non-Hispanic Black Women Research Articles

Pregnancy-Related Deaths in the US, 2018-2022

The US has the highest rate of preganncy-related death among high-income countries, and disparities continue to widen despite many of these deaths being largely preventable. To examine the age-standardized national rates of pregnancy-related death from 2018 to 2022 in the US, stratified by cause, and to compare the rates across state and race and ethnicity. This serial cross-sectional study used nationwide data on births and pregnancy-related deaths from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women aged 15 to 54 years from 2018 to 2022 were included. State, race and ethnicity, and age. The primary outcomes were all-cause and cause-specific maternal death and late maternal death (ie, deaths occurring >42 days and up to 1 year after pregnancy). The age-standardized annual and aggregated rate of pregnancy-related mortality (ASR) was estimated by age group and race and ethnicity, and state-specific crude pregnancy-related mortality rates per 100 000 live births and 95% CIs were calculated. During 2018 to 2022, there were 6283 pregnancy-related deaths, including 1891 late maternal deaths. The ASR increased by 27.7% from 25.3 deaths per 100 000 live births (95% CI, 23.7-26.9) in 2018 to 32.6 deaths per 100 000 live births (95% CI, 31.2-34.8) in 2022. The increase was observed across age group and was disproportionately driven by deaths that occurred among women aged 25 to 39 years (by 36.8%, 2018 vs 2022). There was a considerable variation in rates by state, ranging from 18.5 to 59.7 deaths per 100 000 live births. If the national rate was reduced to the lowest state rate, 2679 pregnancy-related deaths could have been prevented in 2018 to 2022. American Indian and Alaska Native women had the highest ASR (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behavior disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death. In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority.

Serum concentrations of persistent endocrine-disrupting chemicals in U.S. military personnel: A comparison by race/ethnicity and sex.

Serum concentrations of persistent endocrine-disrupting chemicals in U.S. military personnel: A comparison by race/ethnicity and sex.

Emergency department visits for undiagnosed pelvic organ prolapse.

Emergency department visits for undiagnosed pelvic organ prolapse.

Evaluating the trend of time to colposcopy follow-up among women with a positive primary human papillomavirus screening result at Kaiser Permanente Southern California.

Evaluating the trend of time to colposcopy follow-up among women with a positive primary human papillomavirus screening result at Kaiser Permanente Southern California.

325 Advancing breast cancer risk identification and care in non-Hispanic Black Women

Objectives/Goals: This project will enrich our understanding of basal breast carcinogenesis, highlighting the distinct biological differences in breast cancer risk between non-Hispanic Black (NHB) or non-Hispanic White (NHW) women, but also has the potential to provide real-world solutions thereby contributing to reducing health disparities in breast cancer outcomes Methods/Study Population: In the biological investigation, I am utilizing a unique cohort of normal breast tissues from Mayo Clinic patients who underwent breast reduction surgery that have self-identified as NHB or NHW premenopausal women. From these tissues, we are able to subculture human mammary epithelial cells, which we will use for our consequent experiments. For the qualitative study, I aim to recruit up to 40–50 eligible NHB women identified at increased risk for breast cancer and conduct semi-structured qualitative interviews informed by the National Institute on Minority Health and Health Disparities Research Framework. Results/Anticipated Results: Gene expression profiling on our cohort of 15 NHB and 40 NHW premenopausal women identified a gene expression signature in NHB women indicative of elevated Hedgehog signaling, a key factor in triple-negative breast cancer (TNBC) development and progression. I hypothesize that persistent activation of Hedgehog signaling within NHB women instigates the proliferation and transformation of basal stem cells within the breast, thus fueling TNBC development. Understanding the perceptions and experiences of NHB women that are identified as being at an increased risk for BC will aid in the identification of barriers and facilitators to their risk reduction care and in turn provide implementation strategies that could contribute to alleviating the racial disparity seen in TNBC morbidity, mortality, and preventative care. Discussion/Significance of Impact: The significance of this project lies in its dual approach, uncovering basal breast cancer mechanisms in a high-risk group using normal breast tissue and evaluating the perspectives from NHB women to enhance the practical relevance of our findings.

137 Disparities in cervical cancer prevention among non-Hispanic Black and Hispanic women

Objectives/Goals: This study aim to identify cervical cancer prevention barriers and facilitators, assess the associations between social determinants of health factors and cervical cancer prevention, and examine the association between levels of health literacy and willingness to undertake HPV vaccine and cervical cancer screening among Black and Hispanic women. Methods/Study Population: To achieve Aim 1, we will conduct a quantitative survey on barriers and facilitators to cancer prevention among non-Hispanic Black and Hispanic women. For Aim 2, we will assess the relationship between Social Determinants of Health and HPV vaccination/cervical cancer screening using the AHC Health-Related Social Needs Screening Tool. For Aim 3, health literacy will be measured using the SAHL–S&E test and its association with willingness to vaccinate or cervical cancer screening. We will analyze the results using chi-square and logistic regression models. Participants will be recruited through multiple methods. We will recruit 250 individuals who were assigned female at birth and identify as non-Hispanic Black or Hispanic, aged 18–26 years, from Caddo and Bossier Parishes. Results/Anticipated Results: We expect to identify several barriers and facilitators to cervical cancer prevention among non-Hispanic Black and Hispanic women, including factors like access to care, cultural beliefs, and knowledge gaps. Social determinants of health (SDOH), such as income, education, and healthcare access, will likely show a strong association with lower HPV vaccination, Pap smear, and HPV screening rates. Additionally, we anticipate that lower health literacy will correlate with reduced willingness to vaccinate or screen for HPV. These findings can bridge the gap between research and practical health applications by guiding the design of community-based behavioral interventions that enhance cervical cancer prevention among minority populations. Discussion/Significance of Impact: This research is the first to assess how SDOH factors impact cervical cancer prevention among Blacks and Hispanic women in North Louisianawhile also exploring the role of health literacy in HPV vaccination and screening. Findings will drive practical interventions to reduce disparities and improve outcomes.

Racialized Economic Segregation, Treatment and Outcomes in Women with Triple-Negative Breast Cancer.

We previously demonstrated differences in treatment and mortality between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with triple-negative breast cancer (TNBC). The impact of residential segregation on TNBC treatment and outcomes remains unknown. We identified NHB and NHW women with TNBC diagnosed from 2010-2015 and followed through 2016, using the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel Cox regression and multilevel logistic regression accounting for county-level clustering were used to calculate hazard ratios (HRs) and odds ratios (ORs). Of 25217 patients, 25.6% were NHB. Compared with patients in counties with the highest concentration of high-income NHW residents (most privileged), patients in counties with the highest concentration of low-income NHB residents (most deprived) had significantly higher risks of breast cancer-specific mortality (HR=1.14, 95% CI 1.01-1.30; Ptrend=0.12), overall mortality (HR=1.15, 95% CI 1.02-1.29; Ptrend=0.06), and late-stage diagnosis (OR=1.15, 95% CI 1.01-1.32; Ptrend=0.03). Overall, 28.2%, 24.5%, and 18.3% of excess risks of breast cancer mortality, overall mortality, and late-stage diagnosis in NHB (vs NHW) patients were explained by residential segregation. There was no significant association between residential segregation and treatment. Living in the most deprived vs privileged neighborhoods was associated with lower likelihoods of early detection and survival of TNBC, contributing to TNBC outcome disparities between NHBs and NHWs. This highlights the importance of breast cancer screening for neighborhoods with predominantly low-income NHB residents and elucidating the pathways linking segregation to TNBC prognosis.

Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women.

Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women.

Differences in plasma metabolome between non-Hispanic White and non-Hispanic Black women

BackgroundTo understand potential racial differences in disease susceptibility and develop targeted prevention strategies, it is essential to establish biological differences between racial groups in healthy individuals. However, knowledge about how race impacts metabolites is limited. We therefore performed a cross-sectional study using comprehensive metabolomics analysis to investigate racial differences in metabolites among 506 non-Hispanic White (NHW) women and 163 non-Hispanic Black (NHB) women.MethodsWe performed untargeted plasma metabolomic profiling using Metabolon’s platform (Durham, NC®) and identified 1074 metabolites in 9 super-pathways. We used multivariable linear regression models, adjusted for confounders, to identify associations between race and metabolites. We applied a Bonferroni correction (p-value < 10–5) to account for multiple testing.ResultsWe identified 26 metabolites that differed significantly between NHW and NHB women. Seven, 10, 17, and 23 metabolites showed absolute percentage differences ≥ 50, ≥ 40%, ≥ 30%, and ≥ 20%, respectively. Xenobiotics (n = 5) and amino acids (n = 2) exhibited the largest absolute percentage differences (≥ 50%) between NHB and NHW women. In the xenobiotics super-pathway, NHB women had higher thymol sulfate, 2-naphthol sulfate, and 2-hydroxyfluorene sulfate, derived from the exposure to polycyclic aromatic hydrocarbons, while NHW women had higher xanthine metabolites. In the amino acid super-pathway, lysine and tryptophan metabolites were lower in NHB women.ConclusionsWe report differences in several metabolites between NHW and NHB women. These findings require validation in a different study and could provide insight into investigating how racial differences in metabolites may impact disease burden across diverse populations.

Years of Potential Life Lost for Children and Adults With Congenital Heart Defects: United States, 2007 to 2017.

Although most children with congenital heart defects (CHDs) live into adulthood, many have increased mortality risk across the lifespan. Little is known about years lost due to premature CHD-related deaths. We estimated the years of potential life lost (YPLL) among individuals with CHDs in the United States. We used 2007 to 2017 death records from the US National Center for Health Statistics to identify decedents with a CHD listed as the underlying or contributing cause of death. We calculated the average percent change in YPLL and the total, mean, crude, and age-standardized YPLL overall, by sex, race and ethnicity, and age group. Of 28.35 million deaths, 42 158 were CHD-related. The premature deaths attributed to CHD for individuals younger than 65 years was almost 2.1 million years; of those 169 756 and 124 067 years were lost prematurely for children and adolescents, respectively. Men and women with CHDs had 1.13 million and 941 115 years lost prematurely, respectively. Non-Hispanic Black individuals and men had the highest age-standardized YPLL (per 100 000) (95.5 [95% CI, 93.2-97.7] and 74.1 [95% CI, 73.0-75.1]). The overall mean YPLL was 70 years (per 100 000) and non-Hispanic Black men and women had the highest mean YPLL. During 2007 to 2017, the YPLL average percent change declined by 17.8% overall, but the YPLL for non-Hispanic Black individuals aged 1 to 4 years (-31.6%) and 35 to 49 years (-24.3%) had the greatest decline. Children with CHDs experience significant premature deaths. Non-Hispanic Black and male individualsexperienced the highest burden of premature deaths associated with CHDs. Further research is needed to elucidate these disparities.

Sex Differences in Cigarette Smoking Among Hispanic and Non-Hispanic Black All of Us Participants: The Relative Importance of Sociodemographic Characteristics and Social Determinants of Health.

Hispanic and Non-Hispanic (NH) Black adults, particularly men, disproportionately experience significant smoking-related health disparities, including cancer. Thus, identifying factors that explicate sex, racial, and ethnic differences in cigarette use is critical for developing tailored interventions to prevent smoking-related diseases among these groups. While sociodemographic characteristics and other social determinants of health (SDOH) are identified as key correlates of cigarette use, little is known about how these factors intersect with sex, race, and ethnicity to influence cigarette use. This study examined data from 15,695 Hispanic and Non-Hispanic (NH) Black participants of the National Institutes of Health All of Us Research Program to examine the role of sociodemographic characteristics and SDOH on cigarette use at the intersection of sex, race, and ethnicity. Using Horn's parallel analysis, we created a composite variable corresponding to cigarette use intensity and duration (CSID). Then, linear regressions and relative importance analyses identified the differential and relative associations among sociodemographic factors and SDOH on CSID across Hispanic men, Hispanic women, NH Black men, and NH Black women. Older age and lower educational level were the factors that were most strongly associated with higher CSID across the four groups. While housing insecurity was the third highest negative correlate for Hispanic men and women, religious service attendance, and being married ranked as third most important for NH Black women and men, respectively. These findings highlight specific factors to incorporate in smoking cessation and prevention programs uniquely designed for these populations.

Peripheral and Central Hemodynamic Responses to Rhythmic Handgrip Exercise in Young, Healthy Black Women.

Non-Hispanic Black (NHB) women in the United States exhibit higher prevalence and mortality rates from cardiovascular diseases compared to non-Hispanic White (NHW) women. Previous studies in NHB men have demonstrated impaired vascular function at rest and during exercise; however, to date, no studies have investigated the hyperemic responses during exercise in NHB women. Therefore, we tested the hypothesis that, compared with NHW women, NHB women would present an attenuated increase in forearm blood flow (FBF) and forearm vascular conductance (FVC) during steady-state rhythmic handgrip exercise. FBF (duplex Doppler ultrasound) and central hemodynamics including mean arterial pressure (MAP; finger photoplethysmography) were measured in healthy young NHW (n = 16) and NHB (n = 14) women during rhythmic handgrip exercise performed at 15%, 30% and 45% of maximal voluntary contraction (MVC). FVC (calculated as FBF/MAP), FBF, and MAP were not different between groups at rest (FVC: 52 ± 13 ml/min/100 mmHg in NHW women vs. 56 ± 14 ml/min/100 mmHg in NHB women; P = 0.43). There was an intensity-dependent increase in FBF and FVC during exercise in both groups, but there was no difference between the groups (e.g., FVC at 45% MVC; NHW: 304 ± 55 ml/min/100 mmHg, NHB: 351 ± 121 ml/min/100 mmHg, interaction P = 0.257). MAP responses during exercise were also not different between groups (e.g., ΔMAP at 45% MVC; NHW: 7 ± 6 mmHg, NHB:8 ± 6 mmHg, P = 0.553). Additionally, all central hemodynamics during exercise, and flow-mediated dilation were comparable between the groups. Collectively, these findings indicate that the hyperemic responses to rhythmic handgrip exercise are not different between young, healthy NHB and NHW women.

The association between depressive symptoms and ischemic heart disease in postmenopausal women: a cross-sectional study.

The negative impact of depression on cardiovascular health has drawn much attention. However, the relationship between depressive symptoms and ischemic heart disease (IHD) in postmenopausal women has not been previously reported. This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018, including 6,538 postmenopausal women. Weighted multivariable logistic regression analyses were conducted to examine the independent association between depressive symptoms and IHD. The fully adjusted model revealed a significant association between depressive symptoms and IHD (OR 1.97, 95% CI [1.24, 3.13]). Subgroup and interaction analyses revealed that depressive symptoms were more strongly linked to IHD risk among younger women, those with lower annual household incomes, non-Hispanic Black women, and individuals with comorbidities such as diabetes and hypercholesterolemia. Moreover, the presence of hypertension moderated the relationship between depressive symptoms and IHD. Our findings indicate a significant association between depressive symptoms and increased IHD prevalence among postmenopausal women in the United States, with hypertension acting as a moderating factor. These results offer new insights and potential targets for improving cardiovascular health in this population.

Cardiac Manifestations in Children of Diabetic Mothers and Fathers.

Diabetic individuals of reproductive age face higher risks of poor pregnancy outcomes and abnormal fetal development. Approximately 4.5% of women of reproductive age have diabetes, with non-Hispanic Black women having the highest prevalence of 15%. Research on the impact of paternal diabetes on offspring cardiac anomalies is limited, but it may interact with metabolic syndrome to increase long-term health risks. Infants of diabetic parents are more likely to develop cyanotic and acyanotic heart defects, hypertrophic cardiomyopathy, and subsequently other cardiovascular issues. Fetal hyperinsulinemia, caused by maternal hyperglycemia, contributes to these conditions through oxidative stress, impaired heart development, and cardiac remodeling. Long-term risks include diabetes, arrhythmias, pulmonary hypertension, heart failure, and early-onset cardiovascular disease. Treatment options are limited, often requiring surgery for severe conditions. Prevention focuses on tight glycemic control, a balanced diet, avoiding teratogens (nicotine, alcohol, or drugs), and using technology like continuous glucose monitors and insulin pumps, along with pregnancy screening and monitoring protocols. Understanding the effects of parental diabetes on offspring's cardiac health is crucial for early intervention, prevention, and improved maternal-fetal care, ultimately reducing the burden of congenital heart defects and long-term cardiovascular complications.

Impact of race/ethnicity on MammaPrint genomic assay risk and prognosis in early breast cancer: A National Cancer Data Base analysis.

Black race is associated with poorer prognosis in hormone receptor (HR)-positive, HER2-negative early breast cancer (EBC). The impact of race/ethnicity on the risk distribution and prognostic information provided by the 70-gene MammaPrint assay was evaluated. Women with HR-positive EBC with tumors up to 5 cm in size and zero to three involved lymph nodes, who were diagnosed between 2009 and 2018, and who had an available MammaPrint result were identified in the National Cancer Data Base (NCDB). t-tests and χ2 tests were used to compare patient characteristics, whereas log-rank tests assessed differences in overall survival (OS) between racial/ethnic subgroups. Of the 6137 women included, 82.8% (n=5084) were non-Hispanic White, 8.9% (n=545) were non-Hispanic Black (NHB), 4.8% (n=292) were Hispanic, and the remainder were other/unknown (n=216). Of these women, 58.4% (n=3587) were MammaPrint low risk and 41.6% (n=2550) were MammaPrint high risk. NHB and Hispanic women were more likely to have a high-risk MammaPrint result (p<.001) than other racial/ethnic subgroups. Five-year OS was worse for the MammaPrint high-risk versus low-risk group (92.6% vs. 96.6%; p<.0001). There were no significant differences in OS on the basis of race/ethnicity in the MammaPrint low-risk (p=.34) or high-risk (p=.79) subgroups. However, Black race did not affect mortality in the overall population (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58). NHB and Hispanic women were more likely to have high-risk MammaPrint results in this NCDB cohort. Although there were no differences in survival by race/ethnicity in the MammaPrint low- and high-risk groups, these findings are limited by the lack of association between race/ethnicity and mortality in the overall population when adjusting for other clinicopathologic prognostic covariates.

Leveraging diagnosis and biometric data from the All of Us Research Program to uncover disparities in obesity diagnosis.

Leveraging diagnosis and biometric data from the All of Us Research Program to uncover disparities in obesity diagnosis.

Evaluating personal care product use by Environmental Working Group hazard scores in relation to consumers' sociodemographic characteristics, purchasing behaviors, and product safety perceptions.

Personal care products (PCPs) are a source of environmental chemical exposures. Little research has examined the specific PCPs people use, the environmental hazards posed by those PCPs, and factors informing PCP selection. To examine chemical hazards of the specific products used in relation to sociodemographic factors, purchasing behaviors, and perceptions about PCP safety. In a cross-sectional, university-based sample (NJ, USA, N = 593), participants reported on sociodemographics, PCP purchasing behaviors and perceptions, and PCP use in the last 24-48 h (including brand and product name). Those PCPs were linked to product hazard scores (1=least hazardous, 10=most hazardous) in the Environmental Working Group's Skin Deep® database. For each participant, we calculated average hazard scores across all PCPs used and by category (e.g., haircare, skincare) and evaluated use of PCPs with high hazard scores (7-10). We fitted adjusted regression models examining associations of sociodemographic factors and participants' perceptions and purchasing behaviors with product hazard scores. Of 9349 unique PCPs used by participants, 68% matched to Skin Deep®. Average hazard scores varied by participant characteristics (e.g., age) for perfumes/colognes, beauty, and skin care products. The relative risk (RR) of recent use of a hair product with a high hazard score was twice as high in non-Hispanic Black women compared to non-Hispanic White women (RR:1.99; 95%CI:1.37, 2.89). Frequent use of healthy product apps (β = -0.49, 95%CI:-0.77, -0.21), reading product ingredient labels (β = -0.26; 95%CI:-0.82, -0.30), and seeking eco-friendly products (β = -0.17; 95%CI:-0.36, -0.01) were associated with use of skin care products with lower hazard scores. Results for hair and beauty products were similar. Concerns about PCP health impacts and regulation were associated with using products with lower hazard scores. Personal care products (PCPs) can contain numerous endocrine disrupting and carcinogenic chemicals. In a U.S. university-based sample, we linked the PCPs used by participants in the last 24-48 h to hazard scores in the Skin Deep® database. Average hazard scores of the PCPs used by participants varied by sociodemographic factors. Participant behaviors (e.g., use of healthy product apps) and perceptions of PCP safety and regulation were associated with the average hazard scores of the PCPs they used. Our findings suggest that education and tools to inform PCP choice may help consumers choose safer products and potentially, reduce chemical exposures.

Psychological resilience and cognitive functioning in Black and White men and women.

Psychological resilience is associated with better physical and mental health, but little is known about its role in cognitive health from an intersectional perspective. This study aimed to assess the relationship between psychological resilience and cognitive function across subgroups of older non-Hispanic Black and White men and women while taking stress exposure into account. 453 participants (Black men=87; Black women=147; White men=98; White women=121) from the Michigan Cognitive Aging Project completed the Brief Resilience Scale and a neuropsychological battery. ANOVAs were used to assess differences in psychological resilience across the intersection of gender and race. Linear regressions assessed relationships between psychological resilience and global cognition, controlling for sociodemographics and discrimination. Interaction terms and stratified regressions characterized these relationships across intersectional groups. Level of psychological resilience did not differ across intersectional groups despite differences in stress exposure. Higher resilience was associated with better global cognition in the whole sample (β= 0.12, p=.002), but this association was found only among Black men (β=0.40, p<.001). Levels of resilience did not differ between Black and White older adults, despite disproportionate stress exposure among Black older adults. Links between psychological resilience and cognition may depend on stressors and resources that are differentially patterned across intersectional groups. Psychological resilience may be particularly important for cognitive health among Black men, who are frequently underrepresented in cognitive aging research.

Sex and Cause-Specific Mortality among US Adults Receiving Maintenance Dialysis: A National U.S. Cohort Study 2000-2021.

We examined sex differences in cause-specific mortality among men and women receiving maintenance dialysis and examined potential effect modification by age and race. We identified all adults aged ≥ 18 years initiating dialysis between 2000 and 2020 from the United States Renal Data System (n=2.16 million; 43.3% women). Cause-specific mortality (i.e., cardiovascular (CVD), withdrawal, infection, cancer) was defined from the Centers for Medicare and Medicaid Death Notification Form. All individuals were followed from dialysis start date until death date, transplant, 10-years, or end of follow-up (December 31, 2021), whichever occurred first. Multivariable Cox proportional hazards models assessed the association between sex and 10-year cause-specific mortality, adjusting for demographic, clinical, and socioeconomic factors overall and stratified by age and race. Overall, 832,259 men (67.9%) and 658,043 women (70.4%) died receiving maintenance dialysis with median survival times of 2.69 (IQR,1.17-5.19) and 2.72 (IQR, 1.16-5.21) years, respectively. CVD was the leading cause of death (38.6% women; 40.2% men), followed by withdrawal (11.1% women; 9.6% men) and infections (9.8% women; 8.6% men). Overall, women had a 9% (adjusted Hazard Ratio: 1.09 [95%CI 1.08-1.11]) and 15% (1.15 [1.14-1.17]) higher likelihood of infection, and withdrawal -related mortality compared with men, respectively. Conversely, women had a 7% (0.93 [0.92-0.94]) and 10% (0.90 [0.87-0.92]) lower likelihood of CVD and cancer-related mortality, respectively, compared with men. By age, younger women (vs. men) aged 18-44 years had higher likelihood of excess mortality across all specific causes (including a 40% increased risk of withdrawal compared to men of the same age), while older women (vs. men) aged >75 years had a lower likelihood. By race, non-Hispanic Black women (vs. men) had higher mortality across all specific causes, but for all other races, sex differences were similar to the overall population. A sex-specific approach that incorporates intersectionality of both age and race in the management of complications among dialysis patients may be recommended to mitigate excess mortality risks.

Influence of Food Desert Residence on Breastfeeding Initiation.

Introduction: Breastfeeding is associated with improved health outcomes. Several social drivers of health impact breastfeeding initiation (BFI). Prior research using ecological data demonstrated that food desert residence (FDR) is associated with lower rates of BFI. The primary objective was to assess the relationship between FDR and BFI using individual-level data. The secondary objective was to assess the relationship between FDR and BFI at the county level. Methods: Individual-level birth data from the Florida Department of Health were linked to food access data from the United States Department of Agriculture Food Access Research Atlas in 2010, 2015, and 2019. Food deserts were identified per the United States Department of Agriculture definition. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were calculated using modified Poisson regression models in 573,368 births. Models were adjusted for confounders and stratified by race/ethnicity. We assessed the association between the percent of the population in low-income and low-access census tracts aggregated to the county level and the percent of mothers initiating breastfeeding per county in Florida (Center for Disease Control and Prevention) using Pearson's correlation and a bivariate map. Results: FDR was associated with BFI (aRR: 1.23, CI: 1.20-1.27). The adjusted risk of not-initiating breastfeeding for those living in a food desert was greatest among non-Hispanic Black women (aRR: 1.29, CI: 1.24-1.35) and Hispanic women (aRR: 1.29, CI: 1.21-1.37). Maternal education was the most significant predictor of BFI. Women who had 9th through 12th-grade education but without a diploma were five times (aRR: 4.96, CI: 4.72-5.20) less likely to initiate breastfeeding relative to college graduates. There was no association between FDR and BFI at the county level, though regional trends were noted. Conclusions: FDR is an important risk factor for not-initiating breastfeeding. Among Floridians, education was the most significant risk factor. Understanding how FDR influences breastfeeding can help target interventions to improve breastfeeding outcomes.