US Adult Women Research Articles

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study.

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women. From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI. Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73. Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

Iron status and anemia in a representative sample of US pregnant women is not associated with pre-pregnancy BMI: Results from the NHANES (1999-2010) study.

Iron deficiency in pregnancy is related to many poor health outcomes, including anemia and low birth weight. A small number of previous studies have identified maternal body mass index (BMI) as a potential risk factor for poor iron status. Our objective was to examine the association between pre-pregnancy BMI, iron status, and anemia in a nationally representative sample of US adult women. We used data from the National Health and Nutrition Examination Survey (NHANES; 1999-2010) for pregnant women ages 18-49 years (n = 1156). BMI (kg/m2) was calculated using pre-pregnancy weight (self-reported) and height (measured at examination). Iron deficiency (ID) was defined as total body iron (calculated from serum ferritin and transferrin receptor using Cook's equation) < 0 mg/kg and anemia as hemoglobin < 11 g/dL. Associations were examined using weighted linear and Poisson regression models, adjusted for confounders (age, race/ethnicity, education, and trimester). Approximately 14% of pregnant women had ID and 8% had anemia in this sample. Ferritin and total body iron trended slightly lower (p = 0.12, p = 0.14) in women with pre-pregnancy BMI in the normal and overweight categories compared to the underweight and obese categories; hemoglobin concentrations were similar across BMI groups (p = 0.76). There were no differences in the prevalence of ID or anemia in women with pre-pregnancy overweight and obesity (ID: overweight, adjusted prevalence ratio (PR) = 1.27, 95%CI: 0.89-1.82; obesity, PR = 0.75, 95%CI: 0.39-1.45; anemia: overweight, PR = 1.08, 95%CI: 0.53-2.19; obesity, PR = 0.99, 95%CI: 0.49-2.01) compared to women with a normal BMI. Findings from these US nationally representative data indicate that total body iron, serum hemoglobin, ID, and anemia in pregnancy do not differ by pre-pregnancy BMI. Since ID and anemia during pregnancy remain significant public health concerns, NHANES should consider measuring current iron status in upcoming cycles.

Associations of sex hormone ratios with metabolic syndrome and inflammation in US adult men and women.

Sex hormones play a critical role in sex differences and cardiovascular disease risk associated with metabolic syndrome (MS) and inflammation. However, the associations of sex hormone ratios with metabolic and inflammatory markers are unclear according to sex and age differences. We evaluated the associations of sex hormone ratios with MS and inflammation among males and females. A retrospective cross-sectional study was conducted by including all adults from the National Health and Nutrition Examination Survey cycles 2013-2016 and excluding any pregnant women, heart disease, diabetes, and those currently taking insulin. MS was defined using the National Cholesterol Education Program criteria and a high-sensitivity C-reactive protein (CRP) level>3 mg/L was defined as a high CRP. Measures of MS components and CRP concentrations were also analyzed. The primary exposures were testosterone to estradiol (excess androgen index), testosterone to sex hormone-binding globulin (free androgen index), and estradiol to sex hormone-binding globulin (free estradiol index). The adjusted associations were summarized with a relative risk (RR) and 95% confidence interval (CI). This study included 9167 subjects with 4360 males and 4807 females. Increases in free estradiol index were positively associated with MS (RR=1.48; 95%CI: 1.39, 1.58; RR=1.31; 95%CI: 1.22, 1.40) and high CRP (RR=1.49; 95%CI: 1.25, 1.77; RR=1.26; 95%CI: 1.06, 1.50) in men with age<50 years and age≥50 years, respectively. Similarly, higher free estradiol index was also robustly associated with increased prevalence of MS (RR=1.22; 95%CI: 1.15, 1.28) and high CRP (RR=1.68; 95%CI: 1.48, 1.90) in women with age ≥50 years. Among women with age<50 years, a higher free androgen index was associated with MS (RR=1.34; 95%CI: 1.25, 1.42) and high CRP (RR=1.13; 95%CI: 1.02, 1.25). These associations were unchanged even after adjusting for all sex hormones. Free estradiol index was consistently and positively associated with MS and high CRP in males of all ages and older females. Free androgen index was positively associated with MS and high CRP in females with age<50 years.

Association between blood cadmium and depression varies by age and smoking status in US adult women: a cross-sectional study from NHANES 2005-2016.

Cadmium, a toxic metal, is widely encountered in diverse environmental contexts. Despite its pervasive exposure, there is limited research on the association between blood cadmium levels and depression, especially among females. This study aimed to investigate the relationship between blood cadmium levels and depression in adult women. Data spanning 2005-2016 from the National Health and Nutrition Examination Survey (NHANES) were selected. Depression was diagnosed with the Patient Health Questionnaire (PHQ-9, score ≥10). Multiple logistic regression, multiple linear regression, and smoothed curve fitting were used to investigate the relationship between blood cadmium and depression. Subgroup analyses and interaction tests were performed to evaluate the stability of this association across populations. A total of 1,173 individuals were diagnosed with depression. The heightened prevalence of depression was linked to increased blood cadmium levels, a trend that persisted even after quartering blood cadmium. In the fully adjusted model, each incremental unit of blood cadmium was associated with a 33% rise in the prevalence of depression (OR = 1.33, 95% CI: 1.21-1.45). Participants in the highest quartile were 63% more likely to experience depression compared to those in the lowest quartile of blood cadmium (OR = 1.63, 95% CI: 1.15-2.30), and PHQ-9 score increased by 0.73 (β = 0.73, 95% CI: 0.30-1.17). This positive association may be relevant to the general population. Blood cadmium levels are associated with depression in adult women, and this association varies by age and smoking status.

Associations between visceral adipose index and stress urinary incontinence among US adult women: a cross-sectional study

ObjectiveVisceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. The present study aimed to investigate the association between VAI levels and stress urinary incontinence (SUI) in a nationally representative population.Materials and methodsThe National Health and Nutrition Examination Survey (NHANES) women population aged > 20 years were analyzed from 2001 to 2018. SUI was determined by self-reported questions. VAI was calculated using physical examination data and laboratory tests. Survey-weighted logistic regression models were used to analyze the correlation between SUI and VAI.ResultsThe final analysis included 9709 women. Among them, 4032 (41.53%) were any SUI, 1130 (11.64%) were at least weekly SUI, and 506 (5.21%) were at least daily SUI. In multivariate analysis, the odds ratio (OR) for overall SUI increased slightly after full adjustment (OR 1.06, 95% CI 1.03–1.10, P = 0.001). Similar results were observed in weekly (OR 1.04, 95% CI 1.00–1.08, P = 0.0327) and daily (OR 1.04, 95% CI 1.00–1.09, P = 0.0702) SUI. The analysis of VAI categorized showed an increased OR of any, weekly, and daily SUI in the highest compared to the lowest tertile (OR 1.44, 95% CI 1.26–1.65, P < 0.0001 for trend, OR 1.38, 95% CI 1.07–1.78, P = 0.0153 for trend, OR 1.33, 95% CI 0.94–1.87, P = 0.094 for trend).ConclusionThis study revealed a significant association between SUI and VAI among US adult women. VAI is an easily applicable index for the evaluation of visceral fat dysfunction, which might be useful for the calculation of SUI risk.

Autistic traits and borderline personality disorder traits are positively correlated in UK and US adult men and women

Co-occurrence of autism and borderline personality disorder (BPD) has been reported and may be more prevalent in women than men. However, the association between these conditions remains poorly understood, as does that between traits found throughout the general population. We present two studies which measured self-reported autistic traits (Autism Spectrum Quotient [AQ]) and BPD traits (McLean Screening Instrument for Borderline Personality Disorder [MSI-BPD]) in UK (N = 695) and US (N = 700) adults. As predicted, autistic and BPD traits correlated positively in both samples. However, there were no significant sex differences in the correlation strength. In the UK sample, the association between autistic traits (AQ total score) and BPD traits was no longer significant once current anxiety and depression symptoms (Hospital Anxiety and Depression Scale [HADS]) were controlled for. However, AQ subscales for Details/Patterns and Communication/Mindreading (but not Social Skills) remained significantly associated with MSI-BPD scores in the US sample. Our findings suggest that an overrepresentation of autistic women in patient populations with BPD may not be explained by traits of these conditions co-occurring to a greater degree in women than men. They also suggest that although both conditions are associated with elevated levels of anxiety and depression, BPD traits remain independently associated with specific domains of autistic traits.

Distant stage melanoma incidence among US adult women.

e21555 Background: To examine trends in distant stage melanoma incidence among U.S. women. Methods: Demographic and clinical data were obtained from the United States Cancer Statistics (USCS) Database from 2001-2019. SEER*Stat 8.3.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate cancer incidences and trends per 100,000. Average annual percentage change (AAPC) was used to describe trends. Age-adjusted incidences were adjusted by the U.S. 2000 standard population. Results: From 2001-2019, 543,051 women were diagnosed with distant stage melanoma. Over this period, incidence rose from 0.37 to 0.59/100,000 with an increasing annual rate of 2.58% per year (p &lt; 0.0001). In 2019, non-Hispanic White women had disproportionately higher incidence rates at 0.76/100,000 compared to Hispanic (0.26/100,000), non-Hispanic Black (0.17/100,000), and non-Hispanic Asian (0.08/100,000) women. Regarding race, the largest increase in distant melanoma incidence was observed in White women with an average annual increase of 2.92% (p &lt; 0.0001). Among age groups, incidence was highest among those aged ≥45 (1.54/100,000) and 40-44 (0.53/100,000) years. However, the largest increases in distant melanoma incidence were found among 30-34-year-olds at a rate of 3.91% per year (p = 0.004) and 40-44-year-olds at 2.78% per year (p = 0.003). When examined by race and age, annual incidence rates were highest among White women aged 40-44 years at 3.68% per year (p &lt; 0.0001). Regarding U.S. state, incidence was highest in Florida (1.34/100,000), West Virginia (1.32/100,000), and Oklahoma (1.20/100,000). The largest annual increases in distant melanoma incidence rates were observed in Nebraska at 8.63% (p = 0.001), Kentucky at 6.18% (p &lt; 0.0001), and West Virginia at 6.06% (p = 0.001). When performing an intersection analysis of race, age, and U.S. stage, White women living in Nebraska aged ≥45 had the largest increase in distant melanoma at a rate of 8.12% annually (p = 0.004). In 2019, White women in Utah had the highest incidence of distant melanoma at 3.45/100,000. Conclusions: Distant stage melanoma is disproportionally increasing among adult women aged 30-44 years, especially among White populations. Further studies are warranted to understand the environmental and socioeconomic implications behind these trends.

Maternal and Neonatal Outcomes of Pregnancy within 7years after Roux-Y Gastric Bypass or Sleeve Gastrectomy Surgery.

Few studies examine whether maternal and neonatal outcomes differ by time from metabolic and bariatric surgery (MBS) to conception. We describe maternal and neonatal outcomes among women with pregnancy after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) overall and by whether conception occurred during the period when pregnancy is not recommended (< 18months postoperative) versus later. A prospective cohort study enrolled 135 US adult women (median age, 30years, body mass index [BMI], 47.2kg/m2) who underwent RYGB or SG (2006-2009) and subsequently reported ≥ 1 pregnancy within 7years. Participants self-reported pregnancy-related information annually. Differences in prevalence of maternal and neonatal outcomes by postoperative conception timeframe (< 18 versus ≥ 18months) were assessed. Thirty-one women reported ≥ 2 postoperative pregnancies. At time of postoperative conception (median 26 [IQR:22-52] months postoperative) median BMI was 31 (IQR:27-36) kg/m2. Excessive gestational weight gain (55%), cesarean section (42%) and preterm labor or rupture of membranes (40%) were the most common maternal outcomes. Forty percent of neonates had a composite outcome of still birth (1%), preterm birth (26%), small for gestational age (11%), or neonatal intensive care unit admission (8%). Prevalence of outcomes did not statistically significantly differ by timeframe. In US women who conceived ≤ 7years following RYGB or SG, 40% of neonates had the composite neonatal outcome. The prevalence of maternal and neonatal outcomes post-MBS were not statistically significant by conception timeframe.

The relationship between fecal incontinence and food insecurity in United States women: an analysis of 2005–2010 National Health and Nutrition Examination Survey

Fecal incontinence is a prevalent debilitating pelvic floor disorder characterized by the involuntary loss of stool. Fecal incontinence is known to be associated with constipation and loose stool, advancing age, chronic comorbidities, and prior anorectal trauma, among other biologic risk factors. The relationship between social determinants of health, such as food insecurity, and fecal incontinence is not well-elucidated. We aimed to investigate the association between fecal incontinence and food insecurity using a nationally representative sample of US adult women. Our secondary aim was to examine the role of diet by assessing dietary differences between participants with versus without fecal incontinence and between food insecure women with and without fecal incontinence. We analyzed data from the National Health and Nutrition Examination Survey, a nationally representative series of cross-sectional health surveys. Fecal incontinence was defined as accidental leakage of stool within the last 30 days. Food insecurity was assessed using the household food security measure created by the US Department of Agriculture. Dietary data from NHANES dietary interviews titled "Individual Foods, First Day" and "Individual Foods, Second Day," which estimates the foods and drinks consumed in the preceding 24 hours, were pooled. The association between fecal incontinence and food insecurity was analyzed using logistic regression after controlling for patient characteristics. A total of 3,216 women were included, representing nearly 130 million US women. Of these, 10.9% had fecal incontinence. There were no significant differences in diet between women with and without fecal incontinence. Food insecure women in the overall sample reported higher carbohydrate and sugar intake and lower fiber and alcohol intake (all p<0.05). Amongst food insecure women, those with fecal incontinence had higher calorie and total fats intake than those without fecal incontinence; there were no significant differences in other dietary components. There was a significant association between food insecurity and fecal incontinence, such that women with food insecurity had higher odds of fecal incontinence after adjusting for patient characteristics and diet (OR 1.76; 95% CI=1.17-2.66; p=0.008). Food insecurity is associated with fecal incontinence even after accounting for diet. Understanding the role of social determinants of health in fecal incontinence symptomatology and treatment is important to potentially alleviate symptom burden and improve quality of life in at-risk populations.

A negative association between total cholesterol and bone mineral density in US adult women.

BackgroundThe association between serum total cholesterol (TC) and bone mineral density (BMD) is still controversial. We aimed to evaluate the association of serum TC with BMD in general US adult women.MethodsA cross-sectional study consisting of 7,092 (age range 20–85) participants from the National Health and Nutrition Examination Survey (NHANES) database was conducted. Weighted multivariate linear regression analyses were performed to evaluate association between serum TC and lumbar spine BMD. In addition, subgroup and interaction analysis were used in this study.ResultsThe serum TC was negatively correlated with lumbar spine BMD after adjusting for confounders. Subgroup analysis found that the strongest negative association mainly exists in women aged over 45 years with body mass index (BMI) < 24.9 kg/m2, and this association is not significant in other groups.ConclusionsThis study found that serum TC exhibit an inverse association with lumbar spine BMD in Us women aged over 45 years. The measurement of serum TC may provide information for predicting poor bone health outcomes in these women.

A multisite focus group study of USadult women's beliefs and assumptions about bladder health and function.

This analysis explored and characterized the ideas adult women have about how the bladder works, the assumptions guiding their bladder-related behaviors, and the beliefs they hold about how their behaviors affect bladder health. This was a directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities, and Experiences, a focus group study conducted at seven United States research centers (July 2017 to April 2018). Participants were 316 adult women organized by fourage categories (age range: 18-93 years). Analysis and interpretation focused on the "bladder assumptions and beliefs" code using a transdisciplinary lens and inductive approach. During their focus group discourse, participants exhibited a speculative mode of thinking about bladder health and function characterized by uncertainty about how the bladder works. They described the bladder as a mechanism for cleansing the body of impurities, viewing it as part of a larger interconnected bodily system to enable the body to stay healthy. They saw it as susceptible to anatomical changes, such as those related to pregnancy and aging. The women also postulated perceived relationships between bladder function and several health behaviors, including eating healthy foods, staying hydrated, engaging in physical activity and exercise, and adopting specific toileting and hygiene practices. The findings underscore the importance of guidance from healthcare professionals and systematic community based educational programs for promoting women's understanding about bladder health and empowering them to exert agency to engage in healthy bladder behaviors.

PD06-12 USAGE AND COST OF URINARY INCONTINENCE PRODUCTS IN WOMEN

You have accessJournal of UrologyCME1 May 2022PD06-12 USAGE AND COST OF URINARY INCONTINENCE PRODUCTS IN WOMEN Leah Chisholm, Elisabeth Sebesta, Stephanie Gleicher, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Leah ChisholmLeah Chisholm More articles by this author , Elisabeth SebestaElisabeth Sebesta More articles by this author , Stephanie GleicherStephanie Gleicher More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002525.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is common in US women, who often use incontinence containment products to self-manage, the cost of which can be a great burden. Because few studies have sought to quantify use and costs of incontinence products associated with subtypes of incontinence and severity, therefore we aimed to quantify incontinence product use and personal costs to women. METHODS: This is a secondary analysis of a sample of 2,627 US adult women, recruited electronically via ResearchMatch. Participants were asked about daily numbers and types of incontinence products used and weekly costs. Urinary symptoms were assessed via LURN SI-10 and ICIQ-UI SF, along with demographic and baseline clinical information. Descriptive statistics were performed, in addition to Wilcoxon rank sum and Kruskal-Wallis tests to compare mean incontinence product usage based on type of incontinence, symptom severity, and other demographics. RESULTS: A total of 1,522 of all women reported any weekly incontinence on ICIQ-UI SF (57.94%). The mean age of incontinent patients was 52.02 +/- 15.86 years, and the majority of patients identified as non-Hispanic white (86.60%). 564 patients (37.06%) reported using pads or diapers daily, with a mean of 1.6 +/- 1.5 (range 0 to 20) pads and a mean weekly cost of $4.98 +/- $8.38 (range $0 - $100). Usage or cost did not differ by type of UI, race, or living community. Usage and cost was more in women who had less than college education, on disability, used Medicaid or were uninsured, had 3 or more unmet social needs, or household income below the poverty line (all results in Table 1). Looking more closely at ICIQ-0UI SF, daily pad use and weekly costs increased with symptom severity, with the biggest increase between those with severe and very severe symptoms. CONCLUSIONS: In this study of incontinent women, those with severe or very severe symptoms on ICIQ-UI SF reported using on average 3 to 11 pads/diapers per day, at a significant personal cost that averaged $10 to $38 weekly. For those with more unmet social needs, uninsured or using Medicaid, less than college education, lower income, and on disability, these costs were even greater, and may be prohibitive. Source of Funding: UL1 TR000445 from NCATS/NIH © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e97 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leah Chisholm More articles by this author Elisabeth Sebesta More articles by this author Stephanie Gleicher More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement PDF DownloadLoading ...

The challenge of COVID-19 for adult men and women in the United States: disparities of psychological distress by gender and age

ObjectivesDuring the COVID-19 pandemic, the prevalence of psychological distress rose from 11% in 2019 to more than 40% in 2020. This study aims to examine the disparities among US adult men and women. Study designWe used 21 waves of cross-sectional data from the Household Pulse Survey that were collected between April and December 2020 for the study. The Household Pulse Survey was developed by the U.S. Census Bureau to document the social and economic impact of COVID-19. MethodsThe study population included four groups of adults: emerging adults (18–24 years); young adults (25–44 years); middle-aged adults (45–64 years); and older adults (65–88 years). Psychological distress was measured by their Generalized Anxiety Disorder score and the Patient Health Questionnaire. The prevalence of psychological stress was calculated using logistic models adjusted for socio-demographic variables including race/ethnicity, education, household income, and household structure. All descriptive and regression analysis considered survey weights. ResultsYounger age groups experienced higher prevalence of psychological distress than older age groups. Among emerging adults, the prevalence of anxiety (42.6%) and depression (39.5%) was more than twice as high as older adults who experienced prevalence of anxiety at 20% and depression at 16.6%. Gender differences were also more apparent in emerging adults. Women between 18 and 24 years reported higher differential rates of anxiety and depression than those with men (anxiety: 43.9% vs. 28.3%; depression: 33.3% vs. 24.9%). ConclusionUnderstanding the complex dynamics between COVID-19 and psychological distress has emerged as a public health priority. Mitigating the negative mental health consequences associated with the COVID-19 pandemic, for younger generations and females in particular, will require local efforts to rebuild capacity for social integration and social connection.

Trends in the incidence of endometrial cancer among young women in the United States, 2001 to 2017.

5578 Background: Endometrial cancer at this time is predominantly being looked at as a disease of postmenopausal population. Increased obesity has been identified as an important risk factor for endometrial cancer. An overall increase incidence of endometrial hyperplasia and endometrial carcinoma in obese premenopausal women has been reported. A close examination of the relationship between trends in endometrial cancer incidence and obesity prevalence in young women will provide important information for prevention and early screening of the disease and its precursors. This study was to assess current trends in endometrial cancer incidence in women ages 20-29 and 30-39 years in relationship to obesity in the US. Methods: We used data on US adult women 20-39 years old from the National Program for Cancer Registries and Surveillance, Epidemiology, and End Results Incidence–U.S. Cancer Statistics 2001–2017 database. This database covered essentially all young female population between 2001 and 2017 in the US (Puerto Rico not included). Incidence was age adjusted to the 2020 U.S. standard population. We also examined the trends in obesity prevalence among females 18-34 years old using data from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2014. Results: There were 24,446 cases of endometrial cancer among young adult women aged 20-39 years during 2001-2017. Endometrial cancer incidence increased from 0.6 per 100,000 in 2001 to 1.2 per 100,000 in 2017 (APC 3.6, 95% CI 2.9-4.4) among young women 20-29 years old, and increased from 4.6 per 100,000 in 2001 to 7.5 per 100,000 in 2017 (APC 3.0, 95% CI 2.7-3.3) among women 30-39 years old. Obesity prevalence also increased significantly from 1988-2014 among females 18-34 years old. Incidence of endometrial cancer and obesity prevalence were both higher in Hispanics than in other racial/ethnic groups. Conclusions: The significant increasing incidence in endometrial cancer among young adult women is in accordance with the concurrent increasing prevalence in obesity in young girls and women in the US. This indicates that endometrial cancer screening might need to be considered at much earlier age among patients with abnormal bleeding and certain ethnic populations.

Abstract 14675: Rising Prevalence of Obesity in the Us: National Health and Nutrition Examination Survey (NHANES) 2003-2018

Introduction: Obesity is increasing globally. Obesity exacerbates risk for diabetes, dyslipidemia, hypertension, and ASCVD. We evaluated the prevalence of overweight and obese adults in the US during 2003-2018. HYPOTHESIS: The percentage of men and women overweight/obese is increasing continuously and may exceed the percentage with ‘normal’ weight. Methods: From 77007 participants in 8 NHANES surveys (between 2003-2004 and 2017-2018), we selected 39952 aged 20-79 years for this analysis. Participants with BMI data (n = 39440, 98.7%) were categorized as being underweight (BMI &lt; 18.5), normal (BMI 18.5 - &lt;25), overweight (BMI 25 - &lt;30), obese (BMI 30 - &lt;40) or morbidly obese (BMI 40+). Results were extrapolated to the entire US population (50 states plus the District of Columbia) using the direct method to the US Census 2000 population. Statistical analyses were performed in the R language. Results: There are statistically significant mean increases in BMI (95% confidence interval and p-value) between successive surveys of 0.18 (0.11, 0.25, p&lt;0.0001) for men and 0.24 (0.14, 0.33, p&lt;0.0001) for women. There are clear trends in morbid obesity (BMI 40+) from 3% in the first survey to 7% among men in the last survey, and from 7% to 12% in women. Obesity/morbid obesity (BMI 30+) increased from 31% to 44% in men and from 34% to 43% in women. About 78% of adult men are either overweight, obese, or morbidly obese (BMI 25+) in the most recent survey, an increase from 71% in the first survey. Among women 70% are either overweight, obese, or morbidly obese, an increase from 63% in the first survey. Very few US adults (1-2%) are underweight (BMI&lt;18.5). About one quarter of US adults have normal weight (BMI 18.5- 25). Conclusion: During the period 2003-2018, there has been a substantial rise among both US adult men and women in BMI who are overweight/obese. This necessitates invigorated public education about the clinical hazards posed and the need for lifestyle/dietary modification to stem this crisis.

Impact of utilization management policy on uptake of hypofractionated radiation in early-stage breast cancer.

7015 Background: While hypofractionated radiation (HFR) after breast-conserving surgery is a cost-effective, patient-centered treatment in early-stage breast cancer (ESBC), less than 40% of eligible women received it in 2013. In 2016, a large commercial payer implemented a utilization management policy to encourage HFR for eligible women through denying reimbursement for extended-course radiation. We assessed the impact of the policy on HFR use and associated spending. Methods: We conducted a retrospective, adjusted difference-in-differences analysis using administrative claims of women continuously enrolled in 14 geographically diverse commercial health plans covering 6.9% of US adult women. The study population included women aged 18 or older with ESBC who were eligible for HFR according to 2011 guidelines from the American Society for Radiation Oncology. Women who received mastectomy, brachytherapy, or &lt; 11 or &gt; 40 external beam fractions were excluded. We compared HFR use and associated spending between women in fully-insured and Medicare Advantage (fully-insured) plans for whom the policy applied vs. self-insured or Medicare supplemental insurance (self-insured) plans for whom the policy did not apply. We adjusted for age, comorbidity, region, Medicare enrollment, and prior chemotherapy. Results: Among 10,540 eligible women, 3,619 (34%) were in fully insured plans and thus subject to the policy. There were no meaningful differences in mean age (63.8 vs. 65.0), Charlson comorbidity index (3.0 vs. 3.2), or practice setting between the fully-insured and self-insured groups. The policy was associated with an increase in HFR (4.2 adjusted percentage point difference-in-difference [ppd], 95% CI 0.0 to 8.4, p = 0.051) and a non-significant decrease in radiotherapy-associated expenditures (-$2,275, p = 0.09). Spillover analyses revealed significantly higher uptake of HFR among self-insured patients who were indirectly exposed to the policy through seeing the providers who also treated fulled insured women (8.5 adjusted ppd, 95% CI 3.6 to 13.5, p = 0.001), compared to those who were not exposed. Conclusions: A payer’s utilization management policy was associated with direct and spillover increases in HFR use, even after accounting for a strong secular trend towards increased hypofractionation use. However, policymakers must balance the impact of this and similar policies against their additional administrative costs.

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

Breast cancer accounts for the largest portion of cancer-related spending in the United States. Although hypofractionated radiotherapy after breast-conserving surgery is a cost-effective and convenient treatment strategy for patients with early-stage breast cancer, less than 40% of eligible women received hypofractionated radiotherapy in 2013. To assess the association of a large commercial payer's utilization management policy with the use of hypofractionated radiotherapy among women with early-stage breast cancer and its associated cost. A retrospective, adjusted difference-in-differences economic analysis was conducted using administrative claims data from January 1, 2012, to June 1, 2018, of women 18 years or older with early-stage breast cancer who were eligible for hypofractionated radiotherapy according to 2011 guidelines from the American Society for Radiation Oncology and were continuously enrolled in 14 geographically diverse commercial health plans covering 6.9% of US adult women. Women who received mastectomy, brachytherapy, or less than 11 or more than 40 external beam fractions of radiotherapy were excluded. A utilization management policy was used to encourage the use of hypofractionated radiotherapy among women in fully insured and Medicare Advantage (fully insured) plans. Under the new policy, claims for extended-course radiotherapy were not reimbursed for fully insured women who were eligible for hypofractionated radiotherapy. This policy did not apply to women in self-insured or Medicare supplemental insurance (self-insured) plans, allowing these groups to serve as a comparison group. The primary outcome was use of hypofractionated radiotherapy, and the secondary outcome was the cost of this type of radiotherapy. Of 10 540 eligible women, 3619 (34.3%) were in fully insured plans and thus subject to the policy. There were no meaningful differences between the fully insured and self-insured groups in mean (SD) age at the start of radiotherapy (63.8 [8.6] vs 65.0 [8.9] years), mean (SD) Charlson Comorbidity Index score (3.0 [1.5] vs 3.2 [1.6]), or practice setting (outpatient hospital setting, 2982 of 3619 [82.4%] vs 5600 of 6921 [80.9%]). The policy was associated with an increase in use of hypofractionated radiotherapy among fully insured patients subject to the policy (adjusted percentage point difference-in-difference, 4.2%; 95% CI, 0.0%-8.4%; P = .05) and a nonsignificant decrease in radiotherapy-associated expenditures (-$2275 relative to self-insured patients; P = .09). Spillover analyses revealed a significantly higher uptake of hypofractionated radiotherapy among self-insured patients who were indirectly exposed to the policy (adjusted percentage point difference-in-difference, 8.5%; 95% CI, 3.6%-13.5%; P < .001) compared with those who were not exposed. This study suggests that a payer's utilization management policy was associated with direct and spillover increases in the use of hypofractionated radiotherapy, even after accounting for a long-term secular trend in the uptake of hypofractionated radiotherapy in the control groups. Utilization management may promote evidence-based cancer care.

Safety and tolerability of injectable Rilpivirine LA in HPTN 076: A phase 2 HIV pre-exposure prophylaxis study in women

BackgroundDaily oral TDF/FTC is protective against HIV infection when used for pre-exposure prophylaxis (PrEP). However, daily adherence to oral PrEP is difficult for many; therefore, finding alternative PrEP strategies remains a priority. HPTN 076 evaluated the long-acting injectable form of rilpivirine (RPV), known as RPV LA for safety, pharmacokinetics and acceptability. MethodsHPTN 076 (NTC 02165202) was a phase 2, double-blind, 2:1 randomized trial comparing the safety of 1200mg RPV LA (LA) to placebo (P). The study included a 28-day oral run-in phase of daily, self- administered oral RPV (25 mg), with directly observed oral dosing about six times. Of 136 enrolled sexually active, HIV-uninfected, low HIV-risk African (100) and US (36) adult women, injectable product was administered in two gluteal, intramuscular (IM) injections once every eight weeks to 122 participants following the oral run-in phase. A maximum of six injection time points occurred over a 48-week period. Acceptability, safety, tolerability and pharmacokinetic (PK) data were collected throughout the study. This paper includes primary endpoint data collected up to the week 52 post enrollment. FindingsThe median age of the enrolled population was 31 years (IQR: 25,38), median weight 75 kg (IQR: 64, 89), median body mass index (BMI) 30 (IQR: 27, 35), 46% married, 94% Black and 60% unemployed. A total of 122 (80 LA, 42 P) women received at least one injection and 98 (64 LA, 34 P) received all six injections. During the injection phase, three women withdrew from the study (2 LA, 1 P) and 16 women discontinued study product (10 LA, 6 P). Fourteen women (11 LA and 3 P) discontinued oral study product and did not enter the injection phase. Study product discontinuations were not significantly different between the two arms throughout. Of the product discontinuations in the injection phase, 8% in LA and 5% in P arm were due to adverse events (AEs), including one randomized to the P arm with prolonged QTc interval on EKG. The proportion of women who experienced Grade 2 or higher AEs during the injection phase as the primary outcome was not significantly different between the two arms [73.8%, 95% CI: (63.2%, 82.1%) for LA and 73.8%, 95% CI: (58.9%, 84.7%), p>0.99]. Transient Grade ≥2 liver abnormalities occurred in 14% of women in the LA arm compared with 12% in P arm. Three LA women (4%) developed Grade 3 injection site reactions compared with none in P arm. In participants who received at least 1 injection, the geometric mean of overall RPV trough concentrations (Ctrough) was 62.2 ng/mL. In participants who received all six injections, the geometric mean of CTrough through the injection phase and after the last injection were 72.8 ng/mL and 100.9 ng/mL, respectively. At week 52 (eight weeks after last injection), the geometric mean of RPV Ctrough was 75.0 ng/mL. At the last injection visit (Week 44), 80 % of women who answered acceptability questions strongly agreed that they would think about using- and 68% that they would definitely use a PrEP injectable in the future. InterpretationRPV LA IM injections every eight weeks in African and US women were safe and acceptable. Overall, despite more injection site reactions and pain in the participants receiving RPV LA the injections were well tolerated. Data from this study support the further development of injectable PrEP agents.

Abstract P2-15-06: BRCA1/2 status, treatment patterns and safety outcomes in HER2- advanced breast cancer (ABC): Results from a US real-world study

Abstract Background: Mutations in breast cancer susceptibility genes 1 and 2 (BRCA1/2) are known risk factors for developing breast cancer. Using the Adelphi Disease Specific Program, we assessed differences in real-world treatment patterns and safety outcomes based on BRCA1/2 mutation status in the US. Methods: Oncologists extracted data from medical charts in US adult women with human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) via the Adelphi Advanced Breast Cancer Disease Specific Program. Data drawn from two different years of data collection (2015 and 2017) were merged across common variables (e.g. age, hormone receptor status, BRCA1/2 testing rates, BRCA status). Patients (pts.) were categorized into 3 mutually exclusive cohorts; BRCA mutations (BRCAm), wild type (BRCAwt), and unknown status (BRCAunk). BRCA1/2 testing rates were analyzed via Fisher Exact tests. Treatments received and adverse event (AE) rates were compared between BRCAm and BRCAwt using Fisher Exact tests. Results: The study included 1,285 US adult women with HER2- ABC; 75% pts were hormone receptor (HR)+/HER2-, 23% triple negative breast cancer (TNBC), and 2% had an unknown HR status. Overall, 50% of the 1,285 pts. received ≥1 BRCA1/2 test at the time of data abstraction [43% HR+/HER2-, 72% TNBC (P&amp;lt;0.001)]. Out of the BRCA1/2 tested pts. (n=648), 112 (17%) were identified as BRCAm, 448 (69%) as BRCAwt, and 88 (14%) as BRCAunk. Pts. with HR+/HER2- ABC and BRCAm were more likely to receive a 1st line chemotherapy (CT) based regimen compared to BRCAwt (62% vs 49%; P=0.098) and less likely to receive endocrine +/- targeted therapies (36% vs 51%; P=0.051) [Table 1]. TNBC treatments consisted primarily of CT based regimens and were similar between BRCAm vs BRCAwt, (77% vs 80%; P=0.802) [Table 1]. Pts. with BRCAm (HR+/HER2-, TNBC, and unknown HR status) were significantly more likely to experience ≥1 AEs compared with those with BRCAwt (57% vs 33%; P&amp;lt;0.001). Conclusions: In this study of US adult women with HER2- ABC, significantly lower BRCA1/2 testing rates were observed among HR+/HER2- vs TNBC pts. Pts. with HR+/HER2- and BRCAm were less likely to receive endocrine +/-targeted therapy and more likely to receive a chemotherapy-based regimen than those with HR+/HER2- and BRCAwt. Pts. with BRCAm were significantly more likely to report experiencing ≥1 adverse event than those with BRCAwt. Opportunities exist to improve safety outcomes in HER2- ABC pts. with BRCAm. Funding: Pfizer Inc. Table 1. 1st line ABC Treatment Patterns Based on BRCA Status and HR SubtypeHR+/HER2-TNBCTreatments Received No. (%)BRCAm (N=53)BRCAwt (N=265)P valuesBRCAm (N=31)BRCAwt (N=111)P valuesCT based33 (62)130 (49)0.09824 (77)89 (80)0.802Endocrine +/-targeted19 (36)135 (51)0.0516 (19)13 (12)0.369Othera1 (2)0 (0)0.1671 (3)9 (8)0.691aIncludes “best supportive care” or “other therapy” Citation Format: Michael P. Lux, Katie Lewis, Alex Rider, Alexander Niyazov. BRCA1/2 status, treatment patterns and safety outcomes in HER2- advanced breast cancer (ABC): Results from a US real-world study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-15-06.

Association between urinary triclosan concentration with bone mass density and osteoporosis in the US adult women, 2005-2010

TPS 633: Health effects of pesticides, Johan Friso Foyer, Floor 1, August 27, 2019, 3:00 PM - 4:30 PM Background: Laboratory studies have demonstrated that Triclosan (TCS) could result in significant interstitial collagen accumulation and an increase in trabecular bone. However, little is known about the relationship between TCS exposure and human bone health. Methods: We used 2005-2010 National Health and Nutrition Examination Survey data to examine the association between urinary TCS concentrations with BMD and osteoporosis in the US adult women (age ≥20 years). Weighted analyses were conducted to account for the complex sampling design and to obtain appropriate standard errors (SE), using the NHANES Analytic and Reporting Guidelines. Results: After adjustment for other covariates, significantly negative associations were observed between tertile 3 of TCS concentration and BMD in regions of total femur (β=-0.016, 95% CI=-0.032, -0.000), intertrochanter (β=-0.022, 95% CI=-0.042, -0.002), and lumbar spine (β=-0.014, 95% CI=-0.029, 0.001), respectively, relative to tertile 1. Compared with women at tertile 1, those at tertile 3 had significantly elevated prevalence of osteoporosis in intertrochanter [odd ratio (OR) =2.464, 95% CI = 1.190, 5.105]. Conclusions: In conclusion, this is the first epidemiological study to investigate the association between unariry TCS concentration with BMD and osteoporosis in the US adult women. We found urinary TCS concentration was negatively associated with BMD and was positively associated with prevalence of osteoporosis. The evidence was stronger in postmenopausal women than in premenopausal women. Prospective studies are warranted to validate the findings in the future.