Proportion Of African Americans Research Articles

Association of serum levels of p,p’- Dichlorodiphenyldichloroethylene (DDE) with type 2 diabetes in African American and Caucasian adult men from agricultural (Delta) and non-agricultural (non-Delta) regions of Mississippi

ABSTRACTEpidemiological associations were reported in several studies between persistent organochlorine organic pollutants and type 2 diabetes mellitus (T2D). Mississippi is a highly agricultural state in the USA, particularly the Delta region, with previous high usage of organochlorine (OC) insecticides such as p,p’- dichlorodiphenyltrichloroethane (DDT). In addition, there is a high proportion of African Americans who display elevated prevalence of T2D. Therefore, this State provides an important dataset for further investigating any relationship between OC compounds and metabolic diseases. The aim of this study was to assess whether soil and serum levels of OC compounds, such as p,p’- dichlorodiphenyldichloroethylene (DDE), arising from the heavy historical use of legacy OC insecticides, might serve as an environmental public health indicator for T2D occurrence. Soil samples from 60 Delta and 60 non-Delta sites randomly selected were analyzed for the presence of OC compounds. A retrospective cohort study of adult men (150 from each region) was recruited to provide a blood sample for OC compound quantitation and select demographic and clinical information including T2D. Using multivariable logistic regression, an association was found between increasing serum DDE levels and T2D occurrence in non-Delta participants (those subjects with lower serum DDE levels), as opposed to Delta participants (individuals with higher serum DDE levels). Thus, while there was a relationship between serum DDE levels and T2D in those with lower burdens of DDE, the lack of association in those with higher levels of DDE indicates a complex non-monotonic correlation between serum DDE levels and T2D occurrence complicating the goal of finding a public health marker for T2D.Abbreviations: BMI, body mass index; CVD, cardiovascular disease; CDC, Center for Disease Control, United States of America; DDE, p,p’- dichlorodiphenyldichloroethylene; DDT, p,p’- dichlorodiphenyltrichloroethane; GC/MS, gas chromatography/mass spectrometry; GIS, geographic information system; GPS, global positioning system; HDL, high-density lipoprotein; HTN, hypertension; IDW, inverse distance weighting; IRB, Institutional Review Board; LDL, low-density lipoprotein; LOQ, limit of quantitation; NHANES, National Health and Nutrition Examination Surveys; POPs, persistent organic pollutants; OC, organochlorine; PCB, polychlorinated biphenyl; SIM, single-ion monitoring; T2D, type 2 diabetes mellitus; USA, United States of America.

Evaluation of the etiology of persistent iritis after cataract surgery

BackgroundThe purpose of this study was to evaluate patients with persistent iritis after cataract surgery to determine its incidence and risk factors. Adjusting the management of patients at risk could allow for a more predictable post-operative course and outcome. A retrospective chart review was performed of patients who had post-operative iritis longer than 1 month after cataract surgery during a 2-year period at Storm Eye Institute at the Medical University of South Carolina (MUSC) in Charleston, South Carolina. Patient demographics and various pre-operative, intra-operative, and post-operative factors were analyzed for trends.ResultsThirty-nine patients (49 eyes) met the inclusion criteria, and this group was compared to a control cohort of 40 patients (66 eyes) who did not have persistent iritis after cataract surgery. The overall incidence of post-operative iritis was 1.75%. In all patients with post-operative iritis lasting greater than 1 month, African American race and pupil expansion device use were statistically significant factors. After excluding patients with a history of ocular inflammation or known inflammatory or autoimmune diagnosis (1.20% incidence), there were still a significantly higher proportion of African Americans compared to the control group. When patients with post-operative iritis of less than 6 months in duration were additionally excluded, the incidence was 0.32%, and history of diabetes was statistically significant in addition to race.ConclusionsRisk factors for persistent iritis after cataract surgery include being diabetic, of African American racial background, and pupil expansion device use. These patients can be better informed of the higher risk of prolonged inflammation in their post-operative course, and peri-operative management can be tailored accordingly.

Access to credentialed elementary physical education teachers in California and students' cardiorespiratory fitness

Physical education (PE) can improve student health. Schools with credentialed PE teachers receive more PE. However, many schools have reduced PE funding, resulting in fewer teachers and potentially poorer student health. We examined if PE teachers are equally available across school districts, and if availability is associated with higher student cardiorespiratory fitness. We contacted California districts educating students in grades K-6 (n = 894) to determine the number of credentialed elementary PE teachers per district in 2016–17. Public datasets provided demographics and student fitness. Generalized linear models examined associations between district-level demographic characteristics and PE teacher-to-student ratio. Linear regression assessed the relationship between PE teacher-to-student ratio and student fitness. Seventy-five percent of districts (n = 669) responded. On average, there were 0.6 PE teachers for every 500 students, including the half (51%) of districts without elementary PE teachers. Each additional100 students of all racial/ethnic backgrounds in the district was associated with a 0.1% (95% CI −0.2%, −0.1%) decrease in the ratio. Each 10% increase in African American and Latino students was associated with 29% (95% CI −47%, −5%) and 18% (95% CI −31%, −3%) decreases in the ratio, respectively. Each additional PE teacher per 500 students was associated with a 3% increase in aerobically fit students (95% CI 1%, 4%). Elementary PE teachers are lacking in California, particularly in districts with a high proportion of African American and Latino students, which may be contributing to health disparities. Creative action to fund PE should be explored to ensure all students benefit from quality PE.

Disparities in retail marketing for little cigars and cigarillos in Los Angeles, California

IntroductionEvidence of a concentration of cigarette advertising in predominantly low-income, non-White neighborhoods underscores the need to examine retail marketing and promotions for novel tobacco products like little cigars and cigarillos (LCCs). We sought to investigate neighborhood racial/ethnic disparities in LCC marketing at retail, including availability, advertising, price promotions, and product placement in Los Angeles, California. MethodsBetween January 2016 and April 2017, community health workers (n = 19) conducted in-person observational audits from tobacco retail stores (n = 679) located in zip codes with a high percentage of non-Hispanic White (n = 196), Black (n = 194), Hispanic/Latino (n = 189), or Korean American (n = 100) residents. To account for clustering effect of zip codes, multilevel modeling approach for a dichotomized outcome was conducted to evaluate the association between racial/ethnic neighborhood sample and dependent variables. ResultsStores located in zip codes with a high percentage of non-Hispanic Blacks had more than eight times higher odds of selling LCCs (OR = 8.10; 95% CI = 3.10–21.11 vs. non-Hispanic White), more than five times higher odds of selling flavored LCCs (OR = 5.20; 95% CI = 2.33–11.61 vs. non-Hispanic White), and more than six times higher odds of displaying storefront exterior LCC signage (OR = 6.03; 95% CI = 2.93–12.40 vs. non-Hispanic White). Stores in Hispanic/Latino and Korean American communities had about three times higher odds of selling LCCs (OR = 3.02; 95% CI = 1.15–7.93 vs. non-Hispanic White; OR = 2.99; 95% CI = 1.33–6.71 vs. non-Hispanic White). ConclusionsLCCs are heavily marketed in retail establishments in Los Angeles, with disproportionate targeting of predominantly non-White neighborhoods, especially stores in neighborhoods with a higher proportion of African Americans. Local, state, and federal flavor restrictions, minimum pack size standards, preventive messages, and campaigns could counter the influence of LCC marketing in retail establishments.

HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South.

BackgroundIn recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering.ObjectiveThe goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data.MethodsWe used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases.ResultsThere were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92).ConclusionsWe used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.

MP46-19 MULTI-INSTITUTIONAL COMPARISON AND EXPERIENCE OF UPGRADING RATES OF STANDARD VS. TARGETED PROSTATE BIOPSIES

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2018MP46-19 MULTI-INSTITUTIONAL COMPARISON AND EXPERIENCE OF UPGRADING RATES OF STANDARD VS. TARGETED PROSTATE BIOPSIES Jonathan B. Bloom, Nabeel Shakir, Niccolo Passoni, Sam Gold, Daniel Wong, Graham Hale, Kareem Rayn, Joseph Baiocco, Sherif Mehralivand, Vladimir Valera, Maria Merino, Bradford J. Wood, Peter L. Choyke, Baris Turkbey, Claus Roehrborn, and Peter A. Pinto Jonathan B. BloomJonathan B. Bloom More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Niccolo PassoniNiccolo Passoni More articles by this author , Sam GoldSam Gold More articles by this author , Daniel WongDaniel Wong More articles by this author , Graham HaleGraham Hale More articles by this author , Kareem RaynKareem Rayn More articles by this author , Joseph BaioccoJoseph Baiocco More articles by this author , Sherif MehralivandSherif Mehralivand More articles by this author , Vladimir ValeraVladimir Valera More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford J. WoodBradford J. Wood More articles by this author , Peter L. ChoykePeter L. Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the advent of multi-parametric Magnetic Resonance Imaging (mpMRI), lesions within the prostate can be targeted with fusion biopsy platforms. This has improved the detection of clinically significant (CS) prostate cancer while decreasing the detection of indolent disease. We sought to compare the upgrading rates in two distinct populations of patients. METHODS A review of prospectively maintained databases of patients who underwent mpMRI then both targeted (TB) and standard template biopsy (SB) was conducted from two high volume institutions. Baseline demographics were obtained as well as pathological results of both biopsies. RESULTS 1913 patients were included with 1673 from the NCI and 240 from UTSW. The main difference in these populations consisted of number of prior biopsies, 1388/1673 (82.96%) NCI vs 106/240 (44.17%) UTSW, p<0.0001, prior negative biopsies 630/1673 (37.66%) NCI vs 54/240 (22.5%) UTSW, p<0.0001 and proportion of African-Americans, 255/1673 (15.24%) NCI vs 26/240 (6.67%) UTSW, p=0.0002. The overall upgrading rate of any Gleason group (GG) via targeted biopsy was 423/1910 (22.11‰) with 344/1913 (20.56%) NCI and 79/240 (32.92%) UTSW, p<0.001. Upgrading from clinically insignificant to CS (GG ≥ 2) disease occurred in 332/1308 (25.38%) with 266/1202 (22.13%) from NCI and 66/106 (62.26%) from UTSW, p<0.001. The upgrading rate to any higher GG via SB occurred in 696/1913 (36.38%) with 628/1673 (37.53%) NCI and 68/240 (28.33%) UTSW. Table 1 demonstrates the biopsy results of the cohort with CS missed disease denoted in red. CS disease was detected by both SB and TB in 194/408 (46.55%) patients. SB undergraded 151/408 (37.01%) while TB undergraded 63/408 (15.44%), p<0.001. Multivariate regression showed race and institution were not associated with TB upgrading while age (OR 1.05; 1.4-1.07), PSA (OR 1.07; 1.05-1.08), MRI volume (OR 0.97; 0.97-0.98), and prior biopsy, (OR 0.59; 0.44-0.79) were associated. CONCLUSIONS In a population who has been biopsed often, the upgrading rate of targeted biopsies is lessened, but remains advantageous. In populations with more biopsy-naive patients and likely higher cancer prevalence, we see upgrading by both TB and SB. Both populations benefitted from the combination of TB and SB, which may be considered as standard of care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e614 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jonathan B. Bloom More articles by this author Nabeel Shakir More articles by this author Niccolo Passoni More articles by this author Sam Gold More articles by this author Daniel Wong More articles by this author Graham Hale More articles by this author Kareem Rayn More articles by this author Joseph Baiocco More articles by this author Sherif Mehralivand More articles by this author Vladimir Valera More articles by this author Maria Merino More articles by this author Bradford J. Wood More articles by this author Peter L. Choyke More articles by this author Baris Turkbey More articles by this author Claus Roehrborn More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract No. 697 New York State demographic trends in radioembolization

Radioembolization (RE) is increasingly being performed in the treatment of hepatocellular carcinoma and liver metastases. This study examines the demographic trends associated with RE performed in New York State. The New York Statewide Planning and Research Cooperative System, which covers all admissions and ambulatory care encounters in New York State, was queried over the period from 2006 to 2014 for encounters involving patients who were diagnosed with a hepatic tumor and where RE was performed. Encounters were divided by year into 3 categories: 2006-2008, 2009-2011, and 2012-2014. Patient demographic information was supplemented by facility information from the American Hospital Association was compared using Mann–Whitney U and chi-square tests. A total of 2,211 encounters involving RE were identified, occurring at a total of 22 facilities in New York State. The number of facilities performing RE increased from 3 in the earliest time period to 22 in the latest. Similarly, the number of RE's increased from 225 to 1,516, representing a 556% increase. The proportion of African-Americans who underwent RE increased from 5% to 14% (p<0.01). The proportion of RE's performed at major teaching hospitals decreased from 100% to 80% (p<0.01). Over the period from 2006 to 2014, the quantity of RE's performed has increased drastically. During this same period, there has been a significant expansion in the proportion of REs performed by non-major academic centers. This expansion has been paralleled by an increase in the proportion of African-Americans undergoing RE.Tabled 1New York State Demographic Trends in Radioembolization[2006,2009)[2009,2012)[2012,2015)Number of Procedures2254701516Number of Patients1773561129Number of Facilities31222Number of Surgeons154581Patient Race (%) Caucasian182 (0.80)315 (0.67)918 (0.60) African American12 (0.05)67 (0.14)212 (0.14) Asian17 (0.08)33 (0.07)86 (0.06) Other14 (0.06)55 (0.12)300 (0.20)Ethnicity (%) Non-Hispanic218 (0.97)434 (0.92)1417 (0.93) Hispanic7 (0.03)36 (0.08)86 (0.06)Patient Age (SD)62.4 (12.10)61.2 (11.51)64.03 (11.06)Patient Primary Insurance (%) Private Insurance60 (0.27)266 (0.57)742 (0.49) Medicaid2 (0.01)13 (0.03)46 (0.03) Medicare69 (0.31)184 (0.39)711 (0.47) Other/Unknown90 (0.40)6 (0.01)12 (0.01)Average Income based on Patient County (sd)70031.25 (8255.35)68441.16 (12405.53)69853.86 (13233.23)Charlson Comorbidity Index (sd)4.12 (2.01)4.26 (2.09)3.89 (2.04)Facility Setting (%) Urban225 (1.00)470 (1.00)1466 (0.97) Rural0 (0.00)0 (0.00)50 (0.03) In NYC138 (0.61)336 (0.71)1073 (0.71)Teaching Affiliation (%) Major225 (1.00)416 (0.89)1219 (0.804090) Minor0 (0.00)52 (0.11)227 (0.149736) Non-Teaching0 (0.00)2 (0.00)70 (0.05) Open table in a new tab

Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL): Rationale, design and baseline characteristics

Underserved and minority populations suffer from a disproportionately high prevalence of obesity and related comorbidities. Effective obesity treatment programs delivered in primary care that produce significant weight loss are currently lacking. The purpose of this trial is to test the effectiveness of a pragmatic, high intensity lifestyle-based obesity treatment program delivered within primary care among an underserved population. We hypothesize that, relative to patients who receive usual care, patients who receive a high-intensity, health literacy- and culturally-appropriate lifestyle intervention will have greater percent reductions in body weight over 24 months. Eighteen clinics (N = 803 patients) serving low income populations with a high proportion of African Americans in Louisiana were randomized to the intervention or usual car. Patients in the intervention participate in a high-intensity lifestyle program delivered by health coaches employed by an academic health center and embedded in the primary care clinics. The program consists of weekly (16 in-person/6 telephone) sessions in the first six months, followed by sessions held at least monthly for the remaining 18 months. Primary care practitioners in usual care receive information on weight management and the current Centers for Medicare and Medicaid Services reimbursement for obesity treatment. The primary outcome is percent weight loss at 24 months. Secondary outcomes include absolute 24-month changes in body weight, waist circumference, blood pressure, fasting glucose and lipids, health-related quality of life, and weight-related quality of life. The results will provide evidence on the effectiveness of implementing high-intensity lifestyle and obesity counseling in primary care settings among underserved populations.Trial Registration: ClinicalTrials.gov Identifier NCT02561221

78: Perioperative outcomes of hysterectomy at a large academic center and elaboration of a clinical decision tree algorithm

To evaluate differences in perioperative outcomes between minimally invasive surgery and abdominal surgery within a large metropolitan academic center and develop an effective algorithm for safe prevention of abdominal hysterectomy based upon our findings. We completed a retrospective chart review of patients who had undergone abdominal, laparoscopic, or vaginal hysterectomies at two different hospitals at our academic medical center between 1/1/2015 and 12/31/2016. Statistical analysis was performed using SPSS 22. Categorical data was analyzed with Chi-square and Fisher’s exact, logistic regression was used to calculate adjusted p-values. T-test and ANOVA were used to obtain p-values for continuous data, and general linear model was used for the adjusted p-values. Six hundred seven charts were reviewed. Surgeries performed for pelvic organ prolapse and robotic hysterectomies were excluded. Four hundred thirteen patients were included in our analysis. Sixty-six percent (n = 273) of the hysterectomies were performed abdominally, 31% (n = 129) were performed laparoscopically and 3% (n = 11) vaginally. The proportion of abdominal hysterectomies (AH) performed at our system’s county hospital and at the university’s private hospital were 70% and 48%, respectively. There was a higher proportion of African Americans who had abdominal hysterectomies (p < 0.05). There was no significant difference (p = 0.316) in the BMI of patients who had AH compared to laparoscopic hysterectomy (LH), but the BMI of patients undergoing vaginal hysterectomy (VH) was significantly lower (p = 0.03) than the other 2 groups. Interestingly, there was no significant difference in the number of comorbidities (p = 0.063) or previous abdominal surgeries (p = 0.846) between the groups. As expected, LH had the least blood loss (mean of 144 ml, p < 0.001). Blood transfusion rates were also significantly lower(p = 0.035) in the laparoscopic than in the AH group. There were no differences in rates of intraoperative consultation, intraoperative complications, post-operative ileus, wound infection, reoperation or readmission rates. Length of stay was significantly less (p < 0.001) with laparoscopic cases with a mean stay of 1.36 days compared to 2.88 days in the AH group. The rate of conversion to laparotomy was 12% (n = 15). The mean uterine size in the conversion to laparotomy group was 13 weeks (SD = 6.3), the mean BMI 30 kg/m2 (SD = 7.4) and most of the patients had at least 1 previous abdominal surgery. The majority of hysterectomies performed at our academic center were AH. Patients who were African-American were more likely to undergo an AH. The vast majority of patients had an open hysterectomy if uterine weight was >500 g. As expected, laparoscopic cases had less blood loss, lower transfusion rates, and shorter length of stay when compared to open and vaginal cases. It is our belief that a good amount of AH could have been avoided. Using criteria gleaned from the patients converted to laparotomy, we created an algorithm (Figure 1) to select the most appropriate type of hysterectomy. This is intended for cases of benign disease with the intent of minimizing the amount of abdominal hysterectomies performed.

Abstract TP202: Vertebrobasilar Insufficiency is an Easy to Ascertain and Important Predictor of Cardiovascular Events in Elderly Population: Analysis of Cardiovascular Health Study

Background: Vertebrobasilar insufficiency is a clinical diagnosis which consists of multiple minor recurrent in the distribution of vertebral or basilar arteries. The value of such clinical symptoms for risk stratification in elderly population remains unknown. Methods: We analyzed data from the Cardiovascular Health Study participants aged ≥65 years who underwent a standard clinical evaluation at baseline evaluation. Each participant was inquired regarding symptoms of stroke using baseline neurological history questionnaire. Vertebrobasilar insufficiency was defined when stroke or TIA was localized to vertebral or basilar artery distribution based on location, duration of symptoms and associated factors. Incident cardiovascular events were identified during annual follow-up examinations and at 6-month telephone contact and adjudicated by appropriate central committees. Hazards ratio [HR] for cardiovascular events during follow up were estimated using Cox proportional Hazards analysis. Results: Vertebrobasilar insufficiency was observed in 62 (1.1%) of 5,888 study participants (50% women, 24.2% African American; mean baseline age, 73.2 ± 5.4 years) who were followed for incident events for a mean (SD) period of 6.5 (1.8) years. There was a significantly higher proportion of African Americans (24.2 % versus 15.2%, p=0.007) and those with congestive heart failure (14.5 % versus 2.7%, p=&lt;.0001) in patients with vertebrobasilar insufficiency. The rate of any stroke (19.4% versus 9.1%, HR 1.8, 95% confidence interval [CI] 1.0 - 3.3), myocardial infarction (19.4% versus 9.1%, HR 1.8, 95% CI 1.1-3.4),and death (38.7% versus 22.1%, HR 1.5, 95% CI 1.0-2.3) were significantly higher among patients with vertebrobasilar insufficiency after adjusting for age, race, congestive heart failure, and previous myocardial infarction. Conclusions: Vertebrobasilar insufficiency is an easy to ascertain and important predictor of cardiovascular events and should be incorporated into routine clinical evaluation.

Early winners and losers in dialysis center pay-for-performance

BackgroundWe examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care.MethodsWe linked the 2012 ESRD QIP Facility Performance File to the 2007–2011 American Community Survey by zip code and dichotomized the QIP total performance scores—derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL—as ‘any’ versus ‘no’ payment reduction. We characterized associations between payment reduction and dialysis facility characteristics and neighborhood demographics, and examined changes in facility outcomes between 2007 and 2010.ResultsIn multivariable analysis, facilities with any payment reduction were more likely to have longer operation (OR 1.03 per year), a medium or large number of stations (OR 1.31 and OR 1.42, respectively), and a larger proportion of African Americans (OR 1.25, highest versus lowest quartile), all p < 0.05. Most improvement in clinical performance was due to reduced overtreatment of anemia, a decline in the percentage of patients with hemoglobin ≥ 12 g/dL; for-profits and facilities in African American neighborhoods had the greatest reduction.ConclusionsIn the first year of CMS pay-for-performance, most clinical improvement was due to reduced overtreatment of anemia. Facilities in African American neighborhoods were more likely to receive a payment reduction, despite their large decline in anemia overtreatment.

Perspectives on the impact of painful diabetic peripheral neuropathy in a multicultural population

BackgroundSince few studies have characterized painful diabetic peripheral neuropathy (pDPN) symptoms in multicultural populations, this study fielded a survey to better understand pDPN and its impact in African-American, Caucasian, and Hispanic populations.MethodsKelton fielded a survey by phone or Internet, in English or Spanish, among adults with pDPN symptoms in the United States between August and October 2015; African-Americans and Hispanics were oversampled to achieve at least 500 subjects for each group. Patients were required to have been diagnosed with pDPN or score ≥ 3 on ID Pain validated screening tool. The survey elicited information on pDPN symptoms and interactions with healthcare providers (HCPs), and included the Brief Pain Inventory and pain-specific Work Productivity and Assessment Questionnaire (WPAI:SHP).ResultsRespondents included 823 Caucasians, 525 African-Americans, and 537 Hispanics; approximately half of African-Americans and Hispanics were <40 years of age, vs 12% of Caucasians. Pain was less likely to be rated moderate or severe by African-Americans (65%) and Hispanics (49%) relative to Caucasians (87%; p < 0.05). African-Americans and Hispanics were less likely than Caucasians to report experiencing specific pDPN sensory symptoms. Significantly fewer African-Americans and Hispanics reported receiving a pDPN diagnosis relative to Caucasians (p < 0.05), and higher proportions of African-Americans and Hispanics reported difficulty communicating with their HCP (p < 0.05). WPAI:SHP activity impairment was lower in Hispanics (43%) relative to African-Americans (53%) and Caucasian (56%; p < 0.05).ConclusionsMulticultural patients reported differences in pDPN symptoms and pain relative to Caucasians, and fewer received a pDPN diagnosis. While further evaluation is needed to understand these differences, these data suggest a need to broaden pDPN educational initiatives to improve patient-HCP dialogue and encourage discussion of pDPN symptoms and their impact in a multicultural setting.

Repeat polymorphisms in the Homo sapiens heme oxygenase-1 gene in diabetic and idiopathic gastroparesis.

BackgroundIdiopathic and diabetic gastroparesis in Homo sapiens cause significant morbidity. Etiology or risk factors have not been clearly identified. Failure to sustain elevated heme oxygenase-1 (HO1) expression is associated with delayed gastric emptying in diabetic mice and polymorphisms in the HO1 gene (HMOX1, NCBI Gene ID:3162) are associated with worse outcomes in other diseases.AimOur hypothesis was that longer polyGT alleles are more common in the HMOX1 genes of individuals with gastroparesis than in controls without upper gastrointestinal motility disorders.MethodsRepeat length was determined in genomic DNA. Controls with diabetes (84 type 1, 84 type 2) and without diabetes (n = 170) were compared to diabetic gastroparetics (99 type 1, 72 type 2) and idiopathic gastroparetics (n = 234). Correlations of repeat lengths with clinical symptom sub-scores on the gastroparesis cardinal symptom index (GCSI) were done. Statistical analyses of short (<29), medium and long (>32) repeat alleles and differences in allele length were used to test for associations with gastroparesis.ResultsThe distribution of allele lengths was different between groups (P = 0.016). Allele lengths were longest in type 2 diabetics with gastroparesis (29.18±0.35, mean ± SEM) and longer in gastroparetics compared to non-diabetic controls (28.50±0.14 vs 27.64±0.20 GT repeats/allele, P = 0.0008). Type 2 diabetic controls had longer alleles than non-diabetic controls. In all gastroparetic groups, allele lengths were longer in African Americans compared to other racial groups, differences in the proportion of African Americans in the groups accounted for the differences between gastroparetics and controls. Diabetic gastroparetics with 1 or 2 long alleles had worse GCSI nausea sub-scores (3.30±0.23) as compared to those with 0 long alleles (2.66±0.12), P = 0.022.ConclusionsLonger poly-GT repeats in the HMOX1 gene are more common in African Americans with gastroparesis. Nausea symptoms are worse in subjects with longer alleles.

Advance Placement and The Achievement Gap in the 21st Century: A Multiple Linear Regression of Marginalized Populations in AP Enrollment

The analysis of the College Board's Advanced Placement (AP) enrollment focused on marginalized populations' (i.e., African American, Hispanic, and poor students) limited access and the schools' efforts to bridge the gaps. Little research has been done on marginalized populations' AP passage rates. The researchers of this correlational study investigated AP enrollment and passage rates in public and charter high schools in Florida (n = 355) by comparing the enrollment and passage proportions amongst Caucasian, African American, and Hispanic students as well as the proportions of students who received free or reduced lunch. The results showed a weak, positive relationship between proportions of Hispanic, African American, and Caucasian students passing AP exams and the proportion of AP students enrolled. There was a strong, positive relationship amongst the proportions of African-American, Hispanic, and Caucasian students who passed the exam. However, a weak, negative relationship was found between the proportions of students who were enrolled in AP classes and those who received free or reduced lunch. There was also a negative relationship between Hispanic, African American, and Caucasian students passing the AP exam and the percentage of the school's population enrolled in free or reduced lunch. The findings suggest that schools with high poverty rates have a low enrollment rate of students in AP courses. The focus on AP enrollment rates for minority students has led to increased rates of minorities successfully completing advanced coursework, but there is still a need for similar focus on high poverty schools.

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OBJECTIVES/SPECIFIC AIMS: Research on social determinants of health (SDHs) in type 2 diabetes have largely examined disease etiology rather than severity. To find factors associated with complications, we investigated socio-demographics, healthcare access, and healthcare utilization in individuals with type 2 diabetes with respect to related comorbidity. METHODS/STUDY POPULATION: Community health workers assessed 8494 participants for type 2 diabetes (n=939; 11%) through HealthStreet, a community-engagement model implemented in North Central Florida. Comorbidities were defined as neuropathy, retinopathy, high cholesterol, hypertension, and kidney failure. We conducted multivariate analyses to test the association of socio-demographic factors and comorbidity status. RESULTS/ANTICIPATED RESULTS: Of 939 members with type 2 diabetes, 164 (17%), 272 (29%), 370 (39%), and 133 (14%) reported having 0, 1, 2, and 3+ comorbidities, respectively. There is a smaller proportion of African-Americans reporting 3+ comorbidities compared with other comorbidity groups (p=0.003). Those with more comorbidity are less employed (p&lt;0.0001) and are more likely to have Medicare/Medicaid (p=0.03) than those without comorbidity. Those with no comorbidity are more likely to be uninsured compared to those with comorbidity (p=0.0297). Adjusting for age, race, gender, and BMI, those that have at least 1 comorbidity are 1.4 times more likely to be food insecure (p=0.004) and are 1.9 times more likely to have seen a doctor in the past 12 months (p=0.002) compared to those without comorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: Although there is complexity among the relationships between SDHs and diabetic comorbidity, results suggest significant sociodemographic and healthcare-related disparities among individuals living with type 2 diabetes. Members with more comorbidity utilize healthcare, but are more likely to be food insecure among other factors. Those with no comorbidity are least likely to see a physician, which could imply a gap in the care continuum. This analysis gives insight into the importance of efficient diabetes management, focused on disparities in economic stability and healthcare access and utilization.

‘Hate at First Sight’: Evidence of consumer discrimination against African-Americans in the US

The paper tests evidence of customer discrimination against African-Americans in the US using a two-sector matching model with racial sector-specific preferences or abilities, employer discrimination, and customer discrimination. The test strategy makes it possible to disentangle customer from pure employer discrimination. This paper proves the existence of discrimination against African-Americans at job entry from both employers and consumers in the US. It also reports that racial prejudice has a quantitative effect on the relative employment and contact probabilities of African-Americans. A decrease in the intensity of discrimination by one standard deviation would raise the raw employment rate of African-Americans by 10% and would increase the proportion of African-Americans in jobs in contact with customers by 25%.

Vape Shop Density and Socio-Demographic Disparities: A US Census Tract Analysis.

Vape shops are an emerging business specializing in the sales and promotion of e-cigarette, e-juice, and other vaping products. This study sought to evaluate the associations between vape shop density and socio-demographic characteristics at the US census tract level. Vape shop data (n = 9943) were collected from three online directories: Yelp.com, Yellowpages.com, and Guidetovaping.com. Addresses of vape shops were geocoded and the density per 10 000 people was estimated at each US census tract. Zero inflated negative binomial regression model was performed to examine the socio-demographic factors associated with vape shop density. Overall, there was a higher vape shop density in urban versus nonurban census tracts. In urban areas, higher vape shop density was associated with larger proportions of Hispanics and Asians, adults aged 18-44 years old and higher poverty, while the decrease in vape shop density was associated with larger proportions of population under 18 years old, higher education, larger household size, and a higher percentage of owner occupied housing units. In nonurban areas, higher vape shop density was associated larger proportions of African Americans and Hispanics, smaller household size and a lower percentage of owner occupied housing units. At the national level, there are inequalities of vape shop density by some socio-demographic characteristics and heterogeneity between urban and nonurban areas. Vape shops are more likely to be concentrated in areas where people with a higher risk for vaping and smoking reside. Our findings could inform initiatives aimed at a stronger licensing requirement for vape shops and federal and state-level regulations of this industry to prevent vape shop from targeting minority and other socially disadvantaged groups.

A Pilot Study to Examine Exposure to Residential Radon in Under-Sampled Census Tracts of DeKalb County, Georgia, in 2015.

While DeKalb County, Georgia, offers free radon screening for all eligible residents, portions of the county remain relatively under-sampled. This pilot study focused on 10% of the census tracts in the county with the lowest proportion of radon testing; most were in southern DeKalb County. In total, 217 households were recruited and homes were tested for indoor radon concentrations on the lowest livable floor over an eight-week period from March–May 2015. Tract-level characteristics were examined to understand the differences in socio-demographic and economic factors between the pilot study area and the rest of the county. The pilot study tracts had a higher proportion of African Americans compared to the rest of DeKalb County (82% versus 47%). Radon was detected above 11.1 Bq/m3 (0.3 pCi/L) in 73% of the indoor samples and 4% of samples were above 148 Bq/m3 (4 pCi/L). Having a basement was the strongest predictive factor for detectable and hazardous levels of radon. Radon screening can identify problems and spur homeowners to remediate but more research should be done to identify why screening rates vary across the county and how that varies with radon levels in homes to reduce radon exposure.

Impact of income in stage IV prostate cancer.

244 Background: There is growing evidence of the impact of socioeconomic status on survival in cancer patients. To our knowledge, this is the largest study to examine demographics and the association between income and survival in patients with stage IV prostate cancer. Methods: Using the National Cancer Database, 50,639 patients diagnosed with stage IV prostate cancer between 2004-2011 were identified. Income was evaluated using the median income of the patient’s zip code. Between-income survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p &lt; .05 indicated statistical significance. Results: Survival differences were indicated between all income quartiles. Median survival was highest for patients in zip codes with a median income ≥ $63,000 and lowest for patients in zip codes with an income &lt; $38,000 (46.1 months vs. 31.6 months, respectively; p &lt; .001). As such, 41% of patients in zip codes with a median income ≥ $63,000 were alive five years following diagnosis, compared to 31% of patients in zip codes with median income &lt; $38,000. Additionally, compared to patients in zip codes in which the median income was &lt; $38,000, patients in zip codes with a median income ≥ $63,000 had a higher rate of zero comorbidities (81% vs. 76%), a greater percentage of patients living in an area where &gt;93% people have a high school degree (58% vs 1%), and a lower proportion of African Americans (8% vs 41%). Conclusions: Compared to patients with a median income &lt; $38,000, patients in zip codes with a median income &gt; $63,000 had a median survival nearly 15 months longer, had 10% more patients alive after 5 years, and had fewer comorbidities. [Table: see text]

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)