Older Age Groups Research Articles

Epidemiology of menstrual-related absenteeism in 44 low-income and middle-income countries: a cross-sectional analysis of Multiple Indicator Cluster Surveys.

Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women's and girls' daily lives and exacerbates gender inequality. We sought to estimate the prevalence of and factors contributing to menstrual-related absenteeism across low-income and middle-income countries. We analysed cross-sectional data from 47 nationally or subnationally representative Multiple Indicator Cluster Surveys from 2017 to 2023, which comprised 3 193 042 individuals from 555 869 households across 44 countries; those with available information on the outcome of interest were included in our analysis. The outcome of interest was menstrual-related absenteeism from work, school, or social activities during the respondent's last menstrual period. Independent factors included age, household wealth index, use (vs no use) of menstrual materials (eg, pads, tampons, or cloth), availability of a private place to wash at home during menstruation, and contraceptive use (hormonal and other). Univariable and multivariable associations between each factor and menstrual-related absenteeism were analysed using log-binomial models. Prevalence ratios, estimated from the log-binomial models, represent the relative prevalence of menstrual-related absenteeism across different levels of the independent variables. Prevalences and associations were pooled by geographical region and overall across all surveys using a random-effects meta-analysis. Heterogeneity was assessed using the I2 statistic, and prediction intervals generated to reflect the variation in associations. We included 673 380 women and girls aged 15-49 years in this analysis. The overall pooled prevalence of menstrual-related absenteeism was 15·0% (95% CI 12·7-17·3), with prevalence being highest in south Asia (19·7% [11·6-27·8]) and west and central Africa (18·5% [13·5-23·5]). After pooling data across surveys, girls aged 15-19 years were found to have a higher prevalence of menstrual-related absenteeism than those in older age groups, with overall pooled prevalence ratios ranging from 0·75 (0·68-0·82) in those aged 35-39 years to 0·92 (0·87-0·97) in those aged 20-24 years relative to the 15-19 years age group, with adjustment for area type (urban or rural). There was no association between menstrual-related absenteeism and household wealth or the use of menstrual materials. By contrast, having a private place to wash at home was associated with an increased prevalence of menstrual-related absenteeism (overall pooled prevalence ratio 1·25 [1·05-1·48], adjusted for wealth and area type). Menstrual-related absenteeism was less prevalent in women and girls using any contraceptives compared with those not using contraceptives (0·92 [0·87-0·96]), and for those using hormonal contraceptives compared with those using non-hormonal or no contraceptives (0·91 [0·84-0·99]), after adjusting for age, wealth, education level, parity, and area type. Menstrual-related absenteeism is prevalent, especially in Asia and Africa and among adolescent girls. The age-independent protective effect of hormonal contraceptive use suggests that symptoms such as heavy menstrual bleeding or pain contribute to absenteeism. Future studies are urgently needed to better characterise these findings to inform relevant public health interventions. National Health and Medical Research Council, Australia.

Post-COVID symptoms after SARS-CoV-2 omicron infection and the effect of booster vaccination: A population-based cohort study.

The impact of vaccination on the type and risk of specific post-COVID symptoms after Omicron infection is not clear. We aimed to investigate the excess risk and patterns of 22 symptoms 3-5months after Omicron infection, comparing uninfected and infected subjects with and without recent booster vaccination. We conducted a population-based prospective study based on four questionnaire-based cohorts linked to national health registries. Our study includes female and male participants aged 11-80years from The Norwegian Mother, Father, and Child Cohort Study, The Norwegian Influenza Pregnancy Cohort, The Senior Cohort, and The Young Adult Cohort. All participants registered presence of 22 COVID-related symptoms irrespective of infection and vaccination status. The study sample includes more than 31,000 uninfected and 26,000 Omicron infected subjects. Among infected subjects, 12% were vaccinated with two doses >130days before the primary infection (median 154days) but had not received a third dose, while 76% had received a third (booster) dose (median 40days before infection). Among those with two doses only, the excess risk for new symptoms after infection (vs. no infection) were up to 15% for women and 9% for men. Among infected subjects with recent booster dose, the corresponding excess risks were 7% among women and up to 5% among men. The largest risk differences after recent booster vaccination were seen for poor memory, brain fog, and fatigue. Post-COVID symptoms were more often detected among young and middle-aged adults than among adolescents and older age groups. Recent booster vaccination before infection substantially reduced both neurocognitive and cardiorespiratory symptoms occurring at least 3months after Omicron infection.

Transition symptom management careers: Historical patterns of mental health symptoms and service use among young adults experiencing a psychiatric crisis.

Young adults access mental health services at lower rates than both older and younger age groups despite high levels of need. Mental health service use is known to be influenced by prior experiences with treatment, with episodes of symptoms and treatment producing patterns of service use over time, or what we call a "symptom management career". This qualitative study examined the symptom management careers of 55 young adults (ages 18-25) who were admitted to an inpatient, short term, crisis stabilization unit. Participants completed research interviews at the hospital following a psychiatrist's assessment. During semi-structured qualitative interviews, participants retrospectively narrated their experiences of mental health symptoms and service use from symptom onset to the current episode. The research team used an inductive qualitative approach to identify distinct patterns of symptom management, while also examining factors that contributed to service use. Six distinct types of symptom management careers were identified based on the timing of symptom onset and service participation. Notably, none of the participants experienced an uninterrupted pattern of service use from adolescence into young adulthood. The team identified a set of themes that influenced these patterns including traumatic experiences, social supports, social service systems, and substance use. Findings highlight the developmental nature of service connection and disconnection and suggest potential points of intervention in non-specialty settings, such as schools, child welfare, and the juvenile legal system. Findings also demonstrate the need for flexible services that respond to the developmental need for autonomy and self-determination as youth transition into young adulthood.

Efficacy, safety, and patient-reported outcomes across young to older age groups of patients with HR+/HER2- advanced breast cancer treated with ribociclib plus endocrine therapy in the randomized MONALEESA-2, -3, and -7 trials.

Ribociclib + endocrine therapy (ET) showed significant progression-free survival (PFS) and overall survival (OS) benefits in the MONALEESA trials in patients with HR+ /HER2 - advanced breast cancer (ABC). We report efficacy, safety, and patient-reported outcomes (PROs) across age groups, including older patients, in these trials. Data from the MONALEESA-2, -3, and -7 trials for pre- and postmenopausal patients receiving first-line treatment for ABC were pooled and analyzed by age (<65y, 65-74y, and ≥75y). PFS, OS, time to first chemotherapy (TTC), and time to definitive deterioration (TTD) in PROs were evaluated using Kaplan-Meier methods; a Cox regression model stratified by study and liver/lung metastasis was used for hazard ratios. Among 1229 patients included, 63 % were < 65y, 27 % were 65-74y, and 10 % were ≥ 75y. Baseline characteristics were generally well balanced. Regardless of patient age, ribociclib+ET showed a consistent PFS and OS benefit and delayed TTC. With ribociclib+ET, the most common first subsequent treatment was ET. Safety results were consistent with those in the overall trial population; no new signals were identified. Rates of discontinuation due to AEs with ribociclib+ET were numerically higher in patients ≥ 75y. Among patients who discontinued treatment due to AEs, the percentage without prior dose reduction was higher in those ≥ 75y. A PRO benefit with ribociclib+ET was observed across all age groups for pain and fatigue scores. This analysis demonstrated that ribociclib+ET is an effective and well-tolerated treatment for patients of all age groups with HR+ /HER2 - ABC, including older patients. (MONALEESA-2, NCT01958021; MONALEESA-3, NCT02422615; MONALEESA-7, NCT02278120).

P-2050. Ad26.COV2.S (Janssen) COVID-19 Vaccine Effectiveness against Hospitalization in Europe: an id.DRIVE Study

Abstract Background Ad26.COV2.S (Janssen COVID-19 Vaccine) is a replication-incompetent viral-vector vaccine used in the international response to the SARS-CoV-2 pandemic. id.DRIVE (previously COVIDRIVE) is a public private partnership that conducts infectious disease studies on vaccines and therapeutics in the European region. Here we present a post-authorization study assessing the vaccine effectiveness (VE) of Ad26.COV2.S single dose against COVID-19 hospitalization. Methods The study was non-interventional, multicentric, combined retrospective and prospective enrolment, and used a test-negative case-control design. Study participants were adults ≥ 18 years old, hospitalized with severe acute respiratory infection (SARI) between 1st May 2021 and 28th February 2023. All participants were tested for SARS-CoV-2 using RT-PCR or another RNA amplification system with equivalent diagnostic testing performances. VE against SARI hospitalization of Ad26.COV2.S single dose compared to unvaccinated was estimated as a single measure over the study period, and stratified by age group and different times since vaccination. All estimates were adjusted for symptom-onset date, age, sex, and number of chronic conditions among a predefined list of comorbidities that increase the risk of severe COVID-19 disease. Results A total of 1318 SARI patients were included, 997 test-positive cases (COVID-19 cases) and 321 test-negative controls. Median age was 57 years, 584 (44%) were female and 785 (60%) had at least one chronic condition. Overall, VE was 55.6% (95% CI 23.6; 74.2) for a median of 146 days since vaccination. VE was 61.6% (95% CI 16.2; 82.4) for 18-49-year-olds, 57.7% (95% CI 3.4; 81.5) for 50-64-year-olds, and 40.8% (95% CI -6.0; 66.9) for ≥ 65-year-olds. By time since vaccination ≥ 14 days-to-12 weeks, 12-to-25 weeks, 25-to-52 weeks and &amp;gt; 52 weeks, VE was 52.4% (95% CI 2.8; 76.7), 59.2% (95% CI 25.0; 77.8), 35% (95% CI -50.2; 71.9) and 79.3 (95% CI -79.0; 97.6), respectively. Conclusion Ad26.COV2.S single dose protected against COVID-19 hospitalization with VE lasting for at least six months. VE estimates were lower in older age groups. Results had low to medium levels of certainty and are to be interpreted with caution. Disclosures Chloé Wyndham-Thomas, PhD, Janssen: This study was funded by Janssen E. Claire Newbern, PhD, Janssen: Employed by Janssen at the time of the study. Janssen funded this study.|Janssen: Stocks/Bonds (Private Company) Ainara Mira-Iglesias, PhD, Janssen: Janssen funded this study Alejandro Orrico-Sánchez, Janssen: Janssen partially funded the hospital network to collect data Irma Casas, PhD, Pfizer: Support from Pfizer to attend Congress in September 2023 Laura Drikite, MSc, Janssen: This study was funded by Janssen Nikki Vroom, MSc, Janssen: This study was funded by Janssen Sebastian Baumgartner, MD, GlaxoSmithKline: Lecture paid by GSK|MSD: Invitation to a meeting by MSD Susana Otero-Romero, PhD, GlaxoSmithKline: Honoraria|Pfizer: Support for attending meetings|Sanofi: Honoraria Kaatje Bollaerts, PhD, AstraZeneca: Advisor/Consultant|Bavarian-Nordic: Advisor/Consultant|CureVac: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Janssen: Advisor/Consultant|Novavax: Advisor/Consultant|P95: Stocks/Bonds (Private Company)|Pfizer: Advisor/Consultant|Valneva: Advisor/Consultant Nicolas Praet, PhD, Janssen: Employed by Janssen. Janssen funded this study.|Janssen: Stocks/Bonds (Private Company)

389. Trends in HIV-Related Mortality Among Reproductive-Aged Women in the United States

Abstract Background Despite advancements in HIV treatment, there remains a significant gap in understanding mortality rates among reproductive-aged women with HIV in the United States. To enhance evidence-based interventions, this study aims to delineate mortality trends from 1999-2020, focusing on demographic characteristics such as age, race, and geographic regions. HIV-related AAMRs per 100,000 individuals stratified by race in women aged 15-44 in the United States, 1999 to 2020. Methods This study involved a retrospective analysis using the CDC WONDER database, extracting data via ICD-10 codes B20-B24 to identify HIV-related deaths among women aged 15-44 from 1999 to 2020. We analyzed demographic disparities in HIV mortality rates over time based on age, ethnicity, and geographic regions using systematic database analysis. Results are presented as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). These were calculated by standardizing HIV-related deaths in the United States in 2000. HIV-related AAMRs per 100,000 individuals stratified by state in in the United States among women aged 15-44 from 1999 to 2020. Results Between 1999 and 2020, a total of 29,358 women aged 15-44 died from HIV in the US (AAMR = 2.2 per 100,000; 95%CI: 2.2-2.2). The crude mortality rate declined from 4.2 in 1999 to 2.1 in 2020. The overall decline in mortality rates masked disparities: Non-Hispanic Black women experienced the highest AAMR (11.3), while Hispanics, though initially higher, saw the most substantial decrease in mortality rates (1.4). Geographical analysis revealed the South as the most affected region (3.5), accounting for 58.3% of deaths, with urban areas presenting higher mortality rates than rural ones (2.4 and 1.4). Notably, older age groups (35-44) accounted for the majority of deaths (67.1%) HIV-related AAMRs per 100,000 individuals among women aged 15-44 from 1999 to 2020 in the United States census regions. *=significant at p &amp;lt; 0.05; confidence interval does not include zero Conclusion HIV-related mortality among reproductive-aged women decreased nationally from 1999 to 2020, yet disparities persist. Our analysis emphasizes the disproportionate impact of HIV-related deaths on non-Hispanic Black women and those residing in the Southern United States, suggesting the need for region and population-specific public health interventions. This highlights the need to improve access to care, particularly in urban areas, and target age-specific prevention programs to further reduce mortality rates. Improving timely diagnosis and addressing the stigma surrounding HIV among women is vital to reduce mortality in this demographic. HIV-related crude mortality percentage stratified by different variables in women aged 15-44 in the United States, 1999 to 2020 Disclosures All Authors: No reported disclosures

Global trends in the burden of ischemic heart disease attributable to smoking from 1990 to 2021: A systematic analysis of the Global Burden of Disease Study 2021.

Ischemic heart disease (IHD) remains a leading cause of death and disability worldwide. This study evaluates the trends in IHD burden attributable to smoking, utilizing Global Burden of Disease Study 2021 (GBD 2021) data, across 204 countries and territories from 1990 to 2021. By examining age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs), the study provides insights into the spatiotemporal variations associated with smokingattributable IHD in different sociodemographic regions. Data on smoking-attributable IHD mortality and DALYs were obtained from the GBD 2021 database. This secondary analysis examined ASDR and ASRDALYs for IHD as primary outcomes, with active smoking as the primary exposure. Temporal trends were analyzed using estimated annual percentage changes (EAPCs). The burden was stratified by age, sex, and sociodemographic index (SDI) to identify disparities across regions. Over the last three decades, global ASDR and ASRDALYs for smokingrelated IHD have generally declined. High-SDI regions had the largest reductions, with EAPCs of -4.31 (95% CI: -5.73 - -2.87) and -4.02 (95% CI: -5.40 - -2.62), respectively. In contrast, low-SDI regions experienced slower declines, with EAPCs of -0.54 (95% CI: -1.41-0.33) and -0.80 (95% CI: -1.52 - -0.08), respectively. Older age groups and males consistently had a higher burden across all regions. Global death rates for populations aged 15-49, 50-74, and ≥75 years were 4.31, 46.57, and 142.52 per 100000, respectively. The global ASDR for males (30.24) was 8.54 times higher than that for females (3.54). Regional disparities were most pronounced in low- and middle-income areas, particularly in Eastern Europe and Central Asia, where smoking related IHD burden remains high. While global reductions in smoking-related IHD burden are encouraging, sustained disparities remain, particularly in low-SDI regions. Males and older populations continue to have a disproportionately higher burden, emphasizing the need for targeted interventions and sustained efforts to address these inequities.

P-992. Global Estimated CMV Seroprevalence by Age and Sex

Abstract Background Cytomegalovirus (CMV) infection, while typically subclinical, is a lifelong latent infection that has been implicated in various adverse outcomes, including accelerated immunosenescence, increased cardiovascular risk, and cognitive decline. However, during pregnancy, CMV infection can cause severe complications in neonates infected in utero (congenital CMV [cCMV]). We present modeled age-, sex-, and country-specific CMV seroprevalence estimates.Figure 1.Modeled CMV Seroprevalence Estimates by Country, Age, and Sex Methods PubMed and EMBASE searches were conducted in August 2022 to identify English-language literature, published 2005-2022, on CMV seroprevalence. Sex-specific seroprevalence by age category was extracted and smoothed using weighted regression; when ≥ 2 studies were identified, a random-effect meta-regression was used. Results Overall, 25 studies were included. Estimated CMV seroprevalence increased with age and varied widely by sex and geographic location (Figure 1). Canada had the lowest seroprevalence estimates: 23.7% for females and 13.7% for males at age 18 years, and 33.5% and 23.5%, respectively, at age 40 years. The highest estimates at age 18 years were in China, with 93.0% for females and 95.3% for males, and at age 39 years in South Korea, with 99.1% and 98.8%, respectively. In Canada, France, Italy, Japan, UK, and USA, estimated seroprevalence was higher in females than in males across all age groups. In Australia, Germany, and Spain, estimated seroprevalence in younger age groups was higher among males than females, but in older age groups was higher among females than males. CMV seroprevalence was &amp;gt; 50% for both sexes in China at age 2 years, Japan at 4 years, and South Korea at 17 years, and for females at 14 years and males at 18 years in Spain. Conclusion Modeled CMV seroprevalence estimates increased with age and were higher among females than males in most countries. The highest modeled CMV burden was observed among the Asian countries. This study highlights the seroprevalence of CMV among females during their reproductive years, with potential risk of cCMV in their unborn children. The findings underscore the urgent need for targeted strategies to mitigate the global burden of CMV, particularly among reproductive-age females. Disclosures Cathy Lally, MSPH, Epidemiologic Research &amp; Methods, LLC: Ownership Interest W. Dana Flanders, MD, DSc, MPH, MA, Epidemiologic Research &amp; Methods, LLC: Ownership Interest Anne Dilley, PhD, Epidemiologic Research &amp; Methods, LLC: Ownership Interest John D. Diaz-Decaro, PhD, MS, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds (Public Company)

The impact of digital literacy in enhancing individuals’ health in China

BackgroundHealth is the cornerstone of individual well-being and a vital factor in socioeconomic development. In an increasingly digitalized world, digital literacy has emerged as one of the indispensable abilities, which not only pertains to an individual’s capacity to acquire, analyze, evaluate, and utilize information but also profoundly influences their health behaviours, health decisions, and overall well-being. This paper uses the 2020 China Family Panel Studies (CFPS) data to explore digital literacy’s impact on individuals’ health.MethodsBy using the Entropy-TOPSIS method, this paper calculates digital literacy as a three-dimensional construct and adopts Ordered Probit and OLS models to analyze the impact of digital literacy on physical and mental health. Additionally, this paper employs the Two-Stage Least Squares (2SLS) to address endogeneity issues. The indirect effects of income, employment quality, and informal social support on individual’s digital literacy and health nexus are also examined by the mediation effect model.ResultsThe results indicate that digital literacy positively impacts individuals’ physical and mental health, which was confirmed by several robustness tests. The heterogeneity analysis shows that digital literacy is more effective in enhancing the health of middle-aged and older groups as well as rural individuals in China. According to mechanism analysis, digital literacy can enhance individuals’ health by boosting income, improving employment quality, and expanding informal social support; however, the effects vary on physical and mental health.ConclusionSeveral policy suggestions emanate from the findings. To enhance the positive impact of digital literacy on individuals’ health, the policy makers should emphasize on enhancing digital literacy particularly in rural areas and older age groups, bridging the digital divide, refining employment services and embracing a healthy concept of online social networking.

P-1037. Prevalence and antifungal susceptibility of Candida species isolated from Korean infants and children with candidemia, 2011-2023

Abstract Background Candida is the most common cause of fungal infections, and candidemia is the most common form of invasive fungal infection. The widespread use of antifungal agents has led to a global increase in non-albicans Candida infections and antifungal resistance. This study aims to investigate the clinical characteristics, treatment outcomes, fungal species, and antifungal susceptibility results of candidemia cases in Korean children. Trend of annual candidemia prevalence and distribution of Candida species Methods This study retrospectively collected and analyzed clinical data from Korean children at two referring hospitals from 2011 to 2023. A case of candidemia was defined as a positive confirmation of any Candida species on at least one blood culture. Information on the Candida species and antifungal susceptibility was obtained from the results of the VITEK II automated equipment. The annual incidence of candidemia was adjusted to the combined number of hospitalized children in the two hospitals, and statistical analysis was performed on 30-day mortality as risk factors. Distribution of Candida species according to the age groups Results A total of 144 cases of candidemia were diagnosed in 139 children. The prevalence rate of candidemia per 1,000 actual hospitalized children was 0.6-2.4 (median 1.6). The age distribution showed 46.0% of individuals were younger than three months. All patients had an underlying medical condition, with prematurity (93.2%) most common in those under three months and hemato-oncology (HO) disease (44.0%) in those three months and older. In the younger age group, Candida glabrata was the most prevalent (31.8%), followed by Candida albicans (27.3%) and Candida parapsilosis (24.2%). In the older age group, C. albicans was the most prevalent (34.9%), followed by C. parapsilosis (26.5%). Non-susceptibility were 0.9% for amphotericin, 15.6% for fluconazole, 0% for voriconazole, 2.9% for caspofungin, and 7.7% for micafungin. The 30-day mortality rate for candidemia was 28%. The distribution of the Candida species was comparable between the mortality and survival groups. Age of 5-9 years and HO underlying disease were significantly associated with 30-day mortality. Antifungal non-susceptibility according to Candida species Conclusion The proportion of candidemia caused by non-albicans Candida species remained high in Korean children, requiring individualized strategies for initial treatment based on age group and underlying medical conditions. Risk factors for 30-mortality in Korean children with candidemia Disclosures All Authors: No reported disclosures

P-849. Characteristics and Outcomes of Patients with Community-acquired and Nosocomial Klebsiella pneumoniae Bacteremia in a Tertiary Hospital in the Philippines

Abstract Background Klebsiella pneumoniae (KPN) bacteremia is associated with higher morbidity and mortality, but there is paucity of local data. This study describes the clinical, microbiologic profile, capsular types, and outcomes of individuals with community-acquired and nosocomial KPN bacteremia. Methods This study prospectively enrolled patients in a private tertiary hospital from January 1, 2023 to December 31, 2023. Hospitalized patients &amp;gt;/= 18 years old with documented KPN bacteremia were included in the study and isolates subjected to capsular typing. The two-tailed t test was used for continuous variables reported as mean and standard deviation whereas chi-square test was used for categorical variables reported as frequencies and percentages. Descriptive statistics were used and univariate analysis using Medcalc Statistical software. Results A total of 25 patients developed KPN bacteremia during the study period; 18 were community-acquired (CA) and 7 were nosocomial. More than half of patients were female (16/25, 64%), with median age 70 (+/- 15) years old. The most common comorbidities were hypertension (15/25, 60%), diabetes mellitus 14/25 (56%), and solid tumor (9/25, 36%). The average intensive care unit stay of 3.4 (+/- 5.9) days for CA KPN bacteremia was significantly shorter than the 13.6 (+/- 16.1) days for those with nosocomial KPN bacteremia. There was no difference in the total length of hospital stay for CA KPN bacteremia (36.7 +/- 85 days) and nosocomial KPN bacteremia (38.6 +/- 23.3 days). Wild-type KPN isolates (15/25, 83.3%) were more commonly found in CA KPN bacteremia, whereas multi-drug resistant isolates were more common for nosocomial KPN. Patients with endotracheal intubation (OR=16, 95% CI 2.2 to 118.3), positive qSOFA (OR=6.42, 95% CI 1.1 to 37.7%), identification of rmpA (OR=9.33, 95% CI 1.5 to 59.5%), and K20 capsular serotype (OR=6.0, 95% CI 1.0 to 35.9%) were more likely to have higher mortality. Conclusion In this cohort, KPN bacteremia occurred more frequently among women, and in the older age group. CA-KPN was more common than nosocomial KPN bacteremia, but the latter was associated with multi-drug resistance. Endotracheal intubation, positive qSOFA, rmpA, and K20 capsular serotypes were associated with higher mortality. Disclosures All Authors: No reported disclosures

P-715. Chronic Conditions as Risk Factors for Respiratory Syncytial Virus-Associated Hospitalization among Community-Dwelling Adults Aged ≥50 Years, 2017 to 2018

Abstract Background In 2023, CDC recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥ 60 years using shared clinical decision-making. Clinical trials of RSV vaccines in younger age groups are ongoing. Identifying chronic conditions associated with increased RSV hospitalization risk can inform vaccination policy.Figure 1.Prevalence of chronic medical conditions among community-dwelling adults aged ≥50 years hospitalized with respiratory syncytial virus (RSV),1 in RSV-NET states,2 and in 50 US states and the District of Columbia2Abbreviations: BMI: body mass index (kg/m2), COPD: chronic obstructive pulmonary disease 1 Prevalence of chronic conditions indicated in the medical record among community-dwelling adults aged ≥50 years hospitalized with laboratory-confirmed RSV infection identified by the RSV Hospitalization Surveillance Network (RSV-NET) from October 2017 to April 2018. 2 Weighted prevalence of community-dwelling adults aged ≥50 years in RSV-NET states (CA, GA, MD, MN, NM, NY, OR, TN) or 50 states and the District of Columbia who self-reported history of chronic medical conditions on the 2018 Behavioral Risk Factor Surveillance System. Methods We compared RSV hospitalization rates among community-dwelling adults aged ≥ 50 years with and without 9 chronic medical conditions in a 38-county catchment area across 8 states. Rate numerators included hospitalizations in adults with and without medical record documentation of each chronic condition, with laboratory-confirmed RSV infection from October 2017 to April 2018 identified by the RSV Hospitalization Surveillance Network (RSV-NET). Rate denominators were catchment area population counts of adults with and without each chronic condition estimated from the 2018 Behavioral Risk Factor Surveillance System, which relies on self-report, and the US Census. Poisson regression using Monte Carlo simulation generated adjusted rate ratios (aRR) and 95% Monte Carlo confidence intervals (CI), adjusted for age, sex, and race and ethnicity group.Table 1.Adjusted models comparing respiratory syncytial virus (RSV) hospitalization rates among community-dwelling adults aged ≥50 years by number of chronic medical conditions— RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: aRR: adjusted rate ratio; CI: Monte Carlo confidence interval1 aRR and 95% Monte Carlo CI were estimated using Poisson regression and Monte Carlo simulation after adjusting for age group (50-59 years, 60-74 years, ≥75 years), sex, and race and ethnicity group (non-Hispanic White, non-Hispanic Black, and other).2 Includes asthma, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, diabetes, history of stroke, obesity (body mass index 30-39 kg/m2), severe obesity (body mass index ≥40 kg/m2), and current smoking. Results Among 1,692 adults aged ≥ 50 years hospitalized with laboratory-confirmed RSV infection, 86.9% had ≥1 chronic condition (Figure 1). RSV hospitalization rates were higher among adults with 1 (aRR=2.7, CI: 1.8, 3.9) or ≥2 chronic conditions (aRR=9.0, CI: 6.3-12.6) vs. none and among adults aged 60-74 years (aRR=1.8, CI: 1.3, 2.6) or ≥ 75 years (aRR=5.4, CI: 3.8-7.8) vs. 50-59 years (Table 1). Adults aged ≥ 50 years with the following individual chronic conditions had higher RSV hospitalization rates compared to those without the conditions: chronic kidney disease (aRR=6.1), COPD (aRR=4.9), severe obesity (aRR=4.0), asthma (aRR=3.2), diabetes (aRR=2.5), current smoking (aRR=2.1), and non-severe obesity (aRR=1.6; Figure 2). RSV hospitalization rates among adults aged ≥ 50 years with each chronic condition were highest in the oldest age groups (Figure 3).Figure 2.Adjusted rate ratios1 comparing respiratory syncytial virus (RSV) hospitalization rates among community-dwelling adults aged ≥50 years with and without chronic medical conditions—RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: aRR: adjusted rate ratio; BMI: body mass index (kg/m2), COPD: chronic obstructive pulmonary disease; SI: simulation interval 1 aRR and 95% Monte Carlo CIs were estimated using Poisson regression and Monte Carlo simulation, after adjusting for age group (50-59 years, 60-74 years, ≥75 years), sex, and race and ethnicity group (non-Hispanic White, non-Hispanic Black, and other). Conclusion In community-dwelling adults aged ≥50 years, RSV hospitalization rates were higher among older adults and those with a history of select chronic conditions. These populations might benefit most from RSV vaccination when recommended for use.Figure 3.Respiratory syncytial virus (RSV) hospitalization rates1 among community-dwelling adults aged ≥50 years with chronic medical condition by age group—RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: BMI: body mass index, COPD: chronic obstructive pulmonary disease 1 Rates of laboratory-confirmed RSV hospitalization account for under-detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests. Rates are of community-dwelling adults and exclude residents of nursing homes and long-term care facilities. Rates are not adjusted for sex or race and ethnicity group. Disclosures All Authors: No reported disclosures

P-1404. Trends and Disparities in Viral Load Suppression Among People Living with HIV in Three Texas Cities: A Decade-Long Retrospective Study

Abstract Background HIV/AIDS remains a significant public health challenge in the United States, especially in states with diverse populations such as Texas. This study examines viral load trends among people living with HIV in Houston, Dallas, and San Antonio over ten years. The aim is to investigate variations in viral load suppression among individuals living with HIV across different cities, considering demographic variables like age, gender, race/ethnicity, and socioeconomic status. Methods A retrospective study was conducted on people with HIV (PWH) from 2009 to 2019. Demographic data, clinical variables, and viral suppression status were analyzed across different groups using time-to-event analysis. Results The analysis revealed that being female was linked to a reduced hazard ratio for detectable viral load (HR: 0.89, 95% CI: 0.82 - 0., p = 0.005) after adjusting for other demographic factors (table 2). Additionally, younger age groups (18-29, 30-39, and 40-49) exhibited significantly higher hazard ratios compared to those aged 50 and above, indicating a higher risk of detectable viral load. Race/ethnicity emerged as a significant factor, with Non-Hispanic Black individuals displaying a higher hazard ratio compared to Non-Hispanic White individuals (HR: 1.35, 95% CI: 1.22 - 1.48, p &amp;lt; 0.001). Furthermore, Medicaid-insured individuals demonstrated higher risk of detectable viral load, consistent with both univariate and multivariate analyses. However, language preference did not significantly influence viral load detection status, as evidenced by the absence of a significant difference between English and Spanish speakers in the multivariate analysis. Conclusion Our research investigates disparities in achieving viral load suppression among individuals with HIV in Texas. Younger people seem to encounter challenges in maintaining viral suppression compared to older age groups. The influence of social determinants of health is highlighted by racial/ethnic disparities. While our study did not find a significant impact of language barriers on viral load detection, further exploration is needed to better comprehend these results. Disclosures Karen J. Vigil, MD, Gilead: speaker|theratechnologies: research|ViiV: Advisor/Consultant Mamta K. Jain, MD, MPH, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support

P-2121. A prospective observational study of usefulness of interferon-gamma release assay for latent tuberculosis infection in pediatric hematopoietic stem cell transplant recipients

Abstract Background Pediatric hematopoietic stem cell transplantation (HSCT) recipients are one of the high-risk groups concerning tuberculosis and screening for latent tuberculosis infection (LTBI) prior to HSCT is important and accurate diagnostic tests for predicting LTBI in these high-risk children are on demand. However, there are concerns for Interferon-gamma release assay(IGRA) being less sensitive in the children group for screening LTBI. This study was aimed to evaluate the predictive value of Quantiferon-TB Gold test (QFT-G) using the enzyme-linked immunosorbent spot assay (T-SPOT.TB) in immunocompromised Korean children. Methods In this prospective observational study, children under age 20 who were scheduled for allogeneic HSCT at Asan Medical Center Children`s Hospital were enrolled during March 2017 and May 2018. QFT-G test and T-SPOT.TB were done prior to HSCT. Concordance rates were calculated among each group. Electronic Medical Records was reviewed for clinical and demographic data of the enrolled patients. Results Among the 62 patients who were planned to receive allogenic HSCT during March 2017 and May 2018, 11 patients were excluded and a total of 51 patients were enrolled. Median age was 10 years and the underlying disease leading to HSCT was mostly aplastic anemia (31.4%). Others were acute myeloid leukemia (23.5%), acute lymphoblastic leukemia (15.7%), myelodysplastic syndrome (7.8%), and other benign disease (17.6%). About 52% of the patients were applied immunosuppressive drugs in the recent 3-month period prior to testing. 4 patients were considered LTBI based on screening test results. At 2 year follow up period, 1 patient was confirmed pulmonary TB. Overall concordance rate was 82.4% (42/51). The age-based concordance rate was 93.8% (14/15) for children younger than 5-years old and 77.8% (28/36) for 5 or above. Concordance rate between negative test results and not TB diagnosis was further checked; QFT-GIT 97.8% (44/45), T-SPOT. TB 97.9% (46/47), and TST 100% (10/10). Conclusion This study shows that the GFT-GIT well matched with the T-SPOT.TB for screening LTBI and children under age 5 showed to have higher concordance rates compared to the older age group. This could provide evidence to testing younger children with IGRA assays. Disclosures All Authors: No reported disclosures

Umbilical Cord-derived Mesenchymal Stem Cells (CLV-100) Infusion in Healthy Subjects: a 5-Year Follow-up Study on Safety and Immunomodulatory Effect

Abstract Purpose Umbilical cord-derived mesenchymal stem cells (UCMSCs) have garnered significant attention in the field of regenerative medicine, specifically in inflammation-related diseases. Our team has previously demonstrated that a single infusion of allogeneic UCMSCs by Cytopeutics® (CLV-100), at both low dose (65 million cells) and high dose (130 million cells), in 11 healthy volunteers was safe up to 6 months with a dose-dependent immunomodulatory effect. In this present follow-up study, we investigated the medium-term safety and efficacy of intravenous administration of CLV-100 in the same healthy subjects. Methods All 11 subjects were enrolled in this 5-year follow-up, and none dropped out (NMRR-13–1152-17400, 28/09/2016). Clinicians conducted consultations to assess overall health indicators. Blood samples and serum were collected for laboratory testing and biomarker analysis, respectively. Results Five years after the CLV-100 infusion, all subjects remained healthy, with no reported side effects or major health conditions. Levels of cancer markers also remained within normal ranges. The anti-inflammatory effect of CLV-100 remained statistically significant in the high-dose group. Notably, major organ health parameters, including those subjects aged over 60 years, remained stable even after 5 years. Conclusion The findings demonstrated the medium-term safety of a single CLV-100 infusion and persistent dose-dependent immunomodulatory effects. CLV-100 may also confer protection against age- and inflammation-related frailty. Lay Summary The current follow-up study provides insight into the safety and immunomodulatory effects of a single infusion of allogeneic umbilical cord-derived mesenchymal stem cells (CLV-100) for up to 5 years in healthy subjects. The effects on the inflammatory cytokines CLV-100 were more pronounced in the high-dose group. In addition, other biomarker levels were comparable between the older and younger age groups. CLV-100 is therefore safe over the medium-term with sustained anti-inflammatory effect in a dose-dependent manner.

Predicting real-world navigation performance from a virtual navigation task in older adults.

Virtual reality environments presented on tablets and smartphones offer a novel way of measuring navigation skill and predicting real-world navigation problems. The extent to which such virtual tests are effective at predicting navigation in older populations remains unclear. We compared the performance of 20 older participants (54-74 years old) in wayfinding tasks in a real-world environment in London, UK, and in similar tasks designed in a mobile app-based test of navigation (Sea Hero Quest). In a previous study with young participants (18-35 years old), we were able to predict navigation performance in real-world tasks in London and Paris using this mobile app. We find that for the older cohort, virtual navigation performance predicts real-world performance for medium difficulty, but not for the easy or difficult environments. Overall, our study supports the utility of using digital tests of spatial cognition in older age groups, while carefully adapting the task difficulty to the population.

Prevalence of metabolically associated steatotic liver disease in the elderly: analysis and perspectives

Metabolically associated steatotic liver disease (MASLD) is becoming a major public health problem, especially among the elderly. The recent change in nomenclature from “nonalcoholic fatty liver disease” to “MASLD” reflects a more accurate understanding of the pathogenesis of the disease, linking it to metabolic disorders such as insulin resistance, obesity, and metabolic syndrome. This new terminology emphasizes the importance of a comprehensive approach to the diagnosis and treatment of the disease, given its close association with metabolic disorders and cardiovascular risk. Current estimates suggest that 24 % of the adult population, i. e. one billion people worldwide, suffer from the disease. Interestingly, the prevalence of fatty liver disease peaks between the ages of 40–50 years in men and 60–69 years in women, and then declines slightly in older age groups (over 70 years). The prevalence of MASLD is increasing worldwide, reflecting the increasing incidence of obesity, type 2 diabetes mellitus, and metabolic syndrome. The elderly are particularly susceptible to MASLD due to age-related metabolic changes, comorbidities. Aging is associated with changes in lipid metabolism, insulin resistance, and increased fat mass, which predispose the elderly to hepatic lipid accumulation and subsequent liver damage. In addition, age-related decline in the liver»s regenerative capacity may exacerbate the progression of hepatic steatosis to advanced stages such as steatohepatitis and hepatic fibrosis. However, MASLD in the elderly remains under-recognized and under-diagnosed, posing challenges for timely intervention and treatment. Prospects for addressing MASLD in the elderly emphasize the importance of comprehensive geriatric assessment, including evaluation of metabolic health and liver function.

Systematic review and quantitative meta-analysis of age-dependent human T-lymphocyte homeostasis

ObjectiveTo evaluate and quantitatively describe age-dependent homeostasis for a broad range of total T-cells and specific T-lymphocyte subpopulations in healthy human subjects.MethodsA systematic literature review was performed to identify and collect relevant quantitative information on T-lymphocyte counts in human blood and various organs. Both individual subject and grouped (aggregated) data on T-lymphocyte observations in absolute and relative values were digitized and curated; cell phenotypes, gating strategies for flow cytometry analyses, organs from which observations were obtained, subjects’ number and age were also systematically inventoried. Age-dependent homeostasis of each T-lymphocyte subpopulation was evaluated via a weighted average calculation within pre-specified age intervals, using a piece-wise equal-effect meta-analysis methodology.ResultsIn total, 124 studies comprising 11722 unique observations from healthy subjects encompassing 20 different T-lymphocyte subpopulations – total CD45+ and CD3+ lymphocytes, as well as specific CD4+ and CD8+ naïve, recent thymic emigrants, activated, effector and various subpopulations of memory T-lymphocytes (total-memory, central-memory, effector-memory, resident-memory) – were systematically collected and included in the final database for a comprehensive analysis. Blood counts of most T-lymphocyte subpopulations demonstrate a decline with age, with a pronounced decrease within the first 10 years of life. Conversely, memory T-lymphocytes display a tendency to increase in older age groups, particularly after ~50 years of age. Notably, an increase in T-lymphocyte numbers is observed in neonates and infants (0 – 1 year of age) towards less differentiated T-lymphocyte subpopulations, while an increase into more differentiated subpopulations emerges later (1 – 5 years of age).ConclusionA comprehensive systematic review and meta-analysis of T-lymphocyte age-dependent homeostasis in healthy humans was performed, to evaluate immune T-cell profiles as a function of age and to characterize generalized estimates of T-lymphocyte counts across age groups. Our study introduces a quantitative description of the fundamental parameters characterizing the maintenance and evolution of T-cell subsets with age, based on a comprehensive integration of available organ-specific and systems-level flow cytometry datasets. Overall, it provides the most up-to-date view of physiological T-cell dynamics and its variance and may be used as a consistent reference for gaining further mechanistic understanding of the human immune status in health and disease.

Depression, Anxiety, Resilience, and Family Functioning Among Different Age Groups During the COVID-19 Pandemic: A One-Year Longitudinal Study

Background/Objectives: The COVID-19 pandemic has profoundly disrupted mental health globally, affecting individuals across all age groups. Understanding its long-term impact is crucial for identifying age-specific vulnerabilities and informing targeted mental health interventions. This longitudinal study aimed to investigate the within-person changes in mental health across different age groups in Greece from the first to the third pandemic wave of coronavirus disease 2019 (COVID-19) (i.e., one year later) during nationwide lockdowns. It further compared the mental health outcomes of three distinct age groups, stratified based on their vulnerability to COVID-19—younger adults (18–29 years), adults (30–59 years), and older adults (60–84 years)—and examined correlates of depression and anxiety during the third pandemic wave. Methods: A total of 720 participants—92 younger adults, 543 adults, and 85 older adults—completed the same set of questionnaires during the first (April–May 2020) and third (March–May 2021) pandemic-related lockdowns. At both time points, participants provided data on the Generalized Anxiety Disorder-2, Patient Health Questionnaire-2, Systemic Clinical Outcome and Routine Evaluation-15, Connor–Davidson Resilience Scale-2, and demographic information. Results: Results indicated a within-individual increase in depression and a decrease in resilience for all participants, irrespective of age. Anxiety increased only among younger adults and adults, whereas family functioning remained stable across all age groups one year post-pandemic onset. Furthermore, younger adults reported higher levels of depression and anxiety, lower resilience, and more impaired family functioning compared to the older age groups in both lockdowns. Among the different age groups, factors independently associated with depression and anxiety were identified through stepwise regression analyses. Conclusions: The present study provides evidence for mental health deterioration during the pandemic across all age groups, with younger adults exhibiting heightened vulnerability.

A Study on Investment Avenues and Preferences in the Region of Dadra and Nagar Haveli

The study explores investment preferences and influencing factors among individuals residing in Dadra and Nagar Haveli, a Union Territory (UT) of India. The research aims to bridge the knowledge gap regarding investor behaviour in UTs, which often differ from larger states, by surveying 142 respondents. The study investigates: Investor demographics, Investment awareness and practice, Investment preferences, and Factors influencing investment decisions. The findings reveal a mix of risk preferences amongst the respondents wherein a significant portion favours traditional, secure options like bank deposits and insurance. Many are interested in mutual funds and the stock market, indicating a willingness to embrace some risk for potentially higher returns. Gold and Post Office schemes also find favour, reflecting a conservative streak. Safety emerges as the most influential factor, followed by return on investment and risk tolerance. The study also finds that younger investors (21-30) are more likely to invest in the stock market and mutual funds compared to older age groups. This research provides valuable insights for: Policymakers so as to design targeted financial products and infrastructure to enhance UTs’ economic growth, financial institutions so that they can tailor their investment offerings and improve investor education in the region, and residents to make informed investment decisions aligned with their financial goals and risk tolerance.