Vulnerable Groups Research Articles

Uncovering antidepressant prescription patterns: a three-year analysis of outpatient trends

BackgroundAntidepressants (ADs) are prescribed for various conditions, including neurological and rheumatoid diseases. This study aims to analyze ADs prescribing trends in Iranian outpatients over three years, with a focus on age, sex, and ADs class.MethodsA retrospective cohort study was conducted using prescription data from the Iranian Health Insurance Organization (IHIO) between March 2021 and March 2024. The dataset included 8,924,431 prescriptions from 3,524,273 patients who received at least one ADs. ADs were classified into four groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical ADs. The data were processed via the cross-industry standard process for data mining and analyzed using a multivariate logistic regression model.ResultsSSRIs were the most commonly prescribed class, accounting for 63.71% of prescriptions, with sertraline being the most common drug (24.65%). Females accounted for 66.11% of the patient population. ADs prescriptions increased with age, and females were more likely to receive TCAs and SNRIs than males, who had higher rates of atypical ADs use.ConclusionsThis study revealed a notable increase in ADs prescriptions in Iran, particularly among women and older individuals. Continued monitoring of ADs prescription is crucial for optimizing outcomes, especially for vulnerable groups such as elderly individuals.

Seabird biomonitoring indicates similar plastic pollution throughout the Canary Current.

Marine plastic pollution is an emerging global threat for biodiversity. Plastic ingestion is one of the most typical and studied consequences with petrels being a particularly vulnerable group. We studied the plastic ingestion by Cory's shearwater (Calonectris borealis) fledglings in three islands of the Canarian Archipelago (Tenerife, Gran Canaria and Lanzarote). Breeders from different islands show substantial spatial segregation in their foraging areas across the Canary Current Large Marine Ecosystem (CCLME), a critical marine biodiversity hotspot and an important fishing ground in the North Atlantic Ocean. Here, we used a combination of plastic ingestion parameters (number, maximum length, type and colour of plastics) and stable isotopes (δ13C and δ15N) to study potential differences in plastic ingestion loads and trophic niche between three colonies. Our findings reveal a high incidence of plastic ingestion (>90%) among birds from the three islands. However, although adult birds show foraging and trophic niche segregation across the CCLME, no substantial differences were found in plastic ingestion. White and transparent threadlike fragments were predominantly ingested, likely originating from fishing activities in the CCLME. We provide a baseline for monitoring of plastic pollution in the CCLME and highlight Cory's shearwater as an effective bioindicator of pelagic ecosystems. Our findings emphasize the need for more standardized plastic monitoring programs covering other islands, and for management measures in the fishing activities conducted in the CCLME.

Experiences and Concerns of Pregnant Refugee Women from Nigeria Seeking for Asylum in Germany - A qualitative analysis

ProblemInsights into and data of the experiences of pregnant women seeking asylum in Germany are largely lacking. BackgroundDue to multiple stress factors, pregnant refugees are considered a vulnerable group. Gender-specific causes of flight, traumatic experiences during flight, and numerous stressors in the respective host country have a decisive impact on the health of women and affect pregnancy and childbirth. AimThis study aims to assess the perspectives and needs of pregnant refugee women from Nigeria, that are residing in an initial reception center in Germany. MethodsExperiences and concerns of N = 20 pregnant refugee women from Nigeria relating to pregnancy and impending childbirth were assessed in semi-structured interviews, conducted by three psychologists in English. FindingsFindings emphasize the need for continuous medical and psychotherapeutic care due to the multiple stressors and the partial lack of social support, especially for single women. The participants described their concerns particularly related to their personal and their family's health, as well as their impending birth, their optimistic attitude about the parenting experience, and confidence in medical care in Germany. Their wishes were predominantly related to items necessary for the care of their children, information about the pregnancy and birth process as well as for their integration. Utilization of resources and positive activities were indicative of adapting coping styles and resilience factors of pregnant refugee women. ConclusionThis study highlights the importance of the context-sensitive medical and psychotherapeutic care to adequately support the women during pregnancy and around childbirth. Furthermore, the study demonstrates the necessity of counteracting the negative effects of experiences on their health and that of their children.

A short screen for lifetime sexual victimization experiences: Expanding research on the Sexual Abuse History Questionnaire (SAHQ) across cultures, genders, and sexual identities.

The Sexual Abuse History Questionnaire (SAHQ), a widely used screening tool for childhood sexual abuse (CSA) and adolescent/adult sexual assault (AASA) experiences, has limited examination of its psychometric properties in diverse populations. Our study assessed the SAHQ's psychometric properties (i.e., structural validity and measurement invariance across demographic groups, know-group validity, and internal consistency) and estimated the frequencies of various types of sexual victimization across 42 countries and in diverse gender-, trans-status-, and sexual-identity-based groups that were previously missing from measurement-focused studies. We used a large, non-representative sample (N = 81,465; 57 % women, 3.4 % gender-diverse individuals, Mage =32.34 years, SD=12.48) from the International Sex Survey, a 42-country cross-sectional, multi-language, online survey. The SAHQ demonstrated excellent structural validity in all country-, gender-, sexual-identity-, and trans-status-based groups, as well as acceptable reliability and known-group validity. Occurrence estimates for six CSA and AASA types were reported across sociodemographic groups, corroborating previous evidence that women and gender- and sexual-minority individuals are at greater risk of CSA and AASA. Pansexual and queer individuals emerged as a particularly vulnerable group. Associations between different types of CSA and AASA revealed that participants who experienced any form of CSA were at least twice as likely to experience AASA. The findings have significant implications for policy and interventions, especially for marginalized groups.

On the Censorship of Conspiracy Theories

ABSTRACT Is it permissible for the state to censor or suppress conspiracy theories, even within liberal democracies? According to a number of political and legal theorists, it is. In this paper, I will argue that the state may sometimes censor conspiracy theories, but it should be permitted to do so only after very strict conditions have been met. I shall first offer some brief thoughts about the definition of ‘conspiracy theory’. I will then critique one existing attempt to address this issue – namely Cíbik and Hardoš’s public reason approach. Next, I shall outline my own proposal. I will argue that we should sometimes consider conspiracy theorising to be a form of discriminatory speech against vulnerable individuals and groups, and we can consider it to be a form of defamation in these cases. Consequently, the state may sometimes be permitted to enact civil laws to sanction such theorising. Finally, I will outline some of the conditions that should be met before state censorship can be considered.

The role and position of informal street vendors in the Onderberg district banana value chain

ABSTRACT The banana value chain is a key driver of socio-economic development in South Africa, supporting food security, job creation, income generation, and rural development. The Onderberg District, located in the Mpumalanga Province, is one of South Africa's six main banana production areas, contributing 35 per cent of the country's total banana cultivation. As such, street vendors play a crucial role in banana retailing, yet they are systematically excluded from the formal banana value chains. The purpose of this article is to map the informal economy banana value chains in the Onderberg District, emphasising the role of street vendors and documenting their value-adding activities. To achieve this, a combination of data collection tools within a cross-sectional time frame, including surveys and interviews, was employed. A total of 119 street vendors were surveyed, and 11 key informants participated in in-depth interviews. Banana value chains were mapped using functional analysis. The value chain analysis reveals the imbalances and challenges faced by street vendors within the banana market. There is a need to enhance the inclusivity of street vendors at every stage of the banana value chain. As members of vulnerable socio-economic groups, street vendors play a crucial role, particularly in informal markets. Analysing banana value chains in these settings can significantly improve economic livelihoods, especially for women, who are often not compensated for the work they do. This study addresses a critical knowledge gap by focusing on street vendors, offering valuable insights for future research, policy development, and practical interventions in similar contexts.

Predicting Delirium in Older Adults with Community-Acquired Pneumonia: A Retrospective Analysis of Stress Hyperglycemia Ratio and Its Interactions with Nutrition and Inflammation

BackgroundCommunity-acquired pneumonia (CAP) increases mortality risk in older patients, often complicated by delirium. Key risk factors include malnutrition and glucose metabolism disorders. This study examines the Stress Hyperglycemia Ratio (SHR) as a predictive marker for delirium in older CAP patients and its role in clinical risk management. MethodsIn this retrospective study, we analyzed patients aged 65 and older diagnosed with CAP at the Second People's Hospital of Lianyungang. Delirium was evaluated using the Confusion Assessment Method (CAM) based on DSM-5 criteria. We assessed clinical data, including nutritional status, SHR, and Interleukin-6 (IL-6) levels. Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Statistical analyses including logistic regression, Receiver Operating Characteristic (ROC) analysis, and mediation analyses were used to ascertain the predictive value of SHR and its interaction with other delirium risk factors. ResultsThe average age of the cohort was 84.20 ± 5.15 years, with a delirium incidence of 19.68% and a 28-day mortality rate of 11.16%. Both SHR and IL-6 were significant risk factors for delirium, while higher MNA-SF scores were protective. An SHR of 1.12 or greater indicated an elevated risk of delirium. Combined assessments of SHR, IL-6, and MNA-SF enhanced predictive accuracy, achieving an AUC of 0.723. SHR and IL-6 independently and synergistically influenced the relationship between nutritional status and delirium onset. ConclusionSHR is a crucial risk factor for delirium in older CAP patients, interacting with nutritional and inflammatory markers. Integrating SHR with nutritional and inflammatory assessments can enhance early risk identification and improve clinical outcomes for this vulnerable group.

Bisphenols in indoor dust: A comprehensive review of global distribution, exposure risks, transformation, and biomonitoring.

Bisphenols (BPs) are pervasive environmental contaminants extensively found in indoor environments worldwide. Despite their ubiquitous presence and potential health risks, there remains a notable gap in the comprehensive reviews focusing on BPs in indoor dust. Existing literature often addresses specific aspects such as exposure pathways, transformation products, or biomonitoring techniques, but lacks a consolidated, in-depth review encompassing all these facets. This review provides a comprehensive overview of the global distribution of BPs, emphasizing their prevalence in diverse indoor settings ranging from households and workplaces to public areas. Variations in BP concentrations across these environments are explored, influenced by factors such as industrial activities, consumer product usage patterns, and geographical location. Exposure assessments highlight ingestion, inhalation, and dermal contact as primary pathways for BP exposure, with ingestion being particularly significant for vulnerable groups such as infants and young children. Studies consistently reveal higher concentrations of BPs in urban indoor dust compared to rural settings, reflecting the impact of urbanization and intensive consumer practices. Moreover, BPs from mobile sources like vehicles contribute significantly to overall human exposure, further complicating exposure assessments. The review also delves into the transformation of BPs within indoor environments, emphasizing the diverse roles of physical, chemical, and biological processes in generating various transformation products (TPs). These TPs can exhibit heightened toxicity compared to their parent compounds, necessitating deeper investigations into their environmental fate and potential health implications. Critical examination of biomonitoring techniques for BPs and their metabolites underscores the importance of non-invasive sampling methods, offering ethical advantages and practicality in assessing human exposure levels. The emerging use of bioindicators, encompassing plants, animals, and innovative approaches like spider webs, presents promising avenues for effectively monitoring environmental contamination.

Survival disparities in small intestine carcinoid tumors: A SEER-based analysis.

653 Background: Small intestine carcinoid tumors (SI-carcinoids) are rare neuroendocrine neoplasms with variable survival outcomes. This study examines the impact of age, sex, race, income, and geographic location on overall survival (OS) in patients with SI-carcinoid tumors. Methods: A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) registry 22 to identify patients aged 20 and above with SI-carcinoid tumors from 2000 to 2021. Kaplan-Meier survival analysis and log-rank tests were used to assess differences in survival. Cox proportional hazards models estimated hazard ratios (HR) for Overall Survival (OS). Results: 20,777 patients were included, with 7,029 deaths recorded. Median OS varied significantly by age, sex, race, income, and tumor site. Patients aged 60-85 had a median OS of 10 months (95% CI: 9.75-10.42), while those over 85 had 2.92 months (95% CI: 2.67-3.33). Females had better OS (13.92 months; 95% CI: 13.42-14.42) than males (12.83 months; 95% CI: 12.42-13.25). Non-Hispanic Black patients had worse OS (12.33 months; 95% CI: 11.50-13.33) compared to Non-Hispanic Whites (13.25 months; 95% CI: 12.92-13.67). Patients earning less than $50,000 had worse OS (11.42 months; 95% CI: 10.67-12.42) than those earning $100,000–$120,000 (15.42 months; 95% CI: 14.25-17.83). Geographic disparities were noted, with nonmetropolitan areas showing worse OS (11.42 months; 95% CI: 10.83-12.92) compared to large metropolitan areas (14.00 months; 95% CI: 13.50-14.42). Cox models confirmed age (HR for 85+ years: 21.99; 95% CI: 17.40-27.81), male sex (HR: 1.12; 95% CI: 1.07-1.17), and Black race (HR: 1.29; 95% CI: 1.18-1.42) were linked to worse OS. Tumor site also affected OS, with ileal tumors showing better survival compared to duodenal tumors (HR: 0.89; 95% CI: 0.84-0.94). Conclusions: Age, sex, race, income, and geographic location significantly affect OS in patients with small intestine carcinoid tumors, highlighting the need for tailored interventions for vulnerable groups.

Emergency managers' challenges with wildfires and related cascading hazards in California.

This study investigates the complexities faced by emergency managers in wildfire-prone areas to uncover pressing issues and potential solutions. Four themes are discerned through three focus group discussions with emergency managers from nine counties across California. First, there is unequal access to resources for both risk assessment and response, with counties that have fewer resources facing significant challenges in effectively managing wildfire risks. Second, effective risk communication depends on the available resources and the unique characteristics of each community. Participants stress the need for improved communication tools to reach vulnerable groups (e.g., seniors, individuals with disabilities, non-English-speaking residents). Third, the complexity and confusion surrounding multi-level collaboration in wildfire management is a recurring theme. Participants note that unclear roles and responsibilities between state and federal agencies hinder response efforts, underscoring the need for better coordination and transparent communication at all levels. Fourth, innovative responses (e.g., creative evacuation strategies, collaborative efforts) are recognized as imperative for managing wildfires and their cascading impacts in resource-constrained areas. The findings highlight that achieving equitable and effective preparation, response, and resilience for vulnerable communities requires a comprehensive understanding of wildfire severity and community susceptibility, coupled with active collaboration among emergency managers, policymakers, and both governmental and non-governmental organizations.

A Narrative Persuasion Approach to Promoting COVID-19- Related Policy Support

Communication scholars warn against focusing on individual behaviors when discussing health issues, arguing that doing so can reduce affect and policy support. Although COVID-19 outcomes are linked to structural barriers to treatment, policy interventions appear to improve outcomes for vulnerable groups. Thus, strategic messages must promote public understanding of social determinants and policy support related to COVID-19. Using concepts from attribution theory and narrative persuasion, we employed an experiment (N = 435) testing the effects of personal responsibility (high, moderate, and low) on affective engagement and COVID-19 policy support. Namely, the manuscript examines (a) affective responses to characters displaying varying levels of personal responsibility for COVID-19 prevention, (b) the impact of these affective responses on policy support, and (c) the moderating role of audience political ideology on these effects. Analyses revealed that a highly responsible protagonist elicited empathy and perceived similarity, increasing policy support. While participants’ political ideology moderated protagonist responsibility on perceived similarity, a more responsible protagonist evoked empathy independently of political leaning. Theoretical and practical implications are offered.

The clinical frailty scale is associated with an increased risk of postoperative complications and the development of post-traumatic osteoarthritis in elderly patients with trimalleolar ankle fractures - a retrospective study

BackgroundThe Clinical Frailty Scale (CFS) is a tool to assess the overall health of older adults. There are few reports of CFS and prognosis of ankle fracture. The objective of this study was to determine the predictive power of the CFS for adverse clinical and radiographic outcomes after surgery in elderly patients with trimalleolar fractures.MethodAll patients aged 65 and older underwent open reduction and internal fixation for trimalleolar fractures between January 2015 to January 2023 were selected. Follow-up time was at least 1 year. Patients with post-traumatic osteoarthritis, bone tumors, bone infection, and other diseases before surgery were excluded. According to the CFS score, the patients were divided into three groups: not frail, vulnerable, and frail. Multivariate logistic regression analysis was used to evaluate the effect of the clinical frailty scale on postoperative complications.ResultExcluding 3 cases of death during the follow-up process, and 4 cases lost to follow-up, the study included a total of 146 patients, who were grouped based on their degree of frailty: the Healthy Group (CFS = 1–3, n = 69), the Vulnerable Group (CFS = 4, n = 50), and the Frail Group (CFS = 5–9, n = 47). In comparison with the not frail group, frail (CFS 5–9) emerged as an independent predictor of any complications (OR = 6.90, CI: 1.43–11.56, P = 0.009), adverse discharge destination (OR = 7.53, CI: 2.06–77.50, P = 0.006), and post-traumatic osteoarthritis (OR = 8.90, CI: 1.94–24.66, P = 0.003).ConclusionsThe frailty assessed by the CFS is associated with adverse discharge destination, any complications, and post-traumatic osteoarthritis in elderly patients undergoing open reduction and internal fixation for trimalleolar fractures.

Antisemitism: Social work’s silence is deafening

ABSTRACT Social workers challenge social injustice. Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers’ social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. These activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision-making for all people (National Association of Social Workers, 2021).

Hospital in-reach family-centred social prescribing pilot for children with neurodisability: mixed methods evaluation with social return on investment analysis

BackgroundSocial prescribing link workers support individuals to engage with community resources, co-creating achievable goals. Most schemes are community-based, targetting adults. Vulnerable populations including hospitalized children with neurodisability and their families, could also benefit from social prescribing.AimsTo pilot a hospital-initiated social prescribing service for children with neurodisability and their families; to explore its feasibility, acceptability and undertake social return on investment (SROI) analysis.MethodsMixed-methods cohort study with SROI analysis. We recruited children aged < 16y with neurodisability, identified during inpatient stays, their parents/carers and siblings. Participants received link worker support for 6 months, extending beyond hospital discharge. Pre- and post-intervention pilot data covered profile of needs (Support Star), quality of life (EQ5D/CHU-9D), wellbeing (WEMWBS/CORS) and financial strain. We undertook 22 qualitative observations of family/link worker interactions and 39 in-depth interviews with families, link workers and healthcare professionals. Together these data were analysed within a SROI to establish the costs and social value generated.ResultsOf 48 families supported by the service, 25 were recruited to the evaluation (26 children, aged 10 m-15y; 4 siblings; 36 parents). Baseline quality of life and wellbeing indices averaged below population norms. Link workers were highly effective at supporting families (only 6/151 goals unmet). Unmet need decreased by 6 months (Support Star, p < 0.001).Families reported having felt overwhelmed when trying to adjust to new ways of life post diagnosis/discharge before link worker intervention, with little support to navigate non-medical needs. Parents, link workers and health care professionals found link worker support invaluable for making community services accessible. Families then felt more connected to their communities, and less isolated, with increased belief in their self-efficacy. Families and healthcare professionals felt that the duration of support, and eligibility criteria, should be extended. Inputs to deliver the service for 1 year (49 families) were estimated at £74,736: outcomes for the 18 families studied were estimated at a value of £205,861.ConclusionHospital in-reach social prescribing is feasible, acceptable, and addresses a range of otherwise unmet needs of children with neurodisability and their families, showing a positive SROI. Other vulnerable patient groups could also benefit from this approach.Trial registrationISRCTN23306751 (2.8.22).

Policy advocacy for inclusive healthcare access from a social work perspective

Access to healthcare is a basic human right, yet systemic barriers like poverty, discrimination, and policy shortcomings continue to create disparities. This paper examines the essential role of social workers in championing healthcare policies that are inclusive and responsive to the needs of vulnerable groups such as low-income families, ethnic minorities, and individuals with disabilities. It explores the limitations of current healthcare frameworks, highlights the methods social workers use to promote equity, and offers evidence-based strategies for reform.

Identification of risk factors for suboptimal adherence in people living with HIV through measurement of medication possession ratio: a cross-sectional study

ABSTRACT The most significant progress in addressing the HIV/AIDS epidemic has been the development of antiretroviral therapy (ART). However, ensuring a high degree of treatment adherence is necessary to prevent resistance and disease progression. We conducted a cross-sectional study to evaluate adherence to ART through the calculation of the medication possession ratio (MPR) and to identify risk factors for suboptimal adherence in a cohort of HIV-positive patients receiving care at a Colombian healthcare institution across 16 cities. Records of 12,145 users were analyzed, and a multivariate logistic regression model was performed, considering optimal adherence (MPR > = 95%) versus suboptimal adherence (MPR < 95%) as the reference. Suboptimal adherence to ART was identified in 29% of users. Residence region, presence of HIV-defining illnesses, chronic kidney disease (CKD), co-infections such as hepatitis C, tuberculosis, and sexually transmitted infections, treatment duration of more than 5 years, and non-suppressed viral load were identified as risk factors for non-adherence. This underscores the need to identify interventions for those vulnerable groups to minimize the likelihood of non-adherence and to intervene in care models focused on the medical needs of these patients.

P-391. Infections in Gender-Affirming Surgery: A Single-center Experience with Gender-affirming Vaginoplasty

Abstract Background There are an estimated 1.3 million transgender adults in the US and about 25% undergo some form of gender-affirming surgery (GAS). Data on infectious complications following GAS is limited. We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty (GAV). We also describe HIV screening and pre-exposure prophylaxis (PrEP) use in this population as transwomen are disproportionately affected by HIV and have the highest prevalence compared to any other group of US adults. Methods In this single-center retrospective cohort study, we identified 398 patients aged ≥18 years who underwent GAV at Oregon Health &amp; Science University from 2016 to 2023. We reviewed medical records up to 6 months from the initial surgery and used standardized criteria to diagnose surgical site infections (SSI), urinary tract infections (UTI), and sexually transmitted infections (STI). Data around HIV screening and PrEP use was also obtained. Results 381 patients underwent primary vaginoplasty and 17 underwent revision of the primary surgery. 332 had standard penile inversion, 64 had robotic vaginoplasty, and 2 patients had intestinal vaginoplasty. UTI was the most common postoperative complication (incidence 13.8 per 100 individuals; n=55), followed by SSI (incidence 5.5 per 100 individuals; n=22). We identified 4 episodes of bacteremia related to surgery- all due to E coli- and one case of pelvic abscess. Only 2 STIs were identified and neither involved the neogenitalia- 1 was primary syphilis and the other was gonococcal urethritis. 16 patients had positive HIV serostatus. All 16 were prescribed ART and 11/16 had an undetectable viral load at the time of surgery. Only 22.5% of HIV seronegative patients had screening within a year before surgery and only 6% were on PrEP at the time of surgery. Conclusion In our study, UTIs and SSIs were the most common infections post-GAV. Serious infections were rare. We also identified a significant gap in HIV screening and PrEP uptake in this especially vulnerable group. Transgender surgery programs should incorporate HIV screening and counseling around PrEP. Disclosures Monica K. Sikka, MD, F2G: Grant/Research Support Christopher Evans, MD, ViiV: Grant/Research Support

The association between secondhand smoke exposure and risk of developing active tuberculosis in individuals with latent tuberculosis infection: a systematic literature review.

Tuberculosis is one of the leading causes of death from infectious diseases in the world, with approximately 25% of the global population having latent tuberculosis infection. Secondhand smoke exposure has been recognised as a significant risk factor in the development of active Tuberculosis in individuals with latent tuberculosis infection. This study used the Systematic Literature Review method based on PRISMA guidelines. Relevant articles published between 2014-2024 were identified through PubMed, ProQuest, and Scopus databases using related keywords. A total of 13 articles met the inclusion criteria for analysis. Secondhand smoke exposure significantly increases the risk of latent tuberculosis infection conversion to active Tuberculosis, with a stronger effect in vulnerable groups such as children and individuals who are in close contact with active Tuberculosis patient and live in the same household with heavy smokers. This risk of exposure to secondhand smoke follows a dose-response pattern, where longer duration and higher intensity of exposure directly increase the likelihood of Tuberculosis activation in individuals with latent tuberculosis infection. The biological mechanisms involve immune suppression and lung damage caused by toxic particles in the tobacco smoke, which weaken the body's defenses against Mycobacterium tuberculosis and facilitate the progression of latent tuberculosis infection to active Tuberculosis. Therefore, reducing exposure to secondhand smoke is important to mitigate its impact on active Tuberculosis progression. Secondhand smoke exposure has been consistently shown to increase the risk of developing active Tuberculosis in individuals with latent tuberculosis infection. To support the global Tuberculosis elimination programme, concerted efforts are needed to reduce exposure to secondhand smoke, especially in individuals with latent tuberculosis infection.

P-418. A Need for Infection Prevention among Patients with ESKD on Maintenance Dialysis: a First Step in Understanding how SARS-CoV-2 Impacts this Population

Abstract Background Although infections are a main cause of hospitalizations and deaths among patients with end-stage kidney disease (ESKD), contemporary post-pandemic data on the pathogen burden and outcomes among these patients are not well characterized. Identifying patients with ESKD and confirmed maintenance dialysis (MD) from electronic medical records (EMR) is challenging due to fragmented care since the majority ( &amp;gt;85%) receive MD at large dialysis organizations. In this study, patients with ESKD identified from the EMR will be linked to claims to characterize real-world outcomes among patients with confirmed MD by select pathogens to identify novel opportunities for prevention.Table.Clinical Characteristics and Infections Among Patients with ESKD between 2020-2023 Methods As a first step, the infection burden among adolescent and adult patients with a diagnosis of ESKD requiring MD (ICD-10-CM codes N18.6, Z99.2) identified between January 2020-March 2023 within the Loopback Analytics US EMR database was described. Patients were followed for 6 months unless they died or were lost to follow-up. Select infections within 6 months after the ESKD diagnosis date were defined using diagnosis codes or positive laboratory test. Comorbidities, types of vascular access, common pathogens, and proportion of patients with pneumonia were reported. References Results Overall, 65,515 patients with ESKD were identified between 2020-2023 and presented with high comorbidity burden (Table). 29.2% of patients with ESKD had documented central vein catheter, 6.9% had fistulas, 12.6% had hemodialysis without documentation of access type, and 2% had peritoneal dialysis. Follow-up of patients showed S. aureus (4.1%), E. coli (2.0%), C. difficile (2.0%), and K. pneumoniae (1.5%) as common bacterial infections. SARS-CoV-2 was the most common viral infection (6.9%). Moreover, 11.6% were diagnosed with pneumonia within 6 months. Conclusion The infection burden among patients with ESKD suggests a need for additional preventative strategies in this vulnerable group. EMR data linked to claims is needed to identify patients with ESKD and confirmed MD, and quantify healthcare costs. Evaluation of outcomes such as hospitalization rates, cardiovascular events, and survival among patients with ESKD and confirmed MD by infection type, such as SARS-CoV-2, is ongoing. Disclosures Emily A Hu, PhD, MS, Graticule, Inc.: Employee|Graticule, Inc.: Stocks/Bonds (Private Company) Jennifer R Dusendang, MPH, Graticule, Inc.: Employee|Graticule, Inc.: Stocks/Bonds (Private Company) Cátia Ferreira, PhD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Lisa Glasser, MD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Sudhir Venkatesan, MPH, PhD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Carla Talarico, PhD, MPH, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options Della Varghese, PhD, MS, PharmD, AstraZeneca: Employee of AstraZeneca and may hold stock and/or stock options

Temporal trends and future projections of incidence rate and mortality for asthma in China: an analysis of the Global Burden of Disease Study 2021

BackgroundAsthma poses a significant public health burden in China, affecting millions with substantial incidence and mortality. Understanding the trends and future projections of asthma incidence and mortality is crucial for healthcare planning.MethodsWe analyzed asthma incidence and mortality data sourced from the Global Burden of Disease (GBD) 2021 study from 1990 to 2021, calculated the age-standardized incidence and mortality rates (ASIR and ASMR) and the estimated annual percentage change (EAPC), meanwhile, employed Joinpoint regression model to assess the trends. The age-period-cohort model was applied to estimate the effects of the age, period, and cohort on the incidence and mortality. Finally, future asthma trends for the next 25 years were predicted utilizing the Bayesian age-period-cohort (BAPC) model.ResultsOver the past three decades, the incidence rate declined in waves while the mortality declined steadily. The ASIR of asthma decreased from 524.81 to 364.17 and the ASMR declined from 5.82 to 1.47. ASIR and ASMR are consistently higher in males than females during this period. The effect attributable to age on incidence was higher for the younger age group while the mortality was higher for older. The period ratio rate of incidence and mortality declined with the calendar year, and the corrections between birth cohort and the risk of incidence and mortality were negative. Our projections indicate that the ASIR and ASMR will continue to decrease by 2046, with expected rates of 330 and 0.69, respectively. Instead, the absolute number of asthma incidence cases and deaths may increase to approximately 4.5 million and 80,000, respectively.ConclusionAlthough asthma incidence rates and mortality have generally declined in China, the burden remains significant, especially among vulnerable groups, with higher rates in males. Continuous monitoring and age-targeted interventions are essential. Future healthcare strategies must address the aging population to manage the projected increase in asthma cases and deaths.