American Journal of Preventive Medicine最新文献

Introduction: The number of U.S. adults who own and carry a firearm for self-defense is rising. Research has established that owning or carrying a firearm increases the risk of injury and death for firearm owners and the people in their lives. This study sought to better understand this paradox by estimating associations of perceived specific and diffuse threats with firearm behaviors among U.S. adults.

Methods: The authors used data from the 2023 National Firearm Attitudes and Behaviors Study, a nationally representative cross-sectional survey of U.S. adults. Binary and ordinal logistic regression estimated associations of perceived specific (fear of attack in the community, fear of someone breaking into the home) and diffuse threats (belief in a dangerous world) with firearm ownership and carriage frequency, overall and stratified by gender. Adjusted models controlled for violence exposures and demographic characteristics. The authors conducted analyses in 2024.

Results: Among all U.S. adults, the perceived specific threat of someone breaking into the home was associated with firearm ownership (AOR: 1.09 [0.98, 1.23]). Among firearm-owning adults, the diffuse threat of belief in a dangerous world was associated with firearm carriage frequency (1.11 [0.98, 1.25]). Both the associations persisted among men (AORs = 1.27 [1.05-1.52] and 1.15 [1.01-1.31], respectively), but analyses found no associations between perceived threats and firearm behaviors among women.

Conclusions: Perceived threats are associated with firearm behaviors among U.S. men, even after accounting for the actual violence they report experiencing or witnessing.

Introduction: Gynecological diseases ranked second among new cases of noncommunicable diseases in women of reproductive age in 1990 and 2019 globally. The aim of this study was to estimate the disease burden of gynecological diseases and describe their trends in women of all ages from 1990 to 2019.

Methods: Using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), authors examined the incidence, disability-adjusted life years, and deaths from gynecological diseases by age in 204 countries and territories worldwide from 1990 to 2019. Analyses were conducted in 2022.

Results: Globally, the age-standardized incidence rate and age-standardized disability-adjusted life year rate (ASDR) of gynecological diseases decreased by -0.176% and -0.245%, respectively from 1990 to 2019. Low socioeconomic development index countries had the highest age-standardized incidence rate and ASDR in 2019. The age-specific incidence rate of gynecological diseases in women aged 15-29 years increased from 1990 to 2019, and the 20-24-year age group increased the greatest by 0.21%. Polycystic ovary syndrome and other types of benign disorders contributed to the major increase.

Conclusions: Although the disease burden of gynecological diseases decreased slightly between 1990 and 2019 globally, it remained highest in low socioeconomic development index countries. The disease burden in 20-24-year age group exhibited the fastest growth, with polycystic ovary syndrome and other types of benign disorders playing a significant role. Urgent and effective measures should be taken to target different age groups, types of gynecological disease, and regions with high disease burdens.

Introduction: Quantifying the impact of smoking on life expectancy and the potential benefits of smoking cessation is crucial for motivating people who smoke to quit. While previous studies have attempted to estimate these effects, they were conducted more than a decade ago and did not include a significant demographic, people over 65 years old who smoke.

Methods: Mortality rates by age and smoking status were calculated using mortality relative risks derived from Cancer Prevention Study II, 2018 National Health Interview Survey smoking prevalence data, 2018 U.S. population census data, and 2018 U.S. mortality rates. Subsequently, life tables by smoking status-never, current, and former-were constructed. Life expectancies for all three smoking statuses, including those of individuals who had quit smoking at various ages ranging from 35 to 75, were then compared. Additionally, probability distributions of years lost due to smoking and years gained by quitting smoking at different ages were generated. Analyses were conducted in 2023.

Results: Compared to people who never smoked, those who smoke currently, aged 35, 45, 55, 65, or 75 years, and who have smoked throughout adulthood until that age, will lose, on average, 9.1, 8.3, 7.3, 5.9, and 4.4 years of life, respectively, if they continue to smoke for the rest of their lives. However, if they quit smoking at each of these ages, they will avoid an average loss of 8.0, 5.6, 3.4, 1.7, and 0.7 years. The chances of gaining at least 1 year of life among those who quit at age 65 and 75 are 23.4% and 14.2%, respectively.

Conclusions: Quitting smoking early will avoid most years otherwise lost due to smoking. Even those who quit at ages 65 and above can still meaningfully increase their life expectancy.

Introduction: Herpes zoster increases stroke and myocardial infarction risk. The objective of this study is to evaluate the impact of live attenuated zoster vaccination on stroke and myocardial infarction risk in patients at risk of zoster, including those with hypertension, diabetes mellites, obesity, hypercholesterolemia, chronic kidney disease, chronic obstructive pulmonary disease, emphysema, asthma, and chronic liver disease.

Methods: This is a retrospective cohort study utilizing continuous de-identified claims data from the IBM MarketScan Commercial Claims and Encounters Database (collected from 2005-2018) containing data for 200 million commercially insured Americans. Participants included 27,093 adults vaccinated against zoster with at least 5 years of continuous enrollment, age and sex-matched 1:5 with unvaccinated controls. OR, risk difference, and the number needed to treat evaluated the effect of vaccination on stroke and myocardial infarction while controlling for relevant comorbidities.

Results: Over the period of 5 years, proportions of myocardial infarction (1.29% vs 1.82%; p<0.05) and stroke (1.61% vs 2.20%; p<0.05) were lower in vaccinated versus unvaccinated individuals, respectively, controlling for age and sex, with the greatest benefit for people with diabetes (stroke OR=0.64, 95% CI=0.58, 0.71; myocardial infarction OR=0.63, 95% CI=0.57, 0.71). Although hypertension and chronic obstructive pulmonary disease had the highest odds of stroke and myocardial infarction, vaccination still provided significant risk-reduction (hypertension: stroke 0.75 [0.68, 0.83], myocardial infarction 0.73 [0.65, 0.81]; chronic obstructive pulmonary disease: stroke 0.75 [0.68, 0.83], myocardial infarction 0.74 [0.66, 0.83]).

Conclusions: Live attenuated zoster vaccination is associated with lower risk of stroke and myocardial infarction in adults with at-risk comorbidities, controlling for age and sex. Vaccination may provide cardiovascular benefits beyond zoster prevention.

Introduction: Successful delivery of the virtual Medicare Diabetes Prevention Program (MDPP) is influenced by a beneficiary's access to a computer and use of the Internet.

Methods: Using the 2020 nationally representative Medicare Current Beneficiary Survey Public Use File, a three-level categorical dependent variable was created: (1) has a computer AND uses Internet, (2) has a computer OR uses Internet, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was performed in 2023 to examine associations between socio-demographics, comorbidities, and computer access and Internet use.

Results: Of study beneficiaries aged ≥65 years with BMI≥25 kg/m² and no history of diabetes (n=3,875), 70.8% had a computer AND used Internet; 14.3% had a computer OR used Internet; and 14.9% had no computer AND did not use Internet. Hispanics and non-Hispanic Blacks (OR=0.28, 95% CI [0.17-0.43]) were less likely than non-Hispanic Whites to have a computer AND use Internet. Beneficiaries with less education (

Conclusions: Approximately 30% of potentially MDPP-eligible beneficiaries (representing ∼6 million beneficiaries) lacked full digital access. Efforts to encourage enrollment in the virtual MDPP must address digital disparities for beneficiaries at-risk for type 2 diabetes.

Introduction: Over 40,000 people die by suicide annually in the U.S., and firearms are the most lethal suicide method. There is limited evidence on the effectiveness of many state-level policies on reducing firearm suicide. The objective of this study was to identify public policies that best predict state-level firearm suicide rates.

Methods: Data from the Centers for Disease Control and Prevention's WONDER system and the State Firearm Law Database, a longitudinal catalog of 134 firearm safety laws, were analyzed. The analysis included 1,450 observations from 50 states spanning 1991-2019. An ElasticNet regression technique was used to analyze the relationship between the policy variables and firearm suicide rates. Nested cross-validation was performed to tune the model hyperparameters. The study data were collected and analyzed in 2023 and 2024.

Results: The optimized ElasticNet approach had a mean squared error of 2.07, which was superior to nonregularized and dummy regressor models. The most influential policies for predicting the firearm suicide rate on average included laws requiring firearm dealers that sell handguns to have a state license and laws requiring individuals to obtain a permit to purchase a firearm through an approval process that includes law enforcement, among others.

Conclusions: On average, firearm suicide rates were lower in state-years that had each influential policy active. Notably, these analyses were ecological and noncausal. However, this study was able to use a supervised machine learning approach with inherent feature selection and many policy types to make predictions using unseen data (i.e., balancing Lasso and Ridge regularization penalties).

Introduction: People experiencing homelessness (PEH) are highly vulnerable to discrimination and violence, which impact physical and mental health. The study examines past-month discrimination and violence against PEH in Los Angeles County (LAC).

Methods: A total of 332 PEH in LAC were surveyed about their past-month experiences with discrimination, physical violence, and sexual violence from April-July 2023. Analyses were conducted in 2023.

Results: 31.8% of respondents reported experiencing discrimination daily and 53.9% reported it weekly, whereas rates of lifetime discrimination in studies of general populations of minoritized groups range between 13-60%. Nearly half of respondents who reported experiencing discrimination (49.6%) believed that their housing situation was the reason they were targeted. Victimization was also common, with 16.0% of participants experiencing physical violence and 7.5% experiencing sexual violence in the past 30 days. These rates of past-month victimization are high when compared to past-year physical violence (3.0%) and sexual violence (0.24%) among general populations in major U.S. cities. In multivariate regression analyses, discrimination was associated with being unsheltered in a vehicle (p<0.05) or outdoors (p<0.001), weekly illicit drug use (p<0.01), and psychological distress (p<0.001); violent victimization was associated with being sheltered (p<0.05) or unsheltered outdoors (p<0.001), physical health conditions (p<0.05), and psychological distress (p<0.01); and sexual victimization was associated with non-male gender (p<0.05) and being unsheltered outdoors (p<0.05). Discrimination and victimization outcomes were not associated with any race/ethnicity, sexual orientation, or time homeless characteristics.

Conclusions: Study findings highlight the dangers of homelessness in the U.S., particularly for those who are unsheltered outdoors.

Introduction: Earth's temperature has risen by an average of 0.11°F per decade since 1850 and experts predict continued global warming. Studies have shown that exposure to extreme temperatures is associated with adverse health outcomes. Missed primary care visits can lead to incomplete preventive health screenings and unmanaged chronic diseases. This study examines the associations between extreme temperature conditions and primary care utilization among adult Philadelphians.

Methods: A total of 1,048,575 appointments from 91,580 patients age ≥ 18 years enrolled in the study at thirteen university-based outpatient clinics in Philadelphia from January 1, 2009 to December 31, 2019. Statistical analysis was performed from June to December 2023. Data on attended and missed appointments was linked with measures of daily maximum temperature and precipitation, stratified by warm and cold seasons. Sociodemographic variables and associations with chronic disease status were explored.

Results: Rates of missed appointments increased by 0.72% for every 1°F decrease in daily maximum temperatures below 39°F and increased by 0.64% for every 1°F increase above 89°F. Individuals ≥ 65 years and those with chronic conditions had stronger associations with an increased rate of missed appointments.

Conclusions: Temperature extremes were associated with higher rates of missed primary care appointments. Individuals with chronic diseases were more likely to have missed appointments associated with extreme temperatures. The findings suggest the need for primary care physicians to explore different modes of care delivery to support vulnerable populations, such as making telemedicine during extreme weather events a viable and affordable option.