bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P242: Accuracy of a Self-Report Screening Tool for Identifying Pregnant People With High Sedentary Behavior
Authors: Barone Gibbs Bethany , Kozai Andrea , McAdoo Shannon , Paley Joshua , Hauspurg Alisse , Davis Keliann , Catov Janet M
Published: March 2023

Introduction:
High levels of sedentary behavior (SB) are emerging as a distinct risk factor in pregnancy for poor maternal-fetal health outcomes. Thigh-worn accelerometry is ideal for quantifying SB but has high cost and participant burden; simple screening questions that could quickly identify those with high SB in clinical or research settings are desirable. We aimed to evaluate the accuracy of self-report screening questions for identifying pregnant participants with high SB.

Methods:
This secondary analysis used baseline data from the
S
edentary Behavior Reduction in
Pr
egnancy
In
tervention (SPRING) feasibility trial. During eligibility screening, participants in their first trimester met at least one of four study-developed, self-reported criteria that put them at risk for high SB: 1) mostly sitting job ≥ 30 h/week; 2) mostly sitting job <30 h/week and reporting sitting ≥ ½ of non-work time; 3) did not work but reported sitting ≥ ¾ of time; and 4) <6,000 steps/d from a wearable device. Eligible participants then underwent baseline SB assessment using a thigh-worn accelerometer (activPAL3, 7 d x 24 h). The proportion of participants meeting evidence-based definitions for high SB were calculated for each criterion. Definitions of high SB included: SB > 10 h/d (+10h), SB > 66.7% of waking time (+66.7%), and < 6,000 steps per day (low steps).

Results:
Participants (n=51) enrolled in the study with mean (SD) age=32 (4) years, 82% White, and 84% with a college degree or greater. Of these, n=50 had valid objective SB data at baseline. On average, participants met high SB definitions with mean (SD) SB of 10.5 (1.5) hours per day, 77% (11%) of waking time in SB, and with 5,646 (2,954) steps per day. Among those with a mostly sitting job ≥ 30 h/week (n=33), 66% were above the +10h definition, 71% met the +66.7% definition, and 57% met the low steps definition. For participants with a mostly sitting but <30 h/week job (n=7) and high sitting otherwise, 57% met the +10h definition, 100% met the +66.7% definition, and 71% met the low steps definition. Participants who did not work and reported ¾ time in SB (n=5) met each definition 80% of the time. Participants who reported <6000 steps per day from a wearable (n=3) met all definitions 66.7% of the time. Those below the +10h SB threshold had mean (range) SB of 8.7 (7.5 to 9.4) h/d, those below the +67% SB threshold were sedentary 57.9% (51.1% to 61.3%) of the time, and those above the low steps threshold had 9,478 (6023 to 14,751) steps per day.

Conclusions:
Screening questions mostly identified participants who were highly sedentary, though approximately one in three did not meet thresholds for objectively-measured high SB. Future research refining screening questions is needed to improve the accuracy of identifying pregnant people with high SB by self-report, who may be at higher risk of adverse pregnancy outcomes.
Abstract P243: Perceived Barriers and Facilitators to Healthy Eating in Pregnant People With Hypertension or at Risk for Hypertensive Disorders of Pregnancy
Authors: Shankara Sravya , Nagarkar Akanksha , Sibai Diana , Wilkie Gianna , Lemon Stephenie C , Kovell Lara
Published: March 2023

Introduction:
Heart-healthy diets are important in preventing hypertension (HTN) and hypertensive disorders of pregnancy (HDP), leading causes of preventable maternal mortality. However, perspectives of pregnant people with these conditions on barriers and facilitators of healthy eating are not well established. This study explored these experiences through qualitative feedback.

Hypothesis:
There are pregnancy-specific barriers and facilitators impacting healthy eating in people with HTN or at risk for HDP.

Methods:
Pregnant people with HTN or at risk for HDP were recruited from a large academic medical center for an electronic survey assessing barriers and facilitators to healthy eating. Participants answered open-ended questions about barriers to healthy diets and agents for change. Qualitative responses were analyzed using thematic analysis.

Results:
Of 46 participants (mean age 31.6 (SD 5.5) years, 35.1% Hispanic), 71.7% (33) responded to the question about barriers to healthy eating, with 56.5% (26) reporting specific barriers and 15.2% (7) reporting no barriers. Major themes for barriers included: (1) lack of education on what is “healthy;” (2) intrinsic factors (i.e., motivation, portion control, food cravings, and food aversions); (3) lack of access due to social determinants (i.e., time, finance, housing, culture and social factors); and (4) current health problems. Furthermore, 67.4% described facilitators to support healthy eating (
Table
), with themes of (1) external support, (2) discipline/routine; (3) increased affordability; and (4) menu/grocery guidance.

Conclusion:
Given lack of access and food preferences were common barriers to healthy eating, pregnant people with HTN or those at risk for HDP may benefit from food insecurity screening and individualized guidance from healthcare professionals. With personalized meal plans, specific recipes, and ingredient lists attainable in terms of cost, time, and social/cultural factors, these patients may be better supported for healthy eating.
Abstract P244: Gestational Glucose Intolerance is Associated With Hypertensive Disorders of Pregnancy in a Large Hospital-Based Multiethnic Cohort
Authors: Maya Jacqueline , James Kaitlyn , Hsu Sarah , Thaweethai Tanayott , Hivert Marie-France , Powe Camille E
Published: March 2023

Introduction:
Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated.

Hypothesis:
We tested the hypothesis that GGI pregnancies have increased odds of HDP.

Methods:
This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test < 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE).

Results:
A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1).

Conclusions:
The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.
Abstract P245: Early Pregnancy Exposure to Per- And Polyfluoroalkyl Substances and Thyroid Function Throughout Gestation: A Longitudinal Study
Authors: Birukov Anna , Lu Ruijin , Yu Guoqi , Qiao Yan , Rahman Mohammad , Sun Qi , Ma Ronald C , Chen Zhen , Hu Frank B , Zhang Cuilin
Published: March 2023

Introduction:
Thyroid function during pregnancy is pivotal for both maternal and fetal health. Data on environmental determinants of thyroid function in pregnancy are yet limited. We prospectively investigated associations of early pregnancy per- and polyfluoroalkyl substances (PFAS), known environmental endocrine disruptors, with thyroid function longitudinally measured throughout pregnancy.

Hypothesis:
Early pregnancy PFAS exposure adversely affects thyroid function.

Methods:
Within the NICHD Fetal Growth Studies-Singleton Cohort, we enrolled 2,802 pregnant women at gestational weeks (gw) 10-14 and measured concentrations of 9 PFAS (NMeFOSAA, PFDA, PFDoDA, PFDS, PFHpA, PFHxS, PFNA, PFOA, PFOS, PFOSA, PFUnDA) in plasma samples collected at enrollment. In a subsample of 321 pregnant women, we determined thyroid markers (fT3, fT4, TSH) at gw 10-14, 15-26, 23-31, 33-39. Associations were assessed with multivariable regressions per standard deviation increase in ln-transformed PFAS (ng/ml), adjusting for age, body mass index, diet, lifestyle and socio-economic factors, and plasma lipids.

Results:
Plasma PFAS in early pregnancy were associated with markers of thyroid function throughout pregnancy. The associations varied by gestational age. Higher levels of several PFAS were associated with lower TSH and higher fT3 and fT4 levels at gw 10-14. Adjusted beta coefficients [95%CI] with TSH (mIU/L) were: -1.13 [-2.30, 0.05] for PFOS, -3.15 [-4.45, -1.86] for PFDA, -1.75 [-2.95, -0.55] for NMeFOSAA, -1.68 [-3.00, -0.37] for PFNA, -1.29 [-2.62, 0.03] for PFDoDA, -2.07 [-3.30, -0.83] for PFOA, but 1.11 [0.12, 2.09] for PFHxS. Most of these associations were attenuated to non-significant or changed the direction of the association in later pregnancy (for instance, PFOS-TSH association at gw 10-14: -1.13 [-2.30, 0.05], gw 15-26: 0.98 [0.18, 1.78], gw 23-31: 1.31 [0.50, 2.13], PFDA-TSH association at gw 10-14: -3.15 [-4.45, -1.86], at gw 23-31: 1.13 [0.16, 2.11]). Consistent and positive associations across pregnancy were observed for PFOA-fT3 (at gw 10-14: 0.48 [0.05, 0.91], gw 15-26: 0.41 [0.04, 0.78], gw 23-31: 0.42 [0.02, 0.80] pmol/L) and PFHxS-fT4 (at gw 10-14: 0.12 [0.02, 0.21], gw 15-26: 0.67 [0.54, 0.81], gw 23-31: 0.22 [0.12, 0.33], gw 33-39: 0.14 [0.02, 0.26] ng/dL).

Conclusions:
Plasma levels of selected PFAS congeners in early pregnancy are significantly associated with thyroid markers in pregnancy. The associations varied by gestational timing. These findings indicate a potential environmental impact on thyroid function. In perspective, multiple assessments of PFAS and thyroid markers throughout pregnancy might be necessary and relevant for conducting gestational age-specific interventional trials.
Abstract P247: Factors Associated With the Severity of the Hypertensive Disorders of Pregnancy
Authors: Loop Matthew S , Urrutia Rachel P , Johnson Jasmine D , Price Thomas M , Wang Tracy Y , Daubert Melissa A
Published: March 2023

Objective:
Hypertensive disorders of pregnancy (HDP) are a spectrum of disorders with increasing severity: gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and severe preeclampsia/eclampsia. Although factors associated with developing an HDP have been established, it is unclear which factors are associated with more severe HDP. This study aimed to estimate the associations between clinical, demographic, and social factors and severity of HDP.

Methods:
We conducted a retrospective, cross-sectional study of electronic medical records of women who delivered between 2014 and 2017 at two academic medical centers and were diagnosed with an HDP during pregnancy or up to 6 weeks postpartum. Patients were categorized by highest severity of HDP. We used ordinal logistic regression models to estimate odds ratios (ORs) for the severity of HDP by covariates including demographic data and clinical characteristics.

Results:
Among 5,607 women diagnosed with an HDP, 2,609 (47%) had gestational hypertension, 1,748 (31%) had preeclampsia, 608 (11%) had preeclampsia superimposed on chronic hypertension, and 642 (11%) had severe preeclampsia/eclampsia. Median (Q1, Q3) maternal age was 30 (25, 34) years; 46% (2,588 of 5,607) were white race, 32% (1,811 of 5,607) were black race, and 22% were other race (1,208 of 5,607); 15% (822 of 5,607) were Hispanic/Latina; 13% (735 of 5,607) had gestational diabetes; 42% (2,351 of 5,607) received care at institution A, 44% (2,445 of 5,607) at institution B, and 14% (811 of 5,607) at both; median (Q1, Q3) maternal body mass index near delivery was 35(30, 41) kg/m^2; and median (Q1, Q3) household income of ZIP code of residence was $50,734 ($43,592, $69,380). Factors independently associated with more severe HDP (OR, 95% CI) included: older maternal age (1.15 per 10-year increase, 1.05 - 1.27), Black race (1.48, 1.3 - 1.68) versus white, Hispanic/Latina ethnicity (1.51, 1.22 - 1.88), gestational diabetes (1.35, 1.16 - 1.65), and receiving care at institution A vs B (1.23, 1.1 - 1.38) or both institutions vs institution B (1.32, 1.13 - 1.54). Maternal body mass index near delivery (0.98 per 10 kg/m^2 increase, 0.92 - 1.05) was not meaningfully associated with more severe HDP.

Conclusions:
Several factors were associated with more severe HDP. Importantly, these factors may help identify women who are at a higher risk for developing a more severe form of HDP. Further study is needed to confirm these findings and determine interventions that can mitigate risk to improve women’s cardiovascular health.
Abstract P251: Using Art to Mitigate Psychosocial Stress and Blood Pressure Among Black Women: A Pilot Trial
Authors: Hines Anika L , Weiderhold Allison , Collins Sarah , Brewer LaPrincess C , Larose Jessica , Cooper Lisa A
Published: March 2023

Background:
Black women demonstrate higher levels of stress over the life course compared to Black men, White men, and White women, which may help to explain their higher cardiovascular disease (CVD) morbidity and mortality. Despite implications for primary and secondary CVD prevention and racial disparities, few interventions have targeted psychosocial stress to improve blood pressure (BP) levels among Black women.

Objective:
To test whether a theory-driven, culturally tailored, community intervention focused on the stress experiences of Black women improves psychological outcomes and BP levels.

Methods:
The “Art for Hearts” pilot trial sought to examine the feasibility, acceptability, and preliminary efficacy of a novel intervention encouraging creative self-expression. This individual level, single-arm pilot trial recruited self-identified Black women ≥18 years. Women participated in an 8-week program, including 4 art sessions with a community artist (a self-identified Black woman) accompanied by a moderated focus group discussion and 4 heart health education sessions (facilitated by a Black woman researcher) on home BP monitoring, stress management techniques, diet/physical activity, and patient-clinician communication. All sessions were conducted in-person in a community space. Participants completed a survey including self-rated stress (scale of 0 to 7), perceived stress (PSS-10), depressive symptoms (PHQ-8), and anxiety symptoms (GAD-7) at baseline and 8 weeks. BP was measured by a trained assessor at baseline and 8 weeks as well as before and after each session. We examined within-participant changes in psychological measures as well as mean systolic and diastolic BP from baseline to 8 weeks.

Results:
The study included 18 Black women with a mean age of 44.1 (SD=15.4) years. Women were highly educated (36.8% with a graduate/professional degree) and 11.1% earned an income of ≥$100,000. Mean systolic BP was 114 mmHg and mean diastolic BP was 66 mmHg at baseline. From baseline to 8 weeks, self-rated stress level decreased by 1-point (from 4.36 to 3.18; p=0.005) (scale range: 0 -7). Perceived stress (-1.08; p=0.58) and anxiety (-1.33; p=0.09) decreased from baseline to 8 weeks; however, these changes did not achieve statistical significance. Depressive symptoms significantly improved from baseline to 8 weeks (19.13 to 13.38; p=0.044). There were no differences in systolic or diastolic BP from baseline to follow-up. The intervention was deemed feasible and acceptable with an attendance rate of >80%; participants expressed high overall satisfaction with the intervention.

Conclusion:
A tailored 8-week pilot intervention using painting self-expression demonstrated feasibility, acceptability, and preliminary efficacy for improving self-rated stress and depressive symptoms. No effects were demonstrated on BP in this sample.
Abstract P258: Global Stress and Masked Hypertension in African-Americans: The Jackson Heart Study
Authors: Miles Miriam A , Akinyelure Oluwasegun P , Sakhuja Swati , Hardy Shakia T , Jaeger Byron C , Spruill Tanya M , Shimbo Daichi , Mizuno Hiroyuki , Sims Mario , Jones Lenette M , Muntner Paul
Published: March 2023

Background:
Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting.

Methods:
We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP < 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use.

Results:
Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score > 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table).

Conclusion:
No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.
Abstract P260: The Association of Changes in Area Deprivation Index With Cardiometabolic Risk Factors: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Clarke Erika , Aryee Ebenezer K , Zhang Sui , Carroll Perri , Palta Priya , Matsushita Kunihiro , Coresh Josef , Cooper Lisa A , Mathews Lena M , Ndumele Chiadi E
Published: March 2023

Introduction:
Higher Area Deprivation Index (ADI) is associated with greater cardiometabolic risk. The impact of changes in ADI on the likelihood of cardiometabolic risk factors is currently unknown.

Methods:
Among 12,044 White and Black participants at ARIC Visit 1 (1987-89), we examined the association of cross-categories of ADI quartiles at Visit 1 and at the last visit attended up to Visit 4 (1996-98) with cardiometabolic risk factors at the time of the second ADI measurement. Cross-categories were grouped as stable low ADI (remaining in ADI quartile 1 or 2), increasing ADI (moving from ADI quartile 1 or 2 at Visit 1 to quartile 3 or 4 at follow-up), decreasing ADI (moving from ADI quartile 3 or 4 at Visit 1 to quartile 1 or 2 at follow-up) or stable high ADI (remaining in ADI quartile 3 or 4).We assessed the prevalence of hypertension, diabetes, and obesity in each group at the follow-up time point and used logistic regression to evaluate associations of changes in ADI over the 9-year period with the odds of cardiometabolic risk factors.

Results:
The study population had a mean age of 63 years, with 55% female and 22% Black adults. Persons with decreasing ADI had a lower prevalence of hypertension, diabetes and obesity at follow-up than those with stable high ADI, while those with increasing ADI had a higher prevalence of hypertension and obesity at follow-up than those with stable low ADI (Figure). In regression models adjusted for age and sex, decreasing ADI was linked to lower odds of hypertension, diabetes and obesity compared to stable high ADI (Table), with stronger associations for hypertension among Black adults (p interaction = 0.03). Increasing ADI was linked to modestly increased odds of obesity compared to stable low ADI. Associations were attenuated after adjustment for lifestyle measures, comorbidities and other social determinants.

Conclusion:
ADI changes are associated with the prevalence of cardiometabolic risk factors. Interventional studies should assess the cardiometabolic impact of targeting the built environment.
Abstract P265: Do Social Determinants of Health for Children’s Cardiometabolic Health Differ by Family Structure Type?
Authors: Song Minkyoung , Musil Carol C , Hayman Laura L
Published: March 2023

Introduction:
Social determinants of health (SDoH) impact cardiometabolic health, and certain SDoH that critically influence cardiometabolic health, such as adverse childhood experiences (ACEs), differ by family structure type. In particular, children living in grandparent-headed households experience a higher number of ACEs, on average, than children living in parent-headed households. Yet, there is limited understanding of whether/how SDoH might impact cardiometabolic health risk in children by family structure type.

Purpose:
We assessed selected SDoH factors known to influence children’s cardiometabolic health risk, stratified by family structure type (two-parent, single-parent, and grandparent-headed households).

Methods:
Utilizing data from the 2019-2020 National Survey of Children’s Health, we evaluated 9 SDoH (race/ethnicity, ACEs, health insurance status, received medical care for health conditions, received preventive check-ups, received food/cash assistance, food insufficiency, school engagement, and living in a safe neighborhood). All these factors were compared by family structure type by using a second-order Rao and Scott X
2
tests.

Results:
Among children aged 6-17 years (n=48,901), we found all 9 SDoH significantly differed by family structure type at p<0.05. Results for each SDoH were as follows, with proportions shown for two-parent, single-parent, and grandparent-headed households, respectively, for each SDoH. Racial/ethnic minorities: 44%, 63%, and 59%; children experiencing ≥ 2 ACEs: 13.3%, 44.2%, and 54.1%; proportion uninsured: 6.3%, 8.3%, and 8.5%; proportion received medical care during past 12 months: 84.1%, 78.3%, and 78.4%; proportion received preventive check-ups during past 12 months; 80.1%, 72.5%, and 74.3%; proportion with food insufficiency: 26.2%, 45.1%, and 38.4%; proportion receiving food/cash assistance: 32.2%, 61.2%, and 73.1%; proportion with children “engaged in school”: 85.8%, 77.3%, and 79.4%; proportion living in unsafe neighborhoods: 4.3%, 8.8%, and 5.4%.

Conclusions:
Our findings show children living in grandparent-headed and single-headed households are more adversely affected by these cardiometabolic health-related SDoH than those living in two-parent households, and thus may be populations at particularly high risk for poor cardiometabolic health. Further investigations are needed to help identify modifiable factors that may influence the associations among family structure type, SDoH, and cardiometabolic health risk in children.
Abstract P266: Complex Patterns of Early Life Adversity Vary by Gender: Associations With Cardiometabolic Health and Pre-Heart Failure Among Hispanics/Latinos in the Midlife
Authors: April-Sanders Ayana K , Gallo Linda , Lee Un Jung , Hurwitz Barry E , Daviglus Martha L , Talavera Gregory A , Shook-Sa Bonnie , Isasi Carmen R , Rodriguez Carlos J
Published: March 2023

Background:
Early life adversities (ELA) are known risk factors for cardiovascular disease, but less understood is how distinct configurations of ELA impart differential risks for cardiometabolic health and heart failure (HF) in adulthood.

Objective:
To determine distinct profiles of ELA and assess whether there are associations between the resultant profiles and multiple indicators of cardiometabolic disease and pre-HF among Hispanic/Latino adults.

Methods:
Data from the Hispanic Community Health Study/Study of Latinos SCAS and ECHO-SOL (N=1143, mean age 55.9±0.4 years, 58.2% female) were used. Latent class analysis was used to identify the optimal number of classes characterizing ELA co-occurrence overall and by gender. Prevalent pre-HF was defined as systolic dysfunction (left ventricular (LF) ejection fraction <50%/ global longitudinal strain >15%) or diastolic dysfunction (≥ Grade 1) or LV remodeling (LV mass index >115 for males, >95 for females/ relative wall thickness >0.42). Weighted multivariable logit models were used to examine associations.

Results:
The best fitting latent classes and characterization are shown in Figure 1. By gender, ELA profiles were associated with cardiometabolic factors. E.g., females with high adversity had greater odds of obesity than those with a low adversity (OR=2.27, 95% CI: 1.39 - 3.72). Alternatively, males experiencing household dysfunction had lower odds of high cholesterol than those with low adversity (OR=0.39, 95% CI: 0.19 - 0.80). Associations were not explained by age, childhood economic hardship, nativity, and Hispanic/Latino background. ELA profiles were not associated with pre-HF (e.g., high adversity OR=0.60, household dysfunction OR=0.75; all p>0.05).

Conclusions:
Distinct patterns of ELA among Hispanic/Latino adults vary by gender; females experience more complex and varied patterns of adversity. Exposure to specific patterns of ELA were associated with several cardiometabolic outcomes, but no associations were found with any measures of pre-HF.
Abstract P267: Examining the Relationship Between Historic Redlining and Contemporary Coronary Heart Disease Prevalence
Authors: Andrews Marcus R , Powell-Wiley Tiffany M
Published: March 2023

Background:
Coronary heart disease (CHD) is the leading cause of death in the United States (US). Evidence supports adverse neighborhood conditions as a contributor to CHD. However, the impact of discriminatory housing practices, including historic redlining, on CHD across US cities remains understudied.

Methods:
Data on CHD for US cities were downloaded from the 500 Cities Project. We merged this data with census tract historic redlining data from the Mapping Inequality Project and census tract level demographic data from the American Community Survey. We used linear regressions to examine relationships between historic redlining scores and CHD adjusting for census tract level covariates.

Results:
12 cities from the US were included in the analyses. After controlling for covariates, these relationships' strength and significance varied by city and region. In the Northeast/Mid-Atlantic region (Boston, Baltimore, and New York), increases in redlining scores were associated with increases in the proportion of people with CHD (Table). In the Midwest, increases in redlining scores were associated with increases in the proportion of people with CHD in Detroit and Cleveland; this relationship was significant in Detroit and marginally significant in Cleveland. There were no significant associations in Chicago. In the South, census tracts with higher redlining scores were associated with higher CHD prevalence in Miami. Paradoxical relationships were seen in Atlanta where higher redlining scores were associated with a lower proportion of people with CHD; there were no significant associations in Dallas. In the West, increases in redlining scores were associated with increases in the proportion of people with CHD in Los Angeles; relationships were not statistically significant in San Francisco or Seattle.

Discussion:
This is one of the first studies to suggest differential impact of historic redlining on CHD across US cities. Additional research is needed to examine potential mechanisms that explain these associations.
Abstract P268: The Impact of Social Determinants of Health on Treatment Adherence in Heart Failure Patients: A Narrative Review
Authors: Burrows William B , Leigh Mary E , Duncan Meredith S , Kucharska-Newton Anna
Published: March 2023

Introduction:
Although effective treatments have reduced the number of deaths attributable to heart failure, there is a growing burden of sub-optimal disease management. Studies have shown that only ~50% of heart failure patients demonstrate treatment non-adherence. Although several known social determinants of health (SDOH) impact incidence and prevalence of heart failure, the intersection between treatment adherence and SDOH and its effect on heart failure patients remains understudied.

Methods:
This narrative literature review aims to identify the effects of SDOH on treatment adherence in heart failure patients. Keywords and MeSH terms were selected to encapsulate SDOH, heart failure, and treatment adherence. Using those terms, a literature search of all studies published from 2006 through 2022 in English or with an available translation was completed using PubMed, CINAHL, and Web of Science. Of the 61 articles identified we removed 9 duplicates, resulting in 51 original articles. Following title and abstract review, 36 articles were selected for full review, following which 8 were included in the final literature review.

Results:
Seven studies were conducted within the United States, one in Italy, and one in Central and South America. The outcome, treatment adherence, was defined as medication adherence (63% of studies, 5 of 8), self-care index (13%, 1 of 8), participation in cardiac rehabilitation (13%, 1 of 8), and lifestyle changes (13%, 1 of 8). Of the studies reviewed, the most frequently examined SDOH were sex (88%, 7 of 8), income (75%, 6 of 8), and education (50%, 4 of 8). Fewer studies included race/ethnicity (38%, 3 of 8), region (25%, 2 of 8), or social support (13%, 1 of 8). Income, social support, and education were correlated with low treatment adherence. High rates of cardiovascular hospitalizations were observed in those with low adherence. Results surrounding sex were mixed; one study showed female sex as protective on treatment adherence while a second study suggested an adverse effect. No studies examined the association between rurality or access to healthcare with treatment adherence in heart failure.

Conclusion:
Several SDOH impact treatment adherence in heart failure patients. However, studies examining the impact of SDOH outside of sex, income, ethnicity, and studies examining components of heart failure treatment, outside of medication adherence, are lacking. This narrative review highlights the paucity of literature investigating facets of treatment other than medication adherence. Additionally, future research should include more robust and informative measures of SDOH to inform strategies for the management of heart failure.
Abstract P269: Associations Between Neighborhood Socioeconomic Deprivation During Pregnancy and Offspring Early Anthropometric Outcomes
Authors: Neally Sam , Widen Elizabeth , Hoyo Cathrine , Martin Chantel
Published: March 2023

Introduction:
Residing in areas with lower neighborhood socioeconomic position (NSEP) is associated with adverse birth outcomes like small for gestational age and low birthweight. Lower NSEP is also associated with higher weight status and blood pressure in adolescence. However, few studies have assessed NSEP and indicators of cardiometabolic health in early childhood. We examined associations between NSEP during gestation and changes in early childhood weight in a North Carolina (NC) birth cohort.

Hypothesis:
We hypothesized that lower gestational NSEP would associate with rapid infant weight gain and increased odds of having overweight in early childhood.

Methods:
The sample was from the Newborn Epigenetics STudy (NEST) cohort. 2,681 gestational parent-offspring pairs were recruited from prenatal visits at obstetrics care facilities in Durham County, NC and enrolled between 2005-2011. For this study, offspring were assessed at birth (N=1,058), 6 months (N=1,268), 1 year (N=1,268), 2 years (N=1,033), and 3 years (N=1,038). NSEP was measured as Neighborhood Deprivation Index (NDI) tertiles at the 2010 US census block group level in NC using parent residential address at enrollment (high NDI=low NSEP). Offspring anthropometric outcomes included: (1) having vs not having overweight (weight for length or body mass index percentiles ≥85
th
) at each study visit; and (2) having rapid vs non-rapid infant weight gain from birth to 6 months and birth to 1 year. Multilevel logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for the relationship between NDI (ref=low) and weight, adjusting for gestational parent age, race, marital status, and education.

Results:
On average, gestational parents were 28 years old with college degrees (35%), followed by high school or equivalent (22%), and identifying as non-Hispanic (NH) Black (43%), followed by NH White (34%). Prior to covariate adjustment, children residing in neighborhoods with high vs low NDI had greater odds of having overweight at 6 months (OR=1.57, 95% CI=1.10-2.25), 1 year (OR=2.01, 95% CI=1.49-2.71), 2 years (OR=1.78, 95% CI=1.25-2.49), and 3 years (OR=1.35, 95% CI=0.96-1.89) and of experiencing rapid infant weight gain from birth to 6 months (OR=1.03, 95% CI=0.79-1.33) and to 1 year (OR=1.62, 95% CI=1.25-2.09). Associations were attenuated after adjustment, but children residing in neighborhoods with high vs low NDI had greater odds of having overweight at 1 year (OR=1.53, 95% CI=1.09-2.15).

Conclusions:
Low NSEP may associate with higher early childhood weight. This has important implications for later developmental milestones and health outcomes in childhood. Several potential mechanisms could explain this association, including biological programming and limited neighborhood opportunities for movement and healthy eating. Future work exploring these and other mechanisms is warranted.
Abstract P271: Spatiotemporal Trends of Cardiovascular Incidence in U.S. Veterans From 2003-2018
Authors: Polonsky Tamar S , Posner Daniel C , Ho Yuk-Lam , Serra Monica C , Houghton Serena C , Ivey Kerry L , Li Yanping , Gagnon David R , Djousse Luc , Cho Kelly M , Wilson Peter W
Published: March 2023

Introduction:
Cardiovascular disease (CVD) is the leading cause of mortality and disability in the United States. Spatiotemporal modeling of disease incidence may guide prevention efforts toward regions most at risk in the future.

Methods:
We examined spatiotemporal trends in composite CVD events, defined as myocardial infarction, ischemic stroke, atrial fibrillation, heart failure, coronary artery disease, or cardiovascular death, using electronic health records from 9,718,107 U.S. Veterans who used VA healthcare facilities from 2003-2018. Age-standardized annual incidence by state was modeled using the Bernardinelli model, a Bayesian Poisson regression with linear temporal trends for the US and individual states.

Results:
There were 626,271 CVD events over 16 years of follow up and annual incidence fell gradually from 11.5% in 2003 to 6.6% in 2018. Incidence among all US veterans decreased an estimated 3.1% [95% CI: -3.3%, -2.9%] per year (RR
year
= 0.969). State-level incidences also decreased monotonically over the follow-up period (Figure panel
A
), ranging from an absolute decrease 5.0% (RI) to 1.7% (OR). Estimated incidence for the five states most above (RI, FL, NC, MT, LA) and most below (OR, NV, CT, OK, MI) the national trend are plotted against the US average in Figure panel
B
. These outlying states differed significantly from the overall trend (posterior probabilities ≥ 99.7%), and the magnitude of trend was loosely correlated with initial incidence rate (in 2003). Notably, four states crossed the national average over the study period: CT and OK started below average in 2003 but ended above in 2018, whereas RI and NC started with high incidence and ended with below average incidence in 2018.

Conclusions:
Among US veterans, there was significant geographic variation in the rate of decline of incident CVD from 2003-2018. Future research will investigate the mechanisms underpinning the observed trends, particularly prevalence and control of risk factors.
Abstract P272: Spatial and Temporal Trends of Infective Endocarditis Hospitalizations in Kentucky, 2008-2018
Authors: Marji Meera , christian Jay , Browning Steven , Leung Steve W , Charnigo Richard , Kucharska-Newton Anna
Published: March 2023

Background:
Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid abuse epidemic. A North Carolina study showed an increase in intravenous drug use infective endocarditis (IDU-IE) from 0.9 to 10.9/100,000 during 2007-2017. In 2016, Kentucky ranked among the top ten states with the highest opioid-related overdose deaths. Limited data about IE trends are available for Kentucky.

Objective:
To examine county-level spatial and temporal trends in IE rates in Kentucky and identify significant high-rate clusters.

Methods:
We used the Kentucky hospital inpatient discharge data (2008-2018). We included hospitalizations for patients 18 years and older who are Kentucky residents. All IE admissions were identified using ICD-9 and ICD-10 diagnosis codes (421.0, 421.1, 421.9, 424.90, 424.91, 424.99, 112.81, I33.0, I39, I33.9, I38, A3282, and B376). IDU-IE were identified using additional ICD codes for injected illicit drug use. We used US Census data to calculate yearly hospitalization rates of IE /100,000 residents. Joinpoint regression was used to calculate annual percent change (APC). We conducted spatiotemporal cluster analysis at the county level using a Poisson model in SaTScan.

Results:
Throughout the study period, there were 17,787 IE hospital admissions, including 3,577 IDU-IE. Medicaid patients were more often in the IDU-IE group rather than the non-IDU-IE (71% versus 15%). The IDU-IE hospitalization rate increased from 1.2 to 27.3 / 100,000 in 2008 to 2018
(Figure).
From 2013 to 2018, APC for IDU-IE hospitalizations was 71.3, (95% CI: 47.8, 98.5). The spatiotemporal scan statistics identified five statistically significant clusters. The largest cluster occurred during 2015-2018 and included 34 counties out of 120 Kentucky counties, all located in the Appalachian region of Eastern Kentucky (RR= 2.1, p<0.00001).

Conclusion:
Our study showed increased rates of IE hospitalizations due to an increase in IDU-IE, especially in Eastern Kentucky.
Abstract P274: Associations of Occupational Physical Activity With Allostatic Load Among Workers in the United States
Authors: Xia Tong , Li Jian , Chen Liwei
Published: March 2023

Introduction:
Occupational physical activity (OPA) has been linked to adverse cardiovascular outcomes and mortality among workers, but underlying mechanisms are not clear. Allostatic load (AL) presents a measure of the accumulative burden of chronic stress and may play a role in the association of OPA with cardiovascular outcomes. We hypothesized that OPA was positively associated with AL in workers.

Methods:
Analyses were conducted in 6487 United States (U.S.) workers (i.e., working at a job or business) aged 20-60 years who were not pregnant, had data on moderate-to-vigorous OPA and biomarkers for AL calculation using a national representative sample, the National Health and Nutrition Examination Survey (2007-2018). OPA was dichotomized primarily by time spent on moderate-to-vigorous OPA (i.e., high: ≥ 150 vs. low: < 150; min/week) and secondarily by energy spent on it (i.e., high: ≥ median vs. low: < median; kcal/week). AL score was calculated using a common method from 9 biomarkers with a range of 0-9. Associations of OPA with AL were assessed using multivariable linear regression models with sampling weights applied to represent U.S. workers.

Results:
AL score was significantly higher among workers who spent higher time on moderate-to-vigorous OPA (β = 0.11, P = 0.02) or had higher energy on it (β = 0.10, P = 0.05) than their counterparts. When stratified by gender and age, the positive associations of OPA with AL remained significant only among females aged 20-40 years (β = 0.16, P = 0.02 for higher time on moderate-to-vigorous OPA; β = 0.35, P < 0.001 for higher energy on moderate-to-vigorous OPA), but such associations were not observed in other groups (females aged 41-60 years, males aged 20-40 years, and males aged 41-60 years).

Conclusions:
We found that OPA was positively associated with AL among U.S. workers, particularly in young female workers. Our findings are novel and worthy of further studies to confirm the role of OPA in explaining cardiometabolic disorders.
Abstract P275: Mediterranean Dietary Pattern Assessment and Cardiac Health in Firefighters
Authors: Feairheller Deborah L
Published: March 2023

Nutritional epidemiology is faced with the challenge of estimating overall diet quality and adherence, along with how this relates to health outcomes. Several dietary assessment tools exist for the Mediterranean dietary pattern. Additionally, we recently validated a clinical study Mediterranean Diet Scoring System (MDSS). Firefighters are a population that faces additional challenges. The leading cause of mortality in firefighters remains cardiovascular, so improving diet is important. Our prior studies have found that blood pressure (BP) surges that firefighters experience are dependent on call type and occupational activity and that firefighters are interested in learning healthy dietary patterns. The purpose of this pilot study was to compare the PREDIMED study screener, MEDI-Lifestyle score, and MDSS. A secondary purpose was to examine relationships between these scores with health outcomes. 15 firefighters (36.3±9.5 yrs) completed surveys, a health history, and a 6-week Mediterranean diet and tactical training intervention. Physiological testing included BP, BMI, ambulatory BP monitoring during a 12-hr work-shift, and fitness testing. Each firefighter was assigned a wellness coach who provided weekly dietary training, answered questions, and tracked diet and exercise progress throughout. Data was self-reported by firefighters through a clinical study website. Firefighters had elevated BP (128.7±9.4 /77.6±7.0 mmHg), overweight BMI classification (29.9±3.2 m/kg
2
), and low fitness (VO
2
30.1±4.4 ml/kg-min). Firefighters scored low on all scales with MEDI-Lifestyle score of 2.9±1.0 out of 7, a PREDIMED score of 6.3±2.3 out of 14, and overall MDSS of 67.1±16.8 out of 102 possible points. We found direct relationships between the screening tools, but sample size is too small to establish significance. MEDI-Lifestyle (r = -0.44) and MDSS (r = -0.6) were inversely related to depression scores (p<.05). MDSS was inversely related to SBP surge with fire-calls (r = -0.6, p<.05). During the work-shift, firefighters experienced BP levels in the hypertensive range (145.5±14.1 /87.8±15.8 mmHg) and extreme BP surges when alarms sounded (21.6±11.8 /15.2±12.8 mmHg). Firefighters with higher DBP had higher overall ambulatory BP levels (r = 0.7, p<.01), higher BP surges (r=0.6, p<.05), and higher overall occupational BP levels (r = 0.7, p<.01). It seems that multiple screening tools are effective at assessing a Mediterranean dietary pattern. Further research is needed to examine dietary adoption and related health outcomes in firefighters. A full study is needed to better understand the relationship between different Mediterranean diet screeners. Furthermore, it needs to be investigated where the relationship lies with DBP and overall cardiac health in firefighters. Subclinical diastolic dysfunction may exist and if undiagnosed, it could lead to cardiac incidents.
Abstract P301: Diet Quality and Frailty in Israeli Adults 65 Years or Older
Authors: Goshen Abigail , Goldbourt Uri , Benyamini Yael , Shimony Tal , Keinan Boker Lital , Gerber Yariv
Published: March 2023

Background:
Frailty represents a transition state between successful aging and disability. Nutrition may promote successful aging. However, only a few studies explicitly examined the association between overall diet quality and frailty in the oldest old age group.

Methods:
We studied an older adult (65+) cohort that participated in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1, N=1,799). Survivors of T1 were contacted, and from 2017-2019, an extensive interview and a functional assessment were conducted (T2) among 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the healthy eating index (HEI-2015), a measure of diet quality used to assess how well a set of foods aligns with key recommendations. A frailty index (FI) based on accumulation of deficits was developed and comprised 33 variables, including clinical, functional, and cognitive measures. A threshold of ≥ 0.26 was used to define frailty. Frail participants at T1 were excluded from the analysis (n=125). Logistic regression models were constructed to assess the association of HEI-2015 with frailty incidence. Inverse probability weighting was used to minimize attrition bias.

Results:
Among the 479 T2 participants analyzed (mean [SD], age 84 [5] years, 50% women), 225 (46%) were classified as frail. Frail participants were older, less educated, with a lower household income and a higher comorbidity burden at baseline than non-frail subjects. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty [odds ratio, 0.56 (95% CI: (0.35-0.90), for the upper tertile; 0.68, (95% CI: 0.42-1.09), for the middle tertile, compared with the lower tertile (
P
for trend = .005). A spline analysis supported a linear decline in frailty with increasing HEI-2015 scores (Figure).

Conclusion:
In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.