Disparities in Cervical Cancer Screening with HPV Test among Females with Diabetes in the Deep South

Background: Due to diabetes being linked with poorer cervical cancer prognosis, this study aimed to evaluate HPV testing behaviors among females with and without diabetes across the U.S. by geographic area in 2016, 2018, and 2020. Methods: This cross-sectional study used the Behavioral Risk Factor Surveillance System (BRFSS) from 2016, 2018, and 2020. The study population included females aged 25–69 years old, stratified by self-reported diabetes status. The primary outcome measure was cervical cancer screening behavior, which was evaluated by self-reported HPV test uptake/receipt (yes/no). Results: A total of 361,546 females from across the U.S. were sampled. Within the study population combined from all study years, the overall likelihood of receiving an HPV test was significantly lower among females with diabetes [37.95% (95% CI: 36.87–39.04)] compared to those without diabetes [46.21% (95% CI: 45.84–46.58)] (p < 0.001). Screening rates with HPV tests were lowest among females with diabetes in the South in 2016 (29.32% (95% CI: 26.82–31.83)), 2018 (39.63% (95% CI: 36.30–42.96)), and 2020 (41.02% (95% CI: 37.60–44.45)). Conclusions: Females with diabetes are screening with HPV tests less frequently than females without diabetes, and females living in the South, particularly states in the Deep South, report the lowest rates of HPV testing.

Knowledge of Hospice Care among Korean American Immigrants in Deep South

Despite the benefits of hospice care in end-of-life care, there is a dearth of research on the knowledge or perceptions of hospice care, particularly among immigrants. A handful number of existing studies with this population have mainly used qualitative research methods. The purpose of the current study was to investigate the knowledge about hospice care and identify its predictors. We used cross-sectional data from 256 Korean American immigrants living in Alabama (Mean age = 44.78, range 23–70, 50.4% female). The outcome variable was measured by whether the respondents had heard of hospice care. Independent variables included sociodemographic (age, gender, education, and income), health (functional limitation and chronic conditions), health care access (health literacy, health insurance, unmet medical needs due to the cost, and social isolation). Logistic regression analyses were performed. About 78% of the respondents reported that they had heard of hospice care. Older age (OR=1.05, 95% CI=1.01-1.09, p &lt;.05), being female (OR=7.13, 95% CI=3.18-15.98, p &lt;.001), and higher levels of education (OR=1.68, 95% CI=1.15-2.45) were significantly related to increased odds of knowledge about hospice care. There were no significant roles of health and health care access factors. Our findings suggest sociodemographic gradients present in immigrants’ knowledge about hospice care, emphasizing the need for a targeted intervention to increase the hospice care knowledge.

Disparities Research at the Deep South Alzheimer’s Disease Center of the University of Alabama at Birmingham

Residents of the US Deep South (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) have a 20–30% higher risk of developing Alzheimer’s disease or related dementia (ADRD). Moreover, &gt;20% of African Americans, who are at higher ADRD risk than whites, live in this region. Therefore, one important goals of the Deep South Alzheimer’s Disease Center (DS-ADC) of the University of Alabama at Birmingham is to spearhead research to address these disparities. This panel presents current DS-ADC research, with two presentations focusing on the local patient population and the last two on the Deep South population compared to the rest of the nation. Addressing the challenge of recruiting representative samples in clinical research, the first paper is part of a research program to understand difference that may exist between African American and white research participants. The second paper examines patients with multiple conditions, in particular dementia and cancer, showing a marked disadvantage in cognition outcomes for African Americans. The next two papers take a broader perspective to better understand the population of older adults with ADRD in the Deep South and in the rest of the US. The third paper examines socioeconomic and medical contexts of African American and white older Medicare beneficiaries with ADRD, and the fourth paper examines differences in utilization of specialists, ADRD drugs, and hospitalizations in the two regions taking these contexts into account. The discussant will close the session by placing these studies in the larger context of the disparities research at the DS-ADC.

Social Determinants of Alzheimer’s Disease and Related Dementias: Racial and Regional Variations

To examine whether racial and regional social determinants of health disparities exist for older adults with Alzheimer’s disease and related dementias (ADRD). We identified 115,879 African American (AA) and White older adults with ADRD (10% from the Deep South) from administrative claims data for a 5% random sample of Medicare beneficiaries (2013-2015). We examined racial and regional differences across sociodemographic characteristics, county-level linked poverty indicators, medical resource availability categories, insurances quality indicators. Social context differences were found between regions including Deep South older adults with ADRD having higher economic impoverishment and lower access rates to specialty medical care services. Older Deep South AA had higher Medicare/Medicaid eligibility rates and less medical access. Significant socioeconomic disparities exist between Deep South and other US regions across several social determinant factors in older adults with ADRD. Social context differences were especially prominent for older Deep South AA with ADRD.

Age, Childhood Trauma, Post-Traumatic Stress Disorder, and Substance Use Disorder in the Deep South

We examined the relationship of reported childhood trauma and PTSD symptoms in a sample (N = 105) of individuals aged 19 to 80 receiving treatment for substance use and opioid use disorders in federally qualified health centers. Fifty-two percent of the sample was age 39 or younger, 30% were in their 40s and 18% were aged 50 and older. Thirty-two percent did not graduate high school and 36% had a high school education or equivalent. Seventy percent reported experiencing adverse childhood experiences (ACES). Although harmful alcohol use was low, 83% of the sample reported substantial or severe substance use, with 41% of the total reporting opioid use. ACES predicted current PTSD symptoms. Telehealth treatment considerations include: 1) internet access, 2) health and mental health literacy, and 3) monitoring for dissociation when using mindfulness-based relapse prevention treatment.