General United States Population Research Articles

A cross sectional analysis of residents by race/ethnicity and specialty from 2020-2023

BackgroundMinorities are underrepresented in all areas of medical education relative to the United States general population, and minority physicians are more likely to practice in disadvantaged areas and in primary care settings. Many individual and structural factors contribute to this discrepancy. We aimed to demonstrate how resident race/ethnicity representation differs across the various resident specialties. MethodsWe used publically available data from the Association of American Medical College's Report on Residents data series and averaged the four academic years from 2019 to 2020 through 2022-2023. We then calculated the odds ratio (OR) of self-reported race/ethnicity (alone and in combination) in thirty-four specialties. ResultsAcross the four-year study period, there were, on average, 147026 unduplicated resident trainees. The average number of duplicated residents by self-identified ethnic category (alone and in combination) include: American Indian or Alaska Native (839, 0.6%), Asian (31627, 21.5%), Black or African American (7935, 5.4%), Hispanic, Latino, or of Spanish Origin (10900, 7.4%), Native Hawaiian or Other Pacific Islander (296, 0.2%), White (76289, 51.9%), Other (4879, 3.3%), Unknown (522, 0.4%), and Non-US Citizens (23914, 16.3%). Across race/ethnicity, there are differences in ORs of representation in different specialties. Key findings include high representation in Public Health and Preventative Medicine by Black and African American (OR=3.7) and Native Hawaiian (OR=2.6) residents, and Family Medicine in Native Americans (OR=1.9), Native Hawaiian (OR=1.7), Black (OR=1.5), and Hispanic (OR=1.3) residents. Psychiatry also had high ORs of representation in minority residents. ConclusionThis study illustrates relative resident ethnic representation across training specialties. Minorities ethnicities were more likely to be represented in primary care and public health domains. This has implications for creating a physician workforce suitable to serve the United States Population.

Covid-19 vaccination status and beliefs of individuals with co-occurring serious mental illness and alcohol use disorder

ObjectiveThe study objective was to determine factors associated with obtaining COVID-19 vaccination in people with co-occurring alcohol use disorder (AUD) and serious mental illness (SMI). MethodsSurvey responses were obtained from 135 adults with SMI seeking community-based AUD treatment about their primary series vaccination status, COVID-19 preventative practices, vaccination motivators, reasons for vaccine hesitancy, and strategies to increase vaccination uptake. Vaccinated and unvaccinated groups were compared. Responses to survey items with nominal or Likert scales were analyzed with chi-square tests of association. Logistic regression was employed to determine predictors of vaccine status. ResultsSeventy-nine percent (n=107) of participants reported they were vaccinated. A higher proportion of vaccinated participants believed COVID-19 was a serious disease. While both groups adopted preventative hygiene practices at similar rates (e.g., washing hands), vaccinated participants engaged in more interpersonal practices directly involving others (e.g., wearing masks and avoiding crowds). The strongest vaccine motivator was protecting personal health, while the primary reason for hesitancy was potential side effects. Most unvaccinated participants endorsed increased safety information availability (61.1 %) and living with a high-risk-for-severe-infection individual (55.6 %) as reasons to overcome hesitancy. ConclusionsVaccination rates, motivators, and hesitancy reasons were similar to the general United States population. Strategies to increase vaccination in this high-risk population should include education on vaccine safety and side effects and the impacts of COVID-19 and other respiratory illnesses on others.

Behavioral risk factors and socioeconomic inequalities in ischemic heart disease mortality in the United States: A causal mediation analysis using record linkage data.

Ischemic heart disease (IHD) is a major cause of death in the United States (US), with marked mortality inequalities. Previous studies have reported inconsistent findings regarding the contributions of behavioral risk factors (BRFs) to socioeconomic inequalities in IHD mortality. To our knowledge, no nationwide study has been conducted on this topic in the US. In this cohort study, we obtained data from the 1997 to 2018 National Health Interview Survey with mortality follow-up until December 31, 2019 from the National Death Index. A total of 524,035 people aged 25 years and older were followed up for 10.3 years on average (SD: 6.1 years), during which 13,256 IHD deaths occurred. Counterfactual-based causal mediation analyses with Cox proportional hazards models were performed to quantify the contributions of 4 BRFs (smoking, alcohol use, physical inactivity, and BMI) to socioeconomic inequalities in IHD mortality. Education was used as the primary indicator for socioeconomic status (SES). Analyses were performed stratified by sex and adjusted for marital status, race and ethnicity, and survey year. In both males and females, clear socioeconomic gradients in IHD mortality were observed, with low- and middle-education people bearing statistically significantly higher risks compared to high-education people. We found statistically significant natural direct effects of SES (HR = 1.16, 95% CI: 1.06, 1.27 in males; HR = 1.28, 95% CI: 1.10, 1.49 in females) on IHD mortality and natural indirect effects through the causal pathways of smoking (HR = 1.18, 95% CI: 1.15, 1.20 in males; HR = 1.11, 95% CI: 1.08, 1.13 in females), physical inactivity (HR = 1.16, 95% CI: 1.14, 1.19 in males; HR = 1.18, 95% CI: 1.15, 1.20 in females), alcohol use (HR = 1.07, 95% CI: 1.06, 1.09 in males; HR = 1.09, 95% CI: 1.08, 1.11 in females), and BMI (HR = 1.03, 95% CI: 1.02, 1.04 in males; HR = 1.03, 95% CI: 1.02, 1.04 in females). Smoking, physical inactivity, alcohol use, and BMI mediated 29% (95% CI, 24%, 35%), 27% (95% CI, 22%, 33%), 12% (95% CI, 10%, 16%), and 5% (95% CI, 4%, 7%) of the inequalities in IHD mortality between low- and high-education males, respectively; the corresponding proportions mediated were 16% (95% CI, 11%, 23%), 26% (95% CI, 20%, 34%), 14% (95% CI, 11%, 19%), and 5% (95% CI, 3%, 7%) in females. Proportions mediated were slightly lower with family income used as the secondary indicator for SES. The main limitation of the methodology is that we could not rule out residual exposure-mediator, exposure-outcome, and mediator-outcome confounding. In this study, BRFs explained more than half of the educational differences in IHD mortality, with some variations by sex. Public health interventions to reduce intermediate risk factors are crucial to reduce the socioeconomic disparities and burden of IHD mortality in the general US population.

Implications of the shift to DSM-5 for alcohol use disorder prevalence estimates in the National Survey on Drug Use and Health.

The Substance Abuse and Mental Health Services Administration's annual National Survey on Drug Use and Health (NSDUH) is a commonly used source for estimating trends in alcohol use disorders (AUD) in the United States. From 2015 to 2019 the annual prevalence of people diagnosed with either Diagnostic and Statistical Manual 4th edition (DSM-IV) alcohol abuse or dependence ranged from 5.3 to 5.9%. More recent estimates, using the DSM 5th edition (DSM-5) AUD diagnostic formulation, have been higher, with AUD base rates ranging from 10.1 to 10.7% from 2020 to 2022. This study aimed to compare the past 12-month base rates of AUD in the United States general population when using the DSM-5 versus DSM-IV AUD (i.e. abuse or dependence) and assess the AUD severity of individuals captured with each diagnostic formulation using DSM-5 AUD symptom counts. We examined descriptive trends in the rate of past-year NSDUH AUD diagnoses from 2015 to 2022. We contrasted them with trends in drinking behavior: the percentage of individuals who had ever reported drinking and the number of drinking days and binge drinking days for those who drink. We also analyzed the concordance between DSM-IV and DSM-5 AUD diagnoses in the 2020 NSDUH, which concurrently assessed AUD with both diagnostic formulations. The transition to DSM-5 AUD formulation coincided with a drastic increase in AUD prevalence rates that occurred without increases in drinking behavior. In 2020 NSDUH data, the estimated past-year DSM-5 AUD prevalence rate was 10.1% compared with a 5.4% rate of past-year DSM-IV abuse or dependence. The DSM-5 AUD formulation captured more mild-severity individuals than the DSM-IV formulation. Higher recent base rates of alcohol use disorders (AUD) in the National Survey on Drug Use and Health are likely, at least partially, explained by measurement changes in AUD; specifically, the shift from DSM-IV abuse or dependence to DSM-5 AUD. The DSM-5 formulation appears substantially more inclusive than the DSM-IV formulation, leading to a larger number of mild severity individuals being captured.

Changes in self-reported cannabis use in the United States from 1979 to 2022.

Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use. Secondary analysis of United States general population survey data. The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan-Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non-interference with state-level legalizations) and 2022 (most recent data available). Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4-5days in the past month, versus 15-16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Long-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers.

Association between generalized anxiety disorder and live microbes intake in the United States general population

Association between generalized anxiety disorder and live microbes intake in the United States general population

Early-life risk factors for depression among young adults in the United States general population: Attributable risks and gender differences

BackgroundThis study adopts individual and societal-level approaches to examine the contribution of childhood risk factors to major depressive episodes (MDE) in 2526 American young adults. MethodsNationally representative data from the 2017 U.S. Panel Study of Income Dynamics – Transition into Adulthood Supplement (PSID-TAS) were analyzed using multivariate methods to assess the impact of parental mental illness, childhood adversities, childhood mental disorders, and childhood physical conditions. Adjusted odds ratios and population attributable risk proportions (PARPs) are calculated to estimate the proportion of MDE cases related to risk factors. ResultsThe 12-month prevalence of positive screens for MDE was 25.4 %. Approximately 34 % of these were attributable to childhood mental disorders, 24 % to childhood physical conditions, 21 % to childhood adversities, and 16 % to parental mental illness. Childhood and parental depression were critical risk factors, both at the individual (odds ratio exceeding 2) and societal (PARP approximately 24 %) levels. Gender-specific risk factors were identified, with childhood physical abuse and childhood anxiety disorders constituting risk factors for females, and childhood externalizing disorders and childhood headaches as risk factors for males. Approximately 60 % of U.S. young adult MDE cases are attributable to risk factors before age 18. LimitationsPossible over reporting of MDE may have biased the associations between predictors and depression. ConclusionsExposure to depression at a young age—one's own or parental depression—is a robust risk factor for both genders. Policies and interventions focused at alleviating the societal burden of depression should value its generational transmission.

The effects of specific vegetable subtypes on constipation incidence in the general United States population.

While the intake of larger quantities of vegetables has been linked to a reduction in constipation risk, which vegetables in particular underlie this risk reduction remains incompletely understood. As such, the present study was developed to explore correlations between the intake of particular vegetable types and the risk of constipation. This cross-sectional analysis was based on data from the National Health and Nutrition Examination Survey (NHANES) collected from 2005-2010. Classifications and intake assessments for different vegetables were assessed with the Food Patterns Equivalents Database (FPED), while stool frequency or stool consistency was used to define constipation. Relationships between the intake of particular vegetable components and constipation were assessed through a weighted logistic regression approach. Subgroup and restricted cubic spline (RCS) regression analyses were further employed to explore associations between specific vegetable subtypes and constipation. This study included 13,860 eligible subjects, of whom 1,405 and 12,455 were respectively classified into the constipated and non-constipated groups. Following multivariate adjustment, the intake of non-starchy vegetables including orange, red, dark green, and other vegetables was found to be positively associated with a reduction in constipation risk. In contrast, constipation was unrelated to total starchy vegetable or potato intake. Tomatoes, in particular, were associated with a marked decrease in constipation risk (odds ratios: 0.80, 95% confidence interval: 0.71-0.91). These results were confirmed through RCS and subgroup analyses. Non-starchy vegetables, particularly tomatoes, were found to be associated with a pronounced reduction in constipation risk, which was unaffected by the intake of potatoes or starchy vegetables.

Representation and Race in Adolescent Idiopathic Scoliosis Research: Disparities in Curve Magnitude and Follow-Up.

Prospective Cohort Study. The present study aims to determine if the racial representation of patients enrolled in a large prospective scoliosis registry is reflective of the general United States population. Further, we studied whether there was an association between race, pre-operative parameters, outcomes and loss to follow-up. Prospectively collected data for patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) was reviewed, including self-reported race/ethnicity. The U.S. pediatric population and U.S. patients enrolled in the prospective registry were compared. The data obtained was analyzed for variations between races, for pre-operative variables and follow-up. Of the 2210 included patients in the registry 66% of patients reported as White, while 52% of the 2018 U.S. pediatric population reported as White. 15% of the registry reported as Hispanic/Latino compared to 22% of the U.S. pediatric population, 13% Black compared to 14% of the U.S. pediatric population, and 4% Asian compared to 5% of the U.S. pediatric population. Asian and White patients had statistically significant higher 2-year follow-up in all but one of six enrollment sites (P < 0.001). Native American, Other, and Hispanic/Latino patients had the highest BMIs. Native American and Black patients had the highest pre-op thoracic Cobb angles. Pre-op ages of Black, Hispanic, and Native American patients were statistically lower (P < 0.01). This study demonstrates the association between race and patient follow-up and pre-operative factors in patients who underwent surgery for AIS. Black, Native American, and Hispanic populations were underrepresented both at pre-op and follow-up when compared to their relative proportion in the U.S. pediatric population.

Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis

BackgroundPrenatal fish intake is a key source of omega-3 (ω-3) polyunsaturated fatty acids needed for brain development, yet intake is generally low, and studies addressing associations with autism spectrum disorder (ASD) and related traits are lacking. ObjectiveThis study aimed to examine associations of prenatal fish intake and ω-3 supplement use with both autism diagnosis and broader autism-related traits. MethodsParticipants were drawn from 32 cohorts in the Environmental influences on Child Health Outcomes Cohort Consortium. Children were born between 1999 and 2019 and part of ongoing follow-up with data available for analysis by August 2022. Exposures included self-reported maternal fish intake and ω-3/fish oil supplement use during pregnancy. Outcome measures included parent report of clinician-diagnosed ASD and parent-reported autism-related traits measured by the Social Responsiveness Scale (SRS)-second edition (n = 3939 and v3609 for fish intake analyses, respectively; n = 4537 and n = 3925 for supplement intake analyses, respectively). ResultsIn adjusted regression models, relative to no fish intake, fish intake during pregnancy was associated with reduced odds of autism diagnosis (odds ratio: 0.84; 95% confidence interval [CI]: 0.77, 0.92), and a modest reduction in raw total SRS scores (β: −1.69; 95% CI: −3.3, −0.08). Estimates were similar across categories of fish consumption from “any” or “less than once per week” to “more than twice per week.” For ω-3 supplement use, relative to no use, no significant associations with autism diagnosis were identified, whereas a modest relation with SRS score was suggested (β: 1.98; 95% CI: 0.33, 3.64). ConclusionsThese results extend previous work by suggesting that prenatal fish intake, but not ω-3 supplement use, may be associated with lower likelihood of both autism diagnosis and related traits. Given the low-fish intake in the United States general population and the rising autism prevalence, these findings suggest the need for better public health messaging regarding guidelines on fish intake for pregnant individuals.

Moral injury among women military veterans and demand for cigarettes: A behavioral economic investigation using a hypothetical purchase task

ObjectivesUnlike the United States general population, veteran women – as opposed to veteran men – have greater smoking prevalence; yet, little is known regarding factors that influence smoking in veteran women. The purpose of this study was to begin examining the relationship between a psychological concept known as moral injury and demand for cigarettes among veteran women. MethodsVeteran women who smoke (n = 44) were recruited for this cross-sectional study from Amazon MTurk, Reddit, and a veteran-serving non-profit organization in June–July 2023. Consenting participants received $2 for completing the cigarette purchase task (CPT), Fagerstrom Test for Nicotine Dependence (FTND), and the military version of the Moral Injury Symptom Scale (MISS-M-SF). We examined five CPT demand indices and calculated a modified exponential demand model stratified by moral injury severity status (i.e., probable vs. unlikely). ResultsProbable morally injured women exhibited significantly higher relative reinforcing value (RRV) for smoking than unlikely morally injured women (F1, 920 = 9.16, p = 0.003). Average cigarette consumption at $0 (i.e., Q0) was 48.56% higher (M = 22.24 vs. M = 13.55) in probable compared to unlikely morally injured women (p = 0.04, Hedge's g = 0.74). FTND scores were significantly correlated with Pmax (i.e., demand elasticity point) and Omax (i.e., maximum expenditure) values in both populations (rs = 0.42–0.68, ps < 0.05). ConclusionsWe provide preliminary evidence of the relatively high RRV of smoking in morally injured veteran women. Continued research is needed to refine the characterization of this relationship.

Sociodemographic differences in suicide/intentional self-harm among cancer survivors versus the general United States population.

11097 Background: Suicide is a national public health crisis, and one of the leading causes of death in the United States. Worse yet, the suicide mortality rate is at least double among cancer survivors compared to the general population. Suicide rates vary across the population, but it is unclear how sociodemographic factors explain differences in suicide rates among cancer survivors versus the general United States population. Methods: We analyzed two sets of population-based data. First, we retrieved suicide/self-harm mortality rates for the general population from the National Vital Statistics System. Next, we accessed cancer case data from the Surveillance, Epidemiology, End Results (SEER) program to estimate number of deaths due to suicide/self-harm among cancer patients, per 100,000 persons, with a 95% confidence interval. All analyses were restricted to contiguous states with full state representation in SEER (CA, CT, GA, ID, IA, KY, LA, NJ, NM, NY, TX, UT). We then compared subgroup differences by sex, race/ethnicity, age, and state. Results: In 2020, there were 15,813 deaths in the general population (12.1 suicide/100,000 persons; 95% CI: 11.9, 12.3), and 1,127 among cancer survivors (22.1 suicide/100,000 persons; 95% CI: 22.0, 22.1) due to suicide/intentional self-harm. Among racial/ethnic groups, the largest difference was found in the non-Hispanic White cancer survivors, with 10.4 more suicide/100,000 persons vs. White individuals in the general population. In contrast, two racial minority groups had higher suicide mortality rate in the general population vs. cancer survivors: Non-Hispanic Black individuals (general population = 7.4 suicide/100,000 persons vs cancer survivors = 6.9 suicide/100,000 persons), and Native American Indian (general population = 16.6 suicide/100,000 persons vs. cancer survivors = 11.3 suicide/100,000 persons). Among females, suicide mortality rate was slightly higher by 1.3 suicide/100,000 persons in cancer survivors vs. general population, and much higher among male cancer survivors vs. general population (19.9 suicide/100,000 persons more). For age groups, the lowest difference in suicide mortality between cancer survivors vs. general population was in the 65-84 age group (5.1 more suicide/100,000 persons). Across all other age groups, suicide rates were 11.9 to 14.4 higher in cancer survivors vs. the general population. Across the 12 states in our analysis, the smallest difference was in Iowa (1.9 more suicide/100,000 persons), and the largest difference was in Idaho (27.0 more suicide/100,000 persons). Conclusions: In most subgroups, people diagnosed with cancer appear to be at greater risk of death from suicide/intentional self-harm than the general population. As the number of people living with cancer continues to grow, policies increasing the quality of life for cancer patients are warranted.

Exogenous factors associated with legacy PFAS concentrations in the general U.S. population: NHANES 1999-2018

To reduce per- and polyfluoroalkyl substances (PFAS) exposure through legislation and other interventions, we must understand factors contributing to individual body burden. Identifying factors associated with serum perfluorinated compounds (PFAS) concentrations also aids in identifying groups at higher risk of adverse health outcomes due to elevated exposure. This exploratory analysis provides initial findings on exposure-related factors associated with legacy PFAS concentrations in the general United States (U.S.) population. We obtained National Health and Nutrition Examination Survey (NHANES) datasets with individual serum PFAS measurements from cycle years 1999-2018 (N = 14,961), excluding the 2001-2002 cycle due to pooled sampling. Over 100 features were evaluated for associations with PFAS concentrations. Data were singly imputed using hot deck and predictive mean matching (PMM) methods, and model performance by imputation method was compared using elastic net regression (ENR) models. Hot-deck imputation explained the most variance in predictive models; thus, a dataset imputed via hot-deck was used for feature selection. ENR models were employed to identify the top variables associated with legacy PFAS concentrations, and selected features were put into linear mixed models to obtain beta estimates and standard errors. Survey year, demographic, income, place of birth and citizenship status, household size, dietary, health, food insecurity, general health and healthcare, housing, social and behavioral, and other characteristics were important factors associated with legacy PFAS concentrations in this nationally representative study population. A better understanding of exogenous factors associated with PFAS concentrations can influence future epidemiological studies, guiding decisions on adjustment for confounding, and advancing our understanding of factors that affect chemical half-lives and toxicokinetics.

Mental Health and Traumatic Occupational Exposure in Wildland Fire Dispatchers

Wildland fire dispatchers play a key role in wildland fire management and response organization; however, to date, wildland fire studies have largely focused on the physical hazards and, to a lesser extent, mental health hazards of wildland firefighting operational personnel, and dispatcher studies have primarily focused on 911 and police dispatchers. Studies of other dispatchers have provided some limited insight into potential strains impacting this workforce, including work-related fatigue, burnout, and traumatic exposure. However, the specific job hazards that are faced by wildland fire dispatchers are poorly understood. In 2023, we conducted a cross-sectional survey of 510 wildland fire dispatchers with questions about their occupational health, general health, and well-being. We used validated screening instruments to measure the rates of anxiety, depression, PTSD, and suicidal thoughts and ideation. Here, we also present the results of mental health and trauma exposure questions that were asked as part of a larger survey. We found that demographic factors were significant indicators of anxiety, depression, and binge/restrictive eating. Our data indicate that rates of anxiety, depression, PTSD, and suicidal thoughts and ideation are significantly higher for both the wildland fire dispatching workforce and other emergency responder populations than those of the general United States population.

Development and validation of the HDSIM™ assessment system: a measure of hemorrhoid disease symptom impact.

Hemorrhoid disease (HD) affects 10 million people in the US at any given time, and 50% of the US population will develop symptomatic hemorrhoids during their lifetime. Approximately 60% of people with hemorrhoids experience symptoms. Despite its prevalence and impact on quality of life, the existing patient-reported outcome measures of HD have not been validated using standard psychometric methods. The present study thus aimed to develop the Hemorrhoid Disease Symptom Impact Measure™ (HDSIM™) assessment system, a patient-reported measure of HD symptoms and impact for use in HD clinical research. On the basis of results from qualitative cognitive interviews, we generated the conceptual model and item pool. A cross-sectional web-based survey (n = 1066) was done, including a randomly selected retest subsample (n = 100) 1-2weeks later. The survey sample was selected to be evenly distributed across mild, moderate, and severe levels of disease and to be nationally representative of the general United States population in terms of race, gender, and region. Existing disease-specific measures of symptoms and generic measures of quality of life and well-being were compared to the new tool for construct validation. The HDSIM system includes 38 items representing six conceptual-model-driven subscales, aligning with the conceptual model: Symptoms at Worst, Symptoms at Best, Bowel Health Impact, Life Impact, Mental Health Impact, and Manageability. Psychometric analyses documented that the subscales had excellent internal consistency reliability, cross-sectional construct validity (i.e., convergent and divergent validity, known groups validity), test-retest stability, and longitudinal construct validity (i.e., responsiveness). The HDSIM system is fit for purpose in hemorrhoid disease clinical trials research. Since measures are validated in an iterative manner over many studies and over time, the present study results should be considered preliminary.

U-shaped relationship between fasting blood glucose and urinary albumin-to-creatinine ratio in the general United States population.

The current controversy surrounding the association between fasting blood glucose (FBG) and albuminuria necessitates further investigation. Hence, the primary objective of this study was to examine the relationship between FBG and urinary albumin-to-creatinine ratio (UACR). A cohort of complete data from National Health and Nutrition Examination Survey (NHANES) participants (1999-2020) was analyzed. Linear regression analyses and a generalized additive model explored the association between FBG and UACR. Furthermore, the stability of this relationship across different populations was assessed. The study involved a total of 20,264 participants who were identified as U.S. citizens. By employing linear regression analysis, a statistically significant relationship was observed between elevated FBG levels and an increase in UACR (P<0.0001). Additionally, using a generalized additive model analysis, a U-shaped correlation between FBG and UACR was identified. Further examination using threshold effect analysis indicated a turning point for FBG at 5.44 mmol/L. A noteworthy finding in multiple populations is the consistent U-shaped association between FBG and UACR, except for individuals with serum uric acid levels ≥420 μmol/L and those who refrain from alcohol consumption. The general U.S. population has a U-shaped nonlinear relationship between FBG and UACR.

Dietary macro and micronutrients associated with MASLD: Analysis of a national US cohort database

Introduction and ObjectivesOur objective was to measure and compare the intake of macro and micronutrients in a cohort of individuals with Metabolic Syndrome Associated Steatotic Liver Disease (MASLD) compared with matched controls to identify areas of further research in this area; we identified nutrition-associated associations with MASLD in the United States general population. Materials and MethodsWe used the 2017 – 2018 NHANES dataset. Elastography Controlled Attenuation Parameter (CAP score>280) in the absence of other liver disease was defined as MASLD in adults (>18). Advanced fibrosis was defined by transient elastography >10 kPa. Controls were adults without liver disease. Results1648 MASLD cases (11.4 % advanced fibrosis) and 2527 controls were identified. MASLD cases were older (P<0.001), more likely males (P = 0.01), less likely to have a college education (P = 0.04) and more likely married (P = 0.002). MASLD cases were more likely to be of Mexican American or Hispanic ethnicity (P = 0.002), have higher BMI, and have higher prevalence of diabetes, hyperlipidemia and hypertension (P<0.001 for all). MASLD cases had higher hs-CRP (P = 0.02) and ferritin (P = 0.02). MASLD cases had lower total (P = 0.004) and added vitamin E in their diet (P = 0.002), lower vitamin K intake (P = 0.005), and higher selenium intake (P = 0.03). Caloric intake (P = 0.04), carbohydrate intake (P = 0.02), cholesterol intake (P = 0.03) and saturated fatty acid intake (P = 0.05) were higher in MASLD. Individuals with MASLD were more likely to be on a diet (P<0.001), sedentary (P = 0.008) and less likely to participate in moderate or vigorous recreational activities (P<0.001). ConclusionsThe deficiencies of micronutrients and excess of macronutrients point to oxidative stress, pro-inflammatory state, and lipotoxicity as pathways linking the US diet to MASLD. MASLD patients are more often on special diets, which may reflect prior provider counseling on diet changes to improve health.

Assessing Fear of Thyroid Cancer in the General U.S. Population: A Cross-Sectional Study.

Background: This study aimed to measure fear of thyroid cancer in the general U.S. population and identify factors associated with a high level of thyroid cancer-specific fear that may contribute to overtreatment. Methods: We conducted a cross-sectional survey using Prolific Academic Ltd.®, an online survey platform. The survey was administered in August 2020 to English speaking adults (>17 years) in the United States who were registered with Prolific. The target sample was stratified to represent the demographics of the U.S. population. A validated, eight-item breast cancer fear scale was adapted to measure thyroid cancer-specific fear. Multivariate logistic regression identified factors significantly associated with high levels of thyroid cancer-specific fear. Results: Of the 1136 respondents (94.3% eligibility), 50.4% were female, 74.1% White, and the mean age was 45 years (SD = 16 years). Overall, 47.5% of respondents had high levels of thyroid cancer-specific fear. Multivariate regression demonstrated that age <40 years (OR = 2.46 vs. 65+ [95% confidence interval {CI} = 1.60-3.80]) and female gender (OR = 1.48 vs. male [CI = 1.13-1.93]) were associated with high levels of thyroid cancer fear. Believing thyroid cancer (OR = 2.71 [CI = 1.99-3.69]) and cancer in general are serious (OR = 1.53 [CI = 1.13-2.08]) were also associated with high levels of thyroid cancer fear. Respondents who overestimated thyroid cancer incidence (OR = 1.64 [CI = 1.25-2.13]) and believed they had a high chance of developing cancer (OR = 1.70 [CI = 1.19-2.42]) were also more likely to have high fear of thyroid cancer. Conclusion: Thyroid cancer-specific fear is prevalent in U.S. adults particularly in females and those younger than 40 years. Because disease-specific fear is associated with overtreatment, targeted education about the seriousness, incidence, and risk factors for developing thyroid cancer may decrease public fear and possibly overtreatment related to "scared decision-making."

Prospective evaluation of cardiovascular risk and mortality in patients with psoriasis: An American population-based study.

The association between psoriasis and cardiovascular disease (CVD) has long been discussed and continually refined. However, there is currently a lack of prospective studies on the cardiovascular risk attributed to psoriasis in the United States general population. Representative adult participants were selected from the National Health and Nutrition Examination Survey (NHANES). Risks of cardiovascular symptoms and diseases prevalence were evaluated between participants with and without psoriasis. The hazards for all-cause mortality and CVD mortality were stratified by psoriasis status. Mediation analysis was then conducted to identify potential mediators between psoriasis and cardiac death. Overall, 19 741 participants were included in the current study, 542 (2.7%) had psoriasis and 19 199 (97.3%) did not have psoriasis. After adjusting for known CVD risk factors, odds for hypertension (OR = 1.37, 95% CI: 1.13-1.66, p = 0.001), hypercholesterolemia (OR = 1.37, 95% CI: 1.13-1.64, p < 0.001) and angina pectoris (OR = 1.74, 95% CI: 1.11-2.60, p = 0.011) were higher in psoriasis patients. Compared with participants without psoriasis, moderate/severe but not mild patients showed significantly higher CVD mortality (HR = 2.55, 95% CI: 1.27-5.15, p = 0.009). This result was supported by subgroup analyses. Mediation analysis further suggested that the direct effect of moderate/severe psoriasis on CVD mortality accounted for 81.4% (65.8%-97.1%). Besides, the indirect effect might derive from disturbance of serum albumin, urea nitrogen and uric acid. Moderate-to-severe psoriasis is an independent risk factor for cardiovascular disease, making it necessary to regularly conduct cardiovascular disease-related examinations for patients with higher severity of psoriasis in clinical settings.

Association between grip strength and albuminuria in the general United States population: NHANES 2011-2014.

Grip strength has been shown to be associated with chronic renal insufficiency, but the relationship between grip strength and albuminuria has not been confirmed. In this study, we used NHANES data to explore the association between grip strength and albuminuria in a US population. In this analytical study, we utilized data sourced from the National Health and Nutrition Examination Survey (NHANES), specifically spanning the years 2011 to 2014. The dataset included 9,638 participants aged 20 years or older. After adjusting for potential confounders, multiple regression models were developed to infer the interrelationship between grip strength and albumin to creatinine ratio (ACR), and subgroup analyses were conducted. After adjusting for all covariates, ACR by 0.49 mg/g [-0.49 (95% CI: -0.93, -0.04)] for each 1 kg increase in grip strength decreased. Subgroup analysis showed that gender, age, hyperlipidemia, hypertension, diabetes mellitus, smoking, alcohol consumption and body mass index did not influence the negative correlation between grip strength and albuminuria. There is a negative correlation between grip strength and albuminuria in the general U.S. population.