The mediation role of allostatic load/chronic stress on the relationship between cancer survivorship and cardiovascular disease mortality.

Background: Cancer survivors face an elevated risk of cardiovascular disease (CVD) and cardiovascular disease mortality (CVDm) compared to the general population. Allostatic load (AL), a composite score reflecting cardiovascular, metabolic, and immune markers, assesses the cumulative impact of chronic stress and life events. Increased AL in cancer patients is linked to up to a 30 % higher CVD risk. We hypothesized that cancer diagnosis and therapy contribute to increased AL, mediating the association between cancer survivorship and CVDm. Methods: This retrospective cohort study analyzed National Health and Nutrition Examination Survey (NHANES) data linked with the National Death Index (NDI) from 1988 to 2019. Cancer survivorship (yes vs. no), AL, and CVDm were the exposure, mediator, and outcome variables, respectively. Mediation analyses adapted to survival outcomes were performed. Results: Among 14,416 participants, cancer survivors <65 years-old exhibited a 41 % higher associated CVDm risk. High AL mediated 5.4 %, 8.9 %, and 3.6 % of the effect for all adults, 18-64 years, and ≥65 years, respectively. Black patients <65 years-old had an 84 % higher associated CVDm risk, with AL mediating 9.2 %, 5.8 %, and 12.6 % for all adults, 18-64 years, and ≥65 years, respectively. White patients showed a 20 % higher associated CVDm risk, with AL mediating 4.4 %, 2.8 %, and 5.7 % for all adults, 18-64 years, and ≥65 years, respectively. Conclusions: Increased CVDm risk among cancer survivors, particularly in Black individuals, is associated with higher AL mediation. These disparities may stem from social determinants of health.

Allostatic Load/Chronic Stress and Cardiovascular Outcomes in Patients Diagnosed With Breast, Lung, or Colorectal Cancer.

BACKGROUND: Cardiovascular disease and cancer share a common risk factor: chronic stress/allostatic load (AL). A 1-point increase in AL is linked to up to a 30% higher risk of major cardiac events (MACE) in patients with prostate cancer. However, AL's role in MACE in breast cancer, lung cancer, or colorectal cancer remains unknown. METHODS AND RESULTS: Patients ≥18 years of age diagnosed with the mentioned 3 cancers of interest (2010-2019) and followed up at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11). Adjusted Fine-Gray competing risks regressions estimated the impact of AL precancer diagnosis on 2-year MACE (a composite of heart failure, ischemic stroke, acute coronary syndrome, and atrial fibrillation). The effect of AL changes over time on MACE was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after cancer diagnosis). Among 16 467 patients, 50.5% had breast cancer, 27.9% had lung cancer, and 21.4% had colorectal cancer. A 1-point elevation in AL before breast cancer diagnosis corresponded to a 10% heightened associated risk of MACE (adjusted hazard ratio, 1.10 [95% CI, 1.06-1.13]). Similar findings were noted in lung cancer (adjusted hazard ratio, 1.16 [95% CI, 1.12-1.20]) and colorectal cancer (adjusted hazard ratio, 1.13 [95% CI, 1.08-1.19]). When considering AL as a time-varying exposure, the peak associated MACE risk occurred with a 1-point AL rise between 6 and 12 months post- breast cancer, lung cancer, and colorectal cancer diagnosis. CONCLUSIONS: AL warrants investigation as a potential marker in these patients to identify those at elevated cardiovascular risk and intervene accordingly.

Colorectal cancer survival disparities in the five regions of Georgia.

BACKGROUND/OBJECTIVE: The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia. METHODS: We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions. RESULTS: Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival. CONCLUSION: We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.

Temporal trends in early-onset colorectal cancer incidence (2000-2020) by age group and five geographic regions in the state of Georgia.

The increase of early-onset colorectal cancer (CRC) among younger adults is a major public health concern. However, little is known about variations in CRC incidence across different age groups within small geographic areas in Georgia. We examined temporal trends of CRC incidence in Clayton, East Central, West Central, Northeast, and Southeast regions, by age groups. Annual incidence rates for CRC in individuals aged 15+ years during 2000-2020 in the five regions of Georgia were included. Temporal trends were examined within the five regions and stratified by age group. Joinpoint regression was employed to calculate the annual percent change and corresponding 95% confidence intervals (CIs). Among 20,215 CRC diagnoses, CRC incidence declined over time for East Central (-2.33%; 95% CI, -3.03, -1.64), Northeast (-1.63%; 95% CI, -2.15, -1.04), Southeast (-1.63%; 95% CI, -2.30, -0.96), and West Central (-1.53%; 95% CI, -2.04, -1.03) Georgia. In the 15-44 age group, a notable increase of CRC incidence was found in Clayton, Northeast, and Southeast regions with a range of 2.2%-3.4%. However, adults aged 60+ years experienced a significant decrease in CRC incidence for most Georgia regions (all p-value <0.05), except for the Clayton region. In conclusion, CRC incidence declined during 2000-2020 in most Georgia regions. However, early-onset CRC is a major concern in Georgia as young adults (<45 years) living in Clayton, Northeast, and Southeast Georgia experienced significant annual increases in CRC incidence. Targeted CRC screening and awareness campaigns should be prioritized for adults <45 years and in the most impacted areas in Georgia.

The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer.

PURPOSE: To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort. METHODS: The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer. RESULTS: Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men. CONCLUSION: Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

Social Determinants of Health Data Improve the Prediction of Cardiac Outcomes in Females with Breast Cancer.

Cardiovascular disease is the leading cause of mortality among breast cancer (BC) patients aged 50 and above. Machine Learning (ML) models are increasingly utilized as prediction tools, and recent evidence suggests that incorporating social determinants of health (SDOH) data can enhance its performance. This study included females ≥ 18 years diagnosed with BC at any stage. The outcomes were the diagnosis and time-to-event of major adverse cardiovascular events (MACEs) within two years following a cancer diagnosis. Covariates encompassed demographics, risk factors, individual and neighborhood-level SDOH, tumor characteristics, and BC treatment. Race-specific and race-agnostic Extreme Gradient Boosting ML models with and without SDOH data were developed and compared based on their C-index. Among 4309 patients, 11.4% experienced a 2-year MACE. The race-agnostic models exhibited a C-index of 0.78 (95% CI 0.76-0.79) and 0.81 (95% CI 0.80-0.82) without and with SDOH data, respectively. In non-Hispanic Black women (NHB; n = 765), models without and with SDOH data achieved a C-index of 0.74 (95% CI 0.72-0.76) and 0.75 (95% CI 0.73-0.78), respectively. Among non-Hispanic White women (n = 3321), models without and with SDOH data yielded a C-index of 0.79 (95% CI 0.77-0.80) and 0.79 (95% CI 0.77-0.80), respectively. In summary, including SDOH data improves the predictive performance of ML models in forecasting 2-year MACE among BC females, particularly within NHB.

Lifetime Body Weight Trajectories and Risk of Renal Cell Cancer: A Large U.S. Prospective Cohort Study.

BACKGROUND: Body mass index (BMI) is a known risk factor for renal cell cancer (RCC), but data are limited as to the effect of lifetime exposure to excess body weight. METHODS: Using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 138,614, 527 incident RCCs), we identified several anthropometric measures to capture the lifetime BMI patterns: (i) BMI at specific ages; (ii) adulthood BMI trajectories; (iii) cumulative exposure to overweight/obesity denoted as weighted years of living overweight/obese (WYO); and (iv) weight change during each age span. We conducted multivariable Cox model to quantify the association between each anthropometric metric and incident RCC. RESULTS: A higher BMI at ages 20 and 50 and at baseline was associated with a greater hazard of RCC. Compared with individuals who retained normal BMI throughout adulthood, we observed an increased hazard of RCC for BMI trajectory of progressing from normal BMI to overweight [HR, 1.49; 95% confidence interval (CI), 1.19-1.87], from normal BMI to obesity (HR, 2.22; 95% CI, 1.70-2.90), and from overweight to obesity (HR, 2.78; 95% CI, 1.81-4.27). Compared with individuals who were never overweight (WYO = 0), elevated HRs were observed among individuals who experienced low (HR, 1.31; 95% CI, 0.99-1.74), medium (HR, 1.57; 95% CI, 1.20-2.05), and high (HR, 2.10; 95% CI, 1.62-2.72) WYO tertile. Weight gain of ≥10 kg was associated with increased RCC incidence for each age span. CONCLUSIONS: Across the lifespan, being overweight/obese, weight gain, and higher cumulative exposure to excess weight were all associated with increased RCC risk. IMPACT: It is important to avoid weight gain and assess BMI from a life-course perspective to reduce RCC risk.

Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer.

BACKGROUND: Racial disparities have been reported for breast cancer and cardiovascular disease (CVD) outcomes. The determinants of racial disparities in CVD outcomes are not yet fully understood. We aimed to examine the impact of individual and neighborhood-level social determinants of health (SDOH) on the racial disparities in major adverse cardiovascular events (MACE; consisting of heart failure, acute coronary syndrome, atrial fibrillation, and ischemic stroke) among female patients with breast cancer. METHODS: This 10-year longitudinal retrospective study was based on a cancer informatics platform with electronic medical record supplementation. We included women aged ≥18 years diagnosed with breast cancer. SDOH were obtained from LexisNexis, and consisted of the domains of social and community context, neighborhood and built environment, education access and quality, and economic stability. Race-agnostic (overall data with race as a feature) and race-specific machine learning models were developed to account for and rank the SDOH impact in 2-year MACE. RESULTS: We included 4,309 patients (765 non-Hispanic Black [NHB]; 3,321 non-Hispanic white). In the race-agnostic model (C-index, 0.79; 95% CI, 0.78-0.80), the 5 most important adverse SDOH variables were neighborhood median household income (SHapley Additive exPlanations [SHAP] score [SS], 0.07), neighborhood crime index (SS = 0.06), number of transportation properties in the household (SS = 0.05), neighborhood burglary index (SS = 0.04), and neighborhood median home values (SS = 0.03). Race was not significantly associated with MACE when adverse SDOH were included as covariates (adjusted subdistribution hazard ratio, 1.22; 95% CI, 0.91-1.64). NHB patients were more likely to have unfavorable SDOH conditions for 8 of the 10 most important SDOH variables for the MACE prediction. CONCLUSIONS: Neighborhood and built environment variables are the most important SDOH predictors for 2-year MACE, and NHB patients were more likely to have unfavorable SDOH conditions. This finding reinforces that race is a social construct.

Perceived economic pressure and colorectal cancer-related perceptions among U.S. males (aged 45-75).

PURPOSE: To examine whether a greater perception of economic pressure would be associated with more-negative attitudes, greater perceived barriers, and lower subjective norms regarding colorectal cancer (CRC) and CRC screening among males aged 45-75 years. METHODS: We recruited 492 self-identified males aged 45-75 years living in the United States. We operationalized perceived economic pressure as a latent factor with three subscales: can't make ends meet, unmet material needs, and financial cutbacks. Our dependent variables were attitudes toward CRC and CRC screening, perceived barriers to completing a CRC screening exam, and subjective norms regarding CRC screening (e.g., how others value CRC screening). We tested a hypothesized model using structural equation modeling with maximum-likelihood estimation, adjusting for covariates, and made post-hoc modifications to improve model fit. RESULTS: Greater perceived economic pressure was associated with more-negative attitudes toward CRC and CRC screening (ß = 0.47, 95% CI: 0.37,0.57) and with greater perceived barriers to CRC screening (ß = 0.22, 95% CI: 0.11, 0.34), but was not significantly associated with subjective norms (ß = 0.07, 95% CI: - 0.05, 0.19). Perceived economic pressure was an indirect pathway by which lower-income and younger age were associated with more-negative attitudes and greater perceived barriers. CONCLUSIONS: Our study is one of the first to show that, among males, perceived economic pressure is associated with two social-cognitive mechanisms (i.e., negative attitudes, greater perceived barriers) that are known to influence CRC screening intent and, ultimately, CRC screening completion. Future research on this topic should employ longitudinal study designs.

Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors.

PURPOSE: Our study aimed to examine the association between the presence of chronic diseases with guideline-concordant colorectal cancer (CRC) screening utilization among breast cancer survivors. METHODS: We analyzed data among women with a history of breast cancer from the 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System. Receipt of guideline-concordant CRC screening was the outcome of interest. Diabetes, coronary heart disease/myocardial infarction, stroke, chronic obstructive pulmonary disease, emphysema/chronic bronchitis, arthritis, depressive disorder, or kidney diseases were included in chronic disease conditions. RESULTS: Among 1324 survivors, those with multi-morbidities (3+ chronic diseases; 88.3%) had higher CRC screening use compared to those with one (84.4%) or two (85.4%) diseases (p-value < 0.05). In multivariable analysis, survivors with multi-morbidities were two times more likely to have CRC screening compared to those with only one disease (OR, 2.10; 95% CI, 1.11-3.98). Among survivors with multi-morbidities, Black women (OR, 14.07; 95% CI, 5.61-35.27), and those with frequent poor physical health (OR, 3.32; 95% CI, 1.57-7.00) were positively associated with CRC screening use. Conversely, survivors with frequent poor mental health were 67% less likely to receive CRC screening (OR, 0.33; 95% CI, 0.14-0.74). CONCLUSION: Among breast cancer survivors, multi-morbidities were positively associated with CRC screening.

How Attributes of Place Threaten Community Trust in the American South: Opportunities for Improving Pandemic-Related Communication.

Trust and mistrust influence the utilization of health services, the quality of overall healthcare, and the prevalence of health disparities. Trust has significant bearing on how communities, and the individuals within them, perceive health information and recommendations. The People and Places Framework is utilized to answer what attributes of place threaten community trust in public health and medical recommendations.Augusta-Richmond County is ranked among the least healthy counties in Georgia despite being home to the best healthcare-to-residence ratios and a vast array of healthcare services. Semi-structured interviews were conducted with 31 neighborhood residents. Data were analyzed using the Sort & Sift, Think & Shift method. Threats to community trust were identified within four local-level attributes of place: availability of products and services, social structures, physical structures, and cultural and media messages. We found a broader web of services, policies, and institutions, beyond interactions with health care, that influence the trust placed in health officials and institutions. Participants spoke to both a potential lack of trust (e.g. needs not being met, as through lack of access to services) and mistrust (e.g. negative motives, such as profit seeking or experimentation). Across the four attributes of place, residents expressed opportunities to build trust. Our findings highlight the importance of examining trust at the community level, providing insight into an array of factors that impact trust at a local level, and extend the work on trust and its related constructs (e.g. mistrust). Implications for improving pandemic-related communication through community relationship building are presented.

The Role of BMI in Allostatic Load and Risk of Cancer Death.

INTRODUCTION: Obesity and proinflammatory conditions are associated with increased risks of cancer. The associations of baseline allostatic load with cancer mortality and whether this association is modified by body mass index (BMI) were examined. METHODS: A retrospective analysis was performed in March-September 2022 using National Health and Nutrition Examination Survey years 1988 through 2010 linked with the National Death Index through December 31, 2019. Fine and Gray Cox proportional hazard models were stratified by BMI status to estimate subdistribution hazard ratios of cancer death between high and low allostatic load status (adjusted for age, sociodemographics, and health factors). RESULTS: In fully adjusted models, high allostatic load was associated with a 23% increased risk of cancer death (adjusted subdistribution hazard ratio=1.23; 95% CI=1.06, 1.43) among all participants, a 3% increased risk of cancer death (adjusted subdistribution hazard ratio=1.03; 95% CI=0.78, 1.34) among underweight/healthy weight adults, a 31% increased risk of cancer death (adjusted subdistribution hazard ratio=1.31; 95% CI=1.02, 1.67) among overweight adults, and a 39% increased risk of death (adjusted subdistribution hazard ratio=1.39; 95% CI=1.04, 1.88) among obese adults, when compared to those with low allostatic load. CONCLUSIONS: The risk of cancer death is highest among those with high allostatic load and obese BMI, but this effect was attenuated among those with high allostatic load and underweight/healthy or overweight BMI.

Allostatic load and cardiovascular outcomes in males with prostate cancer.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in men with prostate cancer (PC). Accumulated stress plays an important role in CVD development. The cumulative burden of chronic stress and life events can be measured using allostatic load (AL). METHODS: The initial cohort included males aged 18 years and older diagnosed with PC (2005-2019). AL was modeled as an ordinal variable (0-11). Fine-Gray competing risk regressions measured the impact of precancer diagnosis AL and postdiagnosis AL in 2-year major cardiac events (MACE). The effect of AL changes over time on MACE development was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after PC diagnosis). RESULTS: We included 5261 PC patients of which 6.6% had a 2-year MACE. For every 1-point increase in AL before and within 60 days after PC diagnosis, the risk of MACE increased 25% (adjusted hazard ratio [aHR] =1.25, 95% confidence interval [CI] = 1.18 to 1.33) and 27% (aHR = 1.27, 95% CI = 1.20 to 1.35), respectively. Using AL as a time-varying exposure, the risk of MACE increased 19% (aHR = 1.19, 95% CI = 1.11 to 1.27), 22% (aHR = 1.22, 95% CI = 1.14 to 1.33), 28% (aHR = 1.28, 95% CI = 1.23 to 1.33), and 31% (aHR = 1.31, 95% CI = 1.27 to 1.35) for every 1-point increase in AL before, 2 months after, 6 months after, and 1 year after PC diagnosis, respectively. CONCLUSION: AL and its changes over time are associated with MACE in PC patients, suggesting a role of a biological measure of stress as a marker of CVD risk among men with PC.

Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors.

PURPOSE: Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS: We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS: We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS: Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS: Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.

Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors.

PURPOSE: To examine whether sociodemographic characteristics, access to care, risk behavior factors, and chronic health conditions were associated with colorectal cancer (CRC) screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. METHODS: We analyzed the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data on 9780 eligible cancer survivors. Descriptive statistics and multivariable logistic regression models were applied to assess the association between guideline-concordant CRC screening and the mentioned characteristics. RESULTS: Overall, 81.9%, 65%, 88%,78.1%, and 80.1% of breast, cervical, prostate, skin, and lung cancer survivors received CRC screening, respectively (p-value < 0.001). In multivariable analysis, breast, cervical, and skin cancer survivors aged 60 years or older were associated with higher odds of receiving CRC screening. Respondents that had their recency of routine checkup two or more years before had lower odds of having CRC screening among cervical (OR = 0.06; 95% CI, 0.02-0.22), prostate (OR = 0.26; 95% CI, 0.14-0.49), and skin cancer (OR = 0.50; 95% CI, 0.36-0.70) survivors. The presence of chronic diseases was also associated with guideline-concordant CRC screening among breast, prostate, and skin cancer survivors. CONCLUSIONS: Our findings provide important evidence on potential factors that are associated with guideline-concordant CRC screening utilization across different cancer survivors, which include older age, recency of routine checkup, and multiple chronic diseases. Moreover, variation in CRC screening utilization across cancer survivors may highlight missed opportunities for secondary cancer prevention. IMPLICATIONS FOR CANCER SURVIVORS: Establishing clear CRC screening guidelines and including patient-provider communication on recommendation in cancer survivorship care may increase adherence to CRC screening.

Investigating Racial Differences in Allostatic Load by Educational Attainment among Non-Hispanic Black and White Men.

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999-2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24-1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.

Early-Onset Colorectal Cancer Survival Differences and Potential Geographic Determinants Among Men and Women in Utah.

By 2030, early-onset colorectal cancer (EOCRC) is expected to become the leading cancer-related cause of death for people age 20 to 49. To improve understanding of this phenomenon, we analyzed the geographic determinants of EOCRC in Utah by examining county-level incidence and mortality. We linked data from the Utah Population Database to the Utah Cancer Registry to identify residents (age 18-49) diagnosed with EOCRC between 2000 and 2020, and we used spatial empirical Bayes smoothing to determine county-level hotspots. We identified 1,867 EOCRC diagnoses (52.7% in male patients, 69.2% in non-Hispanic White patients). Ten counties (34%) were classified as hotspots, with high EOCRC incidence or mortality. Hotspot status was unrelated to incidence rates, but non-Hispanic ethnic-minority men (incidence rate ratio, 1.49; 95% CI, 1.15-1.91), Hispanic White men and women (incidence rate ratio, 2.24; 95% CI, 2.00-2.51), and Hispanic ethnic-minority men and women (incidence rate ratio, 4.59; 95% CI, 3.50-5.91) were more likely to be diagnosed with EOCRC. After adjustment for income and obesity, adults living in hotspots had a 31% higher hazard for death (HR, 1.31; 95% CI, 1.02-1.69). Survival was poorest for adults with a late-stage diagnosis living in hotspots (chi square (1) = 4.0; p = .045). Adults who were married or who had a life partner had a lower hazard for death than single adults (HR, 0.73; 95% CI, 0.58-0.92). The risk for EOCRC is elevated in 34% of Utah counties, warranting future research and interventions aimed at increasing screening and survival in the population age 18 to 49.

Investigation of Differences in Allostatic Load among Black Men by Level of Educational Attainment: High School Graduates Experience the Highest Levels of Stress.

Allostatic load (AL)-the biological assessment of long-term exposure to stress-may explain mortality-rate disparities among non-Hispanic Black (Black) men. We aimed to investigate AL among Black men with equivalent education status after controlling for income. A cross-sectional study was employed to investigate AL among 4113 Black men who participated in the National Health and Nutrition Examination Survey between 1999-2018. A summation of 8 biomarker factors were used to compute AL, differences in socio-demographic characteristics by education status were evaluated, and health behaviors that may influence AL were examined. To determine the high-risk thresholds for each AL component, we examined each component's distribution among NHB men for whom complete biomarker data were available in the NHANES sample. High-risk thresholds were determined as either (1) above the 75th percentile for body mass index (BMI), diastolic blood pressure (DBP), glycated hemoglobin, systolic blood pressure (SBP), total cholesterol, and serum triglycerides; or (2) below the 25th percentile for serum albumin and serum creatinine. Modified Poisson regression models were used to estimate prevalence ratios and their associated 95% confidence intervals for high AL risk while adjusting for potential confounders. Black men with a high school diploma/GED had a greater prevalence of high AL compared with Black men who had other levels of education, and a slightly higher prevalence of high AL compared with Black men who had less than a high school education. Black men with college degrees had a lower prevalence of high AL than Black men with the lowest levels of educational attainment. Researchers must further examine the hidden costs stemming from the interplay between discrimination associated with being Black in America and systemic racism in the educational system-which may be preventing Black men from achieving optimal health.

The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry.

In response to the COVID-19 pandemic, scientists coordinated a complex immunization effort that developed and distributed vaccines by December 2020. This study aimed to explain COVID-19 vaccination decision-making process to inform vaccine communication with patients and the public. Building on quantitative research on COVID-19 vaccine hesitancy, we conducted a grounded theory study, collecting 30 qualitative interviews with employees at a U.S. university that provided vaccine eligibility in December 2020. Analysis followed the Sort and Sift, Think and Shift method. Participants who had chosen to receive the vaccine and those who had not both described five factors that impacted their decision-making: emotional response, understanding, personal values, culture, and social norms. Across these factors, we identified three cross-cutting themes: time, trust, and communication tactics. In a time of emerging science and changing answers, the constant introduction of new information created information overload for participants. COVID-19 vaccine development was a "grand experiment globally," which required trust, not only knowledge, to overcome hesitancy. The complex information environment surrounding COVID-19 vaccination requires multi-level intervention that cannot rely on knowledge translation alone. We need to help patients build trusting relationships with experts that can create scaffolding for future information processing.