Complex Sample Survey Research Articles

Probability-weighted clustered coefficient regression models in complex survey sampling

Probability-weighted clustered coefficient regression models in complex survey sampling

Physical Activity Among Utah Cancer Survivors: Analysis From a Population-Based Statewide Survey.

Regular physical activity improves cancer survivors' health-related quality of life and physical function. We estimated the proportion of Utah cancer survivors meeting U.S. Department of Health and Human Services guidelines for weekly physical activity (aerobic plus strength exercise) and identify sociodemographic, cancer, and health-related factors associated with meeting guidelines. Survivors randomly sampled from Utah Cancer Registry records were surveyed from 2018 to 2022 to ascertain physical activity. We calculated the percent of survivors meeting guidelines and conducted logistic regression to assess predictors of meeting guidelines. Analyses were weighted to account for complex survey sample design and nonresponse and age adjusted. Among Utah cancer survivors, 20.7% (95% CI, 18.5%-23.2%) met guidelines for both aerobic activity and strength exercise. 22.4% reported no aerobic exercise in a typical week, and 59.4% reported no strength exercise. Survivors 75 or older were less likely to meet physical activity guidelines than those under 55 (adjusted odds ratio: 0.40; 95% CI, 0.25-0.65). Survivors with a bachelor's degree or higher were more likely to meet physical activity guidelines than those without a college degree. Individuals with poorer overall health were less likely to report sufficient physical activity. Individuals treated with both chemotherapy and radiation had decreased odds of meeting guidelines compared to no treatment (adjusted odds ratio: 0.54; 95% CI, 0.29-0.99). Most Utah cancer survivors, and particularly those who received multiple modes of adjuvant treatment, are not participating in sufficient physical activity to improve longevity and quality of life after cancer.

COVID-19 vaccination intention among internally displaced persons in complex humanitarian emergency context, Northeast Nigeria.

Internally displaced persons (IDPs) are at high risk for COVID-19 transmission because of congested and unsanitary living conditions. COVID-19 vaccination is essential to build population immunity and prevent severe disease among this population. We determined the prevalence and factors associated with intention to accept COVID-19 vaccine among IDPs in Northeast Nigeria. This cross-sectional study, conducted during July-December 2022, included 1,537 unvaccinated IDPs from 18 IDPs camps. We performed a complex sample survey analysis and described participants' characteristics and vaccination intention with weighted descriptive statistics. We fitted weighted logistic regression models and computed adjusted odds ratios with 95% confidence intervals to identify factors associated with intention to accept COVID-19 vaccine. Of 1,537 IDPs, 55.4% were 18-39 years old, 82.6% were females, and 88.6% had no formal education. Among them, 63.5% (95% CI: 59.0-68.1) expressed intention to accept COVID-19 vaccine. Among the IDPs who intended to reject vaccine, 42.8% provided no reason, 35.3% had COVID-19 misconceptions, 9.5% reported vaccine safety concerns, and 7.4% felt no need. IDPs who perceived COVID-19 as severe (Adjusted Odds Ratio (AOR) = 2.31, [95% CI: 1.35-3.96]), perceived COVID-19 vaccine as effective (AOR = 4.28, [95% CI: 2.46-7.44]) and resided in official camps (AOR = 3.29, [95% CI: 1.94-5.56]) were more likely to accept COVID-19 vaccine. However, IDPs who resided 2 kilometers or farther from the nearest health facility (AOR = 0.34, [95% CI: 0.20-0.58]) were less likely to accept vaccine. Intention to accept COVID-19 vaccine among the IDPs was suboptimal. To improve vaccination acceptance among this population, health education and risk communication should be intensified to counter misinformation, strengthen vaccine confidence, and shape perception of COVID-19 severity, focusing on IDPs in unofficial camps. Appropriate interventions to deliver vaccines to remote households should be ramped up.

National and regional population attributable fractions for anemia risk factors (iron, folate, and vitamin B12) in Belize: potential impact of fortification.

To estimate the national and regional population attributable fraction (PAF) and potential number of preventable anemia cases for three nutritional risk factors (iron, red blood cell folate [RBCF], and vitamin B12 deficiencies) among women of childbearing age in Belize. A national probability-based household and micronutrient survey capturing sociodemographic and health information was conducted among 937 nonpregnant Belizean women aged 15-49 years. Blood samples were collected to determine hemoglobin, ferritin, alpha-1-glycoprotein (AGP), RBCF, and vitamin B12 status. All analyses used sample weights and design variables to reflect a complex sample survey. Logistic regression was used to determine adjusted prevalence risk (aPR) ratios, which were then used to estimate national and regional PAF for anemia. The overall prevalence of anemia (hemoglobin <12 g/dL) was 21.2% (95% CI [18.7, 25.3]). The prevalence of anemia was significantly greater among women with iron deficiency (59.5%, 95% CI [48.7, 69.5]) compared to women without iron deficiency (15.2%, 95% CI [12.2, 18.3]; aPR 3.9, 95% CI [2.9, 5.1]). The three nutritional deficiencies examined contributed to 34.6% (95% CI [22.1, 47.1]) of the anemia cases. If all these nutritional deficiencies could be eliminated, then an estimated 5 953 (95% CI [3 807, 8 114]) anemia cases could be prevented. This study suggests that among women of child-bearing age in Belize, anemia cases might be reduced by a third if three modifiable nutritional risk factors (iron, RBCF, and vitamin B12 deficiencies) could be eliminated. Fortification is one potential strategy to improve nutritional status and reduce the burden of anemia in this population.

COVID-19 in Baghdad, Iraq: adaptive and emotional findings in a household cluster survey.

The objective of this study was to assess the impact of COVID-19 infection on households in Baghdad, Iraq. A cross-sectional household survey was conducted in early 2022; 41 clusters were selected proportional to population size from the districts of the Baghdad governorate. Households were randomly selected for inclusion. The head of household or senior female member present was interviewed to obtain a listing of COVID-19 infections, deaths, and vaccinations among members of the household and to understand if social and economic changes occurred during the pandemic. All analyses incorporated the complex survey design and sample weights for clustering. The findings revealed that there were 1,464 cases of COVID-19 (37.1%) and 34 reported fatalities among the 927 households enrolled in this study. One or more COVID-19 immunizations were received by 50.9% of household members. Preventive measures against COVID-19 were widely reported to be being practiced but were not more commonly reported in households having reported a clinical case of infection. While some households where infections had occurred stated that their household expenses were increased, overall, infections were not associated with significantly increased household costs. In households where COVID-19 had occurred, senior members reported a substantial increase in emotional and psychological problems compared with uninfected households. COVID-19 deaths were rare, though infections were common, suggesting an effect of vaccination and other efforts. The household economic implications were minimal in houses with and without COVID-19-infected members. COVID-19 had mental health consequences on affected and unaffected populations alike. It is conceivable that the fear and uncertainty generated by the pandemic had an effect on senior household members which was out of keeping with the other effects in the households sampled. This suggests that there may be a persisting need for mental health services for a protracted period to manage the consequences of mental health needs arising from the pandemic.

Abstract 17580: "Healthy Smile for a Healthy Heart": A National Study on the Correlation Between Periodontal Diseases and Coronary Artery Disease

Introduction: Chronic inflammatory periodontal disease (CIPD) is a common disease of the supporting tissues of the teeth that manifest as swelling, bleeding, pain, and clinical attachment loss (CAL) upon periodontal examination. CIPD has been associated with a chronic inflammatory state, also a known risk factor for coronary artery disease (CAD). Hypothesis: There is a possible correlation between CIPD and CAD. Methods: We utilized the 2013-2014 National Health and Nutrition Examination Survey database. We included participants aged 30 years and above who reported having gum disease and had undergone a periodontal examination. CAL measured in millimeters, was reported at six different locations around 28 teeth. To obtain national estimates, we conducted complex survey sample analyses, accounting for weights, clustering, and strata. Furthermore, we adjusted for well-known CAD risk factors in multivariate analyses. Results: Our study included 184,010,722 participants; 7.3% had CAD (n=13,461,796), and 17.1% reported CIPD (n=31,425,382). Baseline Characteristics are presented in Table 1. The unadjusted rate of CAD was higher in patients with CIPD than those without CIPD [10.3% (n=3,238,995) vs 6.7% (n=10,222,801), p=0.018]. Similarly, average CAL was higher in patients with CAD (2.04 vs 1.62 mm, p&lt;0.001). After adjusting for confounders listed in Table 1, CIPD was a significant predictor of CAD (OR 1.744, 95% CI 1.088-2.796, p=0.012). The average CAL of all the teeth also predicted CAD (OR 1.195, 95% CI 1.025-1.394, p=0.026). Conclusions: Our data suggest that patients with reported CIPD had a 1.7 times higher risk of developing CAD. Similarly, each 1 mm increase in CAL leads to a 20% increased CAD risk (OR 1.2). Further prospective studies are needed to confirm these findings and to explore whether treatment of CIPD mitigates the increased CAD risk. These findings underscore the significance of optimizing dental health in patients with CAD.

Associations of comorbidities with telehealth use in cancer survivors amidst the COVID-19 pandemic: Findings from the HINTS 6 (2022).

522 Background: Cancer survivors with comorbidities often need specialized care. Telehealth, using remote technologies such as phone calls or video conferences, addresses their specific needs, particularly during the COVID-19 pandemic, offering time and cost savings. However, understanding of telehealth use among cancer survivors with comorbidities is limited. This study examines the associations between comorbidities and telehealth use in cancer survivors during the pandemic. Methods: We analyzed the Health Information National Trends Survey (HINTS) 6, a nationally representative survey conducted in 2022. This study included 4,756 adults aged ≥18 (representing 195 million), including 730 cancer survivors (representing 20 million) in the U.S. The outcome variable was telehealth use in the past 12 months, including video or phone call with healthcare providers. Comorbidities included diabetes, hypertension, heart conditions, lung diseases, and depression. Design-based F-test was used for bivariate analyses. Logistic regression was used to determine associations of comorbidities and telehealth use, controlling for sociodemographic and cancer-related clinical factors. All data analyses accounted for the complex survey design and sample weights using jackknife replication method. Results: Cancer survivors’ telehealth use was slightly higher than adults without cancer (50.37% vs. 43.62%). Among cancer survivors, bivariate analysis revealed associations between telehealth use and younger age and higher number of comorbidities (P&lt;.001). These associations remained significant in the logistic regression model (OR=0.25 and 0.12, 95% CI 0.11-0.57 and 0.05-0.29 for ages 61-75 and &gt;75, respectively; OR=1.65, 95% CI 1.32-2.07 for number of comorbidities; all P&lt;.001). When examining specific comorbidities, the logistic regression model indicated that cancer survivors with heart conditions (OR=6.03, 95% CI 2.34-15.54, P&lt;.001), lung diseases (OR=5.53, 95% CI 1.89-16.17, P=.002), and depression (OR=4.46, 95% CI 2.35-8.46, P&lt;.001) were more likely to utilize telehealth compared to those without comorbidities. Additionally, higher education levels were associated with increased telehealth use, even after adjusting for other factors (OR=2.41, 95% CI 1.04-5.59, P=.04). Conclusions: This national survey analysis detected the higher rate of telehealth use in cancer survivors with comorbidities during the pandemic. Further research is needed to explore the experiences of cancer survivors with heart conditions, lung diseases, and depression regarding telehealth. Additional support is necessary to encourage older individuals and those with lower education levels to embrace telehealth for the delivery of optimal and high-quality care.

Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.

514 Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.

A nationwide study on the prevalence and contributing factors of obstructive sleep apnea in Iran

Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as “sleepy,” “insomnia,” and “restless legs syndrome (RLS).” The prevalence of OSA was 28.7% (95%CI: 26.8–30.6). The prevalence of “sleepy,” “insomnia,” and “RLS” phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. “Sleepy” and “insomnia” phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, “sleepy” phenotype was associated with youth and unmarried status but not in women. The “insomnia” phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. “RLS” phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.

Social-geographic disparities in suicidal ideations among methamphetamine users in the USA

Methamphetamine use is a growing public health concern nationwide. Suicide is the second leading cause of death in 2019 for US citizens aged 10-14 years and 25-34 years and is also a significant public health concern. Understanding the intersection of methamphetamine use and suicidal ideation (SI) is necessary to develop public health and policy solutions that mitigate these ongoing severe public health issues. Our objective was to examine SI in methamphetamine users to allow us to determine prevalence and trends by age, sex, race, and geographical region. Using data collected between 2008 and 2019 from the National Inpatient Sample (NIS) database, we identified hospital admissions (HA) of patients ≥18 years of age with a primary or secondary diagnosis of SI who were also diagnosed as methamphetamine users. Those who used other substances with methamphetamine were excluded from the analysis. To determine the trend and prevalence of hospital admissions due to SI and SI among methamphetamine users, we used trend weights to calculate the national estimates and performed design-based analysis to account for complex survey design and sampling weights on data collected between 2008 and 2019 in the US. The prevalence ratio (PR) of hospitalizations with concurrent SI and methamphetamine use increased 16-fold from 2008 to 2019. The most significant increase occurred between 2015 and 2016; the PR doubled from 6.07 to 12.14. The PR of hospitalizations with concurrent SI and methamphetamine use was highest in patients aged 26-40 (49.08%) and 41-64 (28.49%). Patients aged 41-64 showed the most significant increase from 2008 to 2019 (15.8-fold). While non-Hispanic White patients comprised most of these hospitalizations (77.02%), non-Hispanic Black patients showed the highest proportional increase (39.1-fold). The Southern and Western regions in the US showed the highest PR for these hospitalizations (34.86% and 34.31%, respectively). Our findings indicate that SI in methamphetamine users has been increasing for some time and is likely to grow. In addition, our results suggest that these patients are demographically different. Both conditions are associated with a lesser likelihood of seeking and receiving care. Therefore, when addressing increased SI or methamphetamine use, learning more about patients who share both conditions is necessary to ensure proper care.

Associations of wearable tracker use with physical activity and health outcomes in patients with cancer: Findings from the HINTS-SEER (2021).

131 Background: Physical inactivity is a global issue for cancer survivors. Wearable trackers are promising to address physical inactivity by providing real-time feedback on physical activity (PA) and offer opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable trackers on improved physical inactivity and related health outcomes (e.g., BMI, anxiety and depression, and self-rated health). However, wearable trackers were often used an an adjunct to PA interventions, and the effectiveness of wearable trackers alone is unknown. The aim of this study was to determine the association of wearable trackers with PA and health outcomes (BMI, anxiety and depression, and self-rated health) in patients with cancer, using a national dataset. Methods: Data from 957 cancer survivors from Health Information National Trends Survey – Surveillance, Epidemiology, and End Results Program (HINTS-SEER-2021) were analyzed. The outcome variables examined were: time spent in moderate to vigorous physical activity (MVPA), weekly frequency of strength training, BMI, anxiety/depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable devices within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations, after controlling for sociodemographic, cancer-related clinical (i.e., type, stage, time since diagnosis), and general health-related factors (i.e., BMI and smoking). All data analyses accounted for the complex survey design and sample weights. Results: Only 28% of cancer survivors reported wearable devices use. Bivariate analyses showed younger age, higher income, and employed status were significantly associated with wearable tracker use ( P&lt;.001). Wearable devices use was significantly associated with higher time spent in MVPA (b=37.94, 95% OR:8.38, 67.5; P=.01), more frequent strength training per week (adjusted OR=1.50, 95% OR: 1.09, 2.06; P=.01), and better self-rated health status (adjusted OR=1.58, 95% OR:1.09, 2.29; P=.01), but not associated with BMI or anxiety/depression. Conclusions: This study suggests that the uptake of wearable devices is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable tracker use with PA and self-rated health, supporting using wearable trackers as a promising tool to facilitate PA promotion.

Trajectories of depression and anxiety among older cancer survivors: A group-based trajectory analysis of a nationally representative cohort.

130 Background: Depression and anxiety are common for cancer survivors, especially those aged 65 years or older, which are negatively associated with quality of life and survival. A few studies have described the average population level of longitudinal change in depression and anxiety, but they may not capture the inter-individual variability of the longitudinal trajectory, especially in older cancer survivors. The aims of the current study were to (1) describe the trajectory patterns of depression and anxiety over time among older cancer survivors; (2) examine the socio-demographic and health-related predictors of different subgroups of trajectories. Methods: We used data from the National Health and Aging Trends Study (NHATS), a nationally representative cohort study. The Generalized Anxiety Disorder-2 scale and Patient Health Questionnaire-2 were used to assess levels of depression and anxiety. The group-based trajectory model was used to identify the distinct trajectories of depression and anxiety from 2015 to 2021. Design-based multinomial logistic regression was used to examine the socio-demographic and health-related predictors of different trajectories. All analyses accounted for the complex sample design (stratification and primary sampling units) and survey weights. Results: A total of 1,766 older cancer survivors were included, and the average prevalence of depression and anxiety from 2015 to 2021 was 27.14%. Four trajectories of depression and anxiety were identified: robust (48.9%), deteriorating (24.1%), meliorating (11.0%), and sustained-high (16.1%). Older cancer survivors were at a sustained-high depression and anxiety trajectory if they were older, female, reported poorer health, had a worse cognitive function, and had more difficulty in activities of daily living ( P&lt;0.05). Conclusions: Our findings highlight the heterogeneity and complexity of the depression and anxiety process in older cancer survivors. This study helps identify patients at a high risk of depression and anxiety and develop more individualized strategies to ameliorate the mental health of older cancer survivors.

Communication self-efficacy and contraceptive use at sexual debut among rural adolescent girls in Ethiopia

Introduction Girls with early sexual debuts are exposed to risky sexual behaviours such as unintended pregnancy and contracting sexually transmitted infections. Communication self-efficacy is vital for protecting girls from unwanted pregnancy by educating them about the use of contraceptives. This study aimed to investigate the relationship between communication self-efficacy and contraceptive use at sexual debut in a rural Ethiopian setting. Methods A total of 394 adolescent girls between the age of 13 - 17, who self-reported their sexual debut, were included in the analysis. Communication self-efficacy was measured using two items: adolescents who discussed contraceptives with their partners, and adolescents who discussed contraceptives with to other people. The association between contraceptive use at sexual debut and communication self-efficacy was examined using a multivariable logistic regression model that accounted for a complex sample survey design. Results The mean age of sexual debut was 14.5 years (95% CI 14.38, 14.69) and the proportion of contraceptive use at sexual debut was 17.37% (95% CI 12.75, 22.95). Contraceptive use at sexual debut was higher among girls who talked to their partner about contraceptives (adjusted odds ratio (AOR) = 1.94, 95% CI [0.98 - 3.8]) and those who discussed contraceptives with others (AOR = 2.45, 95% CI [1.56 - 5.55]. Conclusions Contraceptive use at sexual debut was low among young rural adolescent girls. Adolescent girls who had communication self-efficacy were likely to use contraceptives at sexual debut. Life skills interventions that improve communication and negotiation are recommended to enhance contraceptive use.

Perception Towards Epidemiology of Human Immunodeficiency Virus or Acquired Immunodeficiency Syndrome Among Women of Reproductive Age: Analysis of Nationwide Surveys in India.

The knowledge of HIV prevention, attitudes towards people living with HIV (PLHIV), and beliefs in myths related to HIV/AIDS among women of reproductive age group in India hold immense importance. As this group is particularly vulnerable to HIV infection, having accurate knowledge about prevention methods is crucial to protect themselves and their partners. Positive attitudes towards PLHIV foster support, reduce stigma and encourage early testing and treatment. Additionally, debunking myths and misconceptions surrounding HIV/AIDS can help dispel fear and promote informed decision-making. Empowering women with comprehensive knowledge, fostering positive attitudes, and debunking myths can contribute to effective HIV prevention strategies, reduce transmission rates, and improve women's overall well-being in India. Our objective was to create a regression model to show disparities in knowledge of the prevention of HIV/AIDS, attitude towards people living with HIV/AIDS, and belief in myths among women in India with adjusted odds ratio (aOR) for different socio-demographic factors, and to determine if there are any significant changes in the aOR during both surveys. A comparative study using secondary data analysis of two complex sample surveys. Individual Recode files from datasets obtained from Demographic Health Surveys (DHS) Program were exported to STATA v17.0 MP by STATA Corp LLC. Dependent and independent variables were chosen based on a literature review and computed. The design-adjusted chi-square test was used to assess the association between variables. A multinomial logistic regression analysis was used to derive a model. The model assessment was performed using the Wald test after estimation. The age group of 15-19 years had the highest odds of having sufficient knowledge of the prevention of HIV/AIDS during both National Family Health Surveys (NFHS) (aOR: 1.98 during NFHS-4 and aOR: 1.80 during NFHS-5). No education group had the highest odds of negative attitudes towards people living with HIV/AIDS during both surveys (aOR: 4.85 during NFHS-4 and aOR: 2.69 during NFHS-5). Rural areas had higher odds of believing in myths related to HIV/AIDS during both surveys (aOR: 1.07 during NFHS-4 and aOR: 1.13 during NFHS-5). This research study sheds light on the significant relationship between demographic factors and knowledge, attitudes, and beliefs related to HIV/AIDS among women. Specifically, women in the lower age group, lacking education, and residing in rural areas exhibited substantial levels of inadequate knowledge regarding HIV/AIDS prevention. Furthermore, this group was also associated with higher proportions of negative attitudes towards people living with HIV/AIDS and a greater tendency to believe in myths associated with HIV/AIDS.

Mammography Screening Outreach Through Non-Primary Care–Based Services

ObjectiveTo estimate the proportion of patients visiting urgent care centers or emergency departments or being hospitalized who were not up to date with recommended mammography screening to assess the potential impact of non-primary care–based cancer screening interventions. MethodsAdult participants from the 2019 National Health Interview Survey were included. Among participants not up to date with breast cancer screening guidelines based on ACR recommendations, the proportion of patients reporting an urgent care, emergency department visit, or hospitalization within the last year was estimated accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and mammography screening adherence. ResultsThe study included 9,139 women between the ages of 40 and 74 years without history of breast cancer. Of these respondents, 44.9% did not report mammography screening within the last year. Among participants who did not report mammography screening, 29.2% reported visiting an urgent care center, 21.8% reported visiting an emergency room, and 9.6% reported being hospitalized within the last year. The majority of patients receiving non-primary care–based services, who were not up to date with mammography screening, were from historically underserved groups including Black and Hispanic patients. ConclusionNearly 10% to 30% of participants who have not obtained recommended breast cancer screening have visited non-primary care–based services including urgent care centers or emergency rooms or have been hospitalized within the last year.

Preferred Reporting Items for Complex Sample Survey Analysis (PRICSSA)

Abstract Methodological issues pertaining to transparency and analytic error have been widely documented for publications featuring analysis of complex sample survey data. The availability of numerous public use datasets to researchers without adequate training in using these data likely contributes to these problems. In an effort to introduce standards for reporting analyses of survey data and promote replication, we propose the Preferred Reporting Items for Complex Sample Survey Analysis (PRICSSA), an itemized checklist to guide researchers publishing analyses using complex sample survey data. PRICSSA is modeled after other checklists (e.g., PRISMA, CONSORT) that have been widely adopted for other research designs. The PRICSSA items include a variety of survey characteristics, such as data collection dates, mode(s), response rate, and sample selection process. In addition, essential analytic information—such as sample sizes for all estimates, missing data rates and imputation methods (if applicable), disclosing if any data were deleted, specifying what survey weight and sample design variables were used along with method of variance estimation, and reporting design-adjusted standard errors/confidence intervals for all estimates—are also included. PRICSSA also recommends that authors make all corresponding software code available. Widespread adoption of PRICSSA will help improve the quality of secondary analyses of complex sample survey data through transparency and promote scientific rigor and reproducibility.

Inverse Association of the Adequacy and Balance Scores in the Modified Healthy Eating Index with Type 2 Diabetes in Women.

Type 2 diabetes (T2DM) has markedly increased among Asians as their diets and lifestyles become more westernized. We, therefore, investigated the hypothesis that the Korean healthy eating index (KHEI) scores are associated with gender-specific T2DM risk in adults. The hypothesis was tested using the data from the Korea National Health and Nutrition Examination Survey-VI (2013-2017) with a complex sample survey design. Along with the KHEI scores, the modified KHEI (MKHEI) scores for the Korean- (KSD) and Western-style diets (WSD) were used as independent parameters, calculated using a validated semi-quantitative food-frequency questionnaire (SQFFQ). We estimated the association between the KHEI or MKHEI and the T2DM risk using logistic regression after adjusting for T2DM-related covariates. The adults with T2DM were more frequently older men who were less educated, married, on a lower income, and living in rural areas compared to those without T2DM. Not only the fasting serum glucose concentrations but also the waist circumferences and serum triglyceride concentrations were much higher in adults with T2DM than in those without T2DM in both genders. Serum HDL concentrations in the non-T2DM subjects exhibited a greater inverse relationship to serum glucose than in the T2DM group in both genders. Twenty-four-hour recall data revealed that women, but not men, had higher calcium, vitamin C, saturated and monounsaturated fatty acids, retinol, and vitamin B2 intakes than the T2DM group. Furthermore, overall, the KHEI score and the adequacy and balance scores among its components were significantly higher in the non-T2DM group than in the T2DM group, but only in women. The KHEI scores were inversely associated with T2DM only in women. The mixed grain intake score was higher in the non-T2DM than the T2DM group only in men. However, there were no differences between the groups in the MKHEI scores for KSD and WSD. In conclusion, high KHEI scores in the adequacy and balance components might prevent and/or delay T2DM risk, but only in women.

Comparisons of statistical methods for handling attrition in a follow-up visit with complex survey sampling.

Design-based analysis, which accounts for the design features of the study, is commonly used to conduct data analysis in studies with complex survey sampling, such as the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). In this type of longitudinal study, attrition has often been a problem. Although there have been various statistical approaches proposed to handle attrition, such as inverse probability weighting (IPW), non-response cell weighting (NRCW), multiple imputation (MI), and full information maximum likelihood (FIML) approach, there has not been a systematic assessment of these methods to compare their performance in design-based analyses. In this article, we perform extensive simulation studies and compare the performance of different missing data methods in linear and generalized linear population models, and under different missing data mechanism. We find that the design-based analysis is able to produce valid estimation and statistical inference when the missing data are handled appropriately using IPW, NRCW, MI, or FIML approach under missing-completely-at-random or missing-at-random missing mechanism and when the missingness model is correctly specified or over-specified. We also illustrate the use of these methods using data from HCHS/SOL.

Racial Differences in Social Determinants of Health and Outcomes Among Hispanic/Latino Persons with HIV-United States, 2015-2020.

Hispanic/Latino people with HIV (PWH) experience disparities in health outcomes compared with other racial and ethnic groups. Disaggregated data based on race for Hispanic/Latino PWH in the United States are rarely reported, potentially masking inequities. The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV. We used weighted interview and medical record data collected from June 2015-May 2021 to examine differences in social determinants of health (SDH) and health outcomes by self-reported race among Hispanic/Latino adults with diagnosed HIV. Compared with White Hispanic/Latino PWH, Black Hispanic/Latino PWH were more likely to be unemployed (PR, 1.4; CI, 1.2-1.8), have a disability (PR, 1.3; CI, 1.2-1.5), have experienced homelessness (PR, 1.8; CI, 1.2-2.6), and have been incarcerated (PR, 2.6; CI, 1.5-4.5). American Indian/Alaska Native (AI/AN) (PR, 1.8; CI, 1.1-2.7) and multiracial (PR, 2.0; CI, 1.4-2.9) Hispanic/Latino PWH were more likely to have experienced homelessness than White Hispanic/Latino PWH. Black (PR, 1.3; CI, 1.2-1.5) and multiracial (PR, 1.2; CI, 1.1-1.5) Hispanic/Latino PWH were more likely to be virally unsuppressed than White Hispanic/Latino PWH. Black, multiracial, and AI/AN Hispanic/Latino PWH experience disparities in SDH and HIV outcomes. Lumping Hispanic/Latino people into one racial and ethnic category obscures health disparities, which might limit our progress towards reaching national HIV goals. Future studies should consider disaggregating by other factors such as Hispanic origin, place of birth, immigration status, and primary language. Doing so recognizes the diversity of the Hispanic/Latino population.

Hypotheses Testing from Complex Survey Data Using Bootstrap Weights: A Unified Approach

ABSTRACT Standard statistical methods without taking proper account of the complexity of a survey design can lead to erroneous inferences when applied to survey data due to unequal selection probabilities, clustering, and other design features. In particular, the Type I error rates of hypotheses tests using standard methods can be much larger than the nominal significance level. Methods incorporating design features in testing hypotheses have been proposed, including Wald tests and quasi-score tests that involve estimated covariance matrices of parameter estimates. In this article, we present a unified approach to hypothesis testing without requiring estimated covariance matrices or design effects, by constructing bootstrap approximations to quasi-likelihood ratio statistics and quasi-score statistics and establishing its asymptotic validity. The proposed method can be easily implemented without a specific software designed for complex survey sampling. We also consider hypothesis testing for categorical data and present a bootstrap procedure for testing simple goodness of fit and independence in a two-way table. In simulation studies, the Type I error rates of the proposed approach are much closer to their nominal significance level compared with the naive likelihood ratio test and quasi-score test. An application to an educational survey under a logistic regression model is also presented. Supplementary materials for this article are available online.