non-Hispanic Research Articles

Frustrations with time spent on cancer care among patients with metastatic breast or advanced ovarian cancer.

235 Background: Individuals with cancer face substantial demands on their energy and time due to the complexity of cancer care. We sought to describe frustrations with time-consuming aspects of cancer care among individuals with advanced ovarian or breast cancer. We hypothesized that frustrations would be highest for time spent on administrative tasks, particularly for those who are younger, employed, and have dependents. Methods: We analyzed baseline survey data from an ongoing prospective study of the time burdens of cancer care among individuals receiving treatment for ovarian or metastatic breast cancer at the University of Minnesota and University of Alabama-Birmingham. The survey included questions about frustrations with the time needed for cancer-related activities such as travel time, finding transportation, care coordination, receiving treatment, and paperwork (0=Not at all, 10=Extremely frustrated). We summarized the data using descriptive statistics and made comparisons across demographic and clinical characteristics using Wilcoxon rank-sum and Kruskal-Wallis tests. Results: A total of 67 participants completed the baseline survey, 37 (55.2%) with metastatic breast cancer and 30 (44.8%) with ovarian cancer. About 1/4 of participants (26.9%) were under 50 years old, 34.3% had dependents, 39.1% were employed, and 57.6% lived 30+ miles from the cancer clinic; 73.1% were non-Hispanic (NH) White and 22.4% NH Black; 4.5% reported another race/ethnicity. Over half (58.2%) agreed minimizing time spent on cancer-related activities was important to them; those employed were significantly more likely to agree (76.0% vs. 48.7%, p=0.03). Activities with the highest reported frustrations were the number of trips, time for care-related travel or paperwork, and wait time. Younger participants reported higher frustration with wait time (p=0.04) and time at the infusion center than older participants (p=0.03). Employed participants reported significant frustration with having to take time off work (p<0.0001), and those with dependents reported frustration needing to organize dependent care (p=0.01). Participants living 30+ miles from the cancer clinic reported greater frustrations with travel time (p=0.01), time needed for care coordination (p=0.01) and waiting for the provider (p=0.02). Some (10.6%) participants reported lacking reliable transportation and, among those, reported high frustration with the time needed for numerous activities, including finding transportation, paperwork, care coordination, and making appointments (all p<0.05). Conclusions: Cancer-related time demands are frustrating for many patients. Those employed, younger, with dependents, living further from the cancer clinic, and without reliable transportation experience greatest frustrations about time lost, underscoring the need to address these often unrecognized aspects of care.

Favorable Trends in Mortality among Patients with Concomitant Peripheral Arterial Disease and Diabetes Mellitus over Past Two Decades

BackgroundThis study examines the temporal trends in diabetes and peripheral artery disease (PAD)-related mortality in the United States, considering sociodemographic and regional factors, using data from death certificates in a national public database. MethodsData were extracted from the CDC WONDER (Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research) database from 1999 to 2020. Age-adjusted mortality rates (AAMR) per 100,000 individuals and annual percent changes (APC) with 95% confidence intervals (CI) were calculated. ResultsBetween 1999 and 2020, there were 2,252,252 PAD-related and 5,413,811 diabetes-related deaths, with 469,699 deaths involving both conditions. The overall AAMR for PAD and diabetes-related mortality (aged ≥ 25 years) decreased from 7.97 in 1999 to 6.37 in 2020, with a notable decline from 2001 to 2010 (APC: -6.16, 95% CI: -7.07, -5.23). The AAMR for PAD-related mortality fell from 40.25 to 30.56, while the AAMR for diabetes-related deaths rose from 76.71 to 93.63. Males and non-Hispanic (NH) Black individuals had higher AAMRs than females and other racial groups. The highest crude mortality rate (CMR) was in the 80-84 age group. Non-metropolitan areas consistently reported higher AAMRs than metropolitan areas, and states like Ohio, Vermont, District of Columbia, and West Virginia had significantly higher rates. ConclusionOver two decades, PAD and diabetes-related mortality trends show a positive overall reduction in AAMR. However, disparities persist, with higher rates among males, NH Black individuals, and residents of non-metropolitan areas. Significant state-level variations highlight the need for targeted interventions and tailored healthcare strategies.

Trends in Cerebrovascular Disease-related mortality among Older Adults in the United States from 1999 to 2020: an analysis of gender, race/ethnicity, and geographical disparities

One of the most prevalent causes of morbidity and death is cerebrovascular disease in the US. The manifestations and pathophysiology of cerebrovascular disease are significantly impacted by aging and determine the quality of one's late life. However, contemporary mortality trends in cerebrovascular disease and comparison to older adults of different gender, race, and geographic disparities have not been fully examined. A thorough comprehension of these correlations and current cerebrovascular disease death patterns can impact medical treatment and strategies. We examined the mortality trends according to gender, race, and geographical disparities in cerebrovascular disease among older adults, using mortality data (1999 - 2020) from the Centers for Disease Control and Prevention WONDER database METHODS: This research study aims to analyze disparities in cerebrovascular disease among senior citizens in the United States. The analysis has considered factors such as gender, race, and geographical variations over 21 years from 1999 to 2020. Mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database has been utilized for this retrospective cohort analysis, focusing on individuals aged 75 and above. From 1999 to 2020, there were 3,813,729 deaths related to Cerebrovascular disease in older adults, demonstrating a declining trend (AAPC=). Males (880.6) had slightly higher AAMRs than females (866.7). Non-Hispanic (NH) Black (1050) had higher AAMRs than NH whites (880.8) followed by NH American Indians (699.7), Hispanic (673.2), and NH Asians (669.3). AAMRs also varied by region with the Midwest (922) having the highest AAMRs followed by the South (918.2), West (884.3), and Northeast (744). Among states, Tennessee had the highest AAMRs (1076.3), whereas New York had the lowest (609.7). These results indicate a significant decline in cerebrovascular disease-related mortality among older adults from 1999 to 2020, highlighting improvements in healthcare and preventive measures over the two decades. Despite the overall decrease, elderly females had more deaths, elderly males had a higher AAMR, non-Hispanic blacks had the highest AAMR, and the Midwest and non-metropolitan areas had higher mortality burdens. The recent uptick in mortality rates from 2018 to 2020 underscores the need for ongoing public health efforts to address cerebrovascular diseases, particularly targeting vulnerable populations and high-risk regions.

Cannabis vaping use in emerging adulthood: Characterizing transitions between stages of vaping among a diverse cohort in Texas

ObjectiveTo characterize and compare transitions in cannabis (THC) vaping by sociodemographic and other risk factors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021. MethodsWe analyzed six (6) waves of panel data from n = 2605 youth transitioning into young adulthood via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system; participants provided N = 13,974 observations (i.e., completed surveys). The TATAMS sample was 37.7% Hispanic, 31.7% NH-White, 14.5% NH-Black, and 16.1% among NH-Other. We applied a three-state Markov model to estimate cannabis vaping initiation (never→ever), experimentation (never→current), escalation (ever→current), and de-escalation (current→ever). First, we compared transitions in THC vaping by race/ethnicity, with non-Hispanic (NH) Black as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of cannabis vaping transitions, examining differences by: sex, age, alcohol use, depression (PHQ-9), anxiety (GAD-7) and nicotine vaping, across each race/ethnic category. ResultsAt baseline, 72.7% never vaped cannabis, 12.7% ever vaped cannabis, and 14.5% currently vaped cannabis. Across three years, risk for cannabis vaping experimentation (never → current) was significantly greater among NH-Blacks, relative to Hispanics (aHR: 1.89), NH-Whites (aHR: 2.27), and NH-Other (aHR: 2.01). Stratified models showed that current alcohol use was a common predictor of cannabis vaping experimentation among NH-White (aHR: 5.08), Hispanic (aHR: 2.32), and NH-Black (aHR: 2.91) participants. Depression predicted cannabis vaping initiation among Hispanics (aHR: 1.75) and experimentation among NH-Blacks (aHR: 3.95). ConclusionsOnset of cannabis vaping during youth and young adulthood was most common among NH-Black youth, relative to other race/ethnic categories. Alcohol was a common predictor of cannabis vaping across race/ethnic categories while depression was linked to cannabis vaping transitions among Hispanic and NH-Black youth, only. Future research should investigate the link between alcohol use, mental health, and cannabis vaping among young people.

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

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

Abstract A025: Trends in liver cancer mortality by sex, race, and ethnicity in California from 2000-2019

Abstract Background: Liver cancer disproportionately affects foreign-born individuals and racial and ethnic minoritized groups, with higher incidence among Asian American/Pacific Islander (AAPI) and Hispanic populations than non-Hispanic (NH) White populations. California has one of the highest overall mortality rates from liver cancer and a large proportion of AAPI and Hispanic residents compared to other U.S states. While prior studies have examined racial and ethnic disparities in liver cancer incidence and treatment, few studies have examined trends in liver cancer mortality in California by sex, race, and ethnicity. Methods: Adults aged 20+ years diagnosed with first primary malignant liver and intrahepatic bile duct cancer from January 2000 through December 2019 were identified through the California Cancer Registry, a statewide population-based cancer registry. We used SEER*Stat software to compute age-adjusted mortality rates (per 100,000 population; standardized to the 2000 U.S. standard million population) by sex, race, and ethnicity. To analyze temporal trends of mortality rates, we calculated annual percent change (APC) using Joinpoint regression. Results: Overall, the mortality rate of liver cancer increased from 8.05 to 10.75 per 100,000 (average APC=1.53, 95% CI 1.23, 1.82) from 2000-2019. For males, rates increased from 11.39 in 2000 to 15.77 until 2013 (APC=2.53, 95% CI 2.07, 3.21), and stabilizing thereafter (APC=-0.74, 95% CI -2.37, 0.30). In contrast, for females, mortality rates increased continuously from 2000-2019 from 5.27 to 7.17 (APC=1.63, 95% CI 1.27, 2.04). Across racial and ethnic groups, the mortality rate for liver cancer was highest for the AAPI adults at 16.77 in 2000, and this decreased over time to 12.29 in 2019 (APC=-3.17, 95% CI -5.36, -2.24). Similarly, the liver cancer mortality rate among Hispanic adults increased initially and then decreased. Mortality among non-Hispanic Black adults increased from 10.98 in 2000 to 12.99 in 2019 (APC=0.89, 95% CI -0.07, 2.02), though this did not reach statistical significance. The liver cancer mortality rate was lowest among non-Hispanic White adults from 5.65 in 2000 but increased over time to 7.87 in 2019 (APC=1.76, 95% CI 1.39, 2.08), which is still the lowest compared to other racial and ethnic groups. Discussion: In contrast to studies that show a decline in liver cancer mortality in recent years, liver cancer mortality rates have continued to increase in California, particularly for females. Liver cancer mortality rates initially increased for AAPI and Hispanic populations but have started to stabilize. Next steps are to understand multilevel drivers contributing to these trends in liver cancer mortality in California, including individual sociodemographic and clinical factors, healthcare system factors, and neighborhood factors, including neighborhood socioeconomic status and ethnic enclaves. Citation Format: Janet N. Chu, Meera Sangaramoorthy, Meg Mckinley, Stephen Li, Mindy C. DeRouen, Alice Guan, Michele M. Tana, Ma Somsouk, Caroline A. Thompson, Chanda Ho, Hashem B. El-Serag, Iona Cheng, Scarlett L. Gomez, Salma Shariff-Marco. Trends in liver cancer mortality by sex, race, and ethnicity in California from 2000-2019 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A025.

Abstract A024: Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study

Abstract Background: Most hepatocellular carcinoma (HCC) cases in the U.S. have been attributed to chronic hepatitis B (HBV) and hepatitis C virus (HCV) infections, though burden of alcoholic liver disease and metabolic-dysfunction associated fatty liver disease (MAFLD) is rising. Individuals born between 1945-1965 (“the baby boomers”), comprise 25% of the U.S. population but account for 81% of chronic HCV infections and thus bear a disproportionate burden of HCC compared to younger or older cohorts. We examined the association of HCV and other risk factors to liver cancer incidence within liver cancer birth cohorts. Methods: Adults with at least one visit from 2000-2017 to San Francisco Health Network (SFHN), Sutter Health Northern California, and Kaiser Permanente Hawai’i (KPH) were linked to data on incident HCC from the California (SFHN/Sutter) and Hawai’i (KPH) cancer registries through 2017. The three birth cohorts were defined as 1)1895-1944 (“pre-baby boomer”); 2)1945-1965 (“baby boomer”); 3)1966-1999 (“post-baby boomer”). We used Cox proportional hazards regression with age as the timescale to examine association of each risk factor (i.e., HBV, HCV, metabolic syndrome, MAFLD, alcohol use, smoking history) with incident HCC stratified by sex and birth cohort; models were adjusted for site, baseline year, number of encounters, length of active follow-up, race/ethnicity, and cirrhosis. For next steps, we plan to calculate the population attributable fraction for each of these risk factors. Results: From the pooled cohort of 4,248,553 individuals, 2,916 had incident HCC. 15% were born between 1895-1944; 32% from 1945-1965; and 53% from 1966-1999; 55% were females; 39% identified as non-Hispanic (NH) White; 14% as Asian American; 11% as Hispanic; 5% as NH Black. Across all birth cohorts, males and females with active chronic hepatitis B had higher HCC risk compared to those with inactive status. Males and females in the pre-baby boomer and baby boomer cohorts (but not post baby-boomers) with active chronic hepatitis C had higher HCC risk. Males and females in the pre-baby boomer cohort (Hazard Ratio [HR]=2.58, 95% Confidence Interval [CI] 2.01-3.31); HR=2.85, 95% CI 2.03-4.00, respectively) and females in the baby boomer cohort (HR=1.55, 95% CI 1.03-2.32) with metabolic syndrome had higher HCC risk. Having MAFLD was associated with increased HCC risk among males from all three birth cohorts and females in the pre-baby boomer and baby-boomer cohort. Alcohol use was associated with higher HCC among pre-baby boomer males (HR=1.23, 95% CI 1,04-1.46) and baby boomer females (HR=1.39, 95% CI 1.10-1.76). Conclusion: In this racially, ethnically, and socioeconomically diverse cohort, HBV is a significant risk factor in HCC risk across birth cohorts for both males and females, while HCV is among older birth cohorts. Consistent with recent studies, MAFLD is a growing cause across birth cohorts. Understanding the contribution of these risk factors and for whom they are most relevant can help identify targets for intervention to reduce liver cancer burden. Citation Format: Janet N. Chu, Aly Cortella, Alison J. Canchola, Pushkar Inamdar, Sixiang Nie, Mai Vu, Ma Somsouk, Michele M. Tana, Caroline A. Thompson, Chanda Ho, Hashem B. El-Serag, Mi-Ok Kim, Mark Segal, Yihe G. Daida, Su-Ying Liang, Scarlett L. Gomez, Mindy C. Derouen, Salma Shariff-Marco. Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A024.

Abstract A113: National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women

Abstract Background: Lesbian, gay, and/or bisexual (LGB) women have decreased rates of cervical cancer screening compared to heterosexual women which may be due to barriers accessing care. This difficulty accessing care is magnified in racial/ethnic minority LGB women. Objective: To estimate changes in guideline-concordant cervical cancer screening (CCS) over time by sexual orientation and race/ethnicity using National Health Interview Survey (NHIS) data from 2013, 2015, 2019 and 2021(full cohort). Methods: This retrospective, population-based, cross-sectional analysis included cisgender (denotes gender identity corresponding with sex assigned at birth) women aged 21-65 without history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or an identity other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Up to date (UTD) CCS was determined based on NHIS questions “When did you have your most recent Pap test?” and “Did you have a human papillomavirus (HPV) test with your most recent Pap test?”. If most recent screening test was within the intervals defined by the US Preventive Services Task Force screening guidelines for respective ages and modalities, they were considered UTD. We performed joinpoint analysis to characterize piecewise log-linear time calendar trends in the proportion of UTD CCS and calculated Annual Percent Change (APC) from 2013 to 2021. Results: Overall, there were 40,818 participants in the full cohort, of which 4.32% identified as LGB. 70.64% of the LGB participants reported UTD CCS in contrast to 78.92% of the heterosexual participants. In 2013, 80.87% of the heterosexual participants were UTD for CCS in comparison to 70.59% of LGB participants. In 2021, UTD screening rates fell to 75.4% for heterosexual participants and 68.86% in LGB participants. In trend analysis only heterosexual participants had a significant APC in screening of -0.97% (p=.002) from 2013- 2021, and there was no significant trend for LGB individuals. When evaluating screening rates by sexual orientation and race, we found that heterosexual Hispanic and non-Hispanic (NH) White women had decreased in UTD CCS (APC of -1.52, p=0.008 and -0.63, p=0.02, respectively). Additionally, LGB NH Black women had a significant decrease in UTD screening over the study period (APC of -2.67, p<0.005) falling from 85.22% in 2013 to 67.91% in 2019. Conclusions: In 2021 there were approximately 19.72 million cisgender women aged 21-65 who were potentially not UTD with CCS. Of these, 1.76 million LGB women were not UTD for CCS, and a greater proportion of these women identified as NH Black. Future efforts need to improve screening in cisgender populations regardless of sexual orientation, and specific attention should be aimed at LGB and Black identifying cisgender women. Citation Format: Kelley Baumann, Caryn E Peterson, Stacie Geller, Saria Awadalla, Hunter K Holt. National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A113.

Abstract A012: Motherhood and chemotherapy receipt: a population-based study of young women with breast cancer

Abstract Background: Young women, ages 18–39 years, with breast cancer are disproportionately impacted by pronounced socioeconomic disparities, a burden that is exacerbated among mothers as they face competing demands in managing cancer and caregiving responsibilities. Although previous analyses identified 64% of young women with breast cancer as mothers at diagnosis and qualitative studies have reported conflicting views on chemotherapy receipt among mothers, their treatment patterns are not well-defined. Additionally, whether having multiple or young children influences treatment patterns due to increased demands is also unknown. We aimed to determine the association between motherhood or offspring characteristics and chemotherapy receipt by age, stage, race and ethnicity. Methods: We retrospectively linked the Texas Cancer Registry to live birth certificates from 1995 to 2016. Analyses comprised a multicultural, population-based sample of 1,783 mothers who had delivered at least one live birth at diagnosis and 946 young women without children diagnosed with microscopically confirmed invasive breast cancer, between January 1, 2013, and December 31, 2016, at ages 18–39 years. Chemotherapy receipt was based on first course of treatment. Multivariable logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI): model 1 (motherhood), model 2 (number of children), and model 3 (number of young [ages <13 years] children). Model 1 was adjusted for age, stage, insurance, Yost index, receipt of radiation therapy, and surgery type. Models 2 and 3 were adjusted for these covariates plus age of children, number of young children (model 2) and number of children (model 3). Heterogeneity was assessed using single- referent ORs and relative excess risk due to interaction (RERI), and multiplicative models with stratified ORs and likelihood ratio tests (pLRT). Results: Of the 2,729 women, 1,565 (73%) received chemotherapy. There was no association between motherhood (OR=1.00, 95% CI [0.82,1.21]), number of children (OR=0.94, 95% CI [0.72,1.22]), or number of young children (OR =1.07, 95% CI [0.72,1.54]) and chemotherapy receipt. Decreased odds for chemotherapy receipt were observed by race: Non-Hispanic (NH) Black women without children had an ORstratified of 0.57 (95% CI [0.37,0.89]) and NH White mothers had an ORsingle-referent of 0.71 (95% CI [0.51,0.93] and ORstratified of 0.69 (95% CI [0.53,0.95]) compared to NH White women without children (RERI=-0.63, 95% CI [-1.86,-0.09]; pLRT=0.05). Among mothers, those ages >35 years with 2+ young children had an OR of 0.45 (95% CI 0.21,0.98; pLRT=0.39) compared to those with children ages ≥13 years. Conclusion: We found no differences in overall chemotherapy receipt, but observed decreased receipt by race and age, independent of stage, possibly due to unmeasured systemic and clinical factors. Future studies examining detailed tumor characteristics and treatment information could inform targeted interventions to support young women with breast cancer throughout their cancer trajectories. Citation Format: Quiera S Booker, Caitlin C Murphy, Sarah E Messiah, Folefac D. Atem, Bijal S Balasubramanian. Motherhood and chemotherapy receipt: a population-based study of young women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A012.

Abstract C061: Disparities in second breast cancers among women with ductal carcinoma in situ

Abstract Introduction: Breast cancer is the leading cause of cancer-related death among women in the United States and Oklahoma. Outcomes from DCIS are generally favorable, however, up to 50% of patients will develop an SBC after DCIS, with approximately 30% diagnosed as invasive SBC. Our research objective was to use a combination of data sources (registry, demographic, clinical, and socioeconomic data) to explore the presence of disparities and treatment outcomes, among women of different racial, ethnic, and socioeconomic groups in Oklahoma. Methods: We conducted a retrospective cohort study comparing the overall incidence of DCIS, invasive breast cancer (IBC), and the development of SBCs in women residing in Oklahoma at the time of diagnosis. We obtained data from the Oklahoma Central Cancer Registry (OCCR) and included women diagnosed with breast cancer from 1997-2021 in our analyses. We restricted analyses to women with DCIS as their first primary cancer. SBC was defined as a second primary cancer diagnosed at least six months after the first DCIS diagnosis. We evaluated demographic and cancer-related characteristics of women diagnosed with DCIS as their first cancer by development of a SBC. Results: In initial analyses, we identified 7,903 women with DCIS as their initial cancer diagnosis. Of the women with DCIS, 80% were over 50 years of age at diagnosis and the majority were non-Hispanic (NH) White (85%). For cancer-related characteristics, 33% of tumors were well or moderately differentiated (44% unknown) and 51% of tumors originated in the left breast. Of these women, 513 were subsequently diagnosed with a SBC, which included both in situ (26%) and invasive breast cancers (74%). Among women with a SBC, a higher percentage of women were <50 years of age at the initial DCIS diagnosis (27% vs. 19%) and NH Black (9.4% vs. 6.7%) compared to those without a SBC. Discussion: As a next step, we will further evaluate the risk of SBC among women in the OCCR and National Cancer Data Base to evaluate disparities at the national level. We are planning to evaluate the risk of an SBC after diagnosis of a DCIS by demographic and cancer-related characteristics using multivariable models. We will also evaluate survival among women with DCIS who develop a subsequent SBC. Citation Format: Amanda Janitz, Bethany Hannafon, Mary L Williams, Elizabeth Wellberg, Chao Xu, William Dooley. Disparities in second breast cancers among women with ductal carcinoma in situ [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C061.

Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C)

Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10–2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04–1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S.

Trends in cerebrovascular diseases, pelvic and hip fractures-related mortality among older adults in the United States from 1999–2020

BackgroundWe aim to evaluate trends in Cerebrovascular Diseases (CVD) and pelvic and hip fractures (PHF)-related deaths among adults (≥ 65 years) in the US from 1999 to 2020, highlighting the differences based on demographics. MethodsWe analyzed death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database spanning 1999 to 2020, related to CVD and PHF in people aged ≥65 years. Age-Adjusted Mortality Rates (AAMRs) per 100,000 persons and annual percent change (APC) were computed using Joinpoint software. The analysis was organized by year, sex, race/ethnicity, and geographic distribution (states, census regions, metropolitan/non-metropolitan areas). ResultsThe AAMR for CVD and PHF decreased from 4.5 in 1999 to 2.2 in 2020. Similar pattern was observed for AAMR in females and males. Highest overall AAMR was noted in Non-Hispanic (NH) White adults (3.2) and lowest in African Americans (1.2). States of Wyoming, Alaska, North Dakota, Oregon, and Minnesota were in the top 90th percentile of AAMR while Florida, District of Columbia, Nevada, Arizona, and New York were in lower 10th percentile. Highest AAMRs were observed in Midwestern census region, followed by Western, Southern and Northeastern regions (3.8,2.8,2.7, and 1.9 respectively). Nonmetropolitan areas had a higher AAMR (4.4 vs 2.5) than metropolitan areas. ConclusionThe CVDs and PHF related mortality rate increased steadily after 2014. NH white females were found to be at increased risk. A research-based management plan needs to be devised for post stroke pelvic and hip fractures in elderly.

Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea

ObjectiveTo examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). MethodsThis cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data. ResultsWith this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01. ConclusionsThe rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.

Huntington's Disease-Related Mortality Patterns: A Two-Decade Analysis of Mortality Trends in the United States, from 1999-2019.

Huntington's disease (HD) is an autosomal dominant, progressive neurodegenerative disorder debilitating mainly in adults. This study aimed to assess the trends in HD-related mortality regarding various demographic factors. Death certificates from the CDC WONDER were studied from 1999 to 2019, for HD-related mortality in adults aged 25 + years. Age-adjusted Mortality Rate (AAMR) per 100,000 persons and Annual Percentage Change (APC) were calculated and stratified by year, age groups, gender, race/ethnicity, state, census region, urbanization, and place of death. Between 1999 to 2019, 22,595 deaths occurred in adults due to HD. The AAMR increased from 0.43 to 0.54 during this period (APC = 0.50; 95% CI: 0.18 to 0.84). Old adults (65-85 + years) had the highest overall AAMR, followed by middle-aged adults (45-64 years) and young adults (25-44 years) (AAMR old: 1.01 vs. AAMR middle-age: 0.68 vs. AAMR young: 0.16). Men had slightly greater overall AAMRs than women (AAMR men: 0.54 vs. AAMR women: 0.48). When stratified by race, non-Hispanic (NH) Whites had significantly higher mortality rates than NH African Americans (AAMR NH White: 0.61 vs. NH African American: 0.35), while the AAMR were lowest in Hispanic/Latino (0.28). The AAMRs also showed variation by region (overall AAMR: Midwest: 0.63, Northeast: 0.47, West: 0.48, South: 0.46), and non-metropolitan areas had higher HD-related AAMR (0.66) than metropolitan areas (0.47). HD-related mortality in US adults has increased since 1999. Reflecting on the variations in trends observed, new strategies are required to optimize the quality of care in long-term care facilities.

The Add Health Parent Study: A Biosocial Resource for the Study of Multigenerational Racial/Ethnic Disparities in Alzheimer's Disease and Alzheimer's Disease-Related Dementias.

Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) have increased in prevalence. This article describes the Add Health Parent Study (AHPS) Phase 2, a study of social, behavioral, and biological factors influencing healthy aging and risk for AD/ADRD, in a national sample of adults aged 58-90. Sample members are parents of the National Longitudinal Study of Adolescent to Adult Health (Add Health) cohort, initially interviewed in Add Health in midlife (1994-95). AHPS Phase 1 (2015-17) collected longitudinal data on a random subsample of parents and their spouse/partners, who were mostly Non-Hispanic (NH) White. AHPS Phase 2 will collect the same longitudinal socio-behavioral, and health survey data on all remaining NH Black and Hispanic parents (Black and Hispanic Supplement, BHS). Additionally, Phase 2 will collect cognitive and DNA data from AHPS Phase 1 and BHS sample parents and their current spouse/partners. Funded by the National Institute on Aging, recruitment will occur between June 2025 and May 2026, producing an expected total AHPS sample of 5506 parents and their spouse/partners. The AHPS will be the first longitudinal cohort study powered to address multigenerational racial/ethnic disparities in AD/ADRD risk and protective factors across race/ethnic groups and socioeconomic strata.

Temporal trends and regional variations in mortality related to Guillain-Barré syndrome in the United States: a retrospective study from 1999 to 2020

Aim Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder, with an estimated 6.4% increase in cases worldwide from 1990 to 2019. We aim to identify the GBS-related mortality trends in the US stratified by age, sex, race, and region. Methods We used data from the CDC-WONDER database to calculate crude (CMR) and age-adjusted mortality rates (AAMRs) per 1,000,000 people. We examined the temporal trends through annual percent change (APC) and the average annual percent change (AAPC) in rates using Joinpoint regression. Results From 1999 to 2020, a total of 10,097 GBS-related deaths occurred in the US. The AAMR decreased till 2014 (APC: −1.91) but increased back to initial levels by 2020 (APC: 3.77). AAMR was higher in males (1.7) than females (1.1), decreasing till 2015 for females and 2014 for males, but increasing thereafter only for females. Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (1.8) while NH Asians or Pacific Islanders displayed the lowest (0.6). AAMRs also varied by region (West: 1.5; South: 1.5; Midwest: 1.4; Northeast: 1.1). Rural regions exhibited a higher AAMR (1.7) than urban regions (1.3). Most deaths occurred in medical facilities (60.99%). The adults aged ≥85 years exhibited an alarmingly high CMR (14.0). Conclusions While the mortality rates for GBS initially declined till 2014, they climbed back up afterwards. Highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of rural regions, and adults ≥85 years. Equitable efforts are needed to reduce the burden on high-risk populations.

Investigating sex, race, and geographic disparities in bronchus and lung cancer mortality in the United States: a comprehensive longitudinal study (1999-2020) utilizing CDC WONDER data.

Lung and bronchus cancer has become the leading cause of cancer-related mortality in the United States. Understanding the patterns of mortality is an absolute requirement. This study analyzed Lung and Bronchus cancer-associated mortality rates from 1999 to 2020 using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rates (AAMRs), per 100000 people, and annual percentage change (APCs) were also calculated. 3599577 lung and bronchus cancer-related deaths occurred in patients aged younger than 1-85+ years between 1999 and 2020. Overall AAMRs declined from 59.1 in 1999 to 58.9 in 2001 (APC: -0.1364) then to 55.9 in 2005 (APC: -1.4388*) 50.5 by 2010 (APC: -2.0574*) 44.7 by 2014 (APC: -2.9497*) and 35.1 by 2020 (APC: -4.1040*). Men had higher AAMRs than women (overall AAMR men: 61.7 vs. women: 38.3). AAMRs were highest among non-Hispanic (NH) Black or African American (52.7) patients followed by NH White (51.8), NH American Indian or Alaska Native (38.6), NH Asian or Pacific Islander (24.7) and Hispanic or Latino race (20.2). AAMRs varied in region (overall AAMR; South: 52.4; Midwest: 52.3; Northeast: 46.3; West: 39.1). Non-metropolitan areas had a higher AAMR (55.9) as compared to metropolitan areas (46.7). The top 90th percentile states of Lung and Bronchus cancer AAMR were Arkansas, Kentucky, Mississippi, Tennessee, and West Virginia. An overall decreasing trend in AAMRs for lung and bronchus cancer was seen. Public health measures to regulate risk factors and precipitating events are needed.

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

BackgroundThe intersection of race/ethnicity with disability is a critical dimension of mental health outcomes in later ages that remains under-investigated. ObjectiveWe examined the role of race-ethnicity in moderating the associations between functional disabilities and subsequent depression among Americans 51 and older and stratified into the two age-groups of midlife (51-64) and older adults (≥65). MethodsUsing a nationally representative sample of community-dwelling Americans (≥51; n=7,475) in the 2016-2018 Health and Retirement Study, we conducted bivariate and multivariable regression analyses. Racial-ethnic groups included non-Hispanic (NH) Black, Hispanic, and NH White and a binary (0/1) outcome defined subsequent depression in 2018. The total number of difficulties on the Nagi, Lawton, and Katz disability scales represented baseline (2016) functional disabilities with a secondary four-level (no/mild/severe with assistance/severe without assistance) disability indicator incorporated to examine the role of assistance with daily living. ResultsAcross age-groups, subsequent depression was significantly more prevalent among NH Whites with functional disabilities compared to counterparts reporting no disabilities. Compared to NH Black and Hispanic counterparts, midlife NH Whites were three times more likely to report subsequent depression with each unit increase in the functional disability score, after adjusting for covariates. However, we observed no such racial-ethnic differences among older adults. Among the 51+ severe with no assistance group, adjusted odds of subsequent depression among NH Whites was 2.5 times higher than minority counterparts. ConclusionHealth programs and environmental adaptations supporting functional care needs in later ages could be beneficial for improving mental health of adults with disabilities.

Rule-based natural language processing to examine variation in worsening heart failure hospitalizations by age, sex, race and ethnicity, and left ventricular ejection fraction

BackgroundPrior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates. MethodsAdult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014-2018 were followed through 2019 to identify hospitalized WHFE. The main outcome was hospitalizations with a principal or secondary HF discharge diagnosis meeting rule-based Natural Language Processing (NLP) criteria for WHFE. In comparison, we examined hospitalizations with a principal discharge diagnosis of HF. Age-, sex-, and race and ethnicity-adjusted rates per 100 person-years (PY) were calculated among age, sex, race and ethnicity (non-Hispanic (NH) Asian/Pacific Islander [API], Hispanic, NH Black, NH White) and LVEF subgroups. ResultsAmong 44,863 adults with HF, 10,560 (23.5%) had an NLP-defined, hospitalized WHFE. Adjusted rates (per 100 PY) of WHFE using NLP were higher compared to rates based only on HF principal discharge diagnosis codes (12.7 and 9.3, respectively), and this followed similar patterns among subgroups, with the highest rates among adults ≥75 years (16.3 and 11.2), men (13.2 and 9.7), and NH Black (16.9 and 14.3) and Hispanic adults (15.3 and 11.4), and adults with reduced LVEF (16.2 and 14.0). Using NLP disproportionately increased the perceived burden of WHFE among API and adults with mid-range and preserved LVEF. ConclusionRule-based NLP improved the capture of hospitalized WHFE above principal discharge diagnosis codes alone. Applying standardized consensus definitions to EHR data may improve understanding of the burden of WHFE and promote optimal care overall and in specific sociodemographic groups.

Demographical and Regional Trends of HIV-Related Mortality Among Young Adults in the United States From 1999 to 2020

BackgroundHIV remains a leading cause of death in the U.S. Previous research has examined mortality patterns among older adults with HIV, revealing regional and demographic disparities. This study aims to assess demographic and regional trends in HIV-related mortality among young adults from 1999 to 2020. MethodsCenters for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to identify young adults aged 15-44 where HIV was mentioned as either underlying or contributory cause of mortality between 1999 and 2020, using the B20-B24 codes from the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage change (APC) were determined. ResultsThe AAMRs for HIV in young adults consistently declined from 1999 to 2018, followed by a period of stability from 2018 to 2020 (annual percentage change: 0.5%; 95% confidence interval [95% CI], –7.4 to 9.0), with 64% deaths occurred in medical facilities. Overall, males had a twice AAMR than females (female: 2.22, 95% CI 2.19-2.24; male: 5.19, 95% CI 5.15-5.23). Non-Hispanic (NH) Blacks had sevenfold higher mortality rates than Whites (AAMR 14.88 vs. 2.036). The Southern region experienced threefold higher mortality compared to the Midwest. Metropolitan adults had a twofold higher AAMR than nonmetropolitan adults. States in the top 90th percentile for HIV-related mortality, including Mississippi, Maryland, Florida, Louisiana, and the District of Columbia, exhibited six times higher mortality compared to states in the bottom 10th percentile, such as North Dakota, Idaho, Wyoming, Montana, and Utah. ConclusionsTo address these disparities and ensure continued progress, urgent measures are required.