Racial Differences In Incidence Research Articles

Racial Differences in Ischemic and Hemorrhagic Stroke: An Ecological Epidemiological Study.

This study aimed to evaluate racial differences in the incidence of stroke by conducting an ecological epidemiological study using UK Biobank and Korean nationwide data. This study used individual data from the Korean National Health Insurance Service-Health Screening and UK Biobank, which included participants who underwent health examinations between 2006 and 2010. We included 112,750 East Asians (50.7% men, mean age: 52.6 years) and 210,995 Caucasians (44.7% men, mean age: 55.0 years) who were not diagnosed with atrial fibrillation, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, or cancer. The primary outcome was defined as a composite of ischemic and hemorrhagic stroke. East Asians tended to have a lower body mass index (23.7 vs. 26.4 kg/m2, p < 0.001) and a higher proportion of participants who did not engage in moderate-to-vigorous physical activity (49.6% vs. 10.7%, p < 0.001) than Caucasians. During the follow-up, East Asians had higher 5-year incidence rates (presented as per 1,000 person-years) for primary outcome (1.73 vs. 0.50; IR ratio [IRR]: 3.48, 95% confidence interval [CI]: 3.13-3.88), ischemic stroke (1.23 vs. 0.33; IRR: 3.70, 95% CI: 3.25-4.21), hemorrhagic stroke (0.56 vs. 0.18; IRR: 3.20, 95% CI: 2.67-3.84), and atrial fibrillation-related stroke (0.19 vs. 0.09; IRR: 2.04, 95% CI: 1.55-2.68). Based on this ecological epidemiological study, racial differences in stroke incidence were robust to a variety of statistical analyses, regardless of the subtype. This suggests the need for region-specific approaches to stroke prevention.

Racial Differences in Incidence of Anxiety and Depression Among Mastectomy and Microsurgical Breast Reconstruction Patients

Racial Differences in Incidence of Anxiety and Depression Among Mastectomy and Microsurgical Breast Reconstruction Patients

Population simulation modeling of disparities in US breast cancer mortality.

Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence. Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled cancer mortality disparities between Black female populations and the overall US population. Model inputs used racial group-specific data from clinical trials, national registries, nationally representative surveys, and observational studies. Analyses began with cancer mortality in the overall population and sequentially replaced parameters for Black populations to quantify the percentage of modeled breast cancer morality disparities attributable to differences in demographics, incidence, access to screening and treatment, and variation in tumor biology and response to therapy. Results were similar across the 3 models. In 2019, racial differences in incidence and competing mortality accounted for a net ‒1% of mortality disparities, while tumor subtype and stage distributions accounted for a mean of 20% (range across models = 13%-24%), and screening accounted for a mean of 3% (range = 3%-4%) of the modeled mortality disparities. Treatment parameters accounted for the majority of modeled mortality disparities: mean = 17% (range = 16%-19%) for treatment initiation and mean = 61% (range = 57%-63%) for real-world effectiveness. Our model results suggest that changes in policies that target improvements in treatment access could increase breast cancer equity. The findings also highlight that efforts must extend beyond policies targeting equity in treatment initiation to include high-quality treatment completion. This research will facilitate future modeling to test the effects of different specific policy changes on mortality disparities.

Abstract 13402: Racial Differences in Incidence of Acute Kidney Injury in Patients With ST-Elevation Myocardial Infarction

Background: Racial differences in outcomes of STEMI patients continue to persist. Our study aimed to assess the difference in the incidence of acute kidney injury (AKI) post percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), stratified by race into African Americans (AA) vs Caucasians. Methods: All STEMI patients who underwent PCI at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were categorized into two groups depending on a diagnosis of the presence or absence of AKI post PCI. AKI was defined as &gt;0.3mg/dl rise in post PCI creatinine from pre-procedure value. Relative risk of developing AKI depending on race was calculated with the help of a two by two table. Results: Overall, 1847 patients were admitted to our hospital with a STEMI and underwent PCI during the study period. Of these, 267 (15%) developed AKI post PCI. 19% of AA patients developed AKI compared to 13% of Caucasian. Comparison of baseline characteristics amongst patients who developed AKI revealed that AA patients with AKI were younger than their Caucasian counterparts (median age 63 vs 68, p=0.006), but were more likely to having smoking history (52% vs 35%, p=0.014). Upon analyzing the association between race and AKI, AA patients were 48% more likely to develop AKI post PCI compared to Caucasian patients (RR of 1.48, 95% CI 1.17-1.86, p=0.0015). This difference was observed in spite of no significant differences in radial access, contrast dose, or mechanical circulatory support use between the two races. Conclusion: African Americans STEMI patients are almost 50% more likely than Caucasians to develop AKI post PCI. Developing race-specific process measures and further optimization of procedural characteristics may be necessary to improve the outcomes of AA STEMI patients.

Variations in clinical presentation and biomarkers among biopsy-proven lupus nephritis patients: a Top End retrospective cohort study.

Lupus nephritis (LN) is a common feature of systemic lupus erythematosus (SLE) and affects 50% of patients with SLE. Racial differences in incidence and prevalence have been well documented worldwide. In Australia, higher incidence and prevalence of SLE had been previously reported in Aboriginal and Torres Strait Australians compared with non-Indigenous Australians. To describe the differences in clinical features and lupus biomarkers between Aboriginal and Torres Strait Islander Australian and non-Indigenous Australian patients with LN. We retrospectively identified all consecutive biopsy-proven LN patients in our institution and compared the clinical features and lupus biomarkers between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians. Of the 33 consecutive biopsy-proven LN patients, 26 self-identified as of Aboriginal and Torres Strait Islander descent. The estimated incidence of LN in Aboriginal and Torres Strait Islander Australian and non-Indigenous Australians were 5.08 and 0.47 per 100 000 patient-years respectively. Neurological manifestations (23.08% vs 0%), haematological manifestations (46.50% vs 16.67) and right-heart catheter proven pulmonary arterial hypertension (23.08% vs 0%) were more frequently observed among Indigenous Australian patients compared with non-Indigenous Australian patients. The incidence of positive extractable nuclear antigen was also higher among Indigenous Australian patients (84.62% vs 57.14%). The present study further supports the observation that lupus in Aboriginal and Torres Strait Islander Australians were of a 'distinct phenotype' compared with non-Indigenous Australians. Future research should be aimed at delineating the reason for this observed difference.

Racial Differences in Incidence and Mortality from Non-Variceal Upper Gastrointestinal Hemorrhage: A Nationwide Time Trend Analysis, 2008-2018

Journal of Oral and Maxillofacial Surgery | Best Scientific Journals. Racial Differences in Incidence and Mortality from Non-Variceal Upper Gastrointestinal Hemorrhage: A Nationwide Time Trend Analysis, 2008-2018

Racial and Socioeconomic Disparities in Pediatric Heart Transplant Outcomes in the Era of Anti-Thymocyte Globulin Induction

<h3>Purpose</h3> A recent multicenter pediatric study using antithymocyte globulin (ATG) induction found a reduced risk of first yr rejection in Black heart transplant (tx) recipients. We investigated this finding in the broader field and studied the effects of race and socioeconomic disparity on outcomes in ATG-induced children. <h3>Methods</h3> Using the Pediatric Heart Transplant Society registry, we compared outcomes in Black and White children 1-17 yrs old who underwent heart tx with ATG induction between 2000-2020. The primary outcomes of treated rejection, rejection with hemodynamic compromise (HC), and graft loss (death or re-transplant) were studied over 1- and 10-yr time intervals as well as late outcomes conditional on 1-yr survival<i>.</i> We explored the association of these outcomes with race and socioeconomic disparity, assessed using neighborhood deprivation index [NDI] score at 1-yr post-tx (high NDI score implies more socioeconomic disadvantage). <h3>Results</h3> The study cohort included 1719 ATG-induced pediatric heart tx recipients (23% Black, 77% White). There was no racial difference in incidence of first yr treated rejection (Black 24.5%, White 28.1%, p = 0.2). During the 10 yr follow up, the risk of treated rejection was similar between Black and White recipients; however, Black recipients were at higher risk of HC rejection (p = 0.009) and graft loss (p = 0.02, log rank test). Black recipients had a higher mean NDI score (0.43 vs 0.36, p < 0.001). A higher risk of graft loss was associated with high NDI score in both White and Black recipients (p < 0.001, Fig). In a multivariable Cox model, both high NDI score (HR 2.03, 95% CI 1.38-2.98) and Black race (HR 1.99, 95% CI 1.36-2.93) were associated with graft loss. <h3>Conclusion</h3> Black race and socioeconomic disadvantage remain associated with HC rejection and graft loss after the first post-transplant year in pediatric heart tx patients with ATG induction. These disparities represent important opportunities to improve long term tx outcomes in children.

Assessment of racial differences in the incidence of thrombocytopenia induced by trastuzumab emtansine: a systematic review and meta-analysis.

BackgroundTrastuzumab emtansine (T-DM1) has been proved to have value and efficacy in the treatment of advanced metastatic cancer, including in the adjuvant setting. However, there is increasing concern about T-DM1-induced thrombocytopenia (TCP), which shows racial differences in incidence. This meta-analysis aimed to evaluate differences in the incidence of T-DM1-related TCP between Asian and non-Asian patients by combining accessible information from all single-agent T-DM1 clinical trials published to date.MethodsWe conducted systematic searches of the PubMed, Embase, and the Cochrane Library databases to identify relevant clinical studies of T-DM1 that reported on safety, including the incidence of TCP, which were published between January 1980 and March 2020. Two reviewers were responsible for the screening and extraction of data. The pooled-effect estimate calculated with a fixed-effects or random-effects model was represented as incidence with 95% confidence intervals (CIs).ResultsA total of 29 studies involving 6,188 patients were included. The incidence of all-grade TCP in Asian patients and non-Asian patients was 0.39 (95% CI: 0.11–0.67) and 0.29 (95% CI: 0.23–0.35), respectively. The incidence of TCP of grade 3 or higher in Asians was 0.20 (95% CI: 0.10–0.29), compared with 0.02 (95% CI: 0.01–0.03) in non-Asians. Gastrointestinal cancer type and a T-DM1 treatment dose of 2.4 mg/kg Q3W were related to grade 3 or higher TCP events.DiscussionAsian patients have a higher risk of developing TCP after receiving T-DM1 than non-Asian patients. Clinicians should be aware of the importance of careful observation of platelet count in patients receiving T-DM1 therapy.

Racial differences in incidence, outcomes, and genomic alterations in small cell lung cancer.

8514 Background: While the incidence of small cell lung cancer (SCLC) has been decreasing in recent years, an increasing proportion of our patients are younger African American (AA) women. There have been no studies describing these changes as well its impact on outcome and potential genomic differences amongst white and AA populations. Methods: We maintain a clinical/genomic/pathological database of all patients with SCLC treated at our comprehensive cancer center starting from 1998. We compared the baseline characteristics and outcomes (Overall survival [OS] and progression-free survival [PFS]) between AA and white patients, and between females and males. In addition, we looked at genomic alterations in &gt;350 cancer-related genes and compared the frequency and types of mutations in our study population. Results: A total of 917 patients with SCLC were included (median age 66 years, 486 female, 179 African American). Amongst the African American patients, 67.6% were female, a striking difference compared to the white population, where only 49.1% were women (P&lt;0.001). In multivariable analysis, there was no association between gender or race with OS or PFS (P&gt; 0.05). There was an increase in mutational frequency in AA women compared to both AA men and white patients. PIK3CA and KIT mutations were more frequent in females while APC mutations were more frequent in males (P=0.041 for all comparisons). There was a trend toward increased mutational frequencies in TP53, PTEN, and NOTCH1 in AA patients. The relative frequency of gene alterations is shown in the table. In univariable analysis, NOTCH1 mutation was associated with improved OS (HR 0.24 [0.06-0.96], P=0.04). Conclusions: In this large cohort of patients with SCLC followed over 2 decades, there was a striking 2-fold higher incidence of SCLC in AA females than in AA males, although there were no differences in OS or PFS by sex or race. Several genomic alterations occur in higher frequencies in AA patients and AA women, in particular, have higher mutational frequencies.[Table: see text]

Abstract 16415: Racial Differences in Incidence of Atrial Fibrillation After Cryptogenic Stroke

Introduction: The incidence of atrial fibrillation (AF) is lower among non-whites compared to whites, despite a higher burden of AF risk factors. Current knowledge of first detection of AF after cryptogenic stroke (CS) by an implantable cardiac monitor (ICM) is based on a predominantly white cohort. The incidence of new AF after CS among minorities is unknown. We hypothesized that the incidence of AF after CS would be lower in non-whites. Methods: We reviewed charts of all patients without a history of AF undergoing implantation of an ICM after CS at our hospital from July 2014 to December 2019. Incidence of AF was identified through review of ICM monitoring for each patient, including adjudication of AF episodes for accuracy. Kaplan Meier survival analysis was performed, and cumulative incidence of AF using adjusted Cox proportional hazards regression was compared by race. Results: We identified 417 patients who underwent ICM implant after CS during the study period, with a mean follow-up time of 1.5 ± 1.1 years. Mean age was 62 ± 12 years, and 46% (n=190) were male. The majority of patients were non-white (white, 15%, n=63; black, 59%, n=244; Hispanic, 26%, n=110). At baseline, blacks, Hispanics, and whites were of similar age (mean 62.2, 62.1, and 61.5 years, respectively), and blacks and Hispanics had more AF risk factors, including heart failure, hypertension, diabetes, chronic kidney disease, and higher BMI, than whites. Hispanics had more coronary artery disease than whites and blacks (25.5%, 17.5%, 9.1% respectively, p &lt; 0.001). Among blacks, the cumulative incidence of newly detected AF at one, two, and three years was 13.0%, 18.9%, and 23%, which was similar to Hispanics (12.9%, 18.2%, and 20.9%). By comparison, the incidence in whites was significantly higher (20.8%, 34.3%, 40.3%; blacks p=0.02; Hispanics p=0.01) Conclusion: In patients undergoing ICM after CS, the incidence of newly detected AF is approximately double in whites compared to both blacks and Hispanics.

Racial Differences in Incidence of Staphylococcus aureus Joint Infections in Metropolitan Atlanta, 2016–2018

Background:Staphylococcus aureus is the leading cause of joint infections. These infections may arise in native or prosthetic joints. Previous analysis of population-based surveillance has documented racial differences in incidence of invasive S. aureus bloodstream infections. We hypothesized that racial differences in incidence would not persist among of S. aureus joint infections. Methods: We utilized data from the Georgia Emerging Infections Program (GA EIP), which conducts CDC-funded active, population-based surveillance for iSA within the 8-county area of Atlanta. Cases were defined as residents of the surveillance area with S. aureus isolated during 2016–2018 from joint fluid or tissue, and cultures within a 30-day period after the initial culture date were considered a single case. Age- and race-specific incidence were calculated using US census data; incidence rate ratios (RR) and adjusted rate ratios (aRR) were calculated using the Mantel-Hanzel method. Results: Between 2016 and 2018, 500 iSA joint infections were identified (iMRSA, 28.2% and iMSSA, 71.8%): 34.4% occurred in black patients and 65.6% occurred in white patients. Also, 90 cases (18%) had a bloodstream infection (BSI) within 30 days of the joint infection. Incidence of iSA joint infections dropped 22% from 9.4 per 100,000 in 2016 to 7.5 per 100,000 in 2018 (RR, 0.79; 95% CI, 0.7–0.9). Adjusting for year, incidence was 40% lower among blacks than whites (RR, 0.6,; 95% CI, 0.5–0.7); this finding was attributed to blacks having 60% lower incidence of iMSSA joint infections compared to whites (aRR, 0.4; 95% CI, 0.3–0.5) but similar MRSA incidence (aRR, 1.2; 95% CI, 0.8–1.6). The highest incidence was observed among whites aged &gt;65 years with iMSSA infections (30.2 per 100,000) (Fig. 1). Among cases with a full chart review (n = 138), surgery in the prior 90 days was uncommon (n = 42, 30.4%), and a preceding major orthopedic procedure was even more rare (n = 13, 9.4%). Antecedent therapeutic injections and arthroscopic procedures are under investigation. Conclusions: Unlike S. aureus bacteremia, where previous analysis demonstrates higher incidences among blacks predominantly due to MRSA, our data demonstrate that the incidence of S. aureus joint infections is higher in whites, predominantly due to MSSA. Investigations in differential practices regarding orthopedic illness and injury should be pursued.Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.

Abstract PR16: Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium

Abstract Background: The Ovarian Cancer in Women of African Ancestry consortium (OCWAA) was established to address racial disparities in epithelial ovarian cancer (EOC) risk and survival. Specifically, we aim to estimate the degrees to which racial differences in incidence and survival of EOC between African-American (AA) and white women are attributable to differences in the prevalence and timing of risk factors and in the magnitude of risk associations. Methods: OCWAA includes four case-control studies (the African-American Cancer Epidemiology Study, the North Carolina Ovarian Cancer Study, the Los Angeles County Ovarian Cancer Study, and the Cook County Case-Control Study) and two nested case-control studies within cohort studies (the Black Women's Health Study and the Multiethnic Cohort Study). A centralized core database consisting of demographic and epidemiologic risk factors for borderline and invasive EOC, tumor characteristics and prognostic factors has been created, and the majority of data has been harmonized across studies. A histotype classification scheme was uniformly applied using a combination of morphology and grade information to best represent the most recent diagnostic guidelines for ovarian cancer as detailed in the 2014 WHO Classification of Tumors of the Female Reproductive System. Results: A total of 1,169/2,324 AA cases and controls and 2,963/3,934 white cases and controls have been included in the OCWAA database to date. Approximately 83% of cases are invasive EOC, 15% are borderline tumors, and 2% are missing tumor behavior information. Among the invasive EOC cases, 61% are high-grade serous carcinomas. The average age at diagnosis of EOC cases is the same in AA and white women (57.2 years), and the year of diagnosis ranges from 1991 to 2016. The following risk factors showed marked prevalence differences in AA and white controls: obesity (46.3% vs 19.2%), breastfeeding (42.7% vs 54.3%), tubal ligation (31.1% vs 17.9%), postmenopausal hormone use (23.8% vs 40.8%), nulliparity (14.9% vs 19.2%), at least a college degree (35.5% vs 56.4%), and menarche age &amp;lt;13 (51.6% vs 47.4%; p&amp;lt;.01); p&amp;lt;.0001 for all except where noted. In preliminary EOC risk analyses, we observed positive associations with body mass index and nulliparity and inverse associations with tubal ligation, oral contraceptive use and breastfeeding in both AA and white women. The harmonization of other factors including duration, frequency and timing of key risk factors, physical activity, comorbidities, medication use, and treatment information is ongoing. Conclusions: OCWAA represents the largest study investigating disparities in ovarian cancer risk and survival between AA and white women. This consortium is uniquely positioned to study the epidemiology of ovarian cancer in AA, focusing on the role of lifestyle and behavioral characteristics, reproductive risk factors, treatment and other prognostic factors in explaining racial differences in ovarian cancer incidence and survival. This abstract is also being presented as Poster C083. Citation Format: Veronica Wendy Setiawan, Lauren Peres, Lynn Rosenberg, Traci Bethea, Patricia Moorman, Evan Myers, Anna Wu, Charlotte Joslin, Elisa Bandera, Deanna Chyn, Fabian Camacho, Joellen Schildkraut. Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR16.

Abstract C020: Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016

Abstract Objective: The incidence of ovarian cancer in the United States varies by race with the highest rates among white women but lower survival observed among black women and other racial and ethnic groups. These disparities in outcomes among women with ovarian cancer are not well understood, including the differential occurrence of second primary cancers according to race. Our objective was to measure racial differences in incidence of second primary gynecologic cancers (SPGC) among women with malignant ovarian tumors following treatment with chemotherapy. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups in the United States. Methods: We conducted a retrospective cohort study of women ages 20 years and older diagnosed with first primary malignant ovarian tumors treated with definitive surgery and chemotherapy between 2000 and 2016 from 18 population-based registries in the Surveillance, Epidemiology and End Results (SEER) Program. We collected demographic and clinical information on ovarian histologic subtypes, laterality, tumor grade, type of surgery and treatment with radiotherapy. Census tract-level sociodemographic characteristics of women were also described. The incidence of SPGC in our cohort was compared to expected incidence rates in the general population using age-and region-standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for individual racial/ethnic groups. Results: Among 34,081 women with ovarian cancer, 74% were white, 6% were black, 8% were Asian/Pacific Islander (API) and 11% were Hispanic. Median age at diagnosis was lower among API and Hispanic women (54 years) compared to white (60 years) and black women (58 years). Most ovarian tumors were serous or endometrioid, although API women had a higher proportion of clear cell ovarian tumors (15%) compared to white (6%), black (5%) and Hispanic women (6%). Subgroups of API women also differed in distribution of ovarian tumor histology, grade, and age at diagnosis. Whereas incidence of SPGC was observed to be lower than expected among white women (SIR 0.72 CI 0.59-0.87), estimates were suggestive of higher than expected incidence among black (SIR 1.61, CI 0.88-2.71) and API women (SIR 1.64, CI 0.96-2.63), although confidence intervals included 1.0. Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR 23.90, CI 4.93-69.84) and were also significant for risk of uterine cancers (SIR 2.28 CI 1.21-3.90). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. Conclusions: Risk of SPGC following treatment of ovarian cancer differs by race. The increased incidence of secondary gynecological cancers observed in Asian women is driven largely by increased rates of uterine and vaginal cancers among Filipina women. Further research is warranted to understand the possible mechanism(s) underlying this observed disparity. Citation Format: Nita H Mukand, Ashwini N Zolekar, Naomi Y Ko, Gregory S Calip. Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C020.

Abstract 1569: Racial differences in incidence and impact of TP53 deletion on outcome in African American and Caucasian veterans with multiple myeloma

Abstract BACKGROUND: In multiple myeloma (MM), the presence of TP53 deletion is associated with poor prognosis. It is found in roughly 10% of newly diagnosed patients. Lower incidence of TP53 deletion is reported in African American (AA) compared to Caucasian (CA), suggesting a possible contribution of disease biology to clinical disparity in AA. Our recent report of a significantly superior age-adjusted risk of death in AA compared to CA patients in the Veteran population also suggests possible racial differences in disease biology. Here we investigated the incidence of TP53 deletion among younger (&amp;lt;65) versus older AA and CA patients with MM at the VA. METHODS: We identified 15717 patients with MM from 1999 to 2017 using the VA’s nationwide Corporate Data Warehouse. We extracted data on patients’ age, race, and ISS stage, as well as data on their therapy at induction and stem-cell transplant (SCT). Additionally, we extracted data on TP53 deletion testing and results using a natural language processing algorithm and focused our analysis on patients with these data. RESULTS: We identified 5,744 MM patients evaluated for TP53 deletion by conventional cytogenetics and/or FISH, including 32.5% AA (1,864) and 67.5% CA (3,880) patients. Greater proportion of AA patients (53%) were younger (&amp;lt;65 years), compared to CA (39%; p&amp;lt;0.001). Overall, among those tested, TP53 deletion was reported in 9.6% of patients, but the incidence was significantly lower in AA (7.2%) compared to CA (10.7%; p&amp;lt;0.001). Among patients &amp;lt;65 years of age, difference in incidence of TP53 deletion between AA and CA was 3.2% (8.1% vs 11.3%; p=0.01), while in those ≥65 years age, it was 4.1% (6.4% vs 10.5%; p=0.0005), suggesting increased difference in the incidence of TP53 deletion with age. The rates of TP53 deletion across different ISS stages were not significantly different, nor did ISS stage differ across race. The majority of patients with TP53 deletion (95.2%) received either proteasome inhibitor or immunomodulator at induction, but only 24.7% were treated with the combination, and only 21.4% proceeded to SCT. Median survival among younger patients with TP53 deletion appeared substantially lower in AA than in CA (5.1 vs 7.0 years; p=0.74), though without reaching significance, perhaps due to sample size. In contrast, younger AA without TP53 deletion had a significantly longer median survival than CA (8.0 vs 6.2 years; p&amp;lt;0.01). Among older patients, AA had longer median survival regardless of TP53 deletion status. CONCLUSIONS: This large cohort study identified significantly lower incidence of TP53 deletion in AA compared to CA. Yet, when present in younger AA patients, TP53 deletion correlated with worse survival. These results identify racial disparity in both occurrence and impact of TP53 deletion and now suggests the need for a more comprehensive genetic assessment to develop risk stratification in AA myeloma patients. Citation Format: Diana Cirstea, Nathanael Fillmore, Hassan Yameen, Sarvari Yellapragada, Chizoba Ifeorah, Nhan Do, Mary Brophy, Nikhil Munshi. Racial differences in incidence and impact of TP53 deletion on outcome in African American and Caucasian veterans with multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1569.

Abstract 4206: Examining genetic ancestry in diffuse large B-cell lymphoma (DLBCL)

Abstract Background: There are significant racial differences in incidence and outcomes for DLBCL in the United States, and African American patients (pts) present at a younger median age (54 vs. 65 years), more commonly at advanced stage, and have inferior 5-year survival compared to white pts (Shenoy et al., 2011). It is unclear if there are inherent genomic differences contributing to the survival disparities in African American pts compared with white pts. Methods: Using whole exome sequencing data of 1,001 DLBCL pts (Reddy et al., 2013), we performed quality control of samples (heterozygosity, missingness &amp;gt;10%) and single nucleotide variants (SNVs; missingness &amp;gt;20%) with PLINK. For global ancestry estimation, we used unsupervised model-based ADMIXTURE with K=3 postulated ancestral populations and examined correlations with 21 pts (17 African-American, 2 White, and 2 Hispanic) with self-reported race. Pt characteristics (age, gender, serum lactate dehydrogenase, tumor stage, ECOG performance status, number of extranodal sites of disease, B symptoms, International Prognostic Index score, RNA-sequencing based molecular subtype) and survival were compared across ancestry groups. We examined ancestry differences in mutational patterns and frequency of top 20 driver genes. Chi-squared tests and ANOVA were used for the analysis of pt characteristics and clinical pathological features across ancestry groups. Multivariate Cox regression analyses were used to evaluate prognostic factors. Results: ADMIXTURE global ancestry prediction had 100% correlation with self-reported race and identified 619 pts with &amp;gt;90% European ancestry, 81 with &amp;gt;90% African ancestry, and 43 with &amp;gt;90% Asian ancestry. DLBCL pts with &amp;gt;90% African ancestry had an age at diagnosis 10 years younger (p &amp;lt; 0.001), more commonly had B symptoms (p &amp;lt; 0.001), more commonly had elevated LDH (p &amp;lt; 0.001), more commonly had extranodal sites of involvement (p = 0.001), and more commonly had advanced stage diseases (p = 0.007) compared to patients with &amp;gt;90% European ancestry. There were no statistical differences between these ancestry groups in gender, ECOG, IPI score, and molecular subgroup (ABC/GCB/Unclassified). The total variant distribution (missense, truncation, CNV gain, CNV loss) was similar between patients with &amp;gt;90% European ancestry and &amp;gt;90% African ancestry, and only HIST1H1E copy number loss and MGA missense mutations were significantly more common in patients with African ancestry. Conclusions: Additional studies examining the differentially mutated genes or other factors in African American DLBCL pts may explain comparatively adverse features and outcomes for African American pts. Citation Format: Michelle J. Lee, Camber Ileen Jhaney, Christopher R. Flowers, Jean L. Koff. Examining genetic ancestry in diffuse large B-cell lymphoma (DLBCL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4206.

Abstract P029: Racial Differences in Sudden Cardiac Death: Findings From the Atherosclerosis Risk in Communities Study (ARIC)

Background: In hospital-based studies and in studies of participants with pre-existing conditions, African Americans have a higher risk of in- and out-of-hospital sudden cardiac death (SCD) compared with Whites. However, the risk of SCD of African Americans and Whites has never been compared in large-scale community-based cohort studies. Objective: To compare the risk of SCD among African Americans and Whites, and to evaluate the risk factors that may explain racial differences in incidence. Methods: Cohort study of 3,838 African Americans and 11,245 Whites participating in ARIC. Race was self-reported. SCD cases were defined as a sudden pulseless condition from a cardiac cause in a previously stable individual and adjudicated by an expert committee. Mediation effect of covariates was calculated using boot-strapping method. Cox proportional hazards models were adjusted for demographics, social economic status, cardiovascular (CVD), and electrocardiographic risk factors. Results: The mean (SD) age was 53.6 (5.8) for African Americans and 54.4 (5.7) years for Whites. During 25.3 years of follow-up, 215 African Americans and 332 Whites experienced SCD. In multivariable-adjusted models, the HRs (95% CI) for SCD comparing African Americans and Whites were 1.70 (1.37, 2.10) overall, 2.00 (1.40, 2.84) in women, and 1.46 (1.10, 1.92) in men (p-value for race by sex interaction 0.02; Table ). CVD and electrocardiographic risk factors explained 36.6% (21.4, 51.8%) of the excess risk of SCD in African Americans, with a large proportion of racial differences unexplained. Conclusions: The risk of SCD in community-dwelling African Americans was significantly higher than in Whites, particularly among women. CVD risk factors, including higher prevalence of obesity, diabetes, hypertension and LV hypertrophy in African Americans, explained only a small fraction of this difference. Further research is needed to identify factors responsible for race differences in SCD and to implement prevention strategies in high-risk minorities.

Association between Serum 25-Hydroxy-Vitamin D and Aggressive Prostate Cancer in African American Men.

African American men have higher incidence rates of aggressive prostate cancer, where high levels of calcium and serum vitamin D deficient levels play a role in the racial differences in incidence. In this study, we examined associations of serum vitamin D with aggressive prostate cancer to improve our understanding of higher susceptibility of aggressive disease in this racial cohort. From Howard University Hospital, 155 African American men with clinically-identified prostate cancer were identified; 46 aggressive cases, and 58 non-aggressive cases. Serum vitamin D was assessed from fasting blood samples, and total calcium intake was assessed using the Block Food Frequency Questionnaire. Vitamin D receptor polymorphisms from three different loci were genotyped; rs731236, rs1544410, and rs11568820. Multivariate logistic regression models were used to determine odds ratios (OR) and 95% confidence intervals (CI) comparing aggressive to non-aggressive prostate cancer. Vitamin D deficiency (<20 ng/mL) significantly increased risk of aggressive disease (OR: 3.1, 95% CI: 1.03–9.57, p-value = 0.04). Stratification by total calcium showed high calcium levels (≥800 mg/day) modified this association (OR: 7.3, 95% CI: 2.15–47.68, p-interaction = 0.03). Genetic variant rs11568820 appeared to increase the magnitude of association between deficient serum vitamin D and aggressive prostate cancer (OR: 3.64, 95% CI: 1.12–11.75, p-value = 0.05). These findings suggest that high incidence of aggressive prostate cancer risk in African American men may be due in-part to deficient levels of serum vitamin D. Other factors, including genetics, should be considered for future studies.

Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at birth and birth weight

Infantile hemangiomas (IH) are the most common soft-tissue tumors of infancy, but little is known regarding their true incidence. We sought to determine the current incidence of IH and examine trends in incidence, demographics, and lesion characteristics over 3decades. The Rochester Epidemiology Project was used to identify infants residing in Olmsted County, Minnesota, who were given a diagnosis of IH between January 1, 1976, and December 31, 2010. In all, 999 infants were given a diagnosis of IH. Incidence increased over the 3-decade study period from 0.97 to 1.97 per 100 person-years (P<.001). Average gestational age at birth and birth weight for infants with IH decreased over the study period (39.2-38.3weeks, P<.001 and 3383-3185g, P=.003, respectively). The overall age- and sex-adjusted incidence of IH was 1.64 per 100 person-years (95% confidence interval 1.54-1.75). The population of Olmsted County, Minnesota, is predominantly non-Hispanic white, limiting our ability to report racial differences in incidence. This was a retrospective study. This study provides a longitudinal, population-based incidence of IH. Incidence has increased steadily over the past 3decades, correlating significantly with decreasing gestational age at birth and birth weight in affected infants.

The genetics of Ménière's disease.

Our understanding of the genetic basis of Ménière’s disease (MD) is still limited. Although the familial clustering and the geographical and racial differences in incidence strongly suggest a certain role for genetic factors in the development of MD, no convincing evidence for an association with any gene exists, at present. In this review, starting from rational bases for a genetic approach to MD, we explored the numerous reports published in literature and summarize the recent advances in understanding of the genetic fundaments of the disease.

Genome-Wide Association Study Identifies a Novel Susceptibility Locus At 10p12.31-12.2 for Childhood Acute Lymphoblastic Leukemia in Ethinically Diverse Populations

Abstract 877Genetic predisposition to childhood acute lymphoblastic leukemia (ALL) is compellingly evidenced by recent genome-wide association studies (GWAS) identifying ARID5B, IKZF1, CEBPE, and CDKN2A/B as ALL susceptibility loci. However, these 4 loci cumulatively accounted for only 8% of genetic variability in ALL risk, suggesting additional susceptibility variants yet to be identified in larger studies. Moreover, ALL GWAS has been exclusively restricted to populations of European descent, and the genetic basis of ALL susceptibility in the context of diverse ethnic background is largely unknown. This is of particular importance because the incidence of ALL varies substantially by ethnicity.Taking a multi-ethnic GWAS approach, we compared genotype frequency at 709,509 germline single nucleotide polymorphisms (SNPs) between 1,605 children with ALL and 6,661 controls of European, African, and Native American genetic ancestry (i.e., European American [EA], African American [AA], and Hispanics). After adjusting for population structures, 4 loci reached genome-wide significance threshold of P<5×10−8: 10q21.2 (ARID5B, P=5.9×10−46), 7p12.2 (IKZF1, P=5.3×10−24), 14q11.2 (CEBPE, P=9×10−12), as previously reported; and a novel ALL susceptibility locus at 10p12.31-12.2 (PIP4K2A, P=1.1×10−11). While ARID5B, IKZF1, and PIP4K2A SNPs were associated with ALL across different ethnicities, the association at the CEBPE locus was more specific to EAs. ALL risk variants at ARID5B and PIP4K2A SNPs were most common in Hispanics followed by EAs, and least common in AAs, in parallel with racial differences in the incidence of childhood ALL. We also performed multivariate analyses to determine the extent to which SNPs contribute independently to ALL susceptibility at each of the 4 loci. While associations at ARID5B and CEBPE loci were completely explained by the respective top SNP within each region, IKZF1 and PIP4K2A loci harbored multiple independent association signals. All 4 loci were validated in 3 independent replication series at P<0.05 level in multiple ethnic groups: EAs, 574 cases and 2,601 controls; AAs, 128 cases and 1,075 controls; Hispanics, 143 cases and 640 controls. For example, the top PIP4K2A SNP was significant in all 3 replication studies: EAs, P=0.0017; AAs, P=0.009; and Hispanics, P=0.041. We next examined the cumulative effects of these 4 loci on ALL susceptibility by multi-marker analyses of top SNPs at ARID5B, IKZF1, PIP4K2A, and CEBPE. In the combined discovery and replication cohorts (2,450 cases and 10,977 controls), the number of risk alleles at these 4 SNPs (genetic risk burden) was positively correlated with relative ALL risk, e.g., subjects with 6–8 copies of risk alleles (252 cases and 314 controls) were at 9.0-fold (95% confidence interval, 6.9–11.8) higher risk of developing ALL than those with 0–1 copy of the risk alleles (153 cases and 1,753 controls). Interestingly, every copy of allele C at the ARID5BSNP rs10821936 conferred a 1.93-fold increase (95% CI, 1.8–2.08) in the risk of developing ALL in children less than 10 years old (N=1,947) whereas the added disease risk by each C allele was 1.48-fold (95% CI, 1.3–1.68) in children older than 10 (N=503), implying plausible modifying effects of age on genetic predisposition to childhood ALL. The association between rs10821936 SNP genotype and age at ALL diagnosis remained significant even after adjusting for molecular subtypes.In conclusion, we reported the first multi-ethnic GWAS of childhood ALL in which we comprehensively examined the role of inherited genetic variation in ALL susceptibility in diverse populations and identified a novel susceptibility locus at 10p12.31-12.2. Our results not only shed new light on molecular etiology of childhood ALL, but also on the genetic basis of racial differences in ALL incidence. Disclosures:No relevant conflicts of interest to declare.