Lower Smoking Rates Research Articles

P1261 Reproductive Health Outcomes in Colombian Women with Inflammatory Bowel Disease: A Multicenter Cohort Study on Pregnancy, Fertility, and Disease Impact (REINFORCE Study)

Abstract Background The impact of Inflammatory Bowel Disease (IBD) on women's health, particularly in relation to reproductive health, remains an underexplored area in Latin American populations. This study aims to assess the effects of IBD on women's reproductive health, including pregnancy outcomes, fertility, and related complications, within a cohort of Colombian women. Methods Observational, multicenter and descriptive study involving adult and pediatric patients from two IBD Centers in different cities in Colombia. The study focused on evaluating aspects of sexual and reproductive health in women with IBD, with detailed data collection on pregnancy, fertility, childbirth, and cancer screening. Results Out of a total of 121 women with IBD, 63.6% (77/121 patients) were in reproductive age (15–44 years according to World Health Organization) (Table 1), the mean age was 33.2 years (range: 17.2–44.8 years, SD: 8), with a mean age at diagnosis of 28 years (range: 9.3–45.1 years, SD: 8.8) and a disease duration of 5.2 years (range: 0.3–21.9 years, SD: 4.7). UC was more prevalent in this group (71.4%). Most women had low rates of smoking, hospitalization, and surgical interventions for IBD, and pregnancy-related complications were generally rare. The majority of births were vaginal deliveries, and breastfeeding beyond 6 months was common, suggesting protective effects against IBD risk in offspring. Notably, while HPV vaccination rates were low, the prevalence of cervical cancer was also low. Family planning was reported by 48% of participants, and 1% required assisted reproductive technologies. Statistical analysis showed no significant association between age and pregnancy complications across age groups. However, UC was significantly associated with a higher risk of pregnancy complications (OR 5.5; 95% CI: 1.9–14.9; p=0.0001), and Crohn's disease (CD) also showed a trend toward increased risk (OR 4.6; 95% CI : 0.2–20.4; p=0.00002). Previous history of hospitalization due to disease activity, surgery, and the use of biological therapy was associated with an increased risk of pregnancy complications when it occurred (OR 1.97; 95% CI: 1.6–2.5; p= 0.07 for hospitalization, OR 12.12; 95% CI: 4.2–27.8; p=0.03 for surgery, OR 5.2; 95% CI: 1.64-13.1 ;p=0.00001). Conclusion This study underscores the significant impact of IBD on reproductive health in Colombian women, similar to trends in other populations. It emphasizes the importance of effective disease management before conception, given that the use of biological therapies that usually are associated with more severe disease, ongoing disease activity, and prior surgical interventions are risk factors for increased pregnancy complications.

Association Between a Family Caregiver's Relationship to Persons With Dementia and Cardiovascular Disease by Race and Ethnicity: A Secondary Analysis of the Behavioral Risk Factor Surveillance System Data.

Caregiver stress is linked to key mechanisms for developing cardiovascular disease and the burden differs by caregiving relationship (eg, spouse). Furthermore, cardiovascular disease risk in family caregivers (FCGs) has been shown to differ by race and ethnicity. However, little is known about whether the association between caregiving relationship and FCGs' cardiovascular health differs by race and ethnicity. This study examined the association between an FCG's relationship to persons with dementia and risk factors for cardiovascular disease and cardiovascular disease conditions and identified how these associations differed by race and ethnicity in FCGs. This was a secondary analysis of the 2015-2020 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System data. Logistic regression models were used to examine the associations between predictors (caregiving relationship, race/ethnicity, and their interaction) and outcomes (cardiovascular disease risk and conditions). A sample of 6042 FCGs of persons with dementia were included. When analyzing race/ethnicity groups as a whole, cardiovascular disease risk and conditions differed significantly by caregiving relationship. Notably, spouse caregivers were at higher risk of diabetes, stroke, angina, and myocardial infarction, while showing lower rates of current smoking, heavy drinking, and obesity, compared to adult children. The associations between caregiving relationship and select cardiovascular disease risk factors (depression, previous smoking) differed significantly between racial and ethnic groups. There is a need to develop culturally appropriate cardiovascular preventive health care strategies that reduce cardiovascular disease risks by considering caregiving relationship. Research is especially needed among minoritized racial and ethnic FCG groups.

Prevalence of aortoiliac aneurysms in solid organ transplant recipients using the National Inpatient Sample database.

Single-center studies have suggested that solid organ transplant recipients are at increased risk for arterial aneurysms. Moreover, they describe a more aggressive natural history with increased rates of expansion and rupture. In this exploratory analysis, we aimed to assess the frequency of arterial aneurysms in solid organ transplant recipients using a large-scale national database. We queried the National Inpatient Sample dataset from 2016 to 2020 using International Classification of Disease, Tenth Revision, Clinical Modification codes to identify patients with solid organ transplants. We calculated the prevalence of aortoiliac aneurysms by organ transplant type and performed one:one propensity score matching to compare aneurysm rates between transplant recipients and nontransplant patients. Additionally, we used a multivariable model to determine whether the observed aneurysm frequency was due to the transplant intervention or attributable to variable baseline characteristics of the groups. A retrospective analysis of the National Inpatient Sample database identified 34,920,964 nontransplant patients and 34,288 transplant recipients. Among the transplant cohort, kidney transplant recipients made up the largest group at 57.5%. The median age of the transplant group was 55years, with a predominance of male patients and a low smoking rate of 2.19%. The overall frequency of aortoiliac aneurysms in the transplant population was 0.48%. Specifically, the prevalence of thoracic aortic aneurysms, abdominal aortic aneurysms, and iliac artery aneurysms was 0.2%, 0.19%, and 0.06%, respectively. Thoracic organ transplant recipients had a higher frequency of aortoiliac aneurysms compared with those with abdominal organ transplants. The frequencies of aortoiliac aneurysms were 0.81% in heart transplant recipients, 1.37% in single lung recipients, 0.91% in double lung recipients, 0.42% in liver recipients, and 0.42% in kidney recipients. Additionally, the frequency of abdominal aortic aneurysms was 0.42% in heart transplant recipients and 0.51% in single lung transplant recipients. As transplant patient survival continues to improve, monitoring for comorbid conditions will become increasingly important. Given the limited availability of organs and importance of post-transplant care, the observed prevalence of aortoiliac aneurysms in heart, lung, and liver transplant recipients highlights the need for enhanced screening and surveillance. Further studies are required to better understand the rates of aneurysm expansion and rupture in solid organ transplant recipients.

Assessing the effects of Enhanced Multicomponent Proactive Navigator-Assisted Cessation of Tobacco Use within a federally qualified health center (EMPACT-Us): a protocol study

BackgroundCalifornia’s relatively low smoking rate (10.1% in 2019–2020) (About CHIS, UCLA Center for Health Policy Research, 2024) masks deep disparities among low-income populations, where smoking rates are nearly double that of their middle- to upper-income peers. Low-income smokers report a similar desire to quit and similar rates of recent quit attempts as smokers from other groups; yet, they often face barriers in accessing effective resources to facilitate successful cessation.MethodsOur team will conduct a pragmatic stepped-wedge cluster, randomized controlled trial of Enhanced Multicomponent Proactive Navigator-Assisted Cessation of Tobacco Use (EMPACT-Us), a suite of tobacco cessation services supported by patient navigators, designed in close partnership with patients, providers, and community stakeholders. The study will take place at Family Health Centers of San Diego (FHCSD), the largest federally qualified health center (FQHC) in San Diego. Eight primary care clinics are included, where 70% (n = 13,496) of smokers at FHCSD receive care.DiscussionWe hypothesize that multiple points of engagement and integration of navigation services into the workflow of existing staff will improve utilization and cessation success. This study will examine if the enhanced suite of services offers insights on how to best integrate evidence-based tobacco treatment services into usual care.Trial registrationClinicalTrials.gov, NCT05750537, Registered on March 1, 2023.https://clinicaltrials.gov/study/NCT05750537.

Preventive Examinations for Early Detection of Oral Cancer Conducted among Alcohol Addicts

Aim: This study evaluated oral cancer (OC) awareness, risk factors, preventive measures, and early detection in high-risk populations. Materials and methods: Participants included an experimental group (EG) of patients treated for alcohol-related mental disorders at University Hospital Center Sestre milosrdnice (June 2022-March 2023) and a control group (CG) screened during the Oral, Head and Neck Cancer Awareness Week (April 2023) at the University of Zagreb’s School of Dental Medicine. Both groups were surveyed to evaluate their understanding of OC, their opinions, smoking and alcohol consumption habits. Results: In a study of 282 participants, 68.1 % were in the EG and 31.9 % in the CG, with a gender distribution of 34.4 % female and 65.2 % male, and a median age of 52. Smoking was more prevalent in the EG (72.5 %) than in the CG (24.4 %). The EG also had significantly lower education levels (p < 0.009). Awareness of OC was high in both groups (73.2 % EG, 85.4 % CG), but only a small fraction had previously attended screening examinations (SE) (6.9 % EG, 18.7 % CG). A large majority believed that alcohol and smoking together increased OC risk (95.7 % EG, 98.7 % CG), and many expressed interest in learning more about OC (83.2 % EG, 75.3 % CG). Higher education was linked to more frequent SE attendance (p = 0.041) and lower smoking rates (p = 0.042). Conclusion: The study highlights the need for enhanced OC education and screening, especially among high-risk groups, to improve prevention and early detection efforts.

How Did the COVID‐19 Pandemic Change Cigarette Smoking Behavior?

ABSTRACTBackgroundCigarette smoking is the leading cause of preventable death in the United States. Although smoking rates have been declining, it is unclear how the COVID‐19 pandemic impacted smoking behaviors.MethodsFollowing a preregistered plan, we accessed population‐based data from the Behavioral Risk Factor Surveillance System (2010–2023) to analyze three primary outcomes: (1) currently smoking, (2) number of cigarettes per day, and (3) quit smoking in the past year. Two‐way fixed effect linear regression models accounted for state‐level factors and temporal trends. Splitting each survey into an early and late wave, we identified the effect of exposure to the COVID‐19 pandemic by comparing changes in an unexposed reference group (interviewed January 1–March 20, early wave) with the changes in an exposed group (interviewed January 1–March 31, late wave).ResultsThe sample included 1,449,112 responses, among which 12.8% were in the late wave. Baseline smoking prevalence was 15.9% in the late wave, with an average of 12.5 cigarettes smoked per day among smokers. 8.6% of the late‐wave respondents attempted to quit smoking in the past year. Overall, we found a negative 1.7% point association between the pandemic and smoking prevalence. However, among smokers, we found that the pandemic was associated with 5.1 more cigarettes smoked per day. The pandemic was also associated with a 6.3% point decline in the probability of attempting to quit smoking in the past year. While these results did not vary significantly over time, we did observe heterogeneous associations between the pandemic and smoking outcomes by socioeconomic subgroups.ConclusionsSmoking prevalence continues to decline in the United States, and the pandemic appeared to have been associated with lower smoking rates. However, our results suggest that the pandemic was also associated with greater intensity and fewer quit attempts among smokers warranting greater attention from policymakers and researchers.

Modeling the determinants of smoking behavior among young adults in Khuzestan province: a two-level count regression approach.

This study investigates the determinants of smoking behavior among young adults in Khuzestan province, southwest Iran, using two-level count regression models. Given the high prevalence of smoking-related diseases and the social impact of smoking, understanding the factors influencing smoking habits is crucial for effective public health interventions. We conducted a cross-sectional analysis of 1,973 individuals aged 18-35 years, using data from the Daily Smoking Consumption Survey (DSCS) in Khuzestan province collected in 2023. A variety of count regression models, including Poisson, Negative Binomial, Conway-Maxwell Poisson, and their zero-inflated counterparts, were evaluated. The best-fitting model was selected based on goodness-of-fit indices. Approximately 90% of participants were non-smokers. Among smokers, the prevalence of light, moderate, and heavy smoking was 47.7, 19.0, and 33.3%, respectively. The two-level Zero-Inflated Conway-Maxwell Poisson (ZICMP) model provided the appropriate fit for the data. Key determinants of daily cigarette consumption included gender, age, education, and Body Mass Index (BMI). Men consumed 3.24 times more cigarettes per day than women. Higher education levels were inversely related to smoking intensity, with MSc/PhD holders having significantly lower smoking rates. Age and BMI also significantly influenced smoking behavior, with younger and obese individuals showing lower smoking rates. The use of advanced count models capable of handling numerous zeros and overdispersion is crucial for accurately analyzing trends in cigarette consumption across different population groups. The results indicate that factors such as older age, lower education levels, and gender differences influence smoking behavior. Therefore, prevention strategies aimed at delaying the onset of smoking, particularly among men, and promoting education among adolescents can effectively reduce smoking rates. However, further research should consider additional socioeconomic variables and encompass a broader age range to enhance the understanding of smoking behavior.

Trends and Motivations in Dietary Supplement Use Among People with Diabetes: A Population-Based Analysis Using National Health and Nutrition Examination Survey Data from the 2009-2020 Period.

Dietary supplements have gained attention among people with diabetes as an alternative and complementary treatment, yet there is a limited understanding of supplement use and the motivations behind it. Data from the National Health and Nutrition Examination Survey (NHANES) from the 2009-2020 period were analyzed, including data on 5784 people with diabetes aged 20 years or older. Dietary supplement use was self-reported. Trends in supplement use were examined across three periods: 2009-2012, 2013-2016, and 2017-2020. Statistical analyses were conducted while considering NHANES's complex survey design to provide nationally representative estimates for the general noninstitutionalized population of the United States. A total of 61.72% of individuals reported using dietary supplements with a notable increase over time. Supplement users were generally older, more likely to be female, better educated, and had superior blood glucose control with lower smoking rates compared to non-users. Common supplements included multivitamins, multimineral supplements, vitamin D, calcium, zinc, vitamin C, and fish oil. Only 44.58% of individuals used dietary supplements based on medical advice, with the rest opting for self-directed usage. The primary specific health reasons for supplement use were to improve bone health and heart health and enhance the immune system. Dietary supplement use is prevalent among people with diabetes, and most diabetic supplement use is self-directed, which reflects a growing trend toward complementary therapies. Healthcare providers are encouraged to inquire about patients' use of supplements and offer appropriate guidance as an integral component of comprehensive diabetes management.

The relationship between BMI, lifestyle, and dietary preferences of childbearing age women

Abstract. The health of childbearing-age women has attracted much attention from society, among which Body Mass Index (BMI) is an important index to evaluate physical health. Meanwhile, age, race, education, parity the frequency of exercise, lifestyle, and diet structure may also have a potential impact on physical health, and there are few studies in this area. The primary objective of this research is to ascertain whether there is an association between BMI and the above factors in women of both races. A data set of women who are residents of Birmingham was collected through questionnaires and analyzed statistically. The results showed a significant linear relationship between BMI and some factors. The study also found that the AA race had more BMI, education, calories, and lower rates of smoking and sugar intake; Smokers are more likely to be educated, have lower BMIs, exercise more often, and have higher sugar and alcohol intake. For women with less education, they have more children with a higher prevalence of smoking. In terms of diet, they followed a high-calorie diet that contained more sugar but less protein. In summary, it is recommended to provide women with lower education levels and smokers with basic nutrition, exercise, and smoking hazards education to improve overall health. Women of childbearing age should pay attention to moderate exercise in daily life and reasonable allocation of intake ratio of key elements to maintain health, which has important implications for improving quality of life and preventing chronic diseases.

Impact of Individual Characteristics on Hospital Outcomes in Exacerbated COPD in a Biomass-Exposed Turkish Population.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and factors such as biomass exposure, demographic characteristics, and comorbidities significantly influence patient outcomes during exacerbations. Aim: This study aims to clarify the impact of patient characteristics on key hospital outcomes, including ICU admissions, hospital length of stay, and in-hospital mortality, focusing on the contextual role of biomass exposure rather than its direct impact. Methods: Using a multicenter, retrospective cohort design, we analyzed the medical records of patients admitted with COPD exacerbations from January 2021 to December 2023. Eligible patients were over 40 years old with confirmed COPD exacerbation, excluding those with other significant lung conditions, severe organ dysfunction, or incomplete data. The collected data included demographics, smoking history, comorbidities, medications, laboratory results, and clinical outcomes, with smoking status categorized into current, former, or never smokers. Results: Our analysis comprised 334 patients with a mean age of 69 ± 8.8 years, including 52 (15.6%) females. Biomass exposure, observed in 22% of patients, was associated with a higher likelihood of being female (p < 0.001), lower smoking rates (p < 0.001), higher prevalence of diabetes mellitus type 2 (p = 0.020), lower peripheral blood eosinophilia (p = 0.001), increased intensive care unit (ICU) admissions (p = 0.034), and higher in-hospital mortality (p = 0.043). Non-survivors tended to be older and had a higher prevalence of hypertension, a history of childhood pneumonia, longer COPD duration, greater need for non-invasive ventilation (NIV) during hospitalization, and more frequent ICU admissions. Univariate Cox regression analysis revealed no significant associations between characteristics and outcomes. Conclusions: Patients with biomass exposure were more likely to be female and had higher rates of ICU admission and in-hospital mortality.

Health Disparities Among Ultra-Orthodox and Non-Ultra-Orthodox Residents in Neighboring Cities in Israel: A Cross-Sectional Study.

Socioeconomic status and religion are associated with health indicators. This study compared the correlations between religious observance, socioeconomic status, and select health indicators among adults in neighboring cities in Israel based on data collected from the Maccabi Health Services database. One city is characterized by religious observance, while the other is primarily secular. Lower smoking rates and higher rates of low cholesterol, triglycerides and LDL levels were observed in the religious city. No significant differences were found for low HDL rates or diabetes. Unique characteristics of populations must be considered when planning health interventions.

Smoking during pregnancy in an Irish obstetric Population: Prevalence, maternal and ethnic factors

ObjectivesMaternal cigarette smoking during pregnancy is associated with adverse health outcomes for the mother and her fetus in utero. A high prevalence of smoking during pregnancy is reported within an Irish obstetric population. However, there are no recent Irish data regarding change in smoking rates over time, or factors associated with declining smoking prevalence. Therefore, the objectives of this study were: 1. To investigate smoking patterns in pregnancy among an Irish obstetric population, 2. To identify trends over time, and 3. To evaluate associated demographic factors. Study DesignThe data for this study were obtained from EuroKing, a computerised obstetric database, to which data had been entered prospectively during the 8-year period between January 2015 and December 2022 at Galway University Hospital, Ireland. A total of 22,673 deliveries were recorded during this time period. Complete information regarding the mother’s smoking history was available for 19,247 women at the time of antenatal booking, and again at delivery. Statistical analyses was performed using GraphPad Prism (version 10.1.2). Chi-square test for proportions and trend were used to assess differences between groups. ResultsRates of smoking during pregnancy declined over the duration of the study. The percentage of mothers who smoked during pregnancy declined from 8.3 % in 2015 to 6.0 % in 2022 (P = 0.007). The greatest reduction in smoking was observed among those aged 21 to 30 years, from 15.3 % in 2015 to 10.1 % in 2022 (P < 0.001). There was no significant decline in smoking within the other age groups. There was an overall reduction in the rate of smoking from the time of antenatal booking to delivery of 31.9 %. Increasing maternal age was associated with lower rates of smoking (P < 0.001). Increasing parity was associated with higher rates of smoking (P < 0.001). Smoking rates were highest in the White Irish Traveller ethnic group, at 40.3 % across the 8-year study period. Breastfeeding rates were lower in smokers versus non-smokers (P < 0.001). ConclusionThis study indicates that the rate of maternal smoking during pregnancy in Ireland is approximately 6%, which is less than previously reported. A significant proportion of women who smoked at the time of antenatal booking have ceased smoking by the time of delivery. Overall there was a decline in maternal smoking over the duration of the study. However, high rates of smoking were associated with certain sociodemographic characteristics, including younger maternal age, increasing parity and White Irish Traveller background.

All-cause, cancer and cardiovascular mortality among South Asians living in the UK: Follow-up of the London Life Sciences Population (LOLIPOP) cohort

Abstract Background Although South Asians are the largest ethnic minority group in the UK, and the largest ethnic group worldwide, few studies have investigated patterns of mortality in South Asians. Methods We investigated 16,391 South Asian and 6,970 European men and women living in the UK, and participating in the London Life Sciences Prospective Population study. Participants were recruited in 2002-2008, and survival determined to 2019. We examined relationships of clinical, anthropometric, and lifestyle risk factors to mortality outcomes. Findings: Compared to Europeans, South Asians had higher prevalence of diabetes, cardiovascular disease, and hypertension, higher waist-hip ratio, fasting glucose, insulin and triglycerides, but lower smoking rates and HDL cholesterol (all P&amp;lt;0.001). Age and sex adjusted all-cause mortality was lower (Hazard Ratio (HR): 0.75 [0.68-0.81], P&amp;lt;0.001), all-cancer mortality was lower (HR 0.50 [0.43-0.58], P&amp;lt;0.001), and coronary heart disease (CHD) mortality was higher (HR 1.29 [1.05-1.60], P&amp;lt;0.01) in South Asians compared to Europeans. Mortality rates were ~50% lower for 9 of the 10 most common cancers in South Asians. After adjusting for risk factors, ethnic differences were attenuated only for CHD mortality. Interpretation: All-cause and cancer mortality are lower, but CHD mortality is higher, in South Asians compared to Europeans. Measured risk factors do not explain lower all-cause and all-cancer mortality, but do account for higher CHD mortality. Our findings provide evidence for population-specific exposures protective against cancers in South Asians, as well as the motivation to further improve cardiovascular risk reduction in this major ethnic group.

E-Cigarettes in Smoking Cessation and Harm Reduction: A Comprehensive Review of Recent Evidence and Potential Risks

The global prevalence of tobacco use has significantly decreased over the years, with projections indicating further decline. However, the rise of new nicotine products suggests that nicotine addiction will remain a major public health issue. Electronic cigarettes (e-cigarettes) are increasingly recognized as potential tools for smoking cessation and harm reduction. This review evaluates the safety and effectiveness of e-cigarettes both as standalone treatments and in combination with other therapies, such as nicotine replacement therapy (NRT), varenicline, cytisine, and behavioral approaches. A comprehensive analysis of studies published over the past decade, including systematic reviews, meta-analyses, and randomized controlled trials, shows that e-cigarettes can enhance smoking cessation rates and reduce tobacco-related harm. They exhibit comparable short-term efficacy to traditional treatments, with promising results in alleviating withdrawal symptoms and lowering smoking rates. However, the long-term safety and effectiveness of combining e-cigarettes with other therapies remain uncertain and require further investigation. Despite their potential benefits, e-cigarettes pose significant safety concerns, underscoring the need for ongoing research to refine cessation strategies and ensure their safe, long-term use. Rigorous evaluation and regulatory oversight are essential to optimize e-cigarettes' role in reducing tobacco harm.

Prevalence and influencing factors of pulmonary nodules in hospitalized patients with diabetes.

Pulmonary nodules are an early manifestation of many lung cancers, and patients with diabetes are at high risk for lung cancer. However, there is a lack of epidemiological data on pulmonary nodules in patients with diabetes. This study investigated the prevalence rate of pulmonary nodules in hospitalized patients with diabetes and analyzed its influencing factors, with the aim of generating data to inform the management of pulmonary nodules in patients with diabetes. This retrospective study included 1,864 patients with diabetes admitted to the Department of Endocrinology and Metabolism in the North District of Suzhou City Hospital from January 2020 to November 2022. According to the chest computed tomography (CT) examination, the patients were divided into two groups: a no pulmonary nodules group and a pulmonary nodules group. The prevalence rate of pulmonary nodules was calculated, and the number, size, nature, and other imaging characteristics of pulmonary nodules were compared. The pulmonary nodule group was divided into three subgroups according to the following nodule diameters: <5, ≥5 and <10, and ≥10 and ≤30 mm. The clinical data, blood biochemistry, insulin resistance index, and serum tumor marker levels were recorded. A multinomial logistic regression model was used to analyze the influencing factors of pulmonary nodule in diabetic patients. Among the 1,864 hospitalized patients with diabetes, 1,407 were found to have pulmonary nodules, representing a total prevalence rate of 75.48%. Compared with the pulmonary nodules subgroups, the no pulmonary nodules group had a higher proportion of males, a lower smoking rate, and higher incidence of proteinuria (all P values <0.05). Compared with the group with a nodule diameter ≥5 and <10 mm and that with a nodule diameter ≥10 and ≤30 mm, the no pulmonary nodules group had a lower age, insulin use rate, and homocysteine (Hcy) levels but higher fasting and 2-hour postprandial C-peptide level, low-density lipoprotein cholesterol (LDL-C) level and insulin resistance index [Homeostatic Model Assessment for Insulin Resistance 2 (HOMA2IR)] (all P values <0.05). The usage rate of dipeptidyl peptidase 4 (DPP4) inhibitor in the no pulmonary nodules group was lower than that in the subgroup with a nodule diameter ≥5 and <10 mm (P<0.05). Multinomial logistic regression analysis showed that age, smoking, and use of DPP4 inhibitors were independent risk factors for pulmonary nodules. DPP4 inhibitors increased the risk of nodules ≥5 and <10 mm in size, while older age and smoking increased the risk of nodules ≥5 mm in size (all P values <0.05). The prevalence of pulmonary nodules in hospitalized patients with diabetes is up to 75.48%. Older age, smoking, and use of DPP4 inhibitors were found to be independent risk factors for pulmonary nodule development in diabetic patients.

Impact of Body Mass Index on Complication Rates Following Primary Total Ankle Arthroplasty

Category: Ankle; Ankle Arthritis Introduction/Purpose: Recent literature has indicated higher body mass index (BMI) to be of concern for poorer outcomes following total ankle arthroplasty. The purpose of this study is to evaluate the impact of implementing BMI cutoff points on 6-month postoperative outcomes following total ankle arthroplasty (TAA). Methods: The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 5,865 patients undergoing primary elective TAA with a reported BMI range via ICD-10 diagnosis. Our cohort consisted of patients with BMI ≥30 kg/m2, stratified into groups by 5 BMI point intervals. Preoperative demographics, comorbidities, postoperative outcomes, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than BMI. Results: When stratifying by preoperative BMI, higher BMI was associated with significantly lower age (p &lt;.001) and rate of smoking (p &lt;.001), and higher rate of female sex (p &lt;.001), Medicaid insurance (p &lt;.001), higher CCI score (p &lt;.001), among other comorbidities. Multivariate regression analysis of 180-day postoperative outcomes, controlling for demographic and comorbidity differences, found that preoperative BMI 40-44.9 and ≥45 kg/m2 was significantly predictive of increased risk of any complication (44-44.9: OR=1.843; p&lt;.001)(45+: OR=1.960; p&lt;.001), adverse discharge (44-44.9: OR=1.217 p=.015)(45+: OR=2.030; p&lt;.001), and extended stay greater than 4 days (44-44.9: OR=1.653; p&lt;.001)(45+: OR=2.171; p&lt;.001), with BMI ≥45 kg/m2 also being significantly predictive of 65% increased risk of readmission (OR=1.655; p=.004). Conclusion: Higher BMI in TAA is associated with an increased risk of any postoperative complication, adverse discharge, and extended LOS. Specifically, a BMI cutoff of 40kg/m2 would serve to prevent 38.6% of the 963 obese patients experiencing complications following TAA. While our results suggest that implementing a strict BMI cutoff would serve to reduce complications substantially, it will also prevent a large number of patients from undergoing a complication-free surgery that will ultimately serve to reduce pain and increase function. Instead, we suggest physicians consider a BMI cutoff in concert with other comorbidity factors that may affect surgical outcomes following TAA.

Abstract B022: Smoking cessation interventions for Hispanic/Latinx adults in the United States: Results from a systematic review

Abstract Significance: Smoking rates have declined in the U.S. over the last several decades but vary by population subgroup. Hispanic adults generally have lower smoking rates than Non-Hispanic White individuals, but this varies greatly by country of origin, with some Hispanic subgroups, such as Puerto Ricans, reaching smoking prevalence rates up to 28%. Hispanic smokers have lower success rates in cessation attempts and are less likely to receive assistance in quitting, highlighting their unique cessation needs. The purpose of this systematic review was to determine the quantity and range of smoking cessation interventions targeted to Hispanic adults. Methods: A systematic literature search, following PRISMA guidelines, was conducted across seven databases, trial registries, and grey literature published until April 2024. Two authors independently screened titles, abstracts, and full texts for eligibility using Covidence. Study characteristics (e.g., intervention modality, language availability, cultural specificity) and outcomes were narratively summarized, and quality assessment was conducted. A meta-analysis is planned to evaluate the efficacy of smoking cessation interventions tested in RCTs, with a minimum follow-up of 6 months. The association between intervention type/modality and efficacy will be assessed via subgroup analyses. Results: A total of 8,844 records were identified and screened by reviewers. Of these, 456 studies were assessed for full-text eligibility, 49 studies with targeted interventions were identified for inclusion, of which 10 met criteria for meta- analysis. Of the 49 interventions identified, 44 interventions were offered in Spanish, 26 were culturally specific, and 34 had a majority Hispanic sample. Many interventions utilized multiple intervention modalities and included adjunct components. Types of interventions included behavioral counseling (n=26): in person (n=22) or over the phone (n=4), written self-help (n=6), text messaging (n=5), mass media campaigns (n=3), web-site applications or social media (n=3), pharmacotherapy with a behavioral adjunct (n=3), group counseling (n=2), and one smartphone application (n=1). Cessation rates ranged from 8% to 55%. No studies disaggregated smoking outcomes by Hispanic sub-group. Among the RCTs to be included in the planned meta-analysis, 5 out of 10 studies were culturally specific. Methodological quality for these studies ranged from weak (60%) to strong (10%). Conclusions: This systematic review summarizes the quantity and types of smoking cessation interventions for Hispanic smokers. Existing interventions vary in modality and are frequently offered in Spanish. However, few studies were tailored to values of Hispanic culture, and none addressed differences in smoking behavior among Hispanics by country of origin. Among the RCTs, most trials were rated as methodologically weak based on the Cochrane Risk of Bias tool. Results from this review may inform the development of future interventions, specifically guiding the design of rigorous randomized cessation trials for Hispanics. Citation Format: Honor M. Woodward, Ranjita Poudel, Helen Yates, Ursula Martinez, Mary-Katherine Haver, Jennifer I. Vidrine, Youngchul Kim, Thomas H. Brandon, Vani N. Simmons. Smoking cessation interventions for Hispanic/Latinx adults in the United States: Results from a systematic review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B022.

Exploring rheumatoid arthritis associated interstitial lung disease a retrospective study from two Saudi tertiary care centers

BackgroundInterstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. Many risk factors for RA-related ILD were reported. The current study aims to explore the features and risk factors of Saudi patients with RA-ILD.MethodsThis is a multicenter, retrospective, observational study of patients with RA-ILD. Clinical and radiological data from patients with RA-ILD were obtained from electronic medical records, including demographics, clinical characteristics, laboratory tests, pulmonary function tests, ECHO, and HRCT images.ResultOut of 732 patients, 57 had RA-ILD. The mean age at the time of ILD diagnosis was 61.9 (± 12.2) years. RA-ILD diagnosis was significantly less among females (p = 0.008). Patients who ever smoked had significantly more RA-ILD (p < 0.001). Patients with RA-ILD were more likely to present with medical comorbidities, namely diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), and osteoarthritis (p = 0.030). The multivariate analysis revealed that the age (OR: 1.035, 95% CI: 48.45–52.86, p = 0.0001); gender (OR: 2.581, CI: 1.77–1.86, p = 0.001), DM (OR: 2.498, 95% Cl: 1.65–1.76, P = 0.0001), HTN (OR: 1.975, 95% Cl: 1.61–1.74, P = 0.019), IHD (OR: 6.043, 95% Cl: 1.89–1.93, P = 0.0001) have a significant positive association with RA-ILD. No significant differences were observed between seropositive parameters with or without RA-ILD (p > 0.05). The most common symptoms of RA-ILD were cough (55.6%) and dyspnea (30.2%), and the most common ILD pattern was Non-specific Interstitial Pneumonia (NSIP) (55.6%) followed by Usual Interstitial Pneumonia (UIP) (38.9%). Traction bronchiectasis (75.5%) and glass ground opacities (73.6%) were also observed. The mean FVC and DLCO at baseline were 64.6% and 53.3%, respectively.ConclusionIn this cohort of patients, Saudi RA-ILD patients had a predominant NSIP pattern conversely to what is seen globally. These findings could be explained by the lower rates of smoking in our patient population. Future prospective national studies are needed to confirm the current findings and better evaluate RA-ILD epidemiology and risk factors.

Comprehensive appraisal of lung function in young COPD patients: a single center observational study

PurposeThe present study aimed to investigate the clinical characteristics and lung function impairment in young people diagnosed with chronic obstructive pulmonary disease (COPD).Patients and methodsWe retrospectively enrolled patients with COPD who underwent symptom assessment and comprehensive pulmonary function tests at the First Affiliated Hospital of Guangzhou Medical University between August 2017 and March 2022. The patients were categorized into two groups based on age: a young COPD group (aged 20–50 years) and an old COPD group (aged > 50 years).ResultsA total of 1282 patients with COPD were included in the study, with 76 young COPD patients and 1206 old COPD patients. Young COPD patients exhibited a higher likelihood of being asymptomatic, lower rates of smoking, and a lower smoking index compared to old COPD patients. Although young COPD patients had higher median post-bronchodilator forced expiratory volume in 1 s (post-BD FEV1) (1.4 vs.1.2 L, P = 0.019), diffusing capacity of the lung for carbon monoxide (DLCO) (7.2 vs. 4.6, P<0.001), and a lower median residual volume to total lung capacity ratio (RV/TLC) compared to their older counterparts, there were no differences observed in severity distribution by GOLD categories or the proportion of lung hyperinflation (RV/TLC%pred > 120%) between two groups. Surprisingly, the prevalence of reduced DLCO was found to be 71.1% in young COPD, although lower than in old COPD (85.2%).ConclusionYoung COPD showed fewer respiratory symptoms, yet displayed a similar severity distribution by GOLD categories. Furthermore, a majority of them demonstrated lung hyperinflation and reduced DLCO. These results underscore the importance of a comprehensive assessment of lung function in young COPD patients.

Higher stroke risk after carotid endarterectomy and transcarotid artery revascularization is associated with relative surgeon volume ratio

ObjectiveAdoption of transcarotid artery revascularization (TCAR) by surgeons has been variable, with some still performing traditional carotid endarterectomy (CEA), whereas others have shifted to mostly TCAR. Our goal was to evaluate the association of relative surgeon volume of CEA to TCAR with perioperative outcomes. MethodsThe Vascular Quality Initiative CEA and carotid artery stent registries were analyzed from 2021 to 2023 for symptomatic and asymptomatic interventions. Surgeons participating in both registries were categorized in the following CEA to CEA+TCAR volume percentage ratios: 0.25 (majority TCAR), 0.26 to 0.50 (more TCAR), 0.51 to 0.75 (more CEA), and 0.76 to 1.00 (majority CEA). Primary outcomes were rates of perioperative ipsilateral stroke, death, cranial nerve injury, and return to the operating room for bleeding. ResultsThere were 50,189 patients who underwent primary carotid revascularization (64.3% CEA and 35.7% TCAR). CEA patients were younger (71.1 vs 73.5 years, P < .001), with more symptomatic cases, less coronary artery disease, diabetes, and lower antiplatelet and statin use (all P < .001). TCAR patients had lower rates of smoking, obesity, and dialysis or renal transplant (all P < .001). Postoperative stroke after CEA was significantly impacted by the operator CEA to TCAR volume ratio (P = .04), with surgeons who perform majority TCAR and more TCAR having higher postoperative ipsilateral stroke (majority TCAR odds ratio [OR]: 2.15, 95% confidence interval [CI]: 1.16-3.96, P = .01; more TCAR OR: 1.42, 95% CI: 1.02-1.96, P = .04), as compared with those who perform majority CEA. Similarly, postoperative stroke after TCAR was significantly impacted by the CEA to TCAR volume ratio (P = .02), with surgeons who perform majority CEA and more CEA having higher stroke (majority CEA OR: 1.51, 95% CI: 1.00-2.27, P = .05; more CEA OR: 1.50, 95% CI: 1.14-2.00, P = .004), as compared with those who perform majority TCAR. There was no association between surgeon ratio and perioperative death, cranial nerve injury, and return to the operating room for bleeding for either procedure. ConclusionsThe relative surgeon CEA to TCAR ratio is significantly associated with perioperative stroke rate. Surgeons who perform a majority of one procedure have a higher stroke rate in the other. Surgeons offering both operations should maintain a balanced practice and have a low threshold to collaborate as needed.