non-Hispanic White Participants Research Articles

Polygenic risk scores in assessing lung cancer susceptibility in non-Hispanic White and Black populations.

10548 Background: Polygenic risk scores (PRS) have become an increasingly popular approach to evaluate cancer susceptibility, but have not adequately represented Black patients in model development. We used previously identified single nucleotide polymorphisms (SNPs) and annotated SNPs in associated gene regions to develop PRS in non-Hispanic Whites and Blacks using the INHALE dataset. Methods: Using the Multi-Ethnic Genotype Array, 1,204 SNPs for non-Hispanic Whites and 1,515 SNPs for Blacks were evaluated for their association with lung cancer risk adjusting for age, sex, total pack-years, family history of lung cancer, history of COPD and the top five PCs for genetic ancestry. Gene region-specific significant SNPs (p < 0.05) were used to develop race-specific PRS. Results: The race-specific PRS included different sets of significant SNPs and were highly associated with lung cancer risk in both non-Hispanic Whites (OR = 1.07, 95% CI: 1.05-1.09, p = 3.44x10-9) and Blacks (OR = 1.12, 95% CI: 1.08-1.17, p = 9.14x10-8). These models remained significant for both Whites (OR = 1.05, 95% CI: 1.03-1.09, p = 0.0004) and Blacks (OR = 1.08, 95% CI: 1.01-1.15, p = 0.01) who currently do not meet USPSTF screening guidelines. AUC analysis demonstrated the Black-specific model (AUC = 0.68) outperformed the White-specific model (AUC = 0.57) (p = 0.03) when examined exclusively in the Black cohort. Conclusions: Using previously validated SNPs and gene regions, we developed race-specific PRS in non-Hispanic White and Black INHALE participants. Further validation of PRS could enable the incorporation of genetic risk modeling into lung cancer screening to identify patients who do not have traditional risk factors for lung cancer, as well as stratify patients into different levels of risk based on their genetic profile. Through the development of a reliable genetic risk factor prediction model, clinicians will have another method by which to evaluate lung cancer susceptibility, potentially leading to earlier diagnoses that portend more favorable treatment outcomes.

Racial differences in muscle measures and survival among older adults with GI malignancies.

12044 Background: Sarcopenia (low muscle mass) and myosteatosis (fat infiltration of muscle) can be assessed from routinely obtained Computed tomography (CT) images and are independent predictors of chemotherapy toxicities and survival among patients with gastrointestinal (GI) malignancies. However, most studies to date have consisted of predominantly white populations. Therefore, the role of sarcopenia and myosteatosis among racial minority populations is unknown. Our objective was to examine racial differences in muscle measures and their association with survival among older adults with GI malignancies. Methods: This is a prospective cohort study of older adults with GI cancers from the University of Alabama at Birmingham. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. Skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used to approximate muscle composition. Sarcopenia (low SMI) and myosteatosis (low SMD) were defined based on standard cut-offs developed in a cohort of GI malignancies (Martin et al., JCO 2013). We compared differences in muscle measures between non-Hispanic (NH) White and NH Black participants. We utilized Cox models, separated by race, to examine the impact of muscle measures on survival. We adjusted for age, sex, education, cancer type, cancer stage, lines of therapy, and comorbidities. Results: Six hundred sixty patients were included, 76% NH White and 24% NH Black. The median age was 69.4 years, 35% had colorectal cancer, and 42% had stage IV disease. NH Black patients had higher SMD (41.7 vs. 38.3 HU; p < 0.001) and lower rates of myosteatosis (40% vs. 27%; p = 0.04) but similar SMI (42.3 vs. 41.1 cm2/m2) and rates of sarcopenia (58% vs. 55%). In stratified Cox models, each 5 HU unit increase in SMD was associated with reduced risk of all-cause mortality of NH black patients (HR 0.88; 95% CI 0.80-0.98 p = 0.02) and not in NH White patients (HR 0.95; 95% CI-0.88-1.01; p = 0.14). Meanwhile, each 5-unit increase in SMI was associated with improved survival in NH White patients (HR 0.91; CI 0.85-0.98; p = 0.03) but not in NH Black patients (HR 0.89 CI0.78-1.03 p = 0.13). When using existing cut points for sarcopenia and myosteatosis, NH White patients with sarcopenia had worse survival (HR 1.42; CI 1.04-1.92; p = 0.02), but sarcopenia among NH black patients was not associated with worse survival (HR 1.16 95% CI 0.62-2.16 p = 0.64). Myosteatosis was not associated with worse survival in either NH white (HR 95%CI 0.95-1.68 p = 0.10) or NH black patients (HR 1.61 95%CI 0.88-2.95 p = 0.12). Conclusions: Muscle measures may differ by race and have different associations with survival by racial group. Therefore, it is essential to develop cut points for muscle measures incorporating race.

Enrollment representation of age, race, and ethnicity in ovarian cancer registrational clinical trials (2010-2020): An evaluation by the U.S. Food and Drug Administration.

e18527 Background: Ovarian cancer is the fifth leading cause of cancer mortality among U.S. women. Because clinical trials have historically not been demographically representative of real-world patients, an understanding of the extent of disparities is an important step in addressing them. We aimed to evaluate the representation of older adults and racial and ethnic minorities in trials for ovarian cancer drugs. Methods: We conducted a pooled analysis of all trials that were submitted to the U.S. Food and Drug Administration (FDA) from January 1, 2010 to December 31, 2020 in support of marketing applications for epithelial ovarian, fallopian tube, or primary peritoneal indications. Demographic data (age, race, and ethnicity) for adult participants were analyzed alongside incident ovarian cancer case data (diagnosis between 2010 and 2019) from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Enrollment to Incidence Ratio (EIR) is reported and defined as the percentage of participants divided by percentage of U.S. incident ovarian cancer cases. An EIR between 0.80-1.20 indicates adequate representation; <0.80 or >1.20 indicates underrepresentation or overrepresentation, respectively. Participants with race or ethnicity categories reported as unknown or missing, or insufficient for calculation were not included in this analysis. A sensitivity analysis was conducted to evaluate the exclusion of trials enrolling only BRCA+ participants. Results: The analysis included 8,211 participants enrolled across 15 clinical trials. Age was available for all participants; race/ethnicity was not reported for 16.3% of participants. With increasing age, EIR decreased (Table). Non-Hispanic (NH) White participants had the highest EIR of all racial/ethnic groups, while NH Black and Hispanic participants had the lowest EIR. Results were similar when excluding trials enrolling only BRCA+ participants. Conclusions: Adults aged ≥75, NH Black, and Hispanic participants were underrepresented in registrational trials for new ovarian cancer therapies. To enhance understanding of the correlation between age, race, and ethnicity, further analyses are necessary. Prospective measures are essential, as discussed in recent FDA guidances, to enroll an adequately representative population in ovarian cancer clinical trials.[Table: see text]

Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study.

Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia. In a pooled cross-sectional sample of the Health and Retirement Study (n = 9,923), we employed Poisson regression to estimate prevalence ratios and to test the relationship between elevated cystatin C (>1.24 vs. ≤1.24 mg/L) and impaired cognition, adjusted for demographics, behavioral risk factors, other biomarkers, and chronic conditions. Self-reported racialized social categories were a proxy measure for exposure to racism. We calculated additive interaction measures and conducted four-way mediation-interaction decomposition analysis to test the moderating effect of race/ethnicity and mediating effect of cystatin C on the racial disparity. Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.2; 95% CI: 1.0, 1.5). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 0.7 (95% CI: -0.1, 2.4), the attributable proportion was 0.1 (95% CI: -0.2, 0.4), and the synergy index was 1.1 (95% CI: 0.8, 1.8) in a fully adjusted model. Elevated cystatin C was estimated to account for 2% (95% CI: -0, 4%) for the racial disparity in prevalent dementia, and the interaction accounted for 8% (95% CI: -5, 22%). Analyses for Hispanic relative to non-white participants suggested moderation by race/ethnicity, but not mediation. Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White.

Platelet counts in HFE p.C282Y/p.C282Y and wt/wt post-screening clinical evaluation participants

Our aim was to document the effects of genotype HFE p.C282Y/p.C282Y and hemochromatosis-associated laboratory and clinical manifestations on platelet counts (PC). We compiled genotype (p.C282Y/p.C282Y or HFE wt/wt (absence of p.C282Y and p.H63D (rs1799945)), age, sex, body mass index, presence/absence of chronic fatigue, swelling/tenderness of second/third metacarpophalangeal joints, and hyperpigmentation, transferrin saturation (TS), serum ferritin (SF), hemoglobin levels, absolute neutrophil, lymphocyte, and monocyte counts, C-reactive protein levels, and PC of non-Hispanic white participants in a hemochromatosis and iron overload post-screening clinical examination. There were 171 men and 254 women (141 p.C282Y/p.C282Y, 284 wt/wt) of median age 53 y. Median TS and SF were higher in p.C282Y/p.C282Y than wt/wt participants grouped by sex (p < .0001, all comparisons). Median PC by genotype was lower in men than women (p < .0001, both comparisons). Regression on PC using 14 independent variables identified these significant positive associations: absolute neutrophil, lymphocyte, and monocyte counts and C-reactive protein levels and these significant inverse associations: age, TS, and hemoglobin levels. We conclude that PC is significantly associated with absolute neutrophil, lymphocyte, and monocyte counts, and C-reactive protein (positive) and age, TS, and hemoglobin (inverse), after adjustment for other variables. HFE genotypes we studied were not significantly associated with PC.

Disparities in Breast Cancer Screening

Background. Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions.&#x0D; Aims. This secondary data analysis study aimed to examine the disparities in mammography screening by sexual orientation and gender identity among females assigned at birth (FAAB) overall and stratified by race/ethnicity in the U.S.&#x0D; Methods. By using 2014, 2016, and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) data, we conducted adjusted multivariable logistic regression models to estimate the odds of receiving an up-to-date mammography screening in relation to sexual orientation, gender identity, and other correlates among FAAB aged 50-74 years (unweighted N=228,257).&#x0D; Results. Overall, the lifetime and up-to-date prevalence of mammography screening were 96.3% and 76.0% in U.S. FAAB, respectively. Non-Hispanic Black (NHB) participants reported a higher rate of up-to-date mammography screening (84.13%) whereas those who had an income less than $15,000 per year had the lowest (71.31%). Being insured, overweight/obese, and not a current smoker were positively associated with receiving an up-to-date mammography screening across racial and ethnic groups. Besides, being physically active was significant for an up-to-date mammography screening in non-Hispanic White (NHW) and Hispanic participants. Also, Hispanic transgender participants were more likely to have an up-to-date mammography screening than their same-ethnic cisgender counterparts.&#x0D; Contribution to Evidence-Based Care. The findings reveal that the disparities in receiving an up-to-date mammography screening varied by sexual identity, gender identity, and race/ethnicity in FAAB aged 50-74 years. The lower rate of an up-to-date mammography screening was found particularly in Hispanic, bisexual AFAB. Future tailored mammogram programs should integrate physical activity and cultural components for people with multiple minority identities.

0440 Peripheral arterial tonometry–based measures of obstructive sleep apnea in Black, Mexican American and non-Hispanic White adults

Abstract Introduction Racial/ethnic differences may exist in sleep quality and disorders, but there are limited data directly comparing objective measures of obstructive sleep apnea (OSA) among Black, Mexican American (MA) and non-Hispanic White (NHW) populations. Methods To date, the ongoing Health &amp; Aging Brain among Latino Elders (HABLE)-Dormir study has enrolled 761 participants using a community-based participatory research approach. Here we describe OSA indices assessed by in-home assessments using WatchPAT, a Peripheral Arterial Tonometry (PAT)-based home sleep testing system that is validated for the diagnosis of OSA. Results Participants had a mean age of 65.6+/-8.2 (50-90) years, comprised of 64% women; 34% MA, 24% Black and 42% NHW adults. Over half (52.0%) of the participants had moderate or more severe OSA as defined by the respiratory event index (REI based on 3% desaturations) of &amp;gt;=15/hour, 73.1% with REM-OSA (REM-REI &amp;gt;=15/hour) and 40.6% with NREM-OSA (NREM-REI &amp;gt;=15/hour). The median of the average snoring volume through the night was 41 (40-61) dB. The median percentage of sleep time spent with oxygen saturation below 90% (SpO2&amp;lt; 90%) was 1.0%. After adjustment for age, sex, Body Mass Index, cognitive status, and history of hypertension, diabetes, stroke and heart attack, Black and MA participants were 71% and 55% more likely to have REM-OSA compared to NHW participants (p=0.04), but had similar prevalence of NREM-OSA (p=0.80) and overall OSA (p=0.32). The adjusted mean percentage of sleep time spent with over 40dB snoring volume was higher among Black (22.7%, p=0.03) and MA adults (21.2%, p=0.11) than NHW adults (18.5%). The adjusted mean prevalence of nocturnal hypoxemia (SpO2&amp;lt; 90% time &amp;gt;= 1%) was similar among Black (48.2%), MA (51.7%) and NHW (50.0%) adults; p=0.83. Conclusion In this middle-to-older-aged population, PAT-based measures of OSA indicate a higher prevalence in minoritized adults of REM-specific sleep apnea, a phenotype associated with increased rates of hypertension and mortality. Home-based measures that do not distinguish between REM and NREM respiratory events may underestimate sleep apnea in these groups. Support (if any) This research was supported by National Institutes of Health grant R01AG066137.

Food Insecurity During the First Year of COVID-19: Employment and Sociodemographic Factors Among Participants in the CHASING COVID Cohort Study.

While much has been reported about the impact of the COVID-19 pandemic on food insecurity, longitudinal data and the variability experienced by people working in various industries are limited. This study aims to further characterize people experiencing food insecurity during the pandemic in terms of employment, sociodemographic characteristics, and degree of food insecurity. The study sample consisted of people enrolled in the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study from visit 1 (April-July 2020) through visit 7 (May-June 2021). We created weights to account for participants with incomplete or missing data. We used descriptive statistics and logistic regression models to determine employment and sociodemographic correlates of food insecurity. We also examined patterns of food insecurity and use of food support programs. Of 6740 participants, 39.6% (n = 2670) were food insecure. Non-Hispanic Black and Hispanic (vs non-Hispanic White) participants, participants in households with children (vs no children), and participants with lower (vs higher) income and education levels had higher odds of food insecurity. By industry, people employed in construction, leisure and hospitality, and trade, transportation, and utilities industries had the highest prevalence of both food insecurity and income loss. Among participants reporting food insecurity, 42.0% (1122 of 2670) were persistently food insecure (≥4 consecutive visits) and 43.9% (1172 of 2670) did not use any food support programs. The pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in industries vulnerable to economic disruption and ensure those experiencing food insecurity can access food support programs for which they are eligible.

Association between PFAS congeners exposure and asthma among US children in a nationally representative sample.

Over the past few decades, contamination with perfluorinated and polyfluoroalkyl substances (PFAS) has gradually become a worldwide problem. Now that common PFAS such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are being phased out and replaced, people may be exposed to other PFAS congeners, and their potential hazards should be fully studied. We assessed the association of serum PFAS levels (as biomarkers of exposure) with asthma, including 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH), pefluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), using data from participants aged 3-11 from the 2013-2014 National Health and Nutrition Examination Surveys (n = 525), where PFAS was modeled as a binary variable.Me-PFOSA-AcOH (1.36; 95% CI 0.77, 2.38), PFDA (1.33; 95% CI 0.76, 2.33), and PFUnDA (1.89; 95% CI 0.83, 4.35) were nonsignificantly associated with increased odds of asthma. Age, sex, and race/ethnicity modified associations between serum PFUnDA, not other serum PFAS congeners exposure, and odds of asthma. Specifically, for male participants, the OR = 3.06 and 95% CI 1.23-7.62 for serum PFUnDA exposure; for participants aged 3-7years old, the OR = 3.55 and 95% CI 1.04-12.10 for serum PFUnDA exposure; for non-Hispanic White participants, the OR = 3.44 and 95% CI 1.14-10.36 for serum PFUnDA exposure, all of which exhibited a significantly positive relationship. This cross-sectional study provides some evidence for associations between exposure to PFAS congeners and asthma in children. We believe this relationship deserves further exploration. More large-scale epidemiologic studies are needed to evaluate the association of serum PFAS congeners, especially for PFUnDA exposure, with asthma among children.

Racial Disparities in Employment Status After Moderate/Severe Traumatic Brain Injuries in Southeast Michigan

ObjectiveTo examine the progress made in recent decades by assessing the employment rates of Black and non-Hispanic White (NHW) patients after traumatic brain injury (TBI), controlling for pre-TBI employment status and education status. DesignRetrospective analysis in a cohort of patients treated in Southeast Michigan at major trauma centers in more recent years (February 2010 to December 2019). SettingSoutheastern Michigan Traumatic Brain Injury Model System (TBIMS): 1 of 16 TBIMSs across the United States. ParticipantsNHW (n=81) and Black (n=188) patients with moderate/severe TBI (N=269). InterventionNot applicable. Main Outcome MeasuresEmployment status, which is separated into 2 categories: student plus competitive employment and noncompetitive employment. ResultsIn 269 patients, NHW patients had more severe initial TBI, measured by percentage brain computed tomography with compression causing >5-mm midline shift (P<.001). Controlling for pre-TBI employment status, we found NHW participants who were students or had competitive employment prior to TBI had higher rates of competitive employment at 2-year (P=.03) follow-up. Controlling for pre-TBI education status, we found no difference in competitive and noncompetitive employment rates between NHW and Black participants at all follow-up years. ConclusionsBlack patients who were students or had competitive employment before TBI experience worse employment outcomes than their NHW counterparts after TBI at 2 years post TBI. Further research is needed to understand better the factors driving these disparities and how social determinants of health affect these racial differences after TBI.

Racial and Ethnic Differences in Distress, Depression, and Quality of Life in people with hemophilia.

Hemophilia-related distress (HRD) has been shown to be higher among those with lower educational attainment, but potential racial/ethnic differences have not been previously described. Thus, we examined HRD according to race/ethnicity. This cross-sectional study was a planned secondary analysis of the hemophilia-related distress questionnaire (HRDq) validation study data. Adults aged ≥ 18years with Hemophilia A or B were recruited from one of two hemophilia treatment centers between July 2017-December 2019. HRDq scores can range from 0-120, and higher scores indicate higher distress. Self-reported race/ethnicity was grouped as Hispanic, non-Hispanic White (NHW) and non-Hispanic Black (NHB). Unadjusted and multivariable linear regression models were used to examine mediators of race/ethnicity and HRDq scores. Among 149 participants enrolled, 143 completed the HRDq and were included in analyses. Approximately 17.5% of participants were NHB, 9.1% were Hispanic and 72.0% were NHW. HRDq scores ranged from 2 to 83, with a mean of 35.1 [standard deviation (SD) = 16.5]. Average HRDq scores were significantly higher among NHB participants (mean = 42.6,SD = 20.6; p-value = .038) and similar in Hispanic participants (mean = 33.8,SD = 16.7, p-value = .89) compared to NHW (mean = 33.2,SD = 14.9) participants. In multivariable models, differences between NHB vs NHW participants persisted when adjusting for inhibitor status, severity, and target joint. However, after household income was adjusted for, differences in HRDq scores were no longer statistically significant (β = 6.0 SD = 3.7; p-value = .10). NHB participants reported higher HRD than NHW participants. Household income mediated higher distress scores in NHB compared to NHW participants, highlighting the urgent need to understand social determinants of health and financial hardship in persons with hemophilia.

Cardiovascular Disease Risk Assessment Using Traditional Risk Factors and Polygenic Risk Scores in the Million Veteran Program

Primary prevention of atherosclerotic cardiovascular disease (ASCVD) relies on risk stratification. Genome-wide polygenic risk scores (PRSs) are proposed to improve ASCVD risk estimation. To determine whether genome-wide PRSs for coronary artery disease (CAD) and acute ischemic stroke improve ASCVD risk estimation with traditional clinical risk factors in an ancestrally diverse midlife population. This was a prognostic analysis of incident events in a retrospectively defined longitudinal cohort conducted from January 1, 2011, to December 31, 2018. Included in the study were adults free of ASCVD and statin naive at baseline from the Million Veteran Program (MVP), a mega biobank with genetic, survey, and electronic health record data from a large US health care system. Data were analyzed from March 15, 2021, to January 5, 2023. PRSs for CAD and ischemic stroke derived from cohorts of largely European descent and risk factors, including age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, smoking, and diabetes status. Incident nonfatal myocardial infarction (MI), ischemic stroke, ASCVD death, and composite ASCVD events. A total of 79 151 participants (mean [SD] age, 57.8 [13.7] years; 68 503 male [86.5%]) were included in the study. The cohort included participants from the following harmonized genetic ancestry and race and ethnicity categories: 18 505 non-Hispanic Black (23.4%), 6785 Hispanic (8.6%), and 53 861 non-Hispanic White (68.0%) with a median (5th-95th percentile) follow-up of 4.3 (0.7-6.9) years. From 2011 to 2018, 3186 MIs (4.0%), 1933 ischemic strokes (2.4%), 867 ASCVD deaths (1.1%), and 5485 composite ASCVD events (6.9%) were observed. CAD PRS was associated with incident MI in non-Hispanic Black (hazard ratio [HR], 1.10; 95% CI, 1.02-1.19), Hispanic (HR, 1.26; 95% CI, 1.09-1.46), and non-Hispanic White (HR, 1.23; 95% CI, 1.18-1.29) participants. Stroke PRS was associated with incident stroke in non-Hispanic White participants (HR, 1.15; 95% CI, 1.08-1.21). A combined CAD plus stroke PRS was associated with ASCVD deaths among non-Hispanic Black (HR, 1.19; 95% CI, 1.03-1.17) and non-Hispanic (HR, 1.11; 95% CI, 1.03-1.21) participants. The combined PRS was also associated with composite ASCVD across all ancestry groups but greater among non-Hispanic White (HR, 1.20; 95% CI, 1.16-1.24) than non-Hispanic Black (HR, 1.11; 95% CI, 1.05-1.17) and Hispanic (HR, 1.12; 95% CI, 1.00-1.25) participants. Net reclassification improvement from adding PRS to a traditional risk model was modest for the intermediate risk group for composite CVD among men (5-year risk >3.75%, 0.38%; 95% CI, 0.07%-0.68%), among women, (6.79%; 95% CI, 3.01%-10.58%), for age older than 55 years (0.25%; 95% CI, 0.03%-0.47%), and for ages 40 to 55 years (1.61%; 95% CI, -0.07% to 3.30%). Study results suggest that PRSs derived predominantly in European samples were statistically significantly associated with ASCVD in the multiancestry midlife and older-age MVP cohort. Overall, modest improvement in discrimination metrics were observed with addition of PRSs to traditional risk factors with greater magnitude in women and younger age groups.

Barriers to Surrogate Application of Patient Values in Medical Decisions in Acute Stroke: Qualitative Study in a Biethnic Community.

The objective of this study was to identify barriers to surrogate decision-maker application of patient values on life-sustaining treatments after stroke in Mexican American (MA) and non-Hispanic White (NHW) patients. We conducted a qualitative analysis of semistructured interviews with stroke patient surrogate decision-makers completed approximately 6months after hospitalization. Forty-two family surrogate decision-makers participated (median age: 54.5years; female: 83%; patients were MA [60%] and NHW [36%], and 50% were deceased at the time of the interview). We identified three primary barriers to surrogates' applications of patient values and preferences when making decisions on life-sustaining treatments: (1) a minority of surrogates had no prior discussion of what the patient would want in the event of a serious medical illness, (2) surrogates struggled to apply prior known values and preferences to the actual decisions made, and (3) surrogates felt guilt or burden, often even in the setting of some knowledge of patient values or preferences. The first two barriers were seen to a similar degree in MA and NHW participants, though guilt or burden was reported more commonly among MA (28%) than NHW (13%) participants. Maintaining patient independence (e.g., ability to live at home, avoid a nursing home, make their own decisions) was the most important priority for decision-making for both MA and NHW participants; however, MA participants were more likely to list spending time with family as an important priority (24% vs. 7%). Stroke surrogate decision-makers may benefit from (1) continued efforts to make advance care planning more common and more relevant, (2) assistance in how to apply their knowledge of patient values to actual treatment decisions, and (3) psychosocial support to reduce emotional burden. Barriers to surrogate application of patient values were generally similar in MA and NHW participants, though the possibility of greater guilt or burden among MA surrogates warrants further investigation and confirmation.

Assessing how lung cancer screening guidelines contribute to racial disparities in screening access.

Lung cancer (LC) is the leading cause of cancer-related deaths in the United States (U.S.), with non-White people who smoke often bearing the burden of the highest rate of LC mortality. This is often due to later stage diagnoses, leading to poor prognosis and outcomes. We assess here how the eligibility criteria for LC screening set by the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) could contribute to racial disparities in screening access. This paper analyzes data from the National Health and Nutrition Examination Survey (NHANES), an annual survey conducted by the Centers for Disease Control and Prevention (CDC) that gathers health and nutrition data from a representative sample of the U.S. population. After excluding those who were ineligible for LC screening, the final cohort of participants was 5,001, which consisted of 2,669 people who formerly smoked and 2,332 people who currently smoke. Out of 608 participants who were eligible for LC screening, 77.5% were non-Hispanic White (NHW) and 8.7% were non-Hispanic Black (NHB) participants versus 69.4% and 10.8% among 4,393 ineligible participants. Age, pack-years, and age along with pack-years were the most frequent reasons for ineligibility. LC screening ineligible NHW participants were statistically significantly older and had higher mean pack-years than the other racial and ethnic groups. NHB participants among the ineligible group had higher urinary cotinine levels compared to NHW participants. This paper underscores the need for more individualized risk estimates when determining eligibility for LC screening, which could include biomarkers of smoking exposure. The analysis shows that current screening criteria, which rely solely on factors such as age and pack years, contribute to LC racial disparities.

Psychological Trauma of COVID-19 in Pregnancy: Diagnosis, Treatment, and Recovery [ID: 1378016

INTRODUCTION: The objective of this study was to delineate birthing persons' accounts of COVID-19 diagnosis, inpatient treatment, and recovery from infection and the effect on mental health. METHODS: This is a prospective qualitative study of English-speaking birthing people hospitalized for treatment of COVID-19 during pregnancy at a single quaternary care center from August 2021 to March 2022. Semistructured interviews were conducted to examine emotional reactions to developing COVID-19 during pregnancy, experiences with hospital admission and inpatient care, and effect on mental health after recovery. All interviews were audio-recorded, professionally transcribed, and iteratively coded for inductive narrative analysis. RESULTS: Eight birthing people participated in interviews. Universally, participants experienced feelings of fear, panic, and frustration with the diagnosis of COVID-19 infection and their need to be hospitalized. Inpatient care engendered feelings of isolation and disconnection due to separation from family and limited interaction with health care team members. Compared to non-Hispanic White participants, non-Hispanic Black participants were more likely to express feelings of discrimination and disrespectful care. After discharge, participants described intentionally avoiding people to minimize risk of reinfection, further increasing fears of anxiety and isolation even months after diagnosis. Postdischarge recovery also included ongoing recovery from physical symptoms, including breathing and activities of daily living. CONCLUSION: Birthing people reported significant psychological trauma after their diagnosis, treatment, and recovery from COVID-19 infection in pregnancy. These experiences highlight the importance of focusing on mental health as part of recovery and outline opportunities to improve the provision of respectful, equitable care.

Investigating Racial and Ethnic Differences in Diabetes Self-Management Education Among Adults With Diabetes

The purpose of this study was to examine racial and ethnic differences in diabetes self-management education (DSME) participation among adults with diabetes. Population-based, cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System diabetes module were analyzed. Study cohort included 9881 adults age 18 years or older with self-reported diabetes living in 11 US states, Washington, DC, and Puerto Rico. The outcome variable was participation in DSME. Weighted descriptive statistics and multivariable logistic regression were computed to investigate the association between race and ethnicity and participation in DSME, adjusting for self-reported social determinants of health factors (eg, sex, education, employment, health insurance). Overall, 19.3% self-identified as non-Hispanic Black, 16.5% as Hispanic, and 59.9% as non-Hispanic White. Of participants, 44.3% were between 66 and 80 years old, and 50.4% were women. Half (50.1%) reported participating in DSME, and 78.5% had seen clinicians for diabetes-related care 1 to 5 times in the past year. Hispanic participants were less likely to report participation in DSME (28.5%) compared to non-Hispanic Black (60.3%) and non-Hispanic White (53.4%) participants (P < .001). Adults with diabetes who were less likely to participate in DSME tend to be unmarried, have high school or lower-level education, and not exercise regularly. Racial and ethnic differences exist in DSME participation. Because DSME has been shown to improve diabetes outcomes, there is a need to develop strategies promoting equity in DSME participation, particularly among Hispanic populations, to reduce health disparities in diabetes care.

Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities.

COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. To characterize COVID-19 vaccine hesitancy in underserved diverse populations. The Minority and Rural Coronavirus Insights Study recruited a convenience sample of adults (ages ≥18, n=3,735) from Federally Qualified Health Centers in California, Midwest (Illinois/Ohio), Florida and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as responses "no" or "undecided" to the question "Would you get a coronavirus vaccine, if it was available?" ("yes" categorized as not hesitant). The cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed by the chi-squared test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Interactions between geography and each demographic characteristic were evaluated in separate models. The strongest vaccine hesitancy variability was by geographic region: in California 28.3% (26.5-31.1), the Midwest 36.1 % (32.1-40.2), Louisiana 59.1% (56.0-62.1), Florida 67.9% (65.0-70.8). The expected estimates for the general population were lower: 9.7% (California), 15.2 % (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shape age pattern was found, with the highest prevalence among ages 25-34 in the Midwest (39.3%), Florida (79.5%,) and Louisiana (79.4%) (p <0.05). Females were more hesitant than males in the Midwest (36.5% vs 23.9%), Florida (71.6% vs 59.4%), and Louisiana (66.5% vs. 46.4%) (p<0.05). Racial/ethnic differences were found in California with the highest prevalence among non-Hispanic Black (45.8%) and in Florida with the highest among Hispanic (69.3%) participants (p<0.05) but not in the Midwest and Louisiana. The main effect model confirmed the U-shape association with age: strongest association with age 25-34, OR=2.28 (1.74, 2.99). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. The associations with the female gender were strongest in Florida and Louisiana: ORs were 7.83 (5.94, 10.33) and 6.04 (4.52, 8.06) compared to males in California, respectively. Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida and Black in Louisiana: ORs were 11.18 (7.01, 17.85) and 8.94 (5.53, 14.47), respectively. However, the strongest race/ethnicity variability was observed within California and Florida: ORs varied 4.7- and 2-fold between racial/ethnic groups in these regions, respectively. These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns.

A Cross-Sectional Study of Home Blood Pressure Monitoring after Stroke (P11-5.015)

<h3>Objective:</h3> In individuals with hypertension, lowering blood pressure after stroke can lower the risk of stroke recurrence, but many patients do not reach goal. Home blood pressure monitoring (HBPM) can help patients achieve their goal. However, rates of use and quality of technique have not been evaluated, which we aim to evaluate in this cross-sectional study. <h3>Background:</h3> Hypertension (HTN) affects approximately 70% of patients with a recent stroke and treatment is highly effective in reducing risk for recurrence. In multiple studies the reduction of blood pressure, by life style changes or pharmacotherapy have significantly reduced the risk for fatal or non-fatal stroke. Therefore, blood pressure lowering is effective for secondary stroke prevention. <h3>Design/Methods:</h3> We conducted a cross-sectional study of patients with stroke. Patients were eligible if they had a stroke within two years, had hypertension, and lived at home. We classified patients as correctly performing HBPM if they used an arm cuff, sat ≥1 min before measurement, took ≥2 measurements, and use within 6 months. The primary outcome was determine HBPM was used correctly. Which we calculated according to race and ethnicity. We ask for additional steps if BP out of range. <h3>Results:</h3> Among 150 participants, 120 (81%) possessed a HBPM and 29 (21%) used it correctly. We observed no significant disparity in rates of possession or correct use between non-Hispanic White participants and participants from underrepresented groups. Seventy percent of non-Hispanic White patients said they would contact their provider if their BP was above goal vs. 52% of underrepresented patients (p=0.21). <h3>Conclusions:</h3> Most patients after stroke have a HBPM, but only about 1 in 5 use it correctly. Approximately half of patients from underrepresented racial or ethnic groups do not have a plan for responding to values above goal. Our results indicate opportunities to improve the dissemination and correct use of HBPM. <b>Disclosure:</b> Dr. Mariscal has nothing to disclose. Dr. Forman has nothing to disclose. Ms. Viscoli has nothing to disclose. Katherine Meuer has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. Dr. Sansing has nothing to disclose. Dr. De Havenon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Integra. Dr. De Havenon has stock in Certus. The institution of Dr. De Havenon has received research support from NIH/NINDS. The institution of Dr. De Havenon has received research support from Regeneron Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMAG Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMGEN. Dr. De Havenon has received publishing royalties from a publication relating to health care. Dr. Sharma has nothing to disclose. Dr. Kernan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for various law firms.

Participation in and Satisfaction with a Community-Based Physical Activity Program Among Hispanic Cancer Survivors.

The objective of this study was to explore the experience of Hispanic cancer survivors participating in Active Living After Cancer (ALAC), a community-based physical activity program. We analyzed participation and satisfaction data from 250 participants who completed the program from 2017 to 2020 (55% Hispanic, 28% Black, 14% non-Hispanic White). Using a hybrid coding approach, open-text survey comments responses from Hispanic participants (n = 138) were qualitatively analyzed and key themes developed to better contextualize the quantitative results. Quantitative analysis revealed that Hispanic participants attended an average of 9.44 out of 12 sessions. There were no differences in attendance by race/ethnicity; however, Hispanic participants reported significantly higher overall satisfaction ratings than non-Hispanic White participants (4.93 vs 4.65 on a 5-point scale). Open-ended comments indicated that Hispanic ALAC participants experience collective efficacy, self-efficacy, and self-regulation, through observational learning enabled by program facilitation. The ALAC program is highly acceptable and relevant to Hispanic cancer survivors and will inform the continued expansion of other community-based survivorship programs for Hispanic communities throughout Texas.

Factors Associated With Sex Disparities in Leisure-Time Physical Activity: An Analysis of the Behavioral Risk Factor Surveillance System, 2011 to 2021

ObjectiveTo identify whether sex disparities in leisure-time physical activity (LTPA) vary across population subgroups. Participants and MethodsWe used data from the Behavioral Risk Factor Surveillance System (BRFSS) spanning 2011 to 2021. We examined subgroups by age, race/ethnicity, income, employment, education, marital status, body mass index, and cardiometabolic comorbidities (diabetes, hypertension, and cardiovascular disease) to identify where sex disparities in LTPA are most pronounced. ResultsAmong 4,415,992 respondents (57.4% [2,533,234] women and 42.6% [1,882,758] men), women were less likely than men to report LTPA (73.0% vs 76.8%; odds ratio [OR], 0.817; 95% CI, 0.809 to 0.825). The gap was widest between the youngest (OR for the 18- to 24-year age group, 0.71; 95% CI, 0.68 to 0.74) and oldest (OR for the 80 years or older age group, 0.71; 95% CI, 0.69 to 0.73) respondents but was narrower between middle-aged adults (OR for the 50- to 59-year age group, 0.95; 95% CI, 0.93 to 0.97). Disparity was greater among non-Hispanic Black participants (OR, 0.70; 95% CI, 0.68 to 0.72) and Hispanic participants (OR, 0.79; 95% CI, 0.77 to 0.81) than among non-Hispanic White participants (OR, 0.85; 95% CI, 0.84 to 0.86). Disparities were greater at the lowest income levels (OR, 0.81; 95% CI, 0.78 to 0.85) and lower at the highest income levels (OR, 0.94; 95% CI, 0.91 to 0.96). The disparity was greater in unemployed individuals (OR, 0.78; 95% CI, 0.76 to 0.80) compared with employed individuals (OR, 0.91; 95% CI, 0.90 to 0.92). Moreover, disparity was greater in individuals with a body mass index in the overweight or obese range and those with diabetes, hypertension, or cardiovascular disease. ConclusionWomen are less likely than men to engage in LTPA. These disparities are greatest among the young and elderly, Black and Hispanic individuals, lower income and unemployed individuals, and individuals with cardiometabolic disease. Targeted interventions are needed to reduce sex-related disparities.