV16.819.7 (17.1-22.6)34.036.8 (28.0-48.6)31.121.4 (15.4-29.9)22.716.0 (9.2-28.1)Alcohol cirrhosis11.44.7 (3.7-5.8)7.64.5 (2.4-8.5)4.03.8 (1.3-11.7)17.13.3 (1.7-6.8)Alcohol NOS13.12.7 (2.2-2.9)13.21.6 (1.1-2.4)3.72.0 (1.0-4.1)14.81.6 (0.8-3.0)Cirrhosis NOS33.345.5 (41.2-50.4)24.117.9 (12.3-25.9)36.836.9 (26.2-52.0)44.827.6 (18.9-40.3) NOS not otherwise specified. Conclusion: Major HCC risk factor profile is differ across race/ethnical groups. While diabetes is most common risk factor overall, it is most prevalent in Hispanics. HCC related to HCV is more common in blacks and Asians, and to HBV in Asians. Citation Format: Oxana V. Makarova-Rusher, Sean F. Altekruse, Timothy S. McNeel, Barry I. Graubard, Austin G. Duffy, Susanna V. Ulahannan, Tim F. Greten, Katherine A. McGlynn. Risk factors for hepatocellular carcinoma (HCC) by race/ ethnicity in the United States. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 875. doi:10.1158/1538-7445.AM2015-875

Abstract P6-09-10: The comparison of the distribution of breast cancer risk factor between Chinese women, non-Chinese Asian and Caucasian women in the screening cohort of Athena Breast Health Network

Abstract Background: A major area of innovation in breast cancer (BC) is improving risk models for screening efforts. The University of California Athena Breast Health Network uses several risk models, including the Gail model [PMID: 10491430]. The Breast Cancer Surveillance Consortium (BCSC) model [PMID: 18316752] which integrated information on breast density was developed and validated by UCSF investigators and reports Asian-specific risk. The Peking Union Medical College (PUMC) model [PMID: 22662004] is developed from a case-control study in China and reports BC risk in Chinese women. Risk factors and their respective weights included in these models are different. Methods: From December 2012 to April 2014, 2,305 women without previous history of BC and consented to research were enrolled in the UCSF Athena screening cohort. Questions asked included risk factors used in Gail, BCSC and PUMC model, such as age, age of menarche (AOM), age at first live birth, body mass index (BMI), breast biopsy, breast density, hormone replacement therapy (HRT), oral contraceptives (OCP). Women were considered high risk when: Gail &amp;gt; 1.67% 5-year risk, BCSC &amp;gt; 1.67% 5-year risk, PUMC score &amp;gt; 30 (equals &amp;gt;0.20% 1-year risk) respectively. The distribution of the risk factors and the high risk population percentage were compared between Chinese women versus non-Chinese Asian and Caucasian women. Results: 402 Asian women comprise 17.4% of all 2,305 Athena screening cases with 234 Chinese, and 168 non-Chinese Asian (NCA). Differences in risk factor distribution were observed for the following: positive family history was observed 23% for Caucasian, 15% for Chinese and 13% for NCA (p=0.001), and previous breast biopsy was 27%, 17% and 22% respectively (p=0.002). Ever use of HRT was 36% in Caucasian, 17% in Chinese and 11% in NCA (p&amp;lt;0.001). Ever give birth was 68% in Chinese, 65% in NCA, and 57% in Caucasian (p=0.001), while the age at first live birth &amp;lt;30 was 35%, 33%, and 26% correspondingly (p=0.001). Breast density appeared to be higher in Asian women (p=0.095). The high risk proportions by each model are given in Table 1. Table 1 Percentage of high risk population by ethnicity for different risk modelsRisk modelsChinese (n=234)non-Chinese Asian (n=168)Caucasian (n=1,492)P ValueRisklowhighlowhighlowhighGail137 (58.6%)97 (41.4%)107 (63.7%)61 (36.3%)884 (59.2%)608 (40.8%)0.509BCSC211 (90.2%)23 (9.8%)152 (90.5%)16 (9.5%)864 (58.0%)626 (42.0%)0.000PUMC167 (71.7%)66 (28.3%)108 (64.7%)59 (35.3%)781 (52.6%)704 (47.4%)0.000 Conclusion: Chinese and NCA women have a lower proportion of high risk by the BCSC and PUMC model compared to the Caucasian women, whereas by Gail model these proportions appear to be similar. Citation Format: Bo Pan, Jeffrey Tice, Qiang Sun, Celia Kaplan, Zhou Yidong, Yali Xu, Songjie Shen, Changjun Wang, Alexandra Solomon, Lauren Ryan, Paige Kendall, Timothy Henderson, Laura Esserman, Beth Crawford, Athena Breast Health Network, Laura van 't Veer. The comparison of the distribution of breast cancer risk factor between Chinese women, non-Chinese Asian and Caucasian women in the screening cohort of Athena Breast Health Network [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-09-10.

Ascertaining severe perineal trauma and associated risk factors by comparing birth data with multiple sources.

Population data are often used to monitor severe perineal trauma trends and investigate risk factors. Within New South Wales (NSW), two different datasets can be used, the Perinatal Data Collection ('birth' data) or a linked dataset combining birth data with the Admitted Patient Data Collection ('hospital' data). Severe perineal trauma can be ascertained by birth data alone, or by hospital International Classification of Diseases Australian Modification (ICD-10-AM) diagnosis and procedure coding in the linked dataset. The aim of this study was to compare rates and risk factors for severe perineal trauma using birth data alone versus using linked data. The study population consisted of all vaginal births in NSW between 2001 and 2011. Perineal injury coding in birth data was revised in 2006, so data were analysed separately for 2001-06 and 2006-11. Rates of severe perineal injury over time were compared in birth data alone versus linked data. Kappa and agreement statistics were calculated. Risk factor distributions (maternal age, primiparity, instrumental birth, birthweight ≥4 kg, Asian country of birth and episiotomy) were compared between women with severe perineal trauma identified by birth data alone, and those identified by linked data. Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) of severe perineal trauma. Among 697 202 women with vaginal births, 2.1% were identified with severe perineal trauma by birth data alone, and 2.6% by linked data. The rate discrepancy was higher among earlier data (1.7% for birth data, 2.4% for linked data). Kappa for earlier data was 0.78 (95% CI 0.78, 0.79), and 0.89 (95% CI 0.89, 0.89) for more recent data. With the exception of episiotomy, differences in risk factor distributions were small, with similar aORs. The aOR of severe perineal trauma for episiotomy was higher using linked data (1.33, 95% CI 1.27, 1.40) compared with birth data (1.02, 95% CI 0.97, 1.08). Although discrepancies in ascertainment of severe perineal trauma improved after revision of birth data coding in 2006, higher ascertainment by linked data was still evident for recent data. There were also higher risk estimates of severe perineal trauma with episiotomy by linked data than by birth data.

Challenges associated with peripheral arterial disease in women

Peripheral arterial disease (PAD) is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common in men, recent reports based on more sensitive tests have shown that the prevalence of PAD in women is at least the same as in men, if not higher. PAD tends to present itself asymptomatically or with atypical symptoms more frequently in women than in men, and is associated with comorbidities or situations particularly or exclusively found in the female sex, such as osteoporosis, hypothyroidism, the use of oral contraceptives, and a history of complications during pregnancy. Fat-distribution patterns and differential vascular characteristics in women may influence the interpretation of diagnostic methods, whereas sex-related vulnerability to drugs typically used in subjects with PAD, differences in risk-factor distribution among sexes, and distinct responses to revascularization procedures in men and women must be taken into account for proper disease management. All these issues pose important challenges associated with PAD in women. Of note, this group has classically been underrepresented in research studies. As a consequence, several sex-related challenges regarding diagnosis and management issues should be acknowledged, and research gaps should be addressed in order to successfully deal with this major health issue.