Search Results (1,598)

Background: Severe maternal morbidity (SMM) is increasing in the United States. The main objective of this study is to test the use of machine learning (ML) techniques to develop models for predicting SMM during delivery hospitalizations in Maryland. Secondarily, we examine disparities in SMM by key sociodemographic characteristics. Methods: We used the linked State Inpatient Database (SID) and the American Hospital Association (AHA) Annual Survey data from Maryland for 2016–2019 (N = 261,226 delivery hospitalizations). We first estimated relative risks for SMM across key sociodemographic factors (e.g., race, income, insurance, and primary language). Then, we fitted LASSO and, for comparison, Logit models with 75 and 18 features. The selection of SMM features was based on clinical expert opinion, a literature review, statistical significance, and computational resource constraints. Various model performance metrics, including the area under the receiver operating characteristic curve (AUC), accuracy, precision, and recall values were computed to compare predictive performance. Results: During 2016–2019, 76 per 10,000 deliveries (1976 of 261,226) were in patients who experienced an SMM event. The Logit model with a full list of 75 features achieved an AUC of 0.71 in the validation dataset, which marginally decreased to 0.69 in the reduced model with 18 features. The LASSO algorithm with the same 18 features demonstrated slightly superior predictive performance and an AUC of 0.80. We found significant disparities in SMM among patients living in low-income areas, with public insurance, and who were non-Hispanic Black or non-English speakers. Conclusion: Our results demonstrate the feasibility of utilizing ML and administrative hospital discharge data for SMM prediction. The low recall score is a limitation across all models we compared, signifying that the algorithms struggle with identifying all SMM cases. This study identified substantial disparities in SMM across various sociodemographic factors. Addressing these disparities requires multifaceted interventions that include improving access to quality care, enhancing cultural competence among healthcare providers, and implementing policies that help mitigate social determinants of health. Full article

Exposure to traffic-related air pollution is not merely linked to respiratory health issues but also poses significant risks to cardiovascular well-being. Individuals from lower-income communities residing in high-pollution zones are particularly vulnerable to adverse cardiorespiratory health impacts. Pollutants such as fine particulate matter (PM_2.5 and PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃) are recognized as a leading, yet preventable, contributor to cardiorespiratory diseases. Although research has extensively explored the short-term impact of these pollutants on respiratory health, the immediate effects on cardiovascular outcomes require further study. We explored associations of traffic-related air pollutants with airway inflammation, lung function, and cardiovascular health outcomes (metabolic syndrome [MetS]) collected from a sample of low-income participants (N = 662) from a US–Mexico border county. Airway inflammation was measured using exhaled nitric oxide tests (eNO), while lung function parameters were measured by spirometry. MetS risk factors (waist circumference, blood pressure, triglycerides, HDL, and fasting blood glucose) were also measured. While spirometry measures were negatively associated with air pollutants (p < 0.05), no associations were noted for eNO. We also found positive associations in linear and logistic models between air pollutants and obesity (BMI: p < 0.04; waist: p < 0.03), fasting blood glucose (p < 0.03), and metabolic syndrome (p < 0.04). These findings reaffirm the immediate adverse effects of air pollution on respiratory function and shed light on its broader metabolic consequences. Environmental and neighborhood conditions could potentially influence the associations with obesity. At the same time, the links between fasting glucose and metabolic syndrome might indicate underlying oxidative stress and systemic inflammation. Full article

Background: Exposure to traumatic experiences has been positively associated with college students’ academic difficulties and psychological distress. However, little is known about the traumatic events experienced by Hispanic college students. This study examined the types of lifetime traumatic events experienced by Hispanic college students, including immigration enforcement-related events, and the association between events and psychological distress. Methods: College students (N = 1112) completed self-reported measures assessing lifetime traumatic experiences, post-traumatic stress disorder (PTSD) symptoms, and depression symptoms. Results: Most participants (81%) were born in the US, and most (84%) reported that at least one parent was foreign born. Hispanic students reported similar types of traumatic events reported by the general population of college students in previous studies. In addition, many students reported immigration-related potentially traumatic events. The following types of traumatic events were most strongly associated with greater levels of psychological distress: sexual assault or molestation, life-threatening illnesses or accidents, verbal abuse, physical or verbal bullying or mistreatment, directly experienced immigration enforcement events, and having witnessed physical or verbal abuse of someone close. Conclusions: It is important that clinicians use a broad definition of potentially traumatic events in the identification and treatment of Hispanic college students who may have experienced PTSD or depression symptoms following major life events, including immigration enforcement events. Full article

Background: Resection is considered the standard of care for patients with localized esophageal cancer who are “physiologically fit”. Patients who do not meet this standard are considered contraindicated to receive surgery. We hypothesized that among patients with non-metastatic esophageal cancer, the consideration of contraindication status would vary based on clinical and demographic factors and would vary between institutions. Methods: We identified patients with non-metastatic gastric and esophageal cancer in the National Cancer Database (NCDB) from 2004 to 2018. Patients were categorized into three groups based on surgical treatment: surgical resection (including endoscopic mucosal resection), resection contraindicated, and refusal of resection based on the coding of the “reason for no surgery” data element. Demographic, clinical, and institutional characteristics were compared between the groups using bivariate and multivariate techniques to identify factors associated with contraindicated status. A subgroup analysis of cT1N0M0 patients was also used to assess every institution in the NCDB’s observed–expected ratio for contraindication status. Results: In total, 144,591 patients with non-metastatic disease met inclusion criteria: 124,972 (86%) underwent resection, 13,793 (10%) were contraindicated for resection, and 5826 (4%) refused resection. Contraindication was associated with age, non-Hispanic Black race, socioeconomic status, Charlson–Deyo score, insurance type, institution characteristics, clinical T-stage, and clinical N-stage. There were 9459 patients who were cT1N0M0 and had no co-morbidities. In this cohort, there were more than 1000-fold differences between individual programs regarding observed–expected ratio of contraindication status when adjusting for clinical and demographic characteristics. Conclusions: Variation in the assessment of contraindication status varies dramatically between institutions. Underserved minorities, including age, race, and insurance type, are risk factors for being considered contraindicated. These findings highlight the disparities that exist regarding surgical care of non-metastatic esophageal cancer in the United States. Full article

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good. Conclusions: These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity. Full article

This study uses data from the 2006–2012 Health and Retirement Study (HRS) genetic sample (N = 11,667) to explore the “immigrant health paradox” from a novel perspective by examining the nativity differences in genetic predisposition to health-related outcomes. Polygenic indices (PGIs) were used to evaluate whether older non-Hispanic white foreign-born individuals have genotypes that predispose them to better health profiles compared to their U.S.-born counterparts. The results show an immigrant advantage with respect to genetic predisposition to cognitive function, BMI, and smoking frequency. There are no significant differences in genetic predisposition to height, smoking initiation, and depression. Including respective PGIs in multinomial regression models partially explains an immigrant advantage with respect to cognitive function and obesity. The findings are consistent with the “healthy immigrant effect” or selective migration of individuals with a favorable genetic predisposition to health as one of the explanations of the immigrant health paradox. Full article

Background/Objectives: Randomized controlled trials (RCTs) are needed to evaluate the impact of food is medicine (FIM) programs, such as medically tailored groceries (MTGs) to treat hypertension among diverse populations. Partnerships between academic centers’ student-run organizations (SROs) and community-based organizations (CBOs) offer critical safety nets for historically underserved groups, positioning these organizations to effectively undertake FIM programs among populations disproportionately affected by hypertension. We conducted an unblinded pilot RCT whose objectives were to assess the feasibility and acceptability of an SRO-coordinated, CBO-partnered MTGs intervention targeting blood pressure (BP) and food insecurity (FI) in underserved groups. Methods: Adult Black/African American and Hispanic/Latinx patients in Durham, North Carolina, where essential hypertension and FI were randomized (parallel arm, computerized 1:1 ratio) to 12 weeks of home-delivered, hypertension-focused MTGs plus in-person nutrition education sessions with compensation (intervention) versus data collection sessions with compensation (control). We offered transportation, childcare, and home visits to facilitate session attendance. The primary outcomes were the eligibility, enrollment, and retention rates (feasibility), and the survey feedback from the participants and CBO partners (acceptability). The secondary outcomes included the changes in the mean BP and median FI score with associated 95% confidence intervals. Results: Medical record screening identified 1577 eligible participants. Of the 94 reached to confirm eligibility, 77 met the enrollment criteria, and 50 were randomized (82% post-screen eligibility, 65% enrollment). A conventional content analysis of 15 participant surveys and CBO partner feedback affirmed the acceptability, noting intervention components that enhanced the retention (e.g., home delivery, transportation support, home visits). Pre–post analyses of secondary outcomes for 13/25 intervention and 15/25 control participants completing ≥2 sessions ≥2 months apart were performed. The intervention was associated with an average change in systolic BP of −14.2 mmHg (−27.5, −4.5) versus −3.5 mmHg (−11.7, 5.9) in the control group. The FI scores improved by −2 (−2.2, −0.5) in the intervention group and −1 (−1.3, −0.2) in the control group. No adverse events were reported. Conclusions: SRO-CBO partnerships could be feasible and acceptable avenues for conducting FIM trials among underserved populations. This multi-component FIM approach enhanced the study equity by addressing the participants’ disease-related social needs and warrants expansion into a powered RCT. Full article

Background: Incidence of cardiometabolic disease among U.S. Hispanics/Latinos is higher than in non-Hispanic Whites. Prolonged sitting duration is prevalent in older adults, and compounded with menopause, greatly increases cardiometabolic risk in postmenopausal women. Metabolomic analyses of interventions to reduce sitting are lacking and mechanistic understanding of health-promoting behavior change in postmenopausal Latinas is needed. Methods: To address this knowledge gap, an exploratory analysis investigated the plasma metabolome impact of a 12-week increased standing intervention among sedentary postmenopausal Latinas with overweight or obesity. From a parent-randomized controlled trial, a subset of Best Responders (n = 43) was selected using parameters of highest mean change in sitting bout duration and total sitting time; baseline variable-Matched Controls (n = 43) were selected using random forest modeling. Targeted LC-MS/MS analysis of archived baseline and 12-week plasma samples was conducted. Metabolite change was determined using a covariate-controlled general linear model and multivariate testing was performed. A false discovery rate correction was applied to all analyses. Results: Best Responders significantly changed time sitting (−110.0 ± 11.0 min; −21%), standing (104.6 ± 10.1 min; 40%), and sitting in bouts >30 min (−102.3 ± 13.9 min; −35%) compared to Matched Controls (7.1 ± 9.8 min, −7.8 ± 9.0 min, and −4.6 ± 12.7 min, respectively; all p < 0.001). Twelve-week metabolite change was significantly different between the two groups for 24 metabolites (FDR < 0.05). These were primarily related to amino acid metabolism, improved blood flow, and ATP production. Enzyme enrichment analysis predicted significant changes regulating glutamate, histidine, phenylalanine, and mitochondrial short-chain fatty acid catabolism. Pathway analysis showed significant intervention effects on glutamate metabolism and phenylalanine, tyrosine, and tryptophan biosynthesis, potentially indicating reduced cardiometabolic disease risk. Conclusions: Replacing nearly two hours of daily sitting time with standing and reduced prolonged sitting bouts significantly improved metabolomic profiles associated with cardiometabolic risk among postmenopausal Latinas. Full article

Objectives: The aims of this study were to compare pre- and post-operative word recognition scores (WRSs) for the adult Spanish-speaking population and to describe their cochlear implant (CI) performance trajectory. Methods: A retrospective chart review (n = 115) was completed for Spanish-speaking post-lingually deafened adults who underwent a traditional CI evaluation and subsequent surgery between 2018 and 2023. Pre- and post-CI (3, 6, 12-month) Spanish Bisyllable WRSs and CI datalogging (hours per day) were collected for 66 subjects who met inclusion. Patients were, on average, 61.4 years of age (SD = 14.9) at the time of their first CI, and all were Hispanic and White (100%). Results: The outcomes of the 66 subjects who met the inclusion criteria were analyzed. Spanish Bisyllable WRSs improved at all post-CI test intervals, though the mean change between intervals showed a decreasing trend over time, with a plateau in WRSs occurring by 6 months post-CI. Time was a significant predictor of increased post-CI WRSs at 6 months (p = 0.004) and 12 months (p < 0.001). Sex, the implanted ear, electrode type, CI manufacturer, and datalogging hours did not significantly predict Bisyllable WRSs. Conclusions: This study used the largest cohort dataset to date to describe pre-and post-CI WRSs for Spanish-speaking adults. The post-CI performance trajectory is similar in Spanish-speaking CI recipients compared to English-speaking cohorts. This study is fundamental in providing evidence-based outcomes for Spanish-speaking CI recipients and will assist clinicians with pre-CI counseling based on realistic expectations. Full article

Background/Objectives: Human papillomavirus (HPV) is linked to multiple cancers that can be prevented through vaccination. While the optimal age for vaccination is in childhood and adolescence, vaccination recommendations include adults through age 26 who missed childhood/adolescent vaccination. There are limited data about disparities among adults eligible for catch-up HPV vaccination. We conducted a comprehensive examination of HPV vaccination among US young adults, disaggregating the group by race/ethnicity and nativity status to identify subgroups that may require additional interventions. Methods: We analyzed 2019 and 2022 data of individuals aged 18–26 years from the National Health Interview Survey. Generalized linear models using Poisson regression with log link were used to examine the receipt of 1+ dose of HPV vaccine, race/ethnicity, and nativity (i.e., US- versus foreign-born) status. Results: The overall receipt of 1+ doses of HPV vaccine was 47.5%. The vaccination rate among the US-born group was 49.7% versus 31.9% among the foreign-born group with an adjusted prevalence ratio (APR) of 0.72; (95% CI, 0.62–0.82). Foreign-born non-Hispanic (NH) Black individuals (APR 0.31; 95% CI, 0.13–0.70) were less likely to be vaccinated against HPV than foreign-born NH White individuals, while US-born NH Asians (APR 1.27; 95% CI, 1.09–1.48) had a higher prevalence of the vaccination than the US-born NH White group. Additionally, foreign-born NH Asian (APR 0.60; 95% CI, 0.46–0.77), NH Black (APR 0.27; 95% CI, 0.12–0.61), and Hispanic (APR 0.76; 95% CI, 0.60–0.97) populations were less likely to be vaccinated than their respective US-born counterparts. Conclusion: Profound HPV vaccination inequalities exist among US young adults with particularly low vaccine coverage among racially and ethnically minoritized immigrant populations. Full article

Background: E-cigarettes, initially designed for nicotine consumption, are now increasingly being used to smoke cannabis, resulting in a growing trend known as “dual vaping”. This term describes individuals, referred to as “dual users”, who use e-cigarettes for both substances. This study aims to review and analyze existing research on dual vaping, with a focus on the associated health risks and behavioral patterns. Methods: A narrative review of the literature was conducted using PubMed. Studies focusing on individuals who use electronic cigarettes for vaping tobacco and cannabis, either chronically or episodically, were examined. Relevant articles were identified and thematically synthesized to provide a comprehensive overview of the topic. Results: Dual vaping was found to be prevalent among younger men, White and Hispanic populations, and individuals with higher economic status and educational level. The use of one substance was shown to predispose individuals to the use of the other, often leading to concurrent use of both substances. Peer influence and positive expectations regarding e-cigarettes were identified as significant predictors of dual use. Dual vapers exhibited a higher susceptibility to respiratory and systemic symptoms compared to those who exclusively vaped nicotine or cannabis. Moreover, a notable prevalence of psychiatric disorders, such as substance use disorders, anxiety, and depression, was observed in this group. Fruit-flavored e-cigarettes were the most preferred option among dual vapers when using both nicotine and cannabis. Conclusions: Current evidence is insufficient to fully elucidate the long-term impacts of dual vaping on physical and mental health, particularly when compared to individuals who have never vaped. Further studies are needed to gain a more comprehensive understanding of this behavior. Full article

Objectives: The aim of this study was to examine the adherence, changes in weight, and, waist circumference associated with the daily consumption of a culturally preferred food, namely an avocado, among Hispanic/Latina females in the Habitual Diet and Avocado Trial (HAT). Methods: HAT was a multisite, randomized controlled trial conducted between 2018 and 2020. Participants in the Avocado-Supplemented Diet Group were provided with and instructed to consume one avocado/day (~2.2 servings) for 6 months; participants in the Habitual Diet Group were instructed to follow their usual diet and limit intake to ≤2 avocados/month. Avocado consumption was assessed using three random 24 h dietary recalls administered by dietitians. This analysis focused on women who self-identified as Hispanic/Latina. Results: Within HAT, 158 females self-identified as Hispanic/Latina (median age: 42 years, IQR: 36–54). Across the dietary recalls, the Avocado-Supplemented Group (n = 80) consumed 1.9–2.1 avocado servings/day; the Habitual Diet Group (n = 78) consumed 0.04–0.09 servings/day (p < 0.001). The weight and waist circumference measurements were similar between groups. Hispanic/Latina females remained adherent to daily avocado consumption for the 6-month study period, without a significant change in their body weight or waist circumference measurements. Conclusions: Integrating a culturally preferred food into a dietary intervention enhanced adherence amongst Latina adults, with no impact significant impact on body composition. Full article

Background/Objectives: Alzheimer’s disease (AD) and related dementias (ADRD) disproportionately impact racial and ethnic minorities. Contributing biological factors that explain this disparity have been elusive. Moreover, non-invasive biomarkers for early detection of AD are needed. Endothelin-1 (ET-1), a vasoconstrictive factor linked to cerebral vascular disease pathology and neuronal injury, could provide insights to better understand racial disparities in AD. As a potent vasoconstrictive peptide that regulates contractions in smooth muscle, endothelial cells, and pericytes, ET-1 may result in cerebral vascular constriction, leading to cerebral hypoperfusion; over time, this may result in neuronal injury, contributing to the pathology of AD. The role of the ET-1 system as a driver of ethnic disparities in AD requires further investigation. In the United States (U.S.), ET-1 dysregulation in Hispanic/Latinx (H/L) ethnic populations has largely been unexplored. Genetics linking ET-1 dysregulation and racial disparities in AD also require further investigation. In this study, we examined the role of the ET-1 protein in human plasma as a potential biomarker with predictive value for correlating with the development of AD by age, race, and sex. Methods: We examined ET-1 protein levels using quantitative mass spectrometry in AA and NHW patients with AD, along with controls. Results: A partial correlation between age at draw and ET-1, stratified by race and sex, while controlling for AD status, was significant for female AAs (r = 0.385, p = 0.016). When the data were not stratified but controlled for AD status, the partial correlation between age at draw and ET-1 was not significant (r = 0.108, p = 0.259). Conclusions: Based on the small number of plasma specimens and no plasma specimens from H/L individuals with AD, we conclude that ET-1 was clearly not a significant factor in predicting AD in this study and will require a larger scale study for validation. Full article

Background: Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status. Methods: We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0–2, 3–4, and 5–9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence. Results: Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively). Conclusions: Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit. Full article