African American Females Research Articles

Role of Taste Receptor Gene Variations (SNPs) on Diet Quality in Adolescent Females

The prevalence of pediatric obesity has increased over the past 40 years and the rate in females 6 to 19 years old is currently over 19%. This profound increase in obesity is predicted to negatively impact health and result in multiple obesity‐related comorbidities in adulthood. Obesity disproportionately affects ethnic minorities with a higher percentage of adolescent African‐American females (~29%) with obesity compared to non‐Hispanic, white females (~15%). The overconsumption of highly palatable, energy dense, foods are linked to obesity and single nucleotide polymorphisms (SNP) from taste genes are linked to alterations in taste perception and food choices. SNPs are associated with higher rates of obesity and altered fat perception (CD36; fat), higher caloric intake from sugar (TAS1R2; sweet) and increased energy intake (TAS2R38, bitter). An enhanced understanding of genetic, environmental, and behavioral factors contributing to excess weight in adolescents is paramount. Therefore, the goal of the current study was to investigate the intersection of genotype (rs1761667 of CD36 (AA), rs35874116 of TAS1R2 (TT) and rs713598 of TAS2R38 (CC)) and phenotype on diet intake and quality in adolescent African‐American and white females. Genotype was determined by allelic discrimination assay in females (10‐16 years old; n=142) enrolled in the Translational Investigation of Growth and Everyday Routines in Kids (TIGER Kids) Study. Anthropometrics and 24‐hour dietary recalls were conducted for each participant and Healthy Eating Index (HEI) scores, a measure of diet quality, were calculated. The effect of race and genetic variation was assessed using a two‐way ANOVA. Based on allelic discrimination assays, the expression rates of CD36 AA, TAS1R2 TT and TAS2R38 CC in white females (27.7%, 45.0%, 38.3%, respectively) and African‐American females (15.3%, 37.3%, 31.0%, respectively) were determined. Preliminary results indicated that BMI percentiles were higher in African‐American females across all genotypes (p<.05) and moderately affected by TAS2R38 genotype (p<.06). CD36 and race differentially affected HEI for added sugar, total vegetable, greens and beans, whole grain, seafood and plant protein and total HEI, (p<.05). TAS1R2 and race differentially affected HEI‐added sugar (p<.05). TAS2R38 significantly affected HEI‐sodium and total protein (p<.05) and TAS2R38 and race differentially affected HEI for total vegetables, fruits, and whole fruits (p<.09). Fat and sugar intake (g) were positively correlated with SNPs previously associated with altered fat perception (CD36 AA), sugar intake (TAS1R2 TT) and overall energy intake (TAS2R39 CC) in white (p<.05), but not African‐American females, suggesting that the effects of taste receptor SNPs on the relationship between fat and sugar intake differs by race. Overall, the results from these analyses support the intersection between race and genetic variation on HEI, and suggest that SNPs in taste receptor genes differently affect diet quality in adolescent females. Further understanding of the role of taste receptor SNPs on food choices and diet quality is needed to better tailor dietary interventions in the pediatric population.

Sex Differences in Demographic and Pharmacological Factors in Alzheimer Patients With Dementia and Cognitive Impairments.

ObjectiveThe current study investigates sex differences associated with pharmacological and demographic characteristics in Alzheimer patients (AD) with dementia (ADD) or mild cognitive impairment (MCI).MethodA retrospective analytical approach was used to analyze data from 45,696 AD patients with MCI or ADD. The univariate analysis was used to determine differences in demographic, and pharmacological characteristics for male and female ADD and MCI-AD patients. Multivariate analysis was used to predict specific pharmacological and demographic factors that are associated with male and female MCI and ADD patients.ResultIn the adjusted analysis for male patients, Hispanics [0.166,0.020 – 1.355, P = 0.094] or African Americans [OR = 2.380, 95% CI,2.120 – 2.674, P < 0.001], were more likely to have MCI-AD and be treated with galantamine [OR = 0.559, 95% CI, 0.382 – 0.818, P = 0.003], donepezil [OR = 1.639, 95% CI,1.503 – 1.787, P < 0.001], rivastigmine [OR = 1.394, 95% CI,1.184 – 1.642, P < 0.001], olanzapine [OR = 2.727, 95% CI,2.315 – 3.212, P < 0.001], risperidone [OR = 2.973, 95% CI,2.506 – 3.526, P < 0.001], present with increasing age [1.075,1.071 – 1.079, P < 0.001], and are on tobacco use [OR = 1.150, 95% CI,1.054 – 1.254, P = 0.002]. For female patients, buspirone [OR = 0.767, 95% CI, 0.683 – 0.861, P < 0.001] and a history of alcohol (ETOH) use [OR = 0.484, 95% CI, 0.442 – 0.529, P < 0.001] were associated with MCI-AD. Increasing age [OR = 1.096, 95% CI, 1.093 – 1.100, P < 0.001], donepezil [OR = 2.185, 95% CI, 2.035 – 2.346, P < 0.001], memantine [OR = 2.283, 95% CI, 2.104 – 2.477, P < 0.001] aripiprazole [OR = 1.807, 95% CI, 1.544 – 2.113, P < 0.001] olanzapine [OR = 2.289, 95% CI, 1.986 – 2.640, P < 0.001] risperidone [OR = 2.548, 95% CI, 2.246 – 2.889, P < 0.001] buspirone [OR = 0.767, 95% CI, 0.683 – 0.861, P < 0.001] escitalopram [OR = 1.213, 95% CI,1.119 – 1.315, P < 0.001] African Americans [OR = 1.395, 95% CI, 1.268 – 1.535, P < 0.001] and tobacco use [OR = 1.150, 95% CI, 1.073 – 1.233, P < 0.001] were associated with ADD.ConclusionOur findings reveal that MCI-AD patients were more likely to be Hispanics or African American males treated with rivastigmine, olanzapine and citalopram. African American females were associated with ADD and more likely to be treated with buspirone and presented with a history of ETOH. This finding suggests the need for a pharmacological treatment approach encompassing sex-sensitive strategies for MCI-AD and ADD patients.

Racial differences in running and landing measures associated with injury risk vary by sex

ABSTRACT It is unknown whether running and landing mechanics differ between racial groups despite injury disparities between African Americans (AA) and white Americans (WA). This study aimed to identify potential racial differences in running and landing mechanics and understand whether anthropometric, strength, and health status factors contribute to these differences. Venous blood samples, anthropometry, lower-extremity strength, and health status assessments were collected (n = 84, 18–30y). Three-dimensional motion capture and force plate data were recorded during 7 running and 7 drop vertical jump trials. Racial effects were determined, and regression models evaluated explanatory factors. AA females ran with longer stance times (p = 0.003) than WA females, while AA males ran with smaller loading rates (p = 0.046) and larger peak vertical ground reaction forces (p = 0.036) than WA males. Frontal plane knee range of motion during landing was greater in AA females (p = 0.033) than WA females; larger waist circumference and weaker knee extension strength accounted for this significance. Although outcome measures were associated with physiologic, anthropometric, and activity measures, their explanatory power for race was ambiguous, except for knee range of motion in females. Modifiable factors explaining racial effects during landing in females are potential intervention targets to reduce racial health disparities in running and landing injuries.

DXA-Based Detection of Low Muscle Mass Using the Total Body Muscularity Assessment Index (TB-MAXI): A New Index with Cutoff Values from the NHANES 1999-2004.

The aims of this study were to investigate age-related changes in total body skeletal muscle mass (TBSMM) and the between-limb asymmetry in lean mass in a large sample of adults. Demographic, anthropometric, and DXA-derived data of National Health and Nutrition Examination Survey participants were considered. The sample included 10,014 participants of two ethnic groups (Caucasians and African Americans). The age-related decline of TBSMM absolute values was between 5% and 6% per decade in males and between 4.5% and 5.0% per decade in females. The adjustment of TBSMM for body surface area (TB-MAXI) showed that muscle mass peaked in the second decade and decreased progressively during the subsequent decades. The following thresholds were identified to distinguish between low and normal TB-MAXI: (i) 10.0 kg/m2 and 11.0 kg/m2 in Caucasian and African American females; and (ii) 12.5 kg/m2 and 14.5 kg/m2 in Caucasian and African American males. The lean asymmetry indices were higher for the lower limbs compared with the upper limbs and were higher for males compared with females. In conclusion, the present study proposes the TB-MAXI and lean asymmetry index, which can be used (and included in DXA reports) as clinically relevant markers for muscle amount and lean distribution.

Clinician Decisions After Notification of Elevated Blood Pressure Measurements From Patients in a Remote Monitoring Program

Guidelines recommend using telehealth for hypertension management, but insufficient evidence is available to guide strategies for incorporating telehealth data into clinical practice. To describe how primary care teams responded to elevated remote blood pressure (BP) alerts in the electronic health record (EHR) in a randomized clinical trial of BP telemonitoring conducted in routine practice settings. This retrospective cohort study reviewed EHR documentation from May 8, 2018, to August 9, 2019, in a single urban academic family practice site. Primary care teams comprising 28 attending physicians and nurse practitioners, residents, and nurses cared for 162 patients in a text-based clinical trial of remote BP monitoring remote BP monitoring. Data were analyzed from October 21, 2019, to April 30, 2021. Clinicians received a direct message in their EHR inbox when patients submitted at least 3 elevated BP readings. Categories and frequencies of clinician action, created via review of EHR-documented clinician responses to EHR alerts by 2 physicians. Patients in this study (n = 162) were predominantly female (111 [68.5%]) and Black or African American (146 [90.1%]), whereas attending physicians (n = 21) were predominantly female (13 [61.9%]) and non-Hispanic White (19 [90.5%]) with a mean (SD) age of 51.6 (11.1) years. Five hundred fifty-two alerts fell into 12 categories of clinical actions. Clinicians acted on 343 alerts (62.1%). Common remote activities were to reconcile medications and assess adherence (120 of 552 alerts [21.7%]) and verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly requested appointments (120 of 552 alerts [21.7%]) and/or saw the patient in a subsequent office visit (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes; half of these changes were remote (48 of 96 [50.0%]), and the other half were visit-based. For 209 of 552 alerts (37.9%), no changes were made to the care plan, typically without documenting clinical rationale (196 of 209 instances [93.8%]). Exploratory EHR review was used to infer potential clinical rationale for 106 (54.1%) of such cases, but there was insufficient information for the remaining 90 (45.9%). These findings suggest that EHR alerts for elevated BP during remote monitoring were effective in prompting a mix of remote and office-based management. It was also common for the plan of care to remain unchanged, possibly suggesting need for more refined alerts and improved clinician support.

Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors

Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood. Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens. Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index). Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese. Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.

Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors.

Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood.Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens.Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index).Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese.Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.

Racial and gender differences of cervical vertebral maturation staging between African Americans versus Caucasian patients of various age groups: A retrospective study

The primary purpose of this study was to compare CVM staging between African American (AA) and Caucasian (CC) subjects, grouped based on gender. The secondary objectives were to conduct a CVM comparison of (1) male vs. female subjects, grouped based on their race, and (2) AA vs. CC subjects, categorized based on their age group. All patients between 8-18 years of age (University of XXX), meeting the criteria, were included between the period of the year 2007 to 2020. Three blinded independent evaluators analysed the lateral cephalograms for a 6-stage CVM system (CS1 to CS6) as described by McNamara and Franchi. Samples were divided based on race, gender, and age to conduct the statistical analysis for racial and gender comparisons. Out of the initial 1,300 lateral cephalograms, 1,276 with the mean age: 12.7 years SD 2.5 years, and median CVM: 4 (IQR: 25% percentile- 2 and 75% percentile- 4) were included. Gender-specific racial age comparison showed no significant differences for male subjects for most of the CVM stages (P>0.05). Overall and race-specific gender comparison of age showed significant differences for almost all CVM stages (P<0.05). No significant difference of CVM was found on racial comparison for overall, females (P=0.6131) or males (P=0.0825) subjects. On age-specific racial comparison, AA girls (8-10 years) were skeletally more mature than CC girls (P=0.0143); over 14-year-old CC girls (P<0.0001) and over 16-year-old CC boys (P=0.0008), being skeletally more mature than AA boys of the same age. There was no significant difference between AA and CC subjects on gender-specific comparisons for most of the CVM stages. A significant difference of age was observed for most of the CVM stage between male and female subjects on race-specific comparisons. Female patients were ahead in skeletal maturity as compared to males for each CVM stage. The CVM for 8-12-year-old AA females was significantly higher than that of the CC females, whereas the CVM for>14-year-old CC females was significantly higher than AA females.

Vol. 9, Issue 1, 2022 January 03, 2022 EDT Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors

Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood. Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens. Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index). Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese. Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.

Factors Associated With Disordered Eating Behavior Among Adolescent Girls: Screening and Education

Introduction/Objectives:An unhealthy relationship with food can lead to disordered eating in adolescence, highlighting the importance of screening. This study describes the frequency of disordered eating behavior among female adolescents, as well as associated characteristics and health behaviors.Methods:Data are from a multidimensional risk factor screening survey administered at a university medical center’s adolescent clinic from 2016 to 2018. The instrument was adapted from existing screening tools such as the Rapid Assessment for Adolescent Preventive Services (RAAPS), the American Medical Association’s Guidelines for Adolescent Preventive Services (GAPS), and the Youth Risk Behavior Survey (YRBS). Analysis was limited to self-reported responses provided by females aged 10 to 21 years (N = 915). Statistical analyses included chi-square tests and independent sample T-tests.Results:Of the N = 915 females who reported on disordered eating behavior, n = 57 (6.2%) had engaged in some form of disordered eating behavior within the past 12 months. Disordered eating was significantly associated (P < .001) with not consistently wearing a helmet while biking, having tried e-cigarettes, being bullied in the past 30 days, having an adverse childhood experience (ACE), and being African American (P = .005). Subgroup analysis of the relationship between disordered eating and bullying, by race, yielded significant findings: disordered eating was more highly associated with being bullied in the past 30 days among African American females (P = .038). The relationship between disordered eating and ACE was also significant (P < .001) among Caucasian girls when stratified by race.Conclusions:Adolescent risk behaviors often co-occur, and disordered eating behavior may be differentially observed by race. Findings highlight the importance of education and screening to prevent the development of disordered eating, and identify those who may be struggling. These results can be useful to community health education and in healthcare to develop and implement health promotion and eating disorder prevention strategies. Further studies are needed to assess additional factors that promote or protect against disordered eating to improve prevention.

Hyperpigmented nodular rash in a 61-year-old African American female

A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before spreading across her upper arms, lower leg, back, face and scalp. She has a history of controlled type 2 diabetes mellitus, cerebral aneurysm rupture, Sjögren’s syndrome, asthma and a left below-the-knee amputation due to osteomyelitis. She smokes cigarettes but does not use alcohol or illicit substances. She has also noticed a dry cough with mild dyspnea on exertion over the past 6 months. On physical exam, hyperpigmented nodules are palpable in both the intradermal and subcutaneous layers of the skin. Nodules are firm, mobile and nontender. Alopecia is noted where scalp nodules are present. Her lungs exhibit diminished air movement throughout, with scattered, end-expiratory wheezing.

Can African American Females Do Stem?

Can African American Females Do Stem?

Abstract PO-216: Circulating 27-hydroxycholesterol is associated with decreased breast cancer risk: The Multiethnic Cohort Study

Abstract Background: Obesity is one of the most significant risk factors for breast cancer among postmenopausal women. Body fat distribution varies across racial/ethnic groups, which may partially explain the differences in breast cancer incidence across race/ethnicity. Laboratory studies have indicated that a cholesterol metabolite, 27-hydroxycholesterol (27HC), is an endogenous selective estrogen receptor modulator (SERM) and may represent an important obesity-related mechanism in breast cancer etiology. However, epidemiologic evidence for the role of 27HC in breast cancer risk is lacking, particularly in multiethnic populations. Methods: In a nested case-control study of 1,472 cases and 1.472 matched controls within the Multiethnic Cohort Study (MEC), we examined the association of circulating 27HC and lipids with breast cancer risk among African American, Japanese American, Native Hawaiian, Latino, and non-Latino White females. We conducted multivariable conditional logistic regression to assess associations of pre-diagnostic 27HC and lipids (modeled continuously on the log scale) with postmenopausal breast cancer risk adjusting for age at blood draw. Race/ethnicity stratified analyses were also conducted to assess differences in associations across racial/ethnic groups. Results: Among all females, higher levels of circulating 27HC were associated with a reduced risk of breast cancer (OR per log ng/ml: 0.71; 95% confidence interval (CI): 0.51, 0.99). Analyses stratified by race/ethnicity indicate that this association was driven by the Latino (OR: 0.39; 95% CI: 0.16, 0.93) and Japanese American (OR: 0.62; 95% CI: 0.35, 1.08) groups. Inverse associations were also observed with high-density lipoprotein and total cholesterol levels, while low-density lipoprotein levels were positively associated with breast cancer risk among all females. Conclusions: Ours is the first U.S. study to report a protective association between circulating 27HC and breast cancer risk in a multiethnic population. Interestingly, parallel analyses of a sub-cohort of healthy females in the MEC indicate inverse associations of total fat mass and percent subcutaneous fat assessed by dual X-ray absorptiometry and abdominal magnetic resonance imaging, respectively, with circulating 27HC. Ongoing analyses are evaluating joint associations of circulating 27HC, lipids, estrogens, and androgen levels with breast cancer risk. Results from this study will improve our understanding of racial/ethnic differences in breast cancer risk in relation to body fat distribution and inform prevention strategies for postmenopausal breast cancer. Citation Format: Mindy C DeRouen, Juan Yang, Yuqing li, Adrian A. Franke, Anne Tome, Kami White, Brenda Hernandez, Yurii Shvestov, V. Wendy Setiawan, Anna H. Wu, Lynne Wilkens, Loic Le Marchand, Lenora WM Loo, Iona Cheng. Circulating 27-hydroxycholesterol is associated with decreased breast cancer risk: The Multiethnic Cohort Study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-216.

The demographics of autoimmune hepatitis in human immunodeficiency virus-infected patients: a United States cross-sectional study.

Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver with increasing global prevalence. However, no epidemiological data exist for AIH in human immunodeficiency virus (HIV)-infected patients. To determine the demographics and comorbid conditions associated with AIH among HIV-infected individuals in the United States. The United States National Inpatient Sample database was used to identify HIV hospital encounters in 2012-2014. The encounters were then classified into 2 groups based on a concomitant primary diagnosis of AIH. Primary outcomes included the demographics and comorbid conditions of AIH among HIV-infected patients. Secondary outcomes assessed the independent predictors of AIH. A total of 48,3310 patients with an HIV diagnosis were included. The estimated AIH prevalence was 52.8/100,000 HIV hospital encounters. The female gender was more likely to have AIH with an odds ratio (OR) of 1.82; 95% confidence interval (CI) 1.42-2.32, p < 0.0001. The age intervals of 35-50 and 51-65 years had higher odds of AIH 110 (43.1%) and 115 (45.1%) with OR = 1.30; 95% CI: 1.02-1.67, p = 0.03 and OR = 1.34; 95% CI: 1.05-1.71, p = 0.02, respectively. African American and Hispanic races were more commonly affected. Moreover, HIV-infected patients with AIH had a higher risk of having elevated transaminases, long-term steroid use, rheumatoid arthritis, and ulcerative colitis. This study illustrates that the estimated prevalence of AIH in HIV-infected patients in the United States is 52.8/100,000. AIH in HIV-positive individuals has a predilection for the female gender and African American and Hispanic races, and shows a higher correlation with rheumatoid arthritis and ulcerative colitis.

Attitudinal Judgments of Dialect Traits and Colorism in African Americans

This study demonstrates how language and complexion influence professional and social perceptions of African Americans. This study contains an online verbal-guise survey where participants either saw a photo of a lighter skin-toned African-American male and female or an electronically darkened version. Audio was attached to each photo, which contains traits of African-American Vernacular English (AAVE) in the case of the male and Standard American English for the female. The results suggest African-American females are more likely to experience colorism in professional traits while African-American males are more likely to experience colorism in social traits. Additionally, the respondent’s race influences perceptions of AAVE.

The Preparedness for Caregiving Scale in African American and White Caregivers of Hospitalized Persons With Dementia

This study evaluated the Preparedness for Caregiving Scale (PCS) upon discharge from the hospital. The caregivers reported a mean age of 60.5 years (SD=13.9). The majority of caregivers were female (72%), married (59%), non-Hispanic/Latino (98%) and either white (52%) or African American (48%). Fifty percent were employed outside of the home and averaged 40.7 (SD= 14.4) hours of outside work per week. The average PCS was 24.4 (SD=6.9, 0-32). One-factor structure of the PCS and measurement invariance by race was fully supported. Predicative validity revealed significant association between the PCS and anxiety (β =-.41, t = -7.61(287), p <.001), depression (β =-.44, t =-8.39 (287), p <.001), and strain (β =-.48, t =-9.29(287), p <.001). The PCS is a valid and meaningful tool to measure preparedness in African American and white family caregivers of persons with dementia during post- hospitalization transition.

Adapted Tango to improve blood inflammatory markers in middle‐aged African‐American female caregivers of persons with Alzheimer's disease: A clinical trial

AbstractBackgroundAlzheimer’s disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. Ethnicity‐related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among females for developing AD indicates that AA female with a parent with AD are at great risk for developing dementias.MethodThis phase I study assessed the impact of a 12 week, 20‐lesson adapted Argentine Tango intervention (N=24) vs. a no‐contact control group (N=10) on measures of cognition, motor and psychosocial performance, and plasma inflammatory markers in middle‐aged (45‐65 years) AA females who are at increased risk for AD by virtue of parental history.ResultSome females (n=17) were also caregivers, and thus the impact of the program on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of balance, strength, and cognition, including visuospatial and executive function. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine levels: IL‐7 (p=.003), IFN‐γ (p=.011), and TNFα (p=.011), compared to controls. Participants in Tango improved on the Fullerton Advanced Balance Scale, which measures both dynamic and static balance (p=.023), the 30 second chair stand, which assesses functional lower body strength in older adults (p=.018), and inhibition of the color word interference test, which measures to ability to inhibit cognitive interference (p=0.031). Large effects were noted for the Tango group from pre to postintervention in the Trails B test score, which measures executive control and functioning. Other non‐significant, yet large effects were noted in gait speed, spatial cognition, and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers.ConclusionThese data show substantial cognitive and motor improvements and reduction in inflammatory biomarkers through a non‐pharmacologic and affordable intervention among a small cohort of AA females with a parental history of AD.

Determinants of all-cause in-hospital mortality among patients who presented with COVID-19 to a community teaching hospital in Michigan

Background & objectivesRace plays an important role in healthcare disparities, often resulting in worse health outcomes. It is unclear if other patient factors and race interactions may influence mortality in patients with COVID-19. We aimed to evaluate how multiple determinants of all-cause in-hospital mortality from COVID-19 were linked to race. MethodsA retrospective observational study was conducted at two hospitals in metropolitan Detroit. We identified patients aged ≥18 years-old who had tested positive for COVID-19 and were admitted between March 9 through May 16, 2020. Multivariable logistic regression was performed assessing predictors of all-cause in-hospital mortality in COVID-19. ResultsWe identified 1064 unique patients; 74% were African Americans (AA). The all-cause in-hospital mortality was 21.7%, with the majority of deaths seen in AA (65.4%, P = 0.002) and patients 80 years or older (52%, P < 0.0001). AA women had lower all-cause mortality than AA men, white women, and white men based on race-gender interactions. In multivariable logistic regression analysis, older age (>80-year-old), dementia, and chronic kidney disease were associated with worse all-cause in-hospital mortality. Adjusted for race and body mass index (BMI), the main odds ratios (OR) and 95% confidence intervals (CI) are: Age 80 and older vs < 60 in females: OR = 7.4, 95% CI: 2.9, 18.7; in males OR = 7.3, 95% CI: 3.3, 16.2; Chronic Kidney Disease (CKD): OR = 1.7, 95% CI: 1.2, 2.6; Dementia: OR = 2.2, 95% CI: 1.5, 3.3. ConclusionGender significantly modified the association of race and COVID-19 mortality. African American females had the lowest all-cause in-hospital mortality risk compared to other gender-race groups.

Whole Exome Sequence Study of Mild Cognitive Impairment in African and European Americans; the Atherosclerosis Risk in Communities‐Neurocognitive Study

AbstractBackgroundMild cognitive impairment (MCI) encompasses cognitive deficits beyond normal aging that minimally impact daily functioning. Uncovering the genetic architecture of MCI, which can progress to Alzheimer’s disease in some individuals, may facilitate the development of lifestyle and pharmacologic interventions to minimize cognitive impairment or prevent dementia. We conducted a whole exome sequence study of MCI in 1,144 African American (AA) and 3,358 European American (EA) participants aged 67‐90 years from the Atherosclerosis Risk in Communities‐Neurocognitive Study.MethodsFor both single‐variant and gene‐based tests, we employed seqMeta to perform race‐stratified analyses of functional (nonsynonymous, splicing, stopgain, stoploss, or frameshift) variants in each sex alone and both sexes combined. Models were adjusted for age, sex (except sex‐stratified models), field center, and population substructure (the first ten principal components). Logistic regression models were fit on autosomal single‐variants with minor allele frequency (MAF) ≥0.01 while SKAT‐O, T1 burden, and SKAT (beta weights and MAF ≤ 0.05) gene‐based tests were conducted. The significance and suggestive p‐value thresholds were 1.13E‐06 and 2.27E‐05 for single‐variant tests and 2.81E‐06 and 5.63E‐05 for gene‐based tests, respectively, after Bonferroni correction.ResultsThe analysis sample contained 993 MCI cases and 3,509 cognitively normal participants; Table 1 contains the count for each race and sex subgroup. One significant (p‐value=1.06E‐7) single‐variant association (chr6:51712759:T:C in PKHD1) was detected in AA males (Figure 1). This variant had MAF=0.025 in AA males but was monomorphic in EA males. Four significant gene‐based associations with minor allele counts (MAC) ≥ 10 were discovered: CDC27 in AA females (SKAT‐O p‐value=6.63E‐07), C19orf18 in AA males (SKAT‐O p‐value=1.26E‐07), SLC16A10 in EA males and females combined (SKAT p‐value=1.90E‐06), and ZNF804A in EA females (T1 p‐value=2.69E‐07). Twenty‐three suggestive single‐variant and gene‐based associations with MAC ≥ 10 were identified (Figure 2).ConclusionsMCI‐associated genes have diverse biological functions including cell division, sodium‐independent transportation of amino acids, and zinc finger binding. Our findings imply that the genetic underpinnings of MCI may differ by race and sex. External replication of our findings, as well as investigations using large samples in consortia, will provide insight into the pervasiveness of sex‐specific genetic effects in dementia‐related traits.

Race and sex based disparities in sepsis

BackgroundStudies of sepsis evaluating sex- and race-related disparities in treatment and outcome have been limited by using administrative databases, which may not adequately capture sepsis diagnosis, used limited number and types of races, or not included both sex and race in the analyses. ObjectiveTo determine if patients of different races and sexes with sepsis have different mortality, receipt of mechanical ventilation or renal replacement therapy, or time to antibiotics? MethodsWe retrospectively analyzed clinical data from 34,999 patients with sepsis, defined by Sepsis-3 criteria, using logistic regression and linear regression. ResultsAfter adjustments for confounders, Asian females had the lowest adjusted 90-day mortality (OR=0.656, 95% CI=0.385–1.118, p<0.001 compared to White males). Similarly, compared to White males, African-American males had a lower adjusted mortality (OR=0.790, 95% CI=0.648–0.963, p = 0.019), while Asian males (OR=1.185, 95% CI=0. 828–1.696, p = 0.354) and both African-American (OR=0.972, 95% CI=0.800–1.182, p = 0.779) and Caucasian (OR=1.054, 95% CI=0.960–1.158, p = 0.270) females had similar mortality. Both male and female patients with Other/unknown race had higher mortality (OR=1.776, 95% CI=1.395–2.261, p<0.001 and OR=1.658, 95% CI=1.359–2.021, p<0.001), respectively. In the secondary analyses for new-onset mechanical ventilation and new-onset renal replacement therapy post-sepsis, we found no association between any of the race-sex groups and receipt of these therapies. ConclusionWe found that Asian females had the lowest adjusted 90-day mortality for patients with sepsis. Understanding the reasons for disparities in outcome after sepsis may improve care and outcomes in diverse populations.