Population Subgroups Research Articles

Hormone replacement therapy is associated with improved cognition and larger brain volumes in at-risk APOE4 women: results from the European Prevention of Alzheimer’s Disease (EPAD) cohort

BackgroundThe risk of dementia is higher in women than men. The metabolic consequences of estrogen decline during menopause accelerate neuropathology in women. The use of hormone replacement therapy (HRT) in the prevention of cognitive decline has shown conflicting results. Here we investigate the modulating role of APOE genotype and age at HRT initiation on the heterogeneity in cognitive response to HRT.MethodsThe analysis used baseline data from participants in the European Prevention of Alzheimer’s Dementia (EPAD) cohort (total n= 1906, women= 1178, 61.8%). Analysis of covariate (ANCOVA) models were employed to test the independent and interactive impact of APOE genotype and HRT on select cognitive tests, such as MMSE, RBANS, dot counting, Four Mountain Test (FMT), and the supermarket trolley test (SMT), together with volumes of the medial temporal lobe (MTL) regions by MRI. Multiple linear regression models were used to examine the impact of age of HRT initiation according to APOE4 carrier status on these cognitive and MRI outcomes.ResultsAPOE4 HRT users had the highest RBANS delayed memory index score (P-APOE*HRT interaction = 0.009) compared to APOE4 non-users and to non-APOE4 carriers, with 6–10% larger entorhinal (left) and amygdala (right and left) volumes (P-interaction= 0.002, 0.003, and 0.005 respectively). Earlier introduction of HRT was associated with larger right (standardized β= −0.555, p=0.035) and left hippocampal volumes (standardized β= −0.577, p=0.028) only in APOE4 carriers.ConclusionHRT introduction is associated with improved delayed memory and larger entorhinal and amygdala volumes in APOE4 carriers only. This may represent an effective targeted strategy to mitigate the higher life-time risk of AD in this large at-risk population subgroup. Confirmation of findings in a fit for purpose RCT with prospective recruitment based on APOE genotype is needed to establish causality.

The Growing Intergenerational Housing Wealth Divide: Drivers And Interactions In Australia

ABSTRACT This paper unpacks the drivers of growing intergenerational housing wealth inequality in Australia. We also account for the multidimensional nature of housing wealth divides by examining the interaction between age and other divides. We find that the Australian intergenerational housing wealth gap widened from 161% in 1997–98 to 234% in 2017–18, favouring the older cohort. This was driven by lower rates of homeownership and lower property value growth among younger cohorts, with the relative lack of homeownership access the more significant driver. However, higher rates of couple formation and tertiary education amongst the young mitigated a further widening of the gap. The intergenerational housing wealth gap is exacerbated within specific population subgroups. The growing housing wealth gap between the income-poor young and income-rich old has been particularly alarming, climbing from 532% to 1230% over two decades. We discuss implications for policies seeking to alleviate intergenerational tensions in housing markets.

Whole-genome resequencing reveals genetic diversity and selection characteristics of dairy goat.

The dairy goat is one of the earliest dairy livestock species, which plays an important role in the economic development, especially for developing countries. With the development of agricultural civilization, dairy goats have been widely distributed across the world. However, few studies have been conducted on the specific characteristics of dairy goat. In this study, we collected the whole-genome data of 89 goat individuals by sequencing 48 goats and employing 41 publicly available goats, including five dairy goat breeds (Saanen, Nubian, Alpine, Toggenburg, and Guanzhong dairy goat; n = 24, 15, 11, 6, 6), and three goat breeds (Guishan goat, Longlin goat, Yunshang Black goat; n = 6, 15, 6). Through compared the genomes of dairy goat and non-dairy goat to analyze genetic diversity and selection characteristics of dairy goat. The results show that the eight goats could be divided into three subgroups of European, African, and Chinese indigenous goat populations, and we also found that Australian Nubian, Toggenburg, and Australian Alpine had the highest linkage disequilibrium, the lowest level of nucleotide diversity, and a higher inbreeding coefficient, indicating that they were strongly artificially selected. In addition, we identified several candidate genes related to the specificity of dairy goat, particularly genes associated with milk production traits (GHR, DGAT2, ELF5, GLYCAM1, ACSBG2, ACSS2), reproduction traits (TSHR, TSHB, PTGS2, ESR2), immunity traits (JAK1, POU2F2, LRRC66). Our results provide not only insights into the evolutionary history and breed characteristics of dairy goat, but also valuable information for the implementation and improvement of dairy goat cross breeding program.

CT-Based Radiomic Score: A Risk Stratifier in Far-Advanced Gastric Cancer Patients

To prolong the survival, the value of a computed tomography-based radiomic score (RS) in stratifying survival and guiding personalized chemotherapy strategies in far-advanced gastric cancer (FGC) was investigated. This retrospective multicenter study enrolled 283 FGC patients (cT4a/bNxM0-1) from three centers. Patients from one center were randomly divided into the training (n=166) and internal validation (n=83) cohorts, whereas the external validation cohort (n=34) consisted of patients from the two other centers. The RS was calculated for each patient to predict progression-free survival (PFS). Features from the primary tumor and main metastasis (peritoneum, liver, and lymph node) were integrated in the training cohort and then validated for its ability to stratify PFS and overall survival (OS) in the validation cohort. The association between the RS and efficacy of neoadjuvant intraperitoneal and systemic (NIPS) therapy was also explored. The RS demonstrated a favorable prognostic ability to predict PFS in all cohorts (training: C-index 0.83, 95% confidence interval [CI]: 0.788-0.872; internal validation: C-index 0.75, 95% CI: 0.682-0.818; external validation: C-index 0.76, 95% CI: 0.669-0.851; all p < 0.05), as well as an excellent ability to stratify the PFS and OS in both the whole population and metastatic subgroups (p < 0.05). Patients with a low score were more likely to undergo surgery after perioperative chemotherapy (p < 0.05). Furthermore, only high-scoring patients with peritoneal metastasis benefited from NIPS. The RS may be an effective risk stratifier for the outcomes of FGC patients and may be used to select patients who can benefit from NIPS therapy.

Association between ambient cold exposure and mortality risk in Shandong Province, China: Modification effect of particulate matter size.

Numerous studies have reported the modification of particulate matters (PMs) on the association between cold temperature and health. However, it remains uncertain whether the modification effect may vary by size of PMs, especially in Shandong Province, China where the disease burdens associated with cold temperature and PMs are both substantial. This study aimed to examine various interactive effects of cold exposure and ambient PMs with diameters ≤1/2.5 μm (PM1 and PM2.5) on premature deaths in Shandong Province, China. In the 2013-2018 cold seasons, data on daily mortality, PM1 and PM2.5, and weather conditions were collected from the 1822 sub-districts of Shandong Province. A time-stratified case-crossover study design was performed to quantify the cumulative association between ambient cold and mortality over lag 0-12 days, with a linear interactive term between temperature and PM1 and PM2.5 additionally added into the model. The mortality risk increased with temperature decline, with the cumulative OR of extreme cold (-16.9°C, the 1st percentile of temperature range) being 1.83 (95% CI: 1.66, 2.02), compared with the minimum mortality temperature. The cold-related mortality risk was 2.20 (95%CI: 1.83, 2.64) and 2.24 (95%CI: 1.78, 2.81) on high PM1 and PM2.5 days, which dropped to 1.60 (95%CI: 1.39, 1.84) and 1.60 (95%CI: 1.37, 1.88) on low PM1 and PM2.5 days. PM1 showed greater modification effect for per unit concentration increase than PM2.5. For example, for each 10?g/m3 increase in PM1 and PM2.5, the mortality risk associated with extreme cold temperature increased by 7.6% (95% CI: 1.3%, 14.2%) and 2.6% (95% CI: -0.7%, 5.9%), respectively. The increment of smaller PMs' modification effect varied by population subgroups, which was particularly strong in the elderly aged over 75 years and individuals with middle school education and below. Specific health promotion strategies should be developed towards the greater modification effect of smaller PMs on cold effect.

Hepatitis E Virus Seroprevalence Indicated a Significantly Increased Risk Selectively in Patients with Gastric Cancer among 17 Common Malignancies.

The impact of hepatitis E virus (HEV) infection on cancer development has been poorly investigated. This study aimed to explore the relationship between HEV seroprevalence and cancer risks and to identify high cancer risk subgroups in HEV-exposed populations. HEV seroprevalence status was determined in cancer and non-cancer subjects. Logistic regression and sensitivity analyses were used to assess the relationship between HEV antibody seropositivity and cancer risk for 17 cancer types. Additionally, interaction analyses were applied to interpret the association of HEV seroprevalence and other cancer risk factors. Of the enrolled 4948 cancer and 4948 non-cancer subjects, cancer subjects had a higher anti-HEV seropositivity than non-cancer subjects (46.36% vs. 32.50%, p &lt; 0.01). However, this divergency varied in degrees across different cancer types. Additionally, HEV seroprevalence was associated with cancer risk in young males (OR: 1.64, 95% CI: 1.19-2.27, p &lt; 0.01). Remarkably, a significant association between HEV seroprevalence and cancer risk was observed only in gastric cancer patients (OR: 1.82, 95% CI: 1.07-3.09, p = 0.03). HEV seroprevalence was associated with cancer risk selectively in gastric cancer patients and young males, suggesting that cancer screening, particularly gastric cancer, should be regularly performed in young males with a history of HEV exposure.

A machine-learning approach to estimating public intentions to become a living kidney donor in England: Evidence from repeated cross-sectional survey data.

Living kidney organ donors offer a cost-effective alternative to deceased organ donation. They enable patients with life-threatening conditions to receive grafts that would otherwise not be available, thereby creating space for other patients waiting for organs and contributing to reducing overall waiting times for organs. There is an emerging consensus that an increase in living donation could contribute even more than deceased donation to reducing inequalities in organ donation between different population sub-groups in England. Increasing living donation is thus a priority for National Health Service Blood and Transplant (NHSBT) in the United Kingdom. Using the random forest model, a machine learning (ML) approach, this study analyzed eight waves of repeated cross-sectional survey data collected from 2017 to 2021 (n = 14,278) as part of the organ donation attitudinal tracker survey commissioned by NHSBT in England to identify and help predict key factors that inform public intentions to become living donors. Overall, around 58.8% of the population would consider donating their kidney to a family member (50.5%), a friend (28%) or an unknown person (13.2%). The ML algorithm identified important factors that influence intentions to become a living kidney donor. They include, in reducing order of importance, support for organ donation, awareness of organ donation publicity campaigns, gender, age, occupation, religion, number of children in the household, and ethnic origin. Support for organ donation, awareness of public campaigns, and being younger were all positively associated with predicted propensity for living donation. The variable importance scores show that ethnic origin and religion were less important than the other variables in predicting living donor intention. Factors influencing intentions to become a living donor are complex and highly individual in nature. Machine learning methods that allow for complex interactions between characteristics can be helpful in explaining these decisions. This work has identified important factors and subgroups that have higher propensity for living donation. Interventions should target both potential live donors and recipients. Research is needed to explore the extent to which these preferences are malleable to better understand what works and in which contexts to increase live organ donation.

Preparing for Group B Streptococcus vaccine. Attitudes of pregnant women in two countries

ABSTRACT Group B Streptococcus (GBS) vaccines, designed to be given to pregnant women, are in clinical trials. There is an opportunity to conduct preparatory research now to understand the drivers of and barriers to GBS vaccine acceptance. This will enable targeted interventions so that delays in vaccine uptake might be avoided. A multicenter, mixed-methodology, cross-sectional study evaluated the acceptability of a hypothetical GBS vaccine among pregnant women in two countries with differing health systems. Pregnant women in Philadelphia, US, and Dublin, Ireland, completed an electronic survey and a Discrete Choice Experiment. Five hundred and two women were included in the final analysis. Fifty-three percent of US and 30% of Irish participants reported both awareness and understanding of GBS. The median likelihood score for vaccine receipt (measured on a 10-point scale) was 9 (US: 9 (IQR 7–10), IRL: 9 (IQR 6–10)). Among the US participants, identifying as Black or African American was associated with a lower likelihood of vaccine receipt. Possession of a college degree was associated with increased likelihood of vaccine receipt. Perceived infant benefit was the most important driver of GBS vaccine acceptance. Safety concerns about a novel vaccine was the most prominent barrier identified. Good GBS vaccine uptake is achievable through strong messaging that highlights vaccine safety and the potential infant benefits. Preparation for vaccine implementation should include efforts to increase awareness among pregnant women about GBS infection and a continued focus on improving acceptability of currently recommended maternal vaccines, particularly in population subgroups with low uptake of maternal immunizations.

The Termination of Publicly Funded Private School Contracts: Supply and Demand Side Effects

ABSTRACT We evaluate the demand and supply side effects of a policy which cuts funding to a significant portion of publicly funded private classes in Portugal, Contratos de Associação (AC), in which students do not pay tuition fees and are under the same admission criteria as in Public Schools – i.e., these private schools cannot select students based on their socioeconomic status or prior achievement. This policy established that from 2016/17, Private school classes would no longer receive Contratos de Associação funding if the government deemed that there were enough nearby Public Schools with capacity to absorb the new student cohorts. Compared to the pre-reform student cohort, we find that affected students changed the demand patterns for different types of schools: both the number of Public school classes and regular Full-Fee Private School classes increased, but the rise in the former was larger in absolute terms. Nevertheless, this pattern of movements was heterogenous across different sub-groups of the student population. While non-low-income students switched both to Public and Private school classes, we verify practically a one-to-one movement of the low-income student cohort from AC schools to Public schools only. On the supply-side, we find that the decrease in AC schools was not fully compensated by the increase of schools that are now under different Private School systems and that some of these schools later shut down.

COVID-19 and women's mental health during a pandemic – A scoping review

The novel coronavirus disease (COVID-19) has infected more than 10 million people globally, and it caused more than 500 thousand deaths. Researchers have highlighted the need for early detection and intervention for psychological ill effect of the pandemic on various population subgroups. Women may be more vulnerable in such a crisis phase. This review addresses the mental health needs of women and the kind of interventions needed to cater to their various psychological issues. All existing literature was searched using PubMed, Google Scholar, and Medline databases for articles published on mental health aspects of women during COVID-19 pandemic. Only English language articles published till June 15, 2020, were considered for the review. Data were extracted by the authors from the selected articles, and the findings were synthesized in a narrative format. From the available literature, following themes were identified for further discussion: sexual health and contraception, pregnancy, lactation, domestic abuse, female healthcare workers, women with pre-existing mental illness, women with substance use disorders, homeless women, refugees, and professional sex workers. Studies have reported a higher burden of mental health issues in females than male counterparts and an increase in domestic violence and crises for those at-risk (such as refugees and women with pre-existing illnesses). Women mental health is compromised in many aspects due to COVID-19 pandemic. Findings stress upon the increased need for early detection and prompt intervention for women in the community to alleviate the long-term psychological consequences of this pandemic.

Assessment of eHealth literacy to reduce financial toxicity and improve shared decision-making in cancer patients: A cross-sectional study.

This study aimed to investigate the associations between eHealth literacy, preferences for financial decision-making, and financial toxicity (FT) in a sample of Chinese cancer patients. Eligible cancer patients were invited to participate in a cross-sectional survey from January to April 2021. Three measures (eHealth literacy scale, control preference scale, and COST) were used to analyze patients' eHealth literacy, decisional preferences, and FT, respectively. Wilcoxon signed-rank test and Kruskal-Wallis H test assessed the differences between population subgroups. Binary logistic and multivariate linear regression models were used to assess the relationships between eHealth literacy, decisional preferences, and FT. A total of 590 cancer patients completed the questionnaire. We found that high FT was associated with poor ECOG performance, severe cancer stage, and longer cancer duration. Patients who preferred to adopt collaborative attitude toward decision-making showed a significantly higher eHealth literacy. However, there was an inverse relationship between eHealth literacy and a patient-driven attitude toward decision-making in female cancer patients. Regression analysis indicated that patients who were highly educated and actively employed might report a higher eHealth literacy. A significant relationship was found between high eHealth literacy and low FT. However, this relationship became insignificant when the background characteristics of cancer patients were taken into account. A relationship between enhanced eHealth literacy, preference for collaborative decision-making, and low risk of FT is identified. Interventions to improve patients' ability to use quality and reliable web-based information on cancer care should be encouraged.

Sedative-hypnotic Co-prescribing with Opioids in a Large Network of Community Health Centers.

When prescribed with opioids, sedative-hypnotics substantially increase the risk of overdose. The objective of this paper was to describe characteristics and trends in opioid sedative-hypnotic co-prescribing in a network of safety-net clinics serving low-income, publicly insured, and uninsured individuals. This retrospective longitudinal analysis of prescription orders examined opioid sedative-hypnotic co-prescribing rates between 2009 and 2018 in the OCHIN network of safety-net community health centers. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (eg, zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. From 2009 to 2018, 240 587 patients had ≥1 opioid prescriptions. Most were White (65%), female (59%), and had Medicaid insurance (43%). One in 4 were chronic opioid users (25%). During this period, 55 332 (23%) were co-prescribed a sedative-hypnotic. The prevalence of co-prescribing was highest for females (26% vs 19% for males), non-Hispanic Whites (28% vs 13% for Hispanic to 20% for unknown), those over 44 years of age (25% vs 20% for <44 years), Medicare insurance (30% vs 21% for uninsured to 22% for other/unknown), and among those on chronic opioid therapy (40%). Co-prescribing peaked in 2010 (32%) and declined steadily through 2018 (20%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained elevated for those with chronic opioid use (27%), non-Hispanic Whites (24%), females (23%), and those with Medicare (23%) or commercial insurance (22%). Co-prescribed sedative-hypnotic use has declined steadily since 2010 across all demographic subgroups in the OCHIN population. Concurrent use remains elevated in several population subgroups.

Depressive symptoms occurring after stroke by age, sex and socioeconomic status in six population-based studies: Longitudinal analyses and meta-analyses.

Population-based cohort studies that examined the effects of stroke on depressive symptoms in elderly participants with and without stroke in different countries/regions had yielded scant evidence. The objectives of this multi-cohort study were to identify the relationships between stroke and depressive symptoms and to assess the pooled risks of depressive symptoms in total populations and in stratified samples by age, sex, education levels, and total household income in large-scale studies. The associations in the overall participants in the six cohorts were examined using univariate and multivariable Cox proportional hazards models. The relationships in the population subgroups of the cohorts were determined using multivariable Cox regression models. Crude hazard ratios (HRs) were estimated, and adjusted or time-varying HRs were calculated and then pooled by meta-analyses. During a median follow-up time of 3.8 (interquartile range [IQR]: 2.2-4.5) -7.9 (IQR: 4.0-8.0) years, 18267 participants out of 62150 participants developed incident cases of depressive symptoms. In the univariate Cox regression analyses, stroke was consistently linked to depressive symptoms across all studies, with HRs ranging from 1.39 (95% confidence interval [CI]: 1.04-1.85) to 1.84 (95% CI: 1.38-2.46). Adjusted HRs varied between 1.19 (95% CI: 0.89-1.59) and 1.48 (95% CI: 1.00-1.98), and time-varying HRs remained largely unchanged. According to the meta-analysis of overall HRs, stroke survivors were more likely than non-survivors to develop depressive symptoms (pooled HR: 1.35 (95% CI: 1.26-1.44)). In general, stroke significantly increased the risk of depressive symptoms in total and stratified participants in most cohorts. In the future, extensive research will be needed to assess the variations in associations between various population subgroups.

Neighborhood divides: Where you live matters for commuting and its efficiency

Excess commuting reflects a cits overall commuting efficiency by quantifying the proportion of non-optimal commute that would be avoided if resident workers could freely swap houses or jobs in a given urban form. This framework has been widely used to evaluate urban land use and transportation policy decision-makings. One major methodological limitation in the excess commuting literature is that most existing studies establish on an oversimplified assumption of homogeneous resident workers/jobs, which neglects the complexity of residential (and employment) location choices. To fill this gap, this research develops a methodology to measure excess commuting across worker subgroups differentiated by residential neighborhood type, which captures the comprehensive socioeconomic profiles of workers defined based on multiple attributes. Based on a cross-sectional study of Portland, Boston, New Orleans, and Detroit, it is found that the traditional method overestimates the commuting benchmarks and causes biased evaluation of commuting efficiency performance. Moreover, this research reveals significant disparities in excess commuting across different neighborhood types and identifies three representative subgroups of distinct excess commuting patterns, which are the traditional suburban subgroup, new starts subgroup, and socioeconomically disadvantaged subgroup. With this proposed methodology, more effective and heterogeneous policies targeting different population subgroups could be developed. • Measures excess commuting across worker subgroups by residential neighborhood type • Performs a cross-sectional study of Portland, Boston, New Orleans, and Detroit • The traditional method overestimates commuting benchmarks. • Reveals significant disparities in excess commuting across different neighborhood types • Identifies three representative subgroups of distinctive excess commuting patterns

Status of Hypertension Control in Urban Slums of Central India: A community Health Worker-Based Two-Year Follow-Up.

Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Relationship between historical developments in the percentages of low birthweight and fetal mortality in Spain

ObjectiveTo document the differences in low birthweight in different population subgroups and to analyze its possible relationship with fetal mortality rates in Spain. MethodWe used the microdata on live births and stillbirths since 1975 to 2020 from the Spanish National Statistics Institute to examine differentials in delivering a low birthweight controlling for different sociodemographic variables and to determine the relationship between low birthweight and fetal mortality. No statistical analysis was necessary beyond the calculation of percentages and rates. ResultsThe data at our disposal for Spain confirm the historical increase in the incidence of low birthweight and allow us to link trends in low birthweight with a decrease in the fetal mortality rate. When fetal mortality is high, the incidence of low birthweight is low, given that a natural selection effect takes place. ConclusionsThe surprising historical increase in the incidence of low birthweight in Spain can be explained by the improvement in mortality rates. As more fetuses of lower gestational age are born alive, cases of low birthweight also increase.

Abstract PR008: Landscape of actionable mutations and outcomes in metastatic non-small cell lung cancer across age, sex, and race

Abstract Introduction: Lung cancer is the leading cause of cancer-related death due to frequent diagnosis at an advanced stage, especially among underserved populations. Given the marked heterogeneity in disease course for metastatic non-small cell lung cancer (mNSCLC), we sought to further explore its distribution of genomic alterations and outcomes across population subgroups. Methods: Clinicogenomics data were downloaded from the MSK-MET cohort study, one of the largest publicly accessible databases of metastatic cancer featuring 25775 patients in the February 2022 release. Tumor mutation burden (TMB) was quantified as number of non-synonymous mutations per megabase (Mb) sequenced. Categorical variables were compared using the χ2-test. Analysis of overall survival (OS) was performed using Cox proportional hazards regression. Results: Between 2013 and 2020, tumor and matched-normal samples from 4710 adult patients (58% female) with mNSCLC (86% adenocarcinoma) were obtained for genomic characterization. Median age at diagnosis was 67 years (IQR 59–73) and median OS was 38 months (95% CI 34–40 months). Smoking status and treatment history were unavailable. Patients self-identified as non-Hispanic white (76%), Asian (10%), Black (5%), Hispanic (4%), Native American (1%), or none of the above (1%). Compared to patients of other races, Hispanic patients were more likely to be diagnosed with mNSCLC prior to age 50 (17% vs. 7%, P&amp;lt;0.001); Asian patients had a higher frequency of EGFR mutations (56% vs. 22%, P&amp;lt;0.001), lower frequency of KRAS mutations (11% vs. 32%, P&amp;lt;0.001), and longer OS (HR 0.84, 95% CI 0.72–0.98, P=0.026); Black patients had greater TMB (9% vs. 5% with ≥20 mutations per Mb, P=0.019). Every actionable mutation was more common in non-squamous cell carcinoma (SCC) than SCC, except ROS1 fusions (4% vs. 7%, P&amp;lt;0.001). Across and within each race group, men were more likely to possess no actionable mutations compared to women (29% [range 22–67%] vs. 16% [range 5–20%], P&amp;lt;0.05). In multivariable analysis, male sex, diagnosis earlier than age 50 or later than age 70, non-adenocarcinoma histology, greater TMB, and absence of actionable mutations involving EGFR, ALK, MET, or RET were independently associated with worse OS (P&amp;lt;0.05). Conclusions: In this large clinicogenomic analysis of mNSCLC, men were more likely to have no actionable mutations and worse OS. Diagnosis prior to age 50 (most common among Hispanic patients) and greater TMB (most common among Black patients) also independently conferred worse OS. These findings highlight the wide heterogeneity of molecular features and outcomes in mNSCLC across age, sex, and race, underscoring the need to further individualize workup and management. Citation Format: David C. Qian, Conor E. Steuer, Sibo Tian, Jennifer W. Carlisle, Ticiana A. Leal, Madhusmita Behera, Jeffrey D. Bradley, Suresh S. Ramalingam, Kristin A. Higgins. Landscape of actionable mutations and outcomes in metastatic non-small cell lung cancer across age, sex, and race [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR008.

Barriers to integrated primary care and specialty mental health services: Perspectives from Latinx and non-Latinx White primary care patients.

Significant disparities in access to mental health care exist in the current mental health system; integrated primary care (IPC) offers an alternative model of service delivery with initial evidence for reducing disparities. Little is known about whether, and how, IPC reduces barriers to mental health services. Here we report on a set of three studies using mixed methodology to explore the perceptions of potential recipients of care regarding barriers to accessing mental health treatment by setting (IPC or specialty mental health [SMH]) and ethnicity (Latinx or non-Latinx White). In Study 1, a main effect of setting indicated IPC patients perceived fewer barriers to accessing IPC than SMH. A setting by ethnicity interaction revealed Latinx patients perceived greater barriers to SMH than non-Latinx White patients. In Study 2, data from qualitative interviews suggested IPC patients found behavioral health treatment in IPC to be accessible and satisfactory. In Study 3, a non-treatment-seeking sample did not endorse a difference in barriers by setting or ethnicity. Overall, it appears IPC patients perceive behavioral health treatment delivered in primary care to be satisfactory, beneficial, and successful in reaching individuals with mental health need who otherwise may not receive care. Non-treatment-seeking individuals with lower psychiatric distress did not identify a difference in barriers between IPC and SMH settings. Findings are consistent with the potential of the IPC setting for reducing barriers to care, although key elements of IPC may need to be addressed to increase acceptability across all population subgroups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social divisions and risk perception drive divergent epidemics and large later waves.

During infectious disease outbreaks, individuals may adopt protective measures like vaccination and physical distancing in response to awareness of disease burden. Prior work showed how feedbacks between epidemic intensity and awareness-based behaviour shape disease dynamics. These models often overlook social divisions, where population subgroups may be disproportionately impacted by a disease and more responsive to the effects of disease within their group. We develop a compartmental model of disease transmission and awareness-based protective behaviour in a population split into two groups to explore the impacts of awareness separation (relatively greater in- vs. out-group awareness of epidemic severity) and mixing separation (relatively greater in- vs. out-group contact rates). Using simulations, we show that groups that are more separated in awareness have smaller differences in mortality. Fatigue (i.e. abandonment of protective measures over time) can drive additional infection waves that can even exceed the size of the initial wave, particularly if uniform awareness drives early protection in one group, leaving that group largely susceptible to future infection. Counterintuitively, vaccine or infection-acquired immunity that is more protective against transmission and mortality may indirectly lead to more infections by reducing perceived risk of infection and therefore vaccine uptake. Awareness-based protective behaviour, including awareness separation, can fundamentally alter disease dynamics. Social media summary: Depending on group division, behaviour based on perceived risk can change epidemic dynamics & produce large later waves.

Effects of the Affordable Care Act Medicaid Expansions on Mental Health During the COVID-19 Pandemic in 2020-2021.

To examine whether previous Affordable Care Act (ACA) Medicaid expansions had an added effect on the mental health of low-income adults during the COVID-19 pandemic in 2020 and 2021. We use the 2017-2021 Behavioral Risk Factor Surveillance System (BRFSS) data. We use an event study difference-in-differences model to compare the number of days in poor mental health in the past 30 days and the likelihood of frequent mental distress among 18 to 64 year old individuals with household incomes below 100% of the federal poverty level who participated in BRFSS in one of the surveys from 2017 to 2021 and who resided in states that expanded Medicaid by 2016 or states that had not expanded by 2021. We also examine the heterogeneity of the expansion effects across subpopulation groups. We find some evidence that the Medicaid expansion was associated with better mental health during the pandemic for adults younger than 45, females, and non-Hispanic Black and other non-Hispanic non-White individuals. There is some evidence of an added benefit to mental health from Medicaid expansion status during the pandemic for some subgroups among low-income adults, suggesting potential health benefits from Medicaid eligibility during public health and economic crises.