American Journal of Preventive Medicine最新文献

Introduction: This study aimed to investigate the patterns of healthcare system utilization before sudden cardiac death (SCD) in Taiwan, and compare the patterns between patients treated at medical centers and non-center hospitals.

Methods: This descriptive multicenter retrospective cohort study recruited adult, nontraumatic SCD patients who were admitted to the National Taiwan University Hospital and its affiliated hospitals between January 2017 and December 2022. Healthcare utilization patterns, such as outpatient visits, emergency department (ED) visits, short-term ED returns, and hospitalizations, were analyzed during the weeks prior to SCD. The statistical analysis compared the above patterns between medical center and non-center cohorts to identify potential differences in patient behavior and healthcare use.

Results: Analysis of 3,649 eligible patients revealed a significant increase in healthcare utilization before SCD. Outpatient visits began to rise sharply five weeks prior to SCD, peaking at 16.5% in the overall cohort. The number of ED visits showed a notable increase starting ten weeks prior, with a peak in the week immediately before the SCD, reaching 3.7%. Hospitalization rates exhibited a distinct pattern, peaking at 2.5% three weeks before SCD and then declining. The consistency between hospitalization diagnoses and the cause of SCD was approximately 40% within three weeks prior to SCD. The increases were consistent across both the medical center and non-center cohorts, although non-center patients generally exhibited higher utilization rates.

Conclusions: Healthcare utilization significantly increased before SCD, including outpatient visits, ED visits, and hospitalization. This pattern was consistent among patients treated at medical centers and non-medical centers.

Introduction: Electronic nicotine delivery systems (ENDS) can benefit those who use combustible tobacco if they transition completely to ENDS. ENDS can also result in nicotine addiction among nicotine naïve people.

Methods: ENDS-related tobacco use transitions were assessed among US youth and adults using weighted Population Assessment of Tobacco and Health Study wave four (2016-2017) and five (2018-2019) adult and youth data. A 'beneficial' transition was defined as those who used combustible tobacco and transitioned exclusively to ENDS use or quit with the help of ENDS. A 'harmful' transition was defined as (1) nonusers of any tobacco product who initiated ENDS (with or without combustible tobacco co-use) or (2) those who exclusively used ENDS and then added or transitioned to combustible tobacco use. Sensitivity analyses were conducted to examine modified definitions of beneficial and harmful transitions based on different assumptions. The analyses were conducted between August 2024 and November 2024.

Results: Total sample size (n=31,733) represented ∼256 million (m) people. For those using a combustible tobacco product in wave four, 2.1m (∼4.6%) transitioned to exclusive ENDS use or to ENDS-assisted cessation of a combustible tobacco product (benefit). In addition, 4.6m (∼%2.2) transitioned from non-use to ENDS or, among people who use ENDS exclusively in wave four, added combustible or transitioned to combustible tobacco use in wave five (harm).

Conclusion: For every 1 beneficial transition, ENDS use was associated with 2.15 harmful transitions; this ratio ranged from 0.75 to 2.77 in sensitivity analyses. With effective restrictions on ENDS access and marketing for tobacco naïve people, the population benefits of ENDS could outweigh population harms.

Introduction: Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the United States (US) population over age 50 meet the United States Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown. This study evaluated the proportion of Veterans who are USPSTF-eligible and tested the hypothesis that more USPSTF-2021-eligible Veterans reside in rural versus non-rural areas.

Methods: Investigators cross-sectionally surveyed a national sample of Veterans age 50 years and older January-November 2022. Oversampling ensured inclusion of minority groups and accounted for geographic variation in tobacco use. Analyses in 2023-2024 evaluated the proportion of USPSTF-eligible Veterans by year (2013 and 2021) and tested USPSTF-2021 eligibility by rural status (rural vs non-rural) using Chi square tests. Weighting accounted for survey non-response and applied results to the whole Veteran population in a sensitivity analysis.

Results: Of 2,000 surveyed, 754 responded (37.7% response rate); most respondents were White (74.4%), male (92.6%), resided in non-rural areas (66.0%). Proportions meeting USPSTF criteria were 35.5% (95% CI 31.6-39.6%) in 2021 and 27.8% (95%CI 24.3-31.7%) in 2013. The proportion of USPSTF-2021-eligible rural Veterans (41.2%;95%CI 34.8-48.0%) was higher compared with non-rural (32.5%;95% CI 27.7-37.7%), P=0.037. A sensitivity analysis found the proportion of Veterans USPSTF-2021-eligible in the whole population was 33.0%.

Conclusions: The proportion of Veterans USPSTF-2021-eligible was nearly three times higher than the general US population (11.2%), and a greater proportion of eligible Veterans resided in rural compared with non-rural areas. These findings are critical for policies aimed at fully implementing lung cancer screening at scale.

Introduction: Persistent racial and ethnic disparities exist for type 2 diabetes (T2D) in the United States. Racial and ethnic minorities have higher T2D risk and studies suggest they engage in less exercise than Whites. This study examined whether, and to what degree, racial differences in T2D were explained by exercise.

Methods: Adults aged 45-84 years without T2D at baseline (2000-2002) were included from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort and followed through 2020. Associations of race with T2D were examined using multivariable Cox proportional hazards regressions. Effects explained by exercise were assessed using natural mediation effects. Analyses were conducted in 2023.

Results: Controlling for confounders, Hispanic [adjusted hazard ratio (HR) (95% confidence interval, CI): 2.02 (1.74-2.34)], Chinese [1.50 (1.24-1.82)], and Black participants [1.66 (1.44-1.93)] had higher T2D risks than White participants. Compared with White participants, Hispanic [β (SE): -0.29 (0.04) square root of MET-hour/day, P < 0.001] and Chinese [-0.25 (0.04), P < 0.001] participants had lower habitual intentional exercise, this was not true for Black participants [-0.01 (0.03), P = 0.85]. Habitual intentional exercise explained T2D relative risk by 13.6% for Hispanic and 13.2% for Chinese, but did not explain for Black participants, compared with White participants.

Conclusions: Habitual intentional exercise accounted for one-tenth of racial differences in T2D when comparing Hispanic or Chinese populations with White populations. Interventions promoting exercise are crucial to decrease T2D risk for all racial groups but may additionally narrow disparities in T2D among Hispanic and Chinese populations.

Introduction: This study aimed to examine the association of county-level racial and economic residential segregation with mortality rates in the U.S. between 2018 and 2022.

Methods: Residential segregation was measured by the Index of Concentration at Extremes and categorized into quintiles. Outcomes included 2018-2022 county-level age-adjusted mortality rates from all causes and the top 10 causes. Multi-level linear mixed modeling was clustered at the state level and adjusted for county's poverty, metropolitan status, and racial composition.

Results: A total of 3,129 counties were included. County-level age-adjusted mortality rates decreased as the segregation level decreased for all causes (from 1078.8 deaths in the most segregated counties to 734.92 deaths in the least segregated counties per 100,000 persons per year) and for 10 leading causes. Adjusted rate ratios showed dose-response associations between segregation and mortality from all-causes and 9 out 10 leading causes. Using the least segregated counties as the reference group, the adjusted rate ratios (aRR) for all-cause mortality was 1.25 (95% confidence interval: 1.22, 1.28), 1.20 (1.17, 1.22), 1.13 (1.11, 1.15), and 1.09 (1.08, 1.10) for the first (most segregated) through the fourth quintile of segregation, respectively.

Conclusions: Racial and economic residential segregation was positively associated with mortality rates at the county level in the contemporary U.S. Future study should elucidate the mechanisms underlying associations to inform evidence-based interventions and improve the health of the entire population.

Introduction Cash bail reforms that end pretrial detention due to the inability to afford bail have been highly debated across the US. A major concern cited by bail reform opponents is that reducing pretrial detention will increase community violence, particularly violence against women. The objective of this study was to assess if New Jersey's cash bail reform was associated with changes in rates of fatal violence against women. Methods This study used synthetic control methods to evaluate the impact of bail reform on rates of fatal violence against women in New Jersey compared with a weighted combination of 21 control states with no bail reform from 2015-2019. Outcome data were from the National Violent Death Reporting System and included intimate partner violence (IPV)-related homicides, pregnancy-associated homicides, and overall homicides of adult women. Outcomes were measured for all adult women and within racialized groups. Analyses were performed in 2024. Results There were no significant changes in rates of IPV-related homicide (average treatment effect on the treated [ATT], -0.11 deaths per 100,000 women, p-value=0.1), pregnancy-associated homicide (0.28 deaths per 100,000 births, p=0.8), and overall homicide (-0.03 deaths per 100,000, p=0.1) during the post-policy period. There were also no significant changes within racialized groups. Conclusion Violence against women and mass incarceration are urgent and interconnected public health crises. These findings demonstrate the potential for policies to reduce the number of people incarcerated pretrial without increasing fatal violence against women. Addressing these public health crises requires holistic structural interventions, like housing and economic support, that reduce violence without criminalization.

Introduction: National surveillance efforts have reported rural-urban disparities in childhood vaccination coverage by metropolitan statistical area designations, measured at the county level. This study's objective was to quantify vaccination trends using more discrete measures of coverage and rurality than prior work.

Methods: Serial, cross-sectional analyses of National Immunization Survey-Child restricted-use data collected in 2015-2021 for U.S. children born 2014-2018 were conducted. ZIP code of residence was merged with rural-urban commuting area codes. Vaccination coverage and patterns, including on-time receipt of recommended vaccines, were assessed using vaccinations recorded from birth through age 23 months. To determine whether trends differed by rurality, an interaction between birth year and RUCA was tested in multivariable regression models. Analyses were conducted in November 2023-January 2024.

Results: In nationally representative analyses of N=59,361 children, 87.7%, 7.1%, and 5.3% lived in urban, large rural, or small town/rural areas, respectively. Among children born in 2018, coverage for the combined 7-vaccine series was 71.2% (95% CI=69.6%, 72.9%) in urban, 64.9% (95% CI=58.8%, 71.0%) in large rural, and 62.6% (95% CI=56.2%, 68.9%) in small town/rural areas. There was a positive trend in on-time vaccination in urban areas (adjusted prevalence ratio [aPR] for birth year=1.06; 95% CI=1.05, 1.08). While the trend did not significantly differ for large rural versus urban areas (interaction aPR=1.02; 95% CI=0.96, 1.08), there was less improvement in on-time vaccination in small town/rural areas (interaction aPR=0.93; 95% CI=0.88, 0.99).

Conclusions: Increased efforts are needed to eliminate disparities in routine and on-time vaccination for rural children.

Introduction: This study aimed to evaluate the burden and underlying causes of traumatic brain injury (TBI) in 204 countries and territories from 1990 to 2021.

Methods: Utilizing data from the Global Burden of Disease (GBD) 2021 study, which derived estimates of TBI burden from hospital and emergency department records, national surveys, and claims data, the incidence, prevalence, and years lived with disability (YLDs) associated with TBI were analyzed. A comparative analysis of TBI burden by location, age, sex, and socio-demographic index was performed, along with an underlying assessment of 15 major causes contributing to age-standardized incidence rates. Analyses were conducted in 2024.

Results: In 2021, there were 20.84 million (95% UI: 18.13, 23.84) incident cases and 37.93 million (95% UI: 36.33, 39.77) prevalent cases of TBI globally, resulting in 5.48 million (95% UI: 3.87, 7.33) YLDs. While the absolute number increased from 1990 to 2021, age-standardized rates of TBI incidence, prevalence, and YLDs showed a significant decline. These rates generally increased with age and were higher in males than females. The highest age-standardized prevalence and YLD rates were observed in Eastern and Central Europe. Globally, falls were the leading cause of TBI in 2021, followed by road injuries, interpersonal violence, and exposure to mechanical forces.

Conclusions: Despite declines in age-standardized rates, the total number of TBI cases and associated disabilities has risen since 1990, indicating a persistent global burden. Targeted interventions are urgently needed in high-burden regions like Eastern and Central Europe, with focus on leading causes and vulnerable populations.