Population Demographics Research Articles

A surrogate FRAX model for Nepal.

FRAX models are frequently requested for countries with little or no data on the incidence of hip fractures. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country. This report describes the development and characteristics of a surrogate FRAX model for Nepal. The FRAX model used the ethnic-specific incidence of hip fracture in the Indian community of Singapore, combined with the death risk for Nepal in 2015-2019. The number of hip fractures in 2015 and 2050 was estimated based on the United Nations' predicted changes in population demography. The surrogate model gave similar hip fracture probabilities to estimates from Sri Lanka, India and Pakistan but lower 10-year fracture probabilities for men and women at older ages compared to the model for Singapore, reflecting a higher mortality risk in Nepal compared with Singapore. There were very close correlations in fracture probabilities between the Nepalese and the Singapore models (r > 0.995) so that the use of the Nepalese model had little impact on the rank order of risk, i.e. a person at the xth percentile of risk with one model will be at the xth percentile of risk with the other. It was estimated that 6897 hip fractures arose in 2015 in individuals aged 50 years and older in Nepal, with a predicted 3-fold increase expected by 2050, when 23,409 hip fractures are expected nationally. The surrogate FRAX model for Nepal provides an opportunity to determine fracture probability within the Nepalese population and help guide decisions about treatment.

A scoping review of global patterns in reporting race, ethnicity, nationality, or religion in palliative care randomized controlled trials: Recommendations for transparency.

Though randomized controlled trials of non-pharmacological palliative care interventions have shown positive outcomes, findings are often generalized with limited consideration for the impact of the influence of race, ethnicity, nationality, or religion on said outcomes. To identify trends and gaps in global reporting of racial, ethnic, nationality, and religious demographics in non-pharmacological palliative care randomized controlled trials. We conducted a scoping review guided by the Joanna Briggs methodology. Global randomized controlled trials published in English, between 1999 and 2021 extracted from databases: Cochrane, PubMed, and Scopus. Inclusion criteria were non-pharmacological palliative care interventions for people with serious conditions reporting on one or more of the demographics of race, ethnicity, nationality, or religion. Our review included 131 (44%) articles published from 19 countries, predominantly the USA (n = 84, 64%). Most studies focused on cancer (n = 71, 54%) in inpatient settings (n = 85, 64%). Race was the most commonly reported demographic (n = 93, 70%), followed by ethnicity (n = 54, 41%), religion (n = 46, 35%), nationality (n = 20, 15%). Within racial reporting, 86 (92%) indicating a majority White/Caucasian sample. Only 14 (10%) articles provided context connecting participant demographics to intervention outcomes. Demographic data was discussed only as a limitation to generalizability in 18 cases (41%). Improving greater transparency in study reporting of social and historical context about population demographics, including specific demographic data collected, may better identify unmet palliative needs, facilitate cross-cultural interpretation, and improve adaptation and implementation of non-pharmacological palliative care interventions.

Dynamic fine-tuning of anti-predator behaviour in snowshoe hares illustrates the context dependence of risk effects.

Research Highlight: Shiratsuru, S., & Pauli, J. N. (2024). Food-safety trade-offs drive dynamic behavioural antipredator responses among snowshoe hares. Journal of Animal Ecology, DOI: 10.1111/1365-2656.14183. Predation-risk effects are known to be context dependent, with impacts of perceived predation threat on individual antipredator responses, prey population demography, species interactions and community organization hinging on traits of the prey, the predator(s) and setting of the interaction. Yet, few empirical studies to date have simultaneously explored how these three drivers shape contingency in antipredator behaviour, the key first step in the process by which predation-risk effects play out, especially in free-living vertebrates. In a new study, Shiratsuru & Pauli (2024) address this knowledge deficit by showing that snowshoe hares (Lepus americanus) trade foraging for anti-predator vigilance dynamically as a function of winter food availability (a proxy for individual energetic state), the timing and intensity of predator activity, and environmental properties associated with elevated vulnerability to predator-induced mortality, notably including coat colour mismatch caused by variation in snow cover. These results offer new insight into the complexity of predation-risk effects and should serve as a guide for research aiming to better understand the expression of these effects under varying circumstances.

Predictive value of systemic immune-inflammatory biomarkers for drug-induced liver injury in hepatitis B virus surface antigen positive tuberculosis patients: A retrospective observational study.

Drug-induced liver injury (DILI) is a major concern in tuberculosis (TB) treatment. For early detection of DILI, immune-inflammatory biomarkers are needed for better management. To explore the predictive effect of systemic immune-inflammation index (SII) combined with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil (EOS%), and CD4/CD8 on DILI occurrence in TB patients with HBsAg positive. This is a retrospective study enrolling patients who were treated with anti-tuberculosis drugs and infected with hepatitis B virus (HBV) in the Guangzhou Chest Hospital from 2018 to 2023. Population demographics and clinical data of 2643 patients were collected by reviewing electronic medical records. Using a propensity score matching model, the study ultimately included 516 patients (258 patients with DILI and 258 patients without DILI). Logistic regression analysis was conducted to investigate the predictive role of systemic immune-inflammatory biomarkers (SII, NLR, MLR, EOS%, and CD4/CD8) in DILI in hepatitis B virus surface antigen-positive TB patients (HBV-TB-DILI). As compared to patients without DILI, patients with DILI have elevated levels of systemic immune-inflammatory biomarkers (SII, NLR, MLR, EOS%, and CD4/CD8), (all P < .05). The SII, NLR, MLR, PLR, EOS%, and CD4/CD8 are risk factors of HBV-TB-DILI. The NLR, MLR, SII, and EOS% were positively correlated with liver function (P < .001). The combination of SII, NLR, MLR, EOS%, and CD4/CD8 demonstrated good predictive performance for DILI occurrence in HBV-TB patients. The combination of SII, NLR, MLR, EOS%, and CD4/CD8 demonstrated good predictive performance for DILI occurrence in HBV-TB patients.

Who Is Perceived as Deserving? How Social Identities Shape Attitudes about Disaster Assistance in the United States

ABSTRACT Research has shown that as the size of government assistance programs grow, and the recipients of such programs are increasingly non-white and/or non-citizen, public support for them declines. Our study examines this phenomenon on the question of deservingness in federal disaster assistance. Using a 2018 survey experiment that leverages two devastating hurricanes—Hurricane Maria and Hurricane Harvey—that hit different parts of the United States in 2017, we explore how the social identities of race/ethnicity and partisanship affect attitudes about disaster deservingness. Our results demonstrate that although federal disaster assistance has broad support, it is contingent on perceptions about the disaster victim and the type of assistance. Respondents were less likely to support disaster assistance to Hurricane Maria–affected people than those affected by Hurricane Harvey. Moreover, white and Republican respondents were more likely to favor market-based assistance whereas race-/ethnic-minority and Democratic respondents were more likely to support more generous forms of disaster assistance. These findings have important implications for the allocation of disaster funds as climate change intensifies and the frequency of billion-dollar disaster events increases. This is exacerbated by political polarization and heightened social vulnerability due to changing population demographics.

Assessment of muscle strength in elderly as a screening method for sarcopenia in primary care: a scoping review

ObjectivesTo identify and map the available evidence for whether a test of handgrip strength (HGS) and/or the chair stand test (CST) have been used as screening tools for the detection...

Prenatal exercise and its effects on postpartum mental health: systematic review and meta-analysis.

The perinatal period, spanning from pregnancy through the first year after childbirth, is characterized by significant physiological, psychological, and socio-contextual changes. Women face complex stressors including psychosocial pressures, financial constraints, interpersonal dynamics, anticipatory stress related to parenthood, hormonal fluctuations, and societal expectations. These factors collectively influence the perinatal experience, increasing vulnerabilities and stress levels. A systematic review was conducted in October 2023 using PubMed, SPORTDiscus, PsycInfo, and Scopus databases. Only English-language publications were included. For the meta-analysis, only randomized controlled trials (RCTs) using the Edinburgh Postnatal Depression Scale (EPDS) were considered. Data extraction was performed independently by two reviewers using Covidence, focusing on study characteristics, population demographics, interventions, and outcomes. The initial search identified 2,373 articles, with 1,196 duplicates removed, leaving 1,177 articles. After screening titles and abstracts, 1,247 were excluded for not meeting the inclusion criteria, resulting in 30 full-text articles reviewed for eligibility by two researchers. Nineteen studies were included in the systematic review, with four in the meta-analysis. Results indicated that higher levels of physical activity during pregnancy were consistently associated with improved postpartum mental health outcomes, including reduced depressive symptoms, lower anxiety, and enhanced overall well-being. Low-intensity exercises, such as yoga, were particularly effective in reducing postpartum depressive symptoms. The impact of moderate-intensity exercise varied, with some studies showing no significant effects. The meta-analysis of four RCTs using the EPDS demonstrated a significant reduction in depression and anxiety symptoms among postpartum women who participated in physical activity interventions, with a substantial overall effect size. Developing physical activity and exercise regimens encompassing a range of intensities can address the unique physiological and psychological demands of the perinatal period, maximizing the therapeutic benefits of physical activity interventions.

Sex ratios of olive ridley sea turtles in the North Pacific high seas: implications for climate change research

Size-class distributions and sex ratio data provide critical information to assess the demography and reproductive potential of animal populations, such as sea turtles. Sea turtle sex is determined by incubation temperature, whereby warmer temperatures during a certain period of embryonic development produce more female hatchlings. Whereas hatchling sex ratios have been well-studied, sex ratios of sea turtle foraging aggregations are less known for most populations. Here we report on sex ratios of immature and mature olive ridley sea turtles Lepidochelys olivacea in the Eastern Tropical Pacific (ETP) and Central North Pacific (CNP) based on blood plasma hormone analysis, refined with Bayesian modeling, or gonad examination. Our findings established that (1) the commercial enzyme-linked immunosorbent assay used in the present study was appropriate to analyze testosterone concentration in olive ridley blood plasma to determine foraging ground sex ratios (via a Bayesian model); (2) size-at-maturity is generally larger in males than females in the ETP; (3) the overall sex ratio among all turtles was 1.2F:1.0M; and (4) the sex ratio of smaller-sized immature turtles from both study regions was female-biased (ETP, 1.6F:1.0M and CNP, 2.1F:1.0M). These are the first sex ratio estimates for olive ridleys foraging in the high seas of the North Pacific Ocean. The data can inform population models for species conservation, particularly those that contribute to the development of conservation plans that consider climate change projections.

Correction to: Smallmouth buffalo (Ictiobus bubalus Rafinesque) population trends and demographics in the Upper Mississippi River System

Correction to: Smallmouth buffalo (Ictiobus bubalus Rafinesque) population trends and demographics in the Upper Mississippi River System

Observing the interaction between energy generation carbon emissions and economic conditions could consider generation, intensity, and times of the day.

Management of carbon emissions of regional electricity generation involves resolving much nuanced relationships. However, current studies pertaining to the relationship between energy and the economy utilize only quarterly and annual data and focus on the long-run relationship but are oblivious to temporal associations. This study takes the context of the State of Texas and utilizes per 15min of data between 2007 and 2020 to derive the monthly time series of life-cycle emissions, emissions factor, and energy generation. The study also divides each day into three portions (0:00-8:00, 8:00-16:00, and 16:00-24:00) in order to descend precision down to the hourly level. Impulse-response analysis indicates that (1) employment conditions impact emissions by affecting the amount of electric energy generated, while demographic (population as reflected by property price) tends to impact emissions by affecting the carbon intensity of electricity, and (2) the emissions produced during 0:00-8:00 display different reaction to fluctuation of regional economic conditions compared to emissions produced during other periods, the effect emanates from either energy generation fluctuation or emissions factor shocks. The broader implication of the findings lies in an emphasis on time-interval-specific analysis and concurrent consideration of both energy generation and emissions factors that can lead to optimized policy implementation results.

Biophysical and socioeconomic characterization of Agewmariam experimental watershed in Northern Ethiopia: insights and management options.

Watershed characterization is essential for sustainable watershed management and effective resource utilization, particularly in assessing changes resulting from interventions. This study investigates the biophysical and socio-economic conditions of the Agewmariam watershed, aiming to develop land capability and suitability maps while identifying viable management options. Biophysical data, including land slope, soil properties, erosion severity, stoniness/rockiness cover, and vegetation cover, were collected through field surveys and analyzed using overlay analysis in ArcGIS. Socio-economic data, encompassing population demographics, income, and expenditure, were gathered via individual interviews, complete census, and focus group discussions and summarized using descriptive statistics. The study identified 259 households with an average family size of 4 and a demographic dependency ratio of 96.6%. The major sources of income are crop production and livestock rearing supplemented by casual labor and food aid. The average farmland holding size is 0.5ha, with sorghum, barley, teff, and wheat as the dominant crops. The watershed is characterized by six land capability classes (classes II, III, IV, VI, VII, and VIII). The suitability analysis indicated that the watershed is not currently suitable for wheat and teff crops unless physical, chemical, and biological management improvements are implemented. The study revealed that the major limiting factors for land capability and suitability were slope, erosion severity, stoniness, soil organic matter, and soil texture. The socio-economic characterization enhanced awareness about the local socio-economic condition, informing appropriate planning and management strategies. The study recommends intensive soil and water conservation intervention, afforestation on hillsides, changing the land use system, and the addition of organic matter and fertilizers to enhance land capability and suitability for sustainable agricultural practices.

Sexual behaviours and risk of SARS-CoV-2 infection among MSM during the first COVID-19 lockdown

BackgroundThe social distancing measures associated with the COVID-19 pandemic had far reaching effects on sexual behavior worldwide. However, it remains unclear whether sexual contact with non-steady partners was a contributor to the spread of SARS-CoV-2. The aim of this study was to (i) describe risk factors for SARS-CoV-2 seropositivity after the first pandemic wave among people using HIV Pre-Exposure Prophylaxis (PrEP) in Zurich, Switzerland, including sexual contact with non-steady partners, and (ii) assess whether the SARS-CoV-2 seropositivity among PrEP users in this time period differed from that of a demographic matched population level comparison group.MethodsThe study was conducted between July 2020 and October 2020 as a nested cross-sectional study within two ongoing cohort studies, SwissPrEPared (all eligible PrEP users in Switzerland ≥ 18 years old) and Corona Immunitas (a series of cross-sectional and longitudinal studies measuring the SARS-CoV-2 seroprevalence across Switzerland, beginning in April 2020). All SwissPrEPared participants were recruited from Checkpoint Zurich (the main PrEP clinic in Zurich) and were men having sex with men or transgender women. Data were collected on participants’ SARS-CoV-2 antibody status, social characteristics and behavioral data after the first wave of the pandemic in Switzerland, and seroprevalence was compared with a propensity score-matched sample from the general Zurich population.ResultsOf the 218 participants enrolled, 8.7% (n = 19, 95% CI: 5.5–13.5%) were seropositive for SARS-CoV-2 during the first pandemic wave, higher than that of the general male population in Zurich aged 20–65 (5.5%, 95% CI: 3.8–8.2%). Participants on average reduced their social outings, but the seronegative were more socially active before, during, and after the first lockdown period. In a logistic model, increasing mean sexual partner count was not associated with seropositivity (OR: 1.02, 95% CI: 0.95, 1.07). The estimated risk ratio for seropositivity for the participants compared to the general Zurich population after propensity score matching was 1.46 (95% CI: 0.53, 3.99).ConclusionsOur study suggests that SARS-CoV-2 seropositivity was slightly elevated among people taking PrEP in Zurich during the first wave of the pandemic, but that socializing and sexual activity were less important than other factors in contributing to risk.

Biogeographic Patterns in Density, Recruitment, Body Size and Zonation of Rocky Intertidal Predators Suggest Increased Population Vulnerability Near Southern Range Limits

ABSTRACTAimSurveying the demography of populations near species range edges may indicate their vulnerability to range contractions or local extinction as the climate changes. In the rocky intertidal, not only are latitudinal ranges constricted by thermal stress, but tides also create zonation or a ‘vertical range’ driven by sharp environmental gradients. By investigating demographics along the latitudinal and vertical ranges simultaneously, we can investigate whether populations may be vulnerable to a changing climate.LocationRocky intertidal habitats along west coast of the United States.TaxaOchre sea star Pisaster ochraceus, six‐armed sea star Leptasterias spp., emarginate whelks (Nucella ostrina and N. emarginata) and channeled whelk N. canaliculata.MethodsIn 2018, we surveyed the demographics of the taxa above at 33 sites spanning &gt; 11° latitude from central Oregon to southern California, near the southern range limits of each taxon. We counted and sized individuals from the high to low intertidal zone. To understand how environmental stress changed with latitude, we evaluated intertidal temperatures in situ, as well as tidal extremes, tidal amplitude and wave exposure using offshore buoys.ResultsFor all taxa, population density, the relative proportion of smaller individuals (except for emarginate whelks) and the upper vertical limits on the shore declined from north to south as temperatures increased and high tide height, tidal amplitude and wave heights decreased. In addition, smaller individual Leptasterias spp. generally inhabited lower shore levels while smaller individual emarginate whelks inhabited higher shore levels coastwide. For N. canaliculata, smaller animals were higher on shore northward, but lower on shore southward.Main ConclusionsWhile this study is a snapshot in time and cannot assess impacts of climate change, our surveys suggest environmentally‐related demographic limitation toward southern range limits and demographically vulnerable southern populations. Therefore, a warming climate may cause local extinctions or range contractions near southern limits.

Estimating Demographic Parameters for Bearded Seals, Erignathus barbatus, in Alaska Using Close-Kin Mark-Recapture Methods.

Reliable estimates of population abundance and demographics are essential for managing harvested species. Ice-associated phocids, "ice seals," are a vital resource for subsistence-dependent coastal Native communities in western and northern Alaska, USA. In 2012, the Beringia distinct population segment of the bearded seal, Erignathus barbatus nauticus, was listed as "threatened" under the US Endangered Species Act requiring greater scrutiny for management assessments. We sought to estimate requisite population parameters from harvested seals by using close-kin mark-recapture (CKMR) methods, the first such application for marine mammals. Samples from 1758 bearded seals harvested by Bering, Chukchi, and Beaufort Sea communities during 1998-2020 were genotyped, genetically sexed, and aged by tooth annuli. After rigorous quality control, kin relationships were established for 1484 seals including two parent-offspring pairs (POPs) and 25 potential second-order kin pairs. Most of the second-order kin were half-sibling pairs (HSPs), but four were potential grandparent-grandchild pairs (GGPs). There were no full sibling pairs, suggesting a lack of mate fidelity. Mitochondrial DNA analysis identified 17 potential HSPs as paternally related, providing substantial evidence of persistent heterogeneity in reproductive success among adult males. The statistical CKMR model incorporates probabilities associated with POPs, HSPs, and GGPs and assumes known ages and a stable population. Our top model accommodates heterogeneity in adult male breeding success and yields an abundance estimate of ~409,000 with a coefficient of variation (CV) = 0.35, which is substantially greater than the "non-heterogeneity" model estimate of ~232,000 (CV = 0.21), an important difference for managing a harvested species. Using CKMR methods with harvested species provides estimates of abundance with the added opportunity to acquire information about adult survival, fecundity, and breeding success that could be applied to other species of concern, marine and terrestrial.

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register

BackgroundDue to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment. MethodsThe study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis. ResultsThe study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures. ConclusionCalcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically. Level of evidenceIV, retrospective observational cohort study

Regional Distribution of Foreign-Born Medical Graduates in US Primary Care Specialty Residencies from 2010 to 2022.

The United States has more foreign-born (FB) individuals than any other country and a large international medical graduate (IMG) workforce. Yet little is known about the trends of FB IMGs matching into primary care specialties residency programs or the alignment between FB individuals and FB IMGs. This study examined the recent trends in FB IMGs entry into primary care specialty residency programs and their distribution in relation to the US FB population. In this retrospective study, we used archives of National Resident Matching Program (NRMP) data on the main residency match from 2010 to 2022. We extracted match data and program directors' policies for internal medicine, pediatrics, family medicine, and internal medicine/pediatrics. We also extracted data on the total population and FB individuals from the US Census Bureau for each US state from 2010 to 2022. From 2010 to 2022, 17.2% of primary care specialty positions were filled by FB IMGs, with 22.1% for internal medicine, 11.3% for pediatrics, 10.7% for family medicine, and 3.2% for internal medicine/pediatrics. The percentage of primary care specialty positions filled by FB IMGs was significantly higher than the percentage of FB people in the US overall and 7 of 9 US regions (p < 0.001) (excepting Pacific and Mountain). The percentage of family medicine, pediatrics, and internal medicine/pediatrics positions filled by FB IMGs was significantly lower than the proportion of FB people (p < 0.001). Internal medicine had a higher proportion of positions filled by FB IMGs compared to the proportion of FB individuals in the general population (p < 0.001). Distribution of FB IMGs varies in primary care specialties compared to FB people in the US. Given the importance of aligning medical education with patients' needs, programs could take into account population demographics while assessing and admitting the applicants.

Dermoid Cysts of the Auricle: A Review of the Literature.

Dermoid cysts are congenital anomalies that contain ectodermal elements such as teeth, bone, and nerves. The purpose of this study was to identify trends in the characteristics of dermoid cysts of the auricle and the demographics of the patient population they affect. A PubMed and EMBASE search for English-language publications that included cases of dermoid cyst(s) of the auricle from database inception to October 2022 was performed. A total of 38 cases of dermoid cysts of the auricle were identified from 20 publications. The age, sex, and Fitzpatrick skin type of the patients, locations of the dermoid cysts, associated anomalies, treatment methods, and postoperative outcomes were examined. Patients' ages ranged from 0 to 63 years, with 27.6% (8/29) in the 0-17 age range. 56.8% (21/37) were reported as male. Dermoid cysts were frequently present on the postauricular surface (18/24, 75.0%) and on light skin (Fitzpatrick types I-III; 18/22, 81.8%). Unilateral dermoid cysts were more commonly reported on the right ear (17/22, 77.3%); only one patient had bilateral cysts. Associated anomalies included microtia, prominent ears, foot polysyndactyly, hemifacial microsomia, and cryptotia. All auricular dermoid cysts were managed with complete surgical excision, and no postoperative complications or recurrences were reported. Dermoid cysts of the auricle are reported more frequently in individuals with lighter skin; however, this is likely due to reporting bias. Complete surgical excision can be used to treat patients successfully, with a very low risk of complications and no need for preoperative imaging.

1.D. Scientific session: Cross national perspectives: the many faces of health inequities

Abstract Health inequities come in different forms in different countries, often times based on country and population demographics, and exist around the world. Ample evidence has revealed how inequities to accessing and utilizing health services can have detrimental consequences for certain populations and exist across numerous strata including geography, income, race and ethnicity, age, and gender. This workshop identifies different examples of inequities across countries, and their impact on health outcomes and health care use. Health inequities, in whichever form, lead to one common outcome: worse health outcomes and lower life expectancy for those who are marginalized by inequities compared to their counterparts. This session will dive into the research on health inequities by geography (rural versus non rural), income (low/average income versus high income), race/ethnicity, and among people with substance use disorder (SUD) particularly those who use and inject drugs with the goal of 1) exposing the stark disparities in health care among these populations; 2) discussing lessons which can be learned and adapted from other countries; and 3) discussing promising solutions and approaches to restoring justice and access to care for all. The panel will be composed of 1 moderator and up to 5 panelists. Panelists are experts in their fields, established researchers and practitioners, and either employees of the Commonwealth Fund or alumni of the Harkness Fellowship from various high-income countries including Canada, Germany, Norway, the United Kingdom, and the United States. A moderator from the Commonwealth Fund will frame the discussion by introducing a deep dive into affordability barriers utilizing the Commonwealth’s Fund International Health Policy Survey of nine countries. Munira Gunja, senior researcher on the Commonwealth Fund’s International program, will present how a lack of affordability in health care is a growing threat and will likely widen the disparities by income without serious health reforms. Neil MacKinnon, Senior Harkness Fellow from Canada, will continue the discussion focusing on an analysis he and his team at Augusta University completed on disparities in health care by geography in eleven (primarily European) countries. The second panelist, Sidra Khan-Gokkaya, the 2023-2024 Harkness Fellow from Germany, will present on her study of racism in health care in Germany and the U.S. Another of the 2023-2024 Harkness Fellows, Claire Wilson, will present on her research of racial disparities in perinatal mental illness in the U.K. and U.S. Lastly, the fifth panelist, Ane Kristine Finbråten will discuss the unique health needs of those with SUD and the inequities faced by people who use and inject drugs as they navigate health care. Each panelist will speak for roughly 8 minutes, with 20 minutes saved for moderator and audience questions. Key messages • All stakeholders, including patients, public health systems, and health systems benefit when all populations are able to access comprehensive health services. • Health inequities come in many different forms, and to improve health outcomes, we must address them at all levels.

Validation of digital cardiovascular risk score (DiCAVA) in the United States All of Us dataset

Abstract Introduction The cardiovascular disease (CVD) risk score DiCAVA was developed in 2021 using UK Biobank data with the aim to be used for population health screening by deriving its predictions only from variables readily available to every individual, omitting difficult-to-obtain measurements such as blood pressure and invasive blood tests for metrics like cholesterol or HbA1c, which are commonly used in clinical CVD risk assessment tools. The original set of variables was reduced to 30 in the DiCAVA Lite score to further improve usability in a digital solution accessible to the general population, while maintaining its discrimination ability. Purpose Like many countries, the US has a large burden of CVD and would benefit from easily accessible screening tools. However, to ensure generalisability of the UK-developed score, it is necessary to evaluate its performance in a population where the score is intended to be used. Methods Data from a large real-world modern observational study in the US, All of Us, was used to evaluate discrimination and calibration metrics of the risk score. Participants with pre-existing CVD and without available electronic health records were excluded from the study. Variables from the All of Us dataset were matched to the original variables and any missing values were imputed using multiple imputation. Results 216,985 participants with a median follow-up time of 3.44 years were included in the study. The median age was 51 years and 63% of the population were female. Discrimination ability in the All of Us dataset (C-index 0.76) slightly surpassed the discrimination achieved at training with UK Biobank (C-index 0.73), and that of Framingham risk score calculated for the All of Us population (C-index 0.72), demonstrating the score’s usability in the US. The score showed very good discrimination in both males (C-index 0.74) and females (C-index 0.77), all ethnic groups and age groups, with the exception of the population over 65 years of age, where the C-index dropped to 0.65 as expected (similar to that observed in the UK Biobank). Calibration of the original model was assessed at 3 years and showed under-estimation of the predicted risk (calibration-in-the-large of 2.37%). Following re-calibration, the algorithm demonstrated excellent results with the average predicted 3-year risk showing 0.59% difference from the observed CVD rate (calibration plot in Figure). Conclusions Overall, the DiCAVA Lite score has shown very good discrimination in the US, showing its generalisability in different demographic populations. Its re-calibrated form is now validated for use in the US population and because of its ability to be utilised outside clinical settings, it can be deployed widely in the general population as an initial screening tool and potentially boost awareness of cardiovascular health in an effort to drive preventative care of CVD.Re-calibration of the DiCAVA Lite score

The Change in Public Perception and Knowledge Acquisition Methods of Chronic Kidney Disease Among General Population in Okayama Prefecture, Japan

CKD public education plays a very important role in effective chronic kidney disease (CKD) countermeasure. We have been conducting CKD public education programs in Okayama Prefecture since 2007. Here, we aimed to examine the actual status of CKD perceptance and changes in CKD perceptance due to these education programs. The study was conducted on individuals who underwent health checkups at 12 medical institutions across five medical regions in Okayama Prefecture between 1 October and 30 November in 2015, 2019, and 2023. The results showed that overall CKD perceptance has improved over time (perceptance of “CKD” 4% to 7%, “chronic kidney disease” 27% to 34%, 2015 vs. 2023). “Chronic kidney disease” was more commonly recognized than “CKD”, and the elderly were more aware of the disease than younger people. The CKD perceptance improved across all age groups. However, the rate of CKD perceptance is still low, especially among young people. Previously, newspapers were the second most common resource of information about CKD after television. However, the Internet has recently replaced newspapers as the second most common source of information, especially among younger people. Understanding of the exact diagnosis of CKD also remains insufficient. It is necessary to continue more effective CKD public education programs through more intelligible terminology and information sources that match the demographics of target population.