Racial Distribution Research Articles

Associations Between the Legalization and Implementation of Medical Aid in Dying and Suicide Rates in the United States

Background Some have hypothesized that changing attitudes toward medical aid in dying (MAID) contribute to increased suicide rates, perhaps by increasing interest in dying or the perceived acceptability of suicide. This would represent a strong criticism of MAID policies. We sought to evaluate the association between the legalization and implementation of MAID across the U.S. and changing suicide rates. Methods We evaluated state-level monthly suicide death rates from 1995 to 2021. Because suicide rates vary by state, we constructed geographically-weighted regression models controlling for annualized state-level sociodemographic factors, such as racial distribution (percent Caucasian), average age, income levels, unemployment rates, rates of spiritual engagement, firearm ownership rates, gender ratios, and education levels. We applied a difference-in-difference analysis within our geographically-weighted models. Results 927,929 Suicide deaths were represented in the study. Ten states and the District of Columbia had legalized MAID within the study period. In an univariable analysis, states that legalized MAID differed significantly from non-MAID states with respect to mean monthly suicide rate (non-MAID States: 1.46; MAID states: 1.78; p < 0.0001), as well as several covariates. Monthly suicide death rates were spatially autocorrelated (Moran’s I = 0.607, p < 0.0001). In separate geographically-weighted difference-in-difference analyses, changes in suicide rates were not significantly associated with MAID legalization (β = 0.042, p = 0.33) or with later MAID implementation (β = 0.030, p = 0.63), with differences in suicide rates in MAID and non-MAID states being attributable to baseline between-state differences. Conclusions Our study failed to find evidence that suicide rates were positively associated with MAID legalization or MAID implementation, when controlling for geographic variation and multiple sociodemographic factors associated with suicide risk. This finding contrasts with other studies that have reported a positive association between suicide rates and MAID, and so calls into question one argument against MAID legalization.

Implementing Cancer Registry Data With the PCORnet Common Data Model: The Greater Plains Collaborative Experience.

Electronic health records (EHRs) comprise a rich source of real-world data for cancer studies, but they often lack critical structured data elements such as diagnosis date and disease stage. Fortunately, such concepts are available from hospital cancer registries. We describe experiences from integrating cancer registry data with EHR and billing data in an interoperable data model across a multisite clinical research network. After sites implemented cancer registry data into a tumor table compatible with the PCORnet Common Data Model (CDM), distributed queries were performed to assess quality issues. After remediation of quality issues, another query produced descriptive frequencies of cancer types and demographic characteristics. This included linked BMI. We also report two current use cases of the new resource. Eleven sites implemented the tumor table, yielding a resource with data for 572,902 tumors. Institutional and technical barriers were surmounted to accomplish this. Variations in racial and ethnic distributions across the sites were observed; the percent of tumors among Black patients ranged from <1% to 15% across sites, and the percent of tumors among Hispanic patients ranged from 1% to 46% across sites. Current use cases include a pragmatic prospective cohort study of a rare cancer and a retrospective cohort study leveraging body size and chemotherapy dosing. Integrating cancer registry data with the PCORnet CDM across multiple institutions creates a powerful resource for cancer studies. It provides a wider array of structured, cancer-relevant concepts, and it allows investigators to examine variability in those concepts across many treatment environments. Having the CDM tumor table in place enhances the impact of the network's effectiveness for real-world cancer research.

Clinical Validation of a Prenatal Cell-Free DNA Screening Test for Fetal RHD in a Large U.S. Cohort.

To present a large U.S. clinical validation of a next-generation sequencing-based, noninvasive prenatal cell-free DNA test for fetal RHD. This clinical validation study assessed the performance of a commercially available, next-generation sequencing-based cell-free DNA test for fetal RHD status. Samples that passed quality metrics were included if the patient had a previously reported cell-free DNA result for fetal aneuploidy, maternal RhD-negative serology, newborn RhD serology, and maternal RHD deletion or RHD-CE-D hybrid(r's) genotype. Dizygotic twin pregnancies were excluded. Maternal and fetal RHD genotypes were evaluated with prospective cell-free DNA next-generation sequencing analysis. At the time of analysis, investigators were blinded to fetal RhD status. The cohort consisted of 655 pregnant patients with serologic results for RhD antigen. Patient demographics included a representative distribution of race and ethnicities in the RhD-negative U.S. population (74.0% White, 13.7% Hispanic, 7.0% Black, and 2.1% Asian). Cell-free DNA fetal RHD was not reported in two cases. There were zero false-negative cases; 356 of 356 fetuses were correctly identified as fetal RhD positive (sensitivity 100%, 95% CI, 98.9-100%). Of the 297 RhD-negative fetuses, 295 were correctly identified as RhD negative (specificity 99.3%, 95% CI, 97.6-99.8%). Of the fetuses with a negative RhD phenotype, the cell-free DNA test accurately identified three with the fetal RHD pseudogene (RHDΨ) genotype. Validation of this test in this large U.S. cohort of RhD-negative patients provides data on early and accurate noninvasive prenatal identification of fetal RHD genotype at 9 weeks of gestation or more. This test has the potential to assist patients and clinicians in the prevention and management of RhD alloimmunization.

Case-control study of clotting differences using ROTEM testing in pregnant patients with early vaginal bleeding

BackgroundVaginal bleeding in early pregnancy is a common presentation in the Emergency Department (ED), often resulting in pregnancy loss. Hypercoagulability exceeding normal physiological changes may be associated with miscarriage, but conventional clotting tests do not reliably detect this effect. Rotational thromboelastometry (ROTEM), which performs a more comprehensive clotting evaluation, may demonstrate coagulopathic abnormalities contributing to vaginal bleeding and miscarriage in early pregnancy that are not present in normal gestation. ObjectiveThis study aimed to evaluate the relationship between coagulation results from ROTEM testing in patients undergoing active evaluation for possible miscarriage compared to samples taken from asymptomatic patients with healthy pregnancies. Study DesignThis was a prospective case control study from a single center. Patients with chief complaint of vaginal bleeding in early pregnancy (less than 20 weeks) were recruited from the ED for ROTEM testing. These results were compared to healthy pregnant women presenting for routine prenatal care at our hospital’s obstetrical clinic. Crude results were analyzed using t-test for ROTEM measures, and differences were then compared using multiple linear regression, controlling for patient age, race, ethnicity, number of prior pregnancies, and estimated gestational age (EGA) in weeks. ROTEM measurements of interest were the clot formation kinetics using EXTEM, INTEM, and NATEM tracings. ResultsOver the study, 46 patients were recruited from the ED and 51 from the obstetric clinic. Both groups had similar mean ages, and racial and ethnic distribution. ED patients had earlier EGA than OB clinic patients, 7.6 weeks vs. 10.7 weeks, but higher patient age and higher number of prior pregnancies. ROTEM results were not significantly different between groups on univariate analysis except for INTEM CFT and INTEM MCF. After controlling for the patient age and estimated gestational age, no ROTEM result differed between groups. ConclusionIn pregnant patients presenting to the ED with vaginal bleeding before 20 weeks, ROTEM differences were not different in comparison to healthy pregnant patients at the same gestation stage. This suggests that ROTEM clotting profiles may not be useful in the evaluation of vaginal bleeding within this population.

Abstract A064: Lung cancer screening adherence among participants in DETECT-A, the first prospective interventional trial of a multi-cancer early detection (MCED) blood test

Abstract Background: Lung cancer is the leading cause of cancer death in the US. Adherence to guideline- recommended low-dose computed tomography screening is poor and late-stage diagnosis is common. MCED tests may improve early cancer detection if adherence to guideline- recommended single cancer screening is maintained. The DETECT-A study evaluated an MCED test in 9,911 women in Geisinger Health System (GHS), age 65-75, without personal cancer history. This analysis evaluates lung cancer screening adherence among DETECT-A participants to determine if adherence changed significantly following receipt of an MCED test. Methods: Monthly screening eligibility and adherence data (2013 USPSTF criteria) were available from September 2016 - May 2020 for DETECT-A participants and screening-eligible women in GHS who met DETECT-A eligibility criteria but did not participate in DETECT-A. A control group was constructed by randomly selecting GHS non-participants at a 7:1 ratio and assigning index months that matched the distribution of consent months for DETECT-A participants. All analyzed participants had ≥24 consecutive months of adherence data centered around the consent/index month. The proportion adherent at consent/index month and the end of active study participation at 12 months were calculated descriptively. Changes in adherence over time, as well as group comparisons, were assessed using a mixed effects logistic regression model. Results: DETECT-A participants (n=364) and controls (n=2,548) had similar age, race, and ethnicity distributions. The population was predominantly white (&amp;gt;98%) and non-Hispanic (&amp;gt;90%). The odds of adherence at 12 months were significantly higher than at consent/index for both DETECT-A participants (OR: 3.20 [1.04 -9.80], p=0.042) and controls (OR: 2.02 [1.23- 3.33], p=0.006). The increase in odds of adherence between consent/index and 12 months was not significantly different between the groups (OR: 1.58 [0.47-5.31], p=0.461). DETECT-A participant adherence was 28.0% (23.4%-32.6%) in the consent month and increased to 38.5% (33.5-43.5%) at 12 months. Among the 102 DETECT-A participants adherent in the consent month, 70 (68.6%) were also adherent at 12 months. Control adherence was 16.0% (14.6%-17.4%) in the index month and increased to 20.2% (18.7%-21.8%) at 12 months. Among 408 controls adherent in the index month, 257 (63.0%) were also adherent at 12 months. Conclusions: DETECT-A participation did not negatively affect lung cancer screening adherence among this subset of participants. Screening adherence increased over time in both DETECT-A participants and controls; most DETECT-A participants adherent in the study consent month were also adherent 12 months later. Effectiveness of GHS screening programs, DETECT-A participant self-selection, and DETECT-A educational efforts promoting screening may have contributed to these observations. Citation Format: Adam H. Buchanan, Anne Marie Lennon, Paul Z. Elias, Amy M. Lehman, Yongqiang Zhang, Darl D. Flake II, Eric S. Wagner, Seema P. Rego, Omair A. Choudhry, Nickolas Papadopoulos, Tomasz M. Beer. Lung cancer screening adherence among participants in DETECT-A, the first prospective interventional trial of a multi-cancer early detection (MCED) blood test [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A064.

Abstract 4128377: Association between Mean Platelet Volume (MPV) and coronary artery disease: An analysis of NHANEs 2017-2020

Background: Recent data showed that mean platelet volume (MPV) is linked to mortality after myocardial infarction and restenosis following coronary angioplasty. However, its association with coronary artery disease (CAD) remains unclear. Therefore, we aim to investigate the association between MPV and CAD using a nationwide database. Methods: We analyzed retrospective cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, including participants aged 18 years and older. The data on MPV were classified into three groups: below the 10th percentile (P10), between the 10th and 90th percentiles (P10 to P90), and above the 90th percentile (P90). Univariable and multivariable logistic regression models were utilized to identify the association between MPV and CAD. Results: A total of 12,156 patients with MPV results were identified. Their mean age was 37 ± 24 years, with females constituting 51.0% of the population. The racial distribution was primarily White at 33.8%, Black at 25.7%, Mexican American at 13.2%, Asian at 10.7%, and other races at 16.6%. The participants were categorized into three MPV groups: below P10 (11.2%), P10 to P90 (77.3%), and above P90 (11.5%), with median MPV values of 6.8, 8, and 9.7 fL, respectively. In a univariable analysis using participants with MPV in the P10 to P90 as a reference, those with MPV above the 90th percentile had a significantly higher risk of CAD, with an OR of 1.39 (P90-MPV: 95% CI 1.05, 1.83; P=0.021). No significant association was found between participants with MPV below the 10th percentile and risk of CAD (P10-MPV: OR 0.91, 95% CI 0.59, 1.41; P=0.684). After adjusting for age, gender, smoking status, blood pressure (SBP &gt;130 vs &lt;130 mmHg), type 2 diabetes, urine albumin creatinine levels, serum creatinine, heart failure, and stroke history, the association between those with MPV above P90 and increased CAD risk remained significant (P90-MPV aOR 1.65; 95% CI 1.16, 2.34; P=0.005). Gender and race did not modify this effect. Conclusion: Our findings indicate that high MPV (above the 90th percentile) is positively associated with the risk of CAD in the general population. Further longitudinal cohort studies are necessary to explore this relationship and its clinical implications thoroughly.

Abstract 4136805: Type 2 Myocardial Infarction Patients Have Significantly More Days Not at Home

Background: A Type 2 (T2) myocardial infarction (MI) occurs “secondary to ischemia due to either increased oxygen demand or decreased supply,” while a Type 1 MI (T1) is atherothrombotic. Treatment includes correction of the underlying cause and not catheterization. The current study's aim is to assess the patient-centered outcome of days not at home (DNAH) within a year of discharge among older adults hospitalized with T1 and T2 MI, and to evaluate the distribution of non-home days. Methods: Data for this analysis came from a prospective cohort study of adults ≥75 years old hospitalized with MI at 94 U.S. hospitals and linked to Medicare claims and encounter data. MI type was adjudicated according to the Fourth Universal Definition of MI. Patient characteristics were identified via chart review or self-report. DNAH was defined as the number of days dead or in a hospital, skilled nursing facility (SNF), rehab facility, or hospice. Multivariable-adjusted negative binomial regression was used to evaluate the association between MI type and DNAH in the year after discharge. Results: Of the 375 participants evaluated in this interim analysis, 264 (70.4%) had T1 MI and 111 (29.6%) had T2 MI. There was no difference in distribution of age, gender, or race. T2 patients were more likely to have heart failure (HF), coronary artery disease (CAD), COPD, and arrythmias. Patients with T2 MI had a median [interquartile range] of 5 [0-71] DNAH in the year after discharge, compared with 2 [0-10] DNAH among patients with T1 MI (p = 0.008). After adjusting for age and comorbidities, T2 patients had 137% more DNAH (IRR = 2.37, 95% CI = 1.43, 3.94, p &lt; 0.001) than T1 patients. The number of days dead or in SNF was significantly higher among patients with T2 MI compared with T1 MI, whereas the association between MI type and increase in days readmitted was borderline (p = 0.06). In the multivariable model, age, HF, and CAD were significantly associated with more DNAH, but COPD and arrhythmias were not. Conclusion: Our findings demonstrate that older patients with T2 MI have more days not at home, attributable to death, SNF stays, and to a lesser extent, rehospitalization. Interestingly, accounting for comorbidities did not significantly attenuate this association. Further studies are needed to develop guidelines for medical teams, including evaluating how receipt of cardiac interventions impacts home days in older patients with T1 and T2 MI.

Abstract 4140149: Differences in Interventional Treatment Outcomes of Peripheral Arterial Disease between African American Females, African American Males, and Caucasian Females

Introduction: Several recent publications demonstrated worse outcomes of interventional treatment of peripheral arterial disease (PAD) in patients of African American (AA) descent compared to Caucasians (C), and in female patients compared to male patients. However, studies addressing sex differences in outcomes, included predominantly white female patients. To our knowledge, there are no published studies specifically addressing outcomes of interventional treatment of PAD in female patients of African American descent. Aims: 1. To determine if the outcomes of interventional treatment of PAD in female patients of African American (FAA) descent differ from male African American patients (MAA), and Caucasian female patients (FC). If such differences exist, to identify factors associated with it. Methods: This study has a cross-sectional design with systematically retrospective data collection by the National Vascular Quality Initiative. Included in this study was data on patients treated with endovascular and open surgical options for symptomatic PAD. Statistical analysis was done using IBM Statistic SPSS V25. Results: 447,263 unique cases containing required data were available in the VQI database. Among them, 171,250 were female patients, of which 32,966 were FAA, 126,519 FC, and 39,461 MAA. This race and gender distribution is not significantly different from the US population structure (US Census Bureau 2023). 1 However, female to male ratio was higher in AA (0.83) compared to C (0.58, p&lt;0.0001). FAA were younger (65.143+/-9.59) compared to FC (69.16+/-10.32, P&lt;0.00001). Comparison of comorbidities, smoking rates, pre-interventional medications and post-interventional outcomes are listed in Table 1. Multivariate analysis confirmed higher amputation rate among FAA compared to FC and to MAA and showed no significant difference in mortality. Conclusions: FAA patients who require interventional treatment for PAD have significantly higher rate of hypertension and diabetes compared to FC and MAA patients and have higher amputation rates. It appears that differences in clinical outcomes of PAD treatment in FAA are related mostly if not entirely to poorly managed comorbidities existed prior to intervention.

Predictors of Radiotherapy Utilization and Outcome in Multiple Myeloma: A Single-Center Retrospective Study

Introduction/Background Radiotherapy (RT) is frequently used in the management of multiple myeloma (MM) for local control and symptom palliation. However, racial disparities and predictors of RT utilization in MM remain underexplored. This study aims to evaluate the relationship between patient demographics, disease characteristics, and RT utilization in a diverse MM patient cohort. Methods We conducted a single-center retrospective study of 208 MM patients treated with RT between 2008-2023 at Northwell Health. Patients without a MM diagnosis, initial diagnostic data, or follow up were excluded. We collected data on patient demographics, myeloma risk status based on cytogenetics and Revised International Staging System (R-ISS) criteria, self-identified race, and RT frequency. Statistical analysis was done using Stata v.18. High risk group is categorized as patients who had FGFR3/IGH fusion or t(4;14), MAF/IGH fusion or t(14;16), IGH/MAFB fusion or t (14:20), TP53 (17p) deletion, 1q amplification or stage 2/3 disease. Logistic regression analysis was performed to identify predictors of receiving three or more RT courses, and survival analysis was conducted to assess the impact of repeat RT on patient outcomes. Results The study included 124 patients, with race data available for 121 patients. Median age was 66 years, and 51.6% were male. Racial distribution was as follows: African American/Black 35.54%, White 28.93% Asian 6.61%, American Indian or Alaska Native 1.65%, and Others 27.27%. There was no significant relationship between MM risk status and the number of RT courses. However, White patients were more likely to receive multiple RT treatments to the same site of the body compared to all other racial groups (p=0.04). Logistic regression showed age as the only significant predictor for receiving three or more RT courses [odds ratio=0.92, 95% confidence interval (CI) 0.87-0.98, p=0.006], indicating that younger patients were more likely to undergo multiple RT courses. Age at diagnosis negatively correlated with the number of RT courses. At median follow up of 30 months, 36 deaths (29%) occurred. There was no significant difference in overall survival (OS) between patients who received one RT course compared to those who received more than one RT course (p= 0.27). However, survival analysis revealed that patients receiving repeat RT to the same site had higher risk of death compared to those who did not get repeat RT [hazard ratio 2.37, 95% CI 0.70-8.03, p=0.04], with median OS 52.3 months vs. 87.8 months, respectively. Conclusions This study highlights significant racial disparities in the utilization of RT among MM patients, with White patients more likely to receive multiple RT treatments to the same site. Age is a significant predictor of RT utilization, with younger patients receiving more courses. Additionally, repeat RT to the same site is associated with shorter OS. However, our study is limited by the sample size and exclusion of patients with insufficient data, with to potential bias. Further studies are needed to explore the role of race in access to RT.

Retrospective analysis of HPV infection: Cotesting and HPV genotyping in cervical cancer screening within a large academic health care system.

In 2019, the American Society for Colposcopy and Cervical Pathology introduced fundamental shifts toward "risk-based" guidelines, with human papillomavirus (HPV) genotyping as a principal test for investigating squamous intraepithelial lesions. This study aims to provide practice-based evidence and supplement the updated guidelines by investigating HPV demographic distribution and uncovering the pathological features of high-grade squamous intraepithelial lesions (HSILs) caused by high-risk HPV (hrHPV) subtypes. Patients who underwent Papanicolaou screening and HPV testing in two hospital systems over the course of 4 years were recruited. The cytology results were categorized on the basis of the 2014 Bethesda classification. DNA sequences of 14 types of hrHPV were detected by Aptima test. The histological features of HSILs caused by different subtypes were compared between biopsies and excisions. A total of 63,709 cases were included. The HPV prevalence was 14.70%, predominantly in the 30 to 39-year-old age group, with slightly higher rates observed in African Americans. There was no significant racial distribution difference between HPV 16/18/45 and other types. HPV 16/18/45 infection was directly correlated with the severity of abnormal cytology, although the other subtypes were the major causes of cytological abnormalities. The trend for HPV prevalence was consistent across calendar years, and was associated with 8.77% negative for intraepithelial lesion or malignancy, 30.46% atypical squamous cell of undetermined significance, 64.62% low-grade squamous intraepithelial lesion, 66.75% atypical squamous cell-cannot exclude a high-grade squamous intraepithelial lesion, and 91.80% HSIL. Furthermore, 29.09% of HSILs associated with other subtypes were not detectable on subsequent resections. Given the HPV demographic distribution and the histological features of HSILs caused by different subtypes, cotesting with reflex HPV genotyping in specific populations, or expanding the subtypes in the primary HPV screening test, should be considered.

Primer pairs to identify physiological races of Plasmodiophora brassicae

Clubroot is a soil-borne disease caused by infection with Plasmodiophora brassicae, the causal agent of clubroot, and clubroot can directly cause enormous economic losses in cruciferous crops. The latent spores of P. brassicae are highly active, have a high rate of infection, and are transmitted over a wide range of channels. The manifestation of P. brassicae in fields is often caused by the mixed infection of multiple physiological races, and such mixed infections often pose a substantial challenge to the breeding of plants that are resistant to P. brassicae. In this study, a set of multiple molecular markers for the identification of the main physiological race of P. brassicae was established by utilizing a system to detect the clubroot microspecies-specific primers SCL14 (UP/LP), PBRA_000030-2 (F/R), PBRA_000303-1 (F/R), PBRA_009348-2 (F/R), and Novel342-1 (F/R). The molecular identification of clubroot physiological race resulted in identifying of five such races, including No. 1, 4, 7, 9, and 11. The primers used in this study were more specific, and some strains were not only identified as No. 4 but also as No. 7, such as strains P2, P3, and P4, or as No. 1, such as strain P60. The highest frequency and widest distribution of the small species No. 4 in the sampling site indicated that race No. 4 is the dominant race of P. brassicae. Based on the distribution of race in the sampling site, it was found that the isolated strains of P. brassicae were more differentiated and caused more types of disease. In this study, the primers obtained for the molecular identification of P. brassicae in previous studies were improved and combined to form a multi-molecular marker method to identify the physiological race isolates of P. brassicae, which will provide a theoretical basis to identify the isolates of P. brassicae using molecular markers.

Dupilumab reduces psychiatric and sleep disorder risk in atopic dermatitis: a population-based cohort study

BackgroundPatients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders. ObjectiveTo compare the risk of psychiatric and sleep disorders in AD patients treated with dupilumab versus those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, azathioprine). MethodsThis retrospective cohort study used the TriNetX Global Collaborative Network and included adult AD patients newly prescribed dupilumab (DUPI-cohort) or conventional drugs without prior dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder (ADHD), as well as sleep disorders, were compared between cohorts, with hazard ratios (HRs) determined using Cox regression. ResultsAfter matching, both the DUPI- and CONV-cohorts included 6,114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was roughly 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (HR 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), while the risk of ADHD was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients. ConclusionAD patients prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.

The Association Between Accelerated Biological Aging and Cardiovascular Outcomes in Older Adults with Hypertension

BackgroundCurrent hypertension treatments rely on chronological age, which may not reflect individual differences in aging and its impact on cardiovascular health. This study aimed to determine whether biological age can predict adverse outcomes in older adults with hypertension, independent of traditional risk factors including chronological age. MethodsAn analysis of a prospective cohort was conducted using data from the Health and Retirement Study, a longitudinal survey of older adults in the United States. The Klemera-Doubal method was employed to calculate the biological age of the participants with hypertension at the time of enrollment in 2016. Discrete-time survival analysis was conducted to analyze the relationship between accelerated biological aging and the risk of mortality, heart disease, and stroke over four years of follow-up. ResultsA total of 4,442 individuals were analyzed. Of these, 2,438 showed decelerated aging, whereas 2,004 experienced accelerated aging (biological age > chronological age). The median age of the patients in both groups was around 70 years. Both groups had similar racial and ethnic distributions and predominantly consisted of non-Hispanic whites. The accelerated aging group had a higher prevalence of chronic diseases, lower education levels, and less wealth than the decelerated aging group. After adjustment for these differences, accelerated aging was associated with a higher risk of a composite outcome of death, heart disease, and stroke, with an adjusted hazard ratio (a-HR) of 1.62 (95% confidence interval: 1.27-2.06, p= 0.001). ConclusionsAccelerated biological age is a predictor of cardiovascular outcomes and death in patients with hypertension.

Examining dermatology residency applicant profiles for the 2023-2024 cycle: a cross-sectional analysis.

Dermatology remains highly competitive, with strong USMLE Step 1 scores traditionally crucial for securing residency positions. The 2023-2024 cycle introduced significant changes, including pass/fail USMLE Step 1 score reports and an expanded program signaling system. This study explores dermatology residency applicant profiles within this new context. A survey of 2023-2024 dermatology applicants was conducted via social media to gather demographic and application data. A total of 63 survey responses were collected: 74.6% matched and 25.4% unmatched. The racial distribution was 54% White/Caucasian, 25.4% Asian/Pacific Islander, 9.5% Black/African American, 4.8% Hispanic/Latino, and 6.3% other. The median USMLE Step 2 score was 257 (215-277). Racial differences in USMLE Step 2 scores were significant (P = 0.031), but did not affect match rates (P = 0.116). Letters of recommendation from dermatology program directors were linked to lower match rates (P = 0.036). A positive correlation was found between the number of audition rotations completed and matching at such programs (r²=0.817). Of all matched respondents, 46.8% matched to a program they did not signal; of these, 50.0% matched to a program at which they completed an audition rotation and 40.9% to their home dermatology program affiliation. The mean number of interviews was 8.02, with matched applicants receiving more invitations than unmatched applicants (9.02 vs. 5.06, P = 0.002). The shift to pass/fail USMLE Step 1 scores and expanded program signaling did not notably affect the median USMLE Step 2 score from prior years or match rates among underrepresented minorities. Success in matching continues to depend on a holistic evaluation.

Alcohol perceptions and driving decisions among adolescents: Exploring the role of peer and parental influences in Virginia

Objective This study aims to explore the role of peer and parental influences on adolescent driving behaviors, particularly concerning distracted and alcohol-impaired driving, in light of the significant number of road accidents and fatalities involving young drivers. Methods A cross-sectional study was conducted using data from the IMPACT program. Adolescents aged 14 to 19 in the Richmond area were recruited from local high schools through convenience sampling. Parental consent was obtained via media release forms provided by Virginia Commonwealth University (VCU), with students having the option to opt out of participation. Self-report surveys were administered during IMPACT program events and captured via REDCap. The surveys included demographic information, driving history, driving behaviors, alcohol attitudes, drinking and driving behaviors, and a driving knowledge section. Results The mean age of participants was 15.230 years (SD = 1.545). Gender distribution was as follows: Female 53.1% and male 42.1%. Racial distribution included White/Caucasian (48.9%), Black/African American (22.4%), and multiple races (8.8%). Peer influence on drinking and driving was significant (P = .038). Driving under the influence was associated with both parental and peer influence (P < .050). A positive correlation was found between peer digital distraction and car crashes (coefficient = 0.038, P = .038). Additionally, parental alcohol-impaired driving was linked to decreased positive attitudes among adolescents toward driving under the influence (coefficient = −0.024, P = .000). Though parent distracted driving positively influenced adolescent driving behavior, this effect was not statistically significant (coefficient = 0.008, P = .320). Conclusion The findings indicate a significant reduction in risky behaviors such as drinking and driving and an increase in seat belt use among adolescents. There is heightened awareness regarding the dangers of texting and driving. A multifaceted approach was effective in improving attitudes and practices related to driving safety.

Spatial and Racial/Ethnic Variation in the Prevalence of Cesarean Delivery in a South Carolina Medical Center.

While racial/ethnic disparities in cesarean delivery have been noted in the literature, less is known about the intersection between individual-level race/ethnicity and community-level social vulnerability as factors in cesarean delivery. The goal was to use medical record data from a large medical center combined with census tract-level data to examine patterns of social vulnerability, racial population distribution, and prevalence of cesarean delivery. Data were obtained from electronic medical records of patients from a large medical center in South Carolina from 2019 to 2020. The outcome variable was cesarean delivery (yes/no), and covariates included the year of delivery; age of patient; race/ethnicity; spoken language; BMI categories; clinical indications of anemia, hypertension, preeclampsia, and diabetes; and census tract Social Vulnerability Index (SVI). Generalized linear mixed models for multilevel binary logistic regression were used to test the main hypothesis that the census tract level Social Vulnerability Index is positively associated with cesarean delivery. Among a total of 5011 patients, we found that non-Hispanic Black mothers were more likely to have cesarean deliveries compared with non-Hispanic White mothers. After controlling for census tract-level SVI, the individual-level race/ethnicity association was no longer significant. Significant spatial autocorrelation across census tracts was evident for cesarean delivery prevalence, non-Hispanic Black population, and SVI. A high prevalence of cesarean delivery tended to cluster with high SVI and a high non-Hispanic Black population. We found that non-Hispanic Black mothers were more likely to have cesarean deliveries, which was explained by census tract differences in the SVI.

Comparison of targeted web-based advertising versus traditional methods for recruiting older adults into clinical trials.

Recruiting older adults into clinical trials can be particularly challenging. Our objective was to determine if targeted web-based advertising is an effective recruitment strategy. We compared the recruitment rates of traditional and targeted web-based methods for three representative clinical trials involving older adults. All studies utilized traditional recruitment methods initially, but shifted toward primarily targeted web-based advertising after experiencing slow recruitment rates. We found that web-based advertising reached more individuals compared to traditional methods. Compared to traditional methods, web-based methods also had at least twice the rate of expressed interest, completion of telephone and in-person screening, eligibility, and enrollment. Additionally, the proportion of individuals excluded after the telephone screening did not differ according to whether targeted web-based advertising (STAMINA: 51%; Berries and Steps: 62%; ISTIM: 20%) or traditional methods (STAMINA: 48%; Berries and Steps: 69%; ISTIM: 23%) were used within each study. Those recruited using web-based advertisements tended to be younger compared to traditional methods, but were similar in racial distribution and education. Targeted web-based advertisements may be more effective in recruiting older adults for clinical trials at a faster rate than traditional recruitment methods, but need further evaluation of compatible study designs, potential population bias, and cost-effectiveness.

Grade-stratified meningioma risk among individuals who are Non-Hispanic black and interactions with male sex.

Meningioma risk factors include older age, female sex, and African-American race. Limited data explore how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade. The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade in this retrospective study. 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR = 1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR = 1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR = 1.17; 95% CI: 1.16-1.18) and was further elevated in males (IRR = 1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (PInteraction=0.001). Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred greater risk of meningioma among men than women, and greater risk of grade 2/3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the U.S.

Disease Associations among Patients Afflicted with Both Glaucoma and Age-Related Macular Degeneration.

Background/Objectives: This study investigates whether there is an increased propensity to systemic conditions in patients with both age-related macular degeneration (AMD) and glaucoma in order to provide greater insight into patients' overall health and response to physiologic stress. Methods: A large retrospective dataset review was conducted between April 2004 and June 2018, distinguishing four groups based on international classification of diseases (ICD) codes: glaucoma only, AMD only, glaucoma and AMD, and cataracts only (as an age-matched control). The systemic disease prevalence of each group was calculated, and a Friedman analysis was used to compare the prevalence between the groups. Results: This study identified 5243 patients with glaucoma only, 6726 with AMD only, 402 with combined disease, and 25,450 with cataracts only. Age and racial distributions varied between groups in a predictable manner. Two conditions, heart failure (HF) and dementia, had a statistically higher prevalence in patients with both glaucoma and AMD compared to those with glaucoma alone (HF p = 0.036, dementia p = 0.024) and cataracts alone (HF p = 0.003, dementia p = 0.036). There was no significant difference observed in terms of ethnicity and gender among the different disease groups (p > 0.05). Conclusions: Both AMD and glaucoma individually portend a higher rate of comorbidities than age-matched controls. Patients with concomitant AMD and glaucoma demonstrate a uniquely higher prevalence of heart failure and dementia than those with either disease alone. The underlying association and pathologic mechanisms warrant further investigation to improve the overall health management and prognostication for these individuals.

8725 Subcutaneous Compared With Intravenous Insulin Protocol For Management Of DKA: A Longitudinal Experience In A Single Center

Abstract Disclosure: S. Avula: None. M. Salim: None. E. Wetherbee: None. C. Wenner: None. A. Gravely: None. A.D. Westanmo: None. N.G. Ercan-Fang: None. Background: Diabetic ketoacidosis (DKA) is a critical condition requiring immediate medical attention to prevent severe health complications and even death. Typically, patients are placed under the care of the intensive care unit (ICU) to ensure close supervision. With implementation of effective subcutaneous insulin protocol (SIP), patients can be safely managed outside of ICU without any significant change in mortality or morbidity, potentially decreasing financial burden of costly ICU stay. Aim: To review and compare the experience with subcutaneous and intravenous insulin protocols for management of DKA at Minneapolis Veterans Affairs Health Care System (MVAHCS). Methods: We conducted a retrospective chart review of patients who were admitted with DKA at MVAHCS from 2013 - 2023 and were treated with either I.V insulin or SIP. Inclusion criteria: Adults (age &amp;gt;/=18 years) admitted with DKA between 2013 and 2023. Exclusion criteria: Non availability of VBG/ABG and patients who were not treated initially at MVAHCS. Statistical analysis used was basic descriptive analysis, Pearson’s Chi-Square and Two sample T test. Results: Majority of patients included were males: 57 (96.61%) and 16 (88.89) in SIP and I.V insulin, respectively. Racial distribution of patients was skewed towards a white population: Total of 57 (74.03%) were white, 12 (15.58%) were African American (AA). A significant majority of white patients 47 (79.66%) were on SIP, while 10 (55.56%) were on I.V insulin. Mean age of SIP and I.V insulin study populations were 58.9 (SD 16.21) and 59.2 years (SD 12.23), respectively. Baseline mean pH of the SIP and I.V insulin study populations were 7.27 (SD 0.08) and 7.13 (0.13), respectively. Mean bicarb for SIP was 14.9 mEq/L (SD 4.60) and I.V Insulin was 10.1 mEq/L ( SD 4.57). Mean time for anion gap (AG) closure among patients on SIP was modestly higher at 19.7 hours (SD 15.3) when compared to that on I.V insulin of 17.1 hours (SD 12.4) but the difference did not reach statistical significance. Similarly, 55.6% (n=10) of patients on I.V insulin and 58.6% (n=34) of those on SIP had anion gap closure of &amp;gt;/= 12 hours (p = 0.8187). When adjusted for baseline pH and bicarbonate, 46% of patients in the I.V insulin group had AG closure &amp;gt;=12 hours, whereas 67% of those in the SIP group had AG closure &amp;gt;=12 hours with total difference of 21% (p= 0.2098). Conclusion: Our results demonstrate that SIP can be safely implemented outside of the ICU setting. Compared with SIP, baseline pH was slightly less in the IV group (our protocol directs sicker patients with lower baseline pH towards the I.V insulin rather than SIP), however, AG closure time was similar between the two groups even after performing multiple regression analysis where we adjusted for baseline differences between two treatment groups in pH, bicarbonate, AG. These results indicate that SIP could be safe and potentially cost saving alternative for DKA management. Presentation: 6/3/2024