Journal of Racial and Ethnic Health Disparities

The Asian population in Los Angeles is among the largest and most heterogeneous in the U.S. This is true culturally and health-wise. Older Asians have differing risks for cardiovascular and cardiometabolic disease, depending on their ethnicity, health literacy, and lifestyle choices. This pilot examines several of these factors in a small but diverse group of older Asian adults who attended community health events from 2024-2025. Self-reported and biometric data were collected at five such events hosted by the Asian Pacific Health Corps at UCLA. The pilot generated health literacy and lifestyle (HLL) scores for all participating attendees and explored how they relate to their socio-demographics, healthcare habits, and predictions of their own health data. Overall, there were significantly more females than males with higher HLL scores (p = 0.027). College education (p = 0.028) and "normal" ranges for biometric data (e.g., blood pressure, BMI, blood glucose, cholesterol) were related to higher median HLL scores. With a few exceptions, fewer than 50% accurately predicted their biometric numbers regardless of HLL scores, suggesting a disconnect between perception and reality, and that better provider-patient communication may help foster greater patient understanding about their chronic conditions. These HLL score distributions indicate that educational attainment, better awareness of one's health, and high health literacy are individual factors that may influence older Asians' understanding and potential approach to managing their health conditions.

This cross-sectional study aimed to examine the prevalence of alcohol use and its sociodemographic correlates among adults with cardiovascular disease (CVD). We analyzed data from two large US cohorts: the All of Us Research Program (2017-2023) and the National Health and Nutrition Examination Survey (NHANES, 1999-2016). Both CVD diagnosis and past-year alcohol consumption were self-reported. Risky drinking was defined as exceeding moderate drinking or binge drinking (All of Us), or moderate/heavy drinking (NHANES). Multivariable logistic regression was used to exam associations with sociodemographic and lifestyle factors. Among 32,788 current drinkers with CVD in the All of Us cohort, 15% exceeded moderate drinking thresholds and 26% reported binge drinking. Older age, female sex, and higher socioeconomic status were inversely associated with risky drinking, while smoking was positively associated. In NHANES, moderate drinking rose from 47.3% to 57.2% and heavy drinking from 6.7% to 7.2%. Moderate/heavy drinking was positively associated with age <65 but inversely with age [&ge;]65. Higher education and income were linked to moderate drinking, while current smoking was strongly associated with heavy drinking. These results highlight the need to integrate holistic screening for alcohol use, tobacco use, and social context into routine cardiovascular care.

Objective: To verify the association between perceived social & emotional support and self-reported food insecurity in the United States Design: Cross-sectional secondary data analysis Setting: Behavioral Risk Factor Surveillance System (BRFSS) data from 2024, collected via a nationwide telephone survey. Food insecurity was defined as responding always, usually, or sometimes to "During the past 12 months how often did the food that you bought not last, and you didn't have money to buy more?" Social support was measured using a BRFSS item assessing the frequency with which respondents received the social and emotional support they needed. Adjusted logistic regression models were used to assess the relationship between these variables while controlling for a wide variety of demographic, socioeconomic, and health status factors. Participants: Adults (n = 190,577) aged 18-80 years old (72.3% non-Hispanic White) Results: Individuals who reported only "sometimes" receiving the social and emotional support they need were more likely to report food insecurity as compared to those who "always" receive such support (aOR = 1.75; 95% CI 1.56, 1.96). Conclusions: These findings indicate that decreased social support may put individuals at higher risk of food insecurity. Future work should seek to understand the mechanisms of this association to inform targeted policy and other interventional programs.

Importance: Despite the benefits of statin therapy in individuals with diabetes, fewer than 70% of adults with diabetes meet contemporary guidelines for statin therapy and reducing low-density lipoprotein cholesterol (LDL) to <100 mg/dL. Evidence describing delays in statin initiation after diabetes diagnosis and associated clinical outcomes may motivate process of care interventions to improve guideline recommended care in individuals newly diagnosed with type 2 diabetes mellitus (T2D). Objective: To examine the timing of statin initiation and achievement of LDL <100 mg/dL after diabetes diagnosis, and to determine the association of early LDL reduction among statin initiators with incident atherosclerotic cardiovascular disease (ASCVD). Design: Retrospective observational cohort study using data from 2005-2021 Setting: Veterans Affairs Health Care System (VA) Participants: Individuals with newly diagnosed T2D Exposure: Primary exposure was ASCVD risk based on ACC/AHA Pooled Cohort Equations; secondary exposure was LDL <100 mg/dL in the first year after T2D diagnosis among statin initiators Main Outcomes and Measures: Co-primary outcomes were initiation of statin therapy and achievement of LDL <100 mg/dL within 5 years of diabetes diagnosis; incident 5-year ASCVD was a secondary outcome. Results: Among 100,406 individuals with newly diagnosed T2D, 59,615 were prescribed statin therapy within five years (59.4%), and 44,783 (57.5%) of those with LDL above goal achieved LDL <100 mg/dL within 5 years. Relative to those at low (<7.5%) 10-year ASCVD risk, individuals at intermediate (7.5-20%) and high (>20%) risk were more likely to be initiated on a statin (intermediate: Hazard Ratio [HR] 1.14 [95% CI 1.11, 1.17]; high: HR 1.16 [95% CI 1.13, 1.19]) and to achieve LDL <100 mg/dL (intermediate: HR 1.23 [95% CI 1.19, 1.26]; high: HR 1.34 [95% CI 1.30, 1.38]). Among those prescribed a statin within one year of diabetes diagnosis, achieving LDL <100 mg/dL in the first year after diabetes diagnosis was associated with lower risk of 5-year incident ASCVD (HR 0.84 [95% CI 0.77, 0.92]). Conclusions and Relevance: Gaps in guideline-directed primary prevention of ASCVD arise early following initial diabetes diagnosis. Guideline recommended early LDL lowering among statin initiators was associated with improved clinical outcomes.

ABSTRACT Background: Microvascular complications are common in patients with Type 2 Diabetes Mellitus (T2DM) and contribute to significant morbidity, especially in resource-limited settings. Limited literature exists on the prevalence and associated risk factors of microvascular complications in developing countries, including Uganda. Objective: This study sought to determine the prevalence of microvascular complications and explore socioeconomic and health clinical factors associated with them among patients attending the diabetic clinic at Masaka Regional Referral Hospital. Methods: A descriptive cross-sectional study was conducted among 244 systematically selected patients with T2DM. Data were collected using structured questionnaires and clinical records and analysed using SPSS version 25.0. Pearson's Chi-square tests were used to assess associations between study variables and microvascular complications. Results: The overall prevalence of microvascular complications was 41.0% (n=100). Males comprised 51.6% of respondents. The most prevalent individual complication was cognitive impairment (55.3%), followed by neuropathy and retinopathy (13.2%). All socioeconomic factors examined, including frequency of healthcare visits, physical activity, dietary habits, smoking and alcohol consumption, were significantly associated with microvascular complications (p=0.000). All health clinical factors examined, including duration of T2DM, primary treatment, blood sugar monitoring frequency, HbA1c testing, and hypertension diagnosis, were also significantly associated with microvascular complications (p=0.000). Conclusion: Microvascular complications affect a substantial proportion of T2DM patients at Masaka Regional Referral Hospital. Poor glycemic control, longer disease duration, and high neighbourhood deprivation were the dominant drivers. Targeted clinical and socioeconomic interventions are urgently needed to reduce this burden. Keywords: microvascular complications, type 2 diabetes mellitus, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, Uganda, Masaka

Introduction: Cardiovascular diseases (CVDs) are the leading cause for death and disability worldwide accounting for 75% of deaths in low- and middle-income countries (LMICs) like Nepal. Urbanization and globalization remains the major cause of rise in CVDs among urban poor population along with growth in slum settlements. This study aims to assess the knowledge, attitude and practice (KAP) of CVDs and its risk factors among women of one such urban poor community in Nepal. Methodology: This cross-sectional study (n=388) in the Sinamangal-Minbhawan slum area was conducted using semi structured questionnaire based on STEPs survey and HARDIC study among the participants selected through convenient sampling. Descriptive analysis was done using SPSS version 21 and KAP scores were further categorized based on median score to perform multivariate logistic analysis. Additionally, Anthropometric and blood pressure measurements were also recorded and analyzed. Results: The median age (Interquartile range) of participants was 33 years (17) with majority of them being Dalit by ethnicity, housewives, with up to primary level education belonging to upper lower socioeconomic class. More than half (53.3%) of the participants were obese and over 23% were hypertensive. While half of the hypertensive women were aware of their status, only 3% had their blood pressure under control.The median knowledge, attitude and practice (KAP) scores were 12, 60 and 10 respectively. The KAP scores were positively associated with socioeconomic status of the participants. Conclusion: The study revealed low knowledge with high prevalence of behavioral risk factors of CVDs along with high prevalence of other metabolic risk factors like high body mass index, high waist hip ratio and hypertension among women of slum area with a positive attitude to prevent CVDs and its risk factors.

Background: Depression and heart disease frequently co-occur in the aging population and are associated with functional decline and poor health outcomes. Understanding how depressive symptoms relate to different aspects of physical function among adults with heart disease may help identify high-risk subgroups. Objective: To examine the association of depressive symptoms with self-reported and observed physical function measures among participants with heart disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and assess whether associations differ by sex and race?sex groups. Methods: We conducted a cross-sectional analysis using data from REGARDS study second in-home visit (2013?2016). Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression scale (CES D 10), considering scores ?10 as clinically significant. Physical function measures were instrumental activities of daily living (IADL), activities of daily living (ADL), chair stand time (5 repetitions), and gait speed. Linear regression models estimated associations of depressive symptoms with function, adjusting for sociodemographic, health behavior, antidepressant medications, body mass index, and social support. Effect modification by sex and race?sex group was evaluated. Results: Among 3,055 participants, 11.7% had CES D 10 ?10. Compared to CES-D-10 scores <10, CES D 10 ?10 was associated with more limitations in IADL (1.84 points; 95% CI 1.62, 2.06), ADL (0.43 points; 95% CI 0.34, 0.52) and slower chair stand time (0.88 second; 95% CI 0.07, 1.69); associations with gait speed were modest (?0.04 meters/second; 95% CI ?0.08, -0.01). Women had a stronger association between CES-D-10 and ADL (0.49 points; 95% CI 0.35, 0.64) than men (0.33 points; 95% CI 0.21, 0.44; p for interaction = 0.01). Interaction between CES D 10 and race?sex groups was not statistically significant. Conclusions: Among adults with heart disease, clinically significant depressive symptoms were associated with lower physical function, particularly among women.

Background Cardiometabolic-based chronic disease (CMBCD) at an individual level results from complex interactions among a multi-tiered network of sociodemographic, behavioral, and metabolic factors. Though a consensus set of risk factors drives CMBCD, population context influences risk factor effects and interactions. To better understand this phenomenon, we investigated the multi-tiered networking of cardiometabolic variables across diverse populations using a comparative modelling approach. Methods and Findings Utilizing nationally representative cross-sectional data from 48 countries participating in the World Health Organization "STEPwise approach to noncommunicable disease risk factor surveillance" survey, we learned country-specific Bayesian networks including sociodemographic, behavioral, and cardiometabolic variables (adiposity, diabetes, hypertension, hyperlipidemia, and cardiovascular disease). By computing the structural Hamming distance between pairs of networks, we compared differences in network structures across regions and country income levels. We then used the learned networks to assess individual risk factor influences and interactions on cardiometabolic outcomes. Country-specific Bayesian networks varied in terms of the risk factors directly and indirectly associated with the cardiometabolic outcomes. Network structures differed significantly across regions (p = 0.023) but not across income levels (p = 0.91). These results were robust to an alternative learning algorithm, network comparison metric, and data imputation approach. Older age (60+ vs. 30-44 years old) was associated with a greater increase in probability of obesity in Europe and Central Asia (+80%) compared to other regions. Higher education was associated with increased probability of obesity (+53%), diabetes (+18%), and hypertension (+2%) in South Asia but decreased probability of obesity (-10%), diabetes (-32%), hypertension (-16%), and hyperlipidemia (-25%) in Middle East and North Africa. The interaction between age and sex in predicting obesity was significant in the highest proportion of countries in Europe and Central Asia compared to other regions. While this dataset provided standardized data across multiple countries to define cardiometabolic risk factors and drivers, there was limited data on certain health outcomes and uneven availability of data across regions. Conclusions These results revealed specific regional patterns of multi-tiered cardiometabolic risk structures, emphasizing the need for regionally tailored public health strategies rather than applying generalized consensus evidence-based models. Future research should explore the structural drivers of regional differences in inter-relationships of cardiometabolic risk factors, drivers, and disease.

Background: Black and Latino adults in the United States experience a disproportionate burden of cardiometabolic conditions due to interacting behavioral, social, and structural drivers of health. Less is known about the impact of integrating digital health tools into CHW-led interventions to improve cardiometabolic health. This trial evaluates a multilevel community-digital health promotion model delivered by CHWs to improve service utilization, health behaviors and cardiometabolic health among Black and Latino adults. Methods: This community-partnered trial uses a randomized delayed-control group with a phased recruitment design. Four cohorts (N = 664) are enrolled through three community-based organizations (CBOs). Eligible participants are 18 years who self-identify as Black or Latino, and have prediabetes/diabetes, hypertension, or overweight/obesity. Participants are allocated to either (1) a multilevel intervention consisting of CBO and CHW capacity building combined with individualized CHW-led lifestyle coaching and group activities supported by digital tools, or (2) a delayed control group receiving SMS-only cardiometabolic health education. Data collected at baseline, 6, 9, and 18 months include surveys and health metrics. Qualitative data are collected from participants and community partners to assess intervention acceptability, implementation facilitators and barriers, and sustainability. Results: The primary outcome is health service utilization at 6 and 9 months. Secondary outcomes include health behaviors, health metrics, and social determinants of health. Sustainability of health behaviors and health metrics is assessed at 18 months. Conclusions: Findings will provide evidence to inform scalable, sustainable community-digital health models for CHW-supported cardiometabolic health interventions in underserved communities.

Objective: To characterize pregnancy outcomes and menstrual irregularities in Mexican women with systemic lupus erythematosus (SLE) and identify clinical factors associated with adverse pregnancy outcomes and early-onset menopause. Methods: We conducted a cross-sectional study of women with SLE enrolled in the Mexican Lupus Registry (LupusRGMX) between May 2021 and September 2024. Clinical and reproductive data were collected using standardized questionnaires. Menopause was defined as the absence of menstruation for [&ge;]12 consecutive months, and early menopause as onset before age 40. Univariable and multivariable logistic regression analyses were used to identify factors associated with pregnancy complications and early menopause. Results: A total of 210 women were included. Median age was 38 years (IQR 29-46) and median disease duration was 4 years (IQR 1-10). Among women with a history of pregnancy (47%), full-term delivery predominated (61%), while pregnancy loss occurred in 26% and preterm delivery in 13%. Pregnancy complications were reported in 9.6%, most commonly preeclampsia (6.7%). Younger maternal age was independently associated with pregnancy complications (OR 0.89, 95% CI 0.83-0.95) and adverse outcomes (OR 0.95, 95% CI 0.92-0.98). Higher disease activity was associated with complications in univariable analysis. Most pregnancies (68.3%) occurred before diagnosis. Early menopause was observed in 6.2% and independently associated with longer disease duration and older age. Conclusion: Younger maternal age was independently associated with adverse pregnancy outcomes, whereas disease activity showed an association in univariable analysis. Most pregnancies occurred prior to SLE diagnosis. Early menopause was associated with longer disease duration, suggesting impact of cumulative disease burden on ovarian function.

Introduction Perinatal Empowerment is widely referenced in maternity care research, yet its use often lacks clear conceptual definitions and validated measures. Existing instruments do not capture the multidimensional nature of perinatal empowerment, including both external dimensions (e.g., gender equity, resource access), and internal dimensions (e.g., confidence, agency and informed decision making). This gap has limited the ability to rigorously evaluate how healthcare experiences shape empowerment during pregnancy, birth, and the postpartum period. Aim To develop a valid and reliable instrument that measures dimensions of perinatal empowerment, both external and internal. Methods Instrument development followed the seven-step MEASURE framework. Initial item generation was guided by a concept analysis, a scoping review of existing instruments, and feedback from international midwifery experts. A preliminary 51-item instrument underwent expert content validity review, resulting in 48 items, which were then pilot-tested with six pregnant and postnatal women. A large-scale validation study was conducted via an international online survey (N=155). Psychometric testing included exploratory factor analysis (EFA), reliability assessment using Cronbachs , known-groups validity testing, and regression analyses adjusting for potential confounders. Results EFA supported two overarching dimensions--external and internal empowerment--with six factors across 30 final items (18 external, 12 internal). Sampling adequacy was high, and item loadings exceeded recommended thresholds. Internal consistency was strong for both dimensions (=0.88 external; =0.87 internal). Women receiving midwifery continuity of care reported significantly higher empowerment scores across total, external, and internal dimensions compared with other care models (p<.001). Differences between primiparous and multiparous women were not statistically significant. Conclusion The MPower instrument represents a conceptually grounded, psychometrically robust measure of multidimensional perinatal empowerment in high-income settings. Further validation in more diverse populations is needed to refine the instrument and expand its applicability across clinical and research contexts.

Background: Poor glycemic control, a contributor to the development of diabetes related complications among patients with diabetes mellitus, remains a public health challenge in low- and middle-income countries. In Uganda, limited evidence exists on predictors of poor glycemic control among diabetic patients attending peri-urban primary healthcare facilities. The study assessed predictors of poor glycemic control among adults attending the diabetic clinic at Kasangati Health Centre IV in Wakiso district. Methods: We conducted cross-sectional study among 283 diabetic patients attending Kasangati Health Centre IV between March and April 2025. Data were collected using interviewer-administered structured questionnaires and data abstraction tools. Poor glycemic control was defined as glycated hemoglobin (HbA1c) levels [&ge;]7%. Modified Poisson regression with robust standard errors was used to determine factors associated with poor glycemic control. Adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) were reported. Results: Overall, 67.8% of the participants had poor glycemic control. Poor glycemic control was significantly associated with older age, low income status (aPR: 1.4, 95%CI: 1.24-1.58), use of multiple anti-diabetic medications, non-adherence to regular follow-up (aPR: 1.5, 95%CI: 1.33-1.65), medication side effects (aPR: 1.2, 95%CI: 1.01-1.32), physical inactivity (aPR: 1.1, 95%CI: 1.05-1.21), non-adherence to recommended dietary plans (aPR: 1.1, 95%CI: 1.02-1.22), perceived treatment regimen complexity (aPR: 1.2, 95%CI: 1.12-1.34), stress (aPR: 1.1, 95%CI: 1.08-1.20), lack of peer support groups (aPR: 1.2, 95%CI: 1.08-1.23), and high costs of accessing care (aPR: 1.2, 95%CI: 1.17-1.33). Conclusion: Almost two-thirds of the diabetic patients suffered from poor glycemic control which was determined by various socio-economic, behavioral, clinical and health system factors. Enhancing adherence counseling, encouraging healthy lifestyles, adopting age-based supportive healthcare approaches, better psychosocial support and reduction of cost barriers in accessing diabetic healthcare could improve the glycemic status of diabetic patients in peri-urban primary healthcare settings.

Introduction: Even though state minimum wage (MW) is a policy lever that affects income and poverty and can prevent of violence, no prior study has comprehensively evaluated its impact in the United States (US). In this study, we estimated the impact of at least a $1 USD increase in state MW above the federal MW on overall, firearm, and non-firearm homicide mortality and examined its impact on racialized inequities. Methods: We conducted a quasi-experimental study using controlled interrupted time series (CITS) and synthetic controlled interrupted time series (SCITS) approaches to examine immediate and sustained impact of state MW increases. We used state-month level homicide victimization mortality data from 2010-2019. Homicide victimization death was identified using International Classification of Disease codes, 10th revision. State MW data was obtained from the Bureau of Labor Statistics. Results: Demographic and social variables from intervention, never-exposed, and always-exposed states were similar to each other and representative of the total US population from all 50 states. The CITS results show that after MW increases in the intervention states, these states experienced a sustained decline of -0.22 (-0.37, -0.07) homicide victimizations/ 100,000 person-years/ year relative to the never-exposed states and -0.39 (-0.59, -0.18) relative to always-exposed states. This resulted in 5,657 fewer homicide victimization deaths in the intervention states over four years of post-MW increase period compared to the never-exposed states. SCITS results were similar to the CITS results, and the majority of sustained declines were observed in firearm-related deaths and among Black population. Conclusion: MW increase was associated with a reduction in homicide victimization rates, which were robust in multiple sensitivity analyses, more pronounced for firearm-related homicide deaths, and reduced homicide victimization inequities for Black Americans.

Diagnosed diabetes disproportionately burdens socioeconomically disadvantaged populations in the United States, particularly Hispanic communities in the Texas-Mexico border region. Few studies have quantified whether geographic border-region status is independently associated with county-level diagnosed diabetes prevalence after accounting for lifestyle and food-environment factors. This cross-sectional ecological study examined 253 Texas counties using CDC PLACES 2025 health estimates and USDA Food Environment Atlas food-access data, including the 2015 county-level low-food-access measure. Border-region counties were defined using the official La Paz Agreement 32-county definition, which includes counties within 100 km of the US-Mexico boundary. Multiple linear regression with HC3 robust standard errors was used to estimate associations between border-region status, low food access, physical inactivity, and diagnosed diabetes prevalence. Variance inflation factor analysis assessed multicollinearity, and Global Moran's I tested spatial autocorrelation in diagnosed diabetes prevalence and OLS residuals. Border-region counties had 33% higher unadjusted mean diagnosed diabetes prevalence than non-border counties (16.1% vs. 12.1%). After adjustment, border-region status remained significantly associated with a 0.625 percentage-point higher diagnosed diabetes prevalence ({beta} = 0.625, 95% CI [0.357, 0.893], p < 0.001). Physical inactivity was the strongest independent predictor ({beta} = 0.404, 95% CI [0.391, 0.417], p < 0.001). The model explained 96.0% of county-level variance (R{superscript 2} = 0.960, N = 253), reflecting ecological associations among modeled county-level health indicators. Global Moran's I confirmed strong spatial clustering of diagnosed diabetes prevalence (I = 0.5734, p = 0.001), with reduced but significant residual spatial autocorrelation after OLS adjustment (I = 0.1696, p = 0.001). These findings suggest that border-region status is associated with elevated diagnosed diabetes prevalence beyond physical inactivity and low food access, supporting targeted public health investment in the Texas-Mexico border region

Background/Objectives People living with HIV face overlapping hardship through medical, behavioral, and social needs that require an integrated and coordinated approach. Harlem United multiservice model provides healthcare, food assistance, housing support, harm reduction services, behavioral health counseling, case management, and much more to support their clients. This study is an examination on how the participation in the Harlem United multiservice model is associated with changes over time in client health, behavioral health, and social outcomes. Methods This study performed a longitudinal program evaluation examining Harlem United clients enrolled between January 2020 and January 2025 who remained engaged in services for a minimum of one year. Client outcomes were assessed across three time points: Baseline, Year 1, and Year 2. The sample included 154 clients at baseline (N=154) with a total of 428 observations (N=428). Quantitative measures that were assessed included program involvement, housing stability, PHQ4 scores, food insecurity, medication adherence, and viral suppression. Data was analyzed using IBM SPSS Statistics through descriptive statistics, frequency tables, and generalized estimating equation models (GEE) to account for repeated observation over time. Results Medication adherence and viral suppression remained consistently high across all time points in the longitudinal study suggesting that most clients were virally suppressed or undetectable at baseline. Housing stability was statistically significant Wald X2 (2) = 156.073, p < 0.001 with improvements noted in Year 1 and Year 2 compared to baseline. Program level was significantly associated with PHQ4 scores, Wald X2 (1) = 7.902, p = 0.005. Food insecurity was also associated with PHQ4 scores, Wald X2 (1) = 5.462, p = 0.019. Findings suggest that clients with higher PHQ4 scores were involved in more programs compared to clients only enrolled in 1-2 programs. Additionally, clients with higher PHQ4 scores were more food insecure highlighting the relationship between social needs and mental health. Conclusion: Findings suggest that the Harlem United multiservice model played a supportive role in the maintenance of health and social outcomes through medication adherence and viral suppression. Although, significant improvement was not reflected across several outcomes, the association between PHQ4 scores, food insecurity, and an increase in program involvement suggest that the multiservice is reaching more clients with complex behavioral and social needs. Continued integration of these services is important for sustaining client stability while addressing social determinants of health.

Background: Late complications after stroke (LCAS), including cognitive symptoms, impact quality of life and recovery. It is not known if neighborhood-level measures of socioeconomic status (SES) influence LCAS. This study assessed associations between SES measures, including neighborhood income inequality (Gini) and area deprivation index (ADI), and cognitive symptoms after acute ischemic stroke (AIS) in a hospital leveraging active surveillance of LCAS. Methods: This retrospective cohort study included 512 patients hospitalized with AIS at Tufts Medical Center with subsequent follow-up (between zero and three months or between three and twelve months) in the Stroke Clinic from 1/1/2018 - 12/31/2022. Using ZIP code data, patients were characterized as low Gini (low inequality) and high ADI (high deprivation) (Gini <= 0.4302, ADI >= 5) by state medians. These variables were combined, indicating patients who were living in both a low Gini and high ADI neighborhood to evaluate the effects of living in a homogeneously deprived area. There were 206 and 281 patients in the low Gini and high ADI groups respectively. 140 patients lived in a low Gini and high ADI neighborhood. The multivariable logistic analysis assessed the likelihood of cognitive symptoms, adjusting for age, race, ethnicity, sex, NIH Stroke Scale (NIHSS), thrombolysis, active LCAS surveillance, poverty, and ADI-Gini combination. Results: There were no associations between high ADI (OR: 1.03, 95% CI: 0.67 ? 1.57) or low Gini (OR: 1.74, 95% CI: 0.98 ? 3.07) alone and cognitive symptoms after AIS. However, the combined variable demonstrated increased likelihood of cognitive symptoms in the high ADI-low Gini group (OR: 1.82, 95% CI: 1.08 ? 3.06). Conclusions: This study suggests that individuals living in homogeneously deprived neighborhoods report higher likelihood of cognitive symptoms after AIS. Further studies with increased power are needed to investigate the underlying causes of these disparities and to develop interventions to reduce these complications.

Background: Kenya replaced the National Health Insurance Fund with the Social Health Authority in October 2024, making the 2022 Kenya Demographic and Health Survey the last nationally representative pre-transition baseline. Evidence on insurance coverage and treatment gaps among adults already diagnosed with hypertension or diabetes remains limited, including how these patterns differ by sex. We aimed to estimate the level, distribution, and correlates of insurance coverage and treatment gaps among diagnosed adults at the close of the NHIF era. Methods: We conducted a cross-sectional secondary analysis of the 2022 Kenya Demographic and Health Survey. Insurance status, prior diagnosis, and current medication use were reported by respondents. Analyses were sex-stratified and survey-weighted, with adjusted prevalence ratios estimated to assess associations between insurance coverage and treatment gaps. Wealth-related inequality was examined using concentration indices. Results: The analytic sample included 1,932 diagnosed adults (1,384 women and 548 men). Any insurance coverage was 47.7%, largely driven by National Health Insurance Fund enrolment (43.4%). Overall, 63.8% of diagnosed adults reported not receiving treatment, including 67.1% of women and 59.8% of men, with treatment gaps exceeding 60% across all wealth quintiles. Insurance coverage was strongly pro-rich, whereas treatment gaps were distributed across the wealth gradient. After adjustment, insurance was not strongly associated with lower treatment-gap prevalence among women or men, with no evidence of effect modification by sex. Among women, lack of money for treatment was reported as a major barrier far more frequently among the uninsured than the insured. Conclusions: Before the Social Health Authority transition, Kenya faced both incomplete insurance coverage and substantial treatment gaps among adults diagnosed with hypertension or diabetes. These findings provide a critical pre-transition benchmark and suggest that expanding insurance enrolment alone may be insufficient to close treatment gaps without improvements in benefit depth, medicine availability, and frontline readiness for chronic care delivery.

Objective: Patients and physicians frequently focus on HbA1c and weight alone. We hypothesized that individuals with similar HbA1c and BMI may present markedly distinct metabolic backgrounds. We investigated whether the adipo-B index- composite of adipose insulin resistance (adipo-IR) and beta-cell function (HOMA-B)-can uncover hidden heterogeneity in this clinically homogeneous population. Methods: A total of 399 newly diagnosed, drug-naive Japanese subjects with T2DM were analyzed. Histograms of HbA1c and BMI demonstrated peak distributions within HbA1c 8-10% and BMI 24-26. Based on these distributions, a clinically homogeneous subgroup was defined to minimize confounding by glycemic severity and adiposity. Metabolic parameters including FBG, insulin, FFA, HOMA-R, HOMA-B, adipo-IR, adipo-B, T-C, TG, HDL-C and non-HDL-C were analyzed. Simple regression, multivariable linear regression, and subgroup stratification analyses were performed. Results: Despite comparable HbA1c and BMI by design, adipo-B stratification revealed significant differences in HOMA-B, FFA, non-HDL-C, and TG, whereas HOMA-R stratification identified only higher insulin and adipo-IR without differences in lipids or HOMA-B. Thus, adipo-B-but not HOMA-R-identified a lipotoxic, beta-cell-stressed phenotype invisible to conventional markers. Simple regression showed significant positive correlations between adipo-B and HbA1c, FBG, FFA, T-C, TG, and non-HDL-C, and negative correlations with insulin and HOMA-B. Multivariable linear regression confirmed that adipo-B was independently associated with non-HDL cholesterol, TG, and FFA after adjustment for HbA1c and BMI. Conclusion: Even among patients with identical HbA1c and BMI, the adipo-B index uncovers clinically relevant metabolic heterogeneity, supporting its role as a functional marker of the adipose-pancreas axis and a potential tool for precision phenotyping in early T2DM.

Introduction Cardiovascular disease (CVD) remains Vietnam's leading cause of mortality, yet no comprehensive national analysis of burden trends and future projections exists. This study characterizes Vietnam's CVD burden from 1990 to 2023 and projects burden through 2050. Methods Using Global Burden of Disease 2023 data, we analyzed CVD prevalence, incidence, mortality, and disability-adjusted life years (DALYs) in Vietnam from 1990 to 2023, stratified by sex and age. Joinpoint regression quantified temporal trends. Decomposition analysis separated contributions of population growth, aging, and epidemiological change. ARIMA modeling, validated against pre-pandemic and COVID 19 periods, projected burden through 2050. Results Despite age-standardized CVD prevalence below global estimates, stroke mortality and DALYs rates exceeded global benchmarks. Age-standardized CVD mortality (ASMR) declined significantly (average annual percentage change [APC]:-1.34%), yet absolute deaths nearly doubled from 121,611 to 223,068. Population aging contributed 140.9% to observed mortality increases while epidemiological improvements averted over 102,000 deaths. Male age-standardized CVD mortality was approximately twice that of females. High systolic blood pressure remained the leading attributable risk factor, while high BMI and alcohol use showed the largest rank escalations. CVD incidence reversed its declining trend during 2019 - 2023 (APC:+0.69%). By 2050, ASMR are projected to decline by 51.0% (218.8 to 107.1 per 100,000 [95%CI: 64.1 - 150.2]), while absolute deaths are projected to increase by 43.4% (206,677 to 296,335 [95%CI: 272,323 - 320,348]). Conclusions Vietnam faces a demographic paradox of improving age-specific outcomes alongside a rising absolute burden driven by population aging, demanding urgent reorientation toward aging-specific prevention, hypertension control, and chronic cardiovascular care.

Given the growing crisis in youth mental health, there is a critical need to rebuild and sustain healthy social environments. Cooperative experiences (e.g., sports, clubs) may promote mental health but we lack rigorously tested measures to drive research and evaluation. This study sought to develop a measure of cooperative experiences and test associations with health. We developed and revised a measure of cooperative experiences based on interdisciplinary literature and 20 cognitive interviews. We recruited youth aged 13-25 years (N = 262) through youth-serving organizations and snowball sampling to complete an investigator-administered (n = 50) or self-administered (n = 212) survey assessing cooperative experiences (48 items), mental and physical health, and demographics. We assessed item characteristics, dimensionality, reliability, and construct validity. Multivariable linear regressions were used to estimate the association between the total score and self-reported health. Participants were 57% female, 69% Latino, 55% high school students, and 25% college students. The measure was reduced to 35 items (alpha = 0.90) with six subscales: sense of a unified group (7 items, alpha = 0.83), goal alignment (3 items, alpha = 0.80), inclusion and shared purpose (10 items, alpha = 0.88), social exclusion (2 items, alpha = 0.91), positive interdependence (7 items, alpha = 0.77), and negative interdependence (6 items, alpha = 0.87). A higher total score was associated with better self-reported mental health (beta = 0.25 standard deviation change in health score for each standard deviation change in cooperation scale, 95% CI [0.108, 0.394], p = 0.001) and self-reported general health (beta = 0.25, 95% CI [0.107, 0.395], p = 0.001). The study provides preliminary support for the reliability and validity of a new measure of exposure to cooperative experiences among youth. The measure holds promise as a tool to examine the relationship between social environments and health outcomes in real-world settings.