Race-stratified Models Research Articles

Trust in Black and White Breast Cancer Patients: Opportunities to Enhance Trustworthiness in Cancer Care

IntroductionThis study evaluated the relationships between patient and cancer delivery factors with trust in oncology providers in a racial/ethnically diverse group of cancer patients. MethodsData were analyzed from a prospective cohort study of women with hormone receptor positive (HR+) breast cancer. A standardized survey collected validated measures of trust in providers, psychosocial factors, and cancer care delivery factors. Multivariable logistic regression models and race-stratified models were employed to calculate odds ratios and 95% confidence intervals associated with trust. ResultsOf the 567 participants, 28% identified as Black and the rest were White. Compared to White women Black women reported lower trust in providers. Four domains of cancer care delivery were significantly associated with patients’ higher trust in their providers: general satisfaction with care (P < .0001), technical quality of the provider (P < .001), interpersonal manner of the provider (P = .0008) and provider communication (P = .0010). Race-stratified models revealed 2 significant cancer care delivery domains for both groups (ie, general satisfaction and interpersonal) and 2 care domains (technical quality and communication) that were only significant among White women. ConclusionEfforts are needed to nurture trusting relationships between Black women and their oncology providers. Factors related to the organization and delivery of cancer care are modifiable targets for interventions as these were robust predictors of patient trust regardless of a woman's self-reported race. Investments in strategies that strengthen the structure and organization of care towards a structures of trust worthiness may better support providers and patients and ultimately reduce cancer care disparities.

State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment.

Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school. We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race. Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages. Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations.

Abstract P426: County-Level Structural Racism and Diabetes Prevalence Among White and Black US Adults

Background: Diabetes Mellitus affects 12.7% non-Hispanic Black adults as opposed to 7% non-Hispanic White Adults. We hypothesized that higher structural racism (SR) is associated with greater diabetes prevalence among Black and White adults. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 US Black and White adults from 48 contiguous US states in 2003-2007. We linked a novel county-level structural racism (CSR) metric reflecting domains of housing dissimilarity, school dissimilarity, high school graduation, incarceration, poverty, primary care access, and ambulatory care access. CSR was determined linked to REGARDS participants’ county location at time of recruitment. Diabetes was defined as fasting blood glucose ≥126 mg/dL or random blood glucose ≥200 mg/dL or use of diabetes medications. We excluded those missing CSR score and diabetes status. Poisson regression estimated relative risk (RR) of prevalent diabetes by higher (more adverse) CSR. Results: Among the 28,329 included participants (mean [SD] age 65 years, [9.43], 55% female participants, 42% Black participants). There was a greater proportion of Black adults in areas with higher CSR. As is shown in Table 1 , higher CSR was associated with higher RR of prevalent diabetes overall. However, higher CSR was associated with lower RR in race stratified models. Conclusions: Adverse levels of CSR were associated with lower diabetes prevalence in Black adults. It is unclear if this observation reflects operationalization of CSR, omitted variable bias, survival bias, or a true structural racism-diabetes association. Table 1 - Relative risk (RR) of Diabetes Prevalence age and sex adjusted per 1-point higher CSR*

The Intersections of COVID-19, HIV, and Race/Ethnicity: Machine Learning Methods to Identify and Model Risk Factors for Severe COVID-19 in a Large U.S. National Dataset.

We investigate risk factors for severe COVID-19 in persons living with HIV (PWH), including among racialized PWH, using the U.S. population-sampled National COVID Cohort Collaborative (N3C) data released from January 1, 2020 to October 10, 2022. We defined severe COVID-19 as hospitalized with invasive mechanical ventilation, extracorporeal membrane oxygenation, discharge to hospice or death. We used machine learning methods to identify highly ranked, uncorrelated factors predicting severe COVID-19, and used multivariable logistic regression models to assess the associations of these variables with severe COVID-19 in several models, including race-stratified models. There were 3 241 627 individuals with incident COVID-19 cases and 81 549 (2.5%) with severe COVID-19, of which 17 445 incident COVID-19 and 1 020 (5.8%) severe cases were among PWH. The top highly ranked factors of severe COVID-19 were age, congestive heart failure (CHF), dementia, renal disease, sodium concentration, smoking status, and sex. Among PWH, age and sodium concentration were important predictors of COVID-19 severity, and the effect of sodium concentration was more pronounced in Hispanics (aOR 4.11 compared to aOR range: 1.47-1.88 for Black, White, and Other non-Hispanics). Dementia, CHF, and renal disease was associated with higher odds of severe COVID-19 among Black, Hispanic, and Other non-Hispanics PWH, respectively. Our findings suggest that the impact of factors, especially clinical comorbidities, predictive of severe COVID-19 among PWH varies by racialized groups, highlighting a need to account for race and comorbidity burden when assessing the risk of PWH developing severe COVID-19.

Simulating the population impact of interventions to reduce racial gaps in breast cancer treatment.

Inequities in guideline-concordant treatment receipt contribute to worse survival in Black patients with breast cancer. Inequity-reduction interventions (eg, navigation, bias training, tracking dashboards) can close such treatment gaps. We simulated the population-level impact of statewide implementation of inequity-reduction interventions on racial breast cancer inequities in North Carolina. Using registry-linked multipayer claims data, we calculated inequities between Black and White patients receiving endocrine therapy (n = 12 033) and chemotherapy (n = 1819). We then built cohort-stratified (endocrine therapy and chemotherapy) and race-stratified Markov models to simulate the potential increase in the proportion of patients receiving endocrine therapy or chemotherapy and subsequent improvements in breast cancer outcomes if inequity-reducing intervention were implemented statewide. We report uncertainty bounds representing 95% of simulation results. In total, 75.6% and 72.1% of Black patients received endocrine therapy and chemotherapy, respectively, over the 2006-2015 and 2004-2015 periods (vs 79.3% and 78.9% of White patients, respectively). Inequity-reduction interventions could increase endocrine therapy and chemotherapy receipt among Black patients to 89.9% (85.3%, 94.6%) and 85.7% (80.7%, 90.9%). Such interventions could also decrease 5-year and 10-year breast cancer mortality gaps from 3.4 to 3.2 (3.0, 3.3) and from 6.7 to 6.1 (5.9, 6.4) percentage points in the endocrine therapy cohorts and from 8.6 to 8.1 (7.7, 8.4) and from 8.2 to 7.8 (7.3, 8.1) percentage points in the chemotherapy cohorts. Inequity-focused interventions could improve cancer outcomes for Black patients, but they would not fully close the racial breast cancer mortality gap. Addressing other inequities along the cancer continuum (eg, screening, pre- and postdiagnosis risk factors) is required to achieve full equity in breast cancer outcomes.

The role of neighborhood deprivation in the cervicovaginal microbiota

BackgroundLactobacillus-deficient cervicovaginal microbiota is associated with spontaneous preterm birth and is more common among Black individuals. Persistent racial segregation in the United States has led to differential neighborhood exposures by race that can affect pregnancy outcomes. The extent to which neighborhood exposures may explain racial differences in the cervicovaginal microbiota is unknown. ObjectiveWe sought to determine if neighborhood deprivation, defined as material community deprivation, is associated with a Lactobacillus-deficient cervicovaginal microbiota in a prospective cohort of pregnant individuals. Our hypothesis is that racial differences in neighborhood deprivation may explain the higher prevalence of Lactobacillus-deficient cervicovaginal microbiota in Black birthing people. Design/MethodsWe analyzed data from Motherhood & Microbiome, a prospective pregnancy cohort enrolled from prenatal clinics in a single hospital system 2013-2016 in which a Lactobacillus-deficient cervicovaginal microbiota was previously shown to be associated with spontaneous preterm birth. We geocoded addresses to obtain census tract neighborhood deprivation data from the Brokamp Nationwide Community Deprivation Index that uses weighted proportions of poverty, income, public assistance, lack of health insurance, and vacant housing. Generalized linear mixed models quantified associations of deprivation with the cervicovaginal microbiota accounting for geographical clustering by census tract and potential confounders. Due to different distributions of neighborhood deprivation and the cervicovaginal microbiota, we performed race-stratified models. Mediation analyses quantified the extent to which deprivation may contribute to racial differences in the cervicovaginal microbiota. ResultsHigher neighborhood deprivation was associated with a Lactobacillus-deficient cervicovaginal microbiota. Per standard deviation increment of deprivation, participants had 28% higher adjusted odds (aOR 1.28, 95% CI: 1.04-1.58) of a Lactobacillus-deficient microbiota. Black participants had higher odds of a Lactobacillus-deficient microbiota than White participants (aOR 4.00, 95% CI: 2.05, 8.26), and mediation analysis revealed that deprivation accounted for 22% (P=0.046) of that disparity. ConclusionNeighborhood deprivation was associated a Lactobacillus-deficient cervicovaginal microbiota and may partially explain Black-White disparities in the cervicovaginal microbiota. Mechanistic studies to explore how environmental exposures modify the cervicovaginal microbiota are warranted to identify novel opportunities for future interventional strategies to prevent preterm birth. As these findings demonstrate a potential biologic impact from neighborhood conditions, policies that drive urban planning should be explored to improve pregnancy outcomes.

Abstract 13528: A Comparison of Five Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study

Background: Accelerated biological aging is an increasingly popular way to track the effects of chronic stress over time. Biological aging is linked to external and internal chronic stressors and has the potential to be used clinically to understand a person’s personalized functioning and to predict future disease. Aims: The primary aim was to investigate the similarities and differences in the association of different measures of biological aging and incident cardiovascular disease (CVD). Hypotheses: Our novel predictor, Clinical Marker-Derived Age Acceleration (CAA), and the Framingham Risk Score (FRS) will be most robustly associated with incident CVD, and the associations will be stronger among Black participants. The latter is based on previous findings that Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study have, on average, more adverse social determinants of health. Methods: We used Multiple Informants Models (MIM) to compare the strength of five measures of accelerated aging (Intrinsic and Extrinsic Epigenetic Age Acceleration, GrimAge Acceleration, PhenoAge Acceleration, CAA (including clinical biomarkers, e.g., CRP, lung function, glucose, etc.), and one established clinical predictor of future CVD, FRS, to predict incident CVD over 11 years (2007 – 2018). Participants were 913 Black or White individuals examined by CARDIA in 2005-2006, when their mean age was 45 years. We also included race-specific analysis. Measures were standardized (M = 0, SD=1) to facilitate comparison. Results: The incidence rate of CVD within our sample was 7.8 per 1,000 person years and the prevalence of CVD was 7.5%. CAA and FRS significantly predicted incident CVD in the fully adjusted model (OR = 1.31, 95% CI: 1.06 – 1.63) and (OR = 1.28, 95% CI: 1.05 – 1.56), respectively. CAA and FRS were the best predictors of CVD, but there was no significant difference in the predictive value of CAA and FRS (Chi2 = 0.05, p = 0.828). In race-stratified models, CAA was the strongest and most consistent predictor in the Black-only models. Conclusions: Our findings support the association of CAA, a multi-system clinical composite, with incident CVD. Further, this composite may account for some of the well-known racial variation in incident CVD.

6 The Role of CPAP Treatment on Associations Between Obstructive Sleep Apnea and Cognition Among Black and White Older Adults

Objective:Obstructive sleep apnea (OSA) may be a modifiable risk factor for late-life cognitive impairment. We previously demonstrated that non-Hispanic Black older adults are less likely to be diagnosed with OSA despite having equal or greater health risk for OSA compared to non-Hispanic White older adults, and this disparity in diagnosis was strongest among individuals with lower education. Here, we aimed to determine 1) whether there are racial differences in continuous positive airway pressure (CPAP) treatment, 2) how CPAP treatment may influence OSA-cognition associations, and 3) whether CPAP differentially influences OSA-cognition associations across racial groups.Participants and Methods:Cross-sectional data were obtained from 424 socioeconomically diverse community-dwelling adults ages 55-83 (63.4±3.2 years, 41.7% male, 53.5% Black) from the Michigan Cognitive Aging Project. Physician-diagnosed OSA and current CPAP use were self-reported. Global cognition was operationalized as a composite of five factor scores derived from a comprehensive neuropsychological battery. Racial group differences were investigated with chi-square and Fisher’s exact tests with statistical significance set at the .05 level. Associations between OSA and cognition (adjusted for age, gender, race, and years of education) were investigated with linear regressions. Subsequent models isolated effects of uncontrolled OSA by excluding individuals using CPAP. Racial differences in OSA-cognition associations were investigated with race-stratified models.Results:Fewer Black participants (9.2%) reported diagnosed OSA compared to White participants (12.3%; x2 (1, N=424) =5.314, p=.021, cp=.112). In the whole sample, 47.3% of participants with diagnosed OSA reported CPAP use, and this proportion did not differ across race (x2 [1, N=86] =.048, p=.826). In the whole sample, OSA diagnosis was only associated with cognition when CPAP users were excluded (excluding CPAP users: ß=-.085, SE=.037, p=.024; including CPAP users: ß=-.067, SE=.036, p=.062). In race-stratified models, diagnosed OSA was only associated with cognition among Black participants, and this association was stronger when CPAP users were excluded (excluding CPAP users: ß=-.142, SE=.060, p=.018; including CPAP users: ß=-.126, SE=.058, p=.030). Diagnosed OSA was not associated with cognition among White participants, irrespective of whether CPAP users were included (excluding CPAP users: ß=-.084,SE=.068, p=.215; including CPAP users: ß=-.056, SE=.064, p=.378).Conclusions:Our findings support CPAP treatment as a potential intervention to mitigate late-life cognitive impairment among those with OSA. Despite being less likely to receive a diagnosis of OSA, Black older adults were equally likely to engage in CPAP treatment as White older adults when diagnosed. The detrimental impact of OSA on cognition may be more salient among Black older adults, which may reflect racial disparities in cardiovascular risk and/or resources that promote cognitive reserve. However, CPAP appears to be an effective treatment to reduce OSA-related cognitive impairment for Black older adults, highlighting the critical importance of diagnosis and treatment in this group. Intervention efforts that abate racial inequalities in access to quality healthcare in order to facilitate acquisition of a formal OSA diagnosis and CPAP treatment may help to reduce preventable cognitive health disparities among older adults.

Maternal hepatitis C virus infection and three adverse maternal outcomes in the United States.

Hepatitis Virus C (HCV) infection rates have trended upwards among pregnant people in the USA since 2009. Existing evidence about HCV infections and maternal outcomes is limited; therefore, we used birth certificate data to investigate the association between HCV infection and maternal health outcomes. We used the 2017 US birth certificate dataset (a cross-section of 1.4 million birth records) to assess the association between prevalent HCV infection and gestational diabetes, gestational hypertension, and eclampsia. Potential confounding variables included prenatal care, age, education, smoking, presence of sexually transmitted infections (STIs), body mass index (BMI), and weight gain during pregnancy. We restricted our analysis to only women with a first singleton pregnancy. Odds ratios were estimated by logistic regression models and separate models were tested for white and Black women. Only 0.31% of the women in our sample were infected with HCV (n = 4412). In an unadjusted model, we observed a modest significant protective association between HCV infection and gestational diabetes (Odds ratio [OR]: 0.83; 95% CI: 0.76-0.96); but this was attenuated with adjustment for confounding variables (Adjusted odds ratio [AOR]: 0.88; 95% CI: 0.76, 1.02). There was no association between HCV and gestational hypertension (AOR: 1.03; 95% CI: 0.91, 1.16) or eclampsia (AOR: 1.15; 95% CI: 0.69, 1.93). Results from the race stratified models were similar to the non-stratified summary models. We observed no statistically significant associations between maternal HCV infection with maternal health outcomes. Although, our analysis did indicate that HCV may lower the risk of gestational diabetes, this may be attributable to confounding. Studies utilizing more accurately measured HCV infection including those collecting type and timing of testing, and timing of infection are warranted to ensure HCV does not adversely impact maternal and/or fetal health. Particularly in the absence of recommended therapy for HCV during pregnancy.

State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults

RationaleBlack adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s–1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function. ObjectiveWe determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents’ educational attainment. MethodsWe linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects. ResultsGreater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment. ConclusionsOur findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.

A national examination of discrimination, resilience, and depressive symptoms during the COVID-19 pandemic: the All of Us Research Program.

To examine the impact of resilience on the association between discrimination and trajectories of depressive symptoms during the COVID-19 pandemic across racial and ethnic groups. Data were drawn from 5 waves of the All of Us Research Program's survey on the impact of COVID-19 on the lives of American adults. Linear mixed-effects models were fitted to assess the association between discrimination exposure throughout the pandemic and depressive symptoms over time. An interaction term was introduced between resilience and discrimination exposure to assess if resilience buffered the association between discrimination and depressive symptoms over time. Race-stratified linear mixed-effects models examined racial/ethnic differences in the association between resilience, discrimination, and depressive symptoms over time. Fifty-one thousand nine hundred fifty-eight participants completed surveys between May and December of 2020. Results indicated that exposure to more discrimination was associated with increasing trajectories of depressive symptoms over time (b = 0.48, p < 0.001). However, resilience moderated the association between discrimination and well-being over time such that higher resilience mitigated the detrimental effect of experiencing discrimination on depressive symptoms across time (b = -0.02, p < 0.001). Identifying protective features such as resilience can promote the development of culturally tailored interventions to address mental health in the context of discrimination.

Racial and Ethnic Bias in Risk Prediction Models for Colorectal Cancer Recurrence When Race and Ethnicity Are Omitted as Predictors

ImportanceIncluding race and ethnicity as a predictor in clinical risk prediction algorithms has received increased scrutiny, but there continues to be a lack of empirical studies addressing whether simply omitting race and ethnicity from the algorithms will ultimately affect decision-making for patients of minoritized racial and ethnic groups.ObjectiveTo examine whether including race and ethnicity as a predictor in a colorectal cancer recurrence risk algorithm is associated with racial bias, defined as racial and ethnic differences in model accuracy that could potentially lead to unequal treatment.Design, Setting, and ParticipantsThis retrospective prognostic study was conducted using data from a large integrated health care system in Southern California for patients with colorectal cancer who received primary treatment between 2008 and 2013 and follow-up until December 31, 2018. Data were analyzed from January 2021 to June 2022.Main Outcomes and MeasuresFour Cox proportional hazards regression prediction models were fitted to predict time from surveillance start to cancer recurrence: (1) a race-neutral model that explicitly excluded race and ethnicity as a predictor, (2) a race-sensitive model that included race and ethnicity, (3) a model with 2-way interactions between clinical predictors and race and ethnicity, and (4) separate models by race and ethnicity. Algorithmic fairness was assessed using model calibration, discriminative ability, false-positive and false-negative rates, positive predictive value (PPV), and negative predictive value (NPV).ResultsThe study cohort included 4230 patients (mean [SD] age, 65.3 [12.5] years; 2034 [48.1%] female; 490 [11.6%] Asian, Hawaiian, or Pacific Islander; 554 [13.1%] Black or African American; 937 [22.1%] Hispanic; and 2249 [53.1%] non-Hispanic White). The race-neutral model had worse calibration, NPV, and false-negative rates among racial and ethnic minority subgroups than non-Hispanic White individuals (eg, false-negative rate for Hispanic patients: 12.0% [95% CI, 6.0%-18.6%]; for non-Hispanic White patients: 3.1% [95% CI, 0.8%-6.2%]). Adding race and ethnicity as a predictor improved algorithmic fairness in calibration slope, discriminative ability, PPV, and false-negative rates (eg, false-negative rate for Hispanic patients: 9.2% [95% CI, 3.9%-14.9%]; for non-Hispanic White patients: 7.9% [95% CI, 4.3%-11.9%]). Inclusion of race interaction terms or using race-stratified models did not improve model fairness, likely due to small sample sizes in subgroups.Conclusions and RelevanceIn this prognostic study of the racial bias in a cancer recurrence risk algorithm, removing race and ethnicity as a predictor worsened algorithmic fairness in multiple measures, which could lead to inappropriate care recommendations for patients who belong to minoritized racial and ethnic groups. Clinical algorithm development should include evaluation of fairness criteria to understand the potential consequences of removing race and ethnicity for health inequities.

Neighborhood Walkability as a Risk Factor for Preterm Birth Phenotypes in Two Philadelphia Hospitals from 2013-2016.

A total of one in ten infants is born preterm in the U.S. with large racial disparities. Recent data suggest that neighborhood exposures may play a role. Walkability-how easily individuals can walk to amenities-may encourage physical activity. We hypothesized that walkability would be associated with a decreased risk of preterm birth (PTB) and that associations would vary by PTB phenotype. PTB can be spontaneous (sPTB) from conditions such as preterm labor and preterm premature rupture of membranes, or medically indicated (mPTB) from conditions such as poor fetal growth and preeclampsia. We analyzed associations of neighborhood walkability (quantified by their Walk Score® ranking) with sPTB and mPTB in a Philadelphia birth cohort (n = 19,203). Given racial residential segregation, we also examined associations in race-stratified models. Walkability (per 10 points of Walk Score ranking) was associated with decreased odds of mPTB (aOR 0.90, 95% CI: 0.83, 0.98), but not sPTB (aOR 1.04, 95% CI: 0.97, 1.12). Walkability was not protective for mPTB for all patients; there was a non-significant protective effect for White (aOR 0.87, 95% CI: 0.75, 1.01), but not Black patients (aOR 1.05, 95% CI: 0.92, 1.21) (interaction p = 0.03). Measuring health effects of neighborhood characteristics across populations is key for urban planning efforts focused on health equity.

Do Police Encounters Increase the Risk for Cardiovascular Disease? Police Encounters and Framingham 30-Year Cardiovascular Risk Score.

Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk. Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models. We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men. The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.

Disparities in opioid use disorder–related hospital use among postpartum Virginia Medicaid members

IntroductionThe overdose crisis is increasingly revealing disparities in opioid use disorder (OUD) outcomes by race and ethnicity. Virginia, like other states, has witnessed drastic increases in overdose deaths. However, research has not described how the overdose crisis has impacted pregnant and postpartum Virginians. We report the prevalence of OUD-related hospital use during the first year postpartum among Virginia Medicaid members in the years preceding the COVID-19 pandemic. We secondarily assess how prenatal OUD treatment is associated with postpartum OUD-related hospital use. MethodsThis population-level retrospective cohort study used Virginia Medicaid claims data for live infant deliveries between July 2016 and June 2019. The primary outcome of OUD-related hospital use included overdose events, emergency department visits, and acute inpatient stays. Independent variables of interest were prenatal receipt of medication for OUD (MOUD) and receipt of non-MOUD treatment components in line with a comprehensive care approach (e.g., case management, behavioral health). Both descriptive and multivariate analyses were performed for all deliveries and stratified by White and Black non-Hispanic individuals to bring attention to the devastating impacts of the overdose crisis within communities of color. ResultsThe study sample included 96,649 deliveries. Over a third were by Black birthing individuals (n = 34,283). Prenatally, 2.5 % had evidence of OUD, which occurred more often among White (4 %) than Black (0.8 %) non-Hispanic birthing individuals. Postpartum OUD-related hospital use occurred in 10.7 % of deliveries with OUD, more commonly after deliveries by Black, non-Hispanic birthing individuals with OUD (16.5 %) than their White, non-Hispanic counterparts (9.7 %), and this disparity persisted in the multivariable analysis (Black AOR 1.64, 95 % CI 1.14–2.36). Postpartum OUD-related hospital events were less frequent for individuals receiving versus not receiving postpartum MOUD within 30 days prior to the event. Prenatal OUD treatment, including MOUD, was not associated with decreased odds of postpartum OUD-related hospital use in the race-stratified models. ConclusionPostpartum individuals with OUD are at high risk for mortality and morbidity, especially Black individuals not receiving MOUD after delivery. An urgent need remains to effectively address the systemic and structural drivers of racial disparities in transitions of OUD care through the one-year postpartum period.

DO FRIENDS GET UNDER THE SKIN? DAILY INTERACTIONS AND CARDIOVASCULAR FUNCTIONING AMONG BLACK AND WHITE AMERICANS

Abstract Scarce research has examined racial differences in cardiovascular health in the context of social interactions. This study investigated whether (a) friend interactions were associated with better cardiovascular functioning, and (b) such associations vary among Black and White adults. This study employed dual assessment techniques—ecological momentary assessments (EMA) and ambulatory physiological assessments—to examine the co-occurrence of social interactions and cardiovascular functioning. Multilevel models revealed no racial differences in ambulatory HRV and frequency of friend interactions throughout the day. Findings revealed a between-person link of friend interactions and better HRV in the overall sample. Race-stratified models found a within-person link between friendship interaction and worse HRV and a between-person link between friendship interaction and better HRV for Blacks but not for Whites. Findings suggest friend interactions are more salient for Blacks’ cardiovascular health and may serve as a modifiable factor for preventing cardiovascular diseases.

Intergenerational effects of maternal lifetime stressor exposure on offspring telomere length in Black and White women.

Although maternal stressor exposure has been associated with shorter telomere length (TL) in offspring, this literature is based largely on White samples. Furthermore, timing of maternal stressors has rarely been examined. Here, we examined how maternal stressors occurring during adolescence, pregnancy, and across the lifespan related to child TL in Black and White mothers. Mothers (112 Black; 110 White; Mage = 39) and their youngest offspring (n = 222; Mage = 8) were part of a larger prospective cohort study, wherein mothers reported their stressors during adolescence (assessed twice during adolescence for the past year), pregnancy (assessed in midlife for most recent pregnancy), and across their lifespan (assessed in midlife). Mother and child provided saliva for TL measurement. Multiple linear regression models examined the interaction of maternal stressor exposure and race in relation to child TL, controlling for maternal TL and child gender and age. Race-stratified analyses were also conducted. Neither maternal adolescence nor lifespan stressors interacted with race in relation to child TL. In contrast, greater maternal pregnancy stressors were associated with shorter child TL, but this effect was present for children of White but not Black mothers. Moreover, this effect was significant for financial but not social pregnancy stressors. Race-stratified models revealed that greater financial pregnancy stressors predicted shorter telomeres in offspring of White, but not Black mothers. Race and maternal stressors interact and are related to biological aging across generations, but these effects are specific to certain races, stressors, and exposure time periods.

Racial Differences in the Association of MIND Diet/Physical Activity Combinations and Cognition in older adults

AbstractBackgroundDiet and physical activity (PA) are important factors associated with improved cognition. Few studies have investigated the synergistic association with cognitive decline and further, whether the association differs by race. In this study, we investigate whether the observed association of high MIND diet score/high self‐reported PA and cognitive decline is different between African Americans (AA’s) and European Americans (EA’s).MethodWe examined the association of baseline MIND diet and PA combinations on cognition in 3,657 participants (2206 AAs and 1451 EAs; mean age = 73.2±SD5.8 years) from the Chicago Health and Aging Project. Diet was assessed using a validated 144‐item food frequency questionnaire; self‐reported PA was measured by frequency of engagement in six activities. Cognition was evaluated using a four‐test cognitive battery from which a global composite score and two domains were derived. Participants were followed on average 8.5±SD4.8 years and separated into 9 combinations of MIND diet score and PA (high, moderate, low for MIND diet and high, moderate, low, for PA). Using linear mixed models we examined the rate of cognitive decline; adjusting for age, sex, education, race, ApoE‐4, smoking, and caloric intake. Subsequent models were stratified by race to investigate potential differences in the association of diet and PA combinations with cognitive decline.ResultParticipants who reported high MIND/high PA had a slower rate of decline in global cognition (β = 0.015, 24.87% slower, p = 0.007), memory score (β = 0.014, 31.86% slower, p = 0.042) and improved MMSE (β = 0.023, 33.62% improvement, p&lt;0.001) when compared to participants with low MIND/low PA. In race stratified models, we found that in European Americans, high MIND/high PA was associated with slower rates of decline in global cognition (β = 0.028, 37.1% slower, p = 0.007), memory score (β = 0.026, 48.59% slower, p = 0.033) and improved MMSE (β = 0.050, 50.0% improvement, p&lt;0.0001) versus low MIND diet/low PA. However, only an improved MMSE (β = 0.017, 27.11% improvement, p = 0.033) was observed to be associated in African Americans.ConclusionHigh adherence to MIND diet/physical activity is associated with slower cognitive decline, regardless of race. However, the breadth of these associations may differ by race. Additional studies are required to elucidate the potential racial differences observed and determine which interventions are most impactful.

Abstract 15533: The Association Between Life’s Simple 7 and Arterial Stiffness in Black and White Women

Background: Black women have a higher prevalence of nonideal cardiovascular health (CVH) related risk factors across most components of the American Heart Association’s Life’s Simple 7 (LS7) than White women. Due to a higher burden of CVH-related risk factors, research suggests that Black women have accelerated and higher arterial stiffness than White women. However, the association between LS7 CVH and arterial stiffness among Black and White women is unknown. Objective: To examine the association between LS7 and arterial stiffness and investigate whether race modifies this association. Methods: We examined 1,640 adult women (n=1165 White, n=475 Black) from the Morehouse-Emory Center for Health Equity and Predictive Health Institute cohorts. Carotid-femoral pulse wave velocity (cfPWV), a marker of arterial stiffness, was assessed by applanation tonometry (SphygmoCor®). LS7 summary score (range 2-13) of 2-4 indicate ‘poor’, 5-9 ‘intermediate’, and 10-13 ‘ideal’ CVH. Cross-sectional analysis between the LS7 CVH 3-level categorical variable, cfPWV, and effect modification by race were examined. Multivariable linear regression models were conducted to examine the association between LS7 CVH and cfPWV, adjusting for model 1:(race, age); model 2:(model 1+ education, income). Results: Mean age 51±10.2 years. Compared to ‘ideal’ CVH, ‘poor’ ( β =1.08 m/s; 95% CI, 0.44, 1.71) and ‘intermediate’ ( β = 0.32 m/s; 95% CI, 0.20, 0.45) CVH groups had higher mean cfPWV in the minimal and fully adjusted models. Interaction of LS7 CVH and race on cfPWV was significant (p=.03) with Black women having higher mean cfPWV for each CVH group compared to White women. In race-stratified models, Black women with ‘poor’ ( β =1.56 m/s; 95% CI, 0.79, 2.32) and ‘intermediate’ ( β =0.46 m/s; 95% CI, 0.23, 0.68) CVH had higher cfPWV after minimal and full adjustment. Conclusions: Better CVH was associated with lower arterial stiffness. Compared to White women, Black women had greater arterial stiffness that was most pronounced for ‘poor’ and ‘intermediate’ CVH. Given that arterial stiffness is a prognostic measure, further study of health behaviors and psychosocial factors that contribute to higher arterial stiffness in Black women is warranted.

244.1: Prediction of ESRD Risk in Living Kidney Donors Through Thirty Years Postdonation

Introduction: Living kidney donors face increased risk of ESRD, although absolute risk remains low through 20 years postdonation. The ethical practice of living donor nephrectomy depends on accurate estimates of postdonation ESRD risk. Methods: Using SRTR data 1987-2020, we modeled the association between donor characteristics and ESRD risk: age, sex, race (White/Black/Other), first-degree biological relationship to recipient, predonation systolic blood pressure, predonation eGFR, and BMI, with multiple imputation to handle missingness. We censored for mortality and fit race-stratified models to investigate interactions. Results: Among 158,304 donors, 589 experienced ESRD. Overall cumulative incidence of ESRD was 0.5% at 20 years postdonation, 1.1% at 25 years postdonation, and 1.5% at 30 years postdonation. 30-year risk of ESRD was higher for first-degree related donors (1.6% vs 0.9%), men (2.1% vs 0.9%), and Black donors (3.6% vs 1.1% White/1.5% Other) (all p<0.01). Older age was associated with increased ESRD risk among White donors but decreased risk among Black donors (Figure). Among nonwhite/nonblack donors, there was no monotonic relationship between age and ESRD risk, with the lowest risk for donors age 31-40 (0.95%) and highest for donors age>50 (2.10%). In multivariable models, higher SBP, BMI>30, and history of cigarette use were associated with increased ESRD risk. There was no evidence of association between predonation eGFR and postdonation ESRD risk, in unadjusted models or after adjusting for age, sex, race, and biological relationship to recipient. The final multivariable model predicted ESRD risk with C-statistic=0.71 (Table). Conclusion: ESRD risk through 30 years postdonation varies substantially by donor characteristics, and can be estimated based on predonation characteristics. Donor candidates with high predicted risk should be counseled about their ESRD risk and postdonation behaviors that can preserve function in the remaining kidney.