Self-reported Disease Research Articles

Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders

Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

P114 Promoting physical activity using mobile health technology in people living with Rheumatoid Arthritis: MOTIVATE RA

Abstract Background/Aims People living with rheumatoid arthritis (RA) tend to be less active than the general population which may be due to RA associated musculoskeletal pain, stiffness and fatigue. The health benefits of physical activity (PA) are widely recognised in the general population and studies in RA have also highlighted improvement in RA associated symptoms. However, encouraging increased PA in people living with RA is challenging and adherence to PA is usually low. Mobile health (mHealth) technology (i.e., fitness watches and apps) may provide an effective and economical solution to promoting PA in this high-risk population. The aims of the current study were to assess whether use of mHealth technology in RA i) increases PA levels and ii) reduces RA disease activity. Methods People with RA were randomised to either the MOTIVATE (mHealth intervention) or conventional care (CC) groups. The CC group were provided with online educational materials, as provided in routine care (e.g., PA information leaflets), to increase PA whereas the MOTIVATE group were provided with a personalised, progressive walking programme delivered via mHealth technology with ongoing, individualised support throughout the 12-week intervention. All participants received a self-testing kit, via mail, at baseline (week 0) and post-intervention (12 weeks). Measures included anthropometrics, blood pressure, PA monitoring, health questionnaires and all were requested to self-report RA disease activity using RADAI-5. Change data between weeks 0 and 12 were compared between groups using One-Way ANCOVA, controlling for baseline, and reported as mean difference (95% CI). Results Of 50 participants, 25 were randomised to the MOTIVATE group (age 50±11years; BMI 29±7kg/m2; females n=23), and 25 to CC (n=25, age 50±11years; BMI 26±6 kg/m2; females n=24). An increase in moderate-to-vigorous PA was observed in the MOTIVATE group, compared to a decrease in CC [81min (1, 160) vs. -35min (-123, 53); P=0.09)]. This was accompanied by an increase in steps per day in the MOTIVATE group, and a decrease in CC [763 (-432, 1957) vs. -76 (-1267, 1115); P=0.40]. A reduction in PHQ-9 depression score was evident in the MOTIVATE group whilst CC were unchanged [-2 (-2, -3) vs. 0 (-2, 0); P=0.07]. RADAI-5 decreased in the MOTIVATE group and stayed the same in CC [-2 (-2, 0) vs. 0(-2, 0), P=0.27]. Conclusion These findings identify the potential effectiveness of an mHealth PA programme to increase PA levels in people living with RA. Use of remote PA monitoring, with support from exercise specialists, may be an effective strategy to improve engagement in exercise and PA in the RA population. Data is suggestive this could improve RA related symptoms, although we did not observe statistical significance. Disclosure D.J. Bannell: Grants/research support; Research grant from the Aintree Arthritis Trust. M. France-Ratcliffe: None. K.L. Hesketh: None. M. Cocks: None. N. Goodson: None. C. Taylor: None. T. Pecanha: None. H. Jones: None. D.A. Low: None. V.S. Sprung: None.

The association of pre-cancer diagnosis cardiovascular risk factors with memory aging after a cancer diagnosis, overall and by race/ethnicity.

Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998-2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups.

EQ-5D-3L and EQ-5D-5L population norms for Thailand

BackgroundThe previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20–70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases.MethodsIndividual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases.ResultsThe means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558–0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments.ConclusionsThe Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Temporal trends and racial/ethnic- and sex-differences in LDL cholesterol control among US adults with self-reported atherosclerotic cardiovascular disease

ObjectiveCurrent guidelines for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend targeting a low-density lipoprotein cholesterol (LDL-C) of < 70 mg/dL. However, temporal trends and racial/ethnic- and sex-differences in achievement of LDL-C targets are not well described. We assessed trends and racial/ethnic- and sex-differences in achievement of LDL-C < 70 mg/dL using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 to 2017-March 2020. MethodsWe combined NHANES cycles into 4 periods: 2005–2008, 2009–2012, 2013–2016, and 2017-March 2020 and included participants ≥ 40 years with self-reported ASCVD. We estimated LDL-C < 70 mg/dL prevalence over time and further stratified by sex and race/ethnicity. We used multivariable logistic regression adjusted for social determinants of health and clinical covariates to model LDL-C target attainment. ResultsAmong 1,826 NHANES participants representing 7,161,221 US adults with self-reported ASCVD (59.6% ≥ 65 years, 56.4% male, 74.8% White), LDL-C target attainment increased from 19.0% (95% CI, 15.3%-23.3%) in 2005–2008 to 26.3% (95% CI, 20.4%-33.1%) in 2017-March 2020 (P = 0.012 for trend). Achievement of LDL-C < 70 mg/dL significantly rose among men from19.5% (95% CI, 15.1%-24.8%) to 29.4% (95% CI, 20.7%-29.9%) without significant change in women (from 18.3% [95% CI, 13.6%-24.2%] to 22.5% [95% CI, 13.0%-35.9%]; P = 0.241 for trend). Improvement in LDL-C target attainment was similar among White, Black, and Hispanic individuals (∼5–7% increase) and was greatest among individuals of other (non-White, Hispanic, or Black) race/ethnicity (23.1% increase). In our multivariable analysis, comorbid diabetes and ages 65–75 and > 75 years were associated with LDL-C target attainment. ConclusionLDL-C control modestly improved between 2005 and 2008 and 2017-March 2020; however, only ∼1/4 of individuals met guideline-directed LDL-C treatment targets by 2017-March 2020. Women had lower LDL-C control and lesser magnitude of improvement in LDL-C control than men, highlighting a need for targeted interventions to improve lipid-lowering therapy utilization in this population.

Trends in cardiovascular health metrics and associations with long-term mortality among US adults with coronary heart disease

Background and aimsOur study examined the trends of cardiovascular health metrics in individuals with coronary heart disease (CHD) and their associations with all-cause and cardiovascular disease mortality in the US. Methods and resultsThe cohort study was conducted based on the National Health and Nutrition Examination Survey 1999–2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) in CHD, while the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 44% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively. ConclusionSubstantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.

Coronavirus disease 2019 infection among working-aged people with multiple sclerosis and the impact of disease-modifying therapies.

The risk of coronavirus disease 2019 among people with multiple sclerosis with different disease-modifying therapies is not well established. To investigate the occurrence of coronavirus disease 2019 and the remaining symptoms among people with multiple sclerosis and the associations with different disease-modifying therapies. Individuals aged 20-50 listed in the Swedish Multiple Sclerosis Registry were invited to participate in a survey in 2021. Information on reported coronavirus disease 2019 infection and remaining symptoms were linked to individual-level register data. The risks by disease-modifying therapy of having coronavirus disease 2019 or having remaining symptoms were estimated with logistic regression. Of the 4393 participants, 1030 (23.4%) self-reported coronavirus disease 2019 (749 confirmed and 281 suspected). The observed odds for coronavirus disease 2019 did not differ by disease-modifying therapy (p-values <0.05). The majority reporting coronavirus disease 2019 had fully recovered (68.5%), 4.2% were currently/recently sick, and 27.0% had symptoms remaining after 2 months. The most frequently reported remaining symptoms involved one's sense of smell or taste (37.0%), fatigue (20.0%), and breathing (12.0%). No statistically significant associations were observed between having remaining symptoms and the disease-modifying therapy. Despite the initial concerns of differing infection risks by MS treatments, we observed no differences in coronavirus disease 2019 occurrence or remaining symptoms among those who had coronavirus disease 2019. Nonetheless, exercising caution in interpreting our findings, it remains implicit that people with multiple sclerosis are particularly susceptible to infection and that lingering symptoms may persist beyond the initial infection.

Determinants of self-rated health among highly educated Ukrainian women refugees in Czechia: analysis based on cross-sectional study in 2022

BackgroundRussia’s military aggression against Ukraine set in motion a large number of refugees. Considerable amount of them came and stayed in Czechia. Refugees represent special vulnerable individuals often affected by war physically and psychologically. Due to the national regulations not allowing most of Ukrainian men aged 18–60 to leave the country, nowadays Ukrainian forced migration is relatively young and strongly gendered. Evidence suggests the higher probability for searching the safe refuge abroad among Ukrainian women with small children as well as those with relatively higher economic and cultural capital. The aim of this study is to identify the structural features of systemic risks associated with war migration by examining determinants of self-rated health among forcibly displaced highly educated Ukrainian women of productive age residing in Czechia.MethodsData from one wave of the panel survey among Ukrainian refugees in Czechia conducted in September 2022 was used. Determinants of self-rated health including self-reported diseases and healthcare factors, lifestyle, human and social capital, economic factors, and migration characteristics were analysed using binary logistic regression.ResultsAbout 45% highly educated Ukrainian women refugees in Czechia assessed their health as poor. The poor self-rated health was mostly associated with the number of diseases and depressive symptoms, and by social capital and economic factors. Having four and more diseases (OR = 13.26; 95%-CI: 5.61–31.35), showing some severe depressive symptoms (OR = 7.20; 95%-CI: 3.95–13.13), experiencing difficulties to seek help from others (OR = 2.25; 95%-CI: 1.20–4.23), living alone in a household (OR = 2.67; 95%-CI: 1.37–5.27), having severe material deprivation (OR = 2.70; 95%-CI: 1.35–5.41) and coming originally from the eastern part of Ukraine (OR = 2.96; 95%-CI: 1.34–6.55) increased the chance of these refugees to assess their health as poor.ConclusionSocial and economic determinants such as lack of social contacts for seeking help and material deprivation were found to be crucial for self-rated health and should be tackled via migration policies. Further, qualitative research is needed to better understand the mechanisms behind the factors affecting subjectively assessed health.

Disease burden and unmet need for acute allergic reactions – A patient perspective

BackgroundAcute allergic reactions (AARs) occur shortly after exposure to an allergen, and the severity is on a continuum. Systemic corticosteroids (CS) are mainstay treatment of moderate to severe AARs, whereas those at risk of the most severe AARs (ie, anaphylaxis) are also recommended prescription of epinephrine autoinjectors. There is limited research on the impact of AARs not fulfilling the criteria for anaphylaxis. We have characterized a sample with a history of moderate to severe AARs and evaluated their self-reported disease burden (ie, daily life impact, anxiety, and treatment impediments). MethodsSurvey study of adults with experience of AARs treated with CS. Participants recruited from a web-based panel and using social media were asked to complete a questionnaire related to their allergy and experience of AARs. The results were summarized for the whole sample and across subgroups with and without prescription of epinephrine. ResultsThe final study sample included 387 participants (80% women, mean age 41), of which 129 (33%) had at some point been prescribed epinephrine. The most common symptoms were respiratory (80%) and skin (78%) manifestations, and the mean (standard deviation, SD) self-rated severity score (scale from 0 [very mild] to 10 [very severe]) of the most recent AAR was 6.1 (2.0). More than 80% had experience of AARs interrupting daily activities and 50% of AARs that had limited work/studies or participation in leisure activities. Most of the respondents reported some degree of anxiety related to AARs and 43% had feared for their lives. Moreover, difficulties swallowing allergy medicine at an AAR was experienced by 26% and not having the medicine available when needed by 66%. Participants with prescription of epinephrine experienced more severe AARs than those without such prescription (mean [SD] severity 6.8 [2.1] vs 5.8 [1.8], p < 0.0001); however, also those without epinephrine prescription reported considerable anxiety and impact on daily life and to a similar degree as those with prescription. ConclusionsIn this sample, subjects with experience of AARs treated with CS showed a considerable disease burden with anxiety and interruption on daily life, as well as problems related to access to, and swallowing of, medication. Although respondents with epinephrine prescription had more severe disease, a high disease burden was also evident among those without epinephrine. The study increases the knowledge of people with moderate to severe AARs, a patient population that has previously been underrepresented in the research literature.

Chronic diseases and determinants of community health services utilization among adult residents in southern China: a community-based cross-sectional study

BackgroundThe burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents.MethodsData were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization.ResultsAccording to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently.ConclusionsGiven the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents’ access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.

The impact of health on labour market outcomes: A rapid systematic review

The relationship between an individual's health and their labour market outcomes has long been a subject of health economics research. This review aims to provide an up-to-date, global review of the substantive findings in the existing literature. We pay particular attention to causal effects, acknowledging the methodological complexities that have long challenged the research and emphasizing the importance of overcoming them to present robust, policy-relevant evidence. The recent literature shows a notable advancement in addressing these methodological issues compared to previous work.The evidence reviewed suggests that individuals with better health overwhelmingly exhibit higher earnings and often enhanced labour supply. These findings extend beyond geographical boundaries, as evidence from diverse regions underscores the global significance of this association. The review covers evidence from a wide range of health indicators and conditions – including e.g. self-reported health, chronic diseases, disability, nutritional health, infections, mental health, addictions and others. Within and across the different health domains, the health-related factors exert varying degrees of influence on labour market outcomes, highlighting the multifaceted nature of the health-labour relationship and its potentially profound implications for individuals, communities, and economies.

Correlation between cervical lesions of the teeth and self-reported systemic diseases in young people

Correlation between cervical lesions of the teeth and self-reported systemic diseases in young people

Abstract 7454: Cognitive function in older breast cancer survivors after chemotherapy

Abstract Background: In the United States, over 60% of breast cancer survivors are 65 years and older; however, little is known about patient-reported symptoms and the effect that cancer treatments could have on survivors years after their primary treatment and diagnosis. This study evaluated perceived cognitive function in older breast cancer survivors and whether prior chemotherapy was associated with cognitive outcomes. Methods: Breast cancer patients aged 65 years and older, diagnosed 2012-2013, with local and regional stage disease, were identified through the linked Texas Cancer Registry-Medicare dataset (TCR). Survivors were mailed a survey to assess their cognitive function through the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog V3) instrument (section G of the survey). The survey also collected demographic and clinical data and was collected between April 2018 and October 2019. Utilizing the data from the self-administered questionnaires, TCR, and Medicare claims, the cognitive function and quality of life among elderly patients were evaluated to assess whether prior chemotherapy and/or endocrine therapy impacts long-term health. A linear regression model was used to examine the significance of receiving chemotherapy to FACT-Cog V3 primary score while controlling for respondent sociodemographic and clinical variables. Results: Of 4,448 eligible patients, 1,954 (43.9% response rate) responded to section G. Of these, 1,065 respondents completed all 4 sections, 37 questions. Eighty of those 1065 respondents self-reported disease recurrence which excluded them from the analyses in order to avoid biases, leaving a total of 985 cases for this study. Median time from diagnosis to survey completion was 68 months (IQR 62-73). Receipt of chemotherapy was associated with a slightly lower FACT-Cog score. In total, those with chemotherapy scored, on average, 105.6 (SD 21.2) while those without scored 107.1 (SD 22.3). The largest difference in mean scores is attributed to the Perceived Cognitive Impairment subsection (scored from 0-72) where those with chemotherapy scored, on average, 57.2 (SD 13.8) and those without scored 58.7 (SD 14.0). Responsible Conduct Of Research: We need to ensure that the privacy of our patients will be protected when using their information from the surveys. Conclusion: Adjuvant chemotherapy was associated with more self-reported cognitive impairment in older breast cancer survivors, even 5-6 years after diagnosis. However, the difference between patients who received chemotherapy versus those who did not was modest, suggesting limited clinical significance. Further research is needed to determine the long-term impact of cancer treatments, particularly in older cancer survivors. Citation Format: Rachel Kim, Kai-Ping Liao, Susan Peterson, Daria Zorzi, Liang Li, Mariana Chavez MacGregor, Sharon Giordano. Cognitive function in older breast cancer survivors after chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7454.

Associations Between Dietary Patterns and Kidney Health Assessed in the Population-Based CHRIS Study Using Reduced Rank Regression

ObjectiveWhile diet plays a key role in CKD management, the potential for diet to impact CKD prevention in the general population is less clear. Using a priori knowledge, we derived disease-related dietary patterns (DPs) through reduced rank regression (RRR) and investigated associations with kidney function, separately focusing on generally healthy individuals and those with self-reported kidney diseases, hypertension or diabetes mellitus. Methods8,686 participants from the population-based Cooperative Health Research in South Tyrol (CHRIS) study were split into a group free of kidney disease, hypertension and diabetes (n=6,133) and a group with any of the three conditions (n=2,553). Diet was assessed through the self-administered GA2LEN food frequency questionnaire (FFQ) and DPs were derived through RRR selecting FFQ-derived sodium, potassium, phosphorus and protein intake as mediators. Outcomes were creatinine-based estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), CKD and microalbuminuria. Multiple linear and logistic models were used to assess associations between RRR-based DPs and kidney outcomes separately in the two analytic groups. ResultsWe identified three DPs, where high adherence reflected high levels of all nutrients (DP1), high potassium-phosphorus and low protein-sodium levels (DP2), and low potassium-sodium and high protein-phosphorus levels (DP3), respectively. We observed heterogeneous associations with kidney outcomes, varying by analytic group and sex. Kidney outcomes were much more strongly associated with DPs than with single nutrients. ConclusionRRR is a feasible approach to estimate disease-related DPs and explore the combined effects of nutrients on kidney health. Heterogeneous associations across kidney outcomes suggest possible specificity to kidney function or damage. In individuals reporting kidney disease, hypertension or diabetes, specific dietary habits were associated with better kidney health, indicating that disease-specific dietary interventions can be effective for disease control.

Abstract P529: Ideal Cardiovascular Health May Mitigate Age-Related Increases in Subclinical Myocardial Damage in US Adults

Background: High-sensitivity cardiac troponins (hs-cTn) levels reflect myocardial damage and increase with age. Even minor elevations in hs-cTn are linked to increased cardiovascular risk. Little data exists on how level of cardiovascular health impacts age-related rises in hs-cTn among individuals in the population. Methods: We conducted a cross-sectional analysis of 6,955 adults aged 20 years or older free of self-reported coronary artery disease and heart failure who participated in the 1999-2004 National Health and Nutrition Examination Survey. Hs-cTnT and hs-cTnI were measured from stored samples. Total cardiovascular health was modeled using the AHA’s Life’s Essential 8 metrics (all variables excluding sleep) and categorized as low, moderate, or high. For the distinct participants within each level of cardiovascular health, we compared average levels (geometric means) of hs-cTn across each decade of age. Using multivariable linear regression, we estimated the percent rise in hs-cTn per decade within each cardiovascular health stratum. Results: The mean age was 45 years, with 54% being female and 72% being White adults. There was a stepwise rise in average levels of hs-cTn per decade, however the difference in average hs-cTn in older age vs young adulthood was least for those with high cardiovascular health, and greater for those with lesser cardiovascular health (Figure). In linear regression, those with high cardiovascular health had lesser percent rise in hs-cTnT per decade than those with moderate and low cardiovascular health (13% vs 19% vs 23%, p interaction &lt;0.001). Similar differences per decade between those with high versus moderate and low cardiovascular health were seen for hs-cTnI (17% vs 19% vs 23%, p interaction = 0.04). Conclusion: Level of cardiovascular health may influence the degree of myocardial damage associated with aging. Mitigation of age-related myocardial damage may be one mechanism underlying the cardiovascular benefits of maintaining ideal cardiovascular health.

Abstract P397: Choline Metabolites Are Associated With Non-Alcoholic Fatty Liver Disease: A Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Non-alcoholic fatty liver disease (NAFLD), a common cause of chronic liver disease, has become increasingly prevalent. Choline deficiency has long been a model for the study of accelerated NAFLD, in preclinical and small-scale human studies. More recently, NAFLD has been associated with choline metabolites betaine (inversely) and trimethylamine N-oxide (TMAO) (positively). There has been a paucity of research on circulating choline metabolites and NAFLD in diverse and population-based cohort studies. Methods: We used data from 2,413 CARDIA participants who did not self-report liver disease or heavy alcohol intake at Y15, had stored plasma available from Y15, and chest computed tomography (CT) measures from Y25. NAFLD was defined as a mean CT-derived liver attenuation score &lt;51 Hounsfield units; severe NAFLD was &lt;40 Hounsfield units. Liquid chromatography mass spectrometry was used to quantify choline, betaine, and TMAO concentrations from stored plasma samples. Plasma metabolite concentrations were standardized for analysis. Plasma TMAO was natural log transformed for normality. Multivariable-adjusted logistic regression models quantified associations between plasma choline metabolites and NAFLD. Results (Table): In fully adjusted models, plasma betaine was inversely associated with NAFLD, and plasma TMAO was positively associated with NAFLD. Plasma choline was not associated with NAFLD in fully adjusted models. Conclusions: Our findings support an inverse association between plasma betaine and NAFLD in a diverse, population-based US cohort, and a positive association between plasma TMAO and NAFLD. Circulating betaine reflects dietary intake of betaine, as well as conversion from choline. TMAO reflects an alternative fate of choline, through metabolism by the gut microbiota. These results contribute to a growing literature on choline metabolism and cardiometabolic risk.

Abstract P234: Prison Inmate Awareness of Heart Disease Status While Incarcerated in State and Federal Prisons, 2016

Background: Heart disease (HD) is the leading cause of death of inmates incarcerated in state prisons in the US, as it is in the general population. However, in 2001-2019 the mortality rate of HD in incarcerated populations was reported to increase, while it decreased in the US population. . This is despite constitutionally mandated access to healthcare. There are few studies assessing healthcare utilization in prison populations. The 2016 Survey of Prison Inmates is exceptional in that it explores utilization across both state and federal prisons, and allows us to explore factors that may contribute to decreased understanding of health status. Methods: This study is a secondary analysis of the 2016 Survey of Prison Inmates collected by the Bureau of Justice Statistics, a cross sectional survey of the state and federal prison population across the United States. Data collection took place from January to October 2016. All participants were above 18 years of age, incarcerated across 1808 state and 193 federal institutions. All analysis was restricted to those with a reported history HD, which included heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems. Awareness of their current heart disease status was operationalized by combining self-reported history and current heart disease status. Results: When asked, 27.9% of survey respondents reported a history of heart disease but denied currently having heart disease. Yet 89.3% of these unaware patients had seen a healthcare provider since incarceration. . Independent of age, those with difficulty walking/climbing stairs or doing activities alone, and older in age (all p&lt;0.01) were more likely to be aware of HD status. Factors including veteran status (OR=0.7; CI: 0.5-0.9), homeless 30 days prior to incarceration (37.8% vs 27.7%; p=0.036) and those experiencing homelessness before 18 years of age (40.4% vs 25.8%; p&lt;0.001) were associated with being unaware of heart disease status. Individuals with ADD/ADHD (prevalence=23.7%) had weaker (non-significant) association between awareness of their heart disease and healthcare utilizing behavior (Mantel-Haenszel test for heterogeneity; p=0.006). Meanwhile, those without ADD/ADHD had nearly 4 times the odds of correctly reporting their heart disease status if they had seen a provider (OR=3.90; CI: 2.32-6.59), compared to those who hadn’t seen one. Those with a history of ADD/ADHD were more likely to report experiencing homelessness prior to age 18 (p&lt;&lt;0.001), 30 days prior to arrest (p=0.002) and 12 months prior to arrest (p&lt;0.001). Conclusions: Awareness was associated with utilizing healthcare since incarceration, but only 72.4% were clear that HD is a chronic condition. The associations between awareness and disability and other life experiences show an influence from socioeconomic status which could inform much-needed health promotion programming.

The PlexiQoL, a patient-reported outcome measure on quality of life in neurofibromatosis type 1-associated plexiform neurofibroma: translation, cultural adaptation and validation into the Dutch language for the Netherlands.

Half of the patients with Neurofibromatosis type 1 (NF1) develop one or more tumours called plexiform neurofibromas, which can have a significant impact on Quality of Life (QoL). The PlexiQoL questionnaire is a disease-specific QoL measure for adults with NF1-associated plexiform neurofibromas. The aim of this study was to adapt and validate a Dutch version of the PlexiQoL for the Netherlands. The PlexiQoL was translated using the dual-panel methodology, followed by cognitive debriefing interviews to assess face and content validity. The psychometric properties were evaluated by administering the questionnaire on two separate occasions to a sample of adults with NF1 and plexiform neurofibromas. Feasibility was evaluated by the presence of floor/ceiling effects. Reliability was assessed by evaluating Cronbach's alpha coefficient and test-retest reliability, using Spearman's rank correlation coefficients. Mann-Whitney U tests were used to check for known group validity. The Nottingham Health Profile (NHP) questionnaire was used as comparator questionnaire to evaluate convergent validity. The translation and cognitive debriefing interviews resulted in a Dutch version of the PlexiQoL that reflected the original concept and underlying semantic meanings of the UK English version. Forty participants completed the validation survey. The Dutch PlexiQoL demonstrated excellent internal consistency (Cronbach's α 0.825) and test-retest reliability (Spearman correlation coefficient 0.928). The questionnaire detected differences in PlexiQoL scores between participants based on self-reported general health and disease severity. Convergent validity was confirmed for relevant NHP subsections. The Dutch PlexiQoL demonstrated excellent psychometric properties and can be reliably used to measure plexiform neurofibroma-related QoL in adults with NF1 in the Netherlands.

Bidirectional associations between sleep quality/duration and multimorbidity in middle-aged and older people Chinese adults: a longitudinal study

BackgroundMultimorbidity and sleep disorder possess high incidence rates in the middle-aged and older people populations, posing a significant threat to quality of life and physical and mental health. However, investigators have previously only analysed the unidirectional association between sleep status and multimorbidity. We aimed to investigate bidirectional associations between sleep quality or duration and multimorbidity in middle-aged and older Chinese adults from a longitudinal perspective.MethodWe enrolled a total of 9823 participants 45 years and older from the China Health and Retirement Longitudinal Study from 2015 to 2018 in our study. Multimorbidity was defined as two or more coexisting chronic diseases in the same individual based on 14 self-reported disease questions. Sleep quality was classified as “good” (restless < 1 day per week) and “poor” (restless ≥ 1 days per week); and sleep duration was divided into short (< 6 h), medium (6–9 h), and long (> 9 h). The bidirectional association between multimorbidity and sleep condition was examined using multivariate logistic regression models with adjustments for covariates.ResultsIndividuals with poor sleep quality showed a significantly higher prevalence of multimorbidity in the future. The adjusted OR (95% CI) values of individuals with poor sleep quality with respect to developing two diseases, three diseases, and ≥ 4 diseases were 1.39 (1.19, 1.63), 1.56 (1.23, 2.03), and 2.36 (1.68, 3.33), respectively. In addition, individuals with multimorbidity exhibited a significantly higher risk of poor sleep quality in the future. Short sleep duration led to multimorbidity in the future (OR = 1.49; 95 CI%, 1.37–1.63), while multimorbidity contributed to short sleep duration (< 6 h) in the future (OR = 1.39; 95% CI, 1.27–1.51) after full adjustment.ConclusionsThere was a bidirectional association between sleep quality or short sleep duration and multimorbidity in middle-aged and older Chinese adults. We recommend that greater attention be given to clinical management among adults with sleep disorders or physical multimorbidities.

Adverse childhood experiences and subsequent physical and mental health among young adults: Results from six universities in China

Research has shown that individuals with adverse childhood experiences (ACEs) are more likely to encounter heightened risks of physical and psychological challenges later in life. However, limited research has explored the comprehensive impact on the physical and mental health of young adults. Thus, we conducted a study to investigate the associations of ACEs with the physical and mental health of 18,723 college students in China. Their physical and mental health status was assessed using self-perceived health assessments, self-reported disease diagnoses, and the Generalized Anxiety Disorder-7-item scale. Results showed that 82.6 % of participants had experienced at least one ACE, with 10.7 % reporting exposure to four or more ACEs. Compared to participants with low ACEs exposure (≤ 1), participants with high ACEs exposure (≥ 4) had a nearly twofold increase in the odds of cardiometabolic diseases (OR [95 % CI] = 2.06 [1.55-2.74]) and fractures (2.32 [1.88-2.87]). Additionally, individuals with high ACE exposure exhibited a threefold increased odds of severe anxiety symptoms (3.78 [2.59-5.51]) and bipolar disorder/schizophrenia (3.38 [2.18-5.23]). These findings highlight ACEs as a significant risk factor for poor physical and mental health among young adults. Targeted support and interventions for individuals with multiple ACEs may help mitigate their long-term disease burden.