Texas Department Of State Health Services Research Articles

FRI520 Disparities In Available Surgeons And Specialty Physicians Providing Endocrine-related Health Care Coverage To Populations In South Texas And The Rio Grande Valley

Abstract Disclosure: V. Alia: None. E.W. Alvarado: None. E.M. Diaz: None. H. Reinhart: None. Introduction: The Rio Grande Valley and South Texas is home to some of the most medically underserved populations in the nation, with gaps in health care ranging from low rates of adequately insured individuals, to the amount of primary and specialty healthcare services available [1]. Populations living in these areas near the Texas-Mexico border have some of the highest incidence of metabolic and endocrine-related disease in the U.S., while paradoxically having a large deficit in endocrine-specialists available to meet the medical and surgical needs of the community [1,2,3]. Methodology: We analyzed data from the National Center for Health Workforce Analysis (NCHWA), as well as data from the Texas department of state health services (TDSHS) to determine current and projected endocrine-related healthcare coverage needs in South Texas and the Rio Grande Valley (RGV) between 2013 to 2025 and 2018 to 2032 respectively [2,3]. Results: Analysis of the data provided by the NCHWA revealed that by 2025 the southern region of the U.S. is projected to have the largest shortage of full-time equivalent (FTE) surgical specialty physicians in the entire country with a deficit of 10,210 [3]. ​Additionally, data displaying critical-shortages provided by the TDSHS stated that in 2018 the percent demand met (PDM) for FTE endocrinologists in South Texas was only 76.6% with a projected decline to 65.7% by 2032 [2]. Noteworthy data from the TDSHS also stated that in 2018 the RGV specifically had a significant deficit in endocrinologists with a PDM of only 53.6%, while simultaneously having a projected increase to 66.4% by 2032 [2]. The TDSHS classified specialties in South Texas to be critically short when they are projected to have a deficit of ≥100 FTEs and <80% of the physician demand being met [2]. Conclusion: The collection of data analyzed led us to effectively identify significant disparities in endocrine-related healthcare coverage in the South Texas region, specifically the RGV. Additionally, new multidisciplinary healthcare institutions built in the RGV are striving to improve patient access to primary and subspecialty care by recruiting and training physicians in the area, but further action is still needed to counteract the described critical-shortages in physicians responsible for the long-term management of endocrine-related diseases. Presentation: Friday, June 16, 2023

Longstanding Rural-Urban Disparities Exacerbated by COVID-19: The Experiences of Older Residents in West Texas: Lessons Learned

Purpose: The primary objective of this study was to examine differences in COVID-19 testing, diagnosis, symptoms, preventive measures, and healthcare resources and services between urban- and rural-dwelling older adults of the West Texas region. Methods: Data from surveys of 303 adult urban and rural residents (>40 years old) between June 2020 and January 2021 were conducted. County-level data from the Texas Department of State Health Services (TDSHS) were analyzed for the period between March 2020 and February 2021. Findings: County-level data from TDSHS revealed greater access to COVID-19 testing and higher case numbers yet lower COVID-19 fatalities among urban residents. On the contrary, rural counties had fewer overall COVID-19 cases, less access to COVID-19 testing, and higher COVID-19 fatalities. Conclusion: The COVID-19 pandemic exasperated the long-standing healthcare disparities documented between rural and urban neighborhoods, resulting in devastating consequences in rural areas suffering from poor healthcare infrastructure. Findings revealed disparities in COVID-19 experiences among urban and rural communities, which highlight the need for strategies aimed at improving healthcare access in rural areas through telemedicine and other innovative approaches.

Abstract PO-075: Barriers and facilitators to recruiting research study participants from community-based HIV/AIDS service organizations: Lessons learned during the COVID-19 pandemic

Abstract Background: People living with HIV (PLWH) have a compromised immune system, which increases their risk for developing AIDS-defining cancers (ADC; i.e., Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer) and non-AIDS-defining cancers (NADC; i.e., anal, liver, lung, oral, vaginal, and vulvar cancers). Although evidence- based prevention practices (EBPPs) such as smoking cessation, vaccination (hepatitis B, human papillomavirus), and screening tests (cervical, lung) can reduce ADC and NADC risk across the cancer continuum, disease burden persists among PLWH. Community-based HIV/AIDS service organizations (ASOs) are an ideal setting in which to adopt, implement, and maintain EBPPs because they are able to reach marginalized PLWH who may not be engaged in HIV care due to a complex array of healthcare access barriers such homeless, substance use (also a risk factor for some NADCs), etc. Unfortunately, health risk and healthcare access barriers among PLWH have likely been exacerbated during the COVID-19 pandemic. Objective: To describe barriers and facilitators to recruiting female ASO clients to participate in a cross- sectional study during a pandemic. Methods: We used the Texas Department of State Health Services (DSHS) list of HIV/STD Service Providers (n = 147, last updated on 6/18/2020) and the CDC National Prevention Information Network HIV/AIDS Service Finder (n = 642 on 8/2/2020) to create a list of ASOs located in Texas (n = 789). HHS (hiv.gov) and HRSA (hab.hiv.gov) data sources were not used because statewide searches were not an option or could only be done within a 100-mile radius. ASOs that did not have an email address (N = 657 / 789, 83%) were excluded. The Dillman Tailored Design Method for online surveys was used to send up to five recruitment emails to 132 of 789 (17%) ASOs over a four-week period in July/August 2020. A content analysis approach was used to categorize various types of non- response. Results: According information on the Texas DSHS website (last updated 6/23/2020), 24% (n = 35 / 147) of ASOs remained open, while more than half (60%; n = 88 / 147) were open with limitations during COVID-19. Phone, website, and Facebook were the preferred contact methods during the pandemic (none provided an email address). Of the 132 of 789 total (147 Texas DSHS + 642 CDC NPIN) that we attempted to recruit via email, only 6 individuals (5%; n = 6 / 132) had responded as of 8/3/2020. Most were non-responders (71%; n = 94 / 132). Other types of non- response included 22% undeliverable (n = 29 / 132) and delivery was delayed for 2% (n = 3 / 102). Conclusions: Although we used the Dillman method for online surveys, our response rate was very dismal. Since many ASOs were affected by COVID-19, it is reasonable to assume that our low response rate was attributed in part to the pandemic. Our recruitment experience underscores the importance of building strong community partnerships and contextualizing non-response to online surveys, especially during a pandemic when in-person data collection activities may not be feasible. Citation Format: Lisa T. Wigfall. Barriers and facilitators to recruiting research study participants from community-based HIV/AIDS service organizations: Lessons learned during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-075.

A Synergistic Approach to Data-Driven Response Planning.

Public health practitioners face challenging, potentially high-consequence, problems that require computational support. Available computational tools may not adequately fit these problems, thus forcing practitioners to rely on qualitative estimates when making critical decisions. Scientists at the Center for Computational Epidemiology and Response Analysis and practitioners from the Texas Department of State Health Services (TXDSHS) have established a participatory development cycle where public health practitioners work closely with academia to foster the development of data-driven solutions for specific public health problems and to translate these solutions to practice. Tools developed through this cycle have been deployed at TXDSHS offices where they have been used to refine and enhance the region's medical countermeasure distribution and dispensing capabilities. Consequently, TXDSHS practitioners planning for a 49-county region in North Texas have achieved a 29% reduction in the number of points of dispensing required to complete dispensing to the region within time limitations. Further, an entire receiving, staging, and storing site has been removed from regional plans, thus freeing limited resources (eg, personnel, security, and infrastructure) for other uses. In 2018, planners from Southeast Texas began using these tools to plan for a multi-county, full-scale exercise which was scheduled to be conducted in October 2019.

Hantavirus pulmonary syndrome in Texas: An update covering years 1993 through 2016

Background: Hantavirus pulmonary syndrome continues to occur sporadically in Texas.Rivers and coworkers published a summary of cases identified between 1993 and 2006. Thisreport updates the information on Hantavirus pulmonary syndrome cases identified between 2007and 2016 to determine whether or not there are differences in clinical presentation or outcomes.Methods: The Texas Department of State Health Services collects information on the Hantaviruspulmonary syndrome using the Centers for Disease Control and Prevention, Special PathogensBranch case report form (OMB No.0920-0090). This form collects demographic information, patientexposure information, timeline, clinical information, laboratory tests, and outcomes.Results: This report summarizes information from the Texas Department of State HealthServices on 45 cases with Hantavirus pulmonary syndrome reported between 1993 and2016. Most patients were men and were non-Hispanic white or Hispanics. Laboratory testsrevealed leukocytosis, an increased percentage of neutrophil bands, hemoconcentration,thrombocytopenia, and variable acute kidney injury. The case fatality rate was 31%. Since2007, the case fatality rate has decreased. The cases remain clustered in the Northwest Texas(Public Health Region 1).Summary: Hantavirus pulmonary syndrome continues to occur sporadically in Texas. Theclinical presentation has not changed since 1993, but outcomes appear to be improving. Publichealth efforts need to focus on public education to reduce the risk of exposure.

Regional Governance of Syndromic Surveillance for the Texas Gulf Coast

ObjectiveDescribe and explain the transition of the syndromic surveillanceprogram at the Houston Health Department (HHD) from being alocally managed and aging system to an ESSENCE system governedby a regional Consortium of public health agencies and stakeholdersin the 13-county area of the southeast Texas.IntroductionSyndromic surveillance systems are large and complex technologyprojects that increasingly require large investments of financial andpolitical capital to be sustainable. What was once a minor surveillancetool in the mid-2000s has evolved into a program that is regardedas valuable to public health yet is increasingly difficult to maintainand operate for local health departments. The Houston HealthDepartment installed a syndromic surveillance system (SyS) sixyears before Meaning Use became known to healthcare communities.The system chosen at the time was the Real-time Outbreak DiseaseSurveillance System (RODS) which, at the time and for its purpose,was a suitable platform for syndromic surveillance. During the past13 years however, maintaining, operating, and growing a SyS by alocal health department has become increasingly difficult. Inclusionin Meaningful Use elevated the importance and profile of syndromicsurveillance such that network growth, transparency of operations,ease of data sharing, and cooperation with other state systems inTexas became program imperatives.MethodsWith support from the informatics group at Tarrant County PublicHealth (TCPH) in the form of mentoring, HHD devised a two prongstrategy to re-invigorate the syndromic program. The first was toreplace RODS with ESSENCE from Johns Hopkins Applied PhysicsLaboratory (JH/APL). The second was to strengthen the regionalnetwork by creating a governance structure that included outsideagencies and stakeholders. The product of this second effort wasthe creation of the Syndromic Surveillance Consortium of SoutheastTexas (SSCSeT) on the Communities of Practice model1usingparliamentary procedure2.ResultsAcquiring ESSENCE and forming SSCSeT were necessary stepsfor the continuing operation of the SyS. The Consortium includesmembers from local health jurisdictions, health care providers, healthpolicy advocates, academicians, and data aggregators. Created asa democratic society, SSCSeT wrote its constitution and by-laws,voted in officers, formed working groups and has begun developingpolicies. The Consortium is cooperating with the Texas Departmentof State Health Services (DSHS) as well as TCPH. Having ESSENCEwill ensure the HHD-SyS will conform to standards being developedin the state and provide a robust syndromic platform for the partnersof the Consortium.ConclusionsSyndromic systems operated by local health departments canadapt to regulatory changes by growing their networks and engagingregional stakeholders using the Communities of Practice model.

Abstract TP237: Uneven Distribution of Stroke Patients and Stroke Centers

Background: Texas is a large state with high demographic and geographic diversity. We analyzed the distribution of high-risk patients and stroke care hospitals to determine how to optimally distribute resources to benefit the largest number of patients. Methods: Data on overall state demographics were based on 2013 estimates derived from 2010 US census data. The number of hospitals was provided by the Department of State Health Services (DSHS). Stroke patients were ascertained via cms.gov and Texas DSHS data. Stroke data were available from 233 of 254 counties. Hospital designation in Texas is based on state-based criteria, but largely follows the definitions used by the Joint Commission. Results: Texas has approximately 26.4 million people (43% white, 39% Hispanic, 12% black, and 6% other). There are almost 3.3 million Medicare beneficiaries, of whom 94,071 have had a stroke. Texas has 649 hospitals with 84,000 licensed beds. There are 135 stroke facilities in 49 counties; 205 counties have no designated stroke facilities. Stroke designated hospitals include 12 CSCs, 110 PSCs, and 13 ASRH. There are 79 Critical Access Hospitals (CAH) that provide varying degrees of stroke care but have diverse locations (see map). The majority of Stroke Centers are located in or around large urban areas. The number of stroke patients varied significantly by county, with as few as 11 and as many as 12,844 in some counties. Many counties with large Medicare populations have few or no stroke centers. Conclusions: The distribution of stroke patients and stroke facilities in Texas is often mismatched. Processes to better match stroke resources with high-risk populations might improve stroke systems of care and perhaps outcomes. Conversion of some CAHs to ASRHs might alleviate some of these disparities.

Exploratory spatial analysis of Lyme disease in Texas -what can we learn from the reported cases?

BackgroundLyme disease (LD) is a tick-borne zoonotic illness caused by the bacterium Borrelia burgdorferi. Texas is considered a non-endemic state for LD and the spatial distribution of the state’s reported LD cases is unknown.MethodsWe analyzed human LD cases reported to the Texas Department of State Health Services (TX-DSHS) between 2000 and 2011 using exploratory spatial analysis with the objective to investigate the spatial patterns of LD in Texas. Case data were aggregated at the county level, and census data were used as the population at risk. Empirical Bayesian smoothing was performed to stabilize the variance. Global Moran’s I was calculated to assess the presence and type of spatial autocorrelation. Local Indicator of Spatial Association (LISA) was used to determine the location of spatial clusters and outliers.Results and DiscussionThere was significant positive spatial autocorrelation of LD incidence in Texas with Moran’s I of 0.41 (p = 0.001). LISA revealed significant variation in the spatial distribution of human LD in Texas. First, we identified a high-risk cluster in Central Texas, in a region that is thought to be beyond the geographical range of the main vector, Ixodes scapularis. Second, the eastern part of Texas, which is thought to provide the most suitable habitat for I. scapularis, did not appear to be a high-risk area. Third, LD cases were reported from several counties in western Texas, a region considered unsuitable for the survival of Ixodes ticks.ConclusionsThese results emphasize the need for follow-up investigations to determine whether the identified spatial pattern is due to: clustering of misdiagnosed cases, clustering of patients with an out-of state travel history, or presence of a clustered unknown enzootic cycle of B. burgdorferi in Texas. This would enable an improved surveillance and reporting of LD in Texas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2286-0) contains supplementary material, which is available to authorized users.

Laser Safety Program Development at Texas A&M University--Issues and Challenges.

Implementing a laser safety program within a University setting encompassing a wide variety of Class 3b and Class 4 lasers with varied potential uses introduces many challenges. Texas A&M University (TAMU) currently has over 310 laser units that are registered with the Texas Department of State Health Services (TDSHS). One primary task in maintaining the laser registration is to have a program that identifies the regulatory responsibilities of the registrant. The Radiological Safety Staff, a part of Environmental Health and Safety (EHS), administers the use of both ionizing and non-ionizing radiation. The Radiological Safety Officer (RSO)/Laser Safety Officer (LSO) maintains the laser registration. This article outlines key elements that were put forth in the development and implementation of the laser safety program at TAMU.

A workplace tuberculosis case investigation in the presence of immigrant contacts from high prevalence countries.

The highest prevalence of tuberculosis (TB) occurs in foreign born immigrants in the United States. Contact investigations at work sites with mostly immigrant workers present multiple practical problems. Recently 402 contacts were investigated at a meat packing plant in rural Texas by the Texas Department of State Health Services (DSHS). Our objective was to study the approach and effectiveness of this intensive investigation. We reviewed information, including symptoms, BCG status, TB history, X-rays, and treatment, on the sentinel case and 47 contacts managed by the Texas DSHS TB Division in Lubbock, TX. We used a gamma interferon release assay (T-SPOT.TB) to identify contacts with TB infection. The sentinel case was foreign born and had cavitary TB with acid-fast positive smears. Forty-two work site contacts were foreign born, and five were US born. The foreign born contacts were from Sudan, Somalia, Mexico, Burma, and Haiti; 18 contacts had a history of BCG vaccination. T-SPOT.TB tests were positive in 20 contacts, borderline in four, and negative in 23. Contacts with borderline results had negative repeat tests. Twenty-three contacts with negative T-SPOT.TB tests were scheduled for repeat tests in 4 weeks, but only four returned for this testing. Chest X-rays were abnormal in two contacts who were started on treatment. Sputum was collected in three individuals; one was culture positive for pan-sensitive Mycobacterium tuberculosis. Twelve contacts were treated for latent TB. Our investigation established an infection rate of 42.5% in this work site contact cohort, which is similar to the 39% prevalence reported by the Center for Disease Control. The use of T-SPOT.TB assays simplified testing in immigrants with high rates of BCG vaccination. Our investigation was complicated by language barriers, varying and uncertain levels of exposure, and a high rate of drop outs in the negative T-SPOT.TB contacts. This concerted effort provides a model for investigating work site contacts, especially with numerous immigrants, and illustrates the problems associated with these investigations.

Playing to Our Strengths: An Academic/Health Department Collaboration to Facilitate Public Protections Against Tuberculosis

Background. Economic modeling and analysis can facilitate evidence-based policy and practice. Such analyses may exceed the technical capacity and mission of public health agencies, yet may be critical to sustain health protections such as tuberculosis (TB) control. The net effect of TB prevention is incompletely understood, hampering objective value judgments of national TB elimination policies. This may promote inefficiencies and threaten individual and public health protections. We describe how a HRSA-funded Texas Public Health Training Center (TPHTC) coordinated specialized analytical skills with the needs of a state public health department to create a user-friendly tool to inform planning and resource allocation; and to identify risks, benefits, opportunities, and value in the context of Texas' Department of State Health Services (TDSHS) TB control programs. Methods. Key informants within TDSHS and faculty from the University of North Texas Health Science Center (UNTHSC) and its associated TPHTC collaborated to develop a combined health, cost, and outcome model to answer questions of interest to TDSHS. The model incorporates standard techniques, TB specific logic and data, and Texas specific population, epidemiologic, and programmatic data into a Microsoft Excel platform. Outcome measures include 2013 USD costs from a public agency perspective and health losses denominated in Quality Adjusted Life Years (QALYs) (but not assigned a dollar value). Outcomes represent the 10-year accrued net present value (NPV) of variable costs associated with each incident TB case. The model used only publicly available, nonconfidential data. Results. Under current public TB prevention and control practices we estimate public spending for acute medical care and health losses for Texas' 1325 TB cases in 2011 will exceed a NPV $100 000 000 and 4800 QALYs by 2022; societal costs would likely be much higher. Public TB control is relatively cost effective and preserves 3.7 QALYs/case averted at $54 000/QALY. Implications. Partnerships between academic institutions and public health departments offer the potential to produce the economic analyses needed for judicious use of public resources. We used accessible methods, data, and technology to create a model to analyze the relative value of public TB control in Texas as well as to identify potential efficiencies within activities. Our analysis suggests public efforts against latent TB infection effectively and efficiently mitigate some of the substantial health and cost impact of TB to Texas. Most of TB's burden remains, however, and more careful targeting of prevention by risk promises rich rewards. [ABSTRACT FROM AUTHOR]

Genesis of antibiotic resistance VII: implementation of unused prescription antibiotics/antimicrobial recycling and incidence of antibiotic resistant bacterial infections in Texas (986.7)

An effort has been made to explore the implementation of a prescription medicine (Antibiotics) recycling program in Texas. According to The Office of the Regional Medical Director, Texas Department of State Health Services (TDSHS) Region 8 at present there are no programs for recycling the unused prescription medications, Antibiotics in particular in existence in the State of Texas. http://www.dshs.state.tx.us/contact.shtm. Pertaining to the infectious diseases and antibiotic resistance as per the information available and Region 8 Medical director, VISA/VRSA Vancomycin‐Intermediate/Resistant Stapylococcus aureus are the only diseases that are reportable to the TDSHS. Of the 609 infections related to Staphylococcus aureus isolated reports through TxHSN in 2012, 55% tested sensitive to oxacillin/methicillin. NDM‐1, which stands for New Delhi metallo‐beta‐lactamase 1 has been considered to become a global public health problem, but is not detected in Texas. Though 4% of US hospitals had at least one patient with a CRE (carbapenem‐resistant Enterobacteriaceae) infection during the first half of 2012, none were reported in Texas. In 2011, 1,325 cases of tuberculosis (TB) were reported in Texas however, the total number of the antibiotic resistant form of TB among this population is not known. The implications of the discrepancy in the Annual Federal Prescription Drug retake program and lack of recycling of the prescription medicines (Antibiotics) in the evolution of antibiotic resistance shall be presented in the EB2014.Grant Funding Source: Professional Development Funds from SWTJC, Eagle Pass, Texas

Optimizing Distribution of Pandemic Influenza Antivirals

Mass distribution of antiviral medications is central to many national and international pandemic influenza response plans. These drugs are used both prophylactically, to prevent infection, and therapeutically, to lessen the severity and duration of illness. In the United States, large stockpiles of antivirals are maintained by both federal and state public health agencies in preparation for future pandemics. During the 2009 H1N1 influenza pandemic, many states relied on commercial pharmacies to distribute stockpiled antivirals fairly and effectively to geographically and demographically diverse populations. Here, we present a data-driven method for optimizing pharmacy-based distributions of antiviral medications during future pandemics, in terms of overall access for the target population, and apply it to the state of Texas in the U.S. We compare the access achieved by the model solutions to that actually achieved by the Texas Department of State Health Services (DSHS) during the 2009 H1N1 pandemic. We find that, in general, the major national chains provide sufficient access in highly populated areas, while independent pharmacies are essential for reaching less populated areas. This model was developed jointly by scientists and public health officials, and is now available as a decision-support tool for Texas DSHS via a user-friendly web-based interface.

Women, Infant and Children (WIC) Peer Counselor Contact with First Time Breastfeeding Mothers

This study was designed to determine whether singleton women who had not previously breastfed and who had a women, infant and children (WIC) peer counselor were more likely to initiate breastfeeding than women not exposed to the WIC peer counselor. The retrospective cross-sectional study used data from the 2009 Texas Department of State Health Services (DSHS) WIC Infant Feeding Practices Survey (IFPS) administered through 73 local WIC agencies. Of the 5,427 responses to the 2009 Texas DSHS WIC IFP Survey, 56.6% (N=3,070) were included in this study. The Texas DSHS WIC IFPS, a 55-item survey with multiple-choice and two open-ended questions, was used to evaluate breastfeeding beliefs, attitudes, and practices among women receiving WIC services. Women who had peer counselor contact during pregnancy, in the hospital, and after delivery were more likely to initiate breastfeeding than women without such contacts, OR=1.36, 2.06, 1.85, respectively. Women's decision to initiate breastfeeding is significantly associated with WIC peer counselor contacts. Continued WIC peer counselor program services may increase breastfeeding initiation rates among WIC participants.

Evaluation of Active Mortality Surveillance System Data for Monitoring Hurricane-Related Deaths—Texas, 2008

The Texas Department of State Health Services (DSHS) implemented an active mortality surveillance system to enumerate and characterize hurricane-related deaths during Hurricane Ike in 2008. This surveillance system used established guidelines and case definitions to categorize deaths as directly, indirectly, and possibly related to Hurricane Ike. The objective of this study was to evaluate Texas DSHS' active mortality surveillance system using US Centers for Disease Control and Prevention's (CDC) surveillance system evaluation guidelines. Using CDC's Updated Guidelines for Surveillance System Evaluation, the active mortality surveillance system of the Texas DSHS was evaluated. Data from the active mortality surveillance system were compared with Texas vital statistics data for the same time period to estimate the completeness of reported disaster-related deaths. From September 8 through October 13, 2008, medical examiners (MEs) and Justices of the Peace (JPs) in 44 affected counties reported deaths daily by using a one-page, standardized mortality form. The active mortality surveillance system identified 74 hurricane-related deaths, whereas a review of vital statistics data revealed only four deaths that were hurricane-related. The average time of reporting a death by active mortality surveillance and vital statistics was 14 days and 16 days, respectively. Texas's active mortality surveillance system successfully identified hurricane-related deaths. Evaluation of the active mortality surveillance system suggested that it is necessary to collect detailed and representative mortality data during a hurricane because vital statistics do not capture sufficient information to identify whether deaths are hurricane-related. The results from this evaluation will help improve active mortality surveillance during hurricanes which, in turn, will enhance preparedness and response plans and identify public health interventions to reduce future hurricane-related mortality rates.

Incidence and Risk Factors for Hepatocellular Carcinoma in Texas Latinos: Implications for Prevention Research

BackgroundHepatocellular carcinoma (HCC) is increasing in the U.S. despite a decline in cancer overall. Latinos have higher rates of HCC than the general population according to the Surveillance, Epidemiology, and End Results (SEER) Program. Not included in SEER, Texas Latinos make up one-fifth of the U.S. Latino population. To determine whether HCC incidence differs among U.S. and Texas Latinos, this descriptive study compares HCC incidence from 1995 through 2006 among three Latino populations: U.S. SEER, Texas overall and a South Texas subset. To identify lines of prevention research, we compare prevalence of known HCC risk factors among these Latino groups.MethodsData were collected from the U.S. SEER Program, Texas Cancer Registry and Texas Department of State Health Services (TDSHS). Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals were calculated as well as prevalence of obesity, diabetes, heavy alcohol use and cigarette smoking.ResultsOf the three Latino groups compared, South Texas Latinos had the highest age-adjusted HCC incidence rates and SEER Latinos had the lowest (10.6/100,000 (10.1–11.1) and 7.5/100,000 (7.2–7.7), respectively). HCC incidence significantly increased over time (APCs>0) among Latinos in all three geographic groups. Between 1995 and 2006, there was an increase in obesity among all three populations, and obesity was highest among South Texas Latinos. Diabetes increased among U.S. Latinos, and Latino women in South Texas had significantly higher diabetes prevalence than U.S. Latino women. Cigarette smoking and heavy alcohol use were similar among groups.ConclusionsThe incidence of HCC among Latinos in South Texas is higher than elsewhere in the United States. Higher rates of HCC among Texas and South Texas Latinos may be associated with greater prevalence of obesity and diabetes, risk factors for HCC that are amenable to intervention.

Abstract 3595: Hepatocellular carcinoma and diabetes among Latinos: Implications for prevention

Abstract Introduction. Hepatocellular carcinoma (HCC) has increased in the U.S. from 1975-2006 while overall cancer has declined. Moreover, HCC among South Texas Latinos is higher than other U.S. Latinos. In recent years a number of risk factors have been associated with HCC including hepatitis-C virus infection, heavy alcohol use, obesity, diabetes and others. Of these, only diabetes exhibits characteristics which make it a candidate for why HCC is increasing in the U.S. Latino population and increasingly higher among South Texas Latinos. This study compares incidence rates of HCC and prevalence rates of diabetes among U.S. Latinos and South Texas Latinos. We hypothesize that these data implicate diabetes in HCC and suggest a clear path to informed HCC prevention. Methods. Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Age-adjusted HCC incidence rates were calculated using SEER*Stat and SPSS software and aggregated over 3-year periods. Likewise, annual prevalence of diabetes was calculated and aggregated over the same periods. For each measure values for the mutually exclusive U.S. and South Texas populations were compared. Trend slopes for both HCC and diabetes were calculated and displayed graphically. Group differences were assessed at p < .05 if confidence intervals did not overlap. Results. U.S. (SEER) Latino HCC incidence averaged 6.1/100,000 during 1995-1997 and increased to 8.0 during 2004-2006 (slope m = 0.455). South Texas Latino rates averaged 9.2 and 11.7 during the same periods (slope m = 0.625) (incidence rate difference, p < .05). Simultaneously, the prevalence rate of diabetes was 5.9% and 7.7% among U.S. SEER Latinos (slope m = 0.450) and 7.6% and 9.6% among South Texas Latinos (slope m = 0.500) (prevalence rate difference, p < .05). Although slope differences could not be calculated, they indicate a greater rate of increase among South Texas Latinos than U.S. SEER Latinos. Conclusion. Our findings support observations that HCC and diabetes are increasing in the United States. We have described an important relationship between increasing rates of HCC and diabetes in the U.S. SEER and South Texas Latino populations. We suggest this relationship may explain higher rates of HCC among Latinos. There is a need to focus HCC etiological research to account for this relationship while simultaneously on other attributable risks for the disease as well as genetic, cultural and socioeconomic predisposing features. We note that diabetes is preventable or treatable. The potential contribution of this research can firmly establish associations and inform HCC prevention. Acknowledgements. The San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3595. doi:1538-7445.AM2012-3595

Abstract PR1: Hepatocellular carcinoma research and prevention in South Texas: The imperative

Abstract Introduction: Hepatocellular carcinoma (HCC) incidence is increasing in the U.S. for unknown reasons despite a decline in cancer overall during 1975–2006. Latinos have higher rates of HCC than other groups, and attributable risks for HCC among Latinos have been identified. This study compared HCC incidence and behavioral risk factors associated with it from 1995 through 2006 between U.S. Latinos, Texas Latinos and a South Texas Latino subset. We hypothesized that HCC incidence is higher among South Texas Latinos in conjunction with higher attributable behavioral risk factors during the same period. Methods: Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals (CI) were calculated as well as prevalences of obesity, diabetes, heavy alcohol use and smoking. Analyses were performed using SEER*Stat and SPSS Complex Samples software. Groups were compared using Chi-Squared and T-Tests with differences assessed at p < .05 if confidence intervals did not overlap. Results: Latinos accounted for more than a third of HCC in Texas and nearly three-fourths of all HCC in South Texas, significantly greater proportions than SEER. More than 70% of HCC in Latinos occurred in men, with similar percentages observed among SEER, Texas and South Texas groups. HCC in Latinos was highest in South Texas (10.6/100,000) and Texas (9.7/100,000) compared to SEER (7.5/100,000). South Texas Latinos were older than their SEER counterparts (Median = 67 vs. 62). More South Texas and Texas Latinos than SEER resided in rural areas (14.8%, 14.3% vs. 5.2%). Prevalence percentages of HCC-related behavioral risk factors for Latinos in the U.S., Texas and South Texas for two time periods, 1995–1997 and 2004–2006 show that obesity increased among all three groups of Latinos overall from the first to the second time period. Additionally, Texas and South Texas Latinos had higher obesity prevalence than U.S. Latinos during the most recent period (30.2% and 35.0% versus 26.7%). Moreover diabetes prevalence increased among U.S. Latinos. Texas and South Texas Latinos also showed an increasing pattern, although confidence intervals overlapped. For 2004–2006, the prevalence of diabetes was higher in South Texas Latinas than U.S. Latinas (10.3% and 7.8%, respectively). Heavy alcohol and cigarette use did not change significantly over time among any Latino group. Conclusion: Our findings support observations that HCC is alarmingly on the rise in the United States. We have described an important constellation of risks for HCC in this group that may result in higher rates of the disease among Latinos. Most if not all of these risks are modifiable, preventable or treatable. Clearly there is a need to focus on HCC etiological research and intervention that takes into account not only the most significant attributable risks for the disease, but also genetic, cultural and socioeconomic predisposing features. The potential contribution of these to HCC indicates a need for etiologic research to firmly establish associations and inform HCC-related prevention interventions. Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR1.

Dengue Hemorrhagic Fever—U.S.-Mexico Border, 2005

Dengue fever is a mosquito-transmitted disease caused by any of four closely related virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) of the genus Flavivirus. Infection with one of these serotypes provides lifelong immunity to the infecting serotype only. Therefore, persons can acquire a second dengue infection from a different serotype, and second infections place them at greater risk for dengue hemorrhagic fever (DHF), the more severe form of the disease. DHF is characterized by bleeding manifestations, thrombocytopenia, and increased vascular permeability that can lead to life-threatening shock. In south Texas, near the border with Mexico, sporadic, locally acquired outbreaks of dengue fever have been reported previously; however, on the Texas side of the border, these outbreaks have not included recognized cases of locally acquired DHF in persons native to the area. In July 2005, a case of DHF was reported in a resident of Brownsville, Texas. In August 2005, health authorities in the neighboring state of Tamaulipas, Mexico, reported an ongoing dengue outbreak with 1,251 cases of dengue fever, including 223 cases (17.8%) of DHF. To characterize this dengue outbreak, the Texas Department of State Health Services (TDSHS), Mexican health authorities, and CDC conducted a clinical and epidemiologic investigation. This report summarizes the results of that investigation, which determined that the percentage of DHF cases associated with dengue fever outbreaks at the Texas-Tamaulipas border has increased. Health-care providers along the U.S. border with Mexico should be vigilant for DHF and familiar with its diagnosis and management to reduce the number of severe illnesses and deaths associated with outbreaks of dengue fever.