Journal of Racial and Ethnic Health Disparities

Background: Cardiovascular-Kidney-Metabolic Syndrome (CKMS) is defined as a cluster of disease conditions that are highly prevalent in the U.S. population. This study aims to assess psychosocial adversities at different CKMS stages in a large survey of U.S. adults, measured by lack of emotional support, low life satisfaction, and loneliness. Methods: This cross-sectional study used data on 159,511 adults from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) survey. Proxy CKMS stages (0, 1, 2/3, and 4) were determined using self-reported health conditions. Separate multivariable logistic regression models were estimated to obtain the predictive margins of respective psychosocial attributes across proxy CKMS stages. Results: Compared to adults at lower CKMS stages (Stages 0 and 1), adults at advanced CKMS stages (Stages 2/3 and 4) generally reported having higher psychosocial toll. At CKMS stage 4, the predicted probabilities of lack of emotional support, low life satisfaction, and loneliness were 6.96, 3.24, and 10.10 percentage points (pp) higher, respectively, than at stage 0. Compared to stage 1, the corresponding differences were 5.92, 2.89, and 9.65 pp. At CKMS stage 2/3, the corresponding differences were 4.36, 1.66, and 5.69 pp compared to stage 0 and 3.33, 1.32, and 5.25 pp compared to stage 1. The high burden at advanced CKMS stages was generally evident across sex, and different socioeconomic status conditions manifested by income and education. Conclusions: Findings of this study suggest that adults with advanced CKMS stages were more likely to experience a psychosocial toll. Further research is warranted to facilitate strategies for improving psychosocial wellbeing of CKMS patients.

South Asian Americans are often aggregated within broader Asian American research on mental health help-seeking, potentially obscuring culturally specific family and community processes. This study examined how family systems, sociocultural expectations, and family roles shape recognition of emotional distress and pathways to mental health care among South Asian American young adults. Five semi-structured virtual focus groups were conducted with 23 South Asian American young adults (ages 18-30) residing in Texas. Discussions explored mental health stigma, family influences, help-seeking, barriers to care, and strategies for improving mental health support. Transcripts were analyzed using MAXQDA, with analytic memos and reflexive practices informing theme development. Nine interconnected themes emerged. Participants described community stigma becoming internalized through expectations of self-reliance, perfectionism, and family responsibility, shaping whether distress was recognized as warranting professional support. Families functioned as both barriers and facilitators of help-seeking, while intergenerational differences and mental health literacy influenced recognition and treatment acceptance. Older siblings described greater caregiving responsibilities and serving as early mental health advocates, while younger siblings described benefiting from increased family openness established by older siblings. Participants also emphasized privacy, culturally responsive care with cultural humility, and peer support through shared lived experiences. These findings extend broader Asian American help-seeking literature by identifying how community stigma may become internalized through family and sociocultural expectations and highlighting sibling roles in shaping mental health attitudes within South Asian American families. Findings highlight culturally responsive care, family-centered mental health education, mental health literacy, and professionally facilitated peer support as potential pathways to care.

Importance: Chronic stress may contribute to adverse health outcomes through cumulative physiologic dysregulation. Allostatic load (AL), a composite measure of multisystem physiologic burden, may capture biologic effects of structural, social, and psychosocial stress not reflected by self-reported measures. Objective: To evaluate racial and ethnic differences in AL among women with familial cancer risk and examine how socioeconomic status, psychosocial factors, clinical characteristics, and health behaviors contribute to variations in AL. Design: Cross-sectional study of underrepresented minority participants enrolled in the HERSTORY cohort from October 2023 through September 2025, with comparison participants from the UCLA ATLAS biobank. Setting: UCLA academic health system. Participants: The study included 303 racially and ethnically diverse female HERSTORY participants aged [≥]35 years with a family history of cancer and matched non-Hispanic White female ATLAS participants (n=709). Exposures: Race and ethnicity, age, neighborhood deprivation, cancer history and stage, depression, perceived stress, cancer worry, and physical activity. Main Outcomes and Measures: The primary outcome was AL, calculated from cardiometabolic and organ-function measures. A secondary index incorporated race- and ethnicity-specific neutrophil-to-lymphocyte ratio (NLR) derived from 326,826 women in the UCLA Health population. Multivariable regression models evaluated factors associated with elevated AL. Results: Compared with matched non-Hispanic White participants, Black and Asian/Pacific Islander HERSTORY participants had significantly higher AL after adjustment. Hispanic/Latina participants did not have significantly elevated AL. Older age, greater area-level socioeconomic deprivation, and depression were independently associated with higher AL. Prior cancer diagnosis, cancer worry and perceived stress were not significantly associated with AL, whereas regular physical activity was associated with lower AL. Among cancer patients, advanced stage was associated with greater AL. Conclusions and Relevance: This study demonstrates elevated AL among understudied racial/ethnic minority groups with familial cancer risk and identifies associations with neighborhood deprivation, depression, and physical activity. The association between cancer stage and AL suggests that physiologic stress may reflect variation in cancer burden. The lack of association with perceived stress and cancer worry further indicates that physiologic and self-reported psychosocial measures capture distinct dimensions of stress. The development of race/ethnicity-specific NLR thresholds derived from large population samples provide a benchmark for future studies.

ABSTRACT Background: To examine trends in Indonesia's diabetes care cascade from 2013 to 2023, identify key determinants, and assess progress toward global targets of 80% diagnosis and 80% glycemic control among those diagnosed. Methods: We analyzed nationally representative data from Indonesia's Health Surveys in 2013, 2018, and 2023. Diabetes was defined using fasting plasma glucose and oral glucose tolerance tests. We estimated diagnosis, treatment, and control rates and examined sociodemographic predictors of cascade progression using survey-weighted logistic regression models. Results: Between 2013 and 2023, the prevalence of diabetes among adults aged [≥]15 years remained stable, ranging from 10.7% to 11.8%. Diagnosis increased from 15.1% (95% CI: 13.4-16.7) to 20.7% (18.5-22.9), treatment nearly doubled from 10.5% (9.1-11.9) to 19.0% (16.9-21.2), and control rose modestly from 4.6% (3.6-5.6) to 6.5% (5.2-7.8). Older age, urban residence, higher socioeconomic status, and insurance coverage were associated with greater progression through the cascade. Wealth-related inequalities persisted in 2023: one-third of cases were diagnosed among the richest (35.3% [29.0-41.7]) versus only 11.0% (7.9-14.2%) among the poorest. Compared with the lowest quintile, wealthier individuals had higher odds of diagnosis (AOR 3.55 [2.11-5.98] for diagnosis, 3.59 [2.01-6.41] for treatment, and 2.24 [1.12-4.51] for control). Conclusions: Indonesia achieved meaningful improvements in the diabetes care cascade over the past decade, yet remains far below global 80/80 targets, with nearly 80% of cases undiagnosed and control below 10%. Persistent wealth-based inequities highlight that near-universal insurance coverage has not been translated into equitable care access, underscoring the need for equity-focused screening and primary care strengthening. Keywords: Diabetes, Care Cascade, Health Services, Indonesia

This study examines the impact of various maternal factors and continuous labor support on birth outcomes among 124 birthing people in the Baltimore region of Maryland who sought and/or received doula care. The cohort primarily consists of Black birthing people and includes detailed data on maternal age, race, education level, employment status, health insurance status, income level, preexisting health challenges, and pregnancy or delivery-related health challenges. The study also explores whether the pregnancy was the birthing person's first, as well as neonatal outcomes such as NICU admission, low birth weight, and other newborn health concerns. Due dates and delivery dates were compared and analyzed, where available, to provide a comprehensive understanding of the timing of births among the cohort. The findings highlight known correlations between maternal socioeconomic factors, health factors, and adverse birth outcomes, emphasizing the critical role of doula support during the prenatal period and labor and delivery in improving maternal and neonatal health, as well as in providing culturally competent care and positive birth experiences. This research contributes to the growing body of evidence on the benefits of doula care, particularly for marginalized communities, and underscores the need for targeted interventions to address health disparities among Black Birthing persons.

Background: Although barriers to mental health help-seeking among Asian American populations are well documented, less is known about how favorable individual attitudes toward mental health treatment coexist with family and community influences among South Asian American young adults or which intervention strategies members of this population themselves prioritize. Methods: A cross-sectional mixed-methods survey was completed by 191 South Asian American young adults aged 18-30 years residing in Texas between May and June 2026 using convenience sampling. Participants completed 5-point Likert-scale measures assessing mental health attitudes, stigma, help-seeking, and barriers to care. 144 participants also provided responses to optional open-ended questions exploring barriers to mental health care and recommendations for improving access to mental health support. Quantitative data were analyzed using IBM SPSS Statistics, and qualitative responses underwent thematic analysis in MAXQDA. Results: Participants reported generally positive attitudes toward mental health care and high perceived importance of mental health despite family- and community-level barriers. Greater family pressure was strongly associated with increased mental health stigma (r = 0.711, p < 0.001) and perceived barriers to care (r = 0.654, p < 0.001), while greater perceived barriers were associated with less favorable help-seeking attitudes (r = -0.158, p = 0.036). Qualitative responses contextualized these findings, identifying anticipated community judgment, family expectations, privacy concerns, and limited mental health literacy among older generations as barriers to care. Participants emphasized culturally responsive care and recommended mental health education involving parents, elders, faith leaders, and trusted community institutions. Conclusions: South Asian American young adults may hold favorable attitudes toward professional mental health care while navigating family, community, and cultural contexts that constrain help-seeking. Participant-generated recommendations prioritized culturally responsive care and community-level mental health education involving parents, elders, faith leaders, and trusted institutions, suggesting that interventions targeting individual attitudes alone may be insufficient.

Background South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) experience a disproportionately high burden of cardiovascular disease, with hypertension serving as a major modifiable risk factor. Despite this elevated risk, hypertension often remains underdiagnosed, particularly in community settings with limited access to routine screening. This study assessed the prevalence of hypertension and undiagnosed hypertension among South Asian adults participating in community-based health screenings in Northern California and examined regional disparities between the San Francisco Bay Area and the Central Valley. Methods A cross-sectional survey-based study was conducted among adults attending screenings organized by Jeeva Clinic at religious and community institutions. Participants voluntarily completed a survey collecting demographic information, cardiovascular health history, lifestyle factors, and recent blood pressure measurements obtained either during screening or through self-report. A total of 300 participants were included in the final analysis. Results Among participants with sufficient blood pressure data for hypertension classification (n = 245), 82.9% met criteria for hypertension. Among participants with sufficient data to determine undiagnosed hypertension status (n = 244), 59.8% exhibited previously undiagnosed hypertension. Hypertension prevalence was significantly higher among participants in the Central Valley than among those in the Bay Area (97.9% vs 71.0%; chi-square = 31.2; p < 0.001). Undiagnosed hypertension was also substantially more prevalent in the Central Valley (91.7% vs 37.0%; chi-square = 71.0; p < 0.001). In multivariable analysis, Central Valley residence was associated with significantly higher odds of hypertension (OR = 14.29; 95% CI, 2.89 to 70.63; p = 0.001), and higher BMI was independently associated with hypertension (OR = 1.26 per unit increase; 95% CI, 1.10 to 1.43; p < 0.001). Conclusions These findings highlight a high burden of hypertension and significant regional disparities among South Asian adults in Northern California, suggesting that a large proportion of cardiovascular risk in this population remains undetected in routine care settings. Community-based screening initiatives, such as Jeeva Clinic, may help identify individuals at elevated risk and improve early detection in underserved populations.

Objective: To examine associations of health insurance status, household income, and cost-related healthcare barriers with receipt of a routine medical checkup among U.S. adults. Methods: This cross-sectional study analyzed 2024 Behavioral Risk Factor Surveillance System data. Survey-weighted descriptive estimates and multivariable logistic regression incorporated sampling weights, strata, and primary sampling units. The outcome was a routine medical checkup within the previous 12 months. Results: Among 321,592 complete cases, 78.0% of U.S. adults reported a recent routine checkup. Cost-related barriers (adjusted odds ratio [AOR], 0.56; 95% confidence interval [CI], 0.54-0.57) and uninsurance (AOR, 0.28; 95% CI, 0.27-0.29) were associated with lower checkup utilization. Lower household-income groups generally had lower adjusted odds than adults with incomes of $200,000 or more. Conclusions: Insurance, income, and reported cost barriers were independently associated with routine checkup utilization. Findings are descriptive and do not establish causal effects. Keywords: health insurance; household income; cost-related barriers; routine medical checkup; healthcare utilization; BRFSS

Indiana still faces significant health challenges, ranking among the least healthy U.S. states due to high obesity rates, mental health issues, and other chronic conditions. These disparities are closely linked to inequities in healthcare access, which are largely shaped by social determinants of health. Using data from the Social Vulnerability Index and County Health Rankings and Roadmaps, this study analyzes trends in obesity, mental health, and premature death across Indiana counties before, during, and after the COVID-19 pandemic. Descriptive statistics, correlation analyses, and Negative Binomial regression models were used to evaluate county-level disparities. In 2018, higher rates of uninsured, obese, and physically inactive populations were associated with increased premature death. In 2020, diabetes, smoking, and alcohol consumption were significant factors. By 2022, unemployment, education, obesity, insurance, exercise access, and mental health provider availability were associated with premature death. Findings indicate that socially vulnerable counties experienced amplified health impacts, with obesity rising most sharply where exercise infrastructure was limited and poor mental health days increasing across all counties. These results highlight persistent service gaps and the critical need for targeted investments in recreational infrastructure and mental healthcare. Future research should examine policy influences and causal relationships to inform equity-focused interventions.

Objectives To describe the prevalence of anxiety and depression symptoms among Black-Latines compared to other racial/ethnic groups in the United States. Methods This cross-sectional analysis leveraged data from the 2022 National Health Interview Survey (NHIS) to estimate the prevalence of anxiety and depression as measured by the GAD-7 and PHQ-8, respectively. Anxiety and depression scores in Black-Latine were compared to White-Latine, Non-Latine White, and Non-Latine Black respondents. Results Black-Latines were more likely to score higher on both the GAD-7 and PHQ-8 indicating higher prevalence of more than minimal anxiety (22.0%) and more than minimal depression (26.0%) than both Non-Latine Black, anxiety (18.0%) and depression (22.0%), and White-Latine, anxiety (16.0%) and depression (18.0%), respondents. Conclusions Black-Latines are more likely to report more depression and anxiety symptoms than their Non-Latine Black and White-Latine counterparts. Studies should try to disaggregate Black subgroups in order to identify the most vulnerable populations.

Background and Objectives: More research is required to determine the associations of high-density lipoprotein (HDL) cholesterol concentration and particle count with mortality. The objectives of this analysis were to investigate whether there were non-linear associations of HDL concentration with all-cause mortality, whether cardiovascular disease (CVD) deaths, cancer deaths or other deaths drove these associations, and whether small, medium, or large HDL particle count was associated with mortality. Methods and Results: The sample included 47,123 men and 97,589 women from the Mexico City Prospective Study. Models were adjusted for confounders and competing risks. There were 11,264 deaths in men and 15,486 in women. There was a J-shaped association of HDL concentration with all-cause mortality in men driven by other deaths. For example, compared with the >40th-60th percentile, the hazard ratio (95% confidence interval) for other mortality was 1.27 (1.11, 1.44) in the >95th-99th percentile and 1.82 (1.45, 2.28) in the >99th-100th percentile. There was a U-shaped association in women driven by CVD deaths at lower concentrations and other deaths at higher concentrations: the hazard ratio for CVD mortality was 1.23 (1.05, 1.43) in the two lowest percentiles groups and the hazard ratio for other mortality was 1.33 (1.18, 1.50) in the two highest percentile groups. Small HDL particle count was associated with reduced risk of all-cause, CVD, and other mortality in men and women. For example, compared with the bottom quartile, the hazard ratio for all-cause mortality was 0.79 (0.73, 0.86) in the top quartile in men and 0.77 (0.72, 0.82) in the top quartile in women. Conclusions: There is a J-shaped association of HDL concentration with mortality in men and a U-shaped association in women. More research is required to confirm the novel finding that small HDL particle count reduces the risk of all-cause, CVD, and other mortality in men and women.

Background Cardiovascular-Kidney-Metabolic (CKM) syndrome encompasses interconnected conditions such as type 2 diabetes (T2D), hypertension, hypertriglyceridemia, metabolic syndrome (MetS), and chronic kidney disease (CKD). As CKM progresses, cardiorenal risks increase. Although Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have demonstrated cardiorenal and cardiometabolic benefits, offering an opportunity to slow CKM progression, their use may vary across social determinants of health (SDoH) and stage 2 CKM subgroups. Objective To evaluate the influence of SDoH on access to GLP-1 RA among patients with T2D and other stage 2 CKM conditions. Methods This cross-sectional study used data from the U.S. National Health and Nutrition Examination Survey (NHANES), 2005?2020. Adults aged [&ge;]30 years with T2D and/or other stage 2 CKM conditions were included. Weighted descriptive analysis, multivariable logistic regression and LASSO were applied to assess associations between SDoH and GLP-1 RA use. Results Among 4,520 participants (representing approximately 84.0 million U.S. adults), weighted mean age was 61.4 years, 48.9% were female, and 61.5% were non-Hispanic White. Among participants with T2D, GLP-1 RA use was higher among individuals with higher education (3.39% vs 1.43%), private insurance (3.00% vs 0.58%), and higher income (4.70% vs 1.87%), while no use was observed among those without routine places for care. In adjusted analyses, individuals with lower income, less than high school education, lack of insurance, and being unmarried had 64%, 51%, 81%, and 40% lower likelihood of GLP-1 RA use, respectively. LASSO identified income, education, insurance, and access to care as predictors. Lower income, lower educational attainment, and lack of insurance were associated with 48%, 34%, and 79% lower likelihood of GLP-1 RA use, respectively, adjusting for age, sex, and race/ethnicity. Conclusion SDoH-driven disparities limit GLP-1 RA access. Expanding GLP-1 RA access by addressing socioeconomic barriers is critical to slowing CKM progression, reducing cardiovascular risk, and mitigating health disparities.

Background Type 2 diabetes mellitus (T2DM) is a rapidly growing public health crisis in Bangladesh, where an estimated 13.1 million adults were living with the condition in 2021, with projections suggesting this figure will nearly 22.3 million by 2045. Poor medication adherence and impaired health-related quality of life (HRQoL) are recognized consequences of long-term T2DM management, yet data from northwestern Bangladesh remain scarce. This study aimed to assess treatment adherence, HRQoL and identify their associated factors among T2DM patients in Rajshahi, Bangladesh. Methods We conducted a cross-sectional study between January and December 2021 among 205 T2DM patients from two tertiary-level hospitals in Rajshahi. Treatment adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), and HRQoL was measured using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L). Results The mean age of participants was 54.43 ({+/-}10.75) years; 50.73% were female. The majority (85.85%) had HbA1c [&ge;]6.5%, reflecting widespread poor glycaemic control. Regarding treatment adherence, 40.98% of patients had low adherence, 26.83% had medium adherence, and 32.19% had high adherence. In terms of HRQoL, only 6.83% were in perfect health state, while 52.68% had slight/moderate problems and 40.49% had severe/extreme problems across EQ-5D-5L domains. The association between treatment adherence and HRQoL was not statistically significant (p=0.265). Multiple regression analysis (Adjusted R{superscript 2}=0.620) identified diabetic complications, illiteracy, primary education, female gender, higher BMI, joint family type, treatment adherence, older age, and two antidiabetic medications as significant predictors of poorer HRQoL, while urban residence and family history of DM were independently associated with better HRQoL. Conclusions A substantial proportion of T2DM patients exhibited low treatment adherence and markedly impaired HRQoL. While adherence and HRQoL were not directly associated, diabetic complications emerged as the strongest independent predictor of poor quality of life. These findings highlight the urgent need for multidisciplinary interventions to prevent complications in this population.

Abstract Baclground: School teachers are the first responders in the early detection and referral of students with mental health issues and there is an urgent need for Mental Health Literacy training to support this. Childhood and adolescent mental health has emerged as a national health problem, so there is a need to plan an intervention program on mental health literacy for teachers in the schools of India as there are very few planned interventions. Objective: To design and test an intervention package for school teachers regarding mental health literacy. Materials and Methods: The training module on mental health literacy for school teachers was developed through a needs assessment, by conducting in-depth interviews with school teachers (n = 12), gathering experts' opinions on the content for the training manual (n = 12), and content validation of the training manual by experts (n = 7). Content validation index and kappa value was used for validation of the manual. Participants: School teachers were targeted in the development of the components of the training manual to orient them to mental health and mental illness, and to prepare them to manage school children with behavioural and mental health disorders and know when to refer. The contents covered the introduction to mental health and mental disorders, myths and stigma related to mental illness, common developmental, behavioural and mental health disorders in children, role of teachers, mental health first aid, and seeking help and finding support. The Kappa value was modified (K = 0.932) and showed that the content was very relevant to use for school teachers. Conclusion: School teachers' mental health literacy programs in India are vital interventions to address the mental health crisis in the country. With the development of structured MHL modules, India can start to overcome this huge treatment gap by enabling educators to become effective early intervention points.

Glycemic control is key to prevention of complications of diabetes. Although eosinophils have been implicated in metabolic regulation, most human studies have been cross-sectional and have yielded inconsistent findings. We conducted a retrospective cohort study of adults with uncontrolled diabetes receiving primary care at Mass General Brigham. We evaluated the relationship between eosinophil count and HbA1c over one year, adjusting for demographic, socioeconomic, and clinical covariates. Among 21,447 patients included in the study, eosinophil count increased by a mean of 2.6 cells/L (SD 157.2 cells/L) and HbA1c decreased by a mean of 0.82% (SD 2.09%) during follow-up. Increases in eosinophil count were associated with reductions in HbA1c (parameter estimate -0.366 per 1,000 cells/L; 95% CI -0.526 to -0.206; P < 0.001), whereas baseline eosinophil count was not significantly associated with HbA1c changes. The association remained significant in a sensitivity analysis excluding systemic glucocorticoid users. Increases in eosinophil count were associated with improved glycemic control in adults with diabetes, whereas baseline eosinophil count was not. These findings extend prior cross-sectional observations and suggest that changes in eosinophils may represent a biomarker of glycemic improvement. Further prospective studies are needed to determine whether this relationship reflects underlying immune-metabolic mechanisms or treatment-related changes.

Background: Elevated blood pressure (BP) during adolescence is an early marker of cardiovascular risk, particularly in settings experiencing under and overnutrition. However, the relationship between detailed body composition and BP across nutritional extremes remains poorly understood. We examined associations between dual-energy X-ray absorptiometry (DXA)-derived body composition and BP among underweight and overweight South African adolescent girls to assess multilevel correlates of BP. Methods: The Ntshembo trial included 1268 girls 13-19-years from rural Agincourt and urban Soweto. Participants were selected as underweight or overweight. BP was measured in triplicate at a single visit and classified into clinic BP category ranges. DXA provided measures of fat mass (FM), fat-free soft tissue mass (FFSTM), and related indices. Results: Mean SBP and DBP were 110.0{+/-}11.2mmHg and 68.7{+/-}8.2mmHg, respectively; 21.1% of participants had elevated or hypertensive-range BP. Overweight adolescents had higher SBP and BP categories compared with underweight adolescents. DXA-derived adiposity measures were positively associated with SBP and BP category. FFSTM showed strong association with SBP. Higher FM/FFSTM was associated with elevated (RRR=4.25, 95%CI:1.77-10.20) and hypertensive-range BP (RRR=19.04, 95%CI:6.43?56.40). Caregiver hypertensive-range BP was independently associated with adolescent hypertensive-range BP (RRR=1.72-1.82). Sedentary behaviour independently associated with elevated BP, highlighting a modifiable behavioural target alongside intergenerational risk. Associations were more consistent for SBP than DBP. Conclusions: both FM and FFSTM positively associated with BP, particularly SBP. Regional percentage analyses were consistent with higher BP when a greater proportion of total fat was distributed centrally rather than peripherally.

Background: HbA1c and mean glucose summarize average glycemia but do not capture glucose dispersion. Whether free-living glucose dispersion is associated with visual function beyond average glycemia remains unclear. Aim: To determine whether glucose dispersion is associated with mesopic and photopic contrast sensitivity independently of HbA1c and contemporaneous CGM mean glucose. Methods: We analyzed 2,218 AI-READI participants with continuous glucose monitoring and visual-function data. Glucose dispersion was represented primarily by mean absolute deviation from mean glucose (AAD), and associations were assessed using multivariable linear regression. Results: Higher AAD was associated with lower mesopic and photopic contrast sensitivity after adjustment for age and HbA1c (beta = -0.188 and -0.165; P = 1.28e-11 and 8.55e-9) and after adjustment for age and CGM mean glucose (beta = -0.221 and -0.195; P = 4.84e-13 and 5.66e-10). Associations persisted with additional adjustment and sensitivity analyses; glucose SD yielded concordant results. Conclusion: Glucose dispersion is associated with contrast sensitivity beyond average glycemia, suggesting that glycemic exposure may relate to visual function through its average level and dispersion.

Abstract Background: Hypertension is a growing public health problem worldwide; however, evidence of the burden and determinants in populations affected by conflict and displacement remains limited. This study aimed to determine the magnitude of hypertension and associated factors among conflict-affected adults. Methods: We conducted a community based, cross-sectional study in September and October 2025, among 839 adults aged 25-65 years who were internally displaced, returnees or conflict survivors. Socio-demographics, wealth status, behavioral characteristics, mental health and conflict related experiences data were collected using interview-administered questionnaires following standardized blood pressure and anthropometric measurements. Modified Poisson regression with robust variance was used to estimated crude and adjusted prevalence ratios. Factors with p < 0.05 were considered statistically significant. Results: Overall, 839 were enrolled, 467 (55.7%) were female, the median age was 41 (IQR: 35-46) years, and 264 (31.5%) had hypertension. Factors associated with hypertension were age >44 years, bereavement (aPR=1.89, 95%CI: 1.60-2.25) experiencing major property loss (aPR=1.34, 95%CI: 1.01-1.77), psychological stress (aPR=1.99, 95%CI: 1.57-2.52), lower physical activity (aPR=2.02, 95CI: 1.24-3.30) and processed food consumption (aPR=1.36, 95%CI: 1.17-1.59). Conclusion: The burden of hypertension among conflict-affected populations in Ethiopia is high. Hypertension was significantly associated with several socio-demographic, behavioral, psychosocial, and biological factors. These findings highlight the need for integrated, context-specific interventions that combine cardiovascular care with mental health support, social protection, and strengthened primary health systems in conflict-affected settings. Keywords: Conflict-affected, Hypertension, Crisis-driven, Bereavement and Bio-psychosocial.

Introduction. Perceived neighborhood problems (PNP), such as safety concerns and limited resources, have been linked to elevated hypertension risk through chronic stress pathways. The Identity Vitality Pathology (IVP) framework captures the extent to which individuals experience threats to identity, belonging, and psychosocial vitality in the face of structural disadvantage, and may modify these pathways. Methods. We conducted logistic regression analyses to estimate the association between PNP and hypertension. Models were stratified by race and gender groups (Black women, Black men, White women, White men). Both main effects models and adjusted models included an interaction term between PNP and Identity Vitality Pathology score (IVPS) to assess effect modification. Adjusted models controlled for age, education, perceived support, financial strain, physical activity, diabetes, smoking status, and self-rated health. Interaction terms were used to evaluate whether the association between PNP and hypertension varied by levels of IVPS within each race/gender group. Results. Higher PNP was associated with increased odds of hypertension among White women and men, but not consistently among Black women and men. Identity state moderated this association only among Black women, such that each 1-SD increase in IVPS score was associated with 59% lower odds of hypertension at the highest level of PNP (aOR-0.41; 95% CI: 0.19, 0.88), with no meaningful moderation observed in other groups. Conclusion. Identity state may moderate the association between subjective neighborhood disadvantage and hypertension, particularly among Black women, representing a potentially novel, modifiable protective factor among multiply marginalized persons living in communities with increased risk for hypertension.

Objective: Type 1 diabetes is related to an increased risk of structural brain alterations, cerebral microbleeds (CMBs), and cognitive deficits. We explored brain volumes and their direct and combined associations with CMBs on cognitive performance in middle-aged individuals with type 1 diabetes. Research Design and Methods: Adults with type 1 diabetes (n=163; mean age 46+/-8 years; diabetes duration 31+/-10 years; 53% women) and 48 matched controls underwent brain MRI and clinical and neuropsychological evaluations. Volumetric MRI measures adjusted to intracranial volume included total brain volume (TBV), white matter volume (WMV), and total volumes of cortex, thalamus, hippocampus, nucleus accumbens, and choroid plexus. Results: Individuals with type 1 diabetes had smaller TBV, WMV, and volumes of cortex, thalamus, and nucleus accumbens, and larger choroid plexus compared to controls (Cohen d=0.39-0.54). Those with type 1 diabetes and 3 or more CMBs had smaller TBV, WMV, and volumes of cortex, thalamus, and nucleus accumbens, compared to those with 0-2 CMBs (Cohen d=0.54-0.92). We found no direct associations between brain volumes and processing speed or executive functions. However, TBV, WMV, nucleus accumbens, and choroid plexus volumes had significant negative synergistic interactions with CMBs on processing speed and executive functions (standardized betas: -0.61 to -0.51 and 0.54 to 0.75, FDR-corrected p=0.006-0.048). Conclusions: Smaller global and regional brain volumes and larger choroid plexus volumes were found in middle-aged individuals with type 1 diabetes compared to healthy controls. Together with CMB burden, structural brain volumetric alterations were associated with accelerated cognitive deficits.