Lifestyle risk score: handling missingness of individual lifestyle components in meta-analysis of gene-by-lifestyle interactions

Recent studies consider lifestyle risk score (LRS), an aggregation of multiple lifestyle exposures, in identifying association of gene-lifestyle interaction with disease traits. However, not all cohorts have data on all lifestyle factors, leading to increased heterogeneity in the environmental exposure in collaborative meta-analyses. We compared and evaluated four approaches (Naive, Safe, Complete and Moderator Approaches) to handle the missingness in LRS-stratified meta-analyses under various scenarios. Compared to "benchmark" results with all lifestyle factors available for all cohorts, the Complete Approach, which included only cohorts with all lifestyle components, was underpowered due to lower sample size, and the Naive Approach, which utilized all available data and ignored the missingness, was slightly inflated. The Safe Approach, which used all data in LRS-exposed group and only included cohorts with all lifestyle factors available in the LRS-unexposed group, and the Moderator Approach, which handled missingness via moderator meta-regression, were both slightly conservative and yielded almost identical p values. We also evaluated the performance of the Safe Approach under different scenarios. We observed that the larger the proportion of cohorts without missingness included, the more accurate the results compared to "benchmark" results. In conclusion, we generally recommend the Safe Approach, a straightforward and non-inflated approach, to handle heterogeneity among cohorts in the LRS based genome-wide interaction meta-analyses.Functional Genomics of Systemic Disorder

Occupational exposure to sharp injuries among medical and dental house officers in Nigeria

Objective: Sharp injuries constitute important occupational exposure in hospital environment, and perhaps the newly graduated medical and dental students, known as House Officers, in the first twelve months of their practice, are the most vulnerable of all health workers. This study was designed to examine the nature and prevalence of occupational injuries among medical and dental house officers and factors associated with reporting these injuries. Materials and Methods: A self-administered questionnaire was used to obtain information on demography, types of exposure, and barriers to official reporting of occupational injuries. One hundred and forty-four medical and dental house officers in 3 government owned hospitals in Edo State, Nigeria participated in the study, between April and May, 2010. Descriptive and multivariable analyses were performed. Results: The overall response rate was 96%. Out of all participants, 69.4% were male; 82.6% were medical house officers. Prevalence of percutaneous injury was 56.9%; where needlestick injury constituted one-third of all injuries. Mean frequency of injury was 1.86±2.24, with medicals having more injuries (p = 0.043). The ward was the most common location for the injury and 14.8% of exposures occurred as a result of lapse in concentration. At least 77.0% did not formally report their injury and perceived low injury risk was the most common reason given (51.67%). Conclusion: This study shows that a substantial number of House Officers are exposed to occupational injuries and that the majority of them does not formally report these. Safer work environment may be achieved by implementing adequate educational programs tailored specifically to house officers, and policies encouraging exposure reporting should be developed

Statewide variability in predictors of survival among geographically and racially diverse breast cancer cohorts

Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free breast cancer screening, case management, patient navigation, and connection to treatment for medically underserved and economically-disadvantaged women aged 40-64 years. The aim of this study was to identify differences in predictors of survival between all women diagnosed with breast cancer in South Carolina versus those enrolled in the SC NBCCEDP. Methods: We established a retrospective cohort of breast cancer patients diagnosed from 2004 to 2015 using the South Carolina Central Cancer Registry. Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center\u27s Social Deprivation Index (SDI) and the Health Provider Shortage Area (HPSA) designation. Potential exposure variables (e.g., SDI, hormone receptor status, age, HER2 receptor status, time to first treatment, region, insurance status, cancer stage, year of diagnosis, rurality, NBCCEDP enrollment, race, marital status, cancer grade, HPSA designation) were entered into a Cox proportional hazard model to identify significant predictors of survival. The multivariable model utilized a backward elimination process to obtain the best fitting model at a pvalue \u3c0.05 for each cohort of survivors (NBCCDP participants and all other breast cancer survivors). Results: A total of 34,518 breast cancer patients were diagnosed during this time out of which 873 (2.5 %) were NBCCEDP participants. Overall, there were nine significant predictors namely race, cancer stage, age, hormone receptor status, HER receptor, cancer grade, marital status, insurance status, and diagnosis year. Among NBCCEDP participants, there were four significant predictors namely cancer stage, age, hormone status, and region. Region was the only significant predictor variable unique to NBCCEDP participants with those living in the Midlands region having an adjusted hazard ratio of 1.8; 95% CI: 1.1-2.8 compared with participants who lived in Lowcountry region. Overall, in both cohorts, race was one of the significant independent predictor variables with Black women having an adjusted hazard ratio of 1.2; 95% CI: 1.1-1.3 compared with white women. Conclusions: Survival was significantly poorer among NBCCEDP participants living in the Midlands region, and Black women overall. To reduce survival disparities and enhance efficiency of NBCCEDP, efforts directed at enhancing support and eliminating barriers to timely detection and treatment should be focused on NBCCEDP participants living in the Midlands region of the state and Black women generally

Disparities in HPV vaccine uptake and provider recommendation by provider facility type

Background: Approximately 46,000 cases of human papillomavirus (HPV) attributable cancers are diagnosed annually in the United States. The HPV vaccine can prevent over 90% of HPV-attributable cancers, yet national uptake remains lower than the Healthy People 2030 target goal of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. We examined the association between provider facility type and provider recommendation and HPV vaccine uptake among adolescents in the US. Methods: We conducted secondary data analysis of the 2020 National Immunization Survey-Teen data (n=20,162), which provides current, population-based estimates of vaccination coverage among adolescents. Provider facility type was classified as public facilities (i.e., public health department-operated clinic, community health center, rural health clinic, tribal/Indian health facility), hospital-based facilities, private facilities, and mixed facilities (i.e., vaccination provided in more than one of the above-mentioned locations). Self-reported provider recommendation was dichotomized as yes/no. HPV vaccine initiation was defined as the receipt of ≥1 dose of the HPV vaccine, and completion was defined as the receipt of ≥2 doses (if the adolescent received first dose before age 15) or ≥3 doses (if the adolescent was at least 15 years old). Weighted, multivariable logistic regression models estimated the odds of receiving provider recommendation and initiating and completing the HPV vaccine by provider facility type, adjusting for adolescents age, gender, race, poverty level, number of doctor visits per year, and mother\u27s age, marital status, and education. Results: Approximately 81% of adolescents received a provider recommendation for the HPV vaccine and 47.5% received their vaccination at providers based in private facilities. The prevalence of HPV vaccine initiation was 75.1% and completion was 58.6%. In the adjusted analyses, adolescents who received their vaccination from public facilities (aOR=0.63; 95% CI: 0.51-0.78) were less likely to receive provider recommendation for the vaccine compared to those who received their vaccination at private facilities. Similarly, adolescents who received their vaccination from public facilities were less likely to initiate (aOR=0.73; 95% CI: 0.59-0.90) and complete (aOR=0.62; 95% CI: 0.52-0.77) the HPV vaccination compared to those who received their vaccination at private facilities. There was no difference between hospital and mixed vs. private facilities for both provider recommendation and vaccination. Conclusions: Both the recommendation for and uptake of the vaccine regimen were less common in public facilities than private facilities. Given the populations served in public facilities and the health disparities that exist in these populations, a greater focus is needed on recommendation for vaccination and follow through