Presentation 1:

Title: Investigating the Impact of Socioeconomic Status and Chronic Disease on Breastfeeding Outcomes

Authors: Lara C. Tang; Lauren Wisk, PhD

Background: Prior studies have demonstrated the independent impact of socioeconomic status (SES) and chronic medical conditions on breastfeeding outcomes. Specifically, low SES, measured by household income and parental education, and chronic disease prior to pregnancy are associated with lower rates of breastfeeding, and shorter duration of any and exclusive breastfeeding. However, the interaction between chronic conditions and socioeconomic status has not been well studied.

Methods: This is a retrospective cohort study of U.S. women who were sampled by the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), which uses a complex sampling design. Participants recruited in only Phase 8 (2016-2019) of PRAMS are analyzed in this study (N=156,965). All analyses apply survey weights to account for the complex sampling design of PRAMS.

Results: Within each income category, except for women with an income of $30,001-$60,000, positive diabetes status was associated with lower rates of breastfeeding initiation. Mean duration of breastfeeding was also significantly associated with diabetes status in all income groups except for those in the highest income group. Lastly, no significant association was found between diabetes status and whether women received information about breastfeeding prior to delivery within income groups, but higher income groups were associated with higher percentages of receiving this information from a healthcare professional (p<0.0001).

Conclusions:  Mothers at the intersection of low income and positive diabetes status are most vulnerable to poor breast-feeding outcomes (lower initiation, shorter duration), potentially due to lack of education from providers. In the future, we will include other chronic medical conditions in our analyses, investigate initiation and duration of exclusive breastfeeding, and identify reasons for differences in breastfeeding outcomes between groups.

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Presentation 2:

Title: Understanding Sociodemographic and Clinical Factors Associated with Vulvar Intraepithelial Neoplasia and Vulvar Squamous Cell Carcinoma

Authors: Lara C. Tang; Natsai C. Nyakudarika, MD; Megha D. Tandel, MPH; Lorna Kwan, MPH; Ritu Salani, MD, MBA

Background:   Prior studies have established that vulvar intraepithelial neoplasia (VIN) may serve as a precursor to vulvar cancer, most commonly vulvar squamous cell carcinoma (vSCC), which accounts for 4% of all genital malignancies in women. Although previous research has established that age, smoking history, HPV infection and an immunocompromised state are all associated with vSCC3, few studies have identified sociodemographic (e.g. BMI, race/ethnicity, insurance type) and clinical (e.g. type of VIN treatment, timing of treatment) factors that are associated with VIN. Even fewer studies have differentiated patient characteristics between women with VIN and women with vSCC who do not have a prior history of VIN.

Methods:   This is an IRB-approved, retrospective case-control study (N=61) that compared women with vSCC (N=44) against women with VIN, but who never developed vSCC (N=17). Patients were included in this study based on pathology samples that showed evidence of vSCC or VIN that were collected at UCLA from 2005 to 2020. Using chart review, sociodemographic data collected include age, race/ethnicity, BMI, smoking history, insurance type, and distance of home address from UCLA. Similarly, clinical data collected include times between initial vulvar lesion presentation and initial treatment/initial biopsy/first GYN/ONC visit, type of provider at initial vulvar lesion presentation and type of initial treatment. Univariate analyses (Chi-square or Fisher’s exact and Wilcoxon rank-sum test) were conducted at an α=0.05 using SAS 9.4.

Results: In the VIN-only group, an immunocompromised state at the time of diagnosis was associated with having a recurrence of VIN (p=0.0230), as supported by the literature. In the vSCC group, surgery as the primary treatment was associated with Stage I vSCC. No significant differences in patient characteristics between the VIN-only. and vSCC groups were found. 

Conclusions:  This study found that within the VIN-only group, having an immunocompromised state, which was defined by a history of chemotherapy within a year of initial diagnosis, chronic use of steroids, and/or having an autoimmune disease, was associated with a recurrence of VIN. This finding is corroborated by what has previously been established in the literature. Our analyses, however, did not find any significant differences in sociodemographic nor clinical characteristics between the VIN-only and vSCC groups. Furthermore, there were no significant differences in patient characteristics between cancer stages within the vSCC group, despite prior research. The limitations of this study include its small sample size (N=61), as well as insufficient sociodemographic and clinical data for several patients which resulted in their exclusion from our analyses. Our future studies will focus on analyzing characteristics of vSCC patients with a prior history of VIN, as well as on comparing characteristics between early and advanced vSCC stages (as opposed to individual stages).