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To examine Metabolic Syndrome (MetS) severity using a recently validated Metabolic Syndrome Severity Score (MetSSS) in order to explore the overall associations between MetSSS and the risk of mortality related to all-causes, heart disease, diabetes mellitus, and hypertension amongst American adults with gout.Mortality-linked data for 12,101 adults aged 18 to 90 years who participated in the National Health and Nutrition Examination Survey III by gout status was analysed. All 5 metabolic features were used to calculate gender-race/ethnicity-specific MetSSS Z-scores in gout patients. The calculated Z-scores are a continuous representation of all MetS conditions while accounting for gender-race/ethnicity disparities.A total of 3,381 deaths were observed, of which 215 had gout. The prevalence amongst adults was 2.59%. Moderate to high MetS severity was significantly prevalent amongst gout patients (47.33% vs. 21.16 % no gout; p-value0.0001). The mean MetSSS Zscore for gout patients was significantly higher than those without gout (0.71 vs. -0.04 no gout; p-value0.0001). A one-unit increase in MetSSS score was associated with significant increases in the risk of all-cause mortality, heart disease, diabetes- and hypertension-related mortalities.Moderate to high MetSSS is significantly prevalent amongst gout patients. A one-unit increase in MetSSS score was associated with significant increases in the risk of all-cause mortality, heart disease, diabetes- and hypertension-related mortalities. MetS is a clinically accessible tool for predicting mortality risks in gout patients with MetS.

ImportanceThere are no approved treatments for nonalcoholic fatty liver disease (NAFLD) despite its association with obesity and increased risk of cardiovascular disease (CVD).ObjectiveTo examine the association between bariatric surgery and CVD risk in individuals with severe obesity and NAFLD.Design, Setting, and ParticipantsThis large, population-based retrospective cohort study obtained data from the MarketScan Commercial Claims and Encounters database from January 1, 2007, to December 31, 2017. Participants included insured adults aged 18 to 64 years with NAFLD and severe obesity (body mass index ≥40) without a history of bariatric surgery or CVD before NAFLD diagnosis. Baseline characteristics were balanced between individuals who underwent surgery (surgical group) and those who did not (nonsurgical group) using inverse probability of treatment weighting. Data were analyzed from March 2020 to April 2021.ExposuresBariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy, and other bariatric procedures) vs nonsurgical care.Main Outcomes and MeasuresThe main outcome was the incidence of cardiovascular events (primary or secondary composite CVD outcomes). The primary composite outcome included myocardial infarction, heart failure, or ischemic stroke, and the secondary composite outcome included secondary ischemic heart events, transient ischemic attack, secondary cerebrovascular events, arterial embolism and thrombosis, or atherosclerosis. Cox proportional hazards regression models with inverse probability treatment weighting were used to examine the associations between bariatric surgery, modeled as time varying, and all outcomes.ResultsThe study included 86 964 adults (mean [SD] age, 44.3 [10.9] years; 59 773 women [68.7%]). Of these individuals, 30 300 (34.8%) underwent bariatric surgery and 56 664 (65.2%) received nonsurgical care. All baseline covariates were balanced after applying inverse probability treatment weighting. In the surgical group, 1568 individuals experienced incident cardiovascular events compared with 7215 individuals in the nonsurgical group (incidence rate difference, 4.8 [95% CI, 4.5-5.0] per 100 person-years). At the end of the study, bariatric surgery was associated with a 49% lower risk of CVD (adjusted hazard ratio [aHR], 0.51; 95% CI, 0.48-0.54) compared with nonsurgical care. The risk of primary composite CVD outcomes was reduced by 47% (aHR, 0.53 [95% CI, 0.48-0.59), and the risk of secondary composite CVD outcomes decreased by 50% (aHR, 0.50; 95% CI, 0.46-0.53) in individuals with vs without surgery.Conclusions and RelevanceResults of this study suggest that, compared with nonsurgical care, bariatric surgery was associated with significant reduction in CVD risk in individuals with severe obesity and NAFLD.

ImportanceElevated allostatic load (AL) has been associated with adverse socioenvironmental stressors and tumor characteristics that convey poor prognosis in patients with breast cancer. Currently, the association between AL and all-cause mortality in patients with breast cancer is unknown.ObjectiveTo examine the association between AL and all-cause mortality in patients with breast cancer.Design, Setting, and ParticipantsThis cohort study used data from an institutional electronic medical record and cancer registry at the National Cancer Institute Comprehensive Cancer Center. Participants were patients with breast cancer diagnoses (stage I-III) between January 1, 2012, through December 31, 2020. Data were analyzed from April 2022 through November 2022.ExposureAL was expressed as a summary score calculated by assigning 1 point for biomarkers in the worst sample quartile. High AL was defined as AL greater than the median.Main Outcomes and MeasuresThe main outcome was all-cause mortality. A Cox proportional hazard models with robust variance tested the association between AL and all-cause mortality.ResultsThere were 4459 patients (median [IQR] age, 59 [49-67] years) with an ethnoracial distribution of 3 Hispanic Black patients (0.1%), 381 non-Hispanic Black patients (8.5%), 23 Hispanic White patients (0.5%), 3861 non-Hispanic White patients (86.6%), 27 Hispanic patients with other race (0.6%), and 164 non-Hispanic patients with other race (3.7%). The mean (SD) AL was 2.6 (1.7). Black patients (adjusted relative ratio [aRR], those with 1.11; 95% CI, 1.04-1.18), single marital status (aRR, 1.06; 95% CI, 1.00-1.12), and those with government-supplied insured (Medicaid aRR, 1.14; 95% CI, 1.07-1.21; Medicare aRR, 1.11; 95% CI, 1.03-1.19) had a higher adjusted mean AL than those who were White, married/living as married, or privately insured, respectively. Adjusting for sociodemographic, clinical, and treatment factors, high AL was associated with a 46% increase in mortality risk (hazard ratio [HR], 1.46; 95% CI, 1.11-1.93) over low AL. Similarly, compared with patients in the first AL quartile, those in the third quartile (HR, 1.53; 95% CI, 1.07-2.18) and the fourth quartile (HR, 1.79; 95% CI, 1.16-2.75) had significantly increased risks of mortality. There was a significant dose-dependent association between increased AL and a higher risk of all-cause mortality. Furthermore, AL remained significantly associated with higher all-cause mortality after adjusting for the Charlson Comorbidity Index.Conclusions and RelevanceThese findings suggest increased AL is reflective of socioeconomic marginalization and associated with all-cause mortality in patients with breast cancer.

Chronic Liver Disease (CLD) is associated with an increased risk of chronic kidney disease (CKD). However, the health care burden of CKD in the CLD spectrum is unknown. We aimed to evaluate the health care use and cost burdens associated with CKD in patients with CLD in the United States by using real-world claims data. We analyzed data from the Truven Health MarketScan Commercial Claims database from 2010 to 2015. A total of 19,664 patients with CLD with or without comorbid CKD were identified using International Classification of Diseases, Ninth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific unadjusted and adjusted health care parameters were analyzed for the 12 months following an index date selected at random to capture whole disease burdens. In CLD, comorbid CKD was associated with a higher annual number of claims per person (CKD vs. no CKD, 69 vs. 55) and higher total annual median health care costs (CKD vs. no CKD, $21,397 vs. $16,995). A subanalysis stratified by CKD category showed that health care use and cost burden in CLD increased with disease stage, with a peak 12-month median cost difference of $77,859 in patients on dialysis. The adjusted per person annual health care cost was higher for CKD cases compared to controls ($35,793 vs. $24,048, respectively; P < 0.0001). Stratified by the type of CLD, the highest between-group adjusted cost differences were for cirrhosis, viral hepatitis, hemochromatosis, and nonalcoholic fatty liver disease. Conclusion: CKD is a cost multiplier in CLD. The CKD health care burden in liver disease differs by the type of CLD. Improved CKD screening and proactive treatment interventions for at-risk patients can limit the excess burden associated with CKD in patients with CLD.

Hepatic encephalopathy (HE) is a complex condition with multiple causes each with varying degrees of severity. HE negatively impacts patients' quality of life, and it is associated with significant burdens to patients and their caregivers. The prevalence of cirrhosis, the most common risk factor for HE, has steadily increased during recent years. In turn, an upsurge in the clinical and health care burdens related to HE is expected in the upcoming years. This article provides a comprehensive review of the epidemiology of HE.

Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer.Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017.Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics.We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.

10547 Background: Disruptions of daily life activities during the CVOID-19 pandemic have adversely affected cancer-prevention behaviors. Socioeconomic status (SES) impacts on changes in cancer prevention behaviors have not been fully investigated. To tackle this gap, we examined the effects of SES on COVID-19 related changes in cancer prevention behaviors. Methods: We invited participants from previous studies conducted at the Ohio State University Comprehensive Cancer Center who agreed to be re-contacted to participate in a survey assessing the impact of COVID-19 on various behaviors between June and November 2020. Participants reported current cancer prevention behaviors, including physical activity, daily fruit and vegetable intake, alcohol consumption, and tobacco use. In addition, participants reported qualitative changes in current behaviors relative to pre-COVID levels. We combined current behaviors with COVID-related changes to construct a 24-point cancer prevention score. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted multinomial logistic regression was used to examine the association between SES and COVID-19 related changes in cancer prevention behaviors. Results: The study sample included 6136 eligible participants. The average age was 57 years, 67% were female, 89% were non-Hispanic White, and 33% lived in non-metro counties. The proportion of participants in the lowest cancer prevention behavior quartile decreased significantly with higher SES [low SES vs. high SES; 32% vs. 28%; P-value

Objectives The healthcare burden associated with porphyria remains unevaluated despite the associated increased risks of morbidity and mortality. We aimed to assess the healthcare utilization and cost burdens of porphyria in the United States (US) using real-world claims data. Methods We performed a case–control analysis of adults in the Truven Health MarketScan® Commercial Claims database (2010–2015). Using propensity scores, 2788 porphyria cases were matched 1:1 to porphyria-free controls with chronic liver disease. Total and service-specific parameters were quantified for the 12 months before porphyria diagnosis versus the 12 months after diagnosis and over the 12 months following a randomly selected date for controls. Wilcoxon signed rank tests and McNemar tests were used to examine incremental differences in burden between cases and controls. Adjusted multivariable generalized linear regression models were used to compare healthcare burdens for cases versus controls. Results Relative to the 12 months before porphyria diagnosis, the following 12 months had more claims per patient (35.94 vs 39.67; p

Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts

Little is known about the health care burden of hemochromatosis in the United States, despite its increased morbidity and mortality due to associated advanced liver diseases.To evaluate the health care utilization and economic burdens of hemochromatosis in the United States using real-world claims data.We performed a case-control analysis of adult participants in the Truven Health MarketScan Commercial Claims database from 2010 to 2015. 37,092 hemochromatosis cases were matched 1:1 by demographics and comorbidities to hemochromatosis-free controls with chronic liver disease using propensity scores. Total and service-specific health care parameters were quantified for the 12 months following versus the 12 months before the first date of hemochromatosis diagnosis and over the 12 months following a randomly selected date for controls. Incremental differences in health care burdens between cases and controls were examined using Wilcoxon signed rank tests and McNemar tests for continuous and dichotomous measures, respectively. Adjusted multivariable regression analyses using generalized linear models were used to compare the health care burdens for cases with controls.In comparison with the year before, the 12 months following first hemochromatosis diagnoses had a higher total number of claims per patient (34.37 vs. 29.99;Hemochromatosis in the United States is associated with significant health care utilization and economic burdens driven by outpatient visits, pharmaceutical claims, and a high number of comorbidities DISCLOSURES: No outside funding supported this study. The authors have no relevant financial or other relationships to disclose. An abstract containing some of the results from this study was accepted for the American Association for the Study of Liver Diseases Meeting; November 9-13, 2018; San Francisco, CA.

BACKGROUND AND AIMS The paucity of data regarding the extent of hepatitis delta virus (HDV) associated health care burden in the United States is an important obstacle to assessing the cost-effectiveness of potential intervention strategies. In this study, we characterized the health care use and cost burdens of HDV in the United States using real-world claims data. APPROACH AND RESULTS We conducted a case-control study using the Truven Health MarketScan Commercial Claims databases from 2011-2014. A total of 2,727 HDV cases were matched 1:1 by sociodemographic characteristics and comorbidities to chronic hepatitis B virus (HBV) controls using propensity scores. The HDV group had significantly higher prevalence of substance abuse, sexually transmitted diseases, decompensated cirrhosis, cirrhosis, and hepatitis C virus compared to patients with chronic HBV. First HDV diagnosis was associated with significant increases in the total number of health care claims (25.61 vs. 28.99; P

Background Metabolic syndrome (MetS) is common amongst gout patients. The MetS is diagnosed when a patient has at least 3 of the following 5 conditions of hyperglycemia, hypertension, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol or abdominal obesity. Little is known about the relationship between the cumulative effects of all five metabolic syndrome conditions and the risk of mortality among adult patients with gout. Metabolic Syndrome Severity Score (MetSSS) is a new clinical prediction score that employs available components (sex, age, race, systolic blood pressure, waistline circumference, high-density lipoprotein, triglycerides and fasting blood glucose). MetSSS is a validated summary score that accounts for the combined effects of all 5 metabolic features. MetSSS allows examination of associations between MetS severity and the risk of mortality. Objectives: to use the MetSSS to examine the overall associations between MetS severity and the risk of mortality related to all-causes, cardiovascular disease and diabetes amongst United States (US) gout patients. Methods Mortality-linked data for 12,101 adults aged 18 to 90 years who participated in the Third National Health and Nutrition Examination Survey (NHANES) III (1988-1994) was analyzed. Data from NHANES III were linked to national mortality records for all participants up to time of death or end of study (i.e. 23 years following initial recruitment). All 5 metabolic features were used to calculate gender-race/ethnicity specific MetSSS Z-scores in gout patients. The Z-score is the number of standard deviations from the mean a data point is and allows a continuous representation of all MetS conditions while accounting for gender-race/ethnicity disparities. Results A total of 3,381 deaths were observed, of whom 215 had gout. The prevalence of gout amongst adults was 2.59% (95% CI; 2.13%-3.05%). Moderate to high MetS severity was significantly prevalent among gout patients (47.33% vs. 21.16% no gout; P-value In a disease-specific survival model, a one-unit increase in MetSSS score was associated with a aHR 1.62 (95% CI; 1.21, 2.15) increase in heart disease related mortality among gout patients. Amongst those with gout, a one-unit increase in MetSSS score was associated with increased risks of diabetes- and hypertension- related mortalities aHR 2.53 (95% CI; 1.43, 4.62), aHR 1.73 (95% CI; 1.07, 2.79), respectively. Conclusion The Z score calculation in our study allowed a quantification of increased diabetes- and hypertension- related mortalities, all- cause and cardiovascular mortality in patients with gout. Use of the MetSSS can provide an opportunity to identify patients at highest risk influencing patients to change their lifestyle and better comply with treatment. References [1] Wiley JF, Carrington MJ. A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors. Prev Med2016;88:189-195. [2] Thottam GE, Krasnokutsky S, Pillinger MH. Gout and metabolic syndrome: a tangled web. Curr Rheumatol Rep2017;19:60. Disclosure of Interests Naomi Schlesinger Grant/research support from: Pfizer, Consultant for: YesNovartis, Horizon Pharma, Proteo Thera, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Mohamed Elsaid: None declared, Vinod Rustgi Grant/research support from: Genfit, Consultant for: yes Allergan, Zydus, Abbvie

Background & Aims Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and increased risk of cancer. The impacts of bariatric surgery on cancer risk in NAFLD patients are unknown. We investigated the effect of bariatric surgery on cancer risk in patients with NAFLD and severe obesity using the MarketScan database. Methods We conducted a retrospective cohort study of 18 to 64 years old newly diagnosed NAFLD patients with severe obesity between 2007 and 2017. We used Cox proportional hazard models to examine the association between bariatric surgery, modeled as a time-varying covariate, and the risks of any cancer and obesity-related cancer, while accounting for confounding using inverse probability of treatment weighting (IPTW). Results A total of 98,090 patients were included in the study, 33,435 (34.1%) received bariatric surgery. In those without surgery, 1898 incident cases of cancer occurred over 115,890.11 person-years of follow-up, compared with 925 cancer cases over 67,389.82 person-years among surgery patients (crude rate ratio, 0.84; 95% CI, 0.77- 0.91). The IPTW-adjusted risk of any cancer and obesity-related cancer was reduced by 18% (hazard ratio, 0.82; 95% CI, 0.76–0.89) and 25% (hazard ratio, 0.65; 95% CI, 0.56–0.75), respectively, in patients with versus without bariatric surgery. The adjusted risks of any cancer and obesity-related cancer were significantly lower in cirrhotic versus non-cirrhotic patients who underwent surgery. In cancer-specific models, bariatric surgery was associated with significant risk reductions for colorectal, pancreatic, endometrial, thyroid cancers, hepatocellular carcinoma, and multiple myeloma. Conclusion Bariatric surgery was associated with significant reductions in the risks of any cancer and obesity-related cancer in NAFLD patients with severe obesity.

Background An estimated 257 million individuals are living with hepatitis B Virus (HBV) worldwide. While the aggregate rate of HBV infection has been firmly decreasing in the United States, Asian males continue to experience the highest risk of infection. This study aims to investigate the racial and gender disparities in HBV vaccination coverage among Asian American adults using the 2012–2015 National Health Interview Survey (NHIS). Methods The study sample included 125,399 adults aged 18 to 85 who participated in the 2012–2015 NHIS. The main outcome was HBV vaccination status. Race/ethnicity was categorized into White-non-Hispanics, Black-non-Hispanics, Hispanics, Other, Asian-Indian, Chinese, Filipino, and Other-Asian (Korean, Vietnamese, Japanese, and other Asian subgroups). Complex survey methods were applied to all models to provide statistical estimates that are representative of US adults. Multivariable logistic regression models adjusting for age, education, region of residence, survey year, health insurance access, chronic liver disease, influenza vaccination, marital, employment and health status were fit to examine the associations between gender, race/ethnicity and HBV vaccinations status. Results An estimated 39.66% (95% CI; 38.07%, 41.25%) of Asian adults living in the US received HBV vaccination. Vaccination prevalence among male Asian adults was lower than their female counterparts 38.05% (95% CI; 35.66%, 40.44%) vs. 41.09% (95% CI; 38.96%, 43.21%). Among Asian adults, the adjusted odds ratio (AOR) of HBV vaccination for females were 1.20 (95% CI; 1.04, 1.39) times higher than males. The AORs of HBV vaccinations were significantly higher when compared with white 1.21 (95% CI; 1.03, 1.41), 1.29 (95% CI; 1.10, 1.51), respectively for Chinese and Filipino Adults. We observed significant gender disparities in HBV vaccination AOR for Asian-Indian and Chinese adults. In both groups, females had higher AOR of HBV vaccination when compared with males, Asian-Indian 1.42 (95% CI; 1.04, 1.94) and Chinese 1.39 (95% CI; 1.07, 1.80). Conclusion Among Asian-Indian and Chinese adult residents of the United States, the association between race and HBV vaccination status differs by gender, with males having lower vaccination rates than females. Healthcare resources should be directed to these target populations to improve these rates. Disclosures V. Rustgi, Genfit: Grant Investigator and Investigator, Research support. Gilead: Speaker’s Bureau, Speaker honorarium. Abbvie: Speaker’s Bureau, Speaker honorarium.

Background While HAV vaccine is recommended for U.S. travelers, vaccination rates among foreign-born adults are lower than U.S.-born adults. Furthermore, some racial minority groups have low HAV vaccination coverage. We aimed to examine the relationship between nativity, race and their interaction as predictors of HAV vaccination status among adult travelers to high-risk countries (HRCs) through analysis of the National Health Interview Survey (NHIS), 2012–2015. Methods The study included 44,871 U.S. adult participants in the 2012–2015 NHIS who traveled to countries where HAV is endemic. The main outcome was self-reported HAV vaccination (≥2 doses). Complex survey methods were applied to all models to provide statistical estimates that are representative of U.S. adults. Multivariable logistic regression models adjusting for covariates were fit to examine the association between nativity, race, race-by-nativity (for interaction) and vaccination status. Results For adult travelers to HRCs, the prevalence of HAV vaccination among foreign-born adults was lower than all adults 13.05% (95% CI; 12.11%, 14.00%) vs. 16.12% (95% CI; 15.60%, 16.64%). The adjusted odds ratio (AOR) of HAV vaccination was lower for foreign-born adults compared with U.S.-born AOR 0.86 (95% CI; 0.76, 0.98). For Hispanics, the AOR of HAV vaccination was 0.80 (95% CI; 0.70, 0.91) as compared with non-Hispanic-Whites. Furthermore, a significant qualitative interaction between nativity and race was found (P-value < 0.05). Among non-Hispanic Blacks, the adjusted odds of HAV vaccination for foreign-born adults were 1.35 (95% CI; 1.06, 1.72) times the odds for U.S.-born adults. In contrast, the AORs of vaccination of foreign-born vs. U.S.-born adults were 36% (95% CI; 17%, 51%) and 30% (95% CI; 12%, 44%), lower for Asians and Hispanics, respectively. Conclusion The association between nativity and HAV vaccination status differs by race among travelers to HRCs, with U.S.-born non-Hispanic Black and foreign-born Asian and Hispanic adults having lower vaccination odds. Healthcare resources should be focused on these target populations to improve travel vaccination compliance. Nativity and race should be both assessed when analyzing and reporting HAV vaccination statistics for adult travelers. Disclosures V. Rustgi, Genfit: Grant Investigator and Investigator, Research support; Gilead: Speaker’s Bureau, Speaker honorarium; Abbvie: Speaker’s Bureau, Speaker honorarium.