US Adults Research Articles

Risk of incident gout following exposure to recombinant zoster vaccine in US adults aged ≥65 years

ObjectiveAssess the risk of incident gout following exposure to recombinant zoster vaccine (RZV). MethodsThis case-only, self-controlled risk interval study included a cohort of US fee-for-service Medicare (Part A, B, and D) beneficiaries aged ≥65 years. The exposure was receipt of at least one dose of the two-dose RZV regimen in 2018 or 2019. The risk and control windows were days 1–30 and days 31–60, respectively, following vaccination. Incident gout was defined as the first episode of gout during the risk or control window, with no evidence of gout in the last 365 days. We estimated the relative risk (RR) and 95 % confidence interval (CI) of incident gout in the risk window relative to the control window, using conditional Poisson regression models. Sensitivity analyses included a dose-compliant subanalysis of individuals who received dose 2 60–183 days after dose 1; dose-specific analysis; seasonality adjustment; and COVID-19 adjustment for potential detection bias due to the pandemic. ResultsThe 1290 RZV-exposed individuals with incident gout were primarily White (86.98 %), male (61.16 %), and aged 70–79 years (55.82 %). The RR of incident gout was 1.00 (95 % CI 0.90, 1.12). In the dose-compliant sensitivity analysis (n = 959 cases of incident gout), the RR of incident gout was 0.99 (95 % CI 0.87, 1.13). The findings were unchanged in the dose-specific, seasonality, and COVID-19 sensitivity analyses. ConclusionThe findings suggest that RZV is not significantly associated with an increased risk of incident gout in the Medicare population aged ≥65 years.

Age, Gender, and BMI Modulate the Hepatotoxic Effects of Brominated Flame Retardant Exposure in US Adolescents and Adults: A Comprehensive Analysis of Liver Injury Biomarkers.

Brominated flame retardants (BFRs), commonly found in consumer products, have been identified as potential hazards to liver function. While the individual effects of specific BFRs are somewhat understood, there is limited evidence on how mixtures of these chemicals, especially when influenced by demographic factors, interact to affect liver function. This study utilized data from 10,828 participants aged 12 and above from the National Health and Nutrition Examination Survey (2005-2016) to investigate the associations between BFRs (both individually and in combinations) and biomarkers of liver injury. The study focused on how age, gender, and body mass index (BMI) modify modulate these effects. Multivariate linear regression, restricted cubic spline function, weighted quantile sum (WQS) regression, and quantile g-computation (qgcomp) models were used to analyze the linear, non-linear, and joint associations between BFR levels and liver function parameters. We found positive associations between the mixed BFRs index and AST, ALT, GGT, ALP, and TBIL levels and a negative association with ALB levels. PBDE28, PBDE47, and PBB153 consistently contributed to the top weight in both the WQS and qgcomp models. Most critically, the study demonstrated that the relationship between co-exposure to BFRs and liver function parameters was modified by age, gender, and BMI. Therefore, our study highlights the importance of considering demographic diversity in assessing the risk of BFR-induced liver damage and supports the implementation of tailored preventive and intervention strategies.

Associations Between Dietary Intake of Tomato and Lycopene with All-Cause and Cancer-Specific Mortality in US Adults with Diabetes: Results From a Cohort Study

This study aimed to explore the association between dietary intake of tomatoes and lycopene with all-cause and cancer mortality among US adults with diabetes. We hypothesized that a higher intake of tomato and lycopene is related to a reduced risk of all-cause and cancer mortality among adults with diabetes. This prospective study was conducted among 9213 US adults with diabetes using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2016. Data on dietary intake of tomatoes and lycopene were obtained from two 24-h dietary recalls. Multivariate Cox proportional hazard models determined the associations between tomato/lycopene intake and mortality. A higher intake of tomatoes and lycopene was significantly associated with a lower risk of all-cause mortality (tomato: Q5 vs. Q1: HR = 0.68, 95% CI = 0.54–0.86, p = 0.001, p for trend = 0.001; lycopene: Q5 vs. Q1: HR = 0.78, 95% CI = 0.64–0.95, p = 0.013, p for trend = 0.006) after adjusting for all covariates. Compared with the lowest quintile of tomato and lycopene intake, the highest quintile was associated with a lower risk of cancer mortality (tomato: HR = 0.58, 95% CI = 0.35–0.96, p = 0.035; lycopene: HR = 0.63, 95% CI = 0.40–0.98, p = 0.043). Our study demonstrated that dietary intake of tomatoes and lycopene was significantly associated with a lower risk of all-cause mortality in US adults with diabetes. High consumption of tomatoes and lycopene was also related to reduced cancer mortality in US adults with diabetes.

Patient-Provider Communication and Access, Use, and Financial Burden of Care

IntroductionEffective patient-provider communication is a critical component of optimal patient care, but its potential impact on the delivery of health care services remains unclear. This study examines the association of patient-provider communication with access to care, health care utilization, and financial burden of care. MethodsUsing the 2013-2021 Medical Expenditure Panel Survey longitudinal data, the level of patient-provider communication was measured across four domains (attentive listening, clear explanation, respectfulness, and time allocation) as a primary independent variable, categorized into low, moderate, and high. A lagged dependent model was employed to examine the associations of patient-provider communication at baseline with subsequent access to care, health care utilization, and financial burden of care, controlling for baseline sample characteristics and outcomes measured at the baseline. Analysis was conducted in February 2024. ResultsAmong 28,955 analytic samples (representing 709,547,678 US adults), 5.3%, 50.2%, and 44.3% reported low, moderate, and high levels of patient-provider communication. Marginalized populations, including racial/ethnic minorities, those with low education and income, and those lacking insurance, were more likely to report low patient-provider communication. Compared with adults with high patient-provider communication, those with low patient-provider communication were more likely to encounter difficulties in accessing medical care (2.6 percentage points; 95% CI: 1.2-3.9), experience delays in obtaining necessary medical care (2.8 percentage points; 1.3-4.4), have emergency room visits (4.2 percentage points; 1.9-6.4), and face difficulties paying medical bills (4.0 percentage points; 2.2-5.8) in the subsequent year. ConclusionsEncouraging effective patient-provider communication is essential for advancing patient-centered care and mitigating health inequities.

Association of Gaps in Medical Insurance Coverage with Vision Care Benefits Among US Adults

ABSTRACT Background In the US, routine vision care and medical services are often covered by separate insurance plans. Unmet needs for vision care are more common among adults with gaps in medical coverage, but it is unclear how gaps in medical coverage correlate with lack of vision benefits among currently insured adults. We hypothesized that gaps in medical coverage in the past 12 months would be associated with lack of coverage for vision care among US adults currently covered by commercial medical insurance. Methods We included adults age 18–65 with private insurance who participated in the 2019–2022 National Health Interview Survey. The primary outcome was any coverage for vision care services, and the secondary outcome was a source of vision coverage (primary health insurance policy as compared to single-service plans only). Results Based on a sample of 50,000 participants, we estimated 4% of commercially insured adults recently experienced coverage gaps, and 75% had coverage for vision care services. On multivariable analysis, commercially insured adults with recent gaps in medical coverage were more likely to lack coverage for vision care at the time of the survey, compared to adults with continuous medical coverage (odds ratio [OR], 0.77; 95% CI: 0.68, 0.86). However, medical coverage gaps were not associated with source of vision care coverage. Conclusions Gaps in medical insurance coverage were associated with lower likelihood of vision care coverage compared to continuous medical coverage. Protecting continuity of health insurance may support access to vision benefits and reduce gaps in routine vision care.

Increases in Self-identifying as Transgender Among US Adults, 2014–2022

Increases in Self-identifying as Transgender Among US Adults, 2014–2022

Association of systemic and demographic risk factors with prevalence of retinopathy in US adults with prediabetes.

To investigate the relative contribution of systemic risk factors to retinopathy in prediabetes using a nationally representative cohort in the US. A group of 2098 participants aged ≥40 years with available HbA1c and gradable retinal images from the National Health and Nutrition Examination Survey 2005-2008 were included in this retrospective cross-sectional analysis. Participants were stratified into control, prediabetes, and diabetes groups based on HbA1c and anti-hyperglycaemic medication use. Logistic regression was used to assess the contribution of potential systemicrisk factors to retinopathy prevalence. The prevalence of retinopathy in the prediabetes group was 7.69%. Multivariable logistic regression revealed an inverse association of female sex (OR, 0.25; 95% CI, 0.08-0.74; p = 0.02), eGFR (OR, 0.98; 95% CI, 0.96-1.00; p = 0.04), and fasting glucose levels (OR, 0.92; 95% CI 0.87-0.98; p = 0.02) with retinopathy in individuals with prediabetes and a positive association with a Race/Ethnicity classification of "Other" (OR, 6.05; 95% CI, 1.65-22.1; p = 0.01). Comparison of ORs between groups indicated differential associations of "Other" race, fasting glucose, and C-reactive protein (CRP) with retinopathy in prediabetes compared with diabetes. The prevalence of retinopathy among individuals with prediabetes in the NHANES database is similar to other studies. Our findings suggest that nonglycemic metabolic risk factors may be especially relevant to the risk of retinopathy in prediabetes and extend the previously suggested protective effect of female sex on retinopathy in diabetes to prediabetes. The increased odds of retinopathy in underrepresented racial/ethnic groups in the setting of prediabetes also have implications for risk assessment in this population.

Associations between ENDS and cigarette use, and compromised immunity in US adults: Findings from the 2021–2022 NHIS

Background Tobacco use presents increased risks for individuals with weakened immune systems (WIS). We investigated the association between cigarette and electronic nicotine delivery systems (ENDS or e-cigarettes) use and WIS in US adults using data from the 2021–2022 National Health Interview Survey. Methods Data from 57,133 adults were analyzed, focusing on WIS prevalence due to health conditions, prescriptions, or both. Cigarette and ENDS use were categorized as never, former, or current. Weighted multivariable regression models adjusted for demographics and other health conditions to assess associations between tobacco use and WIS. Results Among US adults, 4.3% had prescription-related WIS, 4.6% had health condition-related WIS, and 7% had WIS due to either reason. Adjusted results from multivariable regression models indicated that adults with WIS due to health conditions were more likely to be current (AOR = 1.21, 95%CI: 1.05–1.40) and former (AOR = 1.25, 95%CI: 1.11–1.39) cigarette smokers compared to counterparts without WIS. Adults with WIS due to prescriptions were more likely to be former cigarette smokers (AOR = 1.19, 95%CI: 1.06–1.34). Those with WIS for any reason were more likely to be current (AOR = 1.19, 95%CI: 1.05–1.35) and former (AOR = 1.24, 95%CI: 1.13–1.36) cigarette smokers. Adults with WIS due to health conditions (AOR = 1.23, 95%CI: 1.06–1.41) or any reasons (AOR = 1.19, 95%CI:1.05–1.34) were more likely to be former ENDS users compared to those without WIS. Conclusions In this nationally representative study, we found a notable link between cigarette and ENDS use with WIS, particularly among those with health condition-related or prescription-related WIS, underscoring the importance of addressing tobacco use in this vulnerable population.

An Alternative Non-Invasive Screening Model for Liver Fibrosis among US Adults at Risk of MASLD.

Background and Aims: Screening for liver fibrosis presents a clinical challenge. This study aimed to explore a useful alternative method for assessing fibrosis risk among US adults at risk of metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: A liver stiffness score (LSS) model was proposed and tested using data from 3976 participants at possible risk of MASLD, obtained from the US National Health and Nutrition Examination Survey (NHANES). Results: The LSS model was developed using liver stiffness measurements, blood biochemistry, and body measurement data from 2414 NHANES participants at risk of MASLD, sampled between 2017 and 2020: LSS = exp(0.007035 × bodyweightkg - 0.1061 × raceblack1,0 + 0.183221 × diabetes1,0 + 0.008539 × ASTIU/L - 0.0018 × plateletcount1000cell/UL - 0.21011 × albuming/dL + 2.259087). The probability (P) of having fibrosis F3 + F4 is calculated as follows: P = 0.0091 × LSS2 - 0.0791 × LSS + 0.1933. The developed LSS model was tested on 1562 at-risk participants from the 2017-2018 cycle. The results showed that the LSS model achieved AUROC values of 0.79 and 0.78 for diagnosing cirrhosis (F4) and advanced fibrosis (F3 + F4) in the US population, respectively. It outperformed existing models such as NFS, FIB-4, SAFE, and FIB-3. For screening F3 + F4 fibrosis, the LSS model's top decile outperformed the NFS and FIB-4 models by 37.7% and 42.6%, respectively. Additionally, it showed superior performance compared to the waist circumference classification method by 29.5%. Conclusions: derived from an ethnically diverse population dataset, the LSS screening model, along with its probability equation, may offer clinicians a valuable alternative method for assessing the risk of liver fibrosis in the at-risk adult population.

Janus Kinase Inhibitor Therapy and Risk of Age-Related Macular Degeneration in Autoimmune Disease

The involvement of chronic inflammation in the pathogenesis of age-related macular degeneration (AMD) opens therapeutic possibilities to AMD management. To determine whether Janus kinase inhibitors (JAKis) are associated with a reduced risk of AMD development in patients with autoimmune diseases. This retrospective observational cohort study used administrative claims data from Merative MarketScan research databases (Commercial and Medicare Supplemental) and Optum Clinformatics Data Mart databases between January 1, 2010, and January 31, 2022. Patients with autoimmune diseases satisfying study eligibility criteria and who received JAKi treatment (9126 in MarketScan and 5667 in Optum) were propensity score matched (1:1) to identical numbers of study-eligible patients who received non-JAKi-based immunotherapy. Treatment duration of 6 months or longer. Incidence rates of AMD (exudative and nonexudative) over the first 6 to 18 months of treatment were determined, and bayesian Poisson regression models were used to estimate incidence rate ratios, 95% CIs, and posterior probabilities of AMD. After matching, female sex represented the majority of the patient population in both MarketScan and Optum (14 019/18 252 [76.6%] and 8563/3364 [75.2%], respectively in the JAKi patient population). More than 60% of the patient population was older than 55 years of age in both cohorts. Over the specified treatment period, a 49% relative reduction in incidence of AMD was observed among patients who received JAKi therapy (10/9126 events; adjusted incidence rate ratio [AIRR], 0.51; 95% CI, 0.19-0.90) vs those who received non-JAKi therapy (43/9126 events; AIRR, 1 [reference]) in MarketScan, and a 73% relative reduction in incidence of AMD was observed among patients who received JAKi therapy (3/5667 events; AIRR, 0.27; 95% CI, 0.03-0.74) vs those who received non-JAKi therapy (21/5667 events; AIRR, 1 [reference]) in Optum. The absolute percentage reductions were 0.36% (MarketScan) and 0.32% (Optum), favoring patients who received JAKi therapy. Posterior probabilities of the adjusted risk being less than unity were 97.6% (MarketScan) and 98.9% (Optum) for those who received JAKi therapy vs those who received non-JAKi therapy in MarketScan and Optum, respectively. JAKi use may be associated with a reduced risk of incident AMD in US adults with major autoimmune diseases. The absolute percentage reduction is consistent with a potential role for JAKi in this population. Future studies with long-term follow-up are recommended to investigate the association between JAKi use and incident AMD in other disease indications. Investigation into the role of systemic inflammation and JAK-signal transducers and activators of transcription signaling in AMD may improve understanding of the pathophysiology of AMD and lead to new treatment options.

Cardiovascular risk reduction in type 2 diabetes: What the non-specialist needs to know about current guidelines.

In the US, approximately 11% of the population have diagnosed diabetes and nearly 40% have prediabetes. In addition, chronic kidney disease (CKD) affects 14% of the US population including up to 40% of those with diabetes. Cardiovascular disease (CVD) remains the leading cause of death worldwide where it affects approximately half of adults. The presence of CKD or diabetes doubles the risk of cardiovascular events. When both CKD and diabetes occur in the same patient the risks are further increased. The clinical problems of hypertension, hyperglycemia, and hyperlipidemia are all closely related with obesity, metabolic syndrome, Type 2 diabetes, CKD, atherosclerotic cardiovascular disease, heart failure and non-alcoholic fatty liver disease and metabolic dysfunction-associated steatohepatitis. The increasing frequency of obesity has driven increases in all of these medical comorbidities. These conditions frequently cluster together in the same patient exacerbating the risk of morbidity and mortality. They are also associated with cognitive dysfunction/dementia, pulmonary diseases, cancers, gastrointestinal diseases, immune system abnormalities, and inflammatory disorders. Only 6.8% of adults in US meet all targets for cardiovascular risk management with significant disparities based on race and ethnicity. Given the complexity of these multisystem problems in people with diabetes and obesity, it would seem reasonable to attempt to diagnose and treat many of the comorbidities earlier in the course of disease rather than wait for substantial end organ dysfunction to occur. The American Diabetes Association (ADA) has recently published a consensus statement recommending early screening for the diagnosis of heart failure, CKD and diabetes, recognizing both the frequency and gravity of this combination. Likewise, there are recommendations in the guidelines to facilitate screening for microalbuminuria, blood pressure, glycemic control and lipids earlier in patients at risk rather than wait and treat as a secondary prevention program. Thus, the general principle is to facilitate earlier recognition and diagnosis and provide treatment before downstream target organ complications occur. This review will focus on CVD and risk management based on newest recommendations and standards of care in people with diabetes by the ADA. The main considerations in the treatment of people with diabetes are glycemic control, blood pressure, lipids, and the use of medications with proven cardiorenal disease progression capability to prevent or delay.

Prevalence of Nicotine Pouch Use Among US Adults

This cross-sectional study uses data from the 2022 Tobacco Use Supplement of the Current Population Survey to estimate the prevalence of adult US nicotine pouch use and the characteristics of the individuals using pouches.

The “Reasonableness Divide”: Comparing Community Members’ Assessments of Force Reasonableness to Legal Standards

Headlines frequently call attention to the frustrations that many in the community express when members of law enforcement use force. Some believe that the police frequently use excessive force, and yet, more often than not, the officers involved are found not to have violated the law. This “divide” between community member assessments of reasonable force and the law produces great turmoil in our society. We surveyed a national sample of 1,200 US adults to explore the alignment between community members’ views of force reasonableness and the law on reasonable force as well as examine whether and to what extent the “community standard” perspectives for evaluating uses of force contributed to the alignment. Overall, the results indicated that a significant portion of community members’ assessments did not align with the law, and those assessments were driven largely by the “community standard” perspectives they took when evaluating the use of force.

Economic burden of cardiorespiratory hospitalizations associated with respiratory syncytial virus among United States adults in 2017–2019

ABSTRACT Morbidity and mortality caused by respiratory syncytial virus (RSV) in older adults and those with underlying health conditions can be potentially alleviated through vaccination. To assist vaccine policy decision-makers and payers, we estimated the annual economic burden of RSV-associated cardiorespiratory hospitalizations among insured US adults aged ≥18 y in the Merative MarketScan claims database from September through August of 2017–2018 and 2018–2019. Negative binomial regression models were used to estimate the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. This number was multiplied by mean cardiorespiratory hospitalization costs to estimate total costs for RSV-associated cardiorespiratory hospitalizations. Number and cost for International Classification of Diseases (ICD)-coded RSV hospitalizations were quantified from MarketScan. In 2017–2018 and 2018–2019, respectively, 18,515,878 and 16,462,120 adults with commercial or Medicare supplemental benefits were assessed. In 2017–2018, 301,248 cardiorespiratory hospitalizations were observed; 0.32% had RSV-specific ICD codes, costing $44,916,324, and 5.52% were RSV-associated cardiorespiratory hospitalizations, costing $734,078,602 (95% CI: $460,826,580–$1,103,358,799). In 2018–2019, 215,525 cardiorespiratory hospitalizations were observed; 0.34% had RSV-specific ICD codes, costing $33,053,105, and 3.14% were RSV-associated cardiorespiratory hospitalizations, costing $287,549,472 (95% CI: $173,377,778–$421,884,259). RSV contributes to substantial economic burden of cardiorespiratory hospitalizations among US adults. Modeling excess risk using viral positivity data provides a comprehensive estimation of RSV hospitalization burden and associated costs, compared with relying on ICD diagnosis codes alone.

Association between tobacco smoke exposure and serum parathyroid hormone levels among US adults (NHANES 2003–2006)

Tobacco smoke exposure has been demonstrated to impede bone remodeling and diminish bone density, yet research regarding its correlation with parathyroid hormone (PTH) remains limited. This study aims to investigate the relationship between tobacco smoke exposure and serum PTH levels in adults aged 20 years and older. This study included 7,641 participants from two cycles of the National Health and Nutrition Examination Survey (NHANES, United States, 2003- 2006). Reflect tobacco smoke exposure through serum cotinine levels, and use an adjusted weighted multivariate linear regression model to test the independent linear relationship between serum cotinine and PTH. Stratified analysis was conducted to validate the sensitivity of the conclusions. Smooth curve fitting and threshold effect analysis were performed to assess the non-linear relationship. After comprehensive adjustment using weighted multivariate regression analysis, a negative correlation was found between serum cotinine and PTH levels. The interaction p-values in subgroup analyses were all greater than 0.05. Moreover, smooth curve fitting indicated a non-linear relationship between serum cotinine and PTH, with a turning point observed. Our research indicates that tobacco smoke exposure is negatively correlated and independent of serum parathyroid hormone levels, indicating that long-term tobacco smoke exposure may lead to parathyroid dysfunction in adults.

Public Perceptions of Gangs: An Experimental Test of Nomenclature, Race/Ethnicity, Violence, and Organization

This study examines how the public views gangs, surveying 1,000 US adults using a vignette of a teenage collective. Through a factorial design, elements crucial to gang definition debates were randomly manipulated: the name of the group, its racial composition, behavior severity, and organizational structure. Findings reveal that a name associated with known gangs significantly impacts perception, making it more likely for a group to be identified as a gang. The collective’s activity and organizational structure also swayed perceptions, with violent and structured groups more readily classified as gangs. Surprisingly, the group’s racial makeup did not markedly alter perceptions, although joint effects show it did affect the interpretation of other factors. These insights suggest a need to reassess how research shapes our understanding of gangs and, in turn, how public concerns inform policymakers; highlighting the nuances in public opinion that could factor into legal responsibility and guide future legislative decisions.

Retraction Note: Changes in Blood Pressure is Associated with Bone Loss in US Adults: A Cross-Sectional Study from NHANES 2005-2018.

Retraction Note: Changes in Blood Pressure is Associated with Bone Loss in US Adults: A Cross-Sectional Study from NHANES 2005-2018.

Association of the hemoglobin, albumin, lymphocyte, and platelet score with the risk of Erectile dysfunction: a cross-sectional study

Erectile dysfunction (ED) is related to nutritional and inflammatory factors. The hemoglobin, albumin, lymphocyte, and platelet score (HALP), a new index reflecting the nutritional and inflammatory status, has been associated with a higher risk of diabetic retinopathy, particularly at lower values (≤ 42.9). However, studies focusing on the relationship between HALP and ED risk are scarce. Hence, this study aimed to investigate the association between HALP and ED. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Based on self-reported data, participants were classified into either the ED group or the non-ED group. Next, the HALP score was categorized into four quartiles (Q1–4). Weighted multivariate regression analysis was performed to assess the relationship between categorical HALP and ED risk. Additionally, restricted cubic spline (RCS) analysis was conducted to examine the association between continuous HALP scores and ED risk. Furthermore, subgroup analyses were conducted to examine the association between categorical HALP and the risk of ED based on age, as well as the status of hypertension, diabetes and cardiovascular disease. Finally, a mediation analysis was carried out to investigate the mediating effect of HALP and related parameters on the association between urinary cobalt levels and ED. Initially, the data of 21,161 participants were collected. After implementing the inclusion and exclusion criteria, 3406 participants were included in the final analyses. Weighted multivariate regression analysis demonstrated that the Q4 HALP group was associated with a lower risk of ED (OR 0.96, 95% confidence intervals 0.92–1.00, P = 0.037). Meanwhile, RCS analysis showed that HALP was nonlinearly associated with the risk of ED. In addition, subgroup analyses demonstrated that participants in the Q3/4 HALP group had a significantly lower ED risk than those in the Q1 group among patients aged ≥ 50 years, as well as those with hypertension and diabetes. Lastly, mediation analysis revealed that HALP and its associated parameters had a marginal average causal mediation effect on the relationship between urinary cobalt levels and ED risk (P > 0.05). In US adults, high HALP scores were correlated with a lower risk of ED. The relationship was more pronounced in participants aged ≥ 50 years with hypertension and diabetes. Furthermore, HALP and its parameters may not mediate the association between urinary cobalt levels and ED risk.

Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes

ObjectivePopulation-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.MethodsWe used 12-year data (2008–2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).ResultsThe total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808–$15,619) in 2008–2009 to $19,145 (95% CI: $17,988–$20,301) in 2008–2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721–$5646) in 2008–2009 to $7501 (95% CI: $6678–$8325) in 2018–2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643–$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.ConclusionsIn the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.

Association between life’s essential 8 and metabolic dysfunction-associated steatotic liver disease among US adults

BackgroundMetabolic dysfunction-associated steatotic liver disease(MASLD) is the most common cause of chronic liver disease. Clinical evidences have demonstrated the link between MASLD and the increased risk of cardiovascular disease (CVD) development. We aimed to investigate the relationship between Life’s Essential 8 (LE8), an enhanced approach to assessing cardiovascular health(CVH), and MASLD.MethodsData were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2017–2020 cycles. MASLD was assessed by the latest diagnostic criteria. LE8 scores (range 0–100) were obtained from measurements based on American Heart Association definitions, divided into health factor and health behavior scores. Multivariable logistic and restricted cubic spline models were used to assess the associations.Results5646 participants were included based on the inclusion and exclusion criteria, 2616 (46.33%) participants were diagnosed with MASLD. After adjusting for confounding variables, higher LE8 scores were associated with a lower risk of MASLD (OR = 0.19, 95%CI 0.17–0.21; P < 0.001), similar associations were also observed between health behavior and health factor scores with MASLD. Subgroup analyses illustrated that the negative association between LE8 score and MASLD was stronger among younger, non − Hispanic White, and never married participants.ConclusionsIn this nationally representative sample of U.S. adults, LE8 scores, health behavior scores, and health factor scores were negatively associated with the prevalence of MASLD in non-linear fashions. Subjects maintaining ideal health factors and health behaviors are less likely to develop MASLD. Public health policies are needed to advocate healthy behaviors and factors.