Metropolitan Detroit Research Articles

“Livonia is just all racism”: locating black families’ racial and spatial experiences, school choices, and educational agency in metropolitan Detroit

ABSTRACT Focusing on the metropolitan Detroit region, this paper examines how seven Black families’ racial and spatial subjectivities influenced their suburban school and community choices, and more broadly their acts of educational agency. Using a critical phenomenological approach, key findings show that families’ lived experiences of race and racism in the region, along with the increased presence and support of Black students, families, and educators in select suburban schools influenced their choices and efforts to make suburban schools aligned with their educational and communal priorities, revealing the dual nature in which Black families navigate unjust U.S. education landscapes. Implications address the ongoing challenges Black families encounter in U.S. regional education landscapes and the need for more just approaches that honor Black families’ educational agency and placemaking in local contexts.

Infusion Reactions With Alternative Therapies During the National Shortage of Iron Dextran.

Prior to the national shortage of iron dextran in early 2023, it was the most commonly administered intravenous iron infusion at our institution. After the shortage impacted the health system, alternatives such as iron sucrose and sodium ferric gluconate/sucrose were required that utilized lower doses given at more frequent patient visits. Coinciding with their more prevalent use, an increase in iron infusion reactions was observed. Our study analyzed 880 patients who received iron infusions in three Henry Ford Hospital clinics in metropolitan Detroit, Michigan, from July 2022-June 2023. The 74 reactions that occurred were most commonly associated with iron sucrose at the 500 mg dose (41/74, 55.41%, p < 0.0001). Most reactions observed across all iron formulations and doses were mild, with 83.7% being Grade 0 or 1 as defined by the United States Drug Allergy Registry (USDAR) grading scale for immediate reactions. Patients who experienced an infusion reaction were less likely to complete their infusion plans (OR 0.004 for iron dextran, OR 0.128 for iron sucrose, p < 0.0001), with infusions most commonly being completely discontinued thereafter, with a minority pursuing alternative options. More patients with lower number of doses scheduled for iron dextran completed their infusion schedules than those with more doses, but the opposite was seen for iron sucrose. We assessed the impact of the national shortage of iron dextran examining infusion reactions with various iron infusions and doses.

Adiposity throughout Adulthood and Risk of Young Onset Breast Cancer Tumor Subtypes in the Young Women's Health History Study.

The role of adult adiposity in young-onset breast cancer (YOBC) subtype risk is not well understood. In this population-based case(n=1812)-control(n=1381) study of invasive YOBC (aged <50 years), cases were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010-2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity (body mass index (BMI)) and central adiposity (waist circumference (WC), waist-to-height ratio (WHtR)) across adulthood and covariates were collected from in-person interviews and measurements. Odds ratios (ORs) and 95% confidence intervals (CIs) for adiposity and YOBC tumor subtypes (i.e., luminal A, luminal B, HER2+, triple negative (TN)) were calculated, overall and by parity, using multivariable weighted logistic regression. Obese young adult BMI was inversely associated with luminal A YOBC (OR=0.35, 95% CI 0.16-0.79); other subtype associations were non-significant. Similarly, adult overweight and obese BMIs were inversely associated with luminal A (respectively OR=0.66, 95% CI 0.48-0.91 and OR=0.59, 95% CI 0.46-0.87), but not other subtypes. Conversely, larger WC was associated with higher odds of luminal B and TN YOBC (respectively OR=1.48, 95% CI 1.01-2.15 and OR=2.48, 95% CI 1.52-3.88), but not other subtypes (with similar results for WHtR); highest odds were among parous women. Findings show greater general adult adiposity is associated with reduced odds of luminal A YOBC, while greater central adiposity is associated with increased odds of luminal B and TN YOBC, particularly among parous women. Additional studies of central adiposity and YOBC subtype risk, especially incorporating pregnancy history, are warranted.

489 Incidence Rates and Social Factors Associated With Heart Failure-Related Encounters in Metropolitan Detroit, Michigan, Emergency Departments From 2018-2024

489 Incidence Rates and Social Factors Associated With Heart Failure-Related Encounters in Metropolitan Detroit, Michigan, Emergency Departments From 2018-2024

Abstract A056: Assessment of environmental injustice in racial disparities of colorectal cancer mortality in metropolitan Detroit

Abstract Non-Hispanic Black (NHB) patients face the highest colorectal cancer (CRC) mortality rates in the US, heavily influenced by social determinants of health (SDOH). Neighborhood quality, a key SDOH, impacts both socioeconomic factors and exposure to cancer-related environmental contaminants. Thus, in studying the role of environmental justice on health outcomes it is crucial to account for the separate and combinatory effects of environmental and socioeconomic burden. The Centers for Disease Control and Prevention (CDC) created a comprehensive socio- environmental variable available at the census tract level called the Environmental Justice Index (EJI). The EJI utilizes 36 environmental, social, and health factors grouped into modules. We analyzed the EJI's social vulnerability module (SVM), environmental burden module (EBM), and the combined Social Environmental Score (SER) to assess the role of environmental injustice in CRC mortality by race. Patient data including census tract at diagnosis, demographics, and clinical features were obtained from the Metropolitan Detroit Cancer Surveillance System population-based cancer registry for 9727 NHW and 3778 NHB invasive CRC cases. The EJI SVM, EBM, and SER variables were linked to patients by census tract and converted to quartile-level variables, and mortality risk was evaluated for quartile 4 (highest burden) compared to quartile 1 (lowest burden). Cox proportional hazards regression, adjusting for demographics and clinical features, was used to estimate survival associations. We evaluated associations overall and stratified by race (Non-Hispanic White [NHW], NHB) and age of onset (&amp;lt;50, 50+). In nearly all models, we found all EJI variables increased the risk of mortality, with Hazard Ratios (HR) ranging from 1.02-2.89. SVM showed stronger effects overall compared to EBM, and most models showed similar effects among race and age groups in both overall and cancer-specific mortality. A notable exception to this was that NHB early onset (EO) patients showed an elevated risk of cancer-specific mortality due to EBM (HR=2.05, 95% Confidence Interval (CI)=1.21-3.45, p=0.019) compared to SVM (HR = 1.05, 95% CI = 0.58-1.88, p=0.88), and also compared to all EO EBM (HR=1.34, 95% CI=1.04-1.72, p=0.025) and NHW EO EBM (HR=1.25, 95% CI=0.83-1.89, p=0.29) patients. Additionally, cancer-specific mortality of EO patients with colon tumors specifically was highly elevated in both the EBM (HR=2.10, 95% CI=1.19-3.68, p=0.010) and SER (HR=2.89, 95% CI=1.55-5.36, p = 0.00081) models compared to all other groups and models. These results suggest that the combination of socio- environmental burdens contributes to racial disparities in CRC mortality in metropolitan Detroit, largely driven by social rather than environmental factors, except among NHB EOCRC where environmental factors appear to play a stronger role. Further analyses investigating the molecular implications of these exposures are needed to better understand the biological mechanisms driving tumor progression related to disparities among age and race. Citation Format: Natalie G Snider, R. B. Buchalter, Theresa Hastert, Gregory Dyson, Carina Gronlund, Elena Stoffel, Laura Rozek, Ed Peters, Ann Schwartz, Kristen Purrington. Assessment of environmental injustice in racial disparities of colorectal cancer mortality in metropolitan Detroit [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 A056.

Abstract A014: Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women

Abstract Background: Breastfeeding has been associated with a reduced risk of breast cancer (BC), particularly with Triple Negative BC (TNBC). The risk of TNBC is higher among premenopausal women, Black/African American (AA) women, and poorer women. Notably there are significant disparities in breastfeeding, where non-Hispanic Black (NHB) women and poorer women are less likely to breastfeed in the United States. Studies have identified historical racial trauma, unsupportive work and hospital policies, breast milk formula advertising, and knowledge and beliefs about breast feeding as factors that contribute to breast feeding practices. However, there is a paucity of research on pregnancy related medical conditions (PMCs) that potentially impact initiation and duration of breastfeeding. The purpose of this study is to evaluate racial and socioeconomic differences in breastfeeding, and if PMCs impact breastfeeding practices in a population-based sample of non-Hispanic Black and White women. Method: Data are from the Young Women’s History and Health Study (YWHHS), a population- based case-control study of invasive BC among non-Hispanic Black (NHB) and non-Hispanic White (NHW) women aged 20-49 years residing in Metropolitan Detroit and Los Angeles County, 2010-2015. The analytic sample here includes the first pregnancy of control participants with singleton live births (n=675). Area-based control participants were sampled from the 2010 Census. Interviews assessed complete reproductive histories, including breastfeeding history (never, &amp;lt;6 months, and ≥6 months), PMCs experienced during pregnancy, self-reported race, and household financial struggles before age 13 years (to approximate childhood socioeconomic position (chSEP)). PMCs examined included: 1) premature birth, 2) diabetes or pre-diabetes related PMCs, 3) blood pressure-related PMCs, and 4) BMI ≥ 25 kg/m2 at age 18 years. Weighted percentages were evaluated with a chi-square test and considered significant at p &amp;lt; 0.05. Analyses were further stratified by race/ethnicity and chSEP. Result: NHB women were 2.4 times significantly more likely to never breastfeed than NHW women (W% =52.0 (NHB) and 21.3 (NHW), p=&amp;lt;0.0001). Similarly, women with lower compared to higher chSEP were 1.5 times significantly more likely to never breastfeed (W% = 42.7 (lower chSEP) and 28.5 (higher chSEP), p=0.003). Those with BMI ≥ 25 kg/m2 at age 18 years (p&amp;lt;0.001) alone, and with one or more PMCs (p=0.01) were also less likely to breastfeed. When stratified by race/ethnicity the pattern of breastfeeding did not differ significantly by any PMC within NHB and NHW women. When stratified by chSEP, however, BMI ≥ 25 kg/m2 at age 18 years (p = 0.004) and having one or more PMCs (p=0.03) were significantly associated with never breastfeeding among those with higher chSEP. Conclusion: NHB women and women with lower chSEP were substantially less likely to breastfeed. Additionally, BMI ≥ 25 kg/m2 at age 18 and PMCs were associated with lower frequency of breastfeeding overall and among those with higher chSEP. Citation Format: Meheret B. Gebreegziabher, Lydia R. Post, Chris C. Cho, Zhenzhen Zhang, Kelly A. Hirko, Dorothy R. Pathak, Ann S. Hamilton, Ann G. Schwartz, Ellen M. Velie. Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women [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 A014.

Nifedipine outperforms labetalol: A comparative analysis of hypertension management in black pregnancies

BackgroundNifedipine has previously exhibited superior efficacy to labetalol in managing hypertension in the non-pregnant Black population, establishing itself as a first-line treatment option. However, the unique challenges of hypertension during pregnancy, especially prevalent in Black individuals, remain underexplored in terms of effective medication choices. This gap highlights the need for targeted research on antihypertensive efficacy specifically within this population. ObjectiveThis study aims to evaluate the effectiveness of nifedipine versus labetalol in managing blood pressure in Black pregnancies. The primary measure is the mean systolic and diastolic blood pressure trajectories throughout pregnancy, determining the superiority of nifedipine in this context. Study designA retrospective cohort study was conducted at a multi-center institution in the metropolitan Detroit area, encompassing data from 1,235 Black pregnancies affected by chronic hypertension between 2015 and 2022. Mean blood pressure trajectories during pregnancy were fit by linear mixed effects model with a random intercept and time effect. ResultsPatients on nifedipine had an estimated 2.08 mmHg lower mean systolic and 1.60 mmHg lower mean diastolic blood pressure compared to those on labetalol, with significant p-values of 0.040 and 0.028. Additionally, nifedipine users were less likely to need increased doses, with an odds ratio of 0.28 (95 % CI: 0.19–0.40, p < 0.001) compared to labetalol users. ConclusionThis study provides compelling evidence that nifedipine outperforms labetalol in managing blood pressure during Black pregnancies. These findings suggest that the initiation of nifedipine should be considered in the management of chronic hypertension among Black pregnant individuals, offering a potentially more effective treatment option.

Menopause and Traumatic Brain Injury: A NIDILRR Collaborative Traumatic Brain Injury Model Systems Study

ObjectiveTo examine the experience of menopause symptoms in women with traumatic brain injury (TBI). DesignCross-sectional descriptive study. SettingFive sites of the TBI Model Systems (TBIMS) program. ParticipantsParticipants were 210 women, aged 40-60 years, who were not taking systemic hormones and did not have both ovaries removed: 61 participants were enrolled in the TBIMS, who were at least 2 years post-TBI and living in the community. One hundred forty-nine participants without TBI were recruited from a research registry and the metropolitan Detroit community. InterventionsNot applicable. Main Outcome MeasuresA checklist comprised of 21 menopause symptoms assessing 4 symptom clusters (vasomotor, somatic, psychological, and cognitive). ResultsTBI and non-TBI groups did not significantly differ and showed small effect sizes on vasomotor symptoms. On the remaining symptom clusters, women with TBI showed greater presence and severity of symptoms than women without TBI, as well as fewer differences between premenopausal and postmenopausal women on those symptoms. A profile indicating an additive or potentiating effect of TBI on menopause symptoms was not observed. ConclusionsFindings support a conceptual model of menopause and TBI indicating that symptoms most closely associated with estrogen decline are similar for women with and without TBI, whereas symptoms that overlap with common TBI sequelae are generally more frequent and severe among these women. Likely because of lower baseline of symptoms premenopause, postmenopausal women without TBI reported more numerous and severe symptoms relative to their premenopausal counterparts without TBI. Overall, it may be that women without TBI experience menopause as more of a “change” of life, whereas women with TBI chronically face significantly more of these symptoms than women without TBI.

The Effect of COVID-19 on Mood Disorders in Urban and Suburban Detroit

Introduction: The COVID-19 pandemic has increased the global experience of anxiety and depression due to social isolation and government-mandated quarantine for transmission reduction. To date, literature surrounding the mental health effects of COVID-19 for the US population is limited. Methods: This is a retrospective study from a large metropolitan Detroit health system. Patient encounters between December 23, 2018, and June 22, 2021, with March 23, 2020, the start of Michigan state-wide lockdown, were used to define pre- and post-COVID-19. The data was divided into Detroit and non-Detroit based on patient zip code. All patients aged 13+ years old with a visit with a family medicine provider were included. Outcome variables included Patient Health Questionnaires-2 and -9 and General Anxiety Disorder-7 scores, diagnoses of depression, anxiety, adjustment and grief disorders, antidepressant prescriptions, and behavioral health referrals. Logistic regression was used to determine the incidence of composite mood disorder, depression, and anxiety. Results: A total of 20,970 individuals were included in this study: 10,613 in the Detroit subgroup and 10,357 in the non-Detroit subgroup. 88.2% of the Detroit population were Black and 70% were female. Logistic regression shows that the incidence of composite mood disorder decreased with increasing age (odds ratio [OR] 0.787, 0.608, 0.422, and 0.392; p<0.001). Male gender is a protective factor (OR 0.646, p<0.001). Federal insurance is the only factor presenting a statistically significant increased risk (OR 1.395, p<0.001). There was no statistical difference between residing in urban and suburban on incidence of composite mood disorder [OR 0.996 p=0.953] Conclusions: Our research demonstrates that residing in an urban setting did not increase the risk of developing a mental health disorder during the COVID-19 period.

Median Breslow thickness during, post and pre-COVID-19 lockdown and correlation with socioeconomic factors.

e21574 Background: Access to routine cancer care during COVID-19 pandemic was greatly affected. The impact of this on melanoma care is unknown. Breslow thickness (BT) was seen to decrease and then increase during and post-COVID-19 lockdown in Italy. Here, we aim to study the impact of COVID-19 lockdown on melanoma care in the United States. Methods: Patients diagnosed with cutaneous melanoma (CM) pre (September 15th 2019-March 14th 2020), during (March 15th-June 14th 2020), and post-lockdown (June 15th-December 14th 2020) were retrospectively studied using Metropolitan Detroit Cancer Surveillance System (MDCSS) database. Patients without an identifiable primary lesion, or with ocular, mucosal, or acral melanoma were excluded. Demographic and clinical characteristics were reviewed. The primary endpoint was median BT during and post vs pre-lockdown. Fisher's exact and Kruskal-Wallis tests were performed for categorical and continuous variables, respectively, to compare groups. Interaction in subgroup analyses was assessed using likelihood ratio tests. Linear regression analyses were performed with Box-Cox transformed BT. Cox proportional hazards regression analyses were performed for overall survival. Covariates for multivariable analysis were selected using LASSO-based penalized regression models. Results: 802 patients were included (pre N = 347, during N = 87, post N = 368). Patients diagnosed with CM post-lockdown were younger (age &lt; 50 years pre = 14%, during = 13%, post = 23%). More patients diagnosed pre-lockdown carried government-issued insurance (pre = 48%, during = 39%, post = 38%). No difference (diff) in median BT was seen between periods (median = 0.6mm for pre, during, and pos). Married status was associated with a lower BT vs unmarried (diff = -0.19, 95% CI -0.36 to -0.014, p = 0.034) and higher census tract poverty level was associated with a higher BT (5%-10% diff = 0.17, 95% CI 0.004 to 0.33, p = 0.045; 10%-100% diff = 0.27, 95% CI 0.093 to 0.45, p = 0.003) vs 0-5% poverty on univariable analysis. Male gender was associated with a lower BT on multivariable analysis (diff = -0.12, 95% CI -0.20 to -0.04, p = 0.005) and lower risk of death on univariable analysis (HR = 0.50, 95% CI 0.31 to 0.82, p = 0.006). Conclusions: We found no difference in median BT during and post- vs pre-lockdown. We also identified at-risk populations (female, unmarried, and living in greater poverty areas) who could benefit from proactive melanoma care. Time to surgery from initial diagnosis during and post vs pre-lockdown would be of interest to study further.

Multiplicity of benign breast disease lesions and breast cancer risk in African American women.

The risk of developing subsequent breast cancer is higher in women diagnosed with benign breast disease (BBD) but these studies were primarily performed in non-Hispanic white populations. Still, these estimates have been used to inform breast cancer risk models that are being used clinically across all racial and ethnic groups. Given the high breast cancer mortality rates among African American (AA) women, it is critical to study BBD in this population, to ensure the risk models that include this information perform adequately. This study utilized data from AA women who underwent benign breast biopsies at a hospital served by the University Pathology Group in Detroit, Michigan, from 1998 to 2010. Patients were followed for subsequent breast cancers through the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). BBD lesion scores were assigned to represent the severity or extent of benign breast lesions, with higher scores indicating a greater number of distinct lesion types. Of 3,461 eligible AA women with BBD in the cohort, 6.88% (n=238) subsequently developed breast cancer. Examined individually, six of the eleven lesions (apocrine metaplasia, ductal hyperplasia, lobular hyperplasia, intraductal papilloma, sclerosing adenosis, columnar alterations and radial scars) were significantly associated with increased risk of breast cancer after adjustment for age and year of biopsy and were further considered in multiple lesion models. For every different type of benign breast lesion, subsequent risk of breast cancer increased by 25% (RR=1.25, 95% CI: 1.10, 1.42) after adjustment for age at biopsy and proliferative versus non-proliferative disease. In summary, this study affirms the increased breast cancer risk in AA women with BBD, particularly in those with multiple lesions. These findings have implications for the management of breast cancer risk in millions of women affected by BBD, a high risk group that could benefit from personalized surveillance and risk reduction strategies.

Abstract PO4-09-07: Overall Survival According to Race and Socioeconomic Status Among Women Treated for BreastCancer at Ascension Health Hospitals in Metropolitan Detroit

Abstract Background: Despite increasing public awareness and education regarding racial inequality, African American (AA) patients continue to carry higher likelihood of death from breast cancer due to both cancer phenotype and remediable factors of access to care and socioeconomic status. Patients and Methods: We identified 3,241 patients treated for breast cancer between 2006 and 2015 at Ascension St John Hospital (Detroit MI), Ascension Macomb Oakland Hospital (Warren MI) and Ascension Providence Hospital (Southfield MI). Of these, 2530 (78.1%) were categorized as White (W), 658 (20.3%) as African American (AA), and 53 (1.6%) as Other. We considered known risk factors of race and zip code as well as marital status and having any Medicaid insurance (7.4%). 58.55% of patients were married, 15.88% never married, 13.9% widowed, and 11.6% divorced or separated. There were 632 (19.5%) cases represented from the 50 most affluent zip codes in Michigan (median income $83,125 to $140,372), 400 (12.3%) from the 50 least affluent zip codes (median income $14,909 to $33,500), 2199 (67.8%) from the intermediate zip codes, and 10 (0.31%) unknown or out of state. Tumors subtypes were 62% Luminal A (HR+/HER2-), 9.5% Basal (HR-/HER2-), 3.74% Her2 Enriched (HR-/HER2+), and 8% Triple Positive (HR+/HER2+). There were 279 Stage T0 Receptor positive DCIS and 64 Receptor Negative DCIS. 57.3% had lumpectomy or partial mastectomy as the first course of surgery, 27.9% had some form of mastectomy and 14.7 percent mastectomy with reconstruction. SAS for Windows 9.4, Cary, NC and Tableau 2023.1 was used for descriptive and crude analysis. Results: As expected overall survival was highly statistically associated (p&amp;lt; 0.0001) with the variables: age, race, subtype, node positivity and AJCC pathologic stage. Socioeconomic risk factors including zip code (p&amp;lt; 0.0001), marital status (p=0.0006), and carrying Medicaid insurance (p&amp;lt; 0.0001) statistically influenced overall survival. When considering the 50 most affluent zip codes, just 3.79% were African American (AA), with a greater proportion diagnosed at Stage I (49.85%) as compared to the 50 least affluent zip codes (81.97% AA; 37.74% Stage I, p= 0.022). Conclusions: As expected, breast cancer survival was influenced by race, tumor, and patient characteristics. This analysis allows for evaluation of the relative influence of biologic factors (e.g.tumor subtype and cancer stage) and socioeconomic indicators including zip code (stratified by median income) and insurance status. Citation Format: Shaveena Sivapalan, Khalid Berdi, Ali Shamsa, Maria Vlachaki, Aye Thet, Jeffrey Falk, Carrie Dul, Paul Chuba. Overall Survival According to Race and Socioeconomic Status Among Women Treated for BreastCancer at Ascension Health Hospitals in Metropolitan Detroit [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-07.

Abstract 3456: The role of particulate matter exposure in racial differences in colorectal cancer mortality in metropolitan Detroit

Abstract Colorectal cancer (CRC) is the third most diagnosed cancer in the United States and the third leading cause of cancer-related deaths. Non-Hispanic Black (NHB) individuals have the highest rates of CRC incidence and mortality in the United States. These disparities are highly influenced by social determinants of health (SDOH). Neighborhood quality, a well-established SDOH, has been shown to influence cancer outcomes, oftentimes more heavily in minorities. Additionally, neighborhood quality is known to influence an individual’s risk of exposure to harmful environmental contaminants including ambient air pollution as a result of systemic racism such as segregation and historic redlining, leading to environmental injustices. Fine particulate matter (PM2.5) exposure has been shown to increase the risk of CRC mortality, however, its effects by race have not yet been examined. We sought to understand whether higher rates of exposure to PM2.5 played a role in racial differences in CRC survival in metropolitan Detroit. Patient data including census tract at diagnosis, demographics, and clinical features were obtained from the metropolitan Detroit cancer surveillance system registry. Ambient PM2.5 concentration data at the census tract were obtained from the Environmental Protection Agency (EPA) Remote Sensing Information Gateway (RSIG) and converted to annual averages to use in an interval-censored Cox proportional hazards regression model. We found that PM2.5 exposure partly attenuated the effect of race on overall mortality in all patients (NHB vs NHW: Hazard Ratio (HR) = 1.24, 95% Confidence Interval (CI) 1.20 - 1.27, p &amp;lt; 0.0001, NHB vs NHW after accounting for PM2.5: HR = 1.19, 95% CI = 1.16 - 1.23 p &amp;lt; 0.0001) and the effect was stronger among patients under 50 than over 50, though still significant in both models. Additionally, the effect of PM2.5 on mortality was much stronger among NHB patients than NHW patients (NHB HR = 1.30, 95% CI = 1.17 - 1.45, p &amp;lt; 0.0001; NHW HR = 1.06, 95% CI = 1.02 - 1.11 p = 0.008) and especially strong among NHB patients under 50 (HR = 2.51, 95% CI = 2.38 - 3.38, p &amp;lt; 0.0001) compared to any other group. We conclude that ambient air pollution, particularly PM2.5, disproportionately affects mortality risk in NHB CRC patients. These results highlight the importance of environmental justice research in biomedical research, and the need for a better understanding of environmental impact on tumor biology to prevent tumor progression and mortality among all patients. Citation Format: Natalie Gail Snider, Theresa Hastert, Gregory Dyson, Carina Gronlund, Elena M. Stoffel, Ed Peters, Laura Rozek, Ann Schwartz, Kristen Purrington. The role of particulate matter exposure in racial differences in colorectal cancer mortality in metropolitan Detroit [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3456.

Making Muslim Americans: Parenting Practices, Parochial Schools, and the Transmission of Faith Across Generations in Metropolitan Detroit

Making Muslim Americans: Parenting Practices, Parochial Schools, and the Transmission of Faith Across Generations in Metropolitan Detroit

Impression of Primary Care Follow-Up After a PICU Admission: A Pilot Survey of Primary Care Pediatricians.

The majority of PICU general follow-up occurs with primary care providers. Our objective was to investigate primary care pediatricians': 1) comfort with and barriers to caring for children after a PICU admission, 2) knowledge of and screening for post-intensive care syndrome in pediatrics (PICS-P), and 3) resource needs. Pilot cross-sectional survey study. Metropolitan Detroit, Michigan from September 2022 to March 2023. Primary care pediatricians. The survey included 15 questions on provider demographics, comfort with and barriers to caring for children after a PICU admission, knowledge of and screening practices for PICS-P, and resource needs. The median values for continuous data and frequencies for categorical data were calculated. The survey response rate was 17% (26/152). The median age was 38.5 years (interquartile range 34-52 yr) and 19 of 26 (73%) were female. In case studies, 26 of 26 (100%) were "very comfortable" resuming care for a patient with a straightforward bronchiolitis PICU admission while 8 of 26 participants (31%) were "somewhat uncomfortable" and 1 of 26 (4%) was "not at all comfortable" with caring for a patient after a complex acute respiratory distress syndrome PICU admission. Seven of 26 participants (27%) were familiar with the term "post-intensive care syndrome in pediatrics." Over 50% screened for four of five PICS-P domains. Key barriers were care coordination with specialists, discomfort or difficulties with managing new home equipment, and inadequate or missing documentation. In this pilot study, approximately one-third of primary care pediatricians had knowledge of PICS-P. Participants experienced numerous care barriers. Our findings suggest future research could engage improved study methods and designs, and focus on interventions to support primary care-provided PICU follow-up.

A broad wastewater screening and clinical data surveillance for virus-related diseases in the metropolitan Detroit area in Michigan

BackgroundPeriodic bioinformatics-based screening of wastewater for assessing the diversity of potential human viral pathogens circulating in a given community may help to identify novel or potentially emerging infectious diseases. Any identified contigs related to novel or emerging viruses should be confirmed with targeted wastewater and clinical testing.ResultsDuring the COVID-19 pandemic, untreated wastewater samples were collected for a 1-year period from the Great Lakes Water Authority Wastewater Treatment Facility in Detroit, MI, USA, and viral population diversity from both centralized interceptor sites and localized neighborhood sewersheds was investigated. Clinical cases of the diseases caused by human viruses were tabulated and compared with data from viral wastewater monitoring. In addition to Betacoronavirus, comparison using assembled contigs against a custom Swiss-Prot human virus database indicated the potential prevalence of other pathogenic virus genera, including: Orthopoxvirus, Rhadinovirus, Parapoxvirus, Varicellovirus, Hepatovirus, Simplexvirus, Bocaparvovirus, Molluscipoxvirus, Parechovirus, Roseolovirus, Lymphocryptovirus, Alphavirus, Spumavirus, Lentivirus, Deltaretrovirus, Enterovirus, Kobuvirus, Gammaretrovirus, Cardiovirus, Erythroparvovirus, Salivirus, Rubivirus, Orthohepevirus, Cytomegalovirus, Norovirus, and Mamastrovirus. Four nearly complete genomes were recovered from the Astrovirus, Enterovirus, Norovirus and Betapolyomavirus genera and viral species were identified.ConclusionsThe presented findings in wastewater samples are primarily at the genus level and can serve as a preliminary “screening” tool that may serve as indication to initiate further testing for the confirmation of the presence of species that may be associated with human disease. Integrating innovative environmental microbiology technologies like metagenomic sequencing with viral epidemiology offers a significant opportunity to improve the monitoring of, and predictive intelligence for, pathogenic viruses, using wastewater.

Placing career resilience: Collaborative workspaces as situated resources for adaptation and adaptability

Processes of creation and innovation become increasingly mobile and temporarily make use of collaborative (work)spaces for paid and unpaid work, tinkering, social experimentation, collaboration, and entrepreneurship. Diverse forms of collaborative workspaces (CWSs) proliferated in many cities worldwide in the past 15 years and manifested in a diversity of forms, such as e.g. fablabs, maker-, hacker-, or coworking spaces. Despite the diversity, these spaces share three distinctive features: openness for a diversified set of users, aspiration to promote creative processes, and potential to allow for societal experimentation. So far, empirical research either highlights their functions in safeguarding the deficiencies related to new work regimes or the affordances for fostering collaborative creativity and innovation. We propose career resilience as a concept to integrate both perspectives. We investigate CWSs as locally situated contexts enabling users to combine stabilising and transformative resources to advance their careers. The paper draws on more than 100 qualitative interviews with operators, managers, and users of CWSs in the metropolitan regions Amsterdam, Berlin, and Detroit. We inductively develop five different types of practices that address fundamental career related uncertainties to individual and collective measures to create career resilience. In CWSs, users seek company, focus, assets, guidance, and meaning. CWSs are thus spatial and organisational settings that complement multisited, mobile work practices and that illustrate the importance of permanent organisational and material places in increasingly volatile working environments.

Abstract PR019: Evaluating the role of ambient air pollution in racial disparities of colorectal cancer incidence and survival in metropolitan Detroit

Abstract Colorectal cancer (CRC) is the third most diagnosed cancer in the United States and the third leading cause of cancer-related deaths. Moreover, Non-Hispanic Black (NHB) individuals have the highest rates of CRC incidence and mortality in the United States. We have become increasingly aware of the potential impact of social determinants of health (SDOH) on colorectal physiology and carcinogenesis. Other than individual and neighborhood level socioeconomic status (SES), neighborhood quality can also affect an individual’s risk of exposure to harmful environmental contaminants including ambient air pollution. Moreover, as NHB individuals are more likely to live in areas of lower area-level SES they experience these effects even further. We sought to understand whether higher exposure rates to fine particulate matter (PM2.5) played a role in racial differences in CRC incidence and survival in metropolitan Detroit. To do this, we obtained data from the Environmental Protection Agency (EPA) Environmental Justice Mapping and Screening Tool through the Georgetown University Environmental Impact Data Collective (EIDC) and patient data from the Metropolitan Detroit Cancer Surveillance System (MDCSS) registry. Incidence rates were calculated using population data from the American Community Survey. Associations between PM2.5 exposure and CRC incidence were estimated using Poisson modeling. Data were obtained for NHB (n=3778) and Non-Hispanic White (NHW) (n=9727) individuals diagnosed with invasive CRC between 2010 and 2019 in Wayne, Oakland, and Macomb counties, including their geocoded census tract at diagnosis as well as demographic and clinical features. Vital status was reported as months from the date of diagnosis to either death or last contact. PM2.5 metrics were converted to the national percentile of PM2.5 in the air utilizing the Bayesian space-time downscaling fusion model for derived estimates of air quality at the census tract level. Survival was assessed using Cox Proportional Hazards modeling. We found that an increase in the PM2.5 percentile increased the risk for CRC overall for NHB and NHW patients (Relative Risk [RR] = 1.80, 95% Confidence Interval [CI] = 1.55 - 2.08, p-value &amp;lt;0.0001). This association was even stronger among NHB patients (RR = 7.94, 95% CI = 5.45 - 11.52, p-value &amp;lt; 0.0001), but was not statistically significant among NHW patients (RR = 1.12, 95% CI = 0.95 – 1.32, p-value = 0.16). PM2.5 exposure was not associated with survival overall or stratified by race. We conclude that ambient air pollution, particularly PM2.5, increases the risk of CRC cancer and disproportionately affects NHB patients but may not play a role in mortality risk. These results highlight the importance of environmental justice research in biomedical research and the need for a better understanding of the etiology of CRC within and among differing genetic ancestries and races by evaluating the genetic and epigenetic differences in patient tumor samples. Citation Format: Natalie G. Snider, Theresa Hastert, Ed Peters, Elena M. Stoffel, Laura Rozek, Ann Schwartz, Kristen Purrington. Evaluating the role of ambient air pollution in racial disparities of colorectal cancer incidence and survival in metropolitan Detroit [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 PR019.

Efficacy of Direct Oral Anticoagulants Vs Warfarin Vs Low Molecular Weight Heparin in the Treatment of Acute Splanchnic Vein Thrombosis in Patients with Underlying Myeloproliferative Disorder

Introduction: Myeloproliferative neoplasms (MPNs) are hematopoietic stem cell disorders characterized by clonal proliferation of myeloid-lineage cells. Venous thrombosis poses a significant morbidity risk for MPN patients. The current recommended treatments for acute splanchnic vein thrombosis (SVT) are warfarin and low molecular weight heparin (LMWH). Direct oral anticoagulants (DOACs) are potential alternatives due to their predictable dose response and oral administration, but limited data exists for their use in acute SVTs. This retrospective study aims to assess the efficacy and outcomes of DOACs, LMWH, and warfarin in treating acute SVTs in patients with underlying MPN. Methods: We included patients of all ages with underlying myeloproliferative neoplasms and splanchnic vein thrombosis, with no underlying liver diseases, from Henry Ford Hospital Clinics in metropolitan Detroit, Michigan between 2013 and 2023. Patient data, which included age, gender, race, and BMI were recorded. The primary outcome was complete radiographic resolution (CRR) of the SVT, and secondary outcomes included recanalization, thrombosis progression, recurrent thrombosis, major bleeding, thrombocytopenia, and skin necrosis. The outcomes were compared between the three anticoagulant groups and patients using aspirin. Results: Among the 34 MPN patients with SVT, warfarin was prescribed most frequently (n=19), followed by enoxaparin (n=5) and DOACs (n=5). Although no significant differences were observed, warfarin showed the highest CRR rates (41.2%), while enoxaparin and DOACs had equal CRR rates (25%). DOACs showed recanalization rates similar to warfarin and higher than enoxaparin (44.4% and 47.1% vs. 20.0%, respectively). LMWH was associated with increased recurrent thrombosis rates (50.0%), while DOACs had a higher risk of major bleeding. All three anticoagulants had similar effects on thrombocytopenia and SVT progression. Aspirin use was linked to a higher risk of major bleeding (42.9%), but not using aspirin correlated with complete SVT resolution (30.8%), SVT progression (20.8%), recurrent thrombosis (29.2%), and thrombocytopenia (28.6%). Conclusions: Although limited by a small sample size, our study found no significant differences among the three anticoagulant groups. This contributes to establishing the role of DOACs in treating SVTs in patients with underlying MPN. Further studies with larger sample sizes are needed to explore the efficacy of DOACs compared to warfarin. Additionally, investigating the potential benefits of early thrombolysis in conjunction with anticoagulation for SVT patients with underlying MPN should be pursued, as the rates of complete resolution in these patients were low.

Infusion Reactions with Alternative Therapies during the National Shortage of Iron Dextran

Introduction The national shortage of intravenous iron dextran has required patients to receive more alternative iron infusions, such as iron sucrose and sodium ferric gluconate/sucrose, since January 2023. While prior studies have evaluated rates of infusion reactions among some commonly used intravenous iron formulations, data is lacking among differing doses of iron formulations and especially in the setting of this iron dextran shortage. Clinicians at our institution generally observed more adverse reactions with alternative iron infusions during the national shortage of iron dextran compared to prior. Our study examines the infusion reactions of various iron therapies at differing doses and actions providers and patients took thereafter to assess the impact of the iron dextran national shortage on patients. Methods Patients were included who received iron infusions in three Henry Ford Hospital clinics in metropolitan Detroit, Michigan, from July 2022-June 2023 with the national iron dextran shortage impacting the health system since January 2023. Age, race, sex, reason for iron infusion, iron infusion formulation received, time of infusion, and dosing schedule of infusion were recorded for all participants. We assessed the symptoms experienced and actions taken for patients who had an infusion reaction. The number and type of infusion reactions between different iron infusion formulations and doses were then compared. Results Of the 880 unique patients assessed, 496 (56.4%) received iron dextran, iron sucrose, or sodium ferric gluconate/sucrose between July 2022 and December 2022 prior to the national iron dextran shortage and 384 (43.6%) patients had iron infusions between January 2023 and June 2023 during the shortage. Iron dextran accounted for most of the infusions (n= 356, 71.8%) prior to the shortage whereas iron sucrose was the majority (n=312, 81.3%) during the shortage. Prior to the national shortage, 30 iron infusions reactions occurred, with 18 (60%) associated with iron dextran, 9 (30%) with iron sucrose, and 3 (16.7%) with sodium ferric gluconate/sucrose. During the shortage, 44 reactions occurred, with 1 (2.27%) associated with iron dextran, 41 (93.1%) with iron sucrose, and 2 (4.54%) with sodium ferric gluconate/sucrose. The most reactions (n=41, 55.4%) occurred with iron sucrose at a dose of 500mg across the whole study period. Less reactions (n=9, 12.2%) were reported for iron sucrose at progressively lower doses, comparable to reactions with iron dextran at doses greater than 1000mg (n=8, 10.8%) and at lower doses of iron dextran (n=10, 13.5%). The most common reaction across all infusion types was nausea, vomiting, and/or diarrhea. After an iron infusion reaction, the infusion plan was then most commonly discontinued, with patients either switching to alternative iron infusion formulations, continuing the same infusion type with medications for symptoms, or continuing the same infusion type with lower dose and increased frequency. Conclusion More iron infusion reactions occurred after the national shortage of iron dextran since January 2023 in the setting of more frequent use of alternative iron therapies. The most common infusion formulation associated with a reaction was iron sucrose at its higher recommended dose of 500mg, compared with iron dextran and sodium ferric gluconate/sucrose. Providers should be aware of these associated adverse reactions with the different doses of alternative formulations when recommending infusions for patients, and the need for preemptive intervention.