Triple-Negative Breast Cancer in Georgia: Burden, Disparities, and Connections to Georgia\u27s Breast Cancer Genomics Project

Background: Triple negative breast cancer (TNBC) is typically aggressive and unresponsive to traditional cancer treatment, and disproportionately affects young and Black women. Approximately 60%-80% of breast cancers in women with the breast cancer gene (BRCA) mutation are TNBC, and children of a parent with a BRCA mutation have a 50% chance of inheriting it. Current guidelines recommend women diagnosed with TNBC receive genetic testing and counseling. Georgia’s Breast and Cervical Cancer Program (BCCP) routinely screens clients for increased risk of genetic mutation via an online screening tool. Methods: Using data from the Georgia Comprehensive Cancer Registry (GCCR) for 2010-2013, we calculated TNBC percentages/rates, diagnosis stage, and case fatality rate based on vital status. By using TNBC data as a proxy for BRCA gene mutation prevalence, we assessed the burden of TNBC and racial/age disparities to inform Georgia’s genomics efforts. Results: The percentage of invasive breast cancers, versus in-situ, was the same for Georgia Black and White women; however, Black women had almost double the percentage of TNBC as compared to White women. Black women under 40 had a 20% higher breast cancer incidence rate than similarly aged White women, but had almost double the TNBC rate. Georgia TNBC cases were about twice as likely as non-TNBC cases to be deceased, and Black TNBC cases had higher fatality rates than White cases (almost twice as high in women under 40). Conclusions: Georgia’s genomics program began screening in 2012, and participating counties offer screening to all women’s health clients. Awareness of hormone receptor status (and furthermore, possible presence of genetic mutation) for women diagnosed with breast cancer can guide the proper course of treatment. Additionally, family members of women diagnosed with TNBC in Georgia may take advantage of the screening for risk of genetic mutation through the genomics program prior to a cancer diagnosis, and receive counseling where appropriate. Key words: breast cancer, genomics, disparities, epidemiology, preventio

Human Papillomavirus-Associated Cancers in Georgia, 2008-2012

Background: High-risk human papillomaviruses (HPV) cause most anal, vaginal, vulvar, penile, and oropharyngeal cancers, and virtually all cervical cancers. In 2014, in Georgia (GA), fewer than half of adolescent females and males aged 13-17 years received the three doses of the HPV vaccine. Increasing vaccination coverage among this age group, education of adolescents in regard to HPV risks, and cervical cancer screening of adults can prevent HPV-associated cancers. Methods: The incidence of HPV-associated cancers for 2008-2012 in GA was obtained from GA Comprehensive Cancer Registry data. Case definitions for HPV-associated cancers were based on standard definitions of the Centers for Disease Control and Prevention (CDC). Data for anatomic sites known to have HPV-associated cancers, including the cervix, vulva, vagina, penis, anus, and oropharynx, were analyzed. Also derived were ageadjusted rates, age-specific incidence rates, the percentage of each cancer found attributable to HPV, and ageadjusted incidence rates by geography. Results: During 2008-2012, a total of 6,056 HPV-associated cancers were diagnosed (males, 2,408; females, 3,648). Of these, 4,629 cancers were attributable to HPV (males, 1,574; females, 3,055). The most common cancers attributable to HPV were oropharyngeal cancers among males (1,182); and cervical cancers (1,862) among females. Females living in smaller urban counties had a higher cervical cancer incidence rate than females living in metropolitan counties and metro areas (1 million or more population). Males living in rural counties had a lower oropharyngeal cancer incidence compared to the state incidence rate. Conclusions: Since HPV vaccination at age 11-12 years can prevent HPV-related cancers in adulthood, clinicians should promote HPV vaccination along with routine immunizations to adolescents. Surveillance of HPVassociated cancers using GA cancer registry data is needed to track future changes in incidence data due to administering the HPV vaccine, increasing cervical cancer screening, and educating youth in GA about HPV risk factors

Administrative Data Linkage to Evaluate a Quality Improvement Program in Acute Stroke Care, Georgia, 2006–2009

Tracking the vital status of stroke patients through death data is one approach to assessing the impact of quality improvement in stroke care. We assessed the feasibility of linking Georgia hospital discharge data with mortality data to evaluate the effect of participation in the Georgia Coverdell Acute Stroke Registry on survival rates among acute ischemic stroke patients. Methods Multistage probabilistic matching, using a fine-grained record integration and linkage software program and combinations of key variables, was used to link Georgia hospital discharge data for 2005 through 2009 with mortality data for 2006 through 2010. Data from patients admitted with principal diagnoses of acute ischemic stroke were analyzed by using the extended Cox proportional hazard model. The survival times of patients cared for by hospitals participating in the stroke registry and of those treated at nonparticipating hospitals were compared. Results Average age of the 50,579 patients analyzed was 69 years, and 56% of patients were treated in Georgia Coverdell Acute Stroke Registry hospitals. Thirty-day and 365-day mortality after first ad- mission for stroke were 8.1% and 18.5%, respectively. Patients treated at nonparticipating facilities had a hazard ratio for death of 1.14 (95% confidence interval, 1.03–1.26; P = .01) after the first week of admission compared with patients cared for by hospitals participating in the registry. Conclusion Hospital discharge data can be linked with death data to assess the impact of clinical-level or community-level chronic disease control initiatives. Hospitals need to undertake quality improvement activities for a better patient outcome

Factors associated with stroke after COVID-19 vaccination: a statewide analysis

BackgroundThe objective of our study was to evaluate vaccine type, COVID-19 infection, and their association with stroke soon after COVID-19 vaccination.MethodsIn a retrospective cohort study, we estimated the 21-day post-vaccination incidence of stroke among the recipients of the first dose of a COVID-19 vaccine. We linked the Georgia Immunization Registry with the Georgia Coverdell Acute Stroke Registry and the Georgia State Electronic Notifiable Disease Surveillance System data to assess the relative risk of stroke by the vaccine type.ResultsApproximately 5 million adult Georgians received at least one COVID-19 vaccine between 1 December 2020 and 28 February 2022: 54% received BNT162b2, 41% received mRNA-1273, and 5% received Ad26.COV2.S. Those with concurrent COVID-19 infection within 21 days post-vaccination had an increased risk of ischemic (OR = 8.00, 95% CI: 4.18, 15.31) and hemorrhagic stroke (OR = 5.23, 95% CI: 1.11, 24.64) with no evidence for interaction between the vaccine type and concurrent COVID-19 infection. The 21-day post-vaccination incidence of ischemic stroke was 8.14, 11.14, and 10.48 per 100,000 for BNT162b2, mRNA-1273, and Ad26.COV2.S recipients, respectively. After adjusting for age, race, gender, and COVID-19 infection status, there was a 57% higher risk (OR = 1.57, 95% CI: 1.02, 2.42) for ischemic stroke within 21 days of vaccination associated with the Ad26.COV2.S vaccine compared to BNT162b2; there was no difference in stroke risk between mRNA-1273 and BNT162b2.ConclusionConcurrent COVID-19 infection had the strongest association with early ischemic and hemorrhagic stroke after the first dose of COVID-19 vaccination. Although not all determinants of stroke, particularly comorbidities, were considered in this analysis, the Ad26.COV2.S vaccine was associated with a higher risk of early post-vaccination ischemic stroke than BNT162b2

Redefining Our Understanding of The Impact of Firearm-Related Injury in the State of Georgia: A White Paper by the Violence Prevention Task Force of IPRCE

Abstract: Background: Firearm-related injury is a crisis that afflicts vulnerable populations of all ages, ethnicities, races and gender. The purpose of this white paper is to delineate the impact of firearm-related violence on the health and well-being of citizens and communities across Georgia based on the available literature and data. The aim of this white paper is to examine and characterize the currently available data on the impact of firearm violence and injury from a statewide perspective, principally as it relates to the National Violent Death Reporting System (NVDRS) report for Georgia. Materials and method: We performed a literature review to analyze data obtained through the the Web-based Injury Statistics Query and Reporting System (WISQARS™) and NVDRS. We used the data to characterize the types and extent of firearm injuries and deaths in the U.S. and Georgia. Results: We identified an overall mortality rate of 27% for all-types of firearm injuries. The estimated average annual age-adjusted firearm injury rate was 31.5 per 100,000 people. The case fatality rate for suicide due to firearm injury notably had the highest gun-related mortality rate by greater than 6-fold. Furthermore, from 2015 to 2016, the national mean annual case fatality rate was 84% for firearm-related suicide according to 2017 CDC report. Conclusion: Greater investment into research, education and prevention of gun-related violence among citizens in the state of Georgia is necessary. Although firearm-related aggravated assault due to interpersonal violence is common, the case fatality rate due to suicide has a greater than 6-fold higher rate of death

Human Papillomavirus-Associated Cancers in Georgia, 2008-2012

Background: High-risk human papillomaviruses (HPV) cause most anal, vaginal, vulvar, penile, and oropharyngeal cancers, and virtually all cervical cancers. In 2014, in Georgia (GA), fewer than half of adolescent females and males aged 13-17 years received the three doses of the HPV vaccine. Increasing vaccination coverage among this age group, education of adolescents in regard to HPV risks, and cervical cancer screening of adults can prevent HPV-associated cancers. Methods: The incidence of HPV-associated cancers for 2008-2012 in GA was obtained from GA Comprehensive Cancer Registry data. Case definitions for HPV-associated cancers were based on standard definitions of the Centers for Disease Control and Prevention (CDC). Data for anatomic sites known to have HPV-associated cancers, including the cervix, vulva, vagina, penis, anus, and oropharynx, were analyzed. Also derived were ageadjusted rates, age-specific incidence rates, the percentage of each cancer found attributable to HPV, and ageadjusted incidence rates by geography. Results: During 2008-2012, a total of 6,056 HPV-associated cancers were diagnosed (males, 2,408; females, 3,648). Of these, 4,629 cancers were attributable to HPV (males, 1,574; females, 3,055). The most common cancers attributable to HPV were oropharyngeal cancers among males (1,182); and cervical cancers (1,862) among females. Females living in smaller urban counties had a higher cervical cancer incidence rate than females living in metropolitan counties and metro areas (1 million or more population). Males living in rural counties had a lower oropharyngeal cancer incidence compared to the state incidence rate. Conclusions: Since HPV vaccination at age 11-12 years can prevent HPV-related cancers in adulthood, clinicians should promote HPV vaccination along with routine immunizations to adolescents. Surveillance of HPVassociated cancers using GA cancer registry data is needed to track future changes in incidence data due to administering the HPV vaccine, increasing cervical cancer screening, and educating youth in GA about HPV risk factors

Impact of Employment Status on Subjective Cognitive Decline Among Georgians 45 and Older

Background Subjective cognitive decline (SCD) is a self-reported experience of worsening or more frequent confusion or memory loss that is associated with future risk of Alzheimer’s. Unemployment contributes to developing SCD. However, the risk of SCD in the unemployed older population may vary. We investigate the risk of SCD by employment status among adults in Georgia. Methods Data from the 2013, 2015, 2017, 2019, and 2021 Georgia Behavioral Risk Factor Surveillance System were combined. Respondents aged 45 and older experiencing SCD in the past 12 months were identified. Respondents were either employed (employed for wages, self-employed, or out of work less than a year), retired, or unemployed (out of work for more than a year). Logistic regression was performed with SCD as outcome and employment status as predictor. Sex, age, race/ethnicity, education, and income were covariates. Results Overall prevalence of SCD was 12.1%. SCD was higher among those with less than high school education (20.4%), and annual income less than $15,000 (22.9%). SCD prevalence was highest among those unemployed (Adjusted Prevalence Ratio: 2.2, 95% CI: 1.6, 3.0) than retired (APR: 1.6, 95% CI: 1.3, 2.0) compared to those employed. SCD prevalence remained the same when stratified by age, unemployed 45-64 (APR: 1.9, 95% CI: 1.4, 2.8); retired 45-64 (APR: 1.6, 95% CI: 1.2, 2.0); unemployed 65+ (APR: 2.3, 95% CI: 1.1, 4.9); retired 65+ (APR: 1.8, 95% CI: 1.3, 2.4). Conclusion Experiencing SCD is significantly higher among retired and unemployed persons compared to those who are employed. However, the risk of SCD was greater among the unemployed than retired. This reveals that more than the mere absence of employment the reason for unemployment is critical in SCD development. To be effective, programs to prevent SCD among unemployed older adults in Georgia must consider the reason for unemployment