non-Hispanic Asian Research Articles

Abstract 4134754: Trends and Disparities in Mortality Due to Abdominal Aortic Aneurysm: Who Is at Risk?

Background: Screening studies have reported a prevalence of 3-8% for abdominal aortic aneurysms (AAA). Despite a positive trend of decline over the past two decades, mortality linked to AAA remains a significant public health concern. In the United States alone, AAA complications resulted in an estimated 13,640 deaths between 2018 and 2021. Thus, understanding trends and disparities in AAA mortality is crucial for evaluating the effectiveness of current approaches and identifying vulnerable populations. Methods: This study analyzed death certificates from 1999 to 2020 within the CDC WONDER Database. Deaths among individuals aged 25 years and older caused by AAA were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes I71.3 and I71.4. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, 195,117 deaths were reported in patients with AAA (both ruptured and non-ruptured). Overall, AAMRs for AAA significantly decreased from 69.0 deaths in 1999 to 27.9 deaths in 2020. This decline occurred in two phases: a steeper decrease from 1999 to 2014 (APC: -5.47; 95% CI: -5.68 to -5.29) followed by a further significant decrease from 2014 to 2020 (APC: -1.66; 95% CI: -2.46 to -0.57). Gender-based analysis revealed that men consistently had higher AAMRs than women (men: 65.6; 95% CI: 65.3 to 66.0; women: 24.5; 95% CI: 24.3 to 24.7). Similarly, AAMRs varied by race/ethnicity, with the highest rates observed among non-Hispanic Whites (45.6; 95% CI: 45.3 to 45.8), followed by non-Hispanic American Indian or Alaska Natives (30.3; 95% CI: 27.9 to 32.7), non-Hispanic African Americans (27.2; 95% CI: 26.7 to 27.8), non-Hispanic Asian or Pacific Islanders (20.7; 95% CI: 20.0 to 21.4), and Hispanics (17.5; 95% CI: 17.0 to 18.0). Additionally, individuals residing in non-metropolitan areas had significantly higher AAMRs than those in metropolitan areas (non-metropolitan: 50.7; 95% CI: 50.2 to 51.1; vs. metropolitan: 39.2; 95% CI: 39.0 to 39.4) (Figure 1). Conclusions: This analysis revealed a significant decline in mortality from AAA. However, disparities persist, with higher AAMRs observed among men, non-Hispanic Whites, and residents of non-metropolitan areas.

Abstract 4125533: Demographic Trends and Disparities in Mortality Related to Coexisting Heart Failure and Diabetes Mellitus Among Older Adults in the United States: A Large Database Analysis from 1999 to 2020

Background: In the United States, over 38 million people have diabetes mellitus (DM) and more than 6 million have heart failure (HF). DM and HF often coexist, and each condition independently increases the likelihood of developing the other. Approximately 40% of individuals with HF also have DM, and this prevalence is even higher among older adults and hospitalized patients. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends associated with their coexistence has not been thoroughly explored. Methods: This study analyzed death certificates from the CDC WONDER database, specifically focusing on mortality caused by the simultaneous presence of HF and DM among individuals aged 75 years and older. The data covers the period from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, and race/ethnicity. Results: Between 1999 and 2020, a total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with an initial increase from 1999 to 2005 (APC: 0.80; 95% CI: -0.17 to 2.94), a significant decline from 2005 to 2011 (APC: -2.82; 95% confidence interval (CI): -5.47 to – 1.71), a subsequent increase from 2011 to 2018 (APC: 0.61; 95% CI: -0.59 to 2.18), and finally a steep increase from 2018 to 2020 (APC: 11.30; 95% CI: 6.98 to 14.11). Gender-based analysis revealed that older men had consistently higher AAMRs than older women (Men: 185; 95% CI: 184.3 to 185.6; vs Women: 135.4; 95% CI: 135 to 135.8). Furthermore, we found that AAMRs were the highest among non-Hispanic American Indian or Alaska natives (214.4; 95% CI: 207.5 to 221.4) followed by non-Hispanic African Americans (179.9; 95% CI: 178.5 to 181.4), Hispanics (159.5; 95% CI: 158 to 161.1), non-Hispanic White (152.9; 95% CI: 152.5 to 153.3), and non-Hispanic Asian or Pacific Islander populations (104.1; 95% CI 102.4 to 105.8) (Figure 1). Conclusion: The mortality rate due to coexisting HF and DM has increased in the elderly population over the past decade. Males and non-Hispanic American Indians or Alaskan Natives had the highest AAMRs in our study.

Abstract 4134744: Trends and Disparities in Mortality Among Patients with Hypertensive Heart Disease and Congestive Heart Failure in the United States from 1999 to 2020

Background: Hypertensive heart disease (HHD) poses a growing public health concern. Global data reveal a concerning rise in HHD prevalence, deaths, and disability-adjusted life years (DALYs) between 1990 and 2019. The Framingham Study highlights that hypertension is linked to approximately one-quarter of heart failure cases. This association is even stronger among older adults, in whom hypertension is responsible for up to 68% of heart failure cases. Methods: This study analyzed death certificates within the CDC WONDER database for patients in the United States from 1999 to 2020. We identified deaths among individuals aged 25 years and older caused by HHD and CHF using the International Classification of Diseases, Tenth Revision (ICD-10) code I11.0. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, a total of 302,270 deaths were reported in patients due to HHD with CHF. Overall, AAMR increased from 37.3 to 134.9 per 1,000,000 population between 1999 and 2020, with a significant decrease from 1999 to 2004 (APC: -7.91; 95% CI: -20.16 to -1.04), followed by a significant increase from 2004 to 2007 (APC: 42.47; 95% CI: 21.27 to 55.62), a slight decrease from 2007 to 2014 (APC: -0.9; 95% CI: -9.38 to 2.39), and finally a steep increase from 2014 to 2020 (APC: 14.22; 95% CI: 10.87 to 20.84). Gender-based analysis revealed that men had slightly higher AAMRs than women (Men: 63.1; 95% CI: 62.8 to 63.5 vs. Women: 60.7; 95% CI: 60.5 to 61). Moreover, AAMRs were highest among non-Hispanic African Americans (109.6; 95% CI: 108.6 to 110.6), followed by non-Hispanic American Indian or Alaska Natives (66.6; 95% CI: 63.1 to 70.1), non-Hispanic Whites (58.5; 95% CI: 58.2 to 58.7), Hispanics (53.7; 95% CI: 52.9 to 54.5), and non-Hispanic Asian or Pacific Islanders (39; 95% CI: 38–39.9). In addition, non-metropolitan areas had higher AAMRs than metropolitan areas (non-metropolitan: 65.7; 95% CI: 65.2 to 66.3 vs. metropolitan: 62.1; 95% CI: 61.8 to 62.3) (Figure 1). Conclusions: Despite an initial decline, mortality from combined HHD and CHF has risen significantly since 1999. Notably, mortality was most pronounced among men, non-Hispanic African Americans, and individuals residing in non-metropolitan areas.

Abstract 4134863: Major Cardiovascular Events Following Non-Cardiovascular Surgeries in Minority Patients Compared to White Patients

Introduction: Racial disparities are pervasive in cardiovascular outcomes. Although disparities following cardiovascular surgery have been extensively studied, fewer current, nationwide reports exist for postoperative outcomes in non-cardiovascular surgery. Research Aim: To investigate the incidence of 30-day post-operative major adverse cardiac, cerebral and thrombotic events (MACCTE) following non-cardiovascular surgeries in non-White patients as compared to White patients. Methods: This retrospective cohort study used the 2018-2022 National Surgical Quality Improvement Program database. Patients aged 18 or older who underwent non-cardiovascular surgeries (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, obstetrics, and interventional radiology) were included. Race/ethnicity was categorized as non-Hispanic White (Whites), Hispanic, non-Hispanic Asian (Asians), non-Hispanic Black or African American (Blacks), and non-Hispanic Others. MACCTE was defined as a composite of death, MI, cardiac arrest, stroke, PE, or DVT. Five multivariable logistic regression models were used to hierarchically adjust for age, gender, ASA class, surgical subspecialty, operation time, transfer status, and all other comorbidities. Results: Among the 3,775,920 patients: 70.9% were Whites, 11.8% Hispanics, 4.1% Asians, 11.6% Blacks, 1.5% of Other race, 58.9% female, and 46.7% had an ASA classification of 3 or greater. The MACCTE incidence was 1.95% overall and 2.01% in Whites, 1.27% Hispanics, 1.48% Asians, 2.11% Blacks, and 1.69% Others. Compared to Whites, Blacks had higher incidences of cardiac arrest (0.40% vs. 0.23%), stroke (0.17% vs. 0.15%), PE (0.47% vs. 0.34%), and DVT (0.55% vs. 0.48%), and Asians (0.18% vs 0.15%) and Others (0.21% vs. 0.15%) had a higher incidence of stroke (p<0.001). With Whites as reference, the crude odds ratios, OR (95% CI) were 0.63 (0.61-0.65) in Hispanics, 0.73 (0.70-0.76) Asians, 1.05 (1.03-1.07) Blacks, and 0.84 (0.78-0.89) Others. The fully adjusted model odds ratios, OR (95% CI) were 0.88 (0.82-0.95) Hispanics, 0.89 (0.80-1.00) Asians, 1.11 (1.04-1.18) Blacks, and 0.80 (0.69-0.94) Others. Conclusion: Black patients experienced a higher MACCTE risk compared to Whites, even after adjustment for age, sex, ASA class, type of surgical procedure, and other comorbidities. These findings emphasize the importance of implementing comprehensive measures to prevent excess risk and promote equitable surgical care.

Abstract 4134747: Trends and Disparities in Mortality Due to Thoracic Aortic Aneurysm in Patients in the United States from 1999 to 2020

Background: Thoracic aortic aneurysms (TAA) impact approximately 6 to 10 individuals per 100,000 people, though the actual prevalence is likely higher due to frequent asymptomatic presentations, posing a challenge for early diagnosis. The rupture of these aneurysms presents a significant risk, resulting in an estimated 30,000 deaths annually in the United States alone. This emphasizes the urgent need for enhanced detection and treatment strategies. An understanding of trends in TAA mortality is imperative for assessing the efficacy of current approaches, pinpointing vulnerable populations, and ultimately, advancing treatment equity. Methods: This study utilized death certificates from 1999 to 2020 sourced from the CDC WONDER Database. Deaths among individuals aged 25 years and older attributed to TAA were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and stratified based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, 47,136 deaths were reported in patients with TAA. Overall, AAMR decreased from 16.2 to 8.2 per 1,000,000 population between 1999 and 2020, with a significant decline from 1999 to 2013 (APC: -5.00; 95% CI: -5.54 to -4.5), followed by a slight increase from 2013 to 2020 (APC: 0.47; 95% CI: -1.02 to 3.06). Gender-based analysis revealed that men had consistently higher AAMRs than women (men: 11.2; 95% CI: 11 to 11.3; vs. women: 9; 95% CI: 8.9 to 9.1). Moreover, we found that AAMRs were the highest among non-Hispanic African Americans (11; 95% CI: 10.7 to 11.3) followed by non-Hispanic Whites (10.3; 95% CI: 10.2 to 10.4), non-Hispanic Asian or Pacific Islanders (9.5; 95% CI: 9 to 9.9), non-Hispanic American Indian or Alaska Native (7.8; 95% CI: 6.6 to 9), and Hispanic populations (5.2; 95% CI 5 to 5.5). In addition, non-metropolitan areas had higher AAMRs than metropolitan areas (non-metropolitan areas: 11; 95% CI: 10.8 to 11.2; vs. metropolitan: 9.8; 95% CI: 9.7 to 9.9) (Figure 1). Conclusions: This analysis revealed a significant decline in mortality since 1999 from TAA, with a slight upward trend in recent years. However, disparities persist, with higher AAMRs observed among men, non-Hispanic African Americans, and residents of non-metropolitan areas.

Abstract 4138353: Disparities in coronary artery disease-related mortality among patients with obesity in the United States from 1999-2020

Introduction: Coronary artery disease (CAD) is the third leading cause of death in the US for adults aged >35 years. Almost half of the adult US population has obesity, which predisposes to atherosclerosis and may lead to poor prognosis in CAD. We aim to identify CAD-related mortality trends in patients with obesity in the US stratified by age, sex, race, and geographical location. Methods: The CDC-WONDER database was used to extract death certificate data for adults aged ≥25 years. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were delineated by calculating annual percent change (APC) and the average APC (AAPC) in the rates using JoinPoint regression analysis. Results: From 1999 to 2020, a total of 182,436 CAD-related deaths occurred in individuals with obesity. The AAMR increased consistently from 1999 to 2018 (APC: 4.48) and surged thereafter till 2020 (APC: 13.91). The AAMR for males (4.91) was almost double that of females (2.76). Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (5.37) while NH Asians or Pacific Islanders displayed the lowest (0.88). NH Blacks or African Americans displayed an AAMR of 5.06, followed by NH Whites (3.88) and Hispanics or Latinos (2.6). AAMRs also varied substantially by region (Midwest: 4.09; West: 4; Northeast: 3.67; South: 3.53). States with the highest AAMRs were Vermont and Oklahoma. Non-metropolitan regions exhibited a higher AAMR (4.42) than metropolitan regions (3.64). The adults aged 65-74 years exhibited the greatest CMR (8.99). Conclusion: We observed increasing trends in CAD-related deaths in adults with obesity throughout the study period. The highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of the Midwest and non-metropolitan areas, and individuals aged 65-74 years. Better healthcare practices and lifestyle modifications should be promoted in these high-risk populations to reduce the CAD-related mortality rates in adults with obesity.

Abstract 4132212: Trends in Atrial Fibrillation or Flutter Related Mortality Among Adults in the United States: Insights from CDC WONDER Database from 1999-2020

Background: Atrial fibrillation or flutter (Afib/AFL) incidence rates continue to rise and are linked to significant mortality, particularly in older populations. Our analysis examines Afib/AFL mortality trends across different demographics and regions in the U.S. from 1999 to 2020, highlighting the importance of understanding these patterns. Aim: To guide preventive measures that alleviate the impact of Afib/AFL and identify high-risk populations and regions, we sought to quantify trends associated with Afib/AFL related mortality in the U.S. Methods: We conducted a comprehensive search of death certificates from 1999-2020 using Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database focusing on Afib/AFL mortality in adults with ICD-10 codes I48. Gender, race, geographical and urban-rural parameters were investigated by calculating annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons using the Joinpoint Regression Program (Joinpoint V 4.9.0.0, National Cancer Institute). Results: A total of 2,581,488 deaths occurred in patients with Afib/AFL from 1999 to 2020. The AAMR displayed an abrupt rise from 2018 to 2020 (APC: 8.51; 95% CI: 4.84-10.47). Men consistently exhibited a higher AAMR (overall AAMR male: 79.4, 95% CI 79.3-79.6; female: 60.8, 95% CI 60.7-60.9). Non-metropolitan areas showed higher AAMRs than metropolitan areas (overall AAMR non-metropolitan areas: 74.9, 95% CI 74.7-75.1; metropolitan: 67.2, 95% CI 67.1-67.2). Disparities were also observed in AAMRs by region with the West region showing the highest mortality rate with a notable rise between 2010 and 2020 (APC: 3.70, 95% CI 3.30-5.37). Non-hispanic (NH) White population showed the highest mortality (overall AAMR: 74.2, 95% CI 74.1-74.3), followed by NH American Indian (AAMR: 50.3), NH Black (AAMR: 45.8), NH Asian (AAMR: 35.0) and Hispanic (AAMR: 37.9) populations. Conclusion: Mortality from Afib/AFL has risen from 1999 to 2020. Men, NH white populations, and residents in non-metropolitan areas and Western U.S. are at higher risk. Targeted interventions and strategic healthcare resource allocation are needed to address these disparities and improve outcomes.

Abstract 4138275: Demographic, Regional, and State-level Trends of Mortality in patients with Atrial fibrillation in the United States, 1999 to 2020

Background: There exists a paucity of data regarding mortality trends among individuals with atrial fibrillation (AF) based on age, gender, race and ethnicity, and geographic regions. Objective: To investigate the trends in mortality in the United States (US) associated with AF among individuals aged ≥45 years. Methods: We reviewed the death certificate data from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database to examine atrial fibrillation–related mortality trends from 1999 to 2020 in individuals ≥45 years of age. We calculated crude and age adjusted mortality rates (AAMRs) per 100 000 patients and annual percentage change (APC) with 95% CIs. Results: Between 1999 and 2020, 2,576,839 AF-related deaths were identified among US adults over 45 years of age. The age adjusted mortality rate (AAMR) for AF-related deaths rose significantly from 70.6 in 1999 to 149.1 in 2020. Initially, the AAMR remained stable from 1999 to 2009 (APC): 2.31; 95% CI: -0.57 to 5.84), then increased significantly from 2009 to 2018 (APC: 3.60; 95% CI: 2.12 to 4.75), and saw a sharp rise from 2018 to 2020 (APC: 8.46; 95% CI: 4.76 to 10.44). There were notable disparities among demographic groups. Men consistently had higher AAMRs than women from 1999 (men: 79.9, women: 64.4) to 2020 (men: 180.5, women: 125.3). Non-Hispanic (NH) White adults had the highest AAMR (108.6), followed by NH American Indian/Alaska Native (73.4), NH Black (66.7), Hispanic or Latino (55.5), and NH Asian or Pacific Islander adults (51.2). The age group 85+ consistently showed the highest mortality rates throughout the study period. Regional differences were also evident, with the residents of western region (109.5) and nonmetropolitan areas (109.6) having the higher AAMRs when compared to other regions (Midwest: 104.3, Northeast: 95.1, and South: 95.0) and metropolitan areas (98.3), respectively. State-level variations were also significant. Conclusion: Our study found a rise in AF-related mortality in the US from 1999 to 2020, with significant disparities among demographic and geographic subgroups. Higher AAMRs were noted in males, non-Hispanic Whites, adults over 85, and residents of the western and nonmetropolitan US. Addressing disparities in access to quality care, timely diagnosis, insurance maintenance, and implementing targeted health policies can help reduce AF-related mortality.

Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021

Background: The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated. Aim: We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S. Methods: Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region. Results: Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0). Figure 1. Conclusion: Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Abstract Su703: Racial/Ethnic Disparities in Bystander Cardiopulmonary Resuscitation after Witnessed Out-of-Hospital Cardiac Arrest: A NEMSIS Database Study

Introduction: Out of hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with upwards of 360,000 OHCAs annually. Receiving bystander cardiopulmonary resuscitation (CPR) almost doubles an individual’s odds of survival compared to those who don’t receive bystander CPR. Unfortunately, in the US, bystander application of CPR only occurs in 40% of OHCA. Improving the rate of bystander CPR and AED use will improve survival rates for OHCA. Minoritized populations experience worse outcomes from OHCA. Compared to non-Hispanic whites, they are less likely to survive to hospital discharge. A cross-sectional study of witnessed OHCA patients found that Black and Hispanic patients had lower rates of bystander CPR. Less is known about disparities in care for Asian American persons who experience OHCA. Studies using the Resuscitation Outcomes Consortium Epidemiologic Registry (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) have concluded discrepant results, with ROC finding that Asian Americans were less likely to receive bystander CPR and CARES finding that they were just as likely to receive bystander CPR compared to non-Hispanic Whites. To that end, we sought to evaluate the association between bystander CPR and Asian race after witnessed OHCA. Objective: To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA). Methods: Data were obtained from the National Emergency Medical Services Information System (NEMSIS) database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2022. Patients were separated into two groups: Non-Hispanic White and Asians. The primary outcome was the odds of receiving bCPR. Exclusions included traumatic etiology, do-not-resuscitate orders, and arrests witnessed by healthcare providers. Pearson’s chi-square test was used to test significance. Results: A total of 73,215 witnessed OHCA activations were included in this study. Overall, bystander CPR rates were lower for the Asian group (59.8%) compared to the Non-Hispanic White group (65.0%). Pearson’s chi-square test showed a statistically significant difference between the bCPR rates of the Asian group and Non-Hispanic White group, with a p-value of less than 0.001. Conclusion: Racial/ethnic disparities exist for Asian individuals in the odds of receiving bCPR after a witnessed non-traumatic OHCA.

Prevalence of and trends in hyperuricemia by race and ethnicity among US adolescents, 1999–2018

PurposeOur objective was to ascertain the most recent prevalence and trends of hyperuricemia among adolescents, stratified by sex and race/ethnicity subgroups, as well as to investigate potential risk factors associated with hyperuricemia in US adolescents.MethodsData were obtained from adolescents aged 12–17 years in the 1999–2018 NHANES cycles. Hyperuricemia for adolescents was defined as ≥ 5.5 mg/dL. The prevalence of hyperuricemia, along with 95% confidence intervals (CIs), was calculated for each four-year survey cycle, stratified by sex, race/ethnicity, body mass index (BMI), poverty income ratio (PIR), and parental education levels. Linear regression and logistic regression analyses were conducted independently to evaluate the linear trends in mean serum urate levels and the prevalence of hyperuricemia across the four-year cycles. Utilizing NHANES data from 2011 to 2018, we identified factors associated with mean serum urate levels and hyperuricemia through the application of linear regression and Poisson regression analyses.ResultsA total of 11 264 participants were included in the analysis. In 2015–2018, the overall hyperuricemia prevalence was 32.78%, 50.7% in males, and 13.51% in females. No significant trends were identified in the prevalence of hyperuricemia from 1999 to 2002 to 2015–2018. Between 2011 and 2018, hyperuricemia was significantly more prevalent among males compared to females (prevalence ratio [PR], 3.50 [95% CI, 2.83–4.33]), non-Hispanic Asians compared to non-Hispanic Whites (PR, 1.26 [95% CI, 1.04–1.53]), and individuals with overweight (PR, 1.63 [95% CI, 1.32–2.01]) or obesity (PR, 2.45 [95% CI, 2.08–2.88]) compared to those of normal weight. There was a stronger correlation between obesity and hyperuricemia among females (PR, 4.77 [95% CI, 3.08–7.39]) than in males (PR, 2.06 [95% CI, 1.82–2.34]). Furthermore, non-Hispanic Black adolescents with obesity exhibited higher PRs (PR, 3.40 [95% CI, 2.54–4.55]) for hyperuricemia in comparison to other ethnic groups.ConclusionsThis study has updated recent trends in hyperuricemia by sex and race/ethnicity among US adolescents. Our results suggest that hyperuricemia has a significant association with greater obesity in US adolescents, and the degree of correlation varies by sex and race/ethnicity.

Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis.

Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread. This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Over 35.61% (1740/4959) of respondents reported encountering "a lot" of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing "some" amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions.

US Cancer Mortality Trends Among Asian and Pacific Islander Populations

Cancer is the leading cause of death among Asian American individuals and the second leading cause of death among Native Hawaiian and Pacific Islander people. To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Asian American and Pacific Islander populations in the US by demographic characteristics. This cross-sectional study used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to obtain age-adjusted cancer death rates among Asian American and Pacific Islander individuals of all ages between January 1, 1999, and December 31, 2020. Data were analyzed from January 12 to March 19, 2024. Age, sex, cancer type, and US census regions. Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates for non-Hispanic Asian American and Pacific Islander populations were estimated by cancer type, age, sex, and region using Joinpoint regression. Between 1999 and 2020, 305 386 Asian American and Pacific Islander individuals (median [IQR] age, 69.5 [58.5-79.2] years; 51.1% male) died of cancer in the US. Overall, the CSM rate decreased by 1.5% annually. Men experienced a greater CSM rate decrease (AAPC, -1.8%; 95% CI, -2.2% to -1.3%) compared with women (AAPC, -1.1%; 95% CI: -1.2% to -1.0%). For women, death rates decreased for most cancer types but increased for uterine (AAPC, 2.5%; 95% CI, 2.0%-3.0%) and brain and central nervous system (AAPC, 1.4%; 95% CI: 0.7%-2.1%) cancers. Colorectal cancer mortality rates increased among men aged 45 to 54 years (AAPC, 1.3%; 95% CI, 0.5%-2.1%). Liver and intrahepatic bile duct cancer mortality increased for both men and women in all US census regions, uterine cancer mortality increased in all regions for women, and pancreatic cancer mortality increased in the Midwest for both men and women. Although these findings show an overall decrease in CSM among Asian American and Pacific Islander populations, specific cancer types exhibited increased mortality rates, with further disparities by sex and age. Targeted, culturally adapted clinical and public health interventions are needed to narrow disparities in cancer mortality.

COVID-19 vaccine or booster uptake and hesitancy for children aged 6 months–5 years in the United States: A national descriptive study using the household pulse survey between March and May 2023

The Centers for Disease Control and Prevention recommends that children aged 6 months–5 years (children under 5) receive multiple doses of COVID-19 vaccine, including updated (bivalent) COVID-19 vaccine. However, since the updated vaccines became available for children under 5, there has been limited knowledge regarding hesitancy toward the original vaccine or boosters in vaccinating children. To address this gap, this study utilized data from the Household Pulse Survey conducted from March 1, 2023 to May 8, 2023 (Phase 3.8). The purpose of the study was to examine the proportion of children under 5 who had received at least one dose of COVID-19 vaccine and to assess the likelihood of vaccination, categorized as willingness to vaccinate, moderate hesitancy, and strong hesitancy. Additionally, we identified sociodemographic factors that may influence the level of vaccine hesitancy for children. Overall, 24.5 % (95 % CI: 22.2–26.8) of children under 5 had received at least one dose of the COVID-19 vaccine, with the highest percentage among non-Hispanic Asians (42.1 %, 95 % CI: 36.4–47.8). Respondents who had not received the vaccine showed a statistically significant decrease in their inclination to vaccinate children. There was a higher level of vaccine hesitancy among females compared to males regarding vaccinating children under 5. As household income and educational attainment decreased, there was an observed increase in the proportion of individuals showing strong vaccine hesitancy. Households without health insurance had significantly lower vaccine uptake and higher rates of strong vaccine hesitancy compared to those with health insurance. Parents, guardians, and healthcare providers play essential roles in vaccinating children under 5. Targeted interventions are needed to address vaccine hesitancy and promote the importance of booster doses in the vaccination of children.

Sociodemographic Disparities in 1-Year Outcomes of Children With Community-Acquired Acute Kidney Injury

Racial disparities have been identified in pediatric community-acquired acute kidney injury (CA-AKI), and they are associated with increased risk of child mortality, morbidity, and progression of kidney disease. To assess clinical outcomes at 1 year among children with CA-AKI, stratified by age, race, and ethnicity. This retrospective cohort study is a population-based analysis of deidentified, aggregated electronic health record data collected by 61 large health care organizations from 2003 to 2023 and accessed through the TriNetX platform. Outcomes were assessed at 1 year after a CA-AKI episode. Participants included pediatric patients (aged <18 years) with AKI. Data were accessed in January 2024. A diagnosis of CA-AKI and sociodemographic factors such as race, ethnicity, and age, as reported in electronic health records. The primary end point of this study was to assess differences in clinical outcomes within 1 year of an episode of CA-AKI, including all-cause emergency department (ED) visits, intensive care unit (ICU) admissions, mechanical intubation and ventilation, and mortality. Risk was compared between White children and Asian (including Asian, Native Hawaiian, and Other Pacific Islander), Black, and Hispanic children, stratified by age group. Measures of association, Cox proportional hazard analyses, and Kaplan-Meier survival curves were performed within the TriNetX Advanced Analytics Platform between racial and ethnic groups for each analysis. From the total sample of 18 152 children, those with hospital-acquired AKI, chronic kidney disease, end-stage kidney failure, or dialysis dependence were excluded, leaving a final cohort of 17 125 children (mean [SD] age, 11.2 [5.2] years; 9424 male [55.3%]). Eligible patients were divided into racial and ethnic groups as follows: non-Hispanic Asian, 1169 children (6.5%); non-Hispanic Black, 4636 children (27.3%); Hispanic, 1786 children (10.2%); and non-Hispanic White, 9534 children (55.9%). Patients were further subdivided into groups aged 0 to 9 years (546 Asian children, 1675 Black children, 689 Hispanic children, and 3340 White children) and 10 to 18 years (623 Asian children, 2961 Black children, 1091 Hispanic children, and 6104 White children). Within 1 year of CA-AKI diagnosis, compared with White children, Black children experienced greater rates of ED visits (hazard ratio [HR], 1.53; 95% CI, 1.40-1.67), ICU admissions (HR, 1.31; 95% CI, 1.16-1.47), mechanical ventilation (HR, 1.33; 95% CI, 1.13-1.56), and all-cause mortality (HR, 1.27; 95% CI, 1.09-1.48), as well as the greatest risk for composite outcomes (HR, 1.43; 95% CI, 1.33-1.53). Hispanic children experienced greater rates of ED visits (HR, 1.40; 95% CI, 1.21-1.62) and the greatest risk of all-cause mortality (HR, 1.66; 95% CI, 1.31-2.09), whereas Asian children experienced greater rates of mechanical ventilation (HR, 1.69; 95% CI, 1.26-2.27), compared with White children. Black and Hispanic children aged 0 to 9 years were at greatest risk of experiencing poor clinical outcomes. Black children had a 11.41% lower survival probability and Hispanic children had a 7.14% lower survival probability compared with White children after an initial ED encounter. Among children with an identified episode of CA-AKI diagnosed in an ED, within 1 year, Black and Hispanic children had a poorer survival probability compared with White children. Future studies are needed to understand these disparities and improve awareness and follow-up after emergency care.

An Intersectional Approach to Cervical Cancer Screening Disparities by Race/Ethnicity and Immigrant Status.

Background: Disparities in cervical cancer (CC) screening exist within racial/ethnic minority and immigrant groups. However, few studies have explored the joint influence of race/ethnicity and immigrant status on screening, and the disparities that have been identified by existing studies remain incompletely explained. This study aims to identify the joint influence of race/ethnicity and immigrant status on CC screening and elucidate the barriers contributing to identified disparities. Methods: A cross-sectional analysis of 25,660 U.S. women from the 2005, 2010, and 2015 National Health Interview Surveys was done. The CC screening up-to-date status of cases was analyzed by race/ethnicity and immigrant status using logistic regression models. Conceptualized mediators were added to models to identify their contribution to identified disparities. Results: All immigrants had lower screening odds than U.S.-born non-Hispanic White women with foreign-born non-Hispanic Asians having the lowest odds (adjusted odds ratio [aOR]: 0.36, 95% confidence interval [CI]: 0.26-0.49) followed by foreign-born non-Hispanic White (aOR: 0.52, 95% CI: 0.36-0.76), Hispanic/Latinx (aOR: 0.58, 95% CI: 0.47-0.73), and non-Hispanic Black women (aOR: 0.62, 95% CI: 0.38-0.99). Adjusting for only socioeconomic status or access to care attenuated the aOR: for foreign-born Hispanic/Latinx and non-Hispanic Black women only. Adjusting simultaneously for language and acculturation attenuated the aOR: for all immigrants. Conclusions: Disparities in CC screening were only found in the immigrant populations of various racial/ethnic groups. Targeting insurance and health care access may address disparities in immigrant Hispanic/Latinx and non-Hispanic Black women. Focusing on culturally and linguistically competent care and education may be more crucial for immigrant non-Hispanic Asian and White women.

Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015–2020: a cross-sectional analysis

BackgroundAntibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients’ risks for acquiring antibiotic-resistant (AR) uropathogens.MethodsWe identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients’ age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients’ sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients’ census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients’ risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.ResultsWe included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients’ odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients’ odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.ConclusionThe social determinants of health may play important and intersecting roles in determining a patient’s risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

Association between Body Fat Distribution and Nonalcoholic Fatty Liver Disease/Fibrosis Based on Race/Ethnicity.

Body fat distribution may impact nonalcoholic fatty liver disease (NAFLD) and significant fibrosis differently according to race/ethnicity. We determined the relationship between body fat distribution and NAFLD/significant fibrosis according to race/ethnicity. A cross-sectional study of 2,395 participants used the National Health and Nutrition Examination Survey 2017 to 2018. NAFLD and significant fibrosis (≥F2) were defined by controlled attenuation parameter scores and liver stiffness measurements on transient elastography, respectively. Visceral and subcutaneous fat volumes were defined by dual-energy X-ray absorptiometry. The odds ratio (OR) for NAFLD per 1-standard deviation in visceral fat volume and subcutaneous fat volume was 2.31 (95% confidence interval [CI], 1.50 to 3.39) and 1.93 (95% CI, 1.43 to 2.61) in total population, respectively. Visceral fat in non-Hispanic Blacks had the highest odds for NAFLD (OR, 2.86; 95% CI, 1.45 to 5.62), and non-Hispanic Whites (OR, 2.29; 95% CI, 1.19 to 4.40) and non-Hispanic Asians (OR, 1.61; 95% CI, 1.13 to 2.29) were in order. Significant associations between subcutaneous fat volume (OR, 2.10; 95% CI, 1.34 to 3.29; P=0.003) or visceral fat volume (OR, 1.35; 95% CI, 1.05 to 1.73; P=0.023) and significant fibrosis were noted among individuals with NAFLD. Hispanics had the highest odds for NAFLD-associated significant fibrosis (OR, 2.74; 95% CI, 1.32 to 5.70), and non-Hispanic Whites (OR, 2.35; 95% CI, 1.11 to 4.98) and non-Hispanic Asians (OR, 2.01; 95% CI, 1.01 to 4.01) were in order. Visceral adiposity was associated with NAFLD and significant fibrosis despite the association of subcutaneous adiposity in NAFLD and significant fibrosis. Racial/ethnic differences in the association between body fat distribution on NAFLD and significant fibrosis were noted.

Mortality trends, gender, and racial disparities in older adults due to abdominal aortic aneurysm: A nationwide cross-sectional analysis

Abdominal aortic aneurysms (AAAs) are a significant vascular pathology in older adults, often asymptomatic but with high mortality upon rupture. Despite advancements in diagnostic imaging and surgical interventions, AAAs remain a public health concern. This research letter analyzed CDC WONDER data on AAA-related deaths (ICD-10 I71.3 and I71.4) among US adults aged 65+ from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, gender, age group, race/ethnicity, geography, and urbanization status. Between 1999 and 2020, there were 180,037 reported deaths in older adults due to AAA. The overall AAMR decreased from 32.6 to 13.2 per 100,000, with a significant decline from 2014 to 2020 (APC: −1.66; 95% CI: −2.48 to −0.48). Older men had a significantly higher AAMR than older women (31.2 vs. 12). Among racial and ethnic groups, Non-Hispanic (NH) Whites had the highest AAMR at 21.7, followed by NH American Indian or Alaska Native (14.5), NH Black (12.6), NH Asian or Pacific Islander (10.1), and Hispanic populations (8.4). Additionally, non-metropolitan areas exhibited higher AAMRs compared to metropolitan areas (23.9 vs. 18.7). While mortality rates have declined, disparities remain, with higher rates among older men, NH Whites, and non-metropolitan residents, highlighting the need for targeted and equitable interventions.