Survey Weights Research Articles

Workplace support for physicians during the COVID-19 Pandemic: Did it affect burnout?

BackgroundA concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic.MethodsWe surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians’ perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout.ResultsAfter weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 – 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 – 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19–0.99).ConclusionsBurnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.

The mediating role of chronic low-grade inflammation participation in the relationship between obesity and type 2 diabetes: findings from the NHANES

BackgroundChronic low-grade inflammation may mediate the relationship between obesity and diabetes, yet clinical research in this area remains scarce. Thus, this study aimed to explore the mediating role of chronic low-grade inflammation in this relationship using the National Health and Nutrition Examination Survey (NHANES).MethodsThis study involved 2,482 participants enrolled in the NHANES between 2005 and 2016. Based on the complex sampling survey weights of NHANES, logistic regression models were fitted, adjusting for various covariates to investigate the relationship between BMI, INFLA score, and diabetes. Moreover, weighted quantile sum (WQS) regression models were fitted to analyze the proportional contribution of individual components within the INFLA score. Finally, mediation analysis was conducted to quantitatively assess the magnitude of the mediating effect of the INFLA score on the relationship between BMI and diabetes.ResultsAfter adjusting for all potential confounding factors, a significant positive correlation was noted between INFLA score and diabetes [OR (95% CI), 1.038(1.003–1.075), p = 0.035]. Additionally, a significant positive correlation was observed between the high INFLA group and diabetes compared to the low INFLA group [OR (95% CI), 1.599(1.031–2.481), p = 0.037]. WQS regression models revealed that the proportional contributions of C-reactive protein, white blood cell count, platelet count, and neutrophil-to-lymphocyte ratio (NLR) were 55.5%, 34.8%, 8.46%, and 1.19%, respectively. Finally, the results of the mediation analysis indicated that the indirect effect of the INFLA score accounted for 10.20%.ConclusionsChronic low-grade inflammation was associated with diabetes and partially mediates the relationship between obesity and diabetes.

Association of prior military service with olfactory function among older adults.

Olfactory dysfunction (OD) is a condition primarily affecting older adults. Several factors have been implicated in OD, such as age, socioeconomic status, and neurodegenerative disease; however, the effect of military service still requires additional investigation. Here, we aim to determine if there is an association between prior military service and OD among older adults. This cross-sectional study included 2268 adults from Round 1 of the National Social Life, Health, and Aging Project. OD was defined as 0-3 odors correctly identified on the 5-item Sniffin' Sticks test. Bivariate analysis was conducted to calculate crude odds ratios (cOR) for the association of prior military service with OD and identify covariates for regression. Associations between prior military service and OD were assessed using logistic regression, and adjusted odds ratios (aOR) were calculated controlling for age, gender, race/ethnicity, education, stroke history, dementia, diabetes, and mental health. All analyses were weighted using survey weights to account for sampling design. OD was present in 489 adults (21.6%). Among those with OD, the average age was 71.0 ± 7.9 years, whereas the average age in those without OD was 67.0 ± 7.2 years. Among adults with OD, 34.4% reported prior military service, compared to 27.7% of adults without OD (cOR = 1.37; 95% CI: 1.05-1.79). However, after adjusting for covariates, prior military service was not associated with OD (aOR: 1.09; 95% CI: 0.79-1.50). Older age (aOR: 1.07; 95% CI: 1.05-1.09) and worse mental health (aOR: 1.68; 95% CI: 1.14-2.49) were associated with OD. Prior military service was not associated with OD among older adults after controlling for covariates. More nuanced research is needed to examine correlations between OD and specific elements of military service such as duration, toxin exposure, and head trauma.Level of Evidence: Level 4.

Younger Older Americans and Sarcopenic Obesity: The Moderating Role of Living Alone.

Previous studies have indicated that compared to older adults, younger older adults (e.g., baby boomers) are more susceptible to obesity, but their risk decreases as they age. However, there is a lack of research on how individuals experience sarcopenic obesity, which increases in later life and is a mortality risk factor. This study examined how younger cohorts of older Americans and their demographic traits are related to sarcopenic obesity. Generalized estimating equations were used to analyze participants aged 65 years and older, stratified by sex using data from the 2006-2016 Health and Retirement Study, with survey weights (n = 2,896 men and n = 4,268 women). The findings indicate that the youngest cohort (born between 1948 and 1953) had greater odds of sarcopenic obesity than older cohorts (born before 1931). However, the youngest cohort did not have significantly different risks from those born between 1931 and 1947. Unexpectedly, the youngest cohort of older women living alone tended not to have sarcopenic obesity compared to the older cohorts living alone. These results remained significant even after adjusting for various covariates, including marital status, race, education level, wealth, and other factors. This paper contributes to the existing literature on population health and demographic change in 2 ways. First, the risk of sarcopenic obesity is higher among younger cohorts of older Americans relative to older cohorts (born before 1931). Second, living alone may not necessarily be considered a worse health condition, particularly for younger female cohorts.

Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023.

Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy. We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata. Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births. Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

Marijuana Use and Hemoglobin Concentrations in NHANES 2009-2018: Implications for Subclinical Hypoxemia.

Cannabis use is rapidly growing in the United States, but its health implications are poorly understood, particularly when compared with cigarette smoking. Previous research conducted on animal models or non-representative populations with small sample sizes has yielded mixed results on the impact of marijuana use on hemoglobin levels, which may reflect subclinical hypoxemia and/or carbon monoxide exposure. We evaluated the association between marijuana use and hemoglobin levels in a nationally representative sample of U.S. adults. This cross-sectional study included 16,038 individuals aged 18 to 59 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. We related current and former marijuana use with measured hemoglobin levels, with adjustment for demographics, education, housing, and cigarette smoking status in multivariable analyses that incorporated complex survey weights. As candidate positive and negative control exposures, we used similar methods to relate cigarette smoking and benzodiazepine use, respectively, with hemoglobin concentrations. Current marijuana use was associated with significantly higher hemoglobin concentrations. After multivariable adjustment, compared with never use, current marijuana use was associated with a 0.111, 95% CI [0.021,0.201] g/dL higher hemoglobin concentration, whereas former use was associated with a 0.047, 95% CI [-0.018,0.113] g/dL higher concentration (linear trend p=0.01). As hypothesized, cigarette smoking was also associated with higher hemoglobin concentrations, while benzodiazepine use was not. Among American adults, current marijuana use was associated with higher hemoglobin concentrations, as is cigarette smoking but not benzodiazepine use. These results suggest the possibility that marijuana smoking induces subclinical hypoxemia stimulating hemoglobin production. Further confirmation of this observational finding is needed, in light of the increasing medical and recreational use of smoked marijuana products.

Prevalence of tobacco smoking and related factors in people aged 15 years and above in Beijing, 2014-2021

Objective: To evaluate the effect of the implementation of Beijing Smoking Control Regulation in 2015 on the smoking prevalence in people aged ≥15 years in Beijing during 2014-2021, and explore factors associated with tobacco use behavior in local population. Methods Using a pooled cross-sectional design, data from Beijing Adult Tobacco Survey in 2014, 2016, 2019 and 2021 (4 surveys) were combined into one dataset. The 4 surveys used same multistage cluster sampling procedure. After complex survey weighting, multiple logistic regression models were constructed to analyze factors influencing smoking status. Results: A total of 8 484, 9 372, 8 534 and 10 551 respondents were included in the surveys in 2014, 2016, 2019 and 2021, respectively. The smoking prevalence rate was 23.4%, 22.3%, 20.3% and 19.9%, respectively, in Beijing residents aged ≥15 years, exhibiting a linear declining trend (P=0.010). Factors associated with current smoking in men were age 25-44 years (OR=2.22, 95%CI: 1.68-2.95) and 45-64 years, (OR=2.64, 95%CI: 2.06-3.39), educational level of high school (OR=0.69, 95%CI: 0.49-0.95) and undergraduate and above (OR=0.46, 95%CI: 0.33-0.63), and awareness of smoking causing stroke (OR=0.71, 95%CI: 0.61-0.81), and awareness of smoking causing lung cancer (OR=0.53, 95%CI: 0.42-0.66), the differences were significant (all P<0.05). After controlling interfering factors, the current smoking prevalence in men in 2019 (OR=0.73, 95%CI: 0.63-0.87, P<0.001) and 2021 (OR=0.72, 95%CI: 0.61-0.88, P<0.001) were significantly lower than that in 2014. Factors associated with current smoking in women were living alone (OR=1.80, 95%CI: 1.33-2.44), educational level of undergraduate and above (OR=0.43, 95%CI: 0.27-0.69), other occupations except doctor and teacher (OR=8.54, 95%CI: 2.80-26.02) or being retired/unemployed (OR=9.39, 95%CI: 3.19-27.65), and awareness of smoking causing cardiovascular events (OR=0.58, 95%CI: 0.39-0.84), and awareness of smoking causing lung cancer (OR=0.54, 95%CI: 0.35-0.83), the differences were significant (all P<0.05). No significant change in smoking status in women was found in 4 surveys. Conclusions: The smoking prevalence rate in men in Beijing has declined since the implementation of Beijing Smoking Control Regulation 5 years, indicating the effectiveness of legislative approach in tobacco control. Socio-demographic factors and the awareness level of tobacco harm could influence smoking status. Future tobacco control programs should target the people with lower education level, young men, women living alone, and those with occupations other than teachers/doctors or the unemployed/retired and include more comprehensive health education.

The Association Between Depressive Symptoms and the Weekly Duration of Physical Activity Subset by Intensity and Domain: Population-Based, Cross-Sectional Analysis of the National Health and Nutrition Examination Survey From 2007 to 2018.

Prior literature suggests a dose-response relationship between physical activity (PA) and depressive symptoms. The intensity and domain of PA are suggested to be critical to its protective effect against depression; however, existing literature has shown mixed results. The purpose of this population-based study is to examine the associations between depressive symptoms and weekly duration of (1) total PA and (2) PA subset by intensity, domain, or both. A cross-sectional analysis of National Health and Nutrition Examination Survey data from 2007 to 2018 was conducted using multivariable logistic and linear regression models and survey weights. Participants (N=29,730) were 20 years and older and completed the Physical Activity Questionnaire and Depression Screener. The primary outcome was the presence of depressive symptoms, and the secondary outcomes were cognitive-affective and somatic symptoms of depression. Participants (N=29,730) had a weighted mean age of 47.62 (SD 16.99) years, and 15,133 (51.34%) were female. On average, participants without depressive symptoms engaged in 10.87 hours of total PA per week, whereas participants with depressive symptoms engaged in 8.82 hours (P<.001). No significant associations were seen between the weekly duration of total PA and depressive symptom odds, somatic, or cognitive-affective symptoms (all P>.05). Participants with an increased weekly duration of recreational PA had decreases in depressive symptom odds (adjusted odds ratio [aOR] 0.965, 95% CI 0.944-0.986) and in somatic (adjusted coefficient [aβ]=-0.016, 95% CI -0.022 to -0.009) and cognitive-affective (aβ=-0.015, 95% CI -0.023 to -0.007) symptoms. When recreational PA was subset by intensity, participants with an increased weekly duration of vigorous-intensity recreational PA had decreases in depressive symptom odds (aOR 0.926, 95% CI 0.883-0.972) and in somatic (aβ=-0.021, 95% CI -0.032 to -0.010) and cognitive-affective (aβ=-0.022, 95% CI -0.035 to -0.009) symptoms. However, significant associations were not seen for the weekly duration of work-related, moderate- or vigorous-intensity PAs (all P>.05). Findings suggest that recreational, not work-related PA is associated with reduced symptoms of depression. Future studies should explore the impact of the different types and contexts of PA on depressive symptomatology.

Prevalence and factors associated with adverse pregnancy outcomes in South Africa: Evidence from the 2016 Demographic and Health Survey.

Adverse pregnancy outcomes are an important indicator of the overall health of a population and the socioeconomic development of a country. To determine the prevalence and factors associated with adverse pregnancy outcomes among women of reproductive age in South Africa, and to recommend strategies to reduce the burden of these outcomes. We conducted a secondary data analysis on women of reproductive age using data from the nationally representative, population- based, cross-sectional 2016 South Africa Demographic and Health Survey (SADHS). We described the sociodemographic characteristics of the study participants and determined the prevalence and factors associated with adverse pregnancy outcomes using the multivariable logistic regression model. We adjusted all our analyses for complex survey sampling using survey weights. There were 8 514 women of reproductive age, of whom 41.2% had fallen pregnant during the 5-year period preceding the survey. The majority (70.9%) were of age 20 - 34 years, 78% had secondary education, 61.6% were unemployed, 65% were from urban areas, and more than 40% of these women were currently living with a man, while 51.5% reported that they had never been in a union. The prevalence of adverse pregnancy outcomes was 14.6% (95% CI 13.2 - 16.1%). The odds of experiencing adverse pregnancy outcomes were significantly higher for those aged 35 - 49 years (adjusted odds ratio (aOR) 7.41, 95% CI 3.46 - 15.85) or 20 - 34 years (aOR 2.07, 95% CI 1.02 - 4.18), compared with those aged 15 - 19 years. Women who were currently in a union/living with a man (aOR 1.85, 95% CI 1.41 - 2.43) or formerly in a union/living with a man (aOR 2.66, 95% CI 1.64 - 4.29), compared with those who had never been in a union, had higher odds of adverse pregnancy outcomes. Contrarily, adverse pregnancy outcomes were lower with each additional child delivered or ever born (aOR 0.66, 95% CI 0.58 - 0.75). We report a high prevalence of adverse pregnancy outcomes among women of reproductive age in South Africa. We recommend addressing factors such as maternal age and currently/formerly living with a man within interventions to reduce the burden of adverse pregnancy outcomes in South Africa.

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.

Developing survey weights to ensure representativeness in a national, matched cohort study: results from the children and young people with Long Covid (CLoCk) study

BackgroundFindings from studies assessing Long Covid in children and young people (CYP) need to be assessed in light of their methodological limitations. For example, if non-response and/or attrition over time systematically differ by sub-groups of CYP, findings could be biased and any generalisation limited. The present study aimed to (i) construct survey weights for the Children and young people with Long Covid (CLoCk) study, and (ii) apply them to published CLoCk findings showing the prevalence of shortness of breath and tiredness increased over time from baseline to 12-months post-baseline in both SARS-CoV-2 Positive and Negative CYP.MethodsLogistic regression models were fitted to compute the probability of (i) Responding given envisioned to take part, (ii) Responding timely given responded, and (iii) (Re)infection given timely response. Response, timely response and (re)infection weights were generated as the reciprocal of the corresponding probability, with an overall ‘envisioned population’ survey weight derived as the product of these weights. Survey weights were trimmed, and an interactive tool developed to re-calibrate target population survey weights to the general population using data from the 2021 UK Census.ResultsFlexible survey weights for the CLoCk study were successfully developed. In the illustrative example, re-weighted results (when accounting for selection in response, attrition, and (re)infection) were consistent with published findings.ConclusionsFlexible survey weights to address potential bias and selection issues were created for and used in the CLoCk study. Previously reported prospective findings from CLoCk are generalisable to the wider population of CYP in England. This study highlights the importance of considering selection into a sample and attrition over time when considering generalisability of findings.

Hospital readmissions among adults living with and without HIV in the US: findings from the Nationwide Readmissions Database

Thirty-day hospital readmission measures quality of care, but there are limited data among people with HIV (PWH) and people without HIV (PWoH) in the era of universal recommendation for antiretroviral therapy. We descriptively compared 30-day all-cause, unplanned readmission risk between PWH and PWoH. A retrospective cohort study was conducted using the 2019 Nationwide Readmissions Database (2019/01/01-2019/12/31), an all-payer database that represents all US hospitalizations. Index (initial) admissions and readmissions were determined using US Centers for Medicare & Medicaid Services definitions. Crude and age-adjusted risk ratios (aRR) comparing the 30-day all-cause, unplanned readmission risk between PWH to PWoH were estimated using random effect logistic regressions and predicted marginal estimates. Survey weights were applied to all analyses. We included 24,338,782 index admissions from 18,240,176 individuals. The median age was 52(IQR=40-60) years for PWH and 61(IQR=38-74) years for PWoH. The readmission risk was 20.9% for PWH and 12.2% for PWoH (age-adjusted-RR:1.88 [95%CI=1.84-1.92]). Stratified by age and sex, young female (age 18-29 and30-39 years) PWH had a higher readmission risk than young female PWoH (aRR=3.50 [95%CI=3.11-3.88] and aRR=4.00 [95%CI=3.67-4.32], respectively). While the readmission risk increased with age among PWoH, the readmission risk was persistently high across all age groups among PWH. The readmission risk exceeded 30% for PWH admitted for hypertensive heart disease, heart failure, and chronic kidney disease. PWH have a disproportionately higher risk of readmission than PWoH, which is concerning given the aging profile of PWH. More efforts are needed to address readmissions among PWH. US National Institutes of Health.

Considerations in Complex Survey Data Sampling, Weighting, and Analysis for Pediatric Research

Considerations in Complex Survey Data Sampling, Weighting, and Analysis for Pediatric Research

Weighting the United States All of Us Research Program data to known population estimates using raking

BackgroundThe All of Us Research Program aims to collect longitudinal health-related data from a million individuals in the United States. An inherent challenge of a non-probability sampling strategy through voluntary participation in All of Us is that findings may not be nationally representative for addressing health and health care at the population level. We generated survey weights for the All of Us data that can be used to address the challenge. Research designWe developed raked weights using demographic, health, and socioeconomic variables available in both the 2020 National Health Interview Survey (NHIS) and All of Us. We then compared the unweighted and weighted prevalence of a set of health-related variables (health behaviors, health conditions, and health insurance coverage) estimated from All of Us data with the weighted prevalence estimates obtained from NHIS data. SubjectsThe sample included 100,391 All of Us participants 18 years of age and older with complete data collected between May 2017 and January 2022 across the United States. ResultsFinal variables in the raking procedure included age, sex, race/ethnicity, region of residence, annual household income, and home ownership. The mean percentage difference between known proportions obtained from the NHIS and All of Us was reduced by 18.89% for health-related variables after applying the raked weights. ConclusionsRaking improved the comparability of prevalence estimates obtained from All of Us to known national prevalence estimates. Refining the process of variable selection for raking may further improve the comparability between All of Us and nationally representative data.

High deductible health plans and survival among cancer survivors.

11005 Background: High deductible health plans (HDHP) enable lower premiums at the expense of potentially high out-of-pocket costs. They are associated with more advanced cancer stage diagnoses and delayed or forgone care among cancer survivors. However, it is unknown how HDHPs are associated with survival among cancer survivors. Methods: Individuals ages 18-84 years with non-Medicaid insurance were identified from the 2011-2018 National Health Interview Survey (NHIS) with linked mortality files from the National Death Index. HDHP status was defined by the NHIS as a yearly deductible ≥$1200-1350 for an individual or ≥2400-$2700 for a family (values depend on survey year with increases over time). Cox proportional hazards models using age as the time scale were utilized to determine: 1) association of HDHP status with overall survival (OS) and cancer survival (CS; i.e., freedom from cancer death) among cancer survivors, and 2) how associations differed for survivors compared to those without a cancer history. Models accounted for the NHIS survey design and survey weights and were adjusted for insurance status, marital status, sex, comorbidities, education, income, national region, and cancer site and time since cancer diagnosis (if applicable). Sensitivity analyses adjusting for age at cancer diagnosis were performed using time since diagnosis as the time scale. Results: A total of 147,254 respondents were identified, 5.9% of whom were cancer survivors. 25.6% of survivors and 28.5% of individuals without a cancer history reported being insured by a HDHP at the time of NHIS participation. HDHP status was associated with worse OS (HR: 1.46, 95% CI = 1.19 - 1.79) and CS (HR: 1.34, 95% CI = 1.01 - 1.77) among cancer survivors overall in the adjusted model. HDHP status was additionally associated with worse OS among the following subgroups of cancer survivors: non-Hispanic White (HR: 1.45, 95% CI = 1.16 - 1.82), income &gt; 400% federal poverty level (HR: 1.65, 95% CI = 1.16 - 2.36), college (HR: 1.47, 95% CI = 1.07 – 2.00) or high school (HR: 1.59, 95% CI = 1.19 - 2.12) education, and multiple cancers (HR: 1.58, 95% CI = 1.06 - 2.36), without clear patterns by sex, comorbidities, insurance, and cancer site. Sensitivity analyses provided similar results. In contrast, among adults without a history of cancer at the time of NHIS participation, HDHP status was not significantly associated with OS (HR: 1.08, 0.96 - 1.21; Pinteraction &lt; .01) or CS (HR: 0.90, 95% CI = 0.70 - 1.14; Pinteraction &lt; .01). Conclusions: This nationwide population-based analysis suggests that HDHPs are associated with both worse overall survival and cancer survival among cancer survivors but are not associated with survival in adults without a history of cancer. HDHPs may financially disincentivize cancer survivors from utilizing necessary medical care to optimize survivorship thereby compromising mortality and cure. Policy changes to limit the proliferation of these plans may improve cancer outcomes.

Trends in human papilloma virus vaccination uptake by sex and race/ethnicity among US adolescents and young adults, 2011-2020.

10519 Background: High-risk strains of human papillomavirus (HPV) are associated with a variety of oral and anogenital cancers, many of which are preventable through HPV vaccination. In the US, completion of an HPV vaccination series is recommended for all individuals from age 9 through 26; however, national trends in HPV vaccination uptake across sex and racial/ethnic groups over the past decade are not well described. Methods: We analyzed data from the National Health and Nutrition Examination Survey across 4 survey cycles spanning January 2011 to March 2020. We used univariate logistic regression to evaluate temporal trends in HPV vaccination uptake across sex and racial/ethnic strata, with the midpoint of each survey cycle modeled as a continuous independent variable. Vaccination uptake was defined as self/parent-reported receipt of ≥ 1 dose of an HPV vaccine series (estimates for 2 and 3 doses were unreliable due to recall bias and missing data). All estimates incorporated appropriate survey weights to be representative of the US population. Results: We identified 10,927 participants representing 70,066,252 individuals: mean age 17.4 years, 48.8% male, 54.9% White. Between 2011-March 2020, overall HPV vaccination uptake steadily increased from 23.3% to 43.0% ( P trend &lt; 0.001; Table). HPV vaccination rates improved from 37.7% to 49.4% among females ( P trend &lt; 0.001) and from 7.8% to 36.4% among males ( P trend &lt; 0.001). HPV vaccination uptake increased similarly across all racial/ethnic strata by approximately 20%, with White individuals achieving the greatest vaccination uptake (45.5%) by March 2020. Conclusions: Among US adolescents and young adults, HPV vaccination uptake rose by ~20% overall and across all racial/ethnic groups. HPV vaccination uptake accelerated the most among males but still lags behind females, perhaps because routine vaccination wasn’t recommended for males until 2011, 5 years after it had been recommended for females. [Table: see text]

Geographical variation in dementia prevalence across China: a geospatial analysis

Dementia poses great health and social challenges in China. Dementia prevalence may vary across geographic areas, while comparable estimations on provincial level is lacking. This study aims to estimate dementia prevalence by provinces across China, taking into account risk factors of individual level and potential spatial correlation of provinces. In this study, 17,176 adults aged 50 years or older were included from the fourth wave of the ChinaHealth and Retirement Longitudinal Study (CHARLS 2018), covering 28 provinces, autonomous regions and municipalities. To improve provincial representativeness, we constructed provincial survey weights based on China 7th census (2020). The prevalence of dementia and 95% Bayesian credible intervals (BCIs) were estimated using a Bayesian conditional autoregressive (CAR) model with spatially varying coefficients of covariates. The weighted prevalence of dementia at provincial level in China in 2018 ranged from 2.62% (95%BCI: 1.70%, 3.91%) to 13.53% (95%BCI: 8.82%, 20.93%). High dementia prevalence was concentrated in North China, with a prominent high-high cluster, while provinces of low prevalence were concentrated on East and South China, characterized by a low-low cluster. Ordered by the median estimation of prevalence, the top 10% of provinces, include Xinjiang, Jilin, and Beijing. Meanwhile, Fujian, Zhejiang, and Guangdong rank among the last. The association between dementia prevalence and drinking, smoking, social isolation, physical inactivity, hearing impairment, hypertension, and diabetes exhibits provincial variation. Our study identifies a geospatial disparity in dementia prevalence and risk factor effects across China's provinces, with high-high and low-low clusters in some northern and southern provinces, respectively. The findings emphasize the need for targeted strategies, such as addressing hypertension and hearing impairment, in specific regions for more effective dementia prevention and treatment. National Science Foundation of China/the Economic and Social Research Council, UK Research and Innovation joint call: Understanding and Addressing Health and Social Challenges for Ageing in the UK and China. UK-China Health And Social Challenges Ageing Project (UKCHASCAP): present and future burden of dementia, and policy responses (grant number 72061137003, ES/T014377/1).

Psychotic-like experiences and associated factors in resident physicians: A Canadian cross-sectional study.

Medical residency training is associated with a range of sociodemographic, lifestyle and mental health factors that may confer higher risk for psychotic-like experiences (PLEs) in residents, yet little research has examined this question. Thus, we aimed to document the prevalence and associated factors of PLEs among resident physicians. Physicians enrolled in residency programmes in the Province of Québec, Canada (four universities) were recruited in Fall 2022 via their programme coordinators and social media. They completed an online questionnaire assessing PLEs in the past 3 months (the 15-item Community Assessment of Psychic Experiences), as well as sociodemographic characteristics, lifestyle and mental health. Analyses included survey weights and gamma regressions. The sample included 502 residents (mean age, 27.6 years; 65.9% women). Only 1.3% (95% CI: 0.5%, 4.0%) of residents met the screening cut-off for psychotic disorder. Factors associated with higher scores for PLEs included racialised minority status (relative difference: +7.5%; 95% CI: +2.2%, +13.2%) and English versus French as preferred language (relative difference: +7.9% 95% CI: +3.1%, +12.9%), as well as each additional point on scales of depression (relative difference: +0.8%; 95% CI: +0.3%, +1.3%) and anxiety (relative difference: +1.3%; 95% CI: +0.8%, +1.7%). In secondary analyses, racialised minority status was associated with persecutory items, but not with other PLEs. Gender, residency programmes and lifestyle variables were not associated with PLEs. This study found low reports of PLEs in a sample of resident physicians. Associations of PLEs with minoritised status may reflect experiences of discrimination.

Drivers of hospital nurse practitioner turnover: A national sample survey analysis

BackgroundHospital nurse practitioner (NP) turnover is costly and complex. PurposeProvide a pre-COVID-19 pandemic baseline of hospital NP turnover. MethodsA secondary analysis of NSSRN18 data on 6,558 (67,863 weighted) NPs employed in hospitals on 12/31/2017. We describe rates of turnover, intention to leave, and reasons for leaving or staying. Using multivariate logistic regression, we examine the association between individual and organizational characteristics and turnover. Survey weights and jackknife standard errors were applied to analyses. DiscussionApproximately 10% of NPs left their job the following year, and 53% of NPs that remained considered leaving at some point. The top reasons cited for leaving or staying were largely organizational factors. Regression analysis revealed not practicing to one’s fullest scope, lower income, lack team-based care, and non-white race were associated with an increased likelihood to leave. ConclusionWe find several modifiable factors associated with hospital NP turnover that can be used to tailor recruitment and retention strategies.

Variation in Trust in Cancer Information Sources by Perceptions of Social Media Health Mis- and Disinformation and by Race and Ethnicity Among Adults in the United States: Cross-Sectional Study.

Mis- and disinformation on social media have become widespread, which can lead to a lack of trust in health information sources and, in turn, lead to negative health outcomes. Moreover, the effect of mis- and disinformation on trust in information sources may vary by racial and ethnic minoritized populations. We evaluated how trust in multiple sources of cancer information varied by perceptions of health mis- and disinformation on social media and by race and ethnicity. Cross-sectional, nationally representative survey data from noninstitutionalized adults in the United States from the 2022 Health Information National Trends Survey 6 (HINTS 6) were analyzed (N=4137). The dependent variable measured the level of trust in cancer information sources. The independent variables were perceptions about health mis- and disinformation on social media and race and ethnicity. Multivariable logistic regression models were adjusted for survey weight and design, age, birth gender, race and ethnicity, marital status, urban/rural designation, education, employment status, feelings about household income, frequency of social media visits, and personal and family history of cancer. We also tested the interaction effect between perceptions of social media health mis- and disinformation and participants' self-reported race and ethnicity. Perception of "a lot of" health mis- and disinformation on social media, relative to perception of "less than a lot," was associated with a lower likelihood of high levels of trusting cancer information from government health agencies (odds ratio [OR] 0.60, 95% CI 0.47-0.77), family or friends (OR 0.56, 95% CI 0.44-0.71), charitable organizations (OR 0.78, 95% CI 0.63-0.96), and religious organizations and leaders (OR 0.64, 95% CI 0.52-0.79). Among White participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from government health agencies (margin=61%, 95% CI 57%-66%) and family or friends (margin=49%, 95% CI 43%-55%) compared to those who perceived less than a lot of health mis- and disinformation on social media. Among Black participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from religious organizations and leaders (margin=20%, 95% CI 10%-30%) compared to participants who perceived no or a little health mis- and disinformation on social media. Certain sources of cancer information may need enhanced support against the threat of mis- and disinformation, such as government health agencies, charitable organizations, religious organizations and leaders, and family or friends. Moreover, interventions should partner with racial and ethnically minoritized populations that are more likely to have low trust in certain cancer information sources associated with mis- and disinformation on social media.