Disparities In Burden Research Articles

Global, regional, and national burden of age-related macular degeneration, 1990–2019: an age-period-cohort analysis based on the Global Burden of Disease 2019 Study

ObjectivesThis study aimed to explore the burden of disease and disparities in age-related macular degeneration (AMD) at the global, regional, and national levels from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study, with a particular focus on associations with age, period, and cohort.MethodsWe derived disability-adjusted life years (DALYs) and age-standardized rates of AMD from the GBD 2019. We used an age-period-cohort (APC) model to estimate the overall annual percentage changes in DALYs (net drifts), the annual percentage changes in different age groups (local drifts), the longitudinal age profiles (longitudinal age-specific rates), and the relative risks of period and cohort (period and cohort effects) between 1990 and 2019. Further analysis was conducted by country, region, gender and sociodemographic index (SDI).ResultsGlobally, the number of DALYs increased from 296771.9321 (95% uncertainty interval [UI], 205462.8041–418699.8184) in 1990 to 564055.0967 (95% UI, 392930.6967–789194.6407) in 2019 (59.7% were female), while the age-standardized DALYs rates decreased from 8.29 per 100,000 (95% UI, 5.8–11.58/100,000) to 7.05 per 100,000 (95% UI, 4.92–9.84/100,000). With increasing age, the burden of AMD increased, and the DALYs rates in female was greater than that in male in all age groups. The burden of disease varied across SDI regions and countries. The top three countries in terms of the number of DALYs were China, India and Italy, accounting for 45% of the global total.ConclusionThe burden of AMD varied according to SDI, country, and sex from 1990 to 2019. Due to global population growth and aging, AMD will continue to be a major public health problem in the future, and relevant health policies need to be continuously improved and optimized.

Disparities in high fasting plasma glucose-related cardiovascular disease burden in China

Elaborating and understanding disparities in the burden of cardiovascular disease attributable to high fasting plasma glucose is important to improve diabetes prevention and promote cardiovascular health. In this study, we pool data on 791,373 people aged 25 years and older from three population-based surveys, and estimate the burden of cardiovascular disease attributable to high fasting plasma glucose between 2010 and 2018 in China by age, sex, region and socio-demographic index. In 2018, an estimated total of 498.61 thousand (95% uncertainty interval 463.93 to 534.12) cardiovascular disease-related deaths are attributable to high fasting plasma glucose in China. High fasting plasma glucose accounts for 1076.09 years of life lost per 100,000 people (95% uncertainty interval 1026.88–1129.04) due to cardiovascular disease in 2018, with substantial variation across provinces. In 2018, the higher age-standardised cardiovascular disease mortality rate attributable to high fasting plasma glucose is observed in the high-middle socio-demographic index region and the middle socio-demographic index region. Nationally, compared to 2010, exposure to high fasting plasma glucose and population aging in 2018 are the primary drivers of increased fasting plasma glucose-related deaths due to cardiovascular disease. Findings of this study emphasize the importance of developing population-specific tailored measures in China and other regions with similar condition.

Intersecting structural and psychosocial conditions: investigating injection drug use and HIV among transgender women.

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women compared to cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women to a general sample of people who inject drugs (PWID). Participants from National HIV Behavioral Surveillance were recruited via respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Among 1,561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (aPR=1.5, 95%CI=1.2-1.8) than those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (aPR=0.8, 95%CI=0.7-1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to non-judgmental and culturally competent harm reduction services.

Socioeconomic Status and Obesity

Abstract Obesity is a pervasive public health problem that causes debilitating complications across the life course. One opportunity for preventing the onset of obesity is to focus on its social determinants. Socioeconomic status (SES), which includes factors such as income, educational attainment, occupational prestige, and access to resources, is a key determinant of obesity. In this scoping mini-review, we summarized review articles and meta-analyses of the SES-obesity association. From the 1980s to the present, cross-sectional studies have demonstrated a persistent socioeconomic gradient in obesity in which the association is negative in developed countries and positive in developing countries. Longitudinal studies have revealed the bidirectionality of the SES-obesity association; some studies demonstrate that socioeconomic adversity precedes the onset of obesity, while others provide evidence of reverse causality. While earlier studies relied on anthropometric assessments of weight and height to define obesity, the use of modern technologies like dual-energy x-ray absorptiometry and bioelectrical impedance have demonstrated that the socioeconomic gradient in obesity is robust across multiple indicators of body composition, including direct measures of lean and fat mass. More recently, examination of mediators and moderators of the SES-obesity association have highlighted causal pathways and potential intervention targets, with a focus on health behaviors, environmental conditions, psychological factors, and biological processes. We describe current gaps in knowledge and propose opportunities for future innovation to reduce the burden of obesity and related socioeconomic disparities.

Abstract C139: Cancer related excess death and potential life years lost among Black Americans

Abstract Introduction: Cancer represents the second leading cause of death in the United States and disproportionately affects Black Americans. In recent years, cancer-related mortality rates have declined for both Black and White Americans. However, mortality rates and rate ratios alone are insufficient for characterizing the burden of cancer disparities between racial groups. Among the most prevalent cancers in the US, we evaluated trends in excess mortality and years of potential life lost between Black and White Americans. Methods: This was a serial cross-sectional study using US national level data from CDC Wonder between the years 1999-2020. We included White and non-Hispanic Black Americans with a cause of death from breast, prostate, lung, colon, bladder, or uterine cancer. We measured age-adjusted excess death as well as excess years of potential life lost for each cancer site among Black and White Americans, stratified by sex when applicable. Annual mortality rates for each cancer site were sourced from the CDC Cancer Statistic Data Visualization tool. Results: The age adjusted mortality rate for all cancers declined between 1999-2020 for Black (257.2 to 166.8 per 100,000) and White Americans (200.9 to 149.3 per 100,000). Site specific cancer mortality rates declined in Black and White Americans for breast, prostate, lung, colon, and bladder cancer, but increased for uterine cancer. Among the most prevalent cancer sites, there were a total of 115,43 excess deaths with 2,093,327 excess years potential life lost for Black men and 59,134 excess deaths with 1,508,052 excess years potential life lost for Black women over a 22-year period. The trend of annual excess death and years potential life lost has slowly increased for Black men with colon cancer as well as Black women with breast and uterine cancer. Annual excess death and years potential life lost in Black men with prostate cancer decreased until 2013 after which it has slowly increased. Conclusion: Despite declining mortality rates in most cancers in the United States, Black Americans still experience a staggering number of excess deaths and years potential life lost due to cancer. Furthermore, the discordance between declining mortality rates and increasing excess death or years potential life lost in breast, prostate, colon, and uterine cancer highlight that racial disparities in cancer care and outcomes are likely worsening among Black Americans. Action is needed to support interventions and organizations committed to addressing cancer health inequities among Black Americans. Citation Format: Daniel S. Carson, Navya Gunaje, Sarah K. Holt, Nana Frimpong, Jenney R. Lee, Liz Sage, Erika M Wolff, Yaw A. Nyame. Cancer related excess death and potential life years lost among Black Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C139.

Abstract C001: Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database

Abstract Background: Prostate cancer (PCr) is one of the most common cancers among men globally, with considerable variations in incidence and death rates between racial/ethnic groups and geographical regions. With more than 1.4 million new cases reported in 2020, the global burden of PCr is predicted to double over the next two decades, to 2.9 million new cases and approximately 700,000 fatalities. Understanding the disparities in PCr is crucial for designing targeted treatments, and interventions and addressing health inequities. This study seeks to provide a comprehensive analysis of the recent global trends in PCr, focusing on incidence, mortality, and disparities in disease burden. Methods:This study analyzed age-standardized PCr incidence and mortality rates from the GLOBOCAN 2020 database for 174 countries, categorized by region and income level. Descriptive statistics and regression analyses were used to investigate the relationships between PCr rates and socioeconomic factors like the Human Development Index (HDI) and healthcare expenditure (HE). The study evaluated PCr distribution across age and geography, with statistical significance set at p < 0.05. Results:PCr incidence rates were highest in developed regions like Northern America (73.8/100,000), Western Europe (69.1/100,000), and Australia/New Zealand (88.2/100,000), and lowest in Eastern Asia (10.5/100,000) and Northern Africa (9.7/100,000). Mortality patterns were similar, with highest rates in the Caribbean (29.3/100,000) and Sub-Saharan Africa (26.6/100,000), and lowest in Eastern Asia (4.1/100,000) and Northern Africa (8.3/100,000). While incidence correlated positively with the HDI (p<0.001), mortality showed no significant association after adjusting for HE. Conclusion:This global analysis revealed major disparities in PCr incidence and mortality rates. Incidence was higher in developed regions, while mortality was elevated in economically disadvantaged areas. Further research is needed to understand the complex genetic, environmental, and socioeconomic factors driving these disparities. Key Takeaways: There is a continued need for targeted interventions to reduce the global burden of PCr and address disparities in disease burden. Citation Format: Olumide Arigbede, Sarah G. Buxbaum, Sara Falzarano, Suhn K. Rhie. Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C001

Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study

ObjectivesApproximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. Design, setting, and participantsThis qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MeasurementsThemes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. ResultsThe authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. ConclusionsThe study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

Assessing Oral Health Content in Non-dental Professional Association Websites in India: A Cross-Sectional Study.

There is a growing need for inter-professional education (IPE) to reduce the burden of oral diseases and address oral health disparities. Professional websites associated with inter-professional education can serve as a reliable source of information about oral health. Hence, the study was conducted to determine the prevalence of oral health content on non-dental health professional associations' websites in India. Eighty-nine organizations were selected from five types of health professional associations. Six dental search terms were used on searchable websites. The keywords were dental, oral, dentistry, mouth, teeth, and fluoride. Websites were assessed for any oral health content. Only four websites (4.5%) had any oral health content, and all four were physician-related. The study highlights the limited and inconsistent oral health content on non-dental professional association websites. Improving the availability, accuracy, and comprehensiveness of oral health information on these platforms is crucial to enhancing oral health literacy and promoting better oral health outcomes.

Structural Barriers to Primary Care Among Sex Workers: Findings from a Community- Based Cohort in Vancouver, Canada (2014-2021).

Due to structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use services. Given limited evidence on sex workers' broader primary healthcare access, we aimed to examine structural factors associated with primary care access among sex workers over a 7-year period. Data were derived from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women (cis and trans) sex workers in Metro Vancouver, from 2014 to 2021. Descriptive statistics were used to summarize the proportion of primary care use in the past six months and to assess primary care trends over time from 2014-2021. We used multivariate logistic regression with generalized estimating equations (GEE) to identify structural factors associated with primary care access (seeing a family doctor in the last six months), after adjusting for confounders. Amongst 646 participants, most (87.4%) accessed primary care at some point during the study period, and primary care use in the in the last 6 months was relatively stable (ranging from 60-78%) across each follow-up period. At first available observation, participants faced a high burden of sexually transmitted and blood-borne infections (STBBIs) (48.0%, 11.5%, and 10.4% were HCV, HIV, or STI seropositive, respectively), 56.8% were diagnosed with a mental health disorder, 8.1% had recently overdosed, and 14.7% were recently hospitalized. In multivariable GEE analysis, exposure to intimate partner violence was associated with reduced access to primary care (Adjusted odds ratios (AOR) 0.63, 95% Confidence interval (CI): 0.49 - 0.82), and limited English fluency was marginally associated (AOR 0.76 CI: 0.51 - 1.14). This study characterized primary care access and its structural determinants among sex workers over 7-years. Participants faced a high burden of STBBIs and other health disparities, and a proportion faced gaps in primary care access. Scale-up of trauma-informed, culturally and linguistically tailored, sex worker-friendly primary care models are needed, alongside structural interventions to decriminalize and destigmatize sex work and substance use.

Burden of digestive system diseases in China and its provinces during 1990-2019: Results of the 2019 Global Disease Burden Study.

Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces. This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across 31 Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI). In 2019, there were 499.2million cases of digestive system diseases in China, resulting in 1,557,310deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend. Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI, providing valuable insights that can assist public health officials in the estimation of the disease burden in this area.

Recent use of consumer and personal care products and exposures to select endocrine disrupting chemicals among urban children with asthma.

Emerging studies suggest that endocrine disrupting chemicals (EDCs) in personal care and other consumer products are linked with various adverse health effects, including respiratory and reproductive effects. Despite Black persons using more personal care products than other demographic groups and having a high asthma burden, little is known regarding their consumer product use patterns and associated EDC exposures. To examine the association between recent exposure to select EDCs with specific consumer products and behaviors in a cohort of 110 predominantly Black children with asthma, ages 8-17 years, living in Baltimore City, Maryland. We quantified concentrations of bisphenol A (BPA), bisphenol S (BPS), bisphenol F, two dichlorophenols, four parabens, triclosan, benzophenone-3, and triclocarban in spot urine samples. Questionnaires were used to capture recent (last 24-h) consumer product use and behaviors. Associations between EDCs and consumer product uses/behaviors were assessed using multivariable linear regression, adjusting for age, gender, race/ethnicity, and caregiver income level. Effect estimates were expressed as geometric mean ratios of biomarker concentrations of product-users vs non-users. Increased concentrations to select EDCs were associated with recent use of air freshener (ratios; BPA: 1.9, 95%CI 1.4-2; BPS 1.7, 95%CI 1-2.97; propyl paraben: 3.0, 95%CI 1.6-5.6), scented candles (methyl paraben: 2.6, 95%CI 1.1-6.1), and scented carpet powder (2,5-dichlorophenol: 2.8, 95%CI 1.2-6.3). Additionally, consuming canned food was associated with some increased biomarker concentrations (ratios: BPA: 1.7, 95%CI 1.2-2.4; BPS: 2.1, 95% CI: 1.2-3.6). These findings add to the body of evidence suggesting that recent use of select consumer products in Black children contributes to exposure of chemicals of concern and could potentially inform exposure mitigation interventions. Findings have broad potential health implications for pediatric populations and Black children who may face exposure and health disparities. Little is known about how children's personal care product use and consumer behaviors affect their exposures to endocrine disrupting chemicals (EDCs). This is particularly true for Black children who often experience a disparate exposure burden to many EDCs. This is a significant knowledge gap among children that are uniquely vulnerable to EDCs as they undergo critical windows of growth and development. Our findings show associations between consumer products and EDC exposures in predominantly Black children in low-income settings. Identifying EDC exposure determinants has broad health implications as many of these chemicals have been associated with adverse health risks.

ECOG-ACRIN EAZ171: Prospective validation trial of germline variants and taxane type in association with taxane-induced peripheral neuropathy (TIPN) in Black women with early-stage breast cancer.

LBA503 Background: Black women experience higher rates of TIPN compared to White women when receiving weekly paclitaxel (WP) for early-stage breast cancer. This disparity impacts health equity, as TIPN leads to more frequent dose reductions and higher recurrence rates in Black women. Conversely, disparities in TIPN by race are not seen in women receiving every three-week docetaxel (3D). Further, retrospective analyses have identified specific genotypes associated with differential risk of grade 2-4 TIPN in women of African ancestry receiving WP . The primary aim of EAZ171 was to prospectively validate germline predictors of TIPN in Black women receiving WP. Secondary objectives included comparing rates of TIPN and dose reductions in Black women receiving WP compared to 3D. Methods: Women with early-stage breast cancer who self-identified as Black and were planned by physician choice to receive (neo)adjuvant WP (80mg/m2 x 12 doses) or 3D (75 mg/m2 x 4-6 doses) were eligible. Genotyping determined germline neuropathy risk, defined as high ( FCAMR homozygous wt or SBF2 mutated) or low (variant allele in FCAMR and SBF2 wt). Grade 2-4 TIPN by physician-reported CTCAE v.5 was compared between high vs. low risk genotypes, and between the WP vs. 3D arms at one year using Fisher exact tests with two-sided alpha of 0.1. Patient-rated TIPN was captured using PRO-CTCAE items, and patient-reported outcomes (PROs) assessed TIPN symptoms and functional interference (FACT/GOG-NTx, EORTC CIPN20). Results: 249 patients were enrolled between 6/27/19-3/31/22, including 121 receiving at least one dose of WP and 118 receiving a dose of 3D. Of those with genotype data, 91/117 (77.8%) in the WP arm and 87/118 (73.7%) in the 3D arm were classified as high risk. Physician-reported grade 2-4 TIPN was not significantly different in the high vs. low risk genotype groups with WP (47% vs. 35% p=0.27) nor with 3D (28% vs. 19% p=0.47). Grade 2-4 TIPN was significantly higher in the WP vs. 3D arm by physician-rated CTCAE (45% vs. 29% p=0.02) and PRO-CTCAE (40% vs. 24% p=0.03). Trends in worsening neuropathy scores were similar over time using the FACT/GOG-NTx and EORTC CIPN20 questionnaires, but were not significantly different between the two arms at 1 year. Patients receiving WP required more dose reductions due to TIPN (28% vs. 9% p<0.001) or due to any cause (39% vs. 25% p=0.02) than patients receiving 3D. Conclusions: In this prospective trial enrolling only Black women with breast cancer, germline variation did not significantly impact risk of TIPN with WP or 3D. However, 3D was more tolerable evidenced by less grade 2-4 TIPN and fewer dose reductions compared to WP. Given the disparate burden of TIPN and its potential impact on cure rates, this trial suggests docetaxel should be considered the preferred taxane for Black women with early-stage breast cancer. Clinical trial information: NCT04001829 .

Disparity in the Burden of Caring for Older Persons between Families Living in Housing Estates and Traditional Communities in Thailand.

Thailand's rapid population aging and reliance on family-based long-term care requires research into disparities in family caregiver burden. Since the type of residence matters to the caregiving outcome, this research aimed to examine the difference in caregiver burden between residents of private housing estates and traditional village communities. This cross-sectional study was conducted with 1276 family caregivers of community-dwelling Thai older adults, in Chiang Mai province, Thailand. The caregiver burden was examined using the Caregiver Burden Inventory (CBI), and the care recipients' dependency status was examined using Barthel's Activity of Daily Living (ADL). Descriptive analysis, multivariate analysis of variance test, and multiple logistic regression analysis were performed. Family caregivers living in a traditional village community were 1.607 times more likely to experience emotional burden (adj. OR 1.607, 95% CI: 1.049, 2.462) and 2.743 times more likely to experience overall caregiver burden (adj. OR: 1.163, 95% CI: 1.163, 6.471) compared to those in the private housing estate group. Our findings showed significant differences in caregiver burden based on residential area, contributing with insights to evidence-based policies, interventions, and programs to minimize disparities and promote family caregivers' health and well-being.

Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis.

Women living with HIV experience heightened risk of cervical cancer, and over 50% of cases in Southern Africa are attributed to HIV co-infection. Cervical cancer interventions tailored by HIV status delivered with HIV antiretroviral therapy (ART) for treatment can decrease cancer incidence, but impact on HIV-related disparities remains understudied. Using a dynamic model calibrated to KwaZulu-Natal, South Africa, we projected HIV prevalence, cervical cancer incidence, and proportion of cancer cases among women living with HIV between 2021-2071. Relative to the status quo of moderate intervention coverage, we modeled three additive scenarios: 1) ART scale-up only; 2) expanded human papillomavirus (HPV) vaccination, screening, and treatment; and 3) catch-up HPV vaccination and enhanced screening for women living with HIV. Under the status quo, HIV prevalence among women aged 15+ decreased from a median of 35% [Uncertainty Range (UR): 26-42%] in 2021 to 25% [19-34%] in 2071. The proportion of cervical cancer cases that were women living with HIV declined from 73% [63-86%] to 58% [47-74%], but incidence remained 4.3-fold [3.3-5.7] that of women without HIV. ART scale-up reduced HIV prevalence in 2071, but increased the incidence rate ratio to 5.2 [3.7-7.3]. Disparities remained after expanding cancer interventions for all women (incidence rate ratio: 4.8 [3.6-7.6]), while additional catch-up HPV vaccination and screening for women living with HIV decreased the incidence rate ratio to 2.7 [1.9-3.4] in 2071. Tailored cervical cancer interventions for women living with HIV can counteract rising cancer incidence incurred by extended life expectancy on ART and reduce disparate cancer burden.

Gender and race disparities in the prevalence of chronic kidney disease among individuals with hypertension in the United States, 2001-2016.

Chronic kidney disease (CKD) is a common complication among individuals with hypertension. We aimed to identify the prevalence of CKD and the sex and race disparities within the hypertensive population in the United States from 2001-2016. A total of 16,148 participants with hypertension were included, representing 561,909,480 individuals from the U.S. population between 2001 and 2016, as documented in the National Health and Nutrition Examination Survey. The prevalence of albuminuria and CKD stage were assessed using survey-weighted general linear regression analysis. Heterogeneity in the CKD stage among the hypertensive population, stratified by sex and race, was identified through survey-weighted logistic regression analysis. Overall, the prevalence of albuminuria remained stable (p for trend = 0.3196), and changes in the CKD stage were minimal (p for trend > 0.05) from 2001-2016. In the analysis of CKD stage heterogeneity by sex and race, the prevalence of CKD was higher among women than men and higher among individuals of other races combined than non-Hispanic Whites, but the differences were not statistically significant. The overall CKD stage within the hypertensive population plateaued between 2001 and 2016. Our findings highlight the importance of continuous monitoring and potential refinement of renoprotection strategies in individuals with hypertension to mitigate the persistent burden of CKD and address health disparities among different demographic groups.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019.

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Analyzing energy performance in American low income households: A DataDriven approach with machine learning insights

The energy burden within low-income households presents a significant societal challenge that necessitates a thorough understanding for developing effective and sustainable policies. However, very few studies analyze and model energy-related factors among low-income individuals. Thus, this study critically investigates the relationship between various buildings' characteristics and four distinct energy-related outputs (i.e., energy burden, annual energy cost, annual energy cost per square footage, and annual energy cost per square footage per person) for both low-income and non-low-income households across the United States, using six machine learning algorithms. Leveraging the American Housing Survey dataset, this study identifies factors impacting energy burden and consumption and highlights variables contributing to the energy burden disparity among these two household groups, compromising census division, number of floors within the unit, household income, federal poverty level threshold, and number of rooms in the unit for non-low-income households, and the number of persons aged 18 and over, census division, household income, number of rooms in a unit, and unit size in square feet for low-income households. Additionally, it introduces 48 models to predict energy-related outputs and evaluates the accuracy of models. To evaluate the accuracy of these models, two key metrics are employed: R2 (coefficient of determination) and RMSE (root mean square error), which provide insights into the models’ predictive accuracy and error rates, respectively. The study reveals that Gradient Boosting Regression and XGBoost predict outcomes for low-income and non-low-income households with higher accuracy and with fewer inputs, making them cost-effective and efficient models. The findings enhance our understanding of energy equity issues and equip policymakers with actionable insights to alleviate energy burden disparities and promote energy equity across diverse socioeconomic landscapes.

Abstract 6112: Uncovering clinicopathological factors contributing to racial inequities in pancreatic cancer in Hampton Roads, Virginia

Abstract Introduction: Pancreatic Ductal Adenocarcinoma (PDAC) is the 3rd leading cause of cancer-related deaths, with 12% surviving 5 years post-diagnosis. The delayed symptom onset, lack of effective screening, and advanced presentation render most patients ineligible for surgery. For inoperable PDAC, treatment offers only palliative support, resulting in a 1-year median survival, in contrast to 3 years for operable cases. Black patients face a 30-70% higher PDAC mortality rate than other racial groups in the United States. In Hampton Roads, Virginia, from 2015-2019, the black PDAC population had a mortality rate of 17.3%, notably surpassing the 10.8% rate among white PDAC patients. Consequently, this project aims to address the disparate disease burden of PDAC in the black Hampton Roads community. Methods: Chart review of 427 inoperable PDAC patients from the Sentara Cancer Network and Virginia Oncology Associates was conducted. Age at diagnosis, treatment date, treatment type, and death date of the black and white inoperable cohorts were extracted. Average length of disease, age of onset, and time from diagnosis to treatment were calculated. KM survival analysis compared the cohorts’ survival rates. Results: From 2008 to 2016, the white cohort had shorter survival rates than the black cohort. The black population averaged a disease length of 249 days, while the white population faced 190 days. The average age at diagnosis was 67 in the black cohort and 70 in the white cohort. 42.1% of white PDAC patients did not receive treatment, while 29.9% of black PDAC patients went untreated. Discussion: While the black population faces higher mortality, the white PDAC inoperable cohort had shorter disease duration and lower survival. A higher number of white patients also did not receive therapy, likely due to their older age, leading to added comorbidities and advanced stages of disease. Elder patients often decline treatment due to its limited impact on lifespan and quality of life. Further, the longer survival found in black patients may paradoxically contribute to a high mortality rate in Black patients. 21% of the black cohort survived over a year, prompting questions about their classification as inoperable and their access to the only curative treatment. This discovery motivates examination of the decisions behind labeling these patients as inoperable. The ongoing investigation into factors, such as stage at diagnosis and standard of care adherence, strives to continue to uncover the reasons for the high mortality rate in the Black PDAC Hampton Roads population. Citation Format: Fatima W. Chaudhry, Zakary L. Kolkey, Ashleigh E. Hannah, Richard A. Hoefer, Amy Tang. Uncovering clinicopathological factors contributing to racial inequities in pancreatic cancer in Hampton Roads, Virginia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6112.

Global State of the Art and Science of Childhood Dysphagia: Similarities and Disparities in Burden.

Feeding/swallowing and airway protection are complex functions, essential for survival, and continue to evolve throughout the lifetime. Medical and surgical advances across the globe have improved the long-term survival of medically complex children at the cost of increasing comorbidities, including dysfunctional swallowing (dysphagia). Dysphagia is prominent in children with histories of preterm birth, neurologic and neuromuscular diagnoses, developmental delays, and aerodigestive disorders; and is associated with medical, health, and neurodevelopmental problems; and long-term socioeconomic, caregiver, health system, and social burdens. Despite these survival and population trends, data on global prevalence of childhood dysphagia and associated burdens are limited, and practice variations are common. This article reviews current global population and resource-dependent influences on current trends for children with dysphagia, disparities in the availability and access to specialized multidisciplinary care, and potential impacts on burdens. A patient example will illustrate some questions to be considered and decision-making options in relation to age and development, availability and accessibility to resources, as well as diverse cultures and family values. Precise recognition of feeding/swallowing disorders and follow-up intervention are enhanced by awareness and knowledge of global disparities in resources. Initiatives are needed, which address geographic and economic barriers to providing optimal care to children with dysphagia.

Abstract P152: Linguistic Acculturation is Associated With Better Cardiometabolic Health Among Bhutanese Refugees Living in the United States

Background: United States (US) South Asians are a fast-growing immigrant group that on average, while having a higher socioeconomic status, present with an increased prevalence and faster development of cardiometabolic health (CMH) conditions. Acculturation—the process of adapting norms of a host culture—can give rise to a unique set of stressful challenges and is associated with poor CMH outcomes among immigrant groups. However, the impact of acculturation on South Asian CMH is relatively unknown due to limited studies, especially when considering the Bhutanese community; the third largest US refugee group. Hypothesis: We hypothesize that increased English linguistic acculturation among US Bhutanese adults would be associated with poorer CMH. Methods: Using 2021-2022 Bhutanese Community of Central Ohio Health Study data, we examined associations of linguistic acculturation and sociodemographic characteristics in relation to CMH conditions among Bhutanese adults living in Central Ohio (N=495). A summed score for responses of very limited (1 point); limited (2 points); fair (3 points); good (4 points); and excellent (5 points) English language proficiency in speaking, listening and understanding, reading, and writing was used to capture limited (≤8), intermediate (9-19), and excellent (20) linguistic acculturation. CMH was assessed from participant self-report of clinical diagnosed or treated hypertension, type 2 diabetes, and dyslipidemia, as well as weight and height to calculate body mass index (BMI). Adjusting for sex, age, and BMI, we used Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of associations of linguistic acculturation and sociodemographic characteristics in relation to CMH conditions. Results: Most participants were aged 18 to 44 years (69.8%) and migrated to the US ≥11 years ago (60.2%). Linguistic acculturation prevalence was 34.1% for very limited/limited and 65.9% for fair to excellent. Most participants reported no CMH condition (70%), while 12.9% reported one, 10.8% reported two, and 6.3% reported three. Fair to excellent vs. very limited/limited linguistic acculturation were associated with a lower prevalence of having three CMH conditions (PR=0.17 [95% CI: 0.03-0.97]). Migrating to the US ≥11 years vs. <11 years was associated with a higher prevalence of having two CMH conditions (PR=1.67 [95% CI: 0.95-2.95]). Conclusions: In conclusion, more linguistic acculturation was associated with better CMH among Bhutanese adults living in the US. Given the burden of CMH disparities among minoritized racial/ethnic groups in the US, future studies should consider acculturation to further explore the role of language in shaping immigrant and refugee health across the lifecourse.