Abstract P306: Racial/Ethnic Differences In Self-reported Sedentary Time Are Related To Differential Risk For Prevalent Hypertension: NHANES 2011-2016

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jennifer L Mattingly ◽  
Megan E Petrov
Keyword(s):  
Physical Activity ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Cardiovascular Health ◽  
Sedentary Time ◽  
Lower Odds ◽  
Increased Risk ◽  
History Of ◽  
Race Ethnicity ◽  
Racial Ethnic

Introduction: Evidence suggests there are racial/ethnic differences in lifestyle behaviors that may affect cardiovascular health outcomes such as physical activity engagement, diet, and sleep duration. However, the literature on racial/ethnic differences in sedentary time (ST) and whether these differences may be related differentially to cardiovascular health is limited. The goals of this study are to investigate racial/ethnic differences in self-reported ST, and examine if the modifying effect of ST with race/ethnicity will be associated with hypertension (HTN) prevalence. Methods: Adults (N=15903, age ≥20 yrs) from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 reported their race/ethnicity (Mexican American [MA], Other Hispanic [OH], non-Hispanic White [NHW], non-Hispanic Black [NHB], non-Hispanic Asian, Other or mixed race [OM]), ST on a typical day (median split at 6 hrs: Low vs. High ST), and history of physician diagnosed HTN (yes/no). Weighted logistic regression models were conducted to examine the association between race/ethnic groups and ST, and combined racial/ethnic-ST groups (reference group: NHW with Low ST) on HTN prevalence while controlling for age, sex, education, body mass index, smoking status, moderate-vigorous physical activity min/wk, and history of diabetes, cardiovascular (i.e., heart failure, myocardial infarction, stroke, coronary heart disease) and kidney conditions. Results: There was a significant association between race/ethnic groups and ST (Wald F [5,43]=23.4, p <0.001) such that compared to NHW, MA (OR=.43, 95%CI:.36,.51) OH (OR=.51, 95%CI:.42,.62), and OM (OR=.71, 95%CI:.55,.91) had lower odds for High ST. Weighted percent of the sample with HTN was 32.6%. There was a significant effect of combined race by ST groups on HTN (Wald F [11,37] = 9.8, p <0.001). Compared to NHW with Low ST, MA (OR=.70, 95%CI: .54,.90) and OH (OR=.79, 95%CI: .64,.97) with Low ST had lower odds for HTN, whereas NHB with Low ST (OR=1.58, 95%CI: 1.34,1.87) and High ST (OR=1.76, 95%CI: 1.50,2.07) had increased odds of HTN. Conclusion: In a large national cohort, daily ST differed by race/ethnicity, and ST modified the association between race/ethnicity and odds for HTN such that compared to more active NHW, more active Hispanic groups had decreased odds for HTN, but NHB regardless of ST had increased risk for HTN. ST may be a key modifiable risk factor in addressing race/ethnic disparities in cardiovascular health.

Abstract 044: Trends in Race/Ethnic Disparities in Ideal Cardiovascular Health: NHANES 1999-2006

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Norrina B Allen ◽  
Hongyan Ning ◽  
Donald Lloyd-Jones
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Ethnic Groups ◽  
Cardiovascular Health ◽  
Ethnic Disparities ◽  
Percentage Change ◽  
Theil Index ◽  
Health Factors ◽  
Race Ethnicity ◽  
Racial Ethnic

Background: Significant racial/ethnic disparities exist in the cardiovascular health of the nation. Prior studies have identified differences between groups, but have not summarized trends in these disparities across multiple race/ethnic subgroups, which could allow us to assess the extent to which we are achieving disparity-related goals. Methods: We used NHANES Surveys from cycles 1999–2000, 2001–2002, 2003–2004, and 2005–2006 to examine the age-adjusted prevalence of ideal levels of CV health factors by race/ethnicity. Ideal levels of BMI, cholesterol, glucose, blood pressure, diet, physical activity and smoking were defined according to the AHA 2020 strategic goals. Racial/ethnic groups were categorized as Hispanic, Non-Hispanic White, Non-Hispanic Black and other. Both absolute (Between Group Variance- BGV) and relative measures (Theil Index -T) of disparities were calculated, calculations were weighted by population share. The percentage change in disparities relative to 1999–2000 was examined. Results: Age-adjusted rates of ideal CV health components and the percentage change from 1999–2006 varied by race/ethnicity (see Table). Disparities in the prevalence rates of ideal levels of blood pressure, cholesterol and physical activity have increased dramatically between race/ethnic groups in both men and women (see Table). Disparities in smoking and diet have increased in men but decreased in women. Disparities in BMI have changed little in men (BGV= 0.5%, T=−37.8%), but increased dramatically in women (BGV= 894%, T=280%). Findings were generally similar for both absolute and relative measures of disparities. Conclusions: Representative national data on these summary measures of disparities suggest that disparities between race/ethnic groups have increased for many cardiovascular health factors over the past decade. Understanding the issues underlying these increasing disparities and addressing them will be critical to improving the cardiovascular health of all Americans by 2020 and beyond.

scholarly journals Racial/ethnic differences in health-related quality of life among Hawaii adult population

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Eunjung Lim ◽  
James Davis ◽  
Chathura Siriwardhana ◽  
Lovedhi Aggarwal ◽  
Allen Hixon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
General Health ◽  
Related Quality ◽  
Health Related ◽  
History Of ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Background This study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity. Methods This study was conducted under a cross-sectional design. We used the 2011–2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson’s behavioral model on each distress measure by race/ethnicity. Results Among Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups. Conclusions This study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities.

Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre– and Mid–COVID-19 (Preprint)

2021 ◽  
Author(s):  
Ruby Castilla-Puentes ◽  
Jacqueline Pesa ◽  
Caroline Brethenoux ◽  
Patrick Furey ◽  
Liliana Gil Valletta ◽  
...  
Keyword(s):  
Health Belief Model ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Health Belief ◽  
Depression Symptoms ◽  
Seeking Help ◽  
Key Drivers ◽  
Race Ethnicity ◽  
Belief Model ◽  
Racial Ethnic

BACKGROUND The prevalence of depression symptoms in the United States is >3 times higher mid–COVID-19 versus pre-pandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. OBJECTIVE To describe attitudes, mindsets, key drivers, and barriers related to depression pre– and mid–COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. METHODS Advanced search, data extraction, and AI-powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre– (February 1, 2019-February 29, 2020) and mid–COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. RESULTS Of 2.9 and 1.3 million relevant digital conversations pre– and mid–COVID-19, race/ethnicity was determined among 1.8 million (62%) and 979,000 (75%) conversations pre– and mid–COVID-19, respectively. Pre–COVID-19, 1.3 million conversations about depression occurred among non-Hispanic Whites (NHW), 227,200 among Black Americans (BA), 189,200 among Hispanics, and 86,800 among Asian Americans (AS). Mid–COVID-19, 736,100 conversations about depression occurred among NHW, 131,800 among BA, 78,300 among Hispanics, and 32,800 among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre– to mid–COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoidant mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. CONCLUSIONS Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre– and mid–COVID-19. Generally, COVID-19 has made conversations about depression more negative, and with frequent discussions of barriers to seeking care. These data highlight opportunities for culturally competent and targeted approaches to address areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM.

scholarly journals Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly

2021 ◽  
Vol 11 (9) ◽  
pp. 1155
Author(s):  
Minsun Lee ◽  
Jin-Hyeok Nam ◽  
Elizabeth Yi ◽  
Aisha Bhimla ◽  
Julie Nelson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Depressive Symptoms ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Asian American ◽  
Memory Impairment ◽  
Subjective Memory ◽  
Subjective Memory Impairment ◽  
Negative Health Outcomes ◽  
Racial Ethnic

Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer’s disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.

scholarly journals Trends in Cigar Use in the United States, 2002–2016: Diverging Trends by Race/Ethnicity

2019 ◽  
Vol 22 (4) ◽  
pp. 583-587 ◽  
Author(s):  
Andrea H Weinberger ◽  
Cristine D Delnevo ◽  
Jiaqi Zhu ◽  
Misato Gbedemah ◽  
Joun Lee ◽  
...  
Keyword(s):  
United States ◽  
Black Women ◽  
Ethnic Group ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Mixed Race ◽  
The United States ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Over Time

Abstract Introduction Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. Methods Data were drawn from the 2002–2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. Results In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps &lt; .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p &lt; .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p &lt; .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p &lt; .001) and did not change for NH Black men (p = .546). Conclusions Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. Implications This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

Abstract 047: Sedentary Behavior Increases Risk for Cardiovascular Disease in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
John Bellettiere ◽  
Michael J LaMonte ◽  
Eileen Rillamas-Sun ◽  
Jacqueline Kerr ◽  
Kelly R Evenson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Sedentary Behavior ◽  
Older Women ◽  
Cardiovascular Health ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Cvd Risk ◽  
Bout Duration ◽  
Increased Risk

Background: Evidence on sedentary behavior and cardiovascular disease (CVD) is largely based on self-reported sedentary time. Furthermore, how sedentary time is accumulated (in longer vs. shorter bouts) may be related to CVD risk but has not been tested. Methods: Women (n=5638, mean age=79±7) with no history of myocardial infarction or stroke wore accelerometers for 4-7 days and were followed for up to 4 years for incident CVD. Hazard ratios (HR) and 95% confidence intervals (CIs) for CVD and coronary heart disease (CHD) events were estimated across quartiles of sedentary time and mean sedentary bout duration using Cox proportional hazard models adjusting for covariates. Separate models evaluated associations after adding moderate-to-vigorous physical activity (MVPA) and possible mediators: body mass index, diabetes, hypertension, systolic blood pressure, fasting glucose, HDL-cholesterol, and triglycerides. We then tested whether mean bout duration was associated with increased risk for CVD and CHD among women with above median sedentary time (≥10hr/day). Results: Covariate-adjusted HRs for CVD and CHD increased across quartiles of both sedentary time and mean bout duration (Table). All CHD associations remained significant but attenuated after adjustment for possible mediators. After adjustment for MVPA, highest vs. lowest quartile HRs (CI) for CHD were 1.6 (0.7-3.4; p-trend = .08) for sedentary time and 1.8 (0.9-3.5; p-trend = .047) for mean bout duration. Among women with high sedentary time, the HRs (CI) comparing the 75 th vs. 25 th percentile of mean bout duration were 1.05 (0.95-1.15) for CVD and 1.16 (1.01-1.34) for CHD. Conclusions: Both sedentary time and mean bout duration showed independent, dose-response associations with increased risk of CVD and CHD events in older women. Among women with high sedentary time, longer mean bout duration was associated with higher CHD risk. Taken together, this provides evidence that both total sedentary time and the way it is accumulated are predictive of incident CHD.

Abstract P033: Identifying Racial/Ethnic Differences In Patterns Of Early Childhood Cardiovascular Health Using Electronic Health Record Data

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Lindsay Pool ◽  
Xiaoyun Yang ◽  
Amy Krefman ◽  
Amanda M Perak ◽  
Matthew Davis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Early Childhood ◽  
Racial Differences ◽  
Ethnic Differences ◽  
Cardiovascular Health ◽  
Hispanic Children ◽  
Electronic Health Record Data ◽  
Glucose Levels ◽  
Race Ethnicity ◽  
Racial Ethnic

Introduction: Racial/ethnic differences in CVH beginning at age 8 have been identified and linked with the development of cardiometabolic disease in adulthood; however, there is scarce research on CVH in very childhood. Our objective was to use a large, diverse pediatric EHR consortium to identify racial/ethnic patterns of clinical CVH from ages 2-12 years. Methods: We used ambulatory visit data spanning 2010-2018 from children aged 2-12 years within CAPriCORN - an EHR repository that combines medical records throughout the city of Chicago. The 4 clinical CVH metrics - BMI, blood pressure, cholesterol, and glucose - were categorized as ideal or non-ideal using available values of weight, height, blood pressure, laboratory readings, and ICD diagnosis codes. Multiple measurements within a given integer age were averaged by individual. Frequency of ideal and non-ideal status for each CVH metric was plotted by age in years and stratified by race/ethnicity (Figure). Results: There were 162,621 children included (47% female) with a median of 2 visits during follow-up. The race/ethnicity distribution was 4% Asian/Pacific Islander (API), 26% non-Hispanic Black (NHB), 44% non-Hispanic white (NHW), 18% Hispanic, and 8% other/unknown. Sustained decrease in ideal BMI occurred across race/ethnicity groups; however, proportion in ideal was consistently lower for NHB and Hispanic children. Ideal BP appeared to increase across childhood with few racial differences. Ideal cholesterol levels were constant across childhood, but the proportion of NHW children in ideal was lower than NHB and Hispanic children. Almost all individuals had ideal glucose levels throughout early childhood. Conclusions: Early childhood declines in CVH appeared to be driven by changes in ideal BMI. Racial/ethnic differences in ideal BMI and cholesterol were present by age 2 and were mostly sustained through age 12. Selection bias may account for some of these findings; consistent monitoring in early childhood is needed to better understand observed differences.

Abstract P376: Associations Between Moderate To Vigorous Physical Activity And Sedentary Time On Cognitive Function In Older Adults With Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nicole M Hoffmann ◽  
Megan E Petrov
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Cognitive Function ◽  
Sedentary Time ◽  
Reference Group ◽  
Vigorous Physical Activity ◽  
Cognitive Testing ◽  
Digit Symbol Substitution Test ◽  
Increased Risk ◽  
History Of

Cardiovascular disease (CVD) is associated with increased risk for cognitive decline. Lifestyle behaviors such as moderate to vigorous physical activity (MVPA) and reduced sedentary time (ST) may mitigate this decline, but limited research exists. The aim of the study was to examine the joint association of MVPA and ST on cognitive function by CVD status. Adults (n=2844, ≥60yrs) from the 2011-2014 National Health and Nutrition Examination Survey underwent cognitive testing (Digit Symbol Substitution Test [DSST]; Animal Fluency [AF]). Participants reported minutes of MVPA per week (categorized by U.S. PA Guidelines: ≥ 150min MPA and/or ≥ 75min VPA PA vs <150min MPA and <75min VPA), and typical ST per day (≤7hrs vs >7hrs ) , and reported physician-diagnosed CVD (i.e., myocardial infarction, stroke, coronary heart disease, or heart failure). Weighted linear regression analyses assessed the joint association of MVPA and ST on cognitive function, and tested the modifying effect of CVD status (alpha level for interaction terms set at 0.1) after adjustment for demographics, hypertension, diabetes, body mass index, and depression symptomatology. See Table. There were significant main effects for combined MVPA-ST groups on DSST (Wald F (3,30)=4.92, p =.007) and AF (Wald F (3,30)=5.01, p =.006). Individuals who did not engage in MVPA regardless of ST had significantly worse scores on DSST compared to the reference group. There was a significant main effect for CVD on DSST (Wald F (1,32)=8.82, p =.006). There was a significant interaction between MVPA-ST groups and CVD status on DSST (Wald F (3,30)=3.691, p =.023). Stratified analyses indicated among individuals with CVD, the buffering effect of MVPA was maintained, but the interaction was not significant for those without CVD. In a sample of adults with a history of CVD, meeting recommendations for MVPA appeared to preserve executive functioning regardless of ST. This research highlights the added importance for people with a history of CVD to participate in the recommended amount of MVPA.

scholarly journals Characteristics of and Risk Factors for Monoclonal Gammopathy of Undetermined Significance (MGUS) in the Multiethnic Cohort Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 28-29
Author(s):  
Maryam Salehi ◽  
Daniel O. Stram ◽  
Jose A Aparicio ◽  
Liliana Aguinada ◽  
Victoria K. Cortessis ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Monoclonal Gammopathy ◽  
M Protein ◽  
Blood Draw ◽  
Multiethnic Cohort ◽  
Risk Of Progression ◽  
History Of ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Undetermined Significance

Background: There is a 2-3-fold excess of both monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) among African Americans (AAs) compared to non-Hispanic whites (NHWs) for unknown reasons. It is unclear if risk of progression from MGUS to MM is similar across racial/ethnic groups. We identified MGUS patients and controls from the Multiethnic Cohort (MEC), a population-based cohort study in Los Angeles and Hawaii, described characteristics of and examined risk factors for MGUS among different racial/ethnic groups. Methods: A total of 637 MEC participants with a diagnosis of MGUS by CMS billing codes and 1,065 race/ethnicity-matched MM-free and presumed MGUS-free controls were identified. Screening for monoclonal proteinemia was performed at the USC Clinical Laboratories using serum protein electrophoresis (SPEP) with reflex to immunofixation (IFX) when SPEP was abnormal. For this study, MGUS was defined as IFX positive with M-protein concentration&lt; 3g/dL. Controls were SPEP- and IFX-negative with no history of MGUS or MM. MGUS cases who progressed to MM during a mean 8.11-year follow-up were identified by linkage with the SEER databases of the Hawaii Tumor Registry and the California Cancer Registry. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the effect of body mass index kg/m2 (BMI), diabetes or aspirin use prior to diagnosis on the risk of MGUS and progression to MM. Results: A total of 452 participants had laboratory validated MGUS. The racial/ethnic distribution was 109 AAs, 107 NHWs, 95 Latinos, 105 Japanese and 36 Hawaiian's. 58.6% were males. From the pool of laboratory-validated controls, an equal number of controls were frequency matched to cases by race/ethnicity, age and sex. Mean age at blood draw was 65 years for Hawaiians, 69 years for NHWs and Latinos, and 70 years for AAs and Japanese. The distribution of immunoglobulin (Ig) isotypes differed significantly by race/ethnicity(p=0.001) (Figure 1), with AAs having the highest proportion of IgG Kappa (48.1%) and the lowest proportion of IgM (2.8%) compared to other racial/ethnic groups (range IgG Kappa 31.8%-40%, range IgM 11.1%-28.0%). There was no difference in isotype distribution by sex (p=0.28). AAs and NHWs had the highest (mean=0.75 mg/dL ±0.6) and lowest (mean=0.53 mg/dL ±0.6) levels of M-protein, respectively, but there was no significant difference when all racial/ethnic groups were compared. Each unit of BMI (kg/m2) was associated with a 16% increase in risk of MGUS among Hawaiians (95% CI= 1.04,1.30); and a borderline increased risk ranging from 2%-7% among the other racial/ethnic groups. Neither history of aspirin use nor diabetes mellitus were significantly associated with MGUS risk. A total of 109/452 MGUS patients progressed to MM between 1 to 10 years after blood draw. Compared to NHWs, AAs (OR=2.09; 95%CI= 1.08-4.05) and Latinos (OR= 2.55, 95% CI=1.29-5.08) were more likely to progress. Progression was not significantly associated with sex (p=0.34) or BMI (p=0.12). Progressors were slightly younger than non-progressors (-1.6 years, p=0.057). A higher risk of progression was associated with IgA compared to IgG Kappa (OR=2.45; 95% CI=1.34-4.48) and an M-spike &gt;1.5 g/dL compared to &lt;1.5g/dL (OR=5.81, 95% CI=2.92-11.57). IgM was associated with a lower risk of progression (OR=0.03, 95% CI= 0.00-0.23). Conclusion: The distribution of MGUS isotypes and risk of progression to MM differed by race/ethnicity, with AA and Latinos more likely to progress, not explained by age at blood draw. Because we detected prevalent MGUS, lead time bias could explain racial/ethnic differences in risk. More studies with diverse populations and large sample sizes are needed to better understand the disparities in MGUS risk and progression, along with the underlying biological explanations. Disclosures No relevant conflicts of interest to declare.

Racial/Ethnic and Socioeconomic Disparities in the Use of Autologous Hematopoietic Stem Cell Transplant (ASCT) Among Californians with Multiple Myeloma (MM)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 846-846 ◽  
Author(s):  
Aaron S Rosenberg ◽  
Ann M Brunson ◽  
Joseph Tuscano ◽  
Brian A Jonas ◽  
Ted Wun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Logistic Regression ◽  
Health Insurance ◽  
Ethnic Groups ◽  
Research Funding ◽  
Population Based ◽  
Cell Transplant ◽  
Lower Odds ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Background: Recent clinical trials of ASCT have demonstrated improved progression-free and overall survival in MM patients. In a population-level analysis, we reported use of ASCT within 12 months of diagnosis was associated with improved overall survival compared to ASCT performed >12 months after diagnosis. Prior studies suggest that non-Hispanic Whites (NHW) were more likely to utilize ASCT than other racial/ethnic groups. However, no population-based studies have considered the effect of race/ethnicity, neighborhood socioeconomic status (nSES) and type of insurance on ASCT utilization. Methods: Patients diagnosed with MM between 2000 and 2012 were identified in the California Cancer Registry linked to the California Patient Discharge Database. Multivariable logistic regression estimated the effect of race/ethnicity, nSES and health insurance on the odds of undergoing ASCT at any time, accounting for age, sex, year of diagnosis, Elixhauser comorbidity index, marital status and urban (vs rural) residence. A multinomial logistic regression was used to determine the effects of covariates on the odds of receiving early (< 1 year from diagnosis) or late (> 1 year) ASCT (vs. no ASCT). Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CIs). Results: Of the 14,264 MM cases, 8,084 (57%) were NHW, 2,815 (20%) were Hispanic, 1837 (13%) were African-American (AA), 1326 (9%) were Asian/Pacific Islander (API), and 202 (1%) were of other/unknown race/ethnicity. AA and Hispanics were younger (mean age = 64 for both) than NHW and APIs (mean ages = 68 and 67, respectively). Patients undergoing ASCT were younger than those who did not (mean age 56 vs 69, P<0. 001). The racial/ethnic groups differed by nSES (P<0.001), with higher proportions of NHWs (57%) and APIs (50%) residing in the top 40% of nSES than AAs (30%) and Hispanics (24%). Type of health insurance also varied by race/ethnicity, with Medicaid insurance more common among AAs (13%), Hispanics (16%) and APIs (12%), than NHWs (4.3%), and private insurance more common among NHWs and AAs (49% for both) than Hispanics and APIs (42% for both). Medicare was utilized more frequently by NHW (43%) and APIs (41%) than AAs (34%) and Hispanics (36%) (P<0.001). The proportion of uninsured patients was low overall (1.5%), but somewhat higher in AAs (1.6%), Hispanics (2.9%) and APIs (1.9%) than NHWs (0.9%) (P<0.001). After accounting for baseline patient characteristics, older age, AA race/ethnicity (vs NHW), increased number of comorbidities prior to diagnosis, being unmarried, diagnosis earlier in the study time-period and lacking health insurance (vs. private) were associated with lower odds of ASCT at any time (Table). The effects of other factors differed for early and late ASCT. Patients residing in rural areas were more likely to receive early, but not late ASCT. Patients who resided in the lowest 2 nSES levels (vs highest nSES level) had lower odds of early, but not late ASCT. While both Medicaid and Medicare were associated with lower odds early ASCT, only Medicaid was associated with an increased use of late ASCT. Conclusions: This large, population-based analysis indicates that race/ethnicity, neighborhood nSES and insurance status are associated with ASCT use. Lower nSES and Medicaid insurance delayed, but did not prevent, ASCT use, implying that some economic barriers can be overcome. AAs are consistently less likely to undergo ASCT than NHWs, even after adjustment for other predictors, including age, comorbidities, nSES, and health insurance. As AAs are generally diagnosed at younger ages and younger age is associated with increased utilization of ASCT, the nearly 30% decrease in the odds of undergoing ASCT among AAs is striking. Given the demonstrated survival benefits associated with ASCT, further research is necessary to determine and overcome specific barriers to accessing ASCT in patients with MM. Disclosures Wun: Janssen Scientific Affairs, LLC: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Daiichi: Research Funding.

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