Higher Rates Of Diabetes Research Articles

Community-based diabetes prevention randomized controlled trial in refugees with depression: effects on metabolic outcomes and depression

Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either (a) antidepressant medication and/or (b) prolonged elevated depressive symptoms. Participants were randomized to one of three community health worker (CHW) interventions: (1) lifestyle intervention called Eat, Walk, Sleep (EWS), (2) EWS plus medication therapy management sessions with a pharmacist/CHW team to resolve drug therapy problems (EWS + MTM), or, (3) social services (SS; control). Assessments were at baseline, post-treatment (12 months), and follow-up (15 months). The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal educational attainment was 7.0 years. Compared to the other arms, EWS + MTM showed a significant decrease in HbA1c and a trend for reduced inflammation and stress hormones. Depressive symptoms improved for EWS and EWS + MTM relative to SS. There was no change in insulin resistance. Cardiometabolic and mental health can be improved in tandem among immigrant and refugee groups.

Socioeconomic Status Not Associated With Worse Outcomes After Open Lower Extremity Revascularization

Prior research has shown that socioeconomic status (SES) is correlated with higher rates of diabetes, peripheral vascular disease, and amputation. We sought to determine whether socioeconomic status or insurance type increases the risk of mortality, major adverse limb event (MALE), or hospital length of stay following open lower extremity revascularization. We conducted a retrospective analysis of a prospectively maintained database of patients who underwent open lower extremity revascularization at a single tertiary care center from January 2011 to March 2017 (n = 542). Socioeconomic status was determined using state area deprivation index (ADI), a validated metric determined by income, education, employment, and housing quality by census block group. In patients undergoing revascularization procedures on both limbs, each limb was treated individually for analysis. We performed a multivariate analysis of the association between ADI and insurance type with mortality, MALE, and hospital length of stay using Cox proportional hazard models, including confounding variables such as age, gender, smoking status, body mass index, hyperlipidemia, hypertension, and diabetes. The cohort with an ADI of 1, meaning least deprived, and the Medicare cohort were used for reference. P values of <.05 were considered statistically significant. Of 542 patients reviewed, 245 patients undergoing surgery had complete data and were included. Controlling for age, gender, smoking status, body mass index, hyperlipidemia, hypertension, and diabetes, SES was not an independent predictor of mortality (Table I) (P = .974), MALE (P = .989), or hospital length of stay (P = .325). Controlling for the same confounders, insurance type was not independently correlated with mortality (Table II) (P = .164) or MALE (P = .743). Private insurance was associated with significantly longer hospital stays (P = .004). This study suggests that SES does not correlate with increased risk of mortality or MALE in patients undergoing open lower extremity revascularization. While insurance type did not impact risk of mortality or MALE, those with private insurance may have longer hospital stays following surgery. These findings suggest that individuals undergoing open lower extremity revascularization at this single tertiary care center received similar care, regardless of their SES or insurance type. Further study is warranted to determine the factors that led to these findings, including whether individuals with lower SES may be presenting too late for revascularization and instead undergo primary amputation.Table IMultivariate analysis of the association between socioeconomic status and postoperative outcomes using an area deprivation index (ADI) of 1 as the reference groupMultivariate hazard ratio [95% CI]P valueMortality ADI 20.97 [0.32-2.92].952 ADI 31.02 [0.36-2.89].969 ADI 40.91 [0.28-2.96].871 ADI 50.48 [0.17-1.33].159 ADI 60.51 [0.18-1.47].212 ADI 70.71 [0.24-2.10].541 ADI 81.04 [0.34-3.12].950 ADI 91.33 [0.30-5.97].707 ADI 100.98 [0.32-3.03].974 Age1.05 [1.03-1.08]<.001 Gender (male)1.28 [0.76-2.15].361 Smoking (yes vs no)0.79 [0.50-1.24].307 BMI0.99 [0.95-1.02].437 Hyperlipidemia (yes vs no)1.06 [0.57-1.98].844 Hypertension (yes vs no)1.39 [0.53-3.64].509 Diabetes (yes vs no)1.34 [0.86-2.11].201MALE ADI 20.56 [0.12-2.62].462 ADI 31.67 [0.43-6.46].459 ADI 41.12 [0.28-4.53].872 ADI 51.33 [0.35-5.04].677 ADI 61.16 [0.32-4.21].825 ADI 71.30 [0.36-4.75].690 ADI 82.33 [0.62-8.77].212 ADI 92.79 [0.67-11.59].159 ADI 101.01 [0.25-4.08].989 Age0.98 [0.96-1.00].097 Gender (male)0.89 [0.55-1.43].640 Smoking (yes vs no)1.13 [0.71-1.81].607 BMI1.00 [0.96-1.04].943 Hyperlipidemia (yes vs no)0.56 [0.33-0.95].033 Hypertension (yes vs no)2.99 [1.23-7.27].016 Diabetes (yes vs no)1.09 [0.69-1.72].711Hospital length of stay, days ADI 20.66 [0.23-1.91].444 ADI 30.67 [0.24-1.88].446 ADI 40.63 [0.21-1.91].411 ADI 50.73 [0.26-2.01].543 ADI 60.73 [0.27-1.99].532 ADI 70.55 [0.20-1.53].252 ADI 80.48 [0.16-1.41].183 ADI 90.57 [0.14-2.36].434 ADI 100.58 [0.19-1.73].325 Age1.03 [1.01-1.05].014 Gender (male)1.06 [0.66-1.70].821 Smoking (yes vs no)1.47 [0.91-2.35].113 BMI0.99 [0.96-1.03].674 Hyperlipidemia (yes vs no)1.28 [0.68-2.42].446 Hypertension (yes vs no)1.45 [0.53-3.92].469 Diabetes (yes vs no)1.07 [0.69-1.65].773BMI, Body mass index; CI, confidence interval; MALE, major adverse limb events. Open table in a new tab Table IIMultivariate analysis of the association between insurance type and postoperative outcomes using Medicare as the reference groupMultivariate hazard ratio [95% CI]P valueMortality Private1.55 [0.84-2.87].164 Medicaid1.60 [0.68-3.77].283 Self-pay2.46 [0.74-8.25].144 Age1.06 [1.03-1.08]<.0001 Gender (male)1.40 [ 0.88-2.22].150 Smoking (yes vs no)0.83 [0.53-1.30].404 BMI0.98 [0.94-1.01].186 Hyperlipidemia (yes vs no)1.06 [0.57-1.96].862 Hypertension (yes vs no)1.22 [0.47-3.17].679 Diabetes (yes vs no)1.37 [0.89-2.11].157MALE Private1.10 [0.61-1.99].743 Medicaid1.57 [0.75-3.28].236 Self-pay2.16 [0.83-5.61].114 Age0.99 [0.96-1.01].211 Gender (male)0.94 [0.60-1.47].775 Smoking (yes vs no)1.12 [0.71-1.75].625 BMI1.00 [0.96-1.04].914 Hyperlipidemia (yes vs no)0.62 [0.37-1.03].067 Hypertension (yes vs no)2.85 [1.18-6.91].020 Diabetes (yes vs no)1.04 [0.67-1.62].850Hospital length of stay, days Private1.79 [0.91-3.53].090 Medicaid1.28 [0.56-2.93].563 Self-pay1.84 [0.53-6.42].340 Age1.04 [1.02-1.06].001 Gender (male)1.07 [0.68-1.71].765 Smoking (yes vs no)1.56 [0.97-2.51].067 BMI0.99 [0.96-1.03].750 Hyperlipidemia (yes vs no)1.31 [0.69-2.50].415 Hypertension (yes vs no)1.40 [0.54-3.67].488 Diabetes (yes vs no)1.07 [0.69-1.65].757BMI, Body mass index; CI, confidence interval; MALE, major adverse limb events.Boldface entries indicate statistical significance. 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Differences in Long-Term Outcomes in End-Stage Kidney Disease Patients with Chronic Limb-Threatening Ischemia

End-stage kidney disease (ESKD) is a risk factor for peripheral arterial disease and major adverse limb events following infra-inguinal bypass. Despite comprising an important patient population, ESKD patients are rarely analyzed as a subgroup and are underrepresented in vascular surgery guidelines. This study aims to compare the long-term outcomes of patients with and without ESKD undergoing endovascular peripheral vascular intervention (PVI) for chronic limb-threatening ischemia (CLTI). CLTI patients with and without ESKD from 2007-2020 were identified in the Vascular Quality Initiative PVI dataset. Patients with prior bilateral interventions were excluded. Patients undergoing femoral-popliteal and tibial interventions were included. Mortality, reintervention, amputation, and occlusion rates at 21months following intervention were examined. Statistical analyses were completed with the t-test, chi-square, and Kaplan-Meier curves. The ESKD cohort was younger (66.4±11.8 vs. 71.6±12.1years, P<0.001) with higher rates of diabetes (82.2 vs. 60.9%, P<0.001) the non-ESKD cohort. Long-term follow-up was available for 58.4% (N=2,128 procedures) of ESKD patients and 60.8% (N=13,075 procedures) of non-ESKD patients. At 21months, ESKD patients had a higher mortality (41.7 vs. 17.4%, P<0.001) and a higher amputation rate (22.3 vs. 7.1%, P<0.001); however, they had a lower reintervention rate (13.2 vs. 24.6%, P<0.001). CLTI patients with ESKD have worse long-term outcomes at 2years following PVI than non-ESKD patients. Mortality and amputation are higher with ESKD, while the reintervention rate is lower. Development of guidelines within the ESKD population has the potential to improve limb salvage.

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients.

The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status. Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural-urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression. Results demonstrated that patients in small rural/isolated areas with low (B=-4.10, SE=1.93, OR=0.02, p=0.03) to average (B=-2.67, SE=1.32, OR=0.07, p=0.04) food insecurity and average (B=-2.67, SE=1.32, OR=0.07, p=0.04) to high (B=-10.62, SE=4.71, OR=0.00, p=0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B=4.47, SE=0.49, d=0.42, p<0.001) diabetes and low mortality (B=5.70, SE=0.58, d=0.45, p<0.001) rates have significantly more severe postmastectomy complications. These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.

Underutilization of Transcatheter Aortic Valve Replacement in Northern Plains American Indians with Severe Aortic Stenosis

IntroductionTranscatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement and revolutionized the treatment strategy for aortic valve replacement. Little is known on the disparities among minorities, especially American Indians (AI), undergoing this procedure. We explore TAVR outcomes to identify disparities at our institution.MethodsRetrospective chart review was completed on patients who underwent TAVR at a North Dakota community hospital between 2012 and 2021. There were 1133 non-AI and 20 AI patients identified (n = 1153). AI patients were identified by enrollment in nationally recognized tribes, Indian Health Service (IHS), or who self-identified as AI. Patient demographics, preoperative characteristics, procedural information, and outcomes were collected. United States 2020 census data was used for state-wide population racial percentages. Unpaired two tail t test assuming unequal variance and chi-squared tests were used to evaluate data and identify disparities between AI and non-AI.ResultsAI presented at an earlier age (71 vs. 79; p = .001) with higher rates of diabetes (60% vs. 35%; p = .018) and history of smoking (100% vs. 60%; p ≤ .001) than Caucasian/white (C/W). The Society of Thoracic Surgery (STS) risk scores (3.2% vs. 4.6%; p = .054) and aortic valve mean gradients were lower among AI (42.8 mmHg vs. 47.5 mmHg; p = .010). For those deceased, AI had significantly shorter lifespans post-TAVR compared to C/W (374 days vs. 755 days; p = .004). AI from North Dakota had fewer TAVR procedures performed than expected (4 actual vs. 32 expected; p < .001).ConclusionsAI undergoing TAVR presented earlier, with higher rates of diabetes and smoking, lower STS risk scores, and lesser aortic valve gradients than C/W. The number of TAVR procedures performed on AI from North Dakota was lower than anticipated despite a nearly 10-year period and the disparities experienced by AI who could have otherwise benefited from TAVR.

Equity of Cancer and Diabetes Co-Occurrence: A National Study With 44 Million Person-Years of Follow-Up

The co-occurrence of diabetes and cancer is becoming increasingly common, and this is likely to compound existing inequities in outcomes from both conditions within populations. In this study, we investigate the co-occurrence of cancer and diabetes by ethnic groups in New Zealand. National-level diabetes and cancer data on nearly five million individuals over 44 million person-years were used to describe the rate of cancer in a national prevalent cohort of peoples with diabetes versus those without diabetes, by ethnic group (Māori, Pacific, South Asian, Other Asian, and European peoples). The rate of cancer was greater for those with diabetes regardless of ethnic group (age-adjusted rate ratios, Māori, 1.37; 95% CI, 1.33 to 1.42; Pacific, 1.35; 95% CI, 1.28 to 1.43; South Asian, 1.23; 95% CI, 1.12 to 1.36; Other Asian, 1.31; 95% CI, 1.21 to 1.43; European, 1.29; 95% CI, 1.27 to 1.31). Māori had the highest rate of diabetes and cancer co-occurrence. Rates of GI, endocrine, and obesity-related cancers comprised a bulk of the excess cancers occurring among Māori and Pacific peoples with diabetes. Our observations reinforce the need for the primordial prevention of risk factors that are shared between diabetes and cancer. Also, the commonality of diabetes and cancer co-occurrence, particularly for Māori, reinforces the need for a multidisciplinary, joined-up approach to the detection and care of both conditions. Given the disproportionate burden of diabetes and those cancers that share risk factors with diabetes, action in these areas is likely to reduce ethnic inequities in outcomes from both conditions.

The Shifting Nature of Subsistence on the Hopi Indian Reservation

Abstract On the outstretched fingers of Black Mesa lie the longest continually inhabited settlements in North America. Here, on the Hopi Indian Reservation, roots of blue corn reach deep into sandy soil that sustained one of the world's most biologically diverse agricultural systems for over one thousand years. In dry farmed fields fed by violent monsoon storms and in terraced gardens irrigated by ancestral springs, Hopi agriculturalists perfected a system of spiritual and physical subsistence that produced the majority of food consumed in Hopi communities. During the twentieth century, the rise of wage labor and increased access to cash facilitated the shift from a diet comprised primarily of traditional food produced by Hopi farmers to one dependent on food purchased in grocery stores or acquired through food aid programs, contributing to high rates of obesity and diabetes. Despite deep fractures in their food system, Hopis continued to produce and consume traditional foods while negotiating the terms upon which new foods were adopted into their culinary universe, demonstrating sustained resilience in the face of a shifting subsistence base.

Sex-based differences in risk of cardiovascular disease development and cardiovascular risk factors among individuals with hypertension: A cross-sectional study from primary care facilities

BackgroundOver the last two decades, the understanding of cardiovascular disease (CVD) has expanded in Asian countries. Despite this progress, there have been limited investigations into sex-based differences in the development of CVD and cardiovascular risk factors (CVRFs). AimWe investigated whether males and females with hypertension had different risks of developing CVD and CVRFs. MethodsWe used a stratified multi-stage sampling design involving 15 primary care centers in Thailand. We recruited 1,448 individuals aged 35–74 years old. The Framingham cardiovascular risk algorithm was used to determine the risk of CVD development. ResultsFemale patients were overall more likely to have lower CVD risk scores. However, they demonstrated higher scores in the moderate-risk (p < 0.001) and high-risk (p < 0.001) groups as compared with males. One in four females was at a high risk of developing CVD. Females had higher rates of all CVRFs against males across sub-risk groups, with the highest odds ratio observed in the high-risk group, which persisted after adjusting for covariations. Overall, female patients had higher rates of diabetes, hyperlipidemia, obesity, and abdominal obesity as compared with males. Females in the overall group had a lower prevalence of uncontrolled hypertension than males, in contrast to the high-risk group. Female patients also had a lower prevalence of cigarette smoking and alcohol consumption than males. ConclusionThere is evidence of sex-based differences in the risk of CVD development in hypertensive individuals. The interaction of CVRFs with a high risk of developing CVD was noted in females.

Lack of Better Functional Outcomes in Young Border Hispanic Patients with Acute Ischemic Stroke after Endovascular Thrombectomy Compared to Older Patients: A Retrospective Chart Review (P8-5.001)

<h3>Objective:</h3> To study the interaction between age and Hispanic status to assess functional outcomes after endovascular thrombectomy in young versus older patients in a predominantly Hispanic population with a high prevalence of diabetes mellitus and obesity. <h3>Background:</h3> Previous data indicates that young acute ischemic stroke patients have better prognosis after endovascular thrombectomy. However, data has also shown that Hispanic patients are associated with poorer outcomes following thrombectomy, yet the combination of these factors is not well characterized. <h3>Design/Methods:</h3> A retrospective chart review of patients with an anterior circulation large vessel occlusion between August 2012 to January 2022 was performed, comparing the data of young patients (18–49 years) and older patients (≥ 50 years). Baseline characteristics and outcomes including Modified Rankin Scale (mRS), Symptomatic Intracerebral Hemorrhage (sICH), Expanded Treatment in Cerebral Infarction score (eTICI), and mortality were studied, adjusting for confounders. <h3>Results:</h3> A total of 811 patients, with 66 (8%) being 18 to 49 years old (33% female) revealed younger patients had lower presenting median National Institute of Health Stroke Scale (NIHSS) scores (9.5 versus 17, P &lt;0.001), and lower presence of co-morbidities. Both groups had a Hispanic predominance (73 versus 74%, P = 0.97). Subset analysis indicated that 90-day mRS score 0–2, sICH, eTICI, and mortality rates did not differ significantly. <h3>Conclusions:</h3> Our Hispanic population demonstrates no differences in sICH, mortality, and functional independence between young and older acute ischemic stroke patients after endovascular thrombectomy, deviating from previous data. The Texas Rio Grande Valley region has uniquely high rates of diabetes and obesity in young patients compared to elsewhere. Our findings demonstrate that Hispanic status and high diabetes rates in young patients may predominate over age-related outcome differences in prior data. Further investigation is needed to elucidate the unique intersection between Hispanic status, diabetes mellitus, obesity, and age in ischemic stroke patients after endovascular thrombectomy. <b>Disclosure:</b> Ms. Ravi has nothing to disclose. Mr. Desai has nothing to disclose. Mr. Ghozy has nothing to disclose. Dr. Tekle has nothing to disclose. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.

Admission Serum Magnesium Levels Is Associated with Short and Long-Term Clinical Outcomes in COVID-19 Patients.

In the face of the global pandemic that the coronavirus disease 2019 (COVID-19) has created, readily available prognostic markers may be of great use. To evaluate the association between serum magnesium (sMg) levels on admission and clinical outcomes in hospitalized COVID-19 patients. We retrospectively analyzed all patients admitted to a single tertiary center with a primary de novo diagnosis of COVID-19. Patients were followed for a mean of 10 ± 7 months. Demographic, clinical and laboratory data were collected and compared between five groups of patients according to sMg quintiles on hospital admission. The cohort included 1522 patients (58% male, 69 ± 17 years old). A low sMg level (1st quintile) was associated with higher rates of diabetes and steroid use, whereas a high sMg level (5th quintile) was associated with dyslipidemia, renal dysfunction, higher levels of inflammatory markers and stay in the intensive care unit. All-cause in-hospital and long-term mortality was higher in patients with both low and high sMg levels, compared with mid-range sMg levels (2nd, 3rd and 4th quintiles; 19% and 30% vs. 9.5%, 10.7% and 17.8% and 35% and 45.3% vs. 23%, 26.8% and 27.3% respectively; p < 0.001 for all). After adjusting for significant clinical parameters indicating severe disease and renal dysfunction, only low sMg state was independently associated with increased mortality (HR = 1.57, p < 0.001). Both low and high sMg levels were associated with increased mortality in a large cohort of hospitalized COVID-19 patients. However, after correction for renal dysfunction and disease severity, only low sMg maintained its prognostic ability.

Comparative Analysis of Diabetes in China and The United States-Based on Risky Factor, Complications and Quality of Life

Of the two main types of diabetes, the most prevalent kind of diabetes is type 2 diabetes (T2D). In many of the world's countries with high diabetes rates and large populations, China and the United States are two nations that can be used as a point of reference when trying to find a solution to the diabetes problem. This paper analyzes the differences between China and the United States in terms of three aspects: risk factors, complications and the quality of life-related to this disease. Obesity is a risk factor that has a significant impact on diabetes in both the United States and in China, and smoking is also one of the risk factors which is more prominent in China. In terms of complications, the complications in the United States and China are almost the same, and the incidence is basically similar. The poor performance of pancreatic beta-cells and the disparity in treatment levels, however, are likely to blame for China's considerably greater prevalence of diabetic complications than the US. In China, the living quality of patients with any kind of diabetes depends more on the patient's economic status and education level, while in the United States, depends on cultural differences. Race is also an important factor affecting patients’ quality of life.

PD20-11 A NATIONAL COMPARISON OF MORBIDITY AND OPERATIVE OUTCOMES IN BLACK AND WHITE WOMEN UNDERGOING CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD20-11 A NATIONAL COMPARISON OF MORBIDITY AND OPERATIVE OUTCOMES IN BLACK AND WHITE WOMEN UNDERGOING CYSTECTOMY Dhaval Jivanji, Elie Kaplan-Marans, Karis Buford, Katiana Vazquez-Rivera, Allison Polland, Varsha Sinha, Ervin Teper, Michael Silver, and Ariel Schulman Dhaval JivanjiDhaval Jivanji More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Karis BufordKaris Buford More articles by this author , Katiana Vazquez-RiveraKatiana Vazquez-Rivera More articles by this author , Allison PollandAllison Polland More articles by this author , Varsha SinhaVarsha Sinha More articles by this author , Ervin TeperErvin Teper More articles by this author , Michael SilverMichael Silver More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial inequalities are well-documented in many areas of medicine. We used a national database to compare morbidity and operative outcomes in Black and white women undergoing radical cystectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify Black and white women who underwent a cystectomy between 2016 and 2020 (Current Procedural Terminology codes: 51570, 51575, 51580, 51585, 51590, 51595, 51596). Demographics, preoperative comorbidities, and operative outcomes were compared. Chi-square was used to analyze categorical variables and the Mann–Whitney U test was used to analyze continuous variables. RESULTS: Of the 2,002 women identified, 1,813 (90.6%) were white and 189 (9.4%) were Black. Black women were younger (66 years old vs. 69 years old, p=0.001) and had higher BMI (29.8 vs. 27.5, p<0.001) compared to white women. Black women had higher rates of non-insulin dependent diabetes (18.0% vs. 8.9%, p<0.001), hypertension (72.0% vs. 53.8%, p<0.001), and smoking (28.0% vs. 21.3%, p=0.04). There was no difference in length of stay (7 days vs. 6 days, p=0.67) or operative time (359 minutes vs. 344 minutes, p=0.06) between the two groups. No significant differences in major Clavien-Dindo complications or 30-day events were seen (Table 1). CONCLUSIONS: Black women who underwent cystectomy were younger; however, had higher rates of diabetes, hypertension, and smoking compared to white women. Importantly, this did not translate to meaningful differences in surgical outcomes observed in our cohort. These findings are encouraging, and further studies exploring surgical outcomes in non-NSQIP participating hospitals are crucial as the racial profiles may differ at these institutions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e588 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhaval Jivanji More articles by this author Elie Kaplan-Marans More articles by this author Karis Buford More articles by this author Katiana Vazquez-Rivera More articles by this author Allison Polland More articles by this author Varsha Sinha More articles by this author Ervin Teper More articles by this author Michael Silver More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF downloadLoading ...

Differences in Anorectal Manometry Values Among Women With Fecal Incontinence in a Racially, Ethnically, and Socioeconomically Diverse Population.

Anorectal manometry (ARM) is a valuable diagnostic and therapeutic tool that can both aid in identifying mechanisms contributing to fecal incontinence (FI) and inform management strategies. Consensus on standard reference range values has not been established, and women of varying racial and ethnic backgrounds are not well-represented in the current literature. We aimed to compare ARM values between women of different racial and ethnic groups with FI. We conducted a retrospective cross-sectional study of women with FI who underwent ARM at a tertiary health system in an urban underserved community between 2016 and 2021. Demographic information and ARM values were collected from the medical record. Socioeconomic status (SES) was represented by the percent of the population living below the poverty line according to zip code using U.S. census data. Anorectal manometry values were compared between racial and ethnic groups, and multivariable logistic regression was conducted to control for patient characteristics. Fifty-eight women were included in the analysis: 33% Hispanic, 22% Black, and 45% White. Hispanic and Black women had higher body mass index and higher rates of diabetes and loose stools and were of significantly lower SES compared with White women. Black and Hispanic women had significantly lower thresholds for volume at first sensation and higher mean anal squeeze pressure. Differences were maintained after controlling for body mass index, diabetes, SES, and diarrhea (P = 0.03 and P = 0.01, respectively). Other ARM values were not significantly different between groups. Racial and ethnic differences in ARM values among women with FI exist. Further studies are needed to determine whether these differences have an impact on symptom severity, treatment selection and outcomes, and patient satisfaction.

Prevalence of Self-Reported Kidney Disease in Older Adults by Sexual Orientation: Behavioral Risk Factor Surveillance System Analysis (2014-2019).

Studies discusses CKD disparities by age, race and ethnicity, and socioeconomics. However, despite well-documented disparities in CKD risk factors in LGBT+ adults, limited literature addresses CKD prevalence in this population. This analysis uses Behavioral Risk Factor Surveillance System (2014-2019) data to compare self-reported kidney disease prevalence in LGBT+ older adults (older than 50 years) with their heterosexual peers. Our findings indicate that LGBT+ older adults have higher rates of self-reported kidney disease and a higher incidence of CKD risks including smoking, activity limitations, adverse health outcomes, and limited access to health care, housing, and employment. These results support increasing access to screening for CKD risk factors, providing culturally responsive health care, and addressing societal drivers of vulnerability in older LGBT+ adults. Existing research documents disparities in CKD by age, race and ethnicity, and access to health care. However, research on CKD in lesbian, gay, bisexual, and trans (LGBT+) older adults, despite their higher rates of diabetes, heart disease, smoking, and alcohol use, is limited. Pooled data from the Behavioral Risk Factor Surveillance System (2014-2019) for 22,114 LGBT+ adults and 748,963 heterosexuals aged 50 and older were used to estimate the prevalence of self-reported kidney disease. Logistic regressions were used to compare older adults by sexual orientation. Older LGBT+ men (adjusted odds ratio=1.3; 95% confidence interval [CI], 1.09-1.54) were more likely than their heterosexual counterparts to report kidney disease, after controlling for sociodemographic factors, health behaviors, access to health care, and self-reported coronary heart disease, HIV, and diabetes; LGBT+ men and women also reported higher incidences of known risk factors for CKD. For example, both LGBT+ men (odds ratio [OR]=1.39; [95% CI], 1.26-1.54) and LGBT+ women (OR=1.39; [95% CI], 1.25-1.55) were more likely to be smokers and have a higher incidence of activity limitations, adverse health outcomes, and limited access to health care, housing, and employment. These results support increasing access to screenings for CKD risk factors, providing preventative education and culturally responsive and affirming care, and addressing other societal drivers of vulnerability in older LGBT+ adults. The findings also support the value of interventions that address the interaction between CKD risk factors and the social marginalization that older LGBT+ adults experience.

Nonobstructive coronary atherosclerosis is associated with adverse prognosis among patients diagnosed with myocardial infarction without obstructive coronary arteries

Background and aimsThe prognostic impact of nonobstructive coronary artery disease (CAD), as opposed to normal coronary arteries, on long-term outcomes of patients with myocardial infarction with no obstructive coronary arteries (MINOCA) is unclear. We aimed to address the association between nonobstructive-CAD and major adverse events (MAE) following MINOCA. MethodsWe conducted a retrospective cohort study of consecutive MINOCA patients admitted to a large referral medical center between 2005 and 2018. Patients were classified according to coronary angiography as having either normal-coronaries or nonobstructive-CAD. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). ResultsOf the 1544 MINOCA patients, 651 (42%) had normal coronaries, and 893 (58%) had CAD. The mean age was 61.2 ± 12.6 years, and 710 (46%) were females. Nonobstructive-CAD patients were older and less likely to be females, with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal-failure (p < 0.05). At a median follow-up of 7 years, MAE occurred in 203 (23%) patients and 67 (10%) patients in the nonobstructive-CAD and normal-coronaries groups, respectively (p < 0.01). In multivariable models, nonobstructive -CAD was significantly associated with long-term MAE [adjusted-hazard-ratio (aHR):1.67, 95% confidence-interval (95%CI):1.25–2.23; p < 0.001]. Other factors associated with a higher MAE-risk were older-age (aHR:1.05,95%CI:1.03–1.06; p < 0.001) and left ventricular ejection-fraction<40% (aHR:3.04,95%CI:2.03–4.57; p < 0.001), while female-sex (aHR:0.72, 95%CI: 0.56–0.94; p=0.014) and sinus rhythm at presentation (aHR:0.66, 95%CI: 0.44–0.98; p=0.041) were associated with lower MAE-risk. ConclusionsIn MINOCA, nonobstructive-CAD is independently associated with a higher MAE-risk than normal-coronaries. This finding may promote risk-stratification of patients with nonobstructive-CAD-MINOCA who require tighter medical follow-up and treatment optimization.

Racial and Ethnic Disparities in Short-Stay Total Knee Arthroplasty

BackgroundThe purpose of this study was to understand racial and ethnic disparities in hospital-based, Medicare-defined outpatient total knee arthroplasty (TKA). We aimed to determine the following: 1) whether there are differences in preoperative characteristics or postoperative outcomes in outpatient TKA between racial/ethnic groups and 2) trends in outpatient TKA volume, based on race/ethnicity. MethodsThis was a retrospective cohort study of a large national database. Outpatient TKAs performed between 2012 and 2018 were identified. Patient demographics, comorbidities, and 30-day postoperative outcomes were compared between White, Black, Asian, and Hispanic patients. ResultsOf 54,183 outpatient patients, 85.6% were White, 7.4% Black, 2.6% Asian, and 4.1% Hispanic. Black patients had the highest body mass index, and there were higher rates of diabetes among all minority groups (P < .001). All minority groups were more likely to be discharged to a rehabilitation or a skilled care facility compared to White patients (P < .001). Annual percentage increases in outpatient TKA were most pronounced for Asians and Hispanics and least pronounced among Blacks, when compared to White patients. ConclusionThe outcomes of outpatient TKA are impacted by risk factors that reflect underlying disparities in healthcare. As joint arthroplasties have come off the inpatient-only list and procedures move to ambulatory settings, these disparities will likely magnify and impact outcomes, costs, and access points. Extensive preoperative optimization and interventions that target medical and social factors may help to reduce these disparities in TKA and increase access among minority patients. Level of EvidenceIII, retrospective cohort study.

Warning Signs: Occult Diabetes and Dysglycemia in the Hand Surgery Patient Population.

Diabetes mellitus often exists for many years prior to diagnosis, and very little is known about the role of the prediagnosis stage of metabolic impairment in contributing to hand and upper-extremity pathology. The goal of this study is to determine the prevalence of undiagnosed glucose dysregulation in patients presenting with the 2 most commonly treated conditions of the hand and wrist. A retrospective study was performed of hand surgery patients with no established diagnosis of prediabetes or diabetes referred for a 2-hour glucose tolerance test according to American Diabetes Association criteria. Patients were divided into 3 groups: peripheral neuropathies, trigger finger, and controls with various upper-extremity diagnoses. Rates of undiagnosed prediabetes and diabetes were compared between groups, including subgroup analysis of patients based on unilateral or bilateral presentation. Binary logistic regression analysis was also used to calculate odds ratios for multiple variables. Patients with neuropathy had a significantly higher incidence of undiagnosed dysglycemia compared with the control group. Of those patients, 51.3% were prediabetic and 12.8% were diabetic. The control group had significantly lower rates. Within the bilateral neuropathy patients, 59.6% had prediabetes and 15.4% had diabetes, versus 34.6% with prediabetes and 7.7% with diabetes in the unilateral group. Hand surgeons encounter a patient population with high rates of undiagnosed prediabetes and diabetes, with some presentations as much as 6 times higher than the general population. Certain patient presentations should prompt appropriate diagnostic testing and referral, especially those presenting with bilateral compression neuropathy and elevated body mass index.

THE IMPACT OF EARLY CONDITIONS ON THE PREVALENCE OF DIABETES ACROSS THREE COHORTS OF OLDER ADULTS IN MEXICO

Abstract In low-and-middle-income countries like Mexico the impact of disadvantaged early childhood conditions (ECC) on later-life health in not well known and may be changing across birth cohorts. Our objective is to examine the impact of ECC on the propensity to have diabetes in three different cohorts of older adults aged 60-69 (born in 1930-1939, 1940-1949, 1950-1959). We examine to what extent differences in ECC, sociodemographic characteristics, and lifetime obesity explain the differences in the prevalence of diabetes across the cohorts. We use five waves of data from the Mexican Health and Aging Study (n=10,313). We estimate a series of logistic regression models and use counterfactual analyses to identify the roles of ECC and lifetime obesity on cohort-specific diabetes prevalence and on differences in diabetes prevalence across cohorts. Our results suggest that improvements in ECC would decrease prevalence of diabetes by 12.5% in the 1930-1939 cohort and 10% in the 1950-1959 cohort. However, the rise of obesity at age 50 counters this effect and leads to higher prevalence of diabetes in both cohorts. Our models show that if everyone had a normal weight at age 50, the prevalence of diabetes would decrease by 31.3% for the 1930-1939 cohort, 27.3% for the 1940-1949, and 26.7% for the 1950-1959 cohort. Despite improvements in socio-economic conditions during childhood in Mexico, the increase in lifetime obesity appear to offset the benefits derived from better ECC resulting in higher rates of diabetes.

An analysis of sex differences and socioeconomic deprivation among Canadian children with high blood pressure: a retrospective, cross-sectional study.

Understanding which children are at highest risk for high blood pressure (HBP) can inform surveillance and treatment. This study evaluated sex differences in childhood HBP and its associations with socioeconomic status. This retrospective cross-sectional study assessed 74,233 children with data from a national primary care electronic medical record database. Differences between sex and material and social deprivation scores for children with and without HBP were examined. Covariates included age, BMI z-score, diabetes, hyperlipidemia, and depression. HBP was defined as > 90th percentile for < 13-year-olds, and ≥ 120/80 for age ≥ 13years on 2 separate occasions between 2010 and 2017. The prevalence of HBP was 10.2% in males and 7.6% in females (p < 0.0001). Children with HBP had higher BMI z-scores (0.66 vs. 0.18, p < 0.0001), and higher rates of diabetes (1.31 vs. 0.54%, p < 0.0001), depression (9.89 vs. 7.11%, p < 0.0001), and hyperlipidemia (2.82 vs. 0.86%, p < 0.0001). In univariate regression analyses, boys in the most materially deprived quintile had increased odds of HBP (OR 1.24 (95% CI 1.08-1.43)), whereas females did not (OR 1.11 (95% CI 0.95-1.29)). In multivariate regression, male sex was associated with HBP with adjusted OR of 1.39 (95% CI 1.24-1.55). After statistical adjustment, material deprivation was no longer significant (aOR 1.05, 95% CI 0.94-1.17). Male sex is associated with HBP in Canadian children. This study also suggests a possible association between material deprivation and HBP, particularly in boys. Further study is required to better understand this relationship. A higher resolution version of the Graphical abstract is available as Supplementary information.

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review.

Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis. A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes. Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy. Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.