Noninstitutionalized US Adults Research Articles

Utilization of Dental Care and Oral Health Outcomes in the United States: Results from the National Health and Nutrition Examination Survey (2017-2020).

This analysis aims to evaluate the association between the time since and reason for a patient's last dental appointment across clinical oral health outcomes. We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately. Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43). Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes.

Disparities in Exposure to Tobacco on Television or Streaming Platforms

With the rise in popularity of streaming platforms concerns about exposure to tobacco advertising and promotion have emerged. While tobacco marketing and promotion through traditional television (TV) media channels has been extensively studied, less is known about exposure to tobacco through TV or streaming platforms and its associated factors. To examine the prevalence and factors associated with exposure to tobacco products advertised, marketed, or promoted on TV or streaming platforms among US adults. This cross-sectional study used data from the National Cancer Institute's Health Information National Trends Survey (HINTS 6), conducted from March 7 to November 8, 2022. The nationally representative survey included noninstitutionalized civilian US adults. The primary outcome was self-reported exposure to tobacco advertisements, marketing, or promotion on TV or streaming platforms in the past 3 months. Factors associated with exposure were explored using multivariable survey logistic regression. The study included 5775 participants (3415 females [weighted percentage, 50.5%], 970 Hispanic individuals [weighted percentage, 16.9%], 872 non-Hispanic Black or African American individuals [11.1%], 3144 non-White individuals [61.5%], and 632 individuals who currently smoke [12.0%]). The estimated exposure to tobacco advertisements, marketing, or promotion on television or streaming platforms was 12.4% (95% CI, 10.8%-14.2%). Multivariable logistic regression analysis revealed that exposure odds were higher among those who had a level of education of high school or less (adjusted odds ratio [aOR], 1.60; 95% CI, 1.08-2.37), individuals who currently smoke (aOR, 1.85; 95% CI, 1.06-3.25), non-Hispanic Black or African American respondents (aOR, 2.20; 95% CI, 1.40-3.45) and Hispanic respondents (aOR, 1.58; 95% CI, 1.04-2.42). In this study of the prevalence of exposure to tobacco advertisements on TV or streaming platforms among US adults, disparities in exposure by race or ethnicity, education level, and smoking status were identified. These findings underscore the need for targeted public health interventions and regulation to address these disparities and reduce the impact of tobacco advertisements on vulnerable populations.

Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013-2017: A nationwide population-based study.

In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013-2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2-28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92-3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61-5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97-10.48) and HIV (AOR 2.69, 95% CI 2.44-2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03-1.26), ages 30-44 years (AOR 1.37, 95% CI 1.17-1.61), 45-60 years (AOR 1.55, 95% CI 1.30-1.80) and ≥60 years (AOR 1.53, 95% CI 1.28-1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06-1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18-1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66-0.97). These findings may help guide optimal HBV screening in the universal testing era.

Predicted Cardiovascular Risk by the PREVENT Equations in US Adults With Stage 1 Hypertension.

The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends initiation of antihypertensive medication for adults with stage 1 hypertension (systolic blood pressure, 130-139 mm Hg, or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10% estimated by the pooled cohort equations (PCEs). In 2023, the American Heart Association published the predicting risk of cardiovascular disease events (PREVENT) equations to estimate ASCVD and total cardiovascular disease risk. We analyzed US National Health and Nutrition Examination Survey data from 2013 to 2020 for 1703 adults aged 30 to 79 years without self-reported cardiovascular disease with stage 1 hypertension. We estimated 10-year ASCVD risk by the PCEs and 10-year ASCVD and total cardiovascular disease risk by the base PREVENT equations. Analyses were weighted to represent noninstitutionalized US adults with stage 1 hypertension. Mean 10-year ASCVD risk was 5.4% (95% CI, 5.0%-5.9%) and 2.9% (95% CI, 2.7%-3.1%) using the PCEs and PREVENT equations, respectively. The proportion with 10-year ASCVD risk of 10% to <15% and ≥15% was 8.1% and 7.8% estimated by the PCEs, respectively, and 3.0% and 0.3% estimated by the PREVENT equations, respectively. No participants had a 10-year ASCVD risk ≥10% on the PREVENT equations and <10% on the PCEs, while 12.5% had a 10-year ASCVD risk ≥10% on the PCEs and <10% on the PREVENT equations. The mean 10-year total cardiovascular disease risk estimated by the PREVENT equations was lower than the mean 10-year ASCVD risk on the PCEs. Among US adults with stage 1 hypertension, the 10-year predicted ASCVD risk estimated by the PREVENT equations was approximately half the risk estimated by the PCEs.

Perceived Risk for Severe COVID-19 and Oral Antiviral Use Among Antiviral-Eligible US Adults.

Oral antiviral medications are important tools for preventing severe COVID-19 outcomes. However, their uptake remains low for reasons that are not entirely understood. Our study aimed to assess the association between perceived risk for severe COVID-19 outcomes and oral antiviral use among those who were eligible for treatment based on Centers for Disease Control and Prevention (CDC) guidelines. We surveyed 4034 non-institutionalized US adults in April 2023, and report findings from 934 antiviral-eligible participants with at least one confirmed SARS-CoV-2 infection since December 1, 2021 and no current long COVID symptoms. Survey weights were used to yield nationally representative estimates. The primary exposure of interest was whether participants perceived themselves to be "at high risk for severe COVID-19." The primary outcome was use of a COVID-19 oral antiviral within 5days of suspected SARS-CoV-2 infection. Only 18.5% of antiviral-eligible adults considered themselves to be at high risk for severe COVID-19 and 16.8% and 15.9% took oral antivirals at any time or within 5days of SARS-CoV-2 infection, respectively. In contrast, 79.8% were aware of antiviral treatments for COVID-19. Perceived high-risk status was associated with being more likely to be aware (adjusted prevalence ratio [aPR]: 1.11 [95% confidence interval (CI) 1.03-1.20]), to be prescribed (aPR 1.47 [95% CI 1.08-2.01]), and to take oral antivirals at any time (aPR 1.61 [95% CI 1.16-2.24]) or within 5days of infection (aPR 1.72 [95% CI 1.23-2.40]). Despite widespread awareness of the availability of COVID-19 oral antivirals, more than 80% of eligible US adults did not receive them. Our findings suggest that differences between perceived and actual risk for severe COVID-19 (based on current CDC guidelines) may partially explain this low uptake.

Trends in marijuana and heavy alcohol use by cigarette smoking status among US adults: An analysis of the 2002-2019 NSDUH

BackgroundPolysubstance use is associated with adverse health outcomes, yet little research has measured changes in polysubstance use. We aimed to 1) estimate trends in marijuana and heavy alcohol use by cigarette smoking and demographic subgroups, and 2) examine patient factors associated with concurrent use among adults who were smoking. MethodsWe conducted a repeated cross-sectional analysis of 687,225 non-institutionalized US adults ≥18 years from the 2002–2019 National Survey on Drug Use and Health. Participants were stratified into current, former, and never smoking groups. Main outcomes were prevalence of heavy alcohol use, marijuana use, and concurrent use of both substances. ResultsFrom 2002–2019, heavy alcohol use declined from 7.8 % to 6.4 %, marijuana use rose from 6.0 % to 11.8 %, and concurrent use of alcohol and marijuana remained stable. Among adults who were smoking from 2005 to 2019, higher education was associated with higher odds of heavy alcohol use, while older ages, female gender, non-White race/ethnicity, and government-provided health insurance were associated with lower odds. The odds of marijuana use decreased in females, older ages, and higher incomes while increasing in people with poorer health status, higher education, government-provided or no health insurance, and serious mental illness. Compared to White adults who were smoking, Black counterparts had higher odds of marijuana use (OR=1.23; 95 %CI: 1.15–1.29), while Hispanic (OR=0.68; 95 %CI: 0.63–0.72) and other racial/ethnic identities (OR=0.83; 95 %CI: 0.77–0.90) had lower odds. ConclusionsOur study suggests marijuana use might not be sensitive to changes in the use of tobacco and alcohol.

Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey.

Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this. This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable.

Factors Associated with Long COVID Recovery among US Adults

BackgroundWhile factors associated with long COVID (LC) continue to be illuminated, little is known about recovery. This study used national survey data to assess factors associated with recovery from LC. MethodsWe used data from the 2022 National Health Interview Survey, a cross-sectional sample of noninstitutionalized US adults. Survey analysis was used to account for oversampling and nonresponse bias and to obtain nationally representative estimates. A multivariable logistic regression model was used to identify potential predictors of LC recovery. ResultsAmong those reporting ever having COVID-19, 17.7% or an estimated 17.5 million American adults reported ever having LC, and among those with LC, 48.5% or an estimated 8.5 million reported having recovered. Multivariable logistic regression analysis showed that Hispanic adults were significantly more likely than White adults to report recovery from LC. At the same time, those with severe COVID-19 symptoms and those who had more than a high school degree, were aged 40 years or older, or were female were less likely to report recovery. ConclusionSignificant variations in LC recovery were noted across age, sex, race and ethnicity, education, and severity of COVID-19 symptoms. Further work is needed to elucidate the causes of these differences and identify strategies to increase recovery rates.

Wealth Redistribution to Extend Longevity in the US

The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity. To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals. This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (≥50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023. Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles. Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated. The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1% female and 49.9% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan's would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year. These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.

Use of At-Home Medical Tests Among Older US Adults: A Nationally Representative Survey.

The availability of direct-to-consumer, at-home medical tests has grown over the last decade, but it is unknown how frequently older adults purchase at-home tests, how they perceive such tests, and how interested they are in using at-home tests in the future. We conducted a cross-sectional, nationally representative survey of non-institutionalized US adults aged 50 to 80 about their previous use of, perceptions of, and future intentions to use at-home medical tests. We found that nearly half of older adults (48.1%) have purchased an at-home medical test (95% CI 45.2%-51.0%), including 32.0% (95% CI 29.3%-34.8%) who purchased a COVID-19 test, 16.6% (95% CI 14.7%-18.7%) who purchased an at-home DNA or genetic test, 5.6% (95% CI 4.5%-7.0%) who purchased a screening test for cancer, and 4.4% (95% CI 3.4%-5.6%) who purchased a test for an infection other than COVID-19. Compared with White, non-Hispanic adults, Black, non-Hispanic adults were less likely to have purchased an at-home test (35.5% vs 49.6%, P < .01). Those with a college degree and those with an annual household income greater than $100K were more likely than others to have purchased at-home tests (55.5% vs 42.0%, P < .01; 60.6% vs 39.0%, P < .001, respectively). Most older adults had positive perceptions about at-home tests and expressed interest in using at-home tests in the future. At-home medical testing is now common among older adults. Clinicians should be familiar with different tests that patients can purchase and be prepared to discuss the potential advantages and disadvantages of at-home testing.

Connection Between Depression, Sexual Frequency, and All-cause Mortality: Findings from a Nationally Representative Study

We used the 2005–2010 National Health and Nutrition Examination Survey (NHANES), constructed to evaluate health of adults in the United States using consolidated data from interviews and physical exams that were conducted to obtain data for this study. The analysis sample was representative of noninstitutionalized US adults aged 20–59 years. When considering sexual frequency, overall, only female participants with lower sexual frequency were at a higher risk of all-cause death in a dose-response manner with a hazard ratio (HR) of 1.70 (95% CI 1.38–2.10, p trend &lt; .001) during the follow-up period. This relationship was not significant in males. However, when sexual frequency was categorized (&lt;52 times/year vs. ≥52 times/year), the adjusted HR was elevated [2.97 (CI 1.20–7.32, p = .02)] among individuals who had depression and low sexual frequency, but it was close to 1.0 (1.75, CI 0.50–6.07, p = .36) among individuals who had depression and high sexual frequency after adjusting for medical (obesity) and demographic (age, gender, education, and ethnicity) risk factors, indicating a 197% increase in mortality among individuals with low sexual frequency and depression than depression alone. Sexual activity is important for overall cardiovascular health possibly due to reduction of heart rate variability and blood flow increase.

Influence of disabilities on state-level disparity in dental care utilization and tooth loss: Findings from the 2020 Behavioral Risk Factor Surveillance System.

The aim of this study is to describe the prevalence of disparity in access to dental care and tooth loss between US adults with and without disabilities at the state level. This secondary analysis included data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional state-run annual telephone survey of noninstitutionalized US adults aged 18 years or older. The primary predictor, having any disability, was defined as reported difficulty in hearing, vision, cognition, mobility, self-care, or independent living. The two dental outcomes used were reported time since last dental visit and missing teeth status. We conducted descriptive analysis and multinomial regression models on weighted data to report the prevalence and state-level disparity in dental outcomes between individuals with and without disability. Nationally, one in four adults reported a disability, with a disproportionately higher prevalence among females, Native Americans and lower education and income groups. The highest utilization of dental services within a year among individuals with disabilities was found in the Northwestern and Midwestern states. Western states had the highest proportion of individuals with disability to have had a recent dental visit and a complete dentition, while the Southern states had the lowest proportions. After adjusting for sociodemographic factors, 59.1% of individuals with disabilities had dental visits within a year, which is 8.0% points less than those without disabilities. Similarly, only 50.8% of individuals with a disability had complete tooth retention, which is 10.1% points less than individuals without disability. Regardless of the type of disability, adults with a disability were less likely to have visited the dentist in the past year or to have retained all of their teeth. Those with self-care disabilities had the lowest rates of both. There were clear disparities in the utilization of dental care and dentate status among adults with disabilities at the state level. The findings from this study highlighted the necessity of finding local solutions to address the gap in dental care utilization and tooth loss between those with and without disability among the US population.

Abstract 15482: Trends in Cardiovascular Health Among Older Adults With and Without Cardiovascular Diseases: National Health and Nutrition Examination Survey (NHANES), 2013-2018

Introduction: American Heart Association’s (AHA) Life’s Essential 8 (LE8) is a framework for quantifying cardiovascular health (CVH). Prior studies have focused on individuals without clinical cardiovascular disease (CVD). We sought to examine recent trends in LE8 scores among older adults with prevalent CVD. Methods: We included non-institutionalized older US adults (ages 65+) from NHANES (2013-18). Overall LE8 scores (range 0-100; higher = better CVH) were calculated for all participants with or without CVD, using methods recommended by the AHA. CVD diagnoses were self-reported, including coronary heart disease (CHD), stroke, heart failure (HF), hypertension (HTN), angina, and myocardial infarction (MI). Percent change in LE8 scores from 2013-18 was calculated for each diagnosis group, and a linear regression tested for significance of changes within groups. Results: The 3,050 participants represented 37,908,305 adults (54.7% women; mean age 72.6 y); 3.4% self-identified as Asian, 7.2% Black, 3.9% Mexican, 3.3% Other Hispanic, 2.4% Multi-racial, and 79.9% Non-Hispanic White. Overall LE8 scores tended to stay stable or decline between 2013-14 and 2017-18 for individuals with and without CVD (Figure 1). Significant decreases in mean LE8 scores occurred in those with HTN, with a 4.1% decline from 2013-18 (from 59.6 [95% CI: 58.4-60.8] to 57.1 [55.9-58.4]), stroke, with a 11.5% decline (from 60.6 [56.0-65.2] to 53.6 [50.7-56.5]), and HF, with a 15.2% decline (from 60.9 [57.2-64.6] to 51.6 [48.0-55.2]). Conclusions: Recent LE8 scores remained stable or declined for older US adults even before the pandemic. In particular, individuals with HTN, stroke, and HF had significant declines in LE8 scores. Since LE8 metrics include behavioral and physiologic metrics associated with CVD risk, these data indicate concerning trends and primary and secondary prevention opportunities in older US adults, who are at highest risk for incident and recurrent CVD events.

Synergistic impact of co-exposures to whole blood metals on chronic kidney disease in general US adults: a cross‑sectional study of the National Health and Nutrition Examination Survey 2011-2020.

The impact of exposure to metals on chronic kidney disease (CKD) has only been investigated in two-way or single metal interactions in previous studies. We investigated the associations between five single metals in blood and their mixed exposure and CKD by using the machine learning approach. Relevant data were extracted from the National Health and Nutrition Examination Survey (NHANES 2011-2020), and the level of five metals in blood detected by inductively coupled plasma mass spectrometry was considered as exposures, namely, cadmium (Cd), lead (Pb), total mercury (Hg), manganese (Mn), and selenium (Se). The correlations between individual metal and metal mixtures and CKD were then evaluated by survey-multivariable logistic regression (SMLR), generalized weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR). Altogether, our study included 12,412 participants representing 572.6 million non-institutionalized US adults. Several single metals with the high quartile of exposure showed a positive association with the CKD ratio including Cd [(AOR = 1.873, 95% CI: 1.537, 2.284), Q4], Pb [(AOR = 1.559, 95% CI: 1.295, 1.880), Q4], and total Hg [(AOR = 1.169, 95% CI: 1.018, 1.343), Q2], while Mn [(AOR = 0.796, 95% CI: 0.684, 0.927), Q2] and Se [(AOR = 0.805, 95% CI: 0.664, 0.976), Q4] were negatively associated with the CKD ratio. In light of the positive fit of the WQS regression model, a significantly positive correlation was found between mixed metals and CKD (AOR = 1.373, 95% CI: 1.224, 1.539) after full covariate adjustment, and a similar finding was also detected in the BKMR model. Our study revealed that each single metal including Cd, Pb, and total Hg might have a positive association with CKD while this association was negative for both Mn and Se. The five metals might have a positive joint effect on CKD.

Joint effect of whole blood metals exposure with dyslipidemia in representative US adults in NHANES 2011-2020.

With little knowledge on the joint effects of metal exposure on dyslipidemia, we aimed to investigate the relationship between exposure to metal and dyslipidemia among US adults based on the National Health and Nutrition Examination Survey (NHANES). Based on the five NHANES waves (2011-2020), we selected five metals in blood as exposure, namely, cadmium (Cd), lead (Pb), total mercury (Hg), manganese (Mn), and selenium (Se), which were detected by inductively coupled plasma mass spectrometry. Survey-multivariable logistic regression, generalized weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR) were performed to determine whether dyslipidemia was associated with single metals or mixed metals. Our study included 12,526 participants aged from 20 to 80, representing 577.1 million non-institutionalized US adults. We found a positive association between several metals including Pb [adjusted odds ratio (AOR) = 1.332, 95%CI: 1.165, 1.522], total Hg (AOR = 1.264, 95%CI: 1.120, 1.427), Mn (AOR = 1.181, 95%CI: 1.046, 1.334), and Se (AOR = 1.771, 95%CI: 1.576, 1.992) and dyslipidemia. According to the WQS approach, metal mixtures were positively associated with dyslipidemia (AOR: 1.310, 95%CI: 1.216, 1.411) after a full-model adjustment. As is shown in the BKMR model, mixed metals tended to be positively associated with dyslipidemia ratios in a significant manner. Females, non-Hispanic White populations, people aged over 60, and those who did a little physical activity had a greater risk for dyslipidemia. Our findings suggest metals including Cd, Pb, Hg, Mn, and Se and their combinations may adversely affect dyslipidemia among US adults. Due to the cross-sectional nature of the study, it is possible that reverse causation may exist.

Estimated Prevalence and Awareness of Hepatitis C Virus Infection Among US Adults: National Health and Nutrition Examination Survey, January 2017-March 2020.

During January 2017-March 2020, approximately 2.2 million noninstitutionalized civilian US adults had hepatitis C; one-third were unaware of their infection. Prevalence was substantially higher among persons who were uninsured or experiencing poverty. Unrestricted access to testing and curative treatment is needed to reduce disparities and achieve 2030 elimination goals.

Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020

Chronic pain risk and prognosis estimates are needed to inform effective interventions. To estimate rates of chronic pain and high-impact chronic pain (HICP) incidence and persistence in US adults across demographic groups. This cohort study examined a nationally representative cohort with 1 year of follow-up (mean [SD], 1.3 [0.3] years). Data from the 2019-2020 National Health Interview Survey (NHIS) Longitudinal Cohort were used to assess the incidence rates of chronic pain across demographic groups. The cohort was created using random cluster probability sampling of noninstitutionalized civilian US adults 18 years or older in 2019. Of 21 161 baseline participants in the 2019 NHIS who were randomly chosen for follow-up, 1746 were excluded due to proxy response(s) or lack of contact information, and 334 were deceased or institutionalized. Of the 19 081 remaining, the final analytic sample of 10 415 adults also participated in the 2020 NHIS. Data were analyzed from January 2022 to March 2023. Self-reported baseline sex, race, ethnicity, age, and college attainment. Primary outcomes were the incidence rates of chronic pain and HICP, and secondary outcomes were the demographic characteristics and rates across demographic groups. A validated measure of pain status ("In the past 3 months, how often did you have pain? Would you say never, some days, most days, or every day?") yielded 3 discrete categories each year: pain free, nonchronic pain, or chronic pain (pain "most days" or "every day"). Chronic pain present in both survey years was considered persistent; HICP was defined as chronic pain that limited life or work activities on most days or every day. Rates were reported per 1000 person-years (PY) of follow-up, and age standardized based on the 2010 US adult population. Among 10 415 participants included in the analytic sample, 51.7% (95% CI, 50.3%-53.1%) were female, 54.0% (95% CI, 52.4%-55.5%) were aged 18 to 49 years, 72.6% (95% CI, 70.7%-74.6%) were White, 84.5% (95% CI, 81.6%-85.3%) were non-Hispanic or non-Latino, and 70.5% (95% CI, 69.1%-71.9%) were not college graduates. Among pain-free adults in 2019, incidence rates of chronic pain and HICP in 2020 were 52.4 (95% CI, 44.9-59.9) and 12.0 (95% CI, 8.2-15.8) cases per 1000 PY, respectively. The rates of persistent chronic pain and persistent HICP in 2020 were 462.0 (95% CI, 439.7-484.3) and 361.2 (95% CI, 265.6-456.8) cases per 1000 PY, respectively. In this cohort study, the incidence of chronic pain was high compared with other chronic diseases. These results emphasize the high disease burden of chronic pain in the US adult population and the need for early management of pain before it becomes chronic.

Gardening Is Associated With Better Cardiovascular Health Status Among Older Adults in the United States: Analysis of the 2019 Behavioral Risk Factor Surveillance System Survey.

Gardening benefits health in older adults, but previous studies have limited generalizability or do not adequately adjust for sociodemographic factors or physical activity (PA). We examined health outcomes, fruits and vegetables (F&V) intake, and 10-year mortality risk among gardeners and exercisers compared with nonexercisers. Cross-sectional data of noninstitutionalized US adults in the 2019 Behavioral Risk Factor Surveillance System was collected via landline and cellular phone survey. Adults 65 years and older reporting any PA (n= 146,047) were grouped as gardeners, exercisers, or nonexercisers. Outcomes included cardiovascular disease (CVD) risk factors, mental and physical health, F&V intake, and 10-year mortality risk. Summary statistics were calculated and adjusted logistic regression models were conducted to calculate adjusted odds ratios (aORs) and 95% CIs, accounting for the complex survey design. The sample included gardeners (10.2%), exercisers (60.0%), and nonexercisers (30.8%). Gardeners, compared with nonexercisers, had significantly lower odds of reporting all studied health outcomes and higher odds of consuming 5 or more F&V per day (CVD: aOR 0.60, 95% CI 0.53 to 0.68; stroke: aOR 0.55, 95% CI 0.47 to 0.64; heart attack: aOR 0.63, 95% CI 0.55 to 0.73, high cholesterol: aOR 0.86, 95% CI 0.79 to 0.93; high blood pressure: aOR 0.74, 95% CI 0.68 to 0.81; diabetes: aOR 0.51, 95% CI 0.46 to 0.56; body mass index ≥25: aOR 0.74, 95% CI 0.68 to 0.80; poor mental health status: aOR 0.50, 95% CI 0.43 to 0.59; poor physical health status: aOR 0.35, 95% CI 0.31 to 0.39; 5 or more F&V per day: aOR 1.56, 95% CI 1.40 to 1.57; high 10-year mortality risk: aOR 0.39, 95% CI 0.36 to 0.42). Male and female gardeners had significantly lower odds of reporting diabetes even when compared with exercisers. Among adults 65 years and older, gardening is associated with better CVD health status, including lower odds of diabetes. Future longitudinal or interventional studies are warranted to determine whether promoting gardening activities can be a CVD risk reduction strategy.

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data.

Data from the US National Health and Nutrition Examination Survey are freely available and can be analyzed to produce hypertension statistics for the noninstitutionalized US population. The analysis of these data requires statistical programming expertise and knowledge of National Health and Nutrition Examination Survey methodology. We developed a web-based application that provides hypertension statistics for US adults using 10 cycles of National Health and Nutrition Examination Survey data, 1999 to 2000 through 2017 to 2020. We validated the application by reproducing results from prior publications. The application's interface allows users to estimate crude and age-adjusted means, quantiles, and proportions. Population counts can also be estimated. To demonstrate the application's capabilities, we estimated hypertension statistics for noninstitutionalized US adults. The estimated mean systolic blood pressure (BP) declined from 123 mm Hg in 1999 to 2000 to 120 mm Hg in 2009 to 2010 and increased to 123 mm Hg in 2017 to 2020. The age-adjusted prevalence of hypertension (ie, systolic BP≥130 mm Hg, diastolic BP≥80 mm Hg or self-reported antihypertensive medication use) was 47.9% in 1999 to 2000, 43.0% in 2009 to 2010, and 44.7% in 2017 to 2020. In 2017 to 2020, an estimated 115.3 million US adults had hypertension. The age-adjusted prevalence of controlled BP, defined by the 2017 American College of Cardiology/American Heart Association BP guideline, among nonpregnant US adults with hypertension was 9.7% in 1999 to 2000, 25.0% in 2013 to 2014, and 21.9% in 2017 to 2020. After age adjustment and among nonpregnant US adults who self-reported taking antihypertensive medication, 27.5%, 48.5%, and 43.0% had controlled BP in 1999 to 2000, 2013 to 2014, and 2017 to 2020, respectively. The application developed in the current study is publicly available at https://bcjaeger.shinyapps.io/nhanesShinyBP/ and produced valid, transparent and reproducible results.

Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States.

Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18-49 years) from the 2017 to 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of noninstitutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHDs; categorized as 0, 1-13, and 14-30 days of poor mental health in the past 30 days). Outcomes were self-reported CVD (composite of myocardial infarction, angina, or stroke) and suboptimal CVH (≥2 cardiovascular risk factors: hypertension, hypercholesterolemia, overweight/obesity, smoking, diabetes, physical inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHDs with CVD and suboptimal CVH, adjusting for sociodemographic factors (and cardiovascular risk factors for the CVD outcome). Of the 593 616 participants (mean age, 34.7±9.0 years), the weighted prevalence of depression was 19.6% (95% CI, 19.4-19.8), and the weighted prevalence of CVD was 2.5% (95% CI, 2.4-2.6). People with depression had higher odds of CVD than those without depression (odds ratio [OR], 2.32 [95% CI, 2.13-2.51]). There was a graded association of PMHDs with CVD. Compared with individuals with 0 PMHDs, the odds of CVD in those with 1 to 13 PMHDs and 14 to 30 PHMDs were 1.48 (95% CI, 1.34-1.62) and 2.29 (95% CI, 2.08-2.51), respectively, after adjusting for sociodemographic and cardiovascular risk factors. The associations did not differ significantly by sex or urban/rural status. Individuals with depression had higher odds of suboptimal CVH (OR, 1.79 [95% CI, 1.65-1.95]) compared with those without depression, with a similar graded relationship between PMHDs and suboptimal CVH. Conclusions Depression and poor mental health are associated with premature CVD and suboptimal CVH among young adults. Although this association is likely bidirectional, prioritizing mental health may help reduce CVD risk and improve CVH in young adults.