National Health And Nutrition Examination Survey Sample Research Articles

Abstract 4137914: Eligibility for Semaglutide in US Adults with Diabetes and Potentially Preventable Cardiovascular Events Projected from the SUSTAIN-6 Trial

Background: The Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6) trial showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with type 2 diabetes mellitus (T2DM). Purpose: To estimate the number of US adults with T2DM that may be eligible for semaglutide based on SUSTAIN-6 eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SUSTAIN-6. Methods: We included US adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2011– 2020 who had eligibility criteria from SUSTAIN-6. This included an HbA1c>7.0%, age > 50 with established CVD, heart failure, or chronic kidney disease or an age > 60 with at least one CVD risk factor. We estimated the number of primary composite and secondary CVD endpoints that would occur based on SUSTAIN-6 treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on median 2.1 year follow-up time). Results: Among 5002 (projected to 34.0 million [M]) adults we identified with T2DM, we estimated 1,132 (6.9 million) (20.3%) to fit SUSTAIN-6 eligibility criteria. Compared to SUSTAIN-6 trial participants, our sample was slightly older, had a higher proportion of Black participants, shorter duration of diabetes, lower HbA1c and diastolic blood pressure, but similar body mass index and systolic blood pressure. Prior history of ischemic heart disease, myocardial infarction, and stroke were also less common in our NHANES sample. From SUSTAIN-6 semaglutide and placebo primary composite CVD event rates of 6.6% and 8.9%, respectively, we estimated 456,060 and 614,990 events would occur, respectively, for a total of 159,930 preventable CVD events, or 75,681 on an annualized basis. We similarly estimated annualized preventable events for secondary outcomes as shown in the Figure. Conclusion: Semaglutide may prevent many fatal and non-fatal CVD events if provided to US adults meeting SUSTAIN-6 eligibility criteria. More efforts are needed to educate the healthcare providers on the CVD benefits from newer diabetes therapies, including semaglutide.

Estimating hepatitis C prevalence in the United States, 2017-2020.

The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of HCV infection. By accounting for populations inadequately represented in NHANES, we created 2 models to estimate the national hepatitis C prevalence among US adults during 2017-2020. The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who injected drugs [PWID] adjustment), we developed a model to account for the underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% CI: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections. Despite years of an effective cure, the estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013 to 2016 when using a comparable methodology. When accounting for increased injection drug use, the estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.

Development of a diverse osteoporosis screening tool for older US adults from the health and retirement study

Existing osteoporosis screening tools have limitations, including using race as a predictor, and development on homogeneous samples. This biases risk assessment of osteoporosis in diverse populations and increases health inequities. We develop a tool that relies on variables easily learned during point-of-care, known by individuals, and with negligible racial bias. Data from the 2012–2016 waves of the population-based cohort Health and Retirement Study (HRS) were used to build a predictive model of osteoporosis diagnosis on a 75 % training sample of adults ages 50–90. The model was validated on a 25 % holdout sample and a cross-sectional sample of American individuals ages 50–80 from the National Health and Nutrition Examination Survey (NHANES). Sensitivity and specificity were compared across sex and race/ethnicity. The model has high sensitivity in the HRS holdout sample (89.9 %), which holds for those identifying as female and across racial/ethnic groups. Specificity is 57.9 %, and area under the curve (AUC) is approximately 0.81. Validation in the NHANES sample using empirically measured osteoporosis produced relatively good values of sensitivity, specificity, and consistency across groups. The model was used to create a publicly-available, open-source tool called the Osteoporosis Health Equality (& Equity) Evaluation (OsteoHEE). The model provided high sensitivity for osteoporosis diagnosis, with consistently high results for those identifying as female, and across racial/ethnic groups. Use of this tool is expected to improve equity in screening and increase access to bone density scans for those at risk of osteoporosis. Validation on alternative samples is encouraged.

0248 Disparities in Bed and Wake Times in the US Population

Abstract Introduction Although quality sleep is crucial for good health, well-being, and cognitive function, racial and ethnic minority populations are at an increased risk of having shorter sleep duration and poorer sleep quality in comparison to other groups. This study, which is nationally representative, intends to show differences in population-level sleep time. Population-level differences in timing have significant public health ramifications because of the important contribution that circadian rhythms play to health. Methods Data were obtained from adults who participated in the National Health And Nutrition Examination Survey (NHANES), overseen by the CDC, for the 2017-2018 and 2019-2020 (March, pre-pandemic) waves. These data were combined and weighted using NHANES sample weights. Habitual sleep timing was assessed as self-reported typical bedtime and wake time, which was converted to minutes from midnight. Race/ethnicity was self-reported as non-Hispanic White, Black/African-American, Mexican-American, Other Latinx, Asian, or Multiracial/Other. Covariates included demographics (age, sex), socioeconomics (education, income-poverty ratio), health (body mass index, overall health rating), mental health (depressed mood), and sleep health (sleep disturbance, daytime tiredness). Results In the fully-adjusted model, compared to non-Hispanic Whites, Blacks/African-Americans went to bed 17.8 minutes later (95%CI [6.011, 29.497], P=0.003) but did not differ regarding wake time. Asians went to bed 17.8 minutes later (95%CI [6.255, 29.365], p=0.003) and woke up 18.9 minutes later (95%CI [5.222, 32.626], p=0.007). Mexican-Americans went to bed 18.0 minutes earlier (95%CI [-30.722, -5.233], p=0.006) and woke up 33.9 minutes earlier (95%CI [-47.737, -20.112], p< 0.0005). The other groups did not significantly differ from non-Hispanic Whites. As a post-hoc analysis, habitual sleep duration was entered as an additional covariate, and bedtime differences between non-Hispanic Whites and Blacks/African-Americans were no longer significant. Conclusion Even after accounting for other elements of sleep, Blacks/African-Americans, and Asians still exhibit delayed sleep. This timing difference may reflect underlying circadian factors, or social ones that may influence timing of sleep. Future work should explore the possibility that circadian disparities exist as well, and may be related to health disparities since circadian rhythms play so many roles in health. Support (if any)

0650 Sleep and Mental Health Symptoms at the Population Level: Differences by Race/Ethnicity

Abstract Introduction There is a bidirectional relationship between sleep duration and mental health. This relationship may be impacted by race/ethnicity, indicating differential risk profiles across groups. Therefore, we aimed to determine whether race/ethnicity play a role in the relationship between sleep and mental health at the population level. Methods Data were used from adults age 18+ from the combined 2015-2020 (pre-pandemic) National Health and Nutrition Examination Survey (NHANES) (N=16,399). Habitual sleep duration was self-reported in half-hour increments and categorized as < 5h, 5.5-6.5h, 7-8h, 8.5-9.5h, or 10+h. Mental health symptoms in the past 2 weeks were reported as “not at all,” “several days,” “>half of days” or “nearly every day” and included depressed mood, anhedonia, feelings of guilt, appetite dysregulation, and suicide ideation. Race/ethnicity was self-reported as Non-Hispanic White (N=5499), Black/African-American (N=3975), Mexican-American (N=2337), Other Latinx (N=1846), Asian/Pacific-Islander (N=1984), or Multiracial/Other (N=758). Additional covariates included age and sex. NHANES sample weights were used for all analyses. Ordinal logistic regressions examined mental health outcomes associated with sleep duration stratified by race/ethnicity. Results Sleep duration by race/ethnicity interactions were seen for depression (p=0.006), guilt (p=0.009), appetite dysregulation (0.049), and suicide ideation (p< 0.0005), with a trend for anhedonia (p=0.185). Non-Hispanic Whites demonstrated U-shaped relationships with all mental health variables. Blacks/African-Americans demonstrated U-shaped relationships for depressed mood and anhedonia and relationships with short sleep for guilt, appetite, and suicide ideation. Mexican Americans demonstrated a U-shaped association with guilt and an association between long sleep and depressed mood, anhedonia, and suicide ideation. Other Latinx showed a U-shaped association with guilt and appetite, and long sleep relationships with depressed mood, anhedonia, and suicide ideation. Asians/Pacific-Islanders showed short sleep associations with depressed mood and appetite. Multiracial/Others showed a short sleep relationship with guilt and a long sleep relationship with suicide ideation. Conclusion Both short and long sleep duration were associated with worse mental health. However, this pattern of relationships depends on race/ethnicity, as different groups show different patterns of vulnerability. Future work should explore mechanisms of differential vulnerability and develop targeted interventions based on risk profile. Support (if any)

The prevalence of low muscle mass associated with obesity in the USA

BackgroundSarcopenia is defined as age-related low muscle mass and function, and can also describe the loss of muscle mass in certain medical conditions, such as sarcopenic obesity. Sarcopenic obesity describes loss of muscle and function in obese individuals; however, as sarcopenia is an age-related condition and obesity can occur in any age group, a more accurate term is obesity with low lean muscle mass (OLLMM). Given limited data on OLLMM (particularly in those aged < 65 years), the purpose of this study was to estimate the prevalence of OLLMM in adults aged ≥ 20 years in the USA.MethodsData from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 and 1999–2006 were used. OLLMM was defined as an appendicular lean mass, adjusted for body mass index (BMI), cut-off point < 0.789 for males and < 0.512 for females, measured by dual-energy X-ray absorptiometry (DXA). DXA was only measured in individuals 20–59 years old in NHANES 2017–2018; we therefore utilized logistic regression models to predict OLLMM from NHANES 1999–2006 for those aged ≥ 60 years. The prevalence of OLLMM was estimated overall, and by sex, age, race/ethnicity, and clinical subgroup (high BMI, prediabetes, type 2 diabetes mellitus [T2DM], non-alcoholic fatty liver disease [NAFLD] with fibrosis, or post-bariatric surgery). Prevalence estimates were extrapolated to the USA population using NHANES sampling weights.ResultsWe estimated that, during 2017–2018, 28.7 million or 15.9% of the USA population had OLLMM. The prevalence of OLLMM was greater in older individuals (8.1%, aged 20–59 years vs 28.3%, aged ≥ 60 years), highest (66.6%) in Mexican-American females aged ≥ 60 years, and lowest (2.6%) in non-Hispanic Black males aged 20–59 years. There was a higher prevalence of OLLMM in adults with prediabetes (19.7%), T2DM (34.5%), NAFLD with fibrosis (25.4%), or post-bariatric surgery (21.8%), compared with those without each condition.ConclusionsOverall, the burden of OLLMM in the USA is substantial, affecting almost 30 million adults. The prevalence of OLLMM increased with age, and among those with prediabetes, T2DM, NAFLD with fibrosis, or post-bariatric surgery. A unified definition of OLLMM will aid diagnosis and treatment strategies.

Characterization of Choline Nutriture among Adults and Children with Phenylketonuria.

Choline is an essential nutrient for brain development and function that is attained through high-protein foods, which are limited in the phenylalanine-restricted diet of people with phenylketonuria (PKU). This study compared choline consumption among individuals with PKU to a reference sample from the National Health and Nutrition Examination Survey (NHANES), and identified treatment and diet-related factors that may modulate choline needs. Participants were individuals with PKU (n = 120, 4–61 years) managed with dietary therapy alone (n = 49), sapropterin dihydrochloride for ≥1 year (n = 38), or pegvaliase for ≥1 year with no medical food (n = 33). NHANES participants were not pregnant or nursing and came from the 2015–2018 cycles (n = 10,681, 4–70 years). Dietary intake data were used to estimate total usual intake distributions for choline, and mean probability of adequacy (MPA) was calculated as a summary index of nutrient adequacy for four methyl-donor/co-factor nutrients that impact choline utilization (folate, vitamin B12, vitamin B6, and methionine). Only 10.8% (SE: 2.98) of the total PKU sample (14.7% [SE: 4.03] of children; 6.8% [SE: 2.89] of adults) achieved the adequate intake (AI) for choline, while 12.2% (SE:0.79) of the NHANES sample met the recommended level. Adults receiving pegvaliase were the most likely to exceed the AI for choline (14.82% [SE: 4.48]), while adults who were on diet therapy alone were the least likely (5.59% [SE: 2.95]). Without fortified medical foods, individuals on diet therapy and sapropterin would not be able to achieve the AI, and MPA for other methyl donor/co-factor nutrients would be reduced. More frequent monitoring of choline intake and increased choline fortification of medical foods could benefit this population.

Risk factors for metabolic and cardiovascular disease in inpatients with severe mental illness

Patients with severe mental illness (SMI) have increased burden of somatic illnesses, especially cardiovascular disease. Characterizing the cardiovascular risk profile of patients with SMI is therefore crucial to understanding how to decrease morbidity and mortality in these vulnerable populations. In this observational study, entropy balancing (a form of propensity score matching) was used to compare cardiometabolic health in a sample of the general population from the National Health and Nutrition Examination Survey (NHANES) datasets to inpatients hospitalized in a large, urban, academic psychiatric hospital in Harris County, Texas. Data were analyzed using independent linear regression models for blood pressure, blood glucose, TG:HDL ratio, total cholesterol, and body mass index as outcome variables. Systolic blood pressure (F=34•75, p<0•0001), diastolic blood pressure (F=90•53, p<0•0001), blood glucose (F=12•89, p<0•0001), and the TG:HDL ratio (F=3•16, p<0•0001) were all elevated in the psychiatric inpatient sample vs. the NHANES sample. Contrary to expectations, total cholesterol (F=32•18, p<0•0001) and BMI (F=15•05, p<0•0001) were lower in this sample vs. the NHANES sample. Patients hospitalized with SMI show a cardiometabolic profile which confers greater risk of diabetes- and hypertension-related mortality. Approaches should be developed to target indicators of cardiometabolic health in this population to reduce long-term mortality.

New Evidence-based Fitting Paradigm for Over-the-Counter Hearing Aids

New Evidence-based Fitting Paradigm for Over-the-Counter Hearing Aids

Estimated IQ points and lifetime earnings lost to early childhood blood lead levels in the United States.

There is no safe detectable level of lead (Pb) in the blood of children. Blood lead levels (BLLs) at ages 6-24months ≥2μg/dL result in lost grade school intelligence quotient (IQ) points at ages 5-10years. Black children continue to have the highest BLLs in the United States. Therefore, we examined currently undetermined racial/ethnic disparities in anticipated IQ points and associated lifetime earnings lost to early childhood blood lead. We conducted secondary analysis of infants with blood lead (in μg/dL) measured at ages 12-24months by the cross-sectional National Health and Nutrition Examination Survey (NHANES) during 1999 to 2010. Nationally-representative estimates were produced using weighted simulation model. A total of 1241 infants were included from the NHANES sample (52% male; mean [SD] age, 18.5 [3.5] months; 25% Black [non-Hispanic], 42% Hispanic [any race], 5% Other/Multiracial, and 29% White [non-Hispanic]) after excluding 811 without BLL determinations. For national outcomes, Black infants experienced approximately 46-55% greater average estimated loss of grade school IQ points from blood lead than Hispanic or White infants (-1.78 IQ points vs. -1.15 and -1.21 respectively) with similar disparities in costs to expected lifetime earnings (-$47,116 USD vs. -$30,393 and -$32,356 respectively). Our estimated nationwide costs of IQ points lost to BLLs during this 12-year period totaled $554 billion ($46.2 billion/year), in which blood lead <5μg/dL accounted for 74% of this total burden. We report two aspects of the substantial national costs attributable to lead exposure in just the second year of life alone, which disproportionately impact predominately African-American Black infants from continuing legacies of environmental racism in lead exposure. Our findings underscore the remarkably high costs from recognized hazards of blood lead even at the lowest levels and the importance of primary prevention regarding childhood lead exposure.

Prescription Opioid Use and Laboratory Value Derangements: A Cross-Sectional Analysis of NHANES Data

BACKGROUND: The use of opioids for the treatment of pain is a risk versus benefit analysis and metabolic disease is an often overlooked variable in the equation and may lead to increased risk of comorbidities of cardiovascular and cerebrovascular disease and diabetes. OBJECTIVES: Our objective was to identify and describe abnormalities among the comprehensive metabolic and lipid panels of individuals taking prescription opioids. STUDY DESIGN: We performed a cross-sectional study of the laboratory values with 3 cycles (2011–2016) of the National Health and Nutrition Examination Survey (NHANES) in March 2020. SETTING: NHANES sampling is conducted using a multistaged, stratified, cluster sampling technique to create a representative sample of the United States. METHODS: We excluded patients with histories of cancer and under the age of 25 years. Our final sample size was 11,061 (n = 162,547,635), with 797 reportedly using a prescription opioid in the past 30 days—a weighted percent representing 22.95% of the US population. Our analyses identified mean differences in biomarkers between individuals taking prescription opioids and the US population. RESULTS: Laboratory values from the comprehensive metabolic panel were all within reference ranges for both groups, with only bilirubin levels being statistically lower in the group currently taking prescription opioids. Values from the lipid panel of both the opioid using and comparison groups were above reference range for total cholesterol and fasting glucose. The opioid using group was also higher than the reference range for triglycerides (mean [M] = 165.4, standard deviation [SD] = 14.2) and insulin (M = 15.5, SD = 2.2), whereas the comparison group was not. The oral glucose measure was within normal ranges for both groups; however, the opioid using group was 13.7 points higher than the comparison group (M = 122.3, SD = 1.8; M = 108.6, SD = 4.0; P &lt; 0.01). LIMITATIONS: While our study uses a large sample for a robust generalizable analysis it is a correlation study and a longitudinal cohort would provide better evidence linking potential disease states to prescription opioid use. CONCLUSIONS: Although all Americans should be alarmed at the lipid levels reported in this study, specific combinations of heightened lipid laboratory values among prescription opioid users accelerate the trajectories toward comorbidities—heart disease, cerebrovascular disease, and diabetes—leading to diminished quality of life. Therefore pain management and comprehensive drug recovery programs should include nutritional counseling and physical activity as part of their overall treatment plan. KEY WORDS: Opioid use, NHANES, pain management, lab values, analgesics

The concentration of several perfluoroalkyl acids in serum appears to be reduced by dietary fiber

Fiber-rich food intake has been associated with lower serum concentrations of perfluoroalkyl substances (PFAS) in some studies and dietary fiber was related to lower serum PFAS in a recent study. Given the previous epidemiologic data suggesting that fiber might decrease serum PFAS concentrations, we examined the relation of serum PFAS concentrations to intake of dietary fiber in National Health and Nutrition Examination Survey (NHANES) data. We examined the PFAS-fiber association among 6482 adults who participated in the NHANES, 2005–2016. Fiber intake was estimated based on two 24-hour diet recalls. We adjusted the models for determinants of PFAS and potentially confounding factors such as intake of foods reported to increase PFAS exposure. Results were expressed as the percent difference in PFAS concentration per interquartile range (IQR) increase in fiber (and 95 percent confidence interval), and the NHANES sampling parameters were used to make the results generalizable to the U.S. The adjusted percent difference in perfluorooctanoic acid (PFOA) per IQR increase in fiber was −3.64 (−6.15, −1.07); for perfluorooctane sulfonic acid (PFOS) was −6.69 (−9.57, −3.73), and for perfluorononanoic acid (PFNA) was −8.36 (−11.33, −5.29). These results suggest that dietary fiber increases the gastrointestinal excretion of PFOA, PFOS, and PFNA. Because fiber also lowers serum cholesterol, in some studies of the serum cholesterol-PFAS relationship confounding by fiber may be worth evaluating.

Abstract 15214: Food Insecurity and Cardiovascular Disease in NHANES (National Health and Nutrition Examination Survey) 2011-2016

Background: Adherence to a heart-healthy diet is foundational for the prevention, management, and treatment of cardiovascular disease (CVD). Despite the fact that adhering to dietary guidelines may be challenging in the context of food insecurity, little is known about the likelihood of food insecurity in persons with CVD. Hypothesis: We hypothesized that persons with CVD (hypertension, coronary artery disease, heart failure, or stroke) would have significantly higher odds of food insecurity. Methods: This was an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional study of health in the United States. All adults aged 19 years or older with food insecurity data were included across 3 cycles of NHANES (2011-2016). Food insecurity was measured using the 10-item Food Security Scale. CVD diagnosis was measured by self-report. Risk for food insecurity by CVD diagnosis was examined using multivariable logistic regression models, incorporating NHANES sample and person weights, and controlling for common sociodemographic confounders (age, gender, race/ethnicity, education, marital status). Results: The sample consisted of 17,175 persons (weighted study N =229,247,659). Slightly more than half were male (51.9%), and most were non-Hispanic white (65.1%). Just under half (45.6%) were in early adulthood (19-44 years), 35.3% were in middle adulthood (45-64 years), and 18.6% were in late adulthood (≥65 years). One quarter (25.9%) were food insecure. Consistent with our hypothesis, diagnosis of any CVD (stroke, heart failure, coronary artery disease, or hypertension) was significantly associated with higher likelihood for food insecurity (stroke: OR=2.18; 95% CI 1.83-2.60; p&lt;0.001; heart failure OR=1.94, 95% CI 1.46-2.57, p&lt;0.001; coronary artery disease: OR=1.90, 95% CI 1.49-2.43, p&lt;0.001; and hypertension: OR=1.25, 95% CI 1.10-1.42, p=0.001). Conclusions: Diagnoses of hypertension, stroke, coronary artery disease, and heart failure were all significantly associated with higher risk for food insecurity. Given the necessity of dietary modification in CVD, further efforts to study food insecurity in CVD alongside other social determinants of health are urgently needed.

Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

ObjectiveThe objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. MethodsThis was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013–2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥5 medications), CNS polypharmacy (≥3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. ResultsThe NHANES contained 20,146 participants, of whom 135 reported taking ≥1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3–6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04–1.28; IRR per chronic condition: 1.19, 95% CI: 1.11–1.27). Polypharmacy was reported by 47% (95% CI: 38%–57%) of patients, CNS polypharmacy by 34% (23%–47%), benzodiazepine use by 21% (14%–30%), opioid use by 16% (11%–24%), benzodiazepine plus opioid use by 6% (3%–14%), and 6% (2%–15%) reported a drug that lowers the seizure threshold. Twelve percent (7%–20%) took an opioid with either a benzodiazepine or gabapentinoid. ConclusionsPolypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.

Quantitation of Trans-Fatty Acids in Children from the National Health and Nutrition Examination Survey.

Trans-fatty acids (TFA) are geometric isomers of naturally occurring cis-fatty acids, formed industrially through partial hydrogenation of vegetable oils or naturally in ruminant animals. TFA intake has been associated with risk factors for cardiovascular disease; therefore, reduced TFA consumption is a major public health objective. Food intake studies have provided estimates for TFA levels in the U.S. and we previously assessed TFA blood concentrations in fasting U.S. adults in the National Health and Nutrition Examination Survey (NHANES), finding an average 54% decrease in TFA between 1999-2000 and 2009-2010. The aim of this study was to determine nationally representative estimates for plasma TFA concentrations in children in the U.S. population. We used the CDC isotope dilution-gas chromatography-negative chemical ionization-mass spectrometry (ID-GC-NCI-MS) method to quantitate four major TFA, palmitelaidic acid, elaidic acid, trans-vaccenic acid, and linoelaidic acid, in a nationally representative group of children in the U.S. population using NHANES samples. TFA were derivatized with pentafluorobenzyl-bromide and analyzed by GC-MS in selected ion monitoring mode using NCI with methane reagent gas. Separation was carried out on a Select FAME 200m column with hydrogen carrier gas. The TFA limits of detection ranged from 0.02μM to 0.43μM. The intraday and inter-day % coefficients of variation ranged from 1-11% CV and 6-15% CV respectively. The mean accuracy for all four TFA was 102% (95% CI: 98%-107%). The TFA were measured in 916 participants (age: 6-19 years) from NHANES 1999-2000 and 1718 participants (age: 3-19 years) from NHANES 2009-2010, and were detected in all samples. Geometric means for the sum of the 4 TFAs were 80.7 μmol/l (95% CI: 74.6-87.3 μmol/L) and 30.6 μmol/l (95% CI: 29.0-32.3 μmol/L) in the NHANES 1999-2000 and 2009-2010, respectively. Overall TFA concentrations were 62% lower in NHANES 2009-2010 compared to 1999-2000. TFA levels in children in the U.S. population are notably lower in NHANES 2009-2010 compared to NHANES 1999-2000 suggesting an overall reduction of TFA levels in children. N/A.

1093 Population-level Suicide Ideation: Impact Of Combined Roles Of Sleep Duration, Sleep Disturbance, And Daytime Sleepiness

Abstract Introduction Poor sleep has been shown to be related to suicide ideation and depressed mood, but population-level studies have not been done to explore the specific issues within sleep that effect mood, specifically leading to suicide ideation. Methods Data from adults 18 and older in the 2015-2016 National Health and Nutrition Examination Survey (NHANES) who provided complete data were used (N=5,123). Suicide ideation was recorded as the presence of thinking that “you would be better off dead” in the past 2 weeks. Sleep duration was recorded in half-hour increments and transformed to represent absolute distance from 7 hours (to model u-shaped association). Sleep disturbance was recorded as presence of “difficulty falling asleep, staying asleep, or sleeping too much” non, several days, or more than half the days of the past 2 weeks. Sleepiness was frequency feeling “overly sleepy during the day” in the past 12 months. Covariates included age, sex, race/ethnicity, and presence of depressed mood in the past 2 weeks. Additional impact of difficulty thinking/concentrating in the past 2 weeks was explored. NHANES sample weights were used in analyses. Results In adjusted analyses, increase likelihood of suicide ideation was associated with distance from 7hrs (OR=1.24/hr, p=0.008), sleep difficulties most of the time (OR=2.46, p=0.001), but not sleepiness. When both sleep variables were adjusted for each other, results remained significant for U-shaped sleep duration (OR=1.21/hr, p=0.02) and sleep disturbance (OR=2.31, p=0.003). These were attenuated but remained significant when difficulty thinking/concentrating was introduced; a significant sobel test (p&amp;lt;0.0001) suggested partial mediation, with this variable accounting for approximately 13% of the variance of the relationship to sleep. Conclusion In the population, improper and poor sleep was associated with a greater risk of suicide ideation. Support Dr. Grandner is supported by R01MD011600

Severe asthma in the US population and eligibility for mAb therapy

Severe asthma in the US population and eligibility for mAb therapy

Abstract P074: Epidemiology of Diabetes Phenotypes and Association with Cardiovascular Risk in the National Health and Nutrition Examination Survey (NHANES)

Introduction: A recent study among Scandinavian adults identified novel unique diabetes phenotypes using data on traditional diabetes characteristics. Our objective was to assess whether unique diabetes phenotypes are present in a multi-ethnic US sample and, if so, are differentially associated with cardiovascular disease (CVD) risk factors. Methods: We included 4300 NHANES participants (age ≥20 years) from exams 2003-04 to 2013-14 identified as having diabetes by any of the following: self-report of previous diabetes diagnosis, self-report of diabetes medication use, fasting glucose ≥126 mg/dL (≥8 hours fasting), random glucose ≥200 mg/dl, and glycated hemoglobin (HbA1c) ≥6.5%. We used an iterative data-driven method ( k- means clustering) to partition the sex-stratified sample into unique groups based on data for each of the following: self-reported age of diabetes diagnosis, body mass index (BMI), waist circumference, HbA1c, and years of insulin use. We estimated the association between diabetes subgroup with traditional CVD risk factors, accounting for demographics and NHANES sampling methods. Results: We identified four unique subgroups of diabetes phenotypes related to age (AR), insulin use (IU), severe obesity (SOR), and severe hyperglycemia (SHG). Of the 4300 diabetes cases, 51.3% were AR, 5.9% were IU, 30.3% were SOR, and 12.5% were SHG (Table). We observed differences in subgroup prevalence by race/ethnicity. Compared to the AR phenotype, all groups had higher HbA1c and BMI, the IU and SOR groups had greater blood pressure and cholesterol medication use, and the IU group had worse profiles for renal, eye, and neuropathy complications. Conclusion: Our findings corroborate that diabetes is a heterogeneous disease with unique subgroups and, a novel aspect of our work, differentially distributed across race/ethnicity. Our findings challenge whether diabetes prevention and treatment strategies should be reconsidered to phenotype-specific in order to reduce diabetes incidence, morbidity, and mortality.

Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in the United States, and incidence has increased rapidly in recent years, likely owing to increased injection drug use. Current estimates of prevalence at the state level are needed to guide prevention and care efforts but are not available through existing disease surveillance systems. To estimate the prevalence of current HCV infection among adults in each US state and the District of Columbia during the years 2013 to 2016. This survey study used a statistical model to allocate nationally representative HCV prevalence from the National Health and Nutrition Examination Survey (NHANES) according to the spatial demographics and distributions of HCV mortality and narcotic overdose mortality in all National Vital Statistics System death records from 1999 to 2016. Additional literature review and analyses estimated state-level HCV infections among populations not included in the National Health and Nutrition Examination Survey sampling frame. State, accounting for birth cohort, biological sex, race/ethnicity, federal poverty level, and year. State-level prevalence estimates of current HCV RNA. In this study, the estimated national prevalence of HCV from 2013 to 2016 was 0.84% (95% CI, 0.75%-0.96%) among adults in the noninstitutionalized US population represented in the NHANES sampling frame, corresponding to 2 035 100 (95% CI, 1 803 600-2 318 000) persons with current infection; accounting for populations not included in NHANES, there were 231 600 additional persons with HCV, adjusting prevalence to 0.93%. Nine states contained 51.9% of all persons living with HCV infection (California [318 900], Texas [202 500], Florida [151 000], New York [116 000], Pennsylvania [93 900], Ohio [89 600], Michigan [69 100], Tennessee [69 100], and North Carolina [66 400]); 5 of these states were in Appalachia. Jurisdiction-level median (range) HCV RNA prevalence was 0.88% (0.45%-2.34%). Of 13 states in the western United States, 10 were above this median. Three of 10 states with the highest HCV prevalence were in Appalachia. Using extensive national survey and vital statistics data from an 18-year period, this study found higher prevalence of HCV in the West and Appalachian states for 2013 to 2016 compared with other areas. These estimates can guide state prevention and treatment efforts.

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico.

AIMTo compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico.METHODSData for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors.RESULTSAfter adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans.CONCLUSIONIn this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.