Forsyth County Research Articles

Georgia Library Spotlight: Forsyth County Public Library’s Bat Walk

Georgia Library Spotlight: Forsyth County Public Library’s Bat Walk

Enhancing insights in sexually transmitted infection mapping: Syphilis in Forsyth County, North Carolina, a case study.

In 2008-2011 Forsyth County, North Carolina experienced a four-fold increase in syphilis rising to over 35 cases per 100,000 mirroring the 2021 state syphilis rate. Our methodology extends current models with: 1) donut geomasking to enhance resolution while protecting patient privacy; 2) a moving window uniform grid to control the modifiable area unit problem, edge effect and remove kriging islands; and 3) mitigating the "small number problem" with Uniform Model Bayesian Maximum Entropy. Data is 2008-2011 early syphilis cases reported to the NC Department of Health and Human Services for Forsyth County. Results were assessed using latent rate theory cross validation. We show combining a moving window and a UMBME analysis with geomasked data effectively predicted the true or latent syphilis rate 5% to 26% more accurate than the traditional, geopolitical boundary method. It removed kriging islands, reduced background incidence rate to 0, relocated nine outbreak hotspots to more realistic locations, and elucidated hotspot connectivity producing more realistic geographical patterns for targeted insights. Using the Forsyth outbreak as a case study showed how the outbreak emerged from endemic areas spreading through sexual core transmitters and contextualizing the outbreak to current and past outbreaks. As the dynamics of sexually transmitted infections spread have changed to online partnership selection and demographically to include more women, partnership selection continues to remain highly localized. Furthermore, it is important to present methods to increase interpretability and accuracy of visual representations of data.

Evaluating Prenatal Care Compliance and Barriers to Prenatal Care Among Pregnant Individuals in Forsyth County, North Carolina

Background Individuals who gave birth from May 2021 through July 2021 at Atrium Health Wake Forest Baptist (AHWFB) Hospital were surveyed to identify barriers to prenatal care (PNC), assess adequacy of PNC, and examine how these measures relate to race, ethnicity, and income. Methods A survey was administered to 200 individuals giving birth at AHWFB. Eligibility included English- or Spanish-speaking, aged 18 years or older, and a gestational age of 35 weeks or greater at delivery. Primary outcomes included PNC receipt and PNC barriers. Stratification by race, ethnicity, and income were also evaluated. Results PNC receipt rates were 81%, 87%, and 88% in the first 28 weeks, between 28 and 36 weeks, and after 36 weeks, respectively, with 76% of individuals receiving adequate PNC throughout pregnancy. Non-White or Hispanic participants experienced lower PNC rates in the first 28 weeks, and participants reporting an annual household income of less than $20,000 experienced lower PNC rates throughout pregnancy. While 19% of participants reported at least one barrier to PNC, the number of barriers reported did not differ based on race, ethnicity, or income. However, it was found that participants who reported at least one barrier were less likely to receive PNC throughout pregnancy. Limitations This study was limited by convenience sampling and the potential for recall bias. Conclusions: Although race, ethnicity, and income were not associated with the number of reported barriers, they did impact the likelihood of receiving adequate PNC. As self-reported race/ethnicity in our study likely served as a proxy for racism and race-based discrimination, future research should more formally investigate the role of structural racism in the receipt of PNC.

Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality

There are consistent data demonstrating that socioeconomic disadvantage is associated with risk of premature mortality, but research on the relationship between neighborhood socioeconomic factors and premature mortality is limited. Most studies evaluating the association between neighborhood socioeconomic status (SES) and mortality have used a single assessment of SES during middle to older adulthood, thereby not considering the contribution of early life neighborhood SES. To investigate the association of life course neighborhood SES and premature mortality. This cohort study included Black and White participants of the multicenter Atherosclerosis Risk in Communities Study, a multicenter study conducted in 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. Participants were followed up for a mean (SD) of 18.8 (5.7) years (1996-2020). Statistical analysis was performed from March 2023 through May 2024. Participants' residential addresses during childhood, young adulthood, and middle adulthood were linked with US Census-based socioeconomic indicators to create summary neighborhood SES scores for each of these life epochs. Neighborhood SES scores were categorized into distribution-based tertiles. Premature death was defined as all-cause mortality occurring before age 75 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Among 12 610 study participants, the mean (SD) age at baseline was 62.6 (5.6) years; 3181 (25.2%) were Black and 9429 (74.8%) were White; and 7222 (57.3%) were women. The lowest, compared with the highest tertile, of neighborhood SES score in middle adulthood was associated with higher risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54). Similar associations were observed for neighborhood SES in young adulthood among women (HR, 1.25; 95% CI, 1.00-1.56) and neighborhood SES in childhood among White participants (HR, 1.25; 95% CI, 1.01-1.56). Participants whose neighborhood SES remained low from young to middle adulthood had an increased premature mortality risk compared with those whose neighborhood SES remained high (HR, 1.25; 95% CI, 1.05-1.49). In this study, low neighborhood SES was associated with premature mortality. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood SES from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality.

Effect of Hearing Intervention Versus Health Education Control on Fatigue: A Secondary Analysis of the ACHIEVE Study.

Fatigue is a common complaint among older adults with hearing loss. The impact of addressing hearing loss on fatigue symptoms has not been studied in a randomized controlled trial. In a secondary analysis of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, we investigated the effect of hearing intervention versus health education control on 3-year change in fatigue in community-dwelling older adults with hearing loss. Participants aged 70-84 years old with untreated hearing loss recruited across 4 study sites in the United States (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland) were randomized (1:1) to hearing intervention or health education control and followed for 3 years. Three-year change in fatigue symptoms was measured by 2 instruments (RAND-36 and PROMIS). We estimated the intervention effect as the difference in the 3-year change in fatigue between intervention and control groups using a linear mixed-effects model under the intention-to-treat principle. Participants (n = 977) had a mean age (SD) of 76.8 (4.0) years, were 53.5% female and 87.8% White. Over 3 years, a beneficial effect of the hearing intervention versus health education control on fatigue was observed using the RAND-fatigue score (β = -0.12 [95% CI: -0.22, -0.02]). Estimates also suggested beneficial effect of hearing intervention on fatigue when measured by the PROMIS-fatigue score (β = -0.32 [95% CI: -1.15, 0.51]). Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss.

Epigenetic Aging and Racialized, Economic, and Environmental Injustice

Epigenetic age acceleration is associated with exposure to social and economic adversity and may increase the risk of premature morbidity and mortality. However, no studies have included measures of structural racism, and few have compared estimates within or across the first and second generation of epigenetic clocks. To determine whether epigenetic age acceleration is positively associated with exposures to diverse measures of racialized, economic, and environmental injustice measured at different levels and time periods. This cross-sectional study used data from the My Body My Story (MBMS) study between August 8, 2008, and December 31, 2010, and examination 5 of the Multi-Ethnic Atherosclerosis Study (MESA) from April 1, 2010, to February 29, 2012. In the MBMS, DNA extraction was performed in 2021; linkage of structural measures to the MBMS and MESA, in 2022. US-born individuals were randomly selected from 4 community health centers in Boston, Massachusetts (MBMS), and 4 field sites in Baltimore, Maryland; Forsyth County, North Carolina; New York City, New York; and St Paul, Minnesota (MESA). Data were analyzed from November 13, 2021, to August 31, 2023. Ten epigenetic clocks (6 first-generation and 4 second-generation), computed using DNA methylation data (DNAm) from blood spots (MBMS) and purified monocytes (MESA). The US-born study population included 293 MBMS participants (109 men [37.2%], 184 women [62.8%]; mean [SD] age, 49.0 [8.0] years) with 224 Black non-Hispanic and 69 White non-Hispanic participants and 975 MESA participants (492 men [50.5%], 483 women [49.5%]; mean [SD] age, 70.0 [9.3] years) with 229 Black non-Hispanic, 191 Hispanic, and 555 White non-Hispanic participants. Of these, 140 (11.0%) exhibited accelerated aging for all 5 clocks whose estimates are interpretable on the age (years) scale. Among Black non-Hispanic MBMS participants, epigenetic age acceleration was associated with being born in a Jim Crow state by 0.14 (95% CI, 0.003-0.27) SDs and with birth state conservatism by 0.06 (95% CI, 0.01-0.12) SDs, pooling across all clocks. Low parental educational level was associated with epigenetic age acceleration, pooling across all clocks, for both Black non-Hispanic (0.24 [95% CI, 0.08-0.39] SDs) and White non-Hispanic (0.27 [95% CI, 0.03-0.51] SDs) MBMS participants. Adult impoverishment was positively associated with the pooled second-generation clocks among the MESA participants (Black non-Hispanic, 0.06 [95% CI, 0.01-0.12] SDs; Hispanic, 0.07 [95% CI, 0.01-0.14] SDs; White non-Hispanic, 0.05 [95% CI, 0.01-0.08] SDs). The findings of this cross-sectional study of MBMS and MESA participants suggest that epigenetic age acceleration was associated with racialized and economic injustice, potentially contributing to well-documented inequities in premature mortality. Future research should test the hypothesis that epigenetic accelerated aging may be one of the biological mechanisms underlying the well-documented elevated risk of premature morbidity and mortality among social groups subjected to racialized and economic injustice.

Health Needs and Priorities of an Underserved Karenni Refugee Community: A Community Needs Assessment.

Southeast Asian refugee communities are frequently underserved by social and medical systems and experience profound health and health care inequities. The purpose of this study was to detail the health needs, priorities, and health care utilization of the Karenni, a Southeast Asian refugee community, in Forsyth County, North Carolina. A mixed-mode survey (i.e., online and in-person) was distributed in Kayah, Burmese, and English to Karenni adults in Forsyth County. Quantitative and qualitative questions focused on community health needs, health and public health service utilization, and social determinants of health. 101 Karenni adults completed the survey, with a total of 91 participants completing the quantitative portion (N = 91). Utilization of health care and public health services was low and impacted by individual- and contextual-level barriers, such as limited English profi-ciency and social determinants of health (e.g., lower levels of education and employment compared to state and national averages). Mental health, chronic pain, and health care access were highlighted as prominent community concerns while theh plaw theh jie (togetherness) and community organizations were described as community strengths. Data were collected using convenience sampling, and limited knowledge from the Karenni community regarding research served as a barrier to recruitment. Some sensitive questions (e.g., income) also experienced higher levels of missingness. This assessment highlights the need to increase engagement with and lower barriers to care for the Karenni community in Forsyth County, North Carolina. To produce culturally congruent and acceptable care, public health and health care systems should partner with the community to identify and address community needs and priorities, harness assets, and mitigate health and health care inequities.

A comparison of PM2.5 exposure estimates from different estimation methods and their associations with cognitive testing and brain MRI outcomes

BackgroundReported associations between particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) and cognitive outcomes remain mixed. Differences in exposure estimation method may contribute to this heterogeneity. ObjectivesTo assess agreement between PM2.5 exposure concentrations across 11 exposure estimation methods and to compare resulting associations between PM2.5 and cognitive or MRI outcomes. MethodsWe used Visit 5 (2011–2013) cognitive testing and brain MRI data from the Atherosclerosis Risk in Communities (ARIC) Study. We derived address-linked average 2000–2007 PM2.5 exposure concentrations in areas immediately surrounding the four ARIC recruitment sites (Forsyth County, NC; Jackson, MS; suburbs of Minneapolis, MN; Washington County, MD) using 11 estimation methods. We assessed agreement between method-specific PM2.5 concentrations using descriptive statistics and plots, overall and by site. We used adjusted linear regression to estimate associations of method-specific PM2.5 exposure estimates with cognitive scores (n = 4678) and MRI outcomes (n = 1518) stratified by study site and combined site-specific estimates using meta-analyses to derive overall estimates. We explored the potential impact of unmeasured confounding by spatially patterned factors. ResultsExposure estimates from most methods had high agreement across sites, but low agreement within sites. Within-site exposure variation was limited for some methods. Consistently null findings for the PM2.5-cognitive outcome associations regardless of method precluded empirical conclusions about the potential impact of method on study findings in contexts where positive associations are observed. Not accounting for study site led to consistent, adverse associations, regardless of exposure estimation method, suggesting the potential for substantial bias due to residual confounding by spatially patterned factors. DiscussionPM2.5 estimation methods agreed across sites but not within sites. Choice of estimation method may impact findings when participants are concentrated in small geographic areas. Understanding unmeasured confounding by factors that are spatially patterned may be particularly important in studies of air pollution and cognitive or brain health.

Where Do Participants Move and How Do Their New Neighborhoods Compare to Where They Rented? Evidence from a North Carolina First-Time Homeownership Program

In North Carolina, the Forsyth County Homeownership Program (FCHP) seeks to promote improved socioeconomic outcomes and wealth accumulation through home ownership by subsidizing down payments and offering a targeted financial literacy program. An important aspect of the FCHP is that it allows participants to decide what house to buy and where they ultimately live. We offer a first-ever analysis of the neighborhood differences between where participating families rented and where they moved. Analyzing a sample of 452 participants, we find evidence that the average family moved to neighborhoods with improved socioeconomic characteristics, compared to the neighborhoods where they rented. However, their new neighborhoods had worse socioeconomic measurements when compared to the overall county. We offer a discussion of these results and their policy implications.

Q&A: Continuous Coverage Unwinding and Medicaid Expansion on the Ground in Two North Carolina Counties.

After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, "unwinding" this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.

Mapping Leaf Area Index at Various Rice Growth Stages in Southern India Using Airborne Hyperspectral Remote Sensing

Globally, rice is one of the most important staple food crops. The most significant metric for evaluating the rice growth and productivity is the Leaf Area Index (LAI), which can be effectively monitored using remote sensing data. Hyperspectral remote sensing provides contiguous bands at narrow wavelengths for mapping LAI at various rice phenological stages, and it is functionally related to canopy spectral reflectance. Hyperspectral signatures for different phases of rice crop growth was recorded using Airborne Visible Near-Infrared Imaging Spectrometer-Next Generation (AVIRIS-NG) along with corresponding ground based observations. Ground-based hyperspectral canopy spectral reflectance measurements were recorded with FieldSpec 3 Hi-Res spectroradiometer (ASD Inc., Forsyth County, GA, USA; spectral range: 350–2500 nm) and LAI data from 132 farmer’s fields in Southern India. Among 29 hyperspectral vegetation indices tested, 8 were found promising for mapping rice LAI at various phenological stages. Among all the growth stages, the elongation stage was the most accurately estimated using vegetation indices that exhibited a significant correlation with the airborne hyperspectral reflectance. The validation of hyperspectral vegetation indices revealed that the best fit model for estimating rice LAI was mND705 (red-edge, blue, and NIR bands) at seedling and elongation, SAVI (red and NIR bands) at tillering and WDRVI (red and NIR bands) at booting stage.

Clonal Hematopoiesis Risk Score and All-Cause and Cardiovascular Mortality in Older Adults.

Clonal hematopoiesis (CH) with acquired pathogenic variants in myeloid leukemia driver genes is common in older adults but of unknown prognostic value. To investigate the prevalence of CH and the utility of the CH risk score (CHRS) in estimating all-cause and disease-specific mortality in older adults with CH. This population-based prospective cohort study involved community-dwelling older adults (aged 67-90 years) without hematologic malignant neoplasms (HMs) who were participants in the Atherosclerosis Risk in Communities Visit 5 at 4 US centers: Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland. Samples were collected from 2011 to 2013, sequencing was performed in 2022, and data analysis was completed in 2023. The exposure was a diagnosis of CH. CHRS scores (calculated using 8 demographic, complete blood cell count, and molecular factors) were used to categorize individuals with CH into low-risk (CHRS ≤9.5), intermediate-risk (CHRS >9.5 to <12.5), and high-risk (CHRS ≥12.5) groups. The primary outcome was all-cause mortality, and secondary outcomes were HM mortality, cardiovascular disease mortality, and death from other causes. Among 3871 participants without a history of HM (mean [SD] age, 75.7 [5.2] years; 2264 [58.5%] female individuals; 895 [23.1%] Black individuals; 2976 White individuals [76.9%]), 938 (24.2%) had CH. According to the CHRS, 562 (59.9%) were low risk, 318 (33.9%) were intermediate risk, and 58 (6.2%) were high risk. During a median (IQR) follow-up of 7.13 (5.63-7.78) years, 570 participants without CH (19.4%) and 254 participants with CH (27.1%) died. Mortality by CHRS risk group was 128 deaths (22.8%) for low risk, 93 (29.2%) for intermediate risk, and 33 (56.9%) for high risk. By use of multivariable competing risk regression, subdistribution hazard ratios (sHRs) for all-cause mortality were 1.08 (95% CI, 0.89-1.31; P = .42) for low-risk CH, 1.12 (95% CI, 0.89-1.41; P = .31) for intermediate-risk CH, and 2.52 (95% CI, 1.72-3.70; P < .001) for high-risk CH compared with no CH. Among individuals in the high-risk CH group, the sHR of death from HM (6 deaths [10.3%]) was 25.58 (95% CI, 7.55-86.71; P < .001) and that of cardiovascular death (12 deaths [20.7%]) was 2.91 (95% CI, 1.55-5.47; P < .001). In this cohort study, the CHRS was associated with all-cause, HM-related, and cardiovascular disease mortality in older adults with CH and may be useful in shared decision-making to guide clinical management and identify appropriate candidates for clinical trials.

Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration

Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health. To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation. This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023. Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002). At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations. A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005). These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.

Abstract 421: Automated External Defibrillator Implementation Gaps in Three Non-Urban U.S. Communities

Introduction: Automated external defibrillators (AEDs) represent a crucial component of bystander response to out-of-hospital cardiac arrest (OHCA), yet epidemiologic evidence suggests that AEDs are deployed by laypersons in less than 5% of OHCA events in the US. The reasons for low utilization remain poorly characterized, especially in rural/suburban environments. We hypothesized that in these non-urban environments, layperson AED use is mostly in commercial or public locations despite most arrests occuring in private residences. Methods: We conducted an analysis of EMS-treated atraumatic OHCA events from 3 non-urban US regions (Cumberland County, PA; Jackson, TN; Forsyth County, GA), abstracted from EMS patient care reports. Data included Utstein reporting elements, arrest location type, and response intervals as calculated by dispatch and EMS arrival times. We excluded events in skilled nursing facilities and prisons. CPR and AED delivery by laypersons was measured. Results: Between 12/8/17-12/31/21, we identified 1542 adult OHCA patients with median age 66.5 y (IQR 22.5), 37% female, 18% had initial shockable rhythms, and 75% occurred in private residences. Return of spontaneous circulation was obtained in 19% of cases. Bystander CPR was performed in 23% and AEDs were deployed by laypersons in 3%. Laypersons applied AEDs in 12% of OHCA in commercial locations, 6% of OHCA in public, and 3% of OHCA in private residences. EMS response times were 4% less than 4 min, 48% 4-9 min, and 48% &gt;9 min; prevalence of AED use was indistinguishable between time intervals of EMS response. 16% OHCA victims still had initial shockable rhythms even among the &gt;9 min EMS response cases; of these, 1% received AED use from laypersons. Conclusion: In three non-urban US regions, most arrests occurred in private residences while AED use was much more likely in public or commercial locales, suggesting an important gap in AED deployment. Even in cases with prolonged response times, many patients had shockable rhythms, suggesting an important opportunity for earlier AED deployment. Future work will test whether placement of AEDs in residential areas using trained volunteer responders in these same communities will improve OHCA response and survival outcomes.

Working to Reduce Crime: Exploring the Link Between Economic Participation and Crime Rates in Forsyth County, N.C. Neighborhoods

We examine the relationship between economic participation rates and rates of assaults, vandalisms, and drug offenses in neighborhoods in Forsyth County, N.C. We use a unique dataset containing assault, vandalism, and drug offense rates at the neighborhood level from 2013 to 2020. We estimate a two-way fixed effects spatial Durbin regression model relating crime rates to economic participation rates for the three types of crime. The results show that neighborhoods, proxied with census tracts, with higher economic participation rates among its residents have significantly lower crime rates. The relationship exists even after controlling for unobserved heterogeneity and spatial autocorrelation. Workforce programs that recruit individuals from neighborhoods with low economic participation rates may have the additional benefit of reducing crime.

Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study

ObjectivesHearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use. DesignCross-sectional study of community-dwelling older adults at visit 6 (2016–2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN). Setting and ParticipantsPopulation-based study of 3179 participants (mean age = 79.2 years, 58.9% female). MethodsPure-tone audiometry at 0.5–4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26–40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively. ResultsIn our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01–1.57] and frail (OR, 1.62; 95% CI, 1.06–2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity. Conclusions and ImplicationsHearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.

Parity and Risk of Dementia in Women: The Atherosclerosis Risk in Communities Study.

Objective: Reproductive factors, including parity, may contribute to dementia risk, due to hormonal, physiological, social, and demographic factors. We hypothesized that higher parity would be associated with increased dementia risk. Materials and Methods: We utilized data from the Atherosclerosis Risk in Communities (ARIC) community-based cohort study. Participants were recruited in 1987-1989 and followed through 2017. Participants, all born between 1921 and 1945, were from four U.S. communities in Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD. We included all female participants seen at ARIC visit three or five for whom parity and dementia outcomes were available (N = 7,921). The primary exposure was self-reported number of live births. Our primary outcome was dementia, diagnosed via neurocognitive assessments, informant interviews, and expert adjudication. We created Cox proportional hazards models to evaluate the association between parity and incident dementia, adjusting for demographic factors, education level, apolipoprotein E allele status, and vascular risk factors. We tested for interactions by race and birth cohort. Results: The adjusted hazard ratio was 0.82 (95% confidence intervals [CI] 0.69-0.99) for dementia in women with 0-1 births and 0.85 (95% CI 0.72-0.99) for women with 5+ births, compared to women with 2 births (reference group). This association was present in women born from 1924 to 1934, but not in women born in 1935 or later (p-interaction <0.001). Conclusion: We found an inverted U-shaped association of parity with dementia risk. This effect was modified by birth cohort, suggesting that the association may depend on demographic and sociocultural factors.

Abstract P500: Age-Specific Population Attributable Fractions for the Impact of Hypertension on Dementia Risk

Introduction: Hypertension in midlife, but not late life, is a robust predictor of subsequent dementia. However, the fraction of dementia attributable to hypertension might vary depending on the age of the population considered, and the age through which dementia onset occurs. Here, we investigated associations of hypertension assessed at various ages with incident dementia by age 80 or 90, then estimated population attributable fractions (PAF) for dementia from hypertension categories at each of these age groups. Hypothesis: Given hypertension prevalence increases with age but its relative risk for dementia tends to decrease, we had no prior expectation of the age at which the PAF’s would be highest. We hypothesized, however, that PAFs for incident dementia would be higher when hypertension is measured in midlife age groups versus late-life age groups. Methods: We leveraged 32 years of follow-up data from the Atherosclerosis Risk in Communities study (ARIC), a prospective, community-based cohort that enrolled participants aged 45-64 years from four US communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and selected suburbs of Minneapolis, MI) at ARIC visit 1 (1987-1989). Participants were followed through 2018-2019. We used Cox proportional hazards models to estimate hazard ratios, then quantified PAFs, of dementia by age 80 and 90 from hypertension assessed at ages of 45-54 (ARIC visit 1), 55-64 (ARIC visits 1 and 4), 65-74 (ARIC visits 4 and 5), and 75-84 (ARIC visit 5). Results: Hypertension was assessed among 7,572 participants aged 45-54; 12,033 aged 55-64; and 6,561 aged 65-74. By age 80 the number identified as having incident dementia was 711, 910, and 372, respectively. Relative to normotension, hypertension in each age category was associated with hazard ratios (HRs) greater than 1.0 for dementia from hypertension by age 80. The PAF for dementia by age 80 from hypertension measured at age 45-54 was 15.3% (95% CI = 6.9, 22.3%), 19.1% (95% CI = 9.9, 26.9%) at ages 55-64, and 19.9% (95% CI = -4.4, 38.5%) at ages 65-74. By age 90, the number of incident dementia cases were 958; 2,302; and 1,327, respectively; and, among the 2,086 participants aged 75-84, 400 incident dementia cases. HRs were slightly smaller than those by age 80, while hypertension assessed in the 75-84 age group was not significant. The PAFs for dementia by age 90 from hypertension at age 45-54 was 13.8% (95% CI = 6.6, 20.0%), 12.9% (95% CI = 7.0, 18.2%) at ages 55-64, 10.9% (95% CI = 0.02, 21.0%) at ages 65-74, and non-significant at ages 75-84. Conclusions: Public health interventions targeting hypertension in midlife through early late-life might reduce a sizeable proportion of dementia cases.

Abstract 241: Comparison Of A Phone-based Business AED Survey Canvas, 911-Dispatch AED Inventory, And State-Mandated AED Registry In Forsyth County, NC

Introduction: In North Carolina (NC), 911-dispatch centers are accelerating treatment to OHCA by notifying bystanders of nearby public AEDs. This system depends on a comprehensive registry of AED locations. State law requires registration of AEDs with the NC Office of EMS (NC OEMS), but adherence to this legislation is unknown. The purpose of this study was to determine the registration status of public AEDs in a large county in NC. Methods: Using structured phone surveys, we determined the AED status and information for businesses in Forsyth County, NC. Using a national business database, we identified all registered large businesses (&gt;20 employees) and select small businesses (1-19 employees) most likely to have an AED: healthcare, government, childcare, educational, and religious organizations. In addition, AED lists were elicited from large organizations (e.g non-hospital health clinics, universities, and county government) (n=293 AEDs), NC OEMS (n=336), and 911-dispatch center (n=73). Results: Between 1/2/22-5/7/22, we contacted 1,702 businesses (response rate =79.1%). Of these, 411 (30.5%) businesses reported &gt;= 1 AEDs. Additionally, 106 unique AED locations were identified from large organizations; 22 from the 911-dispatch; and 34 from the NC OEMS registry. The final AED list contained 963 AEDs at 573 unique locations (Table). Identified AEDs were most frequently located at health clinics, schools, colleges, offices, industrial facilities, and churches. A majority of AEDs (65.1% [627/963]) were not previously registered in the NC OEMS AED registry. Few business AEDs (11.8% [114/963]) were listed in the county dispatch agency’s geolocation software system. Conclusion: Most businesses and organizations in our survey canvas had AEDs that were unregistered in a state-mandated AED registry. Structured strategies to increase reporting of publicly available AEDs to NC OEMS and transfer of that information to county 911-dispatch systems are needed.

Abstract 242: Association Of The Nearest Static AED With Treatment And Outcome Of OHCA In Forsyth County, North Carolina

Introduction: Over the last two decades, publicly accessible AEDs have become available in communities across the US, allowing bystanders to rapidly intervene during OHCA. The impact of static AEDs on rates of bystander AED application and OHCA outcomes is poorly understood. Methods: We created a static AED registry for Forsyth County, NC (mixed rural-urban county with population ~ 380,000 ) primarily through phone-based surveys of businesses. These data were linked to the Cardiac Arrest Registry to Enhance Survival and geocoded to calculate proximity between OHCA and nearest static AED. The AHA recommends that publicly accessible AEDs be placed to achieve bystander retrieval within 100 meters (m) of OHCA. Multivariable logistic regression modeling examined the relationship between AED proximity and survival to hospital discharge. Results: Included were 2078 patients &gt;18 years old with OHCA between 2013-2019 and 573 businesses with at least one AED. There were 219 (10.5%), 190 (9.1%), 1669 (80.3%) OHCAs with an AED within &lt;100m, 100-200m, and &gt;200m, respectively. OHCA incidence was highest where static AEDs were closest. Static AEDs within 100m of OHCA were primarily at residential facilities (41.1%), health care clinics (26.5%), churches (9.1%), and schools (6.8%). Among OHCAs with nearest AED &gt;200m, AEDs were primarily owned by schools (32.2%), healthcare facilities (15%), industrial facilities (10.6%), and churches (10.4%). Bystander CPR was highest for OHCAs in closest proximity to an AED (&lt;100m: 61.2%; 100-200m: 51.6%; &gt;200m: 39.5%, p&lt;0.001). Bystander AED application was highest where static AEDs were closest to OHCA (28.3%, 14.2%, and 3.8% at &lt;100m, 100-200m, and &gt;200m, respectively, p&lt;0.001). Among patients who were defibrillated, bystander defibrillation was 18.1%, 20%, and 3.9% (p&lt;0.001). There was no difference for survival to hospital discharge (&lt;100m: 15.1%; 100-200m: 15.3%; &gt;200m: 13.1%, p=0.54), even after adjustment (aOR 1.002, 95% CI 0.995-1.008 per 10m decrease). Conclusion: Only 10% of OHCAs in Forsyth County were within 100 meters of a static AED. Bystander CPR and AED application were highest where static AEDs were &lt;100m from OHCA. Despite this, there was no association between AED proximity and survival to hospital discharge.