Vital Statistics System Research Articles

Trends in Short Interpregnancy Interval Births in the United States, 2016–2022

OBJECTIVE: To measure contemporary trends in the prevalence of short interpregnancy interval (IPI) births in the United States. METHODS: We conducted a repeated cross-sectional analysis using 2016–2022 natality data from the National Vital Statistics System. We included all singleton live births to individuals with at least one prior live birth. We examined trends over time in short IPIs less than 18 months, as well as for specific durations within this time frame (less than 6 months, 6–11 months, and 12–17 months), using linear probability models that estimated changes in the prevalence of each IPI duration over time. We then estimated the prevalence of each short IPI duration by maternal race and ethnicity, socioeconomic characteristics (age, education, insurance payer at delivery), and geography (U.S. census region, state of residence). RESULTS: The study sample included 14,770,411 singleton live births to individuals with at least one prior live birth in 2016–2022. Roughly a third (29.8%) of births had an overall IPI of less than 18 months (5.0% less than 6 months, 11.0% 6–11 months, and 13.8% 12–17 months). For IPIs less than 6 months, a slight statistical decline in prevalence was identified over the study period in unadjusted and adjusted models (adjusted annual percentage point change −0.02, 95% CI, −0.03 to −0.02). Slight statistical increases in the prevalence of IPIs of 6–11 and 12–17 months were identified in unadjusted models but were no longer significant and reversed direction in adjusted models, respectively. Long-standing inequities in the distribution of the shortest IPIs (less than 6 months) were stable compared with prior work across the indicators examined in this study. CONCLUSION: Overall, it appears the prevalence of short IPIs has remained stable between 2016 and 2022.

COVID-19 and sepsis-related excess mortality in the US during the first three years: A national-wide time series study.

The COVID-19 pandemic's global impact has been devastating, causing millions of deaths. Our study investigates excess sepsis-related mortality trends over three years during the pandemic. Using CDC's National Vital Statistics System data from January 2018 to March 2023, we projected sepsis-related deaths during the pandemic using a Poisson log-linear regression model. We compared observed versus predicted deaths and analyzed temporal trends by demographics and regions. Among the 753,160 deaths documented between March 2020 and March 2023, a significant downward trend was noted in sepsis-related mortality rates from March 2022 to March 2023, coinciding with the surge of the Omicron variant. The excess mortality rates were 170.6 per million persons (95% CI: 168.2-172.6), 167.5 per million persons (95% CI: 163.6-170.9), and 73.3 per million persons (95% CI: 69.4-76.6) in the first, second, and third years, respectively. Increased sepsis-related mortality was observed across all age subgroups, with the greatest increase noted in those aged 85 years and above compared to middle- and young-aged decedents. Disparities were also observed across racial/ethnic, sex/gender subgroups, and geographic regions. This study highlights the effectiveness of current policies and prevention measures in response to the long-term circulating of SARS-CoV-2 in the community.

Racial disparities in maternal blood transfusion in the United States by mode of delivery.

Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities in maternal blood transfusion. To assess racial disparities in maternal blood transfusion using detailed, self-identified racial groupings in the United States overall and stratified by mode of delivery. We performed a population-based, retrospective cohort study of full term, live births (2016-2021) using the National Vital Statistics System's Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of maternal blood transfusion by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors. The study included 17,905,699 deliveries; maternal blood transfusion occurred in 3.4 per 1,000 deliveries. Compared with individuals who identified as White (3.3 per 1,000 transfusion rate), higher odds of transfusion were found among those who identified as American Indian and Alaska Native (AIAN; aOR 2.36, 95% CI 2.23-2.49), Black (aOR 1.15, 95% CI 1.12-1.17), Filipino (aOR 1.33, 95% CI 1.22-1.44), Korean (aOR 1.25, 95% CI 1.10-1.42), and Pacific Islander (aOR 1.63, 95% CI 1.45-1.83). The frequency of transfusion and racial disparities in transfusion varied substantially by mode of delivery. Lower rates of transfusion in Black vs White patients were observed in the spontaneous vaginal delivery (2.2 vs 2.3 per 1000; aOR 0.95, 95% CI 0.92-0.99), forceps (6.8 vs 8.9 per 1000; aOR 0.77, 95% CI 0.60-0.99), vacuum (4.2 vs 5.0 per 1000; aOR 0.85, 95% CI 0.74-0.97, and cesarean delivery with trial of labour (8.8 vs 8.9 per 1000; aOR 0.95, 95% CI 0.91-1.00) groups, while a higher rate was shown among cesarean deliveries without trial of labour (6.8 vs 4.3 per 1000; aOR 1.45, 95% CI 1.40-1.51). Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly for AIAN and Pacific Islander individuals, and vary by mode of delivery.

Association of Prepregnancy Cardiometabolic Health With Hypertensive Disorders of Pregnancy Among Historically Underrepresented Groups in the United States.

Prepregnancy diabetes and obesity are associated with hypertensive disorders of pregnancy (HDPs). However, the proportion of cases of HDP in the population explained by diabetes and obesity (population attributable fraction), especially among American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander, is not well characterized. We conducted a cross-sectional analysis of data on individuals with a live singleton birth from the US National Vital Statistics System between 2016 and 2019. We used adjusted logistic regression to estimate the prevalence odds ratios of HDPs and tested interaction for race and ethnicity. We calculated the population attributable fraction for the effect of obesity and diabetes on HDPs. Among 13 201 338 birthing individuals, (mean age, 29±6 years), 7% had HDP. The prevalence of HDP was highest among American Indian and Alaska Native individuals (9.1%). Prepregnancy diabetes (prevalence odds ratio, 2.63 [95% CI, 2.59-2.67]) and obesity (prevalence odds ratio, 2.95 [95% CI, 2.93-2.97]) were associated with HDPs. Compared with non-Hispanic White individuals, the association of diabetes with HDPs was strongest among Native Hawaiian and Other Pacific Islander (prevalence odds ratio, 3.05 [95% CI, 2.48-3.77]), and the association of obesity with HDP was strongest among Asian individuals (prevalence odds ratio, 3.44 [95% CI, 3.35-3.54]; all P for interaction <0.05). Population attributable fractions for diabetes and obesity were highest among Native Hawaiian and Other Pacific Islander individuals (diabetes, 3.7% [95% CI, 3.3%-4.0%]; and obesity, 45% [95% CI, 41.9%-47.8%]). Prepregnancy diabetes and obesity are associated with HDP across all racial and ethnic groups. Diabetes and obesity have highest population attributable fractions among Native Hawaiian and Other Pacific Islander individuals and should be aggressively targeted during childhood, adolescence, and young adulthood to reduce risk of HDPs.

Differences in time of birth between spontaneous and operative vaginal births.

Objective Previous studies have identified an association between obstetric interventions and time of day in which they are performed; however, they do not account for granular variations in temporality of delivery interventions, which is influenced by both healthcare provider and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVB) versus operative (forceps- and vacuum-assisted) vaginal births (OVB). Study Design This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016-2021, which includes time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVB per time of day. Results A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVB. Compared to births at other time intervals, those between 4:30-7:30 p.m. were more likely to be OVBs (odds ratio [OR] 1.13, 95% CI 1.12-1.14). Conversely, births between 3:00-6:00 a.m. were less likely to be OVBs (OR 0.87, 95% CI 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30-7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] 1.09, 95% CI 1.08-1.10) and births between 3:00-6:00 a.m. remained less likely to be OVBs (aOR 0.91, 95% CI 0.90-0.92). Conclusions In this population-based study, we identified temporal differences between spontaneous and operative vaginal births with increased use of instrumentation during late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability.

Cardiovascular Disease Mortality Among Native Hawaiian and Pacific Islander Adults Aged 35 Years or Older, 2018 to 2022.

Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults. To describe CVD mortality among NHPI adults. Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022. Fifty states and the District of Columbia. Adults aged 35 years or older at the time of death. CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death. From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]). Potential misclassification of underlying cause of death or race group. NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention. National Institute of General Medical Sciences, National Institutes of Health.

Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations.

We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data. We used 2015-2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternalclinical, and neonatal risk factors. Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors. Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.

Maternal cigarette smoking before or during pregnancy increases the risk of severe neonatal morbidity after delivery: a nationwide population-based retrospective cohort study

BackgroundThe association of maternal cigarette smoking during pregnancy with severe neonatal morbidity (SNM) is still inconclusive. We aimed to examine the associations of the timing and the intensity of maternal...

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018.

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Nulliparous Individuals with Class III Obesity: Adverse Outcomes with Labor versus Planned Cesarean Delivery.

Individuals with class III obesity (body mass index [BMI] ≥ 40 kg/m2) are at increased risk of cesarean delivery (CD) and peripartum complications. We ascertained compositive neonatal and maternal adverse outcomes among individuals with class III obesity who labored versus had planned CD. This was a retrospective cohort study from 2016 to 2021 using the National Vital Statistics System database. Nulliparous individuals with class III obesity prepregnancy were included if they had singleton, nonanomalous pregnancies and delivered at 37 to 41 weeks of gestation. Individuals were excluded if they had hypertensive disorders or diabetes. The primary outcome was a composite neonatal adverse outcome (CNAO), consisting of Apgar score less than 5 at 5 minutes, assisted ventilation > 6 hours, neonatal seizure, or neonatal death. The secondary outcome was a composite maternal adverse outcome (CMAO) that included admission to the intensive care unit, maternal transfusion, uterine rupture, or unplanned hysterectomy. A sensitivity analysis using a CMAO without transfusion was performed. A multivariable Poisson regression model was performed to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs). Of 192,298 individuals who met inclusion criteria, 169,676 (88.2%) labored and 22,622 (11.8%) had a planned CD. Compared with neonates delivered by planned CD, the risk of CNAO was significantly lower in those who delivered after labor (aRR: 0.79, 95% CI: 0.71-0.87). There was no significant difference in the risk of CMAO between groups (aRR: 1.11, 95% CI: 0.87-1.41). However, the risk of CMAO without transfusion was lower in individuals who labored (aRR: 0.57, 95% CI: 0.40-0.83). In nulliparous individuals with class III obesity, the risk of CNAO and of CMAO without transfusion were significantly lower in individuals who labored, versus those who had a planned CD. · Labor in class III obesity: 21% fewer adverse neonatal outcomes.. · Class III obesity: 43% less maternal morbidity with labor.. · Labor in nulliparous individuals with class III obesity is safe..

Suicide Mortality in the United States, 2002-2022.

This report provides final 2022 suicide numbers and age-adjusted rates, updating a provisional 2022 suicide report. Data were analyzed using National Vital Statistics System multiple cause-of-death mortality files for 2002 through 2022, with suicide deaths identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes U03, X60-X84, and Y87.0. Age-adjusted death rates were calculated using the direct method and the 2000 U.S. standard population. Pairwise comparisons were conducted using the z test with an alpha level of 0.05, and trends were assessed using the Joinpoint Regression Program (5.0.2). After increasing from 2002 to 2018, the age-adjusted suicide rate declined from 2018 (14.2 deaths per 100,000 standard population) through 2020 (13.5) but then increased 5%, to 14.2 in 2022. Following a period of decline between 2018 and 2020, suicide rates generally increased between 2020 and 2022 for females ages 25 and older. For males ages 10-14 and 15-24, rates decreased between 2020 and 2022, while rates for older age groups generally increased. For females in 2022, firearm-related suicide (2.0) was the leading means of suicide, with rates generally increasing since 2007. For males in 2022, firearm-related suicide (13.5) was the leading means of suicide, with rates increasing since 2006.

County-level jail and state-level prison incarceration and cancer mortality in the United States.

This study examined the association of county-level jail and state-level prison incarceration rates and cancer mortality rates in the United States. Incarceration rates (1995-2018) were sourced from national data and categorized into quartiles. County- and state-level mortality rates (2000-2019) with invasive cancer as the underlying cause of death were obtained from the National Vital Statistics System. Compared with the first quartile (lowest incarceration rate), the second, third, and fourth quartiles (highest incarceration rate) of county-level jail incarceration rate were associated with 1.3%, 2.3%, and 3.9% higher county-level cancer mortality rates, respectively, in adjusted analyses. Compared with the first quartile, the second, third, and fourth quartiles of state-level prison incarceration rate were associated with 1.7%, 2.5%, and 3.9% higher state-level cancer mortality rates, respectively. Associations were more pronounced for liver and lung cancers. Addressing adverse effects of mass incarceration may potentially improve cancer outcomes in affected communities.

Association between state minimum wage and firearm suicides in the USA, 2000–2020

BackgroundFirearm suicides constitute a major public health issue. Policies that enhance economic security and decrease community-level poverty may be effective strategies for reducing risk of firearm suicide. This study examined...

Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States' National Vital Statistics System.

We assessed chronic liver disease (CLD)-related mortality in the U.S. using death data (2011-2021) obtained from National Vital Statistics System (NVSS). The average annual percentage change (AAPC) from the models selected by Joinpoint regression analysis over the pre-pandemic (2011-2019) and the 2019-2021 were reported because non-linear trend in death rates were observed over the 2011-2021. Liver-specific death was defined as an underlying cause of death and Chronic liver disease (CLD)-related death was defined as any cause of death. During the pre-pandemic, age-standardized HCC- and cirrhosis-specific death rates were annually increased by AAPC = +1.18% (95% confidence interval, 0.34% to 2.03%) and AAPC = +1.95% (1.56% to 2.35%). In contrast, during the 2019-2021, the AAPC in age-standardized cirrhosis-specific death rate (per 100,000) accelerated by up to AAPC +11.25% (15.23 in 2019 to 18.86 in 2021) whereas that in age-standardized HCC-specific death rate slowed to -0.39 (-1.32% to 0.54%) (3.86 in 2019 to 3.84 in 2021). Compared to HCC-specific deaths, cirrhosis-specific deaths were more likely to be non-Hispanic white (72.4% vs. 62.0%) and non-Hispanic American Indian and Alaska native (AIAN) (2.2% vs. 1.1%) and have NAFLD (45.3% vs. 12.5%) and ALD (27.6% vs. 22.0%). During the 2019-2021, the age-standardized HCV- and HBV-related death rate stabilized, whereas the age-standardized NAFLD- and ALD-related deaths rate increased to 20.16 in 2021 (AAPC = +12.13% [7.76% to 16.68%]) and to 14.95 in 2021 (AAPC = +18.30% [13.76% to 23.03%]), which were in contrast to much smaller incremental increases during the pre-pandemic (AAPC = +1.82% [1.29% to 2.35%] and AAPC = +4.54% [3.97% to 5.11%]), respectively). The most pronounced rise in the age-standardized NAFLD-related death rates during the pandemic was observed among AIAN (AAPC = +25.38%), followed by non-Hispanic White female (AAPC = +14.28%), whereas the age-standardized ALD-related death rates during the pandemic were highest among AIAN (AAPC = +40.65%), followed by non-Hispanic Black female (AAPC = +26.79%). COVID-19 pandemic had a major negative impact on cirrhosis-specific and CLD-related mortality in the U.S. with significant racial and gender disparities.

Cardiovascular Disease Mortality Trends, 2010–2022: An Update with Final Data

IntroductionAge-adjusted mortality rates (AAMR) for cardiovascular diseases (CVD) increased in 2020 and 2021, and provisional data indicated an increase in 2022, resulting in substantial excess CVD deaths during the COVID-19 pandemic. Updated estimates using final data for 2022 are needed. MethodsThe National Vital Statistics System's final Multiple Cause of Death files were analyzed in 2024 to calculate AAMR from 2010 to 2022 and excess deaths from 2020 to 2022 for US adults aged ≥35 years, with CVD as the underlying cause of death. ResultsThe CVD AAMR among adults aged ≥35 years in 2022 was 434.6 deaths per 100,000 (95% CI: 433.8, 435.5), which was lower than in 2021 (451.8 deaths per 100,000; 95% CI: 450.9, 452.7). The most recent year with a similarly high CVD AAMR as in 2022 was 2012 (434.7 deaths per 100,000 population, 95% CI: 433.8, 435.7). The CVD AAMR for 2022 calculated using provisional data over-estimated the AAMR calculated using final data by 4.6% (95% CI: 4.3%, 4.9%) or 19.9 (95% CI: 18.6, 21.2) deaths per 100,000 population. From 2020 to 2022, an estimated 190,661 (95% CI: 158,139, 223,325) excess CVD deaths occurred. ConclusionsIn 2022, the CVD AAMR among adults aged ≥35 years did not increase, but rather declined from a peak in 2021, signaling improvements in adverse mortality trends that began in 2020, amid the COVID-19 pandemic. However, the 2022 CVD AAMR remains higher than observed before the COVID-19 pandemic, indicating an ongoing need for cardiovascular disease prevention, detection, and management.

The reliability of multi‐source data linkage for population‐based cancer survival estimates: A study in a metropolitan cancer registry of China

AbstractBackgroundPopulation‐based cancer survival is a key metric in evaluating the overall effectiveness of health services and cancer control activities. Advancement in information technology enables accurate vital status tracking through multi‐source data linkage. However, its reliability for survival estimates in China is unclear.MethodsWe analyzed data from Dalian Cancer Registry to evaluate the reliability of multi‐source data linkage for population‐based cancer survival estimates in China. Newly diagnosed cancer patients in 2015 were included and followed until June 2021. We conducted single‐source data linkage by linking patients to Dalian Vital Statistics System, and multi‐source data linkage by further linking to Dalian Household Registration System and the hospital medical records. Patient vital status was subsequently determined through active follow‐up via telephone calls, referred to as comprehensive follow‐up, which served as the gold standard. Using the cohort method, we calculated 5‐year observed survival and age‐standardized relative survival for 20 cancer types and all cancers combined.ResultsCompared to comprehensive follow‐up, single‐source data linkage overestimated 5‐year observed survival by 3.2% for all cancers combined, ranging from 0.1% to 8.6% across 20 cancer types. Multi‐source data linkage provided a relatively complete patient vital status, with an observed survival estimate of only 0.3% higher for all cancers, ranging from 0% to 1.5% across 20 cancer types.ConclusionMulti‐source data linkage contributes to reliable population‐based cancer survival estimates in China. Linkage of multiple databases might be of great value in improving the efficiency of follow‐up and the quality of survival data for cancer patients in developing countries.

Association of Prepregnancy Cardiometabolic Factors With Gestational Diabetes Among Asian Populations in the United States

BackgroundAsian individuals are among the highest immigrant group to the United States and at particularly high risk of gestational diabetes, which is associated with long-term maternal cardiovascular disease. Limited data are available on the association of prepregnancy cardiometabolic risk factors with gestational diabetes among Asian American subjects. ObjectivesThis study sought to determine the association of prepregnancy hypertension and body mass index (BMI) among Asian ancestry subgroups and by maternal nativity. MethodsUsing data from the National Vital Statistics System from 2016 to 2019, the prevalence of gestational diabetes, stratified according to prepregnancy hypertension and obesity, was examined according to maternal race. Predicted probability of gestational diabetes with continuous BMI was calculated across Asian ancestry subgroups and by maternal nativity. ResultsAmong 13.3 million pregnancies, gestational diabetes occurred in 6.5%. Asian subjects had the highest prevalence (12.3%). Among those with prepregnancy hypertension, Asian subjects had the highest prevalence (29.3%). Across the range of BMI (18-42 kg/m2), Asian subjects had the highest predicted probability. There was substantial heterogeneity across Asian ancestry subgroups between the association of BMI with gestational diabetes, with highest probability among Japanese and Korean American subjects at BMI >23 kg/m2. Predicted probability of gestational diabetes was higher for mothers born outside the United States among all Asian subgroups, except for Japanese American subjects. ConclusionsAsian American individuals have the highest prevalence of gestational diabetes at any BMI and with hypertension. Substantial variation in risk is present across Asian subgroups. Findings suggest a need for more tailored screening and intervention for gestational diabetes among Asian American subjects, with a specific focus on risk for individuals born outside the United States.

Applying a Bayesian Spatiotemporal Model to Examine Excess County-Level Cardiovascular Disease Death Rates During the COVID-19 Pandemic.

Amid the COVID-19 pandemic, national cardiovascular disease (CVD) death rates increased, especially among younger adults. County-level variation has not been documented. Using county-level CVD deaths (ICD-10 codes: I00-I99) from the US National Vital Statistics System, we developed a Bayesian multivariate spatiotemporal model to estimate excess CVD death rates in 2020 based on trends from 2010-2019 for adults aged 35-64 and ≥65 years. Among adults aged 35-64 years, 64.7% of counties experienced significant excess CVD death rates. The median county-level CVD death rate in 2020 was 150 per 100,000 persons, which exceeded the predicted rate for 2020 (median excess death rate: 11 per 100,000; median excess rate ratio: 1.08). Among adults aged ≥65 years, 15.2% of counties experienced significant excess CVD death rates. The median county-level CVD death rate was 1,546 per 100,000 in 2020, which exceeded the predicted rate in 2020 (median excess death rate: 48 per 100,000, median excess rate ratio: 1.03). Counties with significant excess death rates in 2020 were geographically dispersed. In 2020, disruptions of county-level CVD death rates were widespread, especially among younger adults, suggesting the continued importance of CVD prevention and treatment in younger adults in communities across the country.

A closer examination of the "rural mortality penalty": Variability by race, region, and measurement.

Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown. To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured. Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level. Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region. Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.

Tobacco retailer density and its association with birth outcomes in the USA: 2000–2016

IntroductionSignificant progress has been made in reducing maternal exposure to tobacco smoke and subsequent adverse birth outcomes, however, reductions may require strategies that reduce the availability of tobacco retailers. In...