Healthcare Access Variables Research Articles

Infectious diseases transmitted by animals beyond symptoms, how socioeconomic and environmental conditions can influence them

Vector-borne diseases, such as dengue, chikungunya, zika, and leishmaniasis, represent a global public health challenge. This study aimed to understand the impact of socioeconomic, environmental, and healthcare access variables on the incidence of infectious diseases from 2012 to 2021, investigating patterns and correlations. Variables analyzed included the number of healthcare facilities, average income, population size, Gross Domestic Product (GDP), and accumulated deforestation. Multiple linear regression and correlations were used, with data from the Notifiable Diseases Information System (SINAN) and the National Institute for Space Research (INPE). Dengue showed a strong correlation with GDP, the number of healthcare facilities, and deforestation. Chikungunya was associated with population, GDP, and deforestation. Zika showed correlations with population growth and deforestation. Leptospirosis was negatively influenced by healthcare facilities and GDP, while hantavirus infection was inversely related to population growth and healthcare facilities. Leishmaniasis had positive correlations with GDP, healthcare facilities, and deforestation. This study reveals complex interactions between socioeconomic, environmental, and health variables in the incidence of infectious diseases. Understanding these patterns is crucial for formulating effective public policies, highlighting the need for integrated and holistic strategies in the control and prevention of these diseases.

Patient-Reported Outcomes Among Adults With Congenital Heart Disease in the Congenital Heart Initiative Registry

In the US, there are more than 1.5 million adults living with congenital heart disease (CHD). The Congenital Heart Initiative (CHI) is a digital, online, patient-empowered registry that was created to advance multicenter research and improve clinical care by gathering patient-reported outcomes (PROs) in adults with CHD. To report the initial findings of the PROs for adults with CHD from the first 3 years of the CHI. The CHI was launched nationally on December 7, 2020, as an observational cohort (survey) study. Data were collected virtually through December 31, 2023, and stored on Health Insurance Portability and Accountability Act-compliant cloud-based servers with restricted access. Adults with CHD were recruited through email, social media, general advertising through advocacy organizations, and targeted outreach (telephone and in-clinic recruitment) by clinical centers. Demographics and validated survey tools on quality of life, mental health, physical activity, and health care utilization were collected at baseline and every 4 months. Descriptive statistics were used to understand the associations between various factors, including the complexity of heart defects, physical activity levels, mental health comorbidities, and socioeconomic and health care access variables. All categorical variables were analyzed using χ2 or Fischer exact test as appropriate. By December 31, 2023, the CHI had enrolled 4558 participants (2530 female [56%]) with a mean (SD) age of 38.5 (13.9) years, representing all 50 states. Approximately 88% of participants (3998 participants) completed at least 1 electronic visit as of December 31, 2023. The most prevalent CHD anatomy included tetralogy of Fallot (883 participants [22%]), transposition of great arteries (452 participants [11%]), and coarctation of the aorta (429 participants [11%]). Approximately 88% of participants (3998 participants) reported at least 1 comorbidity, with arrhythmia (1300 participants [33%]) as the most common cardiac comorbidity and mood disorder (1326 participants [35%]) as the most common noncardiac comorbidity. Among female participants, 45% (1147 participants) reported having had a pregnancy, with 38% (967 participants) resulting in biological children. Participants with complex CHD were less likely than those with moderate CHD to meet recommended physical activity guidelines (χ22 = 15.9; n = 3320; P < .001), a factor that was more pronounced among female participants. Overall health-related quality of life was rated as good or better by 84% of participants who completed the quality of life PROs (2882 participants), with no difference by CHD complexity. In this cohort study of adults living with CHD, many patients reported mood disorders, but most reported good health-related quality of life. The CHI, the largest registry of adults with CHD, is poised to facilitate multicenter research with the goal of improving clinical outcomes for all adults with CHD.

A Retrospective Observational Study Examining Physical Activity Among Adults in the United States With Angina or Coronary Heart Disease.

Coronary heart disease (CHD) involves inadequate blood supply to the myocardium by the coronary arteries due to the formation of atherosclerotic plaque in the vessel lumen. It has a complex etiopathogenesis. Physical activity (PA) and exercise lead to vascular remodeling and improved endothelial function, which, in turn, improves the arterial blood supply to the myocardium. The study aims to determine the prevalence of self-reported PA among CHD patients in the United States based on demographic, socioeconomic, and healthcare access variables for the year 2021. The data for the study on CHD were extracted using the Behavioral Risk Factor Surveillance System (BRFSS) Web-Enabled Analysis Tool database of the U.S. The control variables used broadly include demographics, socioeconomic, and healthcare access. In 2021, 433,615 people in the USA participated in the BRFSS study. Among them, 22,819 self-identified as having angina or CHD. In the past month, 62.2% of participants with the disease were involved in PA, and 37.8% were not. Among participants without angina or CHD, 76.5% were involved, and 23.5% were not involved in PA in the past month. This study highlights the need for specific interventions to overcome obstacles preventing PA among CHD patients.

Examining Self-Reported Physical Activity Levels Among Kidney Disease Patients in the United States Using the Behavioral Risk Factor Surveillance System (BRFSS) Database: A Retrospective Study.

Kidney diseases have a gradual and subtle onset, which usually results in end-stage renal disease with patients requiring renal replacement therapy. Though pharmacotherapy plays a crucial role, integrating lifestyle modifications like increased physical exercise has been associated with significant improvement in health for kidney disease patients. This study aims to retrospectively analyze the prevalence of self-reported physical activity among patients of kidney disease in the United States, based on demographic, socioeconomic, and healthcare access variables for the year 2021. Data was extracted from the Behavioral Risk Factor Surveillance System Web Enabled Analysis Tool (BRFSS WEAT) for the year 2021. Descriptive data, including numbers and percentages, was generated for each variable using cross-tabulations in the BRFSS WEAT. The data was stored in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), and statistical analysis was conducted using R version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/). Statistical tests employed included the Chi-square test and Fisher's exact test to ensure robust and reliable results. A total of 436,057 people participated in the BRFSS study. Out of this, 17,054 (39%) self-identified to the question "ever told you had kidney disease." In the past month, 10,004 (58.7%) participants having kidney disease were involved in physical activity, whereas 7,050 (41.3%) were not. Also, the level of physical activity among kidney disease participants was highest in ages 18-25 (75.5%), male gender (63.6%), White non-Hispanic race (59.4%), patients having advanced education (64.2%), employed (72.6%), high income (82.1%), and having routine checkup within the past one year (8,957, 58.3%). Kidney disease patients in the United States who self-reported physical activity were found to have statistical significance between various demographic, socioeconomic, and last routine checkup variables. Prospectively, interventions must be designed to increase physical activity among kidney disease patients with a focus on high-risk demographic groups like older adults, people with lower socioeconomic status, and people who don't get regular checkups.

A Retrospective Study Examining Self-Reported Physical Activity Levels Among Asthma Patients Using the Behavioural Risk Factor Surveillance System (BRFSS) Database.

Regular physical activity benefits respiratory health by reducing the risk of developing asthma. This is achieved by reducing bronchial hyperresponsiveness and preventing lung function decline. The objective of the study is to assess the prevalence of self-reported physical activity among asthma patients in the United States in 2021, based on demographic, socioeconomic, and healthcare access variables. The original research study was conducted using the Behavioural Risk Factor Surveillance System (BRFSS) database for the year 2021. Data regarding asthma status, physical activity, age, gender, race, education level, income level, employment status, and time since the last routine check-up were collected. In the BRFSS study conducted in the USA in 2021, there were 43,6121 participants in total. Of these, 61,362 (14.07%) had asthma and 374,759 (85.93%) did not; 43,678 (71.2%) participants with asthma were engaging in physical activity while 17,684 (28.8%) were not. In the group of participants who did not have the disease, 285,932 (76.3%) were engaging in physical activity and 88,827 (23.7%) were not. Demographically, the highest physical activity among those with asthma was observed in the age group of 18 to 24 years (4,079, 83%), male participants (17,725, 76.4%), and white non-Hispanics (31,964, 72.5%). Higher physical activity levels among asthma patients were associated with advanced education 31,947 (76.5%), employment 23,233 (79.8%), and annual incomes exceeding $150,000, 4,091 (89.9%). Participants who self-reported not having asthma have a higher prevalence of physical activity in all categories studied. There is a significant association between physical activity and self-reported asthma, shaped by demographic and socioeconomic factors, as well as the frequency of routine medical check-ups.

Socioeconomic Disparities in Healthcare Access and Implications for All-Cause Mortality among US Adults: A 2000-2019 Record Linkage Study.

The United States (US) has witnessed a notable increase in socioeconomic disparities in all-cause mortality since 2000. While this period is marked by significant macroeconomic and health policy changes, the specific drivers of these mortality trends remain poorly understood. In this study, we assessed healthcare access variables and their association with socioeconomic status (SES)-related differences (exposure) in US all-cause mortality (outcome), since 2000. Our research drew upon cross-sectional data from the National Health Interview Survey (NHIS, 2000-2018), linked to death records from the National Death Index (NDI, 2000-2019) (n=486,257). The findings reveal that the odds of a lack of health insurance and unaffordability of needed medical care were over two-fold higher among individuals with lower education, compared to those with high education, following differential time trends. Moreover, elevated mortality risk was associated with lower education (up to 77%), uninsurance (17%), unaffordability (43%), and delayed care (12%). Uninsurance and unaffordability accounted for 4-6% of the disparities in time to mortality between low- and high-education groups. These findings were corroborated by income-based sensitivity analyses, emphasizing that inadequate healthcare access partially contributed to socioeconomic disparities in mortality. Effective policies promoting equitable healthcare access are imperative to mitigate socioeconomic disparities in mortality.

Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021.

We examined national estimates of breast, cervical, and colorectal cancer (CRC) screening test use and compared them with Healthy People 2030 national targets. Test use in 2021 was compared with prepandemic estimates. In 2022, we used 2021 National Health Interview Survey (NHIS) data to estimate proportions of adults up to date with US Preventive Services Task Force recommendations for breast (women aged 50-74 y), cervical (women aged 21-65 y), and CRC screening (adults aged 50-75 y) across sociodemographic and health care access variables. We compared age-standardized estimates from the 2021 and 2019 NHIS. Percentages of adults up to date in 2021 were 75.7% (95% CI, 74.4%-76.9%), 75.2% (95% CI, 73.9%-76.4%), and 72.2% (95% CI, 71.2%-73.2%) for breast, cervical, and CRC screening, respectively. Estimates were below 50% among those without a wellness check in 3 years (all screening types), among those without a usual source of care or insurance (aged <65 y) (breast and CRC screening), and among those residing in the US for less than 10 years (CRC screening). Percentages of adults who were up to date with breast and cervical cancer screening and colonoscopy were similar in 2019 and 2021. Fecal occult blood/fecal immunochemical test (FOBT/FIT) use was modestly higher in 2021 (P < .001). In 2021, approximately 1 in 4 adults of screening age were not up to date with breast, cervical, and CRC screening recommendations, and Healthy People 2030 national targets were not met. Disparities existed across several characteristics, particularly those related to health care access. Breast, cervical, and colonoscopy test use within recommended screening intervals approximated prepandemic levels. FOBT/FIT estimates were modestly higher in 2021.

Financial strain across 25 years and women’s bladder health: a life course perspective

A small number of cross-sectional studies have found that financial insecurity-a social determinant of health-is associated with lower urinary tract symptoms. This study aimed to examine (1) whether women in the Coronary Artery Risk Development in Young Adult Study with higher levels of financial strain, assessed at 7 time points across 25 years beginning in 1985-1986, were more likely to report lower urinary tract symptoms and impact after the 2010-2011 financial strain assessment and (2) whether healthcare access and comorbidities mediated potential associations. This prospective cohort study recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from the populations of 4 US cities. The analytical sample was composed of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other lower urinary tract symptoms severity, and their impact in 2012-2013, which yielded 4 lower urinary tract symptoms and impact cluster categories: women with no symptom or very mild symptoms and no impact vs women with mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it "very hard," "hard," or "somewhat hard" (vs "not very hard") to pay for the very basics, such as food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on the financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics, such as food and heating, and difficulty paying for medical care) were created by combining 1995-1996 and 2000-2001 values. Two healthcare access variables (difficulty receiving care and underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes mellitus, and depressive symptoms) were created by combining 2005-2006 and 2010-2011 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and lower urinary tract symptoms and impact cluster categories. In comparison to women who were consistently not financially strained, women who were consistently strained (odds ratio, 2.10; 95% confidence interval, 1.13-3.91), shifted into being strained (odds ratio, 2.00; 95% confidence interval, 1.29-3.10), or experienced >1 shift in strain (odds ratio, 1.99; 95% confidence interval, 1.46-2.71) had roughly twice the odds of reporting greater lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities mediated the association between difficulty paying for medical care and lower urinary tract symptoms and impact. In the structural equation model, difficulty paying for medical care and underutilization of care were associated (β=.31; P<.01), as was underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01). Moreover, difficulty paying for medical care and the comorbidity index were associated (β=.34; P<.01), as was the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). Collectively, these mediation pathways eliminated a direct association between difficulty paying for medical care and lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities explained an association between financial strain (difficulty paying for medical care) and lower urinary tract symptoms and impact. Research is needed to confirm the findings and examine other mechanisms that may further explain the association. Accumulated evidence may inform future policies and practices.

Geographical Variation in Social Determinants of Female Breast Cancer Mortality Across US Counties

Breast cancer mortality is complex and traditional approaches that seek to identify determinants of mortality assume that their effects on mortality are stationary across geographic space and scales. To identify geographic variation in the associations of population demographics, environmental, lifestyle, and health care access with breast cancer mortality at the US county-level. This geospatial cross-sectional study used data from the Surveillance, Epidemiology, and End Results (SEER) database on adult female patients with breast cancer. Statistical and spatial analysis was completed using adjusted mortality rates from 2015 to 2019 for 2176 counties in the US. Data were analyzed July 2022. County-level population demographics, environmental, lifestyle, and health care access variables were obtained from open data sources. Model coefficients describing the association between 18 variables and age-adjusted breast cancer mortality rate. Compared with a multivariable linear regression (OLS), multiscale geographically weighted regression (MGWR) relaxed the assumption of spatial stationarity and allowed for the magnitude, direction, and significance of coefficients to change across geographic space. Both OLS and MGWR models agreed that county-level age-adjusted breast cancer mortality rates were significantly positively associated with obesity (OLS: β, 1.21; 95% CI, 0.88 to 1.54; mean [SD] MGWR: β, 0.72 [0.02]) and negatively associated with proportion of adults screened via mammograms (OLS: β, -1.27; 95% CI, -1.70 to -0.84; mean [SD] MGWR: β, -1.07 [0.16]). Furthermore, the MGWR model revealed that these 2 determinants were associated with a stationary effect on mortality across the US. However, the MGWR model provided important insights on other county-level factors differentially associated with breast cancer mortality across the US. Both models agreed that smoking (OLS: β, -0.65; 95% CI, -0.98 to -0.32; mean [SD] MGWR: β, -0.75 [0.92]), food environment index (OLS: β, -1.35; 95% CI, -1.72 to -0.98; mean [SD] MGWR: β, -1.69 [0.70]), exercise opportunities (OLS: β, -0.56; 95% CI, -0.91 to -0.21; mean [SD] MGWR: β, -0.59 [0.81]), racial segregation (OLS: β, -0.60; 95% CI, -0.89 to -0.31; mean [SD] MGWR: β, -0.47 [0.41]), mental health care physician ratio (OLS: β, -0.93; 95% CI, -1.44 to -0.42; mean [SD] MGWR: β, -0.48 [0.92]), and primary care physician ratio (OLS: β, -1.46; 95% CI, -2.13 to -0.79; mean [SD] MGWR: β, -1.06 [0.57]) were negatively associated with breast cancer mortality, and that light pollution was positively associated (OLS: β, 0.48; 95% CI, 0.24 to 0.72; mean [SD] MGWR: β, 0.27 [0.04]). But in the MGWR model, the magnitude of effect sizes and significance varied across geographical regions. Inversely, the OLS model found that disability was not a significant variable for breast cancer mortality, yet the MGWR model found that it was significantly positively associated in some geographical locations. This cross-sectional study found that not all social determinants associated with breast cancer mortality are spatially stationary and provides spatially explicit insights for public health practitioners to guide geographically targeted interventions.

HIV testing and risk behaviors associated with depression in the United States

Given the high correlation between depression and HIV infection rates, our objective was to assess national rates for HIV testing and HIV risk behaviors among U.S. adults stratified by self-reports of depression. We conducted a cross-sectional study using data from the 2018–2020 Behavioral Risk Factor Surveillance System (BRFSS). We included respondents aged 18 years old and above with self-reported depression status (Sample size = 1,228,405). The primary outcomes included HIV testing and HIV-related risk behaviors. For respondents with prior HIV testing experience, we estimated the duration since the last HIV test. We applied a multivariable logistic regression model to analyze the correlation between depression and HIV testing or risk behaviors. The results showed people with depression had 51% higher odds of receiving HIV testing [adjusted odds ratio (AOR) = 1.51, 95% CI = 1.48, 1.55] and 51% higher odds of involvement in HIV risk behaviors [AOR = 1.51, 95% CI = 1.44, 1.58] after adjusting for covariates. Various socio-demographics and healthcare access variables were significantly associated with HIV testing and HIV risk behaviors. When comparing the average time from the last HIV test, people with depression had a shorter period compared to those without depression [Median time in months: 27.1 ± 0.45 vs. 29.3 ± 0.34]. Even though people with depression had higher rates of HIV testing, they still experienced long time periods (median = 2 + years) between HIV testing, which exceeded the recommended annual HIV testing for people at high risk from the Centers for Disease Control and Prevention.

Abstract MP14: Association Between Housing Insecurity With Reduced Access to Healthcare and Cardiovascular Disease Prevention: The Behavior Risk Factor Surveillance System (BRFSS) Study

Introduction: Risk factors including hypertension and hyperlipidemia increase the risk of cardiovascular disease (CVD). Yet, the significantly increased prevalence of CVD in housing insecure populations cannot be explained by the diagnosed prevalence of these risk factors alone. These populations may face unique barriers to care related to lack of access to screening, prevention, and treatment that complicate heart health. Hypothesis: Access to quality healthcare and CVD prevention is reduced for the housing insecure population, independent of income and sociodemographic factors, compared to housing secure populations. Methods: Using data from the 2017 Behavior Risk Factor Surveillance System (BRFSS), housing insecurity was self-reported as not being able to pay mortgage, rent, or utility bills over the past 12 months. Weighted multivariable logistic regressions were used to calculate adjusted odds ratios for the healthcare access variables. Results: In our study population, 8.79% (51.8% female, 71.7% white) experienced housing insecurity. Compared to housing secure individuals, housing insecure individuals were more likely to not have a primary care doctor (OR 1.25 [1.16-1.35]), be unable to afford doctor visits (3.89 [3.63-4.16]), report pending medical bills (2.62 [2.33-2.93]), have Medicare (1.26 [1.01-1.57]) or Medicaid (1.83 [1.46-2.28]), experience gaps in healthcare coverage (2.94 [2.45-3.53]), delayed medical care (2.38 [2.10-2.70]), and were 4 times more likely to not take medications as prescribed due to cost (4.39 [3.86-4.99]). Among those with known hypertension and hypercholesterolemia, respectively, people experiencing housing insecurity were more likely to not be taking antihypertensive (1.35 [1.20-1.51]) and cholesterol-lowering medications (1.33 [1.18-1.48]). Conclusion: Housing insecure populations experience significant healthcare access disparities, potentially exacerbating health outcomes through the underdiagnosis, prevention, and treatment of CVD.

Abstract P023: The impact of limited English proficiency and healthcare access on HPV vaccine uptake in the United States

Abstract Background: Limited English proficiency (LEP) impacts patient-provider communication and access to healthcare, both of which are also associated with human papillomavirus (HPV) vaccine uptake. We examined the association between LEP and HPV vaccine uptake among parents/guardians of adolescents and young adults eligible for the HPV vaccination in the United States. Methods: Using a cross-sectional study design, we analyzed nationally representative data from the National Health and Nutrition Examination Survey between 2017 and 2020 (n = 3,993). Outcome of interest was HPV vaccine uptake, defined as initiation (at least one dose), or completion (at least two or three doses). LEP was defined as completing the questionnaire in a language other than English and/or using an interpreter. Logistic regression models estimated odds of HPV vaccine uptake based on LEP, adjusting for covariates, including age, sex, healthcare access, income, race, and ethnicity. Analyses were stratified into groups aged 9-17 and 18-26 years. Results: LEP rate was 11.2% in the 9 to 17 age-group (n = 2,584), and 8.8% in the 18-26 age-group (n = 1,409). In the adjusted analyses, we found no association between LEP and HPV vaccination in either age groups (for 9-17 years: aORinitiation = 1.10; 95% CI 0.69, 1.77; aORcompletion = 1.04; 95% CI 0.60, 1.81; and for 18-26 years: aORinitiation = 0.70; 95% CI 0.40, 1.25; aORcompletion for 18-26 years = 1.23; 95% CI 0.56, 2.70). However, we found significant associations between HPV vaccine uptake and age, sex, race/ethnicity, and healthcare access variables in both age groups. Conclusions: While language proficiency status was not significantly associated with HPV vaccine uptake in our study, we found that age, sex, race/ethnicity, and access to care are associated with HPV vaccination. This indicates the need for continued interventions targeting factors to increase access to HPV vaccine. Citation Format: Marian F. Talip, Trinity Casimir, Jillian H. Hurst, Daniel J. Rocke, Tammara L. Watts, Trinitia Y. Cannon, Eric Adjei Boakye, Nosayaba Osazuwa-Peters. The impact of limited English proficiency and healthcare access on HPV vaccine uptake in the United States. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P023.

Allostatic load predicts racial disparities in intracerebral hemorrhage cognitive outcomes

A large portion of stroke disparities remains unexplained, even after adjusting for demographic, comorbidity, and health care access variables. There is a critical need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia Medical Center with ICH from 3/2009 to 5/2016. Data included demographics, stroke scores, labs, complications, neuroimaging, medical history, and discharge data. Five markers of AL (HbA1c, WBC, SBP, HR, ALB) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal ranges, with AL score ranging 0–5. A linear regression model, adjusted for stroke severity and ICH volumes, was used to evaluate the relationship between AL and Modified Telephone Interview for Cognitive Status (TICS-m) at discharge, stratified by race-ethnicity. Among 248 white, 195 black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p = 0.51, p = 0.79 respectively). In the overall cohort AL did not predict TICS at discharge (Beta -1.0, SE 1.1, p = 0.353). In Whites (beta 1.18, SE 2.5, p = 0.646) and Hispanics (beta -0.95, SE 1.6, p = 0.552) AL was not associated with TICS at discharge. In Black patients, higher AL was associated with a decrease in TICS at discharge (beta -3.2, SE 1.5, p = 0.049). AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.

Role of Socioeconomic Factors on Physical and Mental Distress Reported by Alabama Adults with COPD.

Educational attainment, income, and race play significant roles in managing and treating patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the impact of these socioeconomic factors and others on the physical and mental distress reported by patients with COPD living in Alabama. A cross-sectional analysis was completed of Alabama Behavioral Risk Factor Surveillance System 2015-2019 data collected from 4123 respondents who reported that a health professional told them they had COPD, chronic bronchitis, or emphysema. Univariate analyses examined descriptive differences in physical and mental distress among racial groups. Multivariable logistic regression models were used to assess physical and mental distress as a function of race and demographic variables (age, sex, employment status, household income, education level), controlling for dichotomous healthcare access variables (enrollment in a health insurance plan, having a usual source of care, routine check-up in the past 2 years). Most Alabama adults with COPD from 2015 to 2019 were female (64%) and older than 45 years (88%). Annual incomes were low, with >40% of respondents (43.84%) earning <$20,000/year; adults making between $35,000 and $49,999 were less likely (odds ratio 0.60, 95% confidence interval 0.38-0.96) to experience mental distress. Younger Alabama adults with COPD (25-64 years) were approximately two times more likely than respondents ages 65 and older to report mental distress. African Americans were less likely to report physical distress as compared with Whites (odds ratio 0.61, 95% confidence interval 0.44-0.83). Alabama adults who could not work were more likely than those with COPD who were employed/self-employed, out of work, retired, or identified as homemakers to report physical distress. Public health and healthcare practitioners across Alabama should use these analyses to direct more targeted, high-yield interventions that will address existing health disparities among state residents living with COPD.

Familiar Infections in Novel Anatomy: Patient Reports of Sexually Transmitted Infections After Gender-Affirming Penile Reconstruction.

Sexually transmitted infections (STIs) after penile reconstruction in transgender, nonbinary, and other gender expansive (T/GE) populations have not previously been described, despite known risk factors in the population. After T/GE penile reconstruction, care providers may underdiagnose STI without anatomically appropriate guidelines. A detailed anonymous online survey of experiences of T/GE penile reconstruction patients was constructed with community input. Respondents were recruited from online support groups. A total of 128 T/GE people with experience of penile reconstruction responded to an anonymous survey posted in online support groups from January to May 2020. Seven respondents (5.5%) self-reported 1 or more of the listed STIs at any point after penile reconstruction. All respondents with neourethras were diagnosed with localized STIs in nonurethral (extrapenile) locations only, and lack of vaginectomy was correlated with STI (P = 0.002). Sexually transmitted infections were correlated with reporting sex with cisgender men (P = 0.001), transgender men (P = 0.009), and transgender women (P = 0.012). Of health care access variables, only receiving health care at a community health center was correlated with STI history (P = 0.003). This exploratory survey indicates that STI occurs after penile reconstruction in T/GE patients. Clinical confirmation is needed to identify specific risk factors and relative susceptibility of postreconstruction anatomy to STIs. Given no previous surveillance recommendations for this population and the correlation of health care provider location with STI prevalence, underdiagnoses are likely. Based on the authors' clinical experience, we describe a urogenital screening algorithm after gender-affirming penile reconstruction.

157. A Multicenter, Mixed-Method Evaluation of Delayed Hospital Discharge in Patients with Invasive Candidiasis Receiving Echinocandins

BackgroundPatients with systemic candidiasis often receive prolonged echinocandin therapy in the inpatient or outpatient setting. Rezafungin is a novel echinocandin currently in clinical trials characterized by once-weekly dosing interval. In order to understand the potential benefit of rezafungin to facilitate earlier hospital discharge, the purpose of this project was to better understand barriers to discharge in patients with proven or suspected invasive candidiasis.MethodsElectronic health records from two large health systems (20+ hospitals) were reviewed to identify patients given an echinocandin. Patients given an echinocandin until hospital discharge were evaluated for outpatient use as well as barriers that prevented earlier discharge. Identified barriers were developed into a quantitative framework and a qualitative interview guide. Using a constant comparative method, the framework for hospital discharge barriers was constructed using a series of open-ended questions and axial coding to identify discharge barrier themes. Results were integrated to produce a mixed-method model.ResultsA total of 1,665 echinocandin courses were evaluated. Five hundred and thirty-four patients (32%) received echinocandin therapy until at least the day of hospital discharge of which 328 of 534 (61%) patients were either discharged to home or transferred to another facility. Significant predictors for outpatient echinocandin use were osteomyelitis (OR 4.07, 95% CI: 1.06-15.66; p=0.041) and other deep-seated infection (OR 4.44; 95% CI: 1.65-11.96; p=0.003). Stewardship analysis identified the majority of patients (54%) had the possibility for at least one day earlier discharge (potential earlier discharge:1.65±1.16 days). The quantitative model identified major barriers to be transition of care-, other medical care-, and infectious diseases-related. The qualitative model largely agreed with the quantitative model with additional psychosocial and health care access variables identified.ConclusionUsing a mixed method approach, barriers to hospital discharge and potential use of new antifungal therapies were identified. These data could be used to assist transitions of care in patients with invasive candidiasis.Disclosures Truc T. Tran, PharmD, Merck (Grant/Research Support) Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)

Nativity moderates the relationship between nationality and healthcare access for some Latinx women in the United States

ABSTRACT Objectives Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women’s access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). Design An outcome variable called ‘any barriers to care’ was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005–2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. Results 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. Conclusions Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy.

Abstract P876: Allostatic Load Predicts Racial Disparities in Intracerebral Hemorrhage Outcomes

Introduction: A large portion of stroke disparities remains unexplained, even after controlling for an array of demographic, comorbidity, and health care access variables. There is a need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. Methods: The Columbia University Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia University Medical Center with a diagnosis of ICH from March 2009 to May 2016. Data included demographics, stroke scores, labs, neurological deterioration, hospital complications, neuroimaging, medical history, and discharge data. Ten markers of AL (BMI, A1c, SBP, triglycerides, CRP, HDL, LDL, HGB, HR, albumin) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal clinical ranges, with an AL score range from 0-10. We used linear regression models to evaluate the relationship between AL and Telephone Interview for Cognitive Status (TICS) at discharge in the entire population, and then stratified by race-ethnicity. Results: Among 248 White, 195 Black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p=0.55, p=0.21 respectively). In the overall ICHOP cohort AL was associated with TICS at discharge (Beta -0.939, SE 0.46, p=0.043). In Whites and Hispanics AL was not associated with TICS at discharge (beta 0.267, SE 0.75, p=0.725, beta -0.71, SE 0.73, p=0.33 respectively). In Black patients, higher AL was associated with a decrease in TICS at discharge (beta -2.24, SE 0.90, p=0.016). Conclusion: AL was associated with cognitive scores at discharge for Black patients but not Hispanics or Whites, suggesting that AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.

Abstract PO-266: Factors affecting Appalachian Kentuckians' beliefs related to colorectal cancer and colorectal cancer screening

Abstract Background: Rural Appalachian Kentucky has much higher colorectal cancer (CRC) morbidity (50.6 per 100,00) and mortality (19.8 per 100,000) than the U.S. Appalachian Kentucky CRC screening rates are 36% compared with 27% statewide and 53% nationally. This study assessed factors affecting Appalachian Kentuckians’ beliefs related to CRC and CRC screening. Methods: Appalachian Kentuckians 50 years of age and older who were not up-to-date on CRC screening (N = 190) completed a survey including subscales measuring perceived CRC susceptibility and perceived benefits of CRC screening. Mann-Whitney U and Kruskal-Wallis tests compared differences in beliefs and Spearman’s Rho examined the correlation between variables. Results: Sixty-two percent were concerned about developing CRC, and 94.7% had completed CRC screening previously. Participants felt more susceptible to CRC if they had a family history of CRC (p &amp;lt; .01) and if their healthcare provider recommended CRC screening (13.03 versus 12.19, p &amp;lt; .01). Perceived benefits of CRC screening were not significantly associated with demographic or healthcare access variables. Conclusions: Although many participants were concerned about developing CRC, very few had completed CRC screening. These findings and those of previous research provide information to guide tailored interventions to promote CRC screening in Appalachian Kentuckians. Individuals with a family history of cancer may perceive a higher CRC susceptibility and be more likely to complete CRC screening. Healthcare providers’ recommendations for CRC screening can influence perceived CRC susceptibility and potentially influence completion of CRC screening in this population. Citation Format: Mollie E. Aleshire, Adebola Adegboyega, Shuying Sha, Jennifer Hatcher. Factors affecting Appalachian Kentuckians' beliefs related to colorectal cancer and colorectal cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-266.

Potential barriers to physician follow-up within 7 days of discharge from a chronic obstructive pulmonary disease hospital admission

RATIONALE: Given that physician follow-up after hospital may reduce readmissions for patients with chronic obstructive pulmonary disease (COPD), understanding factors associated with follow-up could help to improve discharge transitions. OBJECTIVES: To determine rate and factors associated with physician follow-up within 7 days of discharge from a COPD-related hospitalization. METHODS: Population-based retrospective cohort study of patients with COPD discharged from an Ontario hospital between April 1, 2010 and March 31, 2016 using health administrative data. All patients > =35 years old were included. The primary outcome was follow-up with family doctor, respirologist or internal medicine specialist within 7 days of discharge. Multivariable logistic regression analysis was used to determine demographic, socioeconomic, provider and health care access variables associated with follow-up. MEASUREMENTS AND MAIN RESULTS: Overall, 24,438 (29.8%) out of 81,960 patients had physician follow-up within 7 days of discharge. Women (OR 0.89, 95% CI 0.86-0.91), rural dwellers (OR 0.86, 95% CI 0.82-0.90), patients without a family doctor (OR 0.38, 95% CI 0.34-0.44) and those from low-income regions, or those who had hospital length-of-stay >7 days (OR 0.81, 95% CI 0.78-0.85) were less likely to receive follow-up within 7 days. Patients were more likely to receive follow-up if they required intensive care (OR 1.07, 95% CI 1.02-1.12) or had seen a physician frequently in the past. CONCLUSIONS: Fewer than 1 in 3 patients received early follow-up. Barriers to follow-up may exist for women, rural-dwellers, patients without a family doctor, those residing in low-income regions, or who experienced prolonged hospital stays.