non-Hispanic Black People Research Articles

Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression

SummaryBackgroundThe burden of fatal police violence is an urgent public health crisis in the USA. Mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing. Recent high-profile killings by police in the USA have prompted calls for more extensive and public data reporting on police violence. This study examines the presence and extent of under-reporting of police violence in US Government-run vital registration data, offers a method for correcting under-reporting in these datasets, and presents revised estimates of deaths due to police violence in the USA.MethodsWe compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, open-source databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted. We extracted and standardised the age, sex, US state of death registration, year of death, and race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic of other races, and Hispanic of any race) of each decedent for all data sources and used a network meta-regression to quantify the rate of under-reporting within the NVSS. Using these rates to inform correction factors, we provide adjusted estimates of deaths due to police violence for all states, ages, sexes, and racial and ethnic groups from 1980 to 2019 across the USA.FindingsAcross all races and states in the USA, we estimate 30 800 deaths (95% uncertainty interval [UI] 30 300–31 300) from police violence between 1980 and 2018; this represents 17 100 more deaths (16 600–17 600) than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 [95% UI 0·67–0·71] per 100 000), followed by Hispanic people of any race (0·35 [0·34–0·36]), non-Hispanic White people (0·20 [0·19–0·20]), and non-Hispanic people of other races (0·15 [0·14– 0·16]). This variation is further affected by the decedent's sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% (54·8–56·2) of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 (0·24–0·26) per 100 000 in the 1980s and 0·34 (0·34–0·35) per 100 000 in the 2010s, an increase of 38·4% (32·4–45·1) over the period of study.InterpretationWe found that more than half of all deaths due to police violence that we estimated in the USA from 1980 to 2018 were unreported in the NVSS. Compounding this, we found substantial differences in the age-standardised mortality rate due to police violence over time and by racial and ethnic groups within the USA. Proven public health intervention strategies are needed to address these systematic biases. State-level estimates allow for appropriate targeting of these strategies to address police violence and improve its reporting.FundingBill & Melinda Gates Foundation, National Institute on Minority Health and Health Disparities, and National Heart, Lung, and Blood Institute.

Tuberculosis Outbreak Associated With Delayed Diagnosis and Long Infectious Periods in Rural Arkansas, 2010-2018.

During 2010-2018, the Arkansas Department of Health reported 21 genotype-matched cases of tuberculosis (TB) among residents of a rural county in Arkansas with a low incidence of TB and in nearby counties. The Arkansas Department of Health and the Centers for Disease Control and Prevention investigated to determine the extent of TB transmission and provide recommendations for TB control. We reviewed medical and public health records, interviewed patients, and reviewed patients' social media posts to describe patient characteristics, identify epidemiologic links, and establish likely chains of transmission. We identified 21 cases; 11 reported during 2010-2013 and 10 during 2016-2018. All case patients were US-born non-Hispanic Black people. Eighteen case patients had the outbreak genotype, and 3 clinically diagnosed (non-culture-confirmed) case patients had epidemiologic links to patients with the outbreak genotype. Social media reviews revealed epidemiologic links among 10 case patients not previously disclosed during interviews. Eight case patients (38%) had ≥1 health care visit during their infectious period, and 7 patients had estimated infectious periods of >12 months. Delayed diagnoses and prolonged infectiousness led to TB transmission in this rural community. TB education and awareness is critical to reducing transmission, morbidity, and mortality, especially in areas where health care providers have limited TB experience. Use of social media can help elucidate people at risk, especially when traditional TB investigation techniques are insufficient.

Community Versus Hospital Opioid-Related Overdose Deaths in Illinois.

To better understand approaches to reducing mortality from the opioid epidemic, we analyzed in-hospital versus community opioid-related overdose deaths in Illinois. We used data from the Statewide Unintentional Drug Overdose Reporting System (July 2017 through December 2018) to identify deaths that occurred in hospitals and communities (ie, homes or public spaces). We used census tract-level data for 34 Illinois counties to create bivariate mapping by overdose death rates. We used logistic regression to analyze the association of demographic and overdose characteristics with the likelihood of death in a hospital versus a community. During the study period, 2833 opioid-related overdose deaths occurred in 24 Illinois counties, 655 (23.1%) of which occurred in the hospital; of 2178 community deaths, 1888 (86.7%) occurred in the same census tract as the decedent's recorded residence and 1285 (59.0%) occurred in the decedent's home. Non-Hispanic Black people were 1.63 (95% CI, 1.27-2.10) times more likely than non-Hispanic White people to die in a hospital. Decedents from suburban Cook County and other Chicago suburban counties were significantly more likely to die in the hospital than decedents from Chicago or other Illinois counties. Documentation of a previous overdose, history of opioid use, and having bystanders present were significantly associated with hospital deaths. Evidence of a rapid overdose, fentanyl present, or prescription opioids were significantly associated with deaths in a community. The high number of opioid-related overdose deaths in the community illustrates the need to decriminalize illicit drug use and facilitate treatment seeking. Establishing supervised safe consumption sites may have the biggest effect in reducing the number of opioid-related overdose deaths.

SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut

BackgroundInfection fatality rate and infection hospitalization rate, defined as the proportion of deaths and hospitalizations, respectively, of the total infected individuals, can estimate the actual toll of coronavirus disease 2019 (COVID-19) on a community, as the denominator is ideally based on a representative sample of a population, which captures the full spectrum of illness, including asymptomatic and untested individuals. ObjectiveTo determine the COVID-19 infection hospitalization rate and infection fatality rate among the non-congregate population in Connecticut between March 1 and June 1, 2020. MethodsThe infection hospitalization rate and infection fatality rate were calculated for adults residing in non-congregate settings in Connecticut prior to June 2020. Individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies were estimated using the seroprevalence estimates from the recently conducted Post-Infection Prevalence study. Information on total hospitalizations and deaths was obtained from the Connecticut Hospital Association and the Connecticut Department of Public Health, respectively. ResultsPrior to June 1, 2020, nearly 113,515 (90% confidence interval [CI] 56,758-170,273) individuals were estimated to have SARS-CoV-2 antibodies, and there were 7792 hospitalizations and 1079 deaths among the non-congregate population. The overall COVID-19 infection hospitalization rate and infection fatality rate were estimated to be 6.86% (90% CI, 4.58%-13.72%) and 0.95% (90% CI, 0.63%-1.90%), respectively, and there was variation in these rate estimates across subgroups; older people, men, non-Hispanic Black people, and those belonging to 2 of the counties had a higher burden of adverse outcomes, although the differences between most subgroups were not statistically significant. ConclusionsUsing representative seroprevalence estimates, the overall COVID-19 infection hospitalization rate and infection fatality rate were estimated to be 6.86% and 0.95%, respectively, among community residents in Connecticut.

State- and County-Level Social Capital as Predictors of County-Level Suicide Rates in the United States: A Lagged Multilevel Study.

From 1999 through 2017, age-adjusted suicide rates in the United States rose by 33% (from 10.5 to 14.0 per 100 000 population). Social capital, a key social determinant of health, could protect against suicide, but empirical evidence on this association is limited. Using multilevel data from the Centers for Disease Control and Prevention, we explored state- and county-level social capital as predictors of age-adjusted suicide rates pooled from 2010 through 2017 across 2112 US counties. In addition, we tested for causal mediation of these associations by state-level prevalence of depression. A 1-standard deviation increase in state-level social capital predicted lower county-level suicide mortality rates almost 2 decades later (0.87 fewer suicides per 100 000 population; P = .04). This association was present among non-Hispanic Black people and among men but not among non-Hispanic White people and women. We also found evidence of partial mediation by prevalence of depression. Our findings suggest that elevating state- and county-level social capital, such as through policy and local initiatives, may help to reverse the trend of rising suicide rates in the United States.

Racial and gender differences in the relationship between sarcopenia and bone mineral density among older adults.

The purpose of the study was to investigate the racial and gender differences in the relationship between sarcopenia and BMD among older adults. Totally, 5476 subjects (mean age = 65.7 ± 6.4) of non-Hispanic White (n = 3297), non-Hispanic Black (n = 1265), and non-Hispanic Asian (n = 914) were analyzed. Sarcopenia was defined according to the revised European consensus on definition and diagnosis of sarcopenia (EWGSOP2). General linear model and multivariable linear regression model were used to examine the relationship between sarcopenia and regional/whole body BMD stratified by race and sex. Adjustments were conducted for physiological, behavioral, and disease factors. Comparing with normal older participants, presarcopenic and sarcopenic elderly were more likely to have lower BMD. Although the difference was not statistically significant in a few sub-groups, among the three racial groups, the strongest association between sarcopenia and BMD was found in non-Hispanic Black people, followed by non-Hispanic White people and non-Hispanic Asian people. In addition, significant differences of BMD across sarcopenia stages were found in more sub-groups in women than in men after adjusting for covariates. In this older cohort, sarcopenia is significantly related to low regional/whole-body BMD, and these associations vary by race and sex. Consideration in race and sex is warranted when developing strategies to maintain or minimize BMD loss.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Trends and Geographic Variation in Acute Respiratory Failure and ARDS Mortality in the United States

BackgroundDespite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and ARDS, limited contemporary data are available on the mortality burden of ARF and ARDS in the United States.Research QuestionWhat are the contemporary trends and geographic variation in ARF and ARDS-related mortality in the United States?Study Design and MethodsA retrospective analysis of the National Center for Health Statistics’ nationwide mortality data was conducted to assess the ARF and ARDS-related mortality trends from 2014 through 2018 and the geographic distribution of ARF and ARDS-related deaths in 2018 for all American residents. Piecewise linear regression was used to evaluate the trends in age-adjusted mortality rates (AAMRs) in the overall population and various demographic subgroups of age, sex, race, urbanization, and region.ResultsAmong 1,434,349 ARF-related deaths and 52,958 ARDS-related deaths during the study period, the AAMR was highest in older individuals (≥ 65 years), non-Hispanic Black people, and those living in the nonmetropolitan region. The AAMR for ARF-related deaths (per 100,000 people) increased from 74.9 (95% CI, 74.6-75.2) in 2014 to 85.6 (95% CI, 85.3-85.9) in 2018 (annual percentage change [APC], 3.4 [95% CI, 2.2-4.6]; Ptrend = .003). The AAMR (per 100,000 people) for ARDS-related deaths was 3.2 (95% CI, 3.2-3.3) in 2014 and 3.0 (95% CI, 3.0-3.1 in 2018; APC, −0.9 [95% CI, −5.4 to 3.8]; Ptrend = .56). The observed increase in rates for ARF mortality was consistent across the subgroups of age, sex, race or ethnicity, urbanization status, and geographical region (Ptrend < .05 for all). The AAMR (per 100,000 people) for ARF (91.3 [95% CI, 90.8-91.8]) and ARDS-related mortality (3.3 [95% CI, 3.2-3.4]) in 2018 were highest in the South.InterpretationThe ARF-related mortality increased at approximately 3.4% annually, and ARDS-related mortality showed a lack of decline in the last 5 years. These data contextualize important health information to guide priorities for research, clinical care, and policy, especially during the coronavirus disease 2019 pandemic in the United States.

Abstract B129: Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States?

Abstract Upper Aerodigestive tract (UADT) cancers are primarily squamous cell carcinomas that affect the oral cavity (hard palate, front 2/3 of tongue, gums, mucosal lining of lips and cheeks, and the floor of the mouth), oropharynx (base of the tongue, soft palate, and tonsils), hypopharynx, larynx (epiglottis and vocal cords), and the upper third of the esophagus with a five-year survival rate of 65.3% for oral cavity and pharyngeal cancers. If the cancer is detected during the localized stage, the survival rate improves to 84.4% (SEER 18 2009-2015).There have been several risk factors implicated in the pathogenesis of UADT cancers such as, male gender, smoking, alcohol use, and infection with human papilloma virus (HPV) for oropharyngeal cancers. The current literature suggests that regardless of stage people of African descent have a lower incidence of UADT cancers, but higher mortality rates compared to Caucasians. There are many proposed explanations for this paradoxical trend seen in African Americans. However, there is a paucity of research addressing this problem. We seek to understand if socioeconomic status is the underlying factor driving this disparity. We analyzed de-identified data collected from the Surveillance, Epidemiology, and End Results (SEER) program for 114,510 UADT cancer patients diagnosed from 2007-2016. We hypothesized that people who were uninsured or on Medicaid would have a life expectancy that was significantly reduced compared to those that had private insurance or Medicare regardless of race, tumor grade, gender or site of the cancer. Our study design is retrospective cohort. Our multivariate analysis model utilizes survival analysis techniques such as Kaplan-Meier survival, hazard curves and proportional hazards regression to analyze the survival time of our patients as a function of demographic and clinical variables. Survival months ranged from 0 to 119 months, with 25,122 patients experiencing death due to UADT cancers. The proportional hazards regression revealed that across all insurance groups (Insured, Uninsured, Medicaid, and Unknown) the survival time for Non-Hispanic Black People was significantly reduced compared to the other race/ethnicities (Asians, Caucasians, Hispanics (all races)) with Non-Hispanic Caucasians having the highest survival rate. Determining that the racial disparity exists regardless of insurance status, tumor grade, gender, and site of cancer can guide future researchers to focus on biological differences or other factors such as lack of access to care that underlie disease survival for UADT cancers. Citation Format: Joycemary G Amponsem, Dana Marshall, Derek Wilus, Mohammad Tabatabai. Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States? [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 B129.

Educational Attainment Better Increases the Chance of Breast Physical Exam for Non-Hispanic Than Hispanic American Women: National Health Interview Survey.

The Minorities' Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. The current study explored the racial and ethnic differences in the association between educational attainment and breast physical exam (BPE) among women in the U.S. The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis. Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR] = 1.11, 95% CI = 1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR = 0.96, 95% CI = 0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02). In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Methamphetamine Involved in Rising Number of Heroin Treatment Admissions

Back to table of contents Previous article Next article Clinical & ResearchFull AccessMethamphetamine Involved in Rising Number of Heroin Treatment AdmissionsTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:16 Oct 2019https://doi.org/10.1176/appi.pn.2019.10b9AbstractIn a trend that cuts across demographics, adolescents and young adults are among the groups hardest hit.Methamphetamine use is involved in an increasing number of heroin treatment admissions, a study in Addiction has found. In 2017, 12.4% of heroin treatment admissions involved methamphetamine, up from 2.1% in 2008. The trend was pronounced in adolescents and young adults but also cut across sex, age, race, ethnicity, and census regions nationwide.Treatment plans for patients who use heroin and methamphetamine should include medication treatment for opioid use disorder, says Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H.Centers for Disease Control and PreventionThe findings point to a need for more dialogue between health professionals and patients about using multiple substances, lead author Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H., told Psychiatric News. Jones is a senior advisor and the associate director of the Office of Strategy and Innovation in the Injury Center at the Centers for Disease Control and Prevention.“Clinicians should discuss with their patients not only opioid use, but also methamphetamine and other substance use. These drugs work in different ways, and prior research indicates that there are varying motivations for their combined use. These include synergistic euphoric effects or balancing effects, such as using methamphetamine to counter the sedating effects of opioids,” Jones told Psychiatric News. “Understanding why patients are using methamphetamine in addition to opioids can help guide decisions related to treatment and recovery-support services.”Prompted by reports of increased rates of simultaneous opioid and methamphetamine use, Jones and his colleagues analyzed data from more than 3.5 million treatment admissions between 2008 and 2017 in which heroin was the primary substance of use. The data came from the Treatment Episode Data Set, a national database that provides information on the admissions of people aged 12 years and older to substance use treatment centers that receive federal funds.“There were a small number of local studies that had come out in the last two years that started to document this phenomenon. We were interested to see what the patterns looked like in a larger dataset as the findings could help to inform ongoing efforts to combat the evolving opioid overdose epidemic,” Jones said.The researchers found that in 2017, people aged 12 to 24 had the highest rates of admissions for heroin use involving methamphetamine of all the age groups examined: 27.8% of primary heroin treatment admissions for adolescents aged 12 to 17 years involved methamphetamine, and 17.4% of heroin treatment admissions for young adults aged 18 to 24 involved methamphetamine.“Not only do these findings highlight a need to focus intervention and treatment efforts aimed at reaching younger age groups, but together with the finding that early age of heroin initiation was associated with methamphetamine use at treatment admission, these findings underscore the importance of expanding policies, programs, and practices that can prevent initiation of these substances in the first place,” Jones and colleagues wrote.Among females, 15.1% of primary heroin treatment admissions involved methamphetamine in 2017, compared with 10.8% among males. The researchers noted that prior research suggests that females use more methamphetamine and transition from recreational use to dependence more quickly than males.More than 37% of primary heroin treatment admissions among non-Hispanic American Indian or Alaska Natives involved methamphetamine, the highest among all races and ethnicities. Only 2% of primary heroin treatment admissions among non-Hispanic black people involved methamphetamine, the lowest among all races and ethnicities.“Given the increase in risk for negative health outcomes among people using both substances, comprehensive prevention, treatment, and harm-reduction strategies that address the polysubstance nature of opioid use and are appropriately tailored to specific demographic groups and at-risk populations are needed,” Jones and colleagues wrote.Yet despite the greater risk of poor outcomes in people who mix illicit opioids with other drugs, admissions for the use of heroin and methamphetamine are 35% less likely to include medication treatment for opioid use disorder as part of the treatment plan, the study revealed.“Ensuring that the patient treatment plan utilizes evidence-based medications for opioid use disorder treatment along with nonmedication services, especially those that have shown benefit for patients using methamphetamine, is essential,” Jones said. “In addition, given the high risk for overdose among this population, patients should be given or prescribed naloxone for opioid-overdose reversal and trained in its use.” ■“Increases in Methamphetamine Use Among Heroin Treatment Admissions in the United States, 2008-2017,” is posted here. 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Melanoma Among Non-Hispanic Black Americans.

IntroductionFew studies have examined melanoma incidence and survival rates among non-Hispanic black populations because melanoma risk is lower among this group than among non-Hispanic white populations. However, non-Hispanic black people are often diagnosed with melanoma at later stages, and the predominant histologic types of melanomas that occur in non-Hispanic black people have poorer survival rates than the most common types among non-Hispanic white people.MethodsWe used the US Cancer Statistics 2001–2015 Public Use Research Database to examine melanoma incidence and 5-year survival among non-Hispanic black US populations.ResultsFrom 2011 through 2015, the overall incidence of melanoma among non-Hispanic black people was 1.0 per 100,000, and incidence increased with age. Although 63.8% of melanomas in non-Hispanic black people were of unspecified histology, the most commonly diagnosed defined histologic type was acral lentiginous melanoma (16.7%). From 2001 through 2014, the relative 5-year melanoma survival rate among non-Hispanic black people was 66.2%.ConclusionAlthough incidence of melanoma is relatively rare among non-Hispanic black populations, survival rates lag behind rates for non-Hispanic white populations. Improved public education is needed about incidence of acral lentiginous melanoma among non-Hispanic black people along with increased awareness among health care providers.

Preferences for Health Information Technologies Among US Adults: Analysis of the Health Information National Trends Survey.

BackgroundEmerging health technologies are increasingly being used in health care for communication, data collection, patient monitoring, education, and facilitating adherence to chronic disease management. However, there is a lack of studies on differences in the preference for using information exchange technologies between patients with chronic and nonchronic diseases and factors affecting these differences.ObjectiveThe purpose of this paper is to understand the preferences and use of information technology for information exchange among a nationally representative sample of adults with and without 3 chronic disease conditions (ie, cardiovascular disease [CVD], diabetes, and hypertension) and to assess whether these preferences differ according to varying demographic variables.MethodsWe utilized data from the 2012 and 2014 iteration of the Health Information National Trends Survey (N=7307). We used multiple logistic regressions, adjusting for relevant demographic covariates, to identify the independent factors associated with lower odds of using health information technology (HIT), thus, identifying targets for awareness. Analyses were weighted for the US population and adjusted for the sociodemographic variables of age, gender, race, and US census region.ResultsOf 7307 participants, 3529 reported CVD, diabetes, or hypertension. In the unadjusted models, individuals with diabetes, CVD, or hypertension were more likely to report using email to exchange medical information with their provider and less likely to not use any of the technology in health information exchange, as well as more likely to say it was not important for them to access personal medical information electronically. In the unadjusted model, additional significant odds ratio (OR) values were observed. However, after adjustment, most relationships regarding the use and interest in exchanging information with the provider were no longer significant. In the adjusted model, individuals with CVD, diabetes, or hypertension were more likely to access Web-based personal health information through a website or app. Furthermore, we assessed adjusted ORs for demographic variables. Those aged >65 years and Hispanic people were more likely to report no use of email to exchange medical information with their provider. Minorities (Hispanic, non-Hispanic black, and Asian people) were less likely to indicate they had no interest in exchanging general health tips with a provider electronically.ConclusionsThe analysis did not show any significant association among those with comorbidities and their proclivity toward health information, possibly implying that HIT-related interventions, particularly design of information technologies, should focus more on demographic factors, including race, age, and region, than on comorbidities or chronic disease status to increase the likelihood of use. Future research is needed to understand and explore more patient-friendly use and design of information technologies, which can be utilized by diverse age, race, and education or health literacy groups efficiently to further bridge the patient-provider communication gap.

Variations in Cigarette Smoking and Quit Attempts by Health Insurance Among US Adults in 41 States and 2 Jurisdictions, 2014.

Information on the impact of health insurance on smoking and quit attempts at the state level is limited. We examined the state-specific prevalence of cigarette smoking and past-year quit attempts among adults aged 18-64 by health insurance and other individual- and state-level factors. We used data from 41 states, the District of Columbia, and Puerto Rico, the jurisdictions that administered the Health Care Access module of the 2014 Behavioral Risk Factor Surveillance System. Data on quit attempts included current smokers with a past-year quit attempt and former smokers who quit during the past year. Overall, smoking prevalence ranged from 14.6% among those with private insurance to 34.7% among Medicaid enrollees, and past-year quit-attempt prevalence ranged from 66.4% among the uninsured to 71.5% among Medicaid enrollees. By insurance group, differences in the prevalence of state-specific past-year quit attempts ranged from 15 to 26 percentage points. Regardless of insurance type, people who were non-Hispanic white and had lower education levels were less likely to attempt quitting than were Hispanic people, non-Hispanic black people, and adults with more than a high school education. We found disparities in smoking and quit attempts by insurance status and state. Opportunities exist to increase access to cessation treatments through comprehensive state tobacco control programs and improved cessation insurance coverage, coupled with promotion of covered cessation treatments.

SUN-P200: Validity of Equations Using Knee Height to Predict Overall Height Among Older People in Benin

Rationale: Chumlea ’s formulas are a validated means of predicting overall height from knee height (KH) among people over 60 years old, but no formula is validated for use in African countries, including Benin. The purpose of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin. Methods: People over 60 years of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height and KH. A Bland and Altman analysis was carried out by gender and age. The percentage of predictions accurate to ± 5cm compared to the measured height was calculated. The tested formulas were Chumlea ’ s formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians (CC1, CC2). Results: Data from 396 subjects were analysed. The mean age was 66.6 ± 5.2 years and mean height of 165.4 ± 8.0 cm. The sex-ratio was of 4.3. The three formulas achieved 98.0% accuracy, but with 4.6% risk of error (±2 SD: − 6 to +9 cm), which appeared to make them unfitted for the whole population. The predictions of the three formulas in the total population are presented in Table 1. Nevertheless, if a level of prediction ± 5 cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ. Table 1: Predictions of the three formulas studied. n = 396 Acurate prediction (%) Overestimation (+5 cm) (%) Underestimation (−5 cm) (%) CBP 83.1 12.4 4.5 CC1 80.3 15.9 3.8 CC2 78.5 18.2 3.3 Conclusion: CBP formulas seem applicable in 83% of cases (±5 cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition.

Validity of equations using knee height to predict overall height among older people in Benin.

Chumlea's formulas are a validated means of predicting overall height from knee height (KH) among people >60y of age, but, to our knowledge, no formula is validated for use in African countries, including Benin. The aim of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin. Individuals >60y of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height, and KH. A Bland-Altman analysis was carried out by sex and age. The percentage of predictions accurate to ±5cm compared with the measured height was calculated. The tested formulas were Chumlea's formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians. Data from 396 individuals (81.1% male) were analyzed. The three formulas achieved 98% accuracy, but with 4.6% risk for error (±2 SD: -6 to +9cm), which appeared to make them unfit for the whole population. Nevertheless, if a level of prediction ±5cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ. CBP formulas seem applicable in 83% of cases (±5cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition.

Economic Disparities and Syphilis Incidence in Massachusetts, 2001-2013.

We used area-level indicators of poverty to describe economic disparities in the incidence rate of infectious syphilis in Massachusetts to (1) determine whether methods developed in earlier AIDS analyses in Massachusetts could be applied to syphilis and (2) characterize syphilis trends during a time of increased rates of syphilis incidence. Using census tract data and population counts from the US Census Bureau and Massachusetts data on syphilis, we analyzed the incidence rate of syphilis infection from 2001 to 2013 by the poverty level of the census tract in which people with syphilis resided, stratified by age, sex, and race/ethnicity. The syphilis incidence rate increased in all census tract groups in Massachusetts from 2001 to 2013, and disparities in incidence rates by area poverty level persisted over time. The overall incidence rate of syphilis increased 6.9-fold from 2001 to 2013 in all census tract poverty-level groupings (from 1.5 to 10.3 per 100 000 population), but the rise in rate was especially high in the poorest census tracts (from 5.6 to 31.0 per 100 000 population) and among men (from 2.2 to 19.4 per 100 000 population). The highest syphilis incidence rate was among non-Hispanic black people. The largest changes in incidence rate occurred after 2010. One region had a disproportionate increase in incidence rates and a disproportionate impact on the statewide trend. Census tract poverty analyses can inform the targeting of interventions that make progress toward reducing disparities in rates of syphilis incidence possible.

Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System.

The objective of this study was to understand predictors of hepatitis C virus (HCV) antibody positivity in a large urban jail system in New York City. We examined demographic characteristics, risk behaviors, and HCV antibody prevalence among 10 790 jail inmates aged 16 to 86 who were screened from June 13, 2013, to June 13, 2014, based on birth cohort or conventional high-risk criteria. We used logistic regression analysis to determine predictors of HCV antibody positivity. Of the 10 790 inmates screened, 2221 (20.6%) were HCV antibody positive. In the multivariate analysis, HCV antibody positivity was associated most strongly with injection drug use (IDU; adjusted odds ratio [aOR] = 35.0; 95% confidence interval [CI], 28.5-43.0). Women were more likely than men to be infected with HCV (aOR = 1.3; 95% CI, 1.1-1.5). Compared with non-Hispanic black people, Hispanic (aOR = 2.1; 95% CI, 1.8-2.4) and non-Hispanic white (aOR = 1.7; 95% CI, 1.5-2.1) people were more likely to be infected with HCV. Non-IDU, recidivism, HIV infection, homelessness, mental illness, and lower education level were all significantly associated with HCV infection. The prevalence rate of HCV infection among a subset of inmates born after 1965 who denied IDU and were not infected with HIV was 5.6% (198 of 3529). Predictors of HCV infection among this group included non-IDU as well as being non-Hispanic white, Hispanic, recidivist, and homeless. These data reveal differences in HCV infection by sex, race/ethnicity, and socioeconomics in a large jail population, suggesting that a focused public health intervention is required and that universal screening may be warranted. Further sensitivity and cost-benefit analyses are needed to make this determination.

HIV-1 Infection and Transmission Networks of Younger People in Chicago, Illinois, 2005-2011.

Analysis of HIV nucleotide sequences can be used to identify people with highly similar HIV strains and understand transmission patterns. The objective of this study was to identify groups of people highly connected by HIV transmission and the extent to which transmission occurred within and between geographic areas in Chicago, Illinois. We analyzed genetic sequences in the HIV-1 pol region in samples collected from people participating in the VARHS program in Chicago during 2005-2011. We determined pairwise genetic distance, inferred potential transmission events between HIV-infected people whose sequences were ≤1.5% genetically distant, and identified clusters of connected people. We used multivariable analysis to determine demographic characteristics and risk attributes associated with degree of connectivity. Of 1154 sequences, 177 (15.3%) were tied to at least 1 other sequence. We determined that younger people, men, non-Hispanic black people, and men who have sex with men were more highly connected than other HIV-infected people. We also identified a high degree of geographic heterogeneity-48 of 67 clusters (71.6%) contained people from >1 Chicago region (north, south, or west sides). Our results indicate a need to address HIV transmission through the networks of younger non-Hispanic black men who have sex with men. The high level of geographic heterogeneity observed suggests that HIV prevention programs should be targeted toward networks of younger people rather than geographic areas of high incidence. This study could also guide prevention efforts in other diverse metropolitan regions with characteristics similar to those of Chicago.

The 2013 HIV Continuum of Care in Tennessee: Progress Made, but Disparities Persist.

We measured patient engagement in the human immunodeficiency virus (HIV) continuum of care in Tennessee after implementation of enhanced surveillance activities to assess progress toward 2015 statewide goals. We also examined subgroup disparities to identify groups at risk for poor outcomes. We estimated linkage to care, retention in care, and viral suppression among HIV-infected people in Tennessee in 2013, overall and by subgroup, after implementation of enhanced laboratory reporting, address verification, and death-matching procedures. Of 792 people newly diagnosed with HIV infection in 2013, 632 (79.8%) were linked to care, close to the 2015 goal of ≥80%. Of 15 473 people living and diagnosed with HIV infection before 2013, 8458 (54.7%) were retained in care, approaching the 2015 goal of ≥64.0%. A total of 8640 (55.8%) were virally suppressed, surpassing the 2015 goal of ≥51.0%. Compared with people living and diagnosed with HIV infection before 2013, newly diagnosed people were more likely to be younger, male, non-Hispanic black, and men who have sex with men (MSM). For linkage to care, retention in care, and viral suppression, younger and non-Hispanic black people fared worse, whereas females and those enrolled in the Ryan White program fared better. For retention in care and viral suppression, Hispanic people, injection drug users, and East Tennessee residents fared worse than those in Memphis, whereas MSM fared better. Nashville residents fared worse in retention in care than Memphis residents. Tennessee's HIV continuum of care in 2013 showed progress toward 2015 goals. Future efforts to improve the HIV continuum of care should be directed toward vulnerable groups and regions, particularly young, non-Hispanic black, and Hispanic people; injection drug users; and residents of the East Tennessee and Nashville regions.