Risk Trajectories Research Articles

The Life Course of Unemployment: The Timing and Relative Degree of Risk

We use the National Longitudinal Survey of Youth 1979 to identify group-based trajectories of unemployment risk as workers age in the United States. Our novel methodological approach reveals 73% of full-time workers spend much of their 20, 30, and 40 s with a relatively low risk of unemployment. The remaining sizable minority varies in the timing and relative degree of their unemployment risk. Eighteen percent experience early career unemployment risk into their early thirties, well after the transition to adulthood. Chronic unemployment characterizes the labor market experiences of the remaining 9%. When expanding the sample to all workers, we find two key differences: the overall prevalence of unemployment is greater each year for all groups and the distribution of respondents across groups differs, with fewer workers experiencing Lower unemployment and more workers experiencing Early Career or Higher unemployment. Unemployment risk is shaped by experiences of long-term unemployment in young adulthood and early labor market constraints. Moreover, while men and women appear equally at risk of Early career unemployment, men are particularly at risk of Higher unemployment. Black workers were significantly more likely to be at risk of Higher unemployment, but only slightly more likely to be at risk of Early career unemployment. Since Early career unemployment risk gives way to steadier work for most, this suggests that some men and some Black workers face disproportionately high levels of employment precarity. Our findings point to the importance of a life course approach for understanding the relationship between unemployment and labor market precarity.

A Amazônia judaica de Moacyr Scliar: a palavra alheia como afirmação da não-coincidência do outro em si

ABSTRACT By analyzing two of Moacyr Scliar’s novels, Cenas da vida minúscula [Scenes of a Minuscule Life] and A Majestade do Xingu [Xingu’s Magesty], this paper proposes a trajectory of risk and acknowledgment of the word of the other in permanent transit, for possibly affirming the Jewish imaginary, with the Amazon as background for highly inventive plots by the “gaucho” (from Rio Grande do Sul) writer. In both novels, there are powerful orchestrating voices, capable of producing labyrinthine dialogical excavations.1 Such voices refer to the production of several possibilities of affirming the assimilated voice of the other, evoking the projective force of devouring the literary perspective proposed. Understanding the assimilation of the word of the other becomes an essential instrument to contact the complexity of the formation and foundation of many ethnicities that intersected in Brazil.

Risks of neurological and psychiatric sequelae 2 years after hospitalisation or intensive care admission with COVID-19 compared to admissions for other causes

The association between COVID-19 and subsequent neurological and psychiatric disorders is well established. However, two important questions remain unanswered. First, what are the risks in those admitted to intensive care unit (ICU) with COVID-19? Admission to ICU is itself associated with neurological and psychiatric sequelae and it is not clear whether COVID-19 further increases those risks or changes their profile. Second, what are the trajectories of neurological and psychiatric risks in patients admitted to hospital or ICU with COVID-19, and when do the risks subside? We sought to answer these two questions using a retrospective cohort study based on electronic health records (EHR) data from the TriNetX Analytics Network (covering 89 million patients, mostly in the USA). Cohorts of patients admitted to hospital or ICU with COVID-19 were propensity score-matched (for 82 covariates capturing risk factors for COVID-19 and more severe COVID-19 illness) to patients admitted to hospital or ICU (respectively) for any other reason. Matched cohorts were followed for up to two years and the risk of 14 neurological and psychiatric outcomes were compared. A total of 280,173 patients admitted to hospital and 46,573 patients admitted to ICU with COVID-19 were successfully matched to an equal number of patients admitted to hospital or ICU for any other reason. Those hospitalised with COVID-19 were found to be at a greater risk of a range of neurological and psychiatric outcomes including seizure/epilepsy, encephalitis, myoneural junction/muscle disease, Guillain-Barré syndrome (GBS), dementia, cognitive deficits, psychotic disorder, mood and anxiety disorders, but not ischaemic stroke or intracranial haemorrhage. When risks were elevated after COVID-19, most remained so for the whole two years of follow-up (except for mood and anxiety disorders). Risk profiles and trajectories were substantially different among those admitted to ICU: compared to those admitted for any other reasons, those admitted with COVID-19 were at a greater risk of myoneural junction/muscle disease, GBS, cognitive deficits and anxiety disorder, but at a significantly lower risk of ischaemic stroke, intracranial haemorrhage, encephalitis, and mood disorder. When elevated, the risks in those admitted to ICU with COVID-19 were mostly short-lived. In summary, risks of neurological and psychiatric sequelae in patients hospitalised with COVID-19 are wide ranging and long standing whereas those in patients admitted to ICU with COVID-19 are similar to, or lower than, the risks observed post-ICU admission for any other cause. These contrasting risk trajectories are relevant for researchers, clinicians, patients, and policymakers.

Differential Unmet Needs and Experience of Restorative Dental Care in Trajectories of Dental Caries Experience: A Birth Cohort Study

Dental caries is a chronic and cumulative disease but little has been reported on the continuity of the disease and its treatment through life. Group-based multi-trajectory modeling was used to identify developmental trajectories of untreated carious tooth surfaces (DS), restored tooth surfaces (FS), and teeth extracted due to caries (MT) from ages 9 to 45 years in a New Zealand longitudinal birth cohort, the Dunedin Multidisciplinary Health and Development Study (n = 975). Associations between early-life risk factors and trajectory group membership were examined by specifying the probability of group membership according to a multinomial logit model. Six trajectory groups were identified and labeled: “low caries rate”; “moderate caries rate, maintained”; “moderate caries rate, unmaintained”; “high caries rate, restored”; “high caries rate, tooth loss”; and “high caries rate, untreated caries”. The two moderate-caries-rate groups differed in count of FS. The three high-caries-rate groups differed in the relative proportion of accumulated DS, FS, and MT. Early childhood risk factors associated with less favorable trajectories included higher dmfs scores at age 5, lack of exposure to community water fluoridation during the first 5 years of life, lower childhood IQ, and low childhood socioeconomic status. Parent self-ratings of their own or their child’s oral health as “poor” were associated with less favorable caries experience trajectories. Children who had clinical signs of dental caries together with a parent rating of child’s oral health as poor were more likely to follow a less favorable caries trajectory. Higher deciduous dentition caries experience at age 5 years was associated with less favorable caries trajectories, as were children whose parents gave “poor” ratings of their own or their child’s oral health. These findings highlight the considerable intergenerational continuity in dental caries experience from early childhood to midlife. Subjective measures of child oral health are informative and might aid as predictors of adult caries experience in cases where childhood dental clinical data were not available.

Risk assessment and recovery trajectories of a social-ecological system with a discrete-event model after a volcanic eruption

A risk assessment for disasters is usually composed of hazard, vulnerability and exposure variables, which are hardly studied and modeled simultaneously. In volcanology, it remains ambitious to anticipate risk trajectories of pre- and post-eruption regimes. The interdependencies and feedback loops of the system's components, between geological, ecological, social and economic ones, give rise to trade-offs and synergies that should be disentangled for supporting decision-makers and helping local communities to face the risks. We developed here an innovative discrete-event and possibilistic model based on a dynamical network representation to assess volcanological multi-risk and long term post-eruption impacts of such a multifactorial system. We illustrated our method with the region around Mount Meru (Northern Tanzania), a strato-volcano with various eruption styles, located in a growing economic and touristic region (>1 M.inh.).We used qualitative and rule-based Petri nets, largely unused in environmental sciences, for an integrated assessment of the overall system dynamics and associated risks. As a central result, we showed that the region could recover from a blast eruption, irrespective of the timescale. Our study highlights the fact that agriculture and pastoralism remain key activities to favour the recovery of this region. Yet, as soon as subsidies from governmental and non-governmental organizations are lacking, the modeled region remains isolated from national and international activities and shifts to rural dynamics. Our case study can equip environmental risk assessment with innovative models, new dynamical indices (e.g. desirable and non-desirable trajectories), and rigorous reasoning for an ultimate integrated management of social-ecological systems at stake.

The temporal precision of audiovisual integration is associated with longitudinal fall incidents but not sensorimotor fall risk in older adults

Sustained multisensory integration over long inter-stimulus time delays is typically found in older adults, particularly those with a history of falls. However, the extent to which the temporal precision of audio-visual integration is associated with longitudinal fall or fall risk trajectories is unknown. A large sample of older adults (N = 2319) were grouped into longitudinal trajectories of self-reported fall incidents (i.e., decrease, stable, or increase in number) and, separately, their performance on a standard, objective measure of fall risk, Timed Up and Go (TUG; stable, moderate decline, severe decline). Multisensory integration was measured once as susceptibility to the Sound-Induced Flash Illusion (SIFI) across three stimulus onset asynchronies (SOAs): 70 ms, 150 ms and 230 ms. Older adults with an increasing fall number showed a significantly different pattern of performance on the SIFI than non-fallers, depending on age: For adults with increasing incidents of falls, those aged 53–59 years showed a much smaller difference in illusion susceptibility at 70 ms versus 150 ms than those aged 70 + years. In contrast, non-fallers showed a more comparable difference between these SOA conditions across age groups. There was no association between TUG performance trajectories and SIFI susceptibility. These findings suggests that a fall event is associated with distinct temporal patterns of multisensory integration in ageing and have implications for our understanding of the mechanisms underpinning brain health in older age.

Malnutrition and poststroke depression in patients with ischemic stroke

BackgroundIdentifying high-risk patients based on modifiable clinical characteristics, such as malnutrition, is critical to intervening with these variables to reduce the risk of post-stroke depression (PSD). The aim of this study was to investigate the effect of nutritional status on the risk of incident PSD and the trajectory of PSD risk. MethodsConsecutive patients with acute ischemic stroke were recruited in this observational cohort and followed up for 1 year. Multivariate logistic regressions and multilevel mixed-effects logistic regressions with random intercepts and slopes were used to investigate the effects of nutritional indexes [the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI)] and body mass index (BMI) on the risk of incident PSD and the trajectory of PSD risk over the 12-month observation period. ResultsA total of 538 patients were included in the final analysis. Worsening CONUT [odds ratio (OR) = 1.36; confidence interval (CI): 1.15–1.61], NRI (OR = 0.91; CI: 0.87–0.96) and PNI (OR = 0.89; CI: 0.84–0.95) scores were significantly associated with an increased risk of incident PSD. Moderate and severe risk malnutrition statuses were associated with higher incidences of PSD regardless of the malnutrition index (CONUT, NRI or PNI). Additionally, PSD risk decreased over time with a significant two-way interaction between time and CONUT, NRI, and PNI, implying that patients with elevated exposure to malnutrition showed a slower decline in PSD risk. BMI had no significant effect on the occurrence and development of PSD. ConclusionMalnutrition, but not BMI, was associated with a higher probability of incident PSD and was more likely to lead to a slower rate of decline in PSD risk.

Trajectories of body mass index and risk of hypertension and blood pressure among Chinese adults

To explore the relationship between trajectories of body mass index(BMI) and the risk of hypertension and blood pressure among Chinese adults. The current study was based on data from 10 waves of the China Health and Nutrition Survey from 1991 to 2018. A multistage stratified random sample was used in this study.11885 adults whose BMI had been measured at least three times were included in the study. Group-based trajectory modeling(GBTM) was used to identify the BMI trajectories in different genders, Cox regression model was used to analyze the association between BMI trajectories and the risk of incident hypertension. Generalized linear model was used to analyze the association between BMI trajectories and the blood pressure level. Three distinct BMI trajectories were determined for both genders: normal-stable group, normal-overweight group, obesity-stable group. The numbers of each group among males were 3595(63.23%), 1412(24.83%) and 679(11.94%), and the numbers of each group among females were 4566(73.66%), 1214(19.58%) and 419(6.76%). Taking the normal-stable group as a reference, after adjusting for confounding factors, the normal-overweight group, obesity-stable group had 1.14(1.03-1.25), P=0.01 and 1.42(1.24-1.63), P<0.01 increased risk(HR(95% CI)) of developing hypertension in male. The normal-overweight group, obesity-stable group had 1.29(1.13-1.46), P<0.01 and 1.58(1.23-2.03), P<0.01 increased risk of developing hypertension in female. Taking the normal-stable group as a reference, after adjusting for confounding factors, the systolic blood pressure[β(95% CI)] in the male normal-overweight group and obesity-stable group increased by 3.01(1.88-4.14)mmHg, P<0.01 and 5.44(3.85-7.03)mmHg, P<0.01 respectively. The diastolic blood-pressure level was increased by 2.20(1.48-2.91)mmHg, P<0.01 and 4.04(3.04-5.04)mmHg, P<0.01 respectively. The systolic blood pressure in the female normal-overweight group and obesity-stable group were increased by 3.65(2.44-4.85)mmHg, P<0.01 and 2.96(0.97-4.94)mmHg, P<0.01 respectively. The diastolic blood pressure level was increased by 3.11(2.38-3.86)mmHg, P<0.01 and 1.25(0.03-2.47)mmHg, P=0.05 respectively. Both the trajectory of BMI increasing with age and the trajectory of maintaining a high BMI level increased the risk of hypertension, and blood pressure also increased significantly compared with those who maintained normal BMI.

Behavioral and Neural Trajectories of Risk Taking for Peer and Parent in Adolescence.

One feature of adolescence is a rise in risk-taking behaviors, whereby the consequences of adolescents' risky action often impact their immediate surrounding such as their peers and parents (vicarious risk taking). Yet, little is known about how vicarious risk taking develops, particularly depending on who the risk affects and the type of risky behavior. In a 3-wave longitudinal fMRI study, 173 adolescents completed 1-3 years of a risky decision-making task where they took risks to win money for their best friend and parent (n with behavioral and fMRI data ranges from 139-144 and 100-116 participants, respectively, per wave). Results of this preregistered study suggest that adolescents did not differentially take adaptive (sensitivity to the expected value of reward during risk taking) and general (decision-making when the expected values of risk taking and staying safe are equivalent) risks for their best friend and parent from sixth to ninth grade. At the neural level, preregistered ROI analyses revealed no differences in the ventral striatum and ventromedial pFC during general nor adaptive risk taking for best friend versus parent over time. Furthermore, exploratory longitudinal whole-brain analyses revealed subthreshold differences between best friend and parent trajectories within regulatory regions during general vicarious risk taking and social-cognitive regions during adaptive vicarious risk taking. Our findings demonstrate that brain regions implicated in cognitive control and social-cognitive processes may distinguish behaviors involving peers and parents over time.

Dynamic risk trajectories, community context, and juvenile recidivism

PurposeWhile the implementation of risk assessment has expanded, the extent to which there are different trajectories of risk/protective factors among adjudicated youth during supervision in the community remains unanswered. The goal of the current study is to identify the distinct trajectories in dynamic risk and protective factors among youth on probation and assess whether different patterns in risk over time are associated with continued offending. MethodGroup-based trajectory modeling is used to identify distinct trajectories across multiple domains of risk/need. The individual- and neighborhood-level factors associated with these trajectories are then explored, prior to examining their relationship to continued delinquency. ResultsResults suggest that a sizable combination of risk/needs trajectories exist among youth on probation. These distinct trajectories are differentially associated with individual and neighborhood characteristics. A select number of trajectories also appear to be indicative of continued offending post-completion of community supervision. ConclusionsInformation regarding the evolving nature of juvenile risk/needs during supervision is critically important to reduce incarceration, flatten the age-crime curve, and ensure public safety. Findings have implications for the use of dynamic risk assessment among youth on probation as well as juvenile recidivism research more generally.

Middle childhood attachment-based family therapy: Theory and model description.

In middle childhood, the first manifestations of mental health problems can emerge and become a precursor of mental health issues in adolescence. Given that weak parent-child attachment can contribute to this distress, it is possible that strengthening the attachment bond could reduce risk trajectory. Unfortunately, evidence-based attachment-focused interventions are lacking at this age. Attachment-based family therapy (ABFT) is a well-studied intervention for troubled adolescents and has the potential to be extended downward to children. However, ABFT for adolescents focuses on mentalization and trauma conversation strategies that may be developmentally advanced for children's capacities. Therefore, we modified the intervention strategies to be more developmentally sensitive to childhood. Middle childhood ABFT (MCABFT) builds on the theory that insecure attachment develops through a learning process that can be interrupted and reorganized to promote secure attachment development. MCABFT uses less conversation and more play and puts parents more at the center of the therapy compared with ABFT for adolescents. In this article, we describe MCABFT's theoretical and clinical model.

Trajectories of marginal part-time work and risk of depression. Does job or income insecurity mediate the relation?

Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between marginal part-time work and depression and the mediating role of job and income insecurity. We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators. We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant [HR 2.42, 95% confidence interval (CI) 1.83-3.20], mobile (HR 2.84, 95% CI 2.16-3.75), and fluctuating (HR 3.51, 95% CI 2.07-5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92-1.12) or income (HR 0.98, 95% CI 0.89-1.08) insecurity. We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity.

Childhood adversity, emergent psychopathology, and adolescent-to-parent violence: Process mining trajectories from police and health service administrative data

AimTo discover developmental risk trajectories for emerging mental health problems among a sample of adolescent family violence offenders to inform service delivery focused on early preventative interventions with children and their families.DesignA retrospective case-series design employing data linkage.SettingAn Australian regional location.ParticipantsAdolescents (born between 1994 and 2006) issued a legal action by the NSW Police Force for an adolescent-to-parent family violence offense (n = 775).ProcedureDiscrete routinely collected episode data in police and health service electronic records for children, and police data for parents, were linked and transformed into longitudinal person-based records from birth to 19 years to identify trajectories for mental health problems.ResultsSixty-three percent (n = 489) of adolescents had contact with a mental health service before age 19. The majority of these adolescents received a diagnosis for a stress or anxiety disorder (n = 200). Trajectory analysis found childhood exposure to parental intimate partner violence and parental drug and/or alcohol use were dominant events in the pathway to receiving a mental health diagnosis. Being a victim of a sexual offense was found to increase the odds of adolescents having a diagnosis for each of the main mental health categories (with the exception of drug or alcohol disorders).ConclusionsPathways to mental health problems were characterized by inter-related adverse childhood events and poly-victimization for many adolescents. Early identification of at-risk children must be a continued focus of child health services in order to reduce and identify early emerging mental health problems.

BMI Trajectories in Late Middle Age, Genetic Risk, and Incident Diabetes in Older Adults: Evidence From a 26-Year Longitudinal Study.

This study investigated the association between body mass index (BMI) trajectories in late middle age and incident diabetes in later years. A total of 11,441 participants aged 50-60 years from the Health and Retirement Study with at least 2 self-reported BMI records were included. Individual BMI trajectories representing average BMI changes per year were generated using multilevel modeling. Adjusted risk ratios (ARRs) and 95% confidence intervals (95% CIs) were calculated. Associations between BMI trajectories and diabetes risk in participants with different genetic risks were estimated for 5,720 participants of European ancestry. BMI trajectories were significantly associated with diabetes risk in older age (slowly increasing vs. stable: ARR = 1.31, 95% CI: 1.12, 1.54; rapidly increasing vs. stable: ARR = 1.5, 95% CI: 1.25, 1.79). This association was strongest for normal-initial-BMI participants (slowly increasing: ARR = 1.34, 95% CI: 0.96, 1.88; rapidly increasing: ARR = 2.06, 95% CI: 1.37, 3.11). Participants with a higher genetic liability to diabetes and a rapidly increasing BMI trajectory had the highest risk for diabetes (ARR = 2.15, 95% CI: 1.67, 2.76). These findings confirmed that BMI is the leading risk factor for diabetes and that although the normal BMI group has the lowest incidence rate for diabetes, people with normal BMI are most sensitive to changes in BMI.

Visualizing Uncertainty in Hurricane Forecasts with Animated Risk Trajectories

Abstract Hurricane forecasts are often communicated through visualizations depicting the possible future track of the storm. The cone of uncertainty (COU) is a commonly used visualization, but the graphic is prone to misinterpretation such as thinking only locations contained within the cone’s boundary are at risk. In this study, we investigated the utility of conveying hurricane forecast tracks using a set of animated icons, each representing an instance of a possible storm path. We refer to this new visualization as animated risk trajectories (ARTs). We measured nonexperts’ perception of risk when viewing simplified, hypothetical hurricane forecasts presented as ARTs or COUs. To measure perception of risk for each visualization type, we designed experiments to have participants make decisions to evacuate individual towns at varying distances from the most likely forecast path of a storm. The ARTs led to greater risk perception in areas that fell beyond the cone’s boundaries. Nonexperts’ interpretation of risk was impacted by the visual properties of the ARTs, such as the distribution of the icons, including their density, and whether the distribution was unimodal or bimodal. This supports the suggestion that ARTs can have value in communicating spatial–temporal uncertainty. Significance Statement Because of the inherent uncertainties in weather forecasts and emergency management planning, communicating hurricane risk to the public is a unique challenge for decision-makers. Our study investigated the effect of conveying uncertainty in hurricane forecast tracks using a distribution of animated icons [animated risk trajectories (ARTs)], which correspond to potential hurricane tracks that evolve over time. This visualization was compared with a simplified cone-of-uncertainty graphic, such as those used by the National Hurricane Center. We found that ARTs offered flexibility in conveying information about hurricane risk, such as the magnitude of the risk via the number of icons and the location of the risk via the distribution of icons.

Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room.

Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors. This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER. One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up. The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake. Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.

Trajectory of physical activity frequency and cancer risk: Findings from a population-based cohort study

BackgroundPhysical activity (PA) changes throughout an individual’s life, but the association between such changes and cancer risk seems to be overlooked in the literature. Thus, this study aimed to examine the association between the trajectories of PA frequency and cancer incidence among middle-aged Korean adults.MethodsA total of 1,476,335 eligible participants (992,151 men and 484,184 women) aged ≥40 years from the National Health Insurance Service cohort (2002–2018) were included. Assessment of PA frequency was a self-reported measure, based on the question: “How many times per week do you perform exercise that makes you sweat?”. PA frequency trajectories (i.e., trajectory classes of change in PA frequency) from 2002 to 2008 were identified using group-based trajectory modeling. Cox proportional hazards regression was used to assess the associations between the PA trajectories and cancer incidence.ResultsFive PA frequency trajectories over 7 years were identified: persistently low (men:73.5%; women:74.7%), persistently moderate (men:16.2%; women:14.6%), high-to-low (men:3.9%; women:3.7%), low-to-high (men:3.5%; women:3.8%), and persistently high (men:2.9%; women:3.3%). Compared with persistently low frequency, maintaining a high PA frequency was associated with a lower risk of all cancers (Hazard ratio (HR) = 0.92, 95%CI = 0.87–0.98) and breast cancer (HR = 0.82, 95%CI = 0.70–0.96) among women. There was a lower risk for thyroid cancer among men in the high-to-low (HR = 0.83, 95%CI = 0.71–0.98), low-to-high (HR = 0.80, 95%CI = 0.67–0.96), and high PA trajectories (HR = 0.82, 95%CI = 0.68–0.99). There was a significant association between moderate trajectory and lung cancer in men (HR = 0.88, 95%CI = 0.80–0.95), in both smoking and non-smoking men.ConclusionLong-term persistent high frequency of PA as part of the daily routine should be widely promoted and encouraged to reduce the risk for all cancer development in women.

Abstract P4-03-18: Group-based trajectories of endocrine therapy adherence and risk of recurrence in a Danish premenopausal breast cancer cohort

Abstract Background: Adjuvant endocrine therapy (AET) approximately halves the risk of recurrence among the two-thirds of premenopausal breast cancer patients whose tumors overexpress the estrogen receptor (ER+). AET is recommended for a minimum five-year duration, but many premenopausal women discontinue AET prematurely. Adherence to AET is dynamic and influenced by many behavioral, societal, clinical, and genetic factors. Describing longitudinal patterns of AET adherence is an important first step towards identifying patients at highest risk of nonadherence–-and therefore recurrence–-who may benefit from adherence-enhancing interventions. We used group-based trajectory models to (1) describe AET adherence patterns, and (2) estimate associations between AET adherence and breast cancer recurrence in a Danish premenopausal, ER+ breast cancer cohort. Methods: Our cohort included 4,487 premenopausal women diagnosed with ER+, stage I–III primary breast cancer registered in the Danish Breast Cancer Group (DBCG) clinical database and treated with AET (2002–2011). We followed all patients from initiation of AET until recurrence, mortality, 10 years of follow-up, another primary malignancy, or the end of available follow-up. We excluded individuals with less than 1.5 years of follow-up as breast cancer recurrences that occur in this time are unlikely to be related to AET. At semi-annual follow-up visits, women were registered as having received (or not) a six-month supply of AET. We created daily indicators to determine if a woman had at least 80% of days covered by an AET fill within each six-month period for the first 4.5 years following AET initiation, yielding 9 variables indicating time-varying adherence. We used these indicators to characterize adherence trajectory groups. We defined recurrence as local, regional or distant metastases or contralateral breast cancer registered in the DBCG using follow-up data through 2017. We fit Cox regression models, adjusted for age and clinical factors, to estimate the association between adherence trajectory groups and recurrence. Results: We identified distinct trajectory groups in the cohort (Table 1)—high adherence (69%), slow decline (23%), and quick decline (8%). Women with quick decline were more likely to have stage I disease, have no positive lymph nodes, to not be treated with chemotherapy, and to have lumpectomy instead of mastectomy when compared to women with high adherence. Compared with high adherence women, the estimated rate of breast cancer recurrence was higher among those with slow decline (HR=1.12, 95%CI=1.04–1.21) and those with quick decline (HR=1.38, 95%CI=1.22–1.56). Conclusions: Group-trajectory modeling facilitated empirical description of AET adherence patterns in a premenopausal breast cancer cohort. As expected, women who more rapidly became AET-nonadherent were at increased risk of breast cancer recurrence compared with those who remained adherent. Future analyses will explore the contribution of specific socioeconomic, genetic, and clinical factors to AET adherence patterns, which will inform the design of interventions to improve AET adherence and reduce recurrence risk in breast cancer patients. Table 1. Trajectory group and the observed proportion of individuals adherent to their adjuvant endocrine therapy (AET) over 4.5 years of follow-up Citation Format: Kirsten M. Woolpert, Julie A. Schmidt, Thomas P. Ahern, Timothy L. Lash, Lindsay J. Collin, Bent Ejlertsen, Deirdre Cronin-Fenton. Group-based trajectories of endocrine therapy adherence and risk of recurrence in a Danish premenopausal breast cancer cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-18.

Is the Risk for Sexual Revictimization Cumulative? AProspective Examination.

Sexual abuse during childhood is associated with risk for sexual assault as an adult, known as revictimization. Although multiple experiences of sexual assault in adulthood are also common, it is unclear how risk trajectories might continue to evolve in emerging adulthood, defined as ages 18-25. Clarifying risk trajectories is important to inform the development of targeted risk reduction interventions. To fill this gap, we examined cumulative risk for sexual assault in emerging adult women following multiple experiences of childhood sexual abuse (CSA) and adulthood sexual assault (ASA). Women (n=447; aged 18-25years at enrollment) completed behaviorally specific assessments of unwanted sexual experiences at up to 9 time points across 3years. Logistic regression was used to predict any sexual assault during the 3-year period as a function of victimization history at baseline. A multilevel logistic regression analysis among ASA survivors was then used to determine whether each successive ASA increased risk for further victimization. Extending prior research, findings revealed that the risk for sexual assault during the 3-year study was greater for women reporting more prior experiences of CSA and ASA. Unexpectedly, each ASA increased the risk for a subsequent ASA to a lesser extent among women with more experiences of CSA. Findings suggest that the risk for sexual revictimization can be cumulative, but that risk does not increase indefinitely. Future research should investigate the points at which survivors of multiple assaults may begin to experience a decreased risk for later assaults, as well as the factors associated with change in risk status (e.g., removal from violent environments or relationships, changes in institutional policies). Such research could inform intervention targets.

Cognitive trajectories and incident dementia after a cardiovascular event in older adults.

Cardiovascular disease (CVD) is a recognized risk factor for dementia. Here we determined the extent to which an incident CVD event modifies the trajectory of cognitive function and risk of dementia. 19,114 adults (65+) without CVD or dementia were followed prospectively over 9 years. Incident CVD (fatal coronary heart disease, nonfatal myocardial infarction [MI], stroke, hospitalization for heart failure) and dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were adjudicated by experts. Nine hundred twenty-two participants had incident CVD, and 44 developed dementia after CVD (4.9% vs. 4.4% for participants without CVD). Following a CVD event there was a short-term drop in processing speed (-1.97, 95% confidence interval [CI]: -2.57 to -1.41), but there was no significant association with longer-term processing speed. In contrast, faster declines in trajectories of global function (-0.56, 95% CI: -0.76 to -0.36), episodic memory (-0.10, 95% CI: -0.16 to -0.04), and verbal fluency (-0.19, 95% CI: -0.30 to -0.01) were observed. Findings highlight the importance of monitoring cognition after a CVD event.