Abstracts From the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2022 Scientific Sessions

The proceedings contain 385 papers. The topics discussed include: racial and ethnic differences in the population burden of dementia attributable to modifiable risk factors in the United States;higher visit-to-visit variability in fasting glucose and HbA1c is associated with decline in global cognitive performance: the Multi-Ethnic Study of Atherosclerosis (MESA);prevalence of stroke symptoms among Hispanic/Latino adults in the Hispanic community health study/study of Latinos (HCHS/SOL);educational attainment and dementia risk: mediation by vascular risk factors at mid-life in the atherosclerosis risk in communities (ARIC) study;a healthy plant-based diet was associated with slower cognitive decline in African Americans: a biracial community-based cohort of older adults;outcome preferences related to cardiovascular preventive therapies in older adults: an online survey;subclinical myocardial injury, coagulopathy, and inflammation in Covid-19: a meta-analysis;COVID-19 and type II NSTEMI: a comprehensive overview;association of antecedent statin use with outcomes of people with Covid-19 admitted at northwestern medicine health system;and social determinants of health and ambulatory outcomes among Covid-19 positive patients: differences by race/ethnicity.

Ethnic Differences in Cancer Deaths at Home before and during Pandemic

Introduction Place of death is a metric used for planning and monitoring palliative care (PC). The COVID-19 pandemic has seen a significant increase in cancer deaths at home. Aims To determine whether pandemic increases in the percentage of cancer deaths at home differ by ethnic group Methods Data source: death registrations in England, 2018 to 2021 with underlying cause of death cancer (ICD-10 C00-C97). Ethnic group derived from linked hospital episode data. The age and deprivation distribution across ethnic groups varies and each has a strong independent effect on place of death. so, calculated percentage deaths at home were standardised by these factors to make them comparable. Analysis concentrated on the largest ethnic groups: White, Asian/Asian British (Asian), and Black/African/ Caribbean/Black British (Black). Comparisons were made between time periods by analysis of the ratio of percentages 2020-2021 (COVID-19 Pandemic) vs 2018-2019 (Baseline). Results For each ethnic group the age-standardised percentage of cancer deaths at home significantly increased (P < 0.05) from 2018-2019 to 2020-2021 . Asian: 33.5%, 47.5% . Black: 28.8%, 39.0% . White: 30.7%, 41.2% The ratio of standardised percentage of deaths at home (95% CI) was . Asian: 1.42 (1.36,1.48 ) . Black: 1.35 (1.27, 1.44) . White 1.34 (1.33, 1.35) Conclusions Cancer deaths at home increased by > 10 percentage points during the pandemic for Asians, Blacks and Whites. Significant differences between ethnic groups before the pandemic (2018-19) persisted with Asians more likely than Whites, and Blacks less likely than Whites to die at home. The largest increase was for Asians, the group with the highest pre-pandemic home deaths. Impact These ethnic differences merit investigation regarding cultural preferences, access issues and quality of PC experience. Community health and PC teams need additional resources and training in culturally sensitive care to support the increased number of ethnically diverse cancer patients dying at home.

Racial Disparities in the Quality of Life and Vaccination of Breast Cancer Survivors during COVID-19: A Longitudinal Study

Background: Older adults with pre-existing health conditions such as cancer are at higher risks of COVID-related morbidity and mortality. Moreover, the pandemic has triggered new sources of anxiety and stress impairing their quality of life (QoL), such as fear of infection, financial challenges, and social isolation. The goal of this study is to evaluate the changes in QoL of breast cancer patients and survivors during the pandemic and assess whether racial/ethnic minority patients were disproportionately affected. As the COVID-19 vaccines become available, another goal of the study is to examine the vaccination rate and symptoms after vaccination among patients of different racial/ethnic groups. Method(s): Two waves of surveys were sent out to the breast cancer patients registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC) via RedCap in the summers of 2020 and 2021 with response rates of > 48%. To measure anxiety and stress, we calculated an overall score (ranging from 0-44) using 11 questions on a 5-point Likert scale, with lower score representing better QoL. The questions were adopted from existing item banks, and the items showed good internal consistency (Cronbach's alpha = 0.84). The second survey also contained questions on vaccination status, concerns, and symptoms after vaccination. Result(s): In the first wave of survey in 2020, no significant racial differences were found in the anxiety/stress scores among the 1300 breast cancer patients. In the second wave of survey in 2021, 1348 patients responded, with 66% of them also respondents of the previous survey. Compared to 2020, the average anxiety/stress score in 2021 decreased from 13.2 to 12.2 for White patients, while increased from 12.8 to 13.6 for Black patients. Mixed effects models showed that the scores worsened significantly for Black patients while improved significantly for White patients. Compared to Whites, Black patients were significantly less confident to find medical help and keep up with work/home responsibilities, while significantly more likely to feel isolated and overwhelmed, and more frequently worried about being sick and going to hospitals. The racial differences in the anxiety/stress scores became insignificant after adjusting for annual household income in multivariate linear mixed effect models. In terms of Covid-19 vaccination, 92.2% of the respondents got vaccinated, with no significant racial/ethnic difference. However, there were more Black patients who had not decided yet or did not respond to this question (Table). The major concerns for patients were the long-term and short-term side effects of the vaccines. In terms of symptoms after vaccination, the most reported symptoms were pain at injection site (62.0%), tiredness (50.2%) and muscle or body aches (30.8%). Conclusion(s): Through a longitudinal study, we found that although the anxiety/stress scores of our patients remained moderate, White patients were having improved QoL while Black patients were doing worse. A third wave of survey is planned in the summer of 2022 to further examine this trend. In our study, the vaccination rates were very high among all racial/ethnic groups and the symptoms after vaccination were similar to the ones demonstrated in the general population. We hope that this information can proactively address some patients' concerns about getting vaccinated.

Racial/ethnic differences in low-dose aspirin use for preeclampsia risk reduction

Objective: There are significant racial/ethnic disparities in development of preeclampsia and perinatal morbidity and mortality due to preeclampsia. Low-dose aspirin (LDA) is the only strategy proven effective for preeclampsia risk reduction among high-risk patients. This study aims to determine if there are racial/ethnic differences in use of LDA for preeclampsia risk reduction among patients who meet criteria based on ACOG/SMFM recommendations. Study Design: This is a secondary analysis of a retrospective cohort study of all pregnant patients who delivered at 33 US hospitals in 14 states in 2019 and 2020. Patients were included if they had an indication for LDA for preeclampsia risk reduction. Exclusion criteria were missing or other race/ethnicity, missing LDA use, and positive SARS-CoV-2 test. Indications for LDA were defined per ACOG/SMFM recommendations: >= 1 high risk factor (history of preeclampsia, multiple gestation, chronic hypertension, pregestational diabetes, kidney disease, lupus) or >= 2 moderate risk factors (nulliparity, obesity, age >= 35 years, in vitro fertilization). This study was performed before the recommendations were updated in 2021. All data were ed from the medical record by trained and certified perinatal research staff. The primary outcome was LDA use during pregnancy. Multivariable logistic regression adjusted for clinical site. Result(s): A total of 6,853 patients were included: 26.5% non-Hispanic Black (NHB), 47.6% non-Hispanic White (NHW), 4.0% non-Hispanic Asian (NHA), and 21.7% Hispanic. NHB patients were most likely to use LDA (38.7%) followed by NHW (29.6%), Hispanic (27.5%), and NHA (24.7%), p< 0.001. NHB patients had 1.5 times the odds of using LDA compared to NHW patients (95% CI 1.33-1.69);this persisted when adjusting for clinical site (aOR 1.44, 95% CI 1.26-1.64). Conclusion(s): Among pregnant patients at high risk for preeclampsia per ACOG/SMFM guidelines, overall rates of LDA use were low. NHB patients had increased odds of LDA use compared to NHW patients. Future research should seek strategies for increasing LDA use among all patients with high-risk pregnancies. [Formula presented] [Formula presented] Copyright © 2022

The Clinical Conundrum of Diagnosing Children with Fever and Pain Abdomen Amidst a Clustering of Pims-Ts Cases in the Omicron Dominant Era

Aims The Omicron variant of SARS-CoV-2 variant has rapidly spread in the UK since December 2021.There was a significant increase in the number of children testing positive for SARS-CoV-2 in December 2021 in the population served by this DGHS. A clustering of cases of PIMS- TS was noted in the last week of December 2021 and the first week of January 2022. The focus of this descriptive study of PIMS-TS patients from a single centre is to report the clustering of cases in the Omicron dominant period and to describe the dilemma of managing children who present with fever and pain abdomen. Methods Children confirmed to have PIMS-TS and one child who presented mimicking PIMS -TS were identified, their investigations, treatment and outcomes were reviewed Results A cluster of 6 children diagnosed as PIMS -TS presented from the 29th of December 2021 to the 8th of January 2022.The mean age of patients was 9.3 years. There was ethnic variation with 3 Asian, 2 Afro Caribbean and one White child. Mean CRP was 226( range 85-400). All children presented with fever of more than 3 days.3 children presented with partial Kawasaki features, 2 children were treated for shock and 2 children presented with pain abdomen and fever. A 15 year old presented with fever, pain abdomen and tenderness in the right iliac fossa. He was managed initially as appendicitis. Blood markers for PIMS-TS were significantly raised along with raised CRP of 204. CT abdomen showed ileitis. His NPA RT- PCR was positive for SARS-CoV-2. He continued to have high fever, a diagnosis of PIMS-TS was made. There was significant improvement in both clinical condition and biochemical markers following IV Methylprednisolone. On the same day a 11 year old presented with fever, pain abdomen and increased irritability. He had global developmental delay and was PEG fed. He was initially managed as PIMS-TS then diagnosed to have appendicitis. CT abdomen showed a perforated appendix. He had a good outcome after surgery Conclusion The clustering of cases of PIMS- TS may be specific to this geographical area and multi-ethnic population following a period of high SARS-CoV-2 prevalence in the community with the Omicron variant. PIMS-TS can closely mimic appendicitis and distinguishing between both can be difficult. In the first child, CRP was unusually high (202) which helped in making a diagnosis avoiding unnecessary surgery. In the second child clinical acumen and involvement of multiple specialist teams helped in making the diagnosis of appendicitis. The global developmental delay and the child being nonverbal proved to be confounding factors. Cases of PIMS-TS can have bowel inflammation, it is also possible that COVID-19 can occur with other pathologies. Radiology findings need to be interpreted with the clinical picture. Clinical acumen, considering a range of differentials working closely with other specialities enables us to make a correct diagnosis for the unwell child who presents in the COVID-19 pandemic.

Ethnic Variation in Adult and Pediatric Liver Transplantation

Purpose: Despite several policy reforms over the years, disparities in the access to solid organ transplantation continues to exist remains a significant barrier to liver transplant. The MELD Allocation system and subsequently the Share-35 policy (adopted June 2013) were implemented to address the inequitable access to liver transplantation (LT). The implication of these changes on adult and pediatric LT among ethnic groups is uncertain. Therefore the aim of this study, is to explore the factors associated with access to LT across ethnic groups of all age groups. Method(s): The study period (2014 -2019) included the period after Share-35 policy (June 2013) implementation and prior to implantation of Acuity Circle and COVID pandemic (Feb/March 2020). Using the UNOS database, we identified all candidates (Pediatrics and Adults), who received liver Transplant during the study period. Data extracted included type of transplant, liver diagnosis, age, MELD/PELD score, gender and race/ethnicity. Chi square test and anova were used for comparative analysis. Result(s): During the study period, 46,926 candidates received liver transplant of which 96% were Adults, living donor LT (5%) and ethnic distribution (White 69%, Hispanic 15%, Black 9%, Asian 4% and others 3%). In contrast to the Adult recipients in which there is a gender variation with male predominance (65%), among pediatric group there was similar distribution (Male 51% and Female 49%). There was significant ethnic variation in type of insurance payor (Figure 1) and proportion of LT (Figure 2) across age groups. Among pediatric recipients, no significant difference in LT trends across ethnic groups. In contrary, among the adult recipients, though there was no change among White (71% in 2014 and 71% in 2019) and Asian (4% in 2014 and 4% in 2019), there was slight increase among Hispanic ( 13 % in 2014 and 16% in 2019) and a steady decline among Blacks ( 10% in 2014 and 7.3% in 2019). Conclusion(s): Ethnic Variation in Access to Liver Transplantation exists in both Adult and Pediatric Candidates. Future studies to explore the observed difference in Insurance payors, gender gaps among ethnic groups will provide useful insights to the non-medical factors contributing to inequitable LT access irrespective of age. Identification and understanding the key social determinants that impact LT access will be key in developing strategies to reduce and eliminate these barriers across age groups.

RACIAL AND ETHNIC DIFFERENCES IN UNDERLYING CO-MORBIDITIES IN COVID-19 ADMISSIONS WITHIN A LARGE HEALTH CARE SYSTEM

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Some co-morbidities and racial/ethnic groups are associated with worse COVID-19 outcomes. Is there a statistically significant difference in baseline characteristics and co-morbidities among racial and ethnic groups? This question was explored in a descriptive study among patients admitted to Hartford HealthCare. METHODS: A retrospective review of 7049 patients admitted with COVID-19 within the Hartford HealthCare (HHC) System from Feb 23, 2020 to July 15, 2021 was performed via the COVID-19 Research Registry at HHC (an IRB approved registry of patients who tested positive for COVID-19 within HHC). Racial and ethnic categories were compared using chi-square test and multiple column proportions were compared using Bonferroni method. RESULTS: The cohort was comprised of 52% males with an average age of 65 years (SD=17). 20% were non-survivors. Race was reported as 61% White, 22% Other, 13% African American (AA), 2% Asian, 2% Grouped Races (including American Indian, Pacific Islander, refused or unknown). 23% of the cohort reported their ethnicity as Hispanic. The “Other” racial group is comprised of 87% Hispanic ethnicity. A significantly higher proportion of White was >80 years old (30%) as compared to AA (13%), Asian (11%) and Other (13%) categories. No difference in gender distribution was noted. White had increased proportions of CAD (23%) as compared to Grouped and Other groups (10-20%) and COPD (15%) and atrial fibrillation (19%) as compared to all groups (4-10%). A higher proportion of AA had obesity (15%) as compared to Asian and White groups (4-13%) and hypertension (59%) and heart failure (21%) as compared to Asian, Grouped and Other groups (39-52%, 6-14% respectively). AA also had a higher proportion of CKD (42%) as compared to all groups (18-35%). Those in the Other category (87% Hispanic) had increased proportion of diabetes mellitus (41%) as compared to all groups (23-29%) except AA and asthma (16%) compared to all groups (6-12%). A significantly higher proportion of Asian was on private insurance (42%) as compared to all groups (19-23%) except Grouped Races and had lower proportions or no statistically significant difference in co-morbidities. Highest proportion of Other was on Medicare/Medicaid (80%), followed by White (77%), AA (76%), Grouped Races (66%) then Asian (57%). CONCLUSIONS: This descriptive study found statistically significant differences in age, co-morbidites and insurance status among racial/ethnic groups admitted with COVID-19 at HHC. CLINICAL IMPLICATIONS: Studies have shown disproportionate impact of COVID-19 on minorities. Review of our hospitalized cohort shows that perhaps it is not race itself, but rather a complex interaction between patient factors and social determinants of health that likely plays a an essential role. A more complete study looking at the social determinants of health and its impact on COVID-19 mortality would be helpful to direct community interventions. DISCLOSURES: No relevant relationships by Jyoti Chhabra No relevant relationships by Jeffrey Mather No relevant relationships by Hnin Hnin Oo No relevant relationships by Oscar Serrano No relevant relationships by Joseph Tortora

COVID Multi system Inflammatory Syndrome in Children (MIS-C): The Northern NJ Experience

Background: Coronavirus disease (COVID-19) caused by SARSCOV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes of children aged 0-21 years diagnosed with MIS-C in a community hospital setting in the United States. Methods: This is a retrospective medical record review of pediatric patients admitted to the ICU with confirmed diagnosis of MIS-C. Results: We identified 24 cases of MIS-C at two community hospitals during period of March 2020- June 2021. Fever (92%) and nausea/vomiting (79%) were the most frequent symptoms identified, followed by red eyes (54%) and rash (54%). Additional symptoms included diarrhea (46%), abdominal pain (46%), headache (42%), shortness of breath (13%), myalgia (13%), and chest pain (4%). Of the 24 patients, 15 (63%) were male, and 9 (37%) were female. Race and ethnic distribution was African American/Black (66%), Hispanic origin (29%) and Other/not reported (4%). The majority of patients were aged 6-10 years (38%), followed by 1-5 years (25%) and 11-15 years (25%), and over 15 years (12%). Echocardiogram findings showing decreased cardiac function and/or pericardial effusion was found in 38% of patients, with complete recovery of cardiac function in 100%. Management included IVIG administration (92%), with 4 patients requiring second dose, and 1 patient also requiring Anakinra. Additional treatment included steroids (92%) and aspirin (96%). Two patients received Lovenox. Conclusion: As shown in various other studies, minorities seem to be disproportionately impacted and prompt recognition of clinical presentation and management is critical for this population. Ongoing longitudinal studies are needed to determine factors affecting why certain ethnicities are impacted more than others.

ETHNIC VARIATIONS IN SEXUAL RISK BEHAVIOUR, SEXUAL HEALTH SERVICE USE AND UNMET NEED DURING THE FIRST YEAR OF THE COVID-19 PANDEMIC: AN ANALYSIS OF POPULATION-BASED SURVEY AND SURVEILLANCE DATA

Introduction Prior to the COVID-19 pandemic, STIs disproportionately affected some Black communities. We examined ethnic inequalities in sexual health during the pandemic. Methods Analyses were restricted to England residents aged 18-59. We included 5,240 sexually-experienced participants from Natsal-COVID survey Wave 2 (quasi-representative web panel survey) reporting one-year outcomes from March 2020- April 2021. We estimated weighted proportions and adjusted odds ratios (AORs) between ethnicity and sexual risk behaviour (condomless sex with new partner on first occasion), sexual health service (SHS) use, and unmet need (trying but failing to access SHS). Using GUMCAD national surveillance data from before (March 2019-March 2020) and during (March 2020-March 2021) the pandemic, we compared proportional differences in rates of STI tests and diagnoses by ethnicity. Results Compared to Natsal-COVID participants of White ethnicity, sexual risk behaviour (8%) was higher among participants of Mixed/Other (22%, AOR:2.26 [95% CI 1.08-4.73]) and Asian (15%, 1.58 [1.07-2.35]);SHS use (5%) was higher in Black (20%, 3.04 [1.75-5.28]) and Mixed/Other (20%, 2.64 [1.35-5.14]);and unmet need (2%) was higher in Black (11%, 5.01 [2.26-11.09]) and Asian (5%, 2.33 [1.11-4.90]) ethnicity. In GUMCAD, among people attending SHS, we observed similar reductions of around 50% in testing and diagnoses during the pandemic across different ethnic groups, although the greatest reduction was in people of Asian ethnicity (56% and 52% respectively). Discussion Two independent national data sources showed sexual health inequalities persisted during the first year of the pandemic with evidence of more unmet need among minority ethnicities, but further work is needed to assess whether these worsened.

Impacts of the Pandemic on Utilization of Critical Healthcare among New York Medicaid Beneficiaries with Schizophrenia

Background: People with schizophrenia are more likely to become ill with COVID-19 and have poorer COVID-19 outcomes because of pre-existing health conditions and social disadvantage. This risk may be modified by the strength of their connection to the healthcare system. In New York (NY), a state badly impacted by the pandemic, drivers of racial/ethnic healthcare disparities could reduce access to healthcare for minorities relative to white individuals, even if insured. Evidence is limited on the pandemic's impacts on this population's access to behavioral and physical healthcare and whether differences by race/ethnicity exist. Aims of the Study: To examine the early impacts of the pandemic on racial/ethnic differences in access to healthcare among adult NY Medicaid beneficiaries with schizophrenia. Methods: We constructed a cohort of Medicaid beneficiaries aged 18-64 with schizophrenia observed in the pre-pandemic period (March 7, 2019-March 6 2020) or in the early post-pandemic period (March 7 - May 15 2020). Outcomes included access to critical behavioral health outpatient care (utilization of routine and specialty services, and antipsychotic drugs) and unavoidable hospitalizations (suicidality, cardiometabolic emergencies, and pneumonia). We estimated logistic regression models for each outcome. The main independent variables were race/ethnicity, time, and their interaction;adjustors included age, sex, disability, and county. Odds ratios (OR) and 95% CI for differences between minorities and whites were computed. Results: We identifed 23,486,821 and 4,481,176 person-days, preand post-pandemic period respectively, with a majority non-white. Utilization and racial/ethnic differences did not change over time for specialty oupatient care, which favored blacks over whites (OR = 1.21, 95% CI = 1.19, 1.24), or hospitalizations for suicidality and cardiometabolic emergencies. Differences in routine outpatient care and antipsychotic utilization between minorities and whites, largely favoring whites, decreased in the post-pandemic period without closing the gaps. Differences in pneumonia hospitalizations changed over time, with minorities less likely than whites to be hospitalized in the post-pandemic period;e.g., Latinx: pre-period OR = 0.89, 95% CI = 0.66, 1.18;post-period OR = 0.70, 95% CI = 0.53, 0.87. Discussion and Limitations: We found that access to critical behavioral health care and unavoidable hospitalizations for adults with schizophrenia in NY and differences by race/ethnicity remained largely unchanged following the onset of the pandemic. This constancy is noteworthy given how severely NY and its healthcare system were affected by the pandemic. However, the post-pandemic emergence or widening of racial/ethnic differences in hospitalizations for pneumonia is concerning given the larger burden of COVID- 19 disease observed among minorities. Implications for Health Care Provision and Use: Identifying the provider-level factors that enabled the preservation of access to critical behavioral health and hospitalization care will improve the system's capacity to confront future public health emergencies. Implications for Health Policies: Our findings suggest that policies that aimed to preserve healthcare access were successful;however, policies are needed to address the potential for racial/ethnic differences in access to care for the public health emergency. Implications for Further Research: Future research should assess the impact of variable telehealth adoption on quality and effectiveness of care for this population.

Racial/Ethnic Differences in Social Health of Older Adults in a Northern California Healthcare System

Background: The COVID-19 pandemic heightened concerns about the social health of older adults and potential exacerbation of racial disparities in health, well-being, and healthcare access. Methods: We used weighted data for 4282 Kaiser Permanente Northern California (KPNC) members aged 65-85 who responded to the 2020 KPNC Member Health Survey to estimate prevalence of frequent loneliness, lack of social support, financial strains, and other stressors during the prior 12 months. Results: Overall, 5% often felt lonely or socially isolated, and 37% often did not get sufficient social/emotional support (Figure). While approximately 4% had problems “making ends meet”, 10% worried about financial security. Cost led to 2-3% being food insecure, eating less healthy foods, and delaying/foregoing medical care, and 11% delaying/foregoing dental care. Black adults were most likely to report these financial strains, as well as experience harassment/ discrimination and worry about neighborhood violence. Asian/Pacific Islander adults (API) were most likely (57%) and White adults least likely (32%) to report lack of social/emotional support. Conclusions: While many older adults experienced adverse financial and social circumstances during the pandemic, Black adults were more likely than White adults to indicate financial and healthcare access strains. More research is needed on effective screening for financial and other social risks in diverse older adult populations to deliver socially and culturally appropriate care to vulnerable populations.

Need to Improve Minority Representation through COVID-19 Community Research Partnership

Background. Minorities are often unrepresented in research, which limits equity in healthcare advances. The racial and ethnic disparities in outcomes of individuals infected with COVID-19 highlight the importance of inclusivity in research to improve public health measures. Methods. We performed a descriptive analysis of the racial and ethnic distribution of children enrolled in our COVID-19 Community Research Partnership (CRP) study, a syndromic and serological surveillance study of children aged 2 - 17 years receiving care at three healthcare systems spanning North and South Carolina. Syndromic surveillance involved daily symptom reporting using a webbased monitoring application. Participants consenting to serological surveillance were mailed at-home tests sampling finger prick capillary blood. In-person and electronic recruitment efforts were conducted in English and Spanish. At one of the study sites, we compared the racial/ethnic distribution of enrolled children to the racial/ethnic distribution of all children who received care at the same site during the same timeframe. We compared the racial/ethnic distribution of participants who ultimately submitted samples for serological testing compared to those who consented to serologic testing. Results. At total of1630 children were enrolled from April 2, 2021 - June 8, 2021. Most children were > 5 years old, 50.2% were female, and 88.5% were from mostly urban counties (Table 1). Of enrolled children, 4.2% were Hispanic, 8.2% were black, and 81.6% were white (Table 2). Among 135,355 unique children who received care at the institution during the same time, 12.4% were Hispanic, 23.0% were black, and 63.1% were white. Of 1552 participants who consented to serologic testing, 4.4% were Hispanic, 8.1% were black, and 81.8% were white (Table 3). To date, 242 children submitted serologic samples;4.1% were Hispanic, 5.0% were black, and 85.5% were white. Conclusion. Despite efforts to recruit a diverse group of children, the proportion of minorities enrolled in our COVID-19 surveillance study underrepresents the targeted population. Ongoing efforts will work to identify barriers and facilitators to research participation among minority families.

Ethnic Variation in Hospitalized COVID-19 Patients and Correlation with Coagulopathy, Thrombosis, Prognosis and 30 Day Mortality Outcomes in California's Central Valley

[Formula presented] Background: The COVID-19 pandemic has brought a spotlight on the high incidence of thrombosis and abnormal coagulation parameters in patients with the 2019 novel coronavirus. We evaluated 30 day mortality and thrombotic events relative to anticoagulation therapy and coagulation parameters in Hispanic and non-Hispanic patients in California's central valley. Methods: We identified 886 non-pregnant adults hospitalized at Community Medical Centers in the Central Valley of California with SARS-CoV2 infections from 3/1/20 to 9/1/20. We conducted manual chart review and excluded patients on long term anticoagulation prior to admission. We collected data on ethnicity, coagulation labs, thrombotic events and 30 day all-cause mortality outcomes. The distributions of variables were reviewed to detect illogical and out of range values. Differences in means of continuous variables were evaluated via the t-test. Differences in categorical variables were evaluated with chi square tests. All tests are two-sided and a p-value < 0.05 was considered statistically significant. Results: Among the 866 COVID positive patients, 568 (64%) were Hispanic and 318 (36%) were non-Hispanic. The gender distribution was equivalent with 57% males and 43% females. Hispanic patients were younger with a mean age of 56.1 years vs 63.2 years in non-Hispanics. Mean BMI was 32.7 for Hispanics and 30.5 for non-Hispanics (p<0.05). The risk factor assessment for severe COVID-19 infection revealed a history of thrombosis or thrombophilia, bleeding tendency, obesity, active cancer, diabetes, cardiovascular disease, end stage renal disease, liver cirrhosis and immunosuppression, all of which were not statistically significant between Hispanics and non-Hispanics. However, chronic lung disease (p<0.05) and residing in a skilled nursing or long-term care facility (p<0.001) were statistically significant (Table 1). 16% of non-Hispanics had chronic lung disease vs 10.9% of Hispanics. Likewise, 10.4% of non-Hispanics inhabited care facilities compared to 3.9% of Hispanics. Review of initial CRP values exhibited statistical significance (p=0.017) amidst Hispanics at 145.3 and non-Hispanics at 124.8. Other labs including PT, INR, PTT, d-dimer, fibrinogen, platelets, ferritin and ESR were not statistically significant between ethnic groups. Mean hospital stay for Hispanics and non-Hispanics were analogous at 12.8 days and 12.9 days respectively. Intensive care unit admission rates were higher for Hispanics at 32.7% (186/568) in contrast to non-Hispanics at 28.3% (90/318) (p=0.171). Evaluation of 30 day mortality revealed that 14.2% (81/568) of Hispanic patients died compared to 17.9% (57/317) of non-Hispanic patients. (p=0.147). The bleeding rate was 4.8% in Hispanics and 3.8% in non-Hispanics. 59 (6.6%) patients experienced some form of thrombosis, which was dichotomized to show that 39 (6.8%) Hispanics and 20 (6.2%) non-Hispanics incurred thrombosis during hospitalization. 19.4% (18/93) of patients on therapeutic anticoagulation and 5.1% (34/657) of patients on prophylactic low dose anticoagulation developed thrombosis (P=0.00001). 30 day mortality was higher in patients receiving therapeutic vs low dose standard anticoagulation prophylaxis (20.4% Vs 14.5%. p=0.006). Thrombotic events transpired at 4.7% (22/464) in patients with initial d-dimer <2500 in comparison to 15.8% (19/120) of patients with values ≥2500 (p<0.001). Additionally, 30 day mortality was lower for patients with d-dimer < 2500 at 13.4% (62/464) than for patients with d-dimer ≥ 2500 at 30.8% (37/120) (p<0.001). Prothrombin time (PT) > 16 correlated with a higher incidence of thrombosis (17% vs 6.7%. p<0.001) and 30-day mortality (36% vs 15.9%. p <0.001). Similarly, 30 day mortality was increased in patients with ferritin > 1000 (22.7% vs 12.1%. p= 0.002). However, the same was not observed for ferritin levels and thrombosis. Conclusions: This study illuminates ethnic variances with respect to COVID-19 hospital outcomes. Hispanic patients were younger and had less risk factors or severe COVID-19 infections. Regardless of ethnic differences, incidence of thrombosis and 30 day mortality were similar. Despite sicker patients receiving therapeutic anticoagulation, the 30 day mortality and rate of thrombotic events remain higher among these patients. D-dimer ≥ 2500 and elevated PT were associated with higher rate of thrombosis and death. [Formula presented] Disclosures: Abdulhaq: BMS, Alexion, Oncopeptides, Morphosys, Pfizer, Norvartis: Honoraria;Oncopeptides, Alexion, Amgen: Speakers Bureau;Morphosys, BMS, Amgen: Membership on an entity's Board of Directors or advisory committees.

MIS-C at two tertiary hospitals in Cape Town, South Africa: clinical phenotype and distinguishing features from similar acute inflammatory conditions

Introduction: Distinguishing Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) from acute, pyrexial childhood illness can be challenging. We present a case series from two tertiary centres in Cape Town, South Africa and compare the clinical phenotype of MISC with mimicking systemic inflammatory disorders. Objectives: 1. Describe the clinical characteristics of children with MIS-C in the region. 2. Compare the clinical features of children with confirmed MIS-C to those who presented during the same period with suspected MIS-C and ultimately an alternative diagnosis of inflammatory or infective conditions (inflammatory controls). Methods: Children with MIS-C admitted to the Red Cross War Memorial Children's Hospital (RXH) and Tygerberg Hospital (TBH) between 22 June 2020 and 5 March 2021 were recruited. At RXH only, children with suspected MIS-C with an ultimate alternate diagnosis (inflammatory controls) were also recruited. Clinical data were collected. Results: During the time period, 70 children had confirmed MIS-C and 27 suspected MIS-C cases had an alternate diagnosis including typhoid, tuberculosis, sepsis and appendicitis among others. Sixty five percent of children with MIS-C had no SARS-CoV2 contact but all had evidence of SARS-CoV2 exposure by antibody (90%) or Polymerase Chain Reaction (PCR) tests (14%). There was no difference in age, sex or ethnic distribution between children with MIS-C and inflammatory controls (Table 1). The most common presenting features of MIS-C were fever (100%), tachycardia (99%), rash (86%), conjunctivitis (79%), and abdominal pain (60%). Compared to inflammatory controls, the presence of tachycardia, abdominal pain and conjunctivitis resulted in 96%;93% and 91% respectively increased odds of a diagnosis of MIS-C after controlling for all other presenting features. Compared to inflammatory controls, children with MIS-C had lower platelets, sodium and albumin and higher troponin-T and pro-brain natriuretic peptide (pro-BNP) (Table 1). The median minimum ejection fraction in MIS-C was lower than inflammatory controls (52% vs 63%, p=0.048). Ninety four percent of MIS-C patients received at least one dose of intravenous immunoglobulin (IVIG), 63% required methylprednisolone and 6% received IL-6 inhibition. Children with MIS-C were more commonly admitted to ICU compared to inflammatory controls (38% vs 12.5%, p=0.013) although there was no difference in mean hospital stay which was 8.2 days in MIS-C. There was no difference in requirement for inotropes (p=0.142) or ventilation (p=0.493). No children died. Conclusion: Distinguishing MIS-C from acute infectious or inflammatory causes of childhood fever may be challenging. The presence of conjunctivitis, tachycardia or abdominal pain associates with higher odds of MIS-C in this population. Differences in widely available blood tests like sodium, albumin and platelets may be useful to differentiate MIS-C in the acute setting.

Ethnic differences in thromboprophylaxis for COVID-19 patients: should they be considered?

Thromboembolic events contribute to morbidity and mortality in coronavirus disease 2019 (COVID-19). As a result, thromboprophylaxis using low-molecular-weight heparin (LMWH) is universally recommended for hospitalized patients based on multiple guidelines. However, ethnic differences with respect to thrombogenicity have been reported and the incidence of thromboembolic events is considered to be lower in the Asian population. Despite the importance of thromboprophylaxis, bleeding is also a side effect that should be considered. We examine the data relating to potential ethnic differences in thrombosis and bleeding in COVID-19. Although sufficient data is not yet available, current evidence does not oppose routine anticoagulant use and thromboprophylaxis using a standard dose of LMWH for admitted patients regardless of ethnicity based on our review.