Evidence Of Effect Measure Modification Research Articles

Lead brownfields and birth defects in North Carolina 2003-2015: A cross-sectional case-control study.

Brownfields consist of abandoned and disused sites, spanning many former purposes. Brownfields represent a heterogenous yet ubiquitous exposure for many Americans, which may contain hazardous wastes and represent urban blight. Neonates and pregnant individuals are often sensitive to subtle environmental exposures. We evaluate if residential exposure to lead (Pb) brownfields is associated with birth defects. Using North Carolina birth records from 2003 to 2015, we sampled 169,499 births within 10 km of a Pb brownfield with 3255 cardiovascular, central nervous, or external defects identified. Exposure was classified by binary specification of residing within 3 km of a Pb brownfield. We utilized multivariable logistic regression models adjusted for demographic covariates available from birth records and 2010 Census to estimate odds ratios (OR) and 95% confidence intervals (CI). Effect measure modification was assessed by inclusion of interaction terms and stratification for the potential modifiers of race/ethnicity and diabetes status. We observed positive associations between cardiovascular birth defects and residential proximity to Pb brownfields, OR (95%CI): 1.15 (1.04, 1.26), with suggestive positive associations for central nervous 1.16 (0.91, 1.47) and external defects 1.19 (0.88, 1.59). We did observe evidence of effect measure modification via likelihood ratio tests (LRT) for race/ethnicity for central nervous and external defect groups (LRT p values 0.08 and 0.02). We did observe modification by diabetes status for the cardiovascular group (LRT p value 0.08). Our results from this analysis indicate that residential proximity to Pb brownfields is associated with cardiovascular birth defects with suggestive associations for central nervous and external defects. In-depth analyses of individual defects and other contaminants or brownfield site functions may reveal additional novel associations.

Sleepless nights, troubled futures: The association between insufficient sleep and child flourishing

ObjectiveTo examine associations between sleep and flourishing among children ages 0–5 years in the United States and whether these differ by age, developmental needs, and family resilience. Study design and methodsCross-sectional data from the 2020–2021 National Survey of Children's Health (N = 31,095) were used with survey-weighted logistic regression to explore associations between insufficient sleep (defined as not meeting age-recommended daily sleep guidelines: 12–16 h for 4- to 12-month-olds, 11–14 h for 1- to 2-year-olds, and 10–13 h for 3- to 5-year-olds) and flourishing (using four markers combined and categorized into two groups). Tests of effect measure modification (EMM) were performed on the multiplicative and additive scales. ResultsWeak but notable evidence was found that children with insufficient sleep had decreased odds of flourishing (aOR = 0.76; 95 % CI: 0.60, 1.00). No evidence of EMM by child age or family resilience was found. However, the sleep-flourishing association differed significantly by children's developmental needs, suggesting that the combined effect of sleep and developmental needs impact flourishing more than either factor alone. ConclusionsApproximately 38 % of children ages 0–5 years in the United States are estimated to have insufficient sleep. This study provides evidence that insufficient sleep is associated with decreased flourishing among children with special health care needs (CSHCN). Future implicationsIncreasing sleep interventions among children under five is warranted among children with special health care needs. The association between sleep and flourishing within specific CSHCN categories, including emotional, behavioral, or developmental (EBD) criteria, should be explored to optimize sleep policies.

Long-term ambient sulfur dioxide exposure during gestation and preterm birth in North Carolina, 2003–2015

BackgroundCoal-fired power plants are major contributors of ambient sulfur dioxide (SO2) air pollution. Epidemiological literature suggests an adverse association between SO2 exposure during gestation and preterm birth (PTB; <37 weeks completed gestation). PTB is strongly associated with infant mortality and increased risk for later life morbidities. ObjectiveWe investigated associations between SO2 and PTB in North Carolina and evaluated whether the associations were modified by race/ethnicity. MethodsWe assembled a retrospective, administrative cohort of singleton births in North Carolina from 2003 to 2015. We used US EPA EQUATES data to assign long-term SO2 gestational exposures to eligible births for the entire pregnancy and by trimester. We used multivariable generalized linear regression to estimate risk differences (RD (95%CI)) per 1-ppb increase in SO2, adjusted for gestational parent education, Medicaid status, marital status, and season of conception. Multi-pollutant models were additionally adjusted for other criteria air co-pollutants (O3, PM2.5, NO2). ResultsThe median SO2 (24-h average) across exposure windows was ∼1.5 (IQR: 1.8) ppb. The overall baseline risk for PTB was 8756 per 100,000 live births. When stratified by race/ethnicity, the baseline risk for PTB was 12215, 7824, and 7187 per 100,000 live births among non-Hispanic Black, non-Hispanic white, and Hispanic births, respectively. RDs per 1-ppb increase in SO2 averaged across the entire pregnancy were 317.0 (95%CI: 279.4, 354.5) and 568.2 (95%CI: 500.3, 636.1) per 100,000 live births for single- and multi-pollutant models, respectively. For the PTB multi-pollutant models, we observed similar RDs for non-Hispanic Black participants (669.6 [95%CI: 573.9, 765.2]) and non-Hispanic white participants (635.4 [95%CI: 557.2, 713.6]) with smaller RDs for Hispanic participants (336.8 [95%CI: 241.3, 432.2]). SignificanceThe results for our adjusted single- and multi-pollutant models showed adverse associations between SO2 and PTB, with some evidence of effect measure modification by race/ethnicity within subcategories of PTB.

Outcome of Pregnancy Oral Glucose Tolerance Test and Preterm Birth.

Gestational diabetes is associated with adverse outcomes such as preterm birth (<37 weeks). However, there is no international consensus on screening criteria or diagnostic levels for gestational diabetes, and it is unknown whether body mass index (BMI) or obesity modifies the relation between glucose level and preterm birth. We studied a pregnancy cohort restricted to two Danish regions from the linked Danish Medical Birth Register to study associations between glucose measurements from the 2-hour postload 75-g oral glucose tolerance test (one-step approach) and preterm birth from 2004 to 2018. In Denmark, gestational diabetes screening is a targeted strategy for mothers with identified risk factors. We used Poisson regression to estimate rate ratios (RR) of preterm birth with z-standardized glucose measurements. We assessed effect measure modification by stratifying analyses and testing for heterogeneity. Among 11,337 pregnancies (6.2% delivered preterm), we observed an adjusted preterm birth RR of 1.2 (95% confidence interval [CI] = 1.1, 1.3) for a one-standard deviation glucose increase of 1.4 mmol/l from the mean of 6.7 mmol/l. There was evidence for effect measure modification by obesity, for example, adjusted RR for nonobese (BMI, <30): 1.2 (95% CI = 1.1, 1.3) versus obese (BMI, ≥30): 1.3 (95% CI = 1.2-1.5), P = 0.05 for heterogeneity. Among mothers screened for gestational diabetes, increased glucose levels, even those below the diagnostic level for gestational diabetes in Denmark, were associated with increased preterm birth risk. Obesity (BMI, ≥30) may be an effect measure modifier, not just a confounder, of the relation between blood glucose and preterm birth risk.

Impact of Neighborhood Social Cohesion and Rodent Sightings on Mental Health among Residents of New York City During the COVID-19 Pandemic.

Common mental disorders such as depression and anxiety are prevalent globally, and rates are especially high in New York City (NYC) since the COVID-19 pandemic. Neighborhood social and physical environments have been found to influence mental health. We investigated the impact of neighborhood social cohesion and neighborhood rodent sightings (as an indicator of neighborhood cleanliness) on nonspecific serious psychological distress (NSPD) status using 2020 NYC Community Health Survey data from 8781 NYC residents. Multivariable logistic regression was used to evaluate the relationships among social cohesion, rodent sightings, and NSPD adjusted for confounders and complex sampling and weighted to the NYC population. Effect measure modification of rodent sightings on the effect of social cohesion on NSPD was evaluated on the multiplicative scale by adding the interaction term to the multivariable model and, if significant, stratifying on the effect modifier, and on the additive scale using the relative excess risk due to interaction (RERI). Social cohesion was found to decrease the odds of NSPD, and rodent sightings were found to increase the odds of NSPD. We found significant evidence of effect measure modification on the multiplicative scale. In the stratified models, there was a protective effect of social cohesion against NSPD among those not reporting rodent sightings, but no effect among those reporting rodent sightings. Our findings suggest that both neighborhood social cohesion and rodent sightings impact the mental health of New Yorkers and that rodent infestations may diminish the benefit of neighborhood social cohesion.

Association between estimated cardiorespiratory fitness and breast cancer: a prospective cohort study

ObjectiveTo examine the association between cardiorespiratory fitness (CRF) and the risk of breast cancer in postmenopausal women.MethodsThis study used data from 17 840 cancer-free postmenopausal women with a CRF assessment...

Association Between Myopia and Primary Open-Angle Glaucoma by Race and Ethnicity in Older Adults in the California Medicare Population

Racial and ethnic differences in the association between myopia and primary open-angle glaucoma (POAG) are not well understood. To investigate the association between myopia and POAG in the 2019 California Medicare population and to investigate whether there was evidence of effect measure modification of this association by race and ethnicity. This cross-sectional study used administrative claims data from 2019 California Medicare beneficiaries 65 years or older with California residence and active coverage with Medicare parts A and B. Analysis took place between October 2021 and October 2023. The primary exposure was myopia, which was defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. The outcome of interest was POAG, which was defined by ICD-10-CM code. Of 2 717 346 California Medicare beneficiaries in 2019, 1 440 769 (53.0%) were aged 65 to 74 years, 1 544 479 (56.8%) identified as female, 60 211 (2.2%) had myopia, and 171 988 (6.3%) had POAG. Overall, 346 723 individuals (12.8%) identified as Asian, 117 856 (4.3%) as Black, 430 597 (15.8%) as Hispanic, 1 705 807 (62.8%) as White, and 115 363 (4.2%) as other race and ethnicity. In adjusted logistic regression analyses, beneficiaries with myopia had higher odds of POAG compared with beneficiaries without myopia (odds ratio [OR], 2.41; 95% CI, 2.35-2.47). In multivariable models stratified by race and ethnicity, the association between myopia and POAG was stronger in Asian (OR, 2.74; 95% CI, 2.57-2.92), Black (OR, 2.60; 95% CI, 2.31-2.94), and Hispanic (OR, 3.28; 95% CI, 3.08-3.48) beneficiaries compared with non-Hispanic White beneficiaries (OR, 2.14; 95% CI, 2.08-2.21). In the 2019 California Medicare population, myopia was associated with greater adjusted odds of POAG. This association was stronger among Asian, Black, and Hispanic beneficiaries compared with non-Hispanic White beneficiaries. These findings suggest possible disparities in glaucoma risk by race and ethnicity in individuals with myopia and may indicate greater need for glaucoma screening in individuals with myopia from racial and ethnic minority backgrounds.

Abstract P236: Neighborhood Socioeconomic Status and Functional Status Impairment in Late-Life: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity. Hypothesis: Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity. Methods: We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score&lt;4) during the 2016 annual telephone interview. Multivariable logistic regression was used to examine the association between NSES tertiles and functional status impairment adjusting for age, race, ARIC center, and sex. We tested for effect modification by AHA-defined physical activity (categorized as poor, intermediate, ideal based on weekly minutes of moderate-to-vigorous physical activity). We also tested for effect modification by sex, race, and age. Results: Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65). Conclusions: Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.

The association between long‐term PM2.5 exposure and late‐life amyloid burden in the Atherosclerosis Risk in Communities (ARIC) study cohort

AbstractBackgroundA number of studies show an association between long‐term exposure to ambient particulate matter ≤ 2.5 um (PM2.5) and late‐life cognitive impairment. Mechanistic models suggest that PM2.5 may influence cognitive health through promotion of Alzheimer’s disease, which is characterized by brain amyloid accumulation. However, the association between long‐term PM2.5 exposure and brain amyloid deposition remains poorly characterized in epidemiological studies.MethodWe used data from the Atherosclerosis Risk in Communities (ARIC) study cohort. We used a chemical transport model with data fusion to estimate mean PM2.5 concentrations (ug/m3) in 36‐, 12‐, 4‐, and 1‐km grid cells in ARIC study areas. We linked the concentrations to geocoded participant addresses and calculated mean PM2.5 concentrations from 2000 to 2007. We estimated amyloid deposition using florbetapir amyloid positron emission tomography (PET) scans in 346 ARIC‐PET participants with normal cognition or mild cognitive impairment in 2011‐2014. We defined amyloid positivity as a global cortical standardized uptake value ratio (SUVR) ≥ the sample median of 1.2. We used logistic regression models to quantify the association between amyloid positivity and mean 2000‐2007 PM2.5 concentration after adjusting for potential confounders. We additionally explored effect measure modification by APOE e4 allele status and tested whether effect estimates were consistent using alternate PM2.5 exposure methods.ResultAfter restricting to participants with non‐missing exposure and confounder data and excluding one participant with dementia, the analytic sample included 279 participants. At the time of amyloid‐PET scans, their mean age was 78 years, 56% were female, 42% were Black, and 26% had mild cognitive impairment. After adjusting for age, sex, education, and race‐study center, we found no significant association between brain amyloid positivity and long‐term mean PM2.5 exposure. We also found no evidence of effect measure modification by APOE e4 allele status. Results were consistent when we used alternate PM2.5 estimation methods.ConclusionOur findings suggest that ambient PM2.5 may induce neurotoxic effects through non‐amyloid, potentially vascular pathways, though we note the small sample size may have made us underpowered to detect a significant association.

Exposure to ambient sulfur dioxide during gestation and risk of preterm birth among people in North Carolina, 2003-2014

BACKGROUND/AIM: Coal-fired power plants are major contributors of ambient sulfur dioxide (SO2) air pollution. Epidemiological literature suggests an adverse association between SO2 exposure during gestation and preterm birth (PTB; &amp;#x3c;37 weeks completed gestation). PTB is strongly associated with infant mortality and increased risk for later life morbidities. We investigated associations between SO2 and PTB in North Carolina and evaluated whether the associations were modified by race/ethnicity. METHODS: We assembled a retrospective, administrative cohort of singleton births in North Carolina from 2003-2014. We used USEPA CMAQ data to assign SO2 gestational exposures to eligible births for the entire pregnancy and trimesters. We used multivariable generalized linear regression to estimate risk differences (RD (95%CI)) per 1-ppb increase in SO2, adjusted for gestational parent education, marital status, and season of conception. Multi-pollutant models were additionally adjusted for criteria air co-pollutants (CO, O3, PM2.5, NO2). RESULTS: The median SO2 across exposure windows was ~3.5 (IQR: 4) ppb. The overall baseline risk for PTB was 8800 per 100,000 live births. When stratified by race/ethnicity, the baseline risk for PTB was 12200, 7900, and 7100 per 100,000 live births among non-Hispanic Black, non-Hispanic white, and Hispanic births, respectively. Regardless of exposure window, SO2 was adversely associated with PTB with the strongest associations observed for the entire pregnancy period. RDs per 1-ppb increase in SO2 averaged across the entire pregnancy were 133.5 (95%CI: 117.0, 149.9) and 195.7 (171.6, 219.7) per 100,000 live births for single- and multi-pollutant models, respectively. For multi-pollutant models, we observed similar RDs for non-Hispanic Blacks (239.4 (200.7, 278.2)) and non-Hispanic whites (211.5 (182.4, 240.7)) with smaller RDs for Hispanics (119.8 (80.7, 158.9)). CONCLUSIONS: Across exposure windows, the results for our adjusted single- and multi-pollutant models showed adverse associations between SO2 and PTB, with some evidence of effect measure modification by race/ethnicity. KEYWORD: PTB

Circulating biomarker correlates of left atrial size and myocardial extracellular volume fraction among persons living with and without HIV

BackgroundInfection with human immunodeficiency virus (HIV) is associated with higher risk for myocardial disease despite modern combination antiretroviral therapy (cART). Factors contributing to this excess risk, however, remain poorly characterized. We aimed to assess cross-sectional relationships between elevations of left atrial volume index (LAVI) and myocardial extracellular volume (ECV) fraction that have been reported in persons living with HIV and levels of circulating biomarkers of inflammation, fibrosis, and myocyte stretch among persons living with and without HIV (PLWH, PLWOH).MethodsParticipants from three cohorts of PLWH and PLWOH underwent cardiovascular magnetic resonance imaging for measurement of LAVI and ECV. Levels of circulating proteins (IL-6, sCD14, galectin-3, NT-proBNP, GDF-15, TIMP-2, MMP-2, and hsTnI) were measured using immunoassays. Associations were assessed using logistic and linear regression, adjusting for demographics, substance use, and clinical characteristics.ResultsAmong 381 participants with and without HIV, median age (IQR) was 55.1 (51.2, 58.4) years, 28% were female, 69% were Black, and 46% were current smokers. Sixty-two percent were PLWH (n = 235), of whom 88% were receiving cART and 72% were virally suppressed. PLWH had higher levels of sCD14 (p = < 0.001), GDF-15 (p = < 0.001), and NT-proBNP (p = 0.03) compared to PLWOH, while levels of other biomarkers did not differ by HIV serostatus, including IL-6 (p = 0.84). Among PLWH, higher sCD14, GDF-15, and NT-proBNP were also associated with lower CD4 + cell count, and higher NT-proBNP was associated with detectable HIV viral load. NT-proBNP was associated with elevated LAVI (OR: 1.79 [95% CI: 1.31, 2.44]; p < 0.001) with no evidence of effect measure modification by HIV serostatus. Other associations between HIV-associated biomarkers and LAVI or ECV were small or imprecise.ConclusionsOur findings suggest that elevated levels of sCD14, GDF-15, and NT-proBNP among PLWH compared to PLWOH observed in the current cART era may only minimally reflect HIV-associated elevations in LAVI and ECV. Future studies of excess risk of myocardial disease among contemporary cohorts of PLWH should investigate mechanisms other than those connoted by the studied biomarkers.

Gestational Hypertensive Disorders and Maternal Breast Cancer Risk in a Nationwide Cohort of 40,720 Parous Women.

Preeclampsia and gestational hypertension are hypothesized to be associated with reduced maternal breast cancer risk, but the epidemiologic evidence is inconclusive. Our objective was to examine associations between gestational hypertensive disorders and breast cancer in a nationwide cohort of women with a family history of breast cancer. Women ages 35-74 years who had a sister previously diagnosed with breast cancer, but had never had breast cancer themselves, were enrolled in the Sister Study from 2003 to 2009 (N = 50,884). At enrollment, participants reported diagnoses of eclampsia, preeclampsia, or gestational hypertension in each pregnancy. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between history of a gestational hypertensive disorder and incident invasive breast cancer or ductal carcinoma in situ among 40,720 parous women. We used age as the time scale and adjusted for birth cohort, race-ethnicity, and reproductive, socioeconomic, and behavioral factors. We examined effect measure modification by risk factors for gestational hypertensive disease and breast cancer and assessed possible etiologic heterogeneity across tumor characteristics. The prevalence of gestational hypertensive disease was 12%. During follow-up (mean = 10.9 years), 3,198 eligible women self-reported a breast cancer diagnosis. History of a gestational hypertensive disorder was not associated with breast cancer risk (HR = 1.0; 95% CI = 0.90, 1.1). We did not observe clear evidence of effect measure modification or etiologic heterogeneity. History of a gestational hypertensive disorder was not associated with breast cancer risk in a cohort of women with a first-degree family history of breast cancer.

Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study

BackgroundWhile benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent.MethodsWe utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV1), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV1/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status.ResultsWe noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV1 and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV1 (200 m: β = 2.1, 95% CI: 0.1, 3.3; 400 m: β = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: β = 1.8, 95% CI: 0.7, 3.0; 400 m: β = 1.6, 95% CI: 0.3, 2.8; 800 m: β = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV1/FVC were non-significant except exposure at birth in the 400 m buffer (β = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function.ConclusionSensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.

The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis

BackgroundThe optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era.MethodsWe performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for effect measure modification (EMM) by diabetes for adverse events. We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4356 patients, mean follow-up of 4.9 years) and six observational studies (9360 patients, mean follow-up of 5.2 years).ResultsIn RCTs among DM patients, DES-based PCI, compared to CABG, was associated with a 30% increased relative risk (RR) (RR 1.30, 95% CI 1.09–1.56, I2 = 0%), while among non-DM patients, there was a 25% increased relative risk (RR 1.25, 95% CI 1.07–1.44, I2 = 0%) for the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization (MACCE). There was no evidence of EMM (p-value for interaction = 0.70). The mean weighted SYNTAX score was 25.7. In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (RR 1.13, 95% CI 0.91–1.40, I2 = 0%).ConclusionsCABG was superior to PCI for LMCAD in RCTs in DM patients for MACCE. Heart teams may consider DM as one of the many components in the clinical decision-making process, but may not want to consider DM as a primary deciding factor between DES-based PCI and CABG for LMCAD with low to intermediate anatomical complexity in the other coronary arteries.Study registrationCRD42021246931 (PROSPERO).

Abstract P060: The Association Of Lean Mass With Type 2 Diabetes: The Coronary Artery Risk Development In Young Adults (CARDIA) Study

Introduction: Body mass index (BMI) does not capture tissue composition and thus is unable to assess the contribution of each tissue type to cardiometabolic health. This limitation of BMI may explain the paradoxical association of BMI-weight status with mortality for those with type 2 diabetes (T2D), and merits investigation of individual tissues. We assessed the relationship between body composition and incident T2D and assessed for differences by BMI-weight status. We hypothesized that greater lean mass (LM) would be associated with lower risk for T2D for all BMI groups. Methods: Black and White participants from CARDIA without T2D in 2005-06 (baseline) were included in this longitudinal analysis ( N =2,473). LM and fat mass (FM) were assessed via dual-energy X-ray absorptiometry. Incident T2D was defined using American Diabetes Association cut points for fasting and post-load glucose, glycated hemoglobin, and diabetes medication use. We used Cox proportional hazards regression to estimate hazard ratios (HR) for incident T2D over 10 years according to 1-standard deviation (SD) increment in LM (1 SD=1g) and assessed for potential effect measure modification (EMM) of this association by weight status. We assessed a secondary exposure, LM:FM ratio, in relation to incident T2D. Results: Mean baseline age was 45.2±3.6 years (57% White and 57% female). The cumulative incidence of T2D was 7.2% (178 events, total person years=21,421.7). Before and after adjustment, neither LM nor LM:FM were significantly associated with T2D (Table), and we did not observe evidence for EMM by weight status for any association. Conclusions: LM in middle adulthood does not appear to be associated with T2D risk. Whether incorporation of data for other tissue depots is informative to T2D risk merits evaluation.

The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators.

The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI=0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.

1053. The Ecological Relationship Between County-Level HCV Case Rates and Office-Based Buprenorphine in Ohio

BackgroundThe United States is experiencing an epidemic of hepatitis C virus (HCV) infections due to injection drug use, especially in rural areas. Counties may be expanding access to buprenorphine, an evidence-based treatment that has been shown to reduce injection drug use, to control the HCV epidemic. We assessed the county-level relationship between HCV rates in 2013-2015 and office-based buprenorphine prescribing in 2018 in Ohio. We also assessed if this relationship varied between rural and urban counties.MethodsWe fit crude and adjusted negative binomial models to assess the relationship between HCV incidence rates in 2013-2015 and office-based buprenorphine prescribing capacity and frequency in Ohio in 2018. We examined effect measure modification of this relationship by rural-urban status using an interaction term.ResultsWe found that a 1% higher acute HCV rate was associated with an 18% (95% Confidence Interval [CI]: -3%, 44%) higher office-based buprenorphine prescribing capacity and an 22% (95% CI: -4%, 55%) higher office-based buprenorphine prescribing frequency. We found that a 1% higher total HCV rate was associated with a 239% (95% CI: 179%, 317%) higher office-based buprenorphine prescribing capacity and a 273% (95% CI: 183%, 405%) higher office-based buprenorphine prescribing frequency. We found no evidence of effect measure modification by rural-urban status.ConclusionCounties across Ohio may have expanded access to office-based buprenorphine in response to high rates of total HCV. Expansion of office-based buprenorphine may be less associated with acute HCV rates due to the low frequency with which these cases are seen in outpatient settings.Disclosures All Authors: No reported disclosures

Abstract C052: Premenopausal oophorectomy and survival among women with breast cancer: Evidence of effect measure modification by family history status

Abstract In the US, bilateral oophorectomies are frequently performed before menopause for one of two reasons: 1) in concert with hysterectomy for benign gynecologic conditions or 2) prevention of breast or ovarian cancer risk and mortality. Prior literature has consistently shown a reduction in breast cancer-specific mortality among women who had premenopausal hysterectomy with bilateral oophorectomy (H +BO) prior to their breast cancer diagnosis. The present study sought to assess whether the relationship between prediagnosis premenopausal H + BO and breast cancer-specific mortality differed by family history status in women with breast cancer. It is hypothesized that women who may have prognostically different breast cancer due to having family history disproportionately benefit from premenopausal H+ BO compared to more average-risk women with no family history. This study analyzed data from Phases 1 and 2 of the Carolina Breast Cancer Study (CBCS), a population-based study of Black and White women prospectively identified in central and eastern North Carolina with newly diagnosed breast cancer between 1993 and 2001. Women with invasive breast cancer with known gynecologic surgical status were included (n=1,723). Gynecologic surgery was defined as: no surgery; hysterectomy with bilateral oophorectomy (H+BO); hysterectomy with conservation of ≥1 ovary (H + OC). Cause-specific mortality was ascertained using the National Death Index, last updated in 2016. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer-specific mortality were estimated with Cox proportional hazard models. Models were then stratified by family history status, the self-reporting of one or more first-degree relatives with a family history of breast cancer. Models were adjusted for race, age at diagnosis, smoking, alcohol use, menopausal hormone therapy use and reproductive history factors. All participants still living at the end of follow-up were right censored. Among 1,723 women in the sample, 44% (n=759) were Black and 56% (n=964) were White. There were 836 deaths, of which 447 were from breast cancer. In this population, 74.1% (n=1,276) of women reported having no previous premenopausal gynecologic surgery, 8.8% (n=152) reported having H + BO and 17.1% (n=295) reported H + OC. Compared to women who had not had premenopausal gynecologic surgery, the overall adjusted HR for breast cancer-specific mortality associated with H+BO was 0.68 (95% CI: 0.49,0.96) and 0.90 (95% CI: 0.72,1.12) for women with H+OC. In models stratified on family history, the HR for women with H+BO was 0.11 (95% CI: 0.03,0.42) for those with family history and 0.90 (95% CI: 0.63, 1.29) for those without. The HR for women with family history who had H+ OC was 0.77 (95% CI: 0.45, 1.29) and 0.90 (95% CI: 0.63,1.29) for women without. This study suggests that the overall protective relationship observed between premenopausal hysterectomy with bilateral oophorectomy and breast-cancer specific mortality may be driven by a small subset of especially high-risk women. Citation Format: Mya L. Roberson, Whitney R. Robinson, Hazel B. Nichols, Andrew F. Olshan, Melissa A. Troester. Premenopausal oophorectomy and survival among women with breast cancer: Evidence of effect measure modification by family history status [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C052.

The relation of gender role attitudes with depression and generalised anxiety disorder in two Russian cities

BackgroundReported traditional gender role attitudes (GRAs) have been related to worse mental health in western countries. This study examined the link of GRAs with symptoms of depression and generalised anxiety disorder (GAD) in two Russian cities. MethodsWe used interview data from the cross-sectional Know Your Heart Study conducted among 5099 adults aged 35-69 in the Russian cities of Arkhangelsk and Novosibirsk between 2015 and 2017. Attitudes about gender inequality and division of labour between women and men at home or in the public sphere were measured by single items. Binary variables indicating presence of symptoms of depression and GAD were defined by a cut-off of ≥ 5 of the PHQ-9 and GAD-7 scores respectively. Multivariable logistic regression was used to determine crude and adjusted associations. ResultsThere was evidence that all types of GRAs were associated with symptoms of depression and GAD consistent with a U-shape after controlling for confounding with stronger evidence for all relationships for depression than for GAD. Odds of depressive symptoms were elevated among participants strongly agreeing to gender inequality and gender division of labour. There was good evidence for effect measure modification by age. LimitationsThe possibilities of measurement error of the exposure and outcomes, residual confounding and reverse causality are important limitations of this study. ConclusionsAgreeing to gender inequality and gender division of labour was associated with reporting symptoms of common mental disorders in Russia. This study adds evidence for a link of GRAs with mental health from a non-western context.

Does the neighborhood food environment contribute to ethnic inequalities in fast-food intake? findings from the ORiEL study.

The neighborhood food environment may contribute to ethnic inequalities in diet. Using data from 1389 participants in the Olympic Regeneration in East London (UK) study we assessed whether ethnic inequalities in neighborhood availability of fast-food restaurants mediated and/or modified ethnic inequalities in fast-food intake in 13–15 year-old adolescents. We compared the proportion of high fast-food consumers across “White UK”, “Black”, and “South Asian” ethnic categories. We used Poisson regression with robust standard errors to assess direct and indirect effects (mediation analysis) and risk ratios of high fast-food intake by ethnic category and fast-food restaurant availability level (effect measure modification analysis). There were ethnic inequalities in high fast-food intake, with risk ratios in adolescents of Black and South Asian background of 1.53 (95% CI: 1.25, 1.87) and 1.71 (95% CI: 1.41, 2.07) respectively compared to White UK participants. We found no evidence of a mediating effect by fast-food restaurant availability, but found some evidence of effect measure modification: ethnic inequalities in fast-food intake were largest in neighborhoods lacking fast-food restaurants, and narrowed as availability increased. Future research should explore why ethnic minorities are more likely to be high fast-food consumers than the majority ethnic group, especially when fast-food restaurant availability is lowest.