Janis L. Breeze

Supplemental Table 1 shows baseline (1995) characteristics of invited, included, and excluded participants.

Supplemental Table 4 shows path analysis coefficients for the effect of factors related to growth and development on log-transformed absolute dense area

Supplemental Table 3 shows linear regression analysis of growth and developmental factors with absolute measures of breast density, by age at mammogram.

Background:High mammographic density is one of the strongest breast cancer risk factors; however, determinants of high mammographic density are understudied in Black women. We assessed growth and development factors across the lifecourse in relation to mammographic density.Methods:Within the Black Women’s Health Study, we used Cumulus software to assess percent mammographic density from digital screening mammograms for 5,905 women ages 40 to 74 years. We fit linear regression models to quantify the association of lifecourse characteristics including birthweight, childhood somatotype, age at menarche, body mass index (BMI) at age 18 years, height, BMI at mammography, and adulthood waist-to-hip ratio with density overall and by age. We also performed a path analysis to assess the total and mediating effects of the growth and development factors on density.Results:BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio were significantly and inversely associated with density. On path analysis, total effects of childhood somatotype (standardized β = −0.05, P < 0.001), BMI at age 18 years (standardized β = −0.13, P < 0.001), BMI at mammography (standardized β = −0.22, P < 0.001), and waist-to-hip ratio (standardized β = −0.04, P < 0.001) were associated with density.Conclusions:Several factors across the lifecourse—greater childhood somatotype, BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio—were associated with lower mammographic density in this cohort of Black women.Impact:Body size closer to the time of mammography may be more meaningful in determining mammographic density, though early-life adiposity also influences mammographic density.See related In the Spotlight, p. 1541

Supplemental Table 2 shows linear regression analysis of factors related to growth and development with mammographic density among current postmenopausal hormone therapy users

Background: High mammographic density is one of the strongest breast cancer risk factors; however, determinants of high mammographic density are understudied in Black women. We assessed growth and development factors across the lifecourse in relation to mammographic density. Methods: Within the Black Women’s Health Study, we used Cumulus software to assess percent mammographic density from digital screening mammograms for 5,905 women ages 40 to 74 years. We fit linear regression models to quantify the association of lifecourse characteristics including birthweight, childhood somatotype, age at menarche, body mass index (BMI) at age 18 years, height, BMI at mammography, and adulthood waist-to-hip ratio with density overall and by age. We also performed a path analysis to assess the total and mediating effects of the growth and development factors on density. Results: BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio were significantly and inversely associated with density. On path analysis, total effects of childhood somatotype (standardized β = −0.05, P < 0.001), BMI at age 18 years (standardized β = −0.13, P < 0.001), BMI at mammography (standardized β = −0.22, P < 0.001), and waist-to-hip ratio (standardized β = −0.04, P < 0.001) were associated with density. Conclusions: Several factors across the lifecourse—greater childhood somatotype, BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio—were associated with lower mammographic density in this cohort of Black women. Impact: Body size closer to the time of mammography may be more meaningful in determining mammographic density, though early-life adiposity also influences mammographic density. See related In the Spotlight, p. 1541

Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the association between prescriber choice of rivaroxaban vs. apixaban and the study outcomes of stroke/systemic embolism (SE), major bleeding, and death in a retrospective cohort of NVAF patients in the US. Initiators of either medication were linked to their prescribers and followed until the first of the study outcome, the end of rivaroxaban/apixaban use, or 365 days after initiation. PPP for each patient was the percent of rivaroxaban initiations issued by the provider for the prior 10 NVAF patients. Cox regression models tested associations between quintiles of PPP and each outcome. A total of 61,155 patients and 1726 providers were included. The IV was a strong predictor of rivaroxaban prescription (OR = 17.9; 95% CI: 16.6, 19.3). There were statistically significant associations between increasing preference for rivaroxaban and rates of major bleeding (ptrend = 0.041) and death (ptrend = 0.031), but not stroke/SE (ptrend = 0.398). This analysis provides evidence of the relative safety of apixaban over rivaroxaban for the risk of major bleeding and death.

Gender minority (GM) students are at high risk for substance use and depression. This study explores the role of protective factors in reducing rates of substance use and depression based on high school surveys. Univariate and multivariate analyses were conducted to evaluate the association between exposures and outcomes. Youth completed surveys in 2018 (n=16,288) and in 2021 (n=10,792). GM students reported exposure to protective factors less frequently than their cisgender peers: good financial status (88.6% v 96.5% v in 2018 and 95% v 97.8% in 2021), feeling a sense of school/community membership, (mean score 2.7 v 3.0 in 2018 and 2.6 v 3.0 in 2021) or having two or more caring adults in their life (61.5% v 79.7% v in 2018 and 64.2% v. 80.6% in 2021). GM youth experienced risk factors more often than their peers including bias-based bullying (mean score: 0.6 v 0.2 in 2018, 0.5 v. 0.2 in 2021); peer victimization (0.5 v. 0.2 in 2018, 0.3 v 0.1 in 2021), and homelessness/foster care exposure (32.8% v 10.8% in 2018 and 15.8% v. 6.6% in 2021). Several factors mitigated depression and substance use among GM students. GM youth experienced these protective factors less frequently than their peers.

Comparative morbidity after either sternotomy or non-resuscitative thoracotomy in penetrating cardiac injuries (PCI) is unknown. Retrospective review of adults with PCI who underwent either sternotomy or non-resuscitative thoracotomy using the National Trauma Data Bank 2007-2015. Since there is no unique International Classification of Diseases Procedure Coding System (ICD-PCS) codes assigned for resuscitative vs. non-resuscitative thoracotomy, and both procedures were coded as “thoracotomy”, propensity score (PS) methods were applied to avoid inclusion of resuscitative thoracotomy. Despite well PS matching on injury severity score the non-thoracotomy group compared to the sternotomy group had a significantly increased risk of mortality (30 percent vs 8 percent, p<0.0001). The morbidity differed as well—25 percent vs. 12 percent, p=0.0007. The differences in mortality in PCI patients who underwent non-resuscitative thoracotomy vs. sternotomy may be biased by unintentional inclusion of resuscitative thoracotomy. To accurately capture thoracotomy type, separate unique resuscitative and non-resuscitative thoracotomy procedure codes should be created in future revisions of the ICD PCS.

Purpose: Gender differences in faculty advancement persist in academic medicine. Understanding of what drives these differences remains limited. The relationship among self-esteem, gender, and career outcomes has not previously been explored. Method: The authors evaluated the association between gender and 2012–2013 career outcomes, specifically, the number of publications, academic rank, leadership positions, and retention, and whether self-esteem as measured in the 1995 National Faculty Survey mediates this relationship. They measured self-esteem using the modified Rosenberg Self-Esteem Scale. The authors used multivariable logistic regression analysis to understand the association among gender, self-esteem, and the outcomes of rank, leadership, and retention, and negative binomial models for number of publications. Models were adjusted for race, specialty, effort distribution, and years since first faculty appointment. The authors performed a mediation analysis to understand whether self-esteem mediates the relationship between gender and these career outcomes. Results: Overall, self-esteem scores were high. Women had lower self-esteem in 1995 than their male colleagues. In adjusted models, female gender was associated with lower performance on all 4 career outcome metrics. While self-esteem scores were positively associated with all 4 outcomes, the authors’ mediation analysis suggested that self-esteem did not mediate the relationship between gender and these 4 career metrics. Conclusions: Female medical faculty members lag behind men on traditional metrics of faculty achievement. While higher self-esteem is positively associated with faculty achievement, it did not mediate the relationship between gender and career advancement over the 17 years of follow-up and, thus, may not be an ideal target for programs and policies to increase gender parity in academic medicine.