Nonwhite Populations Research Articles

Performance of polygenic risk scores for cancer prediction in a racially diverse academic biobank

PurposeGenome-wide association studies have identified hundreds of single nucleotide variations (formerly single nucleotide polymorphisms) associated with several cancers, but the predictive ability of polygenic risk scores (PRSs) is unclear, especially among non-Whites. MethodsPRSs were derived from genome-wide significant single-nucleotide variations for 15 cancers in 20,079 individuals in an academic biobank. We evaluated the improvement in discriminatory accuracy by including cancer-specific PRS in patients of genetically-determined African and European ancestry. ResultsAmong the individuals of European genetic ancestry, PRSs for breast, colon, melanoma, and prostate were significantly associated with their respective cancers. Among the individuals of African genetic ancestry, PRSs for breast, colon, prostate, and thyroid were significantly associated with their respective cancers. The area under the curve of the model consisting of age, sex, and principal components was 0.621 to 0.710, and it increased by 1% to 4% with the inclusion of PRS in individuals of European genetic ancestry. In individuals of African genetic ancestry, area under the curve was overall higher in the model without the PRS (0.723-0.810) but increased by <1% with the inclusion of PRS for most cancers. ConclusionPRS moderately increased the ability to discriminate the cancer status in individuals of European but not African ancestry. Further large-scale studies are needed to identify ancestry-specific genetic factors in non-White populations to incorporate PRS into cancer risk assessment.

Abstract 9121: Lipoprotein(a) and the Risk for Coronary Heart Disease and Ischemic Stroke Events Among Black and White Adults with Cardiovascular Disease

Introduction: Lp(a) is a risk marker for incident coronary heart disease (CHD) and ischemic stroke. It is unclear if Lp(a) is associated with CHD and stroke events among adults with prevalent cardiovascular disease (CVD), particularly in non-White populations. Hypothesis: Higher Lp(a) levels are associated with an increased risk for both CHD and ischemic stroke events in Black and White adults with prevalent CVD. Methods: We conducted a case-cohort analysis including Black and White adults ≥45 years of age enrolled in the nationwide REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007 who had prevalent CVD at baseline. REGARDS study participants were followed for CHD and ischemic stroke events, which were expert adjudicated. Lp(a) molar concentration was measured using a particle-enhanced turbidimetric immunoassay from blood samples collected at baseline in a random subcohort of participants with prevalent CVD (n=1,948), and in all those with prevalent CVD who experienced a CHD event by December 31, 2017 (n=1,166), or an ischemic stroke by September 30, 2019 (n=492). Results: The median [25 th , 75 th percentile] Lp(a) concentration was 100 nmol/L [48, 186] among Black participants and 23 nmol/L [8, 113] among White participants (p-value &lt;0.001). Higher Lp(a) was associated with an increased risk for CHD events among both Black and White participants, but it was not associated with the risk for ischemic stroke (Table). At baseline, 49% of Black participants and 59% of White participants with prevalent CVD were taking a statin. Among Black and White participants taking a statin, the hazard ratio [95% CI] associated with 1 SD higher log-Lp(a) was 1.69 [0.98, 2.93] and 1.38 [1.03, 1.85], respectively, for CHD, and 1.29 [0.70, 2.40] and 1.18 [0.81, 1.72], respectively, for stroke. Conclusion: Higher Lp(a) is a risk marker for CHD but not for ischemic stroke events in Black and White adults with prevalent CVD, including those taking a statin.

Structural and Social Barriers to Survival in Adolescent and Young Adult (AYA) Patients with Acute Myeloid Leukemia (AML)

IntroductionAYA cancer patients (pts) face unique healthcare disparities due to their social development stage. AYA with AML and minorities continue to suffer reduced survival (Kahn, Cancer, 2016). Our group demonstrated that structural violence, specifically neighborhood socioeconomic status (SES), significantly impacts adult AML survival (Abraham, Blood, 2020). This real-world study, in a segregated metropolitan area, confirms inferior survival in the non-white (NW) AYA AML population and explores social barriers that contribute to disparities.MethodsAYA AML (non-APL) pts, age 18 to 39, diagnosed and treated between 2012- 2018 at 6 cancer centers across the Chicago area were included. Race/ethnicity was categorized as Non-Hispanic White (NHW), Hispanic, non-Hispanic Black (NHB), and Other. Census tract data was collected using the FFIEC Geocoding/Mapping System and computed tract disadvantage and affluence scores, divided into high, moderate, and low tertiles. A survival analysis was performed to generate hazard ratios (HR) for all-cause mortality between NHW and NW pts. Social determinants of health explored for AYA outcomes included caregiver responsibilities, employment, time off work, mental health, Charlson Comorbidity Index (CCI) and obesity.ResultsTable 1 shows demographic data (n=101); 46% were NHW, 17% were NHB, 30% were Hispanic, and 8% were other. Median age was 31 years. The number of pts with children was similar across all groups, while more NHW (29%) and Hispanic (21%) pts reported being caregivers to other household members compared to NHB pts (0%), despite their young age (p=0.09). Overall, 68% of pts never met with a fertility specialist, more frequently due to no counseling (77%) than patient preference (23%). Most pts were not in school during treatment. NHW pts took time off work and filed for disability more commonly than NHB and Hispanic pts. NHW (65%) and Hispanic (71%) pts both reported anxiety and/or depression during treatment more than NHB pts (33%). Yet, NHW pts (68%) were referred to psychiatry more often than Hispanic pts (54%).Payer source differed significantly. Most NHW pts had private insurance, unlike NHB and Hispanic pts (74% vs. 41% vs. 43% respectively). The largest uninsured population was Hispanic (33%) compared to NHW (4%) and NHB (6%) pts. NHB pts (76%) tended to reside in more disadvantaged areas, while Hispanics (60%) tended to live in less affluent areas.ELN classification was comparable amongst NHW and NHB pts, while the largest group of favorable risk pts were Hispanic (37%). Extramedullary disease was more frequent in NHB (25%) and Hispanic (14%) compared to NHW (7%) pts. FLT3-ITD mutations and NPM1 mutations were more prevalent in NHW pts. Molecular testing was not done on most pts.Overall, 87% achieved CR/CRi. Notably, ICU stays during or post induction were higher in NHB (41%) and Hispanic (57%) compared to in NHW (33%) pts. Transplant status differed significantly with 87% of NHW pts receiving a transplant compared to NHB (41%) and Hispanic (57%) pts. Relapse rates were similar between all groups. However, the incidence of death within 2 years of diagnosis was highest in NHB (24%) and Hispanic (30%) pts, and nearly half that in the NHW pts (17%). (Table 2)32 pts died, 22 due to leukemia. Hazard of all-cause mortality was over twice as great for NW than for NHW pts HR=2.22 (95% CI:1.06, 4.65). Statistical adjustment for tract SES accounted for 57% of the survival disparity, reducing the HR to 1.53 (95% CI:0.59, 3.87). Further adjustment for treatment center reduced the HR to 1.25 (95% CI: 0.48, 3.28); together, treatment center and tract SES accounted for 80% of the survival disparity. Adjustment for private insurance, transplant status, clinical trial enrollment, prognosis (based on ELN classification and secondary AML) and BMI/CCI did not appear to account for any of the survival disparity. (Table 3)ConclusionOur study shows that Hispanic and NHB AYA AML pts have inferior survival compared to NHW pts despite similar ELN risk groups, treatment, response and relapse rates. Census tract-level SES related to differential resources in neighborhoods explained a significant proportion of the disparity in hazard of all-cause mortality. Our work highlights social determinants of health in AYA leukemia pts must be elucidated to determine mechanisms underlying structural barriers and inform future interventions to mitigate survival disparities. [Display omitted] DisclosuresPatel: Pfizer: Research Funding; Celgene/BMS: Research Funding. Stock: Pfizer: Consultancy, Honoraria, Research Funding; amgen: Honoraria; agios: Honoraria; jazz: Honoraria; kura: Honoraria; kite: Honoraria; morphosys: Honoraria; servier: Honoraria; syndax: Consultancy, Honoraria; Pluristeem: Consultancy, Honoraria. Altman: Theradex: Consultancy; Syros: Consultancy; Kuro Oncology: Consultancy; Daiichi Sankyo: Consultancy; Astellas: Consultancy; AbbVie: Consultancy; Glycomimetics: Membership on an entity's Board of Directors or advisory committees; BioSight: Consultancy, Other: Travel fees to attend an advisory meeting (I did not accept payment for the advisory board). Dinner: Kite/Gilead: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria.

Disparities in the Use of Mechanical Thrombectomy Alone Compared with Adjunctive Intravenous Thrombolysis in Acute Ischemic Stroke in the United States.

For patients with large-vessel occlusion, mechanical thrombectomy (MT) without IV-tPA is a proved strategy. The relative benefit of direct MT versus MT+IV-tPA for patients with indications for IV-tPA is being actively investigated. We used a national inpatient database to assess trends in use and patient profiles after MT+IV-tPA versus mechanical thrombectomy alone. The National Inpatient Sample was queried between 2013 and 2018 for patients undergoing mechanical thrombectomy for acute ischemic stroke. Patients who received mechanical thrombectomy alone were compared with those who underwent MT+IV-tPA. The Cochran-Armitage test was conducted to assess the linear trend of use of mechanical thrombectomy alone among the entire cohort and between admissions involving non-White and White patients. All estimates were nationalized using discharge weights. A total of 89,645 weighted admissions were identified pertaining to mechanical thrombectomy for acute ischemic stroke from 2013 to 2018. Of these, 59,935 (66.9%) admissions involved mechanical thrombectomy alone. There was an increase in the trend toward the use of mechanical thrombectomy alone (trend: 3.26%; P < .001) per year. Multivariable regression analysis regarding patient profiles indicated that patients who identified as Black (OR = 0.83, P = .001) or Hispanic (OR = 0.79; P < .001) were more likely to undergo mechanical thrombectomy alone compared with those who identified as White. There was no statistically significant difference in the slope between non-White and White populations receiving mechanical thrombectomy alone (trend: +0.93% in favor of non-White; P = .096). Our results indicated that mechanical thrombectomy alone was used more frequently than MT+IV-tPA among patients with acute ischemic stroke. The disparity between those who identify as White and non-White persisted across the years, though it is closing.

Prevalence of cardiac pathology and relation to mortality in a multiethnic population hospitalised with COVID-19

ObjectiveTo determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19.MethodsA retrospective and prospective observational study of...

Association between particulate matter air pollution and heart attacks in San Diego County

ABSTRACT Air pollution is one of the major risk factors contributing to adverse public health outcomes worldwide. Fine particulate matter (PM2.5) has been repeatedly associated with increased risk of cardiovascular events, including heart attacks. Because PM2.5 is unequally distributed with elevated concentrations near high-traffic and industrial zones, PM2.5 is an environmental justice issue of major public health concern. In this study, we reviewed the relationship between PM2.5, emergency visits due to heart attacks, and environmental justice in San Diego County using data from CalEnviroScreen 3.0. Our results indicate that PM2.5, diesel PM emissions, and emergency visits due to heart attacks are weakly, but positively correlated (r = 0.3, R2 < 0.1). Areas classified as environmental justice communities, communities comprised more dominantly of nonwhite populations, and communities closer to the San Diego-Tijuana border are exposed disproportionately to air pollution in San Diego County. Overall, this work demonstrates that there is an association between elevated local PM concentrations in San Diego County communities with emergency hospital visits due to heart attacks, and that these associations are an environmental justice issue disproportionally affecting disadvantaged communities. Implications: Particulate matter is an adverse contributor to overall health throughout the lifespan, contributing to diseases such as asthma, hypertension, stroke, and increased risk of cardiovascular events. Here, we assess the relationship between particulate matter and heart attacks in San Diego County using CalEnviroScreen3.0. Using these tools, we also examine correlations between this relationship and different sociodemographic indicators such as age, race, income, and proximity to the high-traffic U.S.–Mexico border. Overall, we show that specific communities around San Diego are more highly exposed to particulate matter, and that these relationships may be disproportionately contributing to heart attacks in disadvantaged communities.

Racism! What do you mean? From Howell and Richter-Montpetit’s underestimation of the problem, towards situating security through struggle

I suggest in this essay that colonialism and racism penetrate the intellectual foundations of security studies at a level deeper than recent discussion would have us believe. This is because of unstated or disavowed ontological assumptions that shape the parameters of the field and lead scholars to foreclose upon a deeper understanding of systemic, racialized relations of violence. The problem in much critical scholarship on security, I will argue, is not only a failure to grasp the centrality of structural racism to the practices and interventions under examination. It is a more insidious matter of what knowledges, experiences and struggles are invisible, and – as a result – what practices and interventions are not subject to examination because of the centrality given to security. Even when security is understood in the broadest sense, it is still practices that are about threat and danger, friendship and enmity, that catch the eye of the critical scholar. The result is a tendency to natural- ize the denigration and abandonment of non-white and poor populations deemed lacking in the qualities for success within a profoundly violent global political economy. After staking out my critique – and why I think recent discussion of racism in security studies only scratches the surface of the problem – I will consider how research agendas and methods might be recalibrated with a greater sensitivity towards colonialism and race. Crucially, I caution against attempts to ‘decolonize security studies’ by seeking to add the insights of decolonial and critical race scholarship to the field (see Adamson, 2020) without attention to the ontological assumptions that make it natural to centre security. Taking inspiration from Lewis Gordon (2011) and Olivia Rutazibwa (2020), as well as from my own engagement with decolonial social move- ments, I propose that part of what is required is greater attention to lived thought, to how reality always exceeds the questions our scholarly communities lead us to ask, and to what is revealed when we consider security through the lens of struggle.

Climate Justice and California's Methane Superemitters: Environmental Equity Assessment of Community Proximity and Exposure Intensity.

Methane superemitters emit non-methane copollutants that are harmful to human health. Yet, no prior studies have assessed disparities in exposure to methane superemitters with respect to race/ethnicity, socioeconomic status, and civic engagement. To do so, we obtained the location, category (e.g., landfill, refinery), and emission rate of California methane superemitters from Next Generation Airborne Visible/Infrared Imaging Spectrometer (AVIRIS-NG) flights conducted between 2016 and 2018. We identified block groups within 2 km of superemitters (exposed) and 5-10 km away (unexposed) using dasymetric mapping and assigned level of exposure among block groups within 2 km (measured via number of superemitter categories and total methane emissions). Analyses included 483 superemitters. The majority were dairy/manure (n = 213) and oil/gas production sites (n = 127). Results from fully adjusted logistic mixed models indicate environmental injustice in methane superemitter locations. For example, for every 10% increase in non-Hispanic Black residents, the odds of exposure increased by 10% (95% confidence interval (CI): 1.04, 1.17). We observed similar disparities for Hispanics and Native Americans but not with indicators of socioeconomic status. Among block groups located within 2 km, increasing proportions of non-White populations and lower voter turnout were associated with higher superemitter emission intensity. Previously unrecognized racial/ethnic disparities in exposure to California methane superemitters should be considered in policies to tackle methane emissions.

Intense SARS-CoV-2 transmission among affluent Manaus residents preceded the second wave of the epidemic in Brazil

Intense SARS-CoV-2 transmission among affluent Manaus residents preceded the second wave of the epidemic in Brazil

An Association between Bioavailable 25-Hydroxyvitamin D and Bone Mineral Density in a Diverse Cohort of Collegiate Athletes.

Although vitamin D is intimately involved in bone metabolism, the relationship between vitamin D status, as measured by serum total 25-hydroxyvitamin D [25(OH)D] concentration, and bone mineral density (BMD) is weak, particularly in non-White populations. Measurement of bioavailable 25(OH)D has been suggested as a better indicator of vitamin D status than total 25(OH)D concentration. To date, the bioavailable 25(OH)D biomarker has been explored minimally in athletic populations. The purpose of this study was to investigate the relationship between total and bioavailable 25(OH)D concentrations and BMD in collegiate athletes. NCAA Division I basketball and swimming athletes served as study participants (n = 53; 28 females, 25 males; 28 basketball players, 25 swimmers). All participants completed dual-energy x-ray absorptiometry scans for analysis of BMD, blood draws for vitamin D measures, and diet/lifestyle questionnaires. Overall, total 25(OH)D was 80.0 + 13.9 nmol·L-1 and bioavailable 25(OH)D was 6.0 ± 1.9 nmol·L-1. There was strong disagreement between total 25(OH)D and bioavailable 25(OH)D concentrations (κ = -0.299, r = -0.129) (P = 0.100); 53% of total participants and 77% of Black participants were classified differently (low vs normal vitamin D status) based on total and bioavailable 25(OH)D criteria. Black participants had significantly lower total 25(OH)D and higher bioavailable 25(OH)D concentrations than White participants (59.5 vs 102.5 nmol·L-1 and 7.9 vs 5.4 nmol·L-1, respectively) (P < 0.001). Total 25(OH)D and total BMD were not correlated, but bioavailable 25(OH)D and total BMD demonstrated a positive correlation (r = 0.618, P < 0.01). These results suggest that bioavailable 25(OH)D concentration may be a better clinical measure of vitamin D status than total 25(OH)D as related to BMD in collegiate athletes, particularly in Black athletes. Further research on the utility of the bioavailable 25(OH)D biomarker in athletes is needed.

Trends in racial disparities of emergency department utilization for asthma in coronavirus disease 2019

Racial disparities between White and non-White patients with asthma in the United States have been documented before the coronavirus disease 2019 (COVID-19) pandemic.1,2 During the pandemic, non-White populations experienced disproportionately higher rates of COVID-19 infection, hospitalization, and mortality.3 Survey data of patients and providers also suggest that the pandemic worsened the ability of non-White patients with asthma’ to afford asthma medications and control their symptoms.4 The pandemic did, however, hasten the adoption of several societal and health care system changes, including mask use, social distancing, remote work and schooling, and expansion of telemedicine.

Environmental justice and the COVID-19 pandemic: Evidence from New York State

The decline in human mobility and socioeconomic activities during the COVID-19 pandemic has been accompanied by reports of significant improvements in air quality. We evaluate whether there was a uniform improvement in air quality across neighborhoods, with a special attention on differences by race. We focus on the COVID-19 lockdown in New York State, an early epicenter of the pandemic in the United States. Using a triple difference-in-differences model, we find that, despite the seasonal decline in particulate matter pollution starting late March (concurrent with the lockdown period), the lockdown narrowed the disparity in air quality between census tracts with high and low shares of non-white population in rural New York, whereas the racial gap in air quality remained unchanged in urban New York.

Racial and ethnic representation in primary research contributing to pelvic organ prolapse treatment guidelines.

To evaluate whether the studies contributing to the national treatment guidelines on pelvic organ prolapse adequately represent the racial and/or ethnic makeup of the American population. This analysis examines the racial and ethnic makeup of all primary study cohorts contributing to the American College of Obstetricians and Gynecologists/American Urogynecologic Society Practice Bulletin No. 214 on pelvic organ prolapse. References were excluded if they lacked a primary patient population or were from outside the US. Mean proportional representation of racial/ethnic groups was compared to the 2018 United States Census data on race/ethnicity. The representation quotient was also calculated to evaluate for relative representation of each group. Descriptive statistics were used. Of the 110 references, 53 primary studies were included in the final analysis with 30 studies reporting on race/ethnicity. On average, 82% (SD = 15%) of study populations were White, while Blacks, Hispanics, and Asians represented 67% (SD = 7%), 4% (SD = 8%), and < 1% (SD = 1%), respectively, differing significantly from the 2018 US Census (p < 0.01.) The representation quotients for White women was 1.36, demonstrating a 36% overrepresentation, while Black, Hispanic, and Asian women were underrepresented among studies of all evidence levels, with representative quotients of 0.50, 0.23, and 0.09, respectively. Our study demonstrates a significant underrepresentation of non-White populations in primary cohorts of studies contributing to the ACOG/AUGS Practice Bulletin No. 214 on POP. This analysis reinforces that more efforts are required to include and report on racial and ethnically diverse cohorts to better serve all patients.

A Scoping Review of the Health Benefits of Nature-Based Physical Activity

The health benefits of physical activity and spending time in nature are well established. However, children and adults in the United States are not participating in sufficient levels of physical activity and are not spending much time outdoors. Recently, increased access to nature for the health and wellness of all populations has seen growing public health attention, though a specific focus on nature-based physical activity has been limited. The purpose of this scoping review is to operationalize the health benefits of nature-based physical activity to provide guidance to program administrators, advocates, and researchers for nature-based physical activity to facilitate collaborations. Peer-reviewed literature was searched in PubMed, Medline, Web of Science, and Google Scholar as well as in published reviews of the literature. The literature was divided into three categories of: 1) amount and location of nature-based components and physical activity; 2) added health benefits of exposure to nature-based components and physical activity; and 3) nature-based components and physical activity effect on non-white, marginalized, and vulnerable populations. This review supports and encourages multiple strategies to increase nature-based physical activity as this provides even greater benefit to health and wellness than exposure to nature or physical activity alone. Although many of the physical and mental health benefits of nature and physical activity are well established, additional research is needed to better understand the relationship between exposure to nature and nature-based physical activity. However, the existing information justifies the promotion of nature-based physical activities in public health initiatives.

Inclusion of Under-represented Racial and Ethnic Minorities in Randomized Clinical Trials for Inflammatory Bowel Disease

The inflammatory bowel diseases (IBD), consisting of Crohn’s disease and ulcerative colitis, have historically been described predominantly in Western countries and in White populations, but there has been a steady increase in both incidence and prevalence across the globe and in varying racial and ethnic groups.1 A study describing trends in incidence rates of IBD by race in the United States highlighted an increase in incidence of IBD of 134% in non-White populations between 1970 and 2010.2 Furthermore, the incidence of IBD in non-White populations was 60% that of White populations between 2000 and 2010, an increase of 16% compared with the previous decade and a half.

Perceptions of treatment according to sexual orientation in urban substance use disorder (SUD) programs with mostly nonwhite client populations

Few studies have compared clients’ perceptions of substance use disorder (SUD) treatment by sexual orientation in programs with mostly nonwhite populations. In eight such SUD programs, treatment satisfaction, therapeutic alliance with counselors, social affiliation with other clients, and treatment connection between 58 self-identified LGB clients, 72 self-identified heterosexual clients with histories of same-gender sexual experiences (Hetero-SGSE), and 503 self-identified heterosexual clients without histories of same-gender sexual experiences (Heterosexual) were compared. Gay/bisexual men reported less social affiliation than Heterosexual men, with low rates of sexual orientation disclosure in treatment. Hetero-SGSE respondents reported less treatment connection than LGB and Heterosexual participants.

Prevalence and Population Attributable Risk for Early Chronic Obstructive Pulmonary Disease in U.S. Hispanic/Latino Individuals.

Rationale: In predominantly White populations, early chronic obstructive pulmonary disease (COPD) (i.e., COPD in people aged <50 yr) has been linked to higher hospitalization rates and mortality; however, the prevalence, risk factors, and population attributable risk (PAR) of early COPD remain to be determined in non-White populations. Objectives: We aimed to examine the prevalence, risk factors, and PARs of early COPD among Hispanic/Latino individuals, the largest U.S. minority group. Methods: We used baseline data from the Hispanic Community Health Study/Study of Latinos, a population-based probability sample of 16,415 Hispanic/Latino individuals aged 18-74 years. Participants aged <50 years were included (N = 7,323). Early COPD was defined as a forced expiratory volume in 1 second to forced vital capacity ratio less than the lower limit of normal. We used survey logistic regression analysis to identify risk factors and estimate the prevalence of early COPD. PARs of the risk factors identified were estimated. Results: A total of 524 participants met the criteria for early COPD, yielding a sex- and age-adjusted prevalence of 7.6% (95% confidence interval [CI], 6.8-8.6). Asthma (odds ratio [OR], 3.37; 95% CI, 2.57-4.41), smoking status (ever vs. never; OR, 1.65; 95% CI, 1.24-2.20), and chronic sinusitis (OR, 1.71; 95% CI, 1.09-2.66) were associated with increased odds of early COPD. Immigrants versus U.S.-born individuals have lower odds of early COPD (age at immigration <15 yr and living in the United States <10 yr; OR, 0.94; 95% CI, 0.39-2.27; age at immigration <15 yr and living in the United States ⩾10 yr; OR, 0.55; 95% CI, 0.37-0.84; age at immigration ⩾15 yr and living in the United States <10 yr; OR, 0.86; 95% CI, 0.57-1.30; and age at immigration ⩾15 yr and living in the United States ⩾10 yr; OR, 0.63; 95% CI, 0.42-0.95). Among smokers, pack-years was not associated with early COPD (5-9.9 vs. <5 pack-years; OR, 1.04; 95% CI, 0.59-1.82; ⩾10 vs. <5 pack-years; OR, 1.20; 95% CI, 0.74-1.94). The mean PAR for asthma, smoking status, and chronic sinusitis was 26.3% (95% CI, 22.1-30.3), 22.4% (95% CI, 17.4-27.1), and 6.9% (95% CI, 4.3-9.4), respectively. Conclusions: Among U.S. Hispanic/Latino individuals, asthma is one of the most important risk factors for early COPD, followed by smoking and chronic sinusitis. Immigrants appear to have a lower risk of early COPD than U.S.-born Hispanic/Latino individuals.

Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service.

Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients. To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity. For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization. We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed. Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], -3.1%; 95% CI, -5.5% to -0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, -2.1 days; 95% CI, -3.3 to -0.9). Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.

Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK.

BackgroundWe aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood.Methods and findingsParticipants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories.Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards.Study limitations include that the NSHD cohort is composed of individuals of white European heritage only, and findings may not be generalizable to the non-white British population of the same generation and did not account for other important dimensions of SEP such as income and wealth.ConclusionsIn this study, we found that socioeconomically disadvantaged individuals have earlier onset and more rapid accumulation of multimorbidity resulting in widening inequalities into old age, with independent contributions from both childhood and adulthood SEP.

Farming, Pesticides, and Brain Cancer: A 20-Year Updated Systematic Literature Review and Meta-Analysis.

Simple SummaryA synthesis of 40 years of epidemiologic studies of farming and brain cancer that updates two previous meta-analyses finds that farming with its potential for exposure to chemical pesticides is associated with an increased risk of brain cancer.Twenty additional years of epidemiologic literature have become available since the publication of two meta-analyses on farming and brain cancer in 1998. The current systematic literature review and meta-analysis extends previous research and harmonizes findings. A random effects model was used to calculate meta-effect estimates from 52 studies (51 articles or reports), including 11 additional studies since 1998. Forty of the 52 studies reported positive associations between farming and brain cancer with effect estimates ranging from 1.03 to 6.53. The overall meta-risk estimate was 1.13 (95% CI = 1.06, 1.21), suggesting that farming is associated with a 13% increase in risk of brain cancer morbidity or mortality. Farming among white populations was associated with a higher risk of brain cancer than among non-white populations. Livestock farming (meta-RR = 1.34; 95% CI = 1.18, 1.53) was associated with a greater risk compared with crop farming (meta-RR = 1.13; 95% CI = 0.97, 1.30). Farmers with documented exposure to pesticides had greater than a 20% elevated risk of brain cancer. Despite heterogeneity among studies, we conclude that the synthesis of evidence from 40 years of epidemiologic literature supports an association between brain cancer and farming with its potential for exposure to chemical pesticides.