American Journal of Preventive Medicine最新文献

Introduction: Acute kidney injury (AKI) is associated with increased mortality. AKI-related mortality trends by U.S. urban and rural counties were assessed.

Methods: In the cross-sectional study, based on the Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) Multiple Cause of Death data, age-standardized mortality with AKI as the multiple cause was obtained among adults aged ≥25 years from 2001-2020, by age, sex, race and ethnicity, stratified by urban-rural counties. Joinpoint regressions were used to assess trends from 2001-2019 in AKI-related mortality rate. Pairwise comparison was used to compare mean differences in mortality between urban and rural counties from 2001-2019.

Results: From 2001-2020, age-standardized AKI-related mortality was consistently higher in rural than urban counties. AKI-related mortality (per 100,000 population) increased from 18.95 in 2001 to 29.46 in 2020 in urban counties and from 20.10 in 2001 to 38.24 in 2020 in rural counties. In urban counties, AKI-related mortality increased annually by 4.6% during 2001-2009 and decreased annually by 1.8% until 2019 (p<0.001). In rural counties, AKI-related mortality increased annually by 5.0% during 2001-2011 and decreased by 1.2% until 2019 (p<0.01). The overall urban-rural difference in AKI-related mortality was greater after 2009-2011. AKI-related mortality was significantly higher among older adults, men, and non-Hispanic Black adults than their counterparts in both urban and rural counties. Higher mortality was concentrated in rural counties in the Southern United States.

Conclusions: Multidisciplinary efforts are needed to increase AKI awareness and implement strategies to reduce AKI-related mortality in rural and high-risk populations.

Introduction: Social vulnerability, race, and place are three important predictors of fatal police shootings. This research offers the first assessment of these factors at the zip code level.

Methods: The 2015-2022 Mapping Police Violence and Washington Post Fatal Force Data (2015-2022) were used and combined with the American Community Survey (2015-2022). The social vulnerability index (SVI) was computed for each zip code by using indicators suggested by CDC, then categorized into low-, medium-, and high-SVI. The analytical file included police officers who fatally shot 6,901 individuals within 32,736 zip codes between 2015 and 2022. Negative Binomial Regression (NBRG) models were run to estimate the association between number of police shootings and zip code SVI, racial composition, and access to guns using 2015-2022 data.

Results: Moving from low-SVI to high-SVI revealed the number of fatal police shootings increased 8.3 times, with the highest increases in Blacks (20.4 times), and Hispanics (27.1 times). The NBRG showed that moderate-, and high-SVI zip codes experienced higher fatal police shootings by 1.97, and 3.26 times than low-SVI zip codes; zip code racial composition, working age population, number of violent crimes, number of police officers and access to a gun, were other predictors of fatal police shootings.

Conclusions: Social vulnerability and racial composition of a zip code are associated with fatal police shooting, both independently and when considered together. What drives deadly police shootings in the United States is not one single factor, but rather complex interactions between social-vulnerability, race, and place that must be tackled synchronously. Action must be taken to address underlying determinants of disparities in policing.

Introduction: U.S.- and foreign-born Black young adults often have different cultural backgrounds and experiences that can an affect the types of, extent of, and response to the psychosocial stressors encountered. This study examined whether psychosocial and structural stressors are similarly related to any and polytobacco (i.e., 2 or more tobacco products) use among subgroups of Black young adults in the U.S.

Methods: Cross sectional data were collected in 2023 from 445 Black young adults (aged 18-25 years) in the U.S. Stratified regression models were used to examine the association of psychosocial (mental health adversity, race-related adversity, concerns about societal issues) and structural (food insecurity and housing insecurity) stressors with past 6-month any and polytobacco use among U.S.- and foreign-born Black young adults.

Results: Race-related adversity was associated with higher odds of polytobacco use (than odds of nonuse) among both U.S.- (AOR=1.36, 95% CI=1.06, 1.74) and foreign- (AOR=2.18, 95% CI=1.18, 4.03) born Black young adults. Food insecurity was associated with higher odds of polytobacco use among foreign-born Black young adults (AOR=1.92, 95% CI=1.13, 3.27) and any tobacco use among both U.S.- (AOR=1.36, 95% CI=1.04, 1.79) and foreign- (AOR=1.47, 95% CI=1.01, 2.17) born Black young adults. However, concern about societal issues was associated with reduced odds of polytobacco use in both groups.

Conclusions: In all models, experiences of racism and discrimination (race-related adversity) were linked to higher odds of polytobacco use, whereas concern about societal issues was protective. However, there were nativity differences in the association of food insecurity with any and polytobacco use. Findings support the need for culturally/ethnically conscious tobacco prevention strategies that address the underlying psychosocial and structural drivers of tobacco use among Black young adult subgroups.

Introduction: Government and insurance sponsored exercise programs have demonstrated decreased hospitalizations, but it is unclear if this is the case for self-referred programs.

Methods: In this retrospective cohort study from 2013 to 2020, older adults who participated for at least three months at a community-based exercise center (participants) were compared with those who did not (nonparticipants). Each completed a baseline physical assessment and periodic reassessments thereafter. These data were paired with regional hospital data and a national mortality database. Statistical analysis and modeling were performed from 2020 to 2023. Survival to all-cause hospitalization was assessed with a priori subgroup comparison by gender and cox proportional hazard modeling by age, gender, and comorbidities.

Results: The cohort included 718 adults, mean age 69.5 years (SD 8.4), with 411 (57.2%) participants and 307 nonparticipants. Mean follow-up was 26.7 months. Participants had similar baseline measures of fitness (p>0.05) but were more likely to be retired and less likely to have diabetes or prior stroke than nonparticipants. Sustained participation was associated with a reduced rate of all-cause hospitalization (9.0% vs. 12.7%, p=0.02), even when adjusted (HR 0.54; 95% CI 0.34, 0.87, p=0.01). This decrease was noted only in women (p=0.03) but not in men (p=0.49), gender was nonsignificant after adjustment for comorbidities (p=0.15).

Conclusions: Exercise program participation was independently associated with decreased risk of all-cause hospitalization, with possible differential effects by gender. Further randomized trials of the benefits of personalized exercise programs are warranted to assess sex- and gender-specific effects.

Introduction: Disease intervention specialists (DIS) are critical for delivering partner services programs that provide partner notification, counseling, referral, and other services for HIV, sexually transmitted infections (STIs), and other infections. This systematic review of partner services and other DIS-delivered interventions for HIV and STIs was conducted to summarize the effectiveness of these programs and identify evidence gaps.

Methods: A systematic literature review was conducted with a narrative synthesis. Articles were located using keyword searches in MEDLINE, Web of Science, CINAHL, and ProQuest through December 2022 and analyzed in 2023-2024. Included studies addressed an intervention of partner services or other DIS-delivered services for HIV or STIs; a United States setting; primary data collection; and an external comparison group or pre-post design.

Results: A total of 1,915 unique records were screened for eligibility, with 30 studies included. Overall, DIS-delivered interventions improved clinical outcomes among index patients and population outcomes. Many studies focused on program process measures rather than population-level epidemiologic outcomes. All but one studies were scored as having low or medium strength of evidence.

Conclusions: The evidence could be strengthened by establishing a streamlined set of core metrics, assessing impact using rigorous causal inference methodologies, linking program and clinical data systems, and supplementing impact evaluations with evidence on implementation strategies.

Introduction: Firearm-related injuries (FRIs) are serious but a preventable public health issue. The objective of this study was to describe FRI inpatient costs by (1) patient insurance payer type and (2) hospital safety-net mix.

Methods: FRIs were identified using International Classification of Disease diagnosis codes in the National Inpatient Sample. All admissions between 2003 and 2020 were included. The primary outcome was consumer-price index adjusted inpatient stay costs. Mixed effects generalized linear regressions, with a random intercept at the hospital level, were used to describe costs. Analyses were sample weighted and performed between 2023 and 2024.

Results: Among 538,795 FRIs, the median age was 27 years (interquartile range: 21-37 years). Injuries by payer type were highest among self-pay (280,161; 39%), followed by Medicaid (182,716; 34%), private (113,650; 21%), and Medicare (30,110; 6%). Inflation-adjusted costs of FRI stays totaled $15.2 billion, with $6.2 billion from Medicaid and $5 billion from the self-pay group. After 2014, FRI incidence declined among self-pay/no-charge patients and increased among Medicaid-covered patients-representing a 127% total increase in Medicaid costs from $169 million in 2003 to $753 million in 2020. Among moderate-high and high safety-net mix hospitals, costs increased from $257 million in 2003 to $567 million in 2020.

Conclusions: The incidence and costs of FRIs among Medicaid-insured has substantially increased since 2003. Importantly, these increased costs are disproportionately placed on disadvantaged patients and safety-net hospitals.

Introduction: This study examined the association between American Heart Association's (AHA) cardiovascular health (CVH) metrics, Life's Essential 8 (LE8), and predicted heart age among U.S. adults.

Methods: The sample comprised 7,075 participants aged 30-74 years without CVD and/or stroke from the National Health and Nutrition Examination Survey (NHANES) 2015-March 2020. LE8 was measured according to AHA's metrics (overall score ranging from 0 to 100 points), and nonlaboratory-based Framingham Risk Score was used to estimate predicted heart age. Analyses were completed in June 2024.

Results: Median LE8 scores were 62.8 for men and 66.0 for women. Over 80% of participants had less than optimal CVH scores, affecting 141.5 million people and 1-in-6 participants had a low CVH score, impacting 30.0 million people. Mean predicted heart age and excess heart age (EHA, difference between actual and predicted heart age) were 56.6 (95% CI 56.1-57.1) and 8.6 (8.1-9.1) years for men and 54.0 (53.4-54.7) and 5.9 (5.2-6.5) years for women. Participants in the low CVH group (scores<50), had an EHA that was 20.7 years higher than those in the high CVH group (score 80-100). Compared to the high CVH group, participants in low CVH group had 15 times (for men) and 44 times (for women) higher risk of having EHA ≥10 years. The pattern of differences in predicted heart age, EHA, and prevalence of EHA ≥10 years by LE8 groups remained largely consistent across subpopulations.

Conclusions: These findings highlight the importance of maintaining a healthy lifestyle to improve cardiovascular health and reduce excess heart age.

Introduction: This study aims to investigate the bidirectional associations between social isolation (SI) and multimorbidity among Chinese older adults.

Methods: Data from six waves of the Chinese Longitudinal Healthy Longevity Survey spanning from 2002 to 2018 were analyzed. A General Cross-Lagged Model was employed in 2023 to investigate the temporal interrelationships between SI and multimorbidity among individuals aged 65 years and older.

Results: In the short-term, significant bidirectional associations between SI and multimorbidity were found. Higher levels of SI at a given time point were associated with increased multimorbidity scores in the future, while greater levels of multimorbidity at a given time were associated with higher future SI scores. In the long-term, it is more likely that initial multimorbidity affect SI rather than initial SI affecting multimorbidity.

Conclusions: This study contributes to the understanding of the bidirectional associations between SI and multimorbidity among Chinese older adults, highlighting that initial multimorbidity was associated with future SI.

Introduction: In the U.S., rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic.

Methods: Cross-sectional U.S. vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the prepandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality.

Results: During the pandemic, rural-compared to suburban and urban-areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95% CI: 48.8, 59.4), drug-related causes (19.0, 95% CI: 16.0, 22.4), suicide (4.4., 95% CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95% CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from prepandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic.

Conclusions: Rural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.