US Territories Research Articles

The benefits and limitations of establishing the PA profession globally: A systematic review and mixed-methods study.

Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation. A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs. The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support. PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe.

The quest for a good old age: mobility, immobility and Puerto Rican aging in the United States

ABSTRACT Mobility regimes refer to the political economic processes by which people are bounded, emplaced, forced, and permitted to move and to migrate. The literature on aging in contexts of mobility regimes has primarily focused on international migration, even though the framework is multi-scalar. This article examines how older Puerto Rican adults navigate mobility regimes in the quest for a subjective good old age. Puerto Rico is a US territory, which means that Puerto Rico-US migration does not span international borders. Drawing on remote ethnographic research with older Puerto Rican adults, I argue that political-economic processes rooted in US colonialism simultaneously condition migration as a strategy for the pursuit of a good old age and contribute to inequitable circumstances that make a good old age hard to find. These inequitable processes manifest in three ways: (1) Unequal healthcare benefits contribute to mobility; (2) Unequal social welfare benefits contribute to immobility; and (3) The meanings and mobilities associated with unequal benefits shift over the life course. By focusing on how governments differentially regulate the internal migration of their own citizens, this article advances understanding of how mobilities and immobilities operate at multiple scales, with important implications for a good old age.

Abstract B045: Colorectal cancer screening education intervention for Chamoru and Filipinos in Guam and Hawai‘i: Recommendations for culturally and age relevant education

Abstract Background. Pacific Islanders and Filipinos have low rates of colorectal cancer (CRC) screening. Filipinos in the US territory of Guam and the state of Hawai‘i comprise one of the largest ethnic racial groups in these locations, and CHamoru (Chamorro) in Guam constitute a majority of the population. The CRC age-adjusted mortality rate in Guam (17.3) is higher than the overall US (14.2) with a high rate among CHamoru (23.2). In Guam 45.6% of persons aged 45 and above have met USPSTF screening standards while in Hawai‘i Filipinos have the lowest CRC screening rates (69.9%) among Asian and Pacific Islander ethnic subgroups. Interventions to increase CRC screening in these populations are limited. This study explores recommendations for culturally relevant components of a CRC screening education intervention for CHamoru and Filipinos in Guam and Hawai‘i aged 40 and above. Methods. Qualitative methods employed focus groups (FG) and key informant interviews (KII) to facilitate storytelling, creating a familiar and safe space for knowledge, cultural beliefs, and screening education recommendations. Respective community councils advised on the study. A common FG and KII semi-structure guide was implemented. Purposive and snowball sampling was utilized. FGs were age and gender specific, e.g., men in their 40s, women aged 50+, etc. Three levels of thematic coding were performed using Dedoose and included input from community councils. Coding teams comprised of 3 coders compared for corroboration and recoding continued until coders reached agreement. Results: Five FGs and 12 KIIs (N=37) were conducted with persons aged 40 and above. Participants were CHamoru (46%), Filipino (59%), female (59%), and male (41%). In Guam CRC prevention preferences varied by age and gender; those in their 40s preferred culturally tailored video and less preference for an online module compared to groups age 50, and men identified the need for more awareness and outreach. Filipinos in Hawai‘i were not aware of CRC and prevention prioritizing economic obligations (job) over seeking health services. The preferred characteristics of culturally tailored CRC prevention education in Guam and Hawai‘i were trusted knowledge sources to deliver information, storytelling as a format, and involving families. Participants in Guam also preferred online sources while Hawai‘i preferred all types of media in Filipino languages. Conclusion. CHamoru and Filipinos in Guam and Hawai‘i are receptive to family as a source of information and support for CRC prevention, and hearing personal stories motivates CRC screening. Findings give insight toward age-and culturally-tailored CRC screening education with site specific preferences. Findings will be used to develop family-focused interventions for CHamoru and Filipinos to improve CRC screening. Citation Format: Tressa P. Diaz, Angela Sy, Jena Funakoshi, Elizabeth Elmore, Santino Camacho, Alisa Peralta, Marc Rollon. Colorectal cancer screening education intervention for Chamoru and Filipinos in Guam and Hawai‘i: Recommendations for culturally and age relevant education [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B045.

Elder Mistreatment Documentation by Prehospital Clinicians: An Analysis of the National Emergency Medical Services Information System Database

Objectives Elder mistreatment (EM), encompassing abuse and neglect, is a significant public health issue, affecting up to 10% of community-dwelling older adults annually. Elder mistreatment is a growing concern with a higher prevalence in institutional settings and substantial associated healthcare costs. Prehospital clinicians (PHCs) such as emergency medical technicians and paramedics are uniquely positioned to detect and report EM during their interactions with older adults in their homes. The objective of the study is to describe the rate and characteristics of EM documented by PHCs using the National Emergency Medical Services Information System (NEMSIS) database. Methods This study analyzed data from NEMSIS, which includes standardized information about PHC emergency response encounters across the United States. In 2018, 22,532,890 activations were included from 9,599 agencies in 43 states and US territories. Elder mistreatment was identified using specific International Classification of Diseases (ICD) codes related to EM. Demographic data, injury location, and associated physical findings were also examined. Results Out of 9,605,522 EMS encounters for patients aged ≥60, EM was coded in 1,765 encounters (0.02%). Most EM cases were listed as the cause of injury (64%), followed by the clinician’s first impression (25.4%). Physical abuse was the most common type of mistreatment reported (20.8%), followed by sexual abuse (18.2%), neglect (9.7%), and psychological/emotional abuse (0.34%). The median age of patients with documented EM was 72, and 62.3% were female. The most common anatomic locations of injuries were the lower extremities, head, and upper extremities. Conclusions Despite the high prevalence of EM, PHCs infrequently document EM in their encounters with older adults. Additional training and comprehensive protocols are needed to improve the identification and reporting of EM, mainly elder neglect. Empowering PHCs through education and protocol development can significantly impact the detection and intervention of EM.

Assessing ChatGPT as a Tool for Research on US State and Territory Politics

Assessing ChatGPT as a Tool for Research on US State and Territory Politics

Regional Differences in American Indian/Alaska Native Chronic Respiratory Disease Disparity: Evidence from National Survey Results.

American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.

US State and Territorial Indigenous Consultation Laws: A Potential Strategy to Improve the Social Determinants of Health.

The United Nations (UN) has articulated the right to self-determination as a human right for Indigenous people; however, US states and territories have been slow to operationalize this aspect of the UN Declaration on the Rights of Indigenous Peoples. Indigenous consultation laws require all federal executive agencies to consult with tribal nations before implementing policies that have a "tribal implication," and these form the cornerstone of US efforts to implement the UN Declaration on the Rights of Indigenous Peoples. Despite these federal efforts, less is known about the degree to which state and territorial laws require consultation with Indigenous communities. We reviewed all Indigenous consultation laws identified through a search of 50 US states, the District of Columbia, and 5 territories to provide a holistic picture of how jurisdictions have regulated Indigenous consultation efforts. Of the 56 states, 49 (87.5%) had at least 1 Indigenous consultation law; the remaining 7 jurisdictions had none. States engaged in Indigenous consultation in various ways, generally falling into 1 of 3 categories: (1) centralized consultation facilitated through an agency or department, (2) indirect consultation through a designated commission, and (3) fragmented Indigenous consultation through discrete laws. Important gaps were identified, including the lack of a definition for Indigenous consultation, the absence of an appeal process, and the need to train state officials on existing policies. The results provide a baseline on the degree to which US states and territories consult with Indigenous communities and can be used to identify gaps in US compliance with UN human rights mandates.

Defining and Advancing Health Equity in the US Territories and Freely Associated States.

Defining and Advancing Health Equity in the US Territories and Freely Associated States.

United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico.

Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].

Title 42 and the Impact on Asylum Seekers: Exploring the Effects of its Termination and its Changes on the US Immigration System

The repeal of Title 42, an emergency immigration restriction, represents a significant policy shift in how the United States treats migrants who arrive at the southern border, particularly those seeking asylum. For over three years, U.S. border officers used Title 42 to deport hundreds of thousands of migrants to Mexico or their home countries, claiming that their presence could contribute to the spread of the coronavirus. While Title 42 is allegedly a public health policy, it has been utilized to regulate and prevent unauthorized border crossings. Democrats and campaigners have denounced title 42 because it prevents refugees from obtaining asylum, a legal right they normally have once they reach US territory. Republicans described it as an effective border control tool, requesting that Title 42 should be codified into law so that it may be utilized outside of the pandemic setting. The period of Title 42 ended, which created more obstacles than solutions for asylum seekers. As the US ends Title 42, the rules for asylum seeking are changing once again, the United States will revert to Title 8 under the new standards. The Title 8 Code outlines a strict asylum policy which makes it harder for immigrants to file claims and to seek asylum. Under this new regulation everyone coming from Latin-America, except for Mexico, has to face the harsh reality that the requirements of Title 8 make most of them ineligible for asylum. How does the repealing of Title 42 affect the US immigration system and how will it influence the 2024 elections as the termination was introduced at a critical time, when Biden is seeking a second term?

Project Facilitate: An analysis of the increased utilization in the oncology single patient expanded access pathway.

11029 Background: FDA Oncology Center of Excellence’s (OCE) Project Facilitate (PF) was launched in June 2019 in response to perceived barriers providers face when accessing Expanded Access (EA). PF staff provide step-by-step support to oncology healthcare providers requesting use of investigational drugs to treat their patients with cancer. Since launch, PF has received an increased number of oncology single patient EA applications each calendar year. An analysis of single patient investigational new drug applications (IND) received was performed over each calendar year, starting June 1, 2020. Methods: Data was extracted from PF’s central database between June 1, 2020 and December 31, 2023. Data collected included IND receipt date, granting date, status, application type, indication, drug name, address of requestor, and patient demographics. The starting date of June 1, 2020 was chosen since it was when PF staff officially started performing clinical review of applications. Results: Of the 2791 oncology single patient expanded access applications extracted, there were 681 (24.4%) emergency INDs (eIND) and 2110 (75.6%) non-emergency single patient INDs (SPI). Applications received by calendar year increased since June 1, 2020 to December 31, 2020 (397, 14.2%), 2021 (682, 24.4%), 2022 (822, 29.5%), and 2023 (890, 31.9%). The top-3 disease areas requested include high grade glioma (262, 9.4%), multiple myeloma (213, 7.6%), and melanoma (186, 6.7%). The top-3 disease areas requested in pediatric patients < 17 years of age (568, 20.4%) include AML (88, 15.5%), high grade glioma (85, 15%), and ALL (47, 8.3%). Race and ethnicity information was provided in 32 applications containing white/Caucasian (24, 75%), Black or African American (4, 12.5%), Asian (2, 6.25%), and Hispanic or Latino (2, 6.25%). Applications were received from 46 states and 1 US territory, Puerto Rico. The top 3 states requestors resided in were CA (346, 12.4%), NY (317, 11.4%), and TX (276, 9.9%). Although rare, 22 (0.79%) applications were denied or placed on clinical hold most commonly due to curative or established therapies being available. Conclusions: Project Facilitate saw a 20.4% increase in oncology single patient expanded access requests received from calendar year 2021 compared to 2022 and an 8.3% increase from 2022 to 2023, equaling a 30.4% increase in 2023 compared to 2021. [Table: see text]

Discovering the Arizona Republican Newspaper, 1890-1900: Yellow Journalism in America’s Territorial Press

Yellow journalism is widely believed to have grown out of a circulation battle between Joseph Pulitzer and William Hearst in the 1890s. Most scholarship on its inception has been confined to newspapers in large Eastern cities. To date, little study of the period’s journalism has investigated whether, and to what degree, elements of yellow journalism were practiced by newspapers in Western US states and territories. This examination of the Arizona Republican in the 1890s shows yellow journalism was not confined to the East where it was incubated; in territorial Arizona, yellow journalism flourished. Needing to attract readers in a competitive newspaper market with a growing population, the newspaper did so with large headlines, scurrilous reporting, attention-grabbing news, and illustrations. Beyond the Eastern United States, the same force which brought on yellow journalism—publishers’ needs to attract huge readerships—fueled the practice on America’s territorial frontier in the Arizona Republican.

97 BUILD EXITO: a successful collaborative training program for STEM undergraduates to improve workforce diversity

OBJECTIVES/GOALS: To truly improve health equity and accessibility, we must develop a diverse and inclusive workforce. The BUILD EXITO program developed as a collaboration between a network of undergraduate programs and a CTSA hub and now has become a sustainable resource that will outlive NIH funding. We will disseminate our successful model. METHODS/STUDY POPULATION: The BUILD EXITO program has completed 10 years of NIH funding, a partnership between OCTRI and Portland State University (PSU), to create a new model of research training for underrepresented and disadvantaged students. This model provides an opportunity to learn about clinical and translational research academic careers; participate in a research enhancement and professional development curriculum;have a long-term authentic research experience; and receive enhanced mentorship. BUILD EXITO includes PSU, and local and 3 US Pacific territory 2-year colleges. We have developed a sustainable plan that includes these core elements after NIH support for the program ends. We have tracked long-term student outcomes for entry into graduate programs and the research workforce. RESULTS/ANTICIPATED RESULTS: We will describe the experimental model and the network of university and community colleges in BUILD EXITO, including PSU, U of Alaska, and colleges in US territories of Guam, Northern Mariana Islands, and American Samoa. All these universities and colleges have high proportions of underrepresented and disadvantaged students. We will present data on characteristics of the >600 students who have participated in BUILD EXITO to demonstrate the diversity of the cohort. We will also describe 4-year degree completion, engagement in the research workforce, and entry into graduate or professional programs. We will show how this has positively affected faculty inclusion of students in research, institutional policies at the 2-year and 4-year programs, and how this model has become sustainable. DISCUSSION/SIGNIFICANCE: The BUILD EXITO program developed as a collaboration of the CTSA hub at OHSU and a highly diverse undergraduate programs. We have developed a successful model for training a diverse research workforce and will disseminate this sustainable model.

Abstract P447: Heart Disease Health Disparities Among Native Hawaiian and Pacific Islander Communities in the United States: A Systematic Review

Background: Heart disease is a leading cause of death among Native Hawaiian and Pacific Islander (NH/PI) communities. However, the nature of disease development and risk factors is not well characterized due to poor availability of disaggregated data, hampering efforts towards the design and implementation of culturally-relevant interventions. The purpose of our review is examine known gaps in heart disease prevention measures and programs for NH/PI populations to identify opportunities to mitigate health disparities through structural- and provider-level factors. Methods: We conducted a systematic search of PubMed, Embase, and CINAHL databases to identify peer-reviewed articles focused on heart disease (coronary artery disease, heart attack, heart failure) in NH/PI populations. Eligible studies were assessed for their relevance to NH/PI populations living in the US, US territories and Freely Associated States and their coverage of topics such as prevalence, risk factors, cultural determinants, prevention, and management. Results: Of the 1,440 articles initially identified (3 duplicates removed), 1,437 article titles and abstracts were screened, 585 full-text articles were screened for eligibility and 68 articles were included for analysis. The main reasons for exclusion were the absence of NH/PI individuals, lack of focus on heart disease, grouping NH/PI people with Asian American and other racial groups, and studies conducted outside the US (e.g., Australia, New Zealand). Many of the included articles examined prevalence, risk factors, health behaviors, knowledge, and healthcare utilization, from sources such as the Multiethnic Cohort Study, Behavioral Risk Factor Surveillance Systems, National and Hawaii Vital Statistics and claims data. Culturally-grounded interventions, community-based programs, and initiatives (e.g., Native Hawaiian Health Research Project, Ohana Heart Project, Pacific Islander Health Care Project, Wahine Heart Wellness Program), which incorporate traditional practices, were identified as showing promise in reducing risk and improving heart health among NH/PI adults. Conclusion: The review unveiled a disproportionate burden of heart disease and high prevalence of obesity, diabetes, and hypertension among NH/PI communities, often attributable to lifestyle behaviors, socioeconomic factors, and limited access to healthcare. These disparities are compounded by the underrepresentation of NH/PI populations in national health surveys and the scarcity of comprehensive epidemiological studies featuring robust NH/PI samples. It is evident that further research and policy initiatives are crucial to increase research investments and promote data equity and disaggregation for this population.

Age-specific case data reveal varying dengue transmission intensity in US states and territories.

Dengue viruses (DENV) are endemic in the US territories of Puerto Rico, American Samoa, and the US Virgin Islands, with focal outbreaks also reported in the states of Florida and Hawaii. However, little is known about the intensity of dengue virus transmission over time and how dengue viruses have shaped the level of immunity in these populations, despite the importance of understanding how and why levels of immunity against dengue may change over time. These changes need to be considered when responding to future outbreaks and enacting dengue management strategies, such as guiding vaccine deployment. We used catalytic models fitted to case surveillance data stratified by age from the ArboNET national arboviral surveillance system to reconstruct the history of recent dengue virus transmission in Puerto Rico, American Samoa, US Virgin Islands, Florida, Hawaii, and Guam. We estimated average annual transmission intensity (i.e., force of infection) of DENV between 2010 and 2019 and the level of seroprevalence by age group in each population. We compared models and found that assuming all reported cases are secondary infections generally fit the surveillance data better than assuming all cases are primary infections. Using the secondary case model, we found that force of infection was highly heterogeneous between jurisdictions and over time within jurisdictions, ranging from 0.00008 (95% CrI: 0.00002-0.0004) in Florida to 0.08 (95% CrI: 0.044-0.14) in American Samoa during the 2010-2019 period. For early 2020, we estimated that seropositivity in 10 year-olds ranged from 0.09% (0.02%-0.54%) in Florida to 56.3% (43.7%-69.3%) in American Samoa. In the absence of serological data, age-specific case notification data collected through routine surveillance combined with mathematical modeling are powerful tools to monitor arbovirus circulation, estimate the level of population immunity, and design dengue management strategies.

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs’ cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

Evaluation of Family Medicine Residency Programs for Diversity, Equity, and Inclusion Milestones.

In 2020, the Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed and piloted a framework to measure diversity, equity, and inclusion (DEI) initiatives in medical residencies across five domains: curriculum, evaluation, institution, resident pathway, and faculty pathway. The objectives were (1) to measure DEI initiatives across multiple domains in family medicine residencies using the DEI milestones and (2) to obtain current national baseline data providing criteria against which to measure effectiveness of initiatives and create tailored benchmarks. We developed a cross-sectional survey of 12 quantitative residency characteristic items and the five DEI milestone ratings, and distributed the survey to program directors of family medicine residencies accredited by the Accreditation Council for Graduate Medical Education in the spring of 2022. We generated descriptive statistics, including item frequencies and cross-tabulations, and completed subgroup comparisons with analysis of variance. We collected aggregate milestone data for 194 family medicine residencies of 588 eligible programs (33% response rate). Respondents represented 48 states and US territories: 107 community-based, university-affiliated; 48 community-based; 34 university-based; and 5 military/other programs. Overall, the curriculum milestone was rated the highest (mean=2.54, SD=1.03), whereas the faculty pathway (mean=1.94, SD=1.04) and resident pathway (mean=2.02, SD=1.06) milestones were rated lowest. DEI milestone data may support residency programs as they assess their institution's developmental progress across five key domains. Additionally, aggregate data may shed light on collective strengths and areas for improvement.

ПРОСТРАНСТВЕННАЯ НЕОДНОРОДНОСТЬ ТЕРРИТОРИИ США: ЭТНОГЕОГРАФИЧЕСКИЙ ФАКТОР

The US population, formed by the descendants of immigrants, is characterized by extreme ethnogeographic diversity. Thisdiversity has pronounced spatial differentiation, which has been repeatedly examined in geographical studies of the US population. At the sametime, despite the large number of such studies, differentiation of territories according to the ethnogeographic composition of the population has notbeen carried out. The purpose of this study is to classify the territory of the United States according to the ethnogeographic composition of thepopulation and to reveal spatial changes that occurred from 2000 to 2020. The analysis was carried out at the county level with 12 ethnogeographicgroups taken as examples (Americans, African Americans, Mexicans, English, French, Irish, Germans, Italians, Poles, Russians, Chinese, andAsian Indians). To identify types of the US territory, a cluster analysis (k-means algorithm) was conducted. As a result, 13 ethnogeographical typesof the US territory were identified and characterized. The largest cluster in terms of area in 2020 turned out to have no clearly defined ethnogeographic dominant in the population. In general, this feature is typical for more than a third of the territory of the United States. A comparison ofdata for 2000 and 2020 showed that the greatest change in the ethnogeographic composition was experienced by the Southern States, where therewas a significant reduction in the share of people of American ancestry in the total population. The territorial clusters obtained as a result of thestudy can be used to assess other characteristics of the population that US statistics do not consider separately for ethnogeographic groups.

Effects of the COVID-19 Pandemic in Patients with Systemic Autoinflammatory Diseases. An international survey

Background: Early in the COVID-19 pandemic it was recognized that individuals who had worse prognoses had hyperinflammatory reactions associated with SARS CoV-2. This was worrisome for patients with systemic autoinflammatory diseases (SAID) who already have episodic hyperinflammation at baseline. Aim: To assess the effects of the COVID-19 pandemic and SARS CoV-2 infection on patients with SAID. Methods: An anonymous survey developed on the Survey Monkey platform was distributed online through social media and support groups of patients with SAID between January 20th and May 17th of 2021. Results: We analyzed 484 surveys that conveyed data from 593 patients with SAID. Seventy-four percent of the surveys were answered in the United States, US territories, and Canada (n=360/484) and the rest from other countries. Sixty percent (n=330/547) of patients with SAID did not experience changes in the frequency of flares during the first year of the pandemic. Ten percent (n=52/545) of patients had presumed or confirmed COVID-19. Of those, 81% (n=42/52) had mild and moderate symptoms and 4 were hospitalized. Thirty-one percent (n=16/52) experienced flares during or after the infection and 40% (n=21/52) reported post-COVID manifestations. The individuals who had moderate symptoms or were hospitalized for COVID-19 were more likely to report post-COVID manifestations, OR 5.25 (95%CI 1.57-17.6, p=0.0072). Post-COVID integumentary manifestations occurred after asymptomatic and mild COVID-19 whereas neurologic manifestations occurred after acute COVID-19 with moderate symptoms or requiring hospitalization. Conclusion: During the COVID-19 pandemic, over half of patients with SAID did not experience changes in the frequency of flares despite a decreased exposure to environmental triggers. Few individuals with SAID required hospitalization for COVID-19. The presence and type of post-COVID manifestations were associated with the severity of acute COVID-19 in patients with SAID.

Abstract C007: Disparities in occurrence and outcome of male reproductive cancers in the United States Pacific Islander community

Abstract Data from the National Cancer Database indicates prostate cancer (CPa) prevalence in the Pacific Islander (PI) community to be nearly 1.6 times higher than the national standard. Recent data suggests that prostate cancer rates seen in United States PI men are comparable to that of African American men, the community with the longstanding recognition as having the highest rates of the disease in the US. PIs are defined as those originating from or being indigenous to the islands of Polynesia, Melanesia, and Micronesia including the US governed Hawaiian islands, Guam, Northern Marianas Islands, and American Samoa. PIs make up a grossly underrepresented minority group, often being overshadowed by their mainland Asian counterparts when aggregated together as a group defined as “AANHPI” in sociological and epidemiological data sets and studies. In addition, Pacific Islanders, at least in the mainland US, are considered a “new” minority population, and with the exception of those indigenous to US territories, the vast majority of the population are post 1970 first or second generation immigrants. Research into health disparities in the PI community is thus unsurprisingly sparse, and there is great work to be done to explore these alarming trends. The purposes of this study are threefold: further explore the data pertaining to prostate cancer prevalence in the pacific islander community; disaggregate the data between ethnic lines; and provide a foundation for future research that can further elucidate the causes and outcomes of this disease in the Pacific Islander community. Data was taken from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS). The NHPI NHIS is a national survey administered by the CDC-NCHS to collect disease data including health condition and characteristics, health care access and service utilization but specific to the national NHPI population. Among 2588 participants, 4% indicated ever having been diagnosed with cancer among which prostate cancer was the second most commonly diagnosed. This study relies heavily on large-scale national questionnaires, thus future research should incorporate additional qualitative exploratory research, including targeted and ethnicity-specific canvassing and interviews in order to better understand the real life manifestations of the disease. The preliminary findings highlight an ever growing concern for the health outcomes of this community, and provide compelling evidence in support for both disaggregation of the community from Asian Americans, as well as interethnic disaggregation in data sets. A common thread of distancing between PI communities and the healthcare system was particularly evident, raising the concern that PIs are not being screened early enough and are not seeking life saving medical attention until advanced disease progression. A hopeful outcome of this study is a recognition that more outreach and community work must be done to bridge the gap between PIs and the Western healthcare system in order to mitigate the observed disparities. Citation Format: Nicholas A. Sowizral. Disparities in occurrence and outcome of male reproductive cancers in the United States Pacific Islander community [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C007.