United States Survey Research Articles

Patient-reported outcomes related to migraine burden among patients treated with standard-of-care preventive medications or calcitonin gene-related monoclonal antibodies: a United States and Europe cross-sectional survey

Objective To evaluate quality of life, migraine disability, and work productivity and activity impairment in patients with migraine who received preventive treatment by comparing standard of care preventive medications and calcitonin gene-related monoclonal antibodies (CGRP mAbs), including galcanezumab alone. Methods This cross-sectional study conducted across the United States (US) and Europe used data from the Adelphi Migraine Disease Specific Programme. Physicians completed record forms for consecutive patients, who then completed self-report forms assessing patient-reported outcomes (PROs) such as quality of life, migraine disability, and work productivity and activity impairment. T-tests, Fisher’s exact test, and Mann-Whitney U test were used for analysis. Results From May 2022 to June 2023, 557 physicians submitted data for 6723 patients. A total of 4036 patients (US 956; Europe 3080) with a history of preventive treatment were included (>60% female, >80% White, mean [standard deviation] age range, 38.7 [12.8] to 46.3 [12.1]). Patients who received 3+ lines of preventive therapy and were receiving CGRP mAbs (including galcanezumab alone) had enhanced health-related quality of life (HRQoL) compared to those who receivedstandard of care. Similar findings were observed across Europe; however, in the US, there was no significant difference in any PROs. Conclusion Patients with migraine in the overall population and Europe who received 3+ lines of preventive migraine therapy and were receiving CGRP mAbs/galcanezumab demonstrated enhanced HRQoL compared to those who received standard of care.

Local crime and substance use disorders: A comparison of midlife adults in the 1990s and 2000s

This study investigated how sociopolitical changes in the United States between the 1990s and 2000s may explain the increase in substance use disorders and reduced longevity in more recent cohorts of US midlife adults. The 2008 recession which drastically increased unemployment rates across the country may have had negative implications for downstream contextual and individual processes, including both local crime rates and substance use disorders. The Midlife in the United States Survey cohort (1995; n = 6148; 20–75 years) and the MIDUS Refresher cohort (2011; n = 3543; 23–76 years) reported on substance use disorders. These data were linked to Uniform Crime Reporting violent crime rates to determine whether associations between local crime and substance use disorders changed among two separate cohorts of US midlife adults assessed before or after the 2008 recession. In 1995, despite higher local crime rates, substance use disorders were not associated with local crime. The comparatively lower crime rates of 2011, however, associated with greater prevalence of substance use disorders. Considering unemployment rates from the Decennial Census and American Community Survey, which were substantially higher in 2011 relative to 1995, completely diminished the local crime rate-substance use disorder association. The increased prevalence of substance use disorders observed in the more recent cohort of midlife adults assessed in the current study may represent maladaptive coping to local crime after the 2008 recession.

Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the United States.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by abdominal pain and altered bowel habits, with patient-perceived dissatisfaction of treatment symptom control. We assessed disease burden, satisfaction with medication use, and impact on activities, in participants with IBS with constipation (IBS-C) and diarrhea (IBS-D). This study assessed data from a large, United States survey of adults querying demographics, comorbid conditions, quality of life, medication use, satisfaction with symptom control, and work productivity. Participants were grouped into the IBS-C or IBS-D cohort if they met Rome IV criteria, with controls matched 1:1 according to age, sex, race, region, and Charlson Comorbidity Index score. All data were self-reported. Nine hundred and ten participants with IBS-C and 669 with IBS-D were matched to controls. The most reported symptoms were abdominal discomfort for IBS-C and abdominal pain and abdominal discomfort for IBS-D. Among the IBS-C and IBS-D cohorts, 74.2% and 65.9%, respectively, took prescription and/or over-the-counter medication for their symptoms. Respondents were more dissatisfied than satisfied with control of their symptoms. Respondents taking prescription medication(s) with or without over-the-counter medication(s) reported better symptom control than respondents only taking over-the-counter medications (p < 0.001). There was significantly higher mean presenteeism, work productivity loss, and daily activity impairment (p < 0.001 for all) in respondents with IBS compared with controls. This study provides insight into respondents' experiences of IBS symptoms, including the impact on daily activity, as well as satisfaction with control of symptoms and prescription and over-the-counter medications.

Personality traits and the risk of urinary incontinence: Evidence from three longitudinal samples.

Urinary incontinence (UI) is a common condition with a substantial negative impact on older adults' quality of life. This study examines whether individual differences in behavioral, cognitive, and emotional traits assessed by the five major dimensions of personality are related to the risk of concurrent and incident UI. Participants were older women and men (N>26,000) from the Midlife in the United States Survey, the Health and Retirement Study, and the English Longitudinal Study of Aging. In each cohort, personality traits (measured with the Midlife Development Inventory) and demographic (age, sex, education, and race), clinical (body mass index, diabetes, blood pressure), and behavioral (smoking) factors were assessed at baseline. UI was assessed at baseline and again 8-20years later. Results for each cohort were combined in random-effect meta-analyses. Consistently across cohorts, higher neuroticism and lower conscientiousness were related to a higher risk of concurrent and incident UI. To a lesser extent, extraversion, openness, and agreeableness were also related to lower risk of concurrent and incident UI. BMI, diabetes, blood pressure, and smoking partially accounted for these associations. There was little evidence that age or sex moderated the associations. The present study provides novel, robust, and replicable evidence linking personality traits to UI. The higher vulnerability for UI for individuals who score higher on neuroticism and lower on conscientiousness is consistent with findings for other multifactorial geriatric syndromes. Personality traits can help identify individuals at risk and may help contextualize the clinical presentation of comorbid emotional, cognitive, and behavioral symptoms.

Life course socioeconomic status, chronic pain, and the mediating role of allostatic load: findings from the midlife in the United States.

Low socioeconomic status (SES) has been linked to chronic pain (CP); however, the mechanisms by which SES over the life course influences downstream CP outcomes remain unclear. This study utilizes data from the Midlife in the United States (MIDUS) survey, a prospective sample of community-dwelling individuals (N=781), to investigate the chain of risk additive model of SES in relation to CP. Additionally, the study examines the mediating role of allostatic load (AL) in the relationship between life course SES and CP. Confirmatory factor analysis was employed to capture the multidimensionality of life course SES and path analysis was used to examine the direct and indirect effects on CP. AL was computed by quartile-based summation and by latent class analysis. Results indicated lower SES in MIDUS 2 was associated with greater high-interference CP odds in MIDUS 3 (OR=1.069, 95% CI=1.006-1.136, P < 0.05) and no association was found between distal SES and levels of CP interference. Similarly, no significant relationship was observed between SES and the number of CP locations. Additionally, no additive effects of SES were found, and AL did not present mediation effects on the association between life course SES and CP. The present study emphasizes the importance of directly proximal effects of SES on CP, underscoring the need for equitable distribution of health resources and the implementation of policies focused on diminishing socioeconomic inequalities. Further research is needed to examine alternative pathways by which proximal SES impact CP.

Scholarly accomplishments: a United States survey of academic psychologists

Scholarly accomplishments: a United States survey of academic psychologists

The association between excise taxes and smoking and vaping transitions–Findings from the 2016–2020 ITC United States surveys

BackgroundWhile a growing number of studies examined the effect of e-cigarette (EC) excise taxes on tobacco use behaviors using cross-sectional surveys or sales data, there are currently no studies that evaluate the impact of EC taxes on smoking and vaping transitions. MethodsUsing data from the US arm of the 2016–2020 International Tobacco Control Four Country Smoking and Vaping Survey (ITC 4CV), we employed a multinomial logit model with two-way fixed effects to simultaneously estimate the impacts of cigarette/EC taxes on the change in smoking and vaping frequencies. ResultsOur benchmark model suggests that a 10 % increase in cigarette taxes led to an 11 % reduction in smoking frequencies (p < 0.01), while EC taxes did not have a significant effect on smoking frequencies. ConclusionOur findings suggest that increasing cigarette taxes may serve as an effective means of encouraging people who smoke to cut back on smoking or quit smoking. The impact of increasing EC taxes on smoking transitions is less certain at this time.

The Association of Sexual Minority Status with the Prevalence, Diagnosis, and Treatment of Depression among NYC Adults.

Major depressive disorder (MDD) is a common mental health disorder with a lifetime prevalence of 20.6% among United States (US) adults. Multiple US surveys have shown a consistently higher burden of mental health struggles among lesbian, gay, bisexual, trans, and questioning (LGBTQ+) adults compared to non-LGBTQ+ adults. However, it is not known whether diagnosis and treatment for those adults who do report symptoms of MDD differ based on sexual orientation.We test for differences in prevalence, diagnosis, and treatment of MDD in sexual minorities using appropriate multivariable logistic regression using the New York City Health and Nutrition Examination Survey (NYC HANES).About 10% of NYC adults (≥ 20 years old) self-identify as a sexual minority and 8.5% of adults in NYC have MDD based on the Patient Health Questionnaire (PHQ-9) score. Significantly higher proportion of sexual minorities in NYC have depression compared to non-sexual minorities (17.7% vs. 7.6%, p = 0.01). In the multivariable model, sexual minorities were 2.33 (CI = [1.24-4.39], p = 0.009) times more likely to have depression compared to non-sexual minorities. Additionally, people with multimorbidity were more likely to be diagnosed for depression (OR = 3.78, CI = [1.33, 10.75], p = 0.013).Disparities exist in the prevalence, diagnosis, and treatment of MDD in NYC adults. Targeted outreach toward the LGBTQ + community should be considered by public health officials when designing primary and secondary prevention programs for depression.

“Think of the situation in a positive light”: A look at cognitive reappraisal, affective reactivity and health☆

RationaleHow individuals regulate their emotions is critical for maintaining health and well-being. For example, reframing a stressful situation in a positive light, a form of cognitive reappraisal, is beneficial for both physical and mental health as well as subjective well-being. However, it is currently unclear why this relationship exists. One potential mechanism could be how one emotionally reacts to stressors in daily life, termed affective reactivity. ObjectiveThe current study examined longitudinal associations that spanned 20 years between cognitive reappraisal and health outcomes and subjective well-being and if affective reactivity mediated this relationship. MethodsParticipants completed waves 1–3 of the Midlife in the United States (MIDUS) Survey series and were asked various questions about their general health and well-being. Each wave was approximately 10 years apart. A subset of participants from MIDUS II completed the National Study of Daily Experiences (NSDE II), an 8-day daily diary asking about their everyday experiences. The final sample consisted of 1814 participants. ResultsResults found that cognitive reappraisal was significantly associated with future health and well-being outcomes, and negative affective reactivity significantly mediated this relationship. Those who engaged more in cognitive reappraisal tended to be less affectively reactive to stressful events 10 years later, leading to having better health and well-being outcomes 20 years later. ConclusionFindings from this study could better inform stress and well-being interventions by strengthening cognitive reappraisal strategies to target reducing affective reactivity to stressors which should then benefit long-term health and well-being.

Perceived Relational Support Is Associated With Everyday Positive, But Not Negative, Affectivity in a U.S. Sample.

Research suggests that perceived social support bolsters emotional well-being. We tested whether perceived support from friends, family, and spouses/partners was associated with reduced negative and greater positive affectivity (i.e., everyday affective baseline), and whether perceived strain in these relationships had opposite effects, accounting for age and relevant covariates. Using data from the third waves of the Midlife in the United States survey and National Study of Daily Experience (n = 1,124), we found negative affectivity was not tied to relational support nor strain, but instead was associated positively with neuroticism and negatively with conscientiousness. In contrast, positive affectivity was related positively to support from friends and family, conscientiousness, and extroversion, and negatively to strain among partners and neuroticism. Exploratory analyses within second-wave Midlife in Japan data (n = 657) suggest patterns for future cross-cultural study. Some relationship dynamics may vary, but perceived support might enhance emotional well-being by bolstering positive, rather than mitigating negative, emotionality.

Thwarted Belonging and Perceived Burdensomeness During Middle and Older Adulthood: The Role of Generativity.

Using a sample of middle-aged and older adults, this research explores associations between generativity and two key risk factors for suicide: thwarted belonging (T.B.) and perceived burdensomeness (P.B.). These variables are typically studied as predictors of suicide; the current study is unique in examining their psychosocial correlates. Erikson described, generativity as a psychosocial construct that characterizes adult well-being in mid-life, conceptualized as the sense one has successfully guided and contributed to the younger generation through mentoring. Using the Midlife in the United States Survey (MIDUS), the current analyses indicate that generativity is associated with lower levels of P.B. and T.B., even after accounting for measures of hopelessness, depressive symptoms, financial stability, perceived neighborhood quality, chronic health conditions, and respondent's demographic characteristics including gender and age. Results are discussed in terms of applications for suicide-risk prevention, and with regard to the promotion of positive psychosocial development across the lifespan.

How do users compare the costs between nicotine vaping products and cigarettes? Findings from the 2016-2020 International Tobacco Control United States surveys.

Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. We used data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two-way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre-filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low-income populations. Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes.

EFFECTS OF MENOPAUSE AND MARITAL TRANSITIONS ON SUBJECTIVE SEXUAL SELF-EFFICACY AMONG MIDDLE-AGED AND OLDER ADULTS

Abstract Circumstances in aging including menopause, physical decline, widowhood, divorce and remarriage may influence sexual experiences and well-being in later life. While marital transition can affect both men and women in middle and older life, menopausal transition is especially salient for aging women. This study aims to examine how subjective sexual self-efficacy changes over time and whether marital transitions and menopausal transitions moderate the trajectories. Participants completed two waves of the Midlife in the United States (MIDUS) surveys (N = 1002), ranging from 40 to 84 years of age at baseline (M = 57.44; SD = 10.17) with over half being female (54%, n = 538). Factor analysis confirmed a one-factor model with a five-item subjective sexual self-efficacy construct. Over 10 years, 12% of participants experienced marital transitions, and 29% of women reporting menstrual status experienced menopause transition. Growth curve analysis was used the examine the research questions.

EXPLORING THE WITHIN-PERSON RELATIONSHIP BETWEEN DAILY DISCRIMINATION AND DAILY STRESS REACTIVITY

Abstract Experiencing discrimination has been associated with a variety of negative impacts such as poorer health and well-being. Some research has shown that those who experienced discrimination at an initial timepoint were more likely to have poorer health and well-being outcomes 20 years later through the mediating role of threat appraisals and stress reactivity. Research has demonstrated a link between experiencing discrimination and affective reactions to everyday stressful experiences, however, these associations have only been studied at the between-person level. For the current study, we examined the within-person relationship in daily stress reactivity in relation to experiencing discrimination on a daily basis over the course of 20 years. Participants (n = 1,315) completed waves 1 to 3 of the Midlife in the United States (MIDUS) survey with each wave about 10 years apart in which participants were asked to self-report their daily discrimination. Participants also completed the National Study of Daily Experiences (NSDE) which was a daily diary design over 8 consecutive days asking about their daily stress reactivity. Results found that during timepoints when people experienced greater than their average level of discrimination, they also reacted more negatively to daily stressful events (b = .002, 95% CI [0.001, 0.002]). These results are particularly striking because they show that within-person changes in reported discrimination are related to changes in affective responses to daily stressors. These findings suggest that experiencing discrimination is related to greater reactivity to daily stressors, which may lead to worse physical and mental health over time.

2228. Knowledge, Attitudes, and Practices Regarding Antibiotic Use during the COVID-19 Pandemic: A Comparison of United States (US) Survey Respondents Living in the US-Mexico Border Region with those Living in Non-border Regions

Abstract Background Inappropriate use of antibiotics is a driver of antimicrobial resistance globally. The US-Mexico border region is medically underserved and socially vulnerable. This study aimed to assess knowledge, attitudes and practices (KAP) regarding antibiotic use during the COVID-19 pandemic among US residents, and to compare KAPs for those living in border versus non-border regions. Methods A cross-sectional online survey with monetary incentive was deployed to a sample of adults ≥18 years old through Amazon Mechanical Turk with enriched sampling in the US-Mexico border region (defined as residency within 100 km of the border). Surveys were completed from 8/8/2020 to 8/4/2021. KAP questions were aligned with published tools and COVID-19-specific questions were added. Of 602 respondents from the US, 590 (98%) had complete KAP data and were included in this analysis. Chi-square tests were performed to examine the association between KAPs related to antibiotic use and border residency status. Results Overall, for 6 of 8 knowledge items about antibiotic use, fewer than 50% of survey respondents answered correctly (Table 1). 50% of border residents versus 71% of non-border residents (p&amp;lt; 0.01) correctly agreed that “antibiotics should never be saved for the next time you get sick.” Conversely 44% of border residents, versus 31% of non-border residents (p=0.03), correctly disagreed with the statement “when I have a cold, I should take antibiotics to avoid getting a more serious illness.” There was no difference in knowledge about causes of antibiotic resistance by region of residency. Overall, 40% of respondents believed that their personal antibiotic use did not affect antibiotic resistance (Table 2). Finally 37% all respondents said they tried to obtain antibiotics, and 31% tried to obtain chloroquine or hydroxychloroquine, because of concerns about COVID-19 with no difference by region of residency. Table 1: Number and percentage of survey respondents answering correctly to knowledge questions regarding antibiotic use, stratified by residency within 100 kilometers of the US-Mexico border. Table 2: Number and percentage of survey respondants with attitudes consistent with antibiotic stewardship among United States (US) residents, stratified by residency within 100 kilometers of the US-Mexico border. Conclusion KAP findings from this survey suggest that knowledge about antibiotic use is low regardless of proximity to the US-Mexico border. Further, practices related to antibiotic and chloroquine or hydroxychloroquine seeking in the context of COVID-19 suggest a role for public-facing information campaigns regarding medication seeking during public health emergencies. Disclosures All Authors: No reported disclosures

Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk.

Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk. We used the Midlife in the United States Survey ( N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health. ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008-1.047, p = .006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses. ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.

Serologic Immunity to Tetanus in the United States, National Health and Nutrition Examination Survey, 2015-2016.

Tetanus, a life-threatening infection, has become rare in the United States since introduction of tetanus toxoid-containing vaccines (TTCVs), recommended as a childhood series followed by decennial boosters beginning at age 11-12 years; vaccination uptake is high in children but suboptimal in adults. The objective of this study was to estimate the prevalence of sero-immunity to tetanus among persons aged ≥6 years in the United States and to identify factors associated with tetanus sero-immunity. Understanding population protection against tetanus informs current and future vaccine recommendations. Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015-2016 National Health and Nutrition Examination Survey (NHANES) aged ≥6 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as ≥0.10 IU/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression. Overall, 93.8% of the US population aged ≥6 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial/ethnic categories, sex, and poverty levels. By age, ≥ 90% had protective sero-immunity through age 69 years, but prevalence of sero-immunity declined thereafter, with 75.8% of those aged ≥80 years having protective sero-immunity. Older age (adjusted prevalence ratio [aPR]: 0.89, 95% confidence interval [CI]: .85-.92) and being born outside the United States (aPR: 0.96, 95% CI: .93-.98) were significantly associated with lower prevalence of sero-immunity. The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program.

Quantifying COVID-19 policy impacts on subjective well-being during the early phase of the pandemic: A cross-sectional analysis of United States survey data from March to August 2020.

To stop the spread of COVID-19, a number of public health policies and restrictions were implemented during the pre-vaccination phase of the pandemic. This study provides a quantitative assessment of how these policies impacted subjective well-being (SWB) in the United States over a 6-month period spanning March to August 2020. We study two specific research objectives. First, we aim to quantify the impacts of COVID-19 public health policies at different levels of stringency on SWB. Second, we train and implement a conditional inference tree model for predicting individual SWB based both on socio-demographic characteristics and policies then in place. Our results indicate that policies such as enforcing strict stay-at-home requirements and closing workplaces were negatively associated with SWB, and that an individual's socio-demographic characteristics, including income status, job, and gender, conditionally interact with policies such as workplace closure in a predictive model of SWB. Therefore, although such policies may have positive health implications, they also have secondary environmental and social implications that need to be taken into account in any cost-benefit analysis of such policies for future pandemic preparedness. Our proposed methodology suggests a way to quantify such impacts through the lens of SWB, and to further advance the science of pandemic preparedness from a public health perspective.

Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results From a Nationwide Cross-Sectional Study

The estimated prevalence of irritable bowel syndrome (IBS) using Rome IV criteria in the United States (US) ranges from 4.7% to 5.3%, although these estimates arise from studies with relatively small sample sizes. This study assessed the prevalence of IBS and its associated burden of illness using a nationally representative data set with nearly 89,000 people in the US. From May 3 to June 24, 2020, we performed an online survey described to participating adults aged ≥18 years old as a "national health survey." We recruited a representative sample of people in the US to complete the survey, which included the Rome IV IBS questionnaire, National Institutes of Health Patient-Reported Outcome Measurement Information System (PROMIS) gastrointestinal scales, and questions on health care-seeking behavior. Overall, 88,607 people completed the survey, of whom 5414 (6.1%) met Rome IV IBS criteria: mixed IBS (n= 1838 [33.9%]), constipation-predominant IBS (n= 1819 [33.6%]), diarrhea-predominant IBS (n= 1521 [28.1%]), and unsubtyped IBS (n= 236 [4.4%]). Women had higher odds for IBS compared with men, whereas racial/ethnic minorities had lower odds for IBS vs non-Hispanic Whites. Across the 3 main subtypes, 68.2% to 73.2% of people reported ever seeking care for their IBS symptoms, whereas 53.8% to 58.9% did so in the past 12 months. In this nationwide US survey, we found that Rome IV IBS is slightly more prevalent (6.1%) vs prior estimates (4.7%-5.3%). Additional research is needed to determine whether this higher prevalence is in part due to the coronavirus disease 2019 pandemic during which this study was conducted.

Hereditary Angioedema With Normal C1 Inhibitor: US Survey of Prevalence and Provider Practice Patterns.

Hereditary angioedema (HAE) with normal C1-INH (HAE-nl-C1INH) is phenotypically similar to HAE resulting from C1-INH deficiency (HAE-C1INH). Confirmatory diagnostic tests for HAE-nl-C1INH are limited and few clinical study data exist regarding management of the condition. Therefore, survey studies may provide initial estimates of prevalence, diagnosis, and management patterns of this condition. To estimate the prevalence and describe current management patterns for HAE-nl-C1INH in the United States (US). We conducted an Internet-based survey of US physicians to estimate the prevalence of the HAE-nl-C1INH population in the United States. Potential participating physicians were identified from the US Hereditary Angioedema Association database and IQVIA Xponent prescription database. Eligible physicians were invited to complete an online survey between June and September2021. A total of 113 physicians provided data for the estimation of HAE-nl-C1INH prevalence and 81 physicians treating HAE-nl-C1INH patients provided data about treatment patterns. In bias-corrected analysis, we estimated 1,230 to 1,331 HAE-nl-C1INH patients within the United States between May 2019 and April 2020. Mean time to diagnosis for HAE-nl-C1INH was approximately 6 years (range, 2.4-13.5 years). Response to medication was commonly used to inform diagnosis (antihistamine response or nonresponse used by 73% of physician respondents, corticosteroids by 57%, or HAE-specific medications by 74%), and Factor XII genetic testing was used by 43%. These survey data provide estimates of HAE-nl-C1INH prevalence in the United States as well as current diagnosis and management strategies. Results may be useful for developing studies to assess treatment efficacy and safety, and potentially improve the diagnosis for and management of this patient population.