Hispanic Subgroups Research Articles

Abstract B022: Smoking cessation interventions for Hispanic/Latinx adults in the United States: Results from a systematic review

Abstract Significance: Smoking rates have declined in the U.S. over the last several decades but vary by population subgroup. Hispanic adults generally have lower smoking rates than Non-Hispanic White individuals, but this varies greatly by country of origin, with some Hispanic subgroups, such as Puerto Ricans, reaching smoking prevalence rates up to 28%. Hispanic smokers have lower success rates in cessation attempts and are less likely to receive assistance in quitting, highlighting their unique cessation needs. The purpose of this systematic review was to determine the quantity and range of smoking cessation interventions targeted to Hispanic adults. Methods: A systematic literature search, following PRISMA guidelines, was conducted across seven databases, trial registries, and grey literature published until April 2024. Two authors independently screened titles, abstracts, and full texts for eligibility using Covidence. Study characteristics (e.g., intervention modality, language availability, cultural specificity) and outcomes were narratively summarized, and quality assessment was conducted. A meta-analysis is planned to evaluate the efficacy of smoking cessation interventions tested in RCTs, with a minimum follow-up of 6 months. The association between intervention type/modality and efficacy will be assessed via subgroup analyses. Results: A total of 8,844 records were identified and screened by reviewers. Of these, 456 studies were assessed for full-text eligibility, 49 studies with targeted interventions were identified for inclusion, of which 10 met criteria for meta- analysis. Of the 49 interventions identified, 44 interventions were offered in Spanish, 26 were culturally specific, and 34 had a majority Hispanic sample. Many interventions utilized multiple intervention modalities and included adjunct components. Types of interventions included behavioral counseling (n=26): in person (n=22) or over the phone (n=4), written self-help (n=6), text messaging (n=5), mass media campaigns (n=3), web-site applications or social media (n=3), pharmacotherapy with a behavioral adjunct (n=3), group counseling (n=2), and one smartphone application (n=1). Cessation rates ranged from 8% to 55%. No studies disaggregated smoking outcomes by Hispanic sub-group. Among the RCTs to be included in the planned meta-analysis, 5 out of 10 studies were culturally specific. Methodological quality for these studies ranged from weak (60%) to strong (10%). Conclusions: This systematic review summarizes the quantity and types of smoking cessation interventions for Hispanic smokers. Existing interventions vary in modality and are frequently offered in Spanish. However, few studies were tailored to values of Hispanic culture, and none addressed differences in smoking behavior among Hispanics by country of origin. Among the RCTs, most trials were rated as methodologically weak based on the Cochrane Risk of Bias tool. Results from this review may inform the development of future interventions, specifically guiding the design of rigorous randomized cessation trials for Hispanics. Citation Format: Honor M. Woodward, Ranjita Poudel, Helen Yates, Ursula Martinez, Mary-Katherine Haver, Jennifer I. Vidrine, Youngchul Kim, Thomas H. Brandon, Vani N. Simmons. Smoking cessation interventions for Hispanic/Latinx adults in the United States: Results from a systematic review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B022.

Abstract A105: Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience

Abstract Introduction: While uncommon, there has been an increase in non-small cell lung cancer (NSCLC) cases in patients under the age of 50 with little data on young Hispanic patients with NSCLC. This multicenter study describes the clinical characteristics of young Hispanic lung adenocarcinoma patients between two cities with a large Hispanic population. Methods: This retrospective study examined 90 Hispanic patients (18-50 years old) with metastatic lung adenocarcinoma treated at University of Miami (Miami) Sylvester Comprehensive Care Center (n=50), University of Southern California (USC) Norris Comprehensive Care Center/Los Angeles General Medical Center (n=26), and the Memorial Cancer Institute at West (Memorial) (n=14) from 2009-2023. We looked at age at diagnosis, sex, smoking history, stage at diagnosis, brain metastasis at diagnosis, mutations, tyrosine kinase inhibitor (TKI) exposure, and survival status at 24 months, 36 months, and 60 months. Fisher’s exact test was used to compare differences between USC (n=26) in Los Angeles, California, USA and Miami/Memorial (n=64) in Miami, Florida, USA. Results: 63.33% (n=57) of the patients were female. The median age at diagnosis was 41.5 years, including 8.89% (n=8) diagnosed from age 18-30, 33.33% (n=30) diagnosed from age 31-40, and 57.78% (n=52) diagnosed from age 41-50. 63.33% (n=57) identified as never smokers, 30.00% (n=27) identified as former smokers, and 6.67% (n=6) identified as current smokers. 85.56% (n=77) were found to have metastatic disease at diagnosis, including 34.44% (n=31) with brain metastasis at diagnosis. 28.89% (n=26) had an EGFR mutation, 28.89% (n=26) were ALK positive, and 8.89% (n=8) had a KRAS mutation. 55 (61.11%) had been exposed to a TKI. Between treatment sites, there was a greater prevalence of brain metastasis at USC versus Miami/Memorial (15/26, 57.69% vs. 16/64, 25.00%, p<0.01) and a trend towards greater prevalence of EGFR and KRAS mutations (EGFR: 11/26 (42.31%) vs. 15/64 (23.44%), p = 0.12; KRAS: 4/26 (15.38%) vs. 4/64 (6.25%), p = 0.22) and TKI exposure (19/26, 73.08% vs. 36/64, 56.25%, p=0.15) at USC versus Miami/Memorial. Regarding survival for stage IV patients, 37/61 (60.65%) of patients were alive at 24 months, 22/51 (43.1%) at 36 months, and 14/46 (30.4%) at 60 months with a trend towards more USC patients being alive at 36 months (10/18, 55.56% vs. 12/33, 36.36%) and 60 months (6/15, 40% vs. 8/31 25.8%). Conclusion: Young Hispanic lung adenocarcinoma patients are predominantly female, never smokers, diagnosed with metastatic disease, and enriched in EGFR and ALK mutations. There are differences in prevalence of brain metastasis, EGFR and KRAS mutations, TKI exposure, and survival between the USC and Miami/Memorial young lung adenocarcinoma patients. These notable frequencies may be attributed to the different Hispanic subgroups in the west coast versus southeastern USA. This study highlights the need for more attention towards Hispanic ethnicity in the young lung cancer population. Citation Format: Kyle Edwards, Darin Poei, Suset Almuinas de Armas, Coral Olazagasti, Zhonglin Hao, Jorge J. Nieva, Luis E Raez, Gilberto Lopes, Estelamari Rodriguez, Robert Hsu. Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A105.

Fractures by race and ethnicity in a diverse sample of postmenopausal women: a current evaluation among Hispanic and Asian origin groups.

Using 1998-2022 Women's Health Initiative (WHI) data, our study provides contemporary fracture data by race and ethnicity, specifically focusing on Hispanic and Asian women. Fractures of interest included any clinical, hip, and major osteoporotic fractures (MOFs). We utilized the updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups. We computed crude and age-standardized fracture incidence rates per 10 000 woman-years across race and ethnic categories and by Asian and Hispanic origin. We used Cox proportional hazards model, adjusting for age and WHI clinical trial arm, to evaluate the risk of fracture (1) by race compared to White women, (2) Asian origin compared to White women, (3) Hispanic compared to non-Hispanic women, and (4) Asian and Hispanic origins compared the most prevalent origin group. Over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160 824 women experienced any clinical fracture, including 36 278 MOFs and 8962 hip fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only Black and Asian women had significantly lower hip fracture risk. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.

Emphasizing family as a source of social support: implications for work-family conflict and job satisfaction among hispanic professionals

PurposeAlthough Hispanics represent a large and growing proportion of the US workforce, little is known regarding the possible effects of their somewhat unique cultural values, beliefs, and practices on their experiences of work-family conflict or job satisfaction. This research tested theoretically derived hypotheses regarding the protective effect of a component of familism values, family as a source of social support, on these outcomes.Design/methodology/approachA moderated mediation model was tested using survey data from Hispanic professionals (N = 103).FindingsAs predicted, family support was negatively related to work interfering with family (WIF) and positively related to job satisfaction. WIF mediated the relationship between family support and job satisfaction. Additionally, gender moderated this mediated relationship such that the effects were stronger for Hispanic women than men.Research limitations/implicationsGeneralizability of the results should be explored by employing larger samples that include longer tenured workers, employees with higher degrees of management experience, and additional Hispanic subgroups. Results contribute to a growing body of research demonstrating beneficial effects of familism values for Hispanics.Practical implicationsResults suggest that organizations may benefit from taking active steps to support familism values among Hispanic workers.Originality/valueThis is the first empirical study to explore the possible benefits of family support values on workplace outcomes.

Identity and access: Gender-based preferences and physician availability in primary care

Patient preferences for physicians may be influenced by shared characteristics such as gender. We analyzed experimental data from a survey of US adults in which respondents were asked to choose between physician profiles that on average varied only by gender. We find that female patients prefer female physicians to male physicians by 51.8 percentage points (95 % CI: 0.470 to 0.566, p < 0.01), and that result holds across Black, White, and Hispanic sub-groups. With no countervailing preference among male patients, this result holds in the overall sample at 26.8 percentage points (95 % CI: 0.228 to 0.307, p < 0.01). We also analyzed data from a simulated patient field experiment concerning access to primary care appointments and find that female physicians, on average, offer appointments 7.1 days later than male physicians (95 % CI: 5.1 to 9.1, p < 0.01), consistent with the finding that female physicians are preferred. Female physicians’ offices appear to favor female patients, offering appointments to them 2.6 days earlier compared to male patients (95 % CI: -5.3 to 0.195, p = 0.07). However, Hispanic female patients were offered 4.2-percentage-points fewer appointments compared to Hispanic males (95 % CI: -0.069 to -0.014, p < 0.01) by female physicians’ offices. Similarly, Black female patients were told that the physician is “not taking new patients” 3.5 percentage points more often (95 % CI: -0.004 to 0.073, p = 0.08) and were offered appointments that were 2.6 minutes shorter compared to Black males (95 % CI: -4.8 to -0.44, p = 0.02). Overall, our analysis suggests that female primary care physicians are in high demand relative to their supply, and that access to scarce female physicians is mediated by race and ethnicity.

Dissecting racial/ethnic disparities in non-small cell lung cancer staging at diagnosis: Intra-ethnic and geographic differences.

1575 Background: Lung cancer outcomes significantly rely on accurate and early detection. This population-based study aims to identify factors contributing to disparities in the stage of non-small cell lung cancer (NSCLC) diagnoses, focusing on Hispanic ethnic subgroups. Methods: Incident cases diagnosed from 2005–2018 were extracted from the Florida State Cancer Registry. Stage was categorized as resectable (Stage I-IIIA) or nonresectable (Stage IIIB/IIIC/IV) NSCLC. Multivariable logistic regression models were used to assess the association between race/ethnicity and stage at diagnosis, adjusted for socioeconomic, smoking status, and clinical factors. Regional stratification involved separate analyses for heavily Hispanic South Florida and the rest of Florida. Results: Among 157,034 NSCLC patients, with a racial distribution of 81.0% White, 8.3% Black, and 9.2% Hispanic, 43.2% were diagnosed at a resectable stage. Age-adjusted models showed Black patients had 22% higher odds (odds ratio [OR]=1.22; 95% CI: 1.21-1.23) and Hispanic patients had 11% higher odds (OR=1.11; 95% CI: 1.10-1.12) of non-resectable stage across all subgroups diagnoses compared to White patients. However, after further adjustment, higher odds were significant only for NHB (ORadj=1.12; 95% CI: 1.11-1.14) and Central American Hispanics (ORadj=1.41; 95% CI: 1.35-1.47). Regional differences were significant, with Hispanic patients in South Florida showing more favorable staging outcomes than Whites (ORadj=0.95; 95% CI: 0.94-0.97), while in the rest of Florida, Hispanic patients were at a disadvantage (ORadj=1.09; 95% CI: 1.07-1.10). Conclusions: Pronounced NSCLC staging disparities are manifest in Black and Hispanic populations, coupled with striking regional variations among Florida's Hispanic groups which underscores the necessity for targeted research to dissect and address the underlying causes of these inequities in the cancer care continuum.

Meta-analysis of residency program application and acceptance according to sex, race and ethnicity.

We aimed to investigate trends in residency program application and acceptance rates according to sex and race and ethnicity. We collected data from the Journal of the American Medical Association Graduation Medical Education Reports. We extracted the data for 25 residency programs in the United States from 2005 to 2021 and conducted statistical analyses. Men were most matched for orthopedics (84.7%, 95% confidence interval [CI] 84.2%-85.1%), and women for oncology (78.7%, 95% CI 78.2%-79.2%). The most matched program was orthopedics for the White subgroup (43.5%, 95% CI 43.2%-43.9%), radiology for the Black subgroup (20%, 95% CI 18.9%-20.9%), general surgery for the Hispanic subgroup (11%, 95% CI 10.7%-11.2%), and internal medicine for the Asian subgroup (35.3%, 95% CI 34.9%-35.6%). Match rates for women were lower than those for men in all programs except psychiatry, pediatrics, obstetrics and gynecology, and dermatology. Match rates were significantly lower for Black, Hispanic, and Asian subgroups than the White subgroup in all programs except for internal medicine, with the Asian subgroup being higher. We observed a significant increase in both application and acceptance rates for women and racial and ethnic minorities over the past 40 years.

Nativity Disparities in Colorectal Cancer Screening Among Hispanics in the United States.

Hispanics in the United States (U.S.) have previously exhibited lower guideline-concordant colorectal cancer (CRC) screening uptake than non-Hispanic (NH) Whites, with disparities accentuated in foreign-born Hispanics, however it is unclear whether nativity-related CRC screening disparities have changed in the last two decades and whether these disparities are attenuated after adjusting for socioeconomic and demographic characteristics. We evaluated CRC screening adherence in foreign- and U.S.-born Hispanics compared to U.S.-born NH Whites. We used 2019 National Health Interview Survey data to compare the prevalence of up-to-date CRC screening per the 2019 U.S. Preventive Services Task Force recommendations among Hispanic nativity subgroups (i.e., foreign- and U.S.-born) and U.S.-born NH Whites using unadjusted and adjusted weighted log-linked binomial regression. Foreign- and U.S.-born Hispanics had a significantly lower unadjusted prevalence of up-to-date screening than U.S.-born NH Whites (47.18% and 64.18% versus 70.70%; p < 0.0001 and p = 0.0109, respectively). After adjusting for socioeconomic and demographic differences, the prevalence of up-to-date screening was lower in foreign-born Hispanics compared to U.S.-born NH Whites [adjusted prevalence ratio 0.80 (95% confidence interval 0.70-0.91)]; however, no statistically significant difference was observed between U.S.-born Hispanics and NH Whites. Our results suggest a low screening uptake in foreign-born Hispanics independent of socioeconomic and demographic differences. Future interventions should target foreign-born Hispanics to address disparities and promote early detection and prevention of CRC regardless of socioeconomic factors.

Widening Disparities in COVID-19 Mortality and Life Expectancy Among 15 Major Racial and Ethnic Groups in the United States, 2020-2021.

Persistent and often widening racial/ethnic and socioeconomic inequalities in health have long existed in the US. Although racial/ethnic disparities in COVID-19 mortality are well documented, COVID-19 mortality risks and resultant reductions in life expectancy during the pandemic for detailed racial and ethnic groups in the US, including Asian and Hispanic subgroups, are not known. We used 2020-2021 US mortality data to estimate age-adjusted COVID-19 mortality rates, life expectancy, and the consequent declines in life expectancy due to COVID-19 overall and for the 15 largest racial/ethnic groups. We used standard life table methodology, cause-elimination life tables, and inequality indices to analyze trends in racial/ethnic disparities. The number of COVID-19 deaths increased from 350,827 in 2020 to 416,890 in 2021. COVID-19 death rates varied 7-fold among the racial/ethnic groups; Japanese and Chinese had the lowest mortality rates and Mexicans and American Indians/Alaska Natives (AIANs) had the highest rates. In 2021, life expectancy ranged from 70.3 years for Blacks and 70.6 years for AIANs to 85.2 years for Japanese and 87.7 years for Chinese. The life-expectancy gap was wide- 22.4 years in 2020 and 23.2 years in 2021. COVID-19 mortality had the greatest impact in reducing the life expectancy of Mexicans (3.53 years in 2020 and 3.78 years in 2021), Central/South Americans (4.86 years in 2020 and 3.50 years in 2021), and AIANs (2.51 years in 2020 and 2.38 years in 2021). Racial/ethnic inequalities in COVID-19 mortality, life expectancy, and resultant reductions in life expectancy during the pandemic widened between 2020 and 2021.

What's Behind the Dramatic Pre-2020 Declines in Hispanic/Latina Adolescent Childbearing? Decomposing Change by Age, Origin, and Nativity

PurposeTo assess whether the large declines in adolescent childbearing among Hispanic adolescents over the period 2000-2019 have been driven by co-occurring changes in the composition of the Hispanic population and, if so, whether they have done so differentially by Hispanic subgroup. MethodsWe use birth counts from the United States vital statistics system and population denominators from the United States decennial census long form 5-percent Public Use Microdata and the American Community Survey to conduct a decomposition analysis apportioning observed declines in Hispanic adolescent childbearing to: (1) compositional shifts in nativity, age, and region-of-origin and (2) subgroup changes in childbearing rates. ResultsThe Hispanic adolescent fertility rate fell by over 71% from 2000 to 2019, with Mexican-Origin, United States-born, and younger adolescents exhibiting the steepest declines (79%, 70%, and 80% declines, respectively). Results from the decomposition analysis show that almost 90% of the decline is due to within-group rate change, with some variability by subgroup and by decade. Only 10% of the decline was due to compositional changes, with shifts in nativity driving much of the effect. DiscussionDeclines in Hispanic adolescent childbearing over the last decades have occurred in spite of substantial shifts in the composition of the Hispanic population, not because of them. These findings set the stage for a more detailed examination of the drivers of change in sexual activity, contraceptive use, and abortion, all of which are proximate determinants of adolescent pregnancy and childbearing. Additionally, a focus on more distal factors is needed, including the role that changing political, societal, and economic conditions in the United States have for early fertility patterns.

Exploring U.S. Hispanic origin groups diagnosed with uterine cancer - Are there disparities?

ObjectiveTo evaluate patterns and trends of uterine cancer among Hispanic subgroups. MethodsThe United States Cancer Statistics (USCS), National Cancer Database (NCDB), and World Population Review were used to obtain data on incidence, demographic characteristics, and cancer histology. Joinpoint regression program was used for statistical analysis. ResultsBased on 2001–2017 USCS data, the overall incidence of uterine cancer was 27.46 vs. 23.29/100,000 in Hispanics vs. non-Hispanic Whites. There was an over 2-fold higher annual increase in the incidence in Hispanics (1.94%; p < 0.001) vs. Whites (0.85%; p < 0.001), particularly in local stage disease. There was an increase in grade 1 endometrioid carcinoma (1.48%; p < 0.001 vs. −0.52%; p = 0.1) and aggressive histologic subtypes (4.04% p = 0.000 vs. 2.53% p = 0.000) in Hispanics vs. Whites.Using the NCDB (2004–2015), we analyzed 17,351 Hispanics by subgroup (Mexican, South/Central American, Puerto Rican, Cuban, and Dominican). Over the 12 years, there was an increase in the proportion of uterine cancer diagnoses in all Hispanics (5.2% to 11.0%; p < 0.0001). Dominican patients experienced the largest increase in diagnosis (2.6% to 14.9%; p < 0.0001), the highest proportion of advanced disease at 28.0% (p < 0.0001), and the highest incidence of non-endometrioid histologies at 37.1% (p < 0.0001).World Population Review 2023 revealed the highest female obesity rates in Puerto Rico (51.4%), the Dominican Republic (34.1%), and Mexico (32.8%). ConclusionUterine cancer incidence is increased in Hispanics, with the largest increase in Dominican women with more advanced stages and high-risk histologic subtypes. The impact of obesity on cancer risk, especially in Puerto Ricans, Dominicans, and Mexicans, warrants further investigation.

Do Segmented Assimilation Theory and Racialized Place Inequality Framework Help Explain Differences in Deaths Due to COVID-19 Observed among Hispanic Subgroups in New York City?

This article studies the differences in the correlation between deaths and the Hispanic share for different Hispanic subgroups in New York City. Such differences are predicted by Segmented Assimilation Theory as different assimilation paths. The study is carried out at the level of PUMAs, and it is argued that such geographic locations are macro-level factors that determine health outcomes, as the theory of Racialized Place Inequality Framework claims. The study presents a spatially correlated model that allows to decompose the spatial effects into direct and indirect effects. Direct effects are linked to the macro structure where the individual lives, while indirect effects refer to effects in the adjacent macro structures where the individual lives. The results show that both types of effects are significant. The importance of the direct effects is predicted by RPIF, while the importance of the indirect effects is a new result that shows the complexity of the effects of macro structures. The article also shows results for subsamples that allow to test the importance of different factors that have been linked to the excess deaths observed among Hispanics. The effects of such factors are also found to be heterogenous among the different Hispanic subgroups, which also provides evidence in favor of the Segmented Assimilation Theory. Access to health insurance and doctor density are found to be the most important elements that serve as protective factors for all Hispanic subgroups in New York City, signaling its importance in achieving assimilation for Hispanic immigrants to New York City.

FAMILY MATTERS: CROSS-CULTURAL DIFFERENCES IN FAMILISM AND CAREGIVING OUTCOMES

Abstract The increasing number of minority older adults and subsequent increase in minority individuals needed to provide care highlights the need to understand how the caregiving role is experienced and perceived among racial/ethnic minority groups. Familism, a cross-cultural collectivist value, has been examined as a driving mechanism influencing differential outcomes in family caregivers. However, research examining familism in caregiving has yielded mixed results. Guided by the Sociocultural Stress and Coping Model, the purpose of this study is to examine cross-cultural differences in familism and its influence on caregiving outcomes. Baseline data were collected from 243 family caregivers who participated in the Caring for the Caregiver Network randomized controlled trial, a culturally tailored technology-based psychosocial intervention. Results showed that familism was more highly endorsed by Hispanic and African American participants, when compared to Whites, which was subsequently associated with positive aspects of caregiving, depression, and burden. Exploratory analyses among the Hispanic subgroup were conducted to examine how acculturation, operationalized as number of years living in the US, influences familism and found that a longer length of time spent in the US was negatively associated with familism. When dividing our sample into U.S. natives versus non-natives, non-native Hispanic participants reported higher familism compared to natives. Findings indicate that cross-cultural differences in caregiving appraisals may operate as a function of cultural values, which influence one’s subjective evaluation of the caregiving role and contribute to more optimal outcomes – highlighting the need for culturally congruent interventions to promote positive caregiving outcomes particularly among racial/ethnic minorities.

METABOLIC SYNDROME, LIFESTYLE FACTORS, AND SLEEP-DISORDERED BREATHING IN US HISPANICS: IMPLICATIONS FOR MID LIFE

Abstract US Hispanics/Latinos are disproportionately susceptible to metabolic syndrome (MetS), attributed in part to health and lifestyle factors such as low physical activity levels, diet quality, alcohol use, tobacco use, and sleep-disordered breathing. The risk of MetS and MetS-related complications increases with age. We examined the relationships between select health and lifestyle factors and MetS among Hispanic gender-heritage subgroups and determined whether gender and heritage moderate those relationships. Participants included 14,155 Hispanic Americans aged 18–76 (59% women, mean age 45.92 ± 13.97) from seven heritage subgroups. This secondary analysis of cross-sectional data from the observational Hispanic Community Health Study / Study of Latinos dataset used multinomial logistic regression and Hayes’ PROCESS macro to test these relationships; the dependent variable, MetS, included four categories delineating MetS and related medication use. Results include low physical activity (p&amp;lt; .001) and sleep-disordered breathing (p&amp;lt; .001) were associated with the MetS with medication use group. High alcohol use decreased the probability of being in this group (p&amp;lt; .001). Cigarette pack years were not significantly associated with MetS outcomes. Gender moderated the association between MetS and diet quality (p&amp;lt; .001), alcohol use (p&amp;lt; .001), cigarette pack-years (p&amp;lt; .001), and sleep-disordered breathing (p&amp;lt; .001). Low physical activity and sleep-disordered breathing was significantly associated with MetS group membership, whereas low and high alcohol use were associated with decreased MetS risk. Gender-heritage differences were prominent in each of the study variables. Midlife may be an important target for prevention and intervention; other considerations for aging will be discussed.

Risk Factors Amenable to Primary Prevention of Type 2 Diabetes Among Disaggregated Racial and Ethnic Subgroups in the U.S.

Race and ethnicity data disaggregated into detailed subgroups may reveal pronounced heterogeneity in diabetes risk factors. We therefore used disaggregated data to examine the prevalence of type 2 diabetes risk factors related to lifestyle behaviors and barriers to preventive care among adults in the U.S. We conducted a pooled cross-sectional study of 3,437,640 adults aged ≥18 years in the U.S. without diagnosed diabetes from the Behavioral Risk Factor Surveillance System (2013-2021). For self-reported race and ethnicity, the following categories were included: Hispanic (Cuban, Mexican, Puerto Rican, Other Hispanic), non-Hispanic (NH) American Indian/Alaska Native, NH Asian (Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, Other Asian), NH Black, NH Pacific Islander (Guamanian/Chamorro, Native Hawaiian, Samoan, Other Pacific Islander), NH White, NH Multiracial, NH Other. Risk factors included current smoking, hypertension, overweight or obesity, physical inactivity, being uninsured, not having a primary care doctor, health care cost concerns, and no physical exam in the past 12 months. Prevalence of hypertension, lifestyle factors, and barriers to preventive care showed substantial heterogeneity among both aggregated, self-identified racial and ethnic groups and disaggregated subgroups. For example, the prevalence of overweight or obesity ranged from 50.8% (95% CI 49.1-52.5) among Chinese adults to 79.8% (73.5-84.9) among Samoan adults. Prevalence of being uninsured among Hispanic subgroups ranged from 11.4% (10.9-11.9) among Puerto Rican adults to 33.0% (32.5-33.5) among Mexican adults. These findings underscore the importance of using disaggregated race and ethnicity data to accurately characterize disparities in type 2 diabetes risk factors and access to care.

Maternal Nativity and Preterm Birth

Preterm birth is a major contributor to neonatal morbidity and mortality, and considerable differences exist in rates of preterm birth among maternal racial and ethnic groups. Emerging evidence suggests pregnant individuals born outside the US have fewer obstetric complications than those born in the US, but the intersection of maternal nativity with race and ethnicity for preterm birth is not well studied. To determine if there is an association between maternal nativity and preterm birth rates among nulliparous individuals, and whether that association differs by self-reported race and ethnicity of the pregnant individual. This was a nationwide, cross-sectional study conducted using National Center for Health Statistics birth registration records for 8 590 988 nulliparous individuals aged 15 to 44 years with singleton live births in the US from 2014 to 2019. Data were analyzed from March to May 2022. Maternal nativity (non-US-born compared with US-born individuals as the reference, wherein US-born was defined as born within 1 of the 50 US states or Washington, DC) in the overall sample and stratified by self-reported ethnicity and race, including non-Hispanic Asian and disaggregated Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Pacific Islander, Vietnamese, and other Asian), non-Hispanic Black, Hispanic and disaggregated Hispanic subgroups (Cuban, Mexican, Puerto Rican, and other Hispanic), and non-Hispanic White. The primary outcome was preterm birth (<37 weeks of gestation) and the secondary outcome was very preterm birth (<32 weeks of gestation). Of 8 590 988 pregnant individuals included (mean [SD] age at delivery, 28.3 [5.8] years in non-US-born individuals and 26.2 [5.7] years in US-born individuals; 159 497 [2.3%] US-born and 552 938 [31.2%] non-US-born individuals self-identified as Asian or Pacific Islander, 1 050 367 [15.4%] US-born and 178 898 [10.1%] non-US-born individuals were non-Hispanic Black, 1 100 337 [16.1%] US-born and 711 699 [40.2%] non-US-born individuals were of Hispanic origin, and 4 512 294 [66.1%] US-born and 328 205 [18.5%] non-US-born individuals were non-Hispanic White), age-standardized rates of preterm birth were lower among non-US-born individuals compared with US-born individuals (10.2%; 95% CI, 10.2-10.3 vs 10.9%; 95% CI, 10.9-11.0) with an adjusted odds ratio (aOR) of 0.90 (95% CI, 0.89-0.90). The greatest relative difference was observed among Japanese individuals (aOR, 0.69; 95% CI, 0.60-0.79) and non-Hispanic Black individuals (aOR, 0.74; 0.73-0.76) individuals. Non-US-born Pacific Islander individuals experienced higher preterm birth rates compared with US-born Pacific Islander individuals (aOR, 1.15; 95% CI, 1.04-1.27). Puerto Rican individuals born in Puerto Rico compared with those born in US states or Washington, DC, also had higher preterm birth rates (aOR, 1.07; 95% CI, 1.03-1.12). Overall preterm birth rates were lower among non-US-born individuals compared with US-born individuals. However, there was substantial heterogeneity in preterm birth rates across maternal racial and ethnic groups, particularly among disaggregated Asian and Hispanic subgroups.

Abstract 12414: Aggregated Data Masks Racial and Ethnic Disparities in Cardiometabolic Disease Prevalence

Background: Although data disaggregation can unmask important differences in health disparities among subgroups, prevalence of cardiometabolic diseases among disaggregated racial and ethnical subgroups in the United States is inadequately characterized. Research Question: How does prevalence of diagnosed cardiometabolic diseases among US adults vary by racial and ethnic subgroups? Methods: A total of 3,970,904 US adults aged ≥18 years were identified from the Behavioral Risk Factor Surveillance System, 2013-2021. Prevalence of each cardiometabolic disease (diabetes, myocardial infarction, angina or coronary heart disease [CHD], stroke) was based on self-reported diagnosis by a healthcare professional, adjusting for age, sex, and survey year. Results: Adjusted prevalence of diabetes was 10.9% (95% confidence interval: 10.8-11.0%) in the total population, ranging from 9.1% (9.0-9.1%) among Non-Hispanic (NH) White adults, to approximately 16% among NH American Indian/Alaska Native, NH Black, and NH Pacific Islander adults. Diabetes prevalence was 11.5% (11.0-12.0%) for the aggregated NH Asian category, but ranged from 6.3% (4.7-8.4%) in the Vietnamese subgroup to 15.2% (13.8-16.8%) in the Filipino subgroup. Additional adjusted overall prevalences were myocardial infarction 4.3% (4.3-4.3%), angina or CHD 4.1% (4.1-4.2%), and stroke 3.2% (3.1-3.2%). Within the Hispanic subgroups, reported prevalence of angina or CHD ranged from 3.1% (2.3-4.0%) to 6.3% (6.0-6.6%) among Cuban and Puerto Rican subgroups, respectively. Conclusion: Prevalence of diagnosed cardiometabolic diseases varied considerably among racial and ethnic subgroups, highlighting the utility of data disaggregation in accurate characterization of health disparities within specific racial and ethnic populations. Such data can be used to better tailor disease prevention programs to disproportionately-affected subpopulations.

Perceptions of palliative care knowledge among Hispanics in the United States: An analysis of the Health Information National Trends Survey data.

270 Background: Patient knowledge of palliative care (PC) has been demonstrated to improve the quality of end-of-life care. Current evidence indicates decreased knowledge of PC and decreased utilization of services such as hospice and advanced directives among Latinos in the US. Hispanic Americans make up 18.9 % of the US population, however, categories of Latino and Hispanic are broad and encompass different ethnic groups, each with unique cultures and experiences. Previous research has demonstrated different ethnicities have differing perspectives on end-of-life care. In this study, we aim to investigate variations in knowledge of PC between different Latino ethnic subgroups in the US. Methods: We employed data from the National Cancer Institute’s Health Information National Trends Survey (HINTS5–Cycle 2; 2018) for a nationally-representative sample of 3,504 adults (aged ≥18 years). Lack of knowledge of PC was assessed by respondents’ selecting “I’ve never heard of it” when asked, “How would you describe your level of knowledge about palliative care?” We performed a binomial regression assessing knowledge of PC and comparing this answer choice between Hispanic and non-Hispanic respondents as well as a Wilcoxon-Mann-Whitney test to compare among Hispanic subgroups. Results: Of all 3,504 survey respondents, 13.07% self-identified as Hispanic, and 65.2% stated they had never heard of palliative care. In the ethnic subgroups analyzed, 173 (79.4%) Mexicans, 33 (71.7%) Puerto Ricans, and 11 (55%) Cubans reported they had never heard of PC compared to 689 (62.2%) of non-Hispanics. We used a binomial regression to compare this response in Hispanics vs. non-Hispanics and found a significant difference in PC knowledge between Hispanics and non-Hispanics (p &lt; 0.001), with an OR of 0.469 between the lack of PC knowledge answer choice and selecting Hispanic (95% CI 0.37-0.6). A Wilcoxon-Mann-Whitney comparing PC knowledge by subgroups found a significant difference between non-Hispanics and Mexicans (p&lt; 0.001) but no differences between Hispanic sub-groups. Conclusions: Hispanics had lower levels of knowledge of PC than non-Hispanics. When stratified by Hispanic subgroups, only Mexicans had significantly lower PC knowledge than non-Hispanics. This calls for further research into why this ethnic group has lower knowledge of PC and what potential moderating factors could affect this association. Additionally, we need more studies on US Hispanics’ level of PC knowledge to assess if the trends seen between Hispanic subgroups in this survey are replicated.

Pharmacogenetics of weight gain following switch from efavirenz- to integrase inhibitor-containing regimens.

Excessive weight gain affects some persons with HIV after switching to integrase strand transfer inhibitor (INSTI)-containing antiretroviral therapy (ART). We studied associations between CYP2B6 genotype and weight gain after ART switch among ACTG A5001 and A5322 participants. Eligible participants switched from efavirenz- to INSTI-containing ART, had genotype data, and had weight data at least once from 4 weeks to 2 years post-switch. Multivariable linear mixed effects models adjusted for race/ethnicity, CD4, age, BMI and INSTI type assessed relationships between CYP2B6 genotype and estimated differences in weight change. A total of 159 eligible participants switched ART from 2007 to 2019, of whom 138 had plasma HIV-1 RNA < 200 copies/mL (65 CYP2B6 normal, 56 intermediate, 17 poor metabolizers). Among participants with switch HIV-1 RNA < 200 copies/mL, weight increased in all 3 CYP2B6 groups. The rate of weight gain was greater in CYP2B6 poor than in CYP2B6 normal metabolizers overall, and within 9 subgroups (male, female, White, Black, Hispanic, dolutegravir, elvitegravir, raltegravir, and TDF in the pre-switch regimen); only in Hispanic and elvitegravir subgroups were these associations statistically significant ( P < 0.05). Compared to normal metabolizers, CYP2B6 intermediate status was not consistently associated with weight gain. CYP2B6 poor metabolizer genotype was associated with greater weight gain after switch from efavirenz- to INSTI-containing ART, but results were inconsistent. Weight gain in this setting is likely complex and multifactorial.

Development of a prediction model of postpartum hospital use using an equity-focused approach

BackgroundRacial inequities in maternal morbidity and mortality persist into the postpartum period, leading to a higher rate of postpartum hospital use (PHU) among Black and Hispanic people. Delivery hospitalizations provide an opportunity to screen and identify people at high risk to prevent adverse postpartum outcomes. Current models do not adequately incorporate social and structural determinants of health (SSDOH), and some include race, which may result in biased risk stratification. ObjectiveOur objective was to develop a risk prediction model of PHU incorporating novel SSDOH using an equity approach. Study DesignWe conducted a retrospective cohort study using 2016-2018 linked birth certificate and hospital discharge data for liveborn infants in New York City. We included deliveries in 2016-2017 in model development, randomly assigning 70%/30% of deliveries as training/test data. We used deliveries in 2018 for temporal model validation. We defined Composite PHU as at least one readmission or emergency department visit within 30 days of the delivery discharge. We categorized diagnosis at first hospital use into 14 categories based on ICD-10 diagnosis codes. We tested 72 candidate variables, including social determinants of health, demographics, comorbidities, obstetric complications, and severe maternal morbidity. Structural determinants of health were racial-economic segregation at the zip code level using the index of concentration at the extremes (ICE) and publicly available indices of the neighborhood built/natural (BNE) and social/economic (SE) environment. We used four statistical and machine learning algorithms to predict Composite PHU, and an ensemble approach to predict Cause-specific PHU. We simulated the impact of each risk stratification method paired with an effective intervention on race-ethnic equity in PHU. ResultsThe overall incidence of PHU was 5.7%; the incidence among Black, Hispanic and White people was 8.8%, 7.4%, and 3.3%, respectively. Most common diagnoses for hospital use were general perinatal reasons (17.5%), hypertension/eclampsia (12.0%), non-gynecologic infections (10.7%), and wound infections (8.4%). Logistic regression with LASSO selection retained 22 predictor variables and achieved an auROC of 0.69 in the training, 0.69 in test, and 0.69 in validation data. Other machine learning algorithms performed similarly. Selected SSDOH features included ICE, insurance payor, depressive symptoms, and trimester entering prenatal care. The Cause-specific PHU model selected six of the 14 outcome diagnoses: acute cardiovascular disease, gastrointestinal disease, hypertension/eclampsia, psychiatric disease, sepsis, and wound infection, achieving an auROC of 0.75 in training, 0.77 in the test data, and 0.75 in the validation data using cross-validation approach. Models had slightly lower performance in Black and Hispanic subgroups. When simulating use of the risk stratification models with a postpartum intervention, identifying high-risk individuals using the Composite PHU model resulted in the greatest reduction in racial-ethnic disparities in PHU, compared to the Cause-specific PHU model or a standard approach to identifying high-risk individuals with common pregnancy complications. ConclusionA Composite PHU prediction model incorporating SSDOH can be used at delivery discharge to identify persons at risk for PHU..