Search Results (311)

Background: Aortic stenosis (AS) represents a prevalent valvular condition in older adults, associated with significant morbidity and mortality. The objective of the study was to examine trends in mortality related to AS in the United States (U.S.). Methods: The U.S. CDC WONDER dataset was analyzed, extracting age-adjusted mortality rates (AAMR) per 100,000 and calculating annual percentage change (APC) through Joinpoint regression. The results were stratified to identify temporal, sex-specific, racial/ethnic, and regional differences. Results: From 1999 to 2020, 267,515 deaths among older adults (>65 years old) were attributed to AS, with the AAMR declining from 28.00 to 23.69. Males had a higher AAMR (30.35) compared to females (27.42), though more deaths occurred in females (164,104 vs. 103,411). Non-Hispanic (NH) Whites exhibited the greatest AAMR (31.61), trailed by NH American Indian/Alaska Native individuals (16.62), whereas NH Asians/Pacific Islanders had the least (11.50). Significant state-wise variations were noted, with AAMRs ranging from 60.55 in Oregon to 17.23 in Mississippi, and 19 states depicting a concerning rise over the study duration. Regionally, the Northeast (32.09) had the highest AAMRs, while the South (23.06) had the lowest. Micropolitan (32.28) and noncore (28.43) areas reported higher AAMRs compared to large central metropolitan areas (24.32). Conclusions: While there is a trend towards decreased mortality due to AS in the U.S., significant disparities based on race, sex, and region persist and may be worsening. The underlying causes of these discrepancies require further investigation, and targeted strategies must be developed to address them effectively. Full article

Despite extensive and multigenerational efforts by the three federally recognized Cherokee tribes to educate the larger public about the sovereign right and authority of Cherokee governments to determine affiliation, well over a million unaffiliated and unsubstantiated American claimants still declare Cherokee heritage in official records, deforming public understanding and reinforcing dangerously anti-Native racial logics. This article considers the problems associated with the “Cherokee” population categories in the 2020 U.S. census, its relationship to genealogical stereotypes in mainstream family history research, its dangers to Cherokee nationhood, and its consequences for Indian Country as a whole. Full article

Contemporary data on coccidioidomycosis death rates are sparse. Death certificate data for 2018–2023 from the US National Vital Statistics System were evaluated. Coccidioidomycosis deaths were identified using diagnosis codes B38.x listed anywhere on certificates. Deaths and age-adjusted mortality rates (AAMRs)/1,000,000 people, with 95% confidence intervals (CIs), were determined. We identified 1760 coccidioidomycosis-attributable deaths (AAMR = 0.75; 0.72–0.79). Most occurred in 55–74-year-olds (43.9%; corresponding AAMR = 1.72; 1.59–1.84). Males had a 2.69-fold increased AAMR versus females and American Indian or Alaska Native individuals had a 4.28-fold increased rate versus White individuals. Hispanics had a higher AAMR than the overall population (AAMR = 1.92; 1.76–2.08). AAMRs increased from 0.52 in 2019 to 0.79–0.94 in later years. Most (89.7%) death certificates were from endemic states, with Arizona having the highest AAMR. Seven hundred and thirteen certificates (40.5%) listed coccidioidomycosis as the primary cause of death, with 43.8% coded for pulmonary, 34.9% coded for disseminated, and 21.3% coded for unspecified coccidioidomycosis. Diabetes, COVID-19, and human immunodeficiency virus were more frequent on certificates with coccidioidomycosis versus without (RR range = 1.47–17.20). Mortality remained closely tied to demographic and geographic factors identified in prior studies, with county-level mapping revealing high-burden areas for targeted intervention. Coccidioidomycosis-attributable AAMRs rose over time, possibly influenced by concurrent COVID-19 infection. Only 40% of death certificates listed it as the primary cause, indicating that most patients experience chronic infection rather than death directly from the disease. These findings suggest the need for heightened clinical awareness of coccidioidomycosis, along with earlier diagnosis and prompt initiation of antifungal treatment in these high-risk groups. Full article

Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the socio-demographic factors associated with pain-reliever misuse across different racial and ethnic groups. Methods: This cross-sectional study utilizes data from the 2022 United States National Survey on Drug Use and Health (NSDUH). Participants were categorized into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (Hispanic), and Other (American Indian, Alaska Native, Asian, Native Hawaiian or other Pacific Islanders, and two or more races) groups. Comparisons were made between individuals regarding pain-reliever misuse, socio-demographic characteristics, SPD, suicidal thoughts, and World Health Organization Disability Assessment Schedule (WHODAS) scores, using Rao–Scott Chi-square tests. Stepwise multivariable logistic regression analyses were conducted to identify socio-demographic factors associated with pain-reliever misuse. Results: The study included 45,451 participants, with 27,551 (62.00 wt%) identified as NHW, 5186 (11.98 wt%) as NHB, 7795 (17.15 wt%) as Hispanic, and 4919 (8.87 wt%) as other racial and ethnic groups. The rate of pain-reliever misuse was 2.90% among NHWs, 3.40% among NHBs, 3.61% among Hispanics, and 2.05% among individuals of other races and ethnicities (p = 0.043). Among those who misused pain relievers, a significantly higher proportion experienced SPD (36.00% vs. 14.05%), suicidal thoughts (15.51% vs. 4.91%), and difficulties in performing daily activities (73.77% vs. 52.84%) compared to those who did not misuse pain relievers (p < 0.001). Socio-demographic factors associated with a lower risk of misuse included being female (AOR = 0.80, 95% CI 0.67–0.95, p = 0.013), being employed (AOR = 0.66, 95% CI 0.48–0.90, p = 0.010), and having a college or higher education (AOR = 0.54, 95% CI 0.37–0.79, p = 0.002). Conclusions: The prevalence of pain-reliever misuse varies across racial and ethnic groups, with Hispanic individuals demonstrating the highest rates of misuse. Pain-reliever misuse is strongly associated with SPD, suicidal thoughts, and impaired daily functioning. Socio-demographic factors are crucial in predicting the likelihood of pain-reliever misuse. These findings highlight the importance of culturally tailored prevention strategies and public health policies aimed at mitigating misuse, especially among vulnerable populations. Full article

Short sleep duration (≤6 h) is a public health concern linked to cardiometabolic disease and premature mortality. However, persistent disparities across sociodemographic, psychosocial, and structural domains remain underexplored in recent nationally representative samples. We analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, including 228,463 adults (weighted N ≈ 122 million). Sleep duration was dichotomized as short (≤6 h) versus adequate (≥7 h). Complex samples logistic regression estimated associations between sociodemographic, psychosocial, behavioral, and structural determinants and short sleep, accounting for survey design. The weighted prevalence of short sleep was 33.2%. Non-Hispanic Black (AOR = 1.56, 95% CI: 1.46–1.65) and American Indian/Alaska Native adults (AOR = 1.46, 95% CI: 1.29–1.65) were disproportionately affected compared with non-Hispanic White adults. Psychosocial factors contributed strongly: life dissatisfaction, limited emotional support, and low social connectedness increased odds, whereas high connectedness was protective. Food insecurity and smoking were significant structural and behavioral risks, while binge drinking and urbanicity were not. One-third of U.S. adults report short sleep, with marked disparities across demographic, socioeconomic status, psychosocial stressors, and structural barriers. Findings highlight the multifactorial nature of sleep health inequities and the need for multilevel interventions addressing both individual behaviors and upstream determinants. Full article

Importance: Neuroendocrine tumors (NETs) have traditionally been considered rare (orphan) diseases; however, improvements in diagnostic methods and heightened awareness about NETs may have altered their epidemiologic profile in the U.S. Objective: To evaluate trends in incidence, prevalence, and survival of NETs in the United States from 2000 to 2021 using updated data from the SEER-22 registry. Method: This population-based, retrospective cohort study used the SEER-22 database for incidence, prevalence, and survival analyses. Data included 231,659 patients diagnosed with NETs between 2000 and 2021. Age-adjusted incidence, limited-duration prevalence, 5-year overall survival (OS), and hazard ratios (HRs) for survival by grade, stage, year of diagnosis, race, and primary site were investigated. Results: From 2000 to 2021, NET incidence nearly doubled, from 4.6 to 8.2 per 100,000 persons. The prevalence in 2021 reached 0.064%, with grade 1 tumors showing the steepest increase. Five-year OS was 77.4% overall and highest among localized NETs (82.3%) and grade 1 tumors (80.0%). Multivariable analysis showed improved survival over time (HR for 2015–2021 vs. 2000–2004, 0.92; 95% CI, 0.89–0.95). Black and American Indian/Alaska Native patients had significantly worse outcomes than White patients. Conclusions and Relevance: NETs are no longer orphan diseases based on current U.S. incidence and prevalence trends. With increasing survival and patient numbers, there is an urgent need for expanded multidisciplinary NET care and research efforts focused on survivorship and quality of life. Full article

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

Identifying hospitals that disproportionately serve minority and publicly insured patients is important because patients at these hospitals often experience worse outcomes. Studies commonly identify disproportion by using the top decile of hospitals with the greatest proportion of Black discharges nationally. Our study aimed to identify a broader measure that accounts for disproportion by multiple characteristics. Using fee-for-service Medicare data, we classified hospitals as either serving disproportionately or not, examined overlaps in classification, and assessed differences in hospital quality. We found that using a combined measure for any hospitals in the top decile or above a threshold of twice their local healthcare market average of Black, Hispanic, minority, or dual-eligible discharges classified 28.1% (n = 680/2420) of hospitals as serving disproportionately, compared to only 10% (n = 242/2420) when using the top decile of a single characteristic. The combined measure detected moderate differences in hospital star quality ratings (mean difference of 0.57–0.87, all p-values < 0.001; standardized mean difference: 0.50–0.79, 95% CIs all above 0). The combined measure identified hospitals that were smaller, more rural, and served other minorities, namely, Asian and American Indian populations. Future work should consider using this combined measure to more comprehensively identify hospitals that disproportionately serve minority or publicly insured patients. Full article

(1) Background: The COVID-19 pandemic exacerbated existing health inequities for Native American communities, intensifying the challenges faced in accessing addiction and recovery services. As part of a tribal-university collaborative effort in Arizona, our team explored the impacts of the COVID-19 pandemic on mental well-being and resilience among the Indigenous substance use recovery community. (2) Methods: We conducted qualitative analysis of transcribed individual interviews (n = 19) to understand the factors of resilience and mental well-being for providers of Western addiction treatment services and Indigenous community members who were in addiction recovery or engaged in addiction treatment during the pandemic. (3) Results: Four major themes that impacted mental well-being among the Indigenous recovery group during the pandemic were identified: (1) healthcare barriers; (2) culture in recovery; (3) the impact of colonization/historical trauma; and (4) the importance of relationships. (4) Conclusions: This work provides insight into the disproportionate impact of the COVID-19 pandemic on Indigenous communities and vulnerable populations such as the recovery community. Findings from this study highlight the need for Indigenous-grounded and culturally informed recovery interventions. Full article

Allotment—the division of Native American reservations into individually-owned plots of land—has been extensively studied; yet there exists a paucity of reservation-level studies at granular geospatial scales, i.e., at the level of examining the impacts of allotment on individuals, families, and clan or tribal groups. In previous research, we described a new semi-automated method for creating detailed GIS allotment databases and discussed the policies and processes that that lay behind allotment at the Standing Rock Reservation. In this study, we employed our Standing Rock database to map and explore allotment patterns in detail. We primarily focused on patterns of clustering versus dispersion of allotment parcels for individuals, families, and tribal groups by calculating median distance (and other descriptive statistics) and standard distance in GIS. Throughout, we used mapped representations of allotment patterns as visualization tools, both for confirming hypotheses and raising new questions. As anticipated, we discovered patterns of both gain and loss. On the one hand, as we had found earlier, the people at Standing Rock gained land through their insistence on allotments for married women and for children born after the beginning date of allotment (“later-born children”), land they otherwise would not have received. We also confirmed that married women only received half the land that their husbands received and that the early sale of “surplus” reservation lands deprived a future generation of children of the opportunity to receive their own land. Perhaps most importantly, however, we discovered that the belated timing of allotments to married women and later-born children caused their allotments to be located at some distance from those of their husbands or fathers, creating disjunct and dispersed patterns of family land holdings that would have significantly hampered the creation of viable farming and ranching operations. Full article

Emerging evidence reveals that cadmium exposure is associated with hypertension, cardiovascular disease (CVD), and anemia, among others. Toxic metal exposure poses a particular threat to American Indian/Alaska Native populations, particularly given their proximity to mining waste. This review aims to summarize and organize evidence explaining the cardiovascular and hematologic consequences of cadmium exposure in children, including specific data on this exposure in AI/AN people, and strategies and policy actions to mitigate these consequences in AI/AN children. Full article

Background/Objectives: This paper presents cranial MMS data for an American Indian (AI) sample from New Mexico. We compare these data to other population reference samples to understand biological distance and classification patterns. Methods: Cranial MMS data was collected from CT scans of AI individuals (n = 839) in the New Mexico Decedent Image Database. We used 12 traits following a published protocol for CT data and excluded nasal bone contour. The AI sample is compared to other samples of African American or Black, Asian, Hispanic, and White individuals to assess biological distance and classification accuracy. Results: Biological distance analysis indicated similarity among the AI, Hispanic, and Black samples, but dissimilarity among the Asian and White samples to the AI sample. Classification accuracy was low for the overall model, with Hispanic and Black individuals frequently misclassifying as AI. Conclusions: As is true everywhere, ideas about identity are complex in New Mexico. AI and Hispanic individuals in NM self-ascribe to one or both social groups. We found that biological data cannot meaningfully differentiate between these social groups, as crania are morphologically similar when examining cranial MMS traits. These results, coupled with New Mexican identity and genetics, contributes to the difficulty in group attribution in forensic casework. Nevertheless, the reference data for AI presented here can provide more robust statistics that support the likelihood of AI and Hispanic affinity in population affinity analysis. We underscore the need for an understanding of regional population history and structure and reference samples while assessing population affinity in forensic casework. Full article

American Indians and Alaska Natives experience disproportionately high cancer diagnoses and death rates. This study aims to elucidate American Indian and Alaska Native understandings of cancer as voiced through poetry. Ten writers submitted poems in response to a call for American Indians and Alaskan Natives to share their perspectives, experiences, and knowledge about cancer through poetry. Poetry submissions were analyzed for emergent themes through an inductive-deductive approach using framework analyses grounded in the Native Wellness Model and Cancer Control Continuum. Four overarching themes, one within each of the four Native Wellness Model constructs (mind, body, spirit, and context) and 17 sub-themes, reveal that cancer is a holistic experience for American Indian and Alaska Native Peoples. Participant knowledge and experiences varied across the Cancer Control Continuum, with survivorship and palliative care most reflected in the poetry. Fewer poems addressed detection, etiology, and prevention. Poetry can serve as a culturally relevant data source to better understand cancer from American Indian and Alaskan Native perspectives, experiences, and knowledge. More holistic approaches to cancer education, prevention, treatment, and research with American Indians and Alaskan Natives could improve efforts to address cancer within this population. Full article

Most studies on cross-national workplace cultures in technology companies focus either on multiple countries or on individuals of different nationalities within a single country. This paper, however, is unique in being both monocultural and cross-cultural. It examines workplace culture in Indian and U.S. technology companies through the perspectives of returning Indian migrants. The paper is based on in-depth interviews with 50 scientists and engineers who returned to India after studying and working in the U.S. It is monocultural because the participants are professionals working in the Indian technology sector, and cross-cultural because they have also experienced working in the U.S. technology sector. The paper shows that these individuals, motivated by personal and professional factors, represent a new demographic that synthesizes differences and similarities between Indian and American workplace cultures into a cohesive interpretation. Full article

This article analyzes how food functions as a cultural and narrative device in Vicente Blasco Ibáñez’s Around the World of a Novelist (1924), offering insight into early-20th-century global encounters as mediated through diet and gastronomy. Framed within literary analysis and food studies, the study focuses on Blasco Ibáñez’s representations of food across Japan, China, India, and the Americas, identifying how culinary practices serve to construct cultural otherness, negotiate identity, and reflect broader ideological frameworks. The methodology involves close textual reading combined with interpretive tools from cultural anthropology and nutritional science, especially regarding traditional versus industrial food systems. The analysis finds that Japanese foodways are portrayed as ritualized and harmonious, Chinese cuisine as ingenious yet unsettling, Indian diets as spiritually driven but materially scarce, and American food systems as abundant and industrialized. Across these accounts, food emerges not merely as sustenance but as a marker of civilization, modernity, and cultural difference. The article concludes that Blasco Ibáñez’s narrative captures a transitional moment in global food history, documenting both the persistence of traditional culinary systems and the rise of industrialized, globalized nutrition, thereby positioning gastronomy as a key lens for understanding travel literature and cross-cultural representation. Full article