US Residents Research Articles

Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening

Increased use of recommended screening could help achieve the Cancer Moonshot goal of reducing US cancer deaths. To estimate the number of cancer deaths that could be prevented with a 10-percentage point increase in the use of US Preventive Services Task Force (USPSTF)-recommended screening. This decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023. This study simulated contemporary cohorts of US adults eligible for lung, colorectal, breast, and cervical cancer screening. Annual low-dose computed lung tomography among eligible adults aged 50 to 80 years; colonoscopy every 10 years among adults aged 45 to 75 years; biennial mammography among female adults aged 40 to 74 years; and triennial cervical cytology screening among female adults aged 21 to 29 years, followed by human papillomavirus testing every 5 years from ages 30 to 65 years. Estimated number of cancer deaths prevented with a 10-percentage point increase in screening use, assuming screening commences at the USPSTF-recommended starting age and continues throughout the lifetime. Outcomes were presented 2 ways: (1) per 100 000 and (2) among US adults in 2021; and they were expressed among the target population at the age of screening initiation. For lung cancer, estimates were among those who will also meet the smoking eligibility criteria during their lifetime. Harms from increased uptake were also reported. A 10-percentage point increase in screening use at the age that USPSTF recommended screening commences was estimated to prevent 226 lung cancer deaths (range across models within the cancer site, 133-332 deaths), 283 (range, 263-313) colorectal cancer deaths, 82 (range, 61-106) breast cancer deaths, and 81 (1 model; no range available) cervical cancer deaths over the lifetimes of 100 000 persons eligible for screening. These rates corresponded with an estimated 1010 (range, 590-1480) lung cancer deaths prevented, 11 070 (range, 10 280-12 250) colorectal cancer deaths prevented, 1790 (range, 1330-2310) breast cancer deaths prevented, and 1710 (no range available) cervical cancer deaths prevented over the lifetimes of eligible US residents at the recommended age to initiate screening in 2021. Increased uptake was also estimated to generate harms, including 100 000 (range, 45 000-159 000) false-positive lung scans, 6000 (range, 6000-7000) colonoscopy complications, 300 000 (range, 295 000-302 000) false-positive mammograms, and 348 000 (no range available) colposcopies over the lifetime. In this decision analytical model study, a 10-percentage point increase in uptake of USPSTF-recommended lung, colorectal, breast, and cervical cancer screening at the recommended starting age was estimated to yield important reductions in cancer deaths. Achieving these reductions is predicated on ensuring equitable access to screening.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

What attributes of abortion care affect people's decision-making? Results from a discrete choice experiment

ObjectivesWe aimed to measure both stated and experimentally “revealed” abortion provision preferences among US people with capacity for pregnancy. Study designIn July 2022, we recruited US residents assigned female sex at birth and aged 18 to 55 years using Prolific, an online survey hosting platform. We asked participants what first-trimester abortion method and delivery model they would prefer. We also assessed abortion care preferences with a discrete choice experiment, which examined the relative importance of the following care attributes: method, distance, wait time for appointment, delivery model (telehealth vs in-clinic), and cost. ResultsMore than half of the 887 respondents (59%) self-reported a slight (22%) or strong (37%) preference for medication compared to aspiration abortion; 11% stated no preference. Our discrete choice experiment found that cost and wait time had a greater effect on hypothetical decision-making than did method and delivery model (discrete choice experiment average importances = 44.3 and 23.2, respectively, compared to 15.9 and 8.2, respectively). Simulations indicated that holding other attributes constant, respondents preferred medication to aspiration abortion and telehealth to in-clinic care. ConclusionsThis study, the first to examine abortion preferences in the United States, using a discrete choice experiment, demonstrates the importance of wait time and cost in abortion care decision-making. Our work indicates that for this population, factors related to health care financing and organization may matter more than clinical aspects of care. ImplicationsAlthough people in this study preferred medication to aspiration abortion and telehealth to in-clinic care, wait time and cost of care played a greater role in care decision-making. Focusing solely on clinical aspects of care (i.e., method, delivery model) may ignore other attributes of care that are particularly important for potential patients.

Optimizing inhaled corticosteroid use in patients with chronic obstructive pulmonary disease: assessing blood eosinophils, neutrophil-to-lymphocyte ratio, and mortality outcomes in US adults.

Accurate biomarkers for evaluating mortality rates in patients with chronic obstructive pulmonary disease (COPD) remain scarce. This study aimed to explore the relationships between mortality rates in patients with COPD and blood eosinophil counts, neutrophil counts, and lymphocyte counts, along with the neutrophil-to-lymphocyte ratio (NLR). Additionally, we sought to identify the optimal response values for these biomarkers when utilizing inhaled corticosteroids (ICS). Utilizing a nationally representative, multistage cross-sectional design and mortality correlation study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 involving US adults aged 40 years or older with COPD. The primary endpoint was all-cause mortality, with Kaplan-Meier survival curves and restricted cubic splines applied to illustrate the relationship between leukocyte-based inflammatory markers and mortality. The analysis was conducted in 2023. Our analysis included 1,715 COPD participants, representing 6,976,232 non-institutionalized US residents [weighted mean age (SE), 62.09 (0.28) years; range, 40-85 years]. Among the participants, men constituted 50.8% of the population, and the weighted mean follow-up duration was 84.9 months. In the ICS use group, the weighted proportion of participants over 70 years old was significantly higher compared with the non-ICS use group (31.39% vs 25.52%, p < 0.0001). The adjusted hazard ratios for all-cause mortality related to neutrophil counts, lymphocyte counts, and NLR were 1.10 [95% confidence interval (CI), 1.04-1.16, p < 0.001], 0.83 (95% CI, 0.71-0.98; p = 0.03), and 1.10 (95% CI, 1.05-1.15; p < 0.0001), respectively. Optimal ICS response was linked with higher levels of eosinophil count (≥240 cells/μL), neutrophil count (≥3,800 cells/μL), NLR (≥4.79), and lower levels of lymphocyte count (<2,400 cells/μL). Adjusted baseline neutrophil, lymphocyte counts, and NLR serve as independent risk factors for all-cause mortality in patients with COPD. Further, ICS application appears to mitigate mortality risk, particularly when NLR levels reach 4.79 or higher, underlining the importance of ICS in COPD management.

Trends in mortality risk of patients with congenital heart disease during the COVID-19 pandemic

Cardiovascular conditions are considered risk factors for poor outcomes associated with COVID-19. However, the effect of the COVID-19 pandemic on the mortality of patients with congenital heart disease (CHD) is unclear. Our study aims to examine the trends in mortality risk of CHD patients during the COVID-19 pandemic. This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US-based registry of interventions for CHD. We included patients having US residence and direct identifiers; death events were captured by matching with the National Death Index. The observation window (2017-2022) was divided into pre-COVID-19 and COVID-19 era defined around the national onset of COVID-19 disease in 2020. Stratified Cox model was used to assess all-cause mortality between the pre- and the COVID-19 era. Among 45,130 patients with CHD (median age in 2017: 23.3 years, IQR: 19.0-28.4), 503 deaths occurred during the pandemic with 44 deaths (8.7%) attributed to COVID-19 (COVID-19 mortality rate of 0.09%). The overall risk of death for patients with all types of CHD during the pandemic was significantly higher compared to the pre-COVID-19 era (aHR 1.28, 95%CI: 1.08-1.53), with a differential trend towards increased risk in patients with two-ventricle (aHR 1.44, 95% CI: 1.19-1.76) vs unchanged risk for those with single ventricle CHD (aHR=0.83, 95% CI: 0.57-1.21). Adjusted subgroup analysis revealed a higher risk of death during the pandemic for CHD patients with male and chromosomal abnormalities. The excess deaths during the pandemic were attributed to COVID-19 itself rather than CHD or cardiovascular conditions. In this large CHD cohort study, there was a higher risk of death among CHD patients with male and chromosomal abnormalities. A differential trend towards higher risk for those with two vs. unchanged risk for single ventricle CHD was presented. The excess mortality was attributed to the COVID-19 itself and not to conditions potentially related to deferral of care. These results justify targeted protective measures towards the CHD population and may provide guidance for public health and medical care response in future epidemics.

How different types of environmentalists are perceived: changing perceptions by the feature.

Previous research found stereotypes of environmentalists as barriers to public engagement and identification with environmentalism. Yet, there is limited understanding of the distinct attributes of an environmentalist that influence public perceptions and self-identification. In our research, we address this knowledge gap by analyzing reactions to a range of fictional environmentalist profiles. We investigated how multiple features of these profiles (e.g., gender, occupation, type of pro-environmentalism) influenced stereotypes (such as competence, friendliness, and trustworthiness), perceived typicality, and participants' self-identification with the described profiles, using a novel conjoint experiment approach with 678 US residents. We found that profiles described as women, Asians, working as a cleaner or office clerk, and politically moderate or liberal, exhibiting private to moderate environmental behaviors and global environmental concerns, were generally perceived as more typical for environmentalists. Moreover, participants most identified with profiles depicted as women, in a cleaner occupation, and exhibiting private pro-environmental behaviors. Atypical profile descriptions, based on prior research, enhanced participants' impressions only when associated with private pro-environmental behaviors or the cleaner occupation. We introduce new avenues in impression formation research and the use of conjoint analyses in psychological research; moreover, we contribute valuable input to the environmental movement regarding message framing considering the source and content relative to the targeted audience.

The effects of overseas exhibition games on consumer interest: the case of the English Premier League

ABSTRACT Research question This paper attempts to disentangle the impact of overseas exhibition games, a strategic marketing tool frequently implemented by professional sports clubs in their endeavors to expand into foreign markets, on demand. As such, it contributes to the recently growing literature examining the internationalization processes of leagues and clubs. Research methods We implement two different studies. Study 1 analyzes the effects of games played by English Premier League (EPL) clubs in the US in summer 2015 on US residents’ willingness to pay (WTP) for add-on football packages on television. In doing so, we exploit the panel structure of geocoded data collected in two representative surveys and use inverse-probability-weighted regression adjustment estimators. Study 2 focuses on regional audience data on EPL games televised in the US. We account both for summer 2014 and 2015 exhibition games by implementing propensity score stratification. Results and findings Overall, we find that exhibition games played by EPL clubs have a positive effect on both the WTP for TV subscription packages as well as viewership. Further analysis reveals that these effects are primarily driven by top brands traveling abroad (though also some spillover benefits on EPL-wide demand emerge) and dissipate over time. Implications Facilitating the organization of overseas exhibition games seems reasonable from a commercial point of view for league management. For broadcasters, requiring certain top brands to participate in preseason tours in their national markets might be essential if they seek to improve their return on investment.

Abstract 12492: Relation of Medical and Social Determinants of Health to Use of Guideline-Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction in the All of Us Research Program

Background: HFrEF is associated with significant morbidity and mortality. The standard of care is guideline-directed medical therapy (GDMT) consisting of evidence-based pharmacological interventions which have demonstrated improved outcomes in HFrEF. However, paltry adherence to GDMT remains an ongoing challenge. We examined in US adults the relationship between social determinants of health (SDOH), demographics, and risk factors on GDMT adherence for HFrEF. Methods: The NIH All of Us Research Program started in May 2018 with the goal of enrolling over 1 million US residents. Over 315,000 participants have shared electronic health records, physical measurements, surveys, and lab results. Demographics, risk factors, and SDOH measures were captured for HFrEF in US adults 18 years or older. Patients with HFrEF who were on quadruple therapy (ACE-inhibitor/angiotensin receptor/combination angiotensin receptor-neprilysin inhibitor, beta-blocker, SGLT2 inhibitor, mineralocorticoid antagonist) were compared to those on fewer. Multiple logistic regression analyses were conducted to examine the association between risk factors/SDOH measures and medical therapy optimization. Results: In the All of Us data, 6049 patients were identified with HFrEF. Of those patients, 5838 (97%) patients were on less than 4 GDMT, while 210 (3%) patients were on quadruple therapy. Multiple logistics regression showed participants with ASCVD, and diabetes had higher odds (95% CI) of being on quadruple therapy, 2.19 [1.28, 3.99] and 9.07 [4.88, 18.84], respectively, while hypertension had lower odds (0.64 [0.43, 0.95]). Race, income, education, and health insurance types did not predict medical therapy optimization. Conclusion: Various cardiovascular conditions were associated with higher odds of being on quadruple therapy. However, sociodemographic factors did not show a correlation of predicting the odds of achieving maximal medical therapy.

Measuring law's normative force

AbstractAn important question in legal theory and policy is when people are willing to put aside their policy preferences to uphold higher‐order legal values. That is, when does constitutional or international law, for instance, have “normative force”? Around two‐dozen experimental studies have attempted to measure this question empirically, but their designs contain an inherent limitation. While they are interested in gauging the effect of internalizing a norm, they measure only the effect of exposure to that norm. This is significant because subjects in the treatment group whose priors are strongly contrary to the treatment message on the legality of a policy may effectively be “treatment resistant”: it is difficult to successfully treat them because their prior beliefs on the issue are entrenched; as a result, they simply do not believe the treatment message. This treatment failure attenuates any effects, and where a significant portion of the treatment and/or control group is not successfully treated, the results will be biased toward small, null, or even backfire findings. This article first formally models the mechanism underlying experiments on law's normative force. I then demonstrate a methodological solution to the problem of treatment resistance. By using the experimental treatment as an instrumental variable and employing a post‐treatment treatment‐uptake test, the researcher can estimate the causal effect of the real explanatory variable of interest: sincerely holding a belief about a policy's higher‐order lawfulness. Using new data from a 2022 survey experiment conducted on US residents, I illustrate this method for three constitutional or international law issues. The theoretical and empirical results together suggest that backfire effects documented by some studies do not reflect a tepid or negative response against the legal source per se, but rather reflect treatment resistance. These findings suggest that we should re‐evaluate the existing body of experimental studies on law's normative force, and they should prompt researchers to reconsider how we conduct future research in this domain.

The effects of authoritative source cue and argument strength of correction tweets on MMR vaccine-related misinformation credibility

Objectives: This study aimed to examine the joint effect of two core message elements – authoritative source and argument strength – in correction tweets to counter conspiratorial misinformation about the measles, mumps and rubella (MMR) vaccine. Design/Method: An online experiment with US residents ( N = 404) was conducted in a 2 (authoritative correction sources: layperson vs US Centres for Disease Prevention and Control [CDC]) × 2 (correction argument strength: weak vs strong) design. Results: The results indicate that the correction employing strong arguments and a correction provided by the CDC heightened heuristic processing of the corrective information, which in turn increased the perceived credibility of the conspiratorial misinformation. The effect of the CDC correction on heuristic processing was heightened when it contained weak arguments. Notably, user-generated corrections with weak arguments reduced heuristic processing of the information and contributed to reducing the perceived credibility of the misinformation. Conclusion: Based on the findings, we argue that both communicator- and content-related cues jointly influence how audiences process corrective information. The current study discusses the potency of user-generated social media corrections to counter vaccine misinformation and provides practical implications for how user-generated social media correction can be utilised by health practitioners. Public health organisations should prioritise presenting corrective information in an easily understandable manner, using user-generated content that fosters a sense of connection and engagement with individuals.

Applicant Perceptions of Postinterview Communication During the 2022 to 2023 Neurosurgery Recruitment Cycle: A Cross-Sectional Survey Study

To evaluate and describe neurosurgery applicant perceptions of the postinterview communication (PIC) process during the US residency match. A voluntary and anonymous postmatch web-based survey was developed and sent to 209 candidates who applied to 1 academic neurosurgery practice during the 2022-2023 recruitment cycle, approximately 1week following match day. Survey questions focused on their perceptions of and participation behaviors with PIC and how this impacted their final rank list. Seventy-eight (37.3%) of the 209 candidates responded to the survey. Sixty-four (84.2%) respondents reported submitting a letter of intent (LOI) to their number 1 ranked program. Sixty-one (82%) felt pressured to send a LOI to improve their rank status, fearing that it may harm them if they did not. Fifty-four (73.0%) respondents felt pressured to send an early LOI despite not seeing the program in person to communicate interest before programs certified their rank lists. Fourteen (18.9%) respondents agreed that a second look experience impacted their rank list enough to where they regretted an early LOI. Fifty-five (76.4%) respondents disagreed that second-look attendance had no impact on their rank status with a program. Fifty (71.4%) respondents agreed that PIC causes undue stress during the match process. Sixty-one (84.7%) respondents agreed that aspects of PIC require universal guidelines. This is the first study to describe the perceptions of PIC and behaviors of neurosurgery applicants during the US residency match process. Standardized PIC practices may help to ensure transparency and relieve stress for applicants during the match process.

Characteristics of business, pleasure, and VFR segments who travel during risky times

PurposeThis study aims to explore what may have contributed to risk-taking travel behavior during the COVID-19 pandemic and what may be the drivers of satisfaction and intention to travel again. The study compares travelers based on their travel purposes (business, pleasure and visiting friends and relatives [VFR]) and explore the influence of subjective well-being received from their travel activities.Design/methodology/approachData from a structured survey of 323 US residents who traveled during the COVID-19 pandemic were collected on MTurk. Respondents were asked travel behavior questions related to their favorite trips and to rate several multi-item scales measuring the benefits expected and received from their trip, the trip’s contribution to their positive mental and subjective psychological well-being, as well as their satisfaction with the trip and intention to travel in the future. In addition, personality measures focused on risk-taking, thrill-seeking and self-confidence, as well as additional risk-related concepts of optimism bias, probability neglect and proximity to self.FindingsData analysis revealed some differences among respondents who traveled for business, pleasure and VFR purposes. Business travelers were more risk takers and thrill seekers; pleasure travelers achieved more well-being benefits from their favorite trips during the pandemic; however, VFR travelers’ satisfaction and intention to go on similar trips were explained more by the benefits they received from their favorite trips.Originality/valueAlthough several studies addressed consumers’ travel motivation during the COVID-19 pandemic, there is a lack of empirical research comparing the characteristics of travelers based on their travel purposes, as well as their sociodemographics, personality traits and the expected and perceived well-being benefits from traveling.

Trends in Cardiovascular Disease Mortality in US Women Veterans vs Civilians

Cardiovascular disease (CVD) remains the leading cause of death in the US. Women veterans have higher rates of CVD compared with civilian US women; however, analyses of recent trends in mortality from cardiac disease for women veterans are lacking. To investigate trends in cardiac disease mortality among women veterans over approximately the past 2 decades and compare rates with those for civilian women. In this retrospective longitudinal cohort study, US Veterans Health Administration (VHA) electronic health record data, linked with the National Death Index, were analyzed for CVD trends and rates of cardiac disease mortality among women veterans (aged 18 years or older) with VHA health care encounters from January 1, 2000, to December 31, 2017. These data were compared with a national cohort of civilian women (aged 15 years or older) in the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, which provides cause-of-death data using death certificates for all US residents. The data analysis was performed between March 10, 2021, and November 28, 2022. Cardiac disease mortality among women veterans and civilian women. Cardiac disease mortality was based on International Classification of Diseases, Tenth Revision diagnostic codes (I00-I09, I11, I13, and I20-I51 as defined by CDC WONDER). For women veterans and civilian women, crude and age-adjusted cardiac disease mortality rates (per 100 000 life-years) and 95% CIs were calculated, with the 2000 US general population as the reference for age-adjusted rates. From 2000 to 2017, 817 912 women veterans engaged with VHA health care (mean [SD] age, 45.7 [17.1] years), and 19 022 cardiac disease deaths were identified (22.4% of total deaths). The crude and age-adjusted cardiac disease mortality rates, respectively, per 100 000 life-years were 200.2 (95% CI, 181.0-221.0) and 197.6 (95% CI, 175.2-222.0) in 2000 and 196.0 (95% CI, 186.1-206.4) and 208.1 (95% CI, 196.4-220.4) in 2017, reflecting stable crude rates and a 5.3% increase in age-adjusted rates. For civilian women, the crude and age-adjusted rates decreased over time from 320.7 (95% CI, 319.7-321.8) and 268.1 (95% CI, 267.3-269.0) in 2000 to 220.9 (95% CI, 220.1-221.7) and 164.7 (95% CI, 164.1-165.3) in 2017. In this cohort study comparing women veterans and civilian women, cardiac disease mortality rates for women veterans did not exhibit the improvements seen for civilian women during the nearly 2-decade study period. Further research and actionable clinical interventions are warranted to improve cardiovascular care for women veterans, who represent the fastest growing group of patients within the VHA health care system.

Reimagining a pass/fail clinical core clerkship: a US residency program director survey and meta-analysis

Pass/fail (P/F) grading has emerged as an alternative to tiered clerkship grading. Systematically evaluating existing literature and surveying program directors (PD) perspectives on these consequential changes can guide educators in addressing inequalities in academia and students aiming to improve their residency applications.In our survey, a total of 1578 unique PD responses (63.1%) were obtained across 29 medical specialties. With the changes to United States Medical Licensure Examination (USMLE), responses showed increased importance of core clerkships with the implementation of Step 2CK cutoffs. PDs believed core clerkship performance was a reliable representation of an applicant’s preparedness for residency, particularly in Accreditation Council for Graduate Medical Education’s (ACGME)Medical Knowledge and Patient Care and Procedural Skills. PDs disagreed with P/F core clerkships because it more difficult to objectively compare applicants. No statistically significant differences in responses were found in PD preferential selection when comparing applicants from tiered and P/F core clerkship grading systems. If core clerkships adopted P/F scoring, PDs would further increase emphasis on narrative assessment, sub-internship evaluation, reference letters, academic awards, professional development and medical school prestige.In the meta-analysis, of 6 studies from 2,118 participants, adjusted scaled scores with mean difference from an equal variance model from PDs showed residents from tiered clerkship grading systems overall performance, learning ability, work habits, personal evaluations, residency selection and educational evaluation were not statistically significantly different than from residents from P/F systems.Overall, our dual study suggests that while PDs do not favor P/F core clerkships, PDs do not have a selection preference and do not report a difference in performance between applicants from P/F vs. tiered grading core clerkship systems, thus providing fertile grounds for institutions to examine the feasibility of adopting P/F grading for core clerkships.

At-home asthma mortality unchanged despite declining mortality in other settings: US death certificate data (2000-2019)

BackgroundAsthma mortality rates in the United States have declined since 1999; however, asthma mortality by place of death has not been comprehensively evaluated. ObjectiveTo evaluate temporal trends in asthma mortality rates and place of death in the United States. MethodsWe conducted a population-based analysis using data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research platform to evaluate deaths with asthma as the underlying cause (2000-2019) among US residents of all ages. Absolute numbers of asthma-related deaths were described by place of death. Counts were applied to US Census Bureau population counts to calculate mortality rates per 100,000 persons. ResultsIn the 20-year period evaluated, 67,695 asthma deaths were registered in the United States. An overall 32% decline in the asthma mortality rate was observed, from 1.43 to 0.98 per 100,000 persons from 2000 to 2019, respectively. Although asthma mortality rates declined in all medical facility locations, the at-home asthma mortality rate remained stable (0.32 and 0.34 per 100,000 persons in 2000 and 2019, respectively). Consequently, the proportion of at-home asthma deaths increased from 23% in 2000 to 2001 to 36% in 2018 to 2019. The distribution of place of death varied by age, sex, race, ethnicity, and geographic region. ConclusionDespite an overall decline in asthma mortality in the United States, at-home asthma mortality has remained unchanged. In recent years, more than one-third of asthma deaths have occurred at home. These findings warrant further study and underscore the importance of increased efforts to identify and treat uncontrolled asthma across demographic groups.

Western US Residents’ Knowledge of Wild Free-Roaming Horses and Their Management on Federal Public Lands

Wild free-roaming (WFR) horses (Equus ferus caballus) occur on lands administered by the Bureau of Land Management and US Forest Service in 10 western US states. Little is known about public knowledge concerning management of WFR horse populations. In 2020, we conducted a survey to assess public knowledge with the intent of establishing baseline information that may be used to shape horse management programs and policies on the nation's public lands. We obtained responses from 1 124 residents of the western United States. Our survey asked eight knowledge-based questions of WFR horse ecology and management in the western United States. We conducted chi-square analyses to determine the influence of age, gender, region of residence, and income on respondents’ ability to answer these questions appropriately. Our results indicate that these demographic characteristics had little predictive ability to explain the level of the western US public's knowledge of WFR horse ecology and management (for all comparisons, λ < 0.10). Furthermore, our respondents had little knowledge of WFR ecology and management. Approximately 30% of respondents correctly identified WFR horse origins, 8% correctly indicated WFR horse population size, and 37.5% indicated that they were unaware of legal management options. The lack of basic understanding of WFR horse ecology and management may influence the public's ability to support management efforts or determine fact from propaganda. Approximately 60% of the respondents indicated they primarily used government, university, and organization websites when seeking information. Efforts to increase dissemination of facts on multiple venues, such as social media, websites, and newspapers that link back to government and university websites, could increase public support of future management actions. Additionally, the announcement of management actions, such as round-ups, should consistently include basic background information regarding WFR horse ecology and populations to ensure that the public can make informed conclusions.

PROBLEMS WITH ORTHOPEDIC SURGERY TRAINING IN PAKISTAN

PROBLEMS WITH ORTHOPEDIC SURGERY TRAINING IN PAKISTAN

Misinformation, Trust, and Use of Ivermectin and Hydroxychloroquine for COVID-19

The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment. To quantify the prevalence of non-evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists. This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection. Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources. A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non-evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non-evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non-evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non-evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13). In this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non-evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.

Thinking of threats: Economic threat appraisals and health threat appraisals predict differential racial attitudes during COVID‐19

AbstractWe examined whether perceptions of the health and economic threats posed by COVID‐19 predict different patterns of intergroup attitudes, using data gathered during the early phase of the pandemic. Using data from 1339 geographically and politically diverse White US residents, we show that subjective economic threat predicted general anti‐outgroup attitudes, while subjective health threat predicted negative attitudes towards both Asian and Latinx (“stereotypically foreign”) outgroups but not towards other outgroups. Among 303 geographically and politically diverse Black US residents, the pattern instead suggested that threat (regardless of type) was associated with reduced evaluative differentiation between racial ingroups and outgroups.

Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey.

Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment. Cross-sectional. National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versussuboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers. Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.