associated with high-risk patients without HBV vaccination or screening. Results: 232 highrisk patients were included in the study. Patient demographics age ranged from 20-76 (SD: 13.5), and mean BMI: 27.4 kg/m2 (SD: 6.1; range: 15.2-56.4). The most commonly reported high-risk conditions were diabetes (51%), CKD/ESRD (34%), and chronic liver disease (26%). Cardiovascular comorbidities included HTN (57%), HLD (35%), and CAD (19%). 98 (42%) patients had documented hepatitis B serology. There were no significant differences in serological testing rates between races or gender (P>0.05). Rates of PCP (median: 1 vs 2 visits/year; P=0.20) or emergency department (median: 0 vs 0 visits/year; P=0.18) visits were also similar between groups. Patients without hepatitis B serology available were more likely to be older (67 vs 60 years) and lack private health insurance (21% vs 65%; all P<0.05). They were also more likely to have hypertension (71% vs 46%), diabetes (75% vs 35%), coronary artery disease (29% vs 13%), or hyperlipidemia (46% vs 28%; all P<0.05). They were less likely to have been seen by a gastroenterologist (18% vs 60%; P<0.001), undergone hepatitis C screening (20% vs 86%; P<0.001), or received hepatitis A vaccination (0% vs 21%; P=0.10). Multiple logistic regressions revealed that a history of hepatitis C screening was independently associated with having hepatitis B serology (odds ratio: 41.9; 95% CI: 8.28-211; P<0.001). Conclusion: In our study we found that high-risk patients are not adequately screened for hepatitis B or vaccinated. Educating primary care physicians on who should receive HBV vaccination could increase compliance with current CDC guidelines.
AGA Abstracts
Table 1. Baseline Characteristics of the Study Participants.
UC = Ulcerative Colitis, CD = Crohn's Disease, NS = Not Significant
Su1009 THE ASSOCIATION BETWEEN RACE AND THE PREVALENCE OF COLORECTAL CANCER USING THE BRFSS 2014 SURVEY Rachel Dayno, Adam C. Ehrlich, Frank K. Friedenberg Purpose: Colorectal cancer (CRC) is the third leading cause of cancer in the United States. The routine use of screening colonoscopy has led to earlier detection of cancerous lesions and a reduction of CRC incidence and mortality. Inconsistent data have suggested that African Americans have a higher prevalence of CRC and develop CRC at a younger age. Our purpose was to analyze data collected in the Behavioral Risk Factor Surveillance System (BRFSS) to identify whether there is an independent association between race and CRC. Methods: BRFSS telephone interviews are conducted yearly by the CDC. BRFSS primarily queries preventative health practices and risk behaviors related to chronic diseases including malignancy. A stratified sample of ~500,000 interviews are conducted and weighted data is used to provide national estimates. Data collected in the BRFSS questionnaire during 2014 analyzed with SPSS v22 to weigh data after restricting our analysis to participants aged 18-80. Results: After weighting, procedures the sample size included 248,482,532 participants. Mean age was 46.9 years with 48.6% male. The self-reported prevalence of CRC was 78,820 (~32/100,000). In the overall sample, there were 64.4% non-Hispanic White (NHW) and 11.6% non-Hispanic Black (NHB) participants. In the CRC subset, the distribution was 91.3% NHW and 3.4% NHB. Similarly, in the CRC subgroup ≤ 65 years, there were 87.7% NHW and 3.4% NHB. The mean age of patients with CRC was equivalent for NHW and NHB. For all patients ≥ 50 years, 70.1% of NHW and 65.8% of NHB had a colonoscopy or sigmoidoscopy during the preceding 5 years. For the subgroup of patients at any age with CRC, 98.0% of NHW and 78.9% of NHB had a colonoscopy or sigmoidoscopy during the preceding 5 years. Logistic regression assessed independent predictors of prevalent CRC. NHB race was found to be protective (OR = 0.28; 0.27-0.29). Female gender (1.17; 1.16-1.19), increasing age (9.1%/year; 9.0-9.2%), and increasing BMI [BMI 25-30 (1.50; 1.40-1.59), BMI > 30 (2.08; 1.96-2.22)] were also independent risk factors. Adjusting for smoking status did not impact the OR values. The analysis was repeated in the subset ≤ 65 years and the independent protective effect of NHB status was even higher (0.19; 0.170.20). Conclusions: Data from BRFSS 2014 demonstrates lower than expected prevalence of CRC in NHB participants. NHB status was found to be independently protective after controlling for available confounders; however, we caution that this finding may be due to a systematic error in sampling as according to SEER, the US prevalence of CRC was significantly higher than the estimate from BRFSS for the same time period. Therefore, we can conclude that for the subset of US CRC participants sampled by BRFSS, NHB participants had lower odds of prevalent CRC even after controlling for relevant and available confounders.
Su1011 TRENDS IN STATIN PRESCRIPTIONS AMONG PATIENTS WITH CHRONIC LIVER DISEASE AS MEASURED BY THE NATIONAL AMBULATORY MEDICAL CARE SURVEY Vishwas Vanar, Nikhil Kalva, Jinma Ren, Sonu Dhillon Background: A growing number of patients with metabolic syndrome and hyperlipidemia have spectrum of non-alcoholic steatohepatitis (NASH) and receive statins for primary or secondary cardiovascular disease prevention. Although clinically significant liver injury is extremely rare with statin use, asymptomatic transient elevations in liver enzymes are relatively common. Risk for drug induced liver injury with statins has become a source of concern for prescribing physicians despite consensus to the contrary among hepatologists' regarding their overall safety and potential benefits. Our study aims to assess the trends in prescription rates for statins among patients with chronic liver disease (CLD) and identify the determinants of statins prescription among patients with CLD. Methods: The National Ambulatory Medical Care Survey uses a three-stage probability sampling procedure to allow extrapolation to the US population. All visits from approximately 3,000 office-based physicians between 2006 and 2013 were included. ICD9 code (571.xx) was used for CLD diagnoses. All currently FDA approved statin medications were combined into a single categorical variable. Weighted data was used for descriptive and statistical analysis. Following a univariate analysis, a multivariable logistic regression model was used to identify the predictors of statins use. Results: A total of 316,495 visits were recorded for all diagnosis before weighing, including 494 (1.7%) visits for CLD. The rates of statins prescription and office visit for CLD remained relatively stable throughout the examined period (figure 1). For patients with CLD, multivariable analysis showed that statins prescription was not associated with age, gender, race, insurance type, smoking status or physician specialty (internal medicine, neurology, cardiology vs others). However, patients with CLD in Northeast (OR 7.27, p = 0.03) and Midwest (OR 5.72, p = 0.001) were more likely to be prescribed statins when compared to the West. Patients with private insurance (OR 4.05, p = 0.03) and Medicare (OR 5.96, p = 0.02) had higher prescription rates. CLD patients with comorbidities such as ischemic heart disease (OR 12.03, p = 0.006), dyslipidemia (OR 7.23, p = 0.03), congestive heart failure (OR 8.32, p < 0.001) and obesity (OR 2.04, p = 0.02) were more likely to receive statins than those without comorbidities. Conclusions: Rate of prescription of statins among patients with CLD appears to be stable and parallels that of the general population. Trends demonstrate favorable prescription pattern for statins even in patients with CLD. Comorbidities significantly increase the likelihood of statins use among patients with CLD.
Su1010 CLINICAL FACTORS ASSOCIATED WITH HIGH-RISK PATIENTS WHO HAVE NOT UNDERGONE HEPATITIS B SCREENING: DATA FROM TWO LARGE ACADEMIC HOSPITALS IN AN URBAN SETTING Rotimi Ayoola, Sebastian Larion, Rachana H. Koya, Phaniram Sumanam, Darsan Patel, Renee Williams Introduction: The CDC recommends that all high-risk patients be vaccinated for hepatitis B (HBV) and receive post-vaccination serologic testing to prevent disease transmission. However, population vaccination rates in high-risk patients in the practice setting are unknown. Many patients fail to undergo proper vaccination followed by post-vaccination screening with viral serology. We aimed to identify independent clinical factors associated with high-risk patients who have not undergone hepatitis B vaccination or screening using data from two large academic hospitals in an urban setting. Methods: A retrospective casecohort study was performed of consecutive high-risk patients presenting at two urban academic hospitals between 2010-2016. Patients were considered high-risk if their medical history included IVDU, high-risk sexual activity, HIV, chronic liver disease, chronic kidney disease/end-stage renal disease, or diabetes. HBV screening was considered when HBV serology was documented in the patient EMR. Exclusion criteria were patients with a history of previous HBV infection. Multiple logistic regression analysis was used to identify factors
AGA Abstracts
Rate of prescription of statins
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