Sociodemographic Risk Factors Research Articles

Global burden of benign prostatic hyperplasia, urinary tract infections, urolithiasis, bladder cancer, kidney cancer, and prostate cancer from 1990 to 2021

BackgroundThe burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.MethodsWe obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI).ResultsIn 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths.ConclusionsThe global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.

Predictive Factors for Bowel Resection in Childhood Intussusception.

Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. Any delay in diagnosis or management can lead to intestinal ischaemia and perforation. The aim of this study is to determine the sociodemographic and clinical risk factors associated with bowel resection in infants and children with intussusception. This is a retrospective analytical study of 118 patients operated at the Hassan II Hospital and University of Fez between 1 January 2008 and 1 January 2018. A comparison of risk factors between patients with and without bowel resection was performed using multivariate logistic regression. One hundred and eighteen patients met the inclusion criteria. Of these, 44% had undergone bowel resection. Age >2 years (P = 0.006), duration of symptoms progression of more than 2 days (P = 0.002), bilious vomiting (P = 0.04) and palpation of an abdominal mass (P = 0.01) were significantly associated with bowel resection. Multivariate logistic regression showed that age <2 years (odds ratio [OR] =4.47 95% confidence interval [CI]: 1.12-17.78) and duration of symptom progression of more than 2 days (OR = 2.62 95% CI: 1.12-6.11) were independent risk factors for bowel resection. Intussusception that occurs in child old than 2 years of age, or which has progressed for more than 2 days, is associated with an increased risk of intestinal resection.

Characterizing cancer-related cognitive impairments and impact on quality of life in women with metastatic breast cancer.

Little is known about cancer-related cognitive impairments (CRCI) in women with metastatic breast cancer (MBC). The purpose of this study is to (1) comprehensively describe CRCI and any associated psychosocial and behavioral symptoms, (2) determine observable sociodemographic and clinical risk factors for CRCI, and (3) explore cognitive and psychosocial predictors of quality of lifeand social functioning in women living with MBC. Using a cross-sectional design, women with MBC completed assessments (objective and subjective measures of CRCI including 3 open-ended questions, measures of psychosocial and behavioral factors, and assessments of quality of life and social function), and data were analyzed using descriptive statistics, qualitative content analysis, correlation analyses, t tests, analysis of variance, and linear regression models. Data from 52 women were analyzed. 69.2% of the sample reported clinically significant CRCI and 46% of the sample scored < 1 standard deviation below the standardized mean on one or more cognitive tests. Those with triple-negative MBC (compared to HER2+), recurrent MBC (compared to de novo), and no history of chemotherapy had worse subjective CRCI, and those without history of surgery and older age had worse objective CRCI. Subjective CRCI, but not objective CRCI, was significantly associated with quality of life and social functioning. Subjective and objective CRCI are likely a common problem for those with MBC. Subjective CRCI is associated with poorer quality of life and lower social functioning. Healthcare providers should acknowledge cognitive symptoms, continually assess cognitive function, and address associated unmet needs across the MBC trajectory.

Conspiracy theories, social polarization and crises

Social media facilitate the distribution of conspiracy theories. It is uncertain whether indeed the number of myths and also the number of those who appropriate myths has increased. Conspiracy theories have so far essentially been the subject of sociological and psychosociological research showing ageneral disposition to become infected irrespective of the topic of amyth. Are there specific psychopathological risk factors for becoming infected by conspiracy myths? Are there effective therapeutic or preventive measures? Asystematic search was carried out in PubMed using the query "conspir*[title] AND review" followed by manual selection and appraisal only of publications addressing conspiracy theories in general, i.e. not limited to specific myths, with afocus on systematic reviews and meta-analyses. Moreover, the publications identified were manually screened for further meta-analyses. The search resulted in 166 hits. The available evidence is essentially based on studies using questionnaires, which can clarify only associations but not causalities. The evidence suggests that the strongest correlates of conspiratorial ideation pertain to low cognitive abilities, nonanalytic style of thought resulting in reduced balancing of probabilities before deciding, feelings of loss of control, paranoia, schizotypy and the dark triad (narcissism, Machiavellianism, authoritarianism). Specific psychological characteristics are risk factors for conspiratorial ideation. Current research approaches are unsuitable to clarify whether psychiatric disorders are overrepresented. Sociodemographic risk factors include male gender, low level of education, low income, social isolation and are non-specific. Group processes promote, again presumably nonspecifically, conspiracy theories thus contributing to social polarization. The genetic basis and neurobiological mechanisms are unknown. Conspiracy theories were and are used as an instrument of political contention. The enlightened democratic social contract requires free, unbiased thinking. Consequently, the risk factors identified so far facilitate conspiratorial ideation and question the very fundaments of the social contract by impairing unbiased evaluation and decision making. Therefore, prevention is warranted. .

Prevalence, sociodemographic risk factors, and coverage of myopia correction among adolescent students in the central region of Portugal

BackgroundKnowing the prevalence of myopia at school age is essential to implement preventive measures and appropriate interventions, ensure access to vision care, promote a healthier educational environment and improve academic performance. The purpose of this study was to determine the prevalence of myopia and its associated sociodemographic risk factors, as well as to estimate the coverage of myopia correction among adolescents in center of Portugal.MethodsThis cross-sectional study evaluated 1115 adolescents from the 5th to the 9th year of school, with an average of 12.9 years (SD = 1.5) ranging from 10.0 to 18.0 years. Optometric evaluations were carried out in a school environment and consisted of the evaluation of distance visual acuity, assessed using a logarithmic visual acuity chart (ETDRS charts 1 and 2) at 4 m, and measured by refractive error with a pediatric autorefractometer (Plusoptix), by non-cycloplegic. Myopia was defined as spherical equivalent (SE ≤ -0.50 diopter (D)) and uncorrected visual acuity (UVA ≤ 95VAR). Adjusted logistic regression analysis was applied to investigate risk factors.ResultsWe found a myopia rate of 21.5% and a high myopia rate of 1.4%. Higher school level and attendance at urban schools were associated with myopia, but no association was found with age or sex. Only 34.6% of myopic adolescents use the best optical correction and 26.4% do not use any type of optical correction.ConclusionsData on the prevalence of refractive problems in Portugal are scarce and heterogeneous. This study, although regional, provides a valuable contribution with a clear and reproducible methodology, following international guidelines and filling gaps in the existing literature. The results show that the rate of myopia in this age group is similar to reports from other European studies. The high rate of adolescents with uncorrected or under-corrected myopia in Portugal is a problem that deserves attention.

Multiple risks for children of incarcerated mothers: A descriptive study

Objectives and ApproachSurvey data suggests that children of incarcerated mothers are exposed to a range of risk factors that can have negative impacts on life-course outcomes. This retrospective cohort study uses a population sample to describe the extent and mix of risk factors to which children of incarcerated mothers are exposed. Administrative data from health, justice, child protective services, births, and deaths were merged for 9,380 children exposed to maternal incarceration and an unexposed comparison group of 22,716 children. Risk ratios and 95% confidence intervals were calculated for birth complications and adverse childhood experiences (ACEs) for children exposed to maternal incarceration compared to those not exposed, adjusted for sociodemographic risk factors. A multiple risk score summed the number of recorded risk factors (0-17) for children with and without maternal incarceration exposure. ResultsCompared to unexposed children, children of incarcerated mothers had a higher risk of preterm birth, low birthweight, and all ACEs, including a 15-times (95%CI 14.2, 16.3) higher risk of exposure to maternal substance use disorders and 18-times (95%CI 16.8, 20.7) higher risk of placement in out-of-home care. Only 1% of children of incarcerated mothers did not experience any of the included risk factors, compared to 26% of unexposed children (p&lt;0.001). ConclusionsChildren of incarcerated mothers disproportionately experience multiple risks, especially maltreatment, placement in out-of-home care, and maternal substance use. ImplicationsThere is a significant public health opportunity to identify and address the needs of children of incarcerated mothers at the points of maternal arrest, sentencing, and incarceration.

The course of children's mental health symptoms during and beyond the COVID-19 pandemic.

The COVID-19 pandemic is associated with increases in child mental health problems, but the persistence of these changes in the post-pandemic era remains uncertain. Additionally, it is unclear whether changes in mental health problems during the pandemic exceed the anticipated increases as children age. This study controls for the linear effect of age in 1399 children, investigating the course of child-reported anxiety, depression, hyperactivity, and inattention symptoms during and after the pandemic, and identifies risk and protective factors that predict these mental health trajectories. Children (51% male; ages 9-11 at the first timepoint) provided mental health ratings at three pandemic timepoints (July-August 2020; March-April 2021; November 2021-January 2022) and one post-pandemic timepoint (January-July 2023). Mothers reported pre-pandemic mental health (2017-2019) and socio-demographic factors. Children reported socio-demographic factors, risk (e.g. screen time, sleep), and resilience (e.g. optimism) factors during the first timepoint. Average mental health symptoms increased over time, with more children exceeding clinical cut-offs for poor mental health at each subsequent pandemic timepoint. Growth curve modeling, adjusting for age-related effects, revealed a curvilinear course of mental health symptoms across all domains. Examination of risk and protective factors revealed that pre-existing mental health symptoms and optimism were associated with the course of symptoms. After considering age effects, children's mental health follows a curvilinear pattern over time, suggesting an initial decline followed by a rising trend in symptoms post-COVID. These findings underscore the continued need for additional resources and timely, evidence-based mental health prevention and intervention for children.

Thirty-Day Complication Rates After Gender-Affirming Bottom Surgery: An Analysis of the NSQIP Database From 2010 to 2020.

Gender-affirming bottom surgeries (GABS) play a central role in treating gender dysphoria to improve quality of life for transgender and nonbinary (TGNB) patients. However, there exists limited data on operative risks and outcomes for patient populations undergoing GABS. The goal of this study is to identify sociodemographic and clinical risk factors for determining 30-day postoperative complications in patients undergoing GABS. The ACS-NSQIP database from 2010 to 2020 was used to identify patients undergoing gender affirmation surgery (GAS) using Current Procedural Terminology (CPT) codes included in transfeminine and transmasculine bottom surgery. IBS-SPSS software was used to perform a multivariate analysis to determine risk factors for increased 30-day postoperative complications including unplanned reoperation and readmission rates. A total of 1809 GABS were performed in the NSQIP database from 2010 to 2020. There was an upward trend in GABS procedures throughout the years, with 2017 having the most GABS (n = 629). Transmasculine patients with a BMI of 29 and over were at a greater risk for wound complications (P < 0.05). Diabetic transfeminine patients were also at a greater risk for wound complications (P < 0.05). This study identified that several sociodemographic and clinical risk factors, such as BMI and diabetes mellitus type 2, had increased postoperative complications for patients undergoing gender-affirming bottom surgeries. Wound care management and patient education are essential in GABS to prevent long-term complications. Physician awareness of risk factors and social determinants of health can help prevent and improve postoperative care education and patient compliance.

A systematic review and Bayesian meta-analysis of 30 years of stress generation research: Clinical, psychological, and sociodemographic risk and protective factors for prospective negative life events.

Stress generation posits that (a) individuals at-risk for psychopathology may inadvertently experience higher rates of prospective dependent stress (i.e., stressors that are in part influenced by their thoughts and behaviors) but not independent stress (i.e., stressors occurring outside their influence), and (b) this elevated dependent stress, in some measure, is what places these individuals at-risk for future psychopathology. In recognition of 30 years of stress generation research, we conducted a systematic review and meta-analysis using frequentist and Bayesian approaches (102 articles with 104 eligible studies, N = 31,541). Generally strong support was found for psychopathology predicting dependent stress (e.g., dsOverall psychopathology = 0.36-0.52, BF₁₀ = 946.00 to 4.65 × 10¹⁸). Moderator analyses for dependent stress revealed larger effects for briefer assessments periods, shorter follow-ups, and self-report measures than for interviews. Among risk factors, depressogenic cognitive styles (ds = .26-.50, BF₁₀ = 47.50 to 1.00 × 10⁵) and general interpersonal vulnerability (ds = .26-.44, BF₁₀ = 2.72 to 2708.00) received the strongest support as stress generation mechanisms, and current evidence is modest for protective factors predicting dependent stress. Overall, larger effects were generally found for prospective prediction of dependent stress than independent stress. Evaluations of mediation in the research literature were relatively few, limiting the current review to qualitative analysis of the mediation component of stress generation. General support was found, however, for dependent stress as a mediator for psychopathology and associated risk factors in relation to subsequent psychopathology. The current review ends with recommendations for future research and integration of stress generation within minority stress frameworks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

P033 HYPERTENSION AND SOCIAL DETERMINANTS OF HEALTH IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO

Background: New cardiovascular (CV) risk factors have been studied (including social determinants of health - SDHs) that seems to influence the incidence of CV events, life expectancy and mortality rate. Objective: To evaluate the SDHs associated with high blood pressure (BP) in young adults living in the area of a primary care unit in Rio de Janeiro. Methods: Cross-sectional population study to assess the CV risk of adults aged between 20 and 50 years old. Sociodemographic characteristics, anthropometric measurements and CV risk factors were recorded. Pressure and HBPM were recorded. The race was self-declared. Low education was defined as having completed primary education or less. Those with formal or informal employment were considered to have a job. Results: 483 individuals, 299 (62%) female with an average age of 37 ± 9 years. Non-whites people comprised 52% of the sample. 108 individuals (21%) have low education and 98 (20%) do not have a job. Sedentary lifestyle (44%), dyslipidemia (43%), obesity (26%) and hypertension (26%) were the most prevalent risk factors. Abdominal obesity was more prevalent among women (45% vs 26%) and high BP (33% vs 21%) and smoking (18% vs 9%) among men. Black people are older and have less education (24% vs 18%), but race had no relationship with BP levels. Lack of employment was more common among women (79% vs 58%) and in logistic regression it practically doubled the risk of hypertension (OR 1.76, 95%CI 1.02-3.04, p=0.042). Low education was prevalent among older men and logistic regression showed that it doubled the risk of smoking (OR 2.17: 95%CI 1.15-4.08, p=0.016) and high BP (OR 1. 82, 95%CI 1.10-3.03, p=0.021). Lack of employment was more common among women and was not associated with CV risk factors. Conclusion: Low education and lack of employment were the main social determinants of health associated with high BP.

P075 IS OFFICE BLOOD PRESSURE MEASUREMENT SUFFICIENT FOR DIAGNOSING HYPERTENSION IN PRIMARY HEALTH CARE?

Background and Objective: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the scope of primary care. Our objective is to assess the degree of agreement between office BP and HBPM, evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and CV risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM &lt; 135 x 85 mmHg and office BP &lt; 140 x 90 mmHg were considered normal, identifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years, of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). In multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times, respectively. Uncontrolled office BP has high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388) Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: Office BP was not a sufficient measurement to diagnose hypertension. HBPM was a useful procedure in this young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN and in those with high normal office BP, especially if they are male or obese for early diagnosis of masked HTN.

Risk and protective factors of miscarriage: Evidence from a nationally representative sample of women in India

ABSTRACT Context: Miscarriage is the most distressing complication in early pregnancy, with one in every five pregnant women ending in a miscarriage, and its causes are multifactorial. Aim: This study aimed to find the risk and protective factors of miscarriage among women aged 15–49 years in India by using the National Family Health Survey (NFHS-5) data. Methods and Material: The data were taken from NFHS-5; 53,560 women aged 15–49 years who had reported either a miscarriage (n = 5104) or livebirth (n = 48,456) during the last 12 months preceding the survey were included in the study. Statistical Analysis Used: Various sociodemographic, lifestyle, comorbid, and fertility-related factors were considered in the Poisson regression analysis, and adjusted prevalence ratios were obtained. Results: Significant sociodemographic risk factors were age less than 20 years or more than 34 years, urban residence, primary and higher education levels, wealth index middle and above, and occupation as employed. Muslim religion, Scheduled Tribe, and Other Backward Class castes were statistically significant protective factors. Obesity, severe anemia, hypertension, and thyroid disorder were the significant comorbid risk factors, whereas tobacco chewing was the only significant lifestyle risk factor. A higher number of ever-born children was the fertility-related risk factor, whereas the use of intrauterine devices was a significant protective factor for miscarriage. Conclusions: To reduce the incidence of miscarriage in developing countries like India, the respective governments and healthcare providers should develop intervention programs targeting women in well-educated and high-income families.

A retrospective analysis of tuberculosis in livestock farmers in Lahore district, Pakistan.

Mycobacterium tuberculosis is the main cause of tuberculosis in humans, accounting for numerous illnesses and thousands of fatalities globally. Data regarding the association of various risk factors and TB in livestock farmers in Pakistan is scarce. A retrospective matched case-control study of TB cases was performed in Lahore, Pakistan to investigate the potential risk factors that lead to the development of TB in Pakistani livestock farmers. A total of 170 participants were included in the study. The case was matched with control based on neighborhood and the case-control ratio was kept 1:1. Data were statistically analyzed using R version 4.2.1. Conditional logistic regression was conducted to identify biologically and statistically plausible risk factors associated with the TB outcome among livestock farmers. In univariable analysis, 10 risk factors were identified (p < 0.05). Gender, age, being married, family type, living in a big family, BCG vaccination status, history of smoking, working at a cattle farm, co-housing with cattle at night, , consumption of raw milk. The multivariable model identified four risk factors i.e., consumption of raw milk (Odds Ratio [OR]: 7.7; 95% Confidence Interval [CI]: 1.95-30.68), living in big family (OR: 6.2; 95% CI: 1.25-30.82) and working at cattle farm (OR: 4.2; 95% CI: 1.08-16.56), while gender was found to be a protective factor with OR < 1 (OR: 0.06; 95% CI: 0.01-0.26). This study demonstrated that sociodemographic risk factors and exposure to infected cattle can influence the development of TB in farmers.

Assessment of anemia in cases of acute myocardial infarction in a tertiary care hospital in South India

Background: Anemia is a known risk factor for ischemic heart disease and heart failure. It is also associated with increased mortality in acute myocardial infarction (AMI) patients. The study aimed to determine the anemia status of AMI patients and educate them on anemia and its impact on health. Methods: This was a cross-sectional study conducted among 150 AMI patients admitted to the ICCU of Government General Hospital Srikakulam, Andhra Pradesh over 3 months. Hemoglobin levels were recorded and patients were classified as non-anemic, mildly, moderately, or severely anemic based on WHO criteria. Patients’ sociodemographic profiles and risk factors were also collected. Results: Of the 150 patients (mean age 59.6 years), 70% were males. 83% of patients had anemia- 67% mild, 12% moderate, and 4% severe. The 50-65 years age group reported the highest frequency of mild anemia cases (38 out of 54). Absence of anemia was highest among the younger 45-50 years group (3 out of 15). Anemia was higher in females, and patients with a vegetarian diet had comparatively more anemia than those consuming a mixed diet. Additionally, 24% of the cases of anemia were in the 65-75 age group. Conclusions: A high prevalence of anemia was found among AMI patients. Counselling can help improve health by increasing awareness of anemia management. Screening AMI patients for anemia and therapeutic interventions were recommended.

Systemic inflammation and changes in physical well-being in patients with breast cancer: a longitudinal study in community oncology settings.

Chemotherapy adversely affects physical well-being and inflammation may be related to changes in physical well-being. We evaluated the association of systemic inflammation with changes in physical well-being. In a prospective study of 580 patients with stages I-III breast cancer we assessed immune cell counts, neutrophil:lymphocyte ratio (NLR), lymphocyte:monocyte ratio (LMR), and platelet:lymphocyte ratio (PLR) within 7 days before chemotherapy (pre-chemotherapy). Physical well-being was assessed using the Functional Assessment of Cancer Therapy: General-Physical Well-being subscale (FACT-PWB) pre-chemotherapy and 1 month and 6 months post-chemotherapy. Clinically meaningful decline in physical well-being was determined as decreasing FACT-PWB by more than one point from pre-chemotherapy level, and non-resilience defined as having decline post-chemotherapy and not returning to within one-point of pre-chemotherapy FACT-PWB by 6 months post-chemotherapy. Multivariable logistic regressions examined the association between inflammation and changes in physical well-being, adjusting for sociodemographic and clinical characteristics. Fifty-nine percent (310/529) and 36% (178/501) of participants had physical well-being decline post-chemotherapy and 6 months post-chemotherapy, respectively. Fifty percent (147/294) were non-resilient. Low NLR and PLR were associated with 1.78 (P = .01) and 1.66 (P = .02) fold greater odds of having a decline in physical well-being 6 months post-chemotherapy compared to those with high NLR and PLR, respectively. Low NLR and PLR were associated with 1.92 (P = .02) and 2.09 (P = 0.01) fold greater odds of being non-resilient 6 months post-chemotherapy compared to those with high NLR and PLR, respectively. Low NLR and PLR were associated with chemotherapy-induced changes in physical well-being independent of sociodemographic and clinical risk factors.

The impact of health insurance on hypertension care: a household fixed effects study in India

IntroductionHypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care.MethodsWe used secondary data from the nationally representative sample of adults aged 15–49 years from the 2015–2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables.ResultsIn all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93–1.02), 0.97 (0.91–1.03), 0.95 (0.77–1.30), and 0.97 (0.65–1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings.ConclusionsHealth insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.

Viewing Native American Cervical Cancer Disparities through the Lens of the Vaginal Microbiome: A Pilot Study.

Vaginal dysbiosis is implicated in persistent HPV infection and cervical cancer. Yet, there is a paucity of data on the vaginal microbiome in Native American communities. Here, we aimed to elucidate the relationships between microbiome, HPV, sociodemographic and behavioral risk factors to better understand an increased cervical cancer risk in Native American women. In this pilot study, we recruited 31 participants (16 Native American, 15 non-Native women) in Northern Arizona and examined vaginal microbiota composition, HPV status, and immune mediators. We also assessed individuals' sociodemographic information, and physical, mental, sexual, and reproductive health. Overall, microbiota profiles were dominated by common Lactobacillus species (associated with vaginal health) or a mixture of bacterial vaginosis-associated bacteria. Only 44% of Native women exhibited Lactobacillus dominance, compared to 58% of non-Native women. Women with vaginal dysbiosis also had elevated vaginal pH and were more frequently infected with high-risk HPV. Furthermore, we observed associations of multiple people in a household, lower level of education, and high parity with vaginal dysbiosis and abundance of specific bacterial species. Finally, women with dysbiotic microbiota presented with elevated vaginal levels of proinflammatory cytokines. Altogether, these findings indicate an interplay between HPV, vaginal microbiota, and host defense, which may play a role in the cervical cancer disparity among Native American women. Future longitudinal studies are needed to determine the mechanistic role of vaginal microbiota in HPV persistence in the context of social determinants of health toward the long-term goal of reducing health disparities between non-Hispanic White and Native American populations.

Household food insecurity among persons with disabilities in Canada: Findings from the 2021 Canadian Income Survey.

Income-related food insecurity is an important determinant of health. Persons with disabilities are at a higher risk of experiencing household food insecurity (HFI) than those without disabilities. The main objectives of this study were to estimate the prevalence of HFI for persons with different types, numbers, and severity of disabilities, and to examine sociodemographic correlates of HFI among this group. Data from the 2021 Canadian Income Survey (CIS) were used. Disability status was assessed using the short version of the Disability Screening Questions module for one randomly selected household respondent. The Household Food Security Survey Module measured HFI as marginal, moderate, or severe. Weighted descriptive and multivariable analyses were conducted to estimate the prevalence of HFI and analyze the association between various socioeconomic factors and HFI among the study sample. Among CIS participants with disabilities (30% of the total CIS sample: 31 million persons), 26% reported some level of HFI, including 8% with severe HFI. The prevalence of HFI was 13% among those without disabilities. The prevalence of HFI was highest among those with learning, memory, cognition, and seeing disabilities (each at 36%). Levels of HFI were higher for those with more severe disabilities and with a greater number of disabilities. For persons with disabilities, the odds of HFI were two times higher, compared with persons without disabilities (adjusted odds ratio [AOR]: 2.5 [95% confidence interval (CI): 2.2, 2.7]), after adjustment for a range of sociodemographic covariates. Persons with disabilities who were in the lowest income quintile (AOR: 4.0 [95% CI: 3.2, 4.9]) and aged 45 to 54 (AOR: 2.9 [95% CI: 2.1, 4.1]) had the highest odds of HFI, compared with other persons with disabilities living in wealthier households and those aged 65 and older, respectively. Other risk factors included being in a one-parent household, living in the Prairies, and living in a dwelling not owned by the household. HFI prevalence among CIS participants with disabilities was higher than for persons without disabilities, even after adjustment for well-documented sociodemographic risk factors. Consistent monitoring of HFI among persons with disabilities can help inform any ongoing or newly developed poverty reduction strategies for this population.

The Relationship of Cardiorespiratory Fitness, Physical Activity, and Coronary Artery Calcification to Cardiovascular Disease Events in CARDIA Participants.

Moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF), and coronary artery calcification (CAC) are associated with cardiovascular disease (CVD) risk. While a U-shaped relationship between CRF or MVPA and CAC has been reported, the presence of CAC among highly fit individuals might be benign. We examined interactive associations of CRF or MVPA and CAC with outcomes and evaluated the relationship of CRF and MVPA to CAC incidence. CARDIA participants with CAC assessed in 2005-06 were included (n=3,141, mean age 45). MVPA was assessed by self-report and accelerometer. CRF was estimated with a maximal graded exercise test. Adjudicated CVD events and mortality data were obtained through 2019. CAC was reassessed in 2010-11. Cox models were constructed to assess hazard ratios (HRs) for CVD, coronary heart disease (CHD), and mortality in groups defined by CAC presence/absence and lower/higher CRF or MVPA levels. Logistic models were constructed to assess associations with CAC incidence. Adjustment was made for sociodemographic and CVD risk factors. Relative to participants with no CAC and higher CRF, the adjusted HRs for CVD were 4.68 for CAC and higher CRF, 2.22 for no CAC and lower CRF, and 3.72 for CAC and lower CRF. For CHD, the respective HRs were 9.98, 2.28, and 5.52. For mortality, the HRs were 1.15, 1.58, and 3.14, respectively. Similar findings were observed when MVPA, measured either by self-report or accelerometer, was substituted for CRF. A robust inverse association of CRF and accelerometer-derived MVPA with CAC incidence was partly accounted for by adjusting for CVD risk factors. In middle-aged adults, CRF and MVPA demonstrated an inverse association with CAC incidence but did not mitigate the increased cardiovascular risk associated with CAC, indicating that CAC is not benign in individuals with higher CRF or MVPA levels.

Influenza Vaccination Coverage in Children: How Has COVID-19 Influenced It? A Review of Five Seasons (2018-2023) in Central Catalonia, Spain.

Influenza vaccination is the main method of preventing influenza. Vaccination is recommended for certain individuals with diseases that could cause complications in the case of flu infection. The objective of this retrospective observational study was to examine influenza vaccination coverage in patients with risk factors, to describe the characteristics of those vaccinated and to study the influence of COVID-19. The study population was children under 14 years old with risk factors between 2018/19 and 2022/23 in Central Catalonia, sourced through the electronic database of the Catalan Institute of Health. The association of influenza vaccination data with sociodemographic data and risk factors was performed by bivariate and multivariate analysis. A total of 13,137 children were studied. Of those, 4623 had received the influenza vaccine in at least one season. The average influenza vaccination rate was 28.8%. The statistically significant factors associated with vaccination were age and having certain risk factors: asthma, diabetes, haemoglobinopathies and clotting disorders. In all seasons, the immigrant population was vaccinated more than the native population p < 0.05, except for the COVID-19 season (2020/21), where no differences were observed. Of those vaccinated, 7.1% had been vaccinated for 5 consecutive years. Influenza vaccination coverage in the paediatric age group was low. Vaccination promotion measures must be implemented. COVID-19 meant an increase in vaccination of the native population to the same level as that of the immigrant population.