Journal of Racial and Ethnic Health Disparities

Provisional U.S. national COVID-19 mortality data for the year 2020 analyzed by the CDC in March 2021 indicated that non-Hispanic Asians fared markedly better overall than other racial/ethnic minority groups-and marginally better than non-Hispanic Whites-in terms of age-adjusted mortality rates. However, Asians in the United States are composed of diverse array of origin subgroups with highly varying social, economic, and environmental experiences, which influence health outcomes. As such, lumping all Asians together into a single category can mask meaningful health disparities among more vulnerable Asian subgroups. To date, there has not been a national-level analysis of COVID-19 mortality outcomes between Asian subgroups. Utilizing final multiple cause of death data for 2020 and population projections from the U.S. Census Bureaus Current Population Survey Annual Social and Economic Supplement for 2020, crude and age-adjusted national COVID-19 mortality rates, both overall and stratified by sex, were calculated for the six major single-race Asian origin subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and a catch-all seventh category that comprises the remaining Asian subgroups (Other Asians), contrasting them to the corresponding mortality rates of other racial/ethnic groups. A substantially more nuanced picture emerges when disaggregating Asians into its diverse origin subgroups and stratifying by sex, with Filipino males and Asian males outside of the six major Asian subgroups in particular experiencing markedly higher age-adjusted mortality rates than their White male counterparts, whether comparisons were restricted to their non-Hispanic subsets or not. During the COVID-19 pandemic and in the post-pandemic recovery, it is imperative not to overlook the health needs of vulnerable Asian populations. Public health strategies to mitigate the effects of COVID-19 must avoid viewing Asians as a monolithic entity and recognize the heterogeneous risk profiles within the U.S. Asian population.

Objectives. To investigate self-reported discrimination and concern for physical assault due to the COVID-19 pandemic among disaggregated Asian subgroups in the US. Methods. We conducted a nationwide survey to assess self-reported discrimination and concern for physical assault due to COVID-19 across racial/ethnic groups, including diverse subgroups of Asians. Results. Chinese respondents experienced the largest change (15% increase) in proportion of respondents reporting discrimination from 2019 to 2020 (P<.01). Chinese, Korean, Japanese, Vietnamese, and Other API showed up to 3.9 times increased odds of self-reported racial/ethnic discrimination due to COVID-19 and, with the addition of Filipino, experienced up to 5.4 times increased odds of concern for physical assault due to COVID-19 compared to Whites. Conclusions. Our study is the first to examine self-reported discrimination and concern for physical assault due to COVID-19 in subgroups of Asian Americans, finding that East (Chinese, Korean, Japanese) and Southeast (Vietnamese, Filipino) Asian Americans have been disproportionately affected. Future studies should disaggregate Asian subgroups to fully understand experiences of discrimination in diverse populations in the US.

Cardiovascular disease (CVD) remains a leading cause of premature mortality in the Caribbean, with particularly high rates from stroke and hypertensive heart disease. While global outcomes have improved, CVD-related mortality in the Caribbean remains elevated. This study examined sex-specific CVD mortality, risk factors, and health policy indicators across non-Latin Caribbean nations, using data from the 2019 PAHO Enlace Portal and comparing results to North America (United States and Canada). Despite North Americans exhibiting more overall risky CVD behaviors, CVD mortality was higher in the Non-Latin Caribbean compared to North America (196.7 vs. 122.6 deaths per 100,000). Total-to-HDL cholesterol ratios were significantly higher in the Caribbean, both in men (4.01 vs. 3.63; p < 0.0001) and women (3.82 vs. 3.01; p < 0.0001), indicating reduced cardioprotective effects of HDL. Hypertensive heart disease mortality was significantly higher in Caribbean women compared to North American women (p < .01), with a similar but non-significant trend in men. Caribbean men also had significantly higher rates of undiagnosed hypertension compared to North American men (47.6% vs. 20.8%; p < .001). NCD policy implementation across the Caribbean was inconsistent, with major gaps in CVD drug therapy access, alcohol advertising restrictions, NCD planning, and surveillance systems. These findings underscore the urgent need for regional investment in prevention, policy enforcement, and culturally relevant strategies to reduce CVD disparities and improve health outcomes in the Caribbean.

IntroductionCardiometabolic outcomes burden Afro-Caribbean populations disproportionately and their relationship with neighborhood socioeconomic status (SES) is unclear. This study explores neighborhood SES and cardiometabolic outcomes in urban Jamaica. MethodsWe analyzed data from 833 participants (women=557, men=276) to examine associations between neighborhood SES, determined by median property sales price, and measured diabetes, hypertension, high cholesterol, and obesity outcomes. We adjusted for covariates using survey-weighted Poisson regression models. ResultsHigh neighborhood SES was associated with increased prevalence of hypertension (PR=1.33, p=0.044) and high cholesterol (PR=2.46, p<0.001) in fully adjusted models compared with low neighborhood SES. We observed increased obesity for the middle (PR=1.46, p<0.001) and high (PR=1.60, p<0.001) SES tiers and several sex-specific relationships. High neighborhood SES was associated with more obesity among women (P=1.32, p=0.015) and high total cholesterol among men (PR=4.70, p=0.005). Mid SES was associated with increased hypertension among men (PR=2.02, p=0.024). ConclusionAssociations between neighborhood SES and cardiometabolic outcomes in urban Jamaica appear to be nonlinear and influenced by a combination of sex, individual risk factors, and neighborhood characteristics. These findings challenge some conventional assumptions about the protective effects of higher SES on health and underscore the need for a robust understanding of the complex interplay individual and neighborhood determinants in similar contexts worldwide.

BackgroundRace is a social determinant of cardiovascular (CVD) risk and the American Heart Association has called for increased research to understand how this social determinants of health (SDoH) impacts CVD risk. Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular risk. Further, research highlights that disparities exist in these indicators of cardiovascular risk such that racial/ethnic minorities generally exhibit greater characteristics of cardiovascular risk with respect to these indices (e.g., greater cIMT and higher carotid plaque scores) than white individuals due, in part, to exacerbated stress experienced from racial discrimination. At present, the mechanisms driving these racial/ethnic disparities is poorly understood. Methods and ResultsData came from the baseline examination of the Multi-Ethnic Study of Atherosclerosis (MESA). 6,814 participants aged 45-84 free of clinical CVD completed assessments on health behavior, perceived discrimination, CVD-related risk factors, and sociodemographics. Four biological sex-stratified moderated mediation models were used to examine the associations between discrimination, cigarette smoking, and mean cIMT and plaque, modeled separately. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features and that these associations would be moderated by race/ethnicity. While results did not fully support our study hypothesis, racial/ethnic differences were observed across biological sex. Significant indirect effects of discrimination on plaque scores were observed among Hispanic females such that increased discrimination was associated with more cigarette use which, in turn, was associated with higher plaque (b=.04, CI=.01, .08). Similar findings were observed among Hispanic males in relation to mean cIMT (b=.003, CI=.00, .01) and among white (b=.04, CI=.01, .08) and Hispanic males (b=.03, CI=.004, .07) and plaque. No other racial/ethnic differences were observed. ConclusionsResults suggest that cardiovascular risk disparities should be examined within frameworks that consider the importance of the intersection of multiple identities (e.g., race and gender). To better address the American Heart Associations call to examine social determinants of cardiovascular health, researchers must incorporate the complexity of the intersection of various social positions in future work.

ObjectivesLoneliness and social isolation pose significant risks for an individuals physical, mental, and social health including higher incidence of cardiovascular disease (CVD), poorer patient reported outcomes, and earlier mortality compared to those not experiencing loneliness or social isolation. The objective of this study was to assess loneliness and social and emotional support among adults aged 18 years and older who have CVD in the US. DesignUsing the 2023 Behavioral Risk Factor Surveillance Systems social determinants and health equity module, we examined the distribution of US adults with CVD, compared the prevalence of CVD by Hispanic ethnicity, and conducted multivariable logistic regressions assessing the relationship of independent variables with loneliness and social and emotional support. ResultsThe proportion of adults with CVD who felt lonely sometimes, usually, and always was 44.6%. Hispanic adults who felt lonely (56.3% vs. 43.0%; P<0.0001) and did not receive needed social and emotional support (13.7% vs. 9.8%; P=0.0162) experienced a higher prevalence of CVD than their non-Hispanic adult counterparts who felt lonely and did not receive needed social and emotional support. Adults with CVD who reported rarely or never receiving needed social and emotional support (odds ratio [OR]: 1.42; confidence interval [CI]: 1.14-1.77) had 42% higher odds of feeling lonely, compared to adults who indicated receiving social and emotional support sometimes, usually, or always. Among Hispanic adults with CVD, widowed/divorced/separated adults (OR: 2.30; CI: 1.46-3.61), urban residents (OR: 2.14; CI: 1.05-4.36), and unemployed adults (OR: 3.26; CI: 1.93-5.51) had higher odds of feeling lonely compared to married, rural, and employed adults. ConclusionThis study demonstrates significant disparities in loneliness and social and emotional support in CVD among US adults, with Hispanics experiencing a disadvantage in both outcomes. Future studies should examine strategies to improve social connection for those experiencing disparities.

BackgroundDescriptive study of Japanese sexual and gender minority (SGM) population with national representativeness have not been conducted. We sought to estimate the proportion of the Japanese SGM, and to describe those demographic, socioeconomic, and health-related variables. MethodsUtilizing data on a nationwide cross-sectional internet survey from September 12th to October 19th, 2022, we conducted a comprehensive descriptive study by applying inverse probable weighting method for national representativeness. Participants self-reported as heterosexual, homosexual, bisexual, or gender minority (GM) and responded to questions on various demographic, socioeconomic, and health-related concerns. FindingsAmong Japanese adults, 4.8% identified as homosexuals, 1.3% as bisexuals, and 3.8% as GMs. SGMs were less likely to be married/partnered compared to heterosexuals, though a certain proportion were in opposite-sex marriages/partnerships. SGMs had lower household equivalent income, insurance coverage, home ownership, current smoking rates, good self-rated health, and full COVID-19 vaccination rates. They also exhibited higher rates of substance use, severe psychological distress, feelings of loneliness, and fear of COVID-19 compared to heterosexuals. When divided by assigned sex at birth, SGM males had poorer employment status, lower academic attainment, and higher body mass index compared to their heterosexual counterparts, while SGM females showed opposite trends. InterpretationDifferences in demographic, socioeconomic, and health status between heterosexuals and SGMs underscore the need for targeted health policies and interventions to address health disparities among Japanese SGMs. Additionally, these results suggest that directly applying Western health policies to the Japanese context may not always be appropriate. FundingFunded by the Japan Society for the Promotion of Science, the Research Support Program to Apply the Wisdom of the University to tackle COVID-19 Related Emergency Problems, University of Tsukuba, and Health Labour Sciences Research Grantand the Japan Agency for Medical Research and Development.

High-income countries like Canada have the highest self-reported levels of life satisfaction in the world, although little is known regarding the experiences of racialized people and immigrants to these countries. This study investigates the factors that influence subjective well-being among a large national cohort study of 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds cohort study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity, from which racialized status was derived, were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score. Among 8,063 adults average age of 58 years, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. Racialized immigrants had significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born persons, whether racialized or not. Multivariable analysis showed that factors associated with higher life satisfaction included older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Factors associated with lower life satisfaction included being racialized, having a higher social disadvantage, poorer cardiovascular health, and being unable to afford prescription medications. Amongst immigrants, those racialized were more likely to report experiencing discrimination based on skin colour and reported lower life satisfaction. Although high income countries like Canada have amongst the highest life satisfaction scores in the world, racialized people, especially immigrants, have lower life satisfaction compared to non-racialized people. Key MessagesO_LIThis study examines associations of demographic, socioeconomic, health, healthcare access that influence self-reported life satisfaction among adults in Canada, particularly among racialized individuals and immigrants. C_LIO_LIUsing data from the Canadian Alliance of Healthy Hearts and Minds cohort study, we found racialized immigrants report significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born individuals. C_LIO_LIDespite Canadas high average life satisfaction, the data suggests there is still a need for equity-focused and culturally tailored healthcare to improve well-being among structurally marginalized groups. C_LI

BACKGROUNDPrior studies reported large decreases in US life expectancy during 2020 as a result of the COVID-19 pandemic, disproportionately affecting Hispanic and Black populations and vastly exceeding the average change in life expectancy in other high-income countries. Life expectancy estimates for 2021 have not been reported. This study estimated changes in life expectancy during 2019-2021 in the US population, in US racial/ethnic groups, and in 21 peer countries. The study compared outcomes across five US racial/ethnic groups and is the first to estimate changes in life expectancy during the pandemic in non-Hispanic American Indian/Alaska Native and Asian populations. METHODSUS and peer country death data for 2019-2021 were obtained from the National Center for Health Statistics, the Human Mortality Database, and overseas statistical agencies. The 21 peer countries included Australia, Austria, Belgium, Canada, Denmark, England and Wales, Finland, France, Germany, Israel, Italy, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, South Korea, Spain, Sweden, and Switzerland. Life expectancy was calculated for 2019 and 2020 and estimated for 2021 using a previously validated modeling method. RESULTSUS life expectancy decreased from 78.85 years in 2019 to 76.98 years in 2020 and 76.44 years in 2021, a net loss of 2.41 years. In contrast, peer countries averaged a smaller decrease in life expectancy between 2019 and 2020 (0.55 years) and a 0.26-year increase between 2020 and 2021, widening the gap in life expectancy between the United States and peer countries to more than five years. The decrease in US life expectancy was highly racialized: whereas the largest decreases in 2020 occurred among non-Hispanic (NH) American Indian/Alaska Native, Hispanic, NH Black, and NH Asian populations, in 2021 the largest decreases occurred in the NH White population. DISCUSSIONThe US mortality experience during 2020 and 2021 was more severe than in peer countries, deepening a US disadvantage in health and survival that has been building for decades. Over the two-year period between 2019 and 2021, US NH American Indian/Alaska Native, Hispanic, and NH Black populations experienced the largest losses in life expectancy, reflecting the ongoing legacy of systemic racism as well as inadequacies in the US handling of the pandemic. The crossover in racialized outcomes between 2020 and 2021, in which the NH White population experienced the largest decreases, likely has multiple explanations.

PurposeGender identity and sexual orientation are essential factors that must be incorporated into health research to ensure we unearth comprehensive and inclusive insights about the healthcare needs and experiences of diverse people. Despite the calls for more focus on sex and gender in health research, scant attention has been paid to gender identity or sexual orientation. Past research found that 0.35% of Canadian Institutes of Health Research (CIHR) grant abstracts mentioned studying lesbian, gay, bisexual, transgender, queer and/or Two-Spirit (2S/LGBTQ+)-specific health outcomes. However, the nature of that research was not explored. MethodsHere we examine the publicly available database of grant abstracts funded by CIHR from 2009-2020 to analyze what type of 2S/LGBTQ+-specific health outcomes would be studied. ResultsWe found that 58% of awarded grant abstracts mentioned studying sexually transmitted diseases, the majority of which were on human immunodeficiency virus (HIV). Less than 7% of funded 2S/LGBTQ+ grant abstracts mentioned studying cisgender women. Almost 40% mentioned including trans women/girls, and 30% mentioned including trans men/ boys. None of the studies examined mentioned work with the Two-Spirit community. ConclusionThese results reflect larger social and health inequities that require structural level changes in research to support lesbian, bisexual and queer womens health.

IntroductionRecent research underscores the exceptionally young age distribution of Covid-19 deaths in the United States compared with international peers. This brief characterizes how high levels of Covid mortality at midlife ages (45-64) are deeply intertwined with continuing racial inequity in Covid-19 mortality. MethodsMortality data from Minnesota in 2020-2022 were analyzed in June 2022. Death certificate data and published vaccination rates in Minnesota allow vaccination and mortality rates to be observed with greater age and temporal precision than national data. ResultsBlack, Hispanic, and Asian adults under age 65 were all more highly vaccinated than white populations of the same ages during most of Minnesotas substantial and sustained Delta surge and all of the subsequent Omicron surge. However, white mortality rates were lower than those of all other groups. These disparities were extreme; at midlife ages (ages 45-64), during the Omicron period, more highly-vaccinated populations had COVID-19 mortality that was 164% (Asian-American), 115% (Hispanic), or 208% (Black) of white Covid-19 mortality at these ages. In Black, Indigenous, and People of Color (BIPOC) populations as a whole, Covid-19 mortality at ages 55-64 was greater than white mortality at 10 years older. ConclusionsThis discrepancy between vaccination and mortality patterning by race/ethnicity suggests that, if the current period is a "pandemic of the unvaccinated," it also remains a "pandemic of the disadvantaged" in ways that can decouple from vaccination rates. This result implies an urgent need to center health equity in the development of Covid-19 policy measures.

ImportanceAmid efforts in the United States to promote health equity, there is a need to assess progress in reducing excess deaths and years of potential life lost (YPLL) among Black people compared with White people. ObjectiveTo evaluate trends in excess mortality and YPLL among Black people compared with White people. DesignSerial cross-sectional. SettingNational data from the Centers for Disease Control and Prevention, 1999-2020 ParticipantsNon-Hispanic White and non-Hispanic Black people ExposuresRace as documented in the death certificates. Main outcomes and measuresExcess age-adjusted all-cause and disease-specific mortality rate (per 100,000 individuals) and YPLL among Black people compared with White people. ResultsFrom 1999 to 2020, the total number of excess deaths was 658,356 and 1,154,108 among Black females and males, representing 34,938,070 and 47,005,048 excess YPLL among Black females and males. The excess deaths and YPLL were largest among infants and non-elderly adults. Heart disease had the most excess deaths. From 1999, the age-adjusted excess mortality rate declined at an annual average of -9.0 (95% CI: -10.0, -8.0; P<0.001) until 2015 among Black women and at an annual average of -16.3 (95% CI: -20.9, -11.6; P<0.001) until 2012 among Black men, followed by no significant change until 2019 in either group. From 2019 to 2020, excess deaths increased from 90.4 to 192 per 100,000 Black women and from 209.8 to 395 per 100,000 Black men, reaching rates approximating those of 1999. The trends in rates of excess YPLL followed a similar pattern. Conclusions and relevanceOver a recent 22-year period, Black people in the US lost more than 80 million years of life when compared with White people. After a period of progress, improvements stalled, and most gains were eliminated in 2020. KEY POINTSO_ST_ABSQuestionC_ST_ABSHow many excess deaths and years of potential life lost (YPLL) for Black people, compared with White people, occurred in the United States from 1999 through 2020? FindingsBased on Centers for Disease Control and Prevention data, excess deaths and YPLL persisted throughout the period, with initial progress followed by little improvement, and then worsening in 2020 to about 1999 levels. Black people had 1.8 million excess deaths and over 80 million YPLL over the study period. MeaningAfter initial progress, excess mortality and YPLL among Black people stagnated and then worsened, indicating a need for new approaches.

As the uses and needs for heart transplants around the world continue to rise, its vital to investigate how the recent boom in demand comparative to availability affects racial and ethnic groups, especially in the representation in heart transplant waitlists and recipients. Here, comparisons between the racial/ethnic representation in heart transplant waitlists and recipients at heart transplant centers through the Scientific Registry for Transplant Recipients (SRTR) are drawn, comparative to the racial/ethnic representation in the location that these centers are located. Findings point towards the overrepresentation of White individuals in both waitlists and recipients, and underrepresentation in all other ethnic minorities --except African Americans-- in waitlists and recipients comparative to their demographic representation in the location of the centers. This difference in representation is largest for Hispanics/Latinos and those that the SRTR classify as "Other". Though just a snapshot of representation between 07/01/2019 and 06/30/2020, this may point to various systemic issues in the accessibility of care of minorities, especially during the COVID-19 pandemic, that need to be addressed as the general populous ages and heart transplants are increasingly relied upon as a treatment for cardiovascular conditions and failure.

Background: Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States. Methods: In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity. Findings: A total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09). Interpretation: In this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.

Lesbian, gay, bisexual, and queer/questioning people of color (LGBQ POC) are disproportionately more likely to experience issues related to their mental health when compared to their White counterparts. In spite of this persistent mental health disparity, few studies have been dedicated to identifying mental health-related promotive factors among LGBQ POC adults. The current study examined the extent to which attending LGBQ POC Pride events (e. g., Black Pride Festival) was associated with cisgender LGBQ POCs psychological wellbeing. I hypothesized that attendance would be positively associated with psychological well-being due to the unique sociocultural resources offered at these events. I further hypothesized that participants racial/ethnic identity or gender would modulate these effects. Hypotheses were tested using multiple linear regression with data from the 2013 Social Justice Sexuality Project (n = 2,486). Attending LGBQ POC Pride events was positively associated with cisgender LGBQ POCs psychological wellbeing. Post hoc multigroup analysis indicated that participants racial/ethnic identity or gender did not moderate these effects. Findings suggest that attending racially focused LGBQ Pride events may offer cisgender LGBQ POCs unique psychological resources that are not provided by general LGBQ Pride events. Public Health SignificanceLGBQ people of color (POC) are a multiply marginalized population vulnerable to increased levels of psychological distress that is unquietly different from their White LGBQ counterparts. Findings suggest that increasing the prevalence of racially focused Pride events may contribute to the psychological wellbeing of LGBQ POC.

BackgroundRecent evidence suggests that willingness to vaccinate against COVID-19 has been declining throughout the pandemic and is low among ethnic minority groups. MethodsObservational study using a nationally representative longitudinal sample (N =7,840) from the Understanding America Study (UAS). Changes in the percentage of respondents willing to vaccinate, undecided, or intending to refuse a COVID-19 vaccine were examined over 20 survey waves from April 1 2020 to February 15 2021. ResultsAfter a sharp decline in willingness to vaccinate against COVID-19 between April and October 2020 (from 74.0% to 52.7%), willingness to vaccinate increased by 8.1% (p <.001) to 60.8% between October 2020 and February 2021. A significant increase in willingness to vaccinate was observed across all demographic groups examined and Black (15.6% increase) and Hispanic participants (12.1% increase) showed particularly large changes. ConclusionsWillingness to vaccinate against COVID-19 increased in the US from October 2020 to February 2021. Funding statementN/A

BackgroundExcess death for Black people compared with White people is a measure of health equity. We sought to determine the excess deaths under the age of 65 (<65) for Black people in the United States (US) over the most recent 20-year period. We also compared the excess deaths for Black people with a cause of death that is traditionally reported. MethodsWe used the Center of Disease Control (CDC) WONDERs Multiple Cause of Death 1999-2019 dataset to report age-adjusted mortality rates among non-Hispanic Black (Black) and non-Hispanic White (White) people and to calculate annual age-adjusted <65 excess deaths for Black people from 1999-2019. We measured the difference in mortality rates between Black and White people and the 20-year and 5-year trends using linear regression. We compared age-adjusted <65 excess deaths for Black people to the primary causes of death among <65 Black people in the US. ResultsFrom 1999 to 2019, the age-adjusted mortality rate for Black men was 1,186 per 100,000 and for White men was 921 per 100,000, for a difference of 265 per 100,000. The age-adjusted mortality rate for Black women was 802 per 100,000 and for White women was 664 per 100,000, for a difference of 138 per 100,000. While the gap for men and women is less than it was in 1999, it has been increasing among men since 2014. These differences have led to many Black people dying before age 65. In 1999, there were 22,945 age-adjusted excess deaths among Black women <65 and in 2019 there were 14,444--deaths that would not have occurred had their risks been the same as those of White women. Among Black men, 38,882 age-adjusted excess <65 deaths occurred in 1999 and 25,850 in 2019. When compared to the top 5 causes of deaths among <65 Black people, death related to disparities would be the highest mortality rate among both <65 Black men and women. CommentIn the US, over the recent 20-year period, disparities in mortality rates resulted in between 61,827 excess deaths in 1999 and 40,294 excess deaths in 2019 among <65 Black people. The race-based disparity in the US was the leading cause of death among <65 Black people. Societal commitment and investment in eliminating disparities should be on par with those focused on other leading causes of death such as heart disease and cancer.

AimWe examined associations between smoking and HbA1c among U.S. adults, and whether these associations vary by diabetes status. MethodsWe analyzed NHANES data from 2015-2018 for adults aged [&ge;]20 years. Smoking was assessed by self-report and serum cotinine. Survey-weighted multivariable linear regression was used to evaluate the association between smoking and HbA1c in the full population (N=9,214) and in adults without diabetes (N=7,328), adjusting for demographics, blood pressure, waist circumference, lipids, and C-reactive protein. ResultsAfter adjustment for cardiometabolic covariates, there was no significant association between smoking and HbA1c in the full population (former: {beta}=0.029%, p=0.30; current: {beta}=0.053%, p=0.13). Among adults without diabetes, former smoking was not associated with HbA1c, whereas current smoking remained significantly associated (former: {beta}=-0.001%, p=0.923; current: {beta}=0.067%, p<0.001). These findings were similar when cotinine was used as the exposure measure, with active smoking ([&ge;]3.0 ng/mL) associated with higher HbA1c among non-diabetic adults (p<0.001), but not in the full population. ConclusionsAmong adults without diabetes, current but not former smoking was associated with higher HbA1c. The absence of an association in former smokers suggests that this effect may attenuate following cessation. These findings support early cessation interventions and may inform cessation counseling and diabetes screening.

IntroductionDiabetes mellitus is a global issue affecting over 828 million people in 2021. Risk factors for developing diabetes include poor diet, sedentary lifestyle, and genetic predispositions; however, growing evidence suggests significant influence from socioeconomic determinants. The Non-Latin Caribbean continues to be an underrepresented population in diabetes research, particularly The Bahamas. In this paper, we investigate the current state of diabetes in The Bahamas and examine the socioeconomic determinants associated with poor health outcomes. Research Design and MethodsPublicly available data were compiled from the World Health Organization, Food and Agriculture Organization, International Diabetes Federation, PAHO Enlace, World Bank, and regional reports, prioritizing estimates from 2019 to 2022. With a focus on The Bahamas, we collected data from 10 non-Latin Caribbean nations, as well as the United States, Canada, France, and Germany, to compare health and socioeconomic indicators and assess the current state of the Bahamas. Key metrics of interest included the prevalence of diabetes and obesity, diabetes-related mortality, and indicators of socioeconomic conditions. ResultsDiabetes prevalence in The Bahamas was 8.8% in 2021, lower than the United States at 10.7% but well below the highest rate of 16.1% observed in Saint Kitts and Nevis. The proportion of diabetes-related deaths under age 60 in The Bahamas was 6.2%, nearly double the rate in the United States (3.5%) and the third highest in the region, following Belize at 10.6% and Saint Kitts and Nevis at 9.9%. To examine long-term trends, we compared obesity rates across The Bahamas, the United States, France, and Germany. Bahamian women consistently had the highest rates, with 55.06% of those over 18 having a BMI over 30. Additionally, The Bahamas showed higher levels of socioeconomic vulnerabilities across several domains as well as insufficient policy progress compared to North America. ConclusionsDiabetes in The Bahamas remains a serious public health concern, marked by high premature mortality and rising obesity rates that exceed those of several high-income countries. Strengthening national surveillance and addressing socioeconomic disparities will be critical for reversing current trends and supporting effective public health responses.

BACKGROUNDEffective cardiovascular disease (CVD) risk management is a cornerstone of optimal diabetes care. Here, we estimated the prevalence and determinants of CVD risk factor control amongst individuals with diagnosed diabetes in Mexico. METHODSWe analyzed data from individuals with diagnosed diabetes [&ge;]20 years from the 2016-2023 Mexican National Health and Nutrition Surveys. We estimated the prevalence of glycemic, blood pressure (BP), non-current smoking, and combined CVD risk factor control. LDL-C control was assessed using SCORE2-Diabetes risk categories. We estimated the prevalence of BP-lowering, cholesterol-lowering, and glucose-lowering medication use, and explored determinants of control achievement using logistic regression. RESULTSWe analyzed data representing 43.2 million adults with diagnosed diabetes during 2016-2023. In 2023, glycemic control was 29% (95%CI 21%-38%), BP control 22.9% (95%CI 14%-31%), and non-current smoking 89% (95%CI 81%-96%). The proportion of people classified as high or very-high CVD risk increased from 59.8% (95%CI 52.1%-67.0%) in 2016 to 68.4% (95%CI 55.6%-78.9%) in 2023, representing [~]5.1 million adults. LDL-C control prevalence increased from 2.8% (95%CI 1.2%-4.4%) in 2016 to 6.6% (95%CI 1.9%-11.2%) in 2023. Combined risk factor control achievement was low primarily due to suboptimal LDL-C control, despite high medication use; this was more likely achieved in females, younger individuals, and those with college education or living in states with higher socioeconomic position. CONCLUSIONSDespite increasing CVD risk during this period, comprehensive glycemic and CVD risk factor management for adults with diabetes in Mexico remains suboptimal. Our findings highlight the need for strategies to address gaps in CVD risk management to reduce premature mortality in this population. Lay summaryThis study examined how well adults with diabetes in Mexico are controlling key risk factors for cardiovascular disease, such as blood glucose levels, blood pressure, smoking, and cholesterol levels. Authors used nationally representative surveys from 2016-2023 analyzing data which represents over 43.2 million adults living with diagnosed diabetes. O_LIIn 2023, fewer than one-third of individuals with diabetes had adequate blood glucose control, and fewer than one in ten met recommended cholesterol targets, despite high rates of medication use. Cardiovascular risk increased for those at the highest risk by nearly 9% between 2016 and 2023. C_LIO_LIBetter control of these risk factors was more common among women, younger individuals, those with higher education, and those living in more socioeconomically advantaged areas. C_LI GRAPHICAL ABSTRACT O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=81 SRC="FIGDIR/small/24313926v2_ufig1.gif" ALT="Figure 1"> View larger version (39K): org.highwire.dtl.DTLVardef@66e47dorg.highwire.dtl.DTLVardef@122fd03org.highwire.dtl.DTLVardef@10f992org.highwire.dtl.DTLVardef@71094f_HPS_FORMAT_FIGEXP M_FIG C_FIG