Health Atlas Research Articles

Abstract 4123509: The Intersection of Race and Ethnicity, Social Determinants of Health, and Hypertension Prevalence: A Community-Level Analysis

Background: Despite being one of the most diverse cities in the United States, Chicago is also notably segregated. The distinct separation among its 77 communities provides an opportunity to examine racial and ethnic segregation and the impact of social determinants of health (SDOH) on health outcomes. Research Question: How do race/ethnicity and SDOH influence hypertension (HTN) prevalence? Aim: To examine the relationships between race/ethnicity, SDOH, and HTN prevalence at the community level. Methods: This cross-sectional study used data from the Chicago Health Atlas collected between 2021 and 2022. The sample included data from all 77 Chicago communities and 2,738,956 of its residents. Two-step latent profile analyses were performed to classify each of the community according to the predominant race/ethnicity of its residents (Asian, Black, Hispanic, or White) and SDOH level (low, moderate, high), which was defined as how favorable the physical and social conditions are within the community and determined using 14 indicators (Table 1). Kruskal-Wallis tests were used to compare the prevalence of HTN among the communities by predominant race/ethnicity and SDOH level. Results: Among the 77 communities, 28 were predominantly Black, 27 were predominantly White, 21 were predominantly Hispanic, and 1 was predominantly Asian. HTN prevalence was highest in predominantly Black communities (39.9%), then the Asian community (35.8%), Hispanic communities (28.8%), and White communities (25.2%), p <.001. Based on the 14 SDOH indicators, 26 of the communities were classified as low SDOH (unfavorable conditions), 25 as moderate SDOH (moderately favorable), and 26 as high SDOH (favorable). HTN prevalence was highest in low SDOH communities (36.3%), followed by moderate SDOH communities (31.4%), and lowest in high SDOH communities (27.2%), p =.003. Conclusions: The findings highlight significant disparities in HTN prevalence across Chicago's communities, with higher rates observed in predominantly Black and low SDOH areas. These results underscore the need for targeted public health interventions to address the intersection of racial/ethnic segregation and SDOH.

Using EEA environment and health data to communicate with the public: the European Environment and Health Atlas

Abstract The EEA European Environment and Health Atlas presents information on how pollution and other environmental risks affect the health and well-being of Europeans. It is almost exclusively built on the datasets that the EEA collects from its network, and it summarizes only environmental information of relevance to public health, as well as health impacts from key environmental risks like air pollution, noise and industrial emissions.

A global snapshot on health systems capacity for detection, monitoring, and management of acute kidney injury: A multinational study from the ISN-GKHA.

Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in low and lower-middle income countries. Data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) were used to evaluate the organization of structures and services for the provision of AKI care in world countries and ISN regions. An international survey of key stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated with the ISN was conducted from July to September 2022 to assess structures and services for AKI care across countries. Main findings of the study show that overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world's population. Only 4% of countries had an AKI detection program based on national policy or guideline, and 50% of these countries used a reactive approach for AKI identification (i.e., cases managed as identified through clinical practice). Only 19% of national governments recognized AKI as a healthcare priority. Almost all countries (98% of the countries surveyed) reported capacity to provide acute hemodialysis (HD) for AKI, but in 31% of countries, peritoneal dialysis (PD) was unavailable for AKI. About half of all countries (44% of countries surveyed) provided acute dialysis (HD or PD) via public funding, but funding availability varied across ISN regions, including less than a quarter of countries in Oceania and South East Asia (17%) and Africa (24%) and highest availability in Western Europe (91%). Availability increased with the increasing country income level. Initiatives have been developed to propose and promote optimal care for AKI (including the ISN 0-by-25 initiative), but capacity for optimal AKI care remains low, particularly in low- and lower-middle-income countries. Concerted efforts by the global community are required to close these gaps, to improve AKI outcomes across the world.

Progress of nations in the organisation of, and structures for, kidney care delivery between 2019 and 2023: cross sectional survey in 148 countries

ObjectiveTo assess changes in key measures of kidney care using data reported in 2019 and 2023.DesignCross sectional survey in 148 countries.SettingSurveys from International Society of Nephrology Global Kidney Health Atlas...

Structures for quality assurance and measurements for kidney replacement therapies: A multinational study from the ISN-GKHA.

Optimal care for patients with kidney failure reduces the risks of adverse health outcomes, including cardiovascular events and death. We evaluated data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to assess the capacity for quality service delivery for kidney failure care across countries and regions. We explored the quality of kidney failure care delivery and the monitoring of quality indicators from data provided by an international survey of stakeholders from countries affiliated with the ISN from July to September 2022. One hundred and sixty seven countries participated in the survey, representing about 97.4% of the world's population. In countries where haemodialysis (HD) was available, 81% (n = 134) provided standard HD sessions (three times weekly for 3-4 h per session) to patients. Among countries with peritoneal dialysis (PD) services, 61% (n = 101) were able to provide standard PD care (3-4 exchanges per day). In high-income countries, 98% (n = 62) reported that >75% of centers regularly monitored dialysis water quality for bacteria compared to 28% (n = 5) of low-income countries (LICs). Capacity to monitor the administration of immunosuppression drugs was generally available in 21% (n = 4) of LICs, compared to 90% (n = 57) of high-income countries. There was significant variability between and within regions and country income groups in reporting the quality of services utilized for kidney replacement therapies. Quality assurance standards on diagnostic and treatment tools were variable and particularly infrequent in LICs. Standardization of delivered care is essential for improving outcomes for people with kidney failure.

Abstract C009: An exploratory ecologic analysis of the association of neighborhood obesogenic factors with prostate cancer mortality in Chicago, Illinois: Challenges and opportunities

Abstract Introduction: Obesity has been associated with aggressive prostate cancer (PCa). Environments that promote obesity, known as obesogenic environments, may also contribute to PCa progression at the population level. However, studies exploring these factors are limited. The purpose of this study was to examine the association between neighborhood obesogenic factors with PCa mortality rates in Chicago. Methods: We used an ecological study design with Chicago Community Areas (n=77) serving as the geographical area unit of analysis. All community area-level data were obtained from the Chicago Health Atlas public data portal. For each area, two obesogenic factors were examined: food environment and park access. The number of healthy and unhealthy grocery stores was used to characterize the food environment. The retail food establishments data was retrieved for the year 2013. The stores were classified into chain grocery stores, non-chain grocery stores, liquor stores, and convenience stores which included dollar tsores, corner stores and gas stations. Chain and non-chain grocery stores were grouped as healthy food access, and other (convenience store, dollar store and liquor store) as unhealthy food access. The area of public parks per 100,000 community area population was used as a measure of park access. An exclusive park area for each community was calculated by intersecting the community area and park area shape files from the year 2016. The outcome variable was community area-level PCa mortality rate age-adjusted to the community area male population. To normalize the data, all included variables were standardized to zero mean and unit standard deviation. Linear regression models analyzed the association of the standardized measures of obesogenic environment (individually and simultaneously) with age-adjusted rates using the Statistical Analysis Software 9.4. Results: The mean number of healthy (0 - 11) and unhealthy (0 - 10) food stores in each community area were 3.1 and 2.6 respectively and mean park area (14.0 - 4096.5 acres) available in each community area was 453.5 acres per 100,000 population. The mean (0 – 29.6) PCa mortality was 9.8 per 100,000 population. Healthy food access was inversely associated with PCa mortality rates, where for every for one 1-standard deviation increase in healthy food access standard deviation, there is a 0.40 unit decrease in community area PCa mortality rate standard deviation (p=0.002) while accounting for the other obesogenic factors (unhealthy food access and park access). Conclusion: The findings of this study suggest that the neighborhood access to healthy food may be a determinant of neighborhood PCa mortality rates. Ecological studies are helpful to understand the impact at the geographical level. Methodological challenges and opportunity in ecological analyses, such as addressing bias and multivariable control of confounding, will be discussed. Citation Format: Ravneet Kaur, Jiehuan Sun, Nebiyou Y. Tilahun, Vincent L. Freeman. An exploratory ecologic analysis of the association of neighborhood obesogenic factors with prostate cancer mortality in Chicago, Illinois: Challenges and opportunities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C009.

Longitudinal Multi-omic Immune Profiling Reveals Age-Related Immune Cell Dynamics in Healthy Adults.

The generation and maintenance of protective immunity is a dynamic interplay between host and environment that is impacted by age. Understanding fundamental changes in the healthy immune system that occur over a lifespan is critical in developing interventions for age-related susceptibility to infections and diseases. Here, we use multi-omic profiling (scRNA-seq, proteomics, flow cytometry) to examined human peripheral immunity in over 300 healthy adults, with 96 young and older adults followed over two years with yearly vaccination. The resulting resource includes scRNA-seq datasets of >16 million PBMCs, interrogating 71 immune cell subsets from our new Immune Health Atlas. This study allows unique insights into the composition and transcriptional state of immune cells at homeostasis, with vaccine perturbation, and across age. We find that T cells specifically accumulate age-related transcriptional changes more than other immune cells, independent from inflammation and chronic perturbation. Moreover, impaired memory B cell responses to vaccination are linked to a Th2-like state shift in older adults' memory CD4 T cells, revealing possible mechanisms of immune dysregulation during healthy human aging. This extensive resource is provided with a suite of exploration tools at https://apps.allenimmunology.org/aifi/insights/dynamics-imm-health-age/ to enhance data accessibility and further the understanding of immune health across age.

The inverse associations of glycine and histidine in diet with hyperlipidemia and hypertension

BackgroundAmino acids are crucial for nutrition and metabolism, regulating metabolic pathways and activities vital to organismal health and stability. Glycine and histidine act as potent antioxidants and anti-inflammatory agents; however, limited knowledge exists regarding the associations between these amino acids and hyperlipidemia and hypertension. The purpose of this study is to investigate the relationship between dietary glycine and histidine, and hyperlipidemia and hypertension.MethodsThis population-based cross-sectional study evaluated the influence of dietary glycine and histidine, as well as their combined effect, on hyperlipidemia and hypertension in Chinese adults participating in the Nutrition Health Atlas Project (NHAP). General characteristics were acquired using a verified Internet-based Dietary Questionnaire for the Chinese. Binary logistic regression, along with gender, age groups, and median energy intake subgroup analyses, was employed to investigate the associations between dietary glycine and histidine and hyperlipidemia and hypertension. A sensitivity analysis was conducted to assess the impact of excluding individuals who smoke and consume alcohol on the results.ResultsBased on the study’s findings, 418 out of 1091 cases had hyperlipidemia, whereas 673 had hypertension. A significant inverse relationship was found between dietary glycine, histidine, and glycine + histidine and hyperlipidemia and hypertension. Compared with the 1st and 2nd tertiles, the multivariable-adjusted odd ratios (ORs) (95% confidence intervals) (CIs) of the 3rd tertile of dietary glycine for hyperlipidemia and hypertension were 0.64 (0.49–0.84) (p < 0.01) and 0.70 (0.56–0.88) (p < 0.001); histidine was 0.63 (0.49–0.82) (p < 0.01) and 0.80 (0.64–0.99) (p < 0.01); and glycine + histidine was 0.64 (0.49–0.83) (p < 0.01) and 0.74 (0.59–0.92) (p < 0.001), respectively. High glycine and high histidine (HGHH) intake were negatively associated with hyperlipidemia and hypertension OR (95% CIs) were: 0.71 (0.58–0.88) (p < 0.01) and 0.73 (0.61–0.87) (p < 0.01), respectively.ConclusionsDietary glycine and histidine, as well as their HGHH group, revealed an inverse relationship with hyperlipidemia and hypertension. Further investigations are needed to validate these findings.

The Swiss Claw Health Project - an interim assessment after 5 years

The Swiss Claw Health Project (SCHP) started on 1 January 2019 and will last a total of 8 years. The main goals of the SCHP are (a) digital recording of claw health data of cattle in Switzerland by 100 professional claw trimmers, (b) development of claw health programs, (c) improvement of cattle claw health in Switzerland, (d) development of breeding values for claw health and (e) reduction of antibiotic use to control claw health problems. Data was collected digitally by 45 hoof trimmers who had previously successfully completed the training program for diagnosis and digital documentation in accordance with the ICAR Claw Health Atlas. The national animal health database was further developed for data storage. Livestock farms with unfavorable claw health were offered an on farm analysis with subsequent annual support visits. A total of 1155 cattle owners joined the project by the end of the 5th project year. The claw health data of 149753 claw trimmings at cow-level was recorded, and 176 individual visits and analyses of farms with claw health issues were carried out. A health program for mechanical and metabolism-related claw disorders was developed and successfully established. Biosecurity measures during claw trimming were analyzed, and a brochure with recommendations for claw trimmers was developed. Risk factors for the occurrence of digital dermatitis in dairy herds were identified. The prevalence of alarm lesions (painful lesions) decreased significantly and continuously in the participating farms over the project years 2 to 4. The scientific project support proved to be extremely useful, as the progress of the project was continuously monitored, and new issues could be addressed promptly. Digitally recorded findings during herd hoof trimming are essential for monitoring and improving claw health. This description and critical assessment of the SKGP procedure can be used by other consortia planning a similar project.

Global kidney health priorities-perspectives from the ISN-GKHA.

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities.

The transition towards community-based mental health care in the European Union: Current realities and prospects

The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.

Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas

BackgroundThere is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions.MethodsSurvey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN.ResultsData on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters).ConclusionsHigh income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.

Dialysis Outcomes Across Countries and Regions: A Global Perspective From the International Society of Nephrology Global Kidney Health Atlas Study

Kidney failure treated with hemodialysis (HD), or peritoneal dialysis (PD) is a major global health problem that is associated with increased risks of death and hospitalization. This study aimed to compare the incidence and causes of death and hospitalization during the first year of HD or PD among countries. The third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) was conducted between June and September 2022. For this analysis, data were obtained from the cross-sectional survey of key stakeholders from ISN-affiliated countries. A total of 167 countries participated in the survey (response rate 87.4%). In 48% and 58% of countries, 1% to 10% of people treated with HD and PD died within the first year, respectively, withcardiovascular disease being the main cause. Access-related infections or treatment withdrawal owing to cost were important causes of death in low-income countries (LICs). In most countries,<30% and<20% of patients with HD and PD, respectively, required hospitalization during the first year. A greater proportion of patients with HD and PD in LICs were hospitalized in the first year than those in high-income countries (HICs). Access-related infection and cardiovascular disease were the commonest causes of hospitalization among patients with HD, whereas PD-related infection was the commonest cause in patients with PD. There is significant heterogeneity in the incidence and causes of death and hospitalization in patients with kidney failure treated with dialysis. These findings highlight opportunities to improve care, especially in LICs where infectious and social factors are strong contributors to adverse outcomes.

The Steps on the Path of Digital Transformation in Greek Public Healthcare: Challenges and Prospects

Globally, the tremendous growth of Information and Communication Technology (ICT) has led to a great expan- sion of the information produced, emerging new terms such as E-government (EG), Digital Governance (DG), and Digital Transformation (DT) that brought revolutionary changes in public administration and other sectors such as telecommunication, industry, and energy but not enough in public healthcare area. This study set out to explore the level of development of DT of Greek Public Healthcare (GPH) since 2000, focusing on the e-Health and Digital Health (DH) applications and services, and highlighting its accelerated development due to COVID-19 pandemic and its main problems in its application. A review of compara- tive studies published from 2000 to date was conducted. Search was demonstrated on Organisation for Economic Co-operation and Development (OECD), European Com- mission and Open Data Institute (ODI) databases, and Greek Legislation Framework. Keywords we used: «Digital Transformation», “Digital Governance”, “e-Health”, “Digi- tal Health”, “Electronic Health Record”, “e-prescription”, “Health Information Systems”, “Health Atlas”, “m- Health/Mobile Health”, “Telemedicine”, “Telehealth”, “ICT Action Plan”. During the first decade, there were many advances in DG and DT, like the Integrated Health Infor- mation Systems (IHIS), which in the majority of their implementation have not adequately fulfilled their role remaining as isolated HIS. The second decade, marked by the memorandum and the economic crisis, brought many significant changes in the context of the organization and rational administration of the GPH, especially in the field of DT, DG, and e-Health such as e-prescription, ESY.net, e-inventories, e-warehouses, e-invoicing of hospital charges, electronic Statements of Detailed Health Documents (eDAPY), the United4Health project, the National Telemedicine Network and the partially developed Individual Electronic Health Record (IEHR). Taken together, these results suggest that, Greece still lags in the field of e- Health and significant steps are needed to make GPH cost-effective, accessible, and inclusive, such as among others the integration of IEHR and the import of Laboratory Infor- mation System (LIS) and Picture Archiving and Communi- cation System (PACs) data into the IEHR.

Rethinking Schizophrenia: Beyond the Voices of Schizophrenia

Introduction Despite improvements and innovation in recent years, people living with schizophrenia face variations in access to optimal treatment and care. There is a lot about schizophrenia that is not fully understood, and the high-quality care and support needed by people living with this condition is often unavailable.Objectives Develop an evidence-based, compelling policy narrative on schizophrenia Engage a pan-European, multidisciplinary group of experts Offer concrete tools to patient and professional advocacy groups Disseminate findings Draw from our findings practical solutions on how to implement recommendationsMethods Based on carefully selected existing literature and available resources, literature review includes but is not limited to: Value of Treatment Recommendations, Global Burden of Disease Study, Comprehensive Mental Health Action Plan, Mental Health Atlas. The aim is to establish state of play, identify problems and solutions and take stock of current recommendations.We established a multi-disciplinary working group to lead the project, and ensured that representation on this group is cross-disciplinary and cross-sector. The expert group includes country-level patient advocates and clinical leads including key opinion leaders (KOLs) to keep the project focused on what is happening at a national level, and to help create ownership at the national level to take recommendations forward within each country.We conducted qualitative semi-structured interviews with people living with schizophrenia where they provided their insights into how to rethink the way we deal with schizophrenia.ResultsProvide clear, concrete and adaptable solutions Joint ownership by key stakeholder groups of a common policy narrative on schizophrenia Sustained policy engagement on schizophrenia at the EU and national levelConclusionsThere is a clear need to rethink the management of schizophrenia and redesign the care pathways to ensure optimal treatment and care for all people living with schizophrenia in Europe. Based around patient testimonies, the aim of the session is to highlight the need to optimise the way we manage schizophrenia by building a strong, coherent, evidence-based policy narrative which speaks to the current priorities in schizophrenia and draws from the current policy landscape in Europe.Experts involved in the Rethinking Schizophrenia project, coordinated by the European Brain Council, have explored the ways in which we can and need to change the way we deal with schizophrenia. The Rethinking Schizophrenia project falls under the Rethinking the management of brain disorders series, research-driven projects offering policy recommendations to make tangible changes with the aim to improve the lives of people living with brain disorders, neurological and mental alike, across Europe.Disclosure of InterestNone Declared

WCN24-304 Global variations in funding and use of hemodialysis accesses: Analysis of the third iteration of the Global Kidney Health Atlas data

WCN24-304 Global variations in funding and use of hemodialysis accesses: Analysis of the third iteration of the Global Kidney Health Atlas data

Abstract 2142: Spatial distribution of high-risk human papillomavirus (HR-HPV) across 23 Chicago community areas and correlates

Abstract Background: Despite availability of effective vaccines and screening, cervical cancer claimed 4,280 lives in 2022. We explored the spatial distribution of high-risk human papillomavirus (“HR-HPV”) infection across 23 Chicago Community Areas (CCAs) served by the University of Illinois Health Network (UI Health). Using a modified Warnecke et al Health Disparity Outcomes (HDO) model, we hypothesized that CCAs with higher rates of structural violence, the social, economic, and political systems exposing populations to risks and vulnerabilities, would correlate with increased HR-HPV. Methods: Electronic medical records of patients receiving routine cervical cancer screening between January 1, 2015 and December 31, 2019 were reviewed. As per the 2014 ACS guidelines. HR-HPV test results were captured as HR-HPV positive, HR-HPV-16, HR-HPV-18 and non-16/18 HR-HPV, the latter consisting of 12 HR-HPV subtypes. Structural violence variables were used from Chicago Health Atlas (2015-2019) with percent poverty, hardship index score, easy access to fruit and vegetables, routine checkup, homicide, and primary care provider across CCAS. Univariate Poisson regression was used to compare the associations between selected structural violence factors and HR-HPV prevalence. Univariate multinomial logistic regression evaluated associations between structural violence indicators and HR-HPV subtypes Global p-values were obtained using ANOVA at 0.05 significance. Results: 8,566 women met inclusion criteria out of 13,466 total women. 75% were Black or Hispanic. Overall prevalence of cervical HR-HPV infection was 20.3% (n=1,737), ranging from 8.7% to 27.2% across CCAs. Median age for women was 36. Percent with primary care provider was negatively associated with HPV infection (IRR = 0.99 with 95% CI (0.98, 1.00), adjusted p-value=0.023), indicating women living in CCAs with higher rates of primary care provider were less likely to have HR-HPV. Easy access to fruit and vegetables (adjusted p-value = 0.007) and percent with primary care provider (adjusted p-value = 0.009) were significantly associated with HR-HPV subtypes. Women living in CCAs with easy access to fruit and vegetables (OR = 0.99, with 95% CI (0.98,0.99)) as well as those with higher rates of primary care provider (OR = 0.98, with 95% CI (0.97,0.99)) were less likely to have non-16/18 HR-HPV. Conclusion: HR-HPV is the most common sexually transmitted infection, and most women clear the infection naturally. As the origin of 99% of cervical cancer, understanding the reasons HR-HPV persists and progresses to cancer among certain individuals and groups is critical. Novel interventions like increasing access to fruit and vegetables could compliment widely available and effective vaccines. Citation Format: Gelila Goba, Jiehuan Sun, Quetzal Class, Joel Schwartz, Sage Kim, Karriem Watson, Lisa Tussing-Hummphreys, Yamile Molina, Shannon MacLaughlan, Ziqiao Xu, Benjamin Aldred, Subhash Kumar Kolar Rajanna, Tamika Alexander, Anna-Barbara Moscicki. Spatial distribution of high-risk human papillomavirus (HR-HPV) across 23 Chicago community areas and correlates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2142.

An update on the global disparities in kidney disease burden and care across world countries and regions

Since 2015, the International Society of Nephrology (ISN) Global Kidney Health Atlas (ISN-GKHA) has spearheaded multinational efforts to understand the status and capacity of countries to provide optimal kidney care, particularly in low-resource settings. In this iteration of the ISN-GKHA, we sought to extend previous findings by assessing availability, accessibility, quality, and affordability of medicines, kidney replacement therapy (KRT), and conservative kidney management (CKM). A consistent approach was used to obtain country-level data on kidney care capacity during three phases of data collection in 2016, 2018, and 2022. The current report includes a detailed literature review of published reports, databases, and registries to obtain information on the burden of chronic kidney disease and estimate the incidence and prevalence of treated kidney failure. Findings were triangulated with data from a multinational survey of opinion leaders based on the WHO's building blocks for health systems (ie, health financing, service delivery, access to essential medicines and health technology, health information systems, workforce, and governance). Country-level data were stratified by the ISN geographical regions and World Bank income groups and reported as counts and percentages, with global, regional, and income level estimates presented as medians with interquartile ranges. The literature review used information on prevalence of chronic kidney disease from 161 countries. The global median prevalence of chronic kidney disease was 9·5% (IQR 5·9-11·7) with the highest prevalence in Eastern and Central Europe (12·8%, 11·9-14·1). For the survey analysis, responses received covered 167 (87%) of 191 countries, representing 97·4% (7·700 billion of 7·903 billion) of the world population. Chronic haemodialysis was available in 162 (98%) of 165 countries, chronic peritoneal dialysis in 130 (79%), and kidney transplantation in 116 (70%). However, 121 (74%) of 164 countries were able to provide KRT to more than 50% of people with kidney failure. Children did not have access to haemodialysis in 12 (19%) of 62 countries, peritoneal dialysis in three (6%) countries, or kidney transplantation in three (6%) countries. CKM (non-dialysis management of people with kidney failure chosen through shared decision making) was available in 87 (53%) of 165 countries. The annual median costs of KRT were: US$19 380 per person for haemodialysis, $18 959 for peritoneal dialysis, and $26 903 for the first year of kidney transplantation. Overall, 74 (45%) of 166 countries allocated public funding to provide free haemodialysis at the point of delivery; use of this funding scheme increased with country income level. The median global prevalence of nephrologists was 11·8 per million population (IQR 1·8-24·8) with an 80-fold difference between low-income and high-income countries. Differing degrees of health workforce shortages were reported across regions and country income levels. A quarter of countries had a national chronic kidney disease-specific strategy (41 [25%] of 162) and chronic kidney disease was recognised as a health priority in 78 (48%) of 162 countries. This study provides new information about the global burden of kidney disease and its treatment. Countries in low-resource settings have substantially diminished capacity for kidney care delivery. These findings have major policy implications for achieving equitable access to kidney care. International Society of Nephrology.

Behavioral/Mood Disorders and Opioid-Drug Use in Chicago Community Areas Associated with Oral Health and Oral Surgery Need

Introduction: We hypothesize gender, race in Chicago’s community areas (CAs) associated significantly with mood and depressive-behavior disorders, drug related hospitalizations (MDD/DRH) and oral health problems and need for oral surgery services. Methods: We reviewed 18,846 dental records (AxiUm) sorted by zip codes associated with CAs. “Med Alerts” and 185 (14 types) neurotropic medications identified MDD/DRH. Chicago’s Health Atlas 2.0, 77 CAs provided age-adjusted prevalence rates for 29 MDD/DRH related variables, with ORs at 95% confidence limit. Linear regression and relative risk (RR) predicted racial and gender associations for MDD/DRH and opioid prescriptions sites (DEA-2017+ARCOS database). We also tested significance at 95% CI for residents from 16 CAs for oral health association with high MDD/DRH probability by counting decay, missing, and filled teeth (DMFT), bleed on touch (BT), periodontal clinical attachment loss and use of oral surgery services. Results: CAs significantly associated to MDD/DRH variables. MDD/DRH and opioid use were also significantly associated to non-Hispanic Black (NHB) &gt; other persons. NHB from specific geographic CAs showed ANOVA’s significant probability with OR (at 95% CI) and RRs for behavioral disorder indicators. Significantly (p&lt;0.0001) oral health problems and need for oral surgery service consulting associated with medication users and MDD/DRH subjects identified by gender (F&gt;M) and race/ethnicity (NHB&gt;other). Conclusion: Limitations included self-reporting and reliance on dental college populations although we showed statistically significant odds ratios and relative risk for MDD/DRH related to race and gender’s oral health issues and oral surgery needs to suggest a broader role.

Evaluation of Claw Lesions in Beef Cattle Slaughtered in Northern Portugal: A Preliminary Study

Claw diseases have a profound impact on cattle welfare, affecting behaviors such as grazing, rumination, rest, decubitus, and water consumption. This study aimed to assess the prevalence of claw lesions and classify them according to the ICAR Claw Health Atlas (International Committee of Animal Recording) in two slaughterhouses. The influence of claw lesions on carcass weight, classification, and fat deposition was also examined. Involving 343 crossbreed cattle from 103 different extensive or semi-intensive farms, this study found an animal prevalence of claw disorders at 65.8%, with a higher incidence in females (n = 207, 60.35%) compared to males (n = 136, 39.65%). Despite the observed prevalence, claw lesions were not influenced by age or sex (p &gt; 0.05). The main claw lesions identified, including heel horn erosion, double sole, and asymmetric claw, were consistent with the cattle management practices in the study area. These cattle were raised in small, rustic premises with uneven floors, utilizing a mix of manure and plant material as bedding and lacking access to pasture. Also, no negative economic impact was detected concerning carcass weight, classification, or fat deposition. Consequently, it was concluded that the presence of claw lesions in beef cattle raised under the characteristic management of this geographical area does not adversely affect animal health or farm economics.