General United States Population Research Articles

Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic

BackgroundThe novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease.MethodsWe conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients.ResultsThe majority of respondents were female (83.9%), 41–60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it.ConclusionWe found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients’ health behaviors related to COVID-19.

Morphomic phenotyping of oncologic populations.

e13572 Background: We have previously identified body and organ composition measures in pre-treatment CT scans that predict post-treatment mortality or disease recurrence in melanoma as well as esophageal, pancreatic, hepatocellular and lung cancers within single institution cohorts in the US. Similar trends can be identified in Asian cohorts although the absolute range of these body composition measures differ substantially from those in the US. We have also identified body and organ composition measures that predict drug tissue distribution and optimal dosing. The qualitative and relative nature of body and organ composition measures to date have limited their utility for precision treatment of oncologic populations. We have therefore refined the precision, granularity and reliability of these measures (morphomics) in oncologic and reference populations. Methods: Analytic Morphomics, our group’s imaging analysis platform, extracts granular, anatomically-indexed body and organ composition measures from medical imaging. This platform has been updated to use artificial intelligence and nested, supervised machine learning algorithms. Our digital morphomics “assays” are 100% reproducible due to our extensive use of deterministic software algorithms and scalable due to our use of efficient ML algorithms and software code. Our ML models have been trained using state-of-the art techniques in 2D and 3D convolutional neural networks (CNNs) for image segmentation, utilizing repeated randomization cross-validation, hold-out sets, and ensemble modeling methods, with large, broadly representable training image sets, and verified by extensive user testing on clinical scans from nearly 200,000 live subjects. Results: We analyzed curated cohorts reflecting the general United States and Taiwanese population (Ns=5,286; 1,459). In addition, we analyzed oncological cohorts reflecting patients with colon (N=95), ovarian (216), pancreatic (156), and esophageal cancers (Ns=333, 344). Validated morphomic measures include bone mineral density (BMD), visceral fat area (VAT, subcutaneous fat area (SAT), skeletal muscle area (SMA), skeletal muscle density (MD) at multiple vertebral levels. When referenced against measures taken from general non-oncologic (trauma) populations to adjust for non-specific changes due to age and gender, these referenced morphomic measures gain predictive power for mortality and cancer recurrence. Conclusions: The unprecedented level of granularity and precision of these raw and referenced morphomic measures shows clinical utility for improved patient selection, drug dosing as well as evaluation of treatment response and toxicity.

How do psychobehavioural variables shed light on heterogeneity in COVID-19 vaccine acceptance? Evidence from United States general population surveys on a probability panel and social media

ObjectivesTo (1) understand what behaviours, beliefs, demographics and structural factors predict US adults’ intention to get a COVID-19 vaccination, (2) identify segments of the population (‘personas’) who share similar factors...

Body Mass Index Trends among a Cohort of Subjects Enrolled in Medication-Assisted Treatment Programmes for Opioid Use Disorder: Racial/Ethnic, Gender, and Age Differences.

Opioid use disorder (OUD) and obesity are two pressing public health concerns in the United States (US). However, the relationship between these two epidemics has not been well-studied. Our study aims to describe the prevalence rates of obesity in individuals with OUD from a cohort study and compare that to the expected prevalence that would be observed based upon New Jersey state and US population survey data. Additionally, we sought to study whether Body Mass Index (BMI) distribution in this cohort varied by race/ethnicity, gender, and age. Our subjects (N=151) are part of a drug user cohort study of persons enrolled in medication-assisted treatment (MAT) programmes in New Jersey. Using the New Jersey Behavioral Risk Factor Survey (NJBRFS) and the National Health Interview Survey (NHIS), we generated expected BMI distributions based on race/ethnicity, age, and sex. Expected rates were compared to observed BMI. Standardized prevalence ratios were calculated, and 95% confidence intervals were constructed. Among females, obesity was more prevalent in those with OUD than in the general US population. Among persons ≤50 years old, overweight and obesity were more prevalent in those with OUD than in NJBRFS. Persons who did not inject drugs were more likely to be overweight. The prevalence of underweight was significantly higher among Black non-Hispanic minorities, males, older subjects (aged 66-85), and persons who inject drugs. In our study, the trends in BMI vary based on race/ethnicity, gender and age in these patients with OUD. These varying trends highlight the need for tailored screening and prevention strategies. Primary care providers should be aware that their patients with OUD have multiple health problems that need to be addressed beyond their OUD condition itself. Providers are in a pivotal role to screen and implement interventions to improve their health outcomes.

Cardiovascular Risk Factors Among Asian Americans: Perspectives on the Role of Acculturation in Cardiovascular Diseases Health Disparities.

The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US.

Marijuana use is inversely associated with liver steatosis detected by transient elastography in the general United States population in NHANES 2017-2018: A cross-sectional study.

The impact of marijuana on the general population is largely unknown. The present study aimed to assess the association between marijuana use and liver steatosis and fibrosis in the general United States population utilizing data from the National Health and Nutrition Examination Survey (NHANES). This cross-sectional study was performed with data from the 2017-2018 cycle of NHANES. The target population comprised adults in the NHANES database with reliable vibration controlled transient elastography (VCTE) results. The median values of the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to evaluate liver steatosis and fibrosis, respectively. After adjusting for relevant confounders, a logistic regression analysis was used to assess the association between marijuana use and liver steatosis and fibrosis. A total of 2622 participants were included in this study. The proportions of never marijuana users, past users, and current users were 45.9%, 35.0%, and 19.1%, respectively. Compared to never marijuana users, past and current users had a lower prevalence of liver steatosis (P = 0.184 and P = 0.048, respectively). In the alcohol intake-adjusted model, current marijuana use was an independent predictor of a low prevalence of liver steatosis in people with non-heavy alcohol intake. The association between marijuana use and liver fibrosis was not significant in univariate and multivariate regression. In this nationally representative sample, current marijuana use is inversely associated with steatosis. The pathophysiology is unclear and needs further study. No significant association was established between marijuana use and liver fibrosis, irrespective of past or current use.

Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants

BackgroundThe proportion of older adults with food insecurity at 8% has increased faster than that of the general United States population from 2001 to 2017. Many low-income food-insecure older adults rely on food-assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), for meeting energy and nutrient needs, whereas others are eligible but do not participate. Neither updated nutrient intake estimates nor potential differences in meeting the Dietary Reference Intakes from foods alone and with dietary supplements (DS) among low-income older adults using or eligible for SNAP are known. ObjectivesThis study assessed and compared national estimates of usual nutrient adequacy and dietary quality of United States older adults using SNAP and income-eligible nonparticipants. MethodsUsual dietary intake was estimated among older adults (≥60 y; n = 2582) in the 2007–2016 NHANES cross-sectional national survey. Data on food-assistance participation and eligibility (poverty-income-ratio ≤130%), DS use, and ≥24-h dietary recalls were used. The NCI method (Markov Chain Monte Carlo approach) was applied to estimate mean usual nutrient intakes, proportion of inadequate nutrient intake, and dietary quality using the 2015 Healthy Eating Index. ResultsNeither usual nutrient intake from dietary and total sources nor dietary quality differed between older adult SNAP participants and eligible nonparticipants. Low dietary quality and high percentage of inadequate intake for several nutrients were apparent among both groups, especially from food sources alone, including vitamins A (56%), C (55%), D (97%), E (99%), calcium (73%), and magnesium (74%), but rates were attenuated when DS were also considered (i.e., 36% reduced risk for vitamin D inadequacy). ConclusionsDiet quality and usual nutrient intake among older adult SNAP participants and eligible nonparticipants were poor, but DS lowered the risk of nutrient inadequacy. Future policies and programs should focus on improving the intake of vitamins A, C, D, E, calcium, and magnesium and dietary quality for all older adults.

General population reference values for the Functional Assessment of Cancer Therapy-Lung and PROMIS-29.

Therapeutic advances in lung cancer have turned attention toward patient-reported outcome measures (PROMs) as important clinical outcomes. The Functional Assessment of Cancer Therapy-Lung (FACT-L) is a common endpoint in lung cancer trials. This study calculated FACT-L reference values for the United States (US) general population. Adults from the US general population (N = 2001) were surveyed between September 2020 and November 2020. Surveys contained 126 questions, including the FACT-L [36 items; FACT-G and four subscales (Physical Well-Being [PWB], Social Well-Being [SWB], Emotional Well-Being [EWB], and Functional Well-Being [FWB]) and the Lung Cancer Subscale (LCS), and a Trial Outcome Index (TOI)]. Reference values for each FACT-L scale were calculated with means for the total sample and separately for participants with: no comorbidities, COVID-19 as only comorbidity, no COVID-19. In the total sample, the reference scores were as follows: PWB = 23.1; SWB = 16.8; EWB = 18.5; FWB = 17.6; FACT-G = 76.0; LCS = 23.0, TOI = 63.7, and FACT-L Total = 99.0. Scores were lower for those reporting a prior diagnosis of COVID-19, especially for SWB (15.7) and FWB (15.3). SWB scores were lower than previous references values. These data provide US general adult population reference value set for FACT-L. While some of the subscale results were lower than those found in the reference data for other PROMs, these data were obtained in a more contemporaneous time frame juxtaposed with the COVID-19 pandemic and may represent a new peri-pandemic norm. Thus, these reference values will be useful for future clinical research.

The association between iron metabolism with the change of blood pressure and risk of hypertension: A large cross-sectional study

BackgroundThe relationship between iron metabolism and variations in blood pressure and hypertension risk is still not clear. This study aimed to determine whether iron metabolism is associated with changes in blood pressure and hypertension prevalence in the general United States population. MethodsThe National Health and Nutrition Examination Survey (NAHNES) database contains data on 116876 Americans from 1999 to 2020 years. Data from the NHANES database were used to examine the relationships between iron metabolism (serum iron [SI], serum ferritin [SF], and soluble transferrin receptor [sTfR]) and changes in blood pressure and hypertension prevalence. Generalized linear models and restricted cubic spline (RCS) plot curves were used to estimate the relationship between iron metabolism and hypertension. Further, generalized additive models with smooth functions were used to identify the relationship between iron metabolism and blood pressure. Finally, a stratified subgroup analysis was performed. ResultsA total of 6710 participants were included in our analysis. The RCS plot showed a linear relationship between SI, as well as sTfR, and hypertension prevalence. SF and hypertension prevalence were associated in a J-shape. In addition, the relationship between SI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased initially and then increased. A correlation between SF, SBP, and DBP first decreased, then increased, and finally decreased. A positive linear correlation existed between sTfR and SBP, but it increased and then decreased with DBP. ConclusionThe correlation between SF and hypertension prevalence displayed a J-curve. In contrast, the correlation between SI, as well as sTfR, and hypertension risk was negative and positive, respectively.

The association between cognitive ability and body mass index: A sibling-comparison analysis in four longitudinal studies.

Body mass index (BMI) and obesity rates have increased sharply since the 1980s. While multiple epidemiologic studies have found that higher adolescent cognitive ability is associated with lower adult BMI, residual and unobserved confounding due to family background may explain these associations. We used a sibling design to test this association accounting for confounding factors shared within households. We used data from four United States general youth population cohort studies: the National Longitudinal Study of Youth 1979 (NLSY-79), the NLSY-79 Children and Young Adult, the NLSY 1997 (NLSY-97), and the Wisconsin Longitudinal Study (WLS); a total of 12,250 siblings from 5,602 households followed from adolescence up to age 62. We used random effects within-between (REWB) and residualized quantile regression (RQR) models to compare between- and within-family estimates of the association between adolescent cognitive ability and adult BMI (20 to 64 years). In REWB models, moving from the 25th to 75th percentile of adolescent cognitive ability was associated with -0.95 kg/m2 (95% CI = -1.21, -0.69) lower BMI between families. Adjusting for family socioeconomic position reduced the association to -0.61 kg/m2 (-0.90, -0.33). However, within families, the association was just -0.06 kg/m2 (-0.35, 0.23). This pattern of results was found across multiple specifications, including analyses conducted in separate cohorts, models examining age-differences in association, and in RQR models examining the association across the distribution of BMI. Limitations include the possibility that within-family estimates are biased due to measurement error of the exposure, confounding via non-shared factors, and carryover effects. The association between high adolescent cognitive ability and low adult BMI was substantially smaller in within-family compared with between-family analysis. The well-replicated associations between cognitive ability and subsequent BMI may largely reflect confounding by family background factors.

Abstract 5530: A community led approach to addressing disparities in pancreatic cancer care for Native Americans in Oregon

Abstract Pancreatic adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths in the United States (US). Due to unique barriers facing Native Americans (NA) patients, this underrepresented population has worse outcomes and increased mortality. In Oregon, NAs have nearly double the PDAC incidence rate compared to the general US population. Oregon Health & Science University (OHSU) is a leader in PDAC care and research, yet NAs remain underrepresented in pancreatic cancer research at OHSU, and across the country. This highlights the need for a focused and comprehensive research program that collaborates with local tribal communities to identify specific issues and barriers that can be addressed to improve patient care in the NA population. We hypothesize that if we establish a workflow that strengthens existing relationships with tribal communities and leverages established OHSU infrastructure and expertise, we can directly address the unmet need of understanding, preventing and treating PDAC for NA individuals in our local communities. This includes increasing enrollment of NAs in PDAC clinical trials and developing a genetic registry that could help both depict genetic underpinnings that predispose NA individuals to PDAC and potentially guide therapeutic approaches. To build trust within NA communities, we initiated collaborations with Oregon tribes to develop culturally appropriate programs guided by NA community members. Through OHSU’s Northwest Native American Center of Excellence, we developed a close relationship with the Confederated Tribes of Warm Springs. Together with our institution’s Community Outreach, Research, and Engagement (CORE) team, we are working with the Confederated Tribes of Warm Springs to better understand provider and NA community member attitudes towards and barriers to clinical trial participation. We will incorporate these perceptions into a tribe-specific program that describes the multi-faceted facilitators and barriers that inform decision-making. Moreover, we are implementing a patient navigator program to help NA patients overcome clinical trial barriers by providing culturally appropriate patient education, reimbursement for travel-associated expenses, local administration of chemotherapy, and telehealth capabilities. Future work includes co-implementing strategies for tribes to review incoming research requests with the goal of implementing a system to promote awareness and enrollment of NAs in PDAC clinical research. This system will be then be utilized to establish the first NA PDAC tissue registry to identifying gene-environment interactions and unique genetic alterations that may predispose NA individuals to PDAC. Overall, this collaborative work will create a roadmap for engagement and a conscientious process to provide awareness and the best in class treatment for NA individuals with PDAC. Citation Format: Claymore Kills First, Grace A. McCarthy, Charles D. Lopez, Brett C. Sheppard, Jackilen Shannon, Jonathan R. Brody. A community led approach to addressing disparities in pancreatic cancer care for Native Americans in Oregon. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5530.

Association of Serum Uric Acid Level with Risk of Abdominal Aortic Calcification: A Large Cross-Sectional Study.

The association between serum uric acid (sUA) and incident abdominal aortic calcification (AAC), and severe abdominal aortic calcification (SAAC) in the general population of the United States (US) is unclear. Therefore, this research aimed to investigate the association between sUA and the risk of AAC and SAAC. Individuals from National Health and Nutrition Examination Survey (NHANES) database were analyzed cross-sectionally between 2013 and 2014. The restricted cubic spline (RCS), multivariable logistic regression model and subgroup analysis were utilized to evaluate the correlation between sUA and incident AAC, and SAAC. In addition, generalized additive models with smooth functions were employed to survey the relationship between sUA and the degree of AAC. This study included 3016 individuals from the NHANES database. According to the RCS plot, sUA levels were associated with the risk of AAC/SAAC in a U-shaped pattern in the US population. The degree of calcification decreased at first and then increased with the increase in the sUA level. Close monitoring and adequate control of sUA levels in the US general population may reduce the risk of AAC and SAAC.

Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital.

Patients undergoing major limb amputation with TMR were included with minimum one year follow-up and completed questionnaires. Primary clinical outcomes included incidence of symptomatic neuromas, PLP, residual limb pain, narcotic use, and neuromodulator use. A follow-up phone survey was conducted assessing five pediatric Patient Reported Outcomes Measurement Information System (PROMIS) metrics adapted to assess residual limb and PLP. Nine patients (seven male and two female patients, avg. age = 16.83 ± 7.16 years) were eligible. Average time between surgery and phone follow-up was 21.3 ± 9.8 months. Average PROMIS Pediatric t-scores for measures of pain behavior, interference, quality-affective, and quality-sensory for both PLP and residual limb pain were nearly 1 standard deviation lower than the United States general pediatric population. One patient developed a symptomatic neuroma 1 year after surgery. Compared with an adult patient sample reported by Valerio et al, our TMR patients at Nationwide Children's Hospital (NCH) showed similar PLP PROMIS t-scores in pain behavior (50.1 versus 43.9) and pain interference (40.7 versus 45.6). Both pediatric and adult populations had similar residual limb pain including PROMIS pain behavior (36.7 adult versus 38.6 pediatric) and pain interference (40.7 adult versus 42.7 pediatric). TMR at the time of amputation is feasible, safe, and should be considered in the pediatric population.

Correction to “Piloting the use of global health measures in a Down syndrome clinic”

Journal of Applied Research in Intellectual DisabilitiesEarly View CORRIGENDUMFree Access Correction to “Piloting the use of global health measures in a Down syndrome clinic” This article corrects the following: Piloting the use of global health measures in a Down syndrome clinic Stephanie L. Santoro, Ashlee Campbell, Clorinda Cottrell, Karen Donelan, Ben Majewski, Nicolas M. Oreskovic, Vasiliki Patsiogiannis, Amy Torres, Brian G. Skotko, Volume 34Issue 4Journal of Applied Research in Intellectual Disabilities pages: 1108-1117 First Published online: March 23, 2021 First published: 29 March 2023 https://doi.org/10.1111/jar.13099AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Santoro, S. L., Campbell, A., Cottrell, C., Donelan, K., Majewski, B., Oreskovic, N. M., Patsiogiannis, V., Torres, A., & Skotko, B. G. (2021). Piloting the use of global health measures in a Down syndrome clinic. Journal of Applied Research in Intellectual Disabilities, 34, 1108–1117. https://doi.org/10.1111/jar.12866 In Table 3 of the “Results” section, authors' calculation of the T-statistic was incorrect. These T-statistics have been recalculated with updates to the p values shown in grey (Corrected Table 3). Corrected Table 3: T-scores of Global Health in Down syndrome (DS) on 4 measures in comparison to standard score in general population. N Mean Min Max SD T-statistic p value† Parent Proxy Scale v1.0 (all ages) 80 parents 46.4 31.2 66.1 8.30 −3.879 <0.001** Child with DS age 5–6 12 parents 47.4 31.2 60.2 8.47 −1.063 0.31 Child with DS age 7–17 20 parents 48.5 37.9 66.1 8.23 −0.815 0.43 Child with DS age 18+ 48 parents 45.2 34.6 63.2 8.07 −4.121 <0.001** Global Health Scale v1.2 (Mental) 45 adults with DS 52.3 38.8 67.6 7.20 2.143 0.04* Global Health Scale v1.2 (Physical) 43 adults with DS 51.5 34.9 67.7 8.32 1.182 0.24 Peds Scale v1.0 12 children and adolescents (age 7–17) with DS 49.5 37.2 58.3 6.32 −0.274 0.79 † Two-tailed t-test comparing to general population mean = 50, standard deviation = 10. * p value <0.05; ** p value <0.01. Due to this calculation error, in authors' manuscript, the reporting of results related to Table 3 in the following sections should be corrected. In the Abstract, the Results section should state that “Global health T-scores did differ from the available comparative standardized scores from PROMIS® reference population on some measures (p < 0.05).” In the Results section, the final sentences in the “Complete Surveys” paragraph should state that “Scores on some the three global health instruments, as reported by parents, children and adolescents, and adults with DS, did differ from the PROMIS® reference population mean (p < 0.05 on Global Health Scale (Mental) reported by adults with DS, p < 0.01 for Parent Proxy Global Health 7 + 2 reported by all parents, and by the cohort of parents of adults with DS).” In the Discussion section, the second paragraph should read “We learned that the PROMIS® global health instruments can be completed by some individuals with DS in clinic. We benchmarked responses from individuals with DS and their caregivers against the PROMIS® reference population. Our pilot results suggest that scores from people with DS on these measures might differ from those of the PROMIS® reference population in regard to mental health (p < 0.05), but not in regard to their physical health. Global health scores for individuals with DS, as reported by their parents, did differ from the PROMIS® reference population mean, both among all parents and in parents of adults with DS (p < 0.01). Mean T-scores fell within −0.5 to +0.25 SD, which is to say that survey respondents report health that ranges from feeling 0.5 SD less healthy than the United States general population to feeling 0.25 SD more healthy than the United States general population. DS has a unique profile of medical and developmental concerns; there are also some diseases in those without DS, which are less common in individuals with DS, such as solid tumors (Hasle et al., 2016).” REFERENCE Hasle, H., Friedman, J. M., Olsen, J. H., & Rasmussen, S. A. (2016). Low risk of solid tumors in persons with down syndrome. Genetics in Medicine, 18(11), 1151– 1157. https://doi.org/10.1038/gim.2016.23 We apologise for these errors. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Cardiovascular disease preventive effects of aspirin combined with different statins in the United States general population

The purpose of this study was to explore the use of aspirin in conjunction with various statins for cardiovascular disease (CVD) prevention in the general population of the United States (U.S.). A total of 3778 people from the National Health and Nutrition Examination Surveys from 2011 to 2018 were included in our analysis. After adjusting for sociodemographic and common cardiovascular risk factors, we used multivariable logistic regression analysis to determine aspirin should be combined with which type of statin for better CVD preventive effects. Subgroup analyses were carried out subsequently. In comparison to the aspirin use alone, the odds ratios with 95% confidence intervals for CVD were 0.43 (0.33, 0.57), 0.69 (0.42, 1.13), 0.44 (0.31, 0.62), 0.34 (0.23, 0.50) and 0.64 (0.49, 0.84) for the combination use of aspirin and atorvastatin, lovastatin, pravastatin, rosuvastatin as well as simvastatin, respectively, in the fully-adjusted model. Aspirin combined with rosuvastatin was more effective in the prevention of individual CVD, including congestive heart failure, coronary heart disease, angina pectoris and heart attack, than aspirin combined with other statins. In conclusion, statins combined with aspirin have a clear advantage over aspirin alone in preventing CVD. In addition, when various sex, age, and fitness levels were considered, as well as with and without diabetes mellitus, the combination usage of aspirin and rosuvastatin had the greatest CVD preventive effects than aspirin coupled with other statins.

Association of smoking and osteoarthritis in US (NHANES 1999–2018)

Little is currently known about the effect of smoking on osteoarthritis (OA). This study aimed to investigate the relationship between smoking and OA in the United States (US) general population. Cross-sectional study. Level of evidence, 3. 40,201 eligible participants from the National Health and Nutrition Examination Survey 1999–2018 were included and divided into OA and non-arthritis groups. Participants demographics and characteristics were compared between the two groups. Then the participants were divided into non-smokers, former smokers, and current smokers based on their smoking status, also demographics and characteristics among the three groups were compared. Multivariable logistic regression was used to determine the relationship between smoking and OA. The current and former smoking rate in the OA group (53.0%) was significantly higher than that in the non-arthritis group (42.5%; p < 0.001). Multivariable regression analysis including body mass index (BMI), age, sex, race, education level, hypertension, diabetes, asthma and cardiovascular disease showed that smoking was an association for OA. This large national study highlights a positive association between smoking and OA prevalence in the general US population. It is necessary to further study the relationship between smoking and OA in order to determine the specific mechanism of smoking on OA.

Association of Systemic Immune Inflammation Index with All-Cause, Cardiovascular Disease, and Cancer-Related Mortality in Patients with Cardiovascular Disease: A Cross-Sectional Study.

Our research was designed to investigate the relationship between systemic immune inflammation (SII) index and all-cause, cardiovascular disease (CVD), and cancer-related mortality in patients with CVD. We used the National Health and Nutrition Examination Survey data from 1999 to 2018 to conduct this study. The association between SII index and all-cause, CVD, and cancer-related mortality in patients with CVD was examined using restricted cubic splines (RCS), Cox proportional hazard models, and subgroup analysis, respectively. CVD was defined as a composite of five outcomes of CVD, including coronary heart disease (CHD), congestive heart failure (CHF), angina pectoris, myocardial infarction, and stroke. Additionally, the link between SII index and all-cause, CVD, and cancer-related mortality in patients with a composite of five outcomes of CVD was also explored. In total, 5329 participants were included. The RCS also showed a U-curve correlation between SII index and the all-cause, CVD, and cancer-related mortality in patients with CVD. As compared with the individuals with lowest quartile of SII index, hazard ratios with 95% confidence intervals for all-cause, CVD, and cancer-related mortality across the quartiles were (1.202 (0.981, 1.474), 1.184 (0.967, 1.450), and 1.365 (1.115, 1.672)), (1.116 (0.815, 1.527), 1.017 (0.740, 1.398), and 1.220 (0.891, 1.670)), and (1.202 (0.981, 1.474), 1.184 (0.967, 1.450), and 1.365 (1.115, 1.672)), respectively, in the full-adjusted model. The SII index also had a U-shaped relationship with all-cause, CVD, and cancer-related mortality in patients with CHD, angina, and myocardial infarction. Additionally, the U-shaped relationship between SII index and all-cause, and cancer-related mortality also exists in CHF, and stroke. However, there was a positive linear correlation between SII index and CVD mortality in patients with CHF, and stroke. In the United States general population, the correlation between SII index and all-cause, CVD, and cancer-related mortality showed a U-shaped curve in patients with CVD.

Trends in prevalence of probable fibrotic nonalcoholic steatohepatitis in the United States, 1999-2016.

Data are limited on the epidemiology of fibrotic nonalcoholic steatohepatitis (NASH). We applied the recently proposed Fibrotic NASH Index (FNI) to estimate trends in prevalence of probable fibrotic NASH in the general United States population using data from the 1999-2016 cycles of the National Health and Nutrition Examination Survey. A total of 40273 participants aged 20 years and older were included in the analysis. Prevalence of probable fibrotic NASH (FNI≥0.33) in the overall population was 8.4% (95% CI 8.0-8.8), with higher values found in males and in Hispanic participants. It increased from 6.9% (95% CI 6.3-7.6) in 1999-2004 to 9.2% (95% CI 8.4-10.0) in 2011-2016. This positive trend was evident in both sexes and in participants with obesity and diabetes. Finally, it increased progressively with increasing age, body mass index and worse glucose tolerance. NASH prevalence is increasing in the general US population, synchronous with increasing rates of obesity and type 2 diabetes.

A Multicenter Prospective Investigation on Patient Physical and Mental Health After Girdlestone Resection Arthroplasty

BackgroundGirdlestone resection arthroplasty is a salvage procedure for hip periprosthetic joint infection (PJI) that controls infection and reduces chronic pain, but may result in limited postoperative joint function. The aim of this study was to assess physical function and mental health after Girdlestone. MethodsThis was a multicenter, prospective study evaluating patients with Girdlestone. The Prosthesis Evaluation Questionnaire (PEQ) and patient-reported outcomes measurement information system (PROMIS) global physical health and mental health surveys were administered postoperatively via telephone. The PEQ consists of four scales (ie, ambulation, frustration, perceived response, and social burden) with scores ranging from 0 to 10. The PROMIS measures generated T-scores (mean: 50, standard deviation: 10) that enable comparison to the general population. ResultsThirty-five patients completed all surveys. The average time from procedure to survey completion was 6 years (range, 1 to 20). The median scores for the ambulation, frustration, perceived response, and social burden scales of the PEQ were 0.0 [interquartile range: 0-4.1], 6.0 [3.0-9.3], 9.0 [7.2-10.0], and 7.5 [4.3-9.5]. The median raw scores of the PROMIS global physical health and mental health were 11.91 [interquartile range: 9-14] and 14.0 [10.0-16.0]. These corresponded to average T scores of 39.7 (standard error : 4.3) for physical health and 46.1 (standard error: 3.8) for mental health, which were 10.3 points and 3.9 points below the average score in the United States general population, respectively. ConclusionGirdlestone can have a substantial negative impact on physical functions; however, mental health and social interaction may be only moderately affected. These outcomes can be used to guide patient expectations, as this procedure may be necessary in certain salvage scenarios.

1077. Understanding the Psychosocial Burden Associated with Hospitalization Among Adults Diagnosed with COVID-19 in the United States

Abstract Background Due to the coronavirus disease 2019 (COVID-19) pandemic in the United States (US), public health officials sought to reduce transmission. However, the psychosocial impact associated with COVID-19 has received less attention. This study describes psychosocial burden among adults diagnosed with COVID-19 and assesses the unique impact on those who had a COVID-19 hospitalization. Methods This cross-sectional retrospective study used 2021 US National Health and Wellness Survey (NHWS; N=75,098) data. NHWS is an annual web-based self-report survey of the US general adult population (aged ≥ 18 years). Results were weighted to reflect the population on age, gender, race/ethnicity, and education based on US Census. Among adults who self-reported a COVID-19 diagnosis, those with COVID-related hospitalization, emergency room (ER) visit/no hospitalization, and no hospitalization/no ER visit were descriptively compared on demographics, health characteristics, and psychosocial burden measures. Results Almost 16 million adults had a COVID-19 diagnosis in the past year; of these, 8% had a COVID-related hospitalization, and 6% had a COVID-related ER visit/no hospitalization. Compared to adults with no ER visit/no hospitalization or ER visit/no hospitalization, those with a hospitalization were more often male, college educated, and employed. Relative to those with no ER visit/no hospitalization, adults with a hospitalization were more often diagnosed, either pre- or post-COVID-19 diagnosis, with allergies (47% vs 38%), asthma (20% vs 11%), pain (37% vs. 25%), headache (25% vs 16%), migraine (27% vs 15%), type 2 diabetes (16% vs 10%), dry eye (25% vs 12%), and sleep apnea (15% vs 11%). Adults with a hospitalization had lower mental, physical, and general health-related quality of life, 2-3.4 times higher work/non-work impairment, and 2 times higher positive depression screen rate than those with no ER visit/no hospitalization. Conclusion US adults with a COVID-related hospitalization had higher psychosocial burden than those without a hospitalization on several domains. Accordingly, reducing COVID-related hospitalizations, particularly among the employed and those with comorbidities, will be vital to help mitigate this burden. Disclosures Wajeeha Ansari, MPH, Pfizer Inc.: Stocks/Bonds Florin Draica, MD, Pfizer Inc.: Stocks/Bonds Joanna Atkinson, MD, Pfizer Inc.: Stocks/Bonds Kathy Annunziata, MA, Pfizer: Advisor/Consultant|Pfizer: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study Martine C. Maculaitis, PhD, Cerner Enviza: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study. Amie Scott, MPH, Pfizer Inc.: Stocks/Bonds.