non-Hispanic Black Women Research Articles

Worse Clinical and Survival Outcomes in Breast Cancer Patients Living in Puerto Rico Compared to Hispanics, Non-Hispanic Blacks, and Non-Hispanic Whites from Florida.

Herein, we report the characterization of four cohorts of breast cancer patients including (1) non-Hispanic Whites in Florida, (2) non-Hispanic Blacks in Florida, (3) Hispanics in Florida, and (4) Hispanics in Puerto Rico. Data from female breast cancer patients were collected from cancer registry (n = 9361) and self-reported patient questionnaires (n = 4324). Several statistical tests were applied to identify significant group differences. Breast cancer patients from Puerto Rico were least frequently employed and had the lowest rates of college education among the groups. They also reported more live births and less breastfeeding. Both Hispanic groups reported a higher fraction experiencing menstruation at age 11 or younger (Floridian Hispanics [38%] and Puerto Ricans [36%]) compared to non-Hispanic Whites (20%) and non-Hispanic Blacks (22%). Non-Hispanic Black and Puerto Rican women were significantly older at breast cancer diagnosis than their non-Hispanic White and Floridian Hispanic counterparts. The Puerto Rican and non-Hispanic Black groups more frequently had pathology stage T2 or higher primary breast tumors at diagnosis (non-Hispanic Whites [29%], non-Hispanic Blacks [39%], Floridian Hispanics [33%], Puerto Ricans [46%]). The Puerto Rican (73%, 95% CI [66, 82]) and non-Hispanic Black (79%, 95% CI [75, 84]) groups demonstrate reduced 5-year survival compared to non-Hispanic Whites (89%, 95% CI [86, 92]) and Floridian Hispanics (89%, 95% CI [86, 90]). These findings demonstrate that Puerto Rican breast cancer patients suffer significant breast cancer health disparities relative to non-Hispanic Whites and Hispanics from Florida similar to the disparities observed for non-Hispanic Blacks. Future work must seek to better understand and address these disparities.

Abstract 4122048: Disparities in Heart Failure-Related Mortality Among Reproductive-Aged Women in the United States from 1999 to 2019

Introduction: Heart failure (HF) majorly affects the elderly, but can also affect the younger population. This study aims to examine the trends of HF-related deaths among reproductive-aged women in the United States (US). Method: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 codes I11, I13.0, I13.2, and I50 to find HF-related deaths among women aged 15-44 from 1999 to 2019. We examined demographic disparities in HF mortality rates over time, considering age, ethnicity, and geographic areas. Results were reported as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). Joinpoint regression assessed trend changes and annual percentage change (APC). Results: Between 1999 and 2019, a total of 43,683 women aged 15-44 died from HF in the US, with an AAMR of 3.5 per 100,000 (95% CI: 3.5-3.5). The AAMR increased from 2.6 in 1999 to 4.8 in 2019. Non-Hispanic Black women had the highest AAMR at 10.2, while Hispanics had the lowest at 1.8. Geographically, the South was the most affected region with an AAMR of 4.6, contributing to nearly half (48.9%) of all deaths. States including Massachusetts, Oregon, New Hampshire, and Minnesota had the lowest AAMRs. Rural areas showed a higher AAMR compared to urban areas (4.4 Vs. 3.3). The age group (35-44) accounted for the majority of deaths (73.7%). Conclusion: HF-related mortality among reproductive-aged women increased from 1999 to 2019, with the highest burden among non-Hispanic Black women and those in the Southern region. Enhancing access to care, particularly in rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.

Are there differences in overall survival among older breast cancer patients by race and ethnicity?

BackgroundNon-Hispanic Black women have lower breast cancer incidence but twice the mortality of non-Hispanic White women. Recent data suggest that the overall survival difference may not be observed in older women. This study aims to determine overall survival in women aged ≥70 years with operable breast cancer by race and ethnicity and factors contributing to overall survival. MethodsThe National Cancer Database was queried to identify women aged ≥70 years with stage 0–III breast cancer from 2004 to 2018. Patients were separated by race and ethnicity: non-Hispanic White, non-Hispanic Black, Hispanic, and Other. To examine overall survival, a Cox proportional hazards model was created, and overall survival was calculated using the Kaplan-Meier method. ResultsThere were 304,345 eligible patients. The mean age was 76.8 years (standard deviation 5.5 years), and most were non-Hispanic White (85.2%), had Medicare (86.8%), had hormone receptor–positive breast cancer (78.7%), and underwent partial mastectomy (64.5%). Compared with non-Hispanic White women, non-Hispanic Black women had a higher prevalence of stage III disease (10.8% vs 7.5%, P < .001) and triple-negative breast cancer (16.7% vs 8.7% P < .001), and a longer time to treatment initiation (39.2 vs 32.3 days, P < .001). Median follow-up was 5.38 years (interquartile range: 3.83–7.46 years). Non-Hispanic Black women had the lowest median survival time compared with non-Hispanic White women (9.7 vs 10.4 years, P < .001). After adjusting for insurance type, receptor status, stage, comorbidity, time to treatment, and facility type, there was no increased risk of death for non-Hispanic Black patients (hazard ratio: 0.99, 95% confidence interval: 0.96–1.01, P = .29). ConclusionAlthough overall survival was lower in older non-Hispanic Black women, this difference resolved on multivariate modeling, suggesting that other factors likely influence overall survival for this cohort.

Unlocking equity: assessing for gaps in cardiovascular guidelines for pregnant women

Abstract Introduction Cardiovascular disease is the primary contributor to pregnancy-related fatalities in the United States, displaying a gradual rise over the years. Pregnancy introduces unique physiological changes that can impact pre-existing cardiovascular conditions and trigger new complications. Considerable inequalities in pregnancy-related mortality built on race and ethnicity are unmistakable, with the highest rates observed in black non-Hispanic women. Purpose This study aims to evaluate current gaps in racial/ethnic minority participation in randomized control trials (RCTs) cited in major cardiology guidelines. Methods Citations in the 2018 ESC Guidelines for the Management of Cardiovascular Diseases During Pregnancy were evaluated for RCTs. The American Heart Association and American College of Cardiology guidelines were also examined. Manuscripts and supplementary data were examined for participant-level racial or ethnic data, including age, race, and ethnicity. Results Thirteen RCTs, representing 20,665 participants, spanning the period from 2002 to 2017, were reviewed. European guidelines referenced thirteen of the RCTS, while American guidelines referenced two RCTs. The average age of participants was 31 years old. Most of the trials were conducted in Europe (46%). Forty-six percent of RCTs reported race/ethnicity breakdowns, with pooled participation showing a majority of non-Hispanic white participants (76.7%), with limited representation from other racial groups (table). Eight trials focused on hypertension, two on venous thromboembolism, and one on heart failure. Conclusion Pregnant women are frequently excluded from RCTs due to concerns about potential harm to the developing fetus. Consequently, current guidelines lack robust RCTs tailored to pregnant women with various cardiovascular diseases. The underrepresentation of ethnic minorities in cardiovascular disease trials contributes to a scarcity of evidence-based recommendations for managing these conditions during pregnancy and postpartum. Future clinical practice guidelines should advocate for a more personalized and evidence-based approach to managing cardiovascular diseases in pregnancy.

Automated breast density assessment for full-field digital mammography and digital breast tomosynthesis.

Mammographic density is a strong risk factor for breast cancer (BC) and is reported clinically as part of Breast Imaging Reporting and Data System (BI-RADS) results issued by radiologists. Automated assessment of density is needed that can be used for both full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) as both types of exams are acquired in standard clinical practice. We trained a deep learning model to automate the estimation of BI-RADS density from a prospective Washington University (WashU) clinic-based cohort of 9,714 women, entering into the cohort in 2013 with follow-up through, October 31, 2020. The cohort included 27% non-Hispanic Black women. The trained algorithm was assessed in an external validation cohort that included 18,360 women screened at Emory from January 1, 2013 and followed through December 31, 2020 that included 42% non-Hispanic Black women. Our model-estimated BI-RADS density demonstrated substantial agreement with the density as assessed by radiologist. In the external validation, the agreement with radiologists for category B 81% and C 77% for FFDM and B 83% and C 74% for DBT show important distinction for separation of women with dense breast. We obtained a Cohen's κ of 0.72 (95% CI, 0.71, 0.73) in FFDM and 0.71 (95% CI 0.69, 0.73) in DBT. We provided a consistent and fully automated BI-RADS estimation for both FFDM and DBT using a deep learning model. The software can be easily implemented anywhere for clinical use and risk prediction.

An Intersectional Approach to Cervical Cancer Screening Disparities by Race/Ethnicity and Immigrant Status.

Background: Disparities in cervical cancer (CC) screening exist within racial/ethnic minority and immigrant groups. However, few studies have explored the joint influence of race/ethnicity and immigrant status on screening, and the disparities that have been identified by existing studies remain incompletely explained. This study aims to identify the joint influence of race/ethnicity and immigrant status on CC screening and elucidate the barriers contributing to identified disparities. Methods: A cross-sectional analysis of 25,660 U.S. women from the 2005, 2010, and 2015 National Health Interview Surveys was done. The CC screening up-to-date status of cases was analyzed by race/ethnicity and immigrant status using logistic regression models. Conceptualized mediators were added to models to identify their contribution to identified disparities. Results: All immigrants had lower screening odds than U.S.-born non-Hispanic White women with foreign-born non-Hispanic Asians having the lowest odds (adjusted odds ratio [aOR]: 0.36, 95% confidence interval [CI]: 0.26-0.49) followed by foreign-born non-Hispanic White (aOR: 0.52, 95% CI: 0.36-0.76), Hispanic/Latinx (aOR: 0.58, 95% CI: 0.47-0.73), and non-Hispanic Black women (aOR: 0.62, 95% CI: 0.38-0.99). Adjusting for only socioeconomic status or access to care attenuated the aOR: for foreign-born Hispanic/Latinx and non-Hispanic Black women only. Adjusting simultaneously for language and acculturation attenuated the aOR: for all immigrants. Conclusions: Disparities in CC screening were only found in the immigrant populations of various racial/ethnic groups. Targeting insurance and health care access may address disparities in immigrant Hispanic/Latinx and non-Hispanic Black women. Focusing on culturally and linguistically competent care and education may be more crucial for immigrant non-Hispanic Asian and White women.

Breastfeeding Behaviors by Race/Ethnicity and Foreign-Born Status in the United States: An Analysis of the U.S. National Survey of Children's Health.

Objective: The foreign-born population is growing in the United States, but no nationally representative statistics of breastfeeding behavior disaggregated by race/ethnicity and foreign-born status have been published in recent years. This study examines breastfeeding initiation, any breastfeeding, and exclusive breastfeeding at 3 and 6 months among foreign-born and U.S.-born Non-Hispanic (NH) Black, NH White, and Hispanic women in the United States. Methods: This is a cross-sectional study utilizing years 2021 and 2022 of the National Survey of Children's Health. Sample children identified as NH White, NH Black, and Hispanic who were 6 months to 5 years old and residing with their biological or adoptive mother were included (n = 27,818). Results: Foreign-born women in all racial/ethnic groups (NH Black, NH White, and Hispanic) had significantly higher odds of any breastfeeding at 6 months relative to U.S.-born NH White women. However, they did not have significantly different odds of exclusive breastfeeding for 6 months relative to U.S.-born NH White women. U.S.-born Hispanic women had rates of exclusive breastfeeding for 6 months (23.2%) that were much closer to U.S.-born NH Black women (23.4%) than to foreign-born Hispanic women (29.4%) or U.S.-born White women (32.1%). Conclusions: The large percentage of foreign-born women who reported some breastfeeding at 6 months indicates a strong commitment to breastfeeding and may be a leverage point for future exclusive breastfeeding interventions among this group. U.S.-born Hispanic women appear to be struggling with exclusive breastfeeding and may need additional interventions.

Surgical Management of Fibroids: A Changing Landscape.

Background: Uterine fibroids affect patients' quality of life and contribute significantly to health care costs. Studies from 2009 to 2011 demonstrated that fibroids disproportionately affect Black women, with lower odds of uterine preservation and minimally invasive approaches. Objective: This is a retrospective cohort study of data abstracted from the National Surgical Quality Improvement Program database from 2015 to 2019 examining trends in surgical management of uterine fibroids and exploring disparities in surgical approach in a modern cohort. Results: In total, 52,909 women underwent hysterectomy and 15,485 women underwent myomectomy between 2015 and 2019. Over the study period, the overall number of surgeries for fibroids increased by 44.2% with minimally invasive hysterectomy responsible for the majority of this increase. The proportion of patients who underwent myomectomy significantly increased (20.85% to 24.62%, p value <0.0001), whereas hysterectomy significantly decreased (79.15% to 75.38%, p value <0.0001). Bivariate analysis identified younger age, non-White race, and body mass index (BMI) <25 as significantly associated with performance of myomectomy. Non-Hispanic Black (adjusted odds ratio [aOR]: 3.55, 95% confidence interval [CI]: 3.23-3.89), Asian (aOR: 3.26, 95% CI: 2.80-3.80), and Hispanic Black (aOR: 5.50, 95% CI: 3.29-9.25) women were more likely to undergo myomectomy than non-Hispanic White women. Conclusion: Surgical treatment for fibroids increased over time, shifting toward uterine preservation. Myomectomy performance is associated with lower age and BMI and identifying as a racial and/or ethnic minority. These trends may represent improved access to surgical treatment of fibroids, resulting from the growth of minimally invasive gynecological surgery as a specialty and advocacy for equitable health care for all patients.

Blood Pressure Cuff Sizes for Pregnant Women in the United States: Findings from the National Health and Nutrition Examination Survey.

The use of correctly-sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26cm), adult (>26 to ≤34cm), large (>34 to ≤44cm), and extra-large (XL) (>44cm). Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately-sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

7473 Mortality following Hip Fracture among Black and White Women in a Western US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. W. Yang: None. U. Ozomaro: None. M.D. Sharma: None. J.A. Darbinian: None. C. Lee: None. A.L. Wheeler: None. M.M. Khan: None. Background: Prior studies using US Medicare data demonstrate that Black women have higher mortality after hip fracture than White women. However, few studies have examined findings specific to the Western US. We previously found that 1-year mortality after hip fracture (in 2000-2010) was similar among Black and White women in a Western US healthcare system. We now examine 6-month and 1-year mortality in an expanded cohort of Black and White women with hip fracture in the same healthcare system. Methods: This retrospective study includes data from non-Hispanic White and Black women aged ≥65y in a Western US healthcare system who were hospitalized with hip fracture during 2000-2019. The outcome was all-cause mortality, within 6-months and 1-year after hip fracture. Covariates included age at hip fracture, femoral neck vs pertrochanteric (hip) fracture, year of fracture, prior clinical fracture (diagnosed in the prior 5 years), Charlson-Deyo Comorbidity index (CCI based on inpatient/outpatient data in the prior year and during hip fracture hospitalization) and diabetes (diagnosed in the prior 5 years or during hip fracture hospitalization). Modified Poisson regression was used to examine mortality after hip fracture (Black vs White women), adjusting for (a) age, fracture type, year and (b) age, fracture type, year, CCI, prior fracture and diabetes. Results: The cohort included 691 Black women (age 82.9 ± 8.0y; 43.4% age ≥85y) and 20,450 White women (age 82.8 ± 7.7y; 44.2% age ≥85y) with hip fracture in 2000-2019. Black women had a similar proportion with femoral neck fracture (58.2% vs 55.2%) but were more likely to have prior fracture (23.0% vs 33.5%), diabetes (35.2% vs 18.2%), and higher CCI vs White women. For Black vs White women, respectively, group differences in 6-month (18.4% [95% confidence interval 15.7-21.4%] vs 16.4% [15.9-16.9%], p=0.12) and 1-year mortality (23.2% [20.2-26.5%] vs 22.1% [21.4-22.6%], p=0.49) were not significant. In multivariable analyses, the relative risk of death at 1-year for Black (vs White) women was 1.03 [0.90-1.19] adjusting for age, year, fracture type and 0.97 [CI 0.84-1.11] adjusting for age, year, fracture type, CCI, prior fracture, and diabetes. The relative risk of death at 6-months for Black (vs White) women was 1.05 [0.89-1.23] adjusting for covariates. Conclusions: In a Western US healthcare system, differences in 6-month and 1-year mortality post-hip fracture were small and not significant for Black and White women aged ≥65y, after accounting for age and comorbidity burden. However, the number of Black women was small, and data on social factors, frailty, post-fracture morbidity, and other health factors were not available. Nonetheless, these results suggest that racial and ethnic differences in mortality after hip fracture may vary by geographic region. Hip fracture outcomes in larger populations of Black women in the Western US should be examined. Presentation: 6/3/2024

Determinants of utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate

To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate. Retrospective cohort. Academic-affiliated fertility center. Women presenting for initial infertility evaluation from January 2010-December 2021. Initial infertility evaluation and treatment utilization. The prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult versus census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index, were considered determinants of treatment utilization in regression analysis. A total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared to census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared to the NH Asian reference group (35.7 ± 5.1 vs 34.6 ± 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared to 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23 and 21%, respectively) compared to 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (OR 0.79, [95% confidence interval 0.71-0.87], for other vs. private insurance; OR 0.62, [0.53-0.72], for ADI quintile 5 vs. 1, OR 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR 0.96 [0.93-1.00] for each 5-year increase). Relative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization.

Diagnostic evaluation for abnormal uterine bleeding at emergency departments in the United States.

269 Background: Uterine cancer is the most common gynecologic malignancy in the U.S. with well-documented racial disparity in stage at diagnosis (more advanced stage among Black women). As there is no routine screening for uterine cancer, timely and proper evaluation of relevant symptoms is important for early diagnosis. Abnormal uterine bleeding (AUB) is a prominent symptom of uterine cancer, yet data on the quality of care around AUB evaluation are sparse, especially among patients presenting to the emergency departments (ED) who are particularly at risk for delayed diagnosis due to lack of access to primary care. This study aimed to examine the pattern of diagnostic evaluation for AUB in a national sample of women seeking care at EDs and potential racial and ethnic differences. Methods: Using the 2014-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) data, we identified 7,900,653 (weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB. The primary outcomes were whether an ultrasound was performed/ordered at the ED visit and whether a referral/return to a physician or clinic for follow-up consultation was recommended. Multivariable logistic regressions were fit to assess the association of race and ethnicity with these diagnostic evaluations, while accounting for other characteristics of the ED visit (e.g. patient age, comorbidities, involvement of a consulting physician, type of insurance, geographic region, and metropolitan area location). All analyses accounted for the NHAMCS complex sample design and sampling weight to generate nationally representative estimates. Results: Non-Hispanic Black women were less likely than non-Hispanic White women to receive or have an ultrasound ordered (34.9% vs 42.5%, P = 0.004), which remained statistically significant after adjusting for other characteristics of the visit in multivariable analysis (adjusted OR = 0.58, 95% CI 0.36-0.92). Multivariable analysis also showed a lower likelihood of non-Hispanic Black women receiving referral or recommendation for follow-up consultation, compared to non-Hispanic White women (adjusted OR = 0.54, 95% CI 0.31-0.94). Hispanic women did not differ significantly from non-Hispanic White women in these measures. Perimenopausal age (45-54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation. Conclusions: There is racial disparity in the diagnostic evaluation of AUB among women seeking care at EDs. Future efforts to improve care quality and equity in this area may help reduce disparities in early diagnosis of uterine cancer.

The Distribution of Carceral Harm: County-Level Jail Incarceration and Mortality by Race, Sex, and Age

Jail incarceration remains an overlooked yet crucial component of the U.S. carceral system. Although a growing literature has examined the mortality costs associated with residing in areas with high levels of incarceration, far less is known about how local jails shape this burden at the intersection of race, sex, and age. In this study, I examine the relationship between county-level jail incarceration and age-specific mortality for non-Hispanic Black and White men and women, uniquely leveraging race-specific jail rates to account for the unequal racial distribution of jail exposures. This study finds evidence of positive associations between mortality and jail incarceration: this association peaks in late adulthood (ages 50–64), when increases in jail rates are associated with roughly 3% increases in mortality across all race–sex groups. However, patterns vary at the intersection of race, sex, and age. In particular, I find more marked and consistent penalties among women than among men. Additionally, a distinctly divergent age pattern emerges among Black men, who face insignificant but negative associations at younger ages but steep penalties at older ages—significantly larger among those aged 65 or older relative to their White male and Black female counterparts. Evidence further suggests that the use of race-neutral incarceration measures in prior work may mask the degree of harm associated with carceral contexts, because the jail rate for the total population underestimates the association between jail rates and mortality across nearly all race–age–sex combinations. These findings highlight the need for future ecological research to differentiate between jail and prison incarceration, consider the demographic distribution of incarceration's harms, and incorporate racialized measures of exposure so that we may better capture the magnitude of harm associated with America's carceral state.

Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic.

Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. Postpartum depressive symptoms were assessed using the Patient Health Questionnaire 2-item. Average marginal effects and contrasts of predictive margins derived from a multivariable logistic regression model were used to compare the risk of PPD before and during the pandemic in the overall sample and across racial/ethnic subgroups. Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.

Abstract A014: Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women

Abstract Background: Breastfeeding has been associated with a reduced risk of breast cancer (BC), particularly with Triple Negative BC (TNBC). The risk of TNBC is higher among premenopausal women, Black/African American (AA) women, and poorer women. Notably there are significant disparities in breastfeeding, where non-Hispanic Black (NHB) women and poorer women are less likely to breastfeed in the United States. Studies have identified historical racial trauma, unsupportive work and hospital policies, breast milk formula advertising, and knowledge and beliefs about breast feeding as factors that contribute to breast feeding practices. However, there is a paucity of research on pregnancy related medical conditions (PMCs) that potentially impact initiation and duration of breastfeeding. The purpose of this study is to evaluate racial and socioeconomic differences in breastfeeding, and if PMCs impact breastfeeding practices in a population-based sample of non-Hispanic Black and White women. Method: Data are from the Young Women’s History and Health Study (YWHHS), a population- based case-control study of invasive BC among non-Hispanic Black (NHB) and non-Hispanic White (NHW) women aged 20-49 years residing in Metropolitan Detroit and Los Angeles County, 2010-2015. The analytic sample here includes the first pregnancy of control participants with singleton live births (n=675). Area-based control participants were sampled from the 2010 Census. Interviews assessed complete reproductive histories, including breastfeeding history (never, &amp;lt;6 months, and ≥6 months), PMCs experienced during pregnancy, self-reported race, and household financial struggles before age 13 years (to approximate childhood socioeconomic position (chSEP)). PMCs examined included: 1) premature birth, 2) diabetes or pre-diabetes related PMCs, 3) blood pressure-related PMCs, and 4) BMI ≥ 25 kg/m2 at age 18 years. Weighted percentages were evaluated with a chi-square test and considered significant at p &amp;lt; 0.05. Analyses were further stratified by race/ethnicity and chSEP. Result: NHB women were 2.4 times significantly more likely to never breastfeed than NHW women (W% =52.0 (NHB) and 21.3 (NHW), p=&amp;lt;0.0001). Similarly, women with lower compared to higher chSEP were 1.5 times significantly more likely to never breastfeed (W% = 42.7 (lower chSEP) and 28.5 (higher chSEP), p=0.003). Those with BMI ≥ 25 kg/m2 at age 18 years (p&amp;lt;0.001) alone, and with one or more PMCs (p=0.01) were also less likely to breastfeed. When stratified by race/ethnicity the pattern of breastfeeding did not differ significantly by any PMC within NHB and NHW women. When stratified by chSEP, however, BMI ≥ 25 kg/m2 at age 18 years (p = 0.004) and having one or more PMCs (p=0.03) were significantly associated with never breastfeeding among those with higher chSEP. Conclusion: NHB women and women with lower chSEP were substantially less likely to breastfeed. Additionally, BMI ≥ 25 kg/m2 at age 18 and PMCs were associated with lower frequency of breastfeeding overall and among those with higher chSEP. Citation Format: Meheret B. Gebreegziabher, Lydia R. Post, Chris C. Cho, Zhenzhen Zhang, Kelly A. Hirko, Dorothy R. Pathak, Ann S. Hamilton, Ann G. Schwartz, Ellen M. Velie. Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A014.

Abstract A033: Metabolomics reveals racial differences in metabolites among women

Abstract Background: Non-Hispanic Black (NHB) women experience disparities in cancer outcomes and mortality compared with non-Hispanic White (NHW) women. While social determinants of health contribute to these differences, investigating potential biological factors behind the observed racial differences is essential for developing effective health interventions. Therefore, we performed a comprehensive analysis comparing the metabolomic profiles of NHB and NHW women to identify whether differences exist in metabolites. Methods: We performed metabolomic profiling on 674 women recruited at Washington University School of Medicine, St. Louis, MO. A total of 1074 metabolites were profiled at Metabolon. We excluded 246 metabolites with missing values in ≥300 women from the analyses. We used the 10-nearest neighbor method for imputing missing data. We investigated the associations between metabolites and race using linear regression models, adjusting for age, body mass index, alcohol consumption, and education level. Metabolites were log-transformed before regression analyses, and linear coefficients were back-transformed to the original scale. A Bonferroni-adjusted p-value&amp;lt;10-5 was considered statistically significant. Pathway enrichment analyses were conducted for differential metabolites within each super-pathway. Results: Twenty-five (3.0%) of the 828 metabolites differed significantly between NHW and NHB women at the Bonferroni-adjusted p- value&amp;lt;10-5 level, with 19 metabolites higher in NHW women and 6 metabolites higher in NHB women. These metabolites belong to amino acid (n=12), xenobiotics (n=9), lipid (n=2), cofactors and vitamins (n=1), and partially characterized molecules (n=1) super-pathways. In NHB women, the top 3 metabolites with the highest percentage differences compared with NHW women were 2-naphthol sulfate (89.7%, p=3.6×10-6)[chemical], 2-hydroxyfluorene sulfate (71.6%, p=5.9×10-8)[tobacco metabolite], and carotene diol (3) (35.6%, p=1.1×10-6)[vitamin A metabolism]. Conversely, the top 3 metabolites with the highest percentage differences in NHW women compared with NHB women were N6-methyllysine (59.0%, p=1.2×10-26)[lysine metabolism], tryptophan betaine (57.7%, p=2.1×10-11)[tryptophan metabolism], and theophylline (52.8%, p=2.2×10-7)[xanthine metabolism]. Conclusions: We identified racial differences in several functional metabolites among women that may contribute to the observed cancer disparities and have implications for cancer prevention. Citation Format: Ghazaleh Pourali, Liang Li, Kayla R. Getz, Myung Sik Jeon, Jingqin Luo, Chongliang Luo, Adetunji T. Toriola. Metabolomics reveals racial differences in metabolites among women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A033.

Abstract A055: Neighborhood Deprivation and Oncotype DX Recurrence Scores among Black and White Women: the interplay between race, place, and tumor biology

Abstract Background: Breast cancer (BC) mortality disparities have persisted between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women, even those diagnosed with prognostically favorable BC. The Oncotype Dx Recurrence score (ODX) test is a gene expression panel that can be used to identify estrogen receptor (ER)-positive BC with aggressive tumor biology. Previous studies have found that Black women are more likely to have higher ODX scores than White women and socioeconomic factors (e.g., area-level income, urbanicity) are associated with higher ODX scores. We explored race-stratified associations of neighborhood deprivation and ODX to help elucidate the interplay between race, place, and tumor biology. Methods: Neighborhood deprivation was examined in relation to ODX scores among 7,100 NHB and NHW women diagnosed with ER-positive BC (stage I–IIIA and ≤3 lymph nodes) between 2010–2017, followed through 2022, and identified by the Georgia Cancer Registry. The neighborhood deprivation index (NDI) was used to characterize neighborhood deprivation. Principal component analysis of block group-level American Community Survey data representing six domains (poverty, income, occupation, housing, employment, and education) was used to derive the NDI composite score. NDI was assessed in quartiles and linked to patient residence at the time of diagnosis. Three cut-points were used for ODX scores (low &amp;lt;18, intermediate 18–30, high ≥31). Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated to determine the prevalence of ODX scores based on NDI by race/ethnicity. Results: This study included 1651 NHB and 5449 NHW women. There were 4152 (58.5%) with a low ODX Score and 514 (7.2%) with a high ODX score; 2773 (39.1%) resided in the least deprived neighborhoods (NDI quartile 1) and 928 (13.1%) resided in the most deprived neighborhood (NDI quartile 4). Living in the most deprived neighborhood was associated with an increased prevalence of high ODX scores in models adjusted for age, race, and stage (PR=1.23, 95% CI 0.97–1.62). Stratification by race showed associations were stronger among NHW women (PR=1.41, 95% CI 1.02–1.95) but null among NHB women (PR= 0.91, 95% CI 0.59-1.39). Overall, NHB women were more likely to have a high ODX compared to NHW women. The highest prevalence of a high ODX was observed among NHB women living in the least deprived neighborhoods (PR=1.92, 95% CI 1.34–2.77). Conclusions: Findings from this study suggest that living in a deprived neighborhood increases the prevalence of high ODX among NHW women but not NHB women. NHB women in the least deprived neighborhoods had the greatest prevalence of high ODX scores. The intersection between race, neighborhood, and tumor biology needs more nuanced investigation of the social-structural drivers of disparate BC outcomes. Citation Format: Jasmine M. Miller-Kleinhenz, Lauren E. Barber, Lindsay J. Collin, Maret L. Maliniak, Demetria J. Smith-Graziani, Lauren E. McCollough. Neighborhood Deprivation and Oncotype DX Recurrence Scores among Black and White Women: the interplay between race, place, and tumor biology [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A055.

Abstract A146: Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests

Abstract Background: Human papillomavirus (HPV) vaccination and routine Papanicolaou (Pap) testing can prevent morbidity and mortality associated with cervical cancer (CC). Research suggests women who have initiated and completed the HPV vaccine are more likely to have an up-to-date Pap test than women who are unvaccinated against HPV. Limited research has focused on whether the association between HPV vaccination and Pap testing varies based on the number of HPV vaccine doses received across racial/ethnic groups. Methods: We conducted a cross-sectional analysis of 2018 – 2022 Behavioral Risk Factor Surveillance System data to investigate the relationship between HPV vaccination status and having an up-to-date Pap test by race/ethnicity. Based on the Advisory Committee on Immunization Practices’ (ACIP) guidelines, women who received 0 doses of the HPV vaccine were unvaccinated, women who received 1 or 2 doses initiated the vaccine series, and women who received 3 doses completed the HPV vaccine series. Based on the United States Preventive Services Task Force guidelines, women were considered to have an up-to-date Pap test if they reported having one within the past 3 years. We used weighted multivariable logistic regression models to examine the association. Results: Most women (n = 14,615) were unvaccinated (82.9%) and had an up-to- date Pap test (75.5%). Non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (11.8%), followed by non-Hispanic Other (NHO) women (11.2%), non- Hispanic Black (NHB) women (8.6%), and Hispanic women (8.3%). NHW women also had the highest rate of up-to-date Pap test (78.8%). NHB women had the second highest rate (77.6%), followed by Hispanic women (67.8%), and NHO women (66.4%). In adjusted analyses, NHO women were 34% less likely to have an up-to-date Pap test than NHW women (OR, 0.66; 95% CI: 0.51-0.86). Compared to unvaccinated women, those who completed and initiated the HPV vaccine series were more likely to have an up-to-date Pap test (initiated: OR: 1.40, 95% CI: 1.04-1.87; completed: OR:1.77, 95% CI: 1.35-2.34). NHB and NHO women who initiated the HPV vaccine series were more likely to have an up-to-date Pap test (NHB: OR: 3.37, 95% CI: 1.65-6.85; NHO: OR: 3.21, 95% CI: 1.73-5.95). NHW women who completed the HPV vaccine series were more likely to have an up-to-date Pap test (OR: 2.19, 95% CI: 1.55-3.08). Conclusion: NHB and NHO women who initiated the HPV vaccine series were three times as likely to have an up-to-date Pap test; NHW women who have completed the HPV vaccine series were twice as likely to receive an up-to-date Pap test. Women who do not receive Pap tests or the HPV vaccine miss important CC prevention opportunities. Thus, relevant stakeholders should aim to improve HPV vaccination rates; doing so could potentially enhance Pap test adherence simultaneously. This may be especially important for NHB and NHO women as they have lower rates of Pap test adherence and HPV vaccine series completion. Citation Format: Elinita Pollard, Meng-Han Tsai, Minjee Lee, Alice W. Lee, Mary A. Gerend. Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A146.

Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening

Abstract Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with &amp;lt;10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations. Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A135.

Abstract A037: Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer

Abstract Background: Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is one of the most aggressive disease subtypes. Disparities in TNBC exist, where US Black women and women living in urban environments are more likely to be diagnosed with TNBC than their White or rural counterparts. Reasons for these disparities are not completely understood. Social determinants of health, such as the neighborhood environment, have been implicated as potential contributors to breast cancer disparities. To improve our understanding of disparities in TNBC, we examined neighborhood deprivation in relation to breast cancer subtype, according to race and rurality. Methods: We identified 40,095 non-Hispanic Black and White women diagnosed with invasive breast cancer in 2010-2017 in the Georgia Cancer Registry. Neighborhood deprivation was measured by the Neighborhood Deprivation Index (NDI), a composite measure of neighborhood poverty, income, housing, unemployment, occupation, and education derived through principal component analysis using 2011-2015 block group-level American Community Survey data. Georgia Department of Public Health data were used to measure county-level rurality. We estimated case-only multivariable odds ratios (OR) and 95% confidence intervals (CI) for the separate associations between NDI, in quintiles, and each breast cancer subtype (TNBC, ERBB2+, or luminal B vs. luminal A breast cancer), overall and according to race and rurality. Results: Of the 40,095 non-Hispanic Black (31.5%) and White (68.5%) women, 5,328 were diagnosed with TNBC, 1,926 with ERBB2+, 4,958 with luminal B, and 27,883 with luminal A breast cancer. Compared to living in the least deprived neighborhoods, living in the most deprived neighborhoods was associated with a 33% (OR= 1.33, 95% CI 1.19-1.48) increased odds of TNBC vs. luminal A breast cancer. Race and rurality did not modify the association. However, estimates were less pronounced among non-Hispanic Black (OR=1.18, 95% CI 1.00-1.39) compared to non-Hispanic White (OR=1.40, 95% CI 1.18- 1.65) women and among women living in urban (OR=1.33, 95% CI 1.18-1.50) compared to rural (OR=1.52, 95% CI 1.15-2.03) counties. Neighborhood deprivation was associated with an increase in ERBB2+ breast cancer (OR=1.19, 95% CI 1.00-1.40), which was confined to non- Hispanic White women (OR=1.29, 95% CI 1.00-1.66) and women living in urban counties (OR=1.25, 95% CI 1.04-1.52). The OR for luminal B breast cancer was 1.08 (95% CI 0.96- 1.21). Although race did not modify this relationship, an association was observed only among women living in urban counties (OR=1.14, 95% CI 1.00-1.29). Conclusions: In this population of Georgia breast cancer patients, neighborhood deprivation was associated with an increase in TNBC, regardless of race or rurality. The weaker associations among non-Hispanic Black women and women living in urban counties suggests that other factors, in addition to neighborhood deprivation, may play an important role in TNBC development among Black women and women residing in urban environments. Citation Format: Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Maret L. Maliniak, Leah Moubadder, Jeffrey M. Switchenko, Lauren E. McCullough. Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A037.