Metro Area Research Articles

A radio frequency identification based smart shopping trolley system for automated billing

On holidays and weekends, we can notice a large rush at shopping centres in metro areas. This is exacerbated when there are substantial discounts and deals. By applying the notion of internet of thing (IoT) for concerning all things in the grocery store, an automated smart shopping system is created. Each product within such scheme had an economical radio frequency identification (RFID) tag positioned with it. Once an item has been added to a smart cart, the information about the merchandise is quickly read by the RFID reader on the cart. The outcome is, direct invoicing is done out from shopping cart, saving clients from having to wait in a long line at the checkout. The product's expiration date is also displayed and broken products can be determined by their weight. As a result, expired and damaged products will not be taken into account when calculating the cost. Furthermore, this system gains the addition of smart shelves incorporating RFID readers which may check stock and possibly update a central server. Inventory control becomes simpler as a result. Finally, cashier stations could verify a customer's purchase. As a result, billing may be done right in the trolley, saving clients a lot of time.

Abstract A047: Increasing cancer-related community-engagement strategies among Historically Black Colleges and Universities and Minority Serving Institutions

Abstract Addressing cultural beliefs and barriers is imperative to successfully designing and implementing behavior change interventions to increase cancer screening and treatment among underserved communities. Community-based participatory research (CBPR) fosters proven strategies that reduce barriers to cancer screening in several diverse population groups. Citizen scientists are laypersons who do not have formal science training but receive training to engage in research efforts responsive to community needs. Project Brotherhood, a community-based health organization on Chicago’s southside, has developed a community engagement model known as the Murray Model. It specifically engages black men in improving their health status. One aspect is engaging black men as citizen scientists to address cancer disparities within their communities. Evidence shows that citizen scientists were better equipped to understand lung cancer risks and increased their advocacy for better health within their communities. In partnership with Project Brotherhood and the University of Illinois Cancer Center, the National Cancer Institute, Informatics Technology for Cancer Research (ITCR) Training Network (ITN) Program is scaling up the citizen scientist Train-the-Trainer program at historically black colleges and universities and minority-serving universities. The Train-the-Trainer ITCR citizen scientist program is partnering with the Morehouse School of Medicine to increase its community and academic capacities in the Atlanta metro area to address cancer disparities. Citation Format: Rohan D. Jeremiah, Marcus Murray, Maisha Standifer, LeChaun Kendall, Carrie Wright, Candace Savonen, Jeff Leeks. Increasing cancer-related community-engagement strategies among Historically Black Colleges and Universities and Minority Serving Institutions [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 A047.

Neighborhood Safety and Perinatal Mental Health

Neighborhood safety (NS) has important implications for mental health, yet research is needed to clarify how different constructs that measure NS associate with mental health problems. Research is particularly underdeveloped on NS among low-income, postpartum individuals, who may experience greater vulnerability. This study examined two measures of NS, self-reported and coder-rated, and their associations with prenatal and postnatal depression and PTSD symptoms, and lifetime adversity. Participants were 121 perinatal individuals living in a major metro area. Both types of NS were significantly intercorrelated. Neither prenatal nor postnatal depression symptoms predicted self-reported or coder-rated NS. However, higher lifetime adversity and higher postnatal PTSD symptoms predicted lower self-reported postnatal NS (but not coder-rated NS). After controlling for prenatal PTSD symptoms, lower self-reported NS also predicted higher postnatal PTSD symptoms. Findings underscore the importance of focusing on individuals’ lived experiences in their neighborhoods to understand links between perceptions of NS and PTSD symptoms.

Abstract B104: The invisible divide: The impact of race and location on multiple myeloma outcomes in Arkansas

Abstract Cancer survival rates in the United States have seen remarkable improvements attributed to early detection, enhanced screening practices, and innovative treatments. However, these advancements have not translated equally to all communities, particularly among minorities and rural populations. This disparity is amplified by the prevalence of certain cancers, such as multiple myeloma (MM), which disproportionately affects older adults and exhibits significant ethnic disparities. Black people are 2-5 times more likely to develop the disease compared to those of European descent. MM is a malignancy of plasma cells and in 2023, it is expected that in the US there will be 35,730 new MM diagnoses and 12,590 associated deaths. This study focuses on MM patients in Arkansas, where racial segregation and rural population density contribute to healthcare access challenges and poorer outcomes. We retroactively analyzed a dataset composed of 4,639 patients treated at the University of Arkansas for Medical Sciences that have all received a transplant as part of their treatment. In this study, we performed a descriptive analysis of patients’ outcomes with MM treated in Arkansas. We look at the non-metro versus metro areas while also looking at racial differences in survival outcomes between Black and White patients. To pinpoint specific areas of Arkansas with high disparities, we divided the state into 6 regions. Taken in aggregate, there was no significant difference in progression-free survival (PFS) or overall survival (OS). Just looking at the best and worst performing regions, we compared the Central Arkansas region to the Lower Delta. A significant difference was observed in PFS and OS, with p-values of 0.00034 and 0.025, respectively. Patients from the Central region had a significantly higher survival probability. We observed a significant difference in PFS and OS by race (p-value 0.012 and 0.062). We see that Black patients from the Lower Delta had the worst PFS, and PFS was similar between Black and White patients from the Central region. Interestingly, White patients from the Lower Delta had the worst overall survival probability. Black patients from the Central region had the best OS. This research highlights the disparities between non-metro and metro MM patients, as well as the disparities between Black and White populations in Arkansas compared to the rest of the country. Rural region had the largest disparity in PFS and OS compared to the metro Central region of Arkansas. Black patients from the Lower Delta region have worse PFS than African Black patients from the Central region, and White patients from the Lower Delta region have worse OS than White patients from the Central region. These findings emphasize the importance of targeted education efforts aimed at physicians and patients in rural communities, which could potentially lead to significant improvements in MM outcomes and bridge the existing disparities. Citation Format: Michael A. Bauer, Mario Shootman, Chenghui Li, Frits Van Rhee, Samer Al Hadidi, Carolina D. Schinke, John D. Shaughnessy, Joseph L. Su, Fenghuang Zhan, Cody Ashby. The invisible divide: The impact of race and location on multiple myeloma outcomes in Arkansas [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 B104.

Treatment gap for mental and behavioral disorders in Punjab.

There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Academic Outreach and Collaboration with Community Oncology Practices to Enhance Referrals and Reduce Disparities in Hematological Malignancies

Introduction: Disparities in cancer care are widely reported with the reasons being multifactorial. Delays in referral and distance to travel along with lack of public transportation are common structural barriers that further exacerbate the racial and income related disparities in the care of hematological malignancies. A lower proportion of black patients receive transplants, both autologous (AutoSCT) and allogeneic (AlloSCT) for similar indications as compared to white populations. Racial disparities are evident in transplant utilization for hematologic malignancies. When offered similar therapy, the outcomes might be better in black patients as compared to White populations underscoring the effect of biology of the disease. South Georgia region has a very high poverty rate with many counties having a median income much less than the national average. We report our efforts to increase access for hematological malignancies for patients in predominantly rural and minority focused settings. Methods: We reviewed charts of all patients referred to our center from 01/2014 to 12/2022. We divided patients into three groups. Cohort A. 36 months from 1/14 to 06/2017. Cohort B, 36 months from 07/19 to 12/22. The intervening two years were utilized for outreach development. Physicians visited all the community centers and created an easy access physician to physician referral system. In addition, in partnership with community oncology, two clinics were established at 65 miles and 89 miles to our center. Referrals from these sites were seen at these outreach clinics. The total number of Auto and Allo SCT and clinical trial enrollment data were obtained from databases. Outcomes data is from that reported on the SCT patients to the national databases. Statistics are descriptive. Results: Post outreach activity showed a significant increase in volumes. (Figure 1) Patients' referrals for heme-malignancies were up to 1725 compared to 632 (170% increase). The median distance travelled in these groups was 52.7 vs 17.8 miles (range 0-525 vs 2342) demonstrating the larger area covered from outreach activity. Considering our metro area radius of 20 miles, 62% of patients were outside our immediate area. Excluding the patients withing the 20-mile radius between the two groups, median distance travelled by patients in cohort B being 99 miles vs 60 miles in cohort A. The increase was consistent across all races. There was an increase from 254 to 588 in black population and 355 to 1028 in the white populations. The outreach clinics set up in partnership with the community practices added a significant new patient population with numbers increasing from under 25 in the initial cohort to above 250 in cohort B. Overall this increase translated to higher number of transplants with 146 transplants in cohort A compared to 347 in cohort B, a 137% increase. The alloSCT increased from 51 to 85 and autoSCT from 95 to 262 between the two cohorts respectively. In addition, the addition of CAR-T further expanded the cellular therapy program with a total of 131 cellular therapy products in fiscal year 2023 compared to 39 in fiscal year 2015, a 235% increase. Our outcomes have consistently improved as well with the most recent CIBMTR 1 year survival of 74% while the predicted was 68%. Similarly, the increase in referrals translated to an increase in clinical trial enrollment with the most recent 3-year period having an accrual of 216 as compared to 56, a 285% increase overall and 185% in black patients, compared to the initial 3 years. Age is another commonly noted factor that results in lower access to care. Our model resulted in a significant increase in elderly patients as well with > 60 years of age patients increasing from 326 to 1017 while those above 70 increased from 149 to 549 in the respective cohorts. Conclusions: Our model is easily reproducible and shows a substantial increase in the number of referrals for hematological malignancies. The recent approvals of complex therapies like CAR-T and other T cell engaging therapies necessitate a close collaboration between academic and community practices. Similar models if developed at other academic centers can significantly reduce structural barriers and might improve outcomes further in all patient populations.

Racial Discrepancies in the Use of Stigmatizing Language Is Evident in Hematology/Oncology Electronic Medical Records

Healthcare inequities are often attributed to large-scale structural barriers for access to medical care or patient-medical staff interactions. However, the role of the electronic medical record (EMR) in perpetuating hidden biases has been poorly characterized. This passive form of sharing implicit biases with unknown readers may have profound ripple effects asynchronous in place and time from the note writer. This study aims to illustrate racial imbalances in ad hominem patient characterizations as documented by medical staff, regardless of role, in a large metro healthcare system. The use of certain potentially stigmatizing language in emergency department (ED) and inpatient notes for hematology/oncology patients was investigated. Retrospective chart review of four hospitals within a university network in a major metro area between 1/1/2019 - 6/30/2021 was undertaken. Patients ≥22 years old were included with two primary hypotheses in mind: 1) Negative terms are used more frequently for underrepresented minorities, and 2) words with shock value (i.e. curse words) are used more often than more general descriptors of these terms (e.g. “cursing” or “profanity”). Nine positive and twelve negative terms were evaluated, based on the authors' observations of their use in the EMR in past encounters (Table 1). Some were personal descriptors in which the ED or inpatient note writer would be less likely than outpatient providers to have a full sense of outpatient care or social determinants of health (e.g. compliant). Others were behavioral descriptions (e.g. hostile) or words with minimal medical relevance (e.g. curse words). If multiple notes in an encounter included the same word(s), the encounter was only analyzed once for each word to avoid word count inflation, though re-occurrences for the same patient in subsequent encounters were counted. Authors' manual data review using natural language processing software confirmed appropriate use of terms. Generalized estimating equations were used for race-based comparisons to account for same-patient clustered encounters. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for self-reported demographic comparisons with White as the reference category. P≤0.05 was considered significant. A total of 1,059 encounters for 889 hematology/oncology patients were analyzed. Mean age was 61 years (standard deviation 16.7) and 49.4% were female. White race was reported for 80.2% of patients (72% system-wide prevalence during same timeframe) and Black for 11.4% (15.2% system-wide); all others were ≤4% so only White/Black comparisons were included. Positive terms were more prevalent than negative ones (n=535 vs 459). However, negative terms were found more often for Black individuals (OR 2.24, CI 1.41 - 3.56, P<0.001), while the positive terms were less frequently documented in Black patients relative to White patients (OR 0.51, CI 0.33 - 0.77, P=0.001), and neither category was concordant with the overall patient racial demographics. Other significant racial differences existed for the terms “Argumentative”, “Disrespectful”, “Noncompliant”, and “Polite”, all discrepancies which favored White patients (Table 2). Specific curse words were documented nearly as often as “cursing”, “swearing”, or “profanity”, but no racial differences were observed. Some words in the initial search (“Brave”, “Courageous”, “Empathetic”, and “Ambitious”) were not found in hematology/oncology notes in this timeframe. EMR documentation in hospital-based hematology/oncology care demonstrated evidence of racial discrepancies in language that may carry stigma, positively or negatively. Importantly, many of these terms have questionable, if any, medical relevance. The use of stigmatizing terminology in the EMR may reflect implicit biases that extend past the direct patient encounter, passively and subconsciously prejudicing future care from other staff members. Time-saving heuristics and documentation shortcuts like copy-forwarding may further ossify healthcare inequities. This phenomenon is undoubtedly not limited to this hospital system or the hematology/oncology field, but quantitative real-world evidence has been scant. Improved awareness of stigmatizing language in documentation may be one step towards mitigating this contributor to unequal care for hematology/oncology providers and their patients.

Politicized science and rural–urban divides: Exploring how rurality in the place of residence and red and blue media use affected attitudes toward scientists before and during the COVID‐19 pandemic

AbstractBased on the concept of place‐based identity, this study disentangles the effects of rurality and partisanship and considers their interactions with red/blue media use in rural–urban divides in attitudes toward scientists. By employing the 2016 American National Election Survey and our 2021 survey data, we investigated how partisanship, rurality, and red/blue media use related to attitudes toward scientists. Analyses revealed distinct roles for partisanship and rurality in predicting attitudes, even after controlling for demographic variables, including family income and education. Compared to those who resided in large metro areas, residents of more rural areas tended to harbor more negative attitudes toward scientists. This tendency was reinforced by red media use in 2021 but not in 2016. Given the dissimilar results in 2016 and 2021 in terms of the interaction of red media use and rurality, we should pay more attention to rural–urban divides in attitudes toward scientists.

Carbon Dioxide Monitoring Demonstrates Variations in the Quality of Ventilation on Public Transportation Buses and University Student Shuttle Vans and Identifies Effective Interventions.

There is a risk for transmission of severe acute respiratory syndrome 2 (SARS-CoV-2) and other respiratory viruses in motor vehicles, particularly if ventilation is inadequate. We used carbon dioxide monitoring to examine the quality of ventilation in several public transportation buses and in university student shuttle vans in the Cleveland metro area during peak and non-peak travel times. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In the shuttle vans, we evaluated the impact of an intervention to improve ventilation. In large articulated buses with 2 ventilation systems, carbon dioxide concentrations never exceeded 800 ppm, whereas in standard buses with 1 ventilation system concentrations rose above 800 ppm during peak travel times and on some trips during non-peak travel times. In shuttle vans, the ventilation system was not turned on during routine operation, and carbon dioxide levels rose above 800 ppm on all trips during peak and non-peak travel times. In the shuttle vans, an intervention involving operation of the existing ventilation system resulted in a significant reduction in carbon dioxide levels (mean concentration, 1,042 no intervention versus 785 with intervention; P < 0.001). Our findings demonstrate substantial variability in the quality of ventilation in public transportation buses and university shuttle vans. There is a need for efforts to assess and optimize ventilation in motor vehicles used for public transportation to reduce the risk for aerosol-mediated transmission of respiratory viruses. Carbon dioxide monitoring may provide a useful tool to assess and improve ventilation.

Evaluation of Future-Integrated Urban Water Management Using a Risk and Decision Analysis Framework: A Case Study in Denver–Colorado Metro Area (DCMA)

This study examines the DCMA concerning the future risk of the water security status. We considered three risk factors: population growth, economic growth, and natural water supply–demand differences. In the risk analysis part, we consulted with experts from several sectors including academia, Non-Governmental Organizations (NGOs), and industry, to predict that the probability of future water stresses in high-, medium-, and low-risk scenarios are 0.73, 0.24, and 0.03, respectively. In the decision analysis part, we adopted two multiple criteria decision analysis (MCDA) approaches that include multiple attribute value theory (MAVT) and analytic hierarchy process (AHP) methods to evaluate the best alternative decision to alleviate future water stresses in the DCMA. The sensitivity analysis demonstrates that, although expanding existing water reservation might be a solution to tackle the challenge, the best option really closely connects to the weighting scheme of the criteria considered in the framework. This study provides a valuable risk and decision analysis framework to analyze the water security status associated with the future water supply and demand gap decrease caused by three risk factors: population growth, climate change, and natural water supply.

No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system

BackgroundRelease from prison is characterized by discontinuity of healthcare services and results in poor health outcomes, including an increase in mortality. Institutions capable of addressing this gap in care seldom collaborate in comprehensive, data-driven transition of care planning. This study harnesses information from a data exchange between correctional facilities and community-based healthcare agencies in Colorado to model a care continuum after release from prison.MethodsWe merged records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either (a) released to the Denver metro area (Denver and its five neighboring counties), or (b) assigned to the DH Regional Accountable Entity, or (c) assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. Outcomes explored were outpatient, acute care, and inpatient utilization in the first 180 days after release. We used Pearson’s chi-squared tests or Fisher exact for univariate comparisons and logistic regression for multivariable analysis.ResultsThe care continuum describes the healthcare utilization at DH by people released from CDOC. From January 1, 2021, to June 30, 2021, 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the 2848 were released to the Denver metro area or attributed to DH. In the study population of 905, 78.1% had a chronic medical or psychological condition. Within 180 days of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. 10.1% utilized outpatient services within the first 30 days of release.ConclusionsThis care continuum highlights drop offs in accessing healthcare. It can be used by governmental, correctional, community-based, and healthcare agencies to design and evaluate interventions aimed at improving the health of a population at considerable risk for poor health outcomes and death.

Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study – Health Assessment

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study – Health Assessment, (mean age 23±0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life’s Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

Vocational Rehabilitation Service Receipt, Service Expenditures, and Ruralness.

An important factor embedded within Vocational Rehabilitation (VR) delivery capacity relates to geography, such as distance from the VR office and availability of service providers or community rehabilitation programs. We explored receipt of VR job search and placement services based on distance to an urban center, demographic, and disability variables after controlling for local employment conditions. Using 2015 RSA-911 case services data, we used probit to produce estimates for each combination of service and service source (agency and purchased), and Ordinary Least Squares (OLS) and semi-parametric regression to estimate log expenditures for each service category. Being Black or living at a long distance from a metro area increased the probability of receiving agency-based services but lowered the probability of receiving purchased services. Conversely, being older and having less education lowered the probability of receiving agency services but increased the probability of receiving purchased services. Females, Blacks, and those living at a distance greater than 50 miles from a metro area received significantly lower expenditures. Systematic differences in the types of services provided call for more in-depth analysis to ensure that policies and procedures are in place to minimize sociodemographic disparities in service delivery and outcomes.

EPID-08. CLINICAL AND MOLECULAR DETERMINANTS OF BLEEDING-RELATED ADVERSE OUTCOMES IN HIGH-GRADE GLIOMA

Abstract Cancer is an independent risk factor for the development of venous thromboembolism (VTE) however patients with high-grade glioma (HGG) including glioblastoma (GBM) are at a particularly high risk of VTE with an incidence up to 20- 30% per year. Patients are often placed on anticoagulation to reduce the risk of VTE. However, patients with primary brain tumors such as HGG are at increased risk for intracerebral hemorrhage (ICH) even without the administration of anticoagulation. The combination of risk factors for ICH with anticoagulation and HGG complicates decision-making. Currently it is not known which of the direct oral anticoagulants (DOACs) are safest for patients with HGG in terms of adverse bleeding-related outcomes such as ICH. Furthermore, a deeper understanding of the clinical and molecular determinants of bleeding-related adverse outcomes in HGG is not fully characterized. In this study, we gathered data on patients with HGG from two Ascension Seton Hospitals in the Austin metro area from July 1, 2017 through June 30, 2022. We identified 76 pathology-confirmed patients with HGG. Patients who were on rivaroxaban (3/7 (43%), p=.022) had a statistically significant association with more bleeding-related adverse events compared to those on apixaban (0/12 (0%)) or enoxaparin (0/5 (0%)) even though the groups were similar in terms of their characteristics including total time on the respective anticoagulation. Patients on anticoagulation vs those never on anticoagulation did not differ in terms of their studied demographic and clinical characteristics. Intriguingly, logistic regression analysis revealed that patients harboring isocitrate dehydrogenase (IDH) mutations had a statistically significant association with more adverse bleeding-related events even when controlling for other relevant factors (Odds Ratio compared to reference GBM: 115.7; p=.014). This study offers insights into our understanding of relevant factors associated with worse bleeding-related adverse outcomes such as ICH in patients with HGG.

Abstract 131: Sex-Based Differences in the Extracorporeal Cardiopulmonary Resuscitation Population for Out-of-Hospital Cardiac Arrest in the Minneapolis Metro Area

Background: Women constitute nearly 40% of out-of-hospital cardiac arrests (OHCA), receive less bystander CPR, and guideline-directed interventions such as post-arrest coronary angiography. Aims: To identify the presence of sex-based differences in utilization of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory OHCA in the Minneapolis (MSP) metro area. Methods: Patients who met all eligibility criteria for the Minnesota Resuscitation Consortium (MRC) ECPR protocol between 2013-2021 were identified in the Cardiac Arrest Registry to Enhance Survival (CARES) registry. Patients who presented to the University of Minnesota (UMN) for the MRC ECPR protocol between 2014-2021 were identified. Arrest data, patient characteristics and mortality were compared between the sexes in both populations. Results: We identified 2790 OHCA patients through the CARES registry of whom 685 (24.6%) were women. There were 443 referrals to UMN for ECPR, of whom 87 (19.6%) were women. There were significantly more eligible women who arrested than those referred for ECPR (p =0.02). In the MSP metro area, women were more likely to suffer cardiac arrest at home (59% vs 66%, p&lt;0.01), less likely to receive bystander CPR (42% vs 35%, p&lt;0.01) and have greater time to professional CPR (6.3 vs 5.4 minutes, p&lt;0.01). Among referrals for MRC ECPR protocol, there were no differences in arrest characteristics or age between men and women. Multivariate analysis for neurologically favorable survival showed female sex was associated with decreased survival in the community (p=0.03), but trended towards increased survival in the UMN ECPR cohort (p=0.08) (Figure 1). Conclusion: Women suffering from cardiac arrest have higher mortality and are less likely to be referred for ECPR. However, after referral for ECPR, sex is not associated with survival. Pre-hospital factors result in fewer women referred for ECPR and warrant further investigation to identify potential interventions.

Abstract 18140: Is Socioeconomic Status Associated With a Novel Clinical Risk Prediction Score for Sudden Cardiac Death?

Introduction: Lower socioeconomic status (SES) is associated with higher risk of sudden cardiac death (SCD), but SES has not been used for SCD risk stratification. We have recently developed a novel risk score (VFRisk) for avertable SCD (8 clinical factors, 4 ECG markers, and 1 echocardiographic marker). We evaluated the association of the clinical components of the VFRisk score with SES. Hypothesis: Higher VFRisk scores will associate with lower SES. Methods: Individuals with SCD (2002-2019), were identified from a large ongoing study in a northwest US metro area (pop ~1 million). For each SCD case, a partial VFRisk score was calculated limited to the 8 clinical components (VFRisk-clinical; diabetes, HF, stroke, atrial fibrillation, COPD, history of MI, seizure, and syncope). The VFRisk-clinical score was categorized as low (&lt;25 th percentile), moderate (25 th -75 th ), and high (&gt;75 th percentile). SES was defined for each SCD case by residential census tract median household income and categorized into quintiles. Results: Among 4,412 SCD cases, data for SES and VFRisk-clinical was available for 3,606 (82%) with a median VFRisk of 2.8 (min 0 - max 13.4). There was a weak negative linear correlation between median household income quintile and VFRisk-clinical score (r = -0.05, p=0.002) and mean VFRisk-clinical score was slightly lower with higher SES quintile (Figure). However, there was no significant trend in the proportion of SCD cases with a high VFRisk-clinical score (&gt;75 th percentile) by median income quintile (p=0.13). In a logistic regression model, income quintile was not significantly associated with a high VFRisk-clinical score (p=0.60). Conclusions: No clear association was observed between the VFRisk-clinical score and SES, possibly due to involvement of SES early in the causal pathway of these clinical conditions, or due to effects of SES on risk pathways for SCD separate from the components of the VFRisk score.

Abstract 16269: Heart Failure With Preserved Ejection Fraction and Sudden Cardiac Death in the General Population

Background: Published data indicate that 50% of individuals with heart failure and reduced ejection fraction (HFrEF) suffer sudden cardiac death (SCD), however the burden of SCD in heart failure with preserved ejection fraction (HFpEF) remains inconclusive. Aim: Determine the prevalence of HFpEF in a community-based cohort of SCD. Methods: We prospectively identified cases with out-of-hospital SCD in a large metro area of the US Northwest (Pop. 1 million, 2002-2017) and determined HF status prior to SCD based on review of clinical records. Heart failure was subdivided into HFpEF (EF≥50%), HFmrEF (EF 40%-50%), and HFrEF (EF≤40%). In addition, since HFpEF is often underdiagnosed, we evaluated a modified H2FPEF algorithm for the identification of HFpEF among our SCD cohort with unknown HF subtypes. The score was comprised of clinical variables including age, BMI, atrial fibrillation, hypertension, and myocardial infarction. Score accuracy was assessed using receiver operating characteristic (ROC) analysis comparing known HFpEF from clinical records and echocardiography versus non-HF subjects. Next, the score was used to identify missing HFpEF cases within the HF and SCD population. Results: Among 4,683 total SCD cases, 1,013 (22%) had a clinical history of HF. Prevalence of HF sub-types was 42% for HFpEF, 19% for HFmEF and 39% for HFrEF cases. An algorithm score of 5 or greater differentiated HFpEF subjects from non-HF subjects with an AUC of 0.68 (p &lt; 0.01). The algorithm was then deployed on cases with an unknown heart failure subtype and an additional 117 HFpEF subjects were identified. The adjusted total prevalence of HFpEF was 542 subjects (53%) in the SCD the cohort with HF. Conclusion: At least 40% of the SCD cases with HF carry a diagnosis of HFpEF, and our estimates suggest the prevalence may be as high as 53%. Ultimately, these findings highlight the need to develop effective options for primary prevention of SCD in HFpEF patients.

Metro-Nonmetro Differences in Adverse Events in Residential Care Communities: Results From the National Post-Acute and Long-Term Care Study.

More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p < .001) but lower risks of falls (p = .06).

Disparity in initiation of checkpoint inhibitors among commercially insured and Medicare Advantage patients with metastatic melanoma.

BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced melanoma, but racial disparities in melanoma outcomes continue. These inequities are not fully explained by individual factors. OBJECTIVE: To investigate the associations of neighborhood factors with the use of ICIs in metastatic melanoma. METHODS: We conducted a retrospective cohort study of commercially insured US adults with metastatic melanoma diagnosed between January 2011 and December 2020. We examined the associations between the county-level percentage of population from racial and ethnic minority groups and the time from metastatic melanoma diagnosis to initiating ICIs using Cox proportional hazards models adjusting for patient characteristics. RESULTS: We identified 4,052 patients with metastatic melanoma, of which 49% used ICIs. We found that the adoption of ICIs in a county declined with increasing minority quintile (quintile 1: 52.4%, quintile 2: 50.4%, quintile 3: 50.1%, quintile 4: 45.8%, and quintile 5: 44.7%). The delay in ICI initiation also went up as the percentage of minorities in a county increased (log-rank test P = 0.03). Compared with the lowest quintile, the adjusted hazard ratio of ICI initiation of the second, third, fourth, and highest minority quintile was 0.94 (95% CI = 0.81-1.08), 0.88 (95% CI = 0.76-1.02), 0.81 (95% CI = 0.68-0.97), and 0.77 (95% CI = 0.66-0.91), respectively. Secondary analysis revealed that the slower initiation was driven by the counties with the highest percentage of Hispanic population (hazard ratio = 0.74; 95% CI = 0.61-0.89) in both Cox models and sensitivity analyses. High-minority counties correlated with metro areas, higher poverty levels, and a greater number of medical oncologists. CONCLUSIONS: We found that patients with metastatic melanoma living in counties with higher proportion of minorities, particularly of Hispanic origin, are more likely to experience delays in ICI treatment. This study provides important population-level data on neighborhood-level disparity in medication use. More research is needed on the underlying provider- and system-level factors that directly contributed to the lower use of cancer medicines in high-minority areas, which can help inform the development of evidence-based medication use strategies that can improve health outcomes and equity.

4 Educational and Social/Economic Opportunity Associated with IQ in DC Metro Children

Objective:Social determinants of health (SDOH) are social conditions (e.g., employment, access to healthcare, quality schools) which are shown by a growing body of literature to impact many health outcomes, including cognition. The development of community-level measures including the Child Opportunity Index (COI) have allowed for increased understanding of the resources and conditions in neighborhoods and their impact on children’s health. Given the limited existing research on how neighborhood factors impact cognitive development, this study aimed to examine associations between neighborhood context (COI) and cognitive outcomes in children and adolescents who presented for neuropsychological evaluations.Participants and Methods:Participants included 4,633 youth (ages 2-22; M = 10.8 years; SD = 4.1 years; 63% Male; 33% with a medical condition involving the central nervous system [CNS]) living in the DC-VA-MD-WV Metro Area who presented to an outpatient clinic for evaluation and completed an intellectual functioning (IQ) measure (88% Weschler, 11% DAS, &lt;1% Leiter, &lt;1% RIAS). COI values were extracted from electronic medical records based on home address. COI values include an overall index and three domain scores in educational (educational access, quality, and outcomes), health/environment (access to healthy food, healthcare, and greenspace) and social/economic (income, employment, poverty); higher scores indicate higher opportunity. Using metro-based norms, children from all opportunity levels were represented (14% Very Low, 13% Low, 18% Moderate, 21% High, 34% Very High). Multiple regression analyses were conducted to examine main effect associations between COI and Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Non-Verbal IQ (NVIQ) and explore moderation of age, gender, and medical condition on these associations. Additional regression analyses examined these relationships for the three COI domains.Results:Controlling for age, gender, and medical condition, neighborhood opportunity was positively associated with cognitive function (FSIQ: ß=0.198; VIQ: ß=0.202; NVIQ: ß=0.148, p’s &lt;0.01). Models accounted for approximately 10-14% percent of the variance in cognitive outcomes (FSIQ: F[6,4476]=180.331), Adj.R2=0.138; VIQ: F[6,4556]=161.931), Adj.R2=0.124; NVIQ: F[6,4548]=123.893), Adj.R2=0.098). Age moderated the association between overall COI and cognitive outcomes (FSIQ: ß=0.005, p=0.018; VIQ: ß=0.005, p=0.043; NVIQ: ß=0.005, p&lt;0.01) such that the association between neighborhood opportunity and cognitive outcomes was stronger at older ages, though this was a small effect. When examining subdomains of COI, cognitive outcomes were associated with educational (FSIQ: ß=0.094; VIQ: ß=0.099; NVIQ: ß=0.078, p’s &lt;0.01) and social/economic opportunity (FSIQ: ß=0.115; VIQ: B=0.121; NVIQ: ß=0.084, p’s &lt;0.01) but not health/environmental opportunity (FSIQ: ß=-0.001, p=0.991; VIQ: ß=-0.008, p=0.581; NVIQ: ß=-0.008, p=0.553). Medical diagnosis moderated the association between social/economic opportunity and FSIQ; there was a stronger association between IQ and COI in youth with a medical diagnosis (ß=-0.071, p&lt;0.05).Conclusions:These findings demonstrate the importance of neighborhood factors, especially education and social/economic opportunities, on cognitive development. Children living in higher opportunity neighborhoods showed higher cognitive functioning. Older age and CNS-involved medical conditions were associated with higher risk in the context of reduced neighborhood opportunities. These findings emphasize the need for advocacy and other efforts to improve community resources (e.g., access to early childhood education) to address inequities in cognitive development.