National Center For Health Statistics Research Articles

Trends in Sickle Cell Disease Mortality: 1979–2020

BACKGROUND AND OBJECTIVES: Although sickle cell disease (SCD)-related childhood mortality in the United States significantly improved in the 1990s, unclear is the trend in SCD-related mortality more recently given the continued disparities faced by this minoritized population. In this analysis, we aimed to (1) compare the overall and age-specific mortality rates from 1999 to 2009 vs 2010 to 2020 with a particular focus on the age of transition and (2) determine the most common causes of death for the US SCD population for 2010 to 2020. METHODS: We analyzed publicly available data from the Centers for Disease Control and Prevention WONDER database, a compilation of national-level mortality statistics from 1979 to 2020 derived from death certificates compiled by the National Center for Health Statistics. We searched by all individuals of all ethnicities, sexes, and ages using the underlying cause of death. RESULTS: The crude mortality rate for individuals with SCD for 2010 to 2020 was 1.6 per 1 000 000 individuals, which was significantly lower than the period 1999 to 2009 (crude rate 1.7 per 1 000 000, P < .0001). In addition, the mean age at mortality of those with SCD was older in 2010 to 2020 (43 years) versus 1999 to 2009 (39 years). However, there remains a significant increase in mortality rate in the 20 to 24 year age group versus 15 to 19 years (1.7 per 1 000 000 versus 0.7 per 1 000 000, P < .0001), corresponding with the age of transition from pediatric to adult centers. In addition, 39% of underlying causes of death were not caused by SCD, but rather primarily chronic conditions, including cardiovascular, cerebrovascular, malignancy, and renal disease. The study has several limitations mostly because of the imperfections of administrative data sources, including inaccuracies in diagnoses codes, risking over or undercounting. CONCLUSIONS: Although the US SCD-related mortality rate continues to decrease, the age of transition to adult care is a particularly vulnerable time in the lives of this marginalized group. Innovative and expanded approaches to care are greatly needed.

Analysing premature cardiovascular disease mortality in the United States by obesity status and educational attainment.

In the United States (US), premature cardiovascular disease (CVD) mortality rates (35-74years) have exhibited increases in recent years, particularly in younger adults, and large differentials by educational attainment. This trend has occurred concurrently with high and increasing obesity prevalence, which also show significant differences by education. This study aims to jointly model premature CVD mortality trends in the US according to obesity status and educational attainment. We used multiple cause of death data from the National Center for Health Statistics, obesity prevalence data from the National Health and Nutrition Examination Survey (NHANES), and educational attainment data from the American Community Survey and NHANES. We applied Bayes' theorem to these data to calculate the conditional probability of premature CVD mortality given obesity status and educational attainment for 2003-2019. We then projected this conditional probability for 2020-2029 using the Lee-Carter model. The probability of premature CVD mortality was greatest for obesity and low education (not graduated high school) and was substantially higher (females 6.7 times higher, males 5.9) compared with non-obesity and high education (Bachelor's degree or higher) in 2019. There was a widening of the gap in premature CVD mortality from 2003 to 2019 between the obese and non-obese populations, which occurred at each education level and was projected to continue in 2020-2029, especially for males. The conditional probability of premature CVD death for obesity and middle education (finished high school but no Bachelor's degree) increased substantially and was projected to surpass the level for non-obesity and low education in coming years for males and in younger age groups. At high education, the conditional probability of premature CVD death for the obese population was projected to increase to 2029, while for non-obesity it was projected to remain steady for females and fall for males; this projected widening is greatest at older age groups. The findings demonstrate the public health challenge to reduce premature US CVD mortality posed by continued high obesity prevalence, especially for younger ages, lower education groups and males. The relative importance of obesity in influencing premature CVD mortality trends has risen partly due to the decline in CVD mortality attributable to other risk factors.

Abstract 4148077: Heart Failure Mortality Between 1990 and 2020 by US State and Racial and Ethnic Group

Introduction: Heart failure (HF) mortality rates in the US appear to have increased in the past decade. It is unknown how these have changed in recent years by racial and ethnic groups within states. Research Question: To understand disparities in HF mortality patterns between 1990 and 2020 Aim: To estimate the change in HF mortality rates between 1990 and 2020 for Hispanic, non-Hispanic Black, and non-Hispanic White males and females in each US state Methods: We used multiple cause of death records from the National Vital Statistics System and population data from the National Center for Health Statistics to estimate HF mortality from 1990 to 2020 by state, age group, sex, and racial and ethnic group. A binomial model was fit to the data using RegMod, a Bayesian extension of a generalized linear model which incorporated priors from a hierarchy and modeled year as a spline. Results: In 2020, we estimated 566230 (95% UI 566160 to 569740) deaths due to HF. Between 1990 and 2010, HF rates declined in general for all racial and ethnic groups across the US, but not consistently for all states (Figure). From 2010 to 2020, this trend reversed, with age-standardized mortality from HF increasing over this time period, but again this change was not consistent across states. Among the Hispanic population, mortality increased for all states except for Maine, with the largest change for both sexes in Oklahoma. For the non-Hispanic, Black group, mortality increased among all states, with the largest change for both sexes in Oklahoma and South Dakota. Among the non-Hispanic, White populations, mortality decreased for both sexes in District of Columbia, while the largest increases were in Oklahoma. Conclusion: Heart failure mortality increased in the past decade, with striking increases in specific locations by race and ethnic group. Identifying etiologies and drivers of increased HF deaths, including the role of new therapies for subsets of systolic function, could help target novel therapies to subpopulations at highest risk. Differences in trends by state and race and ethnicity groups provides important information for clinicians and policymakers interested in reducing mortality rates.

Abstract 4131228: Where Adults with Advanced Heart Failure Die: Insights from the CDC-WONDER Database

Background: Adults with heart failure (HF) are becoming more and more prevalent. The location of death and related disparities in these patients are poorly understood. Aim: The purpose of the study was to look at the locations of adult deaths from HF and identify any age, race, or ethnicity-related variations over a 25-year period. Methods: The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database provided death certificate data and the National Center for Health Statistics provided individual-level mortality data for the trend-level analysis of adults aged (20-64 and 65+ years) conducted from 1999-2023. Hospital, home, hospice and nursing home/long-term care were the categories for the places of death. Results: Between 1999 and 2023, a total of 7,644,759 adult deaths from HF were recorded (87.9% White, 53.4% female). HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. Conclusion: Prioritize end-of-life planning for HF patients with poor prognosis, regardless of age, to improve quality of life and death.

Physical activity and life expectancy: a life-table analysis

ObjectiveLow physical activity (PA) levels are associated with increased mortality. Improved measurement has resulted in stronger proven associations between PA and mortality, but this has not yet translated to improved...

Disparities, Trends, and Predictions to 2040 in Gastrointestinal Cancer Incidence, Mortality in the USA.

and Importance: Growing gastrointestinal cancers in the U.S. necessitate further research due to substantial healthcare and economic impacts. This study aims to analyze trends and future projections for five major gastrointestinal cancers (colorectal, pancreatic, liver, stomach, and esophageal). Data were sourced from the Surveillance, Epidemiology, and End Results database, National Center for Health Statistics, and Global Burden of Diseases databases. An age-period-cohort model utilizing the Bayesian Information Criterion method was applied to project incidence and mortality rates to 2040. Males consistently exhibited higher incidence and mortality rates across all gastrointestinal cancers, with significant variation across the 51 U.S. states. From 2000 to 2020, colorectal cancer incidence and mortality rates declined across all racial groups, except for the incidence rates of American Indian and Alaska Native (AIAN) men, Hispanic men, and Hispanic women, which remained stable. Pancreatic cancer incidence increased across all groups except for AIAN men, while mortality rates rose only for White men and Hispanic women. Liver cancer incidence rose among AIAN men and White, AIAN, and Hispanic women, while mortality rates declined for most groups. Stomach cancer incidence and mortality either declined or stabilized, and esophageal cancer rates showed a general decline. By 2040, increases in incidence and mortality are projected for most gastrointestinal cancers, particularly in men. Despite varied trends over the past two decades, an overall increase in gastrointestinal cancer incidence and mortality rates is anticipated in the next 20 years in the U.S., underscoring the need for effective prevention and intervention strategies.

Difference in long COVID prevalence due to different definitions and long COVID related risk factors

Abstract Several definitions of long COVID are used in research and practice what challenges epidemiological investigations. Here we present differences in long COVID prevalence accounting for several definitions and concordance between the definitions, as well as the risk factors associated with long COVID. Definitions considered were WHO post-COVID19 condition (PCC) definition with several thresholds (at least low - standard definition, moderate or strong impact on daily activities), NICE1 and NICE2 definitions (reported at least one or at least two symptoms), United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions and perceived long COVID. Prevalence of long COVID among French adult population (N = 10 615) in autumn 2022 ranged from 1.2% to 13.4%, conditional of the definition. The concordance between the definitions was at best moderate. Next, on a smaller representative sample of a French adult population (N = 1 813) eight potential risk factors groups for long COVID were assessed in a systematic epidemiological investigation, following a conceptual model. Fifteen factors from seven groups were associated with long COVID including early-defined sociodemographic characteristics, pre-existing chronic conditions, short-term work-related factors, current socioeconomic position, health behaviours, infection-related factors, and perception of COVID-19 severity and long COVID. The likelihood of long COVID was higher for individuals with higher number of diseases and for nineteen out of twenty-six most prevalent dyads and a triad. A more standardized definition would facilitate research and surveillance of long COVID. Furthermore, long COVID should be observed as an interplay of social, medical and contextual factors rather than a mere complication of SARS-COV-2 infection, while patients with multimorbidity may present some of the particularly vulnerable population groups.

Rurality and outcomes in prostate cancer: role of socioeconomic status and educational attainment

Abstract Background/Introduction Patients diagnosed with prostate cancer (PC) have a higher cardiovascular disease (CVD) prevalence and mortality risk. Rurality have been associated with up to 33% higher CVD risk and 44% higher all-cause mortality risk in patients with PC. Purpose Analyze the impact of rurality (from both patient and provider perspectives) on the development of adverse outcomes after a PC diagnosis according to socioeconomic and educational status. Methods We included men aged ≥66 with a new primary PC diagnosis (defined as ICD-10 = C61) from 2009-2017 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The primary outcomes were CVD (comprising heart failure, atrial fibrillation, acute myocardial infarction, peripheral artery disease, and ischemic stroke), PC-specific mortality (PCsm), cardiovascular disease mortality (CVDm), and all-cause mortality. Patients living in areas with a population of <2,500 or <20,000, not adjacent to a metropolitan area, were considered to have a positive rural status. The provider status (metropolitan vs. non-metropolitan) was defined according to the 2013 National Center for Health Statistics' Urban-Rural Classification Scheme for Counties. Low socioeconomic status (SES) was defined according to Yost Index quintiles. Low educational status was defined according to percentiles of people >25 years old with less than a high school diploma. Multivariable Fine-Gray models, accounting for competing mortality/type of mortality, and Cox regression models were applied. Results We included 75,221 patients with PC (Picture 1), of which 1,828 were from rural areas and 362 were from rural areas with providers from non-metropolitan areas. Among patients from rural areas under the care of non-metropolitan providers, 82.6% had low SES (Yost Index ≤ 2). In this subgroup, patients from rural areas with non-metropolitan providers had 30% higher CVD risk (sHR 1.30; 95% CI 1.04-1.62) and 44% higher all-cause mortality risk (sHR 1.44; 95% CI 1.14-1.83; Picture 2) when compared to patients with low SES from urban or rural areas with providers from metropolitan areas. Additionally, within patients from rural areas with non-metropolitan providers, the median % of people with only high school diploma was 38.3 (IQR 36.2-40.9). Among those with low educational status (≤41% of high school county-rate), patients from rural areas with non-metropolitan providers had a 35% higher associated CVD risk (sHR 1.35; 95% CI 1.06-1.71), 54% higher associated CVDm risk (sHR 1.54; 95% CI 1.01-2.36), and a 32% higher associated all-cause mortality risk (sHR 1.32; 95% CI 1.04-1.66). Conclusion Patients with PC from rural areas with non-metropolitan providers have higher rates of low SES and low educational status and suffer from up to 54% higher associated risks of adverse outcomes, emphasizing the role of multiple domains of the Social Determinants of Health in health outcomes.

The Evolution of Health Information Technology for Enhanced Patient-Centric Care in the United States: Data-Driven Descriptive Study.

Health information technology (health IT) has revolutionized health care in the United States through interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information. This study aims to examine progress in health IT adoption and its alignment with the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP's) mission to enhance health care through data access and exchange. This study leverages data on end users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey IT Supplement (2008 to 2023), Surescripts e-prescribing use data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023). Since 2009, there has been a 10-fold increase in electronic health record (EHR) use among hospitals and a 5-fold increase among physicians. This enabled the interoperable exchange of electronic health information, e- prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. As of 2023, 70% of hospitals are interoperable, with many providers integrated within EHR systems. Nearly all pharmacies and 92% of prescribers possess e-prescribing capabilities, an 85%-point increase since 2008. In 2013, 40% of hospitals and one-third of physicians allowed patients to view their online medical records. Patient access has improved, with 97% of hospitals and 65% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-fourths of individuals report being offered access to patient portals, and over half (57%) report engaging with their health information through their patient portal. Electronic public health reporting has also seen an increase, with most hospitals and physicians actively engaged in key reporting types. Federal incentives have contributed to the widespread adoption of EHRs and broad digitization in health care, while efforts to promote interoperability have encouraged collaboration across health care entities. As a result, interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security concerns, and inequitable patient access persist. Addressing these issues will require collaborative efforts among stakeholders to promote data standardization, implement governance structures, and establish robust health information exchange networks.

Regional differences in autism and intellectual disability risk associated with cesarean section delivery.

Prior epidemiological studies investigating the association between delivery mode (i.e., vaginal birth and cesarean section [C-section]) and autism spectrum disorder (ASD) and intellectual disability (ID) risk have reported mixed findings. This study examined ASD and ID risks associated with primary and repeat C-section within diverse US regions. During even years 2000-2016, 8-years-olds were identified with ASD and/or ID and matched to birth records [ASD only (N = 8566, 83.6% male), ASD + ID (N = 3445, 79.5% male), ID only (N = 6158, 60.8% male)] using the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network methodology. The comparison birth cohort (N = 1,456,914, 51.1% male) comprised all births recorded in the National Center for Health Statistics corresponding to birth years and counties in which surveillance occurred. C-section rates in the birth cohort demonstrated significant regional variation with lowest rates in the West. Overall models demonstrate increased odds of disability associated with primary and repeat C-section. Adjusted models, stratified by region, identified significant variability in disability likelihood associated with repeat C-section: increased odds occurred for all case groups in the Southeast, for ASD only and ID only in the Mid-Atlantic, and no case groups in the West. Regional variability in disability risk associated with repeat C-section coincides with differences in birth cohorts' C-section rates. This suggests increased likelihood of disability is not incurred by the procedure itself, but rather C-section serves as a proxy for exposures with regional variability that influence fetal development and C-section rates.

Predictive factors for the development of depression in children and adolescents: a clinical study.

The prevalence of depression among adolescents has been gradually increasing with the COVID-19 pandemic, and the purpose of this study was to develop and validate logistic regression models to predict the likelihood of depression among 6-17 year olds. We screened participants from the National Center for Health Statistics (NCHS) in 2022. Independent risk factors were identified via univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) for feature screening. Area under the curve (AUC) and decision curve analysis (DCA) were used to compare the predictive performance and clinical utility of these models. In addition, calibration curves were used to assess calibration. Multivariate logistic regression analyses revealed that risk factors for depression included girls, higher age, treated/judged based on race/ethnicity, ever lived with anyone mentally ill, experienced as a victim of/witnessed violence, and ever had autism, ever had attention-deficit disorder (ADD), etc. Afterwards, the results are visualized using a nomogram. The AUC of the training set is 0.731 and the AUC of the test set is 0.740. Also, the DCA and calibration curves demonstrate excellent performance. Validated nomogram can accurately predict the risk of depression in children and adolescents, providing clues for clinical practitioners to develop targeted interventions and support.

Exploring Place of Death among Individuals with Huntington's Disease in the United States

ObjectivesTo describe trends and identify factors associated with place of death among individuals with Huntington's disease (HD). DesignRetrospective cohort of deceased individuals with HD from the Centers for Disease Control and Prevention's National Center for Health Statistics. Setting and ParticipantsA total of 13,350 individuals with HD who died in the United States between 2009 and 2019. MethodsWe analyzed place of death, categorized as long-term care (LTC) facility, home, hospital, hospice facility, and other locations. Trends in the places of death from 2009 to 2019 were assessed using linear regression models. Multivariate logistic regression models were used to identify sociodemographic factors associated with place of death. ResultsFrom 2009 to 2019, the greatest proportion of deaths occurred in LTC facilities (48.4%). There was a significantly decreasing trend in the proportion of deaths occurring in LTC facilities (53.5%–43.9%, P < .001). A greater proportion of deaths in rural areas occurred in LTC facilities compared with all other locations (P < .001 for all comparisons). In the multivariate model, aged younger than 44 years, Black race, Hispanic ethnicity, some college education or greater, and being married were associated with significantly lower odds of dying in a LTC facility compared with home. Conclusions and ImplicationsDespite a decreasing trend, LTC facilities remain a cornerstone of support for individuals with HD, particularly in rural areas. These results suggest multiple avenues for research to improve accessibility and quality of care for individuals with late stages of HD. Future studies are needed to further understand the impact of rurality and lack of support in the home on the accessibility and quality of LTC and hospice care for individuals with HD. These results may also help inform interventions focused on training and staff education within LTC and hospice facilities to better manage HD progression and symptoms.

COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023.

Health disparities, leading to worse health outcomes such as elevated COVID-19 mortality rates, are rooted in social and structural factors. These disparities notably impact individuals from lower socioeconomic backgrounds and more socially vulnerable areas. We analyzed the relationship between COVID-19 deaths and social vulnerability using the Minority Health Social Vulnerability Index (MHSVI). COVID-19 death data in the U.S. was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, where COVID-19 deaths were defined using the ICD-10 code U07.1. MHSVI composite scores were calculated for 3089 U.S. counties and categorized into social vulnerability quartiles, where values ranged from 0 (lowest vulnerability) to 1 (highest vulnerability). Negative binomial regression was employed to determine death rate ratios for each quartile within each theme. Finally, a multivariate negative binomial regression including all MHSVI sub-themes, excluding the overall index ranking, was used to assess the association between each theme and COVID-19 death rates independently. There were 1,134,272 COVID-19 deaths from January 1, 2020 through June 24, 2023. Adjusted rate ratios for COVID-19 deaths in the overall index ranking were 1.06 (95% CI 0.99-1.13), 1.14 (95% CI 1.06-1.22), and 1.41 (95% CI 1.31-1.52) for the second, third and fourth quartiles, respectively. Sub-themes of socioeconomic status (SES), household characteristics (HC), racial and ethnic minority status (REMS), housing type and transportation (HTT), and medical vulnerability (MV) revealed increasing death rates in higher vulnerability quartiles. The healthcare infrastructure and access (HIA) theme had decreasing death rate ratios of 0.74 (95% CI 0.71-0.78), 0.59 (95% CI 0.56-0.62), and 0.42 (95% CI 0.39-0.44) for the second, third, and fourth quartiles, respectively. Finally, the multivariate analysis showed that the HC, HTT, HIA, and MV themes were associated with COVID-19 deaths (P < 0.05). Counties that were identified as more socially vulnerable experienced higher death rates from COVID-19. These areas may need additional public health and social support during future pandemics.

Healthcare Disparities in Telemedicine Access and Use During the COVID‐19 Pandemic

ABSTRACTThis study investigates disparities in telemedicine access and use among racial groups in the United States during the COVID‐19 pandemic. Our analysis of a dataset from the National Center for Health Statistics (NCHS) reveals that telemedicine access and use varied significantly across racial groups, which the NCHS categorized as “Black,” “Hispanic,” “White,” or “Other.” Hispanic respondents were more likely to lack a regular place of care, which might explain their lower access to telemedicine, relative to other groups. White respondents reported relatively high telemedicine access. Black respondents also reported relatively high rates of telemedicine use, contrary to the literature suggesting lower healthcare access among African Americans. Findings underscore the need for public health agencies to disseminate information about telemedicine to all community members. We suggest future research exploring the socioeconomic barriers impacting individuals' ability to access and use telemedicine.

Maternal Mortality in the United States: Are the High and Rising Rates Due to Changes in Obstetrical Factors, Maternal Medical Conditions, or Maternal Mortality Surveillance?

(Abstracted from Am J Obstet Gynecol 2024;230:440.e1–440.e13) High reported maternal death rates in the United States have garnered attention and skepticism, especially with reports indicating a near doubling of maternal mortality between 2018 and 2021. Some attribute this increase to changes in reporting criteria for maternal mortality developed in 2003 by the National Center for Health Statistics (NCHS).

Abstract A104: EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics

Abstract There are known disparities in cancer death rates in the U.S. by demographic, geographic and socioeconomic factors. While there are several widely available webtools to visualize U.S. cancer death rates, none allow for direct comparison of cancer death rates across county-level measures of social determinants of health. The National Cancer Institute has developed a new webtool, EpiTracker Cancer (https://episphere.github.io/epitracker), to allow for customizable visualization of cancer death rates across geography, demographics and county-level characteristics. Cancer death data and decedent race (i.e., American Indian and Alaska Native, Asian, Black, Native Hawaiian and Pacific Islander, White), ethnicity (Hispanic, non-Hispanic), sex, age and county of residence were ascertained from the National Center for Health Statistics (NCHS) death certificate data for 2018-2022. Counts and rates based on &amp;lt;10 deaths are suppressed per NCHS policy. Population data were abstracted from the U.S. Census. County-level characteristics were derived from multiple sources, and include metrics of socioeconomic status (e.g., median income, proportion with a college degree), health status (e.g., proportion who smoke, proportion who are obese), and healthcare access and utilization (e.g., proportion uninsured, proportion of women who have had a mammogram). EpiTracker Cancer is comprised of three main pages, each featuring a different type of visualization. The first page displays bar charts of age-standardized or crude death rates by cancer type, sex, race, ethnicity and age group. The second displays maps of cancer death rates at the county, state and national level. Users can generate national, state and county-level maps for each cause of cancer death that can be compared by race, ethnicity and sex, and can control how outlying rates are handled. The final visualization plots cancer death rates across quartiles, quintiles or deciles of county- level characteristics. The user can choose to display rate ratios comparing to either the highest or lowest quantile of the county-level metric. As an example, a user could visualize the association between county-level education, measured by the fraction of adults with at least some college education, and lung cancer mortality. Compared to counties in the highest quintile of educational attainment, those in the lowest quintile have lung cancer age-adjusted death rates that are 1.77- times (95%CI 1.72-1.82) higher among men and 1.56-times (95%CI 1.51-1.61) higher in women. Future iterations will include more county-level variables, death rates over time and additional visualizations, as well as user suggested improvements and innovations. Citation Format: Meredith Shiels, Lee Mason, Jonas Almeida, Sahar Behpour, Neal Freedman, Peter Kraft, Wayne Lawrence. EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics [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 A104.

Abstract A054 Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors

Abstract Introduction: Racial/ethnic and sex disparities in liver cancer (LC) mortality are well established; yet little is known about the contributions of county-level social risks on these disparities. Methods: We used U.S. national death certificate data from the National Center for Health Statistics (2018-2022) for LC mortality. County-level estimates of income inequality (ratio of household income at the 80th and 20th percentile), and median household income were obtained using the American Community Survey. Severe housing problems (percentage of households with 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities) were abstracted from the U.S. Department of Housing and Urban Development (HUD) and U.S. Census Bureau. We estimated age-adjusted mortality rates (MR) and MR rate ratios (aRR) across metrics of county-level social risk grouped in quartiles overall and by race/ethnicity. Results: There were 101,088 liver cancer (LC) deaths from 2018-2022 (MR=6.16 per 100,000). Areas of highest county-level income inequality had 31% higher LC mortality compared to areas within the lowest quartile (aRR=1.31). LC MRs were 45% higher in counties with the lowest vs. highest median household income (aRR=1.45). Men and women in the highest quartile of severe housing problems had 29% and 22% higher LC MR (aRR=1.29 and 1.22, respectively), than those in the lowest quartiles. Men and women in the lowest quartile of median household income had 43% and 49% higher LC mortality than those in the highest median income quartiles (aRR=1.43 and 1.49, respectively). Within the highest quartile of income inequality, American Indian/Alaskan Native (AI/AN) persons had the highest LC mortality rates (MR=7.07), followed by Hispanic (MR=6.75), Black (MR=6.48), and Asian (MR=5.83) individuals. Similarly, in the highest quartile of severe housing problems, AI/AN persons had the highest LC mortality rate (MR 7.74), while Hispanic persons had 58% higher MR (MR 7.01), followed by Black (MR=6.19), Asian (MR=5.85) and White (MR=4.07) individuals. In the lowest median household income quartile, compared to White persons (MR=5.91), AI/AN persons had the highest MR (MR=8.86), and Hispanic persons had a 70% increase in mortality (MR=8.48). Among counties with the highest income inequality, compared to White persons (aRR=1.15), Black persons had an 80% increase in mortality (aRR=1.43). For those in the most concentrated quartile of severe housing problems, compared to White persons (aRR=1.07), AI/AN persons had an 80% increase in mortality (MR=1.34).Conclusion: All county-level indicators of highest social risk were associated with greater liver cancer mortality, but do not appear to fully account for racial and ethnic disparities in mortality. Therefore, place- based interventions are needed to address the role of county-level economic attributes in liver cancer mortality disparities. Citation Format: Jennifer K. McGee-Avila, Wayne R. Lawrence, Natalie Joe, Cameron B. Haas, Meredith S Shiels. Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors [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 A054.

Abstract A069: Leading causes of death among Asian American individuals compared with Pacific Islander individuals in the United States, 2018-2020

Abstract Background: Asian American and Pacific Islander races are two distinct groups that continue to be aggregated in many large, national mortality statistics in the United States (US), which leads to structural biases encoded into databases and inaccurate health implications that may deprive Pacific Islander individuals from opportunities for interventions aimed at reducing health disparities. Examining mortality rates for disaggregated Asian American and Pacific Islander populations across all 50 states was not possible until 2018. We compared the leading causes of death between Asian American and Pacific Islander individuals in the US during 2018-2020, stratified by sex and age. Methods: Cause of death among non-Hispanic Asian American and Pacific Islander individuals aged ≥20 years who died during 2018-2020 were obtained from the US National Center for Health Statistics. Age-standardized all-cause mortality rates (MRs) and the 5 leading causes of death were reported per 100,000 person-years separately for Asian American and Pacific Islander individuals, by sex (female/male) and age (20-54/55-64/65-74/75- 84 years). MR ratios (MRRs) were calculated by comparing MRs among Pacific Islander with Asian American individuals (reference group), by sex and age. Results: During 2018-2020, 63,338 female and 85,601 male deaths occurred among Asian American adults, and 4,116 female and 5,512 male deaths occurred among Pacific Islander adults. Compared to Asian American individuals, all-cause mortality was higher for Pacific Islander females (MRR=2.50,95%CI=2.43-2.59) and males (MRR=2.10,95%CI=2.04-2.16). Cancer was the leading cause of death for Asian American (MR=93.8) and Pacific Islander females (MR=181.6) and second for Asian American (MR=100.4) and Pacific Islander males (MR=185.2) after heart disease. Death rates for leading causes were substantially higher for Pacific Islander compared to Asian American females: cancer (MRR=1.93,95%CI=1.82-2.06), heart disease (MRR=3.18,95%CI=2.95-3.42), stroke (MRR=2.41,95%CI=2.13-2.73), diabetes (MRR=4.03,95%CI=3.55-4.56), and COVID-19 (MRR=2.60,95%CI=2.25-3.01) and for Pacific Islander compared to Asian American males: heart disease (MRR=2.56,95%CI=2.42-2.71), cancer (MRR=1.52,95%CI=1.42-1.62, diabetes (MRR=3.14,95%CI=2.81-3.50), accidental death (MRR=2.60,95%CI=2.33-2.88), and COVID-19 (MRR=2.04,95%CI=1.82-2.27). The largest relative cancer mortality rate disparity occurred in those aged 20-54 years and declined with older age among women (MRR range=1.37-2.67) and men (MRR range=1.16-2.26). Conclusion: Cancer was among the leading cause of death for both Asian American and Pacific Islander individuals, but cancer mortality rates were twice as high among Pacific Islander women and men compared to Asian American women and men. These disparities persisted among Pacific Islander individuals for nearly all leading causes of death, regardless of sex and age, underscoring the need to disaggregate Pacific Islander from Asian American race data to improve tailored health equity-focused interventions. Citation Format: Jacqueline B. Vo, Jazmyn L Bess, Kekoa Taparra, Paloma R. Mitra, Amy Berrington de Gonzalez, Neal D. Freedman, Meredith S. Shiels, Jaimie Z. Shing. Leading causes of death among Asian American individuals compared with Pacific Islander individuals in the United States, 2018-2020 [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 A069.

Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation

BackgroundColorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults. MethodsWe obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74). ResultsThere was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+. DiscussionThe USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

A Review on Single-Cell analysis of Macrophages in Cancer

Cancer is characterized by uncontrolled cell growth and spread into surrounding tissue. According to the North American Association of Central Cancer Registries (NAACCR) and the National Center for Health Statistics, there were 1,918,030 cancer cases and a total of 609,360 deaths estimated in the US in 2022. Although the direct cause of cancer is not fully understood, it is recognized that the immune system plays a major role in the development and progression of tumors. Investigating tumor-associated macrophages (TAMs) is crucial for understanding the immunosuppressive role that they may play in the tumor microenvironment, which makes them a target for immunotherapies to combat cancer. However, angiogenesis, tumor initiation and invasion promoting signals prevent gaining deeper insight into the intricate molecular mechanisms involved in TAMs and the tumor microenvironment. While researchers in the past have used population samples to analyze cells, recent efforts have incorporated single-cell technologies to study the complex mixture of cells in a tumor, monitor the effects of immunotherapies and more. With the revolutionary advent of the first single-cell RNA sequencing (scRNA-seq), researchers have since been able to gain insight into single-cell data with unprecedented accuracy and develop new immunotherapies through different single-cell technologies, such as polymethylsiloxane (PDMS) and Multiplexed Ion Beam Imaging (MIBI) multiplexing. In this review, we underline the benefits of adopting single-cell technologies to identify distinct cell types in complex environments (i.e., tumors) and highlight the potential application of these technologies along with various multiplexing techniques to immunotherapies.