National Health Interview Survey Data Research Articles

Weighting the United States All of Us Research Program data to known population estimates using raking

BackgroundThe All of Us Research Program aims to collect longitudinal health-related data from a million individuals in the United States. An inherent challenge of a non-probability sampling strategy through voluntary participation in All of Us is that findings may not be nationally representative for addressing health and health care at the population level. We generated survey weights for the All of Us data that can be used to address the challenge. Research designWe developed raked weights using demographic, health, and socioeconomic variables available in both the 2020 National Health Interview Survey (NHIS) and All of Us. We then compared the unweighted and weighted prevalence of a set of health-related variables (health behaviors, health conditions, and health insurance coverage) estimated from All of Us data with the weighted prevalence estimates obtained from NHIS data. SubjectsThe sample included 100,391 All of Us participants 18 years of age and older with complete data collected between May 2017 and January 2022 across the United States. ResultsFinal variables in the raking procedure included age, sex, race/ethnicity, region of residence, annual household income, and home ownership. The mean percentage difference between known proportions obtained from the NHIS and All of Us was reduced by 18.89% for health-related variables after applying the raked weights. ConclusionsRaking improved the comparability of prevalence estimates obtained from All of Us to known national prevalence estimates. Refining the process of variable selection for raking may further improve the comparability between All of Us and nationally representative data.

Unveiling the interplay of social factors in cancer survivorship: A comprehensive social determinants of health (SDOH) profile analysis.

1536 Background: SDOHs contribute to patients’ cancer survivorship outcomes. While studies tend to focus on individual SDOH, understanding the interplay and collective impact of multiple SDOHs is vital for improving patient outcomes and access to care. Our study aims to understand SDOH profiles in cancer survivors and stratify social risks by analyzing relationships between SDOH profiles and health outcomes using a nationally representative dataset. Methods: We conducted an unsupervised clustering analysis using 2013-2018 National Health Interview Survey data, linked to NHIS Mortality Files, to examine 12 social determinants of health (SDOHs) in the general population. 12 SDOH included unmarried status, unemployment, less than high school education, material/psychological/behavioral financial hardship, transportation/food/housing insecurity, delayed care due to other reasons, and low income(less than federal poverty line), and low neighborhood cohesion. K-Modes clustering was used to identify optimal number of cluster. We estimated each cluster’s prevalence in younger (18-64 years) and older (65-79 years) cancer survivors, then used weighted Cox regression to assess the risk of overall (OS)in both age groups, adjusting for demographics. Results: We identified 5 distinct groups based their SDOH profiles, including group A (few SDOH barriers), B (unmarried but no other SDOH barriers), C (unemployed but no other SDOH barriers), D (unmarried, unemployed, occasionally having other SDOH barriers) and E (the highest rate of financial hardship/transportation/food/housing insecurity/low neighborhood cohesion/low income). Notably, group E, compared to all other groups, had the highest rate of racial minorities in both younger and older groups in both younger (71% vs 5-14%) and older populations (74% vs 1-8%). Older survivors in Group C (HR 2.48, 95% CI: 1.02-6.03), Group D (HR 4.09, 95% CI: 1.65-10.14), and Group E (HR 3.88, 95% CI: 1.44-10.46) had significantly lower OS rates compared to those in Group A. For younger survivors, Group D (HR 1.96, 95% CI: 0.97-3.96) and Group E (HR 1.40, 95% CI: 0.67-2.95) were associated with nonsignificant reductions in OS, possibly due to limited sample sizes. Conclusions: SDOHs form distinct clusters, each with profound on cancer survivorship especially among older survivors facing complex social challenges. This necessitates customized health interventions focused on these SDOH profiles, crucial for improving patient outcomes and addressing health disparities.

Health insurance in the United States: A case of effectively maintained inequality?

The theory of Effectively Maintained Inequality (EMI) (Lucas, 2001) posits that goods have both quantitative (how much?) and qualitative (what kind?) dimensions. Coupled with the hypothesized mechanisms of EMI, this simple observation greatly complicates research and policy development concerning inequality. First applied to explain educational inequality in the United States, evidence for the theory has been found in education systems in over 20 countries, including Chile, China, the Czech Republic, Denmark, Egypt, Germany, Greece, Ireland, Nigeria, South Africa, and South Korea. Yet, while EMI was proposed as a general theory of inequality, to date no research has assessed its applicability to domains outside education. This work uses nearly two decades of National Health Interview Survey data (N = 451,161) to provide the first effort to assess whether EMI illuminates patterns of inequality outside education, by taking up the issue of health insurance in the United States.

Association between influenza vaccination and one-year all-cause and cardiovascular mortality risk: A self-controlled case series and matched case-control study.

Debates surrounding the efficacy of influenza vaccination for survival benefits persist, and there is a lack of data regarding its duration of protection. A self-controlled case series (SCCS) and a 1:4 matched case-control study were conducted using the National Health Interview Survey (NHIS) and public-use mortality data from 2005 to 2018 in the United States. The SCCS study identified participants who received influenza vaccination within 12 months before the survey and subsequently died within 1 year of postvaccination. The matched case-control study paired participants who died during the influenza season at the time of survey with four survivors. Among 1167 participants in the SCCS study, there was a 46% reduction in all-cause mortality and a 43% reduction in cardiovascular mortality within 29-196 days of postvaccination. The greatest protection was observed during days 29-56 (all-cause mortality: RI: 0.19; 95% CI: 0.12-0.29; cardiovascular mortality: RI: 0.28; 95% CI: 0.14-0.56). Among 626 cases and 2504 controls included in the matched case-control study, influenza vaccination was associated with a reduction in all-cause mortality (OR: 0.74, 95% CI: 0.60-0.92) and cardiovascular mortality (OR: 0.64, 95% CI: 0.44-0.93) during the influenza season. This study highlights the importance of influenza vaccination in reducing the risks of all-cause and cardiovascular mortality, with effects lasting for approximately 6 months.

Smoking-Attributable Health Care Expenditures for US Adults With Chronic Lower Respiratory Disease

Cigarette smoking is a primary risk factor for chronic lower respiratory disease (CLRD) and is associated with worse symptoms among people with CLRD. It is important to evaluate the economic outcomes of smoking in this population. To estimate smoking prevalence and cigarette smoking-attributable health care expenditures (SAHEs) for adults with CLRD in the US. This cross-sectional study used data from the 2014-2018 and 2020 National Health Interview Surveys (NHIS) and the 2020 Medical Expenditure Panel Survey. The final study population, stratified by age 35 to 64 years and 65 years or older, was extracted from the 2014-2018 NHIS data. The data analysis was performed between February 1 and March 31, 2024. Cigarette smoking, as classified into 4 categories: current smokers, former smokers who quit less than 15 years ago, former smokers who quit 15 or more years ago, and never smokers. Smoking-attributable health care expenditures were assessed using a prevalence-based annual cost approach. Econometric models for the association between cigarette smoking and health care utilization were estimated for 4 types of health care services: inpatient care, emergency department visits, physician visits, and home health visits. In the 2014-2018 NHIS study sample of 13 017 adults, 7400 (weighted 62.4%) were aged 35 to 64 years, 5617 (weighted 37.6%) were 65 years or older, and 8239 (weighted 61.9%) were female. In 2020, among 11 211 222 adults aged 35 to 64 with CLRD, 3 508 504 (31.3%) were current smokers and 3 496 790 (31.2%) were former smokers. Total SAHEs in 2020 for this age group were $13.6 billion, averaging $2752 per current smoker and $1083 per former smoker. In 2020, 7 561 909 adults aged 65 years or older had CLRD, with 1 451 033 (19.2%) being current smokers and 4 104 904 (54.3%) being former smokers. Total SAHEs in 2020 for the older age group were $5.3 billion, averaging $1704 per current smoker and $682 per former smoker. In sum, SAHEs for adults with CLRD aged 35 years or older amounted to $18.9 billion in 2020. In this cross-sectional study of adults with CLRD, cigarette smoking was associated with a substantial health care burden. The higher per-person SAHEs for current smokers compared with former smokers suggest potential cost savings of developing targeted smoking cessation interventions for this population.

Disparities in Smoking and Heavy Drinking Behaviors by Disability Status and Age of Disability Onset: Secondary Analysis of National Health Interview Survey Data.

People with childhood-onset disabilities are living into adulthood, and the prevalence of smoking and illicit drug use among adults with disabilities is high. We evaluated the relationship between disability status and age of disability onset, current cigarette smoking status, and heavy alcohol drinking. We conducted a secondary data analysis of the National Health Interview Survey (NHIS), a US survey on illness and disability. Among 2020 NHIS participants aged 22-80 years (n = 28 225), we compared self-reported prevalence of current cigarette smoking and heavy alcohol drinking among those with and without disabilities and among those with childhood- versus adult-onset disabilities. We used adjusted logistic regression analysis to calculate the adjusted odds ratios (AORs) of current smoking and heavy alcohol drinking based on disability status and age of disability onset. Compared with adults without disabilities, adults with disabilities were significantly more likely to report current smoking (23.5% vs 11.2%; P < .001) and significantly less likely to report heavy alcohol drinking (5.3% vs 7.4%; P = .001). The prevalence of these behaviors did not vary significantly by age of disability onset. In adjusted logistic regression models, adults with disabilities had significantly higher odds of current smoking (AOR = 1.76; 95% CI, 1.53-2.03) and similar odds of heavy alcohol drinking (AOR = 0.82; 95% CI, 0.65-1.04) compared with adults without disabilities. The odds of these health behaviors did not vary significantly by age of disability onset. Adults with disabilities overall may be at high risk for these unhealthy behaviors, particularly smoking, regardless of age of disability onset. Routine screening and cessation counseling related to smoking and unhealthy alcohol use are important for all people with disabilities.

The impact of the 2014 Medicaid expansion on the health, health care access, and financial well-being of low-income young adults.

Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19-25 in the United States were low-income and a third lacked health insurance coverage-both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low-income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well-being of low-income young adults ages 19-25. Using 2010-2017 National Health Interview Survey data, I estimate policy effects by applying a difference-in-differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well-being for low-income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non-Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups.

Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States

ObjectivesDirect care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. DesignAn observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. Setting and ParticipantsThe sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. MethodsWe used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. ResultsThe sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. Conclusions and ImplicationsGiven the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.

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.

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 more than 10 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, although this difference was not statistically significant. However, they had lower odds of psychological distress after 10 years or less in the neighborhood compared to US-born individuals. Similarly, the interaction of foreign-born status and 10 years or less of residence in a neighborhood 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.

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.

Employment Characteristics and Tobacco Product Use, U.S., 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.

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.

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.

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.

Nativity Disparities in Colorectal Cancer Screening Among Hispanics in the United States.

Hispanics in the United States (U.S.) have previously exhibited lower guideline-concordant colorectal cancer (CRC) screening uptake than non-Hispanic (NH) Whites, with disparities accentuated in foreign-born Hispanics, however it is unclear whether nativity-related CRC screening disparities have changed in the last two decades and whether these disparities are attenuated after adjusting for socioeconomic and demographic characteristics. We evaluated CRC screening adherence in foreign- and U.S.-born Hispanics compared to U.S.-born NH Whites. We used 2019 National Health Interview Survey data to compare the prevalence of up-to-date CRC screening per the 2019 U.S. Preventive Services Task Force recommendations among Hispanic nativity subgroups (i.e., foreign- and U.S.-born) and U.S.-born NH Whites using unadjusted and adjusted weighted log-linked binomial regression. Foreign- and U.S.-born Hispanics had a significantly lower unadjusted prevalence of up-to-date screening than U.S.-born NH Whites (47.18% and 64.18% versus 70.70%; p < 0.0001 and p = 0.0109, respectively). After adjusting for socioeconomic and demographic differences, the prevalence of up-to-date screening was lower in foreign-born Hispanics compared to U.S.-born NH Whites [adjusted prevalence ratio 0.80 (95% confidence interval 0.70-0.91)]; however, no statistically significant difference was observed between U.S.-born Hispanics and NH Whites. Our results suggest a low screening uptake in foreign-born Hispanics independent of socioeconomic and demographic differences. Future interventions should target foreign-born Hispanics to address disparities and promote early detection and prevention of CRC regardless of socioeconomic factors.

Need for Enhancing Mental Health Care in Stroke Patients: Insights Into Post-stroke Anxiety and Depression from the National Health Interview Survey (NHIS) Data (P2-5.020)

Need for Enhancing Mental Health Care in Stroke Patients: Insights Into Post-stroke Anxiety and Depression from the National Health Interview Survey (NHIS) Data (P2-5.020)

Health Care Access and Utilization and the Latino Health Paradox.

The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Obesity paradox of cardiovascular mortality in older adults in the United States: A cohort study using 1997–2018 National Health Interview Survey data linked with the National Death Index

BackgroundLarge-scale, population-based investigations primarily investigating the association between body mass index (BMI) and cardiovascular disease (CVD) mortality among older and younger adults in the United States (U.S.) are lacking. ObjectiveTo evaluate the relationship between BMI and CVD mortality in older (≥65 years) and younger (<65 years) adults and to identify the nadir for CVD mortality. DesignThis cohort study used serial cross-sectional data from the 1997 to 2018 National Health Interview Survey (NHIS) linked with the National Death Index. NHIS is an annual nationally representative household interview survey of the civilian noninstitutionalized U.S. population. SettingResidential units of the civilian noninstitutionalized population in the U.S. ParticipantsThe target population for the NHIS is the civilian noninstitutionalized U.S. population at the time of the interview. We included all adults who had BMI data collected at 18 years and older and with mortality data being available. To minimize the risk of reverse causality, we excluded adults whose survival time was ≤2 years of follow-up after their initial BMI was recorded and those with prevalent cancer and/or CVD at baseline. MethodsWe used the BMI record obtained in the year of the NHIS survey. Total CVD mortality used the NHIS data linked to the latest National Death Index data from the survey inception to December 31, 2019. We performed multivariable Cox proportional hazards regression models to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs). ResultsThe study included 425,394 adults; the mean (SD) age was 44 (16.7) years. During a median follow-up period of 11 years, 12,089 CVD-related deaths occurred. In older adults, having overweight was associated with a lower risk of CVD mortality (aHR 0.92 [95 % CI, 0.87–0.97]); having class I obesity (1.04 [0.97–1.12]) and class II obesity (1.12 [1.00–1.26]) was not significantly associated with an increased CVD mortality; and having class III obesity was associated with an increased risk of CVD mortality (1.63 [1.35–1.98]), in comparison with adults who had a normal BMI. Yet, in younger adults, having overweight, class I, II, and III obesity was associated with a progressively higher risk of CVD mortality. The nadir for CVD mortality is 28.2 kg/m2 in older adults and 23.6 kg/m2 in younger adults. ConclusionThis U.S. population-based cohort study highlights the significance of considering age as a crucial factor when providing recommendations and delivering self-care educational initiatives for weight loss to reduce CVD mortality.