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

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< 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 >1.5 g/dL compared to <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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Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance

Blood ◽

10.1182/blood-2005-03-1038 ◽

2005 ◽

Vol 106 (3) ◽

pp. 812-817 ◽

Cited By ~ 405

Author(s):

S. Vincent Rajkumar ◽

Robert A. Kyle ◽

Terry M. Therneau ◽

L. Joseph Melton ◽

Arthur R. Bradwell ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Light Chain ◽

Monoclonal Gammopathy ◽

M Protein ◽

Intermediate Risk ◽

Serum Free ◽

Serum Free Light Chain ◽

Risk Of Progression ◽

Undetermined Significance

AbstractWe hypothesized that the presence of monoclonal free kappa or lambda immunoglobulin light chains in monoclonal gammopathy of undetermined significance (MGUS), as detected by the serum free light chain (FLC) assay increases the risk of progression to malignancy. Of 1384 patients with MGUS from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 1148. At a median follow-up of 15 years, malignant progression had occurred in 87 (7.6%) patients. An abnormal FLC ratio (kappa-lambda ratio < 0.26 or > 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared with patients with a normal ratio (hazard ratio, 3.5; 95% confidence interval [CI], 2.3-5.5; P < .001) and was independent of the size and type of the serum monoclonal (M) protein. Patients with an abnormal serum FLC ratio, non–immunoglobulin G (non-IgG) MGUS, and a high serum M protein level (≥ 15 g/L) had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any 2 of these risk factors (high-intermediate risk), 21% with one risk factor (low-intermediate risk), and 5% when none of the risk factors were present (low risk).

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

Circulation ◽

10.1161/circ.141.suppl_1.p306 ◽

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.

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Progression of Monoclonal Gammopathy with Undetermined Significance to Multiple Myeloma Diagnosed by Kidney Biopsy: A Case Report

Case Reports in Nephrology and Dialysis ◽

10.1159/000439267 ◽

2015 ◽

Vol 5 (3) ◽

pp. 180-186 ◽

Cited By ~ 1

Author(s):

Jin Hae Kim ◽

Ji Won Kim ◽

Young Nam Kim ◽

Hye In Kim ◽

Jun Young Kim ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Renal Function ◽

Case Report ◽

Monoclonal Gammopathy ◽

Kidney Biopsy ◽

M Protein ◽

Tubular Proteinuria ◽

Risk Of Progression ◽

Undetermined Significance

Monoclonal gammopathy with undetermined significance (MGUS) carries a risk of progression to multiple myeloma, and progression is usually diagnosed with changes in M-protein or bone marrow biopsy. We report a case of 62-year-old female patient showing MGUS progression to multiple myeloma without significant changes in M-protein but diagnosed by kidney biopsy. During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein. Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia. The progression of MGUS to multiple myeloma was diagnosed by this kidney biopsy. The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.

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Prognostic Value of Circulating Plasma Cells in Monoclonal Gammopathy of Undetermined Significance

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.159 ◽

2005 ◽

Vol 23 (24) ◽

pp. 5668-5674 ◽

Cited By ~ 74

Author(s):

Shaji Kumar ◽

S. Vincent Rajkumar ◽

Robert A. Kyle ◽

Martha Q. Lacy ◽

Angela Dispenzieri ◽

...

Keyword(s):

Multiple Myeloma ◽

Monoclonal Gammopathy ◽

Prognostic Value ◽

Plasma Cells ◽

Progression Free Survival ◽

M Protein ◽

Free Survival ◽

Risk Of Progression ◽

Plasma Cell Disorder ◽

Undetermined Significance

Purpose Monoclonal gammopathy of undetermined significance (MGUS) progresses to multiple myeloma or another related plasma cell disorder (PCD) at a rate of approximately 1% per year. Identification of patients with MGUS at high risk of progression will allow development of preventive strategies. We studied the prognostic value of circulating plasma cells (PCs) in patients with MGUS to predict progression. Patients and Methods Patients were eligible for this retrospective analysis if they were seen at the Mayo Clinic between 1984 and 1997, were diagnosed with MGUS, and had an analysis of the peripheral blood for circulating PCs by the slide-based immunofluorescence method. Patients were observed for progression to another PCD. Results Three hundred twenty-five patients were eligible and 63 (19%) had circulating PCs. Patients with circulating PCs were twice as likely (hazard ratio, 2.1) to experience progression to another PCD (most commonly myeloma), compared with those without circulating PCs (95% CI, 1.1 to 4.3; P = .03). In patients with circulating PCs, the median progression-free survival was 138 months compared with a median not yet reached for those without circulating PCs (P = .028). The median overall survival also was shorter for those with circulating PCs. Other factors with prognostic value were high levels of M protein and non–immunoglobulin G heavy-chain type. Conclusion The presence of circulating PCs, especially when combined with other known prognostic factors such as M protein concentration and immunoglobulin isotype, identify a group of individuals with MGUS at higher risk of progression to overt multiple myeloma.

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Prognosis of young patients with monoclonal gammopathy of undetermined significance (MGUS)

Blood Cancer Journal ◽

10.1038/s41408-021-00406-6 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Li Pang ◽

S. Vincent Rajkumar ◽

Prashant Kapoor ◽

Francis Buadi ◽

Angela Dispenzieri ◽

...

Keyword(s):

Lower Risk ◽

Monoclonal Gammopathy ◽

Young Patients ◽

Significant Risk ◽

Significant Risk Factor ◽

M Protein ◽

Related Disorder ◽

Risk Of Progression ◽

Similar Risk ◽

Undetermined Significance

AbstractMonoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (age <40 years at diagnosis), with a prevalence of <0.3%, representing ~2% of all patients with MGUS. We hypothesized that MGUS detected in young patients may be associated with a higher risk of progression. We examined 249 patients with MGUS < 40 years old. Among these, 135 patients had immune-related conditions, including infections, autoimmune and inflammatory disorders at the time of diagnosis of MGUS. The risk of progression to multiple myeloma or a related disorder at 5 years and 10 years was 6.0% and 13.8%, respectively. The size of M protein was a significant risk factor for progression (HR 4.2, 95% CI 2.2–7.9). There was a trend that the risk of progression was higher in patients without immune-related conditions (HR 2.36, 95% CI 0.85–6.52, p = 0.088). The M protein resolved in 36 (14%) patients, with a greater likelihood of resolution in patients with immune-related conditions (RR 1.9, 95% CI 1.02–3.6). Young patients with MGUS have a similar risk of progression as older patients, 1.4% per year. Over 50% are diagnosed in the setting of immune-related disorders. Patients with immune-related disorders may have a lower risk of progression.

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Prognosis of young patients with monoclonal gammopathy of undetermined significance.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.8049 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 8049-8049

Author(s):

Li Pang ◽

Shaji Kumar ◽

Arjun Lakshman ◽

Robert A. Kyle ◽

S. Vincent Rajkumar

Keyword(s):

Multiple Myeloma ◽

Monoclonal Gammopathy ◽

Young Patients ◽

Significant Risk ◽

Significant Risk Factor ◽

M Protein ◽

Related Disorder ◽

Kaplan Meier ◽

Risk Of Progression ◽

Undetermined Significance

8049 Background: Monoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (pts; age <40 years at diagnosis), with a prevalence of < 0.3%, representing approximately 2% of all patients with MGUS. We hypothesized that MGUS detected in pts <40 years of age may be associated with a higher risk of progression. Methods: We identified 249 pts with MGUS <40 yrs old, evaluated at Mayo Clinic, Rochester from 1997 to 2016. The endpoint was time to progression assessed by Kaplan-Meier method. Results: 119 were male, 130 were female. Most (n= 179, 72%) were diagnosed between the ages of 30-39. The type of MGUS was IgG 69%, IgA 10%, IgM 15%, and other 5%. 135 pts (54%) had concurrent immune-related conditions, including autoimmune, inflammatory, and infectious disorders at the time of diagnosis of MGUS. Pts without immune-related conditions tend to have higher M protein compared to pts with immune-related conditions (mean, 0.36 gm/dl VS 0.20 gm/dl, p =0.057). During follow up, the M protein resolved in 36 patients. The M protein was more likely to resolve in pts with immune-related conditions compared with pts without immune-related conditions (RR 1.91, 95% CI 1.02-3.59). Progression was seen in 16 pts: 9 smoldering multiple myeloma (SMM), 4 multiple myeloma (MM), 1 macroglobulinemia, 2 non-Hodgkin’s lymphoma. The rate of progression to SMM, MM, or related disorder at 5 and 10 years was 6.0% and 13.8%, respectively. The size of M protein was a significant risk factor for progression (HR 4.23, 95% CI 2.17-7.91) The risk of progression at 5 and 10 years for pts with immune-related conditions concurrently present when MGUS was first diagnosed was 1.5% and 10.1% respectively; corresponding rate in pts without immune-related conditions at the time of diagnosis was higher at 12.3% and 18.9%, respectively (p =0.016), (HR 2.36, 95% CI 0.85-6.52). Similar results were seen when patients in whom the M protein resolved were excluded. Conclusions: Young patients with MGUS may have a higher risk of progression, 1.4% per year; approximately 50% are diagnosed in the setting of immune-related disorders. When occurring in the setting of immune related disorders, the M protein is smaller, more likely to resolve, and may have a lower risk of progression than in pts in whom MGUS is detected without concurrent immune-related disorder.

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

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01625-4 ◽

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.

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Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz022 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Priya Bhagwat ◽

Shashi N Kapadia ◽

Heather J Ribaudo ◽

Roy M Gulick ◽

Judith S Currier

Keyword(s):

Antiretroviral Therapy ◽

Adverse Events ◽

Socioeconomic Factors ◽

Ethnic Groups ◽

Virologic Failure ◽

Virologic Suppression ◽

Factors Associated ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Background Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Methods Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. Results We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. Conclusions Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

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Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients

Blood Cancer Journal ◽

10.1038/s41408-021-00505-4 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

A. Visram ◽

C. Soof ◽

S. V. Rajkumar ◽

S. K. Kumar ◽

S. Bujarski ◽

...

Keyword(s):

Monoclonal Gammopathy ◽

Serum Samples ◽

Risk Models ◽

Independent Validation ◽

Increased Risk ◽

Risk Of Progression ◽

Paired Serum ◽

Smoldering Myeloma ◽

Undetermined Significance

AbstractSoluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07–5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45–2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.

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

10.2196/preprints.33637 ◽

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.

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