Multiethnic Urban Population Research Articles

039 Y-chromosome abnormalities in men with sub-fertility. An analysis of the frequency of abnormalities and determination of a threshold sperm concentration for genetic analysis

Detection of microdeletions of the long arm of the Y chromosome (Yq) is common practice in men with azoospermia and severe oligozoospermia. Guidelines from the European Association of Urology recommend testing for Yq microdeletions in men with a semen concentration of <5 million/mL. We aim to describe the prevalence of Yq microdeletions in a multi-ethnic urban population in London, United Kingdom. We also aim to determine a threshold based on semen concentration (million/mL) for testing for Yq microdeletions. We performed a retrospective cohort study on 1473 men that underwent genetic evaluation between July 2004 and December 2016. Univariate logistic regression analyses were conducted with microdeletions vs no-microdeletions as the response variable. Semen concentration, combined testicular volume, FSH, LH and testosterone were all used as predictor variables. Microdeletions of the Y-chromosome were found in 4% of our population (n = 58). Microdeletion of the AZFc region occurred in 75% of these men followed by AZFb+c in 13.8%, followed by AZFb, then AZFa and partial AZFa. Semen count was a significant predictor of the presence of a microdeletion (p = 0.035). None of the men with an AZF microdeletion had a sperm count of greater than 0.5 million/mL. We propose a reduction in the current semen count threshold at which Yq microdeletions are tested. A threshold value of 0.5 million/mL (a 10-fold reduction compared to the current guidelines), would increase the specificity without adversely affecting the sensitivity (See table 1). The cost savings of this would be significant. The sperm retrieval rate (SSR) following microdissection testicular sperm extraction was 33.2%. This rate is lower than is described in the literature.

Stepping volume and intensity patterns in a multi-ethnic urban Asian population

BackgroundAccelerometer measured physical activity (PA) studies particularly in non-western populations are lacking. Therefore, this study investigated stepping activity in a multi-ethnic urban Asian population.MethodsAdult participants from the Singapore Health Study 2 consented to accelerometer activity monitoring for 7-consecutive days. Mean daily step count, peak stepping intensity (i.e. cadence) over 1-min, 30-min and 60-min and time spent in each cadence band: 0 (non-movement), 1–19, 20–39, 40–59, 60–79, 80–99 and ≥ 100 steps/minute (moderate to vigorous PA) were calculated.ResultsA total of 713 participants (42% male, mean age 47.8 years) were included. Overall, the mean daily step count was 7549. Mean daily step count was significantly lower in Indians (7083 adjusted p = 0.02) but not Malays 7140 (adjusted p = 0.052) compared to Chinese (7745 steps). The proportion of Malays, Indians, and Chinese achieving < 5000 daily steps was 26%, 23% and 14%, respectively (p < 0.01). Regardless of ethnicity, approximately half of the recorded time was spent undertaking 0-steps/minute (7.9 h).ConclusionsGreater promotion of brisk walking is required in light of the low step volume and pace observed in this multi-ethnic Asian population. Ethnic differences in stepping activity were also identified which indicates a need for targeted ethnic specific health promotion interventions.

Residential Proximity to Major Roadways and Risk of Incident Ischemic Stroke in NOMAS (The Northern Manhattan Study).

The evidence supporting the deleterious cardiovascular health effects of living near a major roadway is growing, although this association is not universal. In primary analyses, we hypothesized that residential proximity to a major roadway would be associated with incident ischemic stroke and that cardiovascular risk factors would modify that association. NOMAS (The Northern Manhattan Study) is an ongoing, population-based cohort study designed to measure cardiovascular risk factors, stroke incidence, and other outcomes in a multiethnic urban population. Recruitment occurred from 1993 to 2001 and participants are followed-up annually by telephone. Residential addresses at baseline were geocoded and Euclidean distance to nearest major roadway was estimated and categorized as in prior studies. We used Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for the association of this distance to incidence of stroke and other outcomes, adjusting for sociodemographic and cardiovascular risk factors, year at baseline, and neighborhood socioeconomic status. We assessed whether these associations varied by age, sex, smoking status, diabetes mellitus, and hypertension. During a median follow-up period of 15 years (n=3287), 11% of participants were diagnosed with ischemic stroke. Participants living <100 m from a roadway had a 42% (95% confidence interval, 1.01-2.02) higher rate of ischemic stroke versus those living >400 m away. This association was more pronounced among noncurrent smokers (hazard ratio, 1.54; 95% confidence interval, 1.05-2.26) and not evident among smokers (hazard ratio, 0.69; 95% confidence interval, 0.23-2.06). There was no clear pattern of association between proximity to major roadways and other cardiovascular events including myocardial infarction, all-cause death, or vascular death. In this urban multiethnic cohort, we found evidence supporting that within-city variation in residential proximity to major roadway is associated with higher risk of ischemic stroke. An individual's smoking history modified this association, with the association remaining only among participants not currently smokers.

Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multiethnic Urban Population: The Northern Manhattan Study.

There is growing evidence that increased dietary sodium (Na) intake increases the risk of vascular diseases, including stroke, at least in part via an increase in blood pressure. Higher dietary potassium (K), seen with increased intake of fruits and vegetables, is associated with lower blood pressure. The goal of this study was to determine the association of a dietary Na:K with risk of stroke in a multiethnic urban population. Stroke-free participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were followed-up for incident stroke. Baseline food frequency questionnaires were analyzed for Na and K intake. We estimated the hazard ratios and 95% confidence intervals for the association of Na:K with incident total stroke using multivariable Cox proportional hazards models. Among 2570 participants with dietary data (mean age, 69±10 years; 64% women; 21% white; 55% Hispanic; 24% black), the mean Na:K ratio was 1.22±0.43. Over a mean follow-up of 12 years, there were 274 strokes. In adjusted models, a higher Na:K ratio was associated with increased risk for stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1) and specifically ischemic stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1). Na:K intake is an independent predictor of stroke risk. Further studies are required to understand the joint effect of Na and K intake on risk of cardiovascular disease.

Abstract P318: Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multi-ethnic Urban Dwelling Population: The Northern Manhattan Study

Background: There is growing evidence that an increase in dietary sodium increases morbidity and mortality from cardiovascular disease (CVD) at least in part via an increase in blood pressure (BP). Several researchers have identified an association of higher dietary potassium, seen with increased intake of fruits and vegetables, with lower BP. Moreover, there may be a potential interaction of sodium and potassium on CVD health, such that the relative levels of these variables may be more important than their absolute levels. The goal of this study was to determine the association of dietary sodium to potassium ratio (Na:K) with the risk of stroke and CVD in a multi-ethnic urban dwelling population. Methods: Stroke-free participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were followed prospectively to assess incident stroke, myocardial infarction and vascular death. Baseline food-frequency questionnaires were analyzed for Sodium and Potassium intake based on self-reported food consumption using DIETSYS software (Block Dietary Data System: Dietsys+ analysis software, version 59, 1999). We examined the association of Na:K with incident stroke (ischemic and overall) as well as combined vascular events (CVE)(stroke, myocardial infarction and vascular death) using Cox-proportional Hazards models adjusting for age, sex, race/ethnicity, total daily calories, adherence to a Mediterranean-style diet, smoking, physical activity, BMI, diabetes, hypertension, and hypercholesterolemia. Results: 2570 participants had dietary data, (mean age 69 ± 10 years, 64% women, 21% white, 53% Hispanic, 24% black); the mean of the Na:K ratio intake was 1.22 with a standard deviation of 0.43. Over a mean follow-up time of 11.9 years (SD=5.4), 274 participants developed stroke (N=232 ischemic) and 745 had a vascular event overall. In adjusted models the Na:K intake ratio was associated with an increased risk for ischemic Stroke (HR=1.5, 95% CI: 1.2-2.0), all stroke (HR=1.5, 95% CI: 1.2-1.9) and CVE (HR=1.2, 95% CI: 1.0-1.4). These results were unchanged in models adjusting for sociodemographic variables only. Conclusions: Our findings suggest that Na:K intake may be an important predictor of the risk of ischemic stroke and overall CVE.

Premature Clopidogrel Discontinuation After Drug-Eluting Stent Placement in a Large Urban Safety-Net Hospital

Premature clopidogrel discontinuation is an important cause of stent thrombosis, myocardial infarction, and death after drug-eluting stent (DES) placement. Previous studies of clopidogrel nonadherence after DES placement have had short follow-up and have relied on self-reported adherence. All patients who underwent DES placement from January 2008 to December 2011 at a single safety-net hospital and received medications through the county-subsidized health plan were considered for inclusion; those with <1-year follow-up were excluded. We retrospectively collected 1-year refill data from a large, closed pharmacy system. Our primary outcome was time to failure to obtain a clopidogrel refill, allowing a 5-day grace period. Our study cohort (n = 369) was 34% female, 39% Hispanic, 26% white, and 26% African-American; 26% identified Spanish as their primary language. The time to failure to obtain a clopidogrel refill was 153 days. Cumulative failure to obtain at least 1 refill was 23% for the first refill, increasing to 52% at 6 months and 68% at 1 year. Examining the proportion of days covered (PDC), 21% of patients had 100% coverage, whereas 34% had PDC <80%. There were no independent predictors of nonadherence (PDC <80%). In conclusion, we identified a high rate of clopidogrel nonadherence in a multiethnic urban poor patient population where clopidogrel was provided at discharge and at nominal cost thereafter. In this cohort, prediction models of nonadherence performed poorly. Novel strategies are needed to address this important problem.

Patient Health Literacy and Perception of Provider Communication: Is there a Link?

Inadequate health literacy is a common problem that contributes to poor patient-provider communication. Health literacy screening and specific provider communication practices may be important in clinics where patients are at high risk for inadequate health literacy. This study assessed patients’ health literacy and their perception of provider communication practices in a primary care residency program clinic serving an urban multi-ethnic population. A convenience sample of 324 patients in an urban-based primary care practice was surveyed for health literacy and their perception of physician communication using validated instruments. Of the patients surveyed, 37% had inadequate health literacy. There was high internal consistency of our validated screening questions for health literacy (p < .0001). Overall, the patients surveyed rated the quality of their provider’s communication very highly. We found no statistically significant relationship between patients’ health literacy and their perception of provider communication, suggesting provider communication may be independent of patient understanding in this cohort. Effective communication from providers may compensate for lack of understanding with patients with inadequate health literacy in urban primary care practices.

Patterns of physical activity and sedentary behavior in a representative sample of a multi-ethnic South-East Asian population: a cross-sectional study.

BackgroundFew studies have investigated patterns of physical activity in a multi-ethnic Asian urban population. Even less is known about sedentary behaviors in these populations. The present study examined the prevalence of physical activity, exercise and sedentary behavior. In addition, it investigated socio-demographic correlates and the contribution of different domains towards overall physical activity.MethodsData of 2319 participants from the population-based cross-sectional Singapore Health 2012 study were analyzed. Physical activity, exercise and sedentary behavior were assessed using the Global Physical Activity Questionnaires. A modified Cox regression model was used to estimate the relative prevalence rates (PR) for overall physical activity, leisure-time exercise and high level of sedentary behavior by socio-demographic factors.ResultsOverall, 73.8% of participants met physical activity guidelines, 24.3% did regular leisure-time exercise and 37.0% reported high levels of sedentary behavior. Travel-related activities contributed about half of the total physical activity. There was a consistent association between age of participants with physical activity and exercise. Older participants were less likely to meet the guidelines (PR = 0.74, 95% C I = 0.61 – 0.91) than younger participants. The prevalence of regular exercise was lowest among 30 to 39 years aged participants (PR = 0.62, 95% CI = 0.45 – 0.86). Females exercised less regularly (PR = 0.63, 95% C I = 0.51 – 0.76) than males. Participants with higher education exercised regularly (PR = 2.08, 95% CI = 1.45 – 2.99) than participants with lower education. Employment status was consistently associated with exercise and high levels of sedentary behavior. Participants who were not in full-time employment exercised more regularly (PR = 1.45, 95% CI = 1.1 – 1.92) and were less likely to report high levels of sedentary behavior (PR = 0.65, 95% CI = 0.44 – 0.97) than those in full-time employment.ConclusionsOur population-based study suggests a need to encourage overall physical activity but, particularly regular leisure-time exercise, especially among middle-aged, females and those with lower levels of education and full-time employment. Strategies targeting workplaces may be important to reduce high levels of sedentary behavior.

The association of alcohol consumption with mammographic density in a multiethnic urban population.

BackgroundAlcohol consumption is associated with higher breast cancer risk. While studies suggest a modest association between alcohol intake and mammographic density, few studies have examined the association in racial/ethnic minority populations.MethodsWe assessed dense breast area and total breast area from digitized film mammograms in an urban cohort of African American (42%), African Caribbean (22%), white (22%), and Hispanic Caribbean (9%) women (n = 189, ages 40-61). We examined the association between alcohol intake and mammographic density (percent density and dense area). We used linear regression to examine mean differences in mammographic density across alcohol intake categories. We considered confounding by age, body mass index (BMI), hormone contraceptive use, family history of breast cancer, menopausal status, smoking status, nativity, race/ethnicity, age at first birth, and parity.ResultsFifty percent currently consumed alcohol. Women who consumed >7 servings/week of alcohol, but not those consuming ≤7 servings/week, had higher percent density compared to nondrinkers after full adjustments (servings/week >7 β = 8.2, 95% Confidence Interval (CI) 1.8, 14.6; ≤7 β = -0.5, 95% CI -3.7, 2.8). There was a positive association between high alcohol intake and dense area after full adjustments (servings/week >7 β = 5.8, 95% CI -2.7, 14.2; ≤7 β = -0.1, 95% CI -4.4, 4.2). We did not observe race/ethnicity modification of the association between alcohol intake and percent density. In women with a BMI of <25 kg/m2, drinkers consuming >7 servings/week of alcohol had a 17% increase in percent density compared to nondrinkers (95% CI 5.4, 29.0) and there was no association in women with a BMI ≥ 25 kg/m2 (BMI ≥ 25-30 kg/m2 > 7 β = 5.1, 95% CI -8.5, 18.7 and BMI > 30 kg/m2 > 7 β = 0.5, 95% CI -6.5, 7.5) after adjusting for age and BMI (continuous).ConclusionIn a racially/ethnically diverse cohort, women who consumed >7 servings/week of alcohol, especially those with a BMI < 25 kg/m2, had higher percent density.

Epidemiology of uveitis in a Western urban multiethnic population. The challenge of globalization.

To report the anatomical pattern and etiological spectrum of uveitis in an urban multi-ethnic population from Barcelona, Spain. General and specific epidemiological data for the most prevalent aetiologies are also calculated. A cross-sectional study of consecutive uveitis cases was performed between 1 January 2009 and 31 December 2012. Exogenous endophthalmitis, surgery-related, post-traumatic and toxic uveitis along with masquerade syndromes were excluded. Anatomical (Standard Uveitis Nomenclature criteria) and aetiological patterns (by tailored tests), age, sex, geographical origin and laterality were analysed. Mean incidence and prevalence were calculated for a mid-period reference population. From 1022 patients included, 52% were anterior uveitis (AU), 23% posterior, 15% panuveitis and 9% intermediate uveitis. Aetiologically, 26% were unclassifiable, 29% infectious, 25% associated with systemic immune diseases, and 20% corresponded to ocular-specific syndromes. Among classified causes, herpesvirus (12%), toxoplasma (7%), Behçet's disease (BD) (5%), HLA-B27-isolated AU (5%), ankylosing spondylitis (5%), tuberculosis-related uveitis (TRU) (5%), birdshot chorioretinopathy (3%) and sarcoidosis (3%) were the most frequent. Non-Spanish origin was recorded in 22%, with 47% of Vogt-Koyanagi-Harada and 36% of toxoplasma cases coming from South America, 10% of BD and 11% of TRU from Africa and 24% of TRU cases from Asia. A mean annual incidence of 51.91 cases/100,000 inhabitants was found for the referral population. In our referral area, 74% of the uveitis cases can be correctly classified. A large myriad of uveitis aetiologies with a strong geographical origin burden are found in Western urban multi-ethnic populations.

Ethnic variation in stillbirth risk and the role of maternal obesity: analysis of routine data from a London maternity unit.

BackgroundApproximately 5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades. The aim of this study was to investigate the association between clinical and socio-demographic factors and stillbirth, with a particular focus on ethnicity and obesity.MethodsAnalysis of routine maternity data on 53,293 singleton births occurring in a large London teaching hospital between 2004 and 2012. Logistic regression was used to investigate risk factors for stillbirth and to explore potential effect modification.Results53,293 deliveries occurred during the time period, of which 329 resulted in a stillbirth (6.2 per 1,000 births). Compared to White women, non-White ethnicity was associated with a doubling of the odds of stillbirth (aOR for Black women 2.15, 95% CI 1.56-2.97; aOR for South Asian women 2.33, 95% CI 1.42-3.83). Obese women had a trend towards higher odds of stillbirth compared to women of recommended BMI (aOR 1.38, 95% CI 0.98-1.96), though this was not significant (p 0.07). Both higher parity (≥2 compared to para 1) and hypertension were associated with a higher odds of stillbirth (parity ≥2 aOR 1.65, 95% CI 1.13-2.39; hypertension aOR 1.84, 95% CI 1.22-2.78) but there was no evidence that area deprivation or maternal age were independently associated with stillbirth in this population. There was some evidence of effect modification between ethnicity and obesity (p value for interaction 0.06), with obesity a particularly strong risk factor for stillbirth in South Asian women (aOR 4.64, 95% CI 1.84-11.70).ConclusionsThere was a high prevalence of stillbirth in this multi-ethnic urban population. The increased risk of stillbirth observed in non-White women remains after adjusting for other factors. Our finding of possible effect modification between ethnicity and obesity suggests that further research should be conducted in order to improve understanding of the interplay between ethnicity, obesity and stillbirth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0404-0) contains supplementary material, which is available to authorized users.

Identifying Risk Factors Leading to Suboptimal Bowel Preparation

Introduction: Suboptimal (incomplete or poor) bowel preparation (SOBP) can severely lower adenoma detection rate (ADR) with reported miss rates as high as 45%. Our study aims to identify risk factors that could lead to SOBPs in a multiethnic urban patient population. Methods: We conducted a single-center retrospective chart review of 323 patients with SOBPs who underwent screening colonoscopy at our center over a period of 5 years. We compared this group with regards to their comorbidities to a control group of 395 randomly selected patients who had optimal (good to excellent) bowel preparation (OBP) in the same time period. All patients received standard preparation using polyethylene glycol solution and 4 tabs of bisacodyl. Results: Of our diabetic patients 65% (n=128) had SOBPs vs. 35% (n=70) having OBPs, giving an OR of 3.0 (95% CI 2.2, 4.3), indicating that diabetics are 3 times more likely to have SOBPs. In our hypertensive patients 52% (n=194) had SOBPs vs. 47% (n=174) having OBPs, giving an OR of 1.9 (95% CI 1.4, 2.6) indicating with hypertension are approximately 2 times more likely to have SOBPs. Of our morbidly obese patients 92% (n=46) had SOBPs vs. 8% (n=4) having OBPs, giving an OR 16.4 (95% CI 5.7, 45), indicating that those with morbid obesity are 16.4 times more likely to have SOBPs. Lastly in our liver cirrhosis patients 85% (n=6) had SOBPs vs. 14% (n=1) who had OBPs, giving an OR 7.5 (95% CI 0.9, 62.5), indicating that cirrhotics are 7.5 times more likely to have SOBPs. Conclusion: Our data reveals that diabetes, hypertension, morbid obesity, and liver cirrhosis are risk factors associated with SOBP. With the implementation of the Affordable Care Act and the focus on costeffective quality care, this data is significant as it allows us to risk stratify patients prior to scheduling initial colonoscopies. Such individualized preparation instructions based on comorbidities will ultimately result in higher ADR with lower associated costs.Table 1Table 2

Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study.

BackgroundUnderstanding the population‐level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations.Methods and ResultsThe Northern Manhattan Study (n=3298) is a population‐based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race‐ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non‐Hispanic whites (2.6%; 95% CI, −33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (−0.3%; 95% CI, −34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, −8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/race‐ethnicity.ConclusionsHTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.

Human Fetal Exposure to Triclosan and Triclocarban in an Urban Population from Brooklyn, New York

Triclosan (TCS) and triclocarban (TCC) are antimicrobial agents formulated in a wide variety of consumer products (including soaps, toothpaste, medical devices, plastics, and fabrics) that are regulated by the U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency. In late 2014, the FDA will consider regulating the use of both chemicals, which are under scrutiny regarding lack of effectiveness, potential for endocrine disruption, and potential contribution to bacterial resistance to antibiotics. Here, we report on body burdens of TCS and TCC resulting from real-world exposures during pregnancy. Using liquid chromatography tandem mass spectrometry, we determined the concentrations of TCS, TCC, and its human metabolites (2′-hydroxy-TCC and 3′-hydroxy-TCC) as well as the manufacturing byproduct (3′-chloro-TCC) as total concentrations (Σ−) after conjugate hydrolysis in maternal urine and cord blood plasma from a cohort of 181 expecting mother/infant pairs in an urban multiethnic population from Brooklyn, NY recruited in 2007–09. TCS was detected in 100% of urine and 51% of cord blood samples after conjugate hydrolysis. The interquartile range (IQR) of detected TCS concentrations in urine was highly similar to the IQR reported previously for the age-matched population of the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2004, but typically higher than the IQR reported previously for the general population (detection frequency = 74.6%). Urinary levels of TCC are reported here for the first time from real-world exposures during pregnancy, showing a median concentration of 0.21 μg/L. Urinary concentrations of TCC correlated well with its phase-I metabolite ∑-2′-hydroxy-TCC (r = 0.49) and the manufacturing byproduct ∑-3′-chloro-TCC C (r = 0.79), and ∑-2′-hydroxy-TCC correlated strongly with ∑-3′-hydroxy-TCC (r = 0.99). This human biomonitoring study presents the first body burden data for TCC from exposures occurring during pregnancy and provides additional data on composite exposure to TCS (i.e., from both consumer-product use and environmental sources) in the maternal–fetal unit for an urban population in the United States.

Abstract 165: Premature Clopidogrel Discontinuation after Drug-Eluting Stent Placement

Background: Clopidogrel non-adherence is a strong predictor of stent thrombosis, myocardial infarction, and death after drug-eluting stent (DES) placement. Previous studies on the prevalence of premature clopidogrel discontinuation are based on self-report and have short follow-up. Methods: All patients who underwent DES placement between January 2007 and December 2011 at Parkland Memorial Hospital were considered for inclusion; those with &lt; 1 year follow-up were excluded. We retrospectively collected one-year refill data from a large, closed (county hospital subsidized care) pharmacy system. Our primary outcome was time to failure to obtain a clopidogrel refill, allowing a 5-day grace period. Results: Of 452 patients (61% male, 38% Hispanic, 29% White, 24% African American) meeting entry criteria English was preferred by 71% of study patients, while 27% preferred Spanish. Median time to failure to obtain a clopidogrel refill was 91 days (Figure). By 6 months 58% of patients and by 12 months 85% of patients had failed to obtain a refill allowing a 5-day grace period. At follow-up 26% of patients had failed to obtain their first refill within 5-days after first prescription ending. By one year follow-up, 21% of patients had 100% proportion of days covered (PDC), 60% had PDC ≥ 80%, and 40% had PDC &lt; 80%. Conclusions: We identified a high prevalence of clopidogrel non-adherence in a multi-ethnic urban poor patient population, despite the facts that clopidogrel was provided on discharge and at nominal cost ($5 per month) thereafter, that patients were identified by treating physicians as likely to adhere to treatment, and that intensive patient education on the importance of clopidogrel adherence post-DES was routinely provided. These data call into question the implicit assumptions made about clopidogrel adherence in routine clinical practice.

Association of traffic-related hazardous air pollutants and cervical dysplasia in an urban multiethnic population: a cross-sectional study.

BackgroundHuman papillomavirus (HPV) infection is a necessary cause in the development of cervical cancer; however, not all women infected with HPV develop cervical cancer indicating that other risk factors are involved. Our objective was to determine the association between exposure to ambient levels of common traffic-related air toxics and cervical dysplasia, a precursor lesion for cervical cancer.MethodsThe study sample consisted of women enrolled in a Phase II clinical trial to evaluate diagnostic techniques for cervical disease in Houston, Texas. The current assessment is a secondary data analysis in which cases were defined as women diagnosed with cervical dysplasia, while those without cervical dysplasia served as controls. Residential census tract-level estimates of ambient benzene, diesel particulate matter (DPM), and polycyclic aromatic hydrocarbons (PAHs) were used to assess exposure. Census tract-level pollutant estimates were obtained from the United States Environmental Protection Agency. Multivariable logistic regression was used to estimate prevalence odds ratios (aOR) and 95% confidence intervals (CI) adjusted for age, race/ethnicity, education, smoking status, and HPV status.ResultsWomen in the highest residential exposure categories for benzene and DPM had an increased prevalence of cervical dysplasia compared to the lowest exposure category (Benzene: aOR [95% CI] for high exposure = 1.97[1.07-3.62], very high exposure = 2.30[1.19-4.46]. DPM: aOR [95% CI] for high exposure = 2.83[1.55-5.16], very high exposure = 2.10[1.07-4.11]). Similarly, women with high residential exposure to PAHs had an increased prevalence of cervical dysplasia (aOR [95% CI] = 2.46[1.35-4.48]). The highest PAH exposure category was also positively associated with cervical dysplasia prevalence but was not statistically significant. Assessment of the combined effect of HAP exposure indicates that exposure to high levels of more than one HAP is positively associated with cervical dysplasia prevalence (p for trend = 0.004).ConclusionsTraffic-related HAPs, such as benzene, DPM, and PAHs, are not as well-regulated and monitored as criteria air pollutants (e.g., ozone), underscoring the need for studies evaluating the role of these toxicants on disease risk. Our results suggest that exposure to traffic-related air toxics may increase cervical dysplasia prevalence.

Serum levels of soluble receptor for advanced glycation end-products and metabolic syndrome: The Northern Manhattan Study

ObjectiveRecent studies have shown a strong link between serum soluble receptor for advanced glycation end-products (sRAGE) levels and cardiovascular risk factors and disease. What is less clear is the relationship between metabolic risk factors and sRAGE levels. Here, we tested the hypothesis that lower sRAGE levels may be associated with the metabolic syndrome (MetS) in an urban multi ethnic population. Materials/methodsFrom the Northern Manhattan Study (NOMAS), we included 1101 stroke-free participants (mean age: 71±9years, 60% women, 64% Hispanic, 18% black, 16% white). Serum sRAGE was measured by ELISA. Quantile regression analysis was performed to evaluate the association between sRAGE and MetS components and MetS, after adjusting for sociodemographics, smoking status and kidney function. ResultsThe median (interquartile) sRAGE was 899pg/ml (647–1248pg/ml), 42% had metabolic syndrome. The prevalence of unfavorable metabolic factors was 50% for waist circumference (WC), 81% for blood pressure, 39% for fasting glucose, 35% for reduced high density lipoproteins (HDL), and 23% for triglycerides. After adjustment, the median sRAGE levels were at least 120pg/ml lower in those who had elevated WC (p<0.0001), blood pressure (p=0.0014), and fasting glucose (p<0.0001), and those who had 2 or more unfavorable metabolic factors. No relationship was seen between sRAGE levels and elevated triglycerides or reduced HDL levels. Interaction and stratified analyses revealed that the association of sRAGE with MetS was more prominent in Hispanics compared to whites, and displaying no association with components of MetS in blacks. ConclusionssRAGE levels were mainly associated with MetS factors related to obesity, diabetes and hypertension, and displayed variation with ethnicity in a multi-ethnic population. Further studies of sRAGE, MetS and their relationship to cardiovascular disease are warranted.

SAT0267 Epidemiology of ANCA Associated Vasculitis in A Multi-Ethnic Urban Population

BackgroundThe epidemiology of ANCA-associated vasculitis (AAV) varies geographically, due to both genetic and environmental factors. The epidemiology of AAV is well-described in White Caucasian populations in which there is an...

Su1203 Risk Factors for Helicobacter pylori Acquisition in a Multi-Ethnic Urban Population

Su1203 Risk Factors for Helicobacter pylori Acquisition in a Multi-Ethnic Urban Population

Abstract P172: Attributable risks of hypertension and diabetes for stroke, myocardial infarction and vascular death in the Northern Manhattan Study

Objective: To determine the attributable risks (AR) for vascular events (VE: stroke, myocardial infarction, and vascular death) due to hypertension and diabetes by race/ethnicity, sex and age. Background: Understanding the distribution of risk factors and their contribution to disease incidence is critical for effective allocation of resources for disease prevention. There is little data on the relative contribution of vascular risk factors among multiethnic elderly populations. Methods: The Northern Manhattan Study is a population-based prospective cohort study of incidence, risk factors, and outcomes in a multiethnic urban population. Multi-variable Cox models adjusted for socio-demographic and vascular risk factors were used to calculate hazard ratios, AR and 95% confidence intervals (95%CI) for (1) all stroke and (2) VE. Results: The cohort (n=3,298) had mean age 69.2+/-10 years with 63% women, 52% Hispanic, 73% hypertensive and 21% diabetics. There were 347 strokes and 835 VE during a median follow-up of 12 years. The AR due to hypertension was 30% (95%CI 13-48%) for stroke and 24% (95%CI 13-35%) for VE; AR due to diabetes was 19% (95%CI 12-27%) for stroke and 13% (95%CI 8-17%) for VE.The AR for stroke from hypertension differed by age and race-ethnicity (table), while for diabetes it only differed by age. For VE, the AR of hypertension and diabetes did not differ by age, sex, or race-ethnicity. Conclusions: On a population level diabetes and hypertension have important effects on the risk of VE across all socio-demographic groups. For stroke, these effects are more notable at age&lt; 80. Our results may in part be driven by competing risks for other VE outcomes with stroke, or a differential impact of risk factors on stroke in younger individuals.