Hispanic Adults Research Articles

Association of Epigenetic Aging with Cognitive Aging in Diverse Hispanics/Latinos

AbstractBackgroundAge‐related DNA methylation (DNAm) changes occur in specific regions of the genome and have been shown to be correlated with an individual’s chronological age. Multiple “epigenetic clocks” have been developed to estimate an individual’s DNAm age, which reflect different aspects of the multidimensional aging process. Age acceleration, the deviation of the DNAm‐estimated age from the chronological age, has been proposed as a novel biomarker of aging. We investigated the association between multiple measures of age acceleration and cognitive aging phenotypes in diverse Hispanic and Latino adults.MethodsWe estimated epigenetic age acceleration from 5 epigenetic clocks in 2188 Hispanic and Latino adults (mean age 56.7 years; 64.6% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) who had available blood DNA methylation data at the baseline visit and neurocognitive data. These included first generation clocks, Horvath and Hannum clocks; second generation PhenoAge and GrimAge; and third generation DunedinPACE (Pace of Aging). We used mixed models to test the association of each of these measures with a global measure of cognitive function (PC1) at the baseline visit and with mild cognitive impairment at a follow‐up visit approximately 7 years later.ResultsThere were significant cross‐sectional associations between lower global cognitive function and greater age acceleration based on Hannum, Horvath, PhenoAge, and DunedinPACE algorithms. In addition, a greater age acceleration based on DunedinPACE was strongly associated with a higher risk of MCI 7 years later (Table).ConclusionBiological aging is associated with lower cognitive function and risk of MCI in diverse Hispanic and Latino adults. DunedinPACE, a third generation epigenetic clock, may be a more sensitive predictor of cognitive aging outcomes than previous generation clocks.

Admixture mapping of cognitive function in diverse Hispanic and Latino adults

AbstractBackgroundGenome‐wide association studies (GWAS) conducted primarily in populations of European ancestry have revealed the polygenic nature of cognitive abilities [1, 2] but genetic discoveries in other populations, including Hispanics/Latinos, are lagging. Genetically, US Hispanics/Latinos have uniquely admixed genomes, encompassing African, Amerindian, and European ancestries.[3] Admixture patterns in genomic regions (local ancestry) can be leveraged in gene mapping when frequencies of trait‐associated genetic variants located within these regions differ between ancestries.MethodWe conducted genome‐wide admixture mapping analyses followed by fine mapping to identify genetic variants associated with cognitive function in 7,140 Hispanic and Latino adults (mean age 55 years; 60.5% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Five measures of cognitive function were investigated: Six‐Item Screener (SIS), Brief Spanish English Verbal Learning Test (SEVLT), Word Fluency Test (WFT), Digit Symbol Substitution Test (DSST), and a measure of general cognitive function (PC1). We tested the identified variants for replication in independent samples with similar neurocognitive measures.ResultWe identified 9 significant local ancestry‐associated regions for the 5 cognitive tests. Counts of African ancestry on at 13q12.11, 4q14, 10p12.2 and 9p22.1 were associated with DSST, PC1, SIS, and WFT, respectively. Counts of Amerindian ancestry at 1q25.2 were associated with DSST; and at 12q14.2 and 12q15 with SIS. Counts of European ancestry at 8p22 were associated with SEVLT; and at 13q12.13 with, both, DSST and PC1. Fine mapping via SNP association testing in each region identified genetic variants that partially or totally explained the admixture signal. While statistical evidence of independent replication of the prioritized variants was generally weak, with only two replicated associations at chr8p22 and chr13q12.13, there was strong biological support for the observed associations to cognitive function. For example, the prioritized variant at 8q22 is an eQTL for CNOT7, which regulates synaptic plasticity and is essential for hippocampal‐dependent learning and memory [4].ConclusionOur admixture mapping analyses identified multiple novel loci associated with measures of cognitive function. This demonstrates the effectiveness of admixture mapping in complementing GWAS [5] and provides an opportunity to identify genetic loci that may be particularly relevant in underrepresented populations.

Abstract B133: Disparities in risk factors for nonalcoholic fatty liver disease (NAFLD) among a racially and ethnically diverse cohort

Abstract Background NAFLD has become the leading cause of chronic liver disease and is an important risk factor for liver cancer. About 25% of the U.S. adult population has NAFLD, with prevalence up to 70% among those with type 2 diabetes. Racial and ethnic disparities in NAFLD show Asian and Hispanic Americans at greater risk. Yet, few studies have examined risk factors and the magnitude of influence of these risk factors for NAFLD in racially and ethnically diverse populations. Methods This cohort included patients ≥ 18 years old who had at least two in-person visits at least one year apart between 2000 and 2017 at Kaiser Permanente Hawai`i, a large, integrated healthcare system. We excluded those who had NAFLD diagnosis at baseline (i.e., first year after the first in-person visit from 2000-2017). From the electronic medical record, we obtained data on sociodemographic (age, sex, race, ethnicity) and behavioral (tobacco use, care utilization) characteristics. We also extracted Current Procedural Terminology codes, International Classification of Diseases (ICD)-9 and -10 codes, prescription orders, vital signs, and laboratory results. We used small-area neighborhood data from the Hawaii Neighborhoods Data System. We ran sequential Cox regression models with outcome of incident NAFLD with age as the time-scale, underlying stratification by baseline year and decile of number of outpatient and ED encounters, and clustering by census tract. We added in variables one-by-one based on the order of influence. This was calculated as the percent difference in effect separately for: 1) sex (men compared to women) and 2) for each race and ethnicity group (compared to non-Hispanic White) from the base model when adding in each covariate separately. Results Of 373,032 patients followed for a median of 5.6 years, 8,994 had a diagnosis of incident NAFLD (2.4%). Variables associated with NAFLD and disparities by sex or race/ethnicity included having hypertension, high triglycerides, lower HDL, smoking, diabetes, overweight or obese body mass index (BMI), limited English proficiency, history of smoking, chronic hepatitis C, or low neighborhood SES. High triglycerides (triglycerides ≥150 mg/dL) had a substantial impact on NAFLD risk by sex; when high triglycerides were accounted for, risk among men compared to women changed from higher (HR=1.28; 95% CI:1.16-1.40) to lower (HR=0.74; 0.60-0.91) risk of NAFLD. Risk factors with the greatest impact on NAFLD risk differed across racial/ethnic groups. Among American Indian/Alaska Native and Hispanic adults, chronic hepatitis C virus infection had the greatest impact on NAFLD risk; among Asian American and Native Hawaiian/Pacific Islander adults, it was diabetes mellitus; and among adults with multiple races or ethnicities, it was BMI. Discussion Our analyses show NAFLD risk factors differ by sex and by race and ethnicity. To reduce NAFLD disparities targeted interventions should address the risk factors that are most salient for each of these groups. Citation Format: Janet N. Chu, Mindy C. DeRouen, Alison J. Canchola, Aly Cortella, Pushkar P. Inamdar, Yihe G. Daida, Scarlett L. Gomez, Hashem El-Serag, Salma Shariff-Marco. Disparities in risk factors for nonalcoholic fatty liver disease (NAFLD) among a racially and ethnically diverse cohort [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 B133.

Clinical Manifestations.

Recent studies comparing non-Hispanic Whites (NHW) to non-Hispanic Blacks (NHB) with cognitive impairment found differences in associations between neuropsychological performance and ratings of daily function. Evaluating differences in these relationships by race and ethnicity may be important to interpreting disparities in clinical research outcomes for people with Alzheimer's disease and related disorders. We compared demographic and performance variables across consensus diagnostic groups (CN, impaired-not-MCI, MCI, or dementia) at baseline in NHB (N = 1,609; 15.62%), Hispanic (N = 706, 6.86%) and NHW (N = 7,984,77.52%) adults in the NACC cohort, using data from Version 3.0 of the UDS, collected at the 37 NIA-ADRCs from March 2015 to June 2022 (alz.washington.edu). Spearman's rank correlation examined the associations between CDR-GS, MoCA, and FAS scores by race and ethnicity within consensus diagnostic groups. Among 10,299 participants, 5,964 (57.91%) were women, mean age at baseline was 69.34 (±9.80), and mean education was 16.02 (±2.81) years. Significant differences in gender proportions between race and ethnic groups were observed. NHB had a higher proportion of female participants (χ2 = 233.39 <.0001); and reported the lowest FAS scores (Z = 200.67, P < .001). Hispanic participants had completed fewer years of education (Z = 3999.92, p = <.0001); and reported higher depressive symptoms (Z = 39.81, p = <.0001). Significant correlations were observed between all assessments by race and ethnic groups. When stratified by consensus group, in the NHW and NHB subsamples, CDR and MoCA scores associations were significant except in the "Impaired not MCI" groups. In the Hispanic subsample, significant correlations were only observed in the dementia group. After adjusting for the effects of GDS scores, correlations retained significance except in the NHB MCI group. Significant correlations between CDR and FAS scores were observed except in the "Impaired not MCI" group in the Hispanic subsample. These associations were retained after controlling for depressive symptoms except in the Hispanic MCI group. Associations between cognitive and functional performance measures varied by racial and ethnic group when stratified by consensus groups in the NACC dataset. Specific ethnic, racial and socio-cultural factors, as well as implicit/explicit examiner bias that may drive differences in performance warrant further study.

Feasibility of the CART In‐Home Technology Platform in a Pilot Study of Hispanic Older Adults Residing in South Texas

AbstractBackgroundAs Alzheimer’s disease (AD) prevalence rises, the development of effective screening tools is necessary to aid in earlier AD diagnosis. In the USA, Hispanic and Non‐Hispanic Black adults are at a disproportionately higher risk of developing dementia than non‐Hispanic whites but are poorly represented in AD research. A digital assessment system ‐ the Collaborative Aging Research using Technology (CART) platform, has been developed to remotely and continuously detect early declines in cognition by analyzing changes in everyday activity levels. Although the platform is promising, installing digital technology in a home can cause concerns over privacy and user friendliness, especially in older adults. In our CART pilot study at UTHSCSA, we sought to determine the feasibility of deploying the CART platform in an underrepresented, mostly Hispanic population and to gain insight from their experiences.MethodSeven cognitively intact participants were enrolled in our year‐long pilot study. The CART platform consisted of a watch‐actigraph, digital scale, electronic pillbox, bed mat (measuring sleep), and wall‐mounted motion sensors. Participants completed weekly online surveys including mood assessments, the UDS3 neuropsychological battery at baseline and one‐year follow‐up, and an end‐of‐study user experiences survey. Wilcoxon signed rank exact tests were used to determine significance.ResultOur cohort consisted of five Hispanic, one non‐Hispanic Black, and one non‐Hispanic white participant, ages 65‐80. There were no significant changes in cognition, daily steps, sleep, weight, or heart and respiratory rate measured during sleep over the course of the study (p&gt;0.05). Self‐reported depressive symptoms decreased (p = 0.034) (Figure 1J). Weekly survey results supported this finding because self‐reported feelings of loneliness and “blue mood” also decreased. Responses to the user experience survey demonstrated that participants found the technology installation satisfactory (43%) or very satisfactory (57%) and thought that their privacy concerns were addressed satisfactorily (43%) or very satisfactorily (57%) (Figure 2).ConclusionOur results suggest that the CART platform was widely accepted by our mostly Hispanic older adult participants and that they were comfortable with the study devices. The findings support the feasibility of increasing representation of diverse older adults in dementia prevention research using digital devices.

Time-Trends in Food Insecurity Among US-Born and Foreign-Born Hispanic Adults by Language Use: An Analysis of National Health and Nutrition Examination Survey Data, 1999-2018

BackgroundHistorically, food insecurity prevalence has been higher in Hispanic households than in non-Hispanic White households. Food insecurity prevalence among Hispanic adults, US-born and foreign-born, may vary by language use. ObjectiveTo explore whether or not the relationship between language use and food insecurity varied over time (1999-2018) among US-born and foreign-born Hispanic adults. DesignTrends analysis and multivariable logistic regression modeling using pooled cross-sectional data. Participants and settingFifteen thousand sixty-two Hispanic adults participating in the United States National Health and Nutrition Examination Survey (1999-2018). Main outcome measuresFood insecurity prevalence, assessed with the US Household Food Security Survey Module. Statistical analysisUnadjusted food insecurity trends from 1999 to 2018 by language use (mostly English, both languages equally, or mostly Spanish) among US-born and foreign-born Hispanic adults were analyzed using piecewise-linear regression of log prevalence rates. Multivariable logistic regression models adjusted for sociodemographic characteristics and with an interaction term between language use and time were used to determine if odds of food insecurity among US-born and foreign-born Hispanic adults varied by language use between 1999 and 2018. ResultsHispanic adults’ food insecurity prevalence followed an upward linear trend from 1999 to 2018; this was significant for US-born mostly English-speakers (P < 0.001), US-born mostly Spanish-speakers (P = 0.013), and foreign-born mostly Spanish-speakers (P < 0.001). In fully adjusted logistic regression models, foreign-born Hispanic adults who spoke both languages equally (odds ratio 1.8, 95% CI 1.2 to 2.6) and those who spoke mostly Spanish (odds ratio 1.9, 95% CI 1.4 to 2.8) had significantly higher food insecurity odds, compared with mostly English-speakers. No variations in associations across time were observed between language use and food insecurity (interaction P value > 0.1). ConclusionsHispanic adults’ unadjusted food insecurity trends from 1999 to 2018 varied by language use. When adjusted for sociodemographic characteristics and compared with mostly English-speakers, food insecurity odds were significantly higher only among foreign-born Hispanic adults who spoke either both languages equally or mostly Spanish. Food assistance programs should linguistically adapt their services for Hispanic adults.

Does pain hurt more in Spanish? The neurobiology of pain among Spanish-English bilingual adults.

We previously found Spanish-English bilingual adults reported higher pain intensity when exposed to painful heat in the language of their stronger cultural orientation. Here, we elucidate brain systems involved in language-driven alterations in pain responses. During separate English- and Spanish-speaking fMRI scanning runs, 39 (21 female) bilingual adults rated painful heat intermixed between culturally evocative images and completed sentence reading tasks. Surveys of cultural identity and language use measured relative preference for US-American vs Hispanic culture (cultural orientation). Participants produced higher intensity ratings in Spanish compared to English. Group-level whole-brain differences in pain-evoked activity between languages emerged in somatosensory, cingulate, precuneus and cerebellar cortex. Regions of interest associated with semantic, attention and somatosensory processing showed higher average pain-evoked responses in participants' culturally preferred language, as did expression of a multivariate pain-predictive pattern. Follow-up moderated mediation analyses showed somatosensory activity mediated language effects on pain intensity, particularly for Hispanic oriented participants. These findings relate to distinct ('meddler', 'spotlight' and 'inducer') hypotheses about the nature of language effects on perception and cognition. Knowledge of language influences on pain could improve efficacy of culturally sensitive treatment approaches across the diversity of Hispanic adults to mitigate documented health disparities in this population.

1834. Impact of COVID-19 and Socioeconomic Status on Food Insecurity in the US Adult Population: Analysis of the 2021 National Health Interview Survey

Abstract Background Food insecurity (FI) is a public health concern and negatively affects the health and well-being of many adults in the US, which may have been exacerbated since the COVID-19 pandemic. However, the relationship between COVID-19 and FI among US adults has not been elucidated. Methods Data were from the 2021 National Health Interview Survey that used stratified clustering sampling to interview US adults aged ≥ 18 years. COVID-19 infection (yes/no) was per self-report. FI, determined by a 10-item questionnaire assessing household food situations in the past 30 days, was dichotomized (yes/no). Unweighted frequencies and weighted percentages were calculated and compared using Rao-Scott chi-square tests. Multivariable logistic regression was used to examine differences in FI prevalence by COVID-19. All analyses accounted for complex survey design and weights. Results The unweighted sample size was 28,274 (mean age 48.3 years). Overall, 13.5% (95% CI: 13.0%-14.1%) had COVID-19, and 5.9% (95% CI: 5.5%-6.3%) experienced FI. Adults with COVID-19 reported a significantly higher percentage of FI than those without (7.3% [95% CI: 6.1%-8.6%] vs. 5.6% [95% CI: 5.2%-6.0%], p=0.003). Most (63.2%) were White, followed by 16.7% Hispanic, 11.5% Black, 5.9% Asian, and 2.6% other races; 22.6% were on Medicaid/Medicare and 9.8% were uninsured; 12.9% received food stamps in the past 12 months. In the adjusted model, adults with COVID-19 were more likely to have experienced FI than those without (adjusted odds ratio [aOR]=1.29, 95% CI: 1.07-1.56). Black (aOR=2.08, 95% CI: 1.72-2.50) or Hispanic (aOR=1.26, 95% CI: 1.03-1.53) adults were more likely than their White counterparts to have experienced FI. Uninsured adults (aOR=2.67, 95% CI: 2.15-3.31) or those on Medicaid/Medicare (aOR=1.94, 95% CI: 1.60-2.35) had greater odds of having experienced FI than those privately insured. Adults receiving food stamps were more likely to have experienced FI than those not receiving (aOR=2.87, 95% CI: 2.36-3.50). Conclusion In this study of a nationally representative sample, our findings highlight a higher prevalence of FI among adults with COVID-19, with lower socioeconomic status, or in racial/ethnic minority communities and suggest the need for intervention strategies addressing FI in these adult populations. Disclosures All Authors: No reported disclosures

Association of the affordable care act with racial and ethnic disparities in uninsured emergency department utilization

BackgroundDisparities in uninsured emergency department (ED) use are well documented. However, a comprehensive analysis evaluating how the Affordable Care Act (ACA) may have reduced racial and ethnic disparities is lacking. The goal was to assess the association of the ACA with racial and ethnic disparities in uninsured ED use.MethodsThis study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for Georgia, Florida, Massachusetts, and New York from 2011 to 2017. Participants include non-elderly adults between 18 and 64 years old. Outcomes include uninsured rates of ED visits by racial and ethnic groups and stratified by medical urgency using the New York University ED algorithm. Visits were aggregated to year-quarter ED visits per 100,000 population and stratified for non-Hispanic White, non-Hispanic Black, and Hispanic non-elderly adults. Quasi-experimental difference-in-differences and triple differences regression analyses to identify the effect of the ACA and the separate effect of the Medicaid expansion were used comparing uninsured ED visits by race and ethnicity groups pre-post ACA.ResultsThe ACA was associated with a 14% reduction in the rate of uninsured ED visits per 100,000 population (from 10,258 pre-ACA to 8,877 ED visits per 100,000 population post-ACA) overall. The non-Hispanic Black compared to non-Hispanic White disparity decreased by 12.4% (-275.1 ED visits per 100,000) post-ACA. About 60% of the decline in the Black-White disparity was attributed to disproportionate declines in ED visit rates for conditions classified as not-emergent (-93.2 ED visits per 100,000), and primary care treatable/preventable (-64.1 ED visits per 100,000), while the disparity in ED visit rates for injuries and not preventable conditions also declined (-106.57 ED visits per 100,000). All reductions in disparities were driven by the Medicaid expansion. No significant decrease in Hispanic-White disparity was observed.ConclusionsThe ACA was associated with fewer uninsured ED visits and reduced the Black-White ED disparity, driven mostly by a reduction in less emergent ED visits after the ACA in Medicaid expansion states. Disparities between Hispanic and non-Hispanic White adults did not decline after the ACA. Despite the positive momentum of declining disparities in uninsured ED visits, disparities, especially among Black people, remain.

Linking Air Pollution Exposure to Blood-Based Metabolic Features in a Community-Based Aging Cohort with and without Dementia.

Long-term exposure to air pollution has been associated with changes in levels of metabolites measured in the peripheral blood. However, most research has been conducted in ethnically homogenous, young or middle-aged populations. To study the relationship between the plasma metabolome and long-term exposure to three air pollutants: particulate matter (PM) less than 2.5μm in aerodynamic diameter (PM2.5), PM less than 10μm in aerodynamic diameter (PM10), and nitrogen dioxide (NO2) in an ethnically diverse, older population. Plasma metabolomic profiles of 107 participants of the Washington Heights and Inwood Community Aging Project in New York City, collected from 1995-2015, including non-Hispanic white, Caribbean Hispanic, and non-Hispanic Black older adults were used. We estimated the association between each metabolic feature and predicted annual mean exposure to the air pollutants using three approaches: 1) A metabolome wide association study framework; 2) Feature selection using elastic net regression; and 3) A multivariate approach using partial-least squares discriminant analysis. 79 features associated with exposure to PM2.5 but none associated with PM10 or NO2. PM2.5 exposure was associated with altered amino acid metabolism, energy production, and oxidative stress response, pathways also associated with Alzheimer's disease. Three metabolites were associated with PM2.5 exposure through all three approaches: cysteinylglycine disulfide, a diglyceride, and a dicarboxylic acid. The relationship between several features and PM2.5 exposure was modified by diet and metabolic diseases. These relationships uncover the mechanisms through which PM2.5 exposure can lead to altered metabolic outcomes in an older population.

Postprandial Metabolite Profiles and Risk of Prediabetes in Young People: A Longitudinal Multicohort Study.

Prediabetes in young people is an emerging epidemic that disproportionately impacts Hispanic populations. We aimed to develop a metabolite-based prediction model for prediabetes in young people with overweight/obesity at risk for type 2 diabetes. In independent, prospective cohorts of Hispanic youth (discovery; n = 143 without baseline prediabetes) and predominately Hispanic young adults (validation; n = 56 without baseline prediabetes), we assessed prediabetes via 2-h oral glucose tolerance tests. Baseline metabolite levels were measured in plasma from a 2-h postglucose challenge. In the discovery cohort, least absolute shrinkage and selection operator regression with a stability selection procedure was used to identify robust predictive metabolites for prediabetes. Predictive performance was evaluated in the discovery and validation cohorts using logistic regression. Two metabolites (allylphenol sulfate and caprylic acid) were found to predict prediabetes beyond known risk factors, including sex, BMI, age, ethnicity, fasting/2-h glucose, total cholesterol, and triglycerides. In the discovery cohort, the area under the receiver operator characteristic curve (AUC) of the model with metabolites and known risk factors was 0.80 (95% CI 0.72-0.87), which was higher than the risk factor-only model (AUC 0.63 [0.53-0.73]; P = 0.001). When the predictive models developed in the discovery cohort were applied to the replication cohort, the model with metabolites and risk factors predicted prediabetes more accurately (AUC 0.70 [95% CI 40.55-0.86]) than the same model without metabolites (AUC 0.62 [0.46-0.79]). Metabolite profiles may help improve prediabetes prediction compared with traditional risk factors. Findings suggest that medium-chain fatty acids and phytochemicals are early indicators of prediabetes in high-risk youth.

Perceptions of COVID-19 Among Unvaccinated Hispanics.

Introduction: Despite the availability of an effective COVID-19 vaccine, uptake had been low in Midwestern Hispanic communities. A small qualitative study was undertaken to better understand perceptions of COVID-19 disease and prevention among unvaccinated Hispanic adults. Methods: Individual interviews were conducted, in Spanish, with adults (n = 20) who had not been vaccinated for COVID-19. Interview questions were guided by the Theory of Planned Behavior. Results: Participants (n = 20) were Hispanic adults (male = 5; female = 15). One overarching theme, lack of trust, emerged from the data. Perceived barriers to vaccination included emotions, personal values and myths. Recommendations by trusted health providers and willingness to receive education emerged as facilitators to COVID vaccine uptake. Conclusion: Members of the Kansas City Chapter of National Association of Hispanic Nurses used findings from this study to tailor strategies to enhance vaccine confidence in their local community. The chapter partnered with the local health department and Hispanic-serving organizations to provide COVID-19 education and vaccine access.

Sociodemographic Factors, Leisure-Time Physical Activity and Mortality

Exploring sociodemographic effect modification is important to provide evidence for developing targeted recommendations and reducing health inequalities. This study evaluated how sociodemographic factors including age, sex, race/ethnicity and socioeconomic status (SES) modify the association between leisure-time physical activity (LTPA) and all-cause and major cause-specific mortality. The study sample included 471,992 people from the 1997-2018 National Health Interview Survey (NHIS) and 41,830 people from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in December 2022. Mortality data from the National Death Index were available to December 31, 2019. Sufficient LTPA was defined as at least 150 minutes of moderate and/or vigorous intensity per week. There were 46,289 deaths in NHIS participants and 4,617 deaths in NHANES participants during a mean follow-up of 10 years. Individuals with sufficient LTPA had lower risk of all-cause (NHIS: hazard ratio, 0.74, 95% CI: [0.74-0.74]; NHANES: 0.73 [0.68-0.79]) and cardiovascular mortality (NHIS: 0.75 [0.75-0.75]; NHANES: 0.80 [0.69-0.93]) compared with inactive participants. The subgroup analysis showed significant interactions between LTPA and all sociodemographic factors. Associations between LTPA and mortality were weaker among younger individuals, males, Hispanic adults or those of low SES, respectively. Sociodemographic factors significantly modified the associations between LTPA and mortality. The health benefits of sufficient LTPA were smaller in younger individuals, males, Hispanic adults or those of low SES. These findings can help identify target populations for promotion of physical activity to reduce health inequalities and the development of physical activity guidelines.

Relative importance of behavior-specific determinants of heavy episodic drinking among U.S. young adults

ABSTRACTThe study examined the relative importance of heavy episodic drinking (HED)-specific determinants on past 2-week HED status among White, Black, and Hispanic young adults. Analyzing data from the wave III binge sample of the National Longitudinal Study of Adolescent to Adult Health, the study found that the relevance of HED-specific beliefs/expectancies, injunctive and descriptive norms, social images/prototypes, self-efficacy, and anticipatory emotions may vary within and across these construct domains, and by race and ethnicity. These findings highlight the need for alcohol prevention programs tailored by demographic characteristics such as race and ethnicity to enhance intervention effects. Larger-scale studies are necessary to confirm these results.

Community Exercise Program Participation and Mental Well-Being in the U.S. Texas-Mexico Border Region.

Hispanics are disproportionately affected by low rates of physical activity and high rates of chronic diseases. Hispanics generally and Mexican Americans specifically are underrepresented in research on physical activity and its impact on mental well-being. Some community-based interventions have been effective in increasing physical activity among Hispanics. This study examined data from a sample of low-income Hispanic participants in free community exercise classes to characterize the association between self-reported frequency of exercise class attendance, intensity of physical activity, and participant well-being. As part of two cross-sectional samples recruited from a stratified random sample of community exercise classes, 302 participants completed a questionnaire consisting of a modified version of the Godin-Shephard Leisure-Time Exercise Questionnaire (LTEQ) and the Mental Health Continuum Short Form (MHC-SF). Adjusted logistic regression analyses indicated that those who achieve mild, moderate, and strenuous self-reported physical activity have 130% higher odds (p = 0.0422) of positive mental well-being after adjustment for age, frequency of attendance, and self-reported health. This study provides evidence that the intensity of physical activity is associated with flourishing mental well-being among Hispanic adults. The association between physical activity and mental well-being is more pronounced when considering participants engaged in mild levels of physical activity. The study further provides insight into the planning and development of community-based physical activity programming tailored to low-income populations.

Abstract 19206: Race, Ethnicity, Gender, and Age Differences in Covid-19-Related Mortality From Diseases of the Heart

Introduction: Early evidence showed SARS-CoV-2 infection was associated with increased risk of acute cardiovascular complications. COVID-19 has since been implicated in intermediate and long-term cardiovascular disease. However, the impact of COVID-19 on heart disease mortality for specific demographic groups has not been investigated. Goals: This study aimed to determine whether excess heart disease mortality was COVID-19 related and whether differences existed by race/ethnicity, gender, and age.Research Question: What was the excess heart disease mortality associated with COVID-19 in 2020 and 2021? Methods: Death certificate and population data (2010-2021) for Black, White, and Hispanic adults were analyzed. Deaths with diseases of the heart (DOH) as either underlying or contributing cause were included (ICD-10 I00-I09, I11, I13, I20-I51). We fit a log-linear regression model to annual death rates for 2010-2019. Model coefficients were used to estimate expected DOH death rates for 2020-2021. We then compared observed to expected DOH mortality rate ratios and rate differences by age, sex, and gender for those pandemic years. The proportion of excess DOH deaths which had COVID-19 reported on the death certificate was calculated. Results: From 2010-2019, mortality from DOH was highest among Black men. Ratios of observed to expected DOH mortality rates for 2020-2021 were highest among younger ages (25-44 years), men, and Hispanics and Blacks compared to Whites. The proportion of excess DOH deaths with reported COVID-19 was highest among Hispanics compared to other demographic groups across all ages except those 85+. Seventy-five and 78 percent of excess deaths among Hispanic adults 55-64 years were COVID-19 related. Conclusion: Excess deaths during the COVID-19 pandemic were highest among young Black men and COVID-19 was more often reported with excess DOH deaths among Hispanic adults. Findings are consistent with other evidence of disproportionate negative social and structural impacts of COVID-19 among Black and Hispanic communities.

Abstract 17511: Aortic Stiffness Among Mexican-American Adults With Diabetes and Prediabetes: Evidence of Accelerated Vascular Aging and Increased Cardiac Biomarkers

Introduction: Type 2 diabetes mellitus is associated with increased aortic stiffness, a finding that predicts adverse cardiovascular events. Whether individuals with dysglycemia below the diagnostic threshold for diabetes have increased aortic stiffness has been less studied, particularly in Hispanic adults, a population sharing a disproportionate burden of dysglycemia. Hypothesis: We hypothesized that individuals with prediabetes would: (1) have increased aortic stiffness compared to normal glycemia, and (2) increased aortic stiffness would be associated with biomarkers of myocardial injury. Aims: We aimed to: (1) identify the relationship between aortic stiffness and glycemic status in a Hispanic cohort, and (2) determine the relationship between cardiac biomarkers and aortic stiffness. Methods: We prospectively measured carotid-femoral pulse wave velocity (PWV) and glycemic measures in 728 Mexican American adults in Starr County, Texas. Cardiovascular biomarkers [high-sensitivity troponin T (hs-TnT), galectin-3, and NT-proBNP] were measured in a subset (n=404). Multivariable models (using natural log PWV) were used to adjust for confounders. Results: 45% of participants had diabetes, and 28% had prediabetes. PWV increased across glycemic categories; median PWV (25 th , 75 th ) in diabetes was 11.7 m/sec (9.9, 13.7), prediabetes 9.9 m/sec (8.6, 11.1), and normal glycemia 8.7 m/sec (7.9, 9.9) (adjusted p-value &lt;0.001 and 0.008, respectively). The figure demonstrates PWV stratified by age decade; PWV in prediabetes was similar to PWV in those without diabetes who were a decade younger. Median levels of hs-TnT, galectin-3, and NT-proBNP increased across quartiles of PWV (p trend &lt;0.001 for all). Conclusion: In a cohort of Hispanic adults, increased aortic stiffness develops before the onset of diabetes and seen in those with pre-diabetes. Importantly, increased aortic stiffness is associated with biomarkers of cardiac injury.

Abstract 18538: Results of a Self-Management Intervention to Improve Hypertension in Black Patients Using the Electronic Health Record Patient Portal

Introduction: Nearly half of American adults (47%) have hypertension (HTN), and non-Hispanic Black patients are disproportionately represented among those diagnosed (56% versus 48% for White, 46% for Asian, and 39% Hispanic adults). Models of care to reduce blood pressure for the Black patient population are not consistently implemented, in large part due to systemic and structural barriers to care. Hypothesis: The purpose of this study was to improve access to and use of digital education, skills for self-measured blood pressure (SMBP) monitoring, use of the electronic health record (EHR) patient portal, and blood pressure from baseline to 3 months in a cohort of Black Americans. Methods: A pre-post intervention design was used to evaluate the team-based, nurse-led intervention. Patients received coaching on HTN goals, screening for social determinants of health (SDOH), medication review, self-paced portal-based videos, and teach-back for BP cuff use. Post-implementation blood pressure (BP) and self-management (knowledge, cuff-use, patient portal use, and attendance at follow-up) were measured using the HELM tool, Chronic Care Model (CCM) and American Heart Association (AHA) HTN toolkit. 12-month follow-up is ongoing. Results: Black participants (n=80) averaged 59 (SD 10) years of age; most were female (n=58, 73%), employed (n=59, 75%), non-smokers (n=66, 84%), with average BMI 34.5 (SD8). From 0-3-months, views of portal-pushed videos increased to 69%, knowledge scores improved pre- (M = 67.9, SD = 16.7 to post (M = 75.2, SD = 17.4), and mean systolic BP was significantly reduced by 20.3mmHg (95%CI 16.11, 24.44). Average systolic BP pre was 152.13 (SD = 16.87) and post was 131.85 (SD = 13.13), t (79) = 9.71, p&lt; .001. Sustainability at 12-months is ongoing. Conclusions: A team-based, nurse-led model improves patient engagement, adoption of portal-prescribed education, skills for SMBP, EHR-reported BP, and visit follow-up for Black patients with uncontrolled BP.

Abstract 13829: Assessing the Recovery From COVID-19-Related Disruptions to Cardiovascular-Related Screening Services by Race and Ethnicity

Introduction: The COVID-19 pandemic significantly disrupted routine clinical care in 2020. We aimed to assess recovery from COVID-19’s impacts on health care utilization, affordability, and cardiovascular risk factor screening in 2021, both overall and by race and ethnicity. Methods: We used 2019 and 2021 National Health Interview Survey data-a nationally-representative, cross-sectional household interview survey of US adults ( &gt; 18 years old). Outcomes included measures of health care access, affordability, and cardiovascular risk factor screening. Logistic regression models compared outcomes in 2021 (second year of pandemic) to 2019 (pre-pandemic baseline), adjusting for age and sex. An interaction term for race/ethnicity and year assessed for differential change across racial/ethnic groups. Results: The weighted population size was 250.9 and 253.1 million adults in 2019 and 2021. In 2021, wellness visits significantly decreased for all racial/ethnic groups compared with 2019, a decline most pronounced for Asian adults. Medical financial concerns decreased for White, Black, and Hispanic adults. Blood pressure, cholesterol, and diabetes screening significantly decreased for all groups in 2021 vs. 2019, with the largest declines among Asian adults (see Table 1 and Figure 1 for all results). Conclusions: In this national study of US adults, there were significantly fewer wellness visits and lower rates of cardiovascular risk factor screening in 2021 compared to pre-pandemic levels, overall and across all racial and ethnic groups. These results suggest that policy efforts are needed to improve access and cardiovascular screening as the US emerges from the pandemic.

COVID-19 Vaccine Hesitancy Among US Adults: Safety and Effectiveness Perceptions and Messaging to Increase Vaccine Confidence and Intent to Vaccinate.

Public health agencies have a critical role in providing effective messaging about mitigation strategies during a public health emergency. The objectives of this study were (1) to understand perceptions of COVID-19 vaccines, including concerns about side effects, safety, and effectiveness and how these perceptions influence vaccine decision-making among US adults and (2) to learn what messages might motivate vaccine uptake. In April and May 2021, we conducted 14 online focus groups with non-Hispanic English-speaking and English- and Spanish-speaking Hispanic adults (N = 99) not vaccinated against COVID-19. We oversampled adults aged 18-39 years and rural residents and systematically assessed 10 test messages. Researchers used a standardized guide and an a priori codebook for focus group discussions, coding transcripts, and thematic analysis. Vaccine hesitancy factors included fear of the unknown; long-term side effects, including infertility; and beliefs that the vaccines were developed too quickly and were not sufficiently effective. Motivating factors for receiving vaccination included the ability to safely socialize and travel. Health care providers were considered important trusted messengers. Participants were critical of most messages tested. Messages that came across as "honest" about what is not yet known about COVID-19 vaccines were perceived more positively than other messages tested. Messages were seen as ineffective if perceived as vague or lacking in data and specificity. Messages that were simple and transparent about what is unknown about vaccines relative to emerging science were viewed most favorably. Health care providers, friends, and family were considered influential in vaccination decision-making. Findings underscore the benefits of research-informed strategies for developing and disseminating effective messages addressing critical issues in a public health emergency.