Health Follow-up Study Research Articles

Internal migration and depressive symptoms: Exploring selection and outcomes in a South African cohort

IntroductionInvestigations of migration effects on mental health conditions, including depression are sparse in low- and middle-income countries (LMIC), yet mental health may play a role in a decision to migrate, and migration in turn can impact on mental health outcomes. MethodsThis paper uses two waves of data from the Migrant Health Follow-Up Study, a young adult cohort of 2967 internal migrants and residents of the Agincourt study site in rural northeast South Africa to explore the relationship between internal migration and depressive symptoms, as measured on the Center for Epidemiological Studies Depression (CES-D) scale. We employ logistic regression analysis to investigate selectivity of migrants in relation to depressive symptoms, and we fit generalized linear models to analyse depressive symptoms (CES-D scores) as a function of migration status and sociodemographic and health characteristics, accounting for temporal sequence. ResultsAlthough we observe systematically low reporting of depressive symptoms, average CES-D scores are lower among migrants (comprising approximately 53% of the cohort) compared to Agincourt residents at both survey timepoints. We do not find evidence of a selection effect in relation to mental health among those newly migrating between Wave 2 and 3 (n = 1393). In analyses of the CES-D score outcome, the significant influence of migration status on depressive symptoms is reduced with the inclusion of controls in the models. Consistent employment and higher levels of education are associated with lower CES-D scores, while diagnosis of a chronic condition is associated with higher scores. ConclusionThe relationship between migration and depressive symptoms is influenced by factors preceding a migration and destination-place characteristics and experiences. Further examination of the role of migration at different stages of the process, along with continuing attention to psychosocial measurement considerations for LMIC subpopulations, can improve our understanding of these complex interrelationships and contribute to evidence.

Cohort Profile: Migrant Health Follow-Up Study (MHFUS) of internal migration in South Africa.

Cohort Profile: Migrant Health Follow-Up Study (MHFUS) of internal migration in South Africa.

Neighborhood Archetypes and Cardiovascular Health in Black Breast Cancer Survivors

BackgroundMaintaining cardiovascular health (CVH) is critical for breast cancer (BC) survivors, particularly given the potential cardiotoxic effects of cancer treatments. Poor CVH among Black BC survivors may be influenced by various area-level social determinants of health, yet the impact of neighborhood archetypes in CVH among this population remains understudied. ObjectivesThis study aimed to characterize the neighborhood archetypes where Black BC survivors resided at diagnosis and evaluate their associations with CVH. MethodsWe assessed CVH 24 months post-diagnosis in 713 participants diagnosed between 2012 and 2017 in the Women’s Circle of Health Follow-Up Study, a population-based study of Black BC survivors in New Jersey. Neighborhood archetypes, identified via latent class analysis based on 16 social and built environment features, were categorized into tertiles. Associations between neighborhood archetypes and CVH scores were estimated using polytomous logistic regression. ResultsCVH scores were assessed categorically (low, moderate, and optimal) and as continuous variables. On average, Black BC survivors achieved only half of the recommended score for optimal CVH. Among the 4 identified archetypes, women in the Mostly Culturally Black and Hispanic/Mixed Land Use archetype showed the lowest CVH scores. Compared to this archetype, Black BC survivors in the Culturally Diverse/Mixed Land Use archetype were nearly 3 times as likely to have optimal CVH (relative risk ratio: 2.92; 95% CI: 1.58-5.40), with a stronger association observed in younger or premenopausal women. No significant CVH differences were noted for the other 2 archetypes with fewer built environment features. ConclusionsNeighborhood archetypes, integrating social and built environment factors, may represent crucial targets for promoting CVH among BC survivors.

CD163+ macrophages in the triple-negative breast tumor microenvironment are associated with improved survival in the Women’s Circle of Health Study and the Women’s Circle of Health Follow-Up Study

BackgroundTumor-associated macrophages (TAMs) are a prominent immune subpopulation in the tumor microenvironment that could potentially serve as therapeutic targets for breast cancer. Thus, it is important to characterize this cell population across different tumor subtypes including patterns of association with demographic and prognostic factors, and breast cancer outcomes.MethodsWe investigated CD163+ macrophages in relation to clinicopathologic variables and breast cancer outcomes in the Women’s Circle of Health Study and Women’s Circle of Health Follow-up Study populations of predominantly Black women with breast cancer. We evaluated 611 invasive breast tumor samples (507 from Black women, 104 from White women) with immunohistochemical staining of tissue microarray slides followed by digital image analysis. Multivariable Cox proportional hazards models were used to estimate hazard ratios for overall survival (OS) and breast cancer-specific survival (BCSS) for 546 cases with available survival data (median follow-up time 9.68 years (IQR: 7.43–12.33).ResultsWomen with triple-negative breast cancer showed significantly improved OS in relation to increased levels of tumor-infiltrating CD163+ macrophages in age-adjusted (Q3 vs. Q1: HR = 0.36; 95% CI 0.16–0.83) and fully adjusted models (Q3 vs. Q1: HR = 0.30; 95% CI 0.12–0.73). A similar, but non-statistically significant, association was observed for BCSS. Macrophage infiltration in luminal and HER2+ tumors was not associated with OS or BCSS. In a multivariate regression model that adjusted for age, subtype, grade, and tumor size, there was no significant difference in CD163+ macrophage density between Black and White women (RR = 0.88; 95% CI 0.71–1.10).ConclusionsIn contrast to previous studies, we observed that higher densities of CD163+ macrophages are independently associated with improved OS and BCSS in women with invasive triple-negative breast cancer.Trial registrationNot applicable.

Abstract PO3-09-06: Role of Obesity-Related Biomarkers on Mortality Among Black Breast Cancer Survivors in the Women’s Circle of Health Followup Study

Abstract Background: Central obesity and higher adiposity have been recently associated with higher all-cause and breast cancer-specific mortality in Black breast cancer survivors participating in the Women’s Circle of Health Followup Study. Adipose tissue is a dynamic organ producing adipocytokines, including leptin, adiponectin, adipsin, resistin, lipocalin-2/NGAL, plasminogen-activator inhibitor type 1 (PAI-1) and CXCL11, TNFα, and IL-6, which modulate inflammatory markers in obesity, including the release of proinflammatory C-reactive protein (CRP). These circulating biomarkers play important roles linking obesity with insulin resistance, hyperinsulinemia, chronic inflammation, and altered immunity, which may impact overall and breast cancer mortality. The goal of this analysis was to determine if circulating adipocytokines and obesity-related biomarkers of systemic inflammation are associated with breast cancer and overall survival in Black breast cancer survivors. Methods: Circulating biomarkers were assayed for 460 Black breast cancer survivors who provided a blood sample 2 years post-diagnosis in the Women’s Circle of Health Followup Study, a population-based cohort of Black breast cancer survivors in New Jersey enrolled within 12 months of diagnosis. Associations between biomarkers (by tertiles) and overall survival were assessed using multivariable Cox regression models. Breast cancer specific survival was assessed based on competing risk analyses using the Fine and Gray subdistribution hazard model. Multivariable models were adjusted for age, body mass index as a measure of overall adiposity, education, menopausal status, stage, grade, subtype, and chemotherapy, hormonal therapy, and radiation treatments received. All tests were two-sided at Analyses were conducted at P=0.05. Results: In multivariable analyses, lipocalin-2, CXCL11, and CRP, biomarkers of adipose tissue inflammation closely related to insulin resistance, were associated with worse overall but not breast cancer specific survival. Compared to women in the lowest tertile of lipocalin-2, women in the highest tertile had a 3-fold increased risk of dying from any cause (T3 vs T1, HR=3.08, 95% CI: 1.29-7.39, p= 0.004) and a ~2-fold increased risk of dying from breast cancer, which was not statistically significant (HR= 1.84, 95% CI: 0.59-5.79, p=0.30). Similarly, women in the highest tertile of CXCL11 were at 2-fold increased risk of dying of any cause (HR: 2.10, 95% CI: 0.96-4.57, p=0.06) but no associations were observed with risk of dying from breast cancer (HR:1.31, 0.42-4.13, p=0.64). Circulating CRP, as a marker of systemic inflammation, was also associated with worse overall survival (T3 vs T1 HR: 2.51, 95% CI: 1.07-5.89, p=0.03), showing a borderline significant association with increased breast cancer specific survival (T3 vs T1 HR: 4.32, 95% CI: 0.87-21.38, p=0.07). No associations with overall or breast cancer specific mortality were observed for any of the other adipocytokines examined. Conclusion: In this population-based cohort study of Black breast cancer survivors, biomarkers associated with adipose tissue related inflammation and insulin resistance were associated with reduced overall survival. Relationships with breast cancer survival were not significant, possibly due to limited sample size. Citation Format: Shipra Gandhi, Chi-Chen Hong, Anthony George, Kristopher Attwood, Bo Quin, Nur Zeinomar, Yong Lin, Christine Ambrosone, Kitaw Demissie, Elisa Bandera. Role of Obesity-Related Biomarkers on Mortality Among Black Breast Cancer Survivors in the Women’s Circle of Health Followup Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-09-06.

Abstract 6128: Association between neighborhood disinvestment and all-cause survival moderated by epigenetic age among women with breast cancer

Abstract Background: DNA methylation is hypothesized to mediate relationships between chronic social disadvantage and cancer outcomes. We investigated whether epigenetic age acceleration mediates the association between modifiable neighborhood disinvestment and survival within a cohort of women with breast cancer. Methods: Individual-level data were from the Women’s Circle of Health Follow-up Study, a breast cancer cohort comprising women self-identifying as African American or Black, diagnosed 2013-2019 in New Jersey residents. Demographic, socioeconomic, health behavior, and dietary characteristics were self-reported. Peripheral blood samples from 312 participants collected 18-24 months after diagnosis were profiled for DNA methylation using Illumina’s MethylationEPIC array. After pre-processing, pace of biological aging was estimated using DunedinPACE. Neighborhood disinvestment was assessed using a previously validated virtual audit of 6 disinvestment indicators - garbage, graffiti, dumpsters, poor building conditions, poor yard conditions, abandoned buildings - in 14,671 Google Streetview streetscapes. Accelerated failure time models of all-cause mortality as functions of neighborhood disinvestment and pace of biologic aging were fit to estimate survival time ratios (TR), adjusted for stage at diagnosis and neighborhood socioeconomic composition using causal mediation analyses. End of follow-up was August 13, 2023. Results: There were 46 all-cause deaths through follow-up (median=6.9 years), and 5-year overall survival probability was 0.90 (95% CI: 0.86, 0.93). Minimum, median, and maximum pace of biologic aging was 0.87, 1.26, and 1.72 indicating accelerated aging (> 1.0) among most participants. There was no evidence for mediation of the neighborhood disinvestment - survival effect by pace of biologic aging (indirect effect p-value=0.33). There was evidence of an interaction between pace of biologic aging and neighborhood disinvestment in the adjusted model: survival time decreased 37% (95% CI: 4% - 59%, p=0.03) per 1 standard deviation (SD) increase in neighborhood disinvestment at pace of biologic aging values 1 SD below the average (< 1.13). There was no evidence of such association at pace of biologic aging values 1 SD above the average (p=0.86). Conclusion: Greater neighborhood disinvestment may be associated with shorter survival following a breast cancer diagnosis among those with slower than average epigenetic age acceleration, due to the cumulative nature of neighborhood disinvestment as a chronic indicator of social disadvantage. Citation Format: Jesse J. Plascak, Kellie Archer, Adana A. Llanos, Stephen J. Mooney, Cathleen Y. Xing, Andrew G. Rundle, Helmut Zarbl, B Qin, Nur Zeinomar, Mario Schootman, Song Yao, Christine Ambrosone, Karen Pawlish, Kitaw Demissie, Elisa V. Bandera, Chi-Chen Hong. Association between neighborhood disinvestment and all-cause survival moderated by epigenetic age among women with breast cancer [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 6128.

Abstract 5403: Meeting the Physical Activity Guidelines is associated with increased CD8+ T-cell density in the tumor microenvironment of breast cancer patients

Abstract Background: Our current understanding of how physical activity (PA) is associated with immunity in breast cancer (BC) patients is based on pre-clinical evidence gleaned from mouse models or immune cells in the circulating blood, which may not be reflective of the tumor immune microenvironment (TIME). Whether self-reported PA is associated with immune cell infiltration in the breast TIME, the most relevant site for prognosis, remains a fundamental gap in knowledge. Herein, we examined the association of self-reported PA in the year before BC diagnosis with CD8+ T-cell density in the breast TIME. As prior evidence from healthy adults suggests the relationship between exercise and immunity is not linear, we hypothesized that patients reporting the highest PA level would not have the highest CD8+ T-cell density in their tumor. Methods: We leveraged data and tumor samples from 685 women with BC (548 self-identified Black and 137 self-identified White) enrolled in the Women’s Circle of Health Study and the Women’s Circle of Health Follow-Up Study. CD8+ T-cell density per square millimeter of tumor tissue was derived from IHC staining of tissue microarrays. Weekly PA in the year before diagnosis was categorized as inactive; low active (<7.5 MET hours/week); moderately active [7.5-14.9 MET hours/week, the equivalent of meeting the minimum PA Guidelines (PAG)]; or high active (≥15.0 MET-hours/week, exceeding the minimum PAG). Log transformed mean CD8+ T-cell densities were compared by PA level using t-tests and multivariable linear regression with adjustment for age, race, estrogen receptor status, and tumor grade. Results: Meeting the minimum PA Guidelines was associated with significantly higher CD8+ T-cell density in the breast TIME [120.4 (353.6)] in comparison to inactivity [62.0 (154.5), p=0.02]. Although there were also distinct differences in T-cell density between moderate and low-active patients [120.4 (353.6) versus 69.5 (172.6), p=0.10] and moderate and high-active patients [120.4 (353.6) versus 80.7 (223.3), p=0.051], associations were shy of significance. Multivariable linear regression analyses confirmed that moderately active patients had significantly higher CD8+ T-cell density in comparison to inactive patients, overall (p=0.029), and among Black patients (p=0.021). Conclusions: In comparison to inactivity, BC patients meeting the PAG (moderate activity) had significantly increased CD8+ T-cell density in their tumor, which is associated with better survival outcomes. This new translational knowledge suggests exercise-induced immunomodulation may be an important molecular mechanism underlying the association of PA with improved BC survival. As the immune system is a key player in treatment response and efficacy, further study of the role that PA ancillary to therapy may play in improving treatment and survival outcomes is warranted. Citation Format: Rikki Cannioto, Angela Omilian, Evan Davis, Lucas Mendicino, Scott Abrams, Bo Qin, Chi-Chen Hong, Elisa Bandera, Song Yao, Christine Ambrosone. Meeting the Physical Activity Guidelines is associated with increased CD8+ T-cell density in the tumor microenvironment of breast cancer patients [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 5403.

Changes in Address and the Child Opportunity Index after Delivery in a Cohort of First-time Mothers

Background: The Child Opportunity Index (COI) characterizes social determinants of health across the United States including education, health and environment, and social and economic factors. The objective of the study was to determine if the nulliparous pregnant persons changed addresses between the time of delivery and at the time of follow-up 9-11 years after delivery and to evaluate the trajectory of the COI over time.
 Methods: We analyzed data from nulliparous pregnant people participating in the nuMoM2b Heart Health follow-up Study (HHS). Residential addresses at delivery and at follow-up (~9 years) were compared to determine if the participant changed addresses and to evaluate the COI trajectory. Descriptive characteristics (age, race, income, pregnancy outcomes) and the COI trajectory were compared for those who did and did not move using chi-square and t-tests.
 Results: 410 participants were analyzed. 304 (74%) of the participants changed addresses resulting in changes in census tracts. Moving was associated with a lower mean maternal age (24.3 vs. 27.2 yrs, p≤0.001) and a lower average income (62.3% vs 41.1% <200% FPL,p≤0.001) compared to the participants who did not move. 40.5% moved to a neighborhood with a higher COI quintile, 56 (18.4%) participants moved down a COI quintile, and 125 (41.1%) participants did not have a change in COI category. White participants who moved addresses were significantly more likely to increase their COI category (55%) compared to non-White participants who moved addresses (22.2%, p≤0.001). There were no differences in how COI changed between White and non-White participants who did not move.
 Conclusion: The majority of the participants moved in the years after delivering their first child. Moving was typically associated with an improvement in COI categories, with disparities seen as White participants were more likely to increase their COI if they moved compared to non-White groups.

A 2-year mental health follow-up study subsequent to COVID-19

The COVID-19 pandemic has profoundly impacted the mental health and education of college students. This study examined the interrelationships among loneliness, resilience, and COVID-19 fear among college students in Northern Michigan, a region of the United States severely affected by the pandemic. Data were collected from two student cohorts (n = 258), with half surveyed in early 2022 and the other half in mid-2022, two years after pandemic's onset. The Omicron wave peaked in Michigan in January 2022, but by June 2022, cases, hospitalizations, and deaths had significantly declined. Students completed measures of loneliness, resilience, learning difficulty, and psychological symptoms. Key findings are: 1) Participants' fear, loneliness, and academic difficulty decreased over time, reflecting fluctuations in acute situational and emotional states; 2) Unexpectedly, resilience declined from early to mid-2022, suggesting its diminishing protective role under prolonged, pandemic-induced stress; 3) Despite improvements, students continued reporting high academic difficulties. Loneliness, heightened fear, and dampened happiness together contributed to greater academic difficulties; 4) Pre-existing sex differences equalized two years after the pandemic's onset. While modest improvements were noted, enduring academic and mental health impacts signal a need for continued support.

Abstract IA038: Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors

Abstract Maintaining a healthy weight and cardiovascular health (CVH) after a breast cancer (BC) diagnosis is gaining clinical attention because they are essential for reducing the burden of cardiovascular disease, achieving optimal cancer survivorship, and possibly reducing mortality after a BC diagnosis. Individual behaviors and choices are largely influenced by the surrounding social and built environment; however, the neighborhood risk factors influencing post-diagnosis weight change and CVH are unclear among Black women, who have higher rates of obesity, unfavorable CVH and mortality than any other racial/ethnic group. To address this knowledge gap, we conducted analyses based on the Women's Circle of Health Follow-Up Study (WCHFS), a population-based prospective cohort of Black BC survivors in New Jersey. In the first analysis, adiposity changes during the period ~10 months to 2 years after diagnosis were evaluated among 785 women enrolled in the WCHFS. We found that despite a high baseline prevalence of overweight or obesity, weight gain was common. Greater density of fast-food restaurants and lower walkability were identified as neighborhood-level risk factors for weight gain. We also showed that intentional weight loss was much less common than weight gain, and its neighborhood risk factors were considerably different from unintentional weight loss. In a subsequent analysis, we aimed to capture the complex interplay between neighborhood features through neighborhood archetype analysis based on 16 social and built environment features, and to estimate their associations with CVH around 2 years after diagnosis among Black women. The CVH index used American Heart Association definition and scoring criteria for BMI, diet, smoking, physical activity, blood pressure, cholesterol, glucose, and sleep. We found that Black BC survivors, on average, reached only half of the recommended optimal CVH score, and no participant met all ideal CVH metrics. Among the four neighborhood archetypes identified, we found that the archetype associated with the most favorable post-diagnostic CVH was characterized by diverse racial and ethnic populations, a higher neighborhood socioeconomic status, greater densities of restaurants, food stores, physical activity facilities, walkable destinations, and ambulatory care. However, only 16% of our participants lived in this type of neighborhood. In summary, our work revealed that residential environments may considerably impact adiposity change and CVH among Black BC survivors. Through these studies, we provided insights into the distinct neighborhood characteristics and archetypes that may influence BC survivorship for Black women. Recognizing that social determinants of health act at multiple levels, domains, and factors, it is crucial that future research comprehensively investigates neighborhood and other multilevel determinants to identify the specific social barriers that must be addressed to achieve the most measurable improvements in BC survivorship for Black women. Citation Format: Bo Qin, Carola T. Sánchez-Díaz, Hari S. Iyer, Noreen Goldman, Nur Zeinomar, Andrew G. Rundle, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Gina S. Lovasi, Elisa V. Bandera. Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA038.

Abstract B144: Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast cancer survivors

Abstract Introduction: Racism and discrimination have been associated with poorer mental and physical health, and decreased health-related quality of life (QoL) in the general population, however; there are limited studies examining the impact of discrimination in cancer survivors. We examined the relationship between experiences of discrimination and QoL in Black women diagnosed with breast cancer. Methods: Data were obtained from women enrolled in the Women’s Circle of Health Follow-up Study, a population-based cohort study of Black breast cancer survivors in New Jersey, enrolled within 10 months of diagnosis. Women included in these analyses were diagnosed between 2015-2019. Self-reported experiences of discrimination along with information on potential covariates and effect modifiers were collected during baseline in-person interviews. QoL was assessed at follow-up visits approximately 24 months post-diagnosis using a validated self-reported QoL of measure, the Functional Assessment of Cancer Therapy – Breast (FACT-B), which consists of 5 individual domains (emotional, functional, social/family, and physical wellbeing, as well as a disease specific domain for breast cancer). We examined the association of experiences of discrimination (none, low (<median 43%), high (≥ median 43%)) with continuous total QoL score using linear regression, adjusted for age at diagnosis, tumor stage, educational attainment, household income, smoking status, insurance, and body mass index. We also examined statistical interaction by neighborhood socioeconomic index (nSES), coping strategy (assessed using the Brief Resilient Coping Scale), and spirituality (assessed using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (FACIT-Sp-12) scale) using cross-product terms with experiences of discrimination. Results: Of 220 study participants, 73% of participants reported experiencing any discrimination. In age adjusted models, women who reported the highest experiences of discrimination had lower QoL for overall FACT-B scores and the subscale scores (no discrimination, mean overall FACT-B:117.7, 95% confidence interval (CI): 112.4, 122.9; high discrimination, mean overall FACT-B: 106.8, 95% CI: 102.1, 111.5). Similar associations were observed in fully adjusted models, where women who reported the highest experiences of discrimination had lower QoL. For example, for women who reported no discrimination the mean overall FACT-B score was 114.7 (95% CI: 107.9, 121.4) and 100.8 (95% CI: 94.2, 107.5) for women who reported the highest level of discrimination. No evidence of statistically significant interaction was observed for nSES, spirituality, or coping strategy. Conclusions: In a population-based study of Black breast cancer survivors, experiences of discrimination were associated with poorer QoL, as measured by FACT-B. Citation Format: Nur Zeinomar, Marley M. Perlstein, Bo Qin, Hari S. Iyer, Jesse J. Plascak, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B144.

Abstract B072: Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors

Abstract Background: African American/Black women have higher rates of breast cancer (BrCa) mortality and morbidity than White women. The metabolomics approach using blood samples from epidemiological studies has the potential to elucidate pathways or uncover biomarkers for adverse BrCa outcomes. Therefore, understanding the within-person reproducibility of the blood metabolome of BrCa survivors and factors that influence metabolite levels over time is crucial. However, the stability of blood metabolome among Black BrCa survivors is unknown. Objective: This study aimed to estimate the within-person reproducibility of metabolites over 1 year via global untargeted metabolomic profiling of plasma samples collected in the Women’s Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of Black BrCa survivors in New Jersey. The study also aims to identify factors associated with reproducibility. Methods: We estimated the metabolite reproducibility among 61 Black women with BrCa diagnosed between 2012 and 2017 in WCHFS. Plasma samples were collected once for each participant at ~2 and 3 years post-diagnosis, respectively, and analyzed at Metabolon via ultrahigh performance liquid chromatography-tandem mass spectrometry. Using a mixed-effects model, we calculated the intraclass correlation coefficients (ICC) for each metabolite by dividing the between-person variance by the total variance (i.e., within- and between-person variances). ICCs were compared by age, obesity status, estrogen receptor (ER) status, and seasons, fasting status and time interval between two visits when blood samples were collected. Statistical significance was determined using the Wilcoxon test. Results: Of the 857 named metabolites identified after excluding those undetectable in ≥80% of samples or with a coefficient of variance≥0.25, the median ICC was 0.58 (interquartile range [IQR]: 0.44-0.70). 16.6% had high within-person reproducibility (ICC≥0.75), spanning across all metabolite classes, while 65.6% had an ICC within 0.4-0.75, and the remaining 17.9% had an ICC<0.4. Significant differences in ICCs were noted by participants’ age (median ICC [IQR; same below]: 0.56 [0.40 - 0.68] for younger women, i.e. ≤ 55.6 years vs. 0.61 [0.44 - 0.73] for older women), obesity status (0.55 [0.40 - 0.68] for non-obese vs. 0.62 [0.46 - 0.75] for obese), and ER status (0.56 [0.41 - 0.68] for ER+ vs. 0.62 [0.45 - 0.79] for ER-). The reproducibility also differed by fasting status (0.63 [0.45 - 0.77] for fasting vs. 0.53 [0.39 - 0.67] for non-fasting), but not the seasons or time interval between blood collections. Conclusion: The within-person reproducibility of plasma metabolites over 1 year among Black breast cancer survivors was generally reasonable, suggesting a single-time-point measurement could be useful in evaluating associations between metabolites and BrCa outcomes. However, the reproducibility varied across metabolites and was influenced by participant characteristics and certain sample collection conditions, which need consideration in future analysis or design. Citation Format: Bo Qin, Madhir Vyas, Steven C. Moore, Xiaoyang Su, Eileen White, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B072.

Urban residence and elevated blood pressure among migrant women in South Africa.

This paper demonstrates that internal migration may be contributing to rising non-communicable disease risk in low- and middle-income countries in gendered and geographically differentiated ways. With 2018 baseline data from the Migrant Health Follow-Up Study, we investigate the relationship between internal migration and elevated blood pressure (BP) among 2163 rural-origin men and women in South Africa, testing for sex differences. To examine the influence of place, we test whether the migration-BP relationship differs by migrants' destination locations, controlling for household composition, social support, prior migration, and housing quality. We find that migration is associated with elevated BP only among women, and that this association is greatest for migrants living in Tembisa township. Our research underscores that gender and migration are important social determinants of noncommunicable disease risk in low-resource, rapidly-urbanizing settings.

Parenting in place: Young children's living arrangement and migrants' sleep health in South Africa.

Migration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.

Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis.

In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes sub-populations to risk factors for co-occurring HIV and NCDs. We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18-40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation. Overall, 301 participants (14%; 95% CI 12.6-15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8-16.4) compared to migrants (12.8%; 95% CI 10.3-15.7). Non-migrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07-3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions. In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.

Validity of Self-Report for Ascertaining HIV Status Among Circular Migrants and Permanent Residents in South Africa: A Cross-Sectional, Population-Based Analysis.

While expanded HIV testing is needed in South Africa, increasing accurate self-report of HIV status is an essential parallel goal in this highly mobile population. If self-report can ascertain true HIV-positive status, persons with HIV (PWH) could be linked to life-saving care without the existing delays required by producing medical records or undergoing confirmatory testing, which are especially burdensome for the country's high prevalence of circular migrants. We used Wave 1 data from The Migration and Health Follow-Up Study, a representative adult cohort, including circular migrants and permanent residents, randomly sampled from the Agincourt Health and Demographic Surveillance System in a rural area of Mpumalanga Province. Within the analytic sample (n = 1,918), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-report were calculated with dried blood spot (DBS) HIV test results as the standard. Among in-person participants (n = 2,468), 88.8% consented to DBS-HIV testing. HIV prevalence was 25.3%. Sensitivity of self-report was 43.9% (95% CI: 39.5-48.5), PPV was 93.4% (95% CI: 89.5-96.0); specificity was 99.0% (95% CI: 98.3-99.4) and NPV was 83.9% (95% CI: 82.8-84.9). Self-report of an HIV-positive status was predictive of true status for both migrants and permanent residents in this high-prevalence setting. Persons who self-reported as living with HIV were almost always truly positive, supporting a change to clinical protocol to immediately connect persons who say they are HIV-positive to ART and counselling. However, 56% of PWH did not report as HIV-positive, highlighting the imperative to address barriers to disclosure.

The effect of 5 years of team sport on elderly males' health and social capital-An interdisciplinary follow-up study.

Background and AimsFloorball training induces positive effects on health among untrained older adults. However, the effect of long‐term participation (>2 years) in floorball training among elderly males has not been investigated. The aim of the present study was to examine the effect of 5 years of floorball training on risk factors for lifestyle diseases, fitness, physical function, and social capital of elderly males and compare to a control group that continued their usual lifestyle.MethodsTwenty‐nine recreationally active elderly men aged 75.1 ± 3.3 (mean ± SD; range: 69–81) years with a height, body mass, and body mass index of 1.78 ± 0.06 m, 79.8 ± 10.9 kg, and 25.8 ± 4.1 kg/m2, respectively, volunteered to take part in follow‐up investigations about 5 years after participating in a study on the effect of 12 weeks of floorball or petanque training. At the end of the parental study 15 subjects chose to participate in floorball training (floorball group [FG]) whereas 14 subjects (control group [CG]), resumed their usual lifestyle. FG participated in small‐sided floorball training 1 h ~1.75 times/week for 5 years in a local sports club.ResultsFrom baseline to 5 years, FG had reduced fat percentage, android, and visceral fat, increased total and leg bone mineral density, leg extension maximal voluntary contraction, maximal walk distance in 6 min and 30 s sit‐to‐stand repetitions, decreased time for 5 sit‐to‐stand repetitions and Timed Up and Go (p < 0.05). These changes were all different from less favorable changes in CG (p < 0.05). In FG there was a decline in maximum oxygen uptake which was smaller than the decline in CG (p < 0.05). In addition, FG had developed social capital through the 5 years strengthening their social connectedness and group cohesion.ConclusionIn conclusion, both from a sociological and physiological perspective, small‐sided floorball training can be considered a health‐promoting activity for older men.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors.

PURPOSEUnfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.METHODSAdiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.RESULTSAdiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.CONCLUSIONBoth individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.

Abstract IA-36: Fragmentation of care among Black women who have breast cancer and multiple comorbidities

Abstract Purpose: Black women newly diagnosed with breast cancer and who have multiple comorbidities at the time of cancer diagnosis require greater care coordination to simultaneously manage cancer care and other chronic conditions. Care coordination may be complicated when multiple clinicians from diverse disciplines are involved in managing care and are located in different health systems, defined as care fragmentation. Given that Black women are disproportionately burdened by comorbidities and breast cancer, we examined the degree of care fragmentation and care coordination experienced by this group from a health system and care team perspective using two population-based cohorts. Methods: We analyzed data from two separate cohorts of Black women diagnosed with breast cancer who had diabetes and/or cardiovascular disease. In the first study we used the Women's Circle of Health Follow-Up Study (n=228) to examine types of practice setting for first primary care visit and primary breast surgery, and, through medical chart abstraction, identified whether care visit was within or outside the same health system. In a separate study, we identified women from the SEER-Medicare database (n=3,420) diagnosed with breast cancer and used encounter claims to examine the complexity and composition of the clinical care team. Results: Care fragmentation was experienced by 79% of Black women in the Women's Circle of Health Follow-Up Study, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (p&amp;gt;.05). In the SEER-Medicare cohort, the most common clinical care team composition was oncology with primary care (45%) followed by oncology, primary care, and medical subspecialty (26%). In the adjusted model, Black women were more likely to have a clinical care team of higher complexity if they had cardiopulmonary disease (OR: 1.74; 95% CI: 1.68, 1.81) or diabetes (OR: 1.69; 95% CI: 1.63,1.75) compared with hypertension only. Women were also less likely to have a complex care team if they were dual Medicaid-Medicare covered (OR: 0.56; 95% CI: 0.48, 0.65) compared with Medicare only, rural residents (OR: 0.54; 95% CI: 0.42, 0.65) compared with urban, or diagnosed with stage III cancer (OR: 0.59; 95% CI: 0.47, 0.75) compared with stage I. Conclusion: The majority of Black breast cancer survivors with comorbidities see multiple clinicians from diverse disciplines and in different health systems, illustrating high care coordination demands and care fragmentation. However, the impact of the health system and care team on care outcomes still need to be assessed, and this includes care transitions into survivorship. To address cancer care disparities experienced by Black women, future research should consider examining clinician's perspectives regarding roles and responsibilities for chronic disease management and cancer care, as well as address care fragmentation across diverse healthcare delivery settings. Citation Format: Michelle Doose, Janeth I. Sanchez, Dana Verhoeven, Veronica Chollette, Joel C. Cantor, Jesse J Plascak, Michael Steinberg, Chi-Chen Hong, Kitaw Demissie, Elisa Bandera, Jennifer Tsui, Sallie J. Weaver. Fragmentation of care among Black women who have breast cancer and multiple comorbidities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-36.

Abstract PO-119: Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients

Abstract Purpose: Pathologic complete response (pCR) to neoadjuvant chemotherapy is associated with improved event-free and distant recurrence free survival in women with stage II or III breast cancer (BC). While there is strong evidence that obesity is associated with reduced BC survival, its role on pCR after neoadjuvant chemotherapy among BC patients is unclear. Moreover, data regarding the association of pre-treatment BMI with response to neoadjuvant chemotherapy in Black women – who have the highest obesity prevalence than any other racial/ethnic groups and 40% worse survival outcomes compared to White women – are lacking. The purpose of this study was to examine the association of pretreatment BMI and subsequent pCR after neoadjuvant chemotherapy in Black BC patients. Methods: Data were abstracted from medical records of 131 Black BC patients who received neoadjuvant chemotherapy in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey. pCR was defined as absence of detectable invasive cancer in the breast and lymph nodes (ypT0/Tisand ypN0) at the time of surgery (noninvasive residual BC, i.e. DCIS was allowed). Tumor subtypes were defined by hormone receptor (HR, i.e., ER, PR) and HER2 status. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) of the association between pretreatment obesity (BMI ≥30 kg/m2)vs. non-obese (&amp;lt;30 kg/m2), and pCR, after adjusting for covariates. The association with BMI in a continuous scale was also evaluated. Results: Mean age at BC diagnosis was 50±10.7 years, mean BMI was 31.4±7.1 kg/m2, and 69 (52.7%) women were obese. In terms of tumor subtype, 53 (40.5%) were HR+/HER2-, 40 (30.5%) were HER2+, and 38 (29.0%) were triple negative. All patients received standard chemotherapy regimens and 8.4% of patients had dose reductions due to toxicity. Almost one-third achieved pCR (38 [29.0%]). Consistent with prior evidence, our findings were suggestive of decreased odds of pCR among obese (OR 0.88, 95% CI: 0.39-1.99) compared to non-obese women, although the risk estimate was not statistically significant. We observed similar findings with BMI modeled as a continuous variable (OR 0.85, 95% CI: 0.62-1.15 per 5-unit increase in BMI). No substantive differences were observed by tumor subtype (HR+/HER2: OR 0.80, 95% CI: 0.44-1.46; HER2+: OR 0.93, 95% CI: 0.58-1.47; and triple negative BC: OR 0.86, 95% CI: 0.47-1.57 per 5-unit increase in BMI). Conclusion: Our findings suggest that among Black women, higher BMI is inversely associated with achieving pCR. However, risk estimates did not reach statistical significance, possibly due to small sample size. Alternatively, as shown by our and others' prior work, BMI may be an inadequate measure of adiposity, particularly in this population. Future work should evaluate the impact of body fat distribution and body composition on pCR response to neoadjuvant chemotherapy among Black women after a breast cancer diagnosis. Citation Format: Coral Omene, Saber Amin, Nur Zeinomar, Bo Qin, Dhanya Chanumolu, Adana A.M. Llanos, Chi-Chen Hong, Kitaw Demissie, Elisa V. Bandera. Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-119.