National Sample Research Articles

Longitudinal changes in the US emergency department use of advanced neuroimaging in the mechanical thrombectomy era.

To describe ED neuroimaging trends across the time-period spanning the early adoption of endovascular therapy for acute stroke (2013-2018). We performed a retrospective, cross-sectional study of ED visits using the 2013-2018 National Emergency Department Sample, a 20% sample of ED encounters in the United States. Neuroimaging use was determined by Common Procedural Terminology (CPT) code for non-contrast head CT (NCCT), CT angiography head (CTA), CT perfusion (CTP), and MRI brain (MRI) in non-admitted ED patients. Data was analyzed according to sampling weights and imaging rates were calculated per 100,000 ED visits. Multivariate logistic regression analysis was performed to identify hospital-level factors associated with imaging utilization. Study population comprised 571,935,906 weighted adult ED encounters. Image utilization increased between 2013 and 2018 for all modalities studied, although more pronounced in CTA (80.24/100,000 ED visits to 448.26/100,000 ED visits (p < 0.001)) and CTP (1.75/100,000 ED visits to 28.04/100,000 ED visits p < 0.001)). Regression analysis revealed that teaching hospitals were associated with higher odds of high CTA utilization (OR 1.88 for 2018, p < 0.05), while low-volume EDs and public hospitals showed the reverse (OR 0.39 in 2018, p < 0.05). We identified substantial increases in overall neuroimaging use in a national sample of non-admitted emergency department encounters between 2013 and 2018 with variability in utilization according to both patient and hospital properties. Further investigation into the appropriateness of this imaging is required to ensure that access to acute stroke treatment is balanced against the timing and cost of over-imaging.

Food for thought: The intersection between SNAP stigma, food insecurity, and gender

The Supplemental Nutrition Assistance Program (SNAP) helps millions of families with low incomes to afford and purchase food each year. Prior research has noted that welfare stigma—negative stereotypes about people who participate in public assistance programs—can limit SNAP participation. Stigma may also contribute to worse mental health among subgroups like male participants; qualitative evidence suggests males may struggle to accept public assistance benefits due to norms surrounding gender roles. Yet there is little research about who is most likely to experience stigma, how stigma relates to food insecurity, whether this relationship varies by gender identity, and whether stigma is associated with online shopping (which may protect against stigma). To address these gaps, we analyzed a national survey of 1383 SNAP participants about their experiences of SNAP stigma, food insecurity, and online shopping. In adjusted models, we found that male participants had 40% higher odds (95% CI: 1.09–1.80) of reporting any stigma experience compared to female participants. SNAP participants reporting stigma had over three times the odds (OR: 3.54, 95% CI: 2.60–4.81) of reporting food insecurity relative to those not reporting stigma, and male participants reporting stigma had nearly three times higher odds of food insecurity than female participants reporting stigma (OR: 2.94, 95% CI: 1.53, 5.66). In addition, stigma was not significantly associated with shopping online or using SNAP benefits online. In this national sample of SNAP participants, male respondents had greater odds of welfare stigma, experiences of stigma were associated with greater odds of food insecurity, male respondents experiencing stigma had greater odds of food insecurity compared to female respondents, and stigma was not associated with online shopping behaviors. Efforts to reframe public assistance may be needed to destigmatize programs like SNAP to both improve program uptake among non-participants and improve health outcomes among participants.

Livelihood, Poverty and Multiple Deprivation among Tribals in Odisha

The present study seeks to examine the livelihood pattern, incidence of poverty and multiple deprivation among the tribal communities or Scheduled Tribes (STs) of Odisha by using secondary data collected from the various rounds of the National Sample Survey (NSS), Census of India reports, District Level Household and Facility Survey (DLFS) reports, etc. It evaluates the contributions of the different sources of livelihood on level of living, quality of life and economic well-being of the tribals. Methodologically, the study employs the Foster, Greer and Thorbecke (FGT) class of poverty measures to examine the incidence and magnitude of poverty among the tribals. It finds a strong relationship between livelihood pattern and poverty among them. Though there has been a decline in the incidence of poverty (head count ratio) among the tribals over a period of time, the rate of decline has been slower among the tribal communities than the other social classes. The tribals are confronted with low levels of income and higher levels of poverty due to their subsistence level of livelihood. Most of them are engaged in low-paid works, and suffer from chronic poverty and multiple deprivation. Finally, the study concludes with suggestions on how potential policy options can improve the livelihood condition of the tribals and redress the problem of heavy incidence of poverty among them.

Immune-related adverse events, mood disorders, and the impact of social determinants of health among a national cohort of patients receiving immunotherapy.

364 Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancers such as lung, bladder, head and neck, colorectal cancers, and melanoma. Psychological distress may promote pro-inflammatory states which can exacerbate immune-related adverse events (irAEs) among ICI-treated cancer patients. This study assessed the impact of mood disorders (anxiety and depression diagnoses/medications before or during treatment) on the odds of irAEs among advanced cancer patients receiving ICIs, accounting for clinical characteristics and social determinants of health. Methods: This retrospective cohort study used data from a national sample of N=8,058 deceased adult patients diagnosed with advanced melanoma, lung, colorectal, head and neck, and bladder cancers from the nationwide Flatiron Health electronic health record (EHR) derived de-identified database. Diagnostic codes and medication orders were used to assess for mood disorders and auto-immune conditions documented within 2 years of receiving an ICI (irAEs). Bivariate tests and multivariable logistic regressions with interaction terms were conducted in R. Results: Accounting for age at advanced cancer diagnosis, ethnicity, socioeconomic status, baseline performance status, and number of clinic visits, female patients (aOR 1.25, 95% CI=1.07-1.46, p=0.005), patients seen in an academic practice setting only (aOR=2.16, 95% CI=1.80-2.60, p&lt;0.001), and patients receiving combination CTLA-4 and PD-(L)1 inhibitors (aOR 1.47, 95% CI=1.11-1.95, p=0.008) had higher odds of irAEs compared with male patients, patients treated in community settings only, and patients receiving PD1/L1 inhibitors only. Non-White (aOR 0.61, 95% CI=0.49, 0.77, p&lt;0.001), bladder (aOR 0.53, 95% CI= 0.37, 0.78, p=0.001) and colorectal cancer patients (aOR=0.55, 95% CI=0.32, 0.91, p=0.024) had lower odds of irAEs compared with White and melanoma patients. Insurance type moderated the relationship between mood disorders and IrAEs; commercially-insured ICI patients with mood disorders had higher odds of irAEs (aOR 1.65, 95% CI=1.16, 2.35, p=0.006) compared with Medicare-insured ICI patients with mood disorders. Conclusions: Social determinants of health such as insurance access may exacerbate the relationship between mood disorders and irAEs. These findings have implications for health equity and are an area warranting further study. Future analyses will also examine directionality of the associations between mood disorders and irAEs.

Association between Homelessness and Temperature-Related Health Emergencies in the United States

Abstract Temperature-related illness (TRI) encompasses heat-related illness, such as heat exhaustion and heatstroke, and cold-related illness, such as frostbite and hypothermia. TRI is typically the result of exposure to ambient weather conditions; because of this, unhoused individuals are hypothesized to have higher risk of TRI. However, no national epidemiological studies have been completed to determine this risk. The objective of this study was to determine the association between homelessness and emergency department (ED) diagnosis of TRI in the United States. We conducted a cross-sectional study of adult ED visits in the United States from 2005 through 2020 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative sample of nonfederal ED patient visits. Housing status (housed versus unhoused) was measured using NHAMCS patient residence category, with blank responses excluded. TRI was defined as ED clinician diagnosis of heat- or cold-related illness using International Classification of Disease, versions 9 and 10 (ICD-9 and ICD-10) codes. Multivariable logistic regression was used to determine adjusted odds of TRI by housing status. There were 323 606 nonpediatric ED visits in the NHAMCS sample. TRI diagnosis was present in 288 (0.09%) visits. 4099 visits (0.9%) were categorized as unhoused. After adjusting for sex, mental health diagnosis, and alcohol or substance use or use disorder, the odds ratio of TRI diagnosis in unhoused individuals was 4.08 (95% CI 2.09, 7.95) compared to housed individuals. We found a higher adjusted odds ratio of TRI diagnosis at an ED visit among unhoused individuals compared with housed individuals. Significance Statement Temperature-related health emergencies, or illnesses caused by exposure to ambient weather conditions, affect numerous Americans each year and are expected to become more common as climate change continues. We wanted to understand whether unhoused individuals are at higher risk of these health emergencies. We used a national sample of emergency department visits in the United States to study this and found out that unhoused individuals are at more than four times the risk of these illnesses than housed individuals. Our work highlights the need for prevention of homelessness, stable housing for housing insecure populations, and heating and cooling centers during weather emergencies.

Status and Trend of General Education, Technical Education, and Vocational Education by Persons with Disabilities in India: Reflection of three NSS rounds

Abstract : The present study attempts to estimate the status and trend in educational achievement, particularly in technical and vocational education among persons with disabilities in India across gender and social groups. 47th, 58th, and 76th round unitlevel National Sample Survey data were analyzed using the gender parity index, compound annual growth rate, ordered logit model, and binary logit model. Result shows that though the literacy rate among persons with disabilities in India gradually increases over time, still half of the persons with disabilities were illiterate compared to one-fifth of non-disabled peers. A large section of children with disabilities drops out. The transition of education from school level to higher education, technical and vocational education by persons with disabilities was very slow. Only 4.31 percent, 3.08 percent, and 1.08 percent of persons with disabilities received higher education, vocational education, and technical training in 2018. There was a gradual decrease in gender disparity against women with disabilities and turns in favor of women at all levels of general education. However, gender disparity persisted against females with disabilities, in the attainment of technical and vocational training. The attainment of technical education by males with disabilities was three times higher compared to females with disabilities. Strong caste discrimination still exists in all levels of educational attainment against scheduled castes and scheduled tribes. Educational achievement is negatively related to the severity of the disability, household size, and rural-urban areas, but positively to households' economic status. The study draws important policy implications to improve the education of persons with disabilities. Keywords: Caste discrimination, Gender discrimination, General education, Persons with disabilities, Technical Education, Vocational Education

Diagnostic evaluation for abnormal uterine bleeding at emergency departments in the United States.

269 Background: Uterine cancer is the most common gynecologic malignancy in the U.S. with well-documented racial disparity in stage at diagnosis (more advanced stage among Black women). As there is no routine screening for uterine cancer, timely and proper evaluation of relevant symptoms is important for early diagnosis. Abnormal uterine bleeding (AUB) is a prominent symptom of uterine cancer, yet data on the quality of care around AUB evaluation are sparse, especially among patients presenting to the emergency departments (ED) who are particularly at risk for delayed diagnosis due to lack of access to primary care. This study aimed to examine the pattern of diagnostic evaluation for AUB in a national sample of women seeking care at EDs and potential racial and ethnic differences. Methods: Using the 2014-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) data, we identified 7,900,653 (weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB. The primary outcomes were whether an ultrasound was performed/ordered at the ED visit and whether a referral/return to a physician or clinic for follow-up consultation was recommended. Multivariable logistic regressions were fit to assess the association of race and ethnicity with these diagnostic evaluations, while accounting for other characteristics of the ED visit (e.g. patient age, comorbidities, involvement of a consulting physician, type of insurance, geographic region, and metropolitan area location). All analyses accounted for the NHAMCS complex sample design and sampling weight to generate nationally representative estimates. Results: Non-Hispanic Black women were less likely than non-Hispanic White women to receive or have an ultrasound ordered (34.9% vs 42.5%, P = 0.004), which remained statistically significant after adjusting for other characteristics of the visit in multivariable analysis (adjusted OR = 0.58, 95% CI 0.36-0.92). Multivariable analysis also showed a lower likelihood of non-Hispanic Black women receiving referral or recommendation for follow-up consultation, compared to non-Hispanic White women (adjusted OR = 0.54, 95% CI 0.31-0.94). Hispanic women did not differ significantly from non-Hispanic White women in these measures. Perimenopausal age (45-54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation. Conclusions: There is racial disparity in the diagnostic evaluation of AUB among women seeking care at EDs. Future efforts to improve care quality and equity in this area may help reduce disparities in early diagnosis of uterine cancer.

Engaging sexual minority adolescents in nationwide at-home HIV prevention research in the U.S

ObjectivesThis study examined research-related privacy and confidentiality concerns among adolescent sexual minority males (ASMM) and provides lessons learned to inform recruitment and enrollment strategies for this population. MethodsParticipants were a 2017–2018 internet-based U.S. national sample of sexual minority adolescents who responded to self-report measures of privacy and confidentiality concerns. Results: Bivariate chi-square tests were used to identify participants’ mean differences in worry and likelihood of privacy breach occurrences. Many participants reported privacy-related concerns within remote HIV prevention research. ConclusionsStudy protocols were designed to ensure participants felt safe participating in online HIV prevention research. However, there are challenges to enroll participants with rigorous protocols for ensuring safety and privacy.

Burnout and Well-Being in Trainees: Findings From a National Survey of US Obstetrics and Gynecology Residents.

Background Despite national attention on resident well-being, challenges persist. Effective solutions require greater understanding of personal and program factors. Objective To explore burnout, resilience, self-reported mental health, and perceptions of the learning environment in a national sample of obstetrics and gynecology (OB/GYN) residents. Methods An observational cross-sectional survey of OB/GYN residents taking the January 2022 national in-training examination included an abbreviated 2-item Maslach Burnout Inventory, a short version of the Connor-Davidson Resilience Scale, and subjective experience of other factors. Kruskal-Wallis and chi-square tests explored differences in outcomes and associations between variables. Results Among 5761 residents taking the examination, 3741 (64.9%) participated, with 2425 of 3741 (64.8%) reporting burnout, 2138 (57.2%) depression, 2651 (70.9%) anxiety, and 147 (3.9%) suicidal ideation. Women fared worse than men in terms of burnout (2105 of 3147, 66.9% vs 281 of 496, 56.7%, P<.001), depression (1843 of 3147, 58.6% vs 256 of 496, 51.6%, P=.004), anxiety (2318 of 3147, 73.7% vs 294 of 496, 59.3%, P<.001), and resilience (5.9±2.1 vs 6.2±2.1, P=.006). More nonbinary residents considered leaving residency (17 of 49, 34.7% vs 676 of 3147, 21.5% [women] and 108 of 496, 21.8% [men], P=.008). Race-based differences were seen in depression, suicidal ideation, and thoughts of leaving residency. Increased binge drinking was reported with increasing postgraduate year. Among 614 residents reporting that well-being was not a priority in their program, 539 of 614 (87.8%) reported burnout, 469 of 614 (76.4%) depression, and 508 of 614 (82.7%) anxiety. Conclusions Residents report high rates of mental health concerns, and these are worse among women, gender nonconforming individuals, Black residents, and those who perceive well-being is not a priority in their training program.

Estimating poverty for India after 2011 using private-sector survey data

The last expenditure survey released by India’s National Sample Survey organization dates back to 2011, which underpins the last official estimates of poverty and inequality. This paper adopts a new approach to estimate India’s poverty and inequality trajectory since 2011 using a newly available household panel survey conducted by the private sector. The results suggest that (1) extreme poverty is estimated to be lower in 2019 than in 2011, with greater poverty reductions likely in rural areas, and (2) coinciding with the demonetization event, urban poverty likely rose in 2016. The results should not be interpreted as definite proof. While the estimated trends in poverty sit well with a range of corroborative evidence, significant uncertainty remains stemming from sampling and non-sampling errors associated with the private-sector survey.

Financial needs and opioid use among head and neck cancer (HNC) survivors: Baseline findings from the HN-STAR trial (WF-1805CD).

365 Background: HNC survivors often experience post-treatment pain. Given known disparities in pain management and opioid use in the non-cancer population, we explored sociodemographic predictors of opioid use in HNC survivors enrolled in the HN-STAR trial (NCT04208490, funding: American Cancer Society and UG1CA189824). Methods: Survivors of HNC (stages I-III) who completed therapy 6-24 months prior and had no evidence of disease were enrolled throughout the NCI Community Oncology Research Program (NCORP). Survivors were randomized to a clinical informatics intervention or usual care. Baseline surveys elicited recent prescription opioid use in the prior week (yes/no). Blinded to arm assignment, we conducted bivariate analyses of recent opioid use and the following sociodemographic predictors: age, gender, marital status, race and ethnicity (non-white/Latinx vs all others), highest level of education, and being able to meet daily financial needs in the prior 4 weeks. We conducted stepwise multivariable logistic regression to evaluate the association of these factors on opioid use. Results: Among 254 survivors (mean age 63, 74% male, 25% non-white/non-Latinx, 13% reporting financial need) at 25 oncology practices, 14% (n=35) reported recent opioid use. In bivariate analyses, survivors who reported financial needs were more likely to have used opioids (odds ratio [OR] 4.35, 95% confidence interval [CI] 1.85-10.20, p&lt;.001). In stepwise multivariable analyses, only having financial needs remained in the final model (Table). Conclusions: In a national sample of post-treatment HNC survivors during a subacute survivorship period (6-24 months after treatment completion), 1 in 7 survivors reported using opioids in the past week – more than twice the annual rate of opioid receipt in the general adult population. Several demographic factors related to opioid use were examined and not associated with recent opioid use among HNC survivors. Findings suggest that financial concerns may be a barrier to non-narcotic pain management (e.g., cognitive behavioral approaches, physical therapy) – or simply that unmet financial needs are associated with lower quality of pain management. Attention should focus on equitable pain management in this population. Clinical trial information: NCT04208490 . Predictors of opioid use in past week. Bivariate Models Estimate (standard error) p-value Age (years) -.01 (.02) .52 OR (95% CI) p-value Female .98 (.41, 2.16) .97 Latinx/non-white .71 (.27, 1.63) .45 Married .56 (.27, 1.18) .13 Some college or more .62 (.30, 1.30) .20 Had financial needs 4.35 (1.85,10.20) &lt;.001 Final model OR (95% CI) p-value Had financial needs 4.35 (1.85,10.20) &lt;.001

Differential prevalence of psychiatric disorders and mental health characteristics associated with lifetime suicide attempts in the Asian American and Pacific Islander adult population

BackgroundAsian American and Pacific Islander (AAPI) adults are an understudied group in terms of their mental health and mental healthcare needs. This has been complicated by the difficulty of recruiting adequate national samples of AAPI adults for research. ObjectiveThis study aimed to analyze national data to examine the lifetime prevalence of major psychiatric disorders among AAPI adults relative to non-AAPI adults, as well as to identify and compare sociodemographic and clinical characteristics associated with lifetime suicide attempts among AAPI and non-AAPI adults. MethodsCross-sectional data on 36,109 adults, including 1801 AAPI adults, from the National Epidemiological Survey of Alcohol and Related Conditions-III (NESARC-III), were analyzed with a series of chi-square and logistic regression analyses. ResultsWe found a significantly lower lifetime prevalence of mental health disorders in the AAPI versus the non-AAPI population nationally, including 2% of AAPI adults reporting lifetime suicide attempts as compared to about 5% of non-AAPI adults. Female sex and a history of major depressive disorder diagnosis were associated with lifetime suicide attempts in the AAPI and non-AAPI populations. Several unique factors were associated with having a history of suicide attempts in only the AAPI population, including a military service history and a diagnosis of panic disorder. DiscussionOur analysis demonstrated the significant sectors of the AAPI population that merit research, support, and intervention, including the AAPI veteran population. This study identifies several characteristics among AAPI adults that may make them particularly vulnerable to psychiatric problems and suicide risk, which may inform targeted prevention and efforts to provide culturally competent care to this population.

Should I Stay, or Should I Go? Emotional Exhaustion's Association with Intent to Leave in a National Sample of Female Physician Trainees.

Background: Physician burnout disproportionately affects women and contributes to attrition from the workforce, a costly problem that likely begins in training. Female physicians leave the workforce significantly earlier than male counterparts. The association between burnout and attrition intent in women physician trainees is unknown. Methods: This is a cross-sectional analysis of baseline data from a national sample of female physician trainees in a randomized controlled trial testing a well-being program in 2022. Participants completed surveys on burnout and intent to leave. Associations were analyzed using chi-square testing and univariable linear regression. Results: A total of 1,017 trainees responded. The average standard deviation (SD) age was 30.8 (4.0) years, 959 (94.3%) self-identified as a woman, and 540 (53.1%) as White. One-fifth (207, 20.7%) were in postgraduate year (PGY)-1, 198 (19.8%) PGY-2, and 595 (59.5%) ≥ PGY-3. Most scored positively for burnout; 77.5% experienced high emotional exhaustion (EE). One-fifth (20.6%) reported some intent to leave their program before graduation, and 32.7% reported intent to leave their specialty within 2 years. There was a strong association between EE scores and intent to leave: trainees reporting a high likelihood to leave before graduation had a 22.27 higher EE point average than those reporting no likelihood (95% confidence interval [CI]: 7.80, 36.74, p = 0.003). Conclusions: Attrition intent was associated with burnout. Addressing burnout during training will not only benefit trainees but could impact the retention of women physicians.

Sex differences in insomnia and hypersomnia complaints during major depressive episode: Results from a national sample

BackgroundSex differences in sleep disturbances during major depressive episodes (MDE) have been suggested. This study compares the prevalence, sociodemographic characteristics, and psychiatric comorbidity associated with sleep complaints specific to each sex among adults with MDE. These findings are crucial for precise diagnosis, personalized treatment, and improved clinical outcomes. MethodsIn a large nationally representative prospective survey, we used multi-adjusted logistic regression models including sociodemographic characteristics, psychiatric comorbidity, and depression severity to examine whether associations differ between men and women. ResultsAmong women, 93.3 % reported at least one type of sleep complaints (i.e., trouble falling asleep, early morning awakening or hypersomnia) while 91.0 % of men did, with respectively 78.3 % and 77.2 % of insomnia complaints, and 46.2 % and 41.3 % of hypersomnia complaints. Women with sleep complaints were more likely to be black, with lower individual incomes, have histrionic personality disorder or a specific phobia. Conversely, men with sleep complaints were more likely to have a lifetime diagnosis of mania spectrum disorder, generalized anxiety disorder, drug use disorder, as well as dependent and schizotypal personality disorders. Surprisingly, being “never married” has emerged as a protective factor against sleep complaints in women, while posing as a risk factor in men compared to other marital statuses. Differences and specificities were also noted concerning subtypes of insomnia and hypersomnia complaints. LimitationsThe cross-sectional design means the associations found do not imply causality. ConclusionsThese findings provide insights into the complex relationship between sleep and depression in men and women, highlighting the need for personalized interventions.

Impact of Adoption of European Kidney Consortium Equation (EKFC) on CKD Prevalence and CKD Staging in Older Irish Adults

Abstract Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation tends to overestimate glomerular filtration rate (GFR) and has limitation in younger and older age groups, while the European Kidney Function Consortium (EKFC) full-age spectrum (FAS) correct for these problems and provide better performance in estimating GFR. We compared the 2017 EKFC- FAS(Scr-CysC) equation with 2012 CKD-EPI(Scr-CysC) for estimating CKD prevalence and staging in a national representative sample of older Irish adults. Methods We utilised data from The Irish Longitudinal Study on Ageing (2009-2011), for participants aged 50 to 79 years with complete measurement of serum creatinine (Scr) and Cystatin-C (CysC). Using 2017 EKFC- FAS(Scr-CysC) and 2012 CKD-EPI(Scr-CysC), equations eGFR was calculated. CKD was defined as eGFR below 60 ml/min/1.73 m². Median eGFR, CKD prevalence, concordance correlation coefficient (CCC), and impact of EKFC equation on GFR category reclassification was examined. Results A total of 5,092 participants (53.3% women), median age 61 years were included. CKD prevalence varied significantly from 10.8% (9.9% – 11.8%) using 2021 CKD-EPI (Scr -CysC) to 16.7 % (15.5-17.9%) with the 2017 EKFC- FAS(Scr-CysC) equation. The corresponding numbers of CKD increased from 114,867 to 176,439 individuals respectively. The median eGFR for 2021 CKD-EPI (Scr -CysC) was 82.1 ml/min/1.73m2 and 2017 EKFC- FAS(Scr-CysC) was 74.5 ml/min/1.73m2, P&amp;lt;0.001). The net reclassification was 23.1 % based on 2017 EKFC- FAS (Scr-CysC) equation compared to CKD-EPI 2012 (Scr -CysC) and was towards more worsening CKD stage. The CCC between 2012 CKD-EPI(Scr-CysC) and 2017 EKFC- FAS(Scr-CysC) was 0.88 (95% CI, 0.88-0.89). Conclusion CKD prevalence varies according to eGFR equation with substantially higher numbers of CKD predicted by the European Kidney Function Consortium than CKD-EPI equations. This has direct implications on healthcare planning, resource allocation, and rates of referral to specialist nephrology services in Ireland.

Unfair Racial Treatment in Healthcare, Healthcare Utilization, and Health Status Among Black, Indigenous, Women of Color

Black, Indigenous, Women of Color (BIWOC) face well-documented health disparities in the United States. However, the extent to which recent experiences of unfair racial treatment in medical settings contribute to health disparities is not well understood. The objective of this study was to examine associations of experiencing unfair racial treatment by a provider during the most recent medical encounter with healthcare utilization and health status in BIWOC. We utilized multivariate logistic regression models to examine data from the Association of American Medical Colleges’ biannual Survey of Healthcare Access collected between 2012 and 2019. Data were extracted for 5,549 participants who identified both as a woman and a Black, Indigenous, Person of Color to generate our BIWOC sample of interest. Among BIWOC, experiencing unfair racial treatment during their most recent healthcare visit in the past year was associated with higher odds of delaying healthcare ( OR = 3.50, p &lt; .001) and using the emergency department as their usual source of care ( OR = 1.54, p &lt; .001). Experiencing unfair racial treatment was also associated with having chronic physical conditions ( OR = 1.31, p = .002), chronic depression ( OR = 1.56, p &lt; .001), and activity limitations due to both emotional ( OR = 2.98, p &lt; .001) and physical ( OR = 2.47, p &lt; .001) impairment. Recent experience of racial discrimination by a healthcare provider was associated with lower healthcare utilization and poorer health status in a national sample of BIWOC. Reducing unfair treatment in healthcare settings is critical for improving BIWOC health.

Increasing Police Presence: Examining Race, Ethnicity, and Perceived Neighborhood Disadvantage as Correlates of Support

AbstractGiven its empirical and public support, increasing police presence seems to be a viable preventive policy option for police agencies. However, the theoretical and empirical literature is not clear on whether this support would vary along race/ethnicity and perceived neighborhood disadvantage, which is relevant given that policies of this kind would likely have a greater impact on disadvantaged communities of color. Using survey data from a national sample, we found that racial and ethnic identity were unrelated to support for increased police presence, while perceived neighborhood disorder was related to greater support for police presence. We also found that neighborhood disorder, social cohesion, and informal social control were indirectly related to support for increased police presence through perceptions of police legitimacy and fear of crime, demonstrating some evidence of the overpolicing-underpolicing paradox in disadvantaged communities. Policy implications of these findings are discussed.

Social Deprivation and Multimorbidity Among Community-Based Health Center Patients in the United States.

Multimorbidity - having 2 or more chronic diseases - is a national public health concern that entails burdensome and costly care for patients, their families, and public health programs. Adults residing in socially deprived areas often have limited access to social and material resources. They also experience a greater multimorbidity burden. We conducted a retrospective cohort analysis of electronic health record (EHR) data from 678 community-based health centers (CHCs) in 27 states from the Accelerating Data Value Across a National Community Health Center (ADVANCE) Network, a clinical research network, from 2012-2019. We used mixed-effects Poisson regression to examine the relationship of area-level social deprivation (eg, educational attainment, household income, unemployment) to chronic disease accumulation among a sample of patients aged 45 years or older (N = 816,921) residing across 9,362 zip code tabulation areas and receiving care in safety-net health organizations. We observed high rates of chronic disease among this national sample. Prevalence of multimorbidity varied considerably by geographic location, both within and between states. People in more socially deprived areas with Social Deprivation Index (SDI) scores in quartiles 2, 3, and 4 had greater initial chronic disease counts - 17.1%, 17.7%, and 18.0%, respectively - but a slower rate of accumulation compared with people in the least-deprived quartile. Our findings were consistent for models of the composite SDI and those evaluating disaggregated measures of area-level educational attainment, household income, and unemployment. Social factors play an important role in the development and progression of multimorbidity, which suggests that an assessment and understanding of area-level social deprivation is necessary for developing public health strategies to address multimorbidity.

Obesity is an independent risk factor for postoperative pulmonary embolism after anterior cervical discectomy and fusion

BACKGROUNDOver the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database. PURPOSEThe purpose of this study was to analyze obesity level's influence on perioperative complication rates in patients undergoing ACDF. STUDY DESIGN/SETTINGA retrospective cohort, large multicenter database study. PATIENT SAMPLEThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551. OUTCOME MEASURESMedical and surgical complications within thirty days of operation. METHODSPatients were categorized into four BMI groups: nonobese (BMI 18.5−29.9 kg/m2), obese class I (BMI 30−34.9 kg/m2), obese class II (BMI 35−39.9 kg/m2), and obese class III (BMI ≥40 kg/m2). A univariate analysis conducted for demographic variables and preoperative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to nonobese patients. RESULTSAbout 64,718 patients were identified of whom 33,365 were nonobese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs. 0.24%, p=.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 vs. 0.15%, p=.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs. 0.4%, p<.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129−2.599); OR: 2.213, 95% CI (1.349−3.559); OR: 2.207, 95% CI (1.190--3.892), respectively). CONCLUSIONSRisk for postoperative PEs after an ACDF was significantly higher for obese classes I-III compared to nonobese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.

Supplemental Material for Revision of the Multidimensional Assessment of Parenting Scale (MAPS) in an Ethnoracially Diverse National Sample

Supplemental Material for Revision of the Multidimensional Assessment of Parenting Scale (MAPS) in an Ethnoracially Diverse National Sample