Abstract TP188: Location of Intracerebral Hemorrhage in a Tri-ethnic Cohort: The ERICH Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lee Birnbaum ◽  
Anne Leonard ◽  
Julio Andino ◽  
Charles J Moomaw ◽  
Carl Langfeld ◽  
...  

Background: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) is an ongoing case-control study of spontaneous ICH among non-hispanic whites, non-hispanic blacks, and Hispanics. Prior studies have identified hypertension as a greater risk for non-lobar (NL) ICH as compared with lobar (L) ICH. Given the greater reported prevalence of hypertension among black and Hispanic populations, we hypothesized that the location of ICH may differ by race/ethnicity. Methods: At the time of this analysis, we had ICH location data, lobar vs. non-lobar, on 648 subjects. We performed univariate analysis on known and potential predictors of ICH location: age, sex, race/ethnicity, hypertension, diabetes, BMI, creatinine, cholesterol, aspirin use, smoking, alcohol use, caffeine use, and INR. INR was dichotomized at >1.1. After forcing in age, sex, race, history of diabetes, aspirin use and INR, we added significant and near-significant (p<0.2) variables in a stepwise fashion to complete our final logistic regression model. Our outcome measure was lobar ICH. Conditional pairwise testing was performed for race/ethnicity. Results: Of the 648 subjects (mean age 61.12 ± 14.51 years; 39.8% female; 35.0% Hispanic, 26.5% white, 38.4% black), 181 (27.9%) presented with lobar ICH. Hypertension was present in 525 subjects (75.1% L, 83.3% NL; p=.018), diabetes in 152 (26.0% L, 22.5% NL; p=.348), high cholesterol in 244 (45.9% L, 34.5% NL; p=.008), aspirin use in 200 (37.0% L, 28.5% NL; p=.035), and INR >1.1 (24.1% L, 21.8% NL; p=.535) In our final model, race/ethnicity (p<.024) was associated with location of ICH. Furthermore, white race/ethnicity was associated with L ICH, compared with black (b=.57, p=.016) or Hispanic (b=.56, p=.018). Hypertension (b=-0.63, p=.009) was associated with NL ICH, and smoking (b=0.51, p=.007) was associated with L ICH. Discussion: Our results suggest that there are significant racial/ethnic differences in the distribution of lobar and non-lobar ICH. The conditional pairwise testing for race/ethnicity showed a significantly higher rate of lobar ICH in whites, compared with blacks or Hispanics. These findings are intriguing given the differences in case-fatality rates and age at ICH onset.

2020 ◽  
Vol 258 (11) ◽  
pp. 2431-2439
Author(s):  
Adrien Mazharian ◽  
Christophe Panthier ◽  
Romain Courtin ◽  
Camille Jung ◽  
Radhika Rampat ◽  
...  

Abstract Purpose To evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC). Methods Case-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus. Results Thirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye. Conclusion Our data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.


2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 101-101
Author(s):  
Sarah D Tait ◽  
Yi Ren ◽  
Cushanta C. Horton ◽  
Sachiko M. Oshima ◽  
Samantha M. Thomas ◽  
...  

101 Background: Overall breast cancer mortality in the US has declined since 1990, but racial/ethnic disparities have worsened. Since 1992, NC BCCCP has provided free/low-cost breast cancer screening to underserved women as part of a national effort by the Centers for Disease Control and Prevention (CDC) to mitigate these disparities. We sought to characterize and evaluate benchmarks for this previously unstudied, state-level cohort. Methods: We identified women ≥18y who underwent their first breast cancer screening via NC BCCCP from 2009-2018. Univariate analysis was used to compare differences in timeline of care and rates of breast pathology (i.e., cancer or atypia) by race/ethnicity and age. Logistic and negative binomial regression were used to identify factors associated with cancer diagnosis and time from enrollment to diagnosis (TTD) and treatment (TTT), respectively. Results: 88,893 women with complete records were identified (median age 50y, IQR 44-56): 45.5% were Non-Hispanic (NH) white, 30.9% NH black, 19.5% Hispanic, 1.7% American Indian (AI), and 1.1% Asian. Overall participation peaked in 2012 but steadily increased among Hispanic women over time (p < 0.001). Breast pathology was diagnosed in 2,016 (2.3%) women, with rates ranging from 1% in Hispanic women to 2.7% in NH whites. After adjustment, Hispanic women were least likely (vs NH white women: OR 0.40; 95% CI 0.34-0.47) to be diagnosed with breast cancer. Median TTD was 19d and TTT was 33d, both within the CDC’s 60d standard. In univariate analyses, women < 50 had shorter TTD (median 18d vs 21d) and TTT (median 30d vs 35d) vs women ≥50 (both p < 0.01), and there were no significant differences by race/ethnicity or between women with atypia vs cancer. In multivariate models, however, older age and NH black race were associated with longer TTD and TTT. Conclusions: NC BCCCP meets national quality benchmarks for TTD and TTT. These data also highlight broader opportunities to achieve racial/ethnic parity and improve equity for breast cancer prevention. [Table: see text]


2001 ◽  
Vol 127 (3) ◽  
pp. 535-543 ◽  
Author(s):  
A. KHALAKDINA ◽  
F. TABNAK ◽  
R. K. P. SUN ◽  
J. M. COLFORD

To study whether African-Americans are less likely than whites to present with cryptosporidiosis as an AIDS-defining condition (ADC), a case-control study was conducted using a large, population-based surveillance registry of AIDS patients in California. Data from January 1980 through June 1999 were analysed using risk factor stratification and multivariate logistic regression to evaluate confounding by other risk factors such as gender, injection drug use (IDU), CD4 counts, age and sexual orientation. Cases included 1373 subjects with cryptosporidiosis as an ADC and controls included 97419 subjects with other ADC. The results indicate a significantly lower risk for presentation with cryptosporidiosis as an ADC among African-Americans compared with whites (OR vs. whites = 0·5, 95% CI 0·4, 0·7). Additionally, there is evidence that heterosexuals are less likely than homosexual/bisexual males to present with cryptosporidiosis (OR = 0·5, 95% CI 0·4, 0·7). Our analyses also suggest a decreasing risk with increasing age. The possibility that there may be biologic factors or differential lifetime exposures that account for the difference between the racial/ethnic groups merits further investigation.


2021 ◽  
Author(s):  
Zhenhua Wang ◽  
Xinlan Xiao

Abstract Object:To verify the association between coagulation function and cerebral microbleeds(CMBs) in patients with intracerebral hemorrhage(ICH).Methods: A total of 193 patients underwent 3.0T magnetic resonance image(MRI) and were found ICH,they were divided into CMBs and non-CMBs groups. Indicators of coagulation function and some other flood and clinical data like prothrombin time (PT), activated partial thromboplastin time(APTT), international normalized ratio (INR) were enrolled.univariate and multivariate analysis were used to compare the difference between the two groups and screen risk factors. One or more receiver operating characteristic(ROC) curve were used to present the predictive value of the indicators for CMBs.Result: After a univariate analysis, the result showed that INR levels was significantly higher in the CMBs group than the non-CMBs group [1.06 (0.96, 1.12) vs. 0.97 (0.93, 1.03);P= 0.035), while there was no significant difference between PT, APTT, TT and FBI. To compare the baseline characteristic of the two groups showed that the age ,the proportion of a history of long-term antithrombotic treatment(AT), history of ischemic stroke(IS) and combination with a brain atrophy(BA) cases in the CMBs group was significantly higher than the non-CMBs group(each P < 0.05). Multivariate logistic regression analysis showed that age and IS were independent risk factors for CMBs in patients with ICH (OR:0.967, 95% CI: 0.936-0.998, P = 0.036; OR:2.016, 95% CI: 1.090-3.991,P = 0.044; respectively). ROC curves indicated that the area under curve(AUC) of age and IS for CMBs in patients with ICH was 0.610(95%CI:51.76%-70.32%) and 0.619(95%CI:53.32%-68.87%), respectively.Conclusion:Age and IS were the independent risk factor for CMBs in patients with ICH, among the coagulant indicators, INR showed a significantly higher level in the CMBs group than the non-CMBs group.


2020 ◽  
Author(s):  
Katie Labgold ◽  
Sarah Hamid ◽  
Sarita Shah ◽  
Neel R. Gandhi ◽  
Allison Chamberlain ◽  
...  

AbstractBlack, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. The magnitude of the disparity is unclear, however, because race/ethnicity information is often missing in surveillance data. In this study, we quantified the burden of SARS-CoV-2 infection, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias-adjustment for misclassification. After bias-adjustment, the magnitude of the absolute racial/ethnic disparity, measured as the difference in infection rates between classified Black and Hispanic persons compared to classified White persons, increased 1.3-fold and 1.6-fold respectively. These results highlight that complete case analyses may underestimate absolute disparities in infection rates. Collecting race/ethnicity information at time of testing is optimal. However, when data are missing, combined imputation and bias-adjustment improves estimates of the racial/ethnic disparities in the COVID-19 burden.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kevin N Sheth ◽  
Sharyl R Martini ◽  
David L Tirschwell ◽  
Kyra J Becker ◽  
Bradford B Worrall ◽  
...  

Introduction: Withdrawal of care (WOC) during hospitalization is the most common cause of death after intracerebral hemorrhage (ICH). Prior work suggests minority groups are less likely to choose WOC. Our goal was to evaluate for differences in rates of WOC among racial/ethnic groups from the ERICH cohort. Methods: ERICH is an ongoing multicenter study of genetic and environmental risk factors for spontaneous ICH. We analyzed data from the first 725 individuals. Baseline characteristics,do not resuscitate (DNR) status, intensive care procedures, and WOC were prospectively recorded. A central core analyzed all imaging. We compared characteristics among patients with and without eventual WOC and by race/ethnicity. Logistic regression was used to identify variables independently associated with WOC and associations are presented as the odds ratio (95% confidence interval). Results: 9.9% (72/725) of patients underwent WOC. After controlling for age, ICH volume, initial Glasgow Coma Scale (GCS) score, and presence of intraventricular hemorrhage (IVH), there were no significant differences in WOC between non-Hispanic white, non-Hispanic black (OR 1.82; CI 0.78-4.25), and Hispanic (OR 2.16; CI 0.93-5.00) patients. There were also no differences in rates of DNR/DNI status across racial/ethnic groups. In multivariate analysis, patients who underwent WOC had larger ICH volume (1.75; 1.13-2.73); were older (1.43; 1.27-1.61), more likely to have IVH (3.21; 1.53-6.73), and had lower GCS (2.41; 1.63-3.56). While patients who underwent WOC were more likely to have a DNR/DNI order (12.7; 4.69-34.7), intubated patients were more likely to undergo WOC (4.09; 1.08-9.25), even after adjusting for ICH severity. Conclusions: In our cohort, we were able to model ICH severity and factors predictive of WOC. There were not significant racial/ethnic differences in WOC rates. Intubated patients are more likely to undergo care limitations, independent of ICH severity.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S782-S782 ◽  
Author(s):  
Raymond K C Fong ◽  
Stephen G Donoghue ◽  
Humaira Shafi ◽  
Seow Yen Tan ◽  
Wee Boon Lee ◽  
...  

Abstract Background Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it. Methods A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio. Results A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03). Conclusion Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use. Disclosures All authors: No reported disclosures.


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Liping Meng ◽  
Jianmei Li ◽  
Yuli Cheng ◽  
Tingting Wei ◽  
Yukai Du ◽  
...  

Abstract Several studies have shown that dysmenorrhea increased the risk of depression. However, the association between dysmenorrhea and postpartum depression (PPD) is unclear. The purpose of this study is to evaluate the effects of dysmenorrhea on the development of PPD among Chinese women. A case-control study was performed on parturients who delivered from January 1, 2016, to December 31, 2016, at Bao an Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for maternal postpartum depression. Logistic regression models were used to examine the association between dysmenorrhea and the risk of PPD. A total of 360 women including 120 cases and 240 controls were enrolled. Our study showed that parturients with PPD had a higher percentage of dysmenorrhea than women without PPD (64.2% vs 47.9%, P = 0.004). In univariate analysis, we observed that dysmenorrhea increased the risk for PPD (OR = 1.95; 95% CI: 1.24–3.06; P = 0.004). In the fully adjusted model, dysmenorrhea was still significantly associated with an increased risk of PPD (OR = 2.45; 95% CI: 1.36–4.54; P = 0.003). Our data confirmed that dysmenorrhea may be a risk factor for PPD. Therefore, screening for postpartum depression should be considered in parturients with a history of dysmenorrhea.


Neurology ◽  
2020 ◽  
Vol 94 (12) ◽  
pp. e1271-e1280
Author(s):  
Laura C. Miyares ◽  
Guido J. Falcone ◽  
Audrey Leasure ◽  
Opeolu Adeoye ◽  
Fu-Dong Shi ◽  
...  

ObjectivesWe investigated the predictors of functional outcome in young patients enrolled in a multiethnic study of intracerebral hemorrhage (ICH).MethodsThe Ethnic/Racial Variations in Intracerebral Hemorrhage (ERICH) study is a prospective multicenter study of ICH among adult (age ≥18 years) non-Hispanic white, non-Hispanic black, and Hispanic participants. The study recruited 1,000 participants per racial/ethnic group. The present study utilized the subset of ERICH participants aged <50 years with supratentorial ICH. Functional outcome was ascertained using the modified Rankin Scale (mRS) at 3 months. Logistic regression was used to identify factors associated with poor outcome (mRS 4–6), and analyses were compared by race/ethnicity to identify differences across these groups.ResultsOf the 3,000 patients with ICH enrolled in ERICH, 418 were studied (mean age 43 years, 69% male), of whom 48 (12%) were white, 173 (41%) were black, and 197 (47%) were Hispanic. For supratentorial ICH, black participants (odds ratio [OR], 0.42; p = 0.046) and Hispanic participants (OR, 0.34; p = 0.01) had better outcomes than white participants after adjustment for other factors associated with poor outcome: age, baseline disability, admission blood pressure, admission Glasgow Coma Scale score, ICH volume, deep ICH location, and intraventricular extension.ConclusionsIn young patients with supratentorial ICH, black and Hispanic race/ethnicity is associated with better functional outcomes, compared with white race. Additional studies are needed to identify the biological and social mediators of this association.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 28-29
Author(s):  
Maryam Salehi ◽  
Daniel O. Stram ◽  
Jose A Aparicio ◽  
Liliana Aguinada ◽  
Victoria K. Cortessis ◽  
...  

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.


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