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Hepatology ; 76(Supplement 1):S1379-S1380, 2022.
Article in English | EMBASE | ID: covidwho-2157786


Background: Screening for hepatocellular carcinoma (HCC) is associated with earlier stage at diagnosis and longer HCC-specific survival after diagnosis, but recent studies in Veterans Affairs (VA) cohorts have reached contrasting conclusions regarding this association. Few studies have evaluated screening and overall survival. Direct-acting antivirals (DAAs) for HCV have altered the natural history of HCV cirrhosis. We evaluated screening and overall survival in the post-DAA and pre-COVID era in a national cohort of veterans with cirrhosis largely due to alcohol and HCV. Method(s): All adults in VA care with CTP A or B cirrhosis for at least 1 year prior to January 1, 2015 were followed for incident HCC and all-cause mortality through December 31, 2019. Patients were censored at development of CTP C cirrhosis or maximum follow-up. Percent of time up to date with screening (PTUDS) for eligible follow up was calculated using relevant cross-sectional imaging. Time-updating age, MELD, and comorbidity score were identified for 180-day windows. We used Cox proportional hazards regression to compare survival time after HCC diagnosis by PTUDS and logistic regression to assess 3-year all-cause mortality after HCC diagnosis. Result(s): A total of 21,441 veterans were included, of whom 4.2% developed CTP C cirrhosis, 34.3% died, and 61.6% were censored at maximum follow-up. In all, 30.3% had cirrhosis from alcohol, 24.6% from HCV, 23.4% from alcohol/HCV, and 17.7% from NAFLD. There were 2,021 incident HCCs. Adjusting for time-updating age, MELD, and comorbidities, as well as etiology of cirrhosis, race, tobacco, BMI, CTP class, and GI and PCP visit density per year of follow-up, PTUDS was associated with decreased mortality in veterans diagnosed with HCC (HR for 10% increase in PTUDS 0.90, 95% CI 0.88-0.92). Restricting to those with HCV cirrhosis, PTUDS was associated with decreased mortality in those who cleared HCV (HR=0.88, 95% CI 0.85-0.91) but not in persistently HCV positive patients (HR=0.98, 95% CI 0.95-1.02). Among veterans diagnosed with HCC by December 31, 2016, PTUDS was associated with decreased 3-year overall mortality adjusting for age, MELD, and comorbidities at time of HCC diagnosis (OR for 10% increase in PTUDS 0.76, 95% CI 0.68-0.86). Restricting to those affected by HCV, the association was stronger in those who cleared HCV (OR=0.72, 95% CI 0.62-0.84) than those persistently HCV positive (OR=0.84, 95% CI 0.71-0.99). Conclusion(s): Screening is associated with both longer survival and greater 3-year overall survival in veterans with CTP A and B cirrhosis diagnosed with HCC, in particular among those who have cleared HCV.

Epidemiology ; 70(SUPPL 1):S93, 2022.
Article in English | EMBASE | ID: covidwho-1854019


Background: At the outbreak of the pandemic in Chicago, there were disruptions in daily life, communication and delivery of healthcare services. Our objective was to investigate mental well-being, lifestyle behaviors, self-management capacity and healthcare utilization during the early months of the COVID-19 pandemic among older adults with one or multiple chronic conditions. Methods: Telephone interviews were conducted as part of the ongoing COVID-19 & Chronic Conditions (C3) study between March and May 2020. Participants were recruited from local academic and safety net clinics and participated in existing research studies prepandemic. Self-report items assessed perceived stress due to coronavirus, self-management capacity and healthcare utilization. Validated measures assessed well-being, alcohol consumption, physical activity and self-efficacy. Results: The average age of participants (N=565) was 62.4, most were female (61.4%), and over half (n=310) were non-White or Latinx. One in five (20.7%) participants were stressed about the coronavirus most or all the time. Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, women reported more stress than men. Greater COVID-19 related stress and low health activation were associated with less physical activity, lower self-efficacy, greater difficulty managing health/medications and more avoidance of medical care. Conclusion: Consequences of COVID-19 on the mental wellbeing, lifestyle and ability of adults with chronic conditions to manage health were apparent in the initial months of the pandemic. As the C3 study is ongoing, it will be possible to examine pre- and postpandemic factors over time to understand the influence of the pandemic on the overall health trajectories of older adults.