Geographic Region Of Residence Research Articles

Impact of nutritional risk factors on the development of multiple sclerosis

The literature review considers the data on the assessment of the influence of alimentary factors on the development of a severe neurological disease - multiple sclerosis (MS). MS is a polyetiologic disease, the risk of development of which is influenced by both infectious (Epstein-Barr virus, herpes simplex virus, influenza virus, etc.) and noninfectious factors (genetic predisposition, smoking, geographic region of residence, etc.). MS is a progressive demyelinating disease of the central nervous system (CNS), which leads to neurodegeneration accompanied by a variety of clinical manifestations. The pathogenesis of MS is characterized by immune-mediated damage to the myelin sheaths of nerve fibers, which is manifested by inflammation, neurosynaptic damage, and destruction of white matter, axons, and blood vessels. Rapid non-evolutionary dietary and lifestyle changes, which are driven by urbanization, industrialization and globalization of the food market, are leading to an increase in most chronic non-communicable diseases, including MS. The effects induced by alimentary factors are due to changes in the microbial composition of the gastrointestinal tract (GIT), immune cell function, enzyme systems functioning, etc. The aim of the work is to study the influence of micro/macronutrients, as well as the nature of the diet on the risk of MS development, to assess the role of nutrition in the primary prevention of MS. It has been shown that a diet characterized by a high content of animal fats and trans-isomers of fatty acids (TFA), increased consumption of meat products, but low content of vegetables, fruits and whole-grain products is associated with a higher risk of MS development. Regular inclusion in the diet of sources of polyunsaturated fatty acids (PUFAs) (vegetable oils, seeds, nuts, marine fish) and vitamin D (fatty fish, caviar, butter, egg yolk) leads to lower relapse rates and less new brain lesions among MS patients. The literature review was conducted using open sources posted in electronic databases: PubMed, Medline, Scopus, Google Scholar, World Bank publications, WHO, eLibrary, Cyberleninka, Web of Science.

Perceived Experiences of racism in Relation to Genome-Wide DNA Methylation and Epigenetic Aging in the Black Women's Health Study.

African American women have a disproportionate burden of disease compared to US non-Hispanic white women. Exposure to psychosocial stressors may contribute to these health disparities. Racial discrimination, a major stressor for African American women, could affect health through epigenetic mechanisms. We conducted an epigenome-wide association study (EWAS) to examine the association of interpersonal racism (in daily life and in institutional settings) with DNA methylation in blood in 384 participants of the Black Women's Health Study (BWHS). We also evaluated whether a greater number of perceived experiences of racism was associated with epigenetic aging as measured using different methylation clocks. Models were adjusted for chronological age, body mass index, years of education, neighborhood SES, geographic region of residence, alcohol drinking, smoking, and technical covariates. Higher scores of racism in daily life were associated with higher methylation levels at the cg04494873 site in chromosome 5 (β = 0.64%; 95% CI = 0.41%, 0.87%; P = 6.35E-08). We also replicated one CpG site, cg03317714, which was inversely associated with racial discrimination in a previous EWAS among African American women. In the BWHS, higher scores of racism in daily life were associated with lower methylation levels at that CpG site (β = -0.94%; 95% CI = -1.37%, -0.51%; P =2.2E-05). Higher racism scores were associated with accelerated epigenetic aging in more than one methylation clock. Exposure to discriminatory events may affect the epigenome and accelerate biological aging, which may explain in part the earlier onset of disease in African American women.

Prevalence, cessation, and geographical variation of smoking among middle-aged and elderly adults in China: A population-based study.

Smoking significantly burdens human health, contributing to an increasing incidence of mortality and morbidity. This study aims to explore the prevalence of smoking, cessation, and the association between various risk factors and smoking intensity measured in pack-years among Chinese adults. During 2020-2021, the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) invited participants aged ≥40 years from 31 provinces in mainland China. This cross-sectional study presents the standardized prevalence of smoking and cessation across various demographics, including age, sex, residence, income, education level, BMI, and geographical region of residence. Multivariable logistic regression was used to examine the associations between smoking pack-years and related factors. Among 524741 participants (mean age: 61.9 ± 10.9 years; 41.1% male; 58.9% female), standardized smoking prevalence was 19.3% (95% CI: 19.2-19.4), with men (37.2%; 95% CI: 37.0-37.4) displaying significantly higher rates than women (1.3%; 95% CI: 1.2-1.3). Smoking cessation rate stood at 11.2% (95% CI: 11.0-11.4), with 11.3% (95% CI: 11.1-11.5) for men and 8.4% (95% CI: 7.5-9.2) for women. Urban residents and those with advanced education had lower smoking rates and higher cessation rates. Additionally, the dose-response relationship indicated a more pronounced association between higher smoking pack-years and elevated health risks, including hypertension (AOR=1.30; 95% CI: 1.24-1.36), diabetes (AOR=1.26; 95% CI: 1.20-1.33), hyperlipidemia (AOR=1.22; 95% CI: 1.16-1.28), heart disease (AOR=1.40; 95% CI: 1.26-1.54), and stroke (AOR=1.23; 95% CI: 1.10-1.36). This comprehensive study emphasizes the profound impact of smoking on health in Chinese adults, indicating the critical need for tailored cessation programs, particularly for middle-aged individuals, men, rural residents, and those with lower level of education.

Evaluating the awareness level of zoonotic diseases among final-year veterinary students

Zoonotic diseases have significant implications for public health, and veterinary professionals are essential in their prevention and control. This study aimed to evaluate the level of zoonotic disease awareness among final-year veterinary students and explore their perspectives on protection against these diseases. A survey was administered to 128 final-year veterinary students, and the data were analyzed to investigate the associations between demographic factors and cumulative scores, which were based on six statements related to zoonosis awareness. The results showed a moderate level of awareness among the participants. No significant differences in cumulative scores were observed with respect to age (P = 0.769), gender (P = 0.342), geographical region of residence (P = 0.565), living area (P = 0.748), and grade point average (P = 0.468). However, students who owned or took care of companion animals (4 [1-6]) exhibited higher cumulative scores compared to those who did not own companion animals (3 [1-6]; P = 0.011). Further research is needed to explore the underlying factors and develop educational interventions that promote zoonotic disease awareness among veterinary students

Prevalence and cost of sickle cell disease in France: real-world analysis using data from the Echantillon Généraliste des Bénéficiaires.

Sickle cell disease (SCD) is a genetic disorder of the hemoglobin resulting in chronic anemia, hemolysis, and vaso-occlusions. Its treatment mostly relies on hydroxycarbamide, transfusions, and stem cell transplantation. This study aimed at describing the epidemiology and management of SCD in adolescent and adult patients in France. This was a retrospective study performed among SCD patients aged ≥12 years between 2016 and 2018 and controls. SCD patients were matched on a 1:3 ratio with a group of individuals with no diagnosis of SCD, referred as control group. The matching of SCD patients and controls was a direct matching based on age, sex, CMU-c status (which corresponds to free-of-charge complementary coverage for people with low resources) and geographical region of residence. SCD patients and their matched controls were followed-up for the same amount of time by adjusting controls' follow-up period to that of the associated patients. This study used claims data from the French representative 1/97th sample of health data system. The main outcomes were the patients' characteristics and treatments received, healthcare consumptions and related costs among SCD cases and controls. Between 2016 and 2018, 151 patients with ≥6 months of follow-up were identified out of the total population of 732,164 individuals. SCD prevalence extrapolated to the entire population [95% CI] was 19,502 [19,230, 19,778] in 2018. The median (Q1-Q3) age at inclusion date was 37.0 (25.0-48.0) years, with 69.5% of patients being female. The mean (SD) reimbursed cost over follow-up was €24,310 (89,167), mostly represented by hospitalization costs accounting for €21,156 (86,402). A switch in SCD management was observed with age, as younger patients presented more frequent hospitalizations and acute procedures, while older ones had more frequent medical visits and paramedical care. Mean (SD) annual costs were €25,680 (91,843) and vs. €3,227 (23,372) for patients and controls, respectively (p < 0.001), representing an extra cost of almost €150 million over the entire SCD population. This study highlighted the important costs related to SCD and the related medical need with treatment alternatives, which could be filled by the emergence of new therapies.

Substance use patterns among a global sample of transgender and non-binary people during the COVID-19 pandemic

BackgroundTransgender and non-binary (TNB) people are at high risk of substance misuse compared to cisgender individuals. Few studies have described substance use among non-binary people, and many studies have focused solely on samples from Western countries. In this global study of TNB people, we sought to identify intra-group differences, risk factors, and COVID-related changes in the use of tobacco, alcohol, and cannabis.MethodsWe used cross-sectional data from 926 TNB users of the Hornet app across 76 countries between October and November 2020. Participants self-reported the use of tobacco, alcohol, and cannabis in the past 6 months and any changes in use during the pandemic. We generated descriptive statistics and used logistic regression to assess substance use between TNB subgroups, identify risk factors for each substance by gender identity, and identify changes in substance use before and during the pandemic.ResultsMost TNB participants used tobacco (53.7%, n = 498) and alcohol (66.3%, n = 614). Non-binary participants had increased odds of using cannabis (adjusted odds ratio: 1.62, 95% CI 1.03, 2.55) compared to transfeminine participants. Participants’ geographic region of residence was most associated with higher substance use, compared to other potential factors. Most participants reported increases in at least one substance during COVID-19 (54.2%, n = 276 of 518 responses).ConclusionsIn this global TNB sample, we found that substance use varied by gender identity, and changes in substance use during the pandemic varied by TNB sub-groups. We join researchers calling for gender-specific tailoring of substance-related services for TNB clients and urge further studies with greater inclusion and disaggregation of non-binary and transmasculine individuals to support better-informed analysis of transgender health.

Exploring and Measuring Quality of Life Determinants of Wage Workers in Egypt: A Structural Equation Modelling Approach

AbstractThis paper aims to identify the major significant dimensions that contribute to the overall quality of life (QOL) of wage workers in Egypt. As the QOL is a complex, multidimensional, and interdisciplinary concept, forty-seven indicators under five domains were chosen to investigate the QOL determinants of wage workers in Egypt, namely job characteristics, job satisfaction, ICT access, gender equality and women empowerment, and neighborhood services and utilities. Using data from the 2018 wave of the Egypt Labor Market Panel Survey, the paper employed structural equation modelling (SEM) approach to investigate the impact of proposed dimensions on the overall QOL. In addition, multi-group SEM analysis was implemented to measure how people differ in the way they assess their QOL on the basis of various moderating variables such as the geographical region of residence, age group, and years of schooling. The findings showed the significant impact of the chosen dimensions on the overall QOL. Moreover, the multi-group models showed a significant variation among compared groups, in which the weights of dimensions vary due to the differences in socio-cultural characteristics and the surrounding environment, confirming the complexity of such a concept. As people usually differ in the way they assess their QOL, which is affected by their characteristics and priorities.

Reversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) network: Study protocol and rationale of a multicentre research collaboration.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare, but increasingly recognised cerebrovascular condition with an estimated annual age-standardised incidence of approximately three cases per million. Knowledge about risk factors and triggering conditions and information about prognosis and optimal treatment in these patients are limited. The REversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) project aims to elucidate the epidemiological and clinical characteristics of RCVS by collecting individual patient data from four countries (France, Italy, Taiwan and South Korea) in the setting of a multicentric study. All patients with a diagnosis of definite RCVS will be included. Data on the distribution of risk factors and triggering conditions, imaging data, neurological complications, functional outcome, risk of recurrent vascular events and death and finally the use of specific treatments will be collected. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and geographical region of residence. Ethical approval for the REVERCE study will be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of clinical and epidemiological characteristics of RCVS patients.

OUTC-11. RACE AND AGE ARE ASSOCIATED WITH ICD-10 DIAGNOSES IN THE POST-OPERATIVE PERIOD FOR PEDIATRIC PATIENTS WITH PRIMARY BRAIN TUMORS UNDERGOING NEUROSURGERY

Abstract BACKGROUND Disparities in pediatric cancer care and outcomes are known to exist. This work evaluates the relationship of race, ethnicity, and social determinants of health (SDoH) on the post-operative neurosurgical course of pediatric neuro-oncology patients in a single-institution. METHODS Retrospective data were collected on patients undergoing initial neurosurgery for a primary central nervous system (CNS) tumor between May 2011 and April 2021. Newly attributed ICD-10 codes in the 30-day post-operative period were collected. Descriptive statistics were used to evaluate demographics, geographic region of residence, and insurance type. Logistic regression was performed to estimate the association between covariates and 30-day readmission as well as ICD-10 diagnoses that can complicate the postoperative course including cardiac/respiratory, bleeding, infection, wound, hardware implantation, and neurologic conditions. Linear regression was used to measure association of covariates and length of stay (LOS). RESULTS A total of 836 patients, median age 10.0 years, were included (n=368 females, 44%). Patients were predominantly white (69%) and non-Hispanic/Latino (88%). White (OR [95% CI] 0.55 [0.33,0.90], p=0.02), Native American/Indian (0.25 [0.07,0.89], p=0.03), and multiracial (0.24 [0.08,0.68], p=0.01) patients were significantly less likely to have new ICD-10 codes compared to Black patients. White patients trended toward shorter LOS (p=0.06) compared to Black patients. Younger patients were significantly more likely to have newly reported ICD-10 codes (0.95 [0.92,0.97], p&amp;lt;0.001), increased LOS (r=-0.59 [-0.87,-0.32], p&amp;lt;0.001), and 30-day readmission (0.81 [0.72,0.89], p&amp;lt;0.001). Sex, ethnicity, insurance type, and region had no significant association with outcomes. Income level analyses are ongoing. CONCLUSION Non-black patients were less likely to have new ICD-10 diagnoses reported after surgery for primary CNS tumors. Older age was a protective factor against new post-operative diagnoses, increased LOS, and mortality. More research is necessary to understand the relationship between race, ethnicity, SDoH and post-operative risk including possible mechanisms of interaction across variables.

DETERMINANTS OF ADOLESCENT OBESITY: PARENTAL INFLUENCE AND REGION OF RESIDENCE IN ITALY

Objective: Childhood obesity is on the rise globally, and family environment and socio-economic factors can play a relevant role. In Italy, regional differences in the prevalence of childhood obesity are observed. This study aimed to investigate the interaction between geographical region of residence, family environment and obesity among Italian adolescents. Design and method: Students of primary or secondary schools and their parents, residing in Calabria (South Italy) and Tuscany (Central Italy), were enrolled in a cross-sectional study. All participants were asked to fulfill a questionnaire composed of four sections. First section investigated demography and anthropometry, while General and Sport Nutrition Knowledge questionnaire (GeSNK), Mediterranean Diet Score, and International Physical Activity Questionnaire (IPAQ) assessed nutritional knowledge, dietary habits and physical activity levels respectively. BMI was calculated and students were classified using WHO BMI-for-age charts. Determinants of students’ habits and BMI were investigated with multivariate regression analyses. Results: 179 students and 113 parents from Tuscany, 247 students and 185 parents from Calabria participated in the study. Obesity prevalence was higher in Calabria than in Tuscany among both students and parents, however multivariate regression analysis showed that geographical region of residence was not in itself a determinant of the BMI of students. Although transmission of eating and physical activity habits from parents to sons appears to occur, parental BMI was the only parental characteristic identified as an independent determinant of the students’ BMI at multivariate regression analysis (adjusted for geographical area, students’ age and gender, parental BMI and education level, parents’ and students’ habits and nutritional knowledge). Conclusions: Prevention strategies oriented to reduce childhood obesity should also involve parents.

Prevalence of Sedentary Behavior and Factors Associated with Screen Time among Thai Youths Aged 14–17 Years: A Cross- Sectional Population-Based Survey

Objective: To investigate the prevalence of sedentary behavior (SB) and factors associating with meeting the screen time guidelines among the Thai youth using a nationwide population-based survey. Material and Methods: Data from a national representative sample of 3,900 Thai youths aged 14–17 years old across the country were drawn from the Thailand Physical Activity Children Survey. SB was classified into screen time and sitting down activity. The youths were classified as meeting the screen time guidelines if they spent less than 120 min on screen time activities. A logistic regression analysis was conducted to examine the relationship between sociodemographic factors and meeting the screen time guidelines. Results: Overall, 33.7% of Thai youths were highly sedentary; only 30.5% of them met the screen time guidelines. Regarding screen time activity, the participants spent the highest amount of time using online social media; meanwhile, doing homework was the sitting down activity taking the greatest proportion of their time. The youths who were older and engaged in more screen time activities were significantly more likely to meet the screen time guidelines. Moreover, those who resided in regions other than Bangkok and had longer sleep times were significantly more likely to meet the screen time guidelines. Conclusion: The prevalence estimates of meeting the screen time guideline among the Thai youth were low. Age, geographical region of residence, number of engagements in screen time activities, and sleep time were associated with meeting the screen time guidelines. Our findings indicate that public health policies and interventions are needed to reduce SB among Thai youths; particular attention should be paid to the associating factors of SB.

HLA-B27 positivity in a large miscegenated population of 5,389,143 healthy blood marrow donors in Brazil

BackgroundThe prevalence of HLA-B27 gene positivity in healthy Caucasian communities varies between 8 and 14%. However, there is a lack of information in countries with a high rate of miscegenation, such as Brazil.AimTo estimate the frequency of HLA-B27 in the Brazilian general population using a large national registry database.MethodsThis is a cross-sectional ecological study using the Brazilian Registry of Volunteer Bone Marrow Donors (REDOME) database on HLA-B27 allelic frequency and proportion of positives of healthy donors (18–60 years old). Data were analyzed according to sex, age, race (by self-reported skin color recommended by the Brazilian Institute of Geography and Statistics - IBGE), and geographic region of residence.ResultsFrom 1994 to 2022, a total of 5,389,143 healthy bone marrow donors were included. The overall positivity for HLA-B27 was 4.35% (CI 95% 4.32–4.37%), regardless of sex and age (57.2% were women, mean age was 41.7yo). However, there was a difference between races: 4.85% in Whites; 2.92% in Blacks; 3.76% in Pardos (Browns i.e. mixed races); 3.95% in Amarelos (Yellows i.e. Asian Brazilians); and 3.18% in Indigenous. There was also a difference regarding geographic region of residence (North: 3.62%; Northeast: 3.63%; Southeast: 4.29%; Midwest: 4.5% and 5.25% in South). The homozygosity rate for the HLA-B27 was 1.32% of all the positives and only 0.06% in the general population.ConclusionsOur findings provide the first Brazilian national prevalence for HLA-B27 in 4.35%. There is a gradient gene positivity from North to South, suggesting that the genetic background related to the miscegenation due to colonization, slavery, and some later waves of immigration together with internal migratory flows, could explain our findings.

Association Between Triglycerides and Incident Cognitive Impairment in Black and White Adults in the Reasons for Geographic and Racial Differences in Stroke Study.

Background Elevated nonfasting triglycerides were associated with non-Alzheimer dementia in a recent study. However, this study neither evaluated the association of fasting triglycerides with incident cognitive impairment (ICI) nor adjusted for high-density lipoprotein cholesterol or hs-CRP (high-sensitivity C-reactive protein), known risk markers for ICI and dementia. Methods and Results We examined the association between fasting triglycerides and ICI among 16 170 participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study without cognitive impairment or a history of stroke at baseline in 2003 to 2007 and who had no stroke events during follow-up through September 2018. Overall, 1151 participants developed ICI during the median follow-up of 9.6 years. The relative risk for ICI associated with fasting triglycerides of ≥150 mg/dL versus <100 mg/dL including adjustment for age and geographic region of residence was 1.59 (95% CI, 1.20-2.11) among White women and 1.27 (95% CI, 1.00-1.62) among Black women. After multivariable adjustment, including adjustment for high-density lipoprotein cholesterol and hs-CRP, the relative risk for ICI associated with fasting triglycerides ≥150 mg/dL versus <100 mg/dL was 1.50 (95% CI, 1.09-2.06) among White women and 1.21 (95% CI, 0.93-1.57) among Black women. There was no evidence of an association between triglycerides and ICI among White or Black men. Conclusions Elevated fasting triglycerides were associated with ICI in White women after full adjustment including high-density lipoprotein cholesterol and hs-CRP. The current results suggest that the association between triglycerides and ICI is stronger in women than men.

Social determinants of health (SDOH) and survival among patients with metastatic prostate cancer (mPC): A systematic literature review (SLR).

25 Background: Population level data show strong associations between race and other SDOH including income, education, and geographic region of residence. The relationship between SDOH and clinical outcomes has become increasingly recognized. This review examines the impact of SDOH on survival in patients with mPC in real-world (RW) settings. Methods: A systematic literature search in accordance with Cochrane guidelines was conducted on July 7, 2022, searching for RW studies published as full-text (Jan 2012-July 2022) and conferences (Jan 2019-July 2022) using Ovid MEDLINE, Embase, and Cochrane. A manual search of key congress websites for conference abstracts was also conducted. Studies which assessed the impact of SDOHs on survival, treatment access, and other clinical outcomes in patients with mPC were included in the overall SLR. Here, we present results from studies which assessed the impact of SDOH on overall survival (OS) and prostate cancer specific mortality (PCSM). Clinical trials were excluded. Results: Of 3,228 records screened, 86 studies were included, with findings reported in 67 full-text publications (60 US and 7 ex-US) and 28 conference abstracts (22 US and 6 ex-US). The impact of race on survival was reported in 54 studies. While most studies showed no difference between Black vs White for both OS (n=22) and PCSM (n=8), for patients on specific mPC treatments, there was an association between Black race and improved OS (n=5). Asian patients had improved OS vs White patients (n=4), and reduced PCSM vs White (n=6) and Black patients (n=1). Higher income was generally associated with improved OS (n=7), but no difference in PCSM (n=3). Although the regions compared differed, most studies found disparities in OS among US geographic regions (n=5). Education level was generally not associated with OS (n=2) or PCSM (n=3). Most studies showed that married patients had improved OS (n=4) and reduced PCSM (n=3) compared to unmarried patients. Conclusions: This SLR demonstrated that various SDOH are associated with disparities in survival among mPC patients. Asian race, which is generally associated with higher frequency of better SDOH risk factors, was linked with better OS. In contrast, Black race, which is generally associated with higher frequency of worse SDOH risk factors, was associated with similar or better OS. Having lower income and being unmarried were both associated with reduced OS, while disparities in OS were reported across geographic regions of the US. More studies are needed to understand why SDOH are linked with poor outcomes, including their connection with access to care.

Explaining income inequities in tooth loss among Brazilian adults.

To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults. A nationally representative sample of 65,784 Brazilian adults aged 18-59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups. Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45-59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45-59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined. Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.

Interaction between Geographical Areas and Family Environment of Dietary Habits, Physical Activity, Nutritional Knowledge and Obesity of Adolescents.

There are marked differences in the regional distribution of childhood obesity in Italy. This study sought to investigate the interaction between geographical areas and family environment of dietary habits, physical activity, nutritional knowledge and obesity of adolescents. A cross-sectional study was conducted on 426 school-aged children and 298 parents residing in Central Italy (Florence, Tuscany) and Southern Italy (Corigliano, Calabria), in 2021. Survey questionnaire investigated anthropometry, eating behavior, nutritional knowledge and physical activity. BMI was determined and compared with reference percentile charts for adolescents. Multivariate regression analyses showed that: (1) an adolescent's BMI was directly influenced by their parents' BMI independently of parental nutritional knowledge and dietary or physical activity habits; (2) parents transmitted eating or physical activity habits to their children; (3) the geographic region of residence is not in itself an independent determinant of children's BMI. The clear message is that prevention of childhood obesity should consider family-based approaches. Parental obesity can be the point of convergence of the complex interactions between a parent's and child's habits and should be one of the most important factors to look for.

Abstract PO-271: Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among adults aged 27-45 years in the United States

Abstract Background: More than 36,000 new cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the United States, with racial/ethnic differences observed in incidence and mortality. HPV vaccination is a means of primary prevention against HPV-associated cancers, and in 2018, the Food and Drug Administration expanded age of eligibility for the HPV vaccine to 27-45 years. However, no study has examined differences in vaccine uptake based on race/ethnicity since the expansion of age of eligibility. Objective: To characterize racial/ethnic differences in HPV vaccine uptake among eligible adults aged 27-45 years in the United States, and identify socioeconomic factors associated with differential vaccine uptake. Methods: We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9,440). Outcome of interest was HPV vaccine uptake, defined as receipt of at ≥ 1 dose of the vaccine. Main independent variable was race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other). Other covariates included age, sex, marital status, highest level of education, annual income, insurance status, having a usual place of care, and geographic region of residence. Weighted, multivariable logistic regression model estimated odds of HPV vaccine uptake based on race/ethnicity, while adjusting for other covariates. Results: Majority of respondents were non-Hispanic whites (60.7%). Vaccine uptake rate was only 15.5%. In the unadjusted analysis, there were associations between HPV vaccine uptake and race/ethnicity, sex, marital status, education, income, insurance, place of care, and geography (p &amp;lt; 0.001). After adjusting for covariates, significant racial/ethnic differences in HPV vaccine uptake persisted. Compared to non-Hispanic whites, non-Hispanic blacks were 36% (aOR = 1.36; 95% CI 1.09, 1.70) more likely to receive the HPV vaccine. However, Hispanics were 27% less likely than non-Hispanic whites to receive the HPV vaccine (aOR = 0.73; 95% CI 0.58, 0.92). Additionally, individuals who did not have a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (high school aOR = 0.62; 95% CI 0.50, 0.78; some college aOR = 0.83; 95% CI 0.70, 0.98), compared to college graduates or more. Compared to participants residing in the South, those in the West were more likely to receive the vaccine (aOR = 1.49; 95% CI 1.24, 1.80); and females had over three times the odds of receiving the vaccine (aOR = 3.58; 95% CI 3.03, 4.23) than males. Conclusions: Only 1-in-6 adults between 27 and 45 years in the United States have received at least one dose of the HPV vaccine, and Hispanics are significantly less likely to do so, as are individuals without a usual place of care. Given the importance of the vaccine in cancer prevention, it is critical that these disparities be mitigated. Citation Format: Nosayaba Osazuwa-Peters, Natalie Rincon, Kelsey Rae McDowell, Tiarney Ritchwood, Eric Adjei Boakye. Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among adults aged 27-45 years in the United States [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-271.

Effective Access to Care in a Crisis Period: Hypertension Control During the COVID-19 Pandemic by Telemedicine.

ObjectiveTo assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic.MethodsA quantitative analysis was performed of all home video visits coded with a diagnosis of essential hypertension during the first 12 months of the COVID-19 pandemic (March 2020 through February 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time. Among this population, a total of 569 patients who had 1785 hypertension visits met the criteria of having 2 or more blood pressure (BP) readings, with the last BP reading occurring in the report period. We analyzed baseline characteristics and BP trends of these 569 patients during the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed.ResultsThe mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% (275) were women. More than 62% (355) of the patients had an initial systolic BP (SBP) above 140 mm Hg, and 25.3% (144) had an initial SBP of greater than 160 mm Hg. The average number of visits during the study period was 3.1 visits per patient; an average of 6.4 BP measurements per patient were available. During the study period, 77% (438) of the patients experienced an improvement in either SBP or diastolic BP (DBP), with mean reductions of −9.7 mm Hg and −6.8 mm Hg in SBP and DBP, respectively. A total of 416 patients in the cohort started with a BP above 140/90 mm Hg. For this subset of patients, 55.7% (232) achieved a BP of 140/90 mm Hg or lower by the end of the study period, and the average reductions in SBP and DBP were −17.9 mm Hg and −12.8 mm Hg, respectively, which corresponded to improvements of 11.2% and 12.4%. These improvements did not vary significantly when patients were stratified by age, sex, or geographic region of residence (rural vs urban/suburban). Voluntarily submitted patient surveys indicated a high degree of patient satisfaction, with a mean satisfaction score of 4.94 (5-point scale).ConclusionClinician-patient relationships established in a video-first telemedicine model were broadly effective for addressing suboptimally controlled hypertension. Patient satisfaction with these visits was high.

A Multi-State Model for Senior Patients with Diffuse Large B Cell Lymphoma

Introduction: Diffuse large B-cell lymphoma (DLCBL) is the most common lymphoid malignancy in the United States. The combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has been shown to be effective and is considered as the standard therapy for DLBCL. However, outcomes remain heterogeneous and hence, more detailed analysis is required to correctly characterize the impact of clinical and socio-demographic factors on DLBCL-specific deaths.Data: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 11,780 patients with DLBCL who were diagnosed between 2002 and 2009. 9,508 of these patients received at least a single therapy after diagnosis. In addition to treatment regimens, DLBCL histology, stage, presence of B-symptoms, history of anemia, extranodal primary site of involvement, Charlson comorbidity index and performance status were identified from the SEER data. Other predictors of poor survival available in the data were patient age, sex, race, geographic region of residence, marital status, year of diagnosis, and census tract-level characteristics such as urban status and education level, as a measure of socioeconomic status. Since all subjects were Medicare beneficiaries, all patients were older than 65 at diagnosis. The last day of follow-up was December 31, 2011.Methods: We developed a multi-state model to study the impact of clinical and socio-demographic factors on DLBCL-specific deaths. Given that senior patients die from many causes, a multi-state model is essential to correctly distinguish deaths due to DLBCL from deaths due to other causes and to identify risk factors affecting DLBCL-caused mortality. The AalenJohansen estimator, a generalization of Kaplan-Meier estimator, was used to estimate the likelihood of being in one of four health states: Alive after diagnosis, Alive after treatment, Dead due to DLBCL and Dead due to other causes (see the diagram, top left). A multivariable Cox proportional hazards regression model was fitted to each transition between the model states to identify significant risk factors affecting the time and rate of each transition. The findings are compared with the findings of the conventional overall survival model to discuss the advantages and necessity of using a more detailed multi-state modeling framework. Percentage of (DLBCL-specific and all cause) deaths within two years and median time to (DLBCL-specific death and overall survival) events are also used to evaluate the impact of identified risk factors.Results: 5,732 (69% due to DLBCL) and 7,599 (58% due to DLBCL) patients died within 2 years of their diagnosis and before the last day of follow-up, respectively.For patients receiving R-CHOP, the cumulative risk of DLBCL-specific death was exceeded by the cumulative risk of death due to other causes approximately 5.25 years after diagnosis and remained constant afterwards (see the figure, top right). Multivariable Cox regression analyses revealed that higher age, DLBCL stage and Charslon index categories are associated with an elevated risk of DLBCL-specific death both for patients with or without treatment. In addition, being married or female and having higher socioeconomic status are associated with a reduced risk of DLBCL-specific death for patients receiving treatment (see the table attached for the hazard ratios with 95% confidence intervals). As expected, treatment was shown to reduce the risk of DLBCL-specific death, with first-line therapy R-CHOP having the highest positive impact. Consistent with these findings, the factors with higher risk of DLBCL-specific death had lower median time to DLBCL-specific death and median overall survival duration and higher percentage of DLBCL-specific and all cause deaths within two years.Conclusions: Using a multi-state model, we identified increasing age, DLBCL stage and Charlson comorbidity index, being unmarried or male and low socioeconomic status as significant predictors for overall survival and DLBCL-specific mortality in the elderly population. As opposed to a standard survival model, the multi-state approach enables researchers to capture DLBCL-specific and other deaths separately within the same model and helps accurately examine the influence of factors on each transition. [Display omitted] DisclosuresFlowers:National Institutes Of Health: Research Funding; OptumRx: Consultancy; Onyx: Research Funding; Infinity: Research Funding; Abbvie: Consultancy, Research Funding; Eastern Cooperative Oncology Group: Research Funding; Millennium/Takeda: Research Funding; Bayer: Consultancy; Gilead: Consultancy; Janssen Pharmaceutical: Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; Genentech/Roche: Consultancy, Research Funding; Clinical Care Options: Research Funding; Educational Concepts: Research Funding; Prime Oncology: Research Funding; TG Therapeutics: Research Funding; Acerta: Research Funding; Research to Practice: Research Funding; V Foundation: Research Funding; Burroughs Welcome Fund: Research Funding; Celgene: Consultancy, Research Funding; Seattle Genetics: Consultancy; National Cancer Institute: Research Funding; Spectrum: Consultancy.

Air pollution and breast cancer risk in the Black Women's Health Study

BackgroundAir pollution contains numerous carcinogens and endocrine disruptors which may be relevant for breast cancer. Previous research has predominantly been conducted in White women; however, Black women may have higher air pollution exposure due to geographic and residential factors. ObjectiveWe evaluated the association between air pollution and breast cancer risk in a large prospective population of Black women. MethodsWe estimated annual average ambient levels of particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2) and ozone (O3) at the 1995 residence of 41,317 participants in the Black Women's Health Study who resided in 56 metropolitan areas across the United States. Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for an interquartile range (IQR) increase in each pollutant. We evaluated whether the association varied by menopausal status, estrogen receptor (ER) status of the tumor and geographic region of residence. ResultsWith follow-up through 2015 (mean = 18.3 years), 2146 incident cases of breast cancer were confirmed. Higher exposure to NO2 or O3 was not associated with a higher risk of breast cancer. For PM2.5, although we observed no association overall, there was evidence of modification by geographic region for both ER- (p for heterogeneity = 0.01) and premenopausal breast cancer (p for heterogeneity = 0.01). Among women living in the Midwest, an IQR increase in PM2.5 (2.87 μg/m3), was associated with a higher risk of ER- (HR = 1.53, 95% CI: 1.07–2.19) and premenopausal breast cancer (HR = 1.32, 95% CI: 1.03–1.71). In contrast, among women living in the South, PM2.5 was inversely associated with both ER- (HR = 0.74, 95% CI: 0.56–0.97) and premenopausal breast cancer risk (HR = 0.75, 95% CI: 0.62–0.91). DiscussionOverall, we observed no association between air pollution and increased breast cancer risk among Black women, except perhaps among women living in the Midwestern US.