Disparities In Disease Burden Research Articles

Higher disease burden and lower utilization in mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China.

Whether health inequalities of disease burden and medical utilization exist by ethnicity in Asian breast cancer (BC) patients remains unclear. We aim to measure ethnic disparities in disease burden and utilization among Mongolian and Han female breast cancer patients in China. Based on data extracted from Inner Mongolia Regional Health Information Platform, a retrospective cohort study was established during 2012-2021. Disease burden including incidence, 5-year prevalence, mortality, survival rate, and medical cost were analyzed and compared between Han and Mongolian patients. A total of 34,878 female patients (mean [SD] age, 52.34 [10.93] years) were included among 18.19 million Chinese, and 4,315 [12.03%] participants were Mongolian. Age-standardized rates of incidence are 32.68 (95% CI: 20.39-44.98) per 100,000. Higher age-specific incidence and 5-year prevalence were observed in Mongolian than in Han. The cost of breast cancer annually per capita was significantly lower for Mongolian than Han in FBC ($1,948.43 [590.11-4 776.42] vs. $2,227.35 [686.65-5,929.59], P<0.001). Mongolian females showed higher all-cause mortality (30.92, [95% CI: 28.15-33.89] vs. 27.78, [95% CI: 26.77-28.83] per 1,000, P=0.036) and breast cancer-specific mortality (18.78, [95% CI: 16.64-21.13] vs. 15.22, [95% CI: 14.47-16.00] per 1,000, P=0.002) than Han females. After adjusting covariates, Mongolian were associated with increased all-cause mortality (HR, 1.21, [95% CI, 1.09-1.34]; P<0.001) and breast cancer-specific mortality (HR, 1.31, [95% CI, 1.14-1.49]; P<0.001). The findings of this cohort study highlight a higher level of disease burden with unmet medical demand in Mongolian patients, suggesting that more practical efforts should be made for the minority. Further research is needed to explore the concrete mechanisms of the disparities as well as eliminate health disproportion.

Contribution of High Body Mass Index to the Global Burden of Esophageal Cancer: A Population-Based Study from 1990 to 2019.

The changing patterns of obesity have had a significant impact on the epidemiology of esophageal cancer (EC). This study aimed to investigate the specific burden of EC associated with high body mass index (BMI) across different geographical and Sociodemographic Index (SDI) regions, using data from the Global Burden of Disease Study 2019. Mortality, age-standardized death rates (ASDR), and disability-adjusted life-years (DALYs) from 1990 to 2019 were analyzed for 204 countries and territories. Decomposition analysis, frontier and health inequality analyses, and age-period-cohort models were employed to examine the factors driving disease burden and to predict future trends. High BMI contributed to 89,903.9 [95% uncertainty interval (UI): 27,878.9-171,254.6] EC-related deaths, an ASDR of 1.1 (95% UI 0.3-2.1) per 100,000 population, and 2,202,314.1 (681,901.4-4,173,080.3) DALYs in 2019. There was an increasing trend in these figures over the 29-year period. The middle SDI region (31,023.8, 95% UI 9,180.4-62,631.5) and East Asia (36,939.9, 95% UI 9,620.5-81,495) carried the highest burden of EC-related deaths. Disease burden increased across all age groups and genders globally. Population growth was a major factor driving EC deaths across all SDI quintiles. Disparities in disease burden were observed across countries at all development levels. Predictive models indicated a continued increase in EC-related deaths in the next decade. The study provided a comprehensive understanding of the global burden of EC associated with high BMI over the past decades. Opportunities exist to reduce this burden at all SDI levels through targeted interventions and policies.

Disparities in burden of disease in patients with rheumatoid arthritis across racial and ethnic groups.

To examine racial/ethnic differences in rheumatoid arthritis (RA) disease burden and change in clinical outcomes over time. We included CorEvitas Rheumatoid Arthritis Registry patients from two time periods (2013-2015 and 2018-2020). Clinical Disease Activity Index (CDAI) (as a continuous measure and as a dichotomous measure) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) were assessed at each visit. Marginal means and their corresponding 95% confidence interval (CI) by race/ethnicity were estimated for each outcome using adjusted mixed effects linear and logistic regression models. Overall and pairwise tests were conducted to detect differences between race/ethnicity groups. Of 9,363 eligible patients (8,142 White, 527 Black, 545 Hispanic, 149 Asian), most (76%-85%) were female. At Visit 1, the mean disease duration ranged from 9.8-11.8years. Estimated CDAI was significantly higher for Hispanics compared to Whites at Visit 1 (11.1 vs. 9.9; pairwiseP = 0.033) and Visit 2 (9.2 vs. 8.0, pairwiseP = 0.005). Disease activity improved over the 5-year study period among all race/ethnicity groups, though Hispanics improved less than Whites. Disease activity improved over the 5-year period across all racial/ethnicity groups, and disparities between racial/ethnicity groups in disease activity and functional status did persist over time, suggesting that further effort is needed to understand the drivers of these discrepancies to close this race/ethnicity gap. Key Points • Disease activity improved over the 5-year period across all racial and ethnic groups. • Disparities between racial and ethnic groups in disease activity and functional status did persist over time, suggesting that further effort is needed to understand the drivers of these discrepancies and close this racial gap.

Racial and ethnic disparities in acuity of presentation among children with newly diagnosed acute leukemia.

We evaluated disparities in disease burden, organ dysfunction, vital signs, and timing of therapy in children newly presenting with acute leukemia. Among 899 patients with acute leukemia diagnosed at two large children's hospitals, a priori lab-based definitions of high disease burden, infection risk, renal dysfunction, and coagulopathy were applied to electronic health record data. Black patients with acute myeloid leukemia had increased prevalence of elevated white blood cell count and uric acid; Black patients with acute lymphoblastic leukemia demonstrated increased prevalence of coagulopathy. Black patients' presentation more frequently included multiple lab abnormalities consistent with advanced physiologic dysfunction. No differences were found in days to therapy initiation.

Trends and disparities in disease burden of age-related macular degeneration from 1990 to 2019: Results from the global burden of disease study 2019.

This study aims to estimate the trends and disparities in the worldwide burden for health of AMD, overall and by age, sex, socio-demographic index (SDI), region, and nation using prevalence and years lived with disability (YLDs) from Global Burden of Disease (GBD) study 2019. This retrospective study presents the prevalent AMD cases and YLDs from 1990-2019, as well as the age-standardized prevalence rate (ASPR) and age-standardized YLD rate (ASYR) of AMD. To measure changes over time, estimated annual percentage changes (EAPCs) of the age-standardized rates (ASRs) were analyzed globally, then studied further by sex, SDI, region, and nation. We included data from the 2019 Global Burden of Disease (GBD) database to examine AMD prevalence and YLDs from 1990-2019 in 204 countries and territories, as well as demographic information such as age, sex, SDI, region, and nation. Globally, the number of prevalent AMD cases increased from 3,581,329.17 (95% uncertainty interval [UI], 3,025,619.4-4,188,835.7) in 1990 to 7,792,530 (95% UI, 6,526,081.5-9,159,394.9) in 2019, and the number of YLDs increased from 296,771.93 (95% uncertainty interval [UI], 205,462.8-418,699.82) in 1990 to 564,055.1 (95% UI, 392,930.7-789,194.64) in 2019. The ASPR of AMD had a decreased trend with an EAPC of -0.15 (95% confidence interval [CI], -0.2 to -0.11) from 1990 to 2019, and the ASYR of AMD showed a decreased trend with an EAPC of -0.71 (95% confidence interval [CI], -0.78 to -0.65) during this period. The prevalence and YLDs of AMD in adults over 50 years of age showed a significant increase. The prevalence and YLDs of AMD were significantly higher in females than males, overall. The ASPRs and ASYRs in low SDI regions was greater than in high SDI regions from 1990 to 2019. In addition, increases in prevalence and YLDs differed by regions and nations, as well as level of socio-economic development. The number of prevalent cases and YLDs due to AMD increased over 30 years and were directly linked to age, sex, socio-economic status, and geographic location. These findings can not only guide public health work but also provide an epidemiological basis for global strategy formulation regarding this global health challenge.

A US National View of Prevalent and Newly Diagnosed Multiple Myeloma in 2021: A Retrospective Analysis of National All-Payer Claims Database

Introduction: Multiple myeloma (MM) is a rare and heterogeneous cancer with steadily improving patient survival in recent years due to advancement in therapies. Updates to the prevalence and incidence of MM using the latest nationally representative data are needed to support population health management, resource planning, and health economic assessments. Furthermore, disparities in disease burden, access to care, treatment patterns, and outcomes could exist across patient subpopulations with MM, prompting a need for comprehensive data to understand the population. Currently, there is a gap in such data due to the highly fragmented health care system in the US in which real-world evidence is often siloed and represents only a portion of the population. This study aims to provide a national view of MM by estimating the prevalence and incidence in US adults overall and by state/territory, payer type, race, and ethnicity in 2021. Methods: This is a retrospective study using the All-Payer Real-World Multiple Myeloma Research-Ready Data built using the US national all-payer claims database (APCD), which covers ~87% of the nationally insured population from 1/1/2014 to 1/31/2022. Data included adults with ≥2 claims with MM diagnosis (ICD-9-CM: 203.0x and ICD-10-CM: C90.0x) who had continuous capture with medical and pharmacy benefits for ≥12 months prior to and 30 days after the first MM diagnosis date. To be included in this study, patients also had to have ≥1 claim in 2021. The latest claim date in 2021 was defined as the index date. A subcohort of patients with newly diagnosed MM (NDMM; incident MM cases) were additionally required to have their first MM diagnosis date (the index date for the NDMM cohort) in 2021. Prevalence and incidence of MM were estimated using the number of patients in MM and NDMM cohorts, divided by the total APCD adult population with similar continuous capture eligibility. Prevalence and incidence were calculated for the overall population and stratified by state/territory, payer type, race, and ethnicity. Patient characteristics were captured at the index date and during the baseline period. The proportion of patients with NDMM who initiated their first treatment in 2021 and the time from diagnosis to their first treatment were captured. Results: A total of 63,281 MM and 9,674 NDMM patients met the study criteria. Mean age was 71.1 and 70.0 years, 51.4% and 52.9% were male, and 68.7% and 72.0% were covered by Medicare, respectively. Overall, about two-thirds of the patients had available race (74%), ethnicity (69%), and income data (76%), while 46% had education status. Among those with data, 15.6% of MM and 14.7% of NDMM cohorts were Black, 12.2% and 11.9% were Hispanic, 65.1% and 64.5% had an annual income ≤$50,000, and 67.5% and 67.2% had high school as their highest level of education. The overall prevalence of MM was 73.8 per 100,000 adults in 2021, with the prevalence being the highest among those who were Black (124.8), non-Hispanic (101.3), covered by Medicare (245.2), and residing in the US Virgin Islands (243.6) and Arkansas (126.5). The overall incidence of NDMM was 11.3 per 100,000 adults in 2021, and the incidence was highest among those who were Black (17.8), non-Hispanic (15.3), covered by Medicare (39.3), and those residing in Puerto Rico (24.5), the US Virgin Islands (22.8), and Washington (20.7; Tables 1 and 2). The mean Quan-Charlson comorbidity index (excluding MM diagnosis) was 2.8 for the MM cohort and 2.4 for the NDMM cohort. Commonly observed comorbidities for both cohorts included anemia (44.8% and 47.4%), diabetes with chronic complications (23.9% and 22.4%), peripheral neuropathy (24.8% and 15.2%), renal impairment (22.7% and 20.1%), and infections (21.9% and 14.4%). There were 3,377 (35%) patients with NDMM who initiated their first treatment in 2021, with a mean and median time to treatment of 50.8 (standard deviation = 67.5) and 27 days. Conclusions: While the prevalence and incidence of MM in 2021 estimated in this study were consistent with projected estimates from the literature, variations in rates of MM were observed across race, ethnicity, payer type, and state/territory, indicating potential disparities in the burden of MM. Such a comprehensive view of rates of MM could serve as a foundation for future health policy decisions, quality improvement, resource deployment, and initiatives to address health disparities across subpopulations. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

33965 Learn2Derm: A community-based pilot program assessing beliefs surrounding skin cancer risk factors, presentation, and prevention strategies

Introduction: Underserved and underrepresented communities exhibit disparities across all spectrums in health. Dermatology is not an exception, as there continues to be disparities in burden of disease, access to healthcare, and patient-provider trust. To address such gaps, a community-based, recurring, interactive and educational program, Learn2Derm, was launched. The first event focused on disparities in education and detection of skin cancer in persons of color in Ward 8 in Washington D.C., an underserved community with a population that is 92% black. Methods: To better understand the needs of this community, an IRB-approved survey was disseminated to participants to investigate familiarity with skin cancer presentation and prevention, and to understand barriers to seeking dermatologic care. Results: 49 attendees completed the survey. Postsurvey results indicated participants learned that skin cancer could present under the fingernail and that sunscreen can prevent skin cancer (P < .05). Participants revealed that cost was the greatest barrier to sunscreen utilization. After the event, 50% of those who responded trusted dermatologists more. Similar culture and comprehensible language were reasons most likely to increase trust (n = 23). All attendees that answered the final item on the survey indicated that they enjoyed the event (n = 47). Conclusions: Our data highlight that community-immersion events can facilitate awareness of dermatologic conditions, foster communication between dermatologists and communities, enhance dermatologic access, and may instill trust placed in providers. Consequently, patients from underserved communities may receive and seek dermatologic care at earlier disease presentation and avoid the long-lasting impacts of untreated skin disease.

Spectrum of pediatric acquired demyelinating syndromes (PADS) of the central nervous system in a tropical developing country: A 10-year retrospective study

BackgroundEpidemiological data on the pediatric acquired demyelinating syndromes (PADS) in the Philippines has not been described previously in the literature. There may be geographic differences in frequencies of PADS where true disease burden is not known or underestimated in resource-limited settings due to lack of case recognition and/or diagnostic facilities. The purpose of this study was to determine the frequencies and clinical characteristics of the different subtypes of PADS at our institution and compare these with those in published literature. MethodsWe conducted a retrospective cross-sectional study of children diagnosed with PADS who were admitted at the Philippine General Hospital from January 2009 to December 2018. Charts of these patients were reviewed to determine frequencies, clinical profile, diagnostic findings and outcomes. ResultsA total of 77 patients were identified with PADS using the appropriate diagnostic criteria. The frequencies of the PADS subtypes were the following: transverse myelitis (n = 21; 27.3 %); acute disseminated encephalomyelitis (n = 20, 26.0 %); multiple sclerosis (n = 17, 22.1 %); optic neuritis (n = 13, 16.9 %); clinically isolated syndrome (n = 4, 5.2 %); and neuromyelitis optica spectrum disorder (n = 2, 2.6 %). Overall, the mean age at initial event and at diagnosis were 10.6 ± 4.6 years. Female:male ratio was 1.02:1. On admission, the majority of patients had motor paralysis (n = 49, 63.6 %) while several patients manifested with sensory deficits (n = 31, 40.3 %), visual changes (n = 26, 33.8 %) and brainstem involvement (n = 20, 26.0 %). Nearly all patients had evidence of lesions in magnetic resonance imaging (n = 72, 93.5 %) located in spinal cord (n = 25; 32.5 %), cerebral white matter (n = 24; 31.2 %), and optic nerve (n = 12, 15.6 %). Among patients who underwent cerebrospinal fluid analysis (n = 34), 7 patients had abnormal findings (20.6 %). The most utilized treatment regimens during admission were intravenous methylprednisolone (n = 53, 68.8 %) and oral prednisone (n = 43, 55.8 %). The majority had partial recovery (n = 56, 72.7 %) and 16 experienced full recovery (20.8 %) at discharge. Five patients died (6.5 %). ConclusionsOur study provided the first comprehensive summary on the clinical features of children with PADS admitted in a Philippine tertiary hospital with limited resources. Our study highlights the value of using clinical diagnostic criteria in improving case recognition especially in low-and middle-income countries. Regional disparities in disease burden warrant international registries with wider geographic representation in order to come up with diagnostic and management guidelines suitable for various levels of care.

Advancing digital health innovation in oncology to improve the lives of cancer patients.

e13609 Background: Oncology is renowned for leading innovation in research and in care. However, digital innovation in cancer care and research appears to be limited relative to other therapeutic areas. Methods: A multi-stakeholder roundtable, co-hosted by the Digital Medicine Society (DiMe) and Moffitt Cancer Center, convened experts from 35 leading organizations in life science R&amp;D, regulators, payers, innovators, and with core representation from cancer patients and patient experts. Discussions addressed the current state of digital innovation in cancer care, root causes of digital health innovation challenges in oncology, and identifying action-oriented approaches to collaborative solutions needed to advance the safe, effective, ethical, and equitable use of digital innovations in oncology. Results: There was consensus among roundtable attendees that digital innovation lags behind in oncology relative to other therapeutic areas. Challenges identified as ‘low hanging fruit’ for digital innovation include reducing patient administrative burden, supporting care navigation, optimizing decision making in care and research, optimizing clinical pathways, and improving how we monitor both performance status and safety. Reducing financial toxicity and disparities in disease burden must be imperatives of digital innovation in oncology. Access to care and health outcomes for all patients must also be improved. Impediments to digital innovation in oncology include a proliferation of digital point solutions as opposed to system level innovations; transactional digital solutions that do not promote ongoing engagement and reengagement for the lifetime of the patient journey; lack of trust among patients and clinicians; the absence of data sharing incentives and infrastructure; and business and payer disincentives to digital transformation. Conclusions: Digital innovation frameworks can support more effective and equitable approaches to care that are accessible, scalable, and inclusive, thereby reducing the burden of cancer. To achieve this, clinical, technical, and operational best practices necessary to develop, design, and deploy high-quality digital interventions into cancer care must be established. There is no reason for the successful adoption of digital interventions in oncology to lag behind other therapeutic areas. Intentional action with urgency is required by the multi-stakeholder community through a collaborative effort to realize the full promise of digital innovation for patients and the systems that support those who care for them.

Periodontitis prevalence and severity in an African population: A cross-sectional study in the Greater Accra Region of Ghana.

Periodontitis is a major public health problem affecting many adults, with considerable variation in its prevalence and severity worldwide. There is little data on its prevalence or associated risk factors in Ghana making development of evidence based preventive programs challenging. This study assessed the prevalence, severity, extent, and associated risk factors of periodontitis in an adult Ghanaian population. A population based cross-sectional study involving adults aged ≥25 years in the Greater Accra Region (GAR) of Ghana. A random stratified two-stage sampling method was used to select participants from rural and urban communities. Data on sociodemographic and risk factors were collected using a semi-structured questionnaire. A full-mouth periodontal examination was performed to diagnose and describe the severity of periodontitis following the CDC-AAP case definition. A total of 729 participants were included in the study, with a mean age of 43.9±14.6 years and 61% being female. Majority (84.8%) presented with gingivitis, 46.7% had periodontitis with 41.8% having both, and 13.9% had severe periodontitis. The mean clinical attachment loss (AL) was 1.36 ± 0.67mm and 1.41 ± 0.57mm for probing depth (PD). Factors associated with periodontitis included, increasing age, smoking, and alcohol use; being Muslim provided lower odds of disease. Older people, former smoking, being underweight and not having health insurance were associated with severe periodontitis. This study shows a high burden of periodontitis with comparatively more severe disease. Existing sociodemographic disparities in disease burden highlights the need of developing targeted population based preventive programs.

Geographic Variation in Inpatient Care Utilization, Outcomes and Costs for Dementia Patients Aged 65 Years or Older - China, 2017-2019.

Dementia leads public health issues worldwide. China has the largest population of adults living with dementia in the world, imposing increasing burdens on the public health and healthcare systems. Despite improved access to health services, inadequate and uneven dementia management remains common. The report documents the provincial-level geographic patterns in healthcare utilization, outcomes, and costs for patients hospitalized for dementia in China. Regional patterns demonstrate gaps in equity and efficiency of dementia care and management for dementia patients. Public health policy and practices should consider geographic disparities in disease burden and healthcare provision to promote equitable allocation of resources for dementia care throughout China.

Digging Deep: Barriers to HIV Care Among Indigenous Women

Indigenous women experience a disproportionate burden of ill health, including high rates of HIV. To reduce disparities in disease burden and health outcomes, identification of the barriers preventing access to health care is necessary. Identifying and discussing these barriers can assist service providers in the provision of care, influence policies for health and social well-being, and advance the discourse on equitable health care for Indigenous Peoples. Our research goal was to identify evidence-based, community-driven and asset-based solutions from the perspective of Indigenous women living with HIV. We also aimed to identify the role of the social determinants of health that influence the rates of HIV among Indigenous women. We used a combination of community-based participatory research methodology and Indigenous storytelling during 148 one-on-one interviews with HIV- and/or HCV-positive Indigenous women. Nine additional interviews were executed with healthcare professionals, health directors, and Knowledge Keepers and Elders. The interviews included qualitative, open-ended questions. We utilized NVivo for data analysis as well as Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowina (NAKPA), an Indigenous method for qualitative data analysis. Through the analysis, we identified nine barriers to care including expenses for daily living and health care-associated costs, time, access to computers and/or internet, transportation, childcare, homelessness and missed appointments, age, experiences with healthcare professionals and the health care system, and language. These barriers prevent access to and engagement in health care, leading to poor HIV related health outcomes. Healthcare providers have an essential role in identifying barriers to care, improving access to care in a patient-centered approach, and working to improve culturally safe practices.

Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy.

People with epilepsy, one-third of whom in the United States are on Medicaid, experience a wide range of chronic and physical comorbidities that influence their care and outcomes. In this study, we examine the burden and racial/ethnic disparities of chronic and acute conditions, injuries, and symptoms in a large and diverse group of people with epilepsy on Medicaid. Using 5 years of Medicaid claims data, we identified adults with epilepsy and used all available claims and diagnoses to identify each person's Clinical Classification Codes groups diagnosed during the study period. Using association rule mining, we identified the top combinations of conditions and stratified these by race/ethnicity to identify potential prevalence disparities. We examined the top combinations of conditions in high utilizers; that is, individuals in the top quartile of hospitalizations and emergency department visits. Among 81,963 patients, the most common conditions were anxiety and mood disorders (46.5%), hypertension (36.9%), back problems (35.2%), developmental disorders (31.6%), and headache (29.5%). When examining combinations of conditions, anxiety and mood disorders continued to have an outsized prevalence, appearing in nearly every combination. There were notable disparities in disease burden, with American Indians and Alaskan Natives having a substantially higher prevalence of developmental disorders, while Black individuals had a higher prevalence of hypertension. These disparities persisted to the higher-order combinations that included these conditions. High utilizers had a much higher disease burden, with 75.8% having an anxiety or mood disorder, as well as a higher burden of injuries. This study shows a high prevalence of psychiatric and physical conditions and identifies racial and ethnic disparities affecting people with epilepsy. Targeting interventions to consider the comorbidities, race, and ethnicity has potential to improve clinical care and reduce disparities.

Change trend in disease burden of stroke and its risk factors in China, 1990 – 2017

Objective To analyze change trend in disease burden of stroke and its risk factors in China from 1990 through 2017 and to provide evidences for rational allocation of health resources and the development of targeted stroke prevention and treatment strategies. Methods Data on disease burden of stroke during the period from 1990 through 2017 in China were extracted from the Global Burden of Disease (GBD) Study of 1990, 2000, 2010 and 2017. Years lived with disability (YLDs), years of life lost (YLLs), disability adjusted life years (DALYs) were used to evaluate the disease burden of stroke and population attributable fraction (PAF) was adopted to analyze risk factors of stroke-related disease burden. Disparities in disease burden of stroke between China and the world were compared. Results During the period of 1990 – 2017 in China, the YLLs rate and DALYs rate of stroke increased gradually; the YLLs rate also increased generally but with a temporary decline in 2010. In 2017 in China, the age-specific YLDs, YLLs, and DALYs rate of stroke increased with the increment of age and the highest rates were observed among the population aged ≥ 70 years (2 617.2/100 000 for YLDs, 16 789.4/100 000 for YLLs, and 16 773.4/100 000 for DALYs); the YLDs rate was lower for the males than that for the females (475.5/100 000 vs. 530.9/100 000) but the YLLs and DALYs rate were higher for the males than those for the females (3 181.7/100 000 vs. 2 060.9/100 000 and 3 657.1/100 000 vs. 2 591.8/100 000); the age-standardized YLDs, YLLs, and DALYs rate of stroke were higher than those in the world (374.5/100 000 vs. 235.0/100 000, 1 967.8/100 000 vs. 1 422.2/100 000, and 2 342.3/100 000 vs. 1 657.2/100 000). Compared to those in 1990 in China, the age-standardized YLDs rate of stroke increased by 30.9%; while, the age-standardized YLLs rate and DALYs rate decreased by 38.8% and 33.1%; the change trend of the three rates were consistent with the changes in global stroke burden (5.9% for YLDs, = – 34.5% for YLLs, and – 30.7% for DALYs). Among the 16 risk factors associated with DALYs (million person-years), PAF, and DALYs rate of stroke, the top five were hypertension (24.974, 56.4%, and 1 768.1/100 000), excessive sodium intake (17. 060, 38.5%, and 1 207.8/100 000), insufficient fruit intake (10.717, 24.2%, and 758.7/100000), insufficient cereal intake (10.690, 24.1%, and 756.8/100 000), and smoking (10.037, 22.7%, and 710.6/100 000) for the population in China in 2017; from 1990 to 2017, PAF for the 10 of the 16 stroke risk factors increased and the other 6 decreased, with the highest increase (90.0%) for high body mass index and the greatest decrease ( – 71.3%) for indoor air pollution. Conclusion In China, the disability caused by stroke is increasing gradually and although being effectively controlled, stroke-related premature death is still the main contribution of disease burden. Primary prevention strategies should be promoted to alleviate the disease burden of stroke.

The Y chromosome ancestry marker R1b1b2: a surrogate of the SARS-CoV-2 population affinity

Individual and population susceptibilities to disease remain a murky area of investigation, clouded by past bias based on ideological differences and wars. The current SARS-CoV-2 pandemic, the largest in living memory, brought this matter to forefront as the disparity in disease burden became apparent. A timeline analysis of the pandemic revealed the presence of country clusters that display a marked preponderance of disease among populations carrying the ancestry marker R1b1b2, notably associated with both infection and mortality. This marker is a relic of past human expansions from western Asia and subsequently Europe and the rest of the world, which may have been accompanied by peculiar biological events rendering these populations vulnerable to SARS-CoV-2.

Abstract PO-262: Achieving health equity in cancer preventive services: NIH Workshop insights on barriers and the effectiveness of evidence-based interventions and strategies

Abstract Background: Evidence-based guidelines for preventive services are developed by expert groups such as the U.S. Preventive Services Task Force (USPSTF) to help Americans stay healthy. Despite the proven value of evidence-based preventive services (e.g., screenings, provider counseling, and preventive medications), implementation by providers and uptake by patients vary, contributing to disparities in disease burden and life expectancy. The NIH convened a workshop with multidisciplinary and multisector participants in June 2019 to assess the available scientific evidence on achieving health equity in the use of clinical preventive services for three leading causes of death: diabetes, heart disease, and cancer. Methods: The workshop was framed around five key questions (KQ) and included a systematic evidence review, speaker presentations, and public discussion. KQ 1-2 considered the effects of barriers on the part of providers and patients to adopting and implementing evidence-based preventive services, and how they contribute to health disparities. KQ 3-5 addressed the effectiveness of health information technology and health care organization interventions to reduce disparities in preventive services use. An unbiased, independent panel of experts considered the scientific evidence in addition to speaker and audience perspectives to develop a report of findings and recommendations for addressing disparities in the use of ten clinical preventive services recommended by the USPSTF. Results: Overall, the need for more research on the effects of barriers was identified. However, compared with heart disease and diabetes, the barriers to adopting preventive services for breast, cervical, and colorectal cancer screening have received greater attention. While patient navigation was shown to be effective in increasing cancer screening rates, strategies for bundling preventive services and implementing health information technologies require more study. The importance of addressing unmet basic needs related to health and enhancing community resources to reduce disparities were recurring themes throughout the workshop. Lastly, there were implications for more research in cancer dissemination and implementation. Conclusion: Chronic diseases, including heart disease, cancer, and diabetes, are responsible for seven of every ten deaths in the U.S. each year. Greater use of proven clinical preventive services could avert the loss of millions of life-years. Achieving health equity in preventive services is feasible, but requires efforts at the patient, provider, healthcare organization, and community levels, and greater attention to addressing social determinants of health. Citation Format: Antoinette Percy-Laurry, Richard Berzon, Jennifer Croswell, Carrie Klabunde, Melissa Green Parker, LeShawndra Price, Pamela Thornton, Kate Winseck, Xinzhi Zhang. Achieving health equity in cancer preventive services: NIH Workshop insights on barriers and the effectiveness of evidence-based interventions and strategies [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-262.

Knowledge and attitude on infant oral health among graduating medical students in Nepal

Background: Overall, children less than five years old are seen more by a physician than a dentist. Physician need more knowledge and skills to address children’s oral health due to the prevalence of dental diseases, the racial and socioeconomic disparities in disease burden, and the restricted access to dental care for many children. Thus, integrating oral health disease prevention and promotion strategies into these medical professionals’ practice becomes essential.&#x0D; Objectives: The objective of this study was to evaluate the knowledge and attitude of graduating medical students of Nepal towards infant oral health.&#x0D; Methods: A self-administered questionnaire included questions on knowledge and attitude regarding infant oral health was distributed to 180 final year MBBS students of Nepal. Data were collected and entered in Microsoft Excel sheet and analysis was done using Statistical Package for the Social Sciences (SPSS) software version 20.&#x0D; Results: The mean age of the participants was 23.36 ± 1.12 years. Only 23.9% of them knew that dental caries is infectious and transmissible from mother to baby and 38.9% were aware of the association of poor maternal gum health and preterm, low birth weight baby. Almost 73.9% knew that gum pads should be cleaned regularly and 46.1% knew that first dental visit of a child should be as soon as the first tooth erupts.&#x0D; Conclusion: This study shows that graduating medical students of Nepal were knowledgeable about some aspects of early childhood caries and infant oral health, but uncertain about other aspects like the association between poor maternal gum health and premature low birth weight babies.

COVID-19 disparities: An urgent call for race reporting and representation in clinical research

BackgroundRacial/ethnic disparities in disease burden have gained the spotlight in the United States with the spread of SARS-CoV-2 and surge of COVID-19 cases. The problem of underrepresentation in clinical research persists today. In light of the considerable COVID-19 disparities observed, this study sought to assess the race reporting and representation among COVID-19 therapeutic studies published to date. MethodsAll published COVID-19 treatment-related clinical research studies with study participants in the United States were identified. For each study, the date published, treatment investigated, study design, race/ethnicity of participants, sample size and study site were recorded. For each study site, the race/ethnicity demographics of confirmed COVID-19 positive cases were identified utilizing online publicly available department of public health data. ResultsSix studies (n = 3, observational; n = 3, randomized clinical trial) have been published to date with participants in the United States. A subset (n = 4) reported race/ethnicity data in the publication. Black patients were underrepresented in all studies relative to the affected population in the cities in which the studies took place. ConclusionsGiven that racial/ethnic disparities in COVID-19 disease burden and outcomes have emerged in the United States, it is essential that all investigators uniformly report race/ethnicity data as well as attempt, in earnest, to obtain representativeness among study participants in order to ensure that we do not develop a further widening of the treatment gap during this pandemic.

Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in U.S. Rural Population.

(1) Introduction. A recent viral outbreak of novel coronavirus (CoVID-19) was declared as a pandemic by the World Health Organization (WHO) due to its global public health concern. There has been an aggressive growth in the number of emerging cases suggesting rapid spread of the virus. Since the first reported case of CoVID-19, there has been vast progress in understanding the dynamics of CoVID-19. However, there is an increasing evidence of epidemiological disparity in disease burden between urban and rural areas, with rural areas having minimal pandemic preparedness and their own healthcare challenges. Therefore, this review aims to provide insight on the pathogenesis and the transmission dynamics of CoVID-19 along with pharmacological and non-pharmacological intervention strategies to mitigate the clinical manifestation of this virus. This review also aims to assess existing challenges of the CoVID-19 pandemic in rural areas based on past pandemic experiences and the effect on rural population. (2) Methods. A literature review was conducted using databases such as PubMed, Science Direct, Academic Search Premier, ProQuest, and Google Scholar, along with information from governmental organizations such as Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO). (3) Results. The causative virus, with its likely zoonotic origin, has demonstrated high pathogenicity in humans through increasing human-to-human transmission leading to extensive mitigation strategies, including patient quarantine and mass “social distancing” measures. Although the clinical manifestation of symptoms is mild in majority of the virus-inflicted population, critical patients may present with pneumonia and acute respiratory distress syndrome, exacerbated by pre-existing comorbidities, eventually leading to death. While effective coronavirus disease (CoVID-19)-specific vaccines and drugs are under clinical trials, several pharmacological and non-pharmacological interventions have been adapted to manage symptoms and curtail the effect of the virus to prevent increasing morbidity and mortality. Several persisting challenges have been noted for mitigating CoVID-19 in rural areas, including the poor healthcare infrastructure, health literacy, pandemic preparedness along with the fact that majority of rural population are frail subjects with pre-existing comorbidities. (4) Discussion. The increasing rate of incidence of CoVID-19 presents its own challenges, burdening healthcare institutions and the global economy, and impacting the physical and mental health of people worldwide. Given the clinical insights into CoVID-19 and the challenges presented in this review for the U.S. rural population, mitigation strategies should be designed accordingly to minimize the morbidity and mortality of this contagion.

Rural-urban health disparities for mood disorders and obesity in a midwestern community.

Prior studies indicate greater disease burden for obesity among rural compared with urban residents but no differences for mood disorder based on geographic location. Recent attention has focused on the need to examine regional rural-urban disparities in disease burden. We focused on mood disorders and obesity prevalence within three southeastern Minnesota counties served by the Mayo Clinic Center for Translational Science Award, in Rochester, Minnesota, as these were top priorities identified in community health needs assessments. Cross-sectional study to assess the association of rural-urban locality on 5-year (2009-2014) prevalence of mood disorder and obesity obtained using the Rochester Epidemiological Project medical records linkage system, among subjects residing in three mixed rural-urban counties on April 1, 2014. Multivariable analyses adjusted for demographics, socioeconomic status using an individual housing-based measure, and counties. The study cohort (percent rural location) included 91,202 (15%) for Olmsted, 10,197 (51%) in Dodge, and 10,184 (57%) in Wabasha counties. On multivariate analysis, 5-year prevalence of mood disorders and obesity was significantly greater for urban compared with rural residents, after adjusting for confounders; odds ratios (95% confidence intervals): 1.21 (1.17-1.26), P < 0.001, and 1.05 (1.01-1.10), P = 0.016, respectively. Observed effects were not modified in additional models adjusted for health care utilization (HCU; ≥1 general medical examination visit and flu vaccination). Rural-urban health disparities for burden of mood disorders and obesity are independent of socioeconomic status and HCU in a Midwestern community. It is important to assess potential regional heterogeneity of rural-urban disparities on health outcomes.