Search Results (463)

Background: Population-level predictors of intraocular pressure (IOP)-lowering surgery for neovascular glaucoma (NVG) are understudied. This study examines factors associated with IOP-lowering surgery in California (CA) Medicare beneficiaries with NVG. Methods: The study population included all 2019 CA Medicare beneficiaries with NVG. Covariates included age, sex, race/ethnicity, history of treatments for retinal ischemia, dual Medicare/Medicaid eligibility, Social Vulnerability Index score, and Charlson Comorbidity Index (CCI) score. Outcomes included incidence of trabeculectomy, tube shunt, minimally invasive glaucoma surgery, cyclophotocoagulation (CPC), or any IOP-lowering surgery. Results: Of 1843 beneficiaries, 264 (14.3%) had IOP-lowering surgeries. In multivariable logistic regression including all covariates, CCI ≥ 5 versus 0 was associated with lower odds of any IOP-lowering surgery and of each type of surgery except CPC (adjusted odds ratio [aOR] = 0.47, 95% confidence interval [CI] = 0.29, 0.75 for any versus no surgery; aOR = 1.35, CI = 0.51, 3.60 for CPC). Compared to Non-Hispanic White, racial and ethnic minorities had increased odds of trabeculectomy (aOR = 3.77, CI = 1.05, 13.57 for Black; aOR = 2.69, CI = 1.04, 6.92 for Hispanic) and tube shunt (aOR = 2.62, CI = 1.27, 5.41 for Other/Unknown). Beneficiaries 75–79 versus 65–69 years old had decreased odds of trabeculectomy (aOR = 0.21, CI = 0.05, 0.98). Conclusions: Among CA Medicare beneficiaries, higher systemic disease burden was associated with a decreased likelihood of surgery for NVG, while racial and ethnic minorities were more likely to undergo certain procedures. These findings suggest surgical risk stratification and treatment pattern disparities for individuals with NVG. Full article

Background: The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child-care visits. Early identification facilitates early intervention (EI), which improves developmental outcomes. Historically, Non-Hispanic Black and Hispanic/Latino children in the United States receive autism diagnoses and autism-specific services later than Non-Hispanic White children. Variability in pediatric screening rates may indicate that systemic factors impede screening and referral; enhanced screening across community settings may support autism identification and connection to services. Methods: A feasibility study was conducted with one early learning program (ELP) to determine if screening for autism in ELPs is feasible. ELP teachers and staff received one 90 min training session on screening with the Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R). They were then tasked with independently screening ELP-enrolled children between 16 and 30 months old. Results: Eighty children were eligible for screening and 79 screenings were completed; 14 screens were positive and 65 were negative. Of the 14 positive screens, eight referrals were made to EI. All eight families completed EI evaluations and were eligible for EI services. One family declined an evaluation. Five positive autism screens were for children already receiving general EI services. Those five screening results were communicated to the child’s EI team and an autism-specific evaluation was completed; four of the five children subsequently received autism diagnoses. Conclusions: Our data supports the feasibility of completing autism-specific screenings within an ELP setting. Full article

Background: Colorectal cancer (CRC) remains one of the common causes of cancer-related morbidity and mortality in the United States. Emerging increases in early-onset CRC and persistent disparities remain major public health concerns. Objective: To characterize long-term CRC incidence and mortality trends in the United States, with particular emphasis on identifying demographic groups experiencing rising or plateauing disease burden. Methods: We conducted a population-based ecological study using CRC incidence data from the United States Cancer Statistics database (1999–2022) and mortality data from CDC WONDER (1999–2023). Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), stratified by age, sex, race/ethnicity, and urbanization level. Results: Overall CRC incidence and mortality declined during the study period (both AAPC approximately −2.08%). However, incidence increased significantly among adults younger than 55 years, particularly those aged 20–24 years. Mortality also increased among younger adults aged 25–44 years and remained elevated among individuals aged 45–54 years. Non-Hispanic Black individuals consistently experienced the highest incidence and mortality rates. Mortality declines plateaued in several older age groups after 2018–2020. Conclusions: Despite overall improvements in CRC burden, increasing incidence and mortality among younger adults and persistent disparities highlight the need for risk-stratified prevention, earlier detection strategies, and tailored therapeutic approaches. Full article

Firearm homicide is a leading cause of death among children and young men in the U.S. (ages 1–19), with young Black males in urban environments facing rates 18-to-24-fold higher than their non-Hispanic White peers in 2023. A key precursor to firearm violence victimization is weapon-carrying behavior (WCB), defined as carrying, concealing, or displaying firearms or other weapons in community or social contexts that elevate risk for injury, interpersonal threats, or law enforcement contact. Several structural, behavioral, and trauma-based risk factors fuel weapon-carrying. Yet these WCBs are rarely studied in tandem, leaving a critical gap in our understanding of these high-risk behaviors for youth. This cross-sectional study leveraged baseline data from a convenience sample of 226 violence-exposed urban young Black males, ages 15–24 (M_age = 18.3 years; SD = 3.1) enrolled in a trauma-informed digital firearm violence prevention pilot study. Eligibility required prior personal or witnessed experience of youth violence; reported prevalence therefore characterizes a high-risk subgroup rather than urban young Black males as a whole. Past-30-day weapon-carrying frequency was measured across five YRBS-aligned categories (0, 1, 2 to 3, 4 to 5, and 6+ days) and modeled as a categorical index under negative binomial regression. Associations with peer and community violence exposure, substance use, sociodemographic, and socioeconomic factors were estimated as incidence rate ratios (IRRs) with 95% CI. Past-30-day weapon carrying was reported by 42.5% of participants, with carrying frequency ranging from 1 day to 6 or more days. Participants reported high levels of direct victimization (64.8%), witnessing community violence (76.4%), and use of nonprescribed medications, including in instances preceding violence. In the fully adjusted model, indicators of violence exposure were the most consistent correlates of carrying. Direct victimization (IRR = 1.15, p < 0.05), general exposure to violence or aggression (IRR = 7.82, p < 0.01), and physical fighting (IRR = 1.11, p < 0.05) remained independently significant. Conversely, associations with substance use, dating aggression, and employment were attenuated, suggesting shared ecological vulnerability rather than independent causal pathways. Findings underscore the central role of chronic violence exposure and support the need for trauma-informed, multilevel prevention strategies in clinical and community settings. Full article

Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality and disproportionately affects Black women in the United States. While racial disparities in PTB are well documented, the molecular pathways underlying these differences remain incompletely understood. Extracellular vesicles (EVs) are circulating lipid-bound particles that carry coding and non-coding RNAs reflecting cellular stress states and may serve as integrative molecular indicators of pregnancy biology. In this hypothesis-generating pilot study, EVs were isolated from maternal plasma collected at delivery from non-Hispanic Black and non-Hispanic White women with preterm and full-term births. EV concentration and size were assessed, and EV-associated mRNA and miRNA cargo were profiled by next-generation sequencing (n = 5 per group), enabling differential expression and pathway enrichment analyses stratified by gestational outcome. EV concentrations were significantly elevated in PTB compared with full-term deliveries (p < 0.0001), with a greater increase among Black participants. Analysis of EV-associated mRNA transcripts identified a shared signature enriched for platelet activation and coagulation pathways across racial groups. Race-stratified analyses revealed distinct EV miRNA profiles in PTB, with enrichment of cytokine-mediated signaling pathways among Black participants and apoptosis-related pathways among White participants, while a subset of miRNAs differed by race independent of gestational outcome. These findings support EV profiling as a framework to investigate biological pathways contributing to PTB disparities. Full article

Internalized Weight Bias (IWB) is consistently associated with poor body image, elevated depression, and diminished self-esteem. However, very little research has examined how additional psychological constructs may indirectly influence the association between IWB and these outcomes. This investigation examined whether IWB was associated with body image, depression, and self-esteem among individuals with overweight and obesity indirectly through body shame, experiential avoidance, and self-compassion. The current sample included 403 participants, with slightly over half the participants (51%) identifying as a female with an average age of 48.3 (SD = 16.9, range 18 to 84), and an average BMI of 33.1 (SD = 7.5, range 25 to 68). Participants were recruited through a Qualtrics research panel that was reflective of the United States population on variables of education, geographic location, income, and biological sex. All participants were aged 18+ and had a BMI ≥ 25. To maximize racial/ethnic diversity, the current sample contained three equally represented self-identified racial/ethnic groups: Black non-Hispanic or Latino/a (N = 140), Hispanic or Latino/a (N = 133), and White non-Hispanic or Latino/a (N = 130). Results showed a significant indirect effect of IWB on psychological and body image outcomes through body shame, experiential avoidance, and self-compassion. Future longitudinal research examining the contexts in which body shame, experiential avoidance, and self-compassion may act as mediators will be important to further develop an understanding of IWB. Full article

Background: Hepatitis C virus (HCV) remains a major cause of preventable liver-related mortality in the United States despite highly effective direct-acting antivirals (DAAs). Contemporary assessment of mortality trends and disparities is essential for elimination efforts. Methods: Using CDC WONDER multiple cause-of-death data (1999–2023), we identified HCV-related deaths using ICD-10 codes for acute and chronic HCV (B17.1, B18.2) and calculated age-adjusted mortality rates (AAMRs) per 100,000 (2000 US standard). Rates were stratified by sex, race/ethnicity, census region, and 2013 NCHS urban–rural classification. Joinpoint regression quantified temporal inflection points and annual percent changes (APCs). Results: Overall HCV-related AAMR increased from 1.8 (1999) to a peak of 5.0 (2014), then declined to 2.3 (2023), with a marked post-2014 decrease (APC −8.2%). Mortality was consistently higher in males than females (2023 rate ratio 2.57). In 2023, American Indian/Alaska Native individuals had the highest mortality (AAMR 8.7; rate ratio 3.48 vs. non-Hispanic White), followed by non-Hispanic Black individuals (AAMR 6.2; rate ratio 2.48). Mortality remained highest in the West and was higher in non-metropolitan than metropolitan counties (AAMR 2.8 vs. 2.3; rate ratio 1.22), with a slower post-2014 decline in non-metropolitan areas. Conclusions: Our findings indicate that while the DAA era has been associated with a substantial reduction in HCV-related mortality at the national level, this progress has not been uniform across all populations. Persistent excess mortality among Native American and non-Hispanic Black individuals may reflect inequities in the HCV care cascade, including screening, confirmatory testing, linkage to specialty care, insurance-related restrictions, and the high cost of antiviral therapy. These results highlight the need for policies and public health strategies that improve equitable and affordable access to curative HCV treatment. Full article

Background/Objectives: Racial/ethnic and regional disparities in neoplasm-related mortality remain a significant public health challenge. In this study, we aimed to evaluate long-term trends in county-level neoplasm-related mortality rates by race/ethnicity in the United States and examine associations with social determinants of health. Methods: We conducted a cross-sectional ecological study using population-based data from the Global Burden of Disease Study, including individuals residing in 50 states of the United States and the District of Columbia from 2000 to 2019. We analyzed age-standardized neoplasm-related mortality rates by ethnicity/race. Joinpoint regression analysis was used to identify significant changes in mortality trends, summarized as average annual percentage change. County-level correlations between mortality and key social determinants of health were also assessed. Results: Neoplasm-related mortality rates declined across all racial/ethnic groups from 2000 to 2019; however, disparities persisted. The age-standardized neoplasm-related mortality rates per 100,000 population decreased in all racial/ethnic subgroups. The average annual percentage change ranged from −0.94% (Hispanic and non-Hispanic American Indian or Alaska Native) to −1.90% (Black). Sex-specific analyses revealed similar trends. Southeastern states experienced slower declines than Northeastern states did. County-level smoking and poverty rates were positively correlated, whereas the primary care physician-to-population ratio, excessive alcohol consumption rate, mammography screening rate, and median household income were inversely correlated with neoplasm-related mortality rate, varying by race/ethnicity. Conclusions: Targeted, community-specific interventions are required to reduce inequities in cancer outcomes. Full article

Background/Objectives: Lower circulating testosterone concentrations in postmenopausal women have been associated with adverse sexual, skeletal, and metabolic outcomes, yet population-level prevalence estimates remain inconsistent. In the absence of universally accepted diagnostic thresholds for androgen deficiency in women, interpretation of serum testosterone concentrations remains variable. This study aimed to describe the distribution of serum total testosterone and to evaluate demographic and hormonal correlates among physiologic postmenopausal women in the United States. Methods: This cross-sectional study analyzed women meeting criteria for physiologic menopause from the 2011–2016 and 2021–2023 National Health and Nutrition Examination Survey (NHANES) cycles. Participants using androgenic medications were excluded. Because no universally accepted diagnostic threshold exists for testosterone deficiency in women, serum total testosterone <30 ng/dL was used as an operational, population-based reference point, with <20 ng/dL evaluated as a sensitivity threshold. Survey-weighted analyses characterized the cohort and examined associations between testosterone concentrations below the <30 ng/dL operational threshold and demographic and hormonal variables using logistic regression. Results: Among 2707 postmenopausal women, the weighted mean total testosterone was 25.2 ± 1.1 ng/dL. Using operational, distribution-based thresholds, 56.0% of women had testosterone concentrations <20 ng/dL and 79.9% had concentrations <30 ng/dL (Rao–Scott χ², p < 0.001). In the weighted distribution, both thresholds lay above the weighted median, with 30 ng/dL exceeding the 75th percentile. The proportion of women with testosterone concentrations below the <30 ng/dL threshold differed significantly by race/ethnicity (p < 0.01) and age group (p < 0.01), highest among Non-Hispanic Asian (87.7%) and Mexican American (89.4%) women and lowest among Non-Hispanic Black women (75.5%). In multivariable models, higher sex hormone binding globulin (SHBG) (adjusted OR = 0.720; 95% CI: 0.633–0.820; p < 0.001) and higher estradiol (adjusted OR = 0.577; 95% CI: 0.389–0.856; p < 0.05) were independently associated with lower odds of testosterone concentrations below the <30 ng/dL threshold. Conclusions: Testosterone concentrations below operational thresholds are highly prevalent among U.S. postmenopausal women, although estimates vary depending on the cutoff applied. Higher SHBG and estradiol levels were inversely associated with testosterone concentrations below these thresholds, underscoring the physiologic interrelationship of these hormones in postmenopausal women. These findings highlight the need for standardized, population-specific reference thresholds and clearer clinical frameworks for interpreting androgen levels in women. Full article

Background: Prostate cancer remains a major cause of cancer morbidity and mortality among men in the United States. Differences in diagnosis and survival across racial and socioeconomic groups continue to raise concern in clinical and public health research. Population-based datasets provide an opportunity to examine patterns of advanced disease and survival outcomes across diverse demographic groups. Objective: This study evaluated racial and socioeconomic disparities in cancer-specific survival among patients with metastatic prostate cancer using a national population-based dataset. Methods: A retrospective population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) program. Patients diagnosed with malignant prostate cancer between 2004 and 2020 with distant stage disease were included. The final analytic sample consisted of 54,062 patients. Variables included race and ethnicity, age group, metastatic sites at diagnosis, treatment variables, and median household income. Descriptive analyses compared characteristics by cancer-specific death using chi-square tests for categorical variables and t tests for continuous variables. Survival patterns were examined using Kaplan–Meier methods and log-rank tests. Multivariable Cox proportional hazards model was used to estimate adjusted hazard ratios for factors associated with cancer-specific mortality. Results: Cancer-specific mortality differed across racial and socioeconomic groups. Higher mortality was observed among non-Hispanic Black patients (aHR = 1.15, 95% CI: 1.00 to 1.31, p = 0.046) and non-Hispanic American Indian or Alaska Native patients (aHR = 1.15, 95% CI: 1.10 to 1.20, p < 0.001) compared with non-Hispanic White patients, while Hispanic and non-Hispanic Asian or Pacific Islander patients showed lower mortality risk. Older age groups demonstrated higher mortality. Liver, lung, and brain metastases were associated with increased risk of prostate cancer death. Patients in higher income groups showed lower mortality compared with patients in lower income groups (aHR = 0.83, 95% CI: 0.80 to 0.87, p < 0.001). Conclusions: This study highlights persistent racial and socioeconomic differences in cancer-specific survival among patients with advanced prostate cancer in the United States. These findings support continued efforts to address disparities in early detection, access to care, and treatment pathways. Future research should further explore clinical and structural factors that influence survival differences across population groups. Full article

Mpox is a rare but potentially serious vaccine-preventable disease. The 2022 United States outbreak disproportionately impacted gay, bisexual, and other men who have sex with men, people living with HIV, and people of transgender experience. Early vaccination efforts revealed substantial racial and geographic inequities, with lower uptake among Black and Hispanic cisgender men, transgender women, and residents of rural areas. To address these challenges, Fairview’s Minnesota Immunization Networking Initiative (MINI), a 20-year-old mobile health collaborative, partnered with state and local public health agencies and community-based organizations to expand mpox vaccine access. With support from governmental outbreak response funding and stockpiled vaccine, mobile clinics were deployed in trusted community settings, including Pride events and recurring community sites. Targeted outreach, education, and coordination with local providers supported stigma reduction and second-dose series completion. Program data were collected from October 2022 through December 2024. MINI hosted 125 community-based mpox vaccination events, administered 2259 doses to individuals from 220 cities across the United States, including 195 cities in the Midwest. Pride events were key entry points for first-dose vaccination, particularly in rural areas; urban non-Pride clinics played a complementary role in facilitating second-dose completion. Program-level vaccination-to-case ratios were highest among populations experiencing disproportionate mpox burden, including Black, Hispanic, and American Indian/Alaska Native male participants, suggesting alignment of preventive resources with community need. MINI’s mobile, partnership-driven approach demonstrates the value of pairing large-scale community events with recurring clinics to address barriers to both vaccine access and series completion. These findings underscore the importance of flexible, community-centered infrastructure in advancing health equity and strengthening outbreak preparedness. Full article

Adverse childhood experiences (ACEs) are a public health concern in the United States. Using the 2019 National Survey of Children’s Health, this cross-sectional secondary analysis examined associations between cumulative ACEs (0, 1, 2, and 3 or more) and three health behaviors among children ages 6 to 17, including physical activity, recreational screen time, and sleep. Interaction models were also estimated by child sex and race/ethnicity (White non-Hispanic, Black non-Hispanic, and Hispanic) to assess whether these associations differed across groups. Nearly half of children experienced at least one ACE, and about one in eight experienced three or more. In adjusted models, higher numbers of ACEs were associated with a lower likelihood of meeting recreational screen time guidelines and sleep recommendations, while no statistically significant association was observed for meeting physical activity recommendations. Interaction analyses by child sex and race/ethnicity found no statistically significant differences in these associations across groups. These findings suggest that children with higher numbers of ACEs may be less likely to meet recommended sleep and recreational screen time guidelines, underscoring the potential value of trauma-informed strategies that strengthen sleep routines and healthy media practices. Full article

Background: Despite well-established racial/ethnic disparities in cancer outcomes, little is known about the extent to which race/ethnicity influences adverse pregnancy outcomes (APOs) among women with early onset cancer. We evaluated racial/ethnic disparity in the occurrence of cancer during pregnancy and APOs among women with cancer in the United States. Methods: Data consisted of 17.6 million singleton deliveries among females aged 18–49 years from the National Inpatient Sample. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: From 2000 to 2022, the prevalence of births among women with cancer increased more than 225%, from 120.4 to 391.8 per 100,000. After accounting for sociodemographic and behavioral/lifestyle factors and comorbidity index among women with cancer (n = 49,824, mean age = 33.4 years), non-Hispanic Black women had the highest odds for hypertensive disorders of pregnancy (OR = 1.67, CI: 1.54–1.82), preterm birth (OR = 1.44, CI: 1.26–1.64) and fetal death (OR = 3.04, CI: 1.99–4.63). Asian or Pacific Islander and Native American women had the highest odds for gestational diabetes (OR = 2.48, CI: 2.17–2.85) and fetal growth restriction (OR = 1.92, CI: 1.00–3.69), respectively. Among racial/ethnic minority women, the odds for maternal mortality and several APOs were significantly higher among those with cancer than those without cancer, with the odds for APOs being highest for breast cancer (OR = 1.39, CI: 1.23–1.56). Conclusions: This large population-based study showed significant racial and ethnic disparities in APOs among women with a concurrent cancer diagnosis at delivery. Targeted management of APO risk factors during pregnancy among racial/ethnic minority populations with cancer may help reduce adverse maternal and neonatal outcomes. Full article

Background/Objectives: Racial and ethnic disparities in cesarean birth and labor management persist in the United States, including among individuals considered low risk. Understanding variation in labor progression and cesarean indications within low-risk nulliparous, term, singleton, vertex (NTSV) births may help clarify potential contributors to inequities. This study examined differences in cesarean rates, cesarean indications, and labor duration by race and ethnicity in a low-risk NTSV cohort. Methods: We conducted a retrospective secondary analysis of electronic medical record data from 13,231 low-risk NTSV births within a Midwestern academic health system. Multivariable logistic regression models were used to evaluate the likelihood of cesarean birth and cesarean indications by race and ethnicity, adjusting for maternal age, gestational age, body mass index, insurance type, and labor onset. Linear regression models examined differences in first-stage, second-stage, and total labor duration. Interaction terms assessed whether associations varied by labor onset. Results: The overall cesarean rate was 29%. Absolute cesarean rates were higher among non-Hispanic Black and Hispanic individuals compared with non-Hispanic White individuals; however, these differences were not statistically significant after adjustment. Labor duration differed significantly by race and ethnicity. Non-Hispanic Black and Hispanic individuals experienced longer median first-stage and total labor durations compared with non-Hispanic White individuals; however, second-stage duration was markedly shorter among non-Hispanic Black individuals. Among induced labors resulting in cesarean birth, non-Hispanic Black and Hispanic individuals had increased odds of cesarean for early arrest of dilation, although these findings should be interpreted as hypothesis-generating, given data limitations in labor onset documentation. Body mass index was positively associated with likelihood of cesarean. Conclusions: In this low-risk NTSV cohort, adjusted cesarean rates did not differ significantly by race or ethnicity; however, differences in labor duration and cesarean indication were observed. These findings underscore the importance of continued investigation into labor management practices and structural contributors to obstetric inequities. Full article

Background: Adverse newborn outcomes in patients with severe maternal morbidity (SMM) are understudied, and this study examines their association with insurance type (Medicaid vs. commercial) in patients who experienced SMM. The aim of this study is to examine disparities in preterm birth, low birthweight, and neonatal intensive care (NICU) admission among Medicaid vs. commercially insured patients with severe maternal morbidity in Maryland. Methods: This cross-sectional study analyzed data from 588 SMM patients enrolled in Maryland’s Severe Maternal Morbidity (SMM) Surveillance Program (August 2020–December 2023). We utilized unadjusted and multivariable logistic regression models to evaluate the relationship between primary insurance type and the outcomes of interest: preterm birth (<37 weeks), low birthweight (<2500 g), and neonatal intensive care unit (NICU) admissions. Results: Of 588 patients with SMM, 45.1% had Medicaid. These patients were younger, more often non-Hispanic Black or Hispanic, had higher parity and comorbidity scores, and initiated prenatal care later compared with commercially insured patients. Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for other socio-demographic and medical factors. Patients’ comorbidities significantly increased the odds of adverse newborn outcomes, as did all other primary SMM causes other than obstetric hemorrhage. Conclusions: Adverse newborn outcomes were more prevalent among Medicaid than commercially insured patients who experienced SMM. Differences in maternal health status and primary SMM cause partly explain the observed differences in newborn outcomes. Our findings emphasize the need for comprehensive prenatal care and improved healthcare access for women with high-risk pregnancies. Full article