To test whether national health insurance reforms under the Affordable Care Act (ACA) and state Medicaid expansions affected insurance coverage among American Indian and Alaska Native (AIAN) people and estimate comparative effects for other racial-ethnic groups. We use a difference-in-differences approach that decomposes effects of national insurance reforms from state Medicaid expansions. Data are from the 2011 to 2019 American Community Survey. The analytic sample includes respondents aged 19-64 who identify as non-Hispanic AIAN, non-Hispanic white (NHW), non-Hispanic Black (NHB), or Hispanic and live in areas with a minimum of 50 respondents in each racial-ethnic group for 2009-2013. Medicaid expansions were associated with a 9.0 pp. reduction in uninsurance (p < 0.001), and a 4.4 pp. increase in Medicaid coverage (p = 0.049) among AIAN respondents, with stronger effects among those who reported having Indian Health Services. However, national insurance reforms were not associated with AIAN respondents' insurance coverage. Similarly, Medicaid expansions rather than national reforms improved Hispanic respondents' insurance coverage. Among NHW and NHB respondents, both Medicaid expansions and national reforms improved insurance coverage. Medicaid expansions were the driving force behind the ACA's positive effects on insurance coverage among AIAN people between 2011 and 2019.

Head and neck cancer (HNC) accounts for 5% of U.S. cancers, causing ~14,400 deaths annually. Racial minorities and socioeconomically disadvantaged HNC patients experience worse outcomes, presenting at advanced stages and receiving less effective treatment. Even after adjusting for socioeconomic status, insurance, and disease severity, racial and ethnic disparities persist, suggesting additional contributing factors. Perceived discrimination may drive these disparities. This study examines associations between perceived discrimination and demographic, racial, and oncologic factors in HNC patients, hypothesizing associations with race and later-stage diagnoses. Seventy two HNC patients diagnosed and treated in the past 5 years were recruited. Discrimination was measured using the Discrimination in Medical Settings Scale (DMS), scoring from 7 (no discrimination) to 35 (high discrimination). Patient characteristics and DMS scores were summarized, and associations were analyzed using general linear models. Qualitative insights were collected to guide future research. Most participants were Non-Hispanic White (86.1%), male (68.1%), with an average DMS score of 9.1. Black patients reported lower (nonsignificant) discrimination scores than White patients. Lower-income patients reported significantly higher discrimination scores than high-income patients. No association was found between DMS scores and cancer stage. Qualitative data revealed higher discrimination perceptions among patients with stigmatized histories (e.g., substance use) and lower perceptions among those with limited healthcare exposure. Perceived discrimination in HNC patients is most strongly associated with income, with lower-income patients reporting higher levels of discrimination. Addressing income-related barriers and health-related social needs may help to mitigate perceived discrimination in this population. 3.

Objectives. To expand the understanding of food security among a racially and ethnically diverse sample of US adults living below 200% of the federal poverty line (FPL). Methods. I performed a cross-sectional analysis of the National Health Interview Survey (2019-2023) that included 37 748 respondents. I estimated unadjusted proportions and adjusted probabilities of food security for non-Hispanic White, Black, American Indian/Alaska Native (AIAN), Asian, and Hispanic adults living in severe (< 50% FPL), moderate (50% to < 100% FPL), and near poverty (100% to < 200% FPL). Results. The study reveals important nuances in food security by race and ethnicity. Non-Hispanic Asian adults in severe poverty experienced higher food security than their counterparts in less dire economic situations, non-Hispanic Whites and Hispanics were more similar than previously reported, and non-Hispanic AIAN adults reported extremely low probabilities of food security. Conclusions. Thoroughly documenting and expanding on these patterns of food security for lower-income adults could lead to better understanding of policy mechanisms that could alleviate food insecurity and reduce health disparities by racial and ethnic identity in the United States. (Am J Public Health. 2026;116(6):841-850. https://doi.org/10.2105/AJPH.2026.308508).

Rates and characteristics of firearm access rules among U.S. parents of high-school age teens.

The current AJCC medullary thyroid cancer (MTC) staging system anatomically stratifies lymph node (LN) status but does not incorporate quantitative assessment of LN metastases. Our past work identified ≥ 8 positive LNs and LN ratio (LNR) ≥ 14% as associated with significantly increased MTC-specific mortality. In this study, we 1) validate these thresholds using the NCDB and 2) compare them to the current AJCC staging system. In this retrospective cohort study, patients with MTC were abstracted from NCDB (2004-2020). Chi-square and Fisher's exact tests compared categorical variables, and t-tests continuous variables. Overall survival (OS) was estimated with Kaplan-Meier and log-rank testing. Cox Proportional hazards models estimated the association of LN thresholds with OS after adjusting for covariates. There were 5685 patients (median age: 55years; 56.4% female; 74.3% non-Hispanic White). The 5-year OS was 78.2% (95% confidence interval [CI] 76.4-79.9) for LNR ≥ 14% and 93.9% (95% CI 92.9-94.8) for LNR < 14%. For ≥ 8 positive LNs, 5-year OS was 77.2% (95% CI 74.8-79.4) versus 90.4% (95% CI 89.4-91.4) for < 8. After adjustment, LNR ≥ 14% was associated with a 44% increased mortality risk (hazard ratio [HR] 1.44, 95% CI 1.10-1.88, p = 0.008); ≥ 8 positive LNs conferred a 37% increased hazard (HR 1.37, 95% CI 1.13-1.66, p = 0.001). Neither AJCC N-stage nor nodal status was associated with a significant adjusted hazard difference. Previously identified prognostic LN thresholds for MTC were valid in the NCDB. A LNR ≥ 14% and ≥ 8 positive LNs provide better prognostic discrimination than the current AJCC system and aid refinement of the current MTC staging system.

To describe patterns of gabapentinoid (Gabapentin and Pregabalin) use and concurrent use with other central nervous system (CNS) acting pain medications (opioids and benzodiazepines) among US Medicare beneficiaries following acute ischemic stroke (AIS). We analyzed new outpatient gabapentinoid prescriptions in older stroke survivors between 2009 and 2022. We calculated the percent of new gabapentinoid initiators within 6 months of stroke discharge and analyzed concurrent pain medications prescribed within 30 days of gabapentinoid initiation. We presented trends and geographic patterns standardized by age, discharge destination, and modified Rankin Scale (mRS) to control for variations in the sample composition by age and stroke severity over time. We analyzed a 20% sample of US Medicare beneficiaries aged 65 years or older who were hospitalized for AIS. We included those who met Medicare enrollment criteria, had no prior stroke, no prior gabapentinoid use within 6 months, and were discharged home within 30 days of hospitalization. Among 153,728 stroke survivors, 4.9% received new gabapentinoid prescriptions within 6 months postdischarge. Of the 7595 gabapentinoid initiators, 1579 (21%) had concurrent opioid and 653 (8.6%) had concurrent benzodiazepine prescriptions. In the sample, the median age was 78 years (Quartile Range: 72-84), 55% were female, and 81% were non-Hispanic White. The standardized percentage of gabapentinoid initiators increased from 3.8% in 2009 to 5.9% in 2022 (crude: 3.6% in 2009 to 5.8% in 2022). Despite increases in the number of gabapentinoid initiators, the percentage of concurrent opioid users remained low over time, around 1% of the study population. We observed variation in gabapentinoid initiation and concurrent use with opioids by geography. From 2009 to 2022, poststroke gabapentinoid use increased in older adults, but concurrent use with opioids remained low over time.

Perceptions of the Proposed Food and Drug Administration Graphic Cigarette Warnings Among Adults Who Smoke on a Nondaily or Daily Basis: A Within-Subjects Experiment

This study explores the influence of experiencing one, two or more stressful life events (SLE) in the past year in associations with adolescent sleep and depression symptomatology in the short and long term in the context of coping. Participants were 2323 Hispanic (44.1%), non-Hispanic Black (30.5%), non-Hispanic White (8.6%), and non-Hispanic Asian (16.7%) eighth graders (51.1% female) from 24 public middle schools in southeast Texas in 2019. Multivariate linear and logistic regressions for the depression and sleep outcomes, respectively, were conducted while controlling for clustering in schools. Findings indicated that experiencing two or more SLEs (compared to one or none) was associated with worse adjustment in the short and longer term. Problem-focused coping was concurrently associated with better adjustment but heightened the association between aggregated SLEs and depressive symptoms over time. Avoidant coping was not associated with adjustment longitudinally but, in the short term, it was associated with higher depressive symptoms and exacerbated the association between SLEs and depressive symptomatology. Avoidant coping was also associated with better odds of getting adequate sleep when no SLEs were experienced but conditioned the negative association between experiencing one SLE and worse sleep. Lastly, emotion-focused coping was associated with poorer adjustment both in the short and longer term and exacerbated the negative association between SLEs on short-term adjustment. These findings add incrementally to the literature on adolescent coping with SLEs during a time when researchers and practitioners are grappling with how best to address the increased stress and deteriorating mental health of adolescents.

Objectives. To provide a descriptive assessment of self-reported injury and life disruption attributable to the January 2025 Los Angeles County (LAC), California, firestorm among a sample of people experiencing homelessness (PEH). Methods. We integrated firestorm impact measures into an ongoing longitudinal survey of PEH in LAC. Adult PEH who completed the December 2024 and January 2025 surveys were included. Results. Among 374 respondents (average age 40 years, 45.7% female, 35.8% Hispanic, 23.5% non-Hispanic Black, 30.2% non-Hispanic White, 84.1% chronically homeless), 286 (76.5%) reported life disruption or injury from the firestorm. Compared with sheltered or housed respondents (n = 144), unsheltered vehicular respondents (n = 111) and unsheltered public respondents (n = 119) were more likely to report having their lives in danger, being injured, damage to living space, having to evacuate, damage or loss of belongings, and difficulty finding shelter. Those in evacuation zones (n = 48) more frequently reported having to evacuate, prolonged smoke exposure, and difficulty finding shelter. Conclusions. The firestorm caused injury or disruption for most survey participants, especially unsheltered PEH. Public Health Implications. Wildfire disaster preparedness and response should integrate homeless service coordination, with attention to unsheltered PEH. (Am J Public Health. 2026;116(6):790-797. https://doi.org/10.2105/AJPH.2026.308510).

Disentangling race and ethnicity in predicting symptoms of depression among young adults: A machine learning approach.

To assess trends in births by maternal race and ethnicity following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision. Retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database with detailed geographical data available (2018-2023). States were classified by abortion policy environment based on the Center for Reproductive Rights' five-tier framework. For this analysis, states classified as hostile or illegal were grouped as restrictive, while those classified as expanded access or protected access were grouped as protective. We compared rates of births in restrictive vs. protective states before and after the Dobbs ruling on June 24, 2022, stratified by maternal race and ethnicity. The period from July to December 2022 was considered transitional and excluded from the analysis. The proportion of births among Hispanic patients in restrictive states increased by 12.8 %, while the proportion in protective states increased by 7.6 % (p<0.01). Rates of births among non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients in restrictive states decreased by 3.8 and 5.6 %, respectively (p<0.001). Rates of births among NHW and NHB patients in protective states also decreased by 2.4 and 6.4 %, respectively (p<0.001). Changes for Asian/Pacific Islander and other racial groups were small (<1 % relative change). Following the Dobbs decision, birth rates in restrictive states increased most among Hispanic individuals, while non-Hispanic White and Black populations saw declines. These trends highlight racial and ethnic disparities in the impact of abortion restrictions.

SGLT2 (sodium-glucose cotransporter 2) inhibitors reduce major adverse cardiovascular events (MACE) in type 2 diabetes. However, no direct comparison of individual SGLT2 inhibitor drugs has been conducted, particularly among adults with moderate cardiovascular risk who comprise most people with type 2 diabetes. We used data for commercial, Medicare Advantage, and Medicare fee-for-service beneficiaries to emulate a target trial of adults (≥21 years) with type 2 diabetes and moderate cardiovascular risk who started canagliflozin, dapagliflozin, or empagliflozin between 2015 and 2020. We estimated propensity scores using the super learner ensemble method and incorporated them as inverse probability of treatment weights into Cox models, estimating risk of MACE, expanded MACE, and hyperglycemic and hypoglycemic crises through December 31, 2022. The weighted cohort, balanced on all baseline covariates, included 137 232 patients (mean age 65.7 years [SD, 8.1], 75.3% non-Hispanic White, 57.0% male, 81.9% on metformin, 11.4% on glucagon-like peptide-1 receptor agonists) starting canagliflozin (N=42 877), dapagliflozin (N=17 871), or empagliflozin (N=7648). The risk of MACE was lower among patients starting empagliflozin versus canagliflozin (hazard ratio [HR], 0.92 [95% CI, 0.87-0.97]), driven by reduced risk of all-cause mortality (HR, 0.86 [95% CI, 0.80-0.94]). There was no difference in MACE between empagliflozin versus dapagliflozin or dapagliflozin versus canagliflozin therapy. There was no difference in remaining outcomes between the three drugs. The 3 most used SGLT2 inhibitor medications demonstrate similar effectiveness on cardiovascular outcomes among patients with type 2 diabetes at moderate cardiovascular risk, with differences between these drugs small in magnitude. Clinicians and health systems should prioritize enhancing access to these cardioprotective therapies.

This study aimed to identify dentist, patient, and pre-treatment clinical characteristics associated with local anaesthesia failure during non-surgical endodontic treatment. Data were collected from the National Dental Practice-Based Research Network study entitled "Predicting Outcomes of Root Canal Treatment (PREDICT)", which included 1723 patients. Local anaesthesia failure during treatment was defined as patient-reported pain of 3 or greater on a 0-to-10-point scale. Pre-treatment factors included patient demographics, psychosocial constructs, and pre-treatment clinical findings (e.g., abnormal sensitivity to cold, biting, percussion, palpation). Characteristics with p < 0.1 (after adjustment for clustering with generalized estimating equations) were entered into a model to identify independent associations with failed anaesthesia, and odds ratios were calculated to measure the strength of these associations. A total of 16% of patients reported intra-operative local anaesthesia failure. Failure was associated with patient age < 55 years (p = 0.05), dental treatment fear ("some" to "extremely afraid") (p = 0.005), mandibular teeth (p = 0.005), and greater numbers of abnormal pre-treatment diagnostic findings (p = 0.02). Protective factors included having treatment done by an endodontist (p = 0.002), and the patient being non-Hispanic White (p = 0.007). Comparisons of local anaesthetic techniques by dentist type (general dentist vs. endodontist) showed statistically significant differences in the bivariate analysis, but none remained significant after adjustment for clustering of patients within dentist. Local anaesthesia failed in 16% of cases. Pre-treatment fear was the only significant psychosocial predictor of intra-operative pain. Failure was more likely in mandibular teeth and when multiple abnormal tests were present pre-operatively (e.g., cold sensitivity, percussion tenderness). Younger patients reported more pain, and endodontists had lower pain rates than general dentists.

We assess racial disparities in the prevalence and incidence of clinical outcomes in alcohol-associated liver disease (ALD) in a diverse US population. This is a retrospective multicenter study on patients aged 18-80years with ALD in the Banner Health System from 2012 to 2024. Patients with major adverse liver outcomes (MALO) (ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleeding) at baseline were excluded. Primary outcomes included mortality and the incidence of MALO, cardiovascular diseases (CVD) (coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular accidents (CVA), peripheral artery disease), type II diabetes mellitus (DM), cirrhosis, major adverse cardiovascular events (MACE) (CAD, CHF, CVA, mortality), and all-cause cancer. Competing risk and Cox proportional hazard regression analyses were used for outcome modeling. The cohort included 16,693 patients with ALD. The median age was 50.3 and 67.8% were male. The racial distribution was 66.7% Non-Hispanic White (NHW), 0.4% Asian/Pacific Islander, 3.2% Black, 17.9% Hispanic, and 11.8% Native American/Alaskan (NA). Compared to NHW patients, NA patients had higher mortality (aHR: 1.85, 95% CI: 1.50-2.27) and higher incidence of MALO(aHR: 1.19, 95% CI: 1.04-1.37), cirrhosis (aHR: 1.51, 95% CI: 1.28-1.79) and MACE (aHR: 1.38, 95% CI: 1.20-1.59). NA patients with ALD had higher mortality and incidence of adverse clinical outcomes compared to NHW. Further research is warranted to explore these disparities and develop tailored interventions to improve outcomes.

Social Determinants of Health (SDoH) profoundly influence cancer outcomes, yet their distribution among racially diverse gastrointestinal (GI) cancer patients remains understudied. This study examines racial differences in SDoH between non-Hispanic White (NHW) and Non-White (including Asian, African American, and Hispanic) patients with gastrointestinal (GI) cancers using data from the All of Us Research Program. A total of 6,620 participants with GI cancer were identified using ICD-10 and SNOMED codes, of whom 1,831 completed the SDoH survey and were included in the analysis. Descriptive statistics summarized SDoH constructs such as social cohesion, support, and neighborhood disorder. Variables were categorized using validated scoring tools or grouped into tertiles. Group comparisons used chi-square, t-tests, or Wilcoxon rank-sum tests. Among the 1,831 participants included in the overall cohort, 80.7% (n = 1,478) identified as non-Hispanic White and 13.9% (n = 255) asNon-White, including Black or African American (6.2%), Hispanic or Latino (6.4%), and Asian (1.4%). NHW participants were older (71.0 vs. 64.2years) and reported greater social cohesion (3.9 vs. 3.6, p < 0.001) and support (3.9 vs. 3.7, p < 0.001). Non-White patients reported higher perceived discrimination (1.7 vs. 1.5, p = 0.016), daily spiritual experience (4.5 vs. 3.7, p < 0.001), neighborhood disorder (2.2 vs. 2.1, p < 0.001), food insecurity (23.6% vs. 5.8%, p < 0.001), and housing issues (41.8% vs. 21.8%, p < 0.001). Delayed care (47.1% vs. 26.8%, p < 0.001) and unaffordability of care (9.9% vs. 3.4%, p < 0.001) were also more common. Significant racial disparities in SDoH were observed among GI cancer patients. Non-White individuals faced greater economic hardship, environmental disadvantage, and barriers to healthcare access. WHAT IS KNOWN ON THIS TOPIC: Racial disparities in gastrointestinal cancer outcomes persist, but the social and structural factors underlying these differences are not routinely captured in oncology research. Many cancer datasets emphasize clinical characteristics while underrepresenting patient-reported social, economic, and neighborhood conditions. Addressing social determinants of health is increasingly recognized as necessary to advance equity in cancer care delivery. This study provides a comprehensive, patient-reported assessment of social determinants of health among GI cancer patients in the All of Us Research Program. Non-White patients experience a higher burden of economic instability, neighborhood disadvantage, perceived stress,and barriers to accessing healthcare services. These findings identify concrete social risk domains that can inform equity-focused screening, care navigation, and policy interventions within oncology practice.

Geographic disparities in pediatric and adolescent cancer incidence are poorly characterized in the United States, partly due to suppression of data for small populations. This study describes pediatric cancer incidence rates in and county characteristics of rural counties with publicly available data. We conducted a descriptive study using publicly available age-adjusted all-site pediatric cancer incidence rates per 100,000 children (0-19years) from NCI's State Cancer Profiles (5-year estimates, 2018-2022) combined with county-level sociodemographic characteristics from County Health Rankings (2022). N = 29 non-metropolitan counties (∼2% of rural counties) had publicly available data for analysis. Descriptive statistics summarized incidence rates and county characteristics. Median pediatric cancer incidence in the sample was 23.9 per 100,000 (range: 11.2-39.6). Sample counties had the following medians: population of 105,851; 86.2% non-Hispanic White; 20.8% under 18; 16% child poverty; a $1787 school funding gap; and 51% of children enrolled in free/reduced-price lunch programs. Median primary care physician ratio was 1885:1, and median all-cause child mortality was 48.9 per 100,000. Counties were distributed across all four US Census regions (8 = Northeast, 7 = Midwest, 7 = South, 6 = West). Incidence rates were generally higher in the Northeast and parts of the South, and lower in the West and select Midwest counties, illustrating substantial heterogeneity across the sample rural counties. Despite a non-representative sample, these data provide one of the only recent descriptions of pediatric cancer incidence in rural US counties, highlighting regional variability and the limitations of publicly available surveillance data for pediatric cancers in rural areas.

Bronchiectasis (BE) is a chronic lung disease that impacts health-related quality of life (HRQoL). BE has historically been separated into cystic fibrosis (CF)-related BE (CFBE) and non-CF-related BE (NCFBE [where NCFBE is etiologically heterogeneous or idiopathic]), despite both sharing similar pathophysiology. Patient-reported outcome measures (PROMs) assessing BE symptoms and impacts on HRQoL have largely been developed and validated in NCFBE. This study assessed whether PROMs developed for NCFBE reflect HRQoL experiences of people with CFBE. A preliminary conceptual model of symptoms and HRQoL impacts most relevant to people with CFBE was developed based on expert opinion, the content of existing PROMs, and previous qualitative research. Items from 11 existing PROMs were mapped to this preliminary conceptual model. A focus group discussion guide was created from the preliminary conceptual model. US participants aged ≥ 19 years with a self-reported diagnosis of CF and BE were eligible for participation in one of two focus groups (December 2023 or January 2024). Focus groups were recorded and transcribed verbatim, and thematic analysis (ATLAS.ti Web) was used to identify recurring themes from the discussions. Final themes were mapped back to the preliminary conceptual model to identify potential gaps between existing PROMs and relevant HRQoL impacts. A total of 19 people with CFBE participated in the virtual focus groups. Most participants were female (63%) and non-Hispanic White (95%), ranging from 22 to 67 years of age. Focus group discussions revealed five primary themes: Emotional Symptoms, Physical Function, Physical Symptoms, Social Health, and Treatment Burden. A total of 242 unique mentions of BE-related symptoms and impacts on HRQoL were mapped to the model. Generally, concerns about symptoms and HRQoL impacts expressed by participants were consistent with the model. Potential discrepancies included feelings of loss of control, sinusitis, and hemoptysis. Although not included in the model, loss of control likely overlapped with anxiety or treatment burden. Hemoptysis, although raised during focus group discussions, was not captured in the model, but is captured in several PROMs. Measures developed to assess patient‑reported outcomes in NCFBE may be extended to CFBE, pending cognitive and psychometric validation.

To examine associations between maternal-paternal racial pairings and adverse perinatal outcomes in the United States. We conducted a retrospective population-based cohort study using 2016-2023 U.S. birth certificate data from the CDC National Vital Statistics System. Singleton live births with complete data on maternal and paternal race were included. Parental race was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian, resulting in 16 racial dyads. Outcomes included preterm birth (PTB, <37 weeks), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and small for gestational age (SGA, <10th percentile). Adjusted relative risks (aRRs) were estimated using multivariable Poisson regression with robust error variance, adjusting for maternal age, body mass index, parity, insurance status, nativity, chronic hypertension, pregestational diabetes, smoking, and social vulnerability index. Of 26,284,090 births, 12,595,260 (47.9%) had White fathers, 9,147,469 (34.8%) Hispanic, 3,131,956 (11.9%) Black, and 1,409,405 (5.4%) Asian fathers. Compared to White fathers, PTB risk was higher with Black (aRRs 1.09-1.21) and Hispanic fathers (1.14-1.31), and lower among Asian fathers (0.84-0.93) regardless of maternal race. HDP risk was consistently lower among Asian (0.72-0.87) and Black fathers (0.86-0.93), while associations with Hispanic fathers were inconsistent. GDM risk was lower among Black fathers (0.87-0.94). For Hispanic fathers, GDM risk decreased among White and Black mothers but increased in Hispanic mothers. Asian fathers were associated with higher GDM risk compared to White fathers only among Asian mothers. SGA risk was higher for all non-White paternal groups, highest with Asian fathers (1.40-1.86). Conclusion Paternal race was associated with perinatal risk. Non-White paternal race was associated with higher risks of PTB and SGA, whereas risks of HDP and GDM varied according to the specific maternal-paternal racial pairing.

Arthrosis is prevalent in later life and commonly coexists with cardiovascular and other circulatory conditions. We quantified U.S. mortality in which diseases of the circulatory system (ICD-10: I00-I99) were the underlying cause of death, and arthrosis (M15-M19) was recorded as a contributing cause among adults aged ≥ 55 years. We used the CDC WONDER multiple-cause-of-death database (1999-2023). Age-adjusted mortality rates (AAMRs; standardised to the 2000 U.S. population) and age-specific crude mortality rates were calculated. Temporal trends were evaluated using joinpoint regression to estimate the average annual percent change (AAPC). Analyses were stratified by sex, age group, race/ethnicity, census region, urbanisation, and state. Deaths decreased from 7,290 in 1999 to 2,022 in 2023 (- 72.26%). The AAMR declined from 12.67 to 2.27 per 100,000, with an AAPC of - 6.87% (95% CI: -7.64 to - 6.09); Joinpoint regression revealed a non-linear decline with distinct temporal phases separated by identifiable inflection points. In 2023, the AAMR was higher in females than males (2.63 vs. 1.72 per 100,000) and was concentrated among adults aged ≥ 85 years (21.10 per 100,000). Nonmetropolitan areas had higher AAMRs than metropolitan areas; however, direct comparisons were restricted to 2020, the most recent year with available estimates for both categories. Hispanic (1.34) and non-Hispanic Other (1.02) groups had lower AAMRs than non-Hispanic Black (2.50) and non-Hispanic White (2.48) groups. State-level AAMRs in 2023 ranged from 1.17 (Arizona) to 5.83 (Oregon). U.S. circulatory-system mortality with coexisting arthrosis declined substantially from 1999 to 2023; however, marked demographic and geographic heterogeneity persisted. Continued surveillance is warranted and may inform cardiovascular risk assessment in older adults with arthrosis.

Caring for persons living with dementia often involves high levels of physical demands and emotional burden, which may undermine caregivers' sleep quality. Few studies have examined sleep health among Black caregivers of persons living with dementia, despite the fact that they are underrepresented in dementia research and experience poorer sleep outcomes compared to non-Hispanic White caregivers. This study aimed to examine the relationships between caregiving stressors and sleep health among family caregivers of persons living with dementia and whether these relationships differ between Black and non-Hispanic White caregivers. Data were drawn from 288 Black (Mage = 59.91) and non-Hispanic White (Mage = 62.67) caregivers of persons living with dementia (> 64 years old) in the 2017 National Study of Caregiving. Sleep outcomes included sleep disturbance and prior-night sleep difficulty. Hierarchical multiple linear regression models were conducted to examine the study aims. Subjective caregiving stressor (i.e., role overload) was positively associated with sleep disturbance. A significant interaction showed that the association between role overload and sleep disturbance was stronger among Black caregivers than in non-Hispanic White caregivers. The study identifies the detrimental role of role overload for caregiver sleep health. Findings also suggest that Black caregivers of persons living with dementia may experience greater vulnerability to the adverse role of role overload in relation to sleep. Further research is needed to better understand Black caregivers' experiences and the potential role of culturally appropriate interventions in improving their sleep health.