Public Health Reports最新文献

Objectives: Physical inactivity is associated with socioeconomic and social levels; thus, individuals of low socioeconomic status are less likely than individuals of high socioeconomic status to exercise. We assessed the association between socioeconomic status and changes in physical activity levels among children from 2002 to 2017 in Peru.

Methods: We conducted a secondary data analysis of the Young Lives Study (n = 2052 children aged 8 years [at baseline] and 15 years [at the end of follow-up]), a cohort with data collected in Peru. The outcomes were insufficient physical activity (<5 days of physical activity per week) and physical inactivity (<1 day of physical activity per week), and the exposure variable consisted of 2 socioeconomic indicators (maternal education and wealth index). We assessed the association between outcomes and exposures by using Poisson regression models and reported relative risks (RRs) and 95% CIs.

Results: Of 1888 participants at baseline, the mean (SD) age was 7.9 (0.3) years and 946 (50.1%) were male. The prevalence of physical inactivity and insufficient physical activity was 9.1% (n = 172) and 59.4% (n = 1122), respectively. After 7.0 (SD = 0.1) years of follow-up, in the multivariable model, a high wealth index was associated with low levels of physical activity, but maternal education was not. Thus, children with a high (vs low) level of wealth index had higher rates of physical inactivity (RR = 2.11; 95% CI, 1.47-3.03) and insufficient physical activity (RR = 1.11; 95% CI, 1.03-1.19).

Conclusions: Wealth index was associated with insufficient physical activity and physical inactivity, but maternal education was not. Our results suggest the need to promote physical activity levels according to social context.

Objectives: Nearly half of US adults have hypertension. The prevalence of hypertension is higher among adults with disabilities than among those without disabilities; however, national estimates use old data and definitions, and hypertension awareness and control are understudied. This study compared hypertension prevalence, awareness, and control among adults with and without disabilities.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (August 2021-August 2023) for adults aged ≥18 years (N = 5999). To determine disability status, we used the Washington Group on Disability Statistics questionnaire, which covers the domains of seeing, hearing, walking, communication, cognition, self-care, upper-body function, and affect. Hypertension was defined as blood pressure ≥130/80 mm Hg or use of antihypertensive medication. Among adults with hypertension, awareness was defined as self-report of physician diagnosis and control as blood pressure <130/80 mm Hg. We estimated adjusted prevalence ratios (APRs) using logistic regression, adjusting for demographic and health characteristics and accounting for the complex survey design.

Results: Hypertension prevalence was significantly higher among adults with disabilities than among those without disabilities (57.2% vs 45.1%; P < .001). Among those with hypertension, the prevalence of awareness (71.3% vs 55.0%; P < .001) and control (27.3% vs 18.4%; P < .001) was significantly higher among adults with disabilities than among those without disabilities. Adjusted analyses showed a higher prevalence of hypertension (APR = 1.12; 95% CI, 1.04-1.21), awareness (APR = 1.22; 95% CI, 1.14-1.30), and control (APR = 1.31; 95% CI, 1.12-1.54) among adults with disabilities than among those without disabilities.

Conclusions: Primary prevention may be particularly important for adults with disabilities. Improving awareness and control remains a key public health challenge regardless of disability status.

At the national and state levels, data on changes over time in fruit and vegetable intake among young children are limited. Using nationally representative data from the National Survey of Children's Health during 2021-2023, we examined trends in daily fruit and vegetable intake among children aged 1 to 5 years. We conducted trend analyses nationally, by age, and by state. We found no significant linear trends in daily fruit or vegetable intake at the national level or by age. At the state level, fruit intake increased significantly from 2021 to 2023 in Connecticut (from 65.8% to 77.2%; P = .049), Illinois (from 68.5% to 77.8%; P = .03), and Montana (from 66.1% to 81.0%; P = .01) and decreased significantly in Massachusetts (from 82.2% to 65.0%; P = .001); no state had significant changes in daily vegetable intake. Lack of improvement in daily fruit and vegetable intake among young children emphasizes the continued need for monitoring and evidence-based interventions.

Objectives: Common data sources that examine cancer survival provide limited information on health behaviors or social determinants of health. We linked individual-level cancer registry data to county-level data to examine differences in survival among people diagnosed with lung cancer.

Methods: We linked 2010-2020 National Program of Cancer Registries survival data from 40 registries, covering 85% of the US population, to county-level data on current age-adjusted cigarette smoking prevalence, average daily density of fine particulate matter (PM_2.5) in µg/m³ (fine particulate pollution), and overall social vulnerability. We generated Kaplan-Meier survival curves and used multivariable Cox proportional hazards regression to examine overall and cause-specific survival among people aged ≥20 years diagnosed with lung cancer.

Results: Survival was significantly lower among people who lived in counties with a higher prevalence of cigarette smoking of 14.3% to <17.0% (adjusted hazard ratio [AHR] = 1.06), 17.0% to <20.2% (AHR = 1.08), and 20.2% to 34.8% (AHR = 1.14) compared with 6.7% to <14.3%; fine particulate pollution >12.0 µg/m³ versus ≤12.0 µg/m³ (AHR = 1.04); and social vulnerability scores in the second (AHR = 1.01), third (AHR = 1.02), and fourth (AHR = 1.03) quartiles versus first quartile. Individual-level covariates significantly associated with rates of survival included sex, age at diagnosis, race and ethnicity, histology, stage at diagnosis, receiving surgery during first course of treatment, year of diagnosis, and US Census region.

Conclusions: Multiple characteristics were associated with lower 5-year lung cancer survival rates. Interventions that address these characteristics (eg, promoting tobacco cessation, reducing exposure to fine particulate pollution) may lead to longer survival after lung cancer diagnosis.

Objective: An accurate estimate of the prevalence, demographic characteristics, and geographic distribution of thalassemia in the United States is needed to plan for the health care needs of people with this disease. We developed and evaluated the predictive value of administrative case definitions for correctly identifying people living with thalassemia.

Methods: We conducted a retrospective study of the diagnostic accuracy of 3 claims-based case definitions to identify people with thalassemia in Medicaid administrative data from 2012 through 2019. Case definition 1 was ≥5 encounters with a code for thalassemia; case definition 2 was ≥1 encounter with a code for thalassemia and ≥6 encounters with a transfusion code; and case definition 3 was ≥2 encounters with a code for thalassemia and a transfusion code occurring on the same encounters. We validated our findings by using confirmatory laboratory assessment and expert review by clinicians at thalassemia treatment centers in Georgia (Children's Healthcare of Atlanta) and California (University of California San Francisco) as the gold standard.

Results: Of the 327 people identified, thalassemia was confirmed in 173 (52.9%), excluded in 68 (20.7%), and found indeterminate in 86 (26.2%) people. Case definition 1 had the lowest positive predictive value (PPV) (range, 55%-77%). For case definition 2, the PPV range was 80% to 86%. For case definition 3, the PPV range was the highest (82%-96%) but also captured more indeterminate cases.

Conclusions: Accurately identifying patients with thalassemia using a case definition based on administrative claims data is feasible. Extending our method to other health care databases beyond Medicaid may allow for an estimate of the national prevalence of transfusion-dependent thalassemia. However, cases of nontransfusion-dependent thalassemia were difficult to define with sufficient precision.

Objectives: Illicit fentanyl exposure among US children has increased in the past 10 years. However, whether rates of prescription fentanyl exposure have changed in this population is unknown. We described prescription fentanyl exposure among young children.

Methods: We studied cases of prescription fentanyl exposure among children aged <6 years that were reported to the National Poison Data System (NPDS) from 2012 through 2024. We described the characteristics of prescription fentanyl exposure and US geographic patterns. We used binomial tests, the Pearson χ² test, and joinpoint trend analysis with a type I error rate of .05 as the threshold for significance.

Results: From 2012 through 2024, a total of 376 cases of prescription fentanyl exposure among children aged <6 years were reported to NPDS. Boys (n = 179; 47.6%) and girls (n = 196; 52.1%) were equally represented (P = .48). Significantly more children aged <2 years than aged 2 to 6 years in our study group had prescription fentanyl exposure (61.5%; P < .001), and the most common formulation was transdermal patch (n = 202; 53.7%). Joinpoint trend analysis showed a slight but not significant increase in prescription fentanyl exposure among children aged <6 years from 2012 through 2015. However, from 2015 through 2024, prescription fentanyl exposure significantly decreased (annual percentage change = -7.9; P < .05). The state with the highest annual exposure rate from prescription fentanyl was Vermont (4.3 per 1 million population).

Conclusions: From 2015 through 2024, during a time of increasing exposure to illicit fentanyl, prescription fentanyl exposure among children aged <6 years decreased. Safe disposal of transdermal patches is important, and caregiver education is needed to prevent serious medical outcomes.

Objectives: Lyme carditis is a rare, potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on clinical manifestations are not collected systematically in the United States. We developed a syndromic surveillance definition to identify patients with Lyme carditis in New York State during 2017-2021.

Methods: We developed a definition of Lyme carditis by using diagnostic codes and keywords to identify emergency department visits related to Lyme carditis through the National Syndromic Surveillance Program's BioSense Platform. We systematically abstracted information for each identified patient by reviewing medical records in New York State's regional health information exchange system. Physician reviewers independently assigned a clinical case status to each record. We mapped cases of Lyme carditis by county and described their characteristics.

Results: We identified records for 173 individuals; 32% (n = 55) were classified as confirmed, 16% (n = 27) as probable, and 53% (n = 91) as not a case of Lyme carditis. In total, we identified 82 cases of confirmed or probable Lyme carditis; the positive predictive value of the definition was 47%. Cases occurred in 49% of New York State counties and peaked annually in July and August. Among patients with confirmed and probable Lyme carditis, age distribution was bimodal, with incidence peaking at about ages 32 and 70 years; 71% were male. Eighty-four percent had positive 2-tiered serologic test results for Lyme disease, and second- or third-degree atrioventricular block was present in two-thirds of patients (67%).

Practical implications: This definition may be a useful tool to detect changing patterns of Lyme carditis in areas with a high incidence of Lyme disease.

The Dietary Supplement Health and Education Act of 1994 specified that dietary supplements must be swallowed. In this study, we investigated whether kratom-derived products are being sold to consumers in nonswallowed formulations. Kratom is the fresh or dried leaf powder of the Mitragyna speciosa tree. We identified 49 kratom-derived products being sold in the form of sublingual strips (24%), buccal pouches (8%), and vaping products (67%). Most contained 7-hydroxymitragynine (an alkaloid that the US Food and Drug Administration seeks to make a controlled substance), but we also identified mitragynine extract and mitragynine pseudoindoxyl products. The majority had flavoring or a scent, and some had mascots, pictures of fruit or mint, or formulation colors or packaging that could appeal to children. Most products were not sold in child-resistant packaging. Several kratom vaping products additionally contained intoxicating hemp cannabinoids. With no clinical, safety, or pharmacokinetic data for kratom-derived products that bypass first-pass metabolism (ie, where a chemical absorbed through the stomach or intestines is metabolized in the liver before reaching the general bloodstream), people should be advised to avoid these products, and regulatory action is needed to prevent their sale to consumers.