Percentage Of African Americans Research Articles

County‐level cumulative effect of ambient PM2.5 exposure on the Alzheimer’s disease mortality rate in the west coast regions of the United States

AbstractBackgroundSeveral studies have investigated the relationship between long‐term exposure to fine particulate matter (PM2.5) and the risk of Alzheimer’s disease (AD), yet studies on the cumulative effect of PM2.5 exposure are limited. This study assesses the association between the county‐level cumulative PM2.5 exposure at a level above 35 ug/m3, the safe threshold recommended by the World Health Organization (WHO), on Alzheimer’s mortality in the west coast population of the United States.MethodAnnual county‐level Alzheimer’s disease mortality rates from 2010 to 2019 were obtained from the Centers for Disease Control and Prevention WONDER database, and the cumulative county‐level PM2.5 exposure greater than 35 ug/m3 were derived from publicly accessible data at the Environmental Protection Agency (EPA). Analysis focused on 76 counties for about 48 million people in the states of Washington, Oregon, and California of the US.Analysis was conducted using a Bayesian spatiotemporal linear mixed effects model with the Markov Chain Monte Carlo Simulations. For each county, the log transformed county‐level annual AD mortality rates were regressed against the total number of days with concentration levels of PM2.5 over 35 ug/m3 in the year and its past t years, where t = 1, 2, …, 10 (Figure 1 for t = 10). Each of the 10 regression models was adjusted for thirteen potentially confounding variables including the rate of poverty, percent rural land area, median household income, percent unemployed, percent uninsured, percent obesity, percent smokers, percent excessive drinking, percent African American, percent Asian, percent Hispanic, percent ages under 18, and percent ages 65 and older.ResultResults showed that in periods of three calendar years or longer, having a higher number of days of PM2.5 exceeding the safe level is associated with a higher rate of AD mortality (Figure 2). The results also showed an increasing trend between AD mortality and years of cumulative PM2.5 exposure.ConclusionCumulative PM2.5 exposure at a level above the WHO recommended safe threshold is associated with AD mortality rate in three west coast states of the US.

Interdisciplinary Collaboration: A School Wellness Team Model

This column will focus on a PK–5 public elementary school located in a suburban area in Montgomery County, Maryland. There are approximately 900 students enrolled for the 2022–2023 school year, with 89 percent receiving free and reduced-price lunch. The student population consists of about 85 percent Hispanic, 11 percent African American, and less than 5 percent other races. About 72 percent of the students receive support for multilingual learners. Spanish, followed by French, are the most common languages spoken at home among students (Montgomery County Public Schools, 2021). The school is a Title I school that receives additional funding throughout the school year for use toward various programs that serve the students. The school also receives funding through a community school grant, which can provide services to the families of students, including food assistance, navigating school programs, and connection to community providers. New students are enrolled throughout the school year, especially newcomers who have just immigrated to the United States. The majority of students arrive from Central American countries, and some endure traumatic journeys to get to their new country. Other students experience separation from families during and after arriving to the United States. Once settled in their new country, they may witness violence in the community. The community surrounding the focus school experiences violence, including shootings, which students report to school staff that they have heard or witnessed.

Abstract 4217: Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Abstract Individual environmental contaminants have been associated with breast cancer (BCa); however, simultaneous evaluations of multiple exposures are limited. The USEPA has constructed an environmental quality index (EQI) that includes different exposures across air, water, land, sociodemographic, and built environments. As links between BCa and the EQI have so far been confined to total BCa incidence, herein we investigated if these multiple exposures in broad EQI domains were associated with BCa incidence stratified by stage of disease. Incidence rates of total, in situ, localized, regional, and distant breast cancer were assessed by linking the EQI dataset to county-level age-standardized incidence rates obtained from the North Carolina Central Cancer Registry (2010-2014), which reports all cancer cases diagnosed in NC residents. Generalized linear models (SAS 9.3) were constructed to determine the associations between breast cancer incidence rates by summary stage and the EQI in total and by domain, compared across rural versus urban counties. Models were adjusted for percent African American (AA), percent smokers, and mammography screening rates in each county. Mann-Whitney rank tests and D'Agostino-Pearson normality tests were used to determine statistical significance. Results showed that the EQI is variable across NC, akin to variability across the U.S. (interquartile range 25th-75th% for total EQI in NC: -0.187 to 0.734 vs in the U.S.: –0.606 to 0.706). In counties with poor total EQI scores, and thus poor overall environmental quality, total BCa incidence increased by 10.82 cases per 100,000 persons (95%CI: 2.04, 19.60, p=0.016). This association was most pronounced for localized BCa (β=5.59, 95%CI: 0.59, 10.58, p=0.029). Higher incidence of early-stage disease (carcinoma in situ β=5.25, 95%CI: 2.34, 8.16, p=0.001 and localized BCa β=6.98, 95%CI: 2.24, 11.73, p=0.004) and total breast cancer (β=11.44, 95%CI: 3.01, 19.87, p=0.008) also occurred in counties with poor land quality, especially urban counties. The county AA percentage was associated with increased incidence of regional (0.12 cases per % increase, 95% CI 0.01, 0.22, p=0.022) and distant BCa (0.06 per % increase, 95% CI 0.02, 0.10, p=0.003). Associations persisted and were strengthened in urban counties for regional BCa, and in rural counties for distant BCa. In sum, we found that BCa is associated with environmental quality differentially by disease stage, environmental domain, and urbanicity. Although what drives poor EQI varies by region, our analyses are generalizable to other states and counties across the U.S. and suggest that cumulative environmental exposures should be assessed in the context of cancer stage. Funding: Duke Cancer Institute pilot (GRD, KPH) in P30 Cancer Ctr grant; NIEHS T32-ESO21432-05; NCI-3P20CA202925-04S2 Diversity Supplement (LGS). Citation Format: Larisa M. Gearhart-Serna, Kate Hoffman, Hillary Hsu, Gayathri R. Devi. Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4217.

Abstract P4-03-12: Cumulative Environmental Quality is Associated with Differential Breast Cancer Incidence by Summary Stage and Urbanicity

Abstract Background: Individual environmental contaminants have been associated with breast cancer; however, evaluations of multiple exposures simultaneously are limited. The USPA has constructed an environmental quality index (EQI), which contains county-level environmental exposure data across five overarching environmental domains (air, water, land, sociodemographic, and built environment). Unfortunately, the links made between breast cancer and the EQI are lacking because these analyses used total breast cancer incidence quantities, masking potential associations between EQI domains and specific stages of disease. In this study, we investigated if multiple exposures in broad EQI domains was associated with incidence of breast cancer, stratified by stage. Methods: The EQI data was linked to county-level age-standardized incidence rates (SIRs) obtained from the North Carolina Central Cancer Registry/NC CCR (2010-2014), a reporting system for all cancer cases diagnosed in residents of the state. Incidence rates and SIRs of total, in situ, localized, regional, and distant breast cancers were evaluated stratified by rural-urban status. Associations between county-level age-adjusted cancer incidence rates for each summary stage were assessed using general linear models (SAS 9.3), linear models with a continuous outcome with a p-value cutoff for statistical significance set at p< 0.05. We also evaluated incidence rates by summary stage comparing across rural versus urban counties using Mann-Whitney rank tests, since not all stages were normally distributed, confirmed by the D’Agostino-Pearson normality test. Results: In counties with poor environmental quality compared to those with good environmental quality, total breast cancer incidence was higher by 10.82 cases per 100,000 persons (95%CI: 2.04, 19.60, p=0.016). This association was most pronounced for localized breast cancer (β=5.59, 95%CI: 0.59, 10.58, p=0.029). Higher incidence of early-stage disease (carcinoma in situ β=5.25, 95%CI: 2.34, 8.16, p=0.001 and localized breast cancer β=6.98, 95%CI: 2.24, 11.73, p=0.004) and total breast cancer (β=11.44, 95%CI: 3.01, 19.87, p=0.008) occurred in counties with poor land quality, especially urban counties. Overall, NC counties averaged 21.6% percent African American (AA) which is higher than the US national average of 12.6% at the time of the U.S. 2010 Census. The percentage of AA in each county in bivariate analyses was associated with increased incidence of regional (incident cases 0.12 cases per % increase in AA population, 95% CI 0.01, 0.22, p=0.022) and distant breast cancers (incident cases 0.06 per % increase in AA population, 95% CI 0.02, 0.10, p=0.003) (Table 1). In addition, in stratified models, associations persisted and were strengthened in urban county models for regional breast cancer and in rural county models for distant breast cancer. Conclusions: Environmental quality is variable across NC akin to variability across the US, as the interquartile range (25th-75th percentile) of total EQI in NC is -0.187 to 0.734 while the interquartile range is –0.606 to 0.706 for the US (USEPA), making NC EQI analyses generalizable to a number of states and counties across the U.S., although what drives poor environmental quality varied by region and by county. Our analyses indicate significant associations between EQI and breast cancer incidence, which differ by breast cancer stage and urbanicity, identifying a critical need to assess cumulative environmental exposures in the context of cancer stage. Funding: Duke Cancer Institute seed grant (GRD, KH) as part of the P30 Cancer Ctr grant; Duke Environmental Health Scholars Award and NIEHS T32-ESO21432-05 (LMG). Table 1. Generalized linear model estimates and associated p-values for county characteristics, per 1% increase. Results are stratified by breast cancer stage and urbanicity. Bolded text indicates statistically significant estimates (p<0.05) Citation Format: Larisa M Gearhart-Serna, Hillary Hsu, Oluwadamilola (Lola) Fayanju, Brittany Mills, Kate Hoffman, Gayathri R Devi. Cumulative Environmental Quality is Associated with Differential Breast Cancer Incidence by Summary Stage and Urbanicity [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-12.

How Neighborhood Characteristics Influence Neighborhood Crimes: A Bayesian Hierarchical Spatial Analysis.

Urban crimes are a severe threat to livable and sustainable urban environments. Many studies have investigated the patterns, causes, and strategies for curbing the occurrence of urban crimes. It is found that neighborhood socioeconomic status, physical environment, and ethnic composition all might play a role in the occurrence of urban crimes. Inspired by the recent interest in exploring urban crime patterns with spatial data analysis techniques and the development of Bayesian hierarchical analytical approaches, we attempt to explore the inherently intricate relationships between urban assaultive violent crimes and the neighborhood socioeconomic status, physical environment, and ethnic composition in Paterson, NJ, using census data of the American Community Survey, alcohol and tobacco sales outlet data, and abandoned property listing data from 2013. Analyses are set at the census block group level. Urban crime data are obtained from the Paterson Police Department. Instead of examining relationships at a global level with both non-spatial and spatial analyses, we examine in depth the potential locally varying relationships at the local level through a Bayesian hierarchical spatially varying coefficient model. At both the global and local analysis levels, it is found that median household income is decisively negatively related to urban crime occurrence. Percentage of African Americans and Hispanics, number of tobacco sales outlets, and number of abandoned properties are all positively related with urban crimes. At the local level of analysis, however, the different factors have varying influence on crime occurrence throughout the city of Paterson, with median household income having the broadest influence across the city. The practice of applying a Bayesian hierarchical spatial analysis framework to understand urban crime occurrence and urban neighborhood characteristics enables urban planners, stakeholders, and public safety officials to engage in more active and targeted crime-reduction strategies.

34706 An exploration in racial disparities in access to biologic treatment for psoriasis: The experience of a single academic dermatology practice

Introduction: Psoriasis affects 7.5 million people in the U.S., with severe subtypes more prevalent in non-Caucasians compared with Caucasians. African Americans are less likely to receive biologics. More specifically, among those with Medicare, African Americans are 70% less likely to receive biologics. Similar findings are seen among Hispanics, who are less likely to receive certain biologics compared with non-Hispanics. Objective: Our primary objective is to assess if there is a disparity in access to biologics for the treatment of psoriasis in African Americans compared with Caucasian and if so, to identify whether the disparity is related to insurance status or a specific biologic. Methods: This retrospective cohort study identified patients with a psoriasis diagnosis from 2016-2020. Patient race/ethnicity, insurance status, and treatment history was collected and evaluated. Results: Of 2245 patients, 81% were Caucasian and 61% were female. Males were more likely to be on a biologic. There was no significant difference between access to biologics and race or between insurance status and biologic access. Caucasians were more likely to receive more than one biologic compared with African Americans. Conclusions: Sample size differences between this study and previous studies may explain the lack of significance in percentage of African Americans and Caucasians on biologics. The percentage of Medicare patients on a biologic is consistent with other studies. Caucasian patients were three times more likely to have received more than one biologic compared with African American patients, possibly related to predominance in this cohort.

Assessment of inequity in bicyclist crashes using bivariate Bayesian copulas

Introduction: Physical activity associated with active transport modes such as bicycling has major health benefits and can help to reduce health concerns related to sedentary lifestyles, such as cardiovascular disease, Type II diabetes, and obesity, as well as risks of colon and breast cancer, high blood pressure, lipid disorders, osteoporosis, depression, and anxiety. However, as a vulnerable user group, bicyclists experience negative health impacts of transportation policies and infrastructure, such as traffic crashes and exposure to air and noise pollution that is disproportionately distributed within low-income and underserved areas. Method: This study used aggregated (block-group) bicyclist crash data from Harris County, Texas, to analyze how various equity measures are associated with both fatal and injury (FI) and no injury (property damage only) bicyclist crashes that occurred from 2010 to 2017. We used Bayesian bivariate copula-based random effects regression analysis to evaluate these associations. In contrast to more traditional univariate analysis, this novel methodology can consider the effects of factors of interest across different severity levels or crash types to fully understand their effects and how they may differ across categories. Results: The analysis results indicate that the bicyclist exposure, vehicle exposure, population demographics, population density, the percentage of African-Americans, and households below the poverty level are associated with both FI and PDO bicyclist crashes. Conclusions: Although more location and context-specific analyses are required, this study's overall results once again conform with the findings and assumptions in bicycling safety literature that the low-income and racially diverse communities are prone to experience more bicyclist crashes. Practical Applications: The findings of this study may have implications for future transportation and planning policies. These findings can be used to guide the policies and strategies targeting the elimination of inequity in transportation-related health concerns.

Association of Race and Other Social Determinants of Health With HIV Pre-Exposure Prophylaxis Use: A County-Level Analysis Using the PrEP-to-Need Ratio.

Research is limited on the effect of racism and social determinants of health on HIV pre-exposure prophylaxis (PrEP) use. This study used the PrEP-to-Need Ratio (PNR), which measures PrEP prescriptions divided by HIV diagnoses in the county, to evaluate sufficient PrEP use. AIDSVu datasets were compared to county-level social determinants of health. Standardized regression coefficients (β) were compared to identify strongest associations with PNR. Overall, factors including percent African American and percent uninsured had negative correlations with PNR, whereas median household income and severe housing cost burden had positive associations. Stratifying for population size, percent African American, percent uninsured, and severe housing cost burden were significant for low population areas, whereas median household income, percent in poverty, percent uninsured, and percent African American were significant for large populations. To reduce PrEP disparities, public health must develop strategies to reach those most in need, especially historically disadvantaged communities.

Exploring the socioeconomic drivers of COVID-19 mortality across various spatial regimes.

Identifying the socioeconomic drivers of COVID‐19 deaths is essential for designing effective policies and health interventions. However, how the significance and impact of these factors varies across different spatial regimes has been scantly explored. In this ecological cross‐sectional study, we apply the spatial lag by regimes regression model to examine how the socioeconomic and health determinants of COVID‐19 death rate vary across (a) metropolitan vs. non‐metropolitan, (b) shelter‐in‐place vs. no‐shelter‐in‐place order, and (c) Democratic vs. Republican US counties. A total of 20 variables were studied across 3108 counties in the contiguous US for the first year of the pandemic (6 February 2020 to 5 February 2021). The results show that the COVID‐19 death rate not only depends on a complex interplay of the population demographic, socioeconomic and health‐related characteristics, but also on the spatial regime that the residents live, work and play. Household median income, household size, percentage of African Americans, percentage aged 40–59 and heart disease mortality are significant to metropolitan but not to non‐metropolitan counties. We identified lack of insurance access as a significant driver across all regimes except for Democratic. We also showed that the political orientation of the governor might have impacted COVID‐19 death rates due to the public response (i.e., shelter‐in‐place vs. no‐shelter‐in‐place order). The proposed analysis allows for understanding the socioeconomic context in which public health policies can be applied, and importantly, it presents how COVID‐19 death related factors vary across different spatial regimes.

Abstract 10285: The Association of Food Deserts with Sudden Death in Wake County, North Carolina

Introduction: Food deserts (FD) are low-income areas with limited access to healthy foods associated with an individual’s risk of diabetes, hypertension, and atherosclerosis. These factors likely contribute to the risk of sudden death, but their association with sudden death is unknown. In this study, we aim to determine the impact of living in a food desert on sudden death. Hypothesis: Sudden death will occur more often in FD census tracts than in non-FD low-income tracts and high-income tracts. Methods: Census tract designations of income and FD status were determined from the United States Department of Agriculture's Food Access Research Atlas. The incidence of sudden death in each census tract was determined using a registry of 399 adjudicated out-of-hospital sudden deaths ages 18-64 in Wake County, North Carolina reported by emergency medical services from 2013-2015. A Poisson regression model was fit with FD status as a covariate and adjusted for the population size, percentage of males, and percentage of African Americans in the census tract. A Wald statistic was used to calculate sudden death incidence ratios (IR) with 95% confidence intervals (95% CI) for the populations living in FD tracts and in non-FD low-income tracts, compared with the population residing in high-income tracts (non-low-income and non-FD) as the reference group. Results: After adjusting for population size, sex, and race, the incidence of sudden death in FDs was higher than high-income census tracts (IR=1.466, 95% CI: 1.021-2.105). The incidence in non-FD low-income census tracts was also higher than high-income tracts (IR=1.398, 95% CI: 0.993-1.968). However, the FD census tracts had similar incidence to the non-FD low-income tracts (IR=0.954, 95% CI: 0.665-1.367). Conclusion: Living a food desert in Wake County, NC is associated with sudden death. Public health initiatives addressing healthy food access and income inequality may reduce the incidence of sudden death. However, a larger study, with a greater geographic distribution, is in development to explore the independent association of poverty and availability of healthy foods.

ADAMS-TS13 Inhibitor Level and Risk of Relapse in Acquired Idiopathic Thrombotic Thrombocytopenic Purpura

▪Introduction:Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy due to reduced activity of ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, 13). This disorder can be due to a congenital deficiency state or be acquired (immune TTP (iTTP)) due to an antibody which either inhibits or causes clearance of ADAMTS13.The aim of our study was to determine whether ADAMTS13 inhibitor titer at initial presentation could serve as a predictor of refractory disease and relapse in iTTP. We also measured clinical outcomes across different gender and racial subgroups.Methods:The United States Thrombotic Microangiopathy (USTMA) iTTP registry was used to extract patient information for two academic institutions in Eastern North Carolina.Descriptive statistics were used to analyze the data. The first iTTP episode recorded in the data base was used as the index episode. All patients included in the final analysis had an ADAMTS13 activity of <10%. An inhibitor level of 5 Bethesda units was arbitrarily chosen as the cutoff between low (<5) and high (>/5) inhibitor level. Response time was defined as the number of days of plasma exchange (PEX) required to achieve a platelet count of 150,000 for two consecutive days. Relapse was defined as occurrence of a new episode of iTTP 30 days after achievement of response. Refractory disease was defined as persistence of thrombocytopenia or absence of a sustained platelet count increment or platelet counts of < 50,000 despite 4-7 days of plasma exchanges and steroid treatment. Rituximab resistance was defined as lack of platelet recovery to more than 150,000 within 11 to 14 days of administration of the first dose of Rituximab.Results:A total of 161 patients with iTTP were identified. Ten patients had ADAMTS13 activity >10% and 15 patients did not have a reported inhibitor level. These subjects were not included in the final analysis.The cohort had 28% male (n =38/136) and 72% (n=98/136) female patients. There were more African American patients 73% (n=99/136) than Caucasians 24% (n=32/136). There were also 2 Hispanic, 1 Native American and 2 patients with unidentified race.Median ADAMTS3 inhibitor titer was 1.05 (Range 0-87). Forty three patients with ADAMTS13 activity <10 % had an inhibitor level of 0 (i.e undetectable).They were included in the low inhibitor group.Overall, 88% patients (n=120/136) had low inhibitor level and only 12% (n=16/136) had a high inhibitor. Thirteen percent females (n=13/98) and 8% (n=3/38) males had a high inhibitor level (p=0.387). Fourteen percent (n=14/99) African Americans and 6 % (n=2/32) Caucasians had a high inhibitor, p=0.23.In the low inhibitor group 30% (n=36/120) patients suffered at least one episode of relapse whereas 31% (n=5/16) had relapsed in the high inhibitor group.The median time to response was 6 days (range 1-76) in the low inhibitor group and 7 days (range 4-20) in the high inhibitor group (p=0.61). While looking at the various subgroups, median time to response for males was 6 days (range 4-21), females 6 days (range 1-76) , African Americans 6 days (range 3-29) , and Caucasians 6 days (range 1-76).The frequency of refractory disease was 31 % (n=5/16) in the high inhibitor group and 29% (n=34/119) in the low inhibitor group. At the time of enrollment in the registry, Rituximab was not a part of first line therapy. Only 26 out of 136 patients had received Rituximab. In the low inhibitor group 5 patients displayed Rituximab resistance whereas there were no patients in the high inhibitor group with Rituximab resistance.Conclusion:When evaluating patients presenting with iTTP in two centers in North Carolina, no correlation was found between a high inhibitor levels of >/ 5 Bethesda units and risk of relapse or refractory disease. A larger study is needed to evaluate this further. DisclosuresNo relevant conflicts of interest to declare.

Racial/ethnic, social characteristics and geographic disparities of childhood cancer late-stage diagnosis in Texas, 2005 to 2014

ABSTRACT This study investigated childhood cancer disparities in the state of Texas based on data from 1995 to 2014 from the perspective of race/ethnicity, geographic location, and social factors. The enhanced 2-step floating catchment area (E2SFCA) method was used to measure relative spatial access to Children’s Oncology Group (COG) hospitals. This study also examined the effect of spatial access to specialized COG services along with other variables in explaining the variations of late-stage diagnosis of childhood cancer. Multilevel logistic regression was used to analyse how individual- and contextual-level factors affect the occurrence of childhood cancer disparities (i.e. late-stage diagnosis). The study revealed that Hispanic children were more likely to be diagnosed at a late-stage, after adjusting for age, race/ethnicity, socioeconomic status (SES), socio-culture, education, spatial access to COG hospitals, percent African American, and health insurance coverage. The study also identified that the childhood cancer stage at diagnosis is associated with spatial access to COG services as well as levels of urbanization. Moreover, findings indicate that contextual-level factors, such as SES, socio-cultural factors, education level, and percent health insurance coverage partially explained some of the childhood cancer disparities. Results from this study will contribute to developing more effective and targeted childhood cancer intervention programs in socially underprivileged areas, focusing on population with lower socioeconomic status and lower education levels, limited English-speaking households, areas with a higher percentage of Hispanics and African Americans, locations with a low level of spatial access to COG services.

Review: The Varieties of Nonreligious Experience: Atheism in American Culture, by Jerome P. Baggett

The Varieties of Nonreligious Experience is emblematic of the second of three main streams of atheist books published in the West over the past two decades. On the one hand, Jerome Baggett’s nuanced sentiments resemble the countercultural work of others—such as Alain de Botton’s study of atheist reclamation(s) of religiosity in Religion for Atheists (2012)—that confronts reductionist conceptions of atheists and theists by showcasing the symmetry between their respective worldviews. On the other hand, Baggett differs from the militant first wave tenor of atheist apologists such as Richard Dawkins’ The God Delusion (2006) and Christopher Hitchens’ God Is Not Great (2007). In contrast to the New Atheist defenders of atheist orthodoxy who dominate the media landscape, Baggett illuminates the humanity and humility of ordinary atheists in his survey of more than 500 American nonbelievers. Most atheists, he concludes, are not antireligious as they are so often characterized, but rather freethinkers with multifaceted personalities.The Varieties of Nonreligious Experience has several strengths. The book is the second published in New York University Press’ Secular Studies series, which is edited by the leading sociologist of atheism Phil Zuckerman. Baggett is cognizant of major and minor debates, including whether, and in what ways, atheists contribute to American public life and the inextricable linkages between modern conceptions of God and atheism. In a society bedeviled by self-aggrandizement, Baggett’s self-effacement is quite refreshing. He muses that his book will certainly not become an instant classic. He under-promises hoping to over-deliver. Baggett lucidly takes readers on a narratological trek of case studies to map the perplexities of atheists moving from belief to nonbelief. In the Acknowledgments, Baggett confesses he aspires only to capture interviewees’ stories.Baggett makes coherent arguments and modest inferences too. His expertise as a thinker and writer are on full display. He nimbly situates the current mood of public atheism, from the outset in the Preface, within the broader perspectives of scholarship, theories, and concepts about atheism. Avoiding needless jargon, he introduces rich and relevant analytical categories—empirical, critical, agnostic, and immanent—to contextualize the varying styles of unbelief. The book aptly develops its organizing principle through two clear sections—one on the atheist identity, the other cultivating atheist sensibilities—to highlight how “ordinary atheism” is not an affront to theism. The mirror imaging of the theist versus the atheist stems from a false binary consciousness. Because neither group, the author insinuates, has a monopoly on truth, theists and atheists should be able to learn from one another.In terms of limitations, Baggett’s survey methodology reinscribes facets of a white normativity in the reimagining of atheism in American culture, which reinforces the invisibility and the angst nonreligious people of color face on a daily basis. Mimicking William James’ overreliance on Christian-framed psychological analysis in The Varieties of Religious Experience (1902), Baggett focuses on white atheists’ testimonials, based on the racial and ethnic demographics of the 518 respondents (detailed in Appendix B): 3 percent Asian/Pacific Islanders, 4 percent “others,” 6 percent African Americans, 7 percent Hispanics/Latinos, and 80 percent whites.The issue extends, however, beyond the nonrandom sample size of people of color to the ahistorical and decontextualized questionnaire (detailed in Appendix A). Contrary to western European and white North American atheist populations, African American atheists often become atheist not through the ruminations of Enlightenment scientific rationalism, but through the ramifications of historic-traumatic events, such as the injustices of institutional racism. Baggett could be more intentional in examining how race and ethnicity as well as gender, class, and non-heterosexual subjects and sources color analyses of irreligious literacy to allow for fresher, multilayered meanings of cultural atheisms. In my own undergraduate course in “Atheism, Humanism, and Secularism” at San Diego State University, I will assign Baggett’s text alongside the third book in Zuckerman’s series, Nathan G. Alexander’s Race in a Godless World (2019). When used in tandem, the books offer a counterbalanced cultural, theological, and historical overview of the diversity within, and discrimination encountered by, atheists in America and globally.Despite the limitations of the book, the veracity of Baggett’s central thesis regarding the primacy of incorporating lived atheism in the sociology of religion is difficult to refute. He provides a compelling and complex portrait of rank-and-file nonbelievers living meaningful lives, who cautiously rethink the real and the imagined boundaries of religious constraints. Scholars in the fields of New Religions Studies as well as Third Wave Liberationist-Atheist Studies will surely welcome the challenge to stigmas and stereotypes combatted by a misunderstood community on the margins of society.

Measuring the quality of dental care among privately insured children in the United States.

To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.

Effect of type and timing of systemic therapy on risk of radiation necrosis in patients with HER2+ breast cancer brain metastases.

e14002 Background: It is estimated that 30% of patients with metastatic human epidermal growth factor receptor 2-positive (HER2+) breast cancer will develop brain metastases. Current standard of care options for HER2+ breast cancer brain metastasis (BCBrM) includes radiation therapy (stereotactic radiosurgery [SRS] or whole brain radiation), brain permeable systemic therapies, and in select cases, neurosurgical resection. A multimodal approach combining these different treatment modalities has improved the overall survival and functional outcomes of patients with BCBrM. Some HER2-directed systemic therapies, however, may increase the risk of radiation necrosis (RN), a longer-term consequence of SRS. This study explores the impact of timing and type of systemic therapies on the development of RN in patients treated with SRS for HER2+ BCBrM. Methods: This was a single-institution, retrospective study including patients ≥18 years of age with HER2+ BCBrM who received SRS between 2013 and 2018 at Duke University with at least 12-month post-SRS follow-up. Presence of RN was determined at one-year post-SRS. Demographics, radiotherapy parameters (total dose, fractions, clinical target volume [CTV], gross tumor volume [GTV], conformity index [CI], volume receiving 12 gray [V12Gy]), and timing (during [within 4 weeks of SRS] vs. not during SRS) and type of systemic therapy (HER2-directed therapy, mitosis inhibitors, DNA synthesis inhibitors, others) were evaluated. Results: Among 46 patients with HER2+ BCBrM who received SRS, 28 (60.9%) developed RN and 18 (39.1%) did not. Age at time of SRS did not differ between those who developed RN and those who did not (mean 53.3 vs 50.4 years, respectively). There was a higher percentage of African Americans in the RN group (28.6% vs 11.1%, p = 0.3). There were no significant differences between the measured radiotherapy parameters—including dose, fraction, CTV, GTV, CI, V12Gy—between the two groups (all p &gt; 0.05). Receipt of any type of systemic therapy during SRS did not differ between patients who did or did not develop RN (60.7% vs 55.6%, p = 0.97). However, patients who developed RN more commonly received more than one line of HER2-directed therapy independent of SRS timing compared to those who did not develop RN (75.0% vs 44.4%, p = 0.08). In fact, a significantly higher proportion of those who developed RN received more than one line of HER2-directed therapy during SRS compared to those did not develop RN (35.7% vs 5.6%, p&lt;0.05). Conclusions: Patients with HER2 BCBrM who receive multiple lines of HER2-directed therapy during SRS for BCBrM may be at higher risk of RN. This data supports a practice of holding HER2-directed therapy during SRS if medically acceptable. Further investigation of next generation HER2-directed therapies in a larger cohort of patients should be investigated to help guide best practice to minimize RN.

Determinants of COVID-19 Case Fatality Rate in the United States: Spatial Analysis Over One Year of the Pandemic.

Background: The United States continues to account for the highest proportion of the global Coronavirus Disease-2019 (COVID-19) cases and deaths. Currently, it is important to contextualize COVID-19 fatality to guide mitigation efforts.Objectives: The objective of this study was to assess the ecological factors (policy, health behaviors, socio-economic, physical environment, and clinical care) associated with COVID-19 case fatality rate (CFR) in the United States.Methods: Data from the New York Times’ COVID-19 repository and the Centers for Disease Control and Prevention Data (01/21/2020 - 02/27/2021) were used. County-level CFR was modeled using the Spatial Durbin model (SDM). The SDM estimates were decomposed into direct and indirect impacts.Results: The study found percent positive for COVID-19 (0.057% point), stringency index (0.014% point), percent diabetic (0.011% point), long-term care beds (log) (0.010% point), premature age-adjusted mortality (log) (0.702 % point), income inequality ratio (0.078% point), social association rate (log) (0.014% point), percent 65 years old and over (0.055% point), and percent African Americans (0.016% point) in a given county were positively associated with its COVID-19 CFR. The study also found food insecurity, long-term beds (log), mental health-care provider (log), workforce in construction, social association rate (log), and percent diabetic of a given county as well as neighboring county were associated with given county’s COVID-19 CFR, indicating significant externalities.Conclusion: The spatial models identified percent positive for COVID-19, stringency index, elderly, college education, race/ethnicity, residential segregation, premature mortality, income inequality, workforce composition, and rurality as important ecological determinants of the geographic disparities in COVID-19 CFR.

Abstract PS1-12: Factors associated with chronic breast lymphedema after adjuvant radiation in women undergoing breast conservation therapy

Abstract Purpose/Objective(s):Unlike temporary breast edema caused by post-lumpectomy radiation therapy (RT), the edema that persists beyond one year is not well defined and difficult to treat. The aim of this study is to define the incidence and risk factors for the development of chronic breast lymphedema in women undergoing lumpectomy with RT at a large metropolitan cancer center. Materials/Methods:A retrospective chart review was performed on all patients who underwent lumpectomy from 2014 to 2018. Women who did not undergo RT at our institution and those with stage IV disease were excluded from the analysis. Patient demographics, comorbidities, operative data, RT data and postoperative complications were obtained. Chronic breast lymphedema (CBL) was defined as edema that persisted beyond one year post completion of radiation therapy. Breast volumes were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Using a density curve, the distribution of breast volumes was plotted for patients with and patients without CBL. Univariate analysis was used to evaluate factors associated with CBL. Multivariate regression analysis was used to evaluate factors associated with the risk of CBL while accounting for potential confounding variables as defined by the univariate analysis. Results:A total of 1173 patients were included for analysis. Seventy-four (6.3%) patients developed breast lymphedema beyond one year. For the entire cohort, mean age was 63 years old (SD=11.17), mean BMI was 31.15 kg/m2 (SD=7.17), mean breast volume was 1198.54 cm3 (SD=645.82 cm3), mean total radiation was 59.18 Gy (SD=16.76), and 139 (11.8%) patients underwent ALND. Compared to the cohort that did not develop CBL (n=1099), the CBL cohort (n=74) had a higher median BMI (33.23 kg/m2 vs. 29.81 kg/m2, P&amp;lt;0.001), higher percentage of African Americans (56.8% vs. 37.9%, P=0.004), larger median breast volume (1502.33 cm3 vs. 1083.59 cm3, P&amp;lt;0.001), higher percentage that underwent ALND (23% vs. 11.1%, P=0.005), and larger median size of lumpectomy specimen (128.00 cm3 vs. 94.57 cm3, P=0.002). When accounting for potential confounding variables, multivariate regression analysis revealed when breast volume was evaluated as a continuous variable, for every 1 cm3 increase in breast volume, the risk of breast lymphedema increases by 0.1% (OR=1.001, P&amp;lt;0.001). When breast volume was analyzed as a categorical variable using 1300 cm3 as the optimal cutoff (based on density curve evaluations), patients whose breast volume was greater than 1300 cm3 had nearly 3 times the risk of developing CBL (OR=2.976, P&amp;lt;0.001) compared to those with less than 1300 cm3 breast volume. The multivariate regression also demonstrated that CBL was associated with total radiation dose (OR=1.02, P=0.015) and African American race (OR=1.705, P=0.037). Conclusion:Chronic breast lymphedema presents a clinical concern for women undergoing lumpectomy with postoperative radiation, particularly in women with larger breasts. Further studies should focus on preventative strategies, as well as the psychosocial and economic impact of this morbidity. Citation Format: Sanjay Rama, Cara Canella, Jenna Luker, Kelley Park, Renee Barry, Saheli Ghosh, Simeng Zhu, Yalei Chen, Jessica Bensenhaver, Eleanor Walker, Kenneth Levin, Dunya Atisha, Maristella Evangelista. Factors associated with chronic breast lymphedema after adjuvant radiation in women undergoing breast conservation therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-12.

The built environment and asthma: Los Angeles case study

This study aimed to identify urban characteristics that contribute to the incidence of asthma, applying various elements of built environment relevant to variations in traffic volume and traffic-related air pollution. We used built environment metrics in three dimensions (density, diversity, design) and examined whether those metrics are associated with asthma emergency department (ED) visits among 2343 census tracts in Los Angeles County by applying spatial epidemiologic tools (spatial regression, GIS mapping). We found that increases in population density, land use mix, and the share of open/recreation area are negatively associated with asthma ED visits but found no significant effects of household and street density. The results of neighborhood risk factors (percent of African American, less than high school, median household income, unemployment) confirm the overwhelming impact of the disadvantaged neighborhoods on asthma epidemiology. The findings indicate that high population density contributes to a reduction in acute care utilization for asthma and underscore the beneficial roles of land use mix and a larger share of open/ recreation space for respiratory health by promoting physical activity and improving air quality.

545. The Impact of COVID-19 on African Americans’ Health Attitudes and Information Seeking Behavior

BackgroundAfrican-Americans suffer a disproportionate impact from COVID-19, comprising about 24% of deaths while representing 13% of the US population. We conducted a study to understand COVID-19’s impact on African-Americans’ health attitudes.MethodsIn April 2020, we surveyed online a national sample of US adults on their health attitudes and behaviors before and after the COVID-19 outbreak. Comparisons were analyzed using chi-squared tests.ResultsA total of 2,544 individuals completed the survey: 473 African-Americans, 282 Hispanics and 1,799 Caucasians responded. The mean ages of each group were 41.4 ± 11 years, 38.0 ± 11 years and 45.7 ± 13 years, respectively. Before COVID-19, African-Americans were least likely to report they had trust in science (53% vs. 68% for Hispanics and 77% for Caucasians; p< .01) and government (16% vs. 27% and 28%; p< .01). After COVID-19, the percentage of African-Americans who had trust in science and government fell further to 44% (p< .01) and 9% (p< .01), respectively, and remained significantly lower than the other two groups. Twice as many African-Americans vs. Caucasians stopped following science and health news after COVID-19 (9% vs. 4%, p< .01). The percentage of African-Americans who reported anxiety about their health rose from 30% pre-COVID to 53% after the outbreak (p< .01), and the percentage who reported anxiety about their family members’ health rose from 35% to 61% (p< .01). Only 25% of African-Americans surveyed agreed that if they contracted COVID-19, they were confident they would get the healthcare needed.ConclusionAfter COVID-19, African-Americans’ trust in science and government fell and a meaningful percentage stopped following science and health news, possibly reducing access to important health information. The percentage of African-Americans reporting anxiety about the future, about their health and about their family members’ health all increased significantly after COVID-19. Only a minority of African-Americans agreed they would get the needed healthcare if they contracted COVID-19. These findings have implications for the mental health and behavioral impacts of COVID-19 on African-Americans and for the development of health communications to high-disease-incidence populations.Disclosures All Authors: No reported disclosures

A Place for Us: A Unique Experience That Provides a Creative and Social Experience for People With Dementia

A Place for Us meets weekly in community locations for a half day and is run by a recreation therapist who is also an artist, offering an opportunity to connect with others through participation in creative projects. We have found that collaborating in creating a piece of art, such as a collage provides a context for socializing. Since the program began in 2017, we provided this opportunity to 83 caregivers. The program has broad appeal and has included both men (54%) and women (46%) and people from many racial and ethnic backgrounds: 62.3% white, 13 percent African American, 7% Latino and 5% Asian. Our experience suggests that Interacting through collaborative projects utilizing what has been called, “The creative brain,” offers people with dementia an opportunity to feel at ease in this social setting. A Place for Us allows people to interact socially while engaging in a pleasant and normative activity.