Abstract 744: Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database

Background: People living with HIV (PLWH) with Hodgkin’s lymphoma(HL) have similar response and survival rates to people without HIV when standard of care therapies are given. However, PLWH with HL are less likely to receive cancer treatment for unclear reasons. Our objective was to examine the role of social determinants of health(SDOH) with non-receipt of cancer treatment among PLWH with HL.

Methods: Using the U.S. National Cancer Database, we identified 11,517 persons aged 18-90 years, diagnosed with HL (ICD-O-3 codes; C770-779) between 2018-2019. Most patients were diagnosed with classical HL(9650; n=4534, 39%) or nodular sclerosis classical Hodgkin’s lymphoma (9663; n=4725, 41%). As per NCCN guidelines, receipt of first-line treatment was defined as receiving any chemotherapy, radiotherapy or a combination of both. We compared treatment receipt by HIV status and associations of SDOH (e.g., zip-code median household income) with non-receipt of treatment among those with and without HIV. Using multivariable logistic regression, we evaluated the association of treatment receipt with HIV status after adjustment for age, sex, and stage at diagnosis. We stratified this model by zip-code level income, education and race/ethnicity to evaluate the role of SDOH in this exposure-outcome relationship. For each model, we calculated cluster-robust standard errors to account for non-independence within clusters at the facility level to adjust for correlated patient characteristics within hospitals.

Results: Our sample (n=11,517) included 60% adults aged 50 years or below, 55% men, 71% NH-White and 14% NH-Black. About one-third were treated at an academic/research program and 57% were privately insured. PLWH included 6% of the population. Overall, 12% did not receive first-line recommended treatment and were less likely to receive treatment compared to those without HIV (13% vs. 9%, p=0.012). We identified the following characteristics amongst PLWH to be more likely not to receive treatment compared to those without HIV, persons who were: aged 40 years or younger(13% vs. 6%, p=0.001), male(15% vs. 9%, p<0.001), NH-White(13% vs. 8%) and NH-Black(14% vs. 11%) persons(p<0.001), persons residing in areas with lower levels of educational attainment (20% vs. 10%, p<0.001) and low income areas (14% vs 9%, p<0.001), and were Medicaid insured (17% vs. 8%, p<.001). Stratifying by area-level education, this association persisted among those residing in areas with lower levels of education and income.

Conclusion: PLWH with HL were less likely to receive cancer treatment and continue to experience inequities in cancer treatment receipt, with SDOH playing a potential role in inequitable cancer care delivery.

Citation Format: Jessica Yasmine Islam, Jennifer McGee, Yi Guo, Marlene Camacho-Rivera, Lubomir Sokol, Susan T. Vadaparampil, Gita Suneja. Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 744.

Implementing suicide risk screening as a part of routine cancer care

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Background: Head and neck cancer (HNC) patients are at increased risk for suicide. Few studies have tested approaches to preventing suicide in this population, such as routine suicide risk screening. To address this issue, the current study pilots and assesses the feasibility and implementation of a suicide risk screening program for HNC patients at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. Methods: Routine screening was implemented at all in-person visits in the HNC clinic from February 1, 2021 – January 31, 2022 using the PHQ-9. Patients with passive suicidal ideation were consequently screened by social work for active suicidal ideation. Results: Most (92.6% or 1519/1641) HNC patients with a scheduled in-person visit completed at least one suicide risk screening; 9,968 screenings were completed (mean: 3.7; SD: 3.8 per patient) in total. Among patients who were screened, 3% (49/1519) of HNC patients reported passive suicidal ideation and 0.3% (5/1519) were identified as having active suicidal ideation. Patients with five or more visits were more likely to participate in screening compared with patients who only had one visit during the study period (100% vs. 82.7%; P <.0001). Other patient factors, such as race/ethnicity and socioeconomic status, were not associated with screening participation. Conclusions: Findings suggest suicide screening was feasible and effective at identifying patients at an increased risk for suicide. Longitudinal studies are needed to evaluate the impact of suicide screening on suicide prevention and further research is required to scale up suicide screening to reach additional cancer patients.

Cancer treatment delays among patients with cancer living with HIV during the COVID-19 pandemic in the United States

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Background: The COVID-19 pandemic led to care disruptions across the cancer continuum. It is unknown if immunosuppressed patients with cancer who may be at high risk for SARS-CoV-2 infection were disproportionately impacted. Our objective was to compare delays in cancer treatment initiation between people living with HIV (PLWH) and cancer, the general cancer population (GCP), and patients with cancer and a history of solid organ transplant (SOT), another immunosuppressed patient population. Methods: We used data from Flatiron Health electronic health record-derived de-identified database (2018-2021) comprised of US patients with cancer from 800 sites of care across the country. We included patients with lymphomas, myeloma, and melanoma, as well as cancers of the breast, lung, prostate, head & neck, and gynecologic or gastrointestinal systems. We calculated time to cancer treatment initiation (TTI) as the difference between the date of cancer diagnosis and the earliest date that one of the following treatments was recorded: cell based treatment, other local treatment, radiotherapy, surgery, systemic therapy, or transplant. 16.4%, 19.9%, and 13.3% of the GCP, PLWH, and SOT groups, respectively, did not have treatment information in the database. This may have been due to no receipt of treatment or lack of data in the medical record. All analyses reported were conducted among patients with available treatment data. PLWH and those with a history of SOT were selected using ICD 9/10 codes. After adjusting for age, sex, and metastatic disease (yes/no), we used a difference-in-difference analysis to compute TTI for each study group both prior to and during the COVID-19 pandemic. We then determined whether study group differences in cancer patient TTI (e.g., HIV-associated treatment delays) changed during the pandemic. Results: The sample included 181 PLWH, 65073 GCP patients, and 195 patients with a history of SOT. Overall, no significant delay in TTI was seen between the three groups pre-COVID. However, during the pandemic, the TTI was statistically significantly delayed for PLWH compared to the HIV-uninfected GCP (median TTI 41 days vs. 27 days, p = 0.0017). No significant difference was observed overall between the GCP and the SOT group (median TTI 27 days vs. 20 days, p = 0.376), evidence that COVID-related treatment delays were specific to PLWH. Difference in difference analysis revealed that, when compared to the GCP, there was a significant increase in TTI among PLWH over time, with delays increasing by almost one month during COVID [DID: 32.6 days (8.9-56.3); p = 0.007]. The increase in TTI for PLWH was consistent across treatment modalities, including surgery (DID: 55.1, 95% CI: 28.8-81.3, p < 0.001) and systemic therapy (DID: 30.4; 95% CI: 4.6-56.3, p = 0.021). Conclusions: PLWH and cancer experienced significant delays in cancer treatment initiation after diagnosis during the COVID-19 pandemic.

Food Insecurity Disparities and Mental Health Impacts Among Cancer Survivors During the COVID-19 Pandemic

Introduction:

Methods:

Results:

Conclusion:

Abstract 3585: Disparities in cancer treatment delays or discontinuation among cancer patients diagnosed with SARS-CoV-2 infection: An analysis of the U.S. ASCO COVID-19 and cancer registry

Background: Due to societal factors in the US, racial/ethnic minority adults are disproportionately impacted by the COVID-19 pandemic, particularly those with existing comorbid conditions such as cancer. It is currently unknown whether disparities exist in cancer treatment delivery among racial/ethnic minority patients with cancer and SARS-CoV-2.

Methods: Data were obtained from the ASCO COVID-19 and Cancer Registry (March 2020-July 2021), including data from cancer patients diagnosed with SARS-CoV-2 during their care (n=3193) at 60 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, cancer clinical characteristics, and modifications to cancer treatment plans. Cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the original scheduled date. We descriptively evaluated demographic and clinical characteristics, compared disparities in TDD by race/ethnicity and urban/rural residency, and evaluated reasons for TDD as reported by the clinics. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, body mass index, number of comorbidities, cancer type, cancer extent, cancer status at SARS-CoV-2 diagnosis (progressing/stable) and SARS-CoV-2 severity (death/hospitalization/ICU admission/mechanical ventilation).

Results: Cancer patients with SARS-CoV-2were mostly female (57%), urban residents (84%), and NH-White (66%); 49% were 65+ years old. Most patients had solid tumors (75%). At SARS-CoV-2 diagnosis, 2403 patients (76%) were scheduled to receive drug-based therapy (69%), radiation therapy (7%), surgery (4%), or transplant (0.7%), of whom 49% experienced TDD. The most reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (90%). Overall, NH-Black (64%) and Hispanic (57%) with SARS-CoV-2 were more likely to experience TDD versus NH-White adults (46%) (p&lt;0.001). This disparity was also observed across urban residing adults (p&lt;0.001). Among rural adults, NH-AI/AN (75%) and NH-Black (61%) were more likely to experience TDD versus NH-White patients (39%). In multivariable analyses, disparities persisted, by NH-Black cancer patients with 92% (aOR:1.92, 95% CI:1.24-2.96) and Hispanic patients with 41% (aOR:1.41, 95% CI:1.03-1.91) higher odds of experiencing TDD. We observed consistent results among urban and rural subgroups.

Conclusion: Racial/ethnic disparities exist in TDD among cancer patients with SARS-CoV-2 in urban and rural care settings. Future studies should evaluate the impacts of delays to cancer treatment delivery on cancer outcomes among minoritized communities in the US.

Citation Format: Jessica Yasmine Islam, Cassandra A. Hathaway, Emma Hume, Kea Turner, Julie Hallanger-Johnson, Shelley S. Tworoger, Marlene Camacho-Rivera. Disparities in cancer treatment delays or discontinuation among cancer patients diagnosed with SARS-CoV-2 infection: An analysis of the U.S. ASCO COVID-19 and cancer registry [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3585.

Racial/ethnic disparities of cancer treatment disruptions among patients with breast cancer with SARS-CoV-2 infection: An analysis of the ASCO Survey on COVID-19 in Oncology Registry

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Background: The COVID-19 pandemic has led to disruptions in cancer treatment delivery among breast cancer patients in the U.S. However, it is currently unknown whether racial/ethnic disparities exist in cancer treatment disruptions among patients with breast cancer and SARS-CoV-2 infection. Methods: We obtained data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021) describing breast cancer patients diagnosed with SARS-CoV-2 during their care treated at 46 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, breast cancer characteristics, and modifications to cancer treatment plans. Breast cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the originally scheduled date. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, number of comorbidities, cancer extent, ECOG performance score, pandemic period based on case peaks ( < 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Breast cancer patients (n = 804) with SARS-CoV-2 were mostly aged 50 years and above (75%) and urban residents (83%). The racial/ethnic makeup of the sample included: 13.3% non-Hispanic Black/African American (NH-Black), 11.7% Hispanic/Latinx, 4.9% American Indian/Alaskan Native (NH-AI/AN), 4.6% NH-Asian, and 65% NH-White. At SARS-CoV-2 diagnosis, 736 patients (91%) were scheduled to receive drug-based therapy (78%), radiation therapy (8%), or surgery (6%), of whom 39% experienced TDD. Across treatment modalities, the most commonly reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (̃90%). Overall, NH-Black (62%), Hispanic/Latinx (44%), and NH-Asian (42%) adults with breast cancer and SARS-CoV-2 were more likely to experience TDD versus NH-White adults (34%) (p < 0.001). In multivariable analyses, NH-Black cancer patients were more likely to experience TDD compared to NH-White patients (aOR: 3.12, 95% CI: 1.96-5.47). The data suggest Hispanic/Latinx (aOR: 1.34, 95% CI: 0.78-2.30) breast cancer patients may also experience TDD, although not statistically significant. No association was observed among NH-Asian (aOR: 1.16, 95% CI: 0.50-2.73) or NH-AI/AN (aOR: 0.64, 95% CI: 0.28-1.52) breast cancer patients with TDD. Conclusions: Black or African American breast cancer patients are more likely to experience cancer care disruptions during the pandemic. Future research should evaluate the long-term impacts of care disruptions on breast cancer outcomes among minoritized US communities.

COVID-19 outcomes in patients with cancer and HIV: An analysis of the COVID-19 and Cancer Consortium (CCC19)

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Background: Patients with SARS-CoV-2 with a diagnosis of cancer have increased risk of severe COVID-19 outcomes compared to patients without cancer. However, little is known regarding outcomes of patients with COVID-19 and cancer in the setting of human immunodeficiency virus (HIV). Given the unique risks of this population, we sought to understand COVID-19 outcomes using registry data. Methods: This is a descriptive research study utilizing the CCC19 registry, an international multi-institutional registry with healthcare provider-reported cases of patients with cancer and COVID-19. Between March 2020-December 2021, 116 persons with HIV (PWH) and 10,642 persons without HIV (PWOH) with laboratory-confirmed SARS-CoV-2 infection were identified as eligible for the analysis. Results: Median follow-up time for both groups was 90 days, with interquartile range (IQR) 30-180 days. Most PWH were actively receiving antiretroviral therapy (ART) at the time of COVID-19 diagnosis, with 71% (n = 82) having named drug information available; bictegravir/emtricitabine/tenofovir was the most common ART (n = 25). PWH were of younger age (median 57.5 yrs [IQR 46.5-63.25] vs 65 yrs [IQR 55-74]), male (81% vs 47%), and either non-Hispanic Black or Hispanic (71% vs 34%) compared to PWOH. 12% of PWH (n = 14) were current smokers compared to 6% of PWOH (n = 638), and more than half in each group were never smokers (51% of PWH and 53% of PWOH). The following comorbidities were identified in PWH vs PWOH: cardiovascular (16% vs 20%), pulmonary (16% vs 20%), renal (15% vs 14%), and diabetes mellitus (18% vs 27%). A higher proportion of PWH had hematologic malignancy compared to PWOH (33% vs 19%). More PWH had active cancer which was progressing at the time of SARS-CoV-2 infection compared to PWOH (24% vs 14%). 44% of PWH (n = 51) had received active systemic anticancer therapy within the 3 months preceding SARS-CoV-2 infection (including cytotoxic, targeted, endocrine therapies, and immunotherapy) compared to 51% of PWOH (n = 5,420). PWH had an increased rate of hospitalization (58% vs 55%) compared to PWOH. Although a lower proportion of PWH required supplemental oxygen during hospitalization compared to PWOH (34% vs 38%) and ICU admission rates were identical between the two groups (16% vs 16%), PWH had an increased rate of mechanical ventilation (14% vs 10%) and death (24% vs 18%) compared to PWOH. Conclusions: This is the first known study describing outcomes of patients with cancer and COVID-19 in the PWH population from a large multinational dataset. PWH have characteristics associated with adverse outcomes in prior analyses (male sex, non-Hispanic Black or Hispanic, hematologic malignancy, progressing cancer) but are notably younger and have fewer comorbidities. HIV infection may portend increased risk of severe COVID-19 and death; however, additional analyses, including multivariable regression, are warranted.

The role of rurality in cancer treatment disruptions among patients with cancer diagnosed with SARS-CoV-2: An analysis of the ASCO Survey on COVID-19 in Oncology Registry

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Background: U.S. rural cancer patients experience multifactorial barriers to cancer treatment; however, little is known about the impact of the pandemic on cancer treatment delays or discontinuations (TDD) in the rural context. Our objective was to evaluate the role of rurality at both the patient and clinic level on cancer TDD among patients living with cancer with SARS-CoV-2 infection. Methods: We used data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021), which includes cancer patients diagnosed with SARS-CoV-2 (n = 3193). Data included patient demographics, SARS-CoV-2 treatment, cancer characteristics, and modifications to cancer treatment plans. Cancer-related TDD was defined as any treatment postponed > two weeks from the original scheduled date. Rurality was defined using the USDA Rural-Urban Commuting Area schema. We compared cancer characteristics, COVID-19 outcomes, and TDD by rurality of cancer patients, and TDD by rurality of oncology practices. We computed adjusted odds ratios (aOR) using multivariable logistic regression to evaluate rurality with TDD adjusting for age, race/ethnicity, sex, comorbidities, ECOG score, cancer extent, pandemic time period based on case peaks ( < 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity. Results: Rural cancer patients (n = 499, 16%) with SARS-CoV-2 were mostly over 50 years (87%), female (57%), and NH-White (81%) with solid tumors (76%). Most rural patients received oncology treatment in urban areas (65%, p < 0.001). Rural patients were less likely to receive care through telemedicine (18%) compared to urban patients (26%) (p < 0.001). At SARS-CoV-2 diagnosis, rural patients were scheduled to receive drug-based therapy (72%), radiation therapy (8%), surgery (4%), or transplant (1%). Rural versus urban cancer patients with SARS-CoV-2 were less likely to experience TDD (41% vs. 51%) (p < 0.001). Among patients treated at rural oncology clinics, urban cancer patients were more likely to experience TDD (65%) compared with rural patients (47%) (p < 0.001). Similarly, among patients treated at urban oncology clinics, urban cancer patients were also more likely to experience TDD (51%) compared with rural patients (38%) (p < 0.001). In multivariable analyses, rural cancer patients were 28% less likely to experience TDD (aOR:0.72, 95% CI: 0.55-0.94) than urban cancer patients. Oncology practice rurality was not associated with TDD (aOR: 1.19, 95% CI: 0.81-1.76). Conclusions: Rural cancer patients were less likely to experience TDD than urban patients supporting the urban-rural paradox i.e., geographic distance to cancer care facilities is not consistently associated with treatment delivery in expected ways. Future work should focus on area-level factors of the rural cancer patient experience to disentangle potential reasons for TDD during the pandemic.

Disparities in Awareness of Hepatitis C Virus Among US Adults: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

The U.S. Preventive Services Task Force updated hepatitis C virus (HCV) screening 2020 guidelines to target adults aged 18 to 79 years: a major shift from the prior focus on high-risk populations ("baby boomers" aged ≥55 years as of 2019). To inform efforts to maximize HCV screening coverage, our objective was to identify demographic groups reporting a lack of HCV awareness, particularly by race/ethnicity and age, and sources of health information.

METHODS

We used nationally representative data of adults (≥18 years) included in the 2019 Health Information National Trends Survey (n = 5438). Awareness of HCV was defined using the following question: "Have you ever heard of the hepatitis C virus (also known as Hep C or HCV)?" We estimated frequencies by demographic groups and computed risk differences (RDs) with 95% confidence intervals (CIs) to compare lack of HCV awareness by age (<55 and ≥55 years) and race/ethnicity.

RESULTS

Overall, 17% of adults never heard of HCV. Younger adults (<55 years; 21%) were more likely to have never heard of HCV compared with older adults (≥55 years; 12%; χ2P < 0.001). This observation was consistent across most demographic characteristics including, racial/ethnic categories, and residing in the Southern United States. More than one-third of adults with low English fluency had a lack of HCV awareness in both age groups (χ2P = 0.537). Non-Hispanic (NH) Asian (RD, 25%; 95% CI, 6.9%-43.3%) and Hispanic (RD, 10%; 95% CI, 0.01%-19.6%) adults younger than 55 years were significantly more likely to have never heard of HCV compared with their NH White counterparts after adjustment for sex, educational level, household income, English fluency, and having a regular provider. Adults younger than 55 years with a lack of HCV awareness commonly obtained their health information from the Internet across most sociodemographic characteristics.

CONCLUSIONS

Hispanic and NH Asian young adults should be targeted for public health messaging regarding HCV screening, potentially through social media campaigns.

Perceptions and Patterns of Cigarette and E-Cigarette Use among Hispanics: A Heterogeneity Analysis of the 2017-2019 Health Information National Trends Survey

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.

Racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the United States: An analysis of the 2020 U.S. HINTS

e18573

Background: Despite the use of clinical trials to provide gold-standard evidence of treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the U.S. Methods: We leveraged Health Informational National Trends Survey (HINTS) data, which is a weighted, nationally representative survey of 3865 adults (≥18 years). Data were collected between February-June 2020, and included age, race/ethnicity, sex, cancer history, and comorbidities. Participants were asked questions focused on clinical trials, including their knowledge, influential factors to participate, trusted sources of information, and if they were ever invited or participated in a clinical trial. Among adults who self-reported to have heard of clinical trials (n = 2366), we used multivariable logistic regression to evaluate racial/ethnic differences in self-reported invitation and participation in clinical trials after adjustment for cancer history, age, sex, comorbidities, and insurance status. Results: Overall, the sample included 64% non-Hispanic (NH) White, 11% NH-Black, 17% Hispanic, and 5% NH-Asian respondents. Nine percent were cancer survivors. Almost 60% self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials “A lot”, participants across racial groups most frequently chose “I would want to get better” and “If the standard care was not covered by my insurance.” Cancer survivors also frequently reported their decision would be influenced “A lot” or “Somewhat” if “My doctor encouraged me to participate.” NH-White (76%), NH-Black (78%), and Hispanic (77%) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51%) as well as government health agencies (30%). Compared to NH-White adults, NH-Black adults were more likely to be invited to participate in a clinical trial (OR: 2.60, 95% CI: 1.53-4.43). However, compared to NH-White adults, our data suggest NH-Black adults were less likely to participate in the clinical trial (OR: 0.76, 95% CI: 0.39-1.49) although not statistically significant. Compared to NH-White adults, NH-Asian adults were less likely to participate in clinical trials (OR: 0.10, 95% CI: 0.06-0.18). Conclusions: Health care providers are a trusted source of clinical trial information. Although NH-Black adults are more likely to be invited, they are less likely to participate in a clinical trial; as well as Asian adults. Efforts to leverage insights gained on factors of influence and sources of trusted information on clinical trials should be prioritized.

Preventive Behaviors and Mental Health-Related Symptoms Among Immunocompromised Adults During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey

The COVID-19 pandemic has disrupted the continuity of care of U.S. adults living with chronic diseases, including immunocompromised adults. Disruption in care may be a barrier to identifying COVID-19 associated sequelae, such as mental health symptoms, among the immunocompromised. Our objectives were to evaluate COVID-19-related preventive behaviors, with a focus on canceling doctor's appointments as a proxy for continuity of care, and to compare COVID-19-related mental health symptoms among the immunocompromised with the general population. We used nationally-representative data of 10,760 U.S. adults from the publicly-available COVID-19 Household Impact Survey. We defined immunocompromised as adults with a self-reported diagnosis of "a compromised immune system" (n = 854, 7.6%). We adherence to self-reported COVID-19 preventive behaviors among immunocompromised adults to others using χ2-tests. We focused on continuity of care and estimated determinants of canceling doctor's appointments among the immunocompromised using multivariable Poisson regression to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). We evaluated associations of mental health symptoms with being immunocompromised using multinomial logistic regression and estimated conditional odds ratios (cOR) with 95% CIs. Immunocompromised adults were more likely to adhere to recommended COVID-19 preventive behaviors, including washing or sanitizing hands (96.3% vs. 89.8%, χ2 <0.001), maintaining social distance (91.9% vs. 83.7%, χ2 <0.001), and canceling a doctor's appointment (47.1% vs. 29.7%, χ2 <0.001). Hispanic immunocompromised adults (aPR: 1.47, 95% CI: 1.12-1.92) and immunocompromised women (aPR: 1.25, 95% CI: 1.00-1.56) were more likely to cancel doctor's appointments compared to non-Hispanic White immunocompromised adults and men, respectively. Immunocompromised adults reported higher odds of feeling nervous/anxious/on edge (cOR: 1.89, 95% CI: 1.44-2.51), depressed (cOR: 2.81, 95% CI: 2.17-3.64), lonely (cOR: 2.28, 95% CI: 1.74-2.98), and hopeless (cOR: 2.86, 95% CI: 2.21-3.69) 3-7 days in the last week. Immunocompromised adults were more likely to cancel their doctor's appointments and report COVID19-related mental health symptoms. The continuity of care of immunocompromised adults should be prioritized through alternative interventions, such as telehealth.

Social Support and Mental Health during the COVID19-pandemic among Cancer Survivors: An Analysis of the COVID Impact Survey

Introduction: The COVID-19 pandemic has affected the mental health of adults in the United States (U.S.) due to recommended preventive behaviors such as social distancing. Our objective was to evaluate mental health symptoms and determinants of mental health symptoms among cancer survivors during the COVID-19 pandemic in the U.S. Methods: We used nationally-representative data of 10,760 U.S. adults from the COVID-19 Impact Survey. We defined cancer survivors as a self-reported diagnosis of cancer (n = 854, 7.6%). We estimated the association of mental health symptoms among cancer survivors using multinomial logistic regression and calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). We estimated determinants of experiencing at least one mental health symptom 3–7 times in the last seven days among cancer survivors using Poisson regression models to estimated adjusted prevalence ratios (aPR) and 95% CI. Results: Most cancer survivors were over the age of 60 (65%), NH-White (74%), female (52%), and married or living with a partner (57%). Among cancer survivors who spoke to their neighbors basically every day prior to the start of the COVID-19 pandemic, 62% continued this behavior, and 34% reported to speak to their neighbors only a few times a week in the last month. Among cancer survivors, 16% felt depressed, 14% felt lonely, and 13% felt hopeless about the future in the last seven days. Cancer survivors were more likely to report feeling nervous, anxious or on edge (aOR:1.42, 95% CI: 1.07–1.90), depressed (aOR:1.69, 95% CI: 1.28–2.24), lonely (aOR:1.47, 95% CI: 1.09–1.98), and hopeless (aOR:1.55, 95% CI: 1.14–2.10) 3–7 days per week in the last seven days when compared to adults without cancer. Among cancer survivors, adults aged 30–44 years (aPR: 1.87, 95% CI: 1.18–2.95), females (aPR:1.55, 95% CI: 1.12– 2.13), without a high school degree (aOR: 1.79, 95% CI; 1.05–3.04), and adults with limited social interaction (aPR:1.40, 95% CI: 1.01–1.95) were more likely to experience mental health symptoms 3–7 days/week in the last week. Conclusions: Cancer survivors are experiencing mental health symptoms during the COVID-19 pandemic, particularly young adults, adults without a high school degree, females, and survivors with limited social support.

Prevalence and Risk Factors of COVID-19 Symptoms among U.S. Adults with Allergies

BACKGROUND

This study sought to evaluate COVID-19 associated physical and mental health symptoms among adults with allergies compared to the general U.S. adult population.

METHODS

Data for these analyses were obtained from the publicly available COVID-19 Household Impact Survey, which provides national and regional statistics about physical health, mental health, economic security, and social dynamics among U.S. adults (ages 18 and older). Data from 20-26 April 2020; 4-10 May 2020; and 30 May-8 June 2020 were included. Our primary outcomes for this analysis were physical and mental health symptoms experienced in the last seven days. The primary predictor was participants' self-report of a physician diagnosis of an allergy.

RESULTS/DISCUSSION

This study included 10,760 participants, of whom 44% self-reported having allergies. Adults with allergies were more likely to report physical symptoms compared to adults without allergies including fever (aOR 1.7, 95% CI 1.44-1.99), cough (aOR 1.9, 95% CI 1.60-2.26), shortness of breath (aOR 2.04, 95% CI 1.71-2.43), and loss of taste or sense of smell (aOR 1.9, 95% CI 1.58-2.28). Adults with allergies were more likely to report feeling nervous (cOR 1.34, 95% CI 1.13, 1.60), depressed (cOR 1.32, 95% CI 1.11-1.57), lonely (cOR 1.23, 95% CI 1.04-1.47), hopeless (cOR 1.44, 95% CI 1.21-1.72), or having physical reactions when thinking about COVID-19 pandemic (cOR 2.01, 95% CI 1.44-2.82), compared to those without allergies. During the COVID-19 pandemic, adults with allergies are more likely to report physical and mental health symptoms compared to individuals without allergies. These findings have important implications for diagnostic and treatment challenges for allergy physicians.

Evaluating Mental Health-Related Symptoms Among Cancer Survivors During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey

PURPOSE

The COVID-19 pandemic has affected the mental health of adults in the United States because of recommended preventive behaviors such as physical distancing. Our objective was to evaluate mental health symptoms and identify associated determinants among cancer survivors during the COVID-19 pandemic in the United States.

METHODS

We used nationally representative data of 10,760 US adults from the COVID-19 Impact Survey. We defined cancer survivors as adults with a self-reported diagnosis of cancer (n = 854, 7.6%). We estimated associations of mental health symptoms among cancer survivors using multinomial logistic regression. We estimated determinants of reporting at least one mental health symptom 3-7 times in the 7 days before survey administration among cancer survivors using multivariable Poisson regression.

RESULTS

Cancer survivors were more likely to report feeling nervous, anxious, or on edge (adjusted odds ratio [aOR], 1.42; 95% CI, 1.07 to 1.90); depressed (aOR, 1.57; 95% CI, 1.18 to 2.09); lonely (aOR, 1.42; 95% CI, 1.05 to 1.91); and hopeless (aOR, 1.51; 95% CI, 1.11 to 2.06) 3-7 days per week in the last 7 days when compared with adults without cancer. Among cancer survivors, adults of age 30-44 years (adjusted prevalence ratio [aPR], 1.87; 95% CI, 1.18 to 2.95), females (aPR, 1.55, 95% CI, 1.12 to 2.13), adults without a high school degree (aPR, 1.79; 95% CI, 1.05 to 3.04), and adults with limited social interaction (aPR, 1.40, 95% CI, 1.01 to 1.95) were more likely to report at least one mental health-related symptom in the last 7 days (3-7 days/week).

CONCLUSION

Cancer survivors are reporting mental health symptoms during the COVID-19 pandemic, particularly young adults, adults without a high school degree, women, and survivors with limited social support.

Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey

Background

Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce.

Objective

This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations).

Methods

We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression.

Results

Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19.

Conclusions

Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions.

Comparison of the costs of HPV testing through community health campaigns versus home-based testing in rural Western Kenya: a microcosting study

OBJECTIVES

To estimate the cost of human papillomavirus (HPV)-based screening through community health campaigns (CHCs) and home-based testing.

SETTING

CHCs and home-based testing in six communities in rural Western Kenya.

PARTICIPANTS

CHCs and home-based screening reached 2297 and 1002 women aged 25-65 years, respectively.

OUTCOME MEASURES

Outcome measures were overall cost per woman screened achieved through the CHCs and home-based testing and the cost per woman for each activity comprising the screening intervention.

RESULTS

The mean cost per woman screened through CHCs and home-based testing were similar, at $37.7 (range $26.4-$52.0) and $37.1 (range $27.6-$54.0), respectively. For CHCs, personnel represented 49% of overall cost, supplies 25%, services 5% and capital goods 23%. For home-based testing, these were: personnel 73%, supplies 25%, services 1% and capital goods 2%. A greater number of participants was associated with a lower cost per participant.

CONCLUSIONS

The mean cost per woman screened is comparable for CHC and home-based testing, with differences in type of input. The CHCs generally reached more eligible women in the six communities, whereas home-based strategies more efficiently reached populations with low screening rates.

TRIAL REGISTRATION NUMBER

NCT02124252.

Sex differences in prevalence and determinants of hypertension among adults: a cross-sectional survey of one rural village in Bangladesh

OBJECTIVE

Prevention of mortality due to cardiovascular disease (CVD) through control of hypertension is a public health priority in Bangladesh. Our objective was to assess sex differences in prevalence and determinants of hypertension among adults in one rural area of Bangladesh.

STUDY DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

From January 2014 to December 2015, we conducted a cross-sectional study of 2600 men and women aged ≥18 years located in one rural district of Bangladesh. We collected data on demographics, behavioural factors, physical measurements and health history.

PRIMARY OUTCOME MEASURES

Our primary outcome was hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mm Hg).

RESULTS

The average age of participants was 41.6 years and 53.7% were women. Hypertension prevalence was 6.9% (95% CI 5.9 to 7.9), and was significantly higher among women (8.9%) than men (4.5%). The highest prevalence of hypertension was observed among women aged ≥60 years at 21.3% (95% CI 16.6 to 26.7). A higher proportion of men with hypertension were aware of their condition (72.2%) compared with women (52.4%). Determinants of hypertension included older age, higher education, current tobacco use, increasing body mass index, and hyperglycaemia.

CONCLUSION

Our research suggests that hypertension prevalence is higher among women than men in rural Bangladesh. Sex-specific interventions should be developed to inform adults of the necessary lifestyle changes that may reduce the risk of hypertension and subsequent CVDs.

Overcoming barriers to adolescent vaccination: perspectives from vaccine providers in North Carolina

To capture strategies for achieving high adolescent coverage of tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccination, we surveyed employees of 20 North Carolina (N.C.) clinics that achieved adolescent vaccination coverage higher than the state average. One employee per clinic completed a surveysummarizing clinic practices regarding adolescent vaccination; perceived barriers and facilitators to Tdap/MenACWY/HPV vaccination; and the role of "champions" who made special efforts to promote adolescent vaccination. Common perceived barriers for all vaccinations were parental opposition and logistical barriers to receiving vaccination. For HPV vaccination, employees cited parental concerns about sexual behavior and injection site pain; no school vaccination requirement; and low-perceived benefit in boys. Most clinics (80%) implemented successful changes to increase adolescent vaccination: consistently offering vaccination, tracking vaccination status using existing data, providing appointment reminders, updating providers on vaccination recommendations, and expanding vaccination hours. Strategies to improve HPV vaccination included co-administration with Tdap and MenACWY, and providing reminders to complete the vaccination series. Vaccine champions strongly recommended vaccination to parents (55%) and educated parents on vaccination recommendations (36%). Clinics in N.C.and similar settings can implement these and other low-resource strategies to overcome adolescent vaccination barriers.

ABBREVIATIONS

CDC=Centers for Disease Control and Prevention; EHR=Electronic health record; HPV=Human papillomavirus; Tdap=Tetanus-diphtheria-acellular pertussis vaccine; MenACWY=Meningococcal Conjugate Vaccine; NCIB=North Carolina Immunization Branch; NCIR=North Carolina Immunization Registry; ACIP=Advisory Committee on Immunization Practices.

Estimation of total cardiovascular risk using the 2019 WHO CVD prediction charts and comparison of population-level costs based on alternative drug therapy guidelines: a population-based study of adults in Bangladesh

OBJECTIVE

The objective of this study was to estimate the population distribution of 10-year cardiovascular disease (CVD) risk among Bangladeshi adults aged 40 years and above, using the 2019 WHO CVD risk prediction charts. Additionally, we compared the cost of CVD pharmacological treatment based on the total CVD risk (thresholds ≥30%/≥20%) and the single risk factor (hypertension) cut-off levels in the Bangladeshi context.

STUDY DESIGN

Cross-sectional, population-based study.

SETTING AND PARTICIPANTS

From 2013 to 2014, we collected data from a nationally representative cross-sectional survey of adults aged ≥40 years from urban and rural areas of Bangladesh (n=6189). We estimated CVD risk using the 2019 WHO CVD risk prediction charts and categorised as very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high risk (≥30%). We estimated drug therapy costs using the lowest price of each drug class available (aspirin, thiazide diuretics, statins and ACE inhibitors). We compared the total cost of drug therapy using the total CVD risk versus single risk factor approach.

PRIMARY OUTCOME MEASURES

Our primary outcome was 10-year CVD risk categorised as very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high risk (≥30%).

RESULTS

The majority of adults (85.2%, 95% CI 84.3 to 86.1) have a 10-year CVD risk of less than 10%. The proportion of adults with a 10-year CVD risk of ≥20% was 0.51%. Only one adult was categorised with a 10-year CVD risk of ≥30%. Among adults with CVD risk groups of very low, low and moderate, 17.4%, 27.9% and 41.4% had hypertension (blood pressure (BP) ≥140/90) and 0.1%, 1.7% and 2.9% had severe hypertension (BP ≥160/100), respectively. Using the total CVD risk approach would reduce drug costs per million populations to US$144 540 (risk of ≥20%).

CONCLUSION

To reduce healthcare expenditure for the prevention and treatment of CVD, a total risk approach using the 2019 WHO CVD risk prediction charts may lead to cost savings.

Prevalence and determinants of hyperglycaemia among adults in Bangladesh: results from a population-based national survey

OBJECTIVES

With the increasing burden of non-communicable diseases in low-income and middle-income countries, biological risk factors, such as hyperglycaemia, are a major public health concern in Bangladesh. Hyperglycaemia is an excess of glucose in the bloodstream and is often associated with type 2 diabetes mellitus. Nationally representative data of hyperglycaemia prevalence starting from age ≥18 years are currently unavailable for Bangladeshi adults. The objective of this study was to assess the prevalence and determinants of hyperglycaemia among adults in Bangladesh aged ≥18 years.

STUDY DESIGN

Cross-sectional, population-based study.

SETTING AND PARTICIPANTS

Data for this analysis were collected in November to December 2015, from a population-based nationally representative sample of 1843 adults, aged ≥18 years, from both urban and rural areas of Bangladesh. Demographic information, capillary blood glucose, blood pressure, height, weight, waist circumference and treatment history were recorded.

PRIMARY OUTCOME MEASURES

Hyperglycaemia was defined as a random capillary blood glucose level of ≥11.1 mmol/L (ie, in the diabetic range) or currently taking medication to control type 2 diabetes, based on self-report.

RESULTS

Overall, the prevalence of hyperglycaemia was 5.5% (95% CI 4.5% to 6.6%) and was significantly higher among urban (9.8%, 95% CI 7.7% to 12.2%) than rural residents (2.8%, 95% CI 1.9% to 3.9%). The age-standardised prevalence of hyperglycaemia was 5.6% (95% CI 4.6% to 6.8%). Among both urban and rural residents, the associated determinants of hyperglycaemia included hypertension and abdominal obesity. About 5% of the total population self-reported have been previously diagnosed with type 2 diabetes; among these adults, over 25% were not taking medications to control their diabetes.

CONCLUSIONS

Our study found that about 1 in 20 Bangladeshi adults aged ≥18 years have hyperglycaemia. To control and prevent the development of type 2 diabetes, data from this study can be used to inform public health programming and provide descriptive information on surveillance of progress towards controlling diabetes in Bangladesh.

Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries

PURPOSE

The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.

METHODS

Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9-14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers' attitudes towards a 2-dose schedule were assessed through focus group discussions.

RESULTS

Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.

CONCLUSIONS

Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.

Alcohol consumption among adults in Bangladesh: Results from STEPS 2010

Background Alcohol use is a risk factor for the development of noncommunicable diseases. National data are needed to assess the prevalence of alcohol use in the Bangladeshi population. The objective of this study was to describe the prevalence and patterns of alcohol use among men and women of rural and urban areas of Bangladesh. Additionally, predictors of ever alcohol use were also identified. Methods A nationally representative cross-sectional survey (STEPS 2010) was conducted on 9275 adults between November 2009 and April 2010. Participants were selected using multi-stage random cluster sampling. Data on several risk factors for noncommunicable diseases, including alcohol use, were collected by an interviewer-administered questionnaire. Results Among the total population, 5.6% (n = 519) reported to have ever drunk alcohol and 94.4% (8756) were lifetime abstainers; 2.0% (n = 190) of participants reported to have drunk alcohol within the last 12 months. Of these, 94.7% (n = 180) were men. Only 0.9% (n = 87) of the total population had drunk alcohol within the last 30 days and were categorized as current drinkers. Among current drinkers, 77.0% (n = 67) were defined as binge drinkers, having had at least one episode of heavy drinking in this time period; 92.0% (n = 80) were current smokers and 59.8% (n = 52) had either no formal education or less than primary school education. Ever alcohol use was more common among men, those who live in urban areas and smokers. Conclusion Alcohol use is low in Bangladesh; however, those who do use alcohol frequently binge drink, which is a public health concern. Targeted efforts should be made on these specific groups, to control and prevent the continued use of alcohol in Bangladesh.

Knowledge and Acceptance of Human Papillomavirus Vaccine for Cervical Cancer Prevention Among Urban Professional Women in Bangladesh: A Mixed Method Study

Prophylactic human papillomavirus (HPV) vaccination is the most effective preventive method against invasive cervical cancer, the second leading cause of cancer-related deaths among women in Bangladesh. Evidence on women's knowledge and perception about cervical cancer and HPV vaccination are needed for effective implementation of national cervical cancer prevention programs. The objective of this study was to assess the knowledge, attitude, and acceptance of cervical cancer, HPV, and HPV vaccination among urban professional women in Bangladesh. We recruited 160 female professionals employed at selected private banks in Bangladesh. Participants were selected using nonprobability-based convenience sampling for interviews through a self-administered questionnaire. Later, in-depth interviews were conducted with nine of these women. Quantitative data were analyzed utilizing descriptive statistics, whereas qualitative data were analyzed using a thematic approach. Ninety-eight percent of participants reported that they had previously heard of cervical cancer, however, only half (51%) reported to have heard of HPV as a cause of the disease. Less than 1% of the 160 participants had previously undergone a pap smear, and only 2% were vaccinated with at least one dose of HPV vaccination. Although knowledge was low, intention for acceptance of vaccination was moderate for women and high for their children. Although the majority of women had heard of cervical cancer, few women had in-depth knowledge of HPV and the etiology of invasive disease. This study draws attention to the urgent need of educational interventions on cervical cancer and its prevention to improve uptake of available HPV vaccination in Bangladesh.

Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: a population based, cross-sectional study

BACKGROUND

The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine.

METHODS

A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine.

RESULTS

The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35-44 years (aOR: 2.92 (1.34-6.33) and rural women aged 25-34 years (aOR: 2.90 (1.24-6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67-7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61-5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28-3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high.

CONCLUSIONS

Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on cervical cancer must include information on symptoms, risk factors, and preventive methods. Despite poor knowledge, the study population was willing to receive the HPV vaccine.

Prevalence, treatment patterns, and risk factors of hypertension and pre-hypertension among Bangladeshi adults

In Bangladesh, morbidity and mortality due to non-communicable diseases (NCDs) has increased over the last few decades. Hypertension is an important risk factor for NCDs, specifically cardiovascular disease. The objective of this study was to assess prevalence and risk factors for hypertension and prehypertension among adults in Bangladesh. Data for this analysis were collected during the national NCD Risk Factor Survey of Bangladesh conducted in 2010 from a representative sample of men and women, aged 25 years or above. The survey adopted a multistage, geographically clustered, probability-based sampling approach. WHO STEPS questionnaire was used to collect data on demographics, behavioral risk factors, and physical measurements. Overall, 20% of the study population were hypertensive at study measurement. The prevalence of hypertension increased with age and body mass index(BMI). Twelve percent of the population were previously diagnosed with hypertension. Among these individuals, nearly half were not taking any medications to control their hypertension. Additionally, the prevalence of pre-hypertension was 43%, with higher levels among males, older age groups, and those with higher education, higher wealth index and high BMI. Predictors of hypertension, included older age, high BMI and diabetes comorbidity. Based on this study, we estimate that 1 out of 5 Bangladeshi adults have hypertension. The risk of hypertension increases with older age and high BMI. Additionally, prevalence of pre-hypertension is high in Bangladesh in both rural and urban areas. Findings from this study can be used to inform public health programming to control the spread of NCDs in Bangladesh.