Ethnic Differences In Incidence Research Articles

Disparities in child protective services involvement in pediatric traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI. Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance. Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status. We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2years.

Incidence and predictors of new-onset atrial fibrillation after cardiac surgery at Auckland City Hospital.

To describe the incidence, ethnic differences in incidence, and predictors of post-operative atrial fibrillation (POAF) after cardiac surgery in a New Zealand hospital. Analysis of registry data on 1,630 adults without previous atrial fibrillation having coronary artery bypass grafting and/or valve surgery was used to determine the incidence of POAF. Univariate analysis identified risk factors and stepwise logistic regression was used to create the most parsimonious model to predict POAF. Overall POAF incidence was 29% (n=465) and differed by surgery type (25% after isolated coronary artery bypass surgery (CABG) vs 42% after combined CABG+valve). Incidence was highest in Māori (35%) and NZ/Other Europeans (32%). Māori and Pasifika with POAF were on average ten years younger than NZ/Other Europeans. Independent risk factors were age (OR 1.05, 95%CI 1.04-1.06), body mass index (OR 1.04, 95%CI 1.02-1.06), history of heart failure (OR 2.08, 95%CI 1.47-2.95), and valve surgeries (isolated valve OR 1.51, 95%CI 1.16-1.95; CABG+valve OR 1.59, 95%CI 1.11-2.28), but the model had poor discrimination (AUC 0.67). POAF in a New Zealand hospital occurs at comparable rates to international settings. Risk models using routinely measured factors offer poor predictive accuracy, meaning risk stratification is unlikely to adequately inform targeted POAF prevention in clinical practice.

Identifying racial and ethnic disparities in patients diagnosed with mycosis fungoides/Sezary syndrome in the United States: A contemporary SEER analysis.

7544 Background: Mycosis fungoides (MF) and Sezary syndrome (SS) are rare cutaneous T-cell lymphomas. In this study, we compare demographics, treatment, and survival patterns in Hispanic (HI) vs. Non-Hispanic (NH) patients diagnosed with MF and SS. Methods: Data were analyzed on MF and SS patients in the US reported to SEER 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the total US population, and up to 36% of HI. Racial groups analyzed included NH whites, HI whites, blacks, and Asians/Pacific Islanders. Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups, HI vs NH. Stratification by age, gender, and stage at diagnosis were considered. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage, and B-symptoms. Results: 8578 patients with MF and 275 patients with SS were identified. Of patients with MF, 11% were HI and 89% were NH; of patients with SS, 12% were HI and 88% were NH. In NH patients with MF, most patients were male (58%); for HI patients with MF, a male predominance was not observed (p &lt; 0.001). In patients with SS, most patients were male in both NH and HI (56% NH, 56% HI; p = 0.989). In both MF and SS, HI were diagnosed at younger ages compared to NH, 49 y.o vs 60 y.o (p &lt; 0.001) and 59 y.o vs 71 y.o (p = 0.009) respectively. Most HI and NH with MF and SS did not receive radiotherapy (91% of NH and 92% of HI for MF; 92% of NH and 91% of HI for SS; p values 0.166 and 0.760, respectively). On survival analysis, for patients with MF, the survival probability (SP) at 2, 5, and 10 years for HI vs NH were 94%, 87%, and 77% vs. 91%, 81%, and 69%, respectively. The survival difference observed favored HI (p &lt; 0.001). For patients with SS, there was no statistically significant survival difference between HI and NH with 2, 5, and 10 year SP at 65%, 42%, and 17% for HI and 62%, 36%, and 16% for NH, respectively (p = 0.99). In patients with SS, the median survival time in years was 3.3 and 3.2 in NH and HI patients, respectively. In patients with MF, the median survival time was not reached. On multivariate analysis, when adjusted for age, those patients with MF and SS who were older than 80 y.o and between 60 to 80 y.o, had worse OS compared to those younger than 60 y.o, with HR 17.6 (95%: 13.8 – 22.3 ) and 4.2 (95 % CI: 3.6 – 5) respectively for MF; and HR 1.8 (95% CI: 0.9 – 3.7) and 1.64 (CI 95% 1 – 2.8) respectively for SS. Conclusions: We identified ethnic differences in incidence, age at diagnosis, sex, and survival outcomes in patients with MF and SS. Notably, we identified a survival advantage in patients with MF that favored HI. In patients with SS, there was no ethnic difference in survival.

Ethnic differences in incidence and outcomes of acute aortic syndromes in the Midland region of New Zealand

BackgroundDisparities in cardiovascular disease according to socioeconomic factors and ethnicity are a global issue. The indigenous Māori population of New Zealand is not exempt. The aims of the present study were to assess whether ethnic disparities exist in the presentation and outcomes of acute aortic syndrome (AAS), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, in New Zealand. MethodsA retrospective observational cohort study of consecutive AAS patients presenting to a tertiary referral center covering the Midland region of New Zealand (population, 816,900; 23.3% Māori) during a 10-year period was completed (2010-2020). Data were assessed by ethnicity (Māori vs non-Māori) and Stanford classification of AAS. The incidence of disease, 30-day mortality, and long-term all-cause and aortic-related mortality were recorded and assessed using logistic regression and Cox proportional hazards models. ResultsA total of 250 patients had presented with AAS (Māori, 92 [36.8%]; type A, 144 [57.6%]). The age-standardized rates of AAS were higher in Māori than in non-Māori patients (6.9/100,000 person-years vs 2.0/100,000 person-years; risk ratio, 3.56; 95% confidence interval, 1.50-8.53; P = .002). Māori patients had presented at a younger age for both type A (age, 54.4 ± 12 years vs 66.0 ± 13.2 years; P < .001) and type B (age, 61.3 ± 10.2 years vs 68.8 ± 13.7 years; P = .005) AAS. Mortality at 30 days was higher for those with type A than for those with type B AAS (33.3% vs 13.2%; P < .001) but did not differ by ethnicity in our cohort. On multivariate analysis, no differences were found in 30-day or long-term survival when stratified by ethnicity. ConclusionsThe results from the present study have demonstrated that ethnic disparities in AAS exist in New Zealand, with Māori presenting at a younger age and with a greater incidence compared with other ethnicities. Whether this disparity is related to socioeconomic factors, access to preventive care, or other factors remains to be elucidated. Despite these differences in disease presentation, the survival outcomes when stratified by ethnicity were comparable in the present cohort.

Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study.

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.

Racial and Ethnic Differences in Incidence and Disease Specific Survival of Multiple Myeloma- New Mexico Tumor Registry Based Study

Background: Multiple Myeloma is a plasma cell neoplasm which is characterized by an increase in monoclonal proteins or light chains and end-organ damage. Multiple Myeloma accounts for 1.8% of all new cancer cases in the United States, with an estimated 32,110 new cases annually. In population-based studies, African Americans have a higher incidence of Myeloma and inferior outcomes when compared to Caucasians. Disparities in the incidence of Myeloma for other races in the United States also exist but are not well studied.(1). Analyses of Surveillance, Epidemiology, and End Results program (SEER) data showed that Hispanics had poor or delayed access to novel agents and transplant, and poor overall survival.(2). Data for Native Americans was not reported due to small or insignificant numbers. New Mexico is a majority minority state, with approximately 1 million Hispanics residing in the state, constituting 49.1% of the total population and the largest statewide percentage of Hispanic residents nationally. (3) New Mexico also has a sizable population of 219,237 Native Americans, who make-up nearly 10.5% of the state's entire population. (3) Hence, the significant minority population in New Mexico allows the comparison of incidence between racial and ethnic subgroups as well as disease specific survival of Myeloma in New Mexico residents using the New Mexico Tumor Registry. Methods: We utilized data from the New Mexico Tumor Registry to study patients with a documented diagnosis of Myeloma. Descriptive statistics including the incidence rates of myeloma and Kaplan-Meier product-limit methods to assess cause-specific survival for incident myeloma cases diagnosed among New Mexico residents during the time period 2008-2017. Other variables including transplantation rates were also studied but are not reported in this abstract. Results: Men had higher incidence of Myeloma compared to females (p&amp;lt;0.01) and Hispanic females had a higher incidence compared to Non-Hispanic white females (p&amp;lt;0.05). The incidence of Myeloma (for both sexes) was slightly increased in Hispanics (5.6 /per 100,000, CI- 5.1,6.2) and Native Americans (6.3/per 100,000, CI- 5.1,7.7) compared to Non- Hispanic Caucasians (5.1/per 100,000, CI- 4.7,5.5). (Fig. 1) However, these differences were not statistically significant. The incidence of multiple myeloma has been stable for all racial-ethnic group examined during 1981-2017. (Fig. 2) Modest differences in survival among Non-Hispanic whites, Hispanics, and American Indians were not statistically significant (log-rank test, p=0.3907). (Fig.3) Conclusion: Racial-ethnic differences in incidence and disease specific survival of Multiple Myeloma were evident but were not statistically significant in New Mexico, except incidence of Multiple Myeloma among Hispanic females compared to Non-Hispanic white females. Further study of disease-related factors (high risk disease, mutational profiles, stage at diagnosis) and patient-related factors (access to standard treatments, transplantation or clinical trials) may be needed to understand these differences and better care for the patients. Disclosures Andritsos: Innate Pharma: Consultancy, Honoraria.

Exploring indigenous ethnic inequities in first episode psychosis in New Zealand – A national cohort study

IntroductionFirst episode psychosis (FEP) disproportionately affects rangatahi (young) Māori, the Indigenous people of New Zealand, but little is known about factors contributing to this inequity. This study describes a cohort of rangatahi Māori and young non-Māori with FEP, and explores ethnic differences in incidence rates, and the contribution of deprivation, urbanicity and substance use. MethodsMāori and young non-Māori, aged 13–25 at the time of the first recorded psychosis-related diagnoses, were identified from within Statistics NZ's Integrated Data Infrastructure (IDI), between 2009 and 2012. To estimate age-standardised FEP incidence rates, the population-at-risk was estimated using IDI-based usual resident population estimates for 2009–2012, stratified by ethnicity and single year of age. Poisson regression models were used to estimate ethnic differences in FEP incidence adjusted for age, gender, deprivation, and urban-rural area classification. ResultsA total of 2412 young people with FEP (40% Māori, 60% non-Māori) were identified. Māori were younger, and more likely to live in deprived and rural communities and be diagnosed with schizophrenia. Substance induced psychosis was uncommon. The unadjusted age-standardised FEP incidence rate ratio was 2.48 (95% CI: 2.29–2.69) for rangatahi Māori compared with young non-Māori. While adjusting for age, sex, deprivation and urban rural area classification reduced ethnic differences in incidence, rangatahi Māori were still more than twice as likely to have been diagnosed with FEP compared to young non-Māori. ConclusionsThis study confirms previous findings of elevated rates of psychosis among rangatahi Māori. The difference in rates between Māori and non-Māori were attenuated but remained after adjustment for deprivation and urbanicity.

Ethnic differences in incidence and mortality of stroke in Denmark

Abstract Background Stroke is a leading cause of disability and mortality worldwide. However, studies on incidence and mortality of stroke hereof among ethnic minorities compared with local born are still limited. Methods We conducted a Danish nationwide register-based cohort study between 2004 and 2018. All cases of first ever stroke aged 18-95 years were included. Country of birth was used to construct ethnic groups. Age standardized incidence rate ratio (IRR) of stroke stratified by country of birth and sex were estimated with the Danish born as a reference group. Ethnic minorities were grouped as Western and Non-western for mortality hazard ratio (HR) estimates. Results In overall, ethnic minorities had a higher risk of stroke compared with Danish born. Particularly, the IRR of all stroke was estimated to be 8.3 times higher among Polish men compared to Danish born men (IRR, 8.32; 95% CI, 6.89-10.05). Compared with Danish born women, Pakistan women had the highest risk of all stroke (IRR, 2.89; 95% CI, 2.46-3.39). By contrast, Swedish women had reduced risk of hemorrhagic stroke (IRR, 0.40; 95% CI, 0.18-0.89) and Norwegian women had reduced risk of ischemic stroke (IRR, 0.87; 95% CI, 0.72-1.06). Compared with Danish born men, all-cause 1-year mortality hazard for Non-western men was (HR, 1.61; 95% CI, 1.13-2.29) while for Western men was (HR, 1.07; 95% CI, 0.90-1.29) among ischemic stroke patients. Among hemorrhagic stroke patients, 1-year mortality hazard for Non-western men was (HR, 0.75; 95% CI, 0.39-1.47) whereas Western men had (HR, 1.48; 95% CI, 1.04-2.10). Among women, we observed reduced all cause 1-year mortality hazard in Non-western (HR, 0.32; 95% CI, 0.13-0.80) for hemorrhagic stroke whereas no difference in mortality hazard was observed for ischemic stroke. Conclusions Incidence and post stroke mortality appear to vary among ethnic minorities in comparison to Danish born. It may depend on the type of stroke and sex. Key messages The study contributes knowledge in migration and health. With good quality registers, we are in unique position to establish findings in Denmark, which has a growing migrant population.

We must now put in place an updated, comprehensive newborn screening program for deaf and hard-of-hearing infants

We must now put in place an updated, comprehensive newborn screening program for deaf and hard-of-hearing infants

Abstract 117: A Population Based Study in a Large Ethnically Diverse Metropolitan City Reveals Racial and Ethnic Disparities in Pediatric Cardiac Arrest

Background: Data regarding racial and ethnic differences in incidence and survival in pediatric cardiac arrest are unknown. In large cities, universal tracking of cardiac arrest is limited by multiple response centers fielding calls. This study was performed in Houston, one of the largest and most ethnically diverse cities in the US. Every 911 call in the city is tracked by a single operations center, providing a unique opportunity to conduct a population based study. Objective: We aimed to examine race and ethnic differences in incidence and survival rates among pediatric cardiac arrests utilizing a non-sampled population in a large metropolitan area. Methods: We performed a retrospective review of all 911 emergency response records involving non-traumatic pediatric cardiac arrests &lt;18 years between 2002-2017. Race and ethnicity data among patients with cardiac arrests were compared to Houston population census data. Results: There were 598 (57% males) pediatric cardiac arrests at median age of 10 mo (IQR 2 mo - 6 yrs). Infants &lt;2 yrs accounted for 60% of cases, 2-5 yrs (14%), 6-10 yrs (15%) and 11-17 yrs (11%). Overall, non-Hispanic black children comprised a significantly larger proportion of those with cardiac arrest than would be expected given population distribution (Figure). When evaluating these differences by age, the largest discrepancy was among infants, where odds of arrest in non-Hispanic black or Hispanic was 2.3 (95%CI 1.2-4.4) and 2.9 (95% CI 1.4-5.8) compared to white children. Overall survival was poor (9%) and did not differ by race/ethnicity, sex, bystander CPR, or time from 911 call to emergency personnel arrival. The only variable associated with greater survival was witnessed arrest (OR 2.2, 95%CI 1.2-4.0). Conclusions: There are racial differences in cardiac arrest in Houston based on age. Identifying reasons for these differences may provide insights into environmental or genetic risk factors associated with pediatric cardiac arrests.

Ethnicity-related trends in gynecologic malignancies in Israel, 1993-2013.

To describe trends and ethnic differences in incidence of gynecologic cancer in Israel. In the present retrospective epidemiologic study, age-standardized rates (ASRs) rates of gynecologic malignancies that occurred between January 1, 1993, and December 31, 2013, were extracted from the Israeli National Cancer Registry. The annual percent change (APC) was calculated separately for Jewish and Arab patients for ovarian, endometrial, and cervical cancers. Among Jewish patients, the ASR of ovarian cancer decreased (APC -2.27%, 95% confidence interval [CI], -2.7 to -1.84; P<0.001), the ASR of endometrial cancer increased (APC 1.50%, 95% CI 0.87-2.14; P<0.001), and the ASR of cervical cancer did not change (P=0.737). Among Arab patients, the ASRs of ovarian and cervical cancer did not change (P=0.181 and P=0.575, respectively), and the ASR of endometrial cancer increased (APC 1.98%, 95% CI 0.15-3.85; P=0.021). Between 1993 and 2013, the incidence of gynecologic malignancies showed different trends among Jewish and Arab populations. Endometrial cancer increased among both populations and ovarian cancer decreased among Jewish patients. ASR of cervical cancer was low and stable among both Jewish and Arab groups. These trends could reflect differences in lifestyle and exposure to risk factors associated with each malignancy.

Ethnic Differences in Incidence and Outcomes of Childhood Nephrotic Syndrome.

Ethnic differences in outcomes among children with nephrotic syndrome are unknown. We conducted a longitudinal study at a single regional pediatric center comparing ethnic differences in incidence from 2001 to 2011 census data and longitudinal outcomes, including relapse rates, time to first relapse, frequently relapsing disease, and use of cyclophosphamide. Among 711 children, 24% were European, 33% were South Asian, 10% were East/Southeast Asian, and 33% were of other origins. Over 10 years, the overall incidence increased from 1.99/100,000 to 4.71/100,000 among children ages 1-18 years old. In 2011, South Asians had a higher incidence rate ratio of 6.61 (95% confidence interval, 3.16 to 15.1) compared with Europeans. East/Southeast Asians had a similar incidence rate ratio (0.76; 95% confidence interval, 0.13 to 2.94) to Europeans. We determined outcomes in 455 children from the three largest ethnic groups with steroid-sensitive disease over a median of 4 years. South Asian and East/Southeast Asian children had significantly lower odds of frequently relapsing disease at 12 months (South Asian: adjusted odds ratio; 0.55; 95% confidence interval, 0.39 to 0.77; East/Southeast Asian: adjusted odds ratio; 0.42; 95% confidence interval, 0.34 to 0.51), fewer subsequent relapses (South Asian: adjusted odds ratio; 0.64; 95% confidence interval, 0.50 to 0.81; East/Southeast Asian: adjusted odds ratio; 0.47; 95% confidence interval, 0.24 to 0.91), lower risk of a first relapse (South Asian: adjusted hazard ratio, 0.74; 95% confidence interval, 0.67 to 0.83; East/Southeast Asian: adjusted hazard ratio, 0.65; 95% CI, 0.63 to 0.68), and lower use of cyclophosphamide (South Asian: adjusted hazard ratio, 0.82; 95% confidence interval, 0.53 to 1.28; East/Southeast Asian: adjusted hazard ratio, 0.54; 95% confidence interval, 0.41 to 0.71) compared with European children. Despite the higher incidence among South Asians, South and East/Southeast Asian children have significantly less complicated clinical outcomes compared with Europeans.

Ethnic differences in incidence of hepatitis B surface antigen seroclearance in a real-life multicenter clinical cohort of 4737 patients with chronic hepatitis B infection.

Hepatitis B surface antigen (HBsAg) positivity is associated with increased risk for cirrhosis and hepatocellular carcinoma (HCC). HBsAg seroclearance is thought to be rare in general, but cohort data from US patients are limited. To determine the incidence of HBsAg seroclearance in a real-life US cohort. In total, 4737 patients with chronic hepatitis B from five primary care, gastroenterology and multispecialty centres, and a university medical centre were retrospectively enrolled between 2001 and 2014 with data obtained by manual review of individual patient medical records. Seroclearance was determined by loss of HBsAg seropositivity. Persistent HBsAg was confirmed by direct serology or by proxy with positive hepatitis B e-antigen (HBeAg) or HBV DNA levels. HBsAg seroclearance occurred in 52 patients over 16 844 person-years (0.31% annually, 1.2% overall). Median follow-up was 32 months, and mean age 45 ± 14 years. Incidence of HBsAg seroclearance was higher in non-Asians, age >45, males, and those with baseline HBV DNA ≤10 000 IU/mL. On multivariate Cox proportional modelling, non-Asian ethnicity (HR 2.8), male sex (HR 2.1), baseline HBVDNA ≤10 000 (HR 2.0) and age >45 (HR 1.8) were significant independent predictors of seroclearance. HBsAg seroclearance rates were lower than previously described in this real-life cohort of patients with chronic hepatitis B, especially among Asian, female and younger patients.

Ethnic variations in upper gastrointestinal hospitalizations and deaths: the Scottish Health and Ethnicity Linkage Study.

Upper gastrointestinal (GI) diseases are common, but there is a paucity of data describing variations by ethnic group and so a lack of understanding of potential health inequalities. We studied the incidence of specific upper GI hospitalization and death by ethnicity in Scotland. Using the Scottish Health and Ethnicity Linkage Study, linking NHS hospitalizations and mortality to the Scottish Census 2001, we explored ethnic differences in incidence (2001-10) of oesophagitis, peptic ulcer disease, gallstone disease and pancreatitis. Relative Risks (RRs) and 95% confidence intervals were calculated using Poisson regression, multiplied by 100, stratified by sex and adjusted for age, country of birth (COB) and socio-economic position. The White Scottish population (100) was the reference population. Ethnic variations varied by outcome and sex, e.g. adjusted RRs (95% confidence intervals) for oesophagitis were comparatively higher in Bangladeshi women (209; 124-352) and lower in Chinese men (65; 51-84) and women (69; 55-88). For peptic ulcer disease, RRs were higher in Chinese men (171; 131-223). Pakistani women had higher RRs for gallstone disease (129; 112-148) and pancreatitis (147; 109-199). The risks of upper GI diseases were lower in Other White British and Other White [e.g. for peptic ulcer disease in men, respectively (74; 64-85) and (81; 69-94)]. Risks of common upper GI diseases were comparatively lower in most White ethnic groups in Scotland. In non-White groups, however, risk varied by disease and ethnic group. These results require consideration in health policy, service planning and future research.

O125. Ethnicity: An independent risk factor for adverse perinatal outcome in women with chronic hypertension

Introduction Ethnic variation in incidence of adverse perinatal outcomes has been previously described, but similar data from pregnancies exclusively in women with chronic hypertension are limited. Objectives To perform a retrospective cohort study of pregnant women with chronic hypertension to assess the impact of ethnicity as an independent risk factor on adverse perinatal outcome. Method Demographic and delivery data of women with chronic hypertension and singleton pregnancies from two tertiary obstetric units between 2000 and 2015 were extracted from maternity databases. Women were allocated to one of four groups of ethnicity (aligned to those used by the UK Office for National Statistics) for analysis: White, Black, Asian and other. Risk ratios and risk differences were calculated by generalised linear models, with a log or linear link respectively, together with risk ratios adjusted for baseline characteristics (maternal age, parity, body mass index, smoking); the statistical package Stata version 1.3 (StataCorp, College Station, Texas) was used. Results 4713 singleton pregnancies in women with chronic hypertension were included. All adverse perinatal outcomes occurred more frequently in Black women compared to White women (Table, showing percentages and adjusted risk ratios with 95% confidence intervals using White women as the referent category). Asian women also were at increased risk, though to a lesser extent. Download : Download full-size image Conclusion Black women with chronic hypertension are at markedly increased risk of many adverse perinatal outcomes compared to White women, with features of placental disease. Further research is needed to explore the pathophysiology underpinning these disparities in outcome. Ethnic differences in incidence of chronic hypertension and response to antihypertensive agents in non-pregnant individuals exist. Antihypertensive treatments prescribed in pregnancy may need to account for ethnic variation in response to therapy and an awareness of these potential differences should inform stratification of antenatal care pathways.

Gender and ethnic differences in incidence and survival of lymphoid neoplasm subtypes in an Asian population: Secular trends of a population-based cancer registry from 1998 to 2012.

Descriptive epidemiology on incidence and survival by lymphoid neoplasm (LN) subtypes using the 2008 World Health Organisation (WHO) classification remained limited in Asia. The aim of this study was to evaluate whether gender and ethnic differences in incidence and survival of LN subtypes existed using the Singapore Cancer Registry (SCR) from 1998 to 2012. We derived age standardised incidence rates (ASIRs) by the direct standardisation method and 5-year relative survival (RSR) by the Ederer II method and period approach. Five-year observed survival (OS) was obtained for each ethnicity. Malays had the highest ASIR of total LNs among the three ethnicities for each time period. The largest increase in 5-year RSR subtypes was follicular lymphoma from 43.8% in 1998-2002 to 82.3% in 2008-2012; followed by chronic lymphocytic leukaemia (CLL)/small lymphocytic lymphoma (SLL) from 48.1% in 1998-2002 to 77.9% in 2008-2012. Although males had higher incidence than females in each time period, females had greater 5-year RSR for follicular lymphoma (89.8% in 2008-2012 for females vs. 76.6% in 2008-2012 for males) and CLL/SLL (78.7% in 2008-2012 for females vs. 76.7% in 2008-2012 for males). All three ethnicities experienced an overall increase in 5-year OS for mature B-cell lymphoma, with Indians experiencing the greatest increase (37.1% in 1998-2002 to 61.1% in 2008-2012), followed by Malays (30.8% in 1998-2002 to 48.7% in 2008-2012) and then Chinese (36.4% in 1998-2002 to 51.3% in 2008-2012). Our study demonstrated that improved mature B-cell lymphoma survival was not only observed in the West, but also in Singapore.

The role of body weight, fat distribution and weight change in ethnic differences in the 9-year incidence of hypertension

To investigate the role of body composition (body weight, fat distribution and weight change over time) in ethnic differences in the incidence of hypertension in an ethnic Dutch, South Asian Surinamese and African Surinamese background population living in the Netherlands. We included 361 participants without hypertension at baseline (147 ethnic Dutch, 82 South Asian Surinamese, 132 African Surinamese), aged 35-60 years, in whom anthropometric measurements and blood pressures were measured at baseline and after mean 9 years of follow-up. Data were analysed using logistic regression analyses, with hypertension at follow up as a dependent variable. Body weight, fat distribution and weight gain were positively associated with the risk of developing hypertension; these associations did not statistically significantly differ between ethnic groups [odds ratios (ORs), 95% confidence interval (95% CI) per SD: BMI 1.5 (1.2-2.0); waist circumference 1.5 (1.2-1.9); waist to hip ratio (WHR) 1.4 (1.1-1.9), weight gain of 1-2.9 kg/m 1.8 (0.9-3.8)]. As compared with Dutch, a higher incidence of hypertension was found among South Asian Surinamese [OR 2.6 (1.4-4.8)] and in particular among African Surinamese [OR 3.1 (1.76-5.30)]. Among South Asian Surinamese, adjustment for WHR attenuated the OR the most [OR 1.9 (1.0-3.7)]; among African Surinamese, the strongest effect was observed for adjustment by BMI and WHR simultaneously [OR 2.5 (1.4-4.4)]. The ethnic differences in the incidence of hypertension among a middle-aged group with a Dutch, South Asian Surinamese and African Surinamese background were partly explained by body composition. This suggests that other factors may be involved, including genetic factors or unidentified other determinants.

Retrospective Study Of Incidence Of Thromboses In Chinese Versus African Americans With Multiple Myeloma

BackgroundRisk of arterial (ATE) and venous thromboembolic events (VTE) is increased in multiple myeloma (MM). Immunomodulator therapy (Imid) concurrent with steroids further increases this risk. Retrospective single arm studies suggest that Asian patients with MM may have a lower risk of TE than in other ethnicities. We performed a retrospective study comparing Chinese (C) and African American (AA) patients in two centers, the Department of Clinical Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong (PWH) and the University hospitals, Case Medical Center, Cleveland, Ohio (CMC), for ethnic differences in incidence of TE in MM. Methods120 Chinese patients from PWH and 100 AA patients from CMC fulfilling IMWG consensus criteria for MM diagnosis between Jan 1st 2000 and Dec 31st 2011 were identified and selected for analysis. Data regarding demographics, comorbidities, myeloma characteristics, therapy and thrombotic complications were collected by electronic and paper chart review. Data collection was censored as of Dec 31st 2012. ResultsThe Chinese cohort comprised more men, lower baseline incidence of diabetes (DM), hypertension (HTN) and non-myeloma related renal failure (CRF), advanced myeloma at diagnosis and more IgA subtype than AA. Over 90% of patients of both groups received chemotherapy. 72% of Chinese and 80% of AA received Imid based treatment. Lenalidomide with steroids was used more often in AA (36.8% AA vs 3.6%C, p<0.0001), Chinese received more thalidomide with steroids. (62.2% C vs 42.1%, p:0.004) Use of thromboprophylaxis (TP) is not routine in PWH, less Chinese were on TP during the disease course (11.7% vs 68%, p<0.0001) or during Imid based treatment. (16% vs 85%, p: 0.0001) Relative rates of aspirin, low molecular weight heparin and warfarin usage for TP were similar across both groups.Despite lower TP rates, a significantly lower rate of symptomatic VTE was observed in the Chinese. (3.3% vs 22%, p:0.001) The difference in VTE detection persisted on correction for number of imaging studies performed, 24 imaging tests in Chinese and 145 in AA. (16.7% vs 48.3%, p:0.004). Amongst the Chinese, all 4 events (100%) occurred on thalidomide dexamethasone (TD), 3 events (75%) in the absence of TP. In the AA, 21 of 26 events (81%) occurred on Imid based treatment. 12 events (46%) occurred in the absence of TP. On binary logistic regression using race, gender, prior venous thrombosis, any TP, TD and lenalidomide dexamethasone therapy as covariates, AA race (OR: 5.022, 95% CI:1.3- 19.4) and TD therapy (OR: 4.07, 1.26- 3.13) emerged as significant risk factors for VTE. Overall incidence of VTE on TD treatment was 4.5% in Chinese versus 22% in AA. (p:0.002)An increased number of arterial events were seen in the Chinese (9.2% vs 3% in AA) but the difference did not reach statistical significance. Of the 11 arterial events in Chinese, 5 (46%) occurred on Imid based therapy, 9 events (82%) were in the absence of TP. 7 were cardiac and 4 cerebrovascular. Of the 3 arterial events in AA, 1 (33.3%) occurred on Imids and all patients were receiving TP. 1 was cardiac, 1 abdominal and 1 upper limb. ConclusionOur study suggests that the Chinese have a lower risk of VTE than AA in the setting of MM. However , despite lower prevalence of most vascular risk factors in Chinese, ATE rates in Chinese were higher than AA, while not statistically significant. Larger studies are necessary to further elucidate these differences in thrombosis risk and to develop specific guidelines for TP in Asian patients with MMTable 1Characteristics of AA and Chinese patients with MM (*: p value <0.05, NS: not significant)CharacteristicAA (n=100)Chinese (n=120)pAgeMean age at MM diagnosis64.7 (SD:12.6)65.7 (SD:10.8)NSGender, n (%)Male gender n (%)43 (43%)69 (57.5%)*Blood group, n (%)O36 (36%)44 (36.7%)NSNon O42 (42%)62 (51.7%)Comorbidities, n (%)DM31 (31%)28 (23.3%)NSHTN63 (63%)57 (47.5%)*Lipids32 (32%)10 (8.3%)*Gout2 (2%)12 (10%)*Atrial fibrillation4 (4%)7 (5.8%)NSActive smoking8 (8%)10 (8.3%)NSCRF22 (22%)5 (4.2%)*Pre myeloma arterial thrombosis13 (13%)18 (15%)NSPre myeloma venous thrombosis5 (5%)1 (0.8%)NSMyeloma characteristics, n (%)DSS 1 or 237 (37%)20 (16.7%)*DSS 363 (63%)100 (83.3%)IgG73 (73%)56 (46.7%)*IgA19 (19%)37 (30.8%)IgM1 (1%)0 (0%)Light chain/non secretory/ IgD7 (7%)27 (22.5%)TE events, n (%)VTE after MM diagnosis22 (22%)4 (3.3%)*ATE after MM diagnosis3 (3%)11 (9.2%)NS Disclosures:No relevant conflicts of interest to declare.

OP82 Ethnic Differences in Alcohol-Related Diseases in Scotland

BackgroundAlcohol-related harms, most commonly liver disease-related, are a public health priority in Scotland. Previous research has identified variations in liver disease mortality endpoints using country of birth as a proxy...

PP54 Ethnic differences in Upper Gastrointestinal Disease in Scotland

BackgroundThere is a paucity of data assessing ethnic variations in upper gastrointestinal (GI) disease: we sought to study the incidence of upper GI diseases using adequate measure of ethnicity in...