Inner-city Population Research Articles

Current trends in high-risk human papillomavirus types and association with age and race/ethnicity in an inner-city population

Current trends in high-risk human papillomavirus types and association with age and race/ethnicity in an inner-city population

Anticipatory prescribing in community end-of-life care

ObjectivesOur work aims to critically review the use of anticipatory medicines in our inner-city hospice community population and whether our current practices are fit for purpose.MethodsRetrospective audit of community palliative...

Characteristics of Patients Undergoing Bariatric Surgery in an Inner-City Minority Population: A Pre and Postoperative Comparison Between Patients With and Without Obstructive Sleep Apnea.

Background Obese patients are at an increased risk of obstructive sleep apnea (OSA). Bariatric surgery or weight loss surgery is an important therapeutic measure in obese patients for the management of weight and comorbidities. Data are scarce in inner-city Hispanic and Black patients who undergo bariatric surgery, which eventually leads to health disparity in this minority population. Differences between patients with and without OSA have not been assessed in this population. This study aims to answer these questions. Methodology The study was conducted in a high-volume hospital in the Bronx, New York. Before bariatric surgery, patients underwent a preoperative evaluation that included a variety of blood tests, a sleep study, esophagogastroduodenoscopy, and echocardiography. They also underwent basic anthropometric measurements, such as weight, height, and body mass index (BMI), before surgery and 6 months and 12 months postoperatively. Additional calculations were made using these anthropometric measures, namely, total weight loss, excess weight loss, and delta BMI. Results Most patients were Hispanic (85.2%), with a mean age of 41.9 ± 10.8 years. We found that of the 108 patients included in the study, 69.4% (70/108) had OSA.Preoperative BMI in the study was 43.9 ± 13 kg/m2. Postoperatively, the mean decrease in BMI was 12.3 ± 14.5 kg/m2. Total weight loss and excess weight loss were 30.2 ± 14.3 and 52.6 ± 16.6, respectively. Conclusions In this study, no significant difference was noted in patients with or without OSA in either the laboratory or anthropometric parameters.

Divergent population dynamics: The case of the inner city of Riga

Population dynamics shape the spatial landscape of Europe. Although broadly studied, both suburban sprawl and inner-city reurbanisation have often been treated in isolation. Furthermore, these processes manifest distinctively across different local contexts. This research aimed to explore the population dynamics in the inner city of Riga from 2011 to 2021, contrasting them with the bordering municipalities of Riga, and to analyze how these dynamics align with the urban development model. Covering 58 neighborhoods and 7 bordering municipalities of Riga, the analysis revealed a shift in the trajectory of inner-city population dynamics during the latter half of the decade, which was finally characterized by growth. However, suburbanisation continued to outpace reurbanisation, indicating the coexistence of multiple urban development model stages.

Enrollment strategies to promote inclusion in a colorectal cancer screening study.

e13530 Background: Colorectal cancer (CRC) is the second deadliest cancer in the U.S. and while rates vary among racial/ethnic groups, the Black community is disproportionately impacted with the highest incidence and mortality rates. Notably, CRC rates have also been rising among younger individuals aged 45 to 49. Recruitment of diverse and underrepresented groups, such as the populations described above, is increasingly important to enhance generalizability and real world performance in clinical studies. Freenome is developing a blood-based test (MyTectCRC) with the aim of providing a convenient and accessible option for CRC screening. Clinical validation of MyTectCRC test will be supported by PREEMPT CRC, a prospective, observational, multi-center study. The aim of this analysis is to assess the use of community-based recruitment approaches in a diverse inner-city population in Brooklyn, New York. Methods: PREEMPT CRC enrolled subjects aged 45-85 who were at average risk for CRC. To ensure representation of ethnic groups that have historically been difficult to recruit, the study deliberately engaged sites delivering care in diverse communities. Moskowitz Practice recruited from a patient base consisting largely of city workers in Brooklyn, New York, and deployed several patient-focused, ease-of-access methods such as convenient location for colonoscopy (CS) in an ambulatory surgery center, direct patient education from the physician, direct patient support from attentive and engaged site staff, customizable scheduling and screening reminders, and patient-to-patient referrals. Notably, the same approach was used for all study candidates, regardless of the participant’s ethnic/racial representation. Results: Community-based approaches contributed to strong participation from the site’s community in PREEMPT CRC. Importantly, the participants were representative of the local population with 87.4% of the enrollees identified as Black, a group historically underrepresented in oncology studies. The site also successfully enrolled young participants aged 45 to 50 (20.5%) and more females (58.2%) than males. Participants had relatively healthy lifestyles with 91.4% reporting as non-smokers, and 65% reporting no alcohol use. Study participants were highly compliant with study required procedures such as blood collection (100%) and CS (95%). Conclusions: The community-specific methods utilized by the site helped contribute to the diversity enrollment in PREEMPT CRC while recruiting participants that are representative of the local community. Ensuring diversity in clinical studies is the beginning to promoting equity in CRC screening, diagnosis and treatment. A blood-based test, supported by clinical evidence built on data from a diverse and representative population, may provide a convenient and accessible option for CRC screening and potentially increase the screening rate and reduce the CRC burden. Clinical trial information: NCT04369053 .

Digital health access, uptake, literacy and trust in people with experience of homelessness.

Although digital health promises improved healthcare efficiency and equity, access and uptake might be low indisadvantaged populations. We measured access todigital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness. An existing Australian survey, including a validated digitalhealth literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients. Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner. Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation.

102 Hepatitis B and HIV screening prior to first systemic anticancer therapy (SACT) in an inner-city London thoracic cancer population.

102 Hepatitis B and HIV screening prior to first systemic anticancer therapy (SACT) in an inner-city London thoracic cancer population.

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

Machine learning prediction of pathological complete response and overall survival of breast cancer patients in an underserved inner-city population

BackgroundGeneralizability of predictive models for pathological complete response (pCR) and overall survival (OS) in breast cancer patients requires diverse datasets. This study employed four machine learning models to predict pCR and OS up to 7.5 years using data from a diverse and underserved inner-city population.MethodsDemographics, staging, tumor subtypes, income, insurance status, and data from radiology reports were obtained from 475 breast cancer patients on neoadjuvant chemotherapy in an inner-city health system (01/01/2012 to 12/31/2021). Logistic regression, Neural Network, Random Forest, and Gradient Boosted Regression models were used to predict outcomes (pCR and OS) with fivefold cross validation.ResultspCR was not associated with age, race, ethnicity, tumor staging, Nottingham grade, income, and insurance status (p > 0.05). ER−/HER2+ showed the highest pCR rate, followed by triple negative, ER+/HER2+, and ER+/HER2− (all p < 0.05), tumor size (p < 0.003) and background parenchymal enhancement (BPE) (p < 0.01). Machine learning models ranked ER+/HER2−, ER−/HER2+, tumor size, and BPE as top predictors of pCR (AUC = 0.74–0.76). OS was associated with race, pCR status, tumor subtype, and insurance status (p < 0.05), but not ethnicity and incomes (p > 0.05). Machine learning models ranked tumor stage, pCR, nodal stage, and triple-negative subtype as top predictors of OS (AUC = 0.83–0.85). When grouping race and ethnicity by tumor subtypes, neither OS nor pCR were different due to race and ethnicity for each tumor subtype (p > 0.05).ConclusionTumor subtypes and imaging characteristics were top predictors of pCR in our inner-city population. Insurance status, race, tumor subtypes and pCR were associated with OS. Machine learning models accurately predicted pCR and OS.

Clinical Characteristics of COVID-19 Coagulopathy, Experiences in a New York City Safety Net Hospital

Purpose/Objective: COVID-19 is a significant cause of morbidity and mortality in the inner-city population in New York City (NYC), with COVID-19 coagulopathy and venous thromboembolism (VTE) as major contributing factors. A recent meta-analysis of 17 studies demonstrated a pooled 25% increased risk of VTE incidence in hospitalized COVID-19 patients (Zhang et. al, 2020). To assess morbidity burden, the primary objective of this current study is to investigate COVID-19 coagulopathy incidence in hospitalized patients in an Afro-Caribbean NYC population. The secondary objective was to assess the clinical characteristics and risk factors of COVID-19 coagulopathy, classify disease severity and outcomes. Methods: A retrospective study was performed at the NYC Health and Hospitals/Kings County on patients hospitalized with COVID-19. Data was collected from March 1 st, 2020 to December 31 st, 2021 for hospitalized and intensive care patients. Information was collected on the incidence of VTE, type of VTE (deep vein thrombosis or pulmonary embolism), demographics, VTE prevention strategies, VTE management, inflammatory markers, and outcomes. GraphPad PRISM was used for statistical analysis, through unpaired t-tests and odds ratios, with p&amp;lt;0.05 indicating statistical significance. Results: The primary objective investigated 675 patients to assess COVID-19 incidence, with imaging-confirmed VTE incidence in 32 (4.74%), and mortality in 112 (16.6%) patients (Table 1). To assess factors that influence VTE, we assessed demographic, outcome and infection severity between 32 VTE patients, and 142 non-VTE patients (Table 2). Multivariable analysis of comorbidities demonstrated that obesity was an independent risk factor for VTE (OR=11.4938, 95% CI 4.3512 to 30.3615, p&amp;lt;0.001). Interestingly, prior VTE did not increase the risk of VTE between cohorts. Further, there is a trend towards increased mortality risk in VTE patients compared to non-VTE patients, although not statistically significant (OR= 2.7483, 95% CI 0.9332 to 8.0934, p=0.0666). We were unable to deduce differences between VTE prevention strategies between the cohorts due to insufficient power. Upon analyzing inflammatory markers, D-Dimers were determined to be significantly elevated in VTE patients compared to non-VTE patients (p=0.0274), whereas there was no significant difference between LDH or ferritin between the cohorts. Conclusions/Implications: This study characterized the incidence and demographics of COVID-19 coagulopathy in a safety net NYC hospital, wherein there is decreased VTE incidence compared to prior published literature (Zhang et. al, 2020). Our study also supports current literature which identifies obesity as a risk factor for VTE in COVID-19 patients (Wang et al, 2021). We hypothesize that BMI reduction may be protective against COVID-19 induced VTE risk, and targeted BMI reduction programs may mitigate COVID-19 severity. Future studies should continue to investigate COVID-19 risk reduction strategies in patients with comorbidities and can consider anticoagulation use based on risk factors.

Chatbot-interfaced and cognitive-affective barrier-driven messages to improve colposcopy adherence after abnormal Pap test results in underserved urban women: A feasibility pilot study.

Challenges in ensuring adherence to colposcopy and follow-up recommendations, particularly within underserved communities, hinder the delivery of appropriate care. Informed by our established evidence-based program, we sought to assess the feasibility and acceptability of a novel cognitive-affective intervention delivered through a Chatbot interface, aimed to enhance colposcopy adherence within an urban inner-city population. We developed the evidence-based intervention, CervixChat, to address comprehension of colposcopy's purpose, human papillomavirus (HPV) understanding, cancer-related fatalistic beliefs, procedural concerns, and disease progression, offered in both English and Spanish. Females aged 21-65, with colposcopy appointments at an urban OBGYN clinic, were invited to participate. Enrolled patients experienced real-time counseling messages tailored via a Chatbot-driven barriers assessment, dispatched via text one week before their scheduled colposcopy. Cognitive-affective measures were assessed at baseline and through a 1-month follow-up. Participants also engaged in a brief post-intervention satisfaction survey and interview to capture their acceptance and feedback on the intervention. The primary endpoints encompassed study adherence (CervixChat response rate and follow-up survey rate) and self-evaluated intervention acceptability, with predefined feasibility benchmarks of at least 70% adherence and 80% satisfaction. Among 48 eligible women scheduled for colposcopies, 27 (56.3%) agreed, consented, and completed baseline assessments. Participants had an average age of 34 years, with 14 (52%) identifying as non-Hispanic White. Of these, 21 (77.8%) engaged with the CervixChat intervention via mobile phones. Impressively, 26 participants (96.3%) attended their diagnostic colposcopy within the specified timeframe. Moreover, 22 (81.5%) completed the follow-up survey and a brief interview. Barriers assessment revealed notable encodings in the Affect and Values/Goals domains, highlighting concerns and understanding around HPV, as well as its impact on body image and sexual matters. Persistent and relatively high intrusive thoughts and lowered risk perceptions regarding cervical cancer were reported over time, unaffected by the intervention. Post-intervention evaluations documented high satisfaction and perceived usefulness, with recommendations for incorporating additional practical and educational content. Our findings underscore the robust satisfaction and practicality of the CervixChat intervention among a diverse underserved population. Moving forward, our next step involves evaluating the intervention's efficacy through a Sequential Multiple Assignment Randomized Trial (SMART) design. Enhanced by personalized health coaching, we aim to further bolster women's risk perception, address intrusive thoughts, and streamline resources to effectively improve colposcopy screening attendance.

S327 Improving Colorectal Cancer Screening Rates With Multitarget Stool DNA Testing by Implementing a Comprehensive Program of Tailored Patient Navigation in an Inner-City Population

S327 Improving Colorectal Cancer Screening Rates With Multitarget Stool DNA Testing by Implementing a Comprehensive Program of Tailored Patient Navigation in an Inner-City Population

S1890 Cure Rates of Helicobacter pylori Regimens in an Inner-City Population: One Step Back May Be Two Steps Forward?

S1890 Cure Rates of Helicobacter pylori Regimens in an Inner-City Population: One Step Back May Be Two Steps Forward?

Chronic Spontaneous Urticaria in Belgium: Deciphering the Clinical Profile and Treatment of Patients Visiting an Urban City Immunology Department

Background: Chronic urticaria (CSU) is a chronic inflammatory mast cell-driven disorder of which reliable clinical data in Belgium are lacking. This study focusses on clinical characteristics of CSU patients presenting at an urban Immunology-Allergology department. Methods: Outpatients with CSU were included from 2018 to 2021. Clinical characteristics, Dermatology Life Quality Index (DLQI) and Urticaria activity score (UAS7) were collected by thorough anamnesis and questionnaires. Furthermore, patients underwent provocational testing, an autologous serum skin test (ASST) and a blood analysis. Results: The study included 49 CSU patients and 20 non-CSU subjects. CSU was distributed differently with age and sex, showing higher numbers in female patients below the age of 46 years. 67% of CSU patients had accompanying angioedema of which 9% were reported genital. CSU patients scored a mean 8/30 on their DLQI questionnaire. There was no significant difference in immunoglobulin E (IgE), C-reactive protein, and tryptase levels between CSU patients and controls. Oral glucocorticosteroids were prescribed in 23% of CSU patients during their disease course though only half of these patients had a severity grade 4 CSU. In 82% of the included CSU patients, Urticaria Control Test (UCT) scores were below 12. When we hypothetically considered low IgE levels and high IgG anti-thyroid peroxidase levels as differentiation marker for autoimmune (ai)CSU and non-aiCSU, we found that 4% of all included CSU patients could be considered aiCSU. Conclusion: Generally, the inner-city population displayed the same clinical characteristics, as previous cohorts from Northern Europe. The relatively high rate of CSU patients receiving oral glucocorticosteroid treatment for their disease though not always classified as severe, underlines the need to train doctors of various specialties in the treatment algorithms of CSU. Furthermore, by looking at potential autoimmune characteristics, our findings open perspectives on the identification of new routinely used clinical parameters for the detection of aiCSU, a relatively small immunological subtype of CSU.

Genetic variants in the vitamin D pathway and their association with vitamin D metabolite levels: Detailed studies of an inner-city pediatric population suggest a modest but significant effect in early childhood

ObjectivesIn a large cohort of healthy infants and toddlers 6–36 months of age (n = 776), we have been exploring the potential role of genetic variation in predisposition to vitamin D insufficiency. The genes encoding the key cytochrome P450 hydroxylases (CYP2R1, CYP24A1, and CYP27B1) harbour recurrent mutations of uncertain effect. This study was undertaken to look for biochemically relevant associations of these variants with inter-individual differences in vitamin D metabolism in an at-risk pediatric population. MethodsGenotyping for CYP2R1-CT (c.–1127 C>T, rs10741657), CYP24A1-AG (c.–686A>G, rs111622401), and CYP27B1-CA (c.–1261 C>A, rs10877012) mutations were performed using SNaPshot assay, followed by Sanger sequencing confirmation. Vitamin D metabolites and vitamin D binding protein (DBP) were measured by established methods. ResultsIn a multivariate regression model, with corrections for co-variates, subjects with the homozygous CYP2R1-TT variant had significantly higher concentrations of 25(OH)D, free 25(OH)D, and 24,25(OH)2D levels. In subjects with the CYP24A1-AG mutation, concentrations of 25(OH)D were significantly higher. ConclusionsThe CYP2R1-TT and CYP24A1-AG variants have measurable effects on the vitamin D pathway. It seems unlikely that they will be clinically relevant in isolation, but they may be members of the large pool of infrequent mutations contributing to different risks for the vitamin D deficiency phenotype.

Cohort profile: The South London Stroke Register – a population-based register measuring the incidence and outcomes of stroke

PurposeThe South London Stroke Register (SLSR) is a population-based cohort study, which was established in 1995 to study the causes, incidence, and outcomes of stroke. The SLSR aims to estimate incidence, and acute and long term needs in a multi-ethnic inner-city population, with follow-up durations for some participants exceeding 20 years. ParticipantsThe SLSR aims to recruit residents of a defined area within Lambeth and Southwark who experience a first stroke. More than 7700 people have been registered since inception, and >2750 people continue to be followed up. At the 2011 census, the source population was 357,308. Findings to dateThe SLSR was instrumental in highlighting the inequalities in risk and outcomes in the UK, and demonstrating the dramatic improvements in care quality and outcomes in recent decades. Data from the SLSR informed the UK National Audit Office in its 2005 report criticising the poor state of stroke care in England. For people living in the SLSR area the likelihood of being treated in a stroke unit increased from 19% in 1995–7 to 75% in 2007–9. The SLSR has investigated health inequalities in stroke incidence and outcome. SLSR analyses have demonstrated that lower socioeconomic status was associated with poorer outcome, and that Black people and younger people have not experienced the same improvements in stroke incidence as other groups. Future plansAs part of an NIHR Programme Grant for Applied Research, from April 2022 the SLSR has expanded to recruit ICD-11 defined stroke (including those with <24 h symptoms where there are neuroimaging findings), and have expanded the follow up interviews to collect more detailed information on quality of life, cognition, and care needs. Additional data items will be added over the Programme based on feedback from patients and other stakeholders.

Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population

Social determinants of health are a well-described influencer of pregnancy-related morbidity and mortality. It is unclear how societal changes secondary to the COVID-19 pandemic altered the social determinants of health among pregnant patients.This study aimed to investigate differences in the social determinants of health among patients who experienced pregnancy before and during the COVID-19 pandemic.This was a secondary analysis of an ongoing prospective cohort study examining the social determinants of health in postpartum patients at a single inner-city academic medical center. The planned secondary analysis was to compare the social determinants of health between patients that experienced societal changes before the pandemic and patients that experienced societal changes during the pandemic. Patients were included in the pandemic group if they delivered on or after March 30, 2020; moreover, patients in the pandemic group were compared with those who delivered before March 30, 2020 (referent group). Medical records were used to collect sociodemographic, pregnancy, and infant outcome data. The study participants were interviewed to collect detailed information regarding their perceived social, emotional, and physical environment as indicators of social determinants of health. Generalized linear modeling estimated the influence of social determinants of health on births during the COVID-19 pandemic.Overall, 577 patients were enrolled in the study, of which 452 (78%) delivered before the COVID-19 pandemic and 125 (22%) delivered during the pandemic. Patients who delivered during the pandemic were more likely to report limited social or emotional support (relative risk, 1.62; 95% confidence interval, 1.02-2.59) and higher race-based discrimination (relative risk, 1.59; 95% confidence interval, 1.00-2.53). Mothers in the prepandemic group were more likely to have used federally funded programs, such as Medicaid, food stamps, and the Special Supplemental Nutrition Program for Women, Infants, and Children, during their pregnancy. Furthermore, the referent group reported more limited access to transportation. In addition, mothers in the prepandemic group were more likely to initiate prenatal care at a later gestational age and have fewer total prenatal care visits.The COVID-19 pandemic created unprecedented changes in pregnancy care, and these were reflected in social determinants of health. It is imperative that we focus on the social determinants of health that were mitigated during this time and their effects on maternal and infant health.

Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and vaccine antibody prevalence in a multi-ethnic inner-city antenatal population: A cross-sectional surveillance study.

To determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in pregnancy in an inner-city setting and assess associations with demographic factors and vaccination timing. Repeated cross-sectional surveillance study. London maternity centre. A total of 906 pregnant women attending nuchal scans, July 2020-January 2022. Blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid (N) and spike (S) proteins. Self-reported vaccination status and coronavirus disease 2019 (COVID-19) infection were recorded. Multivariable regression models determined demographic factors associated with seroprevalence and antibody titres. Immunoglobulin G N- and S-protein antibody titres. Of the 960 women, 196 (20.4%) were SARS-CoV-2 seropositive from previous infection. Of these, 70 (35.7%) self-reported previous infection. Among unvaccinated women, women of black ethnic backgrounds were most likely to be SARS-CoV-2 seropositive (versus white adjusted risk ratio [aRR] 1.88, 95% CI 1.35-2.61, p < 0.001). Women from black and mixed ethnic backgrounds were least likely to have a history of vaccination with seropositivity to S-protein (versus white aRR 0.58, 95% CI 0.40-0.84, p = 0.004; aRR 0.56, 95% CI 0.34-0.92, p = 0.021, respectively). Double vaccinated, previously infected women had higher IgG S-protein antibody titres than unvaccinated, previously infected women (mean difference 4.76 fold-change, 95% CI 2.65-6.86, p < 0.001). Vaccination timing before versus during pregnancy did not affect IgG S-antibody titres (mean difference -0.28 fold-change, 95% CI -2.61 to 2.04, p = 0.785). This cross-sectional study demonstrates high rates of asymptomatic SARS-CoV-2 infection with women of black ethnic backgrounds having higher infection risk and lower vaccine uptake. SARS-CoV-2 antibody titres were highest among double-vaccinated, infected women.

The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: study protocol for an interventional feasibility randomised controlled trial

IntroductionAccurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations...

Evaluating the feasibility and acceptability of home-based urinalysis for albumin-creatinine ratio with smartphone technology: A quality improvement project.

Despite albumin-creatinine ratio (urine) testing being recommended for detection of chronic kidney disease among adults with diabetes, testing rates are suboptimal. We implemented and evaluated a quality improvement project in an inner-city diabetes population in London, UK to assess the feasibility and acceptability of implementing novel home-based urinalysis using smartphone technology. After eligible patients were identified and consented, testing kits were sent to the patient's home. Test results and patient feedback were collected through the smartphone application. Focus group discussions were conducted to evaluate primary care staff perspectives on uptake and delivery of the service. In total 2370 patients agreed to take part. Of these, 1244 completed the test (61% of those eligible) and of these, 465 (37%) had clinically significant albuminuria. 98% of patients found the test easy or very easy to use. Staff in primary care found the service to be beneficial for patients, and reported ease of set up and minimal administrative processes. Concerns regarding barriers among patients with lower digital literacy and non-English speakers were raised although these concerns were not substantiated. Home-based albumin-creatinine ratio urine testing may improve the testing rates of people with diabetes at higher risk of chronic kidney disease. This is important post-pandemic, as healthcare services are trying to return to pre-pandemic levels of care. The study also found that the use of smartphone technology in an underserved (deprived) community is feasible, despite reservations about levels of digital literacy and possible language barriers. Further evaluation of effectiveness and costs is required.