NH-White Women Research Articles

Racial differences in the incidence of mental health illness among ovarian cancer patients: An analysis of SEER-Medicare data

BackgroundOvarian cancer (OC) patients have an increased risk for a mental health illness (MHI) after their cancer diagnosis, but limited research exists on whether this risk differs by race/ethnicity. Hence, we used SEER-Medicare data to evaluate racial/ethnic differences in MHI incidence among OC patients aged 65+. MethodsNon-Hispanic (NH) Black, NH White, and Hispanic women diagnosed with OC in 2008–2015 without a mental health history 12 months prior to their cancer diagnosis were identified from SEER-Medicare. Cox proportional hazards regression evaluated new MHI incidence in the first five years post diagnosis and the differences by race/ethnicity. Hazard ratios (HR) and 95% confidence intervals (CI) adjusted for demographic/clinical covariates and healthcare access (HCA) dimensions. ResultsWe identified 5441 OC patients, including 364 NH Black (6.7%), 4982 NH White (91.6%), and 95 Hispanic (1.7%) patients. About 41% of NH White, 33.3% of NH Black, and 37.2% of Hispanic OC patients were diagnosed with MHI during the follow-up period between 2008 and 2016. In the fully adjusted model, NH Black OC patients were less likely to be diagnosed with any MHI (aHR: 0.67, 95% CI: 0.54, 0.82), depression (aHR: 0.66, 95% CI: 0.51, 0.86), and anxiety disorder (aHR: 0.64, 95% CI: 0.49, 0.84), while Hispanic OC patients were less likely to be diagnosed with anxiety disorder (aHR: 0.56, 95% CI: 0.33, 0.95) compared to NH White OC patients. DiscussionNH Black OC patients are less likely to receive a clinical MHI diagnosis compared to NH White OC patients. Further studies on racial differences in MHI incidence after OC diagnosis in primary cohorts are needed to better estimate population-level prevalence less vulnerable to exposure misclassification and to account for patient-level factors impacting MHI.

Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy

PurposeThe purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy.MethodsWe analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt.ResultsThe study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03–1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05–1.21).ConclusionsAmong women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.

0890 Multiple Sleep Measures and Cognition by Race/Ethnicity and Age

Abstract Introduction Disturbed sleep may affect cognition directly (e.g., through sleep fragmentation) and indirectly through effects on related health outcomes (e.g., cardiovascular health). However, investigations of sleep and cognition among diverse racial/ethnic samples and women are sparse. Methods We analyzed longitudinal associations among 50,000 Sister Study participants (enrollment: 2003-2009) who reported on short (< 7 hours) and long sleep duration (>9 hours), sleep debt (≥2-hour difference between longest and shortest sleep duration during the week), frequent napping (≥3 times/week), and insomnia symptoms. Participants completed an eight-item Dementia Screening Interview during two follow-up periods (2012-2014; 2017-2019). Poor cognition was quantified as a change in cognitive function indicative of impairment in ≥2 items. Adjusting for sociodemographic and health behavior characteristics, we used log-binomial regression to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between sleep dimensions and cognition, by race/ethnicity and age. Results Mean age was 55±8.9 years, 83% self-identified as Non-Hispanic [NH]-White, 9% NH-Black, and 5% Hispanic/Latina. Compared to NH-White women, NH-Black and Hispanic/Latina women reported higher prevalence of all poor sleep dimensions but lower prevalence of poor cognition. Participants with short and long sleep duration, sleep dept, napping, and insomnia symptoms had a higher prevalence of poor cognition (RR=1.09 [95% CI: 1.03-1.16]; RR=1.19 [1.06-1.35]; RR=1.18 [1.11-1.25]; RR=1.27 [1.18-1.39]; RR=1.33 [1.26-1.41], respectively). Estimates for short sleep with poor cognition were higher among minoritized racial/ethnic groups (RRNH-Black=1.15 [0.91-1.45]; RRHispanic/Latina=1.48 [1.09-2.03]; RRNH-White=1.08 [1.01-1.15]), although interactions terms were not statistically significant (p-value= 0.37 and 0.07, respectively). Patterns were similar for insomnia. Sleep debt and insomnia symptoms estimates with poor cognition were higher among younger than older groups (sleep debt: RRAge 26-55 years=1.20 [1.11-1.31]; RRAge 56-76 years =1.14 [1.05-1.25]; insomnia: RRAge 26-55 years=1.39 [1.27-1.51]; RRAge 56-76 years =1.27 [1.18-1.38]). Interaction terms were non-significant (p-value= 0.96 and 0.26, respectively). Conclusion Poor sleep health was associated with poorer cognition, and associations may be stronger among minoritized and younger women. Future studies using a life course perspective among large, more diverse populations can elucidate how early-life and later-life factors (e.g., psychosocial experiences; environmental conditions) accumulate to impact sleep health and contribute to differential cognitive risk in adulthood. Support (if any)

Disparities in the provision of perinatal care based on patient race in the United States.

In the United States, there are significant health inequities in perinatal care. This study examined differences in perinatal care provided to women based on the birthing person's designated race, within a large and diverse cohort of women. This retrospective electronic medical record review identified patients receiving perinatal care within a large hospital system between January 2012 and September 2018 and examined associations between maternal designated race/ethnicity (Hispanic or non-Hispanic [NH] Black, Asian or White) and various provider treatment decisions. The study sample (N=7056) was comprised of 36% Hispanic, 34% NH White, 21% NH Black, and 4% NH Asian women, aged 29.7± 6.3 years; 53% of the sample had private insurance, and 45% had Medicaid. Few differences by race were seen in perinatal care based on guidelines or expert recommendations (nondiscretionary care). Discretionary care, however, varied by race: Compared with NH White women, NH Black women were less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]) and more likely to have a urine drug test when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), whereas Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a urine drug test completed when denying drug use. Perinatal care differs by maternal race/ethnicity, particularly when guidelines or expert recommendations are absent. Greater efforts need to be made to identify and mitigate providers' implicit and explicit biases; expanded professional guidelines may offer some protections against inequitable, discretionary care.

Racial, ethnic, and gender differences in the association between higher state minimum wages and health and mental well-being in US adults with low educational attainment

BackgroundTo date, research evaluating the association between minimum wage and health has been heterogenous and varies based on the specific subpopulation or health outcomes under evaluation while associations across racial, ethnic, and gender identities have been understudied. MethodsA triple difference-in-differences strategy using modified Poisson regression was used to evaluate the associations between minimum wage and obesity, hypertension, fair or poor general health, and moderate psychological distress in 25–64-year-old adults with a high school education/GED or less. Data from the 1999–2017 Panel Study of Income Dynamics was linked to state policies and characteristics to estimate the risk ratio (RR) associated with a $1 increase in current and 2-year lagged state minimum wages overall and by race, ethnicity, and gender (non-Hispanic or non-Latino (NH) White men, NH White women, Black, indigenous, or people of color (BIPOC) men, and BIPOC women) adjusting for individual and state-level confounding. ResultsNo associations between minimum wage and health were observed overall. Among NH White men 2-year lagged minimum wage was associated with reduced risk of obesity (RR = 0.82, 95% CI = 0.67, 0.99). Among NH White women, current minimum wage was associated lower risk of moderate psychological distress (RR = 0.73, 95% CI = 0.54, 1.00) while 2-year lagged minimum wage was associated with higher obesity risk (RR = 1.35, 95% CI = 1.12, 1.64) and lower risk of moderate psychological distress (RR = 0.75, 95% CI = 0.56, 1.00). Among BIPOC women, current minimum wage was associated with higher risk of fair or poor health (RR = 1.19, 95% CI = 1.02, 1.40). No associations were observed among BIPOC men. ConclusionWhile no associations were observed overall, heterogeneous associations between minimum wage, obesity, and psychological distress by racial, ethnic, and gender strata warrant further study and have implications for health equity research.

Racial and Ethnic Differences in Maternal and Child COVID-19 Vaccination Intent Among Pregnant and Postpartum Women in the USA (April-June 2020): an Application of Health Belief Model.

This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.

OR01-1 Proximal Femur Fracture Incidence by Sex among Older US Asian/Pacific Islander Adults and non-Hispanic White Adults

Abstract Background The burden of proximal femur (hip) fractures is high in older adults and contributes to substantial mortality. Numerous studies also document racial/ethnic differences in hip fracture incidence, lower among US Asian compared to non-Hispanic White (NH-White) adults. These data have informed base population factors used for fracture risk calculation; for US Asian compared to NH-White populations, ratios of 0.50 and 0.64 have been used for women and men, respectively. In this study, we examined age-adjusted and age-specific incidences of hip fracture in a contemporary population of older US adults and compared findings in Asian and NH-White women and men. Methods Among adults age ≥50 years who were members of a large US healthcare system during 2010-2019, we identified Asian/Pacific Islander (Asian/PI) and NH-White adults based on self-reported race/ethnicity data. Incident hip fractures were identified during follow-up from 2010 to 2021 (censoring at hip fracture, death, or membership end) based on (1) initial principal/primary hospital diagnosis of femoral neck or pertrochanteric fracture or (2) secondary hospital diagnosis with hip fracture repair procedure(s). The incidence of hip fracture (per 100,000 person-years) by sex and age and overall age-standardized incidence (using the 2010 US Census) were reported with [95% confidence intervals]. To compare sex-specific fracture rates between Asian/PI and NH-White adults, Poisson models were fitted, adjusting for age (5-year age categories). Results Among 203,116 Asian/PI and 645,384 NH-White women, we identified 1,436 and 15,214 hip fractures, and among 174,594 Asian/PI and 573,693 NH-White men, we identified 582 and 7051 hip fractures during follow-up, respectively. The age-adjusted incidence of hip fracture was 136 [129-143] and 297 [292-302] per 100,000 person-years for Asian/PI and NH-White women and 54 [49-58] and 149 [145-153] per 100,000 person-years for Asian/PI and NH-White men, respectively. By 5-year age group, hip fracture incidence increased from 4, 40, to 1113 per 100,000 person-years for Asian/PI women and 7, 29, to 528 per 100,000 person-years for Asian/PI men ages 50-54, 65-69, to 85+ years, respectively. These estimates were lower than that observed in respective NH-White women (range 19, 140, to 2068 per 100,000 person-years) and NH-White men (range 22, 85, and 1381 per 100,000 person-years). The age-adjusted relative risk (risk ratio) of fracture comparing Asian/PI to NH-White women was 0.44 [0.41-0.46] and comparing Asian/PI to NH-White men was 0.35 [0.33-0.39]. Conclusion Hip fracture incidence in Asian/PI women and men is 56% and 65% lower than that observed in NH-White women and men. These findings indicate that racial/ethnic differences in proximal femur fracture persist in contemporary aggregate populations of older US Asian/PI adults compared to NH-White adults. However, given the known and increasing heterogeneity of the US Asian/PI population, future studies should examine whether these risk ratios vary by Asian/PI ethnic subgroups. Presentation: Saturday, June 11, 2022 11:30 a.m. - 11:45 a.m.

Racial/ethnic disparities in infertility treatment utilization in the US, 2011–2019

With delayed child-bearing age, there has been an increase in infertility rates globally and in the United States (US). Unsurprisingly, there has been a concomitant substantial increase in the number of individuals seeking infertility treatments over the last decade. This study aimed to examine the relationship between race/ethnicity and the utilization of different infertility treatments over the previous decade. We conducted this retrospective cohort study using the United States (US) Birth data files 2011–2019. We calculated the rates of infertility treatment and its subtypes over the study period. Descriptive statistics were utilized to examine the sociodemographic and birth characteristics for overall births and those associated with any infertility treatment and each of its subtypes. We calculated the level of association between race/ethnicity and utilization of infertility treatment and the subtypes using adjusted logistic regression models. We found that the rate of infertility treatments for all subtypes considered, had steadily increased by 63.7% within the past decade. In contrast, fertility enhancing drugs or Intrauterine Insemination (IUI) increased by 134%, and in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) treatments increased by 40% over the 9-year study period. Non-Hispanic (NH) Asian women had the highest rate of any infertility treatment with a rate of 25 per 1000 births whereas Hispanic women had the lowest rate of any infertility treatment at 5.8 per 1000 births. When compared with NH-White women, NH-Asian women had a modest 7% lower likelihood (OR = 0.93, 95% CI = 0.92–0.94) of receiving any infertility treatment while NH-Black and Hispanic women had about 70% lower likelihood of receiving any infertility treatment. Our report of increased assisted reproductive technology (ART) utilization rates, and marked racial/ethnic differences in ART utilization highlight the importance of expanding knowledge of inequities that continue to impact marginalized groups, a critical step for informing actionable strategy formulations (i.e., advocacy, policy change, patient education, provider training) to address these inequities.

Mammography Screening Disparities in Asian American Women: Findings From the California Health Interview Survey 2015–2016

To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors. A secondary analysis utilized the California Health Interview Survey (CHIS) 2015-2016. California, U.S. Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or "other Asian", aged 40 or above (unweighted N=13 451). Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable. Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity. The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12months, whereas only age and a preventive care visit were significant predictors in Asian women. The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.

Age distributions of breast cancer diagnosis and mortality by race and ethnicity in US women.

Surveillance, Epidemiology, and End Results (SEER) data from 1973-2010 have been used to show that minority women have disproportionately higher percentages of breast cancers diagnosed at younger ages in comparison with White women. The authors analyzed SEER 21 invasive breast cancer incidence data for 2014-2017 and National Center for Health Statistics mortality data for 2014-2018 and compared invasive incidence and mortality by age in non-Hispanic Black (NH-Black), Asian American/Pacific Islander (AAPI), Native American, and Hispanic women with those in non-Hispanic White (NH-White) women. They evaluated incidence rates and percentages of invasive breast cancer cases and breast cancer deaths occurring before the age of 50years along with advanced-stage incidence rates and percentages in minority women versus NH-White women. Recent SEER data showed that invasive breast cancers were diagnosed at significantly younger ages in minority women versus NH-White women. Among women diagnosed with invasive breast cancer, compared with NH-White women, minority women were 72% more likely to be diagnosed under the age of 50years (relative risk [RR], 1.72; 95% confidence interval [CI], 1.70-1.75), 58% more likely to be diagnosed with advanced-stage breast cancer under the age of 50years (RR, 1.58; 95% CI, 1.55-1.61), and 24% more likely to be diagnosed with advanced-stage (regional or distant) breast cancer at all ages (RR, 1.24; 95% CI, 1.23-1.25). Among women dying of breast cancer, minority women were 127% more likely to die under the age of 50years than NH-White women. NH-Black, AAPI, Native American, and Hispanic women have higher proportions of invasive breast cancers at younger ages and at advanced stages and breast cancer deaths at younger ages than NH-White women. This study analyzes the most recently available data on invasive breast cancers and breast cancer deaths in US women by age and race/ethnicity. Its findings show that non-Hispanic Black, Asian American/Pacific Islander, Native American, and Hispanic women have a higher percentage of invasive breast cancers at younger ages and at more advanced stages and a higher percentage of breast cancer deaths at younger ages than non-Hispanic White women.

Temporal trends and risk of small for gestational age (SGA) infants among Asian American mothers by ethnicity

PurposeTo examine the temporal trends and risk of small for gestational age (SGA) phenotypes across Asian American ethnic groups. MethodsWe conducted a population-based retrospective study using the 1992–2018 natality data files obtained from the National Vital Statistics System. Joinpoint regression modeling was employed to calculate the average annual percentage change in SGA birth rates among Asian American sub-groups and NH-White women. Logistic regression was utilized to compute the adjusted odds ratio and 95% confidence interval for the association between maternal race (Asian American sub-groups vs. NH-White) and SGA birth and its phenotypes. ResultsWe analyzed data on 2,821,798 Asian Americans and 62,174,875 NH-White US live-born infants. Overall, NH-Whites had the lowest SGA rates, while all the Asian ethnic groups had almost consistently higher rates during the 27-year period. Disparity in SGA births in the Asian subgroups was observed. Compared to NH-Whites, stratified analyses showed varying and significantly higher odds of any SGA in all Asian ethnic groups. Asian Indians had the highest odds [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 2.22–2.23] of any SGA compared to NH-Whites. ConclusionsOur findings support the evidence that Asian Americans are not a homogenous group and highlight the need to disentangle these differences when conducting population health research and interventions among Asian Americans.

Mammography screening disparities in Asian American women: Findings from the California Health Interview Survey 2015-2016.

e18568 Background: Foreign-born Asians were less likely to utilize preventive care due to medicine beliefs, language barriers, insurance coverage, and more. Their perceptions of breast cancer risks and screening benefits for asymptomatic conditions may differ from individuals born in the United States. It is urgent for preventive health professionals to understand screening disparities in Asian Americans. Methods: Data from the California Health Interview Survey (CHIS) 2015-2016 were used. Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening in relation to socioeconomic, chronic health condition/health behavior, and preventive care utilization, stratified by race. Results: Of NH-White and Asian American women aged 40 and above (unweighted N = 13,451), 78.41% were NH-White, 25.38% were foreign-born, 56.88% spoke only English at home, and 6.44% were not currently insured. The prevalence for self-reported mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. Among Asian American women, the lowest rate of mammograms was in Koreans (55.29%) and Chinese (72.19%) had the highest rate (p = 0.6438). In NH-White women, place of birth, smoking status, borderline diabetes, high blood pressure, is currently insured, and having a preventive care visit in the past 12 months were significant factors. Within Asian American women, borderline hypertension and having a preventive care visit were significant factors, but not ethnicity. Conclusions: The findings indicate that mammogram disparity in relation to socioeconomics, health behaviors, preventive care utilization, and race. Further development of ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should target Asian American women with borderline hypertension and no preventive care visits.

Abstract C061: Neighborhood racial context and race- and subtype-specific breast cancer incidence among non-Hispanic Black and non-Hispanic White women in California, 2006-2015

Abstract BACKGROUND: Determinants of racial inequities in risk of subtype-specific breast cancers are poorly understood. Features of the neighborhood context may contribute to racial inequities along the breast cancer continuum, however few have examined subtype-specific incidence. Therefore, this study aimed to characterize the association between the neighborhood racial context (housing discrimination and racial composition) and race- and subtype-specific breast cancer incidence among NH Black and NH White women in California. METHODS: We merged data from the California Cancer Registry on women aged 20+ diagnosed with primary breast cancer between 2006-2015 with neighborhood racial context at time of diagnosis: census tract % NH Black and a new racial bias index derived using 2007-2013 data from the Home Mortgage Disclosure Act. We used Poisson regression to estimate associations between neighborhood racial context and race- and Luminal A and TNBC (triple-negative breast cancer)-specific incidence rates, adjusting for neighborhood confounders. RESULTS: We identified n=104,716 cases of Luminal A and n=15,739 cases of TNBC over the study period. Among Black women, living in a high % Black census tract was associated with higher incidence of Luminal A (IRRadj=1.16 (1.08, 1.24)) and TNBC (IRRadj=1.17 (1.04, 1.32)) subtypes, relative to residence in low % Black tracts. No statistically significant association between neighborhood racial composition and either subtype was observed among NH Whites, nor between racial bias in mortgage lending and breast cancer among either racial group. CONCLUSION: Neighborhood racial composition may proxy cross-cutting social and environmental risk factors for breast cancer, regardless of subtype. These exposures may disproportionately burden Black versus White women with respect to breast cancer risk. Citation Format: Eli K. Michaels, Kirsten M.M. Beyer, Yuhong Zhou, Alison J. Canchola, Salma Shariff-Marco, Scarlett L. Gomez. Neighborhood racial context and race- and subtype-specific breast cancer incidence among non-Hispanic Black and non-Hispanic White women in California, 2006-2015 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C061.

Mediation of black/white disparities in triple negative breast cancer by socioeconomic position, reproductive factors and diabetes in the Nurses’ Health Study Cohorts I & II.

1565 Background: The higher rates of triple negative (TN) breast cancer (BC) observed among black compared to white women may be attributable to social and reproductive factors, as well as biological conditions like diabetes mellitus type 2. We examine the extent to which the black/white race disparity in TNBC is transmitted through these factors. Methods: Data are from the Nurses’ Health Study I and II prospective cohorts and include non-Hispanic (nH) black (n = 97) and nH white (n = 8,876) women aged 25-55 years at enrollment with invasive BC diagnoses. Participant characteristics are self-reported or drawn from medical records. We estimated average controlled direct associations (ACDA) using logistic regression with model-based standardization to evaluate the age/body mass index (BMI)-adjusted prevalence difference for TN versus luminal A/B type BC by race, and performed a series of ACDA (with comparison of rescaled coefficients (RC)) controlling for diabetes, mean family income before diagnosis (cont.), husband’s education ( < college, college, graduate school), parental ownership of participant’s childhood home (yes/no), age at menarche (cont.), age at first birth (cont.), parity (integer), and breastfeeding (BF) (parous/never BF, parous/ever BF). Results: Compared to nH whites, nh black women had higher prevalence of TNBC (24.5% v. 45.4%; p < 0.01), higher prevalence of diabetes (5.5% v. 11.3%; p = 0.01), lower prevalence of BF (59.2% v. 46.6%; p = 0.02), higher mean BMI (26.1 v. 29.9; p < 0.01), and lower mean family income ($17,304 v. 15,750; p < 0.01). BMI, age, and menopause were positively associated with prevalence of diabetes. In the age/BMI adjusted model, nH black women were 20%-points more likely than nH whites to have TNBC (95% Confidence Interval (CI): 0.11, 0.29). This disparity was reduced to 18.1% after also adjusting for BF (95% CI: 0.09, 0.28), to 13.7% after additionally adjusting for socioeconomic indicators (95% CI: 0.02, 0.25), and to 13.3% after adjusting for all potential mediators (95% CI: 0.01, 0.26). Based on the method of RC, socioeconomic indicators accounted for the largest fraction of mediated effects and BF accounted for most of main effect attenuation associated with reproductive factors; diabetes accounted for negligible effect. Conclusions: Our findings support the hypothesis that observed racial differences in TNBC diagnoses may be at least partially mediated by differences in socioeconomic position and reproductive patterns, namely breastfeeding.

Abstract P307: Trends In Racial And Ethnic Disparities In Metabolic Syndrome Among Us Women Of Reproductive Age: 1988-2016

Objective: To compare trends in the prevalence of metabolic syndrome (MetS) by race/ethnicity among US women ages 18-49 years between 1988 and 2016. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we classified MetS according to AHA/NHLBI criteria and calculated age-standardized prevalence of MetS in the following periods: 1988-94, 1999-04, 2005-10, and 2011-16. Our sample included nonpregnant women 18-49 years of age who self-reported as non-Hispanic White, non-Hispanic Black, or Mexican American. For each period, we estimated relative (prevalence ratio, PR) and absolute (prevalence difference, PD) differences by race/ethnicity. We tested heterogeneity of these estimates using ANOVA to determine if the differences between groups significantly widened or narrowed over time. All analyses were stratified by gravidity (nulligravida vs. primi- and multigravida). Results: Between 1988-94 and 2011-16, the age-standardized prevalence of MetS for nulligravida and primi-/multigravida women increased from 10% to 19% and 16% to 28%, respectively. Among nulligravida women , the relative differences in MetS between NH Black and NH White women decreased (PR 1988-94 =1.6, PR 1999-04 =1.4, PR 2005-10 =1.4, PR 2011-16 =1.0), while the difference between Mexican American and NH White women declined in 1999-04, but increased after (PR 1988-94 =2.2, PR 1999-04 =1.0, PR 2005-10 =1.5, PR 2011-16 =1.7). Compared to NH White women, the absolute differences for NH Black (PD 1988-94 =5.8%, PD 1999-04 =9.2%, PD 2005-10 =7.5%, PD 2011-16 =-0.5%) and Mexican American women (PD 1988-94 =11.1%, PD 1999-04 =-0.2%, PD 2005-10 =9.3%, PD 2011-16 =11.9%) followed similar patterns. Moreover, and among primi-/multigravida women , the relative differences between NH Black and NH White women remained stable (PR 1988-94 =1.3, PR 1999-04 =1.3, PR 2005-10 =1.5, PR 2011-16 =1.3), while the differences between Mexican American and NH White women declined (PR 1988-94 =1.8, PR 1999-04 =1.6, PR 2005-10 =1.3, PR 2011-16 =1.3). Again, compared to NH White women, absolute differences for NH Black (PD 1988-94 =4.4, PD 1999-04 =8.5, PD 2005-10 =10.7, PD 2011-16 =7.0) and Mexican American women (PD 1988-94 =12.2, PD 1999-04 =15.4, PD 2005-10 =5.7, PD 2011-16 =7.1) were similar. We found no evidence of significant heterogeneity of PRs and PDs across time for any group. Conclusions: Since 1988, prevalence of MetS among US women ages 18-49 has nearly doubled. The increase in prevalence was similar across NH White, NH Black and Mexican American women. Among nulligravida women, those that self-reported as Mexican American had the highest burden of MetS, while among primi-/multigravida women, the prevalence of MetS was consistently higher among both Mexican American and non-Hispanic Blacks.

Adverse Pregnancy and Neonatal Outcomes Among Marshallese Women Living in the United States.

Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results Of the 91,662 singleton births in both counties during the study period, 2488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of "other medical risk factors" (PR = 1.47; 95% CI 1.30, 1.65) than NH White women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH White women (PR = 2.65; 95% CI 2.22, 3.17 and 1.89; 95% CI 1.62, 2.21, respectively). Marshallese were also more likely to have tocolysis (PR = 1.43; 95% CI 1.16, 1.76), forceps (PR = 1.68; 95% CI 1.16, 2.43) or vacuum (PR = 1.89; 95% CI 1.60, 2.22) used in delivery and cesarean section (PR = 1.13; 95% CI 1.01, 1.27). Marshallese infants had higher rates of anemia (PR = 3.10; 95% CI 2.01, 4.77), birth injury (PR = 2.13; 95% CI 1.50, 3.03), assisted ventilation < 30min (PR = 2.11; 95% CI 1.64, 2.71), preterm birth (PR = 1.67; 95% CI 1.50, 1.83), and small-for-gestational age (PR = 1.25; 95% CI 1.12, 1.39) than NH White infants. Conclusions Marshallese women and infants had higher rates of adverse perinatal outcomes compared to their NH White counterparts. Additional studies are needed to determine if perinatal outcomes among the Marshallese differed from other Pacific Islander subgroups.

Trends in Cigar Use in the United States, 2002-2016: Diverging Trends by Race/Ethnicity.

Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. Data were drawn from the 2002-2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

Abstract B03: Sociodemographic disparities in breast density notification in the 2015 National Health Interview Survey

Abstract Purpose: To date, 32 states have passed legislation requiring that the estimated 50% of women with dense breast tissue receive written notification after a mammogram. We investigated whether there are sociodemographic disparities in breast density notification, receipt of supplemental MRI and ultrasound screening, and the association of breast density notification with breast cancer risk perception, using a nationally representative sample from the 2015 National Health Interview Survey. Methods: Women age 30 or older who reported ever having had a mammogram were asked: “Were you informed that your mammogram showed that you have dense breast tissue?” We present adjusted odds ratios (AOR) and 95% confidence intervals (CI) from logistic regression models accounting for sampling weights for sociodemographic predictors of density notification, supplemental screening, and breast cancer risk perception with adjustment for geographic region, lifestyle, behavioral, and reproductive factors associated with breast density. We further assess the association between density notification and breast cancer risk perception. Results: Of 10,841 respondents, 2,222 (22.3%) reported receiving notification of dense breast tissue, 8,293 (75.0%) said they had not, and 326 (2.7%) said they did not know. Compared to women with a high school diploma or GED, those with some college (AOR: 1.35, 95% CI: 1.11-1.63) or a college degree or higher (AOR: 1.79, 95% CI: 1.49-2.16) were significantly more likely to report density notification. Non-Hispanic (NH) Black (AOR: 0.55, 95% CI: 0.44-0.70), Hispanic (AOR: 0.53, 95% CI: 0.39-0.73), and NH-Asian (AOR: 0.49, 95% CI: 0.37-0.66) women were less likely than NH-White women to report being notified. Women whose last mammogram was five or more years prior to survey were 36% less likely (AOR: 0.64, 95% CI: 0.45-0.91) to report notification than those with a mammogram in the past two years. Notified women were more likely to have MRI or ultrasound follow-up tests after their most recent mammogram. Women who reported breast density notification were 72% more likely (AOR: 1.72, 95% CI: 1.42-2.07) to report they had higher risk of breast cancer than an average woman their age. Compared to NH-Whites, NH-Black women were less likely to assess themselves as at higher risk, and race did not modify the association between notification and breast cancer risk perception. Conclusions: The purpose of breast density notification is to empower women to make informed decisions about breast-cancer screening, including supplemental use of MRI and ultrasound. Higher reports of density notification among NH-Whites and women with higher educational attainment may reflect greater understanding of notification materials. Additional interventions may be required among lower-education and minority populations to ensure that the purpose of density notification is met. Citation Format: Erica T. Warner. Sociodemographic disparities in breast density notification in the 2015 National Health Interview Survey [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B03.

Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics.

The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics. We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity. Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care. We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.

Racial disparities in the utilization of preventive health services among older women with early-stage endometrial cancer enrolled in Medicare.

To assess differences in the receipt of preventive health services by race/ethnicity among older women with endometrial cancer enrolled in Medicare, we conducted a retrospective population‐based cohort study of women diagnosed with endometrial cancer from 2001 to 2011 in the Surveillance Epidemiology and End Results (SEER)‐Medicare database. Women with stage I or II endometrial cancer of epithelial origin were included. The exposure was race/ethnicity (Non‐Hispanic [NH] White, NH Black, Hispanic, and NH Asian/Pacific Islander [PI]). The services examined were receipt of influenza vaccination and screening tests for diabetes mellitus, hyperlipidemia, and breast cancer. We used multivariate logistic regression to estimate odds ratios with 95% confidence intervals (CI) adjusted for age, region, and year of diagnosis. A total of 13,054 women were included. In the 2 years after diagnosis, receipt of any influenza vaccine ranged from 45% among NH Black women to 67% among NH White women; receipt of a mammogram ranged from 65% among NH Black women to 74% among NH White women. Relative to NH White women, NH Black women had a lower likelihood of receiving both influenza vaccination (adjusted odds ratio [aOR] 0.40, 95% CI 0.33–0.44) and screening mammography (aOR 0.64, 95% CI 0.52–0.79). Hispanic women also were less likely to receive influenza vaccination than NH White women (aOR 0.61, 95% CI 0.51–0.72). There were no significant differences across racial groups for diabetes or cholesterol screening services. Among older women with early‐stage endometrial cancer, racial disparities exist in the utilization of some preventive services.