Predictors of Classes of Well-Being Among Aging Women

Our aim was to examine the relationship of predictors of well-being from prior studies to the well-being profile developed from data from aging WHI participants. Class 1 included women with both low hedonic and eudaemonic well-being scores, class 4 with the highest scores. Classes 2 and 3 had moderate scores, with class 2 having higher hedonic and lower eudaemonic scores and class 3 having lower hedonic and higher eudaemonic scores. We examined associations between predictors and well-being classes. Youngest women were in Class 4 (mean=60.2 years) and oldest in Class 3 (mean=63.2). African American women had higher proportions in in Classes 2 and 3, Latinas in Classes 1 and 3, and Asian/Pacific Islanders in Class 3. College graduates, married women and those with household incomes >$50,000 were most likely in Class 4. Associations with age, race/ethnicity, education, marital status and income were consistent with prior analyses incorporating individual well-being indicators.

The Effect of Neonatal Sepsis on Risk of Autism Diagnosis

Objective The study aimed to examine the association between neonatal sepsis and autism risk among children and whether the risk varied with the timing of exposure, child's sex, and race/ethnicity. Study Design We conducted a retrospective cohort study using electronic health records (EHR) extracted from Kaiser Permanente Southern California Health Care System. Mother–child dyads were constructed by linking records of children born to member mothers and continuing to receive care through the system during the follow-up period with those of their biological mothers (n = 469,789). Clinical health records were used to define neonatal sepsis. Diagnosis of autism was made by medical specialists. Potential confounders included maternal sociodemographic factors, obstetrical history, child's age, sex, race/ethnicity, and maternal and child medical history. Incident rates and adjusted hazard ratios (aHR) were used to estimate the associations. Results Compared with children without the diagnosis of autism, children with the condition were more likely to be from Asian/Pacific Islander descent and male sex. Exposed children showed higher rates of autism as compared with unexposed children (3.43 vs. 1.73 per 1,000 person-years, aHR: 1.67–95% confidence interval [CI]: 1.39–2.00). Both preterm (aHR: 1.47; 95% CI: 1.09–1.98) and term (aHR: 1.63; 95% CI: 1.29–2.06) births were associated with increased risk for autism. Although the magnitude of the HRs and incidence ratios for neonatal sepsis to increase autism risk varied between race ethnicities, neonatal sepsis was associated with significantly increased likelihood of autism diagnosis for all race-ethic groups except for Asian/Pacific Islanders. Although neonatal sepsis was associated with significantly increased autism risk for both boys and girls, incident rates and HR point estimates suggested that the effect may be stronger in girls. Conclusion Neonatal sepsis is associated with increased risk of autism diagnosis in preterm- and term-born children. The association was significant for both girls and boys and all race ethnicities except for Asian-Pacific Islanders. Key Points

Vascular Risk Factor Prevalence and Trends in Native Americans With Ischemic Stroke - A National Inpatient Sample Analysis

IntroductionNative Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the prevalence of vascular risk factors among Native Americans with ischemic stroke over the last two decades along with a comparison to the other race-ethnic groups.MethodsNational/Nationwide Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized ischemic stroke patients during 2000 - 2016. Ischemic stroke and risk factors of interest were identified using validated ICD-9/10 codes. The race-ethnic groups of interest were Native American, White, Black, Hispanic, Asian/Pacific Islanders, and others. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods: 2000-02, 2003-05, 2006-08, 2009-11, 2012-14, and 2015-16. We explored linear trends over the defined time periods using linear regression models, with differences in trends between the Native American group and each of the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data.ResultsOf the 1,278,784 ischemic stroke patients that were included in the analysis, Native Americans constituted 5472. The age-and-sex-standardized prevalence of hypertension (trend slope = 2.24, p < 0.001), hyperlipidemia (trend slope = 6.29, p < 0.001), diabetes (trend slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope = 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased during these time periods among Native Americans, while coronary artery disease prevalence remained unchanged. Similar upward trends of several risk factors were noted across other race-ethnic groups with Native Americans showing larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all the race-ethnic groups.ConclusionThe prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans and other race-ethnic groups over the last two decades. Significantly larger increases in the prevalence of hypertension and smoking were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.

The Rhetoric of Family in the U.S. Immigration Movement

This reflection describes the author’s experiences organizing with the National Queer Asian Pacific Islander Alliance (NQAPIA) to build deeper solidarities between marginalized queer and trans Asian/Pacific Islanders and Black Lives Matter agendas. The author details a series of actions and campaigns to draw attention to shared experiences of policing, surveillance, and profiling. These actions involved storytelling, guerrilla street theater, and political education.

Acute Fulminant Cerebral Edema: A Newly Recognized Phenotype in Children With Suspected Encephalitis

Background Encephalitis is a severe neurological syndrome associated with significant morbidity and mortality. The California Encephalitis Project (CEP) enrolled patients for more than a decade. A subset of patients with acute and fulminant cerebral edema was noted. Methods All pediatric encephalitis patients with cerebral edema referred to the CEP between 1998 and 2012 were reviewed. A case definition was developed for acute fulminant cerebral edema (AFCE) that included the CEP case definition for encephalitis and progression to diffuse cerebral edema on neuroimaging and/or autopsy, and no other recognized etiology for cerebral edema (eg, organic, metabolic, toxin). Prodromic features, demographic and laboratory data, neuroimaging, and outcomes were compared with non-AFCE encephalitis cases. Results Of 1955 pediatric cases referred to the CEP, 30 (1.5%) patients met the AFCE case definition. The median age for AFCE and non-AFCE cases was similar: 8.2 years (1–18 years) and 8.0 years (0.5–18 years), respectively. Asian-Pacific Islanders comprised a larger proportion of AFCE cases (44%) compared with non-AFCE cases (14%, P &lt; .01). AFCE cases often had a prodrome of high fever, vomiting, and profound headache. Mortality among AFCE patients was significantly higher than among non-AFCE patients (80% vs 13%, P &lt; .01). A confirmed etiology was identified in only 2 cases (enterovirus, human herpes virus type 6), while 10 others had evidence of a respiratory pathogen. Thirty pediatric patients referred to the California Encephalitis Project with a unique, and often fatal, form of encephalitis are reported. Demographic and clinical characteristics, possible etiologies and a proposed case definition for acute fulminant cerebral edema (AFCE) are described. Conclusions AFCE is a recently recognized phenotype of encephalitis with a high mortality. AFCE may be triggered by common pediatric infections. Here, we propose a case definition.

Acral lentiginous melanoma: Population-based analysis of incidence and survival in United States from 1993 to 2013.

e22108 Background: Acral Lentiginous melanoma (ALM) is a rare form of cutaneous melanoma with aggressive nature. This study investigates the incidence and survival patterns in patients diagnosed with ALM in USA from 1993-2013 using data from the Surveillance, Epidemiology, and End Results (SEER) Registry. Methods: The 18 cancer registries of SEER program were used to identify patients diagnosed with ALM according to international classification of diseases for oncology (ICDO-3) codes. Age adjusted incidence rates in addition to 5 and 10-year relative survival rates were calculated. Results: 2189 patients were included in this retrospective study.The age-adjusted incidence rate of ALM was 2.11 per million person-years.Hispanic whites had highest incidence rates of ALM among all racial subgroups ( 2.58, p = 0.005). Incidence of ALM was higher between 2003-2013 compared to 1993-2003 (2.3 vs 1.9).Median age at diagnosis was 61.68 years. 53.9 % were female. Our study population was dominated by Non-Hispanic Whites (69.2%) followed by Hispanic Whites (13.5%), Blacks (8.2%), Asians or Pacific Islanders (7.3%) and other races (1.8%). stage III was the most frequent (24.7%) followed by stage I (20.9%). In terms of tumor thickness, 43.2 % presented with T3 thickness at the time of diagnosis. The ALM 5 - and 10-year survival rates were highest in age < 40, females, T1, non ulcerated, lymph node negative lesions ( p < 0.05). Among racial subgroups, non Hispanic whites had highest survival rates (83 vs 74 % ). Asian/Pacific Islanders (75.1%vs 49.8%) had lowest survival rates followed Hispanic whites ( 76.4 % vs 63.9 ) and Blacks (74.7 vs 71.5 %) ( p = 0.19). Conclusions: ALM is rare subtype of cutaneous melanoma with increased incidence in people of color. Patients present with increased tumor thickness and advanced stage at the time of diagnosis. Poor survival rates are seen among Asian/Pacific Islanders and Hispanic whites.

SUN-426 The Impact from AJCC 8Th Edition Staging System on Thyroid Cancer Outcomes by Race And Ethnicity

Background. Previous studies have demonstrated racial and ethnic outcome disparities among differentiated thyroid cancer (DTC) patients. However, the impact of the 8th edition of the American Joint Committee on Cancer staging system (AJCC8) on these disparities is unknown. Methods. DTC patients with sufficient tumor and survival data were identified in the National Cancer Database from 2004-2013. The 7th edition of the staging system (AJCC7) and AJCC8 criteria were compared. Multivariable logistic regression was used to evaluate the association between AJCC7 to AJCC8 staging change and race and ethnicity. Cox-proportional hazards regression was then used to evaluate the association between AJCC7 to AJCC8 staging change and overall survival. Results. Of 33,323 DTC patients, 76.7% were White/Non-Hispanics, 7.6% Blacks, 6.7% Hispanics, 5.4% Asian/Pacific-Islanders, and 3.6% Native-American/Other. Most were female (77%) with papillary DTC (90%). After adjusting for demographic, tumor, and treatment characteristics, Hispanics and Asian/Pacific-Islanders were 27% and 12% less likely to be AJCC7 to AJCC8 downstaged than White/Non-Hispanics (OR=0.73, 95%CI: 0.66-0.81; and OR=0.88, 95%CI: 0.79-0.99, respectively); Blacks had no significant downstaging difference compared to White/Non-Hispanics (OR=0.99, 95% CI: 0.90-1.09, p=0.79). Although AJCC8 was a better survival prognosticator than AJCC7, Cox-proportional hazards regression showed that all AJCC7 to AJCC8 downstaged patients had an increased risk of death compared to patients with unchanged staging, regardless of race and ethnicity: White/Non-Hispanics (HR=2.64, 95%CI: 2.34-2.98), Blacks (HR=1.77, 95%CI: 1.23-2.54), Hispanic (HR=3.27, 95%CI: 2.05-5.22), Asian/Pacific-Islanders (HR=2.31, 95%CI: 1.35-3.98), and Native-American/Other (HR=5.26, 95%CI: 2.10-13.19). However, based on two way interaction, the magnitude of negative change in survival from downstaging was only different between White/Non-Hispanics and Blacks (HR=2.64 vs. HR=1.77, respectively; p=0.04). Conclusions. Racial and ethnic outcome disparities persist with AJCC8. The proportion of downstaged DTC patients with AJCC8 varies by race and ethnicity, with the least impact found in Hispanics and Asian/Pacific-Islanders. Downstaged patients across all racial and ethnic groups had a decreased survival than those with unchanged stage, with the least impact in Blacks. These disparities should be taken into account when counseling patients about their prognosis with the new AJCC8.

CMET-13. THE COMPOSITION OF NEWLY-DIAGNOSED BRAIN METASTASES VARIES WIDELY BY PATIENT DEMOGRAPHICS

INTRODUCTION Metastases comprise a significant subset of all intracranial neoplasms, but their national composition remains unclear and challenging to track in national cancer registries. METHODS The patient demographics and histologic distribution of newly-diagnosed brain metastasis (BM) patients aged >18yo without a prior history of cancer (2010–2015) were evaluated using the National Cancer Database, which comprises >70% of all newly-diagnosed cancers in the U.S. RESULTS 91,686 adults presented with a newly-diagnosed BM between 2010–2015. The most common sites of brain metastases overall were lung (82% of metastatic cases), breast (4.1%), melanoma (3.2%), kidney (2.9%), and colorectal (1.8%). The overall 1-year and 5-year OS rates for all metastatic tumors were 27.0% (95%CI=26.7–27.3]) and 5.3% (95%CI=5.1–5.5), respectively. The distribution of primary sites for newly diagnosed intracranial metastases varied by sex, age, and race. Compared to males, more females had BMs from breast (8.4% versus 0.8%) and fewer had BMs from kidney (1.9% versus 3.8%), melanoma (1.9% versus 4.5%), and esophagus (0.3% versus 2.0%). In young adults, particularly those 20-29yo, BMs were more likely from melanoma, genitourinary (in males), and soft tissue than adults in middle and advanced age. Lung carcinomas comprised fewer BMs in Hispanics (66%) compared to Whites (82%), Blacks (83%), and Asian/Pacific Islanders (85%). BMs from kidney and genitourinary primaries were higher in Hispanics (7.3% and 2.4% of BMs, respectively) than in Whites (2.8% and 0.3%, respectively), Blacks (1.8% and 0.1%, respectively), and Asian/Pacific Islanders (2.6% and 0.2%, respectively). Melanoma was more frequent in Whites (3.8% of BMs) and Hispanics (2.5%) compared to Blacks (0.3%) and Asian/Pacific Islanders (0.6%). CONCLUSION Our results illustrate the national distribution of newly-diagnosed BMs and investigates how the distribution varies by patient demographics.