non-Hispanic Native Americans Research Articles

Temporal trends in rural vs urban colon cancer mortality in Texas: A SEER database analysis from 2012 to 2021.

36 Background: Colorectal cancer is a major concern for the U.S. healthcare system, being the fourth most common cancer by incidence in the country with 152,810 cases in 2024. Measuring the burden this disease places on patients and health resources may serve to optimize our approach to the detection, management and resource allocation for combating this ailment. Methods: Our study is a population-based study cohort of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) for colon cancer deaths in Texas over the most recent available decade, 2012 through 2021. The National Center for Health Statistics Urban-Rural Classification Scheme was used to classify counties according to the 2013 US Census classification: urban (≥ 50,000) and rural (< 50,000). We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. Differences between AAMR were tested by comparing the 95% confidence intervals (95% CI) for the individual rates. The annual percent change (APC) in AAMR was tested using negative binomial regression. Subgroup analyses included age group, sex, and race/ethnicity. Results: Over the study period, 10.8% of the study population lived in rural areas and 89.2% lived in urban areas. A total of 33,591 colon-cancer deaths were reported during the study period with 5,423 (16.1%) in rural counties and 28,168 (83.9%) in urban counties. At the beginning of the study period the rural AAMR (13.9 [12.7 to 15.1]) was significantly higher than urban AAMR 12.1 [95% CI 11.7 - 12.6]). The rural AAMR rose significantly over the study period (APC 1.1% [95% CI 0.3% - 1.9%]; p = 0.0050) to AAMR 14.9 (95% CI 13.7 to 16.1). In contrast, the urban AAMR did not change over study period (APC -0.3% [95% CI -0.7 to 0.1]; p = 0.1444) and was equal to the initial AAMR 12.1 (95% CI 11.7 to 12.5). On subgroup analyses, males, people ages 25-64 years, Hispanics, Non-Hispanic Blacks, Non-Hispanic Asians, and Non-Hispanic Native Americans in rural areas each had significant and increasing trends in AAMR. Conclusions: Our analysis revealed an increase in AAMR in rural counties of Texas, reflecting a concerning trend with regard to colorectal cancer in this region. This may be due to higher poverty rates, lower level of education, more distance from healthcare facilities and difficulties with transportation faced by rural counties. Furthermore, rural areas also report higher rates of obesity and poor dietary habits. Rural areas also face a shortage of Primary Care Physicians (PCP’s), with metropolitan counties retaining 1.7 times as many PCP’s as rural counties, and 82.5% of counties without a PCP being rural.

Abstract 3474: Racial disparities in receipt of surveillance mammography after breast cancer diagnosis

Abstract Background: The 5-year survival rate for breast cancer (BC) stands at an estimated 91%, with approximately 3.8 million BC survivors in the U.S. This large population of breast cancer survivors remains at risk of loco-regional recurrence, with variations noted across racial groups. White survivors face a locoregional breast cancer recurrence rate of 1.8%, whereas Black, Asian, and Hispanic survivors experience higher rates of 3.9%, 3.6%, and 3.1%, respectively. Notably, Black BC survivors with recurrent breast cancer exhibit a median survival time of 1.8 years compared with 3.6 years observed for White BC survivors. Current recommendations from the U.S. Preventative Services Task Force and the American College of Radiology advocate for surveillance through annual mammography and routine clinical visits following breast-conserving surgery and lumpectomies. However, there are gaps in the data available regarding disparities in the utilization of surveillance mammography by race/ethnicity. Thus, the goal of this study is to estimate race/ethnic disparities in surveillance mammography utilization and its impact on survival among breast cancer survivors at a large comprehensive cancer center. Methods: A retrospective cohort study of female breast cancer survivors ≥19 years diagnosed and/or treated at the Duke Cancer Institute (DCI) between 2014 and 2022 was conducted. Data was abstracted on patient socio-demographics, cancer type (invasive ductal and ductal in situ carcinomas) and utilization of surveillance mammography within 2-5 years post initial breast cancer diagnosis. Chi-squared testing will be used to analyze rates of mammography surveillance receipt among different races presenting with BC at DCI. Kaplan-Meier estimates will be used for analysis on survival. Results: A total of 10,904 women with a mean age of 43.7 years were included in the study. The study cohort is comprised of 69% non-Hispanic (NH) White, 24% NH Black, 2.2% Hispanic, 0.5% NH Native American, 1% NH other, and 3.2% NH Asian women. There were 1,791 cases of ductal in situ carcinomas and 9,113 invasive ductal carcinoma cases. NH Black women had the lowest 5-year relative survival rate (81.5%) of all represented racial groups: NH White 89.1%, Hispanic 95.3%, NH Native 87.8%, Asian 97.9%, and NH Other 88.0%. Ongoing analysis will be completed to estimate disparities in the use of post-treatment surveillance mammography amongst breast cancer survivors. Conclusions: This study will inform efforts to increase post-treatment surveillance and improve adherence to survivorship guidelines with the ultimate goal of reducing mortality disparities among breast cancer survivors. Citation Format: Jasmine G. Wilkerson, Frances Wang, Yadurshini Raveendran, Tomi Akinyemiju. Racial disparities in receipt of surveillance mammography after breast cancer diagnosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3474.

Life expectancy among Native Americans during the COVID-19 pandemic: estimates, uncertainty, and obstacles.

Few reliable estimates have been available for assessing the impact of the COVID-19 pandemic on mortality among Native Americans. Using deidentified publicly available data on deaths and populations by age, we estimated life expectancy for the years 2019-2022 for single-race non-Hispanic Native Americans. Life expectancy in 2022 was 67.8years, 2.3years higher than in 2021 but a huge 4-year loss from 2019. Although our life expectancy estimates for 2022 varied under different assumptions about racial/ethnic classification and age misreporting errors, all estimates were lower than the average for middle-income countries. Estimates of losses and gains in life expectancy were consistent across assumptions. Large reductions in COVID-19 death rates between 2021 and 2022 were largely offset by increases in rates of death from unintentional injuries (particularly drug overdoses), chronic liver disease, diabetes, and heart disease, underscoring the difficulties facing Native Americans in achieving reductions in mortality, letalone returning to levels of mortality prior to the pandemic. Serious data problems have persisted for many years, but the scarcity and inadequacy of estimates during the pandemic have underscored the urgent need for timely and accurate demographic data on the Native American population.

Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992–2020

BackgroundWe use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. MethodsWe used data (1992–2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (1999–2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. ResultsWe found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DiscussionSteep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.

Dual Diagnosis and Alcohol/Nicotine Use Disorders: Native American and White Hospital Patients in 3 States

Nationally, mental illness prevalence is comparable among Native Americans and Whites experiencing alcohol and nicotine use disorders. However, authors are concerned that mental illness in Native Americans with substance use disorders may be disparately underdiagnosed in medical settings. For 3 states with large Native American populations, this study compares the prevalence of mental illness diagnoses among Native Americans and Whites hospitalized with alcohol/nicotine use disorders. In 2021, hospital discharge data were used to compare non-Hispanic Native Americans with non-Hispanic Whites in Arizona and New Mexico (2016-2018) and (regardless of Hispanic ethnicity) Native Americans with Whites in Oklahoma (2016-2017). Differences in any mental illness, mood, and anxiety diagnoses were assessed using multilevel regressions (adjusted for demographics, payor, comorbidities, facility). Adjusted predicted probabilities were constructed. Among alcohol-related discharges, probabilities of non-Hispanic Native Americans and non-Hispanic Whites receiving any mental illness diagnoses in Arizona were 18.0% (95% CI=16.1, 19.9) and 36.8% (95% CI=34.1, 39.5), respectively; in New Mexico, they were 24.5% (95% CI=20.7, 28.3) and 43.4% (95% CI=38.7, 48.1). Oklahoma's probabilities for Native Americans and Whites were 30.7% (95% CI=27.4, 34.0) and 36.8% (95% CI=33.5, 40.2), respectively. Among nicotine-related discharges, any mental illness diagnosis probabilities for non-Hispanic Native Americans and non-Hispanic Whites in Arizona were 21.2% (95% CI=18.9, 23.5) and 33.1% (95% CI=30.3, 35.9), respectively; in New Mexico, they were 25.9% (95% CI=22.7, 29.1) and 37.4% (95% CI=33.8, 40.9). Oklahoma's probabilities for Native Americans and Whites were 27.3% (95% CI=25.1, 29.6) and 30.2% (95% CI=28.0, 32.4), respectively. Mood and anxiety diagnoses were also significantly lower for non-Hispanic Native Americans in Arizona/New Mexico and Native Americans in Oklahoma. Findings suggest disparate underdiagnosis of mental illness among Native Americans hospitalized with alcohol/nicotine use disorders in the examined states.

Highly vulnerable communities and the Affordable Care Act: Health insurance coverage effects, 2010-2018.

Initially implemented in 2014 in some U.S. states, the Medicaid expansions under the Affordable Care Act (ACA) aimed to make health insurance coverage more accessible to the low-income population. This paper aims to quantify the impact of the ACA Medicaid expansions on insurance coverage among racial/ethnic minorities, immigrants, single mothers, veterans, and low-education whites-i.e., the sectors of the population identified with some of the highest healthcare needs. We focus on individuals 18-64 years of age earning 138% or less of the federal poverty level from the American Community Survey, 2010-2018 (n=2,927,402). We use difference-in-differences (DD) and difference-in-difference-in-differences (DDD) approaches with propensity scores matched comparison groups to estimate pre-post ACA insurance coverage differences between individuals living in states that participated in the ACA Medicaid expansions and those living in non-participating states, and to estimate if such differences vary across subgroups. We find that insurance coverage rates increased for all subgroups; yet, the ACA benefits have not been evenly distributed across them. Low-education whites, non-Hispanic whites, females, and non-Hispanic Native Americans exhibited the highest improvements in insurance coverage. Our results contribute to the understanding of recent trends in racial and socioeconomic disparities in healthcare and the appropriate policy prescriptions to ameliorate them.

Incidence of VTE Among Patients with a Cancer Diagnosis in Oklahoma County

Background: Patients with cancer are at elevated risk for venous thromboembolism (VTE). Active cancer contributes a 4-7 fold increased risk for VTE; however, the incidence of VTE stratified by subpopulations of patients diagnosed with cancer, especially race/ethnicity, is uncertain. Objective: Describe the incidence of VTE among adult patients (age ≥ 18 years) with a cancer diagnosis in Oklahoma County, OK according to age, gender, race, and cancer type. Methods: In collaboration with the Centers for Disease Control and Prevention, we established a population-based surveillance system for VTE in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Patients were linked to the Oklahoma Central Cancer Registry. Any patient with a cancer diagnosis since 1997, excluding basal or squamous cell carcinoma, were included in the population-at-risk. Active cancer was defined as metastatic or a diagnosis ≤6 months before their VTE diagnosis. Poisson regression was used to estimate incidence rates (IRs) and 95% confidence intervals (CIs), which are reported per 1,000 person years (PY). Estimates with <10 events were suppressed. Results: Among all patients aged ≥18 years with a cancer diagnosis since 1997, 1.5% (n = 881) had a VTE event during the 2-year surveillance period. The overall annual age-adjusted incidence of VTE among those with cancer was 6.8 per 1,000 PY (95% CI: 5.81, 7.95). The demographic-specific incidence rates are summarized in Table 1. The VTE incidence did not significantly differ by sex. When stratified by age, annual VTE incidence was similar among those aged 18-39 years (6.1/1,000 PY, 95% CI: 4.35, 8.61), 40-59 years (6.2/1,000 PY, 95% CI: 5.4, 7.14), and 60-79 years (7.2/1,000 PY, 95% CI: 6.55, 7.90), however, the incidence was significantly higher (p<0.05) in those aged 80+ years (10.1/1,000 PY, 95% CI: 8.77, 11.61). When patients with a cancer diagnosis were stratified by race/ethnicity, non-Hispanic blacks had the highest VTE incidence (11.7/1,000 PY, 95% CI: 10.00, 13.59), followed by Hispanics (8.0/1,000 PY, 95% CI: 5.66, 11.44), non-Hispanic whites (6.9/1,000 PY, 95% CI: 6.41, 7.48), other non-Hispanic/unknown (5.8/1,000 PY, 95% CI: 3.45, 9.85), and non-Hispanic Native Americans (2.6/1,000 PY, 95% CI: 1.39, 4.79). VTE incidence was highest among those with active cancer or a history of cancer within the past three years, after which it appeared to decrease. When stratified by primary cancer type, VTE incidence was highest among those with brain cancer (16.6/1,000 PY, 95% CI: 11.06, 25.04) and lowest among those with prostate cancer (5.2/1,000 PY, 95% CI: 4.20, 6.44). As shown in Table 2, when stratified by cancer type, the incidence of VTE was higher (non-overlapping CIs) among those with active cancer compared to those with a history of cancer >6 months for several tumor types. Discussion: The incidence of VTE among those with cancer differs by race/ethnicity, with non-Hispanic blacks bearing the highest burden of disease. The risk of VTE persists and is particularly elevated up to three years after a cancer diagnosis. Disclosures Raskob: Eli Lilly: Consultancy; Pfizer: Consultancy, Honoraria; Portola: Consultancy; Novartis: Consultancy; BMS: Consultancy, Honoraria; Janssen R&D, LLC: Consultancy, Honoraria; Tetherex: Consultancy; Daiichi Sankyo: Consultancy, Honoraria; Anthos: Consultancy; Bayer Healthcare: Consultancy, Honoraria; Boehringer Ingelheim: Consultancy.

Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US.

BackgroundIncrease in mortality involving poisoning, particularly by narcotics, is known to have been one of the factors that affected life expectancy in the US during the last two decades, especially for white Americans and Native Americans. However, the contribution of medicaments other than narcotics to mortality in different racial/age groups is less studied.MethodsWe regressed annual rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics (ICD-10 codes T36-39.xx or T41-50.8 but not T40.xx present as either underlying or contributing causes of death), as well as annual rates of mortality for certain subcategories of the above, including mortality involving poisoning by psychotropic drugs but not narcotics/psychodysleptics (ICD-10 codes T43.xx but not T40.xx present as either underlying or contributing causes of death) in different age/racial groups for both the 2000–2011 period and the 2011–2017 period against calendar year.ResultsAnnual numbers of deaths involving poisoning by medicaments but not narcotics/psychodysleptics grew from 4,332 between 2000–2001 to 11,401 between 2016–2017, with the growth in the rates of those deaths being higher for the 2011–2017 period compared to the 2000–2011 period. The largest increases in the rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics were in non-elderly Non-Hispanic Native Americans, followed by Non-Hispanic whites. Most of those increases came from increases in the rates of mortality involving poisoning by psychotropic medications; the latter rates grew for the period of 2015–2017 vs. 2000–2002 by factors ranging from 2.75 for ages 35-44y to 5.37 for ages 55-64y.ConclusionsThere were major increases in mortality involving poisoning by non-narcotic, particularly psychotropic medicaments, especially in non-elderly non-Hispanic whites and Native Americans. Our results support the need for a comprehensive evaluation of the effect of psychotropic medications on health-related outcomes, including mortality for causes other than poisoning, and the impact of medication misuse.

Associations Between Maternity Care Practices and 2-Month Breastfeeding Duration Vary by Race, Ethnicity, and Acculturation.

Objectives This study examines the associations between specific maternity care practices and breastfeeding duration for Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White women. Methods We analyzed data from the 2012-2014 New Mexico Pregnancy Risk Assessment Monitoring System. We used survey language as a proxy measure of acculturation and categorized women as Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White. We conducted bivariate analyses to compare rates of breastfeeding at 2 months and experiences of maternity care practices and logistic regression analysis to estimate the effects of these practices on breastfeeding duration for each group. Results Hispanic women were less likely than non-Hispanic women to breastfeed for at least 2 months (67.9% vs. 76.6%; p = 0.000); however, this varied significantly by acculturation level: 78.1% of Spanish-speaking Hispanic women compared to 66.1% of English-speaking Hispanic women breastfed for at least 2 months (p = 0.000). The effects of specific maternity care practices on duration varied across groups. Among non-Hispanic White, Native American, and English-speaking Hispanic women, breastfeeding while at the hospital had the strongest effect (AOR 2.09, 95% CI 1.67-2.61; AOR 2.71, 95% CI 2.08-3.52; and AOR 1.99, 95% CI 1.76-2.25, respectively). Among Spanish-speaking Hispanic women, being encouraged to breastfeed on demand had the strongest effect (AOR 5.179, 95% CI 3.86-6.94). Conclusions for Practice The effects of maternity care practices on breastfeeding duration vary by race, ethnicity, and acculturation level. Health care systems must acknowledge the diversity of their patient populations when seeking to develop and implement breastfeeding-friendly practices.

Race, Ethnicity, and End-of-Life Care in Dialysis Patients in the United States.

End-of-life care is a prominent consideration in patients on maintenance dialysis, especially when death appears imminent and quality of life is poor. To date, examination of race- and ethnicity-associated disparities in end-of-life care for patients with ESRD has largely been restricted to comparisons of white and black patients. We performed a retrospective national study using United States Renal Data System files to determine whether end-of-life care in United States patients on dialysis is subject to racial or ethnic disparity. The primary outcome was a composite of discontinuation of dialysis and death in a nonhospital or hospice setting. Among 1,098,384 patients on dialysis dying between 2000 and 2014, the primary outcome was less likely in patients from any minority group compared with the non-Hispanic white population (10.9% versus 22.6%, P<0.001, respectively). We also observed similar significant disparities between any minority group and non-Hispanic whites for dialysis discontinuation (16.7% versus 31.2%), as well as hospice (10.3% versus 18.1%) and nonhospital death (34.4% versus 46.4%). After extensive covariate adjustment, the primary outcome was less likely in the combined minority group than in the non-Hispanic white population (adjusted odds ratio, 0.55; 95% confidence interval, 0.55 to 0.56; P<0.001). Individual minority groups (non-Hispanic Asian, non-Hispanic black, non-Hispanic Native American, and Hispanic) were significantly less likely than non-Hispanic whites to experience the primary outcome. This disparity was especially pronounced for non-Hispanic Native American and Hispanic subgroups. There appear to be substantial race- and ethnicity-based disparities in end-of-life care practices for United States patients receiving dialysis.

432 Characteristics and Predictors of Tramadol Misuse Results from the 2015 National Survey on Drug Use and Health

The non-medical use of prescription medications, especially opioids, continues to be a serious public health concern impacting emergency departments, with the death rate from synthetic opioids increasing by 72.2% from 2014 - 2015. Tramadol prescriptions have increased substantially over the last decade, including by emergency physicians. The objective of the current study is to determine the predictors of tramadol misuse by utilizing the nationally representative National Survey of Drug Use and Health (NSDUH) data. NSDUH, managed by Substance Abuse and Mental Health Services Administration (SAMHSA), is the annual public use self-report based dataset collecting information on the nature and extent of substance use and misuse in the US. The 2015 NSDUH data files were analyzed for this study using a cross-sectional study design. The respondents were classified into two groups, past year tramadol users, and misusers, based on the screening questions assessing past year use and misuse of tramadol products. The prevalence of selected demographic, clinical factors and substance use and abuse, including prescription medications, was assessed descriptively for the two population groups using cross-tabulated frequencies and chi-sq tests. Logistic regression methods were used to outline the predictors of tramadol abuse adjusting for the selected covariates. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were reported. Overall, the 2015 NSDUH survey comprised of 57,146 respondents, of which 3,211 respondents (5.6%) reported using tramadol products over the last year. Among the total tramadol users, 439 (13.7%) respondents reported misusing these products in the previous year. The prevalence of tramadol misuse in the total 2015 NSDUH sample was 0.8%. The proportion of males (40.3% vs 32.7%, p=0.001), unmarried (75.9% vs 61.3%, p<0.001), non-Hispanic whites (69% vs 65%, p=0.01), and Hispanics (14.9% vs 9.3%, p=0.0001) was higher in past year tramadol misusers. The use and misuse of other substances in the previous year was more prevalent in the tramadol misusers. Tramadol misuse was significantly more likely among previous year users of oxycodone (OR: 2.45, 95% CI: 1.52 - 3.96, p=0.0002), and morphine (OR: 4.46, 95% CI: 2.04 - 9.73, p=0.0002), while hydrocodone and morphine users had a 40% and 52% decreased risk, respectively. Previous year oxycodone misuse (OR: 1.79, 95% CI: 1.07 - 2.99, p=0.01), morphine misuse (OR: 4.71, 95% CI: 2.07 - 10.73, p=0.0002), sedative misuse (OR: 2.76, 95% CI: 1.31 - 5.83, p=0.007), and heavy alcohol use (OR: 1.79, 95% CI: 1.10 - 2.94, p=0.01) were significant predictors of tramadol misuse. In contrast, the risk of tramadol misuse was significantly lower in the ages 26 - 34 years (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04), and non-Hispanic Native Americans (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04). Tramadol is often prescribed in the emergency department. The results indicate a substantial prevalence of tramadol misuse based on the analysis of a nationally representative sample of survey respondents. Prominent demographic and clinical differences exist in the respondents who reported using and misusing tramadol products. Certain opioids were highlighted as predictors of tramadol misuse. Emergency physicians should be aware of the potential of tramadol misuse and potential predictive factors of such misuse.

Risk of ESRD in the United States

Although incidence rates of end-stage renal disease (ESRD) in the United States are reported routinely by the US Renal Data System (USRDS), risks (probabilities) are not reported. Short- and long-term risk estimates need to be updated and expanded to minority populations, including Native Americans, Asian/Pacific Islanders, and Hispanics. Risk estimation from surveillance data in large populations using life-table methods. A competing-risks framework was applied by constructing a hypothetical cohort followed from birth to death. Total US population. Incidence and mortality rates of ESRD were obtained from the USRDS; all-cause mortality rates were obtained from CDC WONDER. Age, sex, race/ethnicity, and year. 10-year to lifetime risks (cumulative incidence) of ESRD. Among males, lifetime risks of ESRD from birth using 2013 data were 3.1% (95% CI, 3.0%-3.1%) for non-Hispanic whites, 8.0% (95% CI, 7.9%-8.2%) for non-Hispanic blacks, 3.8% (95% CI, 3.4%-4.9%) for non-Hispanic Native Americans, 5.1% (95% CI, 4.8%-5.4%) for non-Hispanic Asians/Pacific Islanders, and 6.2% (95% CI, 6.1%-6.4%) for Hispanics. Among females, lifetime risks were 2.0% (95% CI, 2.0%-2.1%) for non-Hispanic whites, 6.8% (95% CI, 6.7%-6.9%) for non-Hispanic blacks, 3.6% (95% CI, 3.3%-4.2%) for non-Hispanic Native Americans, 3.8% (95% CI, 3.6%-4.0%) for non-Hispanic Asian/Pacific Islanders, and 4.3% (95% CI, 4.2%-4.5%) for Hispanics. Lifetime risk of ESRD from birth increased from 3.5% in 2000 to 4.0% in 2013 in males and decreased from 3.0% to 2.8% in females. Standard life-time assumption of fixed age-specific rates over time and possible ESRD misclassification. To be useful in clinical practice, this application will require additional predictors (eg, comorbid conditions and chronic kidney disease stage). ESRD risk in the United States varies more than 2-fold among racial/ethnic groups for both sexes.

The potential protective effects of youth assets from adolescent sexual risk behaviors

Purpose To examine the relationship among individual youth assets and adolescent sexual risk behaviors. Methods Cross-sectional, in-home interview data from randomly selected inner-city neighborhood teenagers (N = 1253) and their parents (N = 1253) were analyzed. Demographic information (e.g., age, parental income, family structure) was statistically controlled for while investigating the relationships among youth asset and sexual activity outcomes using logistic regression analyses. Potential interactions between the demographic variables and the assets were also examined. The five sexual risk behaviors included “never had sexual intercourse,” current sexual activity, number of lifetime sexual partners, current use of birth control, and age at first intercourse. Results Youth mean age was 15.4 (± 1.7) years; 52% were female; 49% were Non-Hispanic Caucasian, 23% Non-Hispanic African-American, 19% Hispanic and 10% Non-Hispanic Native American. Sixty-three percent reported never having had sexual intercourse. Multiple logistic regression analyses indicated that, after controlling for the demographic variables and the other significant assets, Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations were independently significantly related ( p < .05) to whether or not youth had ever participated in sexual intercourse. Individual multiple logistic regression analyses indicated that, after controlling for the demographic variables, Peer Role Model and Family Communication assets were each significantly associated with birth control use by sexually active youth ( p < .05). Conclusions Specific youth assets may have a protective effect from certain sexual risk behaviors.