NH Blacks Research Articles

Racial Disparities in Patterns and Modes of Current and Daily Marijuana Use among Adults Living with Children.

This study sought to examine racial disparities in marijuana use among U.S. adults living with children. Data are drawn from the 2022 Behavioral Risk Factor Surveillance System to examine the prevalence of current (past month) and frequent (≥20 days in the last 30 days) marijuana use along with the mode of marijuana use by 7 racial and ethnic groups (non-Hispanic [NH] White, NH-Black, Hispanic, NH American Indian or Alaskan Native [AI/AN], NH-Asian, NH Native Hawaiian or other Pacific Islander only [NH/PI], and other/multiple races, n=22,659). Compared to NH White adults with children, NH Black adults had a higher prevalence of current marijuana use (23.1% vs. 16.9%, p=0.003) and NH AI/AN adults had two times higher prevalence of frequent use (17.3% vs. 8.4%, p=0.0003). Adults living in recreational marijuana legal states (vs. no) were also more likely to report marijuana use, and there were significant age × race/ethnicity and education × race/ethnicity interactions (p<0.05) on marijuana use. Regarding the mode of use, racial minority users except Asians also reported a higher prevalence of smoking marijuana than their White counterparts. Substantial racial disparities in marijuana use patterns among adults who live with children highlight a potential risk for adolescents' health. Addressing these differences is essential for promoting equitable health outcomes in diverse communities.

Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background.

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

Racial Disparities and Other Socioeconomic Predictors of Mortality in Acute Pulmonary Embolism Treatment from the National Inpatient Sample

PurposeTo explore the significance of socioeconomic factors such as race and ethnicity as predictors of mortality in submassive and massive acute pulmonary embolism (PE). Materials and MethodsHospitalizations of patients aged >18 years with acute, nonseptic PE from 2016 to 2019 were identified from the National Inpatient Sample and divided into interventional radiology (IR) (catheter-directed thrombolysis and thrombectomy) and non-IR (tissue plasminogen activator) treatments. Statistical analyses calculated significant odds ratios (ORs) via 95% confidence intervals (CIs). The primary outcome of interest was mortality rate. Comorbidities affecting mortality were examined secondarily. ResultsNon-Hispanic (NH) Black, Hispanic, and Asian/Pacific Islander patients were significantly less likely to undergo an IR procedure for acute, nonseptic PE compared with White patients (NH Black, OR, 0.83 [95% CI, 0.76–0.90], P < .05; Hispanic, 0.78 [0.68–0.89], P = .06; Asian/Pacific Islander, 0.71 [0.51–0.98], P = .72); however, these differences were eliminated when propensity score matching was performed for age, biological sex, and primary insurance type or for primary insurance type alone. NH Black patients were significantly more likely to die than White patients, regardless of undergoing non-IR or IR treatment. Overall risk of death was 41% higher for NH Black patients than for White patients (relative risk, 1.41 [95% CI, 1.24–1.60]; P < .001). ConclusionsNH Black patients have a higher risk of mortality from acute, nonseptic PE than White patients. Independent of race, undergoing IR management for acute, nonseptic PEs was associated with a lower mortality rate. Matching for primary insurance type eliminates differences in mortality between races, suggesting that socioeconomic status may determine outcomes in acute PE.

Abstract P359: Neighborhood Disinvestment and Racial/Ethnic Disparities in Peripartum Cardiomyopathy in California, From 2004-2019

Introduction: Peripartum cardiomyopathy (PPCM) is a rare life-threatening medical condition presenting as idiopathic heart failure in late pregnancy or during the early postpartum period in otherwise healthy patients. Racial disparities in the rates of morbidity and mortality of PPCM have been extensively documented where higher rates occur in Black patients. There is minimal research examining the relationship between racial/ethnic disparities in PPCM and social determinants of health such as neighborhood social disadvantage. Hypothesis: We hypothesize that neighborhood social disadvantage is associated with PPCM and it contributes to racial/ethnic disparities in PPCM, pre-pregnancy hypertension contributes to disparities, and that the timing of PPCM mostly occurs during the postpartum period. Methods: We used data obtained from the California Department of Health Care Access and Information, which included vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997-2018. We created and standardized the Neighborhood Deprivation Index (NDI) as a proxy measure for neighborhood social disadvantage and categorized it into quartiles, with quartile 1 indicating the least deprivation and quartile 4 indicating the most deprivation. We examined the distribution of population characteristics for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and Hispanic births in the sample by PPCM status. We sequentially adjusted multivariable logistic regression models by maternal and clinical characteristics to estimate the association of NDI and race/ethnicity with PPCM using non-Hispanic White as the reference group. We report odds ratios (OR) and 95% confidence intervals (CI) that reflect the total change in odds of PPCM, and calculated the timing of PPCM diagnosis. Results: Our study included 6,970,681 births and 862 (0.012%) PPCM cases. After adjustment, in the NDI regression models, quartile 2 (Q2) through quartile 4 (Q4) had elevated risk for PPCM (Q2: OR 1.2 (CI 1.0-1.5); Q3: OR 1.7 (CI 1.4-2.1); Q4: OR 1.5 (CI 1.2-1.9)). When adjusting for NDI in the race/ethnicity models, the odds of PPCM slightly decreased for each race/ethnicity. After adjusting for pre-pregnancy hypertension in both the NDI and race/ethnicity models, the odds of PPCM slightly decreased for quartile 3 and 4 and in NH Black births. Most PPCM cases (60.4%) were identified during a postpartum hospital encounter. Conclusions: Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain the racial/ethnic disparities in PPCM. Future research should examine the impact of specific measures of neighborhood deprivation (e.g., access to care, employment levels etc.) on the racial/ethnic disparity in outcomes such as PPCM.

Patterns of mean age at drug use initiation by race and ethnicity, 2004–2019

IntroductionAdolescent drug use can result in clinically significant psychiatric outcomes later in life mitigated by targeted prevention strategies. While mean age of drug initiation has increased over time, there is little research of mean age of drug initiation among adolescents by race/ethnicity. MethodsThe study used the National Survey on Drug Use and Health data (2004–2019). Sample included individuals aged 12 to 21 years. Year-by-year drug use initiation (i.e., first-time use within the past year) trends examined for each drug by race/ethnicity using jointpoint regression. ResultsSample included 95,022 initiates for any of 18 drugs. Year-by-year mean initiation age significantly increased for alcohol (except Non-Hispanic [NH] White, 2004–2012), tobacco cigarettes (except NH American Indian/Alaska Native [AI/AN]), cigars, marijuana (except NH Asian or Pacific Islander, NH Multiracial), cocaine (except NH Black). Significant increase in mean initiation age found for heroin (Hispanic/Latinx only), hallucinogens (NH White, NH Black only), LSD (NH White only), methamphetamines (NH White only), smokeless tobacco (NH White, NH Black only), inhalants (only NH White, NH AI/AN; NH Multiracial, 2004–2011), sedatives (NH White, Hispanic/Latinx only), stimulants (NH White, Hispanic/Latinx only), and ecstasy (NH White, NH Black, Hispanic/Latinx only). Significant decrease in mean initiation age found for alcohol (only NH White, 2013–2019), smokeless tobacco (only Hispanic/Latinx, 2015–2019; NH AI/AN, 2012–2019), and inhalants (only NH Multiracial, 2012–2019). ConclusionMean initiation age differed widely by race/ethnicity. Mean initiation age in most racial/ethnic groups increased for several drugs including alcohol, marijuana, and tobacco products and decreased for some drugs such as inhalants. These findings could help inform groups to target for future prevention strategies.

THE FINANCIAL AND EMOTIONAL IMPACT OF COVID-19 FOR DEMENTIA CAREGIVERS: A COMPARISON OF THE NHATS AND HISPANIC EPESE

Abstract During the COVID-19 pandemic, older adults and their caregivers/care partners (hereafter referred to as “caregivers”) experienced social isolation, reduced autonomy, disruptions in medical care and barriers to community-based services such as adult day centers. We compare the extent to which these disruptions affected white, Black, and Hispanic caregivers. We utilize newly released data on adult children caregivers from the Caregiver Supplement to the Hispanic Establish Population for the Epidemiologic Study of the Elderly (HEPESE CG, 2021) and the National Health and Aging Trends COVID-19 Family Members and Friends Dataset (NHATS FF, 2020/2021) to compare caregiver emotional well-being and financial strain among non-Hispanic White (NH White, n=327), non-Hispanic Black (NH Black, n=57), and Mexican American (n=57) adult children caregivers. Results reveal that a larger fraction of NH Black and Mexican American caregivers reported financial strain than NH White caregivers, and that more Mexican American caregivers reported loneliness and depression than other groups of caregivers. For Mexican American caregivers, those reporting lower financial well-being tended to be younger. For NH Black caregivers, there were no significant predictors of financial strain or wellbeing. Finally, NH White caregivers were younger, and more likely to be female and NH White dementia caregivers reported more financial strain and loneliness than NH White non-dementia caregivers. Taken together, this work provides valuable insight into the role of the COVID-19 pandemic in exacerbating caregiver health disparities among caregivers and provides valuable insight as well as to the high-impact intervention points for caregivers from minoritized populations.

LONGITUDINAL ASSOCIATION OF COGNITIVE IMPAIRMENTS WITH LATE-LIFE WEALTH CHANGES AMONG OLDER AMERICANS

Abstract Disparities in wealth in the US are linked to disadvantageous health outcomes over the lifecourse. Cognitive impairment can widen wealth disparities. We examine how cognitive impairment influences change in wealth starting in mid-life and into older adulthood and the role of social determinants of health in wealth loss due to cognitive impairment. We use biennial longitudinal data (Health and Retirement Study: 2000-2018) on Non-Hispanic White (NH-W), NH-Black (NH-B), and Hispanic (H) middle-aged adults (51-64 years and cognitively healthy in 2000; unweighted n=3,651) to model wealth change (measured as the relative (%) difference in reported wealth between 2000-2018 [in 2018 dollars]) as a function of cognitive status (using three latent phenotypes derived from longitudinal latent class analyses: cognitively healthy [CH; 77%], increasing cognitive impairment [ICI; 19%], and increasing dementia [ID; 4%]). We fit racial/ethnic stratified regression models to examine relationships between cognitive phenotypes and wealth change, adjusting for covariates. Using Blinder-Oaxaca decomposition techniques, we examined the contributions of predisposing (e.g. race/ethnicity), health enabling (e.g. insurance source), and health needs (i.e. chronic conditions) factors in wealth change by cognitive phenotypes. Results show NH-Ws had higher levels of reported wealth in both 2000 and 2018, compared to NH-Bs and Hs. However, the relative rate of change in wealth was not-significantly different across race/ethnic groups. Education, insurance, and health explained most differences in wealth change related to cognitive impairment. Yet, nearly 50% of group differences in wealth changes remained unexplained. Future work should further elucidate sources of these unexplained differences, overall and by race/ethnicity.

Abstract B110: Race/ethnicity, socioeconomic status, and early death among children enrolled in clinical trials for acute lymphoblastic leukemia

Abstract Introduction: Prior work indicates that Hispanic and Black children diagnosed with leukemia may experience a higher risk of death in the period shortly after diagnosis, but no work has examined these disparities taking into account leukemia subtypes and the role socioeconomic status (SES) may play. We investigated reported race/ethnicity (RRE), health insurance status, neighborhood SES, and early death among pediatric acute lymphoblastic leukemia (ALL) patients enrolled on clinical trials. Methods: Using data from the Childhood Cancer Research Network as well as Children’s Oncology Group therapeutic trials, we estimated the associations between RRE (Non-Hispanic [NH] White, NH Black, NH Asian/Pacific Islander [PI], or Hispanic/Native American), health insurance status, neighborhood SES using the Yost Index, and death within 60 days of diagnosis using multivariable logistic regression. All analyses were adjusted for age at diagnosis, sex, and ALL subtype (Standard Risk B-Cell, High Risk B-Cell, Infant ALL, T-Cell). We also estimated associations among non-infant patients diagnosed with B-Cell ALL, additionally adjusting for standard or high-risk disease. All associations were estimated as odds ratios (OR) with 95% confidence intervals (CI). Results: Overall, we analyzed data from 8,634 pediatric ALL cases (7,559 B-Cell; 122 Infant ALL; 953 T-Cell) enrolled across 7 clinical trials (AALL0232, AALL0331, AALL0434, AALL0631, AALL0932, AALL1131, AALL1231). In total, there were 29 deaths within 60 days of diagnosis, including 22 among B-Cell, 4 among infant ALL, and 3 among T-Cell patients. In the full analysis, infant ALL subtype was very strongly associated with early death compared to Standard Risk B-Cell patients (OR: 37.8 [95% CI: 9.22, 137]). We also observed a suggestive association between NH Asian/PI RRE and higher odds of early death compared to NH Whites (OR: 3.10 [95% CI: 0.71, 9.63]), which remained after limiting the analysis to B-Cell patients (OR: 5.63 [95% CI: 1.24, 18.7]). No association was apparent between NH Black or Hispanic/Native American RRE and odds of early death. Neighborhood SES was not significantly associated with early death, though point estimates suggested a potential protective effect of increasing SES. Lack of health insurance was also suggestively associated with greater odds of early death (OR: 2.78 [95% CI: 0.60, 9.47]). Conclusion: Unlike prior work, we observed increased odds of death soon after diagnosis for NH Asian/PI children. Future work incorporating more detailed treatment and cytogenetic subtype information is needed to identify the factors contributing to this disparity. Citation Format: Sarah Lucht, Jeannette M. Sample, Logan Spector, Jenny N. Poynter, Lucie Turcotte, Erin L. Marcotte. Race/ethnicity, socioeconomic status, and early death among children enrolled in clinical trials for acute lymphoblastic leukemia [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 B110.

Abstract B131: Social drivers of adverse health outcomes among cancer survivors

Abstract Purpose of the Study Disparities in health outcomes among cancer survivors are often driven by differences in social-ecological resources. Poor health outcomes and multiple chronic conditions often manifest as a result of shared demographic and social risk factors. The aim of this study was to examine the social drivers that predict adverse health outcomes among cancer survivors. Methods Data from the national longitudinal Population Assessment of Tobacco and Health (PATH) Study was used to examine social drivers of several adverse health outcomes: tobacco use, sleep trouble, high cholesterol, diabetes, and high blood pressure among cancer survivors enrolled in the first cohort (waves 1-3; n=1924). Social drivers included education, financial stress, poverty level, insurance status, and satisfaction with social relationships. Survey-weighted multivariable logistic regression was used to assess demographic and social drivers that predicted health outcomes among cancer survivors. Results Among the 1,924 cancer survivors, most were non-Hispanic, White (77%); 56% female; ages ranged from 18-34 (14%), 35-54 (27%), 55-64 (24%), 65+ (34%). Higher tobacco use was linked (p’s&amp;lt;0.05) to both demographic (males, younger) and social drivers (lower education, poverty, lack of insurance and social dissatisfaction). Trouble sleeping was associated with social drivers including financial stress (p&amp;lt;.001) and social dissatisfaction (p&amp;lt;.0001). High cholesterol was significantly associated with demographics (older age) and social drivers including lower education, access to insurance, and social dissatisfaction (p’s&amp;lt;.05). High blood sugar was significantly associated with demographics (older age, NH Black) and social drivers (lower education and social dissatisfaction (p’s&amp;lt;.05). High blood pressure was significantly associated with demographic (older age, male, NH Black) and social drivers including lower education college (p&amp;lt;.05) and financial stress (p&amp;lt;.05). Conclusions Increased recognition of the critical role of social drivers on health outcomes suggests effective interventions that are sensitive to cancer survivors’ social-ecological contexts are needed to improve health equity and reduce cancer health disparities. Citation Format: Victoria M. Telles, Mateo Banegas, David Strong. Social drivers of adverse health outcomes among cancer survivors [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 B131.

Assessing Epidemiological Differences in Myelofibrosis: A Comparative Study of a Single-Center Cohort and the SEER National Database

Background Myelofibrosis (MF) is a rare class of BCR-ABL negative myeloproliferative neoplasms characterized by clonal proliferation of hematopoietic stem cells and progressive fibrosis of the bone marrow. This study attempts to elucidate epidemiological discrepancies in survival outcomes between MF patients at a single tertiary care center from an underserved population in the Bronx (which ranks last in health outcomes amongst 62 New York state counties) versus the Survival, Epidemiology, and End Results (SEER) national cancer registry by analyzing different population parameters. Methods Our retrospectively constructed single center database included 96 patients with biopsy confirmed primary or secondary MF who were age ≥20 diagnosed after 2000. 75 remained for analysis after excluding subjects without known race or date of diagnosis. The SEER [SEER research plus data, 17 registries, Nov 2022 Sub (2000-2020)] dataset comprised of 5254 patients with microscopically confirmed primary MF (ICD code: 9661.3) diagnosed between 2000 and 2015, had age of diagnosis ≥20, and whose deaths were attributable to MF diagnosis. Both cohorts were independently analyzed via log-rank testing and/or cox proportional hazards (cox-PH) regression with death as event outcome. Results Mean age of our single-center cohort was 65.87 years. Males [37 (49.3%)] and females [38 (50.7%)] were approximately evenly distributed. Races included non-hispanic white (NHW) [26 (34.7%)], NH black (NHB) [20 (26.7%)], NH asian and pacific islanders (NH-API) [6 (8.0%)], and hispanics of all races [23 (30.7%)]. Primary [40 (53.3%)] and secondary [35 (46.7%)] MF were approximately even. Log rank testing detected significance in race (p=.05) but not sex (p=.2) or type (p=.7). Significant univariate cox-PH findings include increased mortality within the NHB group [hazard ratio (HR) 2.69, p=.04] and increased mortality with age (HR 1.07, p=.005) (Table 1). Low event size precluded multivariate analysis. In the SEER cohort, age was grouped into 4 categories: ≤44 years old [214 (4.1%)], 45-64 [1,590 (30.3%)], 65-84 [3,051 (58.1%)], and ≥85 [399 (7.6%)]. There were more females [3,159 (60.1%)] than males [2,095 (39.9%)]. NHW [3,995 (76.0%)] comprised the overwhelming majority of races reported, followed by NHB [441 (8.4%)], hispanic [420 (8.0%)], and NH-API [398 (7.6%)]. Median household income (MHI) data (inflation adjusted to 2021) was divided into &amp;lt;$70,000 and ≥$70,000 (table 2). Univariate cox-PH noted improved survival in NH-APIs (HR .75, p&amp;lt;.001) and MHI ≥$70K (HR .92, p=.05). However this significance disappeared upon adjustment for age and race. In multivariate cox-PH, age demonstrated significance for each category (45-64 HR 2.20; 65-84 HR 4.45; ≥85 HR 6.59, p &amp;lt; .001). Female patients had better survival compared to males (HR .73, p&amp;lt;.001) (Table 2). Conclusion In this comparison study of MF cohorts from an underserved tertiary center and SEER, we found differences in demographic features and their impact on disease mortality. NHW patients constitute the overwhelming majority of subjects in the SEER dataset while the tertiary cohort has nearly equal distribution of NHW, NHB, and hispanic patients. NHB patients from the single-center cohort tended to do worse while SEER showed no differential survival based on race. Possible explanations for this include differences in racial distribution, healthcare accessibility, and other socioeconomic factors. Median income in the Bronx is 36% lower than the national average and the poverty rate is 2.3x higher. Unexpectedly, no significant association was found between MHI and survival in SEER when adjusted for age and race. Also notable is that improved survival in NH-APIs per SEER data disappeared upon adjustment for age, which may suggest that the NH-API group tends to be younger at diagnosis given that age serves as a negative prognostic marker. Further research is warranted. Regarding sex, SEER data suggests that female patients have a decreased mortality risk compared to males which is consistent with literature. Caution in interpretation is necessary given the low tertiary center sample size and the inherent limitations of the SEER dataset.

Abstract 17068: Proportionate Suicide Mortality in Cardiovascular Disease in the United States From 1999 to 2019

Introduction: Few studies have investigated disease associated suicide other than mental health. We aimed to assess suicide mortality in cardiovascular disease. Methods: We used CDC WONDER to access National Vital Statistics System data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years of age were identified from multiple causes of death. Proportionate suicide mortality (PSM) was calculated as number of suicide deaths listed with CVD, divided by number of all cardiovascular-related deaths irrespective of suicide, and reported as PSM per 100,000 cardiovascular deaths. Joinpoint regression was used to examine changes in trend using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age. Results: PSM by disease category from most to least were mental health,, nervous system, musculoskeletal, gastrointestinal, cardiovascular, respiratory, and lastly malignant neoplasm. The CVD PSM increased from 62.8 in 1999 to 90.5 in 2019 (average APC 2.1* [95% CI, 0.2 to 3.9]). Notably, APC decreased from 2013-2019 (APC -2.1 (95% CI -3.6 to -0.5). In racial/ethnic groups, PSM was highest in non-Hispanic White (NHWs) (103.8) then Hispanic/Latino (H/L) (63.6), and lastly NH Black (NHB) (29.2) individuals. PSM was highest in 25-39 years age group (858) followed by 40-54 years (382.8), 55-69 years (146.2), 70-84 years (55.9), and lastly 85+ (17). APC in PSM initially increased in men (3.1 until 2013), women (4.1 until 2014), NHW (3.9 until 2013), H/L (3.5 until 2014), 40-54 (2.9 until 2013), 55-69 (6.0 until 2013) then either stabilized or decreased. While APC in NHBs (1.0) and 25-39 years (1.4) consistently increased till 2019. Conclusion: Among non-mutually exclusive disease categories, CVD ranked 3rd to last. PSM in CVD peaked in the early 2010s, with variable increases across various sex, racial/ethnic, and age groups. Further research is needed to understand the causes of these disparities to develop preventative strategies.

Abstract 13624: Worrisome Atrial Fibrillation-Related Mortality Trends in Older Adults From 1999-2019

Introduction: The U.S. population is aging with concurrent increases in atrial fibrillation (AF) burden. However, AF-related mortality trends among adult’s ≥75 years have not been investigated. The purpose of this study was to assess the trends and regional differences in AF-related mortality among older adults in the United States. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database were examined from 1999 to 2019 for AF-related mortality in adult’s ≥75 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated and stratified by year, sex, race/ethnicity, and geographic region. Results: Between 1999 and 2019, 323,349 AF-related primary deaths occurred among adult’s ≥75 years. The AAMR more than doubled from 44.8 (95% CI, 43.8 to 45.8) in 1999 to 91.7 in 2019 (95% CI: 87.2 to 89.6)). Women had consistently higher AAMR than men from 1999 (AAMR women: 45.8 vs men: 42.3) to 2019 (AAMR women: 93.2 vs men: 88.4). White adults had the highest overall AAMR (77.5), followed by NH American Indian/Alaska Native (41.6), NH Black (41.3) and NH Asian or Pacific Islander adults (36.6). AAMR also varied substantially by region (overall AAMR: Midwest 77.6; West: 75.0; Northeast: 71.6; and South: 69.7). States in the top 90th percentile of AF-related AAMR were Oregon, Idaho and Utah, which had approximately double the AAMRs compared with states that fell into the lower 10th percentile such as South Dakota and Florida. Conclusions: AF-related mortality in U.S. adult’s ≥75 years has continuously increased since 1999. The highest AAMRs were observed among White adults and women, and among patients living in the Midwest and western regions of the United States. Targeted strategies are needed to prevent and treat AF among older adults to curb increasing levels of AF-related mortality.

Receipt of only palliative care among patients with advanced-stage head and neck cancer.

272 Background: Roughly two-thirds of patients diagnosed with head and neck cancer (HNC) have advanced-stage disease and many are eligible for palliative care. However, only approximately 20% of patients actually receive palliative care after their HNC diagnosis. The factors that affect access to palliative care for these individuals are not well understood. This study investigates the sociodemographic and clinical variables associated with receipt of only palliative care among patients with HNC. Methods: Based on data from the National Cancer Database (NCDB), a retrospective cohort was built, consisting of adult individuals diagnosed with advanced-stage (stages III and IV) HNC between 2004 and 2018. Outcome of interest was receipt of only palliative care. Independent variables included race/ethnicity, sex, distance from the treatment facility, health insurance status, and comorbidity burden. To estimate the likelihood of receiving palliative care, we used a multivariable logistic regression model that took accounted the independent variables and adjusted for other demographic and clinical factors. Results: Among the 233,109 patients included in our cohort, 6,146 received only palliative care, forming our analytic cohort. In our final models, male patients had a lower odds of receiving palliative care only (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.84, 0.99). Non-Hispanic Black (NH Black) patients had a higher odds of receiving only palliative care, (aOR = 1.37; 95% CI: 1.22, 1.53), compared to Non-Hispanic White (NH White) patients. Patients who were uninsured (aOR = 2.22; 95% CI: 1.88, 2.61), on Medicaid (aOR = 2.66; 95% CI: 2.36, 3.00), or Medicare/other government insurance (aOR = 1.60; 95% CI: 1.44, 1.79) had a higher odds of receiving only palliative care compared to those with private insurance/managed care. Additionally, higher comorbidity burden was associated with higher the odds of receiving only palliative care only (aOR = 1.67; 95% CI: 1.37, 2.02). Conclusions: Among patients with HNC presenting with advanced-stage disease, receipt of only palliative care is mostly associated with being a Black patient, having a greater comorbidity burden, and inadequate health insurance status. It is critical to improve equitable access to care for patients with HNC in order to optimize survivorship and mitigate disparities in HNC.

A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries-Differences by Chronic Disease and Race/Ethnicity.

Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults. Medicare-linked National Health and Aging Trends Study data (2011-2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients. For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles. These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.

Racial and ethnic disparities in the usage and outcomes of ischemic stroke treatment in the United States

ObjectivesThis study explores racial and ethnic differences in 1) receiving tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) as treatment for ischemic stroke and 2) outcomes and quality of care after use of tPA or EVT in the US. Materials and MethodsAn observational analysis of 89,035 ischemic stroke patients from the 2019 National Inpatient Sample was conducted. We performed weighted logistic regressions between race and ethnicity and 1) tPA and EVT utilization and 2) in-hospital mortality. We also performed a weighted Poisson regression between race and ethnicity and length of stay (LOS) after tPA or EVT. ResultsNon-Hispanic (NH) Black patients had significantly lower odds of receiving tPA (Adjusted odds ratio [AOR] = 0.85, 95 % Confidence Internal [C.I.]: 0.80-0.91) and EVT (AOR = 0.75, 95 % CI: 0.70-0.82) than NH White patients. Minority populations (including but not limited to NH Black, Hispanic, Pacific Islander, Native American, and Asian) had significantly longer hospital LOS after treatment with tPA or EVT. We did not find a significant difference between race/ethnicity and in-hospital mortality post-tPA or EVT. ConclusionsWhile we failed to find a difference in in-hospital mortality, racial and ethnic disparities are still evident in the decreased usage of tPA and EVT and longer LOSs for racial and ethnic minority patients. This study calls for interventions to expand the utilization of tPA and EVT and advance quality of care post-tPA or EVT in order to improve stroke care for minority patients.

Racial and ethnic differences in colon cancer surgery type performed and delayed treatment among people 45 years old and older in the USA between 2007 and 2017: Mediating effect on survival

BackgroundThis study examined the associations of socioeconomic status (SES), race/ethnicity, surgery type, and treatment delays with mortality among colon cancer patients. In addition, the study also quantifies the extent to which clinical and SES factors’ variations explain the racial/ethnic differences in overall survival. Patients and methodsWe studied 111,789 adult patients ≥45 years old who were diagnosed with colon cancer between 2010 and 2017, identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgery type and first course of treatment delays. We also performed mediation analysis to quantify the extent to which treatment, sociodemographic and clinicopathologic factors mediated racial/ethnic differences in survival. ResultsNon-Hispanic (NH) Blacks [adjusted Odds Ratio (aOR) = 1.19, 95% CI:1.13–1.25] were significantly more likely to undergo subtotal colectomy and to experience treatment delays [aOR = 1.39, 95% CI: 1.31–1.48] compared to NH Whites. Hispanics [aOR = 1.59, 95% CI: 1.49–1.69] were more likely to experience treatment delays than NH Whites. Delayed first course of treatment explained 23.56% and 56.73% of the lower survival among NH Blacks and Hispanics, respectively, compared to their NH White counterparts. ConclusionsRace/ethnicity is significantly associated with the surgery type performed and the first course of treatment delays. Variations in treatment, SES, and clinicopathological factors significantly explained racial disparities in overall mortality. These disparities highlight the need for multidisciplinary interventions to address the treatment and social factors perpetuating racial disparities in colon cancer mortality.

Parental education and epigenetic aging in middle-aged and older adults in the United States: A life course perspective

Epigenetic aging is one plausible mechanism by which socioeconomic status (SES) contributes to disparities in morbidity and mortality. Although the association between SES and epigenetic aging is well documented, the role of parental education into adulthood remains understudied. We examined (1) if parental education was independently associated with epigenetic aging, (2) whether upward educational mobility buffered this association, and (3) if the benefit of parental education was differentiated by race/ethnicity. Secondary data analysis of a subsample (n = 3875) of Non-Hispanic [NH] Black, Hispanic, NH White, and NH other race participants from the Venous Blood Study within Health and Retirement Study were examined. Thirteen clocks based on DNA methylation of cytosine-phosphate-guanine sites were used to calculate epigenetic aging. Participants' education (personal) and their report of their respective parent's education (parental; mother's and/or father's) were included as independent variables; several potential confounders were also included. Direct associations and interactions between parental and personal education were estimated via survey-weighted generalized linear models; marginal means for epigenetic aging were estimated and contrasts were made between the education subcategories. Analyses were also stratified by race/ethnicity. Our results showed that higher parental education was independently associated with slower epigenetic aging among four clocks, whereas higher personal education magnified this association among four different epigenetic clocks. Participants with the lowest parental and personal education had higher marginal means (i.e., accelerated aging) compared to participants with the highest parental and personal education, and there was little evidence of upward mobility. These associations were more frequently observed among NH White participants, whereas fewer were observed for Hispanic and NH Black participants. Overall, our findings support that early-life circumstances may be biologically embedded through epigenetic aging, which may also limit the biological benefits associated with one's own education.

125-OR: Disparities in Access to Sodium–Glucose Cotransporter-2 Inhibitors (SGLT2i)

SGLT2i are shown to improve diabetes control and delay the onset of diabetes-related complications. However, socioeconomic (SES) factors may influence access to SGLT2i. We assessed trends and differences in SGLT2i prescription rates by race, ethnicity, and insurance type at a large academic medical center (AMC). Data were extracted from the electronic health records at a large AMC from January 2014 to December 2021. The study outcome was SGLT2i prescription rates over time. Race and ethnicity were classified as Non-Hispanic White (NHW), NH Black (NHB), Hispanics, and Asian/Pacific Islanders (API), and insurance type as Private, Medicare, and Medicaid. Negative binomial regressions were used to estimate the prescription rates by year. Between 2014-2021, 30,030 type 2 diabetes patients received an SGLT2i prescription, and the prescription rates increased significantly from 0.25% to 11.47%, with the rates increasing fastest in Medicare patients. Privately-insured and Medicare patients were more likely to be prescribed SGLT2i than Medicaid patients (p&amp;lt;0.001). NHB, and Hispanic patients were less likely to be prescribed SGLT2i than NHW and API patients (p&amp;lt;0.001). Although SGLT2i prescription rates increased after FDA approval, substantial variations by race, ethnicity, and insurance type exist. Future studies are needed to explore how SES factors drive observed differences in access to SGLT2i. Disclosure D.S.Zhang: None. A.Rajan: None. S.Islam: None. D.M.Charytan: Advisory Panel; Merck &amp; Co., Inc., CSL Behring, GlaxoSmithKline plc., Consultant; Novo Nordisk, Gilead Sciences, Inc., AstraZeneca, Other Relationship; Boehringer Ingelheim and Eli Lilly Alliance, zogenix, medtronic, Research Support; Amgen Inc. A.M.Jacobson: None. J.Divers: None. Funding Doucette Innovation Fund

496-P: Diabetic Retinopathy in Youth with Type 2 Diabetes—Data from Three Academic Health Centers

Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes (T2D) and a major cause of vision loss worldwide. The TODAY study reported a DR prevalence of 51% among patients with youth onset T2D (average T2D duration 13.3 years, mean age of 26.4 years). Prevalence rates of DR in youth-onset T2D with shorter duration and younger age is unclear. In a multicenter analysis, eye exams or retinal images from patients with youth-onset T2D at Cincinnati Children’s, Johns Hopkins, and University of Wisconsin were assessed for presence of DR using t-tests and fisher’s exact test. The study included 228 youth (mean age 16.5±3.5years, mean T2D duration 3.0±2.6 years). Seven participants (3%) were positive for DR. Compared to youth negative for DR (n=221), those with DR (n=7) had a longer duration of diabetes (5.3±3.1 v. 2.9±2.6years, p=0.015) and higher hemoglobin A1c at the time of the diabetic eye exam (10.0±2.1 v. 7.5±2.6%, p=0.012). There were no differences in age, race/ethnicity, sex, or types of medication prescribed between those with and without DR. Of those with DED, when compared to all other ethnicities, NH Black youth had a higher rate of positive diabetic eye exams (p=0.04). Our study found a lower prevalence of DR in youth with T2D at younger age and shorter duration of diabetes. Further work is needed to determine the inflection point when the incidence of DR increases. Disclosure R.Channa: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.S.Shah: None. V.S.Shah: None. M.Bahrainian: None. E.A.Brown: None. T.Liu: None. B.Magella: None. H.Lehmann: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. Funding National Eye Institute (R01EY033233, 5K23EY030911-03)

Modality matters for health disparity groups on the Montreal Cognitive Assessment (MoCA): Findings from the Einstein Aging Study (EAS)

AbstractBackgroundThe Telephone‐Montreal Cognitive Assessment (T‐MoCA) is a widely‐used, remotely administered cognitive screen. The T‐MoCA demonstrates adequate psychometric properties and may be used when standard, in‐person administration of the MoCA is not feasible (Katz et al., 2020). There is a critical need to investigate the agreement of the T‐MoCA across administration modalities (in‐person versus telehealth) among ethnically and racially diverse populations.MethodsThe Einstein Aging Study (EAS) includes a community‐based of racially/ethnically diverse community‐dwelling individuals, ≥ age 70 from the Bronx, NY. Participants (N = 424) were free of dementia at enrollment and completed the T‐MoCA along with in‐person neuropsychological tests including the MoCA‐22, which excludes items unsuitable for telephone administration paralleling the T‐MoCA (Table 1). Intraclass correlation coefficients (ICCs) between T‐MoCA and MoCA‐22 were used to measure agreement. Linear mixed effects models were applied to compare mean scores and ICCs among ethnic/racial groups, with and without adjusting for age, gender, education and depressive symptoms.ResultsParticipants were on average 78.2 years, 65.8% female, 47.6% non‐Hispanic White, 38.0% non‐Hispanic Black, and 14.4% Hispanic. There was no significant difference between mean T‐MoCA and MoCA‐22 scores and no differential associations with age, gender, education, and depressive symptoms. For both modalities, NH Black (difference ‐1.54, p&lt;.0001) and Hispanic (difference ‐2.04, p&lt;.0001) groups demonstrated significantly lower scores compared to non‐Hispanic Whites (Table 2). As shown in Table 2, ICCs among non‐Hispanic White, non‐Hispanic Black, and Hispanic groups were 0.64, 0.50 and 0.42, respectively, and comparisons of ICCs to non‐Hispanic White were significantly lower in non‐Hispanic Black (p = 0.0495) and borderline significant in Hispanic participants (p = 0.0552). Findings were similar after adjusting for covariates.ConclusionThe agreement between telephone and in‐person modalities of the MoCA was weaker in non‐Hispanic Black and Hispanic participants (compared to non‐Hispanic White). Further investigation of factors and/or items that contribute to these lower correlations is warranted. Although the T‐MoCA and other remotely administered cognitive screens have the potential to broaden accessibility to marginalized groups, researchers must use caution when developing or selecting appropriate demographically adjusted norms and interpreting scores of diverse older adults.