Racial and Ethnic Variations in Mortality Associated with Common Pediatric Gastrointestinal Disorders in Children's Hospitals in the US

Background: The objective of this study is to determine the mortality, risk factors, and disease associations of eight common pediatric gastrointestinal (GI) disorders: cystic fibrosis (CF), cirrhosis, gastrointestinal bleeding (GIB), inflammatory bowel disease (IBD), liver failure (LF), liver transplant, acute pancreatitis, and short bowel syndrome (SBS). Methods: Diagnoses were found using the International Classification of Disease (ICD) codes from 2004 through 2020. We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) database from 50 children’s hospitals in the US. We analyzed all encounters with ICD codes for these disorders, then determined the per-encounter mortality rate for each. We performed a mixed-effects logistic regression modeling hospital as a random effect, mortality as the dependent variable, and patient demographics and medical history as independent variables. We hypothesized that demographic factors such as Black race, Hispanic ethnicity, and markers of socioeconomic status would be associated with increased mortality. Results: The per-encounter mortality for each diagnosis was: cirrhosis (2.19%), CF (0.66%), GIB (4.22%), IBD (0.21%), LF (7.03%), liver transplant (0.37%), acute pancreatitis (2.23%), and SBS (1.13%). There was a higher (p<0.05) mortality for those of Asian race and mixed-race populations in GIB (OR 1.76 and 1.37, respectively) and acute pancreatitis (OR 1.94 and 1.34, respectively). For those of Black race, there was a higher mortality in liver transplant and liver failure (OR 1.31 and 1.65 respectively). Additionally, mortality was increased in Hispanic/Latino patients with CF, GIB, and SBS (OR 2.34, 1.39, and 1.41, respectively). Coincident cardiovascular, renal/urologic, and neurologic/neuromuscular abnormalities were also associated with a significant higher mortality. Conclusion: The degree of variation associated with race and ethnicity is unlikely to be accounted for by variation in clinical features, thus the impact of social determinants of health should be the focus of future study. Cirrhosis CF GIB IBD LF Liver Transplant Acute Pancreatitis SBS Mortality Rate 2.19% 0.66% 4.22% 0.21% 7.03% 0.37% 2.23% 1.13% Asian Race OR 1.10 3.77 1.76* 1.71 1.08 0.89 1.94* 1.35 Black Race OR 0.90 0.48 1.03 1.55 1.31* 1.65* 1.15 1.14 Mixed Race OR 1.16 1.12 1.37* 1.44 1.23 0.85 1.34* 1.16 Hispanic/Latino OR 1.13 2.34* 1.39* 1.53 1.16 1.65 1.13 1.41* *Significant OR numbers with an associated p<0.05

P–650 Body weight is the main determinant of systemic follicle stimulating hormone (FSH) concentrations during controlled ovarian stimulation with follitropin delta

Study question Which individual subject characteristics affect systemic FSH concentrations in women undergoing controlled ovarian stimulation with follitropin delta? Summary answer Body weight is the main determinant of systemic FSH concentrations. Renal function, Asian race, country/region, hepatic function and age have at most a small influence. What is known already After administration of FSH, systemic FSH concentrations are inversely related to body weight. It has been observed that the impact of body weight on ovarian response is clinically relevant at low doses but not at high doses. In patients with anti-Müllerian hormone (AMH) ≥15 pmol/L, follitropin delta is dosed according to each patient’s body weight, which influences systemic FSH concentrations, and her AMH level which predicts ovarian response. Study design, size, duration Serum FSH concentrations were assessed in five randomised, controlled, assessor-blinded, multicentre trials of follitropin delta in women undergoing an assisted reproductive technology programme. The trials were conducted in Europe, America and Asia. In all, 1.665 women treated with follitropin delta contributed to the evaluation with 4052 serum FSH concentrations, measured at steady state by an immunoassay. Participants/materials, setting, methods FSH concentrations were described with a pre-specified one-compartment population pharmacokinetic model. The key model parameters were the apparent total clearance (CL/F) of follitropin delta, the interindividual variability herein and the effects of baseline values of body weight, age, race, country/region, renal and hepatic function on CL/F. Renal function was assessed using the estimated glomerular filtration rate (eGFR) and hepatic function by alanine transaminase (ALT) and bilirubin levels. Main results and the role of chance The area under the FSH concentration-time curve during a dosing interval (AUC) was derived from dose and CL/F. Body weight was the covariate with the most pronounced effect on AUC, both in terms of the effect magnitude and statistical significance. AUC was 1.51-fold higher (90% confidence limits: 1.48; 1.54) in women with the lowest observed body weight of 40 kg compared to women with a typical body weight of 58 kg. The effect of renal function on AUC was small and in the same order of magnitude as the bioequivalence limits (0.8; 1.25). AUC was 1.28-fold higher (90% confidence limits: 1.23; 1.33) in women with the lowest observed eGFR value of 44 mL/min/1.73m2, compared to women with a typical eGFR value of 98 mL/min/1.73m2. The effects of Asian race and country/region (Japan, China, Other Asian) were confounded with each other and well within the bioequivalence limits when evaluated independently. The effects of age and the hepatic function markers ALT and bilirubin were well within the bioequivalence limits. Limitations, reasons for caution The women participating in the trials were generally healthy and the results cannot be transferred to women with renal or hepatic disease. A limited number of Black women contributed to the present analysis but the trend was similar. Data is forthcoming from ongoing trials including larger numbers of Black women. Wider implications of the findings: The findings support dosing follitropin delta by body weight and without adjustment for renal function, hepatic function, race, age or country/region. Trial registration number NCT01426386, NCT02309671, NCT01956110, NCT03228680 and NCT03296527

Patient characteristics, biomarkers, and exacerbation risk in severe, uncontrolled asthma

BackgroundGreater precision in asthma exacerbation risk prediction may improve outcomes. We sought to identify clinical characteristics and biomarkers associated with elevated exacerbation risk in patients with severe, uncontrolled asthma.MethodsData were pooled from seven similarly designed Phase II and III randomized controlled clinical trials of biologic therapies for the treatment of severe, uncontrolled asthma that enrolled comparable patient populations. Annualized asthma exacerbation rates (AAERs) for patients randomized to placebo were assessed by baseline clinical characteristics and by biomarker concentrations at baseline and over the study duration.ResultsThe AAER for the 2016 patients in the combined placebo group was 0.91 (95% CI 0.84‒0.98). Baseline characteristics associated with greater AAER were frequent or severe exacerbations within the prior 12 months, nasal polyposis, maintenance oral corticosteroid use, Asian race, and Asian or Western European region. AAER increased with baseline blood eosinophil counts and fractional exhaled nitric oxide (FeNO) concentration, with the greatest AAER occurring for patients with eosinophils ≥300 cells·μL−1 and FeNO ≥50 ppb. No relationship was observed between baseline serum immunoglobulin E concentration and AAER. Combining type 2 inflammation criteria for eosinophils and FeNO had greater prognostic value than either biomarker alone. Persistent eosinophil and FeNO elevations throughout the study period were associated with greater AAER.ConclusionsExacerbation history, maintenance corticosteroid use, nasal polyposis, Asian race, geographic region, and elevations in blood eosinophil counts and FeNO concentrations (particularly when combined and/or persistently achieving type 2 inflammation criteria) were associated with increased exacerbation risk in patients with severe, uncontrolled asthma.

Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy

Objective The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy. Study Design We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p < 0.05) were included in multivariable analysis. Results A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p < 0.001). In multivariable analysis, an elevated 1-hour GCT (adjusted odds ratio [aOR]: 4.54, 95% confidence interval [CI]: 3.02–6.81), first-trimester BMI ≥30 kg/m2 in the index pregnancy (aOR: 3.10, 95% CI: 2.03–4.71), Asian race (aOR: 2.96, 95% CI: 1.70–5.12), Hispanic ethnicity (aOR: 2.11, 95% CI: 1.12–4.00), and increasing age (aOR: 1.07, 95% CI: 1.02–1.12) were significantly associated with an increased risk of GDM in the subsequent pregnancy. Conclusion An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy. Key Points

Yellow in Black and White: Representasi Identitas Asia oleh Rich Brian dalam Musik Hip-Hop di Amerika Serikat

The representation of the Asian race in the US music industry is still relatively small. However, Rich Brian, a person of Chinese descent with Indonesian nationality, succeeded in his career by carrying out the hip-hop genre that was firmly rooted in African-American (black) racial groups in the United States, a country which was dominated by Caucasian (white) races. This study aims to uncover how Brian represented his identity in the US hip-hop music scene using Stuart Hall's circuit of culture theory. The object of this research is the lyrics of several songs in Rich Brian's album. Through the analysis process, it was found that Brian did not cover the nationality and race identity he had. He precisely positioned himself on the spectrum of social identity. This then affects the representation of identity that he does in his songs, including revolving around the theme of the meaning of identity and stereotypes of the Asian race, as well as the struggles experienced by Asians who are part of minority groups in the United States.AbstrakRepresentasi ras Asia dalam industri musik Amerika Serikat masih tergolong sedikit. Namun Rich Brian, seseorang keturunan Tionghoa dan berkewarganegaraan Indonesia, berhasil berkarir dengan mengusung genre hip-hop yang berakar kuat pada kelompok ras Afrika-Amerika (black), di negara Amerika Serikat yang didominasi oleh ras kaukasian (white). Penelitian ini bertujuan untuk mengungkap bagaimana Brian merepresentasikan identitasnya dalam skena musik hip-hop Amerika Serikat menggunakan teori sirkuit budaya oleh Stuart Hall. Objek dalam penelitian ini berupa lirik dari beberapa lagu dalam album milik Rich Brian. Melalui proses analisis, didapati bahwa Brian tidak menutupi identitas kewarganegaraan dan ras yang ia miliki. Ia justru memosisikan dirinya pada spektrum identitas sosial. Hal ini kemudian memengaruhi representasi identitas yang ia lakukan dalam lagu-lagunya, diantaranya berkisar pada tema pemaknaan identitas dan stereotip dari ras Asia, serta perjuangan yang dialami oleh orang Asia yang merupakan bagian dari kelompok minoritas di Amerika Serikat.

Cyberbullying Analysis in Intercultural Educational Environments Using Binary Logistic Regressions

The goal of this study is to analyze how religion, ethnic group, and race influence the likelihood of becoming either a cybervictim or cyberbully in intercultural educational environments. In the research, 755 students in secondary education were analyzed in the south of Spain through the Cyberbullying Scale for students with Cultural and Religious Diversity (CSCRD). The analyses were carried out using the Statistical Package SPSS and the STATA software. The results obtained from the Kruskal–Wallis H test showed significant differences according to these aspects, for both the cybervictim and cyberbully parameters. The results stemming from binary logistic regressions confirmed such differences and regarded those students who belong to the Muslim religion, the gypsy ethnic group and the Asian race as being more likely to become cybervictims. Furthermore, these analyses showed that Gypsy and Asian students were also more likely to be cyberbullies than other groups. The main conclusions state that minority groups are more likely to suffer cyberbullying in intercultural educational environments, and that students from these groups are also more likely to become cyberbullies.

ПАМЯТИ УЧИТЕЛЯ. АНТРОПОЛОГИЧЕСКИЕ ИССЛЕДОВАНИЯ ЦИРКУМБАЙКАЛЬЯ В ТРУДАХ И.И. ГОХМАНА

Статья посвящена памяти выдающегося советского и российского антрополога Ильи Иосифовича Гохмана. Констатирован широкий круг научных интересов исследователя. В сообщении рассмотрен региональный аспект деятельности ученого. Проанализированы работы И.И. Гохмана по антропологии населения Прибайкалья и Забайкалья. Ученый внес значительный вклад в изучение краниологии эпохи неолита, основываясь на материалах Фофановского могильника из Забайкалья. И.И. Гохман дал полную антропологическую характеристику и историческую интерпретацию краниологических данных по населению культуры плиточных могил бронзового века. Выделяются исследования им населения эпохи хунну, в которых была впервые зафиксирована европеоидная примесь у древнего населения Байкальской Сибири, впоследствии подтвержденная в совместной фундаментальной монографии В.П. Алексеева и И.И. Гохмана. В статье проанализированы работы И.И. Гохмана по антропологическим материалам средневековых могильников Улан-Бор и Усть-Талькин в Прибайкалье. Особое место занимает концепция И.И. Гохмана о формировании центральноазиатской расы в результате метисации байкальской расы с европеоидами. Отдельно упомянута выдающаяся работа И.И. Гохмана «Происхождение центральноазиатской расы в свете новых палеоантропологических материалов». В ней ученым были введены новые краниологические индексы, дан новаторский анализ материала, изложена новая теоретическая концепция. И.И. Гохман ввел в научный оборот новые уникальные краниологические материалы, предложил новые теоретические разработки, в корне изменившие представления об антропологических процессах на территории Прибайкалья и Забайкалья. Работы И.И. Гохмана вызвали плодотворную дискуссию среди специалистов и дали импульс новым исследованиям по антропологии Байкальской Сибири. The article is dedicated to the memory of the outstanding Soviet and Russian anthropologist Ilya Iosifovich Gokhman, who had a wide range of scientific interests. The study examines the regional aspect of his research and analyzes his works on anthropology of population of Baikal and Trans-Baikal regions. Gokhman made a significant contribution to the study of craniology of the Neolithic, based on the materials of the Fofanovo burial site from Trans-Baikal. He made a complete anthropological description and historical interpretation of craniological data on the population of the Bronze Age slab graves culture. His outstanding research on the population of the Hunnu era first revealed the Caucasoid admixture among the ancient population of Baikal Siberia, which was later confirmed in a joint fundamental monography by V.P. Alekseev and I.I. Gokhman. The article also analyzes the work of Gokhman on anthropological materials of the medieval burial sites Ulan-Bor and Ust-Talkin in the Baikal region. Another important finding of the scientist is the concept of formation of the Central Asian race as a result of metisation between the Baikal race and the Caucasians. His remarkable paper “The origin of the Central Asian race in the light of new paleoanthropological data” is separately mentioned. In it, Gokhman introduced new craniological indices, made a comprehensive analysis of the material and presented a new theoretical concept. He introduced new unique craniological materials, proposed new theoretical developments that fundamentally changed ideas about anthropological processes on the territory of Baikal and Trans-Baikal regions. The works of I.I. Gokhman provoked insightful debate among experts and gave impulse to new research on anthropology of Baikal Siberia.

Abstract 17339: Racial and Ethnic Minority Groups Are Under-Represented and Under-Reported in Guideline-Informing Heart Failure Clinical Trials

Introduction: Racial/ethnic diversity in clinical trials is essential to ensure that our evidence base reflects the population. We assessed the extent of reporting and representation of race/ethnicity in heart failure (HF) clinical trials referenced in the contemporary ACC/AHA HF guidelines. Methods: All randomized trials referenced in the 2013 ACC/AHA Heart Failure Guidelines and the 2017 Focused Update were included. The prevalence of reporting of race/ethnicity, the proportions of racial/ethnic subgroups enrolled, and subgroup analysis based on intervention type - pharmacologic, device, and other - were evaluated. Results: We identified 256 trials (545 233 subjects) published between 1950 and 2018. Among these, only 95 reported any race/ethnicity (37.1%), 94 reported white race (36.7%), 58 reported black race (22.7%), 16 reported Hispanic ethnicity (6.3%), and 23 reported Asian race (9.0%). In trials reporting white, black, Hispanic, and Asian race/ethnicity respectively, 76.4% (n = 299 153 of 299872) of patients were white, 11.7% (n = 25 274 of 215 905) of patients were black, 11.2% (n = of 8863 of 79 097) of patients were Hispanic, and 10.5% (n = 14925 of 141 504) of patients were Asian. Comparison of trial population proportions with US Census population demonstrates over-representation of white subjects, and under-representation of Hispanic and black subjects (Figure). Stratification by intervention type demonstrated that no device trials referenced in the guidelines report black or Asian race, and just one reported Hispanic race. Conclusions: Trials that dictate clinical care of patients with HF through informing contemporary ACC/AHA HF guidelines under-represent black and Hispanic populations. Additionally, 2/3rds of trials fail to report any race/ ethnicity at all. There is a need for guideline and practice-informing clinical trials to adequately represent all populations, and to provide clinicians the data they need to assess generalizability.