non-Hispanic African American Research Articles

Race, cortisol, and subclinical cardiovascular disease in 9- to 11-year-old children.

Non-Hispanic Black Americans have a greater risk for certain subtypes of cardiovascular disease (CVD; e.g., stroke and heart failure) relative to non-Hispanic White Americans. Moreover, Black relative to White adults consistently show elevated cortisol, a CVD risk. The impact of race, environmental stress, and cortisol on subclinical CVD has yet to be fully researched in children. We assessed diurnal salivary cortisol slopes and hair cortisol in a sample of 9- to 11-year-old children (N = 271; 54% female) with roughly half self-identifying as either Black (57%) or White (43%). Two subclinical CVD indicators were assessed: carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT). We assessed numerous environmental stress indicators. After adjusting for covariates, we found that Black children had significantly flatter diurnal cortisol slopes, higher hair cortisol, and thicker IMT than White children. Significant pathways were found: race → salivary cortisol slope → cfPWV (effect = -0.059, 95% CI [-0.116, -0.002]) and race → hair cortisol → cIMT (effect = -0.008, [-0.016, -0.002]). Black children also experienced significantly more environmental stress than White children; however, only income inequality served as a significant indirect pathway from race to salivary cortisol (effect = 0.029, [0.003, 0.060]). Relative to White children, Black children had significantly greater hair cortisol and flatter diurnal slopes which, in turn, were associated with greater subclinical CVD. As suggested by a significant indirect pathway, income inequality might partially explain the race-cortisol association. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Telemedicine in the Post-Pandemic Period: Understanding Patterns of Use and the Influence of Socioeconomic Demographics, Health Status, and Social Determinants.

Introduction: The rapid expansion of telemedicine during the COVID-19 pandemic has transformed health care delivery. However, it remains unclear whether telemedicine utilization is equitable across different demographic groups and whether the high levels of adoption during the pandemic have persisted in the post-pandemic period. This study investigates telemedicine use and patterns of use in the initial phases of the post-pandemic period and explores the impact of socioeconomic factors, social determinants of health, and patients' health-related factors on telemedicine utilization. Methods: This study analyzes data from the Health Information National Trends Survey (HINTS) 6, comprising responses from 6,046 U.S. adults collected between March and November 2022. Results: Of 6,046 HINTS respondents, 39.3% (2,517 individuals) reported using telemedicine in the past year. Among telemedicine users, 18.5% used video visits, 12.08% used telephone-based telecare, and 8.72% used both. The main reasons for telehealth visits were minor illnesses (29.67%), chronic condition management (21.4%), annual visits (18.82%), mental and behavioral health concerns (15.72%), and medical emergencies (1.58%). Among non-users, only 17% (578 individuals) were offered telehealth visits, with privacy concerns (16.43%), preference for in-person consultation (84.42%), and difficulty using telemedicine technology (18.96%) being the main reasons for non-use. Logistic regression analysis revealed significant associations of social determinants, socioeconomic demographics, and health factors with telemedicine utilization. Women had a higher likelihood of using telemedicine (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.09-1.78). Older adults showed lower inclination toward telemedicine. Married individuals were more likely to use telemedicine (OR = 1.35, 95% CI = 1.06-1.72), while Whites (OR = 1.52, 95% CI = 1.04-2.22) and Hispanics (OR = 1.80, 95% CI = 1.17-2.75) had higher odds of utilizing telemedicine compared with non-Hispanic African Americans. Lack of reliable transportation (OR = 1.29, 95% CI = 1.01-1.66), frequent provider visits (OR = 1.37, 95% CI = 1.28-1.46), a higher number of chronic conditions (OR = 1.39, 95% CI = 1.22-1.57), and residences in metropolitan locations were also associated with increased telemedicine usage. Greater satisfaction with internet connectivity positively influenced telemedicine utilization. Conclusions: This study highlights the continued preference for in-person visits among U.S. adults in the early post-pandemic period, despite the widespread use of telemedicine. Addressing barriers such as limited access, privacy concerns, technological difficulties, and demographic disparities is crucial for achieving equitable utilization of telemedicine.

Firearm Mortality of Non-Hispanic Black Americans by Law Enforcement, 2011-2020.

Law enforcement officers in the U.S. are more likely to use lethal force against non-Hispanic Black citizens than on their non-Hispanic White counterparts. The purpose of this study was to assess estimates of the national prevalence of fatal firearm violence by law enforcement officers (LEOs) against non-Hispanic Black Americans. The Web-Based Injury Statistics Query and Reporting System (WISQARS) from the Centers for Disease Control and Prevention (CDC) were analyzed using descriptive statistics and joinpoint regression from 2011 to 2020. During the decade (2011-2020) LEOs fatally shot 5,073 citizens and 1,170 were non-Hispanic Black (23%). The vast majority (96%) were males and two-thirds (66%) of those killed were ages 20-39 years. The region with the highest number of LEO fatal shootings was the Western U.S. Firearm deaths of non-Hispanic Blacks were the dominant (82%) method of LEO-induced deaths. Non-Hispanic Black Americans experience LEO firearm-related injuries and deaths at a much higher rate than their non-Hispanic White counterparts. In the context of the racial disparities among people who die following LEO-related gunshot wounds, changes to police training systems and an examination of implicit biases among LEOs should be investigated as the next step in reducing the use of lethal force practices.

1298-P: Independent Associations of GAD65, IA2, and ZnT8 Autoantibody (Ab) Positivity with C-Peptide (CPep) in a Diverse Cohort of Youth with Diabetes (DM)

The current DM classification does not fully enable precision medicine in DM due to heterogeneity between and within DM types, especially in racially diverse populations. Insulin deficiency (ID) is one of the most clinically actionable DM outcomes and, while its association with islet autoimmunity is known, the influence of Ab type and number after DM onset is uncertain. Thus, we assessed the effect of Ab characteristics on ID (measured as Cpep loss) in youth with established DM. We studied 151 youth with DM (median [IQR] age 15.0 [4.2] yrs, DM duration 5.4 [3.4] yrs), 61% female, 53% Hispanic and 17% non-Hispanic African American. We measured postprandial serum Cpep, glucose and Ab (GAD65, IA2 and ZnT8) and collected clinical/demographic data. Cpep loss was pre-specified as postprandial CPep <0.6 ng/ml. We found 0, 1, 2, or 3 +Ab in 34%, 22%, 31% and 13% of participants, respectively (Figure, left panel). A Breslow-Day statistic suggested homogeneity of the risk ratios across the 3 Ab types for CPep loss (p = 0.42), which were all larger than 1 (Figure, right panel). Cpep loss was significantly associated with ≥1 (vs 0) Ab+ (p < 0.0001) but not with single (vs multiple) Ab+ (p = 0.60). In sum, each of GAD65, IA2 and ZnT8 Ab are significantly associated with ID among diverse youth with DM. This suggests that models predicting ID post-onset should include each of GAD65, IA2 and ZnT8 Ab. Disclosure M.J.Redondo: None. R.A.Oram: Consultant; Janssen Research & Development, LLC, Research Support; Randox R & D. D.Dabelea: None. W.Hagopian: Research Support; Janssen Research & Development, LLC, Provention Bio, Inc., Randox R & D. Discover study group: n/a. K.K.Harrall: None. D.H.Glueck: None. M.Tosur: Advisory Panel; Provention Bio, Inc. S.Uysal: None. A.Muir: None. K.Vehik: None. T.M.Brusko: Consultant; Repertoire Immune Medicines, Quell Therapeutics, Research Support; Immunocore, Ltd., Adaptive Biotechnologies. M.A.Atkinson: None. Funding National Institutes of Health (R01DK124395)

667-P: Enrollment Characteristics of Adults Aged 18–44 in the National Diabetes Prevention Program (National DPP)

The Centers for Disease Control and Prevention (CDC) estimates that 96 million adults aged 18 years or older had prediabetes in 2019. Of these, 32.2 million, or 33.5%, were aged 18-44, emphasizing the need for efforts to prevent or delay onset of type 2 diabetes within this population. CDC's National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations collaborating to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes or at high risk. While the mean age of participants in the LCP is 51 years, 31.6% of the participants enrolled as of October 2022 were in the 18-44 age group. When examining the characteristics of this age group, 52.1% of participants identified as non-Hispanic or Latino White, 18.4% identified as Hispanic or Latino, and 12.9% identified as non-Hispanic or Latino Black or African American. Overall, 71.4% of participants in this group enrolled in an online program and 81% participated through a worksite wellness program. For those who had the opportunity to complete the year-long LCP, the mean number of days spent in the program was 110. By comparison, among 45-64-year-olds, the mean number of days spent in the program was 161, and for those 65 and older, the mean number of days was 210. This is of note because participants who stay in the LCP longer are more likely to meet the risk reduction outcomes. Participants 18-44 met the programmatic risk reduction 5% weight loss goal at a lower rate (18.4%) than participants aged 45-64 (27%) and 65 and over (40.2%). These findings highlight the opportunity to develop strategies focused on supporting this younger adult population to enroll in and complete the LCP. Disclosure M.Bell: None. M.Papalii: None. S.Van aacken: None. E.Ely: None.

Bullying Victimization and Associations With Substance Use Among US Middle School Students: 2019 Youth Risk Behavior Survey.

Research shows associations between bullying victimization and substance use for teens. However, more research about this relationship for younger adolescents and across race/ethnicity is needed. Prevalence and pooled logistic regression analyses of 2019 Middle School Youth Risk Behavior Survey data from 13 states (N = 74,059 students) examined associations between self-reported bulling victimization (at school, electronically, and both) and having ever tried cigarette smoking, alcohol, or marijuana; used an electronic vapor product; or misused prescription pain medicine. Regression analyses were adjusted by age and sex/race/ethnicity. All 3 measures of bullying victimization were significantly associated (p < .05) with the 5 substance use behaviors examined (adjusted prevalence ratios ranged from 1.29 to 2.32). These associations held across sexes. Significant associations were found within all 7 race/ethnicity categories, with the most associations reported for the non-Hispanic (NH) white, NH black or African American, Hispanic/Latino, and NH Asian groups. The association between bullying and substance use by middle school is a highly relevant issue to consider as students return to classrooms.

Partner-Support and Gestational Duration Among Pregnant Women Who Smoke.

Pregnant women who smoke are at a high risk of preterm birth (PTB) and have low partner-support. In a prospective cohort study, we aimed to examine the role of partner-support in gestational duration and PTB among pregnant women who smoke as well as the interaction with race/ethnicity. We analyzed secondary data of 53 participants from the University at Buffalo Pregnancy and Smoking Cessation Study. Partner-support was measured with Turner's support scale where women reported how much they agreed with five statements about how supportive their partner was. Total partner-support was calculated and split into emotional support and accountability. We fit multivariable linear regression models and log-binomial regression models for gestational duration and PTB, respectively. Gestational duration significantly increased with partner-support (0.22weeks longer per unit increment in partner-support score), emotional support (0.52weeks), and accountability (0.35weeks). This association tended to be stronger among Hispanics and women of other races than non-Hispanic Caucasians and African Americans. Women with a bed partner had 1.48weeks longer gestational duration than women without a bed partner. Partner-support may increase gestational duration and reduce PTB risk among pregnant women who smoke, especially among Hispanic women. Sharing a bed with a partner was associated with a longer gestational duration. Our findings may be interpreted with caution due to limitations such as small sample size, recruitment within a single metropolitan area, and partner-support measurement via maternal reports only. A partner-support intervention to increase gestational duration is warranted.

Progress Toward Equitable Mpox Vaccination Coverage: A Shortfall Analysis — United States, May 2022–April 2023

More than 30,000 monkeypox (mpox) cases were reported in the United States during the 2022 multinational outbreak; cases disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Substantial racial and ethnic disparities in incidence were also reported (1). The national mpox vaccination strategy* emphasizes that efforts to administer the JYNNEOS mpox vaccine should be focused among the populations at elevated risk for exposure to mpox (2). During May 2022-April 2023, a total of 748,329 first JYNNEOS vaccine doses (of the two recommended) were administered in the United States.† During the initial months of the outbreak, lower vaccination coverage rates among racial and ethnic minority groups were reported (1,3); however, after implementation of initiatives developed to expand access to mpox vaccination,§ coverage among racial and ethnic minority groups increased (1,4). A shortfall analysis was conducted to examine whether the increase in mpox vaccination coverage was equitable across all racial and ethnic groups (5). Shortfall was defined as the percentage of the vaccine-eligible population that did not receive the vaccine (i.e., 100% minus the percentage of the eligible population that did receive a first dose). Monthly mpox vaccination shortfalls were calculated and were stratified by race and ethnicity; monthly percent reductions in shortfall were also calculated compared with the preceding month's shortfall (6). The mpox vaccination shortfall decreased among all racial and ethnic groups during May 2022-April 2023; however, based on analysis of vaccine administration data with race and ethnicity reported, 66.0% of vaccine-eligible persons remained unvaccinated at the end of this period. The shortfall was largest among non-Hispanic Black or African American (Black) (77.9%) and non-Hispanic American Indian or Alaska Native (AI/AN) (74.5%) persons, followed by non-Hispanic White (White) (66.6%) and Hispanic or Latino (Hispanic) (63.0%) persons, and was lowest among non-Hispanic Asian (Asian) (38.5%) and non-Hispanic Native Hawaiian and other Pacific Islander (NH/OPI) (43.7%) persons. The largest percentage decreases in the shortfall were achieved during August (17.7%) and September (8.5%). However, during these months, smaller percentage decreases were achieved among Black persons (12.2% and 4.9%, respectively), highlighting the need for a focus on equity for the entirety of a public health response. Achieving equitable progress in JYNNEOS vaccination coverage will require substantial decreases in shortfalls among Black and AI/AN persons.

Prediagnostic 25-Hydroxyvitamin D in Association with Cancer-specific and All-cause Mortality among Low-income, Non-Hispanic Black Americans with Colorectal Cancer.

Observational studies show high prediagnosis 25-hydroxyvitamin D is associated with lower mortality after colorectal cancer diagnosis. Results from clinical trials suggest vitamin D supplementation may improve outcomes among patients with colorectal cancer. Most studies included few Black Americans, who typically have lower 25-hydroxyvitamin D. We evaluated associations between serum 25-hydroxyvitamin D and mortality after colorectal cancer diagnosis among Black American cases. Data arose from 218 Black Americans from the Southern Community Cohort Study diagnosed with colorectal cancer during follow-up (age 40-79 at enrollment). Prediagnostic 25-hydroxyvitamin D was measured at enrollment and categorized as deficient (<12 ng/mL), insufficient (12-19.9 ng/mL), or sufficient (≥20 ng/mL). Mortality was determined from the National Death Index. Cox proportional hazards were used to estimate HRs and 95% confidence intervals (CI) for associations between 25-hydroxyvitamin D and mortality. As a continuous exposure, higher 25-hydroxyvitamin D was associated with overall mortality [HR = 0.79 (0.65-0.96) per-SD increase, Ptrend = 0.02] and colorectal cancer-specific mortality [HR = 0.83 (0.64-1.08), Ptrend = 0.16]. For overall mortality, associations were strongest among females [HR = 0.65 (0.42-0.92)], current smokers [HR = 0.61 (0.38-0.98)], and obese participants [HR = 0.47 (0.29-0.77)]. Compared with those with deficiency, participants with sufficient 25-hydroxyvitamin D had lower overall mortality after multivariable adjustment [HR: 0.61 (0.37-1.01)]. Prediagnosis 25-hydroxyvitamin D is inversely associated with overall and colorectal cancer-specific mortality among Black Americans with colorectal cancer. Correcting vitamin D deficiency may improve survival of these patients, particularly for obese individuals and smokers. Our results support including more Black Americans in trials of vitamin D supplementations to improve colorectal cancer outcomes.

Urban and Rural Mpox Incidence Among Persons Aged 15–64 Years — United States, May 10–December 31, 2022

During May 10-December 31, 2022, a total of 29,980 confirmed and probable† U.S. monkeypox (mpox) cases were reported to CDC, predominantly in cisgender adult men reporting recent same-gender sexual partners (1). Urban-rural differences in health (2) and diagnosis of HIV (3,4) and other sexually transmitted infections (5) are well documented nationally. This report describes urban-rural differences in mpox incidence (cases per 100,000 population) among persons aged 15-64 years, by gender and race and ethnicity. Urbanicity was assessed using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties (2). Substantial differences in incidence by urbanicity, gender, and race and ethnicity were observed; most (71.0%) cases occurred in persons residing in large central urban areas. Among the cases in large central urban areas, most (95.7%) were in cisgender men. The overall incidence of mpox in the United States was 13.5 per 100,000 persons aged 15-64 years and peaked in August in both urban and rural areas. Among cisgender men, incidence in rural areas was approximately 4% that in large central urban areas (risk ratio [RR]=0.04). Among cisgender women, incidence in rural areas was approximately 11% that in large central urban areas (RR=0.11). In both urban and rural areas, incidence among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) persons was consistently higher than that among non-Hispanic White (White) persons; RRs between Black and White persons were highest in rural areas. Support and maintenance of mpox surveillance and prevention efforts including vaccinations should focus on urban areas with the highest incidence of mpox during the 2022 outbreak; however, surveillance and prevention efforts should include all genders, persons of color, and persons residing in both urban and rural areas who are at increased risk for mpox.

A Causal Analysis of Young Adults’ Binge Drinking Reduction and Cessation

This study, using the multiple disadvantage model (MDM), sought to identify factors (disadvantaging social disorganization, social structural, social integration, health/mental health, co-occurring substance use, and substance treatment access factors) in young adults' binge drinking reduction and cessation in the United States. We extracted data on 942 young adult binge drinkers (25-34 years, 47.8% female) from the National Longitudinal Study of Adolescent to Adult Health (Add Health), carrying out a temporal-ordered causal analysis, meaning the evaluation of select variables' impacts on an outcome at a subsequent time. MDM found a relatively high reduction likelihood for non-Hispanic African Americans and respondents with relatively more education. MDM found a relatively low reduction likelihood accompanying an alcohol-related arrest, higher income, and greater number of close friends. Change to nondrinking was found more likely for non-Hispanic African Americans, other non-Hispanic participants having minority ethnicity, older respondents, those with more occupational skills, and healthier respondents. Such change became less likely with an alcohol-related arrest, higher income, relatively more education, greater number of close friends, close friends' disapproval of drinking, and co-occurring drug use. Interventions incorporating a motivational-interviewing style can effectively promote health awareness, assessment of co-occurring disorders, friendships with nondrinkers, and attainment of occupational skills.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014.

Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections — United States, 2017–2020

IntroductionRacial and ethnic minorities are disproportionately affected by end-stage kidney disease (ESKD). ESKD patients on dialysis are at increased risk for Staphylococcus aureus bloodstream infections, but racial, ethnic, and socioeconomic disparities associated with this outcome are not well described. MethodsSurveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017–2020 Emerging Infections Program (EIP) were used to describe bloodstream infections among patients on hemodialysis (hemodialysis patients) and were linked to population-based data sources (CDC/Agency for Toxic Substances and Disease Registry [ATSDR] Social Vulnerability Index [SVI], United States Renal Data System [USRDS], and U.S. Census Bureau) to examine associations with race, ethnicity, and social determinants of health. ResultsIn 2020, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN; 34.2% were attributable to S. aureus . Among seven EIP sites, the S. aureus bloodstream infection rate during 2017–2020 was 100 times higher among hemodialysis patients (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years). Unadjusted S. aureus bloodstream infection rates were highest among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) hemodialysis patients. Vascular access via central venous catheter was strongly associated with S. aureus bloodstream infections (NHSN: adjusted rate ratio [aRR] = 6.2; 95% CI = 5.7–6.7 versus fistula; EIP: aRR = 4.3; 95% CI = 3.9–4.8 versus fistula or graft). Adjusting for EIP site of residence, sex, and vascular access type, S. aureus bloodstream infection risk in EIP was highest in Hispanic patients (aRR = 1.4; 95% CI = 1.2–1.7 versus non-Hispanic White [White] patients), and patients aged 18–49 years (aRR = 1.7; 95% CI = 1.5–1.9 versus patients aged ≥65 years). Areas with higher poverty levels, crowding, and lower education levels accounted for disproportionately higher proportions of hemodialysis-associated S. aureus bloodstream infections. Conclusions and implications for public health practiceDisparities exist in hemodialysis-associated S. aureus infections. Health care providers and public health professionals should prioritize prevention and optimized treatment of ESKD, identify and address barriers to lower-risk vascular access placement, and implement established best practices to prevent bloodstream infections.

Factors Mediating Public Perceptions of Therapeutic Closed-Loop Brain Implants for Epilepsy and Mood Disorders (P6-9.002)

<h3>Objective:</h3> To examine perceptions of implanted neural devices among groups underserved by prevailing neuropsychiatric treatment approaches. <h3>Background:</h3> “Closed-loop” devices that both sense and modulate brain activity represent a new paradigm for neuropsychiatric treatment. However, neurotechnologists and even neuroethicists are not demographically representative of U.S. society, so the concerns of groups most in need of new paradigms may not be reflected in current neurotechnology development. <h3>Design/Methods:</h3> We fielded a nationally representative survey (n=1047) oversampling non-Hispanic Black (n=214), Hispanic (n=210), and rural Americans (n=219), eliciting treatment preferences in scenarios comparing (1) a therapeutic closed-loop brain implant versus surgical resection for refractory epilepsy, and (2) an investigational closed-loop brain implant versus medications for mood disorders. We asked respondents to rate the importance of differing considerations favoring either the implanted device or traditional treatment. We examined whether such considerations mediate demographic differences in treatment preferences using survey-weighted logistic regression models. <h3>Results:</h3> In both scenarios, non-Hispanic Black Americans were less likely to prefer the implanted neural device than non-Hispanic White Americans (epilepsy OR 0.28, p&lt;0.001; mood OR 0.23, p=0.008); there was no main effect contrasting Hispanic with non-Hispanic White Americans, or contrasting rural with urban/suburban Americans. In the epilepsy scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by preference for established treatments, concerns about privacy, and concerns about hacking. In the mood scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by indifference to temporally specific action of a closed-loop device, concerns about changes to core traits, and preference for established treatments. <h3>Conclusions:</h3> Black Americans are less likely than White Americans to prefer closed-loop brain implants to traditional treatment, with specific concerns that may be informed by the history of unethical medical experimentation targeting Black people. <b>Disclosure:</b> Mr. Dada has received personal compensation for serving as an employee of Dreem Health. The institution of Mr. Chen has received research support from the National Institutes of Health (NIH). The institution of Dr. Haeusermann has received research support from the National Institutes of Health (NIH). Ms. Fong has nothing to disclose. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Highland Instruments. Dr. Hamilton has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology (Journal). The institution of Dr. Hamilton has received research support from NIH. The institution of Dr. Hamilton has received research support from Department of Defense. The institution of Dr. James has received research support from National Institute of Health. The institution of Dr. James has received research support from Society of Family Planning . The institution of Dr. James has received research support from Greenwall Foundation. Prof. Dohan has nothing to disclose. The institution of Dr. Chiong has received research support from the National Institutes of Health. The institution of Dr. Chiong has received research support from the Dana Foundation. Dr. Chiong has received personal compensation in the range of $500-$4,999 for serving as a member, NeuroEthics Working Group with National Institutes of Health.

The relationship of history of psychiatric and substance use disorders on risk of dementia among racial and ethnic groups in the United States.

Dementia is characterized by significant declines in cognitive, physical, social, and behavioral functioning, and includes multiple subtypes that differ in etiology. There is limited evidence of the influence of psychiatric and substance use history on the risk of dementia subtypes among older underrepresented racial/ethnic minorities in the United States. Our study explored the role of psychiatric and substance use history on the risk of etiology-specific dementias: Alzheimer's disease (AD) and vascular dementia (VaD), in the context of a racially and ethnically diverse sample based on national data. We conducted secondary data analyses based on the National Alzheimer's Coordinating Center Uniform Data Set (N = 17,592) which is comprised a large, racially, and ethnically diverse cohort of adult research participants in the network of US Alzheimer Disease Research Centers (ADRCs). From 2005 to 2019, participants were assessed for history of five psychiatric and substance use disorders (depression, traumatic brain injury, other psychiatric disorders, alcohol use, and other substance use). Cox proportional hazard models were used to examine the influence of psychiatric and substance use history on the risk of AD and VaD subtypes, and the interactions between psychiatric and substance use history and race/ethnicity with adjustment for demographic and health-related factors. In addition to other substance use, having any one type of psychiatric and substance use history increased the risk of developing AD by 22-51% and VaD by 22-53%. The risk of other psychiatric disorders on AD and VaD risk varied by race/ethnicity. For non-Hispanic White people, history of other psychiatric disorders increased AD risk by 27%, and VaD risk by 116%. For African Americans, AD risk increased by 28% and VaD risk increased by 108% when other psychiatric disorder history was present. The findings indicate that having psychiatric and substance use history increases the risk of developing AD and VaD in later life. Preventing the onset and recurrence of such disorders may prevent or delay the onset of AD and VaD dementia subtypes. Prevention efforts should pay particular attention to non-Hispanic White and African American older adults who have history of other psychiatric disorders.Future research should address diagnostic shortcomings in the measurement of such disorders in ADRCs, especially with regard to diverse racial and ethnic groups.

Stroke Mortality Among Black and White Adults Aged ≥35 Years Before and During the COVID-19 Pandemic — United States, 2015–2021

Stroke is the fifth leading cause of death and a leading cause of long-term disability in the United States (1). Although stroke death rates have declined since the 1950s, age-adjusted rates remained higher among non-Hispanic Black or African American (Black) adults than among non-Hispanic White (White) adults (1,2). Despite intervention efforts to reduce racial disparities in stroke prevention and treatment through reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to treatment and care for stroke (1,3), Black adults were 45% more likely than were White adults to die from stroke in 2018.* In 2019, age-adjusted stroke death rates (AASDRs) (stroke deaths per 100,000 population) were 101.6 among Black adults and 69.1 among White adults aged ≥35 years. Stroke deaths increased during the early phase of the COVID-19 pandemic (March-August 2020), and minority populations experienced a disproportionate increase (4). The current study examined disparities in stroke mortality between Black and White adults before and during the COVID-19 pandemic. Analysts used National Vital Statistics System (NVSS) mortality data accessed via CDC WONDER† to calculate AASDRs among Black and White adults aged ≥35 years prepandemic (2015-2019) and during the pandemic (2020-2021). Compared with that during the prepandemic period, the absolute difference in AASDR between Black and White adults during the pandemic was 21.7% higher (31.3 per 100,000 versus 38.0). During the pandemic period, an estimated 3,835 excess stroke deaths occurred among Black adults (9.4% more than expected) and 15,125 among White adults (6.9% more than expected). These findings underscore the importance of identifying the major factors contributing to the widened disparities; implementing prevention efforts, including the management and control of hypertension, high blood cholesterol, and diabetes; and developing tailored interventions to reduce disparities and advance health equity in stroke mortality between Black and White adults. Stroke is a serious medical condition that requires emergency care. Warning signs of a stroke include sudden face drooping, arm weakness, and speech difficulty. Immediate notification of Emergency Medical Services by calling 9-1-1 is critical upon recognition of stroke signs and symptoms.

Racial and Ethnic Disparities in Mpox Cases and Vaccination Among Adult Males - United States, May-December 2022.

As of December 31, 2022, a total of 29,939 monkeypox (mpox) cases* had been reported in the United States, 93.3% of which occurred in adult males. During May 10-December 31, 2022, 723,112 persons in the United States received the first dose in a 2-dose mpox (JYNNEOS)† vaccination series; 89.7% of these doses were administered to males (1). The current mpox outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and racial and ethnic minority groups (1,2). To examine racial and ethnic disparities in mpox incidence and vaccination rates, rate ratios (RRs) for incidence and vaccination rates and vaccination-to-case ratios were calculated, and trends in these measures were assessed among males aged ≥18 years (males) (3). Incidence in males in all racial and ethnic minority groups except non-Hispanic Asian (Asian) males was higher than that among non-Hispanic White (White) males. At the peak of the outbreak in August 2022, incidences among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) males were higher than incidence among White males (RR=6.9 and 4.1, respectively). Overall, vaccination rates were higher among males in racial and ethnic minority groups than among White males. However, the vaccination-to-case ratio was lower among Black (8.8) and Hispanic (16.2) males than among White males (42.5) during the full analytic period, indicating that vaccination rates among Black and Hispanic males were not proportionate to the elevated incidence rates (i.e., these groups had a higher unmet vaccination need). Efforts to increase vaccination among Black and Hispanic males might have resulted in the observed relative increased rates of vaccination; however, these increases were only partially successful in reducing overall incidence disparities. Continued implementation of equity-based vaccination strategies is needed to further increase vaccination rates and reduce the incidence of mpox among all racial and ethnic groups. Recent modeling data (4) showing that, based on current vaccination coverage levels, many U.S. jurisdictions are vulnerable to resurgent mpox outbreaks, underscore the need for continued vaccination efforts, particularly among racial and ethnic minority groups.

Epidemiologic and Clinical Features of Mpox-Associated Deaths - United States, May 10, 2022-March 7, 2023.

As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States,† predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age=34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR=50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).

Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.

Autism spectrum disorder (ASD). 2020. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range=17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.

Racial and Ethnic Differences in Subjective Cognitive Decline - United States, 2015-2020.

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible.