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Dr. Justin Xavier Moore is an epidemiologist with two specific research interests, which include: 1) examining racial, socioeconomic, and geographic disparities in diseases including cancer and infectious disease; and 2) examining the association between cancer survivorship and risk of infection and sepsis. He is interested in conducting future research in the prevention of excess cancer deaths and infection-related deaths caused by race, place, or social class. Dr. Moore uses a variety of novel epidemiologic methods to examine how community and personal level factors are associated with cancer mortality and sepsis infection. Dr. Moore is skilled in epidemiologic study design and methodology, survival analysis, mediation analysis, complex survey design and methods, geospatial information systems (GIS) analysis, GEE models, and much more.
In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97–5.26–91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99–27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.
Justin Moore; Keon Gilbert; Katie Lively; Christian Laurent; Rishab Chawla; Cynthia Li; Ryan Johnson; Robert Petcu; Mehul Mehra; Antron Spooner; Ravindra Kolhe; Christy Ledford. Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States. Vaccines 2021, 9, 879 .
AMA StyleJustin Moore, Keon Gilbert, Katie Lively, Christian Laurent, Rishab Chawla, Cynthia Li, Ryan Johnson, Robert Petcu, Mehul Mehra, Antron Spooner, Ravindra Kolhe, Christy Ledford. Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States. Vaccines. 2021; 9 (8):879.
Chicago/Turabian StyleJustin Moore; Keon Gilbert; Katie Lively; Christian Laurent; Rishab Chawla; Cynthia Li; Ryan Johnson; Robert Petcu; Mehul Mehra; Antron Spooner; Ravindra Kolhe; Christy Ledford. 2021. "Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States." Vaccines 9, no. 8: 879.
BACKGROUND Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to cancer survivors. However, little is known about website use in this population or its associations with healthy lifestyle changes. OBJECTIVE To describe lifestyle intervention website use (logins, time on website, and clicks) among cancer survivors, as well as patterns of use by participant characteristics. Additionally, associations were explored between website use and changes in healthy lifestyle knowledge and practice. METHODS Thirty-five cancer survivors participated in a single-arm pilot test of the SurvivorSHINE website. Knowledge and practices related to healthful diet and physical activity behaviors were measured at baseline and follow-up. Website use (e.g., time spent on the website, frequency of logins, webpage visits, and clicks) were collected from the SurvivorSHINE administrative site during a 2-week intervention period. Patterns of use were examined by participants’ gender and race. Associations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Independent t-tests were used to compare website use between males and females, and Non-Hispanic Whites (NHW) and Blacks (NHB). Pearson correlations were used to examine associations between website use and behavior change. RESULTS Participants logged into the SurvivorSHINE website an average of 3.2 times (SD = 2) over the 2-week period and spent a total average of 94 minutes (SD = 56 minutes). Examining website activity, 1905 clicks were logged. The user profile (344 clicks) and the home sections (301 clicks) were the most visited components. No associations were observed between the frequency of logins or the total time on the website and improvements in knowledge-related to healthy lifestyles, nor in changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r = 0.74, p = 0.02), as well as self-reported physical activity (r = 0.35, p = 0.047). CONCLUSIONS Cancer survivors demonstrated clear interest in a diet and exercise website as evidenced by their frequency of logins, clicks on numerous features, and total viewing time. Moreover, increased website usage was correlated with improvements in physical activity. CLINICALTRIAL NCT00303875, NCT00630591 INTERNATIONAL REGISTERED REPORT RR2-10.1007/s13187-021-02026-x
Victoria Williams; Nashira Brown; Justin Xavier Moore; David Farrell; Suzanne Perumean-Chaney; Erica Schleicher; Kevin Fontaine; Wendy Demark-Wahnefried; Dori Pekmezi. Lifestyle Intervention Website Use and Associated Participant Characteristics and Behavior Change among Cancer Survivors (Preprint). 2021, 1 .
AMA StyleVictoria Williams, Nashira Brown, Justin Xavier Moore, David Farrell, Suzanne Perumean-Chaney, Erica Schleicher, Kevin Fontaine, Wendy Demark-Wahnefried, Dori Pekmezi. Lifestyle Intervention Website Use and Associated Participant Characteristics and Behavior Change among Cancer Survivors (Preprint). . 2021; ():1.
Chicago/Turabian StyleVictoria Williams; Nashira Brown; Justin Xavier Moore; David Farrell; Suzanne Perumean-Chaney; Erica Schleicher; Kevin Fontaine; Wendy Demark-Wahnefried; Dori Pekmezi. 2021. "Lifestyle Intervention Website Use and Associated Participant Characteristics and Behavior Change among Cancer Survivors (Preprint)." , no. : 1.
Objective: To examine county-level factors associated with coronavirus disease 2019 (COVID-19) incidence and mortality in Georgia, focusing on changes after relaxation of “shelter-in-place” orders on April 24, 2020.Methods: County-level data on confirmed COVID-19 cases and deaths were obtained from the Johns Hopkins 2019 Novel Coronavirus Data Repository and linked with county-level data from the 2020 County Health Rankings. We examined associations of county-level factors with mortality and incidence rates (quantiles) using a logistic regression model. This research was conducted in June–July 2020 in Augusta, GA.Results: Counties in the highest quartile for mortality had higher proportions of non-Hispanic (NH)-Black residents (median: 37.4%; interquartile range [IQR]: 29.5–45.0; p<0.01) and residents with incomes less than $20,000 (median: 32.9%; IQR: 26.6–35.0; p<0.01). Counties in the highest quartile for NH-Black residents (38.7–78.0% NH-Black population) showed a 13-fold increase in odds (odds ratio=13.15, 95% confidence interval=1.40–123.80, p=0.05) for increased COVID-19 mortality controlling for income.Conclusions: Although highlighted by the pandemic, racial disparities predated COVID-19, exposing the urgency for diversion of resources to address the systematic residential segregation, educational gaps, and poverty levels experienced disproportionately by Black communities.
Grace Porter; Koosh Desai; Varghese George; Steven S. Coughlin; Justin Xavier Moore. Racial Disparities in the Epidemiology of COVID-19 in Georgia: Trends Since State-Wide Reopening. Health Equity 2021, 5, 91 -99.
AMA StyleGrace Porter, Koosh Desai, Varghese George, Steven S. Coughlin, Justin Xavier Moore. Racial Disparities in the Epidemiology of COVID-19 in Georgia: Trends Since State-Wide Reopening. Health Equity. 2021; 5 (1):91-99.
Chicago/Turabian StyleGrace Porter; Koosh Desai; Varghese George; Steven S. Coughlin; Justin Xavier Moore. 2021. "Racial Disparities in the Epidemiology of COVID-19 in Georgia: Trends Since State-Wide Reopening." Health Equity 5, no. 1: 91-99.
Objective While emphasized in clinical practice, the association between advanced airway insertion first-pass success (FPS) and patient outcomes is incompletely understood. We sought to determine the association of airway insertion FPS with adult out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). Methods We performed a secondary analysis of PART, a multicenter clinical trial comparing LT and ETI upon adult OHCA outcomes. We defined FPS as successful LT insertion or ETI on the first attempt as reported by EMS personnel. We examined the outcomes return of spontaneous circulation (ROSC), 72 -h survival, hospital survival, and hospital survival with favorable neurologic status (Modified Rankin Scale ≤3). Using multivariable GEE (generalized estimating equations), we determined the association between FPS and OHCA outcomes, adjusting for age, sex, witnessed arrest, bystander CPR, initial rhythm, and initial airway type. Results Of 3,004 patients enrolled in the trial, 1,423 received LT, 1,227 received ETI, 354 received bag-valve-mask ventilation only. FPS was: LT 86.2% and ETI 46.7%. FPS was associated with increased ROSC (aOR 1.23; 95%CI: 1.07-1.41)), but not 72 -h survival (1.22; 0.94-1.58), hospital survival (0.90; 0.68-1.19) or hospital survival with favorable neurologic status (0.66; 0.37-1.19). Conclusion In adult OHCA, airway insertion FPS was associated with increased ROSC but not other OHCA outcomes. The influence of airway insertion FPS upon OHCA outcomes is unclear.
Jason A. Lesnick; Justin X. Moore; Yefei Zhang; Jeffrey Jarvis; Graham Nichol; Mohamud R. Daya; Ahamed H. Idris; Cameron Klug; David Dennis; Jestin N. Carlson; Pratik Doshi; George Sopko; Robert H. Schmicker; Henry E. Wang. Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial. Resuscitation 2020, 158, 151 -156.
AMA StyleJason A. Lesnick, Justin X. Moore, Yefei Zhang, Jeffrey Jarvis, Graham Nichol, Mohamud R. Daya, Ahamed H. Idris, Cameron Klug, David Dennis, Jestin N. Carlson, Pratik Doshi, George Sopko, Robert H. Schmicker, Henry E. Wang. Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial. Resuscitation. 2020; 158 ():151-156.
Chicago/Turabian StyleJason A. Lesnick; Justin X. Moore; Yefei Zhang; Jeffrey Jarvis; Graham Nichol; Mohamud R. Daya; Ahamed H. Idris; Cameron Klug; David Dennis; Jestin N. Carlson; Pratik Doshi; George Sopko; Robert H. Schmicker; Henry E. Wang. 2020. "Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial." Resuscitation 158, no. : 151-156.
Background Black women living in southern states have the highest breast cancer mortality rate in the United States. The prognosis of de novo metastatic breast cancer is poor. Given these mortality rates, we are the first to link nationally representative data on breast cancer mortality hot spots (counties with high breast cancer mortality rates) with cancer mortality data in the United States and investigate the association of geographic breast cancer mortality hot spots with de novo metastatic breast cancer mortality among Black women. Methods We identified 7292 Black women diagnosed with de novo metastatic breast cancer in Surveillance, Epidemiology, and End Results (SEER). The county-level characteristics were obtained from 2014 County Health Rankings and linked to SEER. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality between hot spot and non–hot spot counties. Results Among 7292 patients, 393 (5.4%) resided in breast cancer mortality hot spots. Women residing in hot spots had similar risks of breast cancer–specific mortality (aHR = 0.99, 95% CI = 0.85 to 1.15) and all-cause mortality (aHR = 0.97, 95% CI = 0.84 to 1.11) as women in non–hot spots after adjusting for individual and tumor-level factors and treatments. Additional adjustment for county-level characteristics did not impact mortality. Conclusion Living in a breast cancer mortality hot spot was not associated with de novo metastatic breast cancer mortality among Black women. Future research should begin to examine variation in both individual and population-level determinants, as well as in molecular and genetic determinants that underlie the aggressive nature of de novo metastatic breast cancer.
Yunan Han; Marvin Langston; Lindsay Fuzzell; Saira Khan; Marquita W Lewis-Thames; Graham A Colditz; Justin Xavier Moore. Breast Cancer Mortality Hot Spots Among Black Women With de Novo Metastatic Breast Cancer. JNCI Cancer Spectrum 2020, 5, pkaa086 .
AMA StyleYunan Han, Marvin Langston, Lindsay Fuzzell, Saira Khan, Marquita W Lewis-Thames, Graham A Colditz, Justin Xavier Moore. Breast Cancer Mortality Hot Spots Among Black Women With de Novo Metastatic Breast Cancer. JNCI Cancer Spectrum. 2020; 5 (1):pkaa086.
Chicago/Turabian StyleYunan Han; Marvin Langston; Lindsay Fuzzell; Saira Khan; Marquita W Lewis-Thames; Graham A Colditz; Justin Xavier Moore. 2020. "Breast Cancer Mortality Hot Spots Among Black Women With de Novo Metastatic Breast Cancer." JNCI Cancer Spectrum 5, no. 1: pkaa086.
The pandemic of novel Coronavirus (SARS-CoV-2) is currently spreading rapidly across the United States. We provide a comprehensive overview of COVID-19 epidemiology across the state of Texas, which includes vast rural & vulnerable communities that may be disproportionately impacted by the spread of this new disease. All 254 Texas counties were included in this study. We examined the geographic variation of COVID-19 from March 1 through April 8, 2020 by extracting data on incidence and case fatality from various national and state datasets. We contrasted incidence and case fatality rates by county-level demographic and healthcare resource factors. Counties which are part of metropolitan regions, such as Harris and Dallas, experienced the highest total number of confirmed cases. However, the highest incidence rates per 100,000 population were in found in counties of Donley (353.5), Castro (136.4), Matagorda (114.4) and Galveston (93.4). Among counties with greater than 10 cases, the highest CFR were observed in counties of Comal (10.3%), Hockley (10%), Hood (10%), and Castro (9.1%). Counties with the highest CFR (> 10%) had a higher proportion of non-Hispanic Black residents, adults aged 65 and older, and adults smoking, but lower number of ICU beds per 100,000 population, and number of primary care physicians per 1000 population. Although the urban areas of Texas account for the majority of COVID-19 cases, the higher case-fatality rates and low health care capacity in rural areas need attention.
Swapnil Khose; Justin Xavier Moore; Henry E. Wang. Epidemiology of the 2020 Pandemic of COVID-19 in the State of Texas: The First Month of Community Spread. Journal of Community Health 2020, 45, 696 -701.
AMA StyleSwapnil Khose, Justin Xavier Moore, Henry E. Wang. Epidemiology of the 2020 Pandemic of COVID-19 in the State of Texas: The First Month of Community Spread. Journal of Community Health. 2020; 45 (4):696-701.
Chicago/Turabian StyleSwapnil Khose; Justin Xavier Moore; Henry E. Wang. 2020. "Epidemiology of the 2020 Pandemic of COVID-19 in the State of Texas: The First Month of Community Spread." Journal of Community Health 45, no. 4: 696-701.
Objectives: Novel Coronavirus (COVID‐19) is a global pandemic currently spreading rapidly across the United States. We provide a comprehensive look at COVID‐19 epidemiology across the state of Georgia, which includes vast rural communities that may be disproportionately impacted by the spread of this infectious disease. Methods: All 159 Georgia counties were included in this study. We examined the geographic variation of COVID‐19 in Georgia from March 3 through April 24, 2020 by extracting data on incidence and mortality from various national and state datasets. We contrasted county‐level mortality rates per 100,000 population (MRs) by county‐level factors. Results: Metropolitan Atlanta had the overall highest number of confirmed cases, however, the southwestern rural parts of Georgia, surrounding the city of Albany, had the highest bi‐weekly increases in incidence rate. Among counties with greater than 10 cases, MRs were highest in the rural counties of Randolph (233.2), Terrell (182.5), Early (136.3), and Dougherty (114.2). Counties with the highest MRs (22.5 – 2332 per 100,000) had a higher proportion of: non‐Hispanic Blacks residents, adults aged 60+, adults earning less than $20,000 annually, and residents living in rural communities when compared to counties with lower MRs. These counties also had a lower proportion of the population with a college education, lower number of ICU beds per 100,000 population, and lower number of primary care physicians per 10,000 population. Conclusions: While urban centers in Georgia account for the bulk of COVID‐19 cases, high mortality rates and low critical care capacity in rural Georgia are also of critical concern. This article is protected by copyright. All rights reserved
Justin Xavier Moore; Marvin Langston; Varghese George; Steven S. Coughlin. Epidemiology of the 2020 pandemic of COVID‐19 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread. Journal of the American College of Emergency Physicians Open 2020, 1, 527 -532.
AMA StyleJustin Xavier Moore, Marvin Langston, Varghese George, Steven S. Coughlin. Epidemiology of the 2020 pandemic of COVID‐19 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread. Journal of the American College of Emergency Physicians Open. 2020; 1 (4):527-532.
Chicago/Turabian StyleJustin Xavier Moore; Marvin Langston; Varghese George; Steven S. Coughlin. 2020. "Epidemiology of the 2020 pandemic of COVID‐19 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread." Journal of the American College of Emergency Physicians Open 1, no. 4: 527-532.
It is unclear how resting myocardial workload, as indexed by baseline measures of rate-pressure product (RPP) and physical activity (PA), is associated with the overall risk of cancer mortality. We performed prospective analyses among 28,810 men and women from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We used a novel physical health (PH) composite index and categorized participants into one of four groups based on combinations from self-reported PA and RPP: 1) No PA and High RPP; 2) No PA and Low RPP; 3) Yes PA and High RPP; and 4) Yes PA and Low RPP. We examined the association between baseline PH composite and cancer mortality adjusted for potential confounders using Cox regression. A total of 1191 cancer deaths were observed over the 10-year observation period, with the majority being lung (26.87%) and gastrointestinal (21.49%) cancers. Even after controlling for sociodemographics, health behaviors, baseline comorbidity score, and medications, participants with No PA and High RPP had 71% greater risk of cancer mortality when compared to participants with PA and Low RPP (adjusted HR: 1.71, 95% CI: 1.42–2.06). These associations persisted after examining BMI, smoking, income, and gender as effect modifiers and all-cause mortality as a competing risk. Poorer physical health composite, including the novel RPP metric, was associated with a nearly 2-fold long-term risk of cancer mortality. The physical health composite has important public health implications as it provides a measure of risk beyond traditional measure of obesity and physical activity.
Justin Xavier Moore; Stephen J. Carter; Victoria Williams; Saira Khan; Marquita W. Lewis-Thames; Keon Gilbert; George Howard. Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study. Preventive Medicine 2020, 132, 105989 -105989.
AMA StyleJustin Xavier Moore, Stephen J. Carter, Victoria Williams, Saira Khan, Marquita W. Lewis-Thames, Keon Gilbert, George Howard. Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study. Preventive Medicine. 2020; 132 ():105989-105989.
Chicago/Turabian StyleJustin Xavier Moore; Stephen J. Carter; Victoria Williams; Saira Khan; Marquita W. Lewis-Thames; Keon Gilbert; George Howard. 2020. "Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study." Preventive Medicine 132, no. : 105989-105989.
Steven S. Coughlin; Catherine Clary; J. Aaron Johnson; Adam Berman; Vahe Heboyan; Teal Benevides; Justin Xavier Moore; Varghese George. Continuing Challenges in Rural Health in the United States. 2019, 5, 90 -92.
AMA StyleSteven S. Coughlin, Catherine Clary, J. Aaron Johnson, Adam Berman, Vahe Heboyan, Teal Benevides, Justin Xavier Moore, Varghese George. Continuing Challenges in Rural Health in the United States. . 2019; 5 (2):90-92.
Chicago/Turabian StyleSteven S. Coughlin; Catherine Clary; J. Aaron Johnson; Adam Berman; Vahe Heboyan; Teal Benevides; Justin Xavier Moore; Varghese George. 2019. "Continuing Challenges in Rural Health in the United States." 5, no. 2: 90-92.
Adults living in rural areas, compared to their urban counterparts, are at an increased risk of using tobacco-related products and mortality due to tobacco-related diseases. The harms and benefits of e-cigarette use are mixed, and similarly obscure messaging about these harms and benefits have a critical influence on e-cigarette uptake and perceptions. However, little is known about rural-urban differences in the prevalence of adult e-cigarette daily usage. Using the Health Information National Trends Survey-Food and Drug Administration (HINTS-FDA) cycles 1 and 2, we conducted weighted logistic regressions to assess rural-urban differences in the prevalence of adult e-cigarette daily usage, perceived harm, and e-cigarette information seeking behaviors. This analysis included adults aged 18 years and older in the United States (N = 4229). Both rural and urban respondents reported a similar history of e-cigarette use. Rural respondents were significantly more likely than urban respondents to trust religious organizations and leaders and tobacco companies for information about e-cigarettes. Rural and urban respondents were equally as likely to believe e-cigarettes are addictive, perceive e-cigarette use as harmful, and believe e-cigarettes are more harmful than tobacco cigarettes. Respondents were equally as likely to look for information on e-cigarettes, the health effects of e-cigarettes, and cessation; and, to seek e-cigarette information from healthcare professionals, family and friends, and health organizations and groups. Given our findings, it will be pertinent to continue to research the potential harms of e-cigarette use and develop accurate health communication messages to avoid rural-urban disparities observed for cigarette smoking-related outcomes.
Marquita W. Lewis-Thames; Marvin Langston; Lindsay Fuzzell; Saira Khan; Justin Xavier Moore; Yunan Han. Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study. Preventive Medicine 2019, 130, 105898 -105898.
AMA StyleMarquita W. Lewis-Thames, Marvin Langston, Lindsay Fuzzell, Saira Khan, Justin Xavier Moore, Yunan Han. Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study. Preventive Medicine. 2019; 130 ():105898-105898.
Chicago/Turabian StyleMarquita W. Lewis-Thames; Marvin Langston; Lindsay Fuzzell; Saira Khan; Justin Xavier Moore; Yunan Han. 2019. "Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study." Preventive Medicine 130, no. : 105898-105898.
Background and objectivesapo L1 (APOL1) nephropathy risk alleles are associated with CKD in blacks. Although APOL1 has innate immune functions, little is known about the association of APOL1 genotypes with risk of infectious outcomes, such as sepsis. The objective of this study was to examine the associations of APOL1 nephropathy risk alleles with risk of sepsis in black adults.Design, setting, participants, & measurementsWe assessed the association of APOL1 risk alleles with incident sepsis in 10,366 black participants of the Reasons for Geographic and Racial Differences in Stroke study enrolled between 2003 and 2007 with follow-up through December 31, 2012. In Cox models adjusted for demographics, comorbid conditions, and principal components ancestry, we examined the association of APOL1 risk alleles with incident sepsis using recessive (comparing zero or one versus two risk alleles), dominant (zero versus one or two risk alleles), and additive genetic models. We also examined models stratified by diabetes and CKD status.ResultsA total of 1320 (13%) participants had two APOL1 risk alleles, 4719 (46%) had one risk allele, and 4327 (42%) participants had zero risk alleles. A total of 306 sepsis events occurred over a median 6.5 years (interquartile range, 4.5–8.1). There were no statistically significant associations of APOL1 genotype with sepsis risk under recessive genetic models. APOL1 genotypes were associated with sepsis risk under dominant (hazard ratio, 1.55; 95% confidence interval, 1.13 to 2.11) and additive (hazard ratio per variant allele copy, 1.25; 95% confidence interval, 1.02 to 1.53) genetic models adjusted for covariates and ancestry. These associations did not vary by diabetes or CKD status (Pinteraction>0.10 for both).ConclusionsIn community-dwelling black adults, carriage of APOL1 nephropathy risk alleles are common and associated with higher risk of sepsis.
Ninad S. Chaudhary; Justin Xavier Moore; Neil A. Zakai; Suzanne E. Judd; Rakhi P. Naik; Sophie Limou; Mary Cushman; Leslie A. Lange; Henry E. Wang; Cheryl A. Winkler; Marguerite R. Irvin; Jeffrey B. Kopp; Orlando M. Gutiérrez. APOL1 Nephropathy Risk Alleles and Risk of Sepsis in Blacks. Clinical Journal of the American Society of Nephrology 2019, 14, 1733 -1740.
AMA StyleNinad S. Chaudhary, Justin Xavier Moore, Neil A. Zakai, Suzanne E. Judd, Rakhi P. Naik, Sophie Limou, Mary Cushman, Leslie A. Lange, Henry E. Wang, Cheryl A. Winkler, Marguerite R. Irvin, Jeffrey B. Kopp, Orlando M. Gutiérrez. APOL1 Nephropathy Risk Alleles and Risk of Sepsis in Blacks. Clinical Journal of the American Society of Nephrology. 2019; 14 (12):1733-1740.
Chicago/Turabian StyleNinad S. Chaudhary; Justin Xavier Moore; Neil A. Zakai; Suzanne E. Judd; Rakhi P. Naik; Sophie Limou; Mary Cushman; Leslie A. Lange; Henry E. Wang; Cheryl A. Winkler; Marguerite R. Irvin; Jeffrey B. Kopp; Orlando M. Gutiérrez. 2019. "APOL1 Nephropathy Risk Alleles and Risk of Sepsis in Blacks." Clinical Journal of the American Society of Nephrology 14, no. 12: 1733-1740.
Background: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as “cancer survivors” and those without a history of cancer as “no cancer history.” We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. Results: There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. Conclusion: Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.
Justin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer. Journal of Intensive Care Medicine 2019, 35, 1546 -1555.
AMA StyleJustin Xavier Moore, Tomi Akinyemiju, Alfred Bartolucci, Henry E. Wang, John Waterbor, Russell Griffin. A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer. Journal of Intensive Care Medicine. 2019; 35 (12):1546-1555.
Chicago/Turabian StyleJustin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. 2019. "A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer." Journal of Intensive Care Medicine 35, no. 12: 1546-1555.
Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups. Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments. Among 454,154 patients (73.0% White, 10.0% Black, 7.8% Asian/PI, and 9.2% Hispanic), 54.3% had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95% CI 1.37–1.44) in Black women, 0.82 (95% CI 0.79–0.85) in Asian women, and 1.05 (95% CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95% CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality. Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.
Yunan Han; Justin Xavier Moore; Marvin Langston; Lindsay Fuzzell; Saira Khan; Marquita W. Lewis; Graham Colditz; Ying Liu. Do breast quadrants explain racial disparities in breast cancer outcomes? Cancer Causes & Control 2019, 30, 1171 -1182.
AMA StyleYunan Han, Justin Xavier Moore, Marvin Langston, Lindsay Fuzzell, Saira Khan, Marquita W. Lewis, Graham Colditz, Ying Liu. Do breast quadrants explain racial disparities in breast cancer outcomes? Cancer Causes & Control. 2019; 30 (11):1171-1182.
Chicago/Turabian StyleYunan Han; Justin Xavier Moore; Marvin Langston; Lindsay Fuzzell; Saira Khan; Marquita W. Lewis; Graham Colditz; Ying Liu. 2019. "Do breast quadrants explain racial disparities in breast cancer outcomes?" Cancer Causes & Control 30, no. 11: 1171-1182.
This study examines the association between inflammatory biomarkers and risk of cancer mortality by race. Data were obtained from 1,856 participants in the prospective REGARDS cohort who were cancer-free at baseline, and analyzed in relation to cancer mortality prospectively. Biomarkers were log-transformed and categorized into tertiles due to non-normal distributions, and Cox proportional hazard regression models were utilized to compute hazard ratios with 95% confidence intervals using robust sandwich methods. Individuals in the highest tertile of IL-6 had over a 12-fold increased risk of cancer mortality (HR: 12.97, 95% CI: 3.46-48.63); those in the highest tertile of IL-8 had over a 2-fold increased risk of cancer mortality (HR: 2.21, 95% CI: 0.86-5.71), while those in the highest tertile of IL-10 had over a 3-fold increased risk of cancer mortality (HR: 3.06, 95% CI: 1.35-6.89). In race-stratified analysis, each unit increase in IL-6 was associated with increased risk of cancer mortality among African-Americans (HR: 3.88, 95% CI: 1.17-12.88) and Whites (5.25, 95% CI: 1.24-22.31). If replicated in larger, racially diverse prospective cohorts, these results suggest that cancer patients may benefit from clinical or lifestyle approaches to regulate systemic inflammation as a cancer prevention strategy.
Tomi Akinyemiju; Justin Xavier Moore; Daniel Tefera Dibaba; Maria Pisu; Michael Goodman; Virginia J. Howard; Monika Safford; Susan C. Gilchrist; Mary Cushman; Leann Long; Suzanne E. Judd. Association of baseline inflammatory biomarkers with cancer mortality in the REGARDS cohort. Oncotarget 2019, 10, 4857 -4867.
AMA StyleTomi Akinyemiju, Justin Xavier Moore, Daniel Tefera Dibaba, Maria Pisu, Michael Goodman, Virginia J. Howard, Monika Safford, Susan C. Gilchrist, Mary Cushman, Leann Long, Suzanne E. Judd. Association of baseline inflammatory biomarkers with cancer mortality in the REGARDS cohort. Oncotarget. 2019; 10 (47):4857-4867.
Chicago/Turabian StyleTomi Akinyemiju; Justin Xavier Moore; Daniel Tefera Dibaba; Maria Pisu; Michael Goodman; Virginia J. Howard; Monika Safford; Susan C. Gilchrist; Mary Cushman; Leann Long; Suzanne E. Judd. 2019. "Association of baseline inflammatory biomarkers with cancer mortality in the REGARDS cohort." Oncotarget 10, no. 47: 4857-4867.
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and utilization of health information and in cancer-related beliefs and behaviors. Methods: We used data from the Health Information National Trends Survey 5, Cycle 1 conducted from January 25 through May 5, 2017. Using survey-weighted logistic regression, we explored potential differences in health information-seeking behavior, trusted sources of health care information, engagement with the health care system, awareness of cancer risk factors, cancer fatalism, cancer-related health behaviors, and historical cancer screening between 117 LGB and 2857 heterosexual respondents. Results: LGB respondents were more likely to report looking for information about health or medical topics than heterosexual respondents (adjusted odds ratio [aOR]: 3.12; confidence interval [95% CI]: 1.07-9.06), but less likely to seek health information first from a doctor (aOR: 0.17; 95% CI: 0.06-0.50) after adjusting for age, race, and sex. LGB persons were less likely to report that they trust receiving health or medical information from friends and family and more likely to be worried about getting cancer (aOR: 2.30; 95% CI: 1.04-5.05). Conclusions: Our findings indicate a growing need for the production of tailored cancer prevention and control materials for members of sexual minority groups. More work is needed to understand barriers that LGB populations face in accessing this health information and building informative social support networks.
Marvin E. Langston; Lindsay Fuzzell; Marquita W. Lewis-Thames; Saira Khan; Justin X. Moore. Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States. LGBT Health 2019, 6, 192 -201.
AMA StyleMarvin E. Langston, Lindsay Fuzzell, Marquita W. Lewis-Thames, Saira Khan, Justin X. Moore. Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States. LGBT Health. 2019; 6 (4):192-201.
Chicago/Turabian StyleMarvin E. Langston; Lindsay Fuzzell; Marquita W. Lewis-Thames; Saira Khan; Justin X. Moore. 2019. "Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States." LGBT Health 6, no. 4: 192-201.
Elevated proprotein convertase subtilisin/kexin type 9 (PCSK9) levels have been associated with adverse outcomes in patients hospitalized for sepsis. PCSK9 loss-of-function (LOF) variants area associated with lower low-density lipoprotein cholesterol (LDL-C) levels. Decreased LDL-C is a biomarker of acute and chronic infection and sepsis risk. We examined the association between presence of two genetic PCSK9 LOF variants and risk of infection and sepsis in community-dwelling adults. We analyzed data from 10,924 Black participants tested for PCSK9 LOF variants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary endpoint was hospitalization for a serious infection. Within serious infection hospitalizations, we defined sepsis as ≥2 system inflammatory response syndrome criteria. Using multivariable Cox and logistic regression, we investigated the association between LOF variants and hospitalization for infection and sepsis events, adjusting for sociodemographics, health behaviors, chronic medical conditions and select biomarkers. Among 10,924 Black participants, PCSK9 LOF variants were present in 244 (2.2%). Serious infection hospitalizations occurred in 779 participants (14 with PCSK9 variants and 765 without). The presence of PCSK9 variants was not associated with infection risk (adjusted HR 0.68; 95% CI: 0.38–1.25). Among participants hospitalized for a serious infection, the presence of PCSK9 variants was not associated with sepsis (adjusted OR 7.31; 95% CI = 0.91–58.7). PCSK9 LOF variants are not associated with increased risk of hospitalization for a serious infection. Among those hospitalized for a serious infection, PCSK9 LOF variants was not associated with odds of sepsis.
Kellie A. Mitchell; Justin Xavier Moore; Robert S. Rosenson; Ryan Irvin; Faheem W. Guirgis; Nathan Shapiro; Monika Safford; Henry E. Wang. PCSK9 loss-of-function variants and risk of infection and sepsis in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. PLOS ONE 2019, 14, e0210808 .
AMA StyleKellie A. Mitchell, Justin Xavier Moore, Robert S. Rosenson, Ryan Irvin, Faheem W. Guirgis, Nathan Shapiro, Monika Safford, Henry E. Wang. PCSK9 loss-of-function variants and risk of infection and sepsis in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. PLOS ONE. 2019; 14 (2):e0210808.
Chicago/Turabian StyleKellie A. Mitchell; Justin Xavier Moore; Robert S. Rosenson; Ryan Irvin; Faheem W. Guirgis; Nathan Shapiro; Monika Safford; Henry E. Wang. 2019. "PCSK9 loss-of-function variants and risk of infection and sepsis in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort." PLOS ONE 14, no. 2: e0210808.
Lumbar puncture (LP) is an important technique for assessing and treating neurological symptoms. The objective of this study was to describe the characteristics of diagnostic lumbar punctures performed on hospitalized patients in the United States. We analyzed data from the 2010 National Inpatient Sample (NIS) and the National Emergency Department Survey (NEDS). We included patients treated in the Emergency Department (ED) as well as those admitted to an inpatient bed through the ED. We identified patients undergoing LPs from ICD-9 procedural code 03.31 and CPT code 62270. We generated nationally weighted estimates of the total number of LPs. We also assessed patient and hospital characteristics of cases undergoing LP. Of an estimated 135 million hospitalizations (ED + admission, or ED only), there were an estimated 362,718 LPs (331,248–394,188), including 273,612 (251,850–295,375) among adults and 89,106 (71,870–106,342) among children (<18 years old). Of the 362,718 LPs, 136,764 (122,117–151,410) were performed in the ED without admission. The most common conditions associated with LP among children were fever of unknown origin, meningitis, seizures and other perinatal conditions. The most common conditions associated with LP among adults were headache and meningitis. Lumbar Puncture remains an important procedure for diagnostic and therapeutic uses in United States Hospitals.
Adrienne Vickers; John Donnelly; Justin Xavier Moore; Scott R. Barnum; Theresa N. Schein; Henry E. Wang. Epidemiology of lumbar punctures in hospitalized patients in the United States. PLOS ONE 2018, 13, e0208622 .
AMA StyleAdrienne Vickers, John Donnelly, Justin Xavier Moore, Scott R. Barnum, Theresa N. Schein, Henry E. Wang. Epidemiology of lumbar punctures in hospitalized patients in the United States. PLOS ONE. 2018; 13 (12):e0208622.
Chicago/Turabian StyleAdrienne Vickers; John Donnelly; Justin Xavier Moore; Scott R. Barnum; Theresa N. Schein; Henry E. Wang. 2018. "Epidemiology of lumbar punctures in hospitalized patients in the United States." PLOS ONE 13, no. 12: e0208622.
The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics. We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity. Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care. We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.
Justin Xavier Moore; Kendra J. Royston; Marvin E. Langston; Russell Griffin; Bertha Hidalgo; Henry E. Wang; Graham Colditz; Tomi Akinyemiju. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes & Control 2018, 29, 737 -750.
AMA StyleJustin Xavier Moore, Kendra J. Royston, Marvin E. Langston, Russell Griffin, Bertha Hidalgo, Henry E. Wang, Graham Colditz, Tomi Akinyemiju. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes & Control. 2018; 29 (8):737-750.
Chicago/Turabian StyleJustin Xavier Moore; Kendra J. Royston; Marvin E. Langston; Russell Griffin; Bertha Hidalgo; Henry E. Wang; Graham Colditz; Tomi Akinyemiju. 2018. "Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics." Cancer Causes & Control 29, no. 8: 737-750.
Background: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. Results: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. Conclusion: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.
Justin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer. Journal of Intensive Care Medicine 2018, 35, 708 -719.
AMA StyleJustin Xavier Moore, Tomi Akinyemiju, Alfred Bartolucci, Henry E. Wang, John Waterbor, Russell Griffin. Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer. Journal of Intensive Care Medicine. 2018; 35 (7):708-719.
Chicago/Turabian StyleJustin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. 2018. "Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer." Journal of Intensive Care Medicine 35, no. 7: 708-719.
Hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to patients with no cancer history. We compared the risk of sepsis between cancer survivors and no cancer history participants, and examined whether race was an effect modifier. We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer (adjusted for sociodemographics, health behaviors, and comorbidities), and stratified by race. Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29–2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for Black and White participants (p value for race and cancer interaction = 0.63). In this prospective cohort of community-dwelling adults we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis. Public health efforts should attempt to mitigate sepsis risk by awareness and appropriate treatment (e.g., antibiotic administration) to cancer survivors with suspected infection regardless of the number of years since cancer remission.
Justin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiology 2018, 55, 30 -38.
AMA StyleJustin Xavier Moore, Tomi Akinyemiju, Alfred Bartolucci, Henry E. Wang, John Waterbor, Russell Griffin. A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiology. 2018; 55 ():30-38.
Chicago/Turabian StyleJustin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E. Wang; John Waterbor; Russell Griffin. 2018. "A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort." Cancer Epidemiology 55, no. : 30-38.