Health Care Screening Research Articles

Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes.

Preventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation. To consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups. An open community health screening event (n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views. Seventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care. This study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

COVID-19 and endoscopy: implications for healthcare and digestive cancer screening.

The coronavirus disease 2019 (COVID-19) pandemic is affecting and changing the daily practice of gastrointestinal endoscopy worldwide. To protect patients and endoscopy unit personnel, endoscopy units have had to postpone a large proportion of endoscopic procedures. These delays might have an effect on the screening for and surveillance of digestive cancers.

The early identification of people with personality disorder in the criminal justice system.

The prevalence of personality disorder is very high among criminal justice (correctional) populations, yet our understanding of this condition as it arises in police custody is presently limited. Although healthcare screening has a well-described role within criminal justice settings, including police custody, specific screening for personality disorders has hardly been considered. Yet such screening is broadly in keeping with the aims of liaison and diversion services and the general healthcare principle of early identification, has the potential to inform future care pathways and ameliorate risk and could in some cases inform future sentencing arrangements including community alternatives. Therefore, there is a need for research to consider the design and implementation of a suitable screening tool for application as early as possible in the criminal justice pathway, either as a stand-alone instrument, or as part of a wider package of healthcare screens. It will be important to consider the feasibility of any such design, given environmental and time limitations within police custody and the high levels of substance misuse, with issues relating to intoxication and withdrawal.

COVID-19: Crisis management in congenital heart surgery

COVID-19: Crisis management in congenital heart surgery

Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain.

ABSTRACTThis study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow‐up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: A national population study.

To determine the relationships between urinary incontinence (UI), fecal incontinence (FI), and falls risk among community-dwelling older women and men with complex needs, after controlling for confounders. All community care recipients in New Zealand undergo standardized needs assessments, using the Home Care International Residential Assessment Instrument (interRAI-HC), which elicits information over multiple domains, including UI and FI frequency and falls. Consenting women and men aged greater than or equal to 65 years with at least one interRAI-HC assessment undertaken between 1 July 2012 and 1 June 2018 were investigated using multilevel mixed effects ordinal regression models, stratified by sex. Overall, 57 781 (61.8%) women and 35 681 (38.2%) men were eligible, contributing 138 302 interRAI-HC assessments. At first assessment, the average age was 82.0 years (range: 65-109 years); high falls risk was common, found among 8.8% of women and 12.4% of men; and 43.7% of women and 33.7% of men reported some incontinence. For women, the adjusted odds of increasing falls risk was 1.24 (95% CI: 1.18, 1.30) for those with occasional UI, 1.36 (95% CI: 1.29, 1.43) for those with frequent UI, and 1.19 (95% CI: 1.13, 1.26) for those with any FI compared with their continent counterparts. Among men, the adjusted odds were 1.49 (95% CI: 1.41, 1.58) for any UI and 1.18 (95% CI: 1.10, 1.27) for any FI. UI and FI are common, have separate associations with falls risk among women and men, and would benefit from routine screening in primary health care for older adults.

Priority setting for malnutrition and nutritional screening in healthcare: A James Lind Alliance

Priority setting for malnutrition and nutritional screening in healthcare: A James Lind Alliance

Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

BackgroundIdentifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients’ and physicians’ perspectives.MethodsSix primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention).DiscussionThis is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.Trial registrationDRKS, DRKS00015882, Registered 17 December 2018.

Health screening and preventative health care in refugee women: A qualitative analysis

Background: Regular health screening provides opportunities for early detection and effective treatment of disease. There is underutilisation of health services by migrants from culturally and linguistically diverse backgrounds, particularly refugees in Australia. Aim: To explore the beliefs, understandings, and use of health and healthcare screening services among African refugee women living in Australia. Design/Method: Qualitative secondary analysis. Method: Oral narratives derived from two primary qualitative datasets of Sub-Saharan women in New South Wales, Australia, underwent secondary thematic analysis. Findings: Twenty-two of the forty-two women had refugee status on migrating to Australia. Thematic findings reflection of misinformation, low health literacy, and health screening as not a priority. Conclusions: There is an urgent need to develop innovative strategies to engage refugee migrant women in health screening by provision of culturally meaningful health information. Relevance to clinical practice: Including refugee women’s suggestions for information to be provided by health services may improve attitudes towards screening and preventative health care.

Translation and validation of an extended German version of ID Migraine™ as a migraine screening tool

Background and purpose: Diagnosing a patient with headache as a migraineur is critical for state-of-the-art migraine management. Screening tools are imperative means to improve the diagnostic yield in the primary care settings and specialized clinics. This study aims to translate and assess the diagnostic accuracy of a German version of the ID Migraine™ as a widely used and efficient screening instrument. Methods: The Functional Assessment of Chronic Illness Therapy translation methodology was used to translate the original three-item ID Migraine™, including a fourth question for aura, from the English language into the German language. Diagnostic accuracy of the German ID Migraine™ and predictors of false screening results were assessed among patients presenting to a headache outpatient clinic of a tertiary care center in Germany over a 6-month period. Results: The translation procedure yielded a harmonized German ID Migraine™ and its diagnostic accuracy was assessed in 105 patients (80 female, 46.5 ± 17.2 years of age), including 79 patients (75.2%) with migraine. The three-item German ID Migraine™ provides a sensitivity of 99%, specificity of 68%, and positive and negative predictive values of 90% and 95%, respectively, using a cutoff of ≥2. Positive and negative predictive values in a general headache population are estimated to be 74% and 98%, respectively. The aura question identified 18 out of 20 migraineurs with aura. Conclusions: The German ID Migraine™ is an accurate screening tool for migraine even in a challenging population of a specialized outpatient clinic. Its diagnostic accuracy indicates a potential utility for screening in primary health care.

High prevalence of malnutrition and frailty among older adults at admission to residential aged care.

INTRODUCTION Malnutrition is an under-recognised and under-treated problem often affecting older adults. AIM The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODS A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTS Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93-0.99)], gait speed [0.27 (0.10-0.73)] and pre-frailty status [0.32 (0.12-0.83)]. DISCUSSION This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.

Rates of and Factors Associated With Patient-reported Illicit Drug Use Screening by Health Care Professionals in the United States From 2013 to 2015

To examine rates of and factors associated with patient-reported illicit drug use screening by health care professionals. The National Survey on Drug Use and Health (NSDUH), limited to individuals who reported prior year healthcare service utilization, was used to capture the odds of patient-reported illicit drug use screening for survey years 2013 to 2015. Screened patients were contrasted with those not screened by demographic and behavioral characteristics. Adjusted models were produced by year and adjusted odds ratios were compared for changes across years. A separate adjusted model including year as a fixed effect was produced to estimate changes in overall adjusted screening odds. The percentage of individuals reporting screening by a health care provider increased from 48.5% in 2013 to 50.9% (2014), and 54.3% (2015) (P < 0.0001). The adjusted model, including year as a fixed effect, indicated that the odds of screening significantly increased from 2013 to 2015. In multivariable regression, individuals reporting screening were more likely to be female, of higher income and educational strata, and received drug or alcohol treatment in the past year and were less likely to be non-Hispanic Asian. Only roughly half of individuals seen by a healthcare provider report illicit drug use screening. Racial disparities in screening persist although they are overall decreasing. Coupling screening with treatment initiation, rather than brief intervention, may increase screening rates.

Co-infection with malaria and coronavirus disease-2019

Sir, Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is an ongoing global pandemic. Among the plethora of knowledge being garnered about the virus, the occurrence of co-infections and superinfections is also being reported.[1] Although SARS-CoV-2 is the first culprit to be suspected in symptomatic cases, it is important not to lose sight of the burden India faces with other infectious diseases. We report a case of malaria and COVID-19 co-infection. A 67-year-old male, a known case of type 2 diabetes mellitus and heart disease, presented with complaints of fever and progressive exertional breathlessness for 4 days in the 1st week of May. He had no history of travel or contact with a COVID-19-confirmed case. On examination, his oxygen saturation was 96% on room air. Complete blood count revealed moderate thrombocytopenia of 71.0 × 109/L with normal hemoglobin and white blood cell counts. On peripheral blood examination, ring forms and trophozoites of Plasmodium vivax were seen, along with reactive lymphocytes [Figure 1]. Chest X-ray (anteroposterior view) showed haziness in both lung fields. The patient was started on intravenous injection artesunate, followed by artemether and lumefantrine, per oral. He responded well to the antimalarial treatment with symptomatic relief.Figure 1: Peripheral blood smear showing ring form (red arrow) and trophozoite (white arrow) of Plasmodium vivax. A reactive lymphocyte is also seen (black arrow) (Leishman stain, ×400)Although his first nasopharyngeal swab for SARS-CoV-2 real-time reverse transcription–polymerase chain reaction test indicated the absence of the virus, repeat swabs sent on day 3 revealed positivity for the same. In the coming week, his platelet counts improved to normal levels, and he became clinically asymptomatic and stable. Co-infections of COVID-19 are thought to be very common, as high as 80%, most commonly with seasonal respiratory pathogens.[1] With overlapping symptoms and travel history (significant for COVID-19 and malaria), co-infection diagnosis may be challenging. India witnesses a temporal rise in water-borne and water-related diseases, including malaria, in the monsoon season, annually. With the ongoing pandemic, one can expect an increase in the rate of co-infections with COVID-19. It is important to investigate thoroughly in order to correctly identify a treatable infection as well as the presence of co-infections. While many clinical trials are ongoing for COVID-19 with no approved treatment regimen yet, there are already established antimalarial, antiviral, and antibiotic schemes for known infections. At present, the entire population, globally, is at very high risk of COVID-19. In 2018, it was reported that nearly half of the world population was at risk of malaria.[2] A single case of COVID-19 can potentially be infective to 3.58 susceptible individuals.[3] Likewise, an untreated case of malaria can lead to community spread. Furthermore, due to lockdowns and restricted mobility, there have been interruptions to health-care access and national malarial control programs. The World Health Organization is urging countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic.[4] It is advisable that health-care professionals screen for malaria while they test for COVID-19.[5] This would help in timely identification of two infectious diseases having significant global impacts and reduce unnecessary morbidity and mortality. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Women with Hidden Urinary Incontinence Waiting to Be Discovered: A Snapshot From a Developing Country

Purpose: Urinary incontinence UI , is a public health problem that has an increasing frequency and has an impact on the quality of life QoL of women worldwide. In this study, in which we focus on the general approach to risk factors associated with urinary incontinence, we aim to address the importance of transferring between practical healthcare services and screening programs. Methods: Our study was conducted between December 2018- August 2019 with patients who admitted to Trakya University Medical Hospital with different gynecologic symptoms. This study investigated the relationship between menopause, incontinence, type of delivery, socioeconomic status, and risk factors. A modular inquiry form-short form ICIQ-SF was used for the research in all aspects of urinary incontinence and its impact on the quality of life. Our aim was to increase the awareness of clinics about urinary incontinence.Results: Of the 622 participants, 176 had urinary incontinence symptoms. There was a significant relationship between menopause, age, medical treatment for uriner infection, body mass index, living in rural / urban areas, normal birth rate, education level and urinary incontinence. Conclusion: It’s important to assess the effects of urinary incontinence symptoms on women’s QoL appropriately in UI-related research and clinical studies. Women with urinary incontinence symptoms should ensure that their body mass index is within the ideal range. In every period, quality of women’s life can be improved with the necessary cares. Building awareness about urinary incontinence can help improve treatment-seeking behaviour. Improving the quality of life of women will help to increase the desired levels of quality health and welfare in the management of public health, especially in developing countries

Prevalence of oligomenorrhea among women of childbearing age in China: A large community-based study.

Objective:To investigate the prevalence and the related characteristics of oligomenorrhea among women within childbearing age in China.Study design:A large-scale community-based investigation was conducted from 2013 to 2015. A total of 12,964 women aged 18–49 years from 9 provinces/municipalities in China were recruited for healthcare screening in local community health centers. Outcome measures include clinical history, ultrasonographic exam, and hormonal and metabolic parameters.Results:Among women within childbearing age in China, the prevalence of oligomenorrhea was 12.2% (1,579/12,964). Both sociodemographic factors and medical history were significantly associated with oligomenorrhea (P < 0.05). In such women, the prevalence of obesity, acne, seborrhea, acanthosis, larger ovarian size, and polycystic ovarian morphology was higher when compared with normal women; the prevalence of anti-Mullerian hormone, total testosterone, and androstenedione (P < 0.05) was higher as well. The infertility rates of all women were higher in the oligomenorrhea group (17.2%, 272⁄1,579) than in the non-oligomenorrhea group (9.0%, 1,024⁄11,385), and among women without contraception, for the oligomenorrhea group, the infertility rate was 32.5% (128⁄394), and for the non-oligomenorrhea group, 17.9% (400⁄2,240). In the oligomenorrhea group, 57.4% (156/272) of the women underwent treatments for infertility, which was higher than the non-oligomenorrhea group 36.1% (370/1,024).Conclusions:Obesity, acne, seborrhea, acanthosis, larger ovarian size, and polycystic ovarian morphology were significantly associated with oligomenorrhea. The increase of anti-Mullerian hormone, total testosterone, and androstenedione level was also demonstrated in the oligomenorrhea group. Higher prevalence of infertility and medical treatment rate was observed in women with oligomenorrhea.

Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance.

Malnutrition is one the greatest global health challenges of our generation, leading to the increased utilisation of healthcare resources, as well as morbidity and mortality. Research has primarily been driven by industry, academia and clinical working groups and has had little involvement from patients and carers. The project described in the present study aimed to establish a priority setting partnership allowing patients, carers and healthcare professionals an opportunity to influence the research agenda. A national survey was conducted to gather malnutrition uncertainties and identify key issues (i.e. areas within scope where an evidence-base is lacking) from those with experience of malnutrition. Uncertainties were analysed according to themes. Similar questions were grouped and summary questions were developed. A second survey was conducted and respondents were asked to choose their 10 most important summary questions. A workshop was conducted to finalise the top 10 research priorities from the most frequently indicated uncertainties on the interim survey. Overall, 1128 uncertainty questions were submitted from 268 people. The interim survey had 71 responses and a list of the top 26 questions was generated for the workshop. There were 26 questions discussed, ranked and agreed by healthcare professionals, carers and patients at the workshop. The top 10 research priorities were then chosen. These included questions on oral nutritional supplements, vulnerable groups, screening, community care, use of body mass index and technology. The top 10 research priorities in malnutrition and nutritional screening have been identified from a robust process involving patients, carers and healthcare professionals.

Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers

IntroductionDespite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening.MethodsThis was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities’ social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February–March 2019.ResultsScreening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07).ConclusionsA strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier.

The Impact of Massachusetts Health Reform on Colorectal and Breast Cancer Stage at Diagnosis.

This study examines the expansion of health insurance coverage in Massachusetts under state health reform as a natural experiment to investigate whether expanded insurance coverage reduced the likelihood of advanced stage colorectal cancer (CRC) and breast cancer (BCA) diagnosis. Our study populations include CRC or BCA patients aged 50-64 years observed in the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results (SEER) registries for 2001-2013. We use difference-in-differences regression models to estimate changes in the likelihood of advanced stage diagnosis after Massachusetts health reform, relative to comparison states without expanded coverage (Connecticut, New Jersey, Georgia, Kentucky, and Michigan). We find some suggestive evidence of a decline in the proportion of advanced stage CRC cases. Approximately half of the CRC patients in Massachusetts and control states were diagnosed at advanced stages pre reform; there was a 2 percentage-point increase in this proportion across control states and slight decline in Massachusetts post reform. Adjusted difference-in-difference estimates suggest a 3.4 percentage-point (P=0.005) or 7% decline, relative to Massachusetts baseline, in the likelihood of advanced stage diagnosis after the reform in Massachusetts, though this result is sensitive to years included in the analysis. We did not find a significant effect of reform on BCA stage at diagnosis. The decline in the likelihood of advanced stage CRC diagnosis after Massachusetts health reform may suggest improvements in access to health care and CRC screening. Similar declines were not observed for BCA, perhaps due to established BCA-specific safety-net programs.

Healthcare Access, Utilization, and Preventive Health Behaviors by Eligibility for Lung Cancer Screening.

In 2013, the US Preventive Services Task Force recommended low-dose computed tomography screening for smokers at high risk of lung cancer; however, use remains low. Efforts to promote lung cancer screening need to consider how receptive this population is to preventive healthcare and cancer screening. In addition, because of demonstrated heterogeneity in behaviors by smoking status, interventions may need to differ among eligible high-risk subgroups. To assess the engagement of high-risk smokers in other preventive healthcare behaviors, we examined healthcare use, including non-lung cancer screening, and healthcare provider discussions regarding screening by eligibility for lung cancer screening. We used the 2015 National Health Interview Survey to assess smoking history, healthcare use, cancer screening, vaccinations, and healthcare provider discussions regarding non-lung cancer screening. We calculated weighted prevalence estimates and prevalence ratios comparing eligible and ineligible current and former smokers to never smokers. Eligible current and former smokers had significantly different healthcare utilization and screening concordance compared to never smokers and to each other. Compared to never smokers, eligible current smokers were significantly less likely to be concordant with breast, colorectal, and cervical cancer screening while eligible former smokers were only less likely to be concordant with breast cancer screening. Eligible current smokers were less likely to report physician discussions about non-lung screening tests. Provider discussions about screening and engagement in preventive healthcare differed among current and former smokers eligible for lung cancer screening. Intervention efforts to increase lung cancer screening levels will likely need to differ as well.

977. The Prevalence and Burden of Non-AIDS Co-Morbidities in Women with or At-risk for HIV Infection in the United States

BackgroundAge-related non-AIDS comorbidities (NACM) increasingly account for morbidity and mortality in persons living with HIV. The burden of NACM and its association with HIV is poorly described in women.MethodsWe analyzed data from HIV+ and at-risk HIV− participants who were followed in the Women’s Interagency HIV Study (WIHS) after 2009 (when >80% of participants used antiretroviral therapy). The prevalence of each NACM (defined by a combination of self-report, clinical measurements, and laboratory data) and the number of NACM were summarized at a most recent follow-up visit and were compared by age and HIV serostatus using unadjusted linear regression models.ResultsThere were 3232 women (2309 HIV+, 923 HIV–) with a median follow-up of 15.3 years. The median age was 50 years, 65% were black, 38% currently smoked, 71% had ever used illicit drugs, 50% had annual income < $12,000, and median body mass index was 30 kg/m2. HIV+ women had a median CD4 count of 618 cells/mm3 and 66% had HIV viral suppression. Among 10 NACM evaluated, the following were more prevalent in HIV+ vs. HIV– women (all P < 0.01): psychiatric illness (57%/48%), liver disease (45%/26%), hyperlipidemia (40%/35%), bone disease (40%/33%), chronic kidney disease (15%/7%), and non-AIDS cancer (11%/7%). There was little difference in the prevalence of hypertension (66%/64%), lung disease (41%/43%), diabetes (22%/24%), and cardiovascular disease (19%/19%). Mean number of NACM was higher in HIV+ vs. HIV– women (3.6 vs. 3.0, P < 0.0001). Regardless of HIV serostatus, NACM burden significantly increased with age (P < 0.0001). Compared with women aged <40 of the same HIV serostatus, the estimated mean difference in NACM (HIV+/HIV–) for those 40–49, 50–59, ≥60 years was 1.1/0.7, 2.3/2.3, and 3.6/3.2, respectively (P < 0.0001 for all). Within-age-group comparisons revealed significantly greater NACM burden in HIV+ vs. HIV− women aged 40–49 years (P < 0.0001) and ≥60 years (P = 0.003), but not in those aged <40 or 50–59 years (HIV*age interaction P = 0.02) (figure).ConclusionNACM burden was high in both HIV+ and at-risk HIV– women, but higher in HIV+ women overall and in certain age groups. Accumulation of NACM has complex implications for clinical care, medication management, and healthcare screening that must be further examined in this population. DisclosuresAnandi N. Sheth, MD, MS, Gilead Sciences, Inc.: Research Grant.