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HPV Vaccine Reduces Immune Disease Risk in Women
TOPLINE: Human Papillomavirus (HPV) vaccination is associated with reduced risks of rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes among females aged 9 to 45 years. The analysis of 208,638 vaccinated individuals shows particularly strong protective effects in those aged 9 to 26 years and recipients of 9-valent HPV vaccines.
METHODOLOGY:
Researchers analyzed data from the US Collaborative Network in TriNetX spanning January 1, 2018, to December 20, 2022, enrolling 208,638 females aged 9 to 45 years who received HPV vaccination and matching them with 208,638 unvaccinated individuals using propensity scores.
Analysis included Cox proportional hazard regression to estimate hazard ratios and 95% CIs for immune-mediated diseases, with subgroup analyses stratified by age, race, smoking, obesity, asthma, and HPV vaccine types.
Participants were monitored from 31 days up to 365 days following their respective index dates, with sensitivity analyses conducted to evaluate short-term outcomes and compare results with influenza virus vaccine recipients.
TAKEAWAY:
HPV vaccination demonstrated reduced risks for rheumatoid arthritis (hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.311-0.762), systemic lupus erythematosus (HR, 0.287; 95% CI, 0.179-0.460), and dermatomyositis (HR, 0.299; 95% CI, 0.098-0.908).
Recipients showed lower risks for inflammatory bowel disease (HR, 0.876; 95% CI, 0.811-0.946), celiac disease (HR, 0.400; 95% CI, 0.304-0.526), and type 1 diabetes (HR, 0.242; 95% CI, 0.184-0.318).
Subgroup analyses revealed significant risk reductions among females aged 9 to 26 years and those receiving 9-valent HPV vaccines compared to unvaccinated populations.
White and Black/African American individuals demonstrated reduced risks for various immune-mediated diseases, while Asians showed lower risks only for inflammatory bowel disease and overall immune-mediated diseases.
SOURCE: The study was led by Qianru Zhang, MD, Beijing Tsinghua Changgung Hospital in Beijing, China, James Cheng-Chung Wei, and Shiow-Ing Wang who contributed equally as first authors. It was published online in QJM: An International Journal of Medicine.
LIMITATIONS: According to the authors, research relying on Electronic Health Records (EHR) faced several constraints, including the absence of serial data on HPV antibody titers in vaccinated individuals and limited data regarding vaccination dosing numbers. Additionally, the current functionality of TriNetX prevented performing interaction terms in the statistical model for comprehensive subgroup analysis stratified by age, race, and vaccine types.
DISCLOSURES: The study received support from Chung Shan Medical University Hospital (Grant No. CSH-2023-E-001-Y2), Kaohsiung Veterans General Hospital (KSVGH 113-117), National Science and Technology Council (NSTC 112-2314-B-075B-020), and KSVNSU112-008. The funders had no role in the study's design, conduct, data analysis, or manuscript approval.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: Human Papillomavirus (HPV) vaccination is associated with reduced risks of rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes among females aged 9 to 45 years. The analysis of 208,638 vaccinated individuals shows particularly strong protective effects in those aged 9 to 26 years and recipients of 9-valent HPV vaccines.
METHODOLOGY:
Researchers analyzed data from the US Collaborative Network in TriNetX spanning January 1, 2018, to December 20, 2022, enrolling 208,638 females aged 9 to 45 years who received HPV vaccination and matching them with 208,638 unvaccinated individuals using propensity scores.
Analysis included Cox proportional hazard regression to estimate hazard ratios and 95% CIs for immune-mediated diseases, with subgroup analyses stratified by age, race, smoking, obesity, asthma, and HPV vaccine types.
Participants were monitored from 31 days up to 365 days following their respective index dates, with sensitivity analyses conducted to evaluate short-term outcomes and compare results with influenza virus vaccine recipients.
TAKEAWAY:
HPV vaccination demonstrated reduced risks for rheumatoid arthritis (hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.311-0.762), systemic lupus erythematosus (HR, 0.287; 95% CI, 0.179-0.460), and dermatomyositis (HR, 0.299; 95% CI, 0.098-0.908).
Recipients showed lower risks for inflammatory bowel disease (HR, 0.876; 95% CI, 0.811-0.946), celiac disease (HR, 0.400; 95% CI, 0.304-0.526), and type 1 diabetes (HR, 0.242; 95% CI, 0.184-0.318).
Subgroup analyses revealed significant risk reductions among females aged 9 to 26 years and those receiving 9-valent HPV vaccines compared to unvaccinated populations.
White and Black/African American individuals demonstrated reduced risks for various immune-mediated diseases, while Asians showed lower risks only for inflammatory bowel disease and overall immune-mediated diseases.
SOURCE: The study was led by Qianru Zhang, MD, Beijing Tsinghua Changgung Hospital in Beijing, China, James Cheng-Chung Wei, and Shiow-Ing Wang who contributed equally as first authors. It was published online in QJM: An International Journal of Medicine.
LIMITATIONS: According to the authors, research relying on Electronic Health Records (EHR) faced several constraints, including the absence of serial data on HPV antibody titers in vaccinated individuals and limited data regarding vaccination dosing numbers. Additionally, the current functionality of TriNetX prevented performing interaction terms in the statistical model for comprehensive subgroup analysis stratified by age, race, and vaccine types.
DISCLOSURES: The study received support from Chung Shan Medical University Hospital (Grant No. CSH-2023-E-001-Y2), Kaohsiung Veterans General Hospital (KSVGH 113-117), National Science and Technology Council (NSTC 112-2314-B-075B-020), and KSVNSU112-008. The funders had no role in the study's design, conduct, data analysis, or manuscript approval.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: Human Papillomavirus (HPV) vaccination is associated with reduced risks of rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes among females aged 9 to 45 years. The analysis of 208,638 vaccinated individuals shows particularly strong protective effects in those aged 9 to 26 years and recipients of 9-valent HPV vaccines.
METHODOLOGY:
Researchers analyzed data from the US Collaborative Network in TriNetX spanning January 1, 2018, to December 20, 2022, enrolling 208,638 females aged 9 to 45 years who received HPV vaccination and matching them with 208,638 unvaccinated individuals using propensity scores.
Analysis included Cox proportional hazard regression to estimate hazard ratios and 95% CIs for immune-mediated diseases, with subgroup analyses stratified by age, race, smoking, obesity, asthma, and HPV vaccine types.
Participants were monitored from 31 days up to 365 days following their respective index dates, with sensitivity analyses conducted to evaluate short-term outcomes and compare results with influenza virus vaccine recipients.
TAKEAWAY:
HPV vaccination demonstrated reduced risks for rheumatoid arthritis (hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.311-0.762), systemic lupus erythematosus (HR, 0.287; 95% CI, 0.179-0.460), and dermatomyositis (HR, 0.299; 95% CI, 0.098-0.908).
Recipients showed lower risks for inflammatory bowel disease (HR, 0.876; 95% CI, 0.811-0.946), celiac disease (HR, 0.400; 95% CI, 0.304-0.526), and type 1 diabetes (HR, 0.242; 95% CI, 0.184-0.318).
Subgroup analyses revealed significant risk reductions among females aged 9 to 26 years and those receiving 9-valent HPV vaccines compared to unvaccinated populations.
White and Black/African American individuals demonstrated reduced risks for various immune-mediated diseases, while Asians showed lower risks only for inflammatory bowel disease and overall immune-mediated diseases.
SOURCE: The study was led by Qianru Zhang, MD, Beijing Tsinghua Changgung Hospital in Beijing, China, James Cheng-Chung Wei, and Shiow-Ing Wang who contributed equally as first authors. It was published online in QJM: An International Journal of Medicine.
LIMITATIONS: According to the authors, research relying on Electronic Health Records (EHR) faced several constraints, including the absence of serial data on HPV antibody titers in vaccinated individuals and limited data regarding vaccination dosing numbers. Additionally, the current functionality of TriNetX prevented performing interaction terms in the statistical model for comprehensive subgroup analysis stratified by age, race, and vaccine types.
DISCLOSURES: The study received support from Chung Shan Medical University Hospital (Grant No. CSH-2023-E-001-Y2), Kaohsiung Veterans General Hospital (KSVGH 113-117), National Science and Technology Council (NSTC 112-2314-B-075B-020), and KSVNSU112-008. The funders had no role in the study's design, conduct, data analysis, or manuscript approval.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Agent Orange Exposure and Genetic Factors Independently Raise Risk for Multiple Lymphoma Types
TOPLINE: A large-scale case-control study using the Million Veteran Program (MVP) found The study found independent associations of both genetic predisposition and Agent Orange (AO) exposure for several lymphoid malignant neoplasm subtypes.
METHODOLOGY:
A case-control study included 255,155 US veterans enrolled in the MVP with available genotype, Agent Orange exposure information, and lymphoid malignant neoplasm diagnosis from January 1, 1965, through June T1, 2024.
Analysis focused on non-Hispanic White veterans (median age 67 years; 92.5% male) due to ancestry distribution requirements for genome-wide association studies data availability.
Researchers excluded 628 samples across all lymphoid malignant neoplasm groups and 61,343 control samples due to unavailability of AO exposure information.
Investigators analyzed risk for chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma as primary outcomes.
TAKEAWAY:
Agent Orange exposure was associated with increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).
Polygenic risk scores showed significant associations with all subtypes: chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93), diffuse large B-cell lymphoma (OR, 1.12; 95% CI, 1.02-1.21), follicular lymphoma (OR, 1.33; 95% CI, 1.21-1.47), marginal zone lymphoma (OR, 1.17; 95% CI, 1.04-1.32), and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).
No significant polygenic risk score and AO exposure interactions were observed in the development of any lymphoid malignant neoplasm subtypes.
The researchers found independent associations of both genetic predisposition and Agent Orange exposure on several lymphoid malignant neoplasm subtypes.
IN PRACTICE:
"Our study addressed the public health concerns surrounding AO exposure and lymphoid malignant neoplasms, finding that both AO exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation,” the authors wrote.
SOURCE: The study was led by Xueyi Teng, PhD, Department of Biological Chemistry, School of Medicine, University of California in Irvine, and Helen Ma, MD, Tibor Rubin Veterans Affairs Medical Center in Long Beach. It was published online in JAMA Network Open.
LIMITATIONS: According to the authors, while this represents the largest study of Agent Orange exposure and genetic risk in lymphoid malignant neoplasm development, the power to find interaction associations in specific subtypes might be limited. Self-reported AO exposure may have introduced survival bias, especially in aggressive subtypes, as patients with aggressive tumors might have died before joining the MVP. Additionally, approximately half of the patients were diagnosed with lymphoid malignant neoplasm before self-reporting AO exposure in the survey, potentially introducing recall bias.
DISCLOSURES: Xueyi Teng, PhD, reported receiving grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the conduct of the study. The research was supported by grant MVPOOO and Veterans Affairs Career Development Award 1IK2CX002437-O1A1. No other disclosures were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: A large-scale case-control study using the Million Veteran Program (MVP) found The study found independent associations of both genetic predisposition and Agent Orange (AO) exposure for several lymphoid malignant neoplasm subtypes.
METHODOLOGY:
A case-control study included 255,155 US veterans enrolled in the MVP with available genotype, Agent Orange exposure information, and lymphoid malignant neoplasm diagnosis from January 1, 1965, through June T1, 2024.
Analysis focused on non-Hispanic White veterans (median age 67 years; 92.5% male) due to ancestry distribution requirements for genome-wide association studies data availability.
Researchers excluded 628 samples across all lymphoid malignant neoplasm groups and 61,343 control samples due to unavailability of AO exposure information.
Investigators analyzed risk for chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma as primary outcomes.
TAKEAWAY:
Agent Orange exposure was associated with increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).
Polygenic risk scores showed significant associations with all subtypes: chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93), diffuse large B-cell lymphoma (OR, 1.12; 95% CI, 1.02-1.21), follicular lymphoma (OR, 1.33; 95% CI, 1.21-1.47), marginal zone lymphoma (OR, 1.17; 95% CI, 1.04-1.32), and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).
No significant polygenic risk score and AO exposure interactions were observed in the development of any lymphoid malignant neoplasm subtypes.
The researchers found independent associations of both genetic predisposition and Agent Orange exposure on several lymphoid malignant neoplasm subtypes.
IN PRACTICE:
"Our study addressed the public health concerns surrounding AO exposure and lymphoid malignant neoplasms, finding that both AO exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation,” the authors wrote.
SOURCE: The study was led by Xueyi Teng, PhD, Department of Biological Chemistry, School of Medicine, University of California in Irvine, and Helen Ma, MD, Tibor Rubin Veterans Affairs Medical Center in Long Beach. It was published online in JAMA Network Open.
LIMITATIONS: According to the authors, while this represents the largest study of Agent Orange exposure and genetic risk in lymphoid malignant neoplasm development, the power to find interaction associations in specific subtypes might be limited. Self-reported AO exposure may have introduced survival bias, especially in aggressive subtypes, as patients with aggressive tumors might have died before joining the MVP. Additionally, approximately half of the patients were diagnosed with lymphoid malignant neoplasm before self-reporting AO exposure in the survey, potentially introducing recall bias.
DISCLOSURES: Xueyi Teng, PhD, reported receiving grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the conduct of the study. The research was supported by grant MVPOOO and Veterans Affairs Career Development Award 1IK2CX002437-O1A1. No other disclosures were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: A large-scale case-control study using the Million Veteran Program (MVP) found The study found independent associations of both genetic predisposition and Agent Orange (AO) exposure for several lymphoid malignant neoplasm subtypes.
METHODOLOGY:
A case-control study included 255,155 US veterans enrolled in the MVP with available genotype, Agent Orange exposure information, and lymphoid malignant neoplasm diagnosis from January 1, 1965, through June T1, 2024.
Analysis focused on non-Hispanic White veterans (median age 67 years; 92.5% male) due to ancestry distribution requirements for genome-wide association studies data availability.
Researchers excluded 628 samples across all lymphoid malignant neoplasm groups and 61,343 control samples due to unavailability of AO exposure information.
Investigators analyzed risk for chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, and multiple myeloma as primary outcomes.
TAKEAWAY:
Agent Orange exposure was associated with increased risk for chronic lymphocytic leukemia (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), diffuse large B-cell lymphoma (OR, 1.26; 95% CI, 1.03-1.53), follicular lymphoma (OR, 1.71; 95% CI, 1.39-2.11), and multiple myeloma (OR, 1.58; 95% CI, 1.35-1.86).
Polygenic risk scores showed significant associations with all subtypes: chronic lymphocytic leukemia (OR, 1.81; 95% CI, 1.70-1.93), diffuse large B-cell lymphoma (OR, 1.12; 95% CI, 1.02-1.21), follicular lymphoma (OR, 1.33; 95% CI, 1.21-1.47), marginal zone lymphoma (OR, 1.17; 95% CI, 1.04-1.32), and multiple myeloma (OR, 1.41; 95% CI, 1.31-1.52).
No significant polygenic risk score and AO exposure interactions were observed in the development of any lymphoid malignant neoplasm subtypes.
The researchers found independent associations of both genetic predisposition and Agent Orange exposure on several lymphoid malignant neoplasm subtypes.
IN PRACTICE:
"Our study addressed the public health concerns surrounding AO exposure and lymphoid malignant neoplasms, finding that both AO exposure and polygenic risk are independently associated with disease, suggesting potentially distinct and additive pathways that merit further investigation,” the authors wrote.
SOURCE: The study was led by Xueyi Teng, PhD, Department of Biological Chemistry, School of Medicine, University of California in Irvine, and Helen Ma, MD, Tibor Rubin Veterans Affairs Medical Center in Long Beach. It was published online in JAMA Network Open.
LIMITATIONS: According to the authors, while this represents the largest study of Agent Orange exposure and genetic risk in lymphoid malignant neoplasm development, the power to find interaction associations in specific subtypes might be limited. Self-reported AO exposure may have introduced survival bias, especially in aggressive subtypes, as patients with aggressive tumors might have died before joining the MVP. Additionally, approximately half of the patients were diagnosed with lymphoid malignant neoplasm before self-reporting AO exposure in the survey, potentially introducing recall bias.
DISCLOSURES: Xueyi Teng, PhD, reported receiving grants from the George E. Hewitt Foundation for Medical Research Postdoc Fellowship during the conduct of the study. The research was supported by grant MVPOOO and Veterans Affairs Career Development Award 1IK2CX002437-O1A1. No other disclosures were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Housing Program Expansion Opens Doors to More Veterans
TOPLINE:Expanding United States Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) eligibility to veterans with other-than-honorable (OTH) discharge significantly increased their program enrollments without impacting services for those with honorable discharge. Emergency department visits increased for honorable discharge veterans while hospitalizations rose for both groups.
METHODOLOGY:
- A quality improvement study following SQUIRE 2.0 reporting guidelines analyzed data from 129,873 veterans enrolled in HUD-VASH between June 1, 2019, and September 30, 2021.
- Analysis included 127,876 veterans (98.5%) with honorable/general discharge and 1997 veterans (1.5%) with OTH discharge, with a mean age of 53.7 years.
- Researchers utilized an interrupted time series design to compare program enrollments and healthcare utilization before (June 2019-December 2020) and after (January 2021-September 2021) policy implementation.
- Data linkage between the Homeless Operations and Management Evaluation System database and VA Corporate Data Warehouse enabled tracking of emergency department visits, hospitalizations, and primary care visits.
TAKEAWAY:
- Monthly HUD-VASH enrollments showed a significant increase for OTH veterans after the policy change (difference in slopes, 1.90; 95% confidence interval [CI], 1.28-2.52), while honorable/general veterans experienced a non-significant increase (difference in slopes, 9.23; 95% CI, −20.35-38.79).
- Emergency department visits demonstrated a significant increase for honorable/general veterans (change in slope, 0.24; 95% CI, 0.12-0.35) but not for OTH veterans (change in slope, 0.08;
95% CI, −0.12-0.28). - Hospitalizations significantly increased for both OTH veterans (change in slope, 0.098; 95% CI, 0.009-0.170) and honorable/general veterans (change in slope, 0.078; 95% CI, 0.004-0.060).
- Primary care visits showed no significant changes for either group after the policy implementation (OTH: change in slope, −0.12; 95% CI, −0.65-0.42; honorable/general: change in slope, 0.20;
95% CI, −0.13-0.53).
IN PRACTICE:“Expanding HUD-VASH eligibility increased access to housing and social support for OTH veterans without disrupting services for those with honorable discharges,” the authors reported. “Efforts should focus on improving access to connecting OTH veterans with clinical services outside of HUD-VASH.”
SOURCE:The study was led by Thomas F. Nubong, MD, Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center in Providence. It was published online on August 5 in JAMA Network Open.
LIMITATIONS: According to the authors, the study period overlapped with the COVID-19 pandemic, potentially affecting results. Additionally, staff training on the policy change varied across US Department of Veterans Affairs (VA) sites, introducing implementation inconsistencies. The single-group interrupted time series design, while effective for tracking temporal trends, limited formal comparisons between discharge groups.
DISCLOSURES: The analyses were conducted under the VA Homeless Programs Office with operational funding support. Jack Tsai, PhD, and Eric Jutkowitz, PhD, reported being principal investigators of a VA Merit study on the Impact of COVID-19 for the HUD-VASH program. James L. Rudolph, MD, reported receiving grants from Icosavax outside the submitted work and being a United States government employee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:Expanding United States Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) eligibility to veterans with other-than-honorable (OTH) discharge significantly increased their program enrollments without impacting services for those with honorable discharge. Emergency department visits increased for honorable discharge veterans while hospitalizations rose for both groups.
METHODOLOGY:
- A quality improvement study following SQUIRE 2.0 reporting guidelines analyzed data from 129,873 veterans enrolled in HUD-VASH between June 1, 2019, and September 30, 2021.
- Analysis included 127,876 veterans (98.5%) with honorable/general discharge and 1997 veterans (1.5%) with OTH discharge, with a mean age of 53.7 years.
- Researchers utilized an interrupted time series design to compare program enrollments and healthcare utilization before (June 2019-December 2020) and after (January 2021-September 2021) policy implementation.
- Data linkage between the Homeless Operations and Management Evaluation System database and VA Corporate Data Warehouse enabled tracking of emergency department visits, hospitalizations, and primary care visits.
TAKEAWAY:
- Monthly HUD-VASH enrollments showed a significant increase for OTH veterans after the policy change (difference in slopes, 1.90; 95% confidence interval [CI], 1.28-2.52), while honorable/general veterans experienced a non-significant increase (difference in slopes, 9.23; 95% CI, −20.35-38.79).
- Emergency department visits demonstrated a significant increase for honorable/general veterans (change in slope, 0.24; 95% CI, 0.12-0.35) but not for OTH veterans (change in slope, 0.08;
95% CI, −0.12-0.28). - Hospitalizations significantly increased for both OTH veterans (change in slope, 0.098; 95% CI, 0.009-0.170) and honorable/general veterans (change in slope, 0.078; 95% CI, 0.004-0.060).
- Primary care visits showed no significant changes for either group after the policy implementation (OTH: change in slope, −0.12; 95% CI, −0.65-0.42; honorable/general: change in slope, 0.20;
95% CI, −0.13-0.53).
IN PRACTICE:“Expanding HUD-VASH eligibility increased access to housing and social support for OTH veterans without disrupting services for those with honorable discharges,” the authors reported. “Efforts should focus on improving access to connecting OTH veterans with clinical services outside of HUD-VASH.”
SOURCE:The study was led by Thomas F. Nubong, MD, Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center in Providence. It was published online on August 5 in JAMA Network Open.
LIMITATIONS: According to the authors, the study period overlapped with the COVID-19 pandemic, potentially affecting results. Additionally, staff training on the policy change varied across US Department of Veterans Affairs (VA) sites, introducing implementation inconsistencies. The single-group interrupted time series design, while effective for tracking temporal trends, limited formal comparisons between discharge groups.
DISCLOSURES: The analyses were conducted under the VA Homeless Programs Office with operational funding support. Jack Tsai, PhD, and Eric Jutkowitz, PhD, reported being principal investigators of a VA Merit study on the Impact of COVID-19 for the HUD-VASH program. James L. Rudolph, MD, reported receiving grants from Icosavax outside the submitted work and being a United States government employee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE:Expanding United States Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) eligibility to veterans with other-than-honorable (OTH) discharge significantly increased their program enrollments without impacting services for those with honorable discharge. Emergency department visits increased for honorable discharge veterans while hospitalizations rose for both groups.
METHODOLOGY:
- A quality improvement study following SQUIRE 2.0 reporting guidelines analyzed data from 129,873 veterans enrolled in HUD-VASH between June 1, 2019, and September 30, 2021.
- Analysis included 127,876 veterans (98.5%) with honorable/general discharge and 1997 veterans (1.5%) with OTH discharge, with a mean age of 53.7 years.
- Researchers utilized an interrupted time series design to compare program enrollments and healthcare utilization before (June 2019-December 2020) and after (January 2021-September 2021) policy implementation.
- Data linkage between the Homeless Operations and Management Evaluation System database and VA Corporate Data Warehouse enabled tracking of emergency department visits, hospitalizations, and primary care visits.
TAKEAWAY:
- Monthly HUD-VASH enrollments showed a significant increase for OTH veterans after the policy change (difference in slopes, 1.90; 95% confidence interval [CI], 1.28-2.52), while honorable/general veterans experienced a non-significant increase (difference in slopes, 9.23; 95% CI, −20.35-38.79).
- Emergency department visits demonstrated a significant increase for honorable/general veterans (change in slope, 0.24; 95% CI, 0.12-0.35) but not for OTH veterans (change in slope, 0.08;
95% CI, −0.12-0.28). - Hospitalizations significantly increased for both OTH veterans (change in slope, 0.098; 95% CI, 0.009-0.170) and honorable/general veterans (change in slope, 0.078; 95% CI, 0.004-0.060).
- Primary care visits showed no significant changes for either group after the policy implementation (OTH: change in slope, −0.12; 95% CI, −0.65-0.42; honorable/general: change in slope, 0.20;
95% CI, −0.13-0.53).
IN PRACTICE:“Expanding HUD-VASH eligibility increased access to housing and social support for OTH veterans without disrupting services for those with honorable discharges,” the authors reported. “Efforts should focus on improving access to connecting OTH veterans with clinical services outside of HUD-VASH.”
SOURCE:The study was led by Thomas F. Nubong, MD, Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center in Providence. It was published online on August 5 in JAMA Network Open.
LIMITATIONS: According to the authors, the study period overlapped with the COVID-19 pandemic, potentially affecting results. Additionally, staff training on the policy change varied across US Department of Veterans Affairs (VA) sites, introducing implementation inconsistencies. The single-group interrupted time series design, while effective for tracking temporal trends, limited formal comparisons between discharge groups.
DISCLOSURES: The analyses were conducted under the VA Homeless Programs Office with operational funding support. Jack Tsai, PhD, and Eric Jutkowitz, PhD, reported being principal investigators of a VA Merit study on the Impact of COVID-19 for the HUD-VASH program. James L. Rudolph, MD, reported receiving grants from Icosavax outside the submitted work and being a United States government employee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Genomic Testing Reveals Distinct Mutation Patterns in Black and White Veterans With Metastatic Prostate Cancer
TOPLINE: Next-generation sequencing (NGS) analysis of 5015 veterans with metastatic prostate cancer reveals distinct genomic patterns between non-Hispanic Black and White patients, with Black veterans showing higher odds of immunotherapy targets but lower odds of androgen receptor axis alterations. However, the rates of survival were similar despite the differences.
METHODOLOGY:
Researchers conducted a retrospective cohort study comparing alteration frequencies between 1784 non-Hispanic Black (35.6%) and 3,231 non-Hispanic White (64.4%) veterans who underwent NGS testing from January 23, 2019, to November 2, 2023.
- Analysis included DNA sequencing data from tissue or plasma biospecimens, including prostate biopsy specimens, radical prostatectomy specimens, and prostate cancer metastases, all sequenced with FoundationOne CDx or FoundationOne Liquid CDx platforms.
- Investigators examined pathogenic alterations in individual genes, actionable targets, and canonical prostate cancer pathways, while adjusting for NGS analyte and clinicopathologic covariates.
- Researchers evaluated associations between alteration frequency and race as well as survival through Cox proportional hazards modeling, stratified by race and adjusted for clinical factors.
TAKEAWAY:
Non-Hispanic Black race and ethnicity was associated with higher odds of genomic alterations in SPOP (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.6) and immunotherapy targets (OR, 1.7; 95% CI, 1.1-2.5), including high microsatellite instability status (OR, 3.1; 95% CI, 1.1-9.4).
- Non-Hispanic Black veterans showed lower odds of genomic alterations in the AKT/PI3K pathway (OR, 0.6; 95% CI, 0.4-0.7), androgen receptor axis (OR, 0.7; 95% CI, 0.5-0.9), and tumor suppressor genes (OR, 0.7; 95% CI, 0.5-0.8).
- Tumor suppressor alterations were associated with shorter overall survival in both non-Hispanic Black (hazard ratio [HR], 1.54; 95% CI, 1.13-2.11) and non-Hispanic White (HR, 1.52; 95% CI, 1.25-1.85) veterans.
- CDK12 alterations significantly increased the hazard of death in non-Hispanic Black veterans (HR, 2.04; 95% CI, 1.13-3.67), while immunotherapy targets were associated with increased mortality in non-Hispanic White veterans (HR, 1.44; 95% CI, 1.02-2.02).
IN PRACTICE: " we did not identify any genomic alterations or biomarkers that should not be tested in PCa based on patient self-identified race. Ultimately, this work emphasizes that precision oncology enables the individualization of treatment decisions without having to rely on imprecise characteristics such as self-identified race.," wrote the study authors.
SOURCE: Isla P. Garraway, MD, PhD; Kosj Yamoah, MD, PhD; and Kara N. Maxwell, MD, PhD were co-senior authors. The article was published online on May 12 in JAMA Network Open.
LIMITATIONS: According to the authors, a lack of matched germline data for patients, complicated the interpretation of plasma results. In addition, survivorship bias may have inadvertently excluded the most aggressive metastatic prostate cancer phenotypes, as patients who did not live long enough to undergo NGS testing were not included. Results seen in the veteran population served by the Veterans Health Administration may not be generalizable to the broader population.
DISCLOSURES: The study received support from Challenge Award PCF22CHALO2 from the Prostate Cancer Foundation and the Veterans Affairs National Precision Oncology Program. Luca F. Valle, MD, reported receiving grant support from the Bristol Myers Squibb Foundation during the conduct of the study. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: Next-generation sequencing (NGS) analysis of 5015 veterans with metastatic prostate cancer reveals distinct genomic patterns between non-Hispanic Black and White patients, with Black veterans showing higher odds of immunotherapy targets but lower odds of androgen receptor axis alterations. However, the rates of survival were similar despite the differences.
METHODOLOGY:
Researchers conducted a retrospective cohort study comparing alteration frequencies between 1784 non-Hispanic Black (35.6%) and 3,231 non-Hispanic White (64.4%) veterans who underwent NGS testing from January 23, 2019, to November 2, 2023.
- Analysis included DNA sequencing data from tissue or plasma biospecimens, including prostate biopsy specimens, radical prostatectomy specimens, and prostate cancer metastases, all sequenced with FoundationOne CDx or FoundationOne Liquid CDx platforms.
- Investigators examined pathogenic alterations in individual genes, actionable targets, and canonical prostate cancer pathways, while adjusting for NGS analyte and clinicopathologic covariates.
- Researchers evaluated associations between alteration frequency and race as well as survival through Cox proportional hazards modeling, stratified by race and adjusted for clinical factors.
TAKEAWAY:
Non-Hispanic Black race and ethnicity was associated with higher odds of genomic alterations in SPOP (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.6) and immunotherapy targets (OR, 1.7; 95% CI, 1.1-2.5), including high microsatellite instability status (OR, 3.1; 95% CI, 1.1-9.4).
- Non-Hispanic Black veterans showed lower odds of genomic alterations in the AKT/PI3K pathway (OR, 0.6; 95% CI, 0.4-0.7), androgen receptor axis (OR, 0.7; 95% CI, 0.5-0.9), and tumor suppressor genes (OR, 0.7; 95% CI, 0.5-0.8).
- Tumor suppressor alterations were associated with shorter overall survival in both non-Hispanic Black (hazard ratio [HR], 1.54; 95% CI, 1.13-2.11) and non-Hispanic White (HR, 1.52; 95% CI, 1.25-1.85) veterans.
- CDK12 alterations significantly increased the hazard of death in non-Hispanic Black veterans (HR, 2.04; 95% CI, 1.13-3.67), while immunotherapy targets were associated with increased mortality in non-Hispanic White veterans (HR, 1.44; 95% CI, 1.02-2.02).
IN PRACTICE: " we did not identify any genomic alterations or biomarkers that should not be tested in PCa based on patient self-identified race. Ultimately, this work emphasizes that precision oncology enables the individualization of treatment decisions without having to rely on imprecise characteristics such as self-identified race.," wrote the study authors.
SOURCE: Isla P. Garraway, MD, PhD; Kosj Yamoah, MD, PhD; and Kara N. Maxwell, MD, PhD were co-senior authors. The article was published online on May 12 in JAMA Network Open.
LIMITATIONS: According to the authors, a lack of matched germline data for patients, complicated the interpretation of plasma results. In addition, survivorship bias may have inadvertently excluded the most aggressive metastatic prostate cancer phenotypes, as patients who did not live long enough to undergo NGS testing were not included. Results seen in the veteran population served by the Veterans Health Administration may not be generalizable to the broader population.
DISCLOSURES: The study received support from Challenge Award PCF22CHALO2 from the Prostate Cancer Foundation and the Veterans Affairs National Precision Oncology Program. Luca F. Valle, MD, reported receiving grant support from the Bristol Myers Squibb Foundation during the conduct of the study. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
TOPLINE: Next-generation sequencing (NGS) analysis of 5015 veterans with metastatic prostate cancer reveals distinct genomic patterns between non-Hispanic Black and White patients, with Black veterans showing higher odds of immunotherapy targets but lower odds of androgen receptor axis alterations. However, the rates of survival were similar despite the differences.
METHODOLOGY:
Researchers conducted a retrospective cohort study comparing alteration frequencies between 1784 non-Hispanic Black (35.6%) and 3,231 non-Hispanic White (64.4%) veterans who underwent NGS testing from January 23, 2019, to November 2, 2023.
- Analysis included DNA sequencing data from tissue or plasma biospecimens, including prostate biopsy specimens, radical prostatectomy specimens, and prostate cancer metastases, all sequenced with FoundationOne CDx or FoundationOne Liquid CDx platforms.
- Investigators examined pathogenic alterations in individual genes, actionable targets, and canonical prostate cancer pathways, while adjusting for NGS analyte and clinicopathologic covariates.
- Researchers evaluated associations between alteration frequency and race as well as survival through Cox proportional hazards modeling, stratified by race and adjusted for clinical factors.
TAKEAWAY:
Non-Hispanic Black race and ethnicity was associated with higher odds of genomic alterations in SPOP (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.6) and immunotherapy targets (OR, 1.7; 95% CI, 1.1-2.5), including high microsatellite instability status (OR, 3.1; 95% CI, 1.1-9.4).
- Non-Hispanic Black veterans showed lower odds of genomic alterations in the AKT/PI3K pathway (OR, 0.6; 95% CI, 0.4-0.7), androgen receptor axis (OR, 0.7; 95% CI, 0.5-0.9), and tumor suppressor genes (OR, 0.7; 95% CI, 0.5-0.8).
- Tumor suppressor alterations were associated with shorter overall survival in both non-Hispanic Black (hazard ratio [HR], 1.54; 95% CI, 1.13-2.11) and non-Hispanic White (HR, 1.52; 95% CI, 1.25-1.85) veterans.
- CDK12 alterations significantly increased the hazard of death in non-Hispanic Black veterans (HR, 2.04; 95% CI, 1.13-3.67), while immunotherapy targets were associated with increased mortality in non-Hispanic White veterans (HR, 1.44; 95% CI, 1.02-2.02).
IN PRACTICE: " we did not identify any genomic alterations or biomarkers that should not be tested in PCa based on patient self-identified race. Ultimately, this work emphasizes that precision oncology enables the individualization of treatment decisions without having to rely on imprecise characteristics such as self-identified race.," wrote the study authors.
SOURCE: Isla P. Garraway, MD, PhD; Kosj Yamoah, MD, PhD; and Kara N. Maxwell, MD, PhD were co-senior authors. The article was published online on May 12 in JAMA Network Open.
LIMITATIONS: According to the authors, a lack of matched germline data for patients, complicated the interpretation of plasma results. In addition, survivorship bias may have inadvertently excluded the most aggressive metastatic prostate cancer phenotypes, as patients who did not live long enough to undergo NGS testing were not included. Results seen in the veteran population served by the Veterans Health Administration may not be generalizable to the broader population.
DISCLOSURES: The study received support from Challenge Award PCF22CHALO2 from the Prostate Cancer Foundation and the Veterans Affairs National Precision Oncology Program. Luca F. Valle, MD, reported receiving grant support from the Bristol Myers Squibb Foundation during the conduct of the study. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Be Part of the (Larger) Conversation
Providing free and open access to its high-quality peer-reviewed articles has always been important to Federal Practitioner, but finding them hasn’t always been easy for our readers and researchers. That has now changed. The full text of all
To be sure, Federal Practitioner has always made it easy for print and digital subscribers to find our articles. Print journal subscriptions have been—and will remain—free to the 35,000 subscribers. Furthermore, anyone can access articles online (http://mdedge.com/fedprac), in the Federal Practitioner app, or in our digital edition (http://www.fedprac-digital.com/).
However, until now access beyond our base of loyal readers has been limited. Inclusion in PMC provides a much broader audience for Federal Practitioner authors, because PMC is an integral part of the NLM MEDLINE/PubMed database of 28 million biomedical citations and abstracts from more than 5,000 journals. All PMC articles appear in PubMed searches. On a typical day, about 2.5 million users in the US access PubMed to perform about 3 million searches and access 9 million page views.1
Inclusion also means that Federal Practitioner has passed a rigorous scientific and technical review of its content. Being included in PMC is a recognition of the quality of scholarship the journal publishes and a pledge of our continuing commitment to the highest quality of clinical education and research. Young investigators, clinician-educators, midcareer professionals, and others seeking to launch or enhance an academic career may want to consider or reconsider Federal Practitioner as the destination for manuscript submission.
One of the goals of this journal has been to provide a forum for federal health care providers (HCPs) to discuss and share with other federal colleagues. Federal HCPs from the Military Health System (MHS), Veterans Health Administration (VHA), and Indian Health Service (IHS) have addressed questions in Federal Practitioner that might not be explored elsewhere. Yet something important was missing from those conversations—engagement with the larger public health community. PubMed and PMC enable an ongoing conversation among health care researchers and providers. These are the places where researchers go to understand and respond to the questions that shape their research and clinical care. Now, Federal Practitioner authors can contribute more fully in ongoing debates.
As large integrated health care systems, the VHA, MHS, and IHS confront and address key public health care policy issues. Whether it’s the responsible and safe prescribing of opioids, the resource allocation decisions regarding the treatment of hepatitis C, or addressing suicide risk, the experience of federal HCPs must be a part of the public health debate. Moreover, many Federal Practitioner articles focus not just on preliminary research, but on the practical aspects of implementing patient-centered care. All US HCPs may benefit from hearing about federal providers challenges and success in providing patient-centered care.
Making available the complete text of all the articles furthers the Federal Practitioner mission: to educate federal HCPs and provide a forum for sharing health-care related studies, best practices, guidelines, program profiles, and case studies. We are excited to provide even more benefits for publication in Federal Practitioner. This journal welcomes submissions from new authors, well-traveled scholars, and everyone in between. Come on, join the conversation.
1. Fiorini N, Lipman DJ, Lu Z. Towards PubMed 2.0. eLife. 2017;6:e28801.
Providing free and open access to its high-quality peer-reviewed articles has always been important to Federal Practitioner, but finding them hasn’t always been easy for our readers and researchers. That has now changed. The full text of all
To be sure, Federal Practitioner has always made it easy for print and digital subscribers to find our articles. Print journal subscriptions have been—and will remain—free to the 35,000 subscribers. Furthermore, anyone can access articles online (http://mdedge.com/fedprac), in the Federal Practitioner app, or in our digital edition (http://www.fedprac-digital.com/).
However, until now access beyond our base of loyal readers has been limited. Inclusion in PMC provides a much broader audience for Federal Practitioner authors, because PMC is an integral part of the NLM MEDLINE/PubMed database of 28 million biomedical citations and abstracts from more than 5,000 journals. All PMC articles appear in PubMed searches. On a typical day, about 2.5 million users in the US access PubMed to perform about 3 million searches and access 9 million page views.1
Inclusion also means that Federal Practitioner has passed a rigorous scientific and technical review of its content. Being included in PMC is a recognition of the quality of scholarship the journal publishes and a pledge of our continuing commitment to the highest quality of clinical education and research. Young investigators, clinician-educators, midcareer professionals, and others seeking to launch or enhance an academic career may want to consider or reconsider Federal Practitioner as the destination for manuscript submission.
One of the goals of this journal has been to provide a forum for federal health care providers (HCPs) to discuss and share with other federal colleagues. Federal HCPs from the Military Health System (MHS), Veterans Health Administration (VHA), and Indian Health Service (IHS) have addressed questions in Federal Practitioner that might not be explored elsewhere. Yet something important was missing from those conversations—engagement with the larger public health community. PubMed and PMC enable an ongoing conversation among health care researchers and providers. These are the places where researchers go to understand and respond to the questions that shape their research and clinical care. Now, Federal Practitioner authors can contribute more fully in ongoing debates.
As large integrated health care systems, the VHA, MHS, and IHS confront and address key public health care policy issues. Whether it’s the responsible and safe prescribing of opioids, the resource allocation decisions regarding the treatment of hepatitis C, or addressing suicide risk, the experience of federal HCPs must be a part of the public health debate. Moreover, many Federal Practitioner articles focus not just on preliminary research, but on the practical aspects of implementing patient-centered care. All US HCPs may benefit from hearing about federal providers challenges and success in providing patient-centered care.
Making available the complete text of all the articles furthers the Federal Practitioner mission: to educate federal HCPs and provide a forum for sharing health-care related studies, best practices, guidelines, program profiles, and case studies. We are excited to provide even more benefits for publication in Federal Practitioner. This journal welcomes submissions from new authors, well-traveled scholars, and everyone in between. Come on, join the conversation.
Providing free and open access to its high-quality peer-reviewed articles has always been important to Federal Practitioner, but finding them hasn’t always been easy for our readers and researchers. That has now changed. The full text of all
To be sure, Federal Practitioner has always made it easy for print and digital subscribers to find our articles. Print journal subscriptions have been—and will remain—free to the 35,000 subscribers. Furthermore, anyone can access articles online (http://mdedge.com/fedprac), in the Federal Practitioner app, or in our digital edition (http://www.fedprac-digital.com/).
However, until now access beyond our base of loyal readers has been limited. Inclusion in PMC provides a much broader audience for Federal Practitioner authors, because PMC is an integral part of the NLM MEDLINE/PubMed database of 28 million biomedical citations and abstracts from more than 5,000 journals. All PMC articles appear in PubMed searches. On a typical day, about 2.5 million users in the US access PubMed to perform about 3 million searches and access 9 million page views.1
Inclusion also means that Federal Practitioner has passed a rigorous scientific and technical review of its content. Being included in PMC is a recognition of the quality of scholarship the journal publishes and a pledge of our continuing commitment to the highest quality of clinical education and research. Young investigators, clinician-educators, midcareer professionals, and others seeking to launch or enhance an academic career may want to consider or reconsider Federal Practitioner as the destination for manuscript submission.
One of the goals of this journal has been to provide a forum for federal health care providers (HCPs) to discuss and share with other federal colleagues. Federal HCPs from the Military Health System (MHS), Veterans Health Administration (VHA), and Indian Health Service (IHS) have addressed questions in Federal Practitioner that might not be explored elsewhere. Yet something important was missing from those conversations—engagement with the larger public health community. PubMed and PMC enable an ongoing conversation among health care researchers and providers. These are the places where researchers go to understand and respond to the questions that shape their research and clinical care. Now, Federal Practitioner authors can contribute more fully in ongoing debates.
As large integrated health care systems, the VHA, MHS, and IHS confront and address key public health care policy issues. Whether it’s the responsible and safe prescribing of opioids, the resource allocation decisions regarding the treatment of hepatitis C, or addressing suicide risk, the experience of federal HCPs must be a part of the public health debate. Moreover, many Federal Practitioner articles focus not just on preliminary research, but on the practical aspects of implementing patient-centered care. All US HCPs may benefit from hearing about federal providers challenges and success in providing patient-centered care.
Making available the complete text of all the articles furthers the Federal Practitioner mission: to educate federal HCPs and provide a forum for sharing health-care related studies, best practices, guidelines, program profiles, and case studies. We are excited to provide even more benefits for publication in Federal Practitioner. This journal welcomes submissions from new authors, well-traveled scholars, and everyone in between. Come on, join the conversation.
1. Fiorini N, Lipman DJ, Lu Z. Towards PubMed 2.0. eLife. 2017;6:e28801.
1. Fiorini N, Lipman DJ, Lu Z. Towards PubMed 2.0. eLife. 2017;6:e28801.