non-Hispanic White Males Research Articles

Veterans’ Experiences Using a Complementary and Integrated Healthcare System: Identifying Themes Across Multiple Dimensions of Wellness

<h3>Research Objectives</h3> The Department of Veterans' Affairs (VA) has implemented the Whole Health System (WH), an approach to care focusing on what matters to individual veterans to support health and well-being.1 The approach includes a personalized values-based health plan and complementary and integrative (CIH) health activities.2-4 The purpose of this locally initiated quality improvement effort is to explore veterans' WH experiences, and the programs perceived effect on participants' dimensions of wellness. <h3>Design</h3> A qualitative study design was used to conduct semi-structured telephone interviews; questions aligned with wellness constructs. Data were analyzed using rapid data matrix.5 Data were collected June 2020 through January 2021. <h3>Setting</h3> A WH flagship VA hospital located in the southeast United States. <h3>Participants</h3> This project used purposive recruitment of WH program participants, with emphasis on cohorts of particular interest to the VA including females (n=22) and Veterans with mental health conditions (n=21), chronic pain (n=27), and spinal cord injury (n=4). Participants met inclusionary criteria if they participated in at least two WH program activities. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The perceived effects of WH program participation on veterans' well-being related to mental, emotional, social, physical, financial, spiritual, and environmental dimensions. <h3>Results</h3> Participants (N=50) were predominantly married, non-Hispanic white males with an average age of 61 years, with a college degree and an annual income of $50,000 or more. Data indicates veterans experienced improvements relevant to mental health, including mindfulness and coping strategies; physical ailments, including mobility, pain management, and sleep quality; and social engagement in group sessions and daily life. With respect to financial and spiritual wellness, veterans indicated minimal effect. Notably, approximately 5% of the sample indicated, without prompt, reduced suicidal ideation and improvements relevant to medication use. <h3>Conclusions</h3> WH program participation improved veterans' mental, physical, and social well-being in an integrative, non-pharmacological manner. Further research is warranted to assess the impact of CIH approach to care on veterans' health, specifically relevant to suicidal ideation and medication use. <h3>Author(s) Disclosures</h3> Non-disclosed.

Cannabinoid Poisoning-Related Emergency Department Visits and Inpatient Hospitalizations in Kentucky, 2017 to 2019

Background and objectives: Cannabis is the most used federally illicit substance. Due to widespread medicinal use and state-level legalization, public perceptions of cannabis have shifted toward the assumption that cannabis is safe. However, cannabinoids can cause adverse medical complications that may lead people to seek treatment. This study characterized cannabinoid poisoning-related medical encounters, poisoning involving cannabinoids and other psychoactive substances, and cannabinoid poisoning-related cardiac complications. Methods: Administrative billing data for emergency department visits and inpatient hospitalizations in acute care facilities with a discharge date from January 1, 2017 to December 31, 2019 were used to characterize cannabinoid poisoning events in Kentucky, identified by ICD-10-CM diagnosis code T40.7X. Results: There were 1,490 encounters of cannabinoid poisoning; patients were primarily non-Hispanic White males, ages 15–44, who had Medicaid and lived in a metropolitan area. Of those, 31.21% involved poisoning with a second psychoactive substance, primarily stimulants and/or opioids, and 17.72% experienced a cardiac complication. Cannabinoid-polydrug poisoning was associated with inpatient treatment (χ2=199.18, p < 0.001) and cardiac complications (χ2=4.58, p < 0.001). Discussion and Conclusions: These results are consistent with other state-level data. Patients who were diagnosed with cannabis-polydrug poisoning, compared to cannabis alone poisoning, had greater odds of hospital admission and cardiac complications, and longer length of hospital stays. Scientific Significance: The health risks of cannabinoid use must be more broadly recognized, while timely and accurate data need to be shared to guide policies on cannabis access. Future research on cannabinoid poisoning should consider the involvement of other psychoactive drugs.

Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics - 25 States and the District of Columbia, 2019-2020.

Drug overdose deaths increased approximately 30% from 2019 to 2020 in the United States. Examining rates by demographic and social determinants of health characteristics can identify disproportionately affected populations and inform strategies to reduce drug overdose deaths. Data from the State Unintentional Drug Overdose Reporting System (SUDORS) were used to analyze overdose death rates from 2019 to 2020 in 25 states and the District of Columbia. Rates were examined by race and ethnicity and county-level social determinants of health (e.g., income inequality and treatment provider availability). From 2019 to 2020, drug overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, respectively. Significant disparities were found across sex, age, and racial and ethnic subgroups. In particular, the rate in 2020 among Black males aged ≥65 years (52.6 per 100,000) was nearly seven times that of non-Hispanic White males aged ≥65 years (7.7). A history of substance use was frequently reported. Evidence of previous substance use treatment was lowest for Black persons (8.3%). Disparities in overdose deaths, particularly among Black persons, were larger in counties with greater income inequality. Opioid overdose rates in 2020 were higher in areas with more opioid treatment program availability compared with areas with lower opioid treatment availability, particularly among Black (34.3 versus 16.6) and AI/AN (33.4 versus 16.2) persons. Health disparities in overdose rates continue to worsen, particularly among Black and AI/AN persons; social determinants of health, such as income inequality, exacerbate these inequities. Implementation of available, evidence-based, culturally responsive overdose prevention and response efforts that address health disparities impacting disproportionately affected populations are urgently needed.

Timely orchiopexy by 18 months of age: Are we meeting the standards defined by the 2014 AUA guidelines?

Cryptorchidism is one of the most common reasons for pediatric urology referral and one of the few pediatric urologic conditions in which there are established AUA guidelines that recommend orchiopexy be performed before 18 months of age. While access to timely orchiopexy has been studied previously, there is no current study with data from a national clinical database evaluating timely orchiopexy after the AUA guidelines were published. Additionally, prior studies on delayed orchiopexy may have included patients with an ascended testis, which is a distinct population from those with true undescended testicles. To evaluate in a national, clinical database if timely orchiopexy improved after the AUA guidelines were published in 2014. In particular, we aim to evaluate a younger group of patients, 0-5 years of age, in an effort to account for potential ascending testes. Using Cerner Real-World Data™, a national, de-identified database of 153 million individuals, we analyzed pediatric patients undergoing orchiopexy in the United States from 2000 to 2021. We included males 0-18 years old and further focused on the subset 0-5 years. Primary outcome was timely orchiopexy, defined as age at orchiopexy less than 18 months. Predictor variables included race, ethnicity and insurance status. Statistical analyses were performed using logistic regression. Of the total 17,012 individuals identified as undergoing orchiopexy, 9274 were ages 0-5at the time of surgery. Comparing time periods pre and post AUA guidelines (2000-2014 versus 2015-2021), we found a significant difference in the proportion of timely orchiopexy (51% versus 56%, respectively; p<0.0001) (Figure). In multivariable analyses, Hispanic (OR=0.65, p<0.0001), African American (OR=0.74, p<0.0001), and Native American males (OR=0.66, p=0.008) were less likely to have timely orchiopexy compared to non-Hispanic White males. Individuals without insurance (OR=0.81, p=0.03) or with public insurance (OR=0.88, p=0.02) were less likely to have timely orchiopexy as compared to those with private insurance. Nearly a decade after publication of the AUA cryptorchidism guidelines, a large proportion of patients are still not undergoing orchiopexy by 18 months of age. This is the first study to show that timely orchiopexy has improved among patients 0-5 years, but the majority of patients are still not undergoing timely orchiopexy. Health disparities were apparent among Hispanic, African American, Native American, and uninsured males, highlighting the need for further progress in access to pediatric surgical care.

Life Expectancy for White, Black, and Hispanic Race/Ethnicity in U.S. States: Trends and Disparities, 1990 to 2019.

Life expectancy (LE) differences within and between states by race/ethnicity have not been examined. To estimate LE for selected race/ethnicity groups in states from 1990 to 2019. Cross-sectional time-series analysis. United States. Deidentified death records and Census data were used to construct regression models with smoothed time series of mortality from 1990 to 2019. LE at birth, by sex and year, for subgroups of people reporting Hispanic, non-Hispanic Black, or non-Hispanic White race/ethnicity. Disparities in LE across states were 8.0 years for females and 12.2 years for males in 1990 and 7.9 years for females and 7.8 years for males in 2019. When race/ethnicity groups were accounted for, disparities across states were 20.7 years for females and 24.5 years for males in 1990, decreasing to 18.5 years for females and 23.7 years for males in 2019. Disparities across states increased within each race/ethnicity group between 1990 and 2019, with the largest increase for non-Hispanic White males and the smallest for Hispanic females. The disparity between race/ethnicity groups within states decreased for most of the 23 states with estimates for all 3 groups but increased for females in 7 states and males in 5 states. Because of small sample size, LE was not estimated for 37 of 153 state-race/ethnicity groups. Disparity in LE across states was greater when race/ethnicity groups were considered. Disparities across all state-race/ethnicity groups in general have decreased over the past 3 decades. Within each race/ethnicity group, disparities across states have increased. Although racial/ethnic disparities decreased in most of the 23 states for which LE was estimated for all 3 groups, they increased for females in 7 states and males in 5 states. National Heart, Lung, and Blood Institute.

Abstract 3495: A novel Mediterranean dietary intervention for prostate cancer

Abstract Active surveillance (AS) is a safe management strategy for men with low-risk prostate cancer; however, nearly 35% of men on AS will undergo definitive treatment within 4 years, most commonly due to disease progression. Determining a non-invasive means of limiting disease progression would allow men to avoid quality of life issues associated with radical prostate treatment. Some modifiable factors, such as obesity and lipid levels, are associated with prostate cancer risk, though no behavioral intervention has been shown to affect prostate cancer outcomes. Using a prospective study of men on active surveillance, our group recently demonstrated that higher quality diets were associated with a significantly lower risk of disease progression. The Mediterranean diet (MD) specifically may be beneficial for men with localized prostate cancer (PCa) on active surveillance (AS) because of its anti-inflammatory, antilipidemic, and chemopreventive properties. Furthermore, recent evidence supports that dietary interventions can induce modulation of the gut microbiome, and consequently, immune function and inflammatory pathways, which warrants further investigation of the microbiome’s role in the context of prostate cancer. Here, we describe a novel dietary intervention among a group of men with localized prostate cancer who are electing to undergo prostatectomy for prostate cancer treatment. The intervention is a feeding study involving the provision of an isocaloric, high quality diet based on the lipid-lowering and anti-inflammatory parameters of the Mediterranean diet, including a strong focus on fiber-rich plant foods and healthy sources of mono and poly-unsaturated fatty acids. The primary outcome in this pilot study is the feasibility of a neoadjuvant dietary intervention. Secondary outcomes include studying the effects of the diet on metabolic parameters, the fecal microbiome, and changes in circulating metabolites shown to be associated with progression on active surveillance. Furthermore, by focusing on African-American and non-Hispanic White males, this study may provide insights into the key differences in inflammatory, immune and microbiome signatures, which may underly the prominent cancer-racial disparity seen in African-American men. Therefore, this study will gain preliminary data needed to inform further dietary interventions that may impact risk of progression in select men with prostate cancer enrolled on active surveillance. Citation Format: Samuel Cass, Jennifer Wargo, Curtis Pettaway, Louis Pisters, John Davis, Brian Chapin, John Ward, Carrie Daniel, Justin Gregg. A novel Mediterranean dietary intervention for prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3495.

High-risk non-16 human papillomavirus genotypes in head and neck squamous cell carcinoma.

e18052 Background: Oropharyngeal cancer patients with Human Papillomavirus (HPV)-associated disease have more favorable outcomes. HPV16 is the primary genotype in this population. Our knowledge of the impact of high-risk non-16 HPV (HRN16) subtypes on survival is limited. The objective of this study is to investigate the incidence, demographics, and survival outcomes of HRN16 genotypes in patients with HPV-positive head and neck squamous cell carcinoma (HNSCC). Methods: This is a retrospective chart review of patients diagnosed with HPV+ HNSCC from 2012-2021 at the Mount Sinai Health System. Genotyping was performed with polymerase chain reaction (PCR). Demographic, clinical and tumor data was extracted from electronic medical records.The primary outcomes are overall survival (OS) and event-free survival (EFS) for patients with non-metastatic disease at presentation, treated with curative-intent, with &gt; 6 months follow-up.Survival analysis was performed by Kaplan-Meier method. Results: 733 patients had HPV+ HNSCC, and 109 (14.9%) are HRN16 subtypes. Mean age at diagnosis is 62.4 years. Most individuals are non-Hispanic white males, non-active smokers, social drinkers, and have good performance status (Table). A majority has non-metastatic oropharyngeal cancer treated with standard of care (SOC) definitive therapy. The predominate genotypes are HPV35 (39.4%, n = 41), HPV33 (27.9%, n = 29), and HPV18 (14.4%, n = 15). Survival analysis demonstrated no significant differences in OS (log-rank p = 0.90) and EFS (log-rank p = 0.19) among the different HRN16 subtypes. There was a trend for better EFS for HPV35. Conclusions: HRN16 genotype may not meaningfully impact patient outcomes in HNSCC. Larger multivariate analyses may identify specific site and genotype differences in survival comparedwith HPV16-assoicated disease and indicate if patients with selected HRN16 subtypes are candidates for treatment de-escalation.[Table: see text]

An update on ACEs domain frequencies across race/ethnicity and sex in a nationally representative sample

BackgroundAdverse childhood experiences (ACEs) research has yielded important information regarding ACEs prevalence and impacts; however, few studies have included American Indian/Alaska Native (AI/AN) populations. ObjectiveWe aimed to update and expand the ACEs literature by using recent data (2009–2018; over 50% from 2015 to 2017); using a large, nationally representative sample (total N = 166,606) and AI/AN sub-sample (N = 3369); and including additional covariates (i.e., sex, age, income, education) to provide a comprehensive understanding of ACEs across diverse populations. Participants and settingData were from the CDC's BRFSS, a standardized scale used in most ACEs literature, to improve generalizability of study findings, which may contribute to investigating future ACEs trends. MethodsDescriptive statistics and negative binomial regression analyses were conducted to examine the frequency of ACEs and the eight ACEs domains across racial/ethnic and sex groups. ResultsAI/ANs had the highest ACEs compared to all racial/ethnic groups. Females had higher mean ACEs compared to males of the same racial/ethnic group; significant differences were identified between non-Hispanic White (NHW) females and NHW males, and between Hispanic females and Hispanic males. Across all 10 stratified subgroups, AI/AN females had the highest average ACEs followed by AI/AN males. Emotional abuse was the most reported ACEs domain across all individuals, and family incarceration was the lowest. AI/AN females and males had the highest ACEs frequencies in family substance use, witnessing intimate partner violence, and sexual and emotional abuse. ConclusionsFindings have important implications for public health intervention and prevention efforts that may mitigate the impact of ACEs across racial/ethnic groups, particularly for AI/AN populations.

Disparities in human papillomavirus vaccination coverage in the United States, National Health and Nutrition Examination Survey, January 2017–March 2020

BackgroundWe assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States. MethodsUsing 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9–14, 15–19, and 20–29 years. ResultsAmong those aged 9–14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15–19 and 20–29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons. ConclusionsHPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.

Body fat differences among US youth aged 8-19 by race and Hispanic origin, 2011-2018.

The association between body mass index (BMI) and adiposity differs by race/ethnicity. To examine differences in adiposity by race/Hispanic origin among US youth and explore how those differences relate to differences in BMI using the most recent national data, including non-Hispanic Asian youth. Weight, height and DXA-derived fat mass index (FMI) and percentage body fat (%BF) from 6923 youth 8-19 years in the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were examined. Age-adjusted mean BMI, FMI and %BF were reported. Sex-specific linear regression models predicting %BF and FMI were adjusted for age, BMI category and BMI category*race/Hispanic origin interaction. %BF was highest among Hispanic males (28.2%) and females (35.7%). %BF was lower among non-Hispanic Black (23.9%) compared with non-Hispanic White (26.0%) and non-Hispanic Asian (26.6%) males. There was no difference between non-Hispanic Black females (32.7%) and non-Hispanic White (33.2%) or non-Hispanic Asian (32.7%) females. FMI was higher among Hispanic youth compared with non-Hispanic White youth. Among youth with underweight/healthy weight, predicted %BF and FMI were lower among non-Hispanic Black males (-2.8%; -0.5) and females (-2.0%; -0.3), compared with non-Hispanic White youth, and higher among Hispanic males (0.9%; 0.2) and females (2.0%; 0.5), while %BF but not FMI was higher among non-Hispanic Asian males (1.3%) and females (1.4%). Among females with obesity, non-Hispanic Asian females had lower %BF (-2.3%) and FMI (-1.7) than non-Hispanic White females. Differences in %BF and FMI by race/Hispanic origin were not consistent by BMI category among US youth in 2011-2018.

Changing epidemiology of esophageal cancer: A population-based study over 43 years (1975–2018).

247 Background: Esophageal cancer (EC) is the seventh most common cancer worldwide. Previous studies have indicated that the incidence of squamous cell carcinoma of the esophagus (SCE) in the US has declined since the 1970s. In comparison, the incidence of adenocarcinoma of the esophagus (ACE) has sharply risen in the US since the 1970s. This study aimed to examine temporal trends in incidence rates of EC, ACE, and SCE that include recent decades. Methods: Data were derived from the Surveillance, Epidemiology, and End Results (SEER) of the National Cancer Institute - a population-based cancer database. Using SEER*Stat, we calculated the age-adjusted incidence rates (AAIR) for EC, ACE, and SCE in both SEER 9 (for longest follow-up time) and SEER 21 (the largest cohort covering 36.7% of the US population). Temporal incidence trends were examined using Joinpoint analyses to estimate the annual percent change (APC). Subgroup analyses were performed for sex, age, and race/ethnicity. Results: See Table. When stratified by age, age &lt;64 years had a significant decrease in incidence with an APC of -1.1 (2007-2018), while the incidence plateaued in the remaining age groups. The rise in incidence was highest among non-Hispanic whites (NHW) from 2000-2004 (APC 4.0), especially NHW males (APC 3.0); however, the incidence plateaued in all race/ethnicity groups after 2006. Conclusions: The AAIR of EC as a whole has been decreasing since 2004. The AAIR of ACE has, for the first time, plateaued in the most recent decade (2006-2018), after having risen for three preceding decades (1975-2006); we find this effect is mainly driven by the AAIR from NHW males, age &lt;64 years. The incidence of SCE has continued to decline since 1975. Future studies should further explore the underlying etiology of these patterns.[Table: see text]

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

Abstract PO-106: Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients

Abstract Background: Non-Hispanic Black (NHB) patients are more likely to present with a later stage colon cancer and to die from the disease compared to their non-Hispanic White (NHW) counterparts. Despite a plethora of research regarding their effects on intermediate outcomes (e.g., patient satisfaction, behavioral outcomes), little is known about the role of clinical (i.e., patient-provider communication [PPC]) and non-clinical social support in survival. Objective: To describe clinical (PPC) and non-clinical social support among NHB and NHW urban colon cancer patients, and examine their associations with risk of colon cancer death. Method: Colon Cancer Patterns of Care in Chicago was a cross-sectional, multi-site study that examined disparities in colon cancer screening, diagnostic stage, and treatment. Patients were eligible if they were diagnosed with a first primary colon cancer, self-identified as NHB or NHW, and were between 30 and 79 years of age. Participants completed a 90-minute interview and consented to medical record abstraction. For these analyses we examined: 1) clinical support (PPC), treated as a categorical variable (low, moderate, or high), 2) non-clinical social support (no, yes), and 3) colon cancer death, ascertained via a National Death Index Plus search. We used multivariable Cox proportional hazard models to estimate hazard ratios (HRs) for associations of race, sex, PPC, and social support with colon cancer death. Adjusted models included the following covariates: age, marital status, education, income, insurance, comorbidities, body mass index, having a regular provider, healthcare utilization, and healthcare access. Results: The final sample of 407 colon cancer patients had (by design) a roughly equal distribution by race and gender. Overall, 26% of patients died due to colon cancer, and risk of death was highest for NHB males (33%) and lowest for NHW males (20%). NHB patients were more likely than NHW patients to report low PPC and no non-clinical social support. Low PPC was associated with a two-fold increased hazard of colon cancer death (HR=2.0, 95% CI: 1.06, 3.84), whereas non-clinical social support was not associated with risk of colon cancer death. The hazard of colon cancer death was two-fold (HR=2.05, 95% CI: 1.07, 3.71) greater for NHB males compared to NHW females. Conclusion: These findings suggest that clinical support – specifically PPC - can potentially decrease the risk of colon cancer death, especially among NHB male patients. Future research should determine optimal strategies for PPC improvement, including provider training in shared decision-making practices and high-quality informational support. Reducing survival disparities may thus require not only advances in diagnostics and treatment, but also in clinical support factors. Citation Format: Leslie R. Carnahan, Yamilé Molina, Karriem S. Watson, Susan Altfeld, Carol E. Ferrans, Garth E. Rauscher. Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-106.

Racial Differences in Time at Work Not Working

Racial differences in effort at work, if they exist, can potentially explain race-based wage/earnings disparities in the labor market. The authors estimate specifications of time spent on non-work activities at work by Black and White males and females with data from the American Time Use Survey. Estimates reveal that trivially small differences occur between non-Hispanic Black and non-Hispanic White males in time spent not working while on the job that disappear entirely when correcting for non-response errors. The findings imply that Black–White male differences in the fraction of the workday spent not working are either not large enough to partially explain the Black–White wage gap, or simply do not exist at all.

Comparison of Trimethoprim-Sulfamethoxazole vs. Clindamycin for the Treatment of Children with Musculoskeletal Infections

Background: &#x0D; Musculoskeletal infections ([MSKI]; osteomyelitis, septic arthritis, pyomyositis) are common invasive infections in children. With increasing antibiotic resistance and allergies, treatment options are limited. Trimethoprim-sulfamethoxazole (TMP-SMX) has activity against common MSKI pathogens, yet pediatric MSKI outcomes data are limited. Our aim was to evaluate outcomes of children with MSKI treated with TMP-SMX compared to clindamycin. We hypothesized that outcomes would be similar between groups.&#x0D; Methods: &#x0D; We conducted a retrospective review of children &lt;18 years old, admitted to Riley Hospital for Children from January 2010-June 2021 treated with TMP-SMX or clindamycin for MSKI. Patients were identified by ICD-9/10 codes. Patients were excluded if TMP-SMX or clindamycin was not the main treatment, they had symptoms &gt;30 days, hardware associated infection, or an alternative diagnosis. Treatment success was defined as no evidence of infection at the end therapy. Treatment failure was defined as antibiotic intolerance, or development of recurrent/chronic osteomyelitis. Adverse drug reactions were recorded.&#x0D; Results:&#x0D; One-hundred-sixty-three patients (30 TMP-SMX, 133 clindamycin) met eligibility criteria. The majority were non-Hispanic white males, median age of 1.75 years (IQR, 1-3.75) for the TMP-SMX group, and 7 years (IQR 3-10) for the clindamycin group. Osteomyelitis was the most common infection type in both groups (TMP-SMX 43.3%, clindamycin 54.1%). S. aureus was the most common pathogen in both groups (TMP-SMX 36.7%, clindamycin 48.1%). Of the patients that completed follow-up, 84% successfully completed treatment with TMP-SMX, compared to 86.4% with clindamycin (odds ratio [OR] 0.82; 95% CI 0.25-2.46, p=0.75). Adverse drug reactions occurred in 6.7% of the TMP-SMX group, compared to 10.5% in the clindamycin group (OR 0.61; 95% CI 0.13-2.57, p=0.52).&#x0D; Conclusions:&#x0D; Preliminary results show that TMP-SMX is well tolerated and not associated with higher risk of treatment failure compared to clindamycin in the treatment of pediatric MSKI. Randomized controlled trials to evaluate optimal treatment are needed.

Abstract 10110: Sex and Ethnic/Racial Disparities in Ischemic Heart Disease Related Mortality Rates Among Older Adults

Introduction: Ischemic heart disease (IHD) accounts for significant morbidity and mortality in the elderly population. The aim of this study was to examine the trends in IHD related deaths in elderly population in the United States from 1999 to 2019. Methods: We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. IHD related deaths, age &gt;/=75 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 10,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and racial/ethnic groups. Results: AAMR related to IHD decreased from 271.9 in 1999 to 137.3 in 2019 (average APC-3.4[95% CI, -3.7 to -3.0]). AAMR was higher in men (241.3) than women (156.9). Among the racial/ethnic groups, AAMR was highest in non-Hispanic whites (NHWs) (195.1) followed by non-Hispanic blacks (NHBs) (185.6), non-Hispanics American Indian or Alaska Natives (NH-AIAN) (152.7), Hispanics (147.4), and lastly non-Hispanics Asian or Pacific Islanders (NH-APIs) (110.5). AAMR was highest in NHW males (250.6). APC in AAMR decreased across all the subgroups. After initial decline, the decrease in APC in AAMR decelerated in both women (-2.7) and men (-2.0) since 2014, NHBs (-2.4) since 2014, Hispanics (-2.9) since 2012 and NH-API (-2.2) since 2015. After initial decline, AAMR remained stable in NHWs (APC -1.5) since 2016. After initially remaining stable, AAMR decreased in NH-AIAN (APC -3.3) since 2004. Conclusion: IHD related mortality in elderly has been decreasing at a variable pace across various sex and racial/ethnic groups. The causes of these disparities need to be examined and targeted interventions are required to address these disparities.

Scaling of computed tomography body composition to height: relevance of height‐normalized indices in patients with colorectal cancer

BackgroundBody weight scales to height with a power of ≈2 (weight/height2), forming the basis of body mass index (BMI). The corresponding scaling of body composition measured by abdominal computed tomography (CT) to height has not been established. The objective of this analysis was to quantify the scaling of body composition measured by a single‐slice axial abdominal CT image (skeletal muscle, and visceral, subcutaneous, and total adipose tissue) to height in patients with colorectal cancer (CRC).MethodsThis cross‐sectional study included non‐Hispanic white males and females, aged 18–80 years, who were diagnosed with stage I–III CRC at an integrated health care system in North America between January 2006 and December 2011. Body composition was measured by a single‐slice axial CT image of the third lumbar vertebra and analysed with a semi‐automated threshold segmentation procedure. Allometric regression models were used to quantify height scaling powers (β ± standard error) for each body composition measure, adjusted for age, for males and females. An interaction test was used to determine if height scaling powers were statistically significantly different between males and females.ResultsAmong 2036 subjects, the mean (standard deviation) age was 64 ± 11 years, 1008 (49.5%) were female, and the mean (standard deviation) BMI was 27.9 ± 5.4 kg/m2. Powers for skeletal muscle area were 1.06 ± 0.12 for males and 0.80 ± 0.12 for females (P = 0.049). Powers for visceral adipose tissue area were 1.81 ± 0.64 for males and 0.57 ± 0.79 for females (P = 0.16). Powers for subcutaneous adipose tissue area were 2.04 ± 0.42 for males and 0.81 ± 0.45 for females (P = 0.056). Powers for total abdominal adipose tissue area were 1.80 ± 0.46 for males and 0.76 ± 0.50 for females (P = 0.20).ConclusionsBody composition measured by single‐slice axial abdominal CT, particularly muscle area, scales to height with age‐adjusted powers that are different than 2 and are distinct between males and females. These observations may have implications for the development of height‐adjusted body composition indices in patients with cancer.

Adolescents' Receipt of Sex Education in a Nationally Representative Sample, 2011–2019

PurposeUpdated estimates of adolescents' receipt of sex education are needed to monitor trends and potential inequities. MethodsUsing nationally representative data from the 2011–2015 and 2015–2019 National Survey of Family Growth, we use logistic regression to examine changes in the receipt of formal sex education by gender. For 2015–2019, we estimate patterns by gender and race/ethnicity for content, timing, and location of instruction. ResultsBetween 2011–2015 and 2015–2019, there were few significant changes in adolescents' receipt of formal sex education. Between these periods, instruction on waiting until marriage to have sex declined (73%–67% female [F.], p = .005; 70%–58% males [M.], p < .001). In both the periods, about half of the adolescents received sex education that meets the minimum standard articulated in national goals. In 2015–2019, there were significant gender differences in the instruction about waiting until marriage to have sex (67% F., 58% M., p < 001) and condom skills (55% F., 60% M., p = .003). Non-Hispanic Black and Hispanic males were less likely than non-Hispanic White males to receive formal instruction before the first sex on sexually transmitted infection/HIV, birth control, or where to get birth control. Many adolescents reported religious settings as the sources of instruction about waiting until marriage to have sex (56% F. and 49% M.), but almost none received instruction about birth control from those settings. ConclusionsDifferences in the receipt of sex education, by gender, race/ethnicity, and the location of instruction, leave many adolescents without critical information. Gaps in meeting national objectives indicate the need to expand the provision of sex education.

Permissiveness of firearm laws, pro-gun culture, and suicides by firearm in the U.S., 2000–2016

ObjectivesStricter firearm policies correlate with lower suicides by firearm in the US. However, much work examines policies in isolation and does not investigate firearm policies as they relate to US pro-gun culture. We examine the relation between permissiveness of state firearm laws, gun culture, and suicides by firearm. Study designPanel longitudinal study. MethodsThe count of suicides by firearm for 50 US states from 2000 to 2016 served as the outcome. Permissiveness of multiple state firearm laws, based on ratings from the Traveler's Guide to the Firearm Laws of the Fifty States, served as the exposure. These ratings, measured at the state-year, capture not only the overall policy environment but also the extent to which the state exhibits a pro-gun culture. We applied a fixed effects negative binomial count model, which controls for the population-at-risk, to examine suicides overall and by race/ethnicity and gender. ResultsA 10-unit increase in permissiveness of state firearm laws corresponds with 2% greater suicides by firearm overall (Incidence rate ratio [IRR] = 1.02; 95% CI: 1.01–1.03) and among non-Hispanic white males ([IRR] = 1.02, 95% CI: 1.01–1.02). ConclusionsFindings, if replicated, indicate that states enacting more restrictive firearm policies, and lessening a pro-gun culture, may lead to reductions in suicide by firearm.

S1235 Disparities in the Incidence of Liver and Bile Duct Cancers in Hispanics at the U.S.-Mexico Border Region

Introduction: Primary liver and bile duct cancers are the fifth most common cause of cancer-related death in men and the seventh most common in women. Both Hispanic men and women are twice as likely to be diagnosed and die from liver cancer as non-Hispanic Whites. Several risk factors may be contributing to this disparity, including higher rates of obesity, diabetes, NAFLD, and alcohol-related liver disease among Hispanics. We investigated the incidence rates of liver and bile duct cancers in persons living near the U.S.-Mexico border, a region where these risk factors appear to be more prevalent. Methods: Average annual incidence rates (cases per 100,000 persons) from 2013 to 2017 of liver and bile duct cancers for counties along the U.S.-Mexico border were obtained from the NIH National Cancer Institute. Data was categorized by ethnicity (Hispanic and non-Hispanic White) and gender. The Wilcoxon matched-pairs signed rank test was used to compare rates among Hispanics versus non-Hispanic Whites. The Mann-Whitney test was used to compare incidence rates between border Hispanics and Hispanics at the national level. Counties/counts were excluded if fewer than 16 cases were reported in a specific area, sex, or ethnicity category (to ensure confidentiality). Results: Incidence rates for border Hispanics were significantly higher than for border non-Hispanic Whites (p < 0.01). When comparing among genders, incidence rates for border Hispanic males were higher than for border non-Hispanic White males (p < 0.01). No statistically significant difference was observed among female groups (p = 0.25); likely attributed to the fact that incidence data for non-Hispanic White females was only available for 3 counties. In addition, the aggregated incidence rate for border Hispanics was significantly higher than the national Hispanic rate (p = 0.0019) (Table 1). Conclusion: To our knowledge, this is the first study comparing incidence rates of liver and bile duct cancers between ethnic groups in the U.S.-Mexico border region. Hispanics are disproportionately affected by liver and bile duct cancers. This disparity is even more evident in the U.S.-Mexico border region, where incidence rates for border Hispanics are higher than the national Hispanic rate. These findings may be related to the higher prevalence of modifiable risk factors in the border region.Table 1.: Incidence rates of liver and bile duct cancers for counties along the U.S.-Mexico border region. Average annual incidence rates per 100,000 persons from 2013 to 2017. 95% confidence intervals in parenthesis. NH = Non-Hispanic * Fewer than 16 cases reported - data suppressed to ensure confidentiality and stability of rate estimates.