non-Hispanic Black Populations Research Articles

Factors Associated with Maternal Morbidity among Black Women in the United States.

Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). This is a population-based retrospective case-control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. · The rate of SMM in NHBP may be modifiable.. · NHBP have a three-fold higher rate of maternal mortality.. · Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity..

Abstract 2160: Utilizing geospatial analytics to identify neighborhood cancer hot spots for recruitment of underserved populations in clinical prevention research

Abstract Background: The term “precision public health” has increasingly been used in literature to describe public health practices that utilize new technologies and big data to precisely target the most vulnerable populations for disease control. Following the principles of precision public health, we used geospatial technologies and population-based health data to identify the locations and socioeconomic status of neighborhoods with high cancer incidences for recruitment of participants in prevention research. Methods: Using Florida cancer registry data, geospatial hot spot analyses were carried out to identify statistically significant clusters of census tracts with high incidences of prostate, gastric, and oral cancers within the catchment area of the Sylvester Comprehensive Cancer Center in South Florida. The locations, social determinants of health (US Census’ American Community Survey), and behavioral risk factor data (CDC’s Behavioral Risk Factor Surveillance System) of these hot spots were analyzed to identify the locations of underserved communities facing high risk for these three cancers. Results: Hot spots with high incidences for each of these three cancers overlap in many neighborhoods with high proportions of Hispanic and Non-Hispanic Black populations and high levels of socioeconomic disparities, such as low income, low education level, rental housing, no vehicles, and no access to health insurance. These neighborhoods also have high rates for behavioral risk factors in smoking, lack of physical activity, obesity, and high incidence of cervical cancer (high risk areas for HPV-associated oral cancers). Mobile screening units called the Game Changer Vehicles have been deployed to the locations to recruit participants who were tested on-site for prostate specific antigen (prostate cancer), H. pylori (gastric cancer), or solCD44 (a soluble tumor marker for squamous cell carcinoma) and total protein levels in oral rinse specimens, which can distinguish individuals with molecular features at risk for oral cancers due to tobacco, alcohol use, and human HPV infection. Conclusions: Geospatial analyses of population health data can be used to produce metrics that precisely target neighborhoods with high cancer risk and health disparities to recruit research participants. The same precision approach can also be applied for cancer screening purposes, such as offering cervical self-sample and fecal blood test kits in disadvantaged communities facing heightened risk for cervical and colorectal cancers. Citation Format: Ming S. Lee, Rebecca Kaiser, Ridhi Vyas, Amando Vera, Daniela Flores Quetant, Nancy Elliott, Valerie Bethel, Amanda Rivera, Shria Kumar, Brandon Mahal, Elizabeth Franzmann, Erin Kobetz. Utilizing geospatial analytics to identify neighborhood cancer hot spots for recruitment of underserved populations in clinical prevention research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2160.

Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health

Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults’ health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black–White inequality over the life course.

Abstract P236: Association Between Perceived Discrimination and Arterial Stiffness in Non-Hispanic Black Adults

Introduction: Racial discrimination is a chronic stressor that may contribute to cardiovascular disease (CVD) disparities in non-Hispanic Black (NHB) adults. Compared to non-Hispanic White adults, NHB adults experience greater perceived discrimination (PD), chronic perceived stress (PS), and burden of CVD risk. However, associations between PD, PS, and CVD risk, measured as arterial stiffness (AS), have not been tested in a population-based study of NHB adults in the US, limiting our understanding of whether and how CVD prevention initiatives should target PD and PS. Purpose: Determine the association between PD and AS, and whether this association is modified by biological sex and mediated by PS. Hypothesis: We hypothesized a direct association between PD and AS and that associations will be stronger in females and mediated by PS. Methods: Study sample included 594 NHB adults with complete data who participated in the Jackson Heart (JHS) and Atherosclerosis Risk in Communities (ARIC) studies’ shared cohort. PD (lifetime, everyday, and burden of lifetime discrimination) and PS were measured at JHS baseline (2000-2004). AS was measured at ARIC Visit 5 (2011-2013). PD and PS were coded as continuous variables. Effect modification was evaluated by including an interaction term between sex and PD in fully adjusted models. Mediation was assessed via the natural indirect effects from the CAUSALmed procedure. Models were adjusted for age, sex, body mass index (BMI), blood pressure medication, diabetes status, and mean arterial pressure (MAP). Results: Participants had a mean [95% confidence interval (95%CI)] age of 64.7 [64.3, 65.1] years, BMI of 30.1 [29.7, 30.6] kg/m 2 ; 69% (410 of 594) were female, 24% (143 of 594) had diabetes, and 70% (416 of 594) had hypertension. Mean [95%CI] total scores for everyday, lifetime, and burden of lifetime PD were 1.96 [1.89, 2.03], 2.97 [2.81, 3.14], and 2.28 [2.21, 2.34], respectively. Mean [95%CI] AS, measured as pulse wave velocity, was 12.42 [12.15, 12.70] m/s. A 1-unit increase in lifetime PD score was associated with a decrease in AS ( β =- 0.30 [-0.57, -0.02] m/s ). The association remained after adjusting for demographics and clinical characteristics ( β= -0.29 [-0.55, 0.02] m/s ), but was no longer statistically significant when including MAP ( β= -0.21 [-0.46, 0.05] m/s ). There were non-significant associations between everyday PD and burden of lifetime PD and AS. There was no evidence of effect modification by sex or mediation by PS. Conclusion: Higher lifetime PD, but not everyday PD or burden of lifetime PD, was associated with lower AS in crude models. However, the association was attenuated to non-significance when adjusted for MAP, suggesting the association between PD and AS may be pressure-dependent. Future studies characterizing PD’s role in CVD risk development in other geographical regions and NHB populations.

Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups.

The quality of care experienced by members of racial and ethnic minority groups in Medicare Advantage, which is an increasingly important source of Medicare coverage for these groups, has critical implications for health equity. Comparing gaps in Medicare Advantage and traditional Medicare for three quality-of-care outcomes, measured by adverse health events, between minority and non-Hispanic White populations, we found that the relative magnitude of the gaps varied both by racial and ethnic minority group and by quality measure. Hispanic versus non-Hispanic White gaps were smaller in Medicare Advantage than in traditional Medicare for all outcomes: avoidable emergency department use, preventable hospitalizations, and thirty-day hospital readmissions. The gap between non-Hispanic Black and non-Hispanic White populations was larger in Medicare Advantage than in traditional Medicare for avoidable emergency department use but was no different for hospital readmissions and was smaller for preventable hospitalizations. The Asian versus non-Hispanic White gap was similar in Medicare Advantage and traditional Medicare for avoidable emergency department use and preventable hospitalizations but was larger in Medicare Advantage for hospital readmissions. As Medicare Advantage enrollment expands, monitoring the quality of care for enrollees who are members of racial and ethnic minority groups will remain important.

Racial and ethnic disparities in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) has an increasing prevalence, morbidity, and mortality both within the U.S. and globally. Here, we review newer evidence demonstrating racial and ethnic disparities that exist in the incidence of MASLD in the U.S. Many studies demonstrate that Hispanic populations have the highest prevalence of MASLD within the U.S., followed by non-Hispanic White populations and then non-Hispanic Black populations. In addition, we present the latest research investigating specific factors that contribute to these disparities, including genetics, environmental exposures, diet, physical activity, and socioeconomic disparities. Finally, we discuss future directions and interventions needed to increase knowledge of racial and ethnic disparities in MASLD and reduce future disparities. The necessary strategies include increasing diversity and documentation of race and ethnicity in MASLD clinical studies, and increased screening and preventative health education for MASLD in vulnerable populations.

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Racial disparities in sleep health may mediate the broader health outcomes of structural racism. To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism. Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023. Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview. Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours). Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep. Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

PREVALENCE OF SINGLE AND MULTIPLE CHRONIC CONDITIONS AMONG RESETTLED BHUTANESE OLDER ADULTS IN OHIO

Abstract Background Migrants and refugees are more prone to chronic health conditions, which can worsen with age and accumulated stressors. Bhutanese older adults with refugee backgrounds in the US have not been well-studied. This study aimed to assess the prevalence of chronic diseases (single and multiple conditions) and to identify factors associated with multimorbidity among resettled Bhutanese older adults in Ohio. Additionally, the study compared the prevalence of chronic diseases with state-level data for other racial/ethnic groups. Methods Structured interview was conducted among 276 resettled Bhutanese, aged 55 years and above, in four major Ohio cities (Columbus, Akron, Cleveland, and Cincinnati), selected through snowball sampling with local Bhutanese organizations. State-level data of people, aged 55 years and above in Ohio, from the 2021 Behavioral Risk Factor Surveillance System for Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian populations were used for comparison. Binary logistic regression was used to identify factors associated with multimorbidity. Results Only 14.1% of participants were free of chronic diseases, while 62.3% had multimorbidity. Depression (31.8%), diabetes (42.8%), and respiratory diseases (26.4%) in older Bhutanese were considerably higher than in other racial/ethnic groups. Hypertension prevalence (63.0%) was higher than all other race/ethnic groups, except Non-Hispanic Black individuals (72.3%). Poor self-reported health and the presence of depressive symptoms had higher odds of having multimorbidity. Study Implications: This study underscores valuable insight into the disease burden among resettled Bhutanese older adults and can inform stakeholders to develop targeted public health programs and practices to meet the needs of minority populations.

Performance of cognitive vs. image-guided fusion biopsy for detection of overall and clinically significant prostate cancer in a multiethnic population

PurposeTransrectal ultrasound-guided prostate biopsy remains the most used method for the detection of prostate cancer. We recently reported that detection of clinically significant prostate cancer (cs-CaP) using image-guided fusion biopsies (IGFB) varied by race/ethnicity, which calls for further comparison between cognitive fusion biopsy (CFB) and IGFB among non-Hispanic black and Hispanic populations. Therefore, the aim of our study is to compare the rates of detection of cs-CaP and overall CaP by CFB and IGFB in a multiethnic community. Material and methodsWe performed a retrospective, cross-sectional review of men who underwent MRI-transrectal ultrasound-guided prostate biopsy at our diverse, urban academic medical center. Agreement and discordance between fusion biopsies and systematic biopsies for detection of cs-CaP and overall CaP were determined using Kappa statistics. Univariate and multivariate mixed-effects logistic regression models were used to find associations between fusion modalities and prostate cancer detection. ResultsIn total, 710 men underwent fusion prostate biopsies between December 2015 and June 2021. Upon univariate and multivariate logistic regression analysis, there was no significant association between IGFB vs. CFB and risk of overall CaP (OR = 0.66, 95% CI: 0.36–1.21, P = 0.18) or cs-CaP (OR = 0.57, 95% CI: 0.30–1.08, P = 0.09). We found moderate agreement between fusion and systematic biopsies for both CFB (κ = 0.56) and IGFB (κ = 0.52) in cs-CaP. ConclusionsCFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. CFB represents an effective and accessible means of accurately diagnosing prostate cancer.

Abstract B073: Leveraging genomic diversity identifies additional germline risk loci in SMAD6 for Langerhans cell histiocytosis

Abstract Background: Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia characterized by lesions including pathogenic CD207+ dendritic cells among an inflammatory infiltrate with recurrent, mutually exclusive somatic activating mutations in MAPK pathway genes in ~85% of LCH lesions; however, germline risk factors remain largely unknown. A SEER analysis reported that incidence of high-risk LCH was higher in Hispanic populations than non-Hispanic populations, and lowest in non-Hispanic Black populations. Our group reported that Hispanic mothers/couples were more likely to have children with LCH compared to non-Hispanic white mothers/couples. In the first GWAS of LCH, our group identified and validated a risk variant in SMAD6 associated with a 3-fold increase in risk. Our current objective is to leverage the genomic diversity of our patient population to identify additional SMAD6 LCH risk loci. Methods: Cases diagnosed with LCH were recruited at Texas Children’s Hospital (n=466). Targeted sequencing of SMAD6 was conducted among cases with ~200x coverage at the Avera Institute of Human Genetics. We accessed aggregate-level SMAD6 sequence data in SMAD6 from a median of 15,694 non-cancer controls in gnomAD v2.1.1. Fisher’s exact test was applied to 154 SMAD6 variants (Bonferroni critical P-value of 3.2 x 10-4) to assess association between SMAD6 variation and case status. Analyses were conducted with SAS and population genetics were assessed in Ensembl. Results: In this case-control analysis, 49 variants were significantly associated with LCH risk, including our previous risk locus. Leveraging population genetics, we found that the top 4 SNPs have low MAF globally (range 2-9%) but are enriched (MAF range 15-23%) in Hispanic/Latinx populations (MXL, CLM, PEL). The top two hits are in high LD in some of the Hispanic/Latinx and Black (ASW) populations (r2: MXL= 0.71, ASW = 1.0, PEL = 0.92), but not globally. The third SNP is in high LD with the peak SNP in these populations, as well (r2: MXL= 0.28, ASW = 0.83, PEL = 0.51). The fourth hit, which is our previously identified risk locus, has moderate LD with the peak SNP in Hispanic/Latinx populations (r2: MXL= 0.31, CLM = 0.3, PEL = 0.13). Conversely, the LD between the 1st and 5th SNPs was low globally and within different populations. Conclusion: We identified additional support for the role of SMAD6 variation in LCH susceptibility across and within diverse ancestral populations. These findings suggest that the top four SMAD6 variants identified in this study vary in how they function as independent signals across populations, especially in Hispanic/Latinx patients. The 5th hit in SMAD6 appears to be the next independent variant across all populations. These results indicate that there are common risk variants across populations and ancestry-specific variants for LCH, which may contribute to the differences in ancestry-specific LCH risk. Broadly, our work emphasizes the benefits of leveraging in, rather than adjusting out, the genomic richness of diverse patient populations. Citation Format: Priya B. Shetty, Erin Peckham-Gregory, Erik Stricker, Howard Lin, Brooks Scull, Erik Ehli, Christel Davis, Kenneth McClain, Philip Lupo, Carl Allen, Michael Scheurer. Leveraging genomic diversity identifies additional germline risk loci in SMAD6 for Langerhans cell histiocytosis [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 B073.

Abstract B112: Disparities in cervical cancer survival among Hispanic subpopulations living in the United States

Abstract Purpose: The Hispanic population bears a high burden of cervical cancer; however, disaggregated data, which is vital in equitable resource allocation, lacks in this group. Our study evaluated disparities in cervical cancer survival among Hispanic subpopulations receiving guideline-concordant care and identified factors affecting survival. Methods: Data from the National Cancer Database was used to identify patients with cervical cancer from 2004-2019. The Hispanic cohort was analyzed in its entirety, and by region of origin. Nine quality metrics were established to assess guideline-concordant care for eligible patients across various cancer stages. Demographic data, treatment modalities, and survival were described. Demographic and clinical variables were stratified by Hispanic subpopulation and compared using chi-squared tests. Kaplan-Meier curves were employed to examine cervical cancer survival among the Hispanic subpopulation for each quality metric. Marginal Poisson log-linear models were utilized to evaluate the association Hispanic subpopulation and the receipt of eligible quality metrics, and obtain adjusted relative risks (aRR), while controlling for potential confounders. Results: A total of 77,567 patients were included, 4363 (5.6%) of which identified as Hispanic. Compared to non-Hispanic White (NHW) and non-Hispanic Black (NHB) populations, larger proportion of the Hispanic population was uninsured (19.16%, p &amp;lt; 0.001) and more likely to live in neighborhoods with lowest rates of high school diploma attainment (61.43%, p &amp;lt;0.001). Significant differences in neighborhood income, education level, insurance status, and stage at presentation among Hispanic subpopulations were identified (p&amp;lt;0.001). Survival among patients with stage IA2-IIA2 patients undergoing radical hysterectomy was lowest among NHB and Cuban patients when compared to NHW and other Hispanic patients (p&amp;lt;0.001). Survival among stage IB2-IVA patients undergoing primary radiation and concurrent chemotherapy was also lowest among Cuban, NHW and NHB patients when compared to other populations, and highest among Mexican populations (p&amp;lt;0.001). Among patients with stage IVB disease receiving chemotherapy, Dominican populations had the highest survival rates p&amp;lt;0.001). Compared to Mexican patients, Cuban patients were 1.18 times as likely to receive timely initiation of treatment in early stage (RR 1.18, 95% CI 1.03-1.34, p=0.01). Patients of South or Central American origin (RR 1.18, 95%CI 1.09-1.28, p&amp;lt; 0.001), Cuban (RR 12.5, 95%CI 1.1-1.43, p&amp;lt;0.001), and Dominican (RR1.19, OR 1.01-1.4, p=0.03) were more likely to undergo timely initiation of treatment in locally advanced disease when compared to Mexican patients. Conclusion: Significant differences in survival outcomes for patients with cervical cancer were identified among our cohort, as well as within the Hispanic population. Variation in initial of treatment, treatment type received, and social factors may contribute to these disparities. Citation Format: Andreea Dinicu, Shayan Dioun, Yongzhe Wang, Yongmei Huang, Jason Wright, Ana Tergas. Disparities in cervical cancer survival among Hispanic subpopulations living in the United States [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 B112.

Trends in Pancreatic Cancer Related Mortality in the United States from 1999-2020

Background: Pancreatic cancer related mortality trends in the U.S. population have not been explored recently and the availability of the CDC WONDER database provides us the opportunity to do so. Objectives: The purpose of this study was to determine the directionality of trends and the regional differences in pancreatic cancer related mortality in the United States from 1999 to 2020. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research) database were inspected from 1999 to 2020 for pancreatic cancer related mortality in all age groups of the US population. Age adjusted mortality rates (AAMRs) per 100,000 persons and annual percentage change (APC) were calculated and compared with respect to year, sex, race/ethnicity and geographic region. Results: Between 1999 and 2020, 847589 Pancreatic cancer-related deaths occurred among all age groups of the U.S. population. The overall population AAMR increased from 11.2 in 1999 to 11.7 in 2020 (APC: 0.26; 95% CI: 0.20-0.32). Men had persistently higher AAMRs than women from 1999 (AAMR men: 12.9 vs women: 9.7) to 2020 (AAMR men: 13.6 vs women: 10.2). Non-Hispanic (NH) Black or African American population had the highest overall AAMR (14.5), followed by NH White (11.4), Hispanic or Latino (8.9), NH American Indian or Alaska Native (8.5), and NH Asian or Pacific Islander adults (8.0). AAMRs also varied by region (overall AAMR: Northeast: 11.9; Midwest 11.7; South: 11.3; West: 10.8). In comparing States, District of Columbia had the highest overall AAMR (14.0) and Utah the lowest (9.8). Comparison of 5-year age groups revealed the highest crude death rate in the 80-84 age group (93.5 per 100,000 persons), with an appreciable rise through the middle and older ages. We then analyzed data for adults between the ages of 45 and 84 and saw similar trends as before. Conclusion: Pancreatic Cancer- related mortality in U.S. has increased since 1999. Despite an overall decreasing trend of AAMRs from 1999 to 2020 for the NH Black or African American population, this category still had the highest AAMRs of the races/ethnicities. Men had persistently higher AAMRs than women. A disproportionate AAMR distribution pertaining to the States was exhibited. These differences warrant further investigation and focused approaches are needed to counter these mortality trends.

Abstract 18643: An Index to Measure Inequity-Health Equity Index for Guideline Directed Medical Therapy Among HFrEF

Background: Heart failure affects 6.2 million adults in the US with 50% five-year mortality. Effectiveness of guideline-directed medical therapy (GDMT), composed by four different medications, has been established to reduce morbidity and mortality for heart failure with reduction ejection fraction (HFrEF), and with strong incremental impact of number of GDMT medications. Despite immense positive evidence, &lt; 5% of patients with HFrEF are on the appropriate target doses of all 4 GDMTs, and there is substantial disparity of GDMT use among race/ethnic groups or socio-economical levels. However, the study to quantify the inequity of GDMT prescription is lacking. Hypothesis: Significant inequity exists in the GDMT prescription among HFrEF. Aims: We derived a health equity index (HEI) for GDMT prescription for HFrEF patients to provide administrators with an assessment tool for evaluating disparity of GDMT use at a large healthcare system covering diverse geographic areas and population in northern California. Methods: HEI for GDMT (3+ GDMT medications) is estimated by ratio of observed-to-expected values. The number of expected patients with 3+ GDMT medication level was derived from a weighted average of subpopulation distribution of the 3+ GDMT prescription for each race/ethnicity and medium income race/medium income level within the population catchment area. Observed 3+ GDMT use was captured from the medication order data in the EHR. HEI &gt; 1.0 represents existence of health inequity. We applied this method to the whole HFrEF population, and then to each of geographic area where the race/ethnicity and medium income level vary significantly. Results: Among 45,222 HFrEF patients 24.6% had 3+ GDMTs, varying from 19% to 29% in 6 geographic areas. The HEI for the whole HFrEF population was 1.33. Further analysis revealed that highest disparity occurred at East Bay area (Oakland area) (1.67), serving large proportion of non-Hispanic Black patient population, and lowest at Palo Alto area (1.27). Conclusion: HEI for GDMT reflects disparity in receiving adequate care for HFrEF population. Substantial disparity was observed in different geographic areas, implying the priority of delivering equitable care to HFrEF should start with the area with highest disparity.

Estimates of population highly annoyed from transportation noise in the United States: An unfair share of the burden by race and ethnicity

Transportation is one of the most pervasive sources of community noise. In this study, we used a spatially-resolved model of transportation-related noise with established transportation noise exposure-response functions to estimate the population highly annoyed (HA) due to aviation, road, and railway traffic sources in the United States. Additionally, we employed the use of the Fair Share Ratio to assess race/ethnicity disparities in traffic noise exposures. Our results estimate that in 2020, 7.8 million (2.4%) individuals were highly annoyed by aviation noise, while 5.2 million (1.6%) and 7.9 million (2.4%) people were highly annoyed by rail and roadway noise, respectively, across the US. The Fair Share Ratio revealed that Non-Hispanic Asian, Black, NHPI, and Other, and Hispanic populations were disproportionally highly annoyed by transportation noise nationwide. Notably, Hispanic populations experienced the greatest share of high annoyance from aviation noise (1.69 times their population share). Non-Hispanic Black populations experienced the greatest share of high annoyance from railway noise (1.48 times their population share). Non-Hispanic Asian populations experienced the greatest share of high annoyance from roadway noise (1.51 times their population share). Analyses at the state and Urban Area levels further highlighted varying disparities in transportation noise exposure and annoyance across different race ethnicity groups, but still suggested that Non-Hispanic White populations were less annoyed by all sources of transportation noise compared to non-White populations. Our findings indicate widespread presence of transportation noise annoyance across the US and emphasize the need for targeted source-specific noise mitigation strategies and policies to minimize the disproportionate impact of transportation noise in the US.

State‐Level Acute Myeloid Leukemia Incidence and Mortality Trends and Association with Obesity in the United States

Background : Acute myeloid leukemia (AML) is the most common type of leukemia among adults and carries a dismal prognosis. Recent evidence suggests increasing AML risk in obese individuals. However, state-level temporal trends and whether obesity is associated with temporal changes remain largely unknown. Methods: We obtained data on age-adjusted AML incidence and mortality from 1999 to 2019 for all 50 states and the District of Columbia (DC) from the US Cancer Statistics database maintained by the Centers for Disease Control and Prevention (CDC). Using the JoinPoint regression program, we calculated the annual percent change (APC), average annual percent change (AAPC), and correspondent p values. A positive APC indicated an increasing trend, while a negative APC meant a decreasing trend. State-level obesity information was retrieved from the Behavioral Risk Factor Surveillance System maintained by CDC. Obesity was defined as a body mass index ≥30. Pearson correlation coefficients were used to test state-level correlations between obesity and AAPC of incidence and mortality. Results: During 1999-2019, a total of 271,930 AML cases were diagnosed in the US yielding an incidence rate of 3.99 per 100,000 person-years (PYs). Non-Hispanic White population had the highest incidence of 4.1 per 100,000 PYs. Among Non-Hispanic Black, Hispanic, Asian, and American Indian population, AML incidences were 3.2-3.4 per 100,000 PYs. AML incidence varied across states. The incidence rate ratio between the highest and lowest incidence of states was 1.66. The three states with the highest incidences were Iowa (4.49 per 100,000 PYs), Wisconsin (4.41 per 100,000 PYs) and Maine (4.41 per 100,000 PYs). The lowest incidences were observed in DC (2.71 per 100,000 PYs), Wyoming (3.37 per 100,000 PYs), and New Mexico (3.41 per 100,000 PYs). The national AML incidence decreased by 0.5% each year in 1999-2008 (p = 0.05), followed by an average yearly increase of 6.1% in 2008-2011 (p=0.03), then plateaued in 2011-2019. As shown in Figure 1, during 20-year period, among 45 states with non-suppress yearly incidence, incidence increased in 17 states, and plateaued in all other states. The states with the highest increases were in Kentucky (AAPC = 2.4%, p &amp;lt; 0.01), Tennessee (AAPC = 1.7%, p = 0.01), Virginia (AAPC = 1.4% p&amp;lt;.01), Utah (AAPC = 1.4%, p = 0.01) and North Carolina (AAPC = 1.4%, p&amp;lt;.01). The US Cancer Statistics collected 190,193 AML deaths in 1999-2019 with a mortality rate of 2.77 per 100,000 PYs. Across race and ethnicity groups, mortality rate ranged from 1.8 per 100,000 PYs among American Indian or Alaska Natives to 2.9 per 100,000 PYs among Non-Hispanic White population. The mortality rate ratio between the highest and lowest mortality of states was 1.60. Iowa (3.36 per 100,000 PYs), Washington (3.32 per 100,000 PYs), North Dakota (3.29 per 100,000 PYs) and Wisconsin (3.26 per 100,000 PYs) had the highest mortality rates. The mortality rates were lowest in Hawaii (2.30 per 100,000 PYs), New Mexico (2.26 per 100,000 PYs), and DC (2.10 per 100,000 PYs). National AML mortality plateaued in 1999-2009, then fell on average 0.4% per year over 2009-2019 (p = 0.01). Among 45 states with non-suppressed yearly mortality, mortality decreased in Montana (AAPC = -1.8%, p=0.01), Washington (AAPC = -1.0%, p&amp;lt;0.01), Iowa (AAPC = -0.8%, p = 0.04), and Florida (AAPC = -0.5%, p = 0.03); however, mortality increased in Virginia (AAPC = 0.6%, p = 0.03), Pennsylvania (AAPC = 0.7%, p&amp;lt;0.01), Nebraska (AAPC = 1.1%, p &amp;lt; 0.01), Kentucky (AAPC = 1.3%, p &amp;lt; 0.01), and Nevada (AAPC = 1.3%, p = 0.02) (Figure 2). At state-level, AAPC of AML incidence was positively correlated with percentage of obesity (r = 0.31, p = 0.04). No correlation was observed between percentage of obesity and AAPC of AML mortality at state-level. Conclusion: The findings of this cross-sectional study suggest that large state-level variation in AML incidence and mortality. Despite AML incidence plateauing in the US since 2011, it continued to increase in one-third of the states and may be connected with the differential distribution of obesity. Although AML mortality in the US has been significantly reduced since 2009, the AML mortality continued to increase in some states. Reduction of obesity should be investigated as a potential way to reduce AML incidence and related deaths.

Racial and ethnic disparities in eligibility for postpartum venous thromboembolism prophylaxis in the United States

BackgroundPostpartum venous thromboembolism (VTE) incidence differs by race and ethnicity in the United States. However, it is unclear whether the eligibility criteria for postpartum VTE prophylaxis mirror this disparity. ObjectiveTo characterize the prevalence of risk factors and eligibility for postpartum VTE prophylaxis, among US Birthing people, stratified by race and ethnicity. MethodsWe analyzed the National Inpatient Sample from October 2015 to December 2019, using diagnosis and procedure codes to identify postpartum individuals and their VTE risk factors. We compared proportion of delivery hospitalizations meeting eligibility for thromboprophylaxis stratified by race or ethnicity, according to American College of Gynecology and Obstetrics, American College of Chest Physicians, Royal College of Obstetricians and Gynecologists (RCOG), and American Society for Hematology guidelines. ResultsAmong a national estimate of 14 967 861 delivery hospitalizations in the United States, the proportion of individuals eligible for thromboprophylaxis using the RCOG, American College of Chest Physicians, American College of Gynecology and Obstetrics, and American Society for Hematology guidelines were 32.9%, 8.0%, 0.2%, and 0.2%, respectively. Using the RCOG criteria, non-Hispanic Black individuals had the highest proportion of thromboprophylaxis eligibility (39.7%), whereas it was lowest among Hispanic individuals (30.8%). Racial disparities in thromboprophylaxis eligibility were driven by differences in clinical risk factors (38.8% non-Hispanic Black population vs 30.5% Hispanic population) and cesarean section rates (35.9% vs 32.2%), rather than history of VTE (0.3% vs 0.1%), inherited thrombophilia (0.2% vs 0.2%), or sickle cell disease (0.4% vs <0.1%). ConclusionNon-Hispanic Black individuals were most likely to qualify for postpartum thromboprophylaxis, attributable to clinical risk factors rather than inherited risk factors. An urgent need exists to better understand ethno-racial disparities in thromboprophylaxis use and to equitably address modifiable risk factors for postpartum VTE.

The role of health system penetration rate in estimating the prevalence of type 1 diabetes in children and adolescents using electronic health records.

Having sufficient population coverage from the electronic health records (EHRs)-connected health system is essential for building a comprehensive EHR-based diabetes surveillance system. This study aimed to establish an EHR-based type 1 diabetes (T1D) surveillance system for children and adolescents across racial and ethnic groups by identifying the minimum population coverage from EHR-connected health systems to accurately estimate T1D prevalence. We conducted a retrospective, cross-sectional analysis involving children and adolescents <20years old identified from the OneFlorida+ Clinical Research Network (2018-2020). T1D cases were identified using a previously validated computable phenotyping algorithm. The T1D prevalence for each ZIP Code Tabulation Area (ZCTA, 5 digits), defined as the number of T1D cases divided by the total number of residents in the corresponding ZCTA, was calculated. Population coverage for each ZCTA was measured using observed health system penetration rates (HSPR), which was calculated as the ratio of residents in the corresponding ZTCA and captured by OneFlorida+ to the overall population in the same ZCTA reported by the Census. We used a recursive partitioning algorithm to identify the minimum required observed HSPR to estimate T1D prevalence and compare our estimate with the reported T1D prevalence from the SEARCH study. Observed HSPRs of 55%, 55%, and 60% were identified as the minimum thresholds for the non-Hispanic White, non-Hispanic Black, and Hispanic populations. The estimated T1D prevalence for non-Hispanic White and non-Hispanic Black were 2.87 and 2.29 per 1000 youth, which are comparable to the reference study's estimation. The estimated prevalence of T1D for Hispanics (2.76 per 1000 youth) was higher than the reference study's estimation (1.48-1.64 per 1000 youth). The standardized T1D prevalence in the overall Florida population was 2.81 per 1000 youth in 2019. Our study provides a method to estimate T1D prevalence in children and adolescents using EHRs and reports the estimated HSPRs and prevalence of T1D for different race and ethnicity groups to facilitate EHR-based diabetes surveillance.

Disentangling age, gender, and racial/ethnic disparities in multiple myeloma burden: a modeling study

Multiple myeloma (MM) is a hematological malignancy that is consistently preceded by an asymptomatic condition, monoclonal gammopathy of undetermined significance (MGUS). Disparities by age, gender, and race/ethnicity in both MGUS and MM are well-established. However, it remains unclear whether these disparities can be explained by increased incidence of MGUS and/or accelerated progression from MGUS to MM. Here, we fit a mathematical model to nationally representative data from the United States and showed that the difference in MM incidence can be explained by an increased incidence of MGUS among male and non-Hispanic Black populations. We did not find evidence showing differences in the rate of progression from MGUS to MM by either gender or race/ethnicity. Our results suggest that screening for MGUS among high-risk groups (e.g., non-Hispanic Black men) may hold promise as a strategy to reduce the burden and MM health disparities.

Air quality related equity implications of U.S. decarbonization policy

Climate policies that target greenhouse gas emissions can improve air quality by reducing co-emitted air pollutant emissions. However, the extent to which climate policy could contribute to the targets of reducing existing pollution disparities across different populations remains largely unknown. We quantify potential air pollution exposure reductions under U.S. federal carbon policy, considering implications of resulting health benefits for exposure disparities across U.S. racial/ethnic groups. We focus on policy cases that achieve reductions of 40-60% in 2030 economy-wide carbon dioxide (CO2) emissions, when compared with 2005 emissions. The 50% CO2 reduction policy case reduces average fine particulate matter (PM2.5) exposure across racial/ethnic groups, with greatest benefit for non-Hispanic Black (−0.44 μg/m3) and white populations (−0.37 μg/m3). The average exposure disparity for racial/ethnic minorities rises from 12.4% to 13.1%. Applying an optimization approach to multiple emissions reduction scenarios, we find that no alternate combination of reductions from different CO2 sources would substantially mitigate exposure disparities. Results suggest that CO2-based strategies for this range of reductions are insufficient for fully mitigating PM2.5 exposure disparities between white and racial/ethnic minority populations; addressing disparities may require larger-scale structural changes.

The Lives Lost to Inequities: Avertable Deaths From Neurologic Diseases in the Past Decade.

Mortality rates for neurologic diseases are increasing in the United States, with large disparities across geographical areas and populations. Racial and ethnic populations, notably the non-Hispanic (NH) Black population, experience higher mortality rates for many causes of death, but the magnitude of the disparities for neurologic diseases is unclear. The objectives of this study were to calculate mortality rates for neurologic diseases by race and ethnicity and-to place this disparity in perspective-to estimate how many US deaths would have been averted in the past decade if the NH Black population experienced the same mortality rates as other groups. Mortality rates for deaths attributed to neurologic diseases, as defined by the International Classification of Diseases, were calculated for 2010 to 2019 using death and population data obtained from the Centers for Disease Control and Prevention and the US Census Bureau. Avertable deaths were calculated by indirect standardization: For each calendar year of the decade, age-specific death rates of NH White persons in 10 age groups were multiplied by the NH Black population in each age group. A secondary analysis used Hispanic and NH Asian populations as the reference groups. In 2013, overall age-adjusted mortality rates for neurologic diseases began increasing, with the NH Black population experiencing higher rates than NH White, NH American Indian and Alaska Native, Hispanic, and NH Asian populations (in decreasing order). Other populations with higher mortality rates for neurologic diseases included older adults, the male population, and adults older than 25 years without a high school diploma. The gap in mortality rates for neurologic diseases between the NH Black and NH White populations widened from 4.2 individuals per 100,000 in 2011 to 7.0 per 100,000 in 2019. Over 2010 to 2019, had the NH Black population experienced the neurologic mortality rates of NH White, Hispanic, or NH Asian populations, 29,986, 88,407, or 117,519 deaths, respectively, would have been averted. Death rates for neurologic diseases are increasing. Disproportionately higher neurologic mortality rates in the NH Black population are responsible for a large number of excess deaths, making research and policy efforts to address the systemic causes increasingly urgent.