National Health Interview Survey Research Articles

Health Insurance and Access to Care in U.S. Working Age Adults Experiencing Long COVID.

Long COVID encompasses a wide range of health problems that emerge, persist, or recur following acute COVID-19 illness. Given that the prevalence of self-reported Long COVID is highest among U.S. adults in their prime working years, it is important to identify unmet needs and gaps in healthcare access and coverage among working age adults. Prevalences (95% CI) of health insurance coverage and access to care by Long COVID status were estimated among adults 18-64 years (n = 18,117), accounting for survey design and weighted to the U.S. non-institutionalized population in the 2022 National Health Interview Survey. Analyses were conducted in 2023. Overall, 3.7% (95% CI 3.4, 4.0) of respondents were experiencing Long COVID. Adults experiencing Long COVID were less likely to report being uninsured relative to adults not experiencing Long COVID (P=0.004); however, 49.0% (95% CI 43.2, 54.7) had high deductible health plans. Adjusting for sociodemographic characteristics, adults experiencing Long COVID were more likely to access healthcare compared to adults not experiencing Long COVID (P<0.01 for seeing a doctor, telemedicine appointments, ≥2 urgent care visits, ≥2 emergency department visits, and hospitalized overnight). Despite more frequent healthcare use, adults experiencing Long COVID were also more likely to abstain from and delay medical care, therapy, and prescriptions due to cost compared to adults not experiencing Long COVID (P<0.0001 for all comparisons). These findings may be used to inform healthcare planning for adults experiencing Long COVID and highlight the ongoing need to improve access and affordability of quality and comprehensive care.

The impact of social and emotional support on serious psychological distress among people with functional disabilities and type 2 diabetes.

To examine the impact of social and emotional support on serious psychological distress (SPD) in individuals with type 2 diabetes (T2DM) and functional disabilities after controlling for socio-demographic factors and health status. Findings provide information for healthcare providers to enhance patients' psychological well-being. Data from 529 adults were obtained from the 2021 National Health Interview Survey, including those who had T2DM and also reported significant difficulty or inability to perform an activity in any of the following domains: seeing, hearing, walking or climbing stairs, communicating, remembering or concentrating, or practicing self-care. Descriptive analysis and a hierarchical regression model of SPD were used. The mean age of participants was 67.88 years old, and the mean duration of diabetes diagnosis was 16.88 years. Notably, 12.5% of individuals reported SPD. A decreased likelihood of reporting SPD occurrence was associated with older age (odds ratio (OR) = 0.95), a longer duration of T2DM diagnosis (OR = 0.97), having at least a high school education (OR = 0.54), and receiving social and emotional support. Social and emotional support likely mitigates psychological distress, suggesting that social and emotional support resources should be enhanced, especially among individuals who are younger and those more recently diagnosed with T2DM.

Costs of Severe to Profound Hearing Loss & Cost Savings of Cochlear Implants.

To estimate costs of severe to profound hearing loss, including costs and cost-savings associated with cochlear implantation. Data was obtained from the National Health Interview Survey, the National Health and Nutrition Examination Survey and national Medicare rates. We used continuous time state transition models with individual patient simulations to estimate the costs of severe to profound hearing loss (SPHL) across the lifespan. The model included four states, normal hearing, severe to profound hearing loss, cochlear implantation, and death. The estimated lifetime cost of an individual born with SPHL is $489,274 [377,518; 616,519]. Costs are lower for those who received a cochlear implant before 18 months of age $390,931 [311,976; 471,475], compared to those who are not implanted $608,167 [442,544; 791,719]. For individuals with a later onset of hearing loss (60 years old) lifetime costs were $154,536 [7,093; 302,936]. The annual societal costs for the US population were estimated to be $37 [8; 187] billion. SPHL is a costly condition, with the primary driver being lost productivity. Medical costs were higher for cochlear implantation, however, the higher income earnings offset the higher medical costs. Overall, early implantation substantially reduced lifetime costs. Access to hearing health care and technology is critical given the documented benefits for language, education, and quality of life. Government and insurance policies should be modified to allow for equal access and coverage for hearing technology, which will ultimately reduce lifetime and societal costs. N/A The current study used existing nationally representative datasets. Thus, these levels of evidence do not apply. Laryngoscope, 2024.

To weight or not to weight? The effect of selection bias in 3 large electronic health record-linked biobanks and recommendations for practice.

To develop recommendations regarding the use of weights to reduce selection bias for commonly performed analyses using electronic health record (EHR)-linked biobank data. We mapped diagnosis (ICD code) data to standardized phecodes from 3 EHR-linked biobanks with varying recruitment strategies: All of Us (AOU; n = 244071), Michigan Genomics Initiative (MGI; n = 81243), and UK Biobank (UKB; n = 401167). Using 2019 National Health Interview Survey data, we constructed selection weights for AOU and MGI to represent the US adult population more. We used weights previously developed for UKB to represent the UKB-eligible population. We conducted 4 common analyses comparing unweighted and weighted results. For AOU and MGI, estimated phecode prevalences decreased after weighting (weighted-unweighted median phecode prevalence ratio [MPR]: 0.82 and 0.61), while UKB estimates increased (MPR: 1.06). Weighting minimally impacted latent phenome dimensionality estimation. Comparing weighted versus unweighted phenome-wide association study for colorectal cancer, the strongest associations remained unaltered, with considerable overlap in significant hits. Weighting affected the estimated log-odds ratio for sex and colorectal cancer to align more closely with national registry-based estimates. Weighting had a limited impact on dimensionality estimation and large-scale hypothesis testing but impacted prevalence and association estimation. When interested in estimating effect size, specific signals from untargeted association analyses should be followed up by weighted analysis. EHR-linked biobanks should report recruitment and selection mechanisms and provide selection weights with defined target populations. Researchers should consider their intended estimands, specify source and target populations, and weight EHR-linked biobank analyses accordingly.

Symptom cluster among cancer survivors from a nationally representative survey: a network analysis.

To identify the symptom cluster among cancer survivors and examine their subgroup differences via network analysis based on nationally representative data. This cross-sectional study included 2966 survivors participating in the 2020 National Health Interview Survey (NHIS). Participants self-reported the presence of 14 symptoms capturing four clusters (physical, somatic, sleep, and psychologic problems). Network analysis models were used to reveal the relationships between symptoms and those interactions. Network comparison tests were applied to compare subgroups. The core symptoms of the symptom cluster were fatigue (Bet = 33, Clo = 0.0067, Str = 0.9397), pain (Bet = 11, Clo = 0.0060, Str = 0.9226), wake up well rested (Bet = 25, Clo = 0.0057, Str = 0.8491), and anxiety (Bet = 5, Clo = 0.0043, Str = 0.9697) among cancer survivors. The core symptoms, network structure, and global strength were invariant between time since diagnoses (< 2years vs. ≥ 2years) or between numbers of cancers (1 vs. ≥ 2), yet varied between the comorbidity group and non-comorbidity group (≥ 1 vs. 0). Fatigue would be a potential target for alleviating other symptoms through a negative feedback loop of other related symptoms of cancer survivors. In particular, cancer survivors with other chronic diseases should be the focus of attention and strengthen targeted intervention.

Prevalence of Dysphonia and Dysphagia Among Adults in the United States in 2012 and 2022.

The purpose of this study was to compare the prevalence of dysphonia and dysphagia among adults in the United States between 2012 and 2022. A retrospective and cross-sectional design with national surveys was used. The 2012 and 2022 National Health Interview Surveys were utilized to estimate the number of adults reporting dysphonia and dysphagia in the past 12 months. Multivariate logistic regression models were used to examine associations between the survey year (2022 vs. 2012) and the prevalence rate of dysphonia and dysphagia while accounting for demographics and clinical characteristics. The population-estimated mean age was 46.63 years in 2012, which increased to 48.12 years in 2022. In 2012, adults reporting dysphonia and dysphagia were 17.89 million (7.62%) and 9.44 million (4.02%), respectively. In 2022, these estimates increased to 29.92 million adults (11.71%) and 15.10 million adults (5.91%), respectively. Adults in 2022 had significantly higher odds for reporting dysphonia (odds ratio [OR] = 1.602, 95% confidence intervals [CIs] [1.486, 1.726], p < .0001) and dysphagia (OR = 1.461, 95% CI [1.328, 1.606], p < .0001) in the past 12 months compared to adults in 2012. The population-estimates indicated that in 2022, dysphonia affected one in 8.5 adults and dysphagia affected one in 17 adults. The increase in prevalence of these disorders should serve as a call-to-action to improve access to care and research for voice and swallowing disorders.

Food security status and cardiometabolic health by sex/gender and race/ethnicity among adults in the United States

BackgroundMinoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are projected to widen due to the worsening climate crisis that is straining the agricultural system including food supplies. Nonetheless, studies have not investigated the relationship between food security status and ‘ideal’ CVH in a large, nationally-representative and racially/ethnically diverse US sample.Methods and resultsWe investigated household food security status in relation to ‘ideal’ CVH among US adults (N = 157,001) using 2014–2018/2020 National Health Interview Survey data. Food security status was defined as very low, low, marginal, or high. A summed score of 4 health behaviors and 3 clinical factors totaling 7 different measures was dichotomized (yes/no) to assess modified ‘ideal’ CVH (mICVH). Using Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% CIs of mICVH by household food security status. We stratified models by sex/gender and race/ethnicity. Very low food security prevalence was higher among non-Hispanic (NH)-Black (8.0%) compared to Hispanic/Latinx (5.1%), NH-White (3.1%) and NH-Asian (1.7%) adults. The association between very low versus high food security and mICVH was stronger among women (PR = 0.23 [95% CI: 0.17–0.31]) than men (PR = 0.48 [95% CI: 0.35–0.66]). Compared to NH-White adults with high food security, racially/ethnically minoritized groups with very low to high food security were generally less likely (range: [PRvery low = 0.25[95% CI: 0.14–0.44] – [PRhigh = 0.88 [95% CI: 0.79–0.97]) to meet mICVH criteria.ConclusionsFood insecurity was associated with lower mICVH prevalence and racially/ethnically minoritized groups were disproportionately burdened.

Health-related social needs, medical financial hardship, and mortality risk among cancer survivors.

Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health-related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. Adult cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2-3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. Among cancer survivors 18-64 years old (n=5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65-79 years old (n=5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18-64 years old, severe HRSNs was associated with increased mortality risk(hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36-2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65-79 years old, 2-3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13-2.20, p = .007; reference = 0 domain). HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.

Abstract PS04-07: Associations between Virtual Care Access and Psychological and Mental Health Conditions among Adults with Breast Cancer in the US: A Population-Based Analysis

Abstract Background: Adults with breast cancer (AwBC) often experience psychological and mental health challenges and face many barriers to accessing mental health care and services. Telemedicine can help facilitate access to these care and services and AwBC may benefit uniquely from virtual care. However, little is known about the relationships between virtual care access (VCA) and psychological and mental health conditions in AwBC nationally. Methods: We obtained a population-based sample from the 2021 National Health Interview Survey that used stratified clustering sampling to interview US adults. This study was limited to adults who ever had breast cancer. VCA was defined as having had a virtual (i.e., phone or video) medical visit with a health provider in the past 12 months and was categorized as “yes/no.” Serious psychological distress, measured using the 6-item Kessler scale, was dichotomized based on a cutoff score of 13. Having an anxiety disorder or depression was self-reported as “yes/no.” Weighted proportions and 95% confidence intervals (CI) were tabulated and compared using Rao-Scott chi-square tests. Multivariable logistic regression models were fit to calculate adjusted odds ratios (AOR) and 95% CIs. All statistical analyses accounted for complex sample design and survey weights. Results: The unweighted sample size was 698, representing a weighted sample of 4,379,870 AwBC in the US. The mean age was 67.7 years; 77.6% were White and 9.6% were Black; 53.8% and 38.9% were privately insured and on Medicaid/Medicare, respectively. Of the total, 20.9% (95% CI: 17.3-24.6%) had depression, 17.4% (95% CI: 14.0-20.9%) had an anxiety disorder, and 3.2% (95% CI: 1.7-4.7%) experienced serious psychological distress. Overall, 50.3% (95% CI: 46.1-54.4%) had a virtual visit. White AwBC reported a higher proportion of VCA than Black AwBC (50.6% vs. 38.6%). AwBC on Medicaid/Medicare reported a lower proportion of VCA than those privately insured (47.8% vs. 51.8%). AwBC who experienced serious psychological distress had a higher percentage of VCA than those who did not (78.5% [95% CI: 60.8-96.2%] vs. 48.5% [95% CI: 44.2-52.8%], p=.007). Compared with AwBC who did not have depression, those who did had a higher percentage of VCA (63.9% [95% CI: 54.6-73.2%] vs. 46.6% [42.0-51.3%], p=.002). Similarly, AwBC with an anxiety disorder reported a higher percentage of VCA than those without (60.4% [95% CI: 50.3-70.6%] vs. 48.1% [43.6-52.6%], p=.032). Furthermore, AwBC who frequently felt anxious or depressed were more likely than those who felt less frequently to use telemedicine. In the adjusted regression models, AwBC experiencing serious psychological distress had significantly greater odds of VCA than those not experiencing (AOR=3.79, 95% CI: 1.05-13.7). AwBC with depression had significantly greater odds of VCA than those without (AOR=2.02, 95% CI: 1.25-3.28). Although AwBC with an anxiety disorder also had greater odds of VCA than those without (AOR=1.45, 95% CI: 0.89-2.38), the association was not statistically significant. Conclusions: In this nationally representative sample of US AwBC, more than one in 6 had an anxiety disorder or depression and VCA was prevalent in the past 12 months. AwBC with serious psychological distress, anxiety, or depression were more likely than those without to use telemedicine, indicating a greater need for virtual care among AwBC. Our findings also suggest that to help AwBC improve their psychological and mental health conditions and address their unmet needs, breast cancer support programs would need to ensure equitable access to virtual care and services in this patient population. Citation Format: Jincong Freeman, Ted Akhiwu, Yong Gun Lee, Xinyi Li. Associations between Virtual Care Access and Psychological and Mental Health Conditions among Adults with Breast Cancer in the US: A Population-Based Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS04-07.

Abstract PO3-27-10: Financial Stress and Care Disruption in Breast Cancer: A Ten-Year National Health Interview Survey Analysis

Abstract Background: Financial stress is an adverse event of BC. Increased availability of oral targeted therapy (OTT) is hypothesized to add to this burden. We assess financial stress at the population level as a function of availability of OTT. Design: We used 2013-2022 NHIS adult BC population data. Financial stress markers were care disruption, food insecurity and percent home ownership. Care disruption was defined as at least 1 event of skipping or taking less medication or delayed filling or unable to afford prescriptions. Available oral therapy Florida Blue July 2023 was cross-referenced with the NCI targeted therapy list for breast cancer as of July 2023. Initial FDA approval date for breast cancer for OTT determined the number of available OTT by survey year. We conducted a time-adjusted logistic regression to account of external effects such as COVID and adjusted for sociodemographics. Results: In a population of over 30 million respondents with BC, care disruption affected &amp;lt; 10%; food insecurity, &amp;lt; 1.3%, &amp;gt;83% reported home ownership. The number of available OTT did not affect outcomes. Survey year was associated with reduced care disruption (adjusted OR 0.82, 95% CI 0.68–0.99). Self-reported Black race affected home ownership (aOR 0.57, 95% CI 0.43-0.77) and any care disruption (a2.11, 95% CI 1.38-3.24). Non-White patients more likely reported food insecurity (aOR 5.56, 95% CI 2.58-12.01). Income &amp;lt; 200% of poverty level negatively affected outcomes. Stroke (aOR 1.97, 95% CI 1.09-3.55) and heart attack (aOR 2.10, 95% CI 1.11–4) history increased likelihood of care disruption. Conclusion: Available number of OTT did not influence financial stress in a BC population. Adverse sociodemographics and comorbidities correlated with care disruption. Our study was limited by absence of actual OTT use; further assessment at the individual level is needed. Table. Outcomes Citation Format: Maya Doyle, Erina Quinn, Sarah Bell, Braelyn Wekwerth, Ruth Carlos. Financial Stress and Care Disruption in Breast Cancer: A Ten-Year National Health Interview Survey Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-10.

Psychological Distress and Mental Health Diagnoses in Adults by Disability and Functional Difficulty Status: Findings from the 2021 National Health Interview Survey

BackgroundEvidence suggests that disabled people have worse mental health than non-disabled people, but the degree to which disability contributes to mental health is unclear. ObjectiveThis paper uses 2021 National Health Interview Survey (NHIS) data to estimate the association between disability and depression and anxiety diagnoses as well as psychological distress among adults. MethodsWe calculated disability population prevalence and mental health diagnoses and associated symptoms among 28,534 NHIS respondents. Logistic regressions estimated the odds of depression or anxiety diagnoses and recent psychological distress, controlling for disability and mental health diagnoses. We measured disability using binary and continuum measures of functional disability with the Washington Group Short Set on Functioning. ResultsDisabled people have significantly greater odds of both depression and anxiety diagnoses compared to non-disabled people. Those with high functional disability have 552% greater odds of an anxiety diagnosis (95% CI: 5.61 – 7.58; p<0.01) and 697% greater odds of a depression diagnosis (95% CI: 6.97 – 9.12; p<0.01) compared to those with no functional disability. Similarly, those with any level of functional disability are more likely to have elevated psychological distress in the past 30 days compared to those with no functional disability. ConclusionsFindings support the idea that mental health is worse for disabled people compared to non-disabled people, with increasing functional disability associated with worse mental health. This suggests that mental health is not being adequately addressed for those with the greatest functional disability. Future work should seek to better understand the systemic causes of disparities.

Employment characteristics and tobacco product use, United States, 2021

IntroductionOver 30 million U.S. working adults use tobacco, and tobacco use varies by occupation. Limited information is available on employment characteristics and tobacco use prevalence. The purpose of this study was to describe the prevalence of current tobacco use by employment characteristics and occupation group among U.S. working adults. MethodsThis cross-sectional study used 2021 National Health Interview Survey data for currently working adults (n=16,461) analyzed in 2023. Multivariable logistic regression was used to estimate adjusted odds of tobacco use by employment characteristics and occupation group. ResultsIn 2021, 20.0% of working adults used tobacco. Any tobacco use was significantly lower among workers who were offered workplace health insurance (aOR=0.86, 95% CI=0.77–0.97), had paid sick leave (aOR=0.81, 95% CI=0.73–0.91), and government vs. private employment (aOR=0.61, 95% CI=0.52–0.70). Any tobacco use was significantly higher among workers who usually worked ≥35 hours per week vs. did not usually work ≥35 hours per week (aOR=1.21, 95% CI=1.06–1.39), worked a rotating or ‘some other’ shift vs. daytime shift (aOR=1.19, 95% CI=1.02–1.38), experienced schedule instability (aOR=1.17, 95% CI=1.03–1.31), and worked while physically ill in the past 3 months (aOR=1.25, 95% CI=1.11–1.41). Tobacco use by employment characteristics also varied by occupation group. ConclusionsCurrent tobacco use varied according to employment characteristics and occupation group. Findings from this study could inform workplace tobacco cessation interventions and policies (e.g., access to paid sick leave or insurance coverage) to better support tobacco cessation and overall worker health.

The Influence of Nativity/Birthplace, Neighborhood Cohesion, and Duration Lived in the Neighborhood on Psychological Distress

IntroductionNativity/birthplace and neighborhood cohesion are potential contributing factors to psychological distress. This study explores the impact of nativity/birthplace and neighborhood cohesion on moderate-severe psychological distress among United States (US) adults, considering the duration lived in a neighborhood. MethodsUsing the 2013-2018 National Health Interview Survey data, we conducted a stratified analysis based on years lived in the neighborhood (≤10 years [n= 96,175] and >10 years [n= 68,187]). Bivariate chi-square tests and multivariable logistic regression models were used to assess the statistical differences and associations between moderate-severe psychological distress and nativity/birthplace, and neighborhood cohesion, while adjusting for other covariates. ResultsIndividuals with 10 years or less of residence reported higher levels of moderate-severe psychological distress than those with mor than10 years (22.3% vs. 18.1%). Low or medium neighborhood cohesion, regardless of duration of residence, was associated with significantly higher odds of moderate-severe psychological distress compared to high cohesion. Foreign-born individuals had higher odds of psychological distress after more than 10 years in a neighborhood, though not statistically significant, while they had lower odds after 10 years or less compared to US-born individuals. The interaction of foreign-born status and 10 years or less of residence showed decreased odds of psychological distress. ConclusionsThese findings underscore the importance of strong social cohesion in neighborhoods for positive mental well-being. Establishing community initiatives to enhance neighborhood social cohesion is crucial.

COVID-19 Vaccination Rates and Predictors of Vaccine Uptake Among Adults With Chronic Obstructive Pulmonary Disease: Insights From the 2022 National Health Interview Survey

COVID-19 Vaccination Rates and Predictors of Vaccine Uptake Among Adults With Chronic Obstructive Pulmonary Disease: Insights From the 2022 National Health Interview Survey

Psychological distress and mental health care utilization among Black survivors of adolescent and young adult cancer.

Survivors of adolescent and young adult (AYA) cancer experience significant psychological distress and encounter barriers to accessing mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes among AYA survivors, and none have compared outcomes within a racially minoritized population. National Health Interview Survey data (2010-2018) were analyzed that identified non-Hispanic Black (hereafter, Black) survivors of AYA cancer and age- and sex-matched Black noncancer controls. Sociodemographic factors, chronic health conditions, modifiable behaviors (smoking and alcohol use), and psychological outcomes were assessed with χ2 tests. Logistic regression models, adjusted for survey weights, were used to evaluate the odds of psychological distress by cancer status after adjusting for covariates. Interactions between variables and cancer status were investigated. The study included 334 Black survivors of AYA cancer and 3340 Black controls. Compared to controls, survivors were more likely to report moderate/severe distress (odds ratio [OR],1.64; p<.001), use mental health care (OR,1.53; p=.027), report an inability to afford mental health care (OR,3.82; p<.001), and use medication for anxiety and/or depression (OR,2.16; p=.001). Forty-one percent of survivors reported moderate/severe distress, and only 15% used mental health care. Among survivors, ages 18-39 years (vs. 40-64 years) and current smoking (vs. never smoking) were associated with the presence of moderate/severe distress. Among survivors with distress, high poverty status was associated with reduced utilization of mental health care. A cancer diagnosis for a Black AYA is associated with greater psychological distress within an already vulnerable population.

Alzheimer's Disease and Related Dementias Diagnosis in the United States Among US-Born and Foreign-Born White, Black, Hispanic, and Asian Older Adults.

Timely clinical diagnosis of Alzheimer's disease and related dementias (ADRD) is important for resource allocation, mitigating safety concerns, and improving quality of life. While studies have examined ADRD diagnosis disparities by race/ethnicity, few include its intersection with nativity. Our aims were to (1) estimate the odds of diagnosed ADRD among US- and foreign-born racial/ethnic groups compared to US-born White older adults and (2) make comparisons by nativity within each racial/ethnic group. We linked 2000-2017 National Health Interview Survey (NHIS) and 2001-2018 Medical Expenditure Panel Survey (MEPS) data (65 + years; n = 38,033). Race/ethnicity and nativity were measured using NHIS data. Diagnosed ADRD was determined using ICD-9 (290/294/331/797) or ICD-10 (F01/F03/G30/G31) billing codes created from self-reports during MEPS household interviews. Bivariate and multivariable analyses were adjusted for covariates based on Anderson's behavioral model of health services use. US-born Black (OR = 1.74; 95% CI = 1.48-2.05), Hispanic (OR = 1.62; 95% CI = 1.14-2.29), and foreign-born Hispanic (OR = 1.63; 95% CI = 1.24-2.15) older adults, but not foreign-born Black or Asian older adults, had higher odds of diagnosed ADRD compared to US-born White older adults after adjusting for age and sex. After additional adjustment for education, health insurance, usual source of care, and chronic conditions, only US-born Black older adults continued to show higher odds (OR = 1.54; 95% CI = 1.27-1.87) of diagnosed ADRD compared to US-born White older adults. There were no differences in ADRD diagnosis by nativity within each racial/ethnic group. Findings highlight the need for including nativity in studies comparing racial/ethnic groups to Whites to fully capture the ADRD burden among US-born Black older adults.

Health Care Access and COVID-19 Vaccination in the United States: A Cross-Sectional Analysis.

Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake. To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States. A cross-sectional study. 2021 National Health Interview Survey (Q2-Q4). In all, 21,532 adults aged≥18 were included in the study. Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates. In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses. Receipt of COVID-19 vaccination was self-reported. Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.

Prevalence and determinants of shared decision-making for PSA testing in the United States.

Shared decision-making (SDM) is recommended for prostate-specific antigen (PSA) testing but appears underutilized. This population-based study assessed the prevalence and determinants of SDM for PSA testing among US men. We assessed PSA testing rates and SDM engagement in men aged 40 and older without prostate cancer history using the 2019 National Health Interview Survey. SDM was defined as discussing the advantages and disadvantages of PSA testing with a physician. We used multivariable logistic regression with machine learning to identify factors associated with lack of SDM. Among 9723 eligible participants (mean age 58 years), lifetime PSA testing prevalence was 45.9% and the 1-year testing incidence was 29.1%. Only 24.1% reported engaging in SDM with a physician, while 62.9% never discussed PSA testing. Younger age and lower education levels were the primary determinants of decreased SDM engagement. Men with less education engaged in SDM less than half as often as those with higher education levels across all age groups. Societal guidelines recommend SDM for PSA testing. However, most men, regardless of age, have never engaged in SDM conversations with a healthcare provider about PSA testing, especially those with less education. More efforts are needed to improve patient-provider conversations about the potential benefits and harms of PSA testing.

Psychiatric Symptoms, Treatment Uptake, and Barriers to Mental Health Care Among US Adults With Post–COVID-19 Condition

Psychiatric symptoms are reportedly common among adults with post-COVID-19 condition (PCC). However, nationally representative data regarding symptom prevalence, treatment uptake, and barriers to care are needed to inform the development of care models. To evaluate the prevalence of psychiatric symptoms in US adults with PCC compared with those without PCC and assess treatment uptake and cost-related barriers to treatment. Data from the 2022 National Health Interview Survey (NHIS), a nationally representative US cross-sectional survey, were analyzed between October 2023 and February 2024. Current PCC, defined as new symptoms following SARS-CoV-2 infection lasting more than 3 months and ongoing at the time of interview. Depression symptoms were evaluated by the Patient Health Questionnaire-8 and anxiety symptoms were assessed using the General Anxiety Disorder-7 instrument. Participants were classified as having received treatment if they received mental health counseling or therapy or medications for mental health. Sleep difficulties, cognitive difficulties, disabling fatigue, and cost-related barriers were assessed from additional NHIS questions. Of the 25 122 participants representing approximately 231 million US adults (median [IQR] age, 46 [32-61] years; 49.8% male and 50.2% female participants), a weighted prevalence (wPr) of 3.4% (95% CI, 3.1%-3.6%) had current PCC. Compared with other US adults, participants with current PCC were more likely to have depression symptoms (wPr, 16.8% vs 7.1%; adjusted odds ratio [AOR], 1.96; 95% CI, 1.51-2.55), anxiety symptoms (wPr, 16.7% vs 6.3%; AOR, 2.21; 95% CI, 1.53-3.19), sleep difficulties (wPr, 41.5% vs 22.7%; AOR 1.95; 95% CI, 1.65-2.29), cognitive difficulties (wPr, 35.0% vs 19.5%; AOR, 2.04; 95% CI, 1.66-2.50), and disabling fatigue (wPr, 4.0% vs 1.6%; AOR, 1.85; 95% CI, 1.20-2.86). Among participants who had depression or anxiety symptoms, those with PCC had a similar likelihood of not having received treatment (wPr, 28.2% vs 34.9%; AOR, 1.02; 95% CI, 0.66-1.57). However, participants with current PCC were more likely to report a cost-related barrier to accessing mental health counseling or therapy (wPr, 37.2% vs 23.3%; AOR, 2.05; 95% CI, 1.40-2.98). The findings of this study suggest that people with PCC have a higher prevalence of psychiatric symptoms than other adults but are more likely to experience cost-related barriers to accessing therapy. Care pathways for PCC should consider prioritizing mental health screening and affordable treatment.

Patterns and Reasons for Being Uninsured Among Sexual Minority Adults Before and After the Affordable Care Act Implementation.

Purpose: We aimed to identify the self-reported reasons for being uninsured and sociodemographic factors associated with uninsurance among lesbian, gay, or bisexual (LGB) adults before and after the Affordable Care Act (ACA). Methods: We analyzed the 2013-2018 National Health Interview Survey data using multivariable logistic regression models to estimate the odds of being uninsured and the prevalence of self-reported reasons for not having insurance among LGB adults aged 18-64 years. Results: The study included 2124 LGB adults. The weighted uninsured rate decreased significantly from 19.6% in 2013 to 13.2% in 2017-2018 (odds ratio 0.61; 95% confidence interval 0.47-0.78). The primary reason cited for not having insurance post-ACA was similar to pre-ACA, with cost-related factors being the most commonly reported (31.5%). Conclusion: The overall uninsured rate decreased among LGB adults from 2013 to 2018, whereas disparities across subpopulations remained. Cost-related factors remained significant barriers to obtaining insurance coverage.