Environmental justice indicators and endometrial cancer incidence: Associations with water quality, walkability and tumor molecular profiles

Gynecologic Oncology · 2026-04-23

P-728. Chlamydia and Gonorrhea Infections Are Associated with Hypertensive Disorders of Pregnancy

Open Forum Infectious Diseases · 2026-01-01

Abstract Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the U.S. Bacterial sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, may contribute to HDP through infection-induced inflammation affecting placental development. Evidence for this association remains limited, particularly in urban U.S. populations with routine STI screening. Methods We performed a retrospective cohort study using electronic medical records from two Penn Medicine hospitals in Philadelphia. We identified singleton deliveries from 2010–2022 with chlamydia/gonorrhea testing before 20 weeks gestation. The primary exposure was a positive initial test for chlamydia and/or gonorrhea. The primary outcome was HDP, defined as a composite of gestational hypertension, preeclampsia, eclampsia, or superimposed preeclampsia, based on ICD-9/10 codes. Multivariable logistic regression with generalized estimating equations adjusted for sociodemographic and clinical covariates. Results Among 25,387 pregnancies, 2.7% had a positive initial STI test. HDP occurred in 31.6% of the cohort. A positive initial STI test was associated with increased odds of HDP (adjusted odds ratio [aOR]: 1.23; 95% CI: 1.04–1.46). The association was driven largely by gestational hypertension (aOR: 1.21; 95% CI: 1.01–1.44). Chlamydia alone was significantly associated with HDP (aOR: 1.23; 95% CI: 1.03–1.47). Gonorrhea showed a similar but non-significant trend (aOR: 1.29; 95% CI: 0.84–1.99). No associations were observed for preterm birth or severe maternal morbidity. Findings were consistent in sensitivity analyses. Conclusion Early pregnancy diagnosis of chlamydia and possibly gonorrhea is associated with increased risk of HDP. These findings support further research into the role of maternal infection in HDP pathogenesis and may inform STI screening policies in pregnancy. Disclosures All Authors: No reported disclosures

Barriers to equity: Policy and system gaps in biomarker-driven gynecologic cancer trials across the U.S

Gynecologic Oncology · 2026-04-23

Abstract C025: Endometrial cancer mutation patterns by age with possible increased TP53 and decreased PTEN mutations in patients 50+ years old

Clinical Cancer Research · 2025-12-10

Abstract Introduction: Tumor molecular profiles have contributed to our understanding of the development and behavior of uterine cancer with varying mutational patterns across differing patient populations. Age is an important factor that may influence the microenvironment and molecular landscape of EC. Objectives: Our objective was to explore the relationships of the endometrial cancer (EC) biomarkers TP53, Her2, PTEN, PIK3CA, POle, CCNE1, and KRAS and their relationship with patient age <50 vs age ≥ 50 years old. Methods: The University Institutional Review Board reviewed and exempted this study. We identified patients diagnosed with EC between January 2014 – 2023 within the University of Pennsylvania Health System’s cancer registry and electronic medical record with tumor histology and molecular profile with institutional personalized diagnostics and CARIS Life Sciences©. Only those with confirmation of presence or absence of all mutations were included in this analysis. Analyses were stratified by patient age <50 and ≥50 years old threshold. Results: 3,418 patients were identified, and 211 patients were included in this analysis. 17(8%) were <50 years old and 194 (92%) patients were ≥50 years old. 51(24%) patients were identified as Black/Afr. Amer., 7(3%) Asian, 4 (2%) Other, and 149(71%) as White in their medical records. 102 (48%) were diagnosed at Stage I/II, 88(42%) at Stage III/IV and 21(10%) with an unknown stage. Patients with age ≥50 years old had a greater risk of TP53 mutation (OR 1.54; 95% CI: 1.21, 1.96; p=0.0005). There was no difference with regards to Her2 mutation status (OR=0.99; 95%CI: 0.89, 1.11; p=0.898). However, for PTEN, those ≥50 years old had a lower risk of PTEN mutations (OR=0.69, 95% CI: 0.54, 0.88; p=0.003). There was no difference in age risk for PIK3CA mutation (OR=1.12; 95%CI: 0.87, 1.43; p=0.38), POLe mutation (OR=1.13, 95%CI: 0.97, 1.32; p=0.13) and KRAS mutation (OR=1.04; 95%CI: 0.87, 1.24; p=0.69). No CCNE1 mutations were identified in this patient sample. Conclusions: Patients under <50 years were more likely to have PTEN mutation than patients ≥50 years old. Citation Format: Camille McCallister, Caroline Shermoen, Sneha Kadiyala, Anna Liu, Nathanael Koelper, Ronny Drapkin, Mary Boland, Emily Ko1, Kimberly Lee, Anna Jo Bodurtha Smith. Endometrial cancer mutation patterns by age with possible increased TP53 and decreased PTEN mutations in patients 50+ years old [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr C025.

Geospatial analysis of short sleep duration and cognitive disability in US adults: a multi-state study using machine learning techniques

BioData Mining · 2025-06-13

BACKGROUND: There is evidence of increased risk of cognitive disability due to short sleep duration and adverse Social Determinants of Health (SDoH). To determine whether spatial associations (correlation between spatially distributed variables within a given geographic area) exist between neighborhoods with short sleep duration and cognitive disability across the United States (US) after adjusting for other factors. We conducted a spatial analysis using a spatial lag model at the neighborhood-level with the census tract as unit-of-analysis within each state in the US. We aggregated our results nationally using a weighted analysis to adjust for the number of census tracts per state. This study used Centers for Disease Control and Prevention (CDC) data on short sleep duration, cognitive disability and other health factors. We used 2021-2022 neighborhood-level data from the CDC and US Census Bureau adjusting for social determinants of health (SDoH) and demographics, excluding Florida due to inconsistencies in data availability. Our exposure variable was self-reported short sleep defined by the CDC ("sleep less than 7 hours per 24 hour period"). Our outcome was self-reported cognitive disability defined by the CDC ("difficulty concentrating, remembering, or making decision"). We adjusted for other factors including 'health outcomes', 'preventive practices', and the CDC's Social Vulnerability Index. RESULTS: The spatial analysis revealed a significant association between short sleep duration and an increased risk of cognitive disability across the US (estimate range [0.29; 1.27], p < 0.005) after adjustment. Notably, six Western states (New Mexico, Alaska, Arizona, Nevada, Idaho, and Oregon) were at increased risk of cognitive disability due to short sleep duration and this pattern was significant (p = 0.007). CONCLUSIONS: Our study highlights the importance of short sleep duration as a significant predictor of cognitive disability across the US after adjusting for other confounders. The association between short sleep and cognitive disability was especially strong in the Western region of the US providing a deeper understanding of how geographic context and local factors can shape health outcomes.

Addressing disparities by implementing a supportive care program in oncology.

Journal of Clinical Oncology · 2025-05-28

11082 Background: Financial toxicity, transportation needs, and emotional strain are known barriers to receipt of cancer care and cause for disparities in cancer outcomes. We sought to evaluate the implementation of a supportive care program (SCP) on the delivery of cancer care, its associated health care utilization outcomes and cost. Methods: From May 2022-Nov 2024, SCP included a standardized social determinant of health (SDOH) screening tool, financial navigation, transportation ridesharing, and peer-support program in the 5 gynecologic oncology practices within a NCI Comprehensive Cancer Center. Patients were referred through the SDOH screener or usual clinical care referrals. We report descriptive statistics on the mechanism for referral for SCP, associated health care utilization, and costs. We assessed differences in SCP financial and transportation sub-groups with bivariable non-parametric testing (p-value&lt; .05 considered statistically significant). Results: Of 7159 patients encompassing 22041 encounters, 259 received SCP (41 financial navigation, 177 transportation, 3 transportation + financial navigation, 18 peer-support program). Only 73 (28.7%) were referred through the SDOH screening tool, and the rest through usual clinical care. Most SCP recipients (60.6%) were Black/Asian/Other, in contrast to our general clinical population (63% White). Only 65 (25.6%) of SCP patients were employed, and 72.8% had Medicare or Medicaid. Nearly all SCP patients resided in the MidAtlantic tristate area. Patients receiving financial navigation were younger (p&lt;0.001), more likely to be privately insured (p&lt;0.001), and less likely to reside in the metropolitan area (43.9% v. 63.8%, p=0.05) compared to those receiving transportation. A total of 1770 rides were completed, costing $51885.20 which included the ride and administrative scheduling fee. A total of 14 SCP participants were clinical trial participants; of these, 78.6% utilized transportation assistance. Following receipt of SCP, the total scheduled visits for SCP patients included 7768 visits. Patients receiving transportation assistance had higher rates of unplanned admission (43.5% v. 22.0%, p=0.011), and no-show rates (4.6% vs 1.2%, p&lt;0.001) compared to those receiving financial navigation. Conclusions: Our SCP served primarily racial-minority and publicly insured patients. Only 25% were employed during active cancer treatment. Transportation was the most frequently used SCP service, including by our clinical trial participants. Patients with transportation needs had higher rates of unplanned admissions and no-shows than those receiving financial navigation. Financial toxicity affected younger patients including those privately insured. SCP facilitates cancer care delivery, but requires infrastructural development, substantial investment in resources, and further analyses of health care utilization, outcomes and cost.

Determining the Importance of Clinical Modalities for NeuroDegenerative Disorders and Risk of Patient Injury Using Machine Learning and Survival Analysis.

PubMed · 2025-01-01

Falls among the elderly and especially those with NeuroDegenerative Disorders (NDD) reduces life expectancy. The purpose of this study is to explore the role of Machine Learning on Electronic Health Records (EHR) data for time-to-event survival analysis prediction of injuries, and role of sensitive attributes, e.g., Race, Ethnicity, Sex, in these models. We used multiple survival analysis methods on a cohort of 29,045 patients 65 years and older treated at PennMedicine for either NDD, Mild Cognitive Impairment (MCI), or another disease. We compare the algorithms and explore the role of multiple modalities on improving prediction of injuries among NDD patients, specifically medications and laboratory tests. Overall, we found that medication features resulted in either increased Hazard Ratios (HR) or reduced HR depending on the NDD type. We found that being of Black race significantly increased the risk offall/injury in the models that included only medication and sensitive attribute features. The combined model that used both modalities (medications and laboratory information) removed this relationship between being of Black race and increases in fall/injury. Therefore, we found that combining modalities in these survival models in the prediction offall/injury risk among NDD and MCI individuals results in findings that are robust to different Racial and Ethnic groups with no biases apparent in our final combined modality results. Furthermore, combining modalities (both medications and laboratory values) improved the survival analysis performance across multiple survival analysis methods, when compared using the C-index.

Integrating Social Determinants of Health in a Multi-Modal Deep Clustering Survival Model for Injury-Risk in Alzheimer’s and Related Dementia Patients

PubMed Central · 2025-02-01

Risk of Mortality Among Adult Females Diagnosed with Traumatic Brain Injury in an Academic Medical System

Neurotrauma Reports · 2025-10-08

The objective of this retrospective cohort study was to evaluate mortality risk over five years among 6,432 female patients with a health care encounter diagnosis of TBI from hospitals and outpatient clinics within a university health system. We used TBI severity, defined by the Centers for Disease Control and Department of Defense/Veterans Affairs: mild, moderate/severe/penetrating, indeterminate severity. To determine patient death, we used death in a Penn Medicine facility and linkage to the Social Security Death Index. We used Cox proportional hazards models adjusted for age at the time of TBI diagnosis, race, and encounter type to estimate associations of TBI severity with mortality risk. We evaluated interactions with encounter type and age, and stratified results by inpatient/outpatient and age group (≥65 years). Median age was 47 years (25th–75th percentiles: 29–63). Patients were most commonly self-reported White race ( n = 4,126, 64.0%), and diagnosed at an outpatient encounter ( n = 5,099, 79.3%; among them, 1–2% urgent/emergent). Median follow-up time was 4.22 years (IQR, 2.3–4.9 years). Overall, 2.9% ( n = 185) of patients died within five years of injury. Compared with mild TBI, mortality risk over five years was 2.06 times higher (95% CI = 1.27–3.33) for moderate/severe/penetrating TBI, and 1.54 times higher (95% CI = 0.98–2.42) for indeterminate TBI. Associations were attenuated among females with inpatient encounter type and those aged 65 years or older. Our results demonstrate that TBI severity affects survival among females, and this differs by encounter type and age. Findings motivate future, more focused research into the dynamics of TBI among females.

Improving disparities by implementing a supportive care program: Population served, health care utilization and cost

Gynecologic Oncology · 2025-09-01