National Vital Statistics Reports Research Articles

Associations between youth suicide rates and state school personnel suicide prevention training requirements

ObjectiveAs youth spend the majority of their time in school, school personnel suicide prevention training has gained support as an approach to mitigate rising youth suicide rates. This study examined associations between state school personnel suicide prevention training requirements (i.e., mandatory/non-mandatory and annual/not annual), year of legislation enactment (2013 or earlier/2014 or later), and changes in youth suicide rates by state from 2007-09 to 2016–18. MethodsSchool personnel suicide prevention training requirement data were collected through state-specific Department of Education websites while state-specific youth suicide rates were collected from the Center for Disease Control and Prevention’s 2020 National Vital Statistics Report. Data were analyzed using a mixed effects linear regression model. ResultsTraining is mandated in 40/50 (80 %) states; 19/50 (38 %) require annual training. All states demonstrated increases in youth suicide rates from 2007-09 to 2016–18 (mean increase 3.9/100,000 [sd = 1.8]), but the change did not differ significantly by state requirements for mandatory (p = 0.44) or annual (p = 0.70) training, nor for year of enactment of legislation (p = 0.45). ConclusionsSchool personnel suicide prevention training requirements were not associated with changes in the youth suicide rate, though study results are limited in that data was not available on how successfully schools implemented the required trainings.

Income assistance programs and population health – The dual impact of minimum wages and the earned income tax credit

In this study, we provide new evidence on the interaction of state-level minimum wages and Earned Income Tax Credit (EITC) laws on several measures of population health. Using data from the National Vital Statistics Reports between 1999 and 2018, we estimate difference-in-differences models to evaluate the dual impact of minimum wages and the EITC on various causes of mortality, such as suicides, motor accidents and assaults. While several researchers have examined the health effects of both these policies separately, few studies have examined the potential interaction effects of these policies. Specifically, while previous work has provided evidence that both minimum wages and the EITC can reduce suicide rates, our study contributes to the literature by showing that the policies have a positive dual impact on population health. We find that a $1 increase in minimum wages reduces death rates due to suicides and assaults by 3.8 percent and 15.2 percent in states with EITC laws, respectively. In contrast, we show that minimum wages do not impact these outcomes in states without state-level EITC laws.

Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement.

Inequities in health care are a well-identified contributor to adverse outcomes in neonates of vulnerable populations. 1 2022 March of Dimes Report Card. Accessed March 8, 2023. 〈https://www.marchofdimes.org/report-card〉 Google Scholar , 2 Warren M.D. Hirai A.H. Lee V. Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030. Pediatrics. Published online January. 2022; 3e2021052800https://doi.org/10.1542/peds.2021-052800 Crossref Scopus (2) Google Scholar , 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Societal and institutional inequities rooted within implicit biases and racism result in variable quality of care in the nursery, such as differences in time spent skin-to-skin with infants, clinical resource allocation based on racial background, and a lack of motivation to establish a therapeutic alliance with families who have differing social and cultural needs. 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Most significantly, this inequitable care results in the increased mortality of non-Hispanic black and Hispanic infants as compared to infants of non-Hispanic white backgrounds. 4 National Vital Statistics Reports Volume 69, Number 7 July 16, 2020, Infant Mortality in the United States, 2018 : Data From the Period Linked Birth/Infant Death File. Google Scholar In light of these inequities, the Academic Pediatrics Association (APA) implemented initiatives rooted in active anti-racism to dismantle oppressive power structures across pediatric organizations. 5 Cohen A. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Academic Pediatrics. 2022; 22: 352-355https://doi.org/10.1016/j.acap.2022.01.002 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This urgent commitment to action is further supported by the Association of Pediatric Program Directors (APPD) which maintains that anti-racism involves actively dismantling racism in all that we do. 6 Blankenburg B. et al. Dismantling Racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053https://doi.org/10.1016/j.acap.2020.08.017 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Focus groups of trainees at 4 Bay Area academic medical centers explored gaps in education on newborn health inequities to best understand how to support providers in actively practicing anti-racism in clinical care. Trainees spotlight inequities in their rotations, but feel helpless to address them given a lack of action-based tools, education on inequities, protected time for reflection, and faculty role-modeling. 7 Hume P. , Bowers K. , Robertson L. , et al. Residents’ Perspectives on Neonatal Health Inequities to Guide an Innovative Curriculum. Poster Presentation presented at: APPD; March 2023; Atlanta, Georgia. Google Scholar Given these highlighted gaps, we sought to provide our pediatrics faculty and trainees with action-oriented education to address inequities.

Disability-Adjusted Life Years Resulting from Ocular Injury among Deployed Service Members, 2001–2020

To quantify the burden of ocular injuries on deployed US service members by calculating disability-adjusted life years (DALYs). Retrospective, observational cohort study. US service members with ocular injuries sustained in combat zones from January 1, 2001 toMay 19,2020. Health states and duration of injuries were identified using data from the Defense and Veterans Eye Injury and Vision Registry. These health states were mapped to disability weights from the Global Burden of Disease (GBD) study. Average duration of injury or illness was calculated until remission or death. For the latter, life expectancy at age of sustaining injury, as identified from US Life Tablesfrom the National Vital Statistics Reports 2020, was used. Using Defense Manpower Data Center reports capturing number of service members deployed per year, incidence rates were calculated for ocular injury and DALYs. Disability-adjusted life years of ocular injury. Seventeen thousand five hundred fifty-five patients sustained ocular injury that incurred DALYs. In total, these injuries resulted in 11 214 DALYs (average, 0.64 DALYs per included patient and 20.6 DALYs per 10000 US service members per year). Severe impairment of distance vision (77.9%) and blindness (10.6%) were the primary contributors of DALYs. Although only 9.3% of patients sustained a permanent ocular injury, permanent disability accounted for 99.5% of total DALYs. The average yearly incidence rate of ocular injury was 32.0 cases per 10 000 US service members. Foreign body was the most frequent injury type (2754 occurrences), followed by abrasion (2419 occurrences) and multiple injury types (1429 occurrences). The most DALYs occurred in patients with multiple injury types (2485 DALYs), followed by abrasion (accounting for 725 DALYs) and foreign body (accounting for 461 DALYs). We report higher average DALYs per case ratio among US service members compared with the general population studied by the GBD study, highlighting the differences in probabilities of permanent injury between the two studies. Our study provides understanding of the impact of ocular injuries on active-duty service members and lays the groundwork for further research and interventions to mitigate their burden. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

(441) Quantifying Men with Erectile Dysfunction Potential Candidates for Penile Prosthesis Implantation in the US

Abstract Introduction While penile prosthesis implantation (PPI) is a recommended treatment option per the American Urological Association for men with erectile dysfunction (ED), there are a limited number of urologists performing PPI procedures in the US. Objective This study quantified the number of US men with ED and projected the number of potential candidates for PPI in 2022. Methods An excel-based disease-impact model was constructed using a top-down estimation approach based on two age groups for ED: 18-64 and ≥65 years old. The starting US male population was extracted from the 2022 US Census after the removal of age-specific mortality rates obtained from the National Vital Statistics Reports. Only men who subscribed to public or private health insurance were included in the model using insurance status data from the US Census. ED prevalence rates were obtained from administrative claims data analyses (IBM® MarketScan® Commercial Database [18-64 years] and 5% Medicare Standard Analytical Files [≥65 years]) using relevant International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes to calculate a base-case estimate of men with ED. To quantify the number of PPI candidates, the rate of men with ED but without ED treatment was obtained from the claims data and combined with the proportion of men with moderate-to-severe ED obtained from published research. The ED prevalence obtained from the administrative claims data analyses reflects a documented diagnosis of ED, which may underestimate the actual US prevalence of ED. Therefore, scenario analyses were conducted using patient-reported ED prevalence data obtained from a literature search of Medline. Results Using the ED prevalence obtained from the administrative claims data analyses, an estimated 8.3% of insured men (8,882,548 aged 18-64 and 1,419,992 aged ≥65) had a diagnosis of ED from 124,318,519 eligible US men aged ≥18 in 2022. The base-case estimate using claims data for the untreated ED rate and published literature for the proportion with moderate-to-severe ED showed 17.1% of men with an ED diagnosis claim could benefit from PPI (1,759,248 men aged ≥18). The literature review for the scenario analyses identified 11 publications from 2000 to 2020 with patient-reported ED prevalence. ED prevalence was assessed using different methods: International Index of Erectile Function (IIEF; 3 publications, 27.3%), Massachusetts Male Aging Study (MMAS)-derived questionnaire (3 publications, 27.3%), and other patient self-reported questionnaires (5 publications, 45.5%). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Applying the patient self-reported ED prevalence range to the scenario analyses, it was found that as many as 13,436,363 men in the US with ED could benefit from PPI. Conclusions From this disease-impact model, the estimated number of US men with ED is 124,318,519 as of 2022. Between 1.7 and 13.4 million of these men could potentially benefit from PPI. Ensuring sufficient penile prosthesis implanters could mitigate the potential physical, emotional, and social burden of untreated ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Reply: Modeling concerns.

We appreciate Dr. Tapper’s remarks on our paper1. As mentioned, due to the lack of longitudinal studies with MRE, modeling is a potent approach to connect disease progression with early detection and diagnosis. In addition, by raising questions and objections to the model, you allow us the opportunity to clarify and elaborate upon several points that deserve further attention. While the average age of the patient in the model is 50 years old, patient life span is modeled based on CDC, National Vital Statistics Reports life tables for the US population. The life expectancy for patients is based on age; hence the probability of a patient dying at any given age is predicated on the life tables. As ours is a lifetime model, the inclusion of life expectancy probabilities allows us to ensure that the population tapers off with age. In fact, the probability of dying at age 100 is 1.1 The incremental QALYs gained in the model are higher than the other estimates because we assumed that patients begin in the advanced fibrosis stage within the Markov model. This assumption leads to the effect of diagnosis and treatment to be greater than model stages based on the incidence at the outset. From the advanced fibrosis stage, the patients transition forward, or regress based on the transition probabilities referred in Table 2. As you stated, in practice, all patients may receive the lifestyle modification program at any stage. However, in the model, we assume that only patients identified as positive for advanced fibrosis will receive the lifestyle program as part of an intervention and regression of fibrosis was estimated at 19% per arm1 Lastly, within the MRE arm, the TP (83%) and FP (17%) received the lifestyle modification Within the VCTE arm, the TP (77%) and FP (22%) received the lifestyle modification.1 We agree that the assumption of prevalence of FIB4 > 2.67 to be 80% might be on the high side. However, there are no reliable data on this at the population level. Liver biopsy is required, which is considered as the gold standard for fibrosis staging, but is expensive and with risk to the patients. A study from the NIH NASH clinical Research Network, which consisted of subjects with histological proven NAFLD, evaluated the performance of noninvasive markers of fibrosis in patients with NAFLD. They reported that among their cohort of NAFLD patients, 41 (80%) of the 51 patients with FIB4 > 2.67 were found to have advanced fibrosis.2 The 2 strategies of MRE alone and VCTE+MRE have very similar costs and the difference is only in the magnitude of decimals (rounded in the table). We had hypothesized the VCTE+MRE arm to have higher costs because of including the additional scan. However, the proportion of patients being identified as positive for advanced fibrosis in the VCTE+MRE arm are lower than the MRE alone arm because only patients identified as positive by both are considered positive and move through the Markov stages and accrue costs. Essentially, it’s a proportionality difference that leads to the convergence in costs.

Quantifying the number of US men with erectile dysfunction who are potential candidates for penile prosthesis implantation.

Penile prosthesis implantation (PPI) is a treatment option recommended in clinical guidelines for erectile dysfunction (ED). However, a limited number of urologists perform PPI procedures in the United States. To quantify the number of insured men with ED in the United States and project the number of potential candidates for PPI in 2022. An Excel-based disease impact model was constructed using a top-down estimation approach. The starting US male population consisted of adult men from 2022 US Census data after exclusion of age-specific mortality rates from the National Vital Statistics Reports. Men with health insurance were included in the model based on insurance status data from the US Census database. ED prevalence and ED treatment rates were obtained from administrative claims data analyses-the Merative MarketScan Commercial Database (18-64years) and the 5% Medicare Standard Analytical Files (≥65years)-and literature-based estimates of patient-reported ED prevalence. The number of men with ED in the United States and the number of potential candidates for PPI were estimated. By utilizing ED prevalence based on administrative claims, an estimated 8.3% of insured men (10,302,540 estimated men [8,882,548 aged 18-64 years and 1,419,992 aged ≥65 years]) had a diagnosis of ED and sought ED care, out of 124,318,519 eligible US men aged ≥18 years in 2022. An estimated 17.1% of men with an ED diagnosis claim could benefit from PPI in 2022 (1,759,248 men aged ≥18 years). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Scenario analyses applying the patient self-reported ED prevalence range revealed the number of men in the United States who could benefit from PPI could have been higher than 1.7 million if their ED symptoms were diagnosed by health care providers. Most men with ED in the United States are undertreated, and many could benefit from PPI. This analysis is a US population-level estimation. However, given this study utilized a variety of assumptions, the results may vary if different model assumptions are applied. This disease impact model estimated that approximately 10.3 million men were diagnosed with ED by their health care providers and sought ED care in the United States in 2022. Of those, 1.7 million men could be PPI candidates and benefit from the treatment option.

Access to Pediatric Audiological Evaluation Facilities: Urgent Needs and Why They Matter

Access to Pediatric Audiological Evaluation Facilities: Urgent Needs and Why They Matter

Firearm Deaths are Increasing and Endemic in the USA: It is a Problem of Suicides and Not Homicides.

To analyze and report on the changes in epidemiology traumatic causes of death in the USA. Data were extracted from the annual National Vital Statistics Reports (2008-2017) from Center for Disease Control and analyzed for trends during the time period given. Generalized additive model was applied to evaluate the significance of trend using R software. Firearm deaths (39,790) and firearm death rate (12.2/100,000) in 2017 were the highest reported, and this increasing trend was significant (p < 0.001) the last ten years. Deaths from motor vehicle crash (MVC) and firearm homicides did not change significantly during the same time period. Firearm deaths were lower than MVC deaths by 21% (8,197/39,790) in 2008, but after 10years, the difference was only 1% (458/40,231). Years of life lost from firearms is now higher than MVC. Suicides by firearm in 2017 were the highest reported at 23,854/39,773 (60%). In 2017, suicides by firearm victims were predominantly white 20,328/23,562 (85%), men 20,362/23,562 (86%), and the largest group was between the ages of 55-64. Death from firearms in the USA is increasing and endemic. They were the highest ever reported in 2017 by the CDC. While deaths from MVC used to be the main cause of traumatic death in the USA, deaths from firearms now almost equal it. Calculated years of life lost from firearms is now more than from MVC. Most firearm deaths are not from homicides but are from suicides, and they are predominantly in white older males of the baby boomer generation (born 1946-1964).

Meaning Making as a Central Mechanism of Dignity Therapy for Older Adults With Cancer

Nearly 500,000 older Americans die a cancer-related death each year (National Vital Statistics Report, 2018). Following a diagnosis of a serious illness like cancer, maintaining a sense of dignity is central to a patient’s wellbeing. Dignity Therapy (DT) was recently introduced as an intervention to enhance dignity for terminally ill patients (Chochinov et al., 2005). This therapy provides patients opportunities to foster a sense of dignity though making meaning of their lives (Hack et al., 2010). To date, whether meaning-making actually occurs as a central mechanism of effective DT has not been tested. The current study investigates (i) how often and in what forms meaning-making occurs during DT, and (ii) how patients’ baseline feelings of dignity relate to meaning-making during DT. Participants were 25 male and female cancer outpatients (M age = 63.08; SD = 5.72). They completed the Patient Dignity Inventory (Chochinov et al., 2008) and then participated in Dignity Therapy with a trained provider. Sessions were audio recorded, transcribed, and reliably content-analyzed for meaning-making using an established coding scheme (Park & Folkman, 1997). Content-analysis revealed that all patients made meaning of past life events at least once (range: 1-12 occurrences). Multiple forms of meaning-making emerged, with Finding Benefit and Personal Growth most common. Patients reporting more dignity-related distress prior to DT showed greater meaning-making during the DT session (r = .46, p < 0.05). This study provides foundational evidence that meaning-making is a key mechanism of Dignity Therapy, helping older adults with cancer enhance dignity at end-of-life.

A Magic Bullet? The Potential Impact of E-Cigarettes on the Toll of Cigarette Smoking.

We examine the proportion of US smoking-produced mortality that e-cigarettes might eliminate under assumptions regarding vaping's ability to increase smoking cessation, vaping's health risks, and the possibility that vaping will increase smoking among young people. We employ a dynamic population simulation model that tracks individuals from ages 0 to 110, differentiated by gender and smoking status. Using data from the US Census, the National Vital Statistics Reports, Cancer Prevention Study II, and the National Health Interview Survey, we estimate the number of smoking-related life-years lost (LYL) from 2018 to 2100 in a no-vaping scenario. We then compare results for model runs that assess the impact of vaping under a variety of assumptions. The combination of assumptions produces 360 possible scenarios. 357 (99%) yield positive estimates of life-years saved (LYS) due to vaping by 2100, from 143 000 to 65 million. Most scenarios result in millions of individuals quitting smoking due to vaping. On average, vaping-induced quitters gain an extra 1.2-2.0 years of life compared to smokers who quit without vaping. The impact of vaping is greatest when it most helps smokers who otherwise have the greatest difficulty quitting smoking. While the numbers of LYS are generally large across all scenarios, they often represent a small fraction of the toll of smoking. Vaping is highly likely to reduce smoking-produced mortality. Still, vaping is not "the" answer to the public health crisis created by smoking. Rather, it may well be a tool to add to the armamentarium of effective tobacco control measures. E-cigarettes hold the potential to reduce cigarette smoking's enormous toll. By itself, however, tobacco harm reduction, as embodied in vaping, is no magic bullet. Going forward, tobacco control will require vigilant application of the evidence-based measures that have brought us so much success in combatting smoking. It will require, as well, the search for and adoption of novel means of attacking the remaining problem. Harm reduction can, and many would say should, be a part of the complex formula that will eventually bring about the demise of smoking.

Childhood liver tumors in Argentina: Incidence trend and survival by treatment center. A report from the national pediatric cancer registry, ROHA network 2000-2015.

Information on the epidemiology of pediatric liver tumors in Latin America is limited. To describe the incidence of liver tumors in a pediatric registry in Argentina according to geographic region, national trends over 16years, and survival related to stage, age, sex, and care center. Newly diagnosed liver tumors cases are registered in the Argentine Pediatric Oncology Hospital Registry (ROHA) with an estimated coverage of 91% of national cases. Age-standardized incidence rate per millon (ASR) was calculated based on the National Vital Statistics Reports. Five-year overall survival (OS) was estimated using the Kaplan-Meier method. The log-rank test was used to compare subgroup survival. Two hundred seven cases of hepatoblastoma (HB) and 73 of hepatocellular carcinoma (HCC) were identified. ASR of liver tumors was 1.8/million (95% confidence Interval [CI], 1.6-2.0) per year. ASR was 1.4 (1.2-1.6) for HB and 0.4 (0.3-0.5) for HCC. For HB, the highest incidence was found in the northwest region including the Altiplano. OS was 60.4% (53.4-66.8) for HB and 36.1% (25.2-47.2) for HCC. Five-year survival rate of children with metastatic HB treated at liver transplant hospitals (LTH) was 54.2% (30.3-73.0) compared to 13.3% (2.2-34.6) for those seen at other hospitals (OH) (P=.02), while for HCC this rate was 46.3% (30.7-60.6) at LTH compared to 17.5% (3.1-41.9) at OH (P=.01). The incidence rate of pediatric liver tumors was stable over the 16-year study period. Patients may benefit if at treatment initiation they are evaluated jointly with LTH specialists to define treatment strategies.

Solid organ donation after death in the United States: Data-driven messaging to encourage potential donors.

US deceased donor solid organ transplantation (dd-SOT) depends upon an individual's/family's altruistic willingness to donate organs after death; however, there is a shortage of deceased organ donors in the United States. Informing individuals of their own lifetime risk of needing dd-SOT could reframe the decision-making around organ donation after death. Using United Network for Organ Sharing (UNOS) data (2007-2016), this cross-sectional study identified (1) deceased organ donors, (2) individuals waitlisted for dd-SOT (liver, kidney, pancreas, heart, lung, intestine), and (3) dd-SOT recipients. Using US population projections, life tables, and mortality estimates, we quantified probabilities (Pr) of (1) becoming deceased organ donors, (2) needing dd-SOT, and (3) receiving dd-SOT. Lifetime Pr (per 100000 US population) for males and females of becoming deceased organ donors were 212 and 146, respectively, and of needing dd-SOT were 1323 and 803, respectively. Lifetime Pr of receiving dd-SOT was 50% for males, 48% for females. Over a lifetime, males were 6.2 and females 5.5 times more likely to need dd-SOT than to become deceased organ donors. Organ donation is traditionally contextualized in terms of charity toward others. Our analyses yield a new tool, in the form of quantifying an individual's own likelihood of needing dd-SOT, which may assist with reframing motivations toward deceased donor organ donation.

2450. A data-driven model of the economic burden of healthcare-associated infections as impacted by use of comprehensive genomic analysis of bacteria

BackgroundEach year, nearly 2 million patients contract and are affected by healthcare-associated infections (HAIs) in the United States alone, resulting in nearly 100K deaths. According to the Centers for Disease Control and Prevention (CDC), more patients die from HAIs in the United States per year than all breast and prostate cancer cases combined (National Vital Statistics Report, 2016). In addition to the mortality burden, the financial impact of HAIs within the hospital ecosystem is estimated to total between $28–45 billion. However, no economic model has demonstrated how early effective identification and mitigation of infection clusters can result in cost savings for hospitals until now.MethodsAs there is no publicly available data for infection cluster rates, we based our analysis on anonymized real-world retrospective data spanning 18 months (November 2016 to June 2018) from two US-based academic tertiary hospitals with a combined total of about 1,700 beds, then normalized to 800 beds. A cloud-computing platform (Philips IntelliSpace Epidemiology) was used for whole-genome sequence analysis and cluster identification. We determined that an average 800-bed facility would have an occurrence of 46 genetically related infectious clusters involving 2 or more patients (mean of 7.9, median of 3), affecting 180 patients in total.ResultsGiven the average HAI treatment cost of $24,512 (average costs rescaled from literature to 2019 USD using PPI data), this represents a total cost of $4,412,160. If these clusters could have been limited to 2 patients, an additional 96 infections might have been prevented, representing a potentially avoidable economic burden of $2,353,152 for this 800-bed institution. Our data show that a 20% reduction in transmissions would drive a 3% overall reduction in HAIs, but results in savings of over $450,000.ConclusionActive, genomic-based surveillance can inform timely and precise preventative steps to help lower the size of infectious clusters. This health economic modeling shows that such measures can result in significant cost savings. As such, it recommends that prompt, dynamic detection of infectious clusters via genomics and active surveillance offers a relevant and timely strategy for cost savings within the healthcare ecosystem. Disclosures All authors: No reported disclosures.

Is Previous Periacetabular Osteotomy Associated with Pregnancy, Delivery, and Peripartum Complications?

Surgical candidates for periacetabular osteotomy are commonly women of reproductive age with symptomatic acetabular dysplasia. However, little is known about how this surgical intervention contributes to the decision to become pregnant, obstetrical counseling regarding delivery, mode of delivery, or pregnancy-related complications. (1) Does a history of periacetabular osteotomy affect a patient's decision to become pregnant or does it affect obstetrical counseling regarding the safety of pregnancy and childbirth? (2) Is history of periacetabular osteotomy associated with in an increased risk of undergoing cesarean section compared with the national average? (3) Is a history of periacetabular osteotomy associated with increased complications, decreased infant birth weight, preterm delivery? In conjunction with obstetrician colleagues, we created a survey to investigate patient attitudes toward pregnancy, mode of delivery, pregnancy-related complications, and obstetrical counseling among female patients who previously underwent periacetabular osteotomy. A retrospective cohort of reproductive-age women who underwent periacetabular osteotomy between 2008 and 2015 completed a mailed survey or telephone interview. All 96 patients who were contacted were asked if the history of periacetabular osteotomy affected their decision to become pregnant. Our cohort included 31 patients who had undergone periacetabular osteotomy and had a subsequent pregnancy and delivery with a total of 38 pregnancies resulting in 41 births. A binomial test was used to determine if the rates of cesarean section, low birth weight, or preterm delivery were different from the documented US national average as published by the National Vital Statistics Report and CDC. One patient of 31 felt her periacetabular osteotomy negatively affected the appearance of her child; this surgical history affected 6.5% of patients (2 of 31) positively. Fifty-five percent (17 of 31) patients reported that their obstetrician expressed concern that their history of periacetabular osteotomy could affect their ability to carry to term or deliver vaginally. With a history of periacetabular osteotomy, 53% of deliveries (20 of 38) underwent cesarean section. This is higher than the national average of 32% (odds ratio 0.424 [95% confidence interval 0.214 to 0.837]; p = 0.006). Only one patient with a periacetabular osteotomy suffered a pregnancy-related complication. In singleton pregnancy after periacetabular osteotomy the preterm delivery rate was 14% (5 of 35) and the percentage of low-birth-weight infants was 2.9% (1 of 35). These percentages are not different from US data published by the National Vital Statistics Report, which reports an 8% preterm delivery rate (OR 0.523 [95% CI 0.154 to 1.772]; p = 0.1723) and 6.4% low birth weight (OR 2.34 [95% CI 0.607 to 9.025]; p = 0.3878) in singleton pregnancies. In this small survey study, we found no differences in terms of complications, preterm delivery or low birth weight infants between patients who had a history of periacetabular osteotomy and normative national data regarding complications of pregnancy and delivery. However, we did note that patients with a history of periacetabular osteotomy were more likely to deliver future children by cesarean section, which could be attributable to obstetrician preference as most obstetricians in another small survey study have expressed concern about patients with a history of periacetabular osteotomy. Future studies should aim to increase the knowledge of the association of periacetabular osteotomy and delivery method, specifically with transition to cesarean for failure to progress during labor. Future consideration of using the Academic Network of Conservational Hip Outcomes Research repository to develop National Surgical Quality Improvement Program data may help to elucidate this relationship more clearly and help guide appropriate indications for scheduled cesarean sections in the setting of prior pelvic osteotomy. Level IV, therapeutic study.

Analysis of births, abortions and maternal mortality in adolescents in Ecuador from 2013 to 2016.

IntroductionAdolescent pregnancy is associated to school desertion, violence, termination of pregnancy under suboptimal conditions, obstetric complications and other consequences that can put the woman's quality of life at risk and of those that surround her. The purpose of this study is to describe the situation and tendencies of adolescent pregnancies, abortions and maternal deaths between 2013 and 2016 in Ecuador.MethodsThis cross-sectional study uses secondary data from national Ecuadorian vital statistics reports of adolescents between 10 and 19 years old. The data sources used register all the births, deaths and hospital discharges in the country at both public and private health establishments. We performed a descriptive analysis of qualitative and quantitative variables.ResultsEcuador has approximately 1.5 million female adolescents that gave birth to 256,561 newborns between 2013 and 2016, resulting in an average annual birth rate in early adolescence of 13.9 live births per 1000 and in late adolescence of 86.6 per 1000 live births.The number of registered abortions among adolescents between 2013 and 2016 was of 19,214. The estimated annual abortion rate in late stage adolescents is 6.3 abortions per 1000 women between 15 and 19. The estimated abortion ratio for this same age group is 72.9 per 1000 live births.Of all the adolescents that gave birth, 84.9% self-identified as mestiza, while 71.9% of Ecuador's general population identifies as such. Only 7% of the general population in Ecuador self-identifies as indigenous, while 21.6% of pregnancies come from this population. Out of all adolescents that gave birth, 57.4% of those aged 17 and over; 43% of those between 14 and 16 and 96.7% of adolescents from 10 to 13, completed the level of education for their age. There were 81 maternal deaths among this group. The maternal mortality rate for late stage adolescents is of 7.72 per 100,000.

Abstract 3352: Cost-effectiveness of current and potential serum based colorectal screening strategies: Can a serum based test do better

Abstract Background: Despite efficacy of colorectal cancer (CRC) screening, recent trends in screening rates have not improved. Furthermore, national society recommendations have not prioritized a single screening modality. Both flexible sigmoidoscopy (Flex-Sig) and guaiac fecal occult blood test (gFOBT)) have been recommended. Studies suggest that noninvasive tests may improve screening rates, however, compliance remains modest for such tests. A recent study found that health system transition from gFOBT to a fecal immunochemical test (FIT) moderately improved test compliance rates. However, FIT is an expensive substitute for gFOBT and sensitivity of fecal based tests for precursor lesions in the colon remain inferior to structural examinations. Serum-based blood tests (SBT) may provide higher compliance rates, but necessary accuracy for such a test to be a dominant or cost-effective screening strategy over current recommendations have not been determined. This study analyzed the cost-effectiveness of multiple CRC screening strategies and estimated minimum test characteristics of a hypothetical SBT to be a preferred screening strategy over current modalities. Methods: A Markov microsimulation model was developed to analyze the costs and effects, (quality-adjusted life-years, QALYs) of CRC screening following a hypothetical cohort of 10,000 individuals at age 50 until death. Our model considered three strategies: 1) initial colonoscopy followed by Flex-Sig every 5 years, 2) initial colonoscopy with yearly gFOBT, and 3) initial colonoscopy with yearly FIT. An initial colonoscopy with a hypothetical yearly SBT was also examined at a range of test sensitivities. A long-term payer perspective was assumed for professional and facility costs and lifetime costs of cancer treatment. Model probabilities and utility values were obtained from the literature or calculated from National Vital Statistics Reports. Results: Annual gFOBT was the least costly strategy ($3,242) while annual FIT was eliminated through extended dominance. Flex-Sig was the costliest strategy at $4,667 but had the highest expected QALYs at 19.68. The incremental cost-effectiveness ratio (ICER) of Flex-Sig relative to gFOBT was $35,615. Our secondary analysis demonstrated that a minimum joint sensitivity of 70% and 60% is required for an SBT at 80% and 100% compliance rates, respectively, to achieve extended dominance of both Flex-Sig and FIT by SBT and gFOBT. ICER’s of SBT ranged from $12,984 to $4,779 in these sensitivity ranges compared to gFOBT with expected QALYs as high as 19.96. Total individual costs in the model varied from $365 to $111,535. Conclusion: With improved sensitivity and high compliance rates, annual screening for CRC via a non-invasive SBT is a cost-effective approach compared to structural examinations and currently recommended gFOBT and FIT. Citation Format: Ali Jalali, Richard Nelson, Raminder Nirula. Cost-effectiveness of current and potential serum based colorectal screening strategies: Can a serum based test do better [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3352.

Prevalence of Pharmacogenomic Evidence for the ADME Genes Related to Commonly Used Drugs

BackgroundPharmacogenomics (PGx) is the study of genetic differences in multiple genes that influence the variability in drug response (efficacy and toxicity). The advantages of PGx application include optimization of patient therapy outcomes, improved drug alternatives and decreased healthcare costs. Genes related to absorption, distribution, metabolism and elimination (ADME) are susceptible to genetic polymorphisms and may influence the pharmacokinetic behavior of the medications. Clinical Pharmacogenetics Implementation Consortium (CPIC®) is a platform that advances the PGx practice by developing evidence‐based guidelines. The purpose of the present study was to analyze the involvement of ADME genes in the CPIC practice guidelines for the drugs for the fifteen most prevalent disease states in the United States.MethodsThe study analyzed for the drugs with ADME biomarkers genes (phase I drug metabolizing enzymes, phase II drug metabolizing enzymes and transporters) and level of evidence (A, B, C, D) in the CPIC database. CPIC evidence level A means a strong or moderate PGx intervention is recommended, whereas level B means a discretionary PGx action is recommended. For level C or level D no prescription changes are required due to either variable or very little PGx evidence available at this time. The fifteen most prevalent disease states in the United States were derived from the National Vital Statistics Reports of Centers for Disease Control and Prevention (CDC). The inclusion criteria consisted of drugs used in the treatment of most prevalent diseases as per the CDC reports and CPIC PGx evidence levels available on the CPIC website (www.cpicpgx.org). The exclusion criterion consisted of drugs that did not have CPIC level of evidence. The ADME gene‐related drugs were sorted out by CPIC level of evidence, number of prescriptions dispensed (ClinCalc database; www.Clincalc.com), and disease state. Data were organized and graphically analyzed using Microsoft Excel software.ResultsA total of 123 drugs related to ADME genes were identified from the CPIC database and levels of evidence were profiled. In general, a larger number of drugs are affected by the phase 1 enzyme PGx with a total of 49 drugs than the phase 2 enzyme or transporter PGx. Among the CPIC level of evidences, level D had the most drugs with a total of 55. CYP2D6 (n=25) had the most prevalence in CPIC level of evidence. The CPIC PGx evidence levels for genes‐related to phase I drug metabolizing enzymes were: level A 15 (31%), level B 17 (35%), level C 10 (20%) and level D 7 (14%). The evidence for phase II drug metabolizing enzymes were classified as: level A 3 (7%), level B 0 (0%), level C 6 (15%) and level D 32 (78%). The genes for transporters were found as: level A 1 (3%), level B 3 (9%), level C 13 (39%) and level D 16 (49%). The CPIC level A, C, and D had the most evidence for the drugs related to cancer, whereas CPIC level B had the most evidence for the drugs related depression.ConclusionThe PGx intervention by the biomedical and clinical professionals through the knowledge of ADME‐gene related CPIC PGx guidelines for drugs will ensure patient safety, potentially minimize healthcare cost and facilitate new drug development in a targeted manner. Oncology and depression are the disease conditions with most drugs affected by ADME gene PGx.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Adolescent Infertility: A Case Report

Reproductive health for teens has primarily focused on preventing or delaying pregnancies (and sexually transmitted infections [STIs]) rather than treating infertility. There continues to be millions of teen pregnancies per year ( Martin et al., 2015 Martin J.A. Hamilton B.E. Osterman M.J.K. Curtin S.C. Mathews T.J. Births: Final data for 2013. National Vital Statistics Report. 2015; 64: 1-65 PubMed Google Scholar ), many intended by females and/or their partners, especially in developing countries where adolescent parenting is commonplace to the cultural norms ( Haimov-Kochman et al., 2008 Haimov-Kochman R. Imbar T. Farchat M. Bdolah Y. Hurwitz A. Adolescent infertility—To treat or not to treat. Fertility and Sterility. 2008; 90 (2009.e1–2009.e4) Google Scholar ). In the United States, there is evidence in media reports (e.g., the Massachusetts pregnancy pact [ Kingsbury, 2008 Kingsbury K. Gloucester pregnancy plot thickens. Time. 2008; (Retrieved from)http://content.time.com/time/nation/article/0,8599,1817272,00.html Google Scholar ] and the reality TV program Teen Mom) and in the medical literature that some adolescents consider pregnancy desirable. Crosby et al., 2001 Crosby R.A. DiClemente R.J. Wingood G.M. Sionean C. Cobb B.K. Harrington K. Oh M.K. Correlates of adolescent females’ worry about undesired pregnancy: The importance of partner desire for pregnancy. Journal of Pediatric & Adolescent Gynecology. 2001; 14: 123-127 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar found that 21% of their nonpregnant adolescent participants wanted to become pregnant. What is less clear in the literature and among many clinicians is how to properly manage an adolescent seeking health care when unsuccessful in achieving a desired pregnancy. Anne L. Derouin, Associate Professor, Duke University School of Nursing, Durham, NC. Eleanor L. Stevenson, Associate Professor, Duke University School of Nursing, Durham, NC.

346: Disparate rates of cesarean delivery in term nulliparous women with hypertensive disorders of pregnancy

Despite the evidence supporting the safety of vaginal delivery in the setting of hypertensive disorders of pregnancy, women with this diagnosis continue to have high cesarean delivery (CD) rates. The aim of this study was to evaluate whether the increased CD rate in women with hypertensive disorders of pregnancy could be explained by maternal, sociodemographic, or obstetric comorbidities, or whether other external factors may be driving this phenomenon. This is a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) women delivering at 37 to 42 weeks using the US National Vital Statistics Report dataset for the year 2013. We compared prevalence of maternal, sociodemographic, and potential comorbid obstetric conditions that increase risk for CD between women diagnosed with hypertensive disorders of pregnancy and those without the diagnosis. We then used multivariate logistic regression to control for these risk factors and calculated adjusted probabilities of CD for women with and without a diagnosis of hypertensive disorders of pregnancy. We analyzed 1,439,977 NTSV women, 5% of whom were diagnosed with hypertensive disorders of pregnancy. The subgroup with hypertensive disorders of pregnancy had more risk factors for CD, most notably morbid obesity (9.0% versus 3.1%, p<0.01), diabetes (9.9% versus 4.4%, p<0.01), and induction of labor (59.2 versus 26.9%, p<0.01). The unadjusted probability of CD in women with hypertensive disorders of pregnancy was 39.5% versus 26.8% in those without the diagnosis (p<0.01; Table). After controlling for these risk factors, women with hypertensive disorders of pregnancy were significantly more likely to undergo CD than those without hypertensive disorders of pregnancy (35.1% versus 26.4%; aOR 1.53 [1.50-1.56], p<0.01). After controlling for other risk factors, the diagnosis of hypertensive disorders of pregnancy remained a significant risk factor for primary CD in NTSV women, suggesting a widespread and concerning management practice that is not supported by the most recent clinical evidence. Women with hypertensive disorders of pregnancy may therefore represent an important target population in ongoing efforts aimed at reduction of primary CD rates.