Journal of Racial and Ethnic Health Disparities

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of population-based survey data from New York City (N>6,000 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.63), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.42) and hypertension (OR=1.46). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the lower obesity risk in East Asian enclaves persisted, while elevated risks in South Asian enclaves were partly reduced. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirects scholarly attention toward disaggregated approaches to investigating AA health disparities.

BackgroundThe coexistence of cancer and hypertension presents complex clinical challenges, yet limited research has characterized this population using nationally representative data. Understanding demographic patterns, social determinants of health, and environmental health perceptions in this group is essential for developing targeted interventions. MethodsWe analyzed data from the Health Information National Trends Survey (HINTS) 6, focusing on 507 respondents with both cancer and hypertension (representing 12.82 million U.S. adults when weighted). We compared demographic, clinical, and psychosocial characteristics across sex and race/ethnicity groups using Chi-squared tests, Fishers exact tests, and Wilcoxon rank-sum tests. We examined responses to questions regarding social determinants of health, healthcare information sharing comfort, and climate change perceptions. ResultsSignificant sex-based differences emerged, with females reporting lower marriage rates (49% vs. 75%, p < 0.001), lower income (33% vs. 17% earning <$35,000, p = 0.018), higher depression prevalence (31% vs. 18%, p = 0.043), and lower heart condition prevalence (16% vs. 31%, p = 0.012) compared to males. Racial/ethnic disparities were evident in diabetes prevalence (p = 0.012), with non-Hispanic White individuals showing the lowest rates (30%). Non-Hispanic Black and Asian respondents more frequently reported social determinant challenges including food insecurity, transportation barriers, and housing instability compared to non-Hispanic White respondents (all p < 0.05). Females perceived greater harm from climate change than males (50% vs. 41% responding "Some/A lot", p = 0.013). Non-Hispanic Black respondents demonstrated the highest frequency of sun protection behaviors (90% reporting no recent sunburn). ConclusionsIndividuals with concurrent cancer and hypertension exhibit significant demographic and psychosocial heterogeneity. Sex-based and racial/ethnic disparities in social determinants of health, comorbidity patterns, and environmental health perceptions necessitate tailored, culturally responsive clinical interventions and policies to address the multifaceted needs of this population and reduce health inequities.

ObjectiveTo examine racial and ethnic inequities in wealth and health among New York City adults. MethodsWe conducted the 2024 NYC Racial Wealth and Health Gap Survey using a stratified quota sample of 2,866 adults across 11 racial and ethnic groups. Wealth was measured through self-reported assets and debts, and health through self-reported status and psychological distress. We calculated descriptive statistics across groups and used quantile regression to test for significant differences in assets and debts compared with White respondents. ResultsWhite and Chinese respondents reported the highest median net worth ($142,000 and $320,000), while Other Black and Puerto Rican respondents reported the lowest ($25 and $160). Lower wealth was associated with poorer health and higher psychological distress. Prevalence of excellent or very good health increased from 36% in the lowest wealth quartile to 59% in the highest, with the steepest wealth-health gradients among Chinese and Multiracial respondents. ConclusionWealth inequities are linked to health disparities across racial and ethnic groups in New York City. Surveillance of local wealth data can guide equity-focused policies addressing economic and racial drivers of health disparities.

BackgroundThe COVID-19 pandemic disrupted healthcare services, potentially affecting diabetes management and complications. ObjectiveTo investigate the impact of the pandemic on lower extremity amputation (LEA) rates among individuals with type 1 and type 2 diabetes mellitus, focusing on social determinants of health. MethodsA retrospective observational cohort study using de-identified claims data from a large U.S. health plan. LEA rates were compared before and after the onset of the COVID-19 pandemic using interrupted time series analysis. ResultsIndividuals with type 2 diabetes experienced an initial decline in LEA rates followed by a significant increase (p=0.022) as delayed care needs were addressed. Individuals with type 1 diabetes showed no significant fluctuations in amputation rates. Social determinants were significantly associated with changes in LEA rates among individuals with type 2 diabetes. Lower-income ([&le;]$40,000/year) and less educated individuals experienced significant increases in amputation rates (p=0.027 and p=0.043, respectively). Individuals aged 45-64 years showed a significant increase in LEA rates (p=0.013), while those aged 18-44 experienced a decrease (p=0.017). Metropolitan residents saw significant increases in LEA rates (p=0.021). ConclusionsThe COVID-19 pandemic significantly disrupted healthcare access for individuals with type 2 diabetes, leading to increased LEA rates. Social determinants of health exacerbated existing disparities in diabetes outcomes. These findings underscore the need for targeted interventions to address healthcare disparities, especially during public health crises.

BackgroundUnderrepresentation of minority groups in clinical trials worsens health disparities and reduces generalizability of results. Transthyretin-associated cardiac amyloidosis (ATTR), is a condition that disproportionately impacts some racial and ethnic groups yet the extent to which trial enrollment reflects disease burden remains unclear. Misalignment between disease prevalence and trial representation may delay treatment development and increase the economic burden of late diagnosis and mismanagement. MethodsThis was a systematic review of US-based ATTR clinical trials found on clinicaltrials.gov up to 2025 (search date February 12, 2025). Only completed trials with publicly available results were included. Demographic data were extracted at the trial level. An enrollment fraction (where EF = observed enrollment / expected enrollment based on Cardiac Amyloidosis Registry Study (CARS) prevalence; adequacy defined EF [&ge;] 0.75) was calculated for each group. ResultsOf the 264 clinical trials on ATTR identified, 16 met inclusion criteria. African Americans/Individuals of African descent had EFs below the adequate ratio of 0.75 in all phases of the trials reviewed compared to their Asian or White counterparts. Despite the FDA Final Rule in 2017, our study showed that there was increased study demographic reporting (60% to 85.7%), but a paradoxical decline for Black participants (EF 0.29 to 0.12, p < 0.001) and other minority participants. ConclusionsBlack individuals remain substantially underrepresented in U.S. ATTR-CM clinical trials despite improved demographic reporting after the 2017 Final Rule. Actionable strategies, community engagement, trial-site diversification, enrollment targets, and sponsor accountability are needed to improve representativeness and expand access.

AimsTo identify barriers and facilitators to physical activity (PA) in adults with type 1 diabetes (T1D) living in the United States (U.S.) and identify sociodemographic factors related to meeting recommended PA. MethodsWe conducted a cross-sectional online survey study of adults with T1D aged [&ge;]18 years recruited through online-based platforms. Quantitative questions related to exercise quantity and intensity, demographic characteristics, and exercise barriers and facilitators. Wilcoxon rank sum tests or independent t-tests were used to compare quantitative responses in individuals meeting or below target PA. Barriers and facilitators were also assessed qualitatively with open-ended questions. Logistic regression was performed to determine if the following characteristics were independently associated with meeting PA recommendations: age, sex, income level, and automated insulin delivery system use. ResultsOf 281 respondents who completed questions about exercise quantity, 162 (57.7%) were women, mean age 52.6 {+/-} 16.6 years, and 151 (53.7%) met PA guideline recommendations. Common barrier themes related to T1D included hypoglycemia, time, lack of knowledge about glycemic management, cost, and failure of available treatments to accommodate exercise. Common facilitator themes were insurance reimbursement of exercise program/facility, peer exercise groups, health/fitness advising, and T1D tailored fitness. Middle (vs. upper) income level was independently associated with lower odds of meeting PA recommendations (adjusted odds ratio 0.46, 95% CI: 0.27, 0.78, p = 0.004). ConclusionsIn this predominately U.S. cohort with T1D, financial factors were common novel themes related to PA. Further validation in more socioeconomically diverse cohorts and research examining PA reimbursement cost-efficacy are needed. Novelty statementO_ST_ABSWhat is already known?C_ST_ABSO_LIIn prior qualitative studies in type 1 diabetes, hypoglycemia is a commonly reported barrier to physical activity (PA) engagement. Most studies were conducted outside the United States (U.S.). C_LI What this study foundO_LIIn a predominately U.S. cohort of adults with type 1 diabetes, cost is a newly identified barrier to PA. C_LIO_LIInsurance reimbursement of PA programs/facilities was a reported facilitator. C_LIO_LIIndividuals with highest income were 54% more likely to achieve recommended PA compared to other income categories. C_LI What are the implications of the study?O_LICost-efficacy research examining PA programs/facility reimbursement in type 1 diabetes is needed. C_LI

BackgroundThe 2023 AHA PREVENT (Predicting Risk of Cardiovascular Disease Events) equations were expected to replace the 2013 ACC/AHA Pooled Cohort Equations (PCE) for estimating atherosclerotic cardiovascular disease (ASCVD) risk. The real-world implications of this transition on statin eligibility and disparity are unknown. ObjectivesTo evaluate how transitioning from PCE to AHA PREVENT alters statin eligibility across risk thresholds and racial and ethnic subgroups. Design, Setting, and ParticipantsRetrospective cohort analyses of adults aged 40-75 years without diabetes, LDL-C [&ge;]190 mg/dL, or prior statin use from Sutter Health (2010-2024) and NHANES (2011-2020). Ten-year ASCVD risk was estimated using both equations. Weighted analyses were applied to NHANES data. Main Outcomes and MeasuresStatin eligibility at PREVENT-ASCVD thresholds (3%, 4%, 5%, 6%, 7.5%) compared with PCE [&ge;]7.5%, and the proportion of individuals reclassified below PREVENT-ASCVD thresholds. ResultsAmong 229,839 Sutter Health patients (mean age 53.7 years; 53.8% women), 22.3% had PCE risk [&ge;]7.5%. Among individuals above PREVENT-ASCVD 5% threshold level (18.0% in the cohort) 94.7% also met PCE criteria. However, 6.3% (11,866) would lose eligibility, disproportionately affecting non-Hispanic Black adults (18.7%) compared with non-Hispanic Asian adults (3.3%) among individuals who were below PREVENT-ASCVD 5% threshold. In NHANES (n=3,226; representing 32.7 million adults), 9.4% overall and 21.7% of non-Hispanic Black adults with PCE [&ge;]7.5% lost eligibility at PREVENT-ASCVD 5% threshold level. ConclusionsTransitioning from PCE to PREVENT recalibrates statin eligibility and may disproportionately affect non-Hispanic Black adults. Disparity-focused monitoring is essential for clinical implementation of this new model.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

BackgroundThe diagnostic accuracy of HbA1C for prediabetes has been questioned due to its discordance with fasting plasma glucose (FPG) and 2 h oral glucose tolerance test (OGTT) glucose in non-white populations. This study aims to estimate concordance in the diagnosis of prediabetes using HbA1C FPG, and OGTT in a Filipino-American cohort. MethodsCross-sectional data from 149 Filipino-Americans without known diabetes living in the San Francisco Bay Area were used to compare prevalence of prediabetes as diagnosed by HbA1C, versus diagnosis by FPG and OGTT. ResultsThirty nine percent of subjects met the diagnosis of prediabetes using any one of the measures. Overall agreement between HbA1C, FPG and OGTT was low. Prevalence was 8.1% by FPG, 8.7% by OGTT and 35% by HbA1C. BMI, waist-hip ratio, insulin, HOMA-IR, blood pressure, and triglycerides were significantly higher in those with prediabetes by HbA1C versus normal HbA1C. ConclusionsThere is significant discordance between HbA1C, FPG, and OGTT in diagnosing prediabetes in a Filipino-American cohort. HbA1C detected four times as many individuals with prediabetes than FPG or OGTT. Individuals classified with prediabetes by HbA1C had indicators of more insulin resistance compared to individuals with normal HbA1C suggesting that HbA1C appears to detect true metabolic abnormalities on the path to diabetes as opposed to detecting false positives. These results have important implications for diabetes and prediabetes screening in Filipinos.

BackgroundSex disparities in the delivery of care and in-hospital outcomes following ST-segment elevation myocardial infarction (STEMI) remain a global concern. We performed an updated global meta-analysis comparing clinical outcomes between males and females with STEMI. MethodsThis study was conducted according to PRISMA guidelines (PROSPERO CRD42024612510). We searched major electronic databases from 1st January 2000 to 7th November 2024. Pairwise meta-analysis was performed on outcomes related to time-to-therapy, in-hospital outcomes, and optimal therapy, with subgroup analyses of geographic regions. Meta-regression was performed to evaluate heterogeneity. ResultsA total of 69 studies, involving 891,585 patients (262,773 females; 628,401 males) were included. Males were younger (MD -7.387 years), less likely to have diabetes, hypertension, and prior stroke, had significantly lower risk of in-hospital mortality (RR 0.56, 95%CI 0.53 to 0.61, P<0.05) and major bleeding (RR 0.59, 95%CI 0.50 to 0.71, P<0.05). Males had significantly shorter time to first medical contact (MD - 32.42mins), door-to-balloon (MD -6.17mins) and door-to-needle (MD -5.53mins) times, more likely to undergo PCI (OR 1.34, 95%CI 1.20 to 1.48, P<0.05), receive P2Y12 inhibitors (OR 1,52, 95%CI 1.04 to 2.23, P=0.03), GP IIb/IIIa inhibitors (OR 1.30, 95%CI 1.14 to 1.49, P<0.05), and ACE inhibitors (OR 1.41, 95%CI 0.92 to 2.17, P=0.11). No differences were observed for aspirin and beta-blocker use. Meta-regression showed female sex ({beta} = 1.40) and DM ({beta} = 0.78) were positively correlated with mortality. ConclusionFemales with STEMI experience longer treatment delays, worse in-hospital outcomes, and suboptimal care. There is an urgent need to address sex disparities in STEMI care.

BackgroundPremature coronary artery disease (PCAD) continues to impose a disproportionate burden on younger adults in the United States, yet recent patterns across sex, region, race, and urbanization remain poorly defined. MethodsUsing CDC WONDER data from 1999-2023, we examined PCAD-related age-adjusted mortality rates (AAMR) for males <45 years and females <55 years, stratified by region, race/ethnicity, and urbanization. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). ResultsThe combined AAMR for PCAD in the U.S. is approximately 8.5 deaths per 100,000 population. Both sexes demonstrated overall declines in PCAD mortality since 1999 (AAPC males -0.84%; females -1.07%), interrupted by a transient rise during 2018-2021 (APC = 7.85%; 95% CI 5.41-9.32), followed by a sharp post-pandemic decline (APC = -7.39%; 95% CI -10.64 to -4.53). Females consistently exhibited higher mean AAMRs than males (8.74 vs. 8.34; p<0.00001). Regional analyses showed that mortality rates were highest in the South (males 9.86; females 10.96) and Midwest (8.97; 9.36), with intermediate rates in the Northeast (males 7.09, females 6.77), and the lowest rates in the West (6.35; 6.16). Non-metropolitan residents carried a 1.5-1.7-fold greater mortality burden than metropolitan populations (males 12.20 vs. 7.74; females 13.31 vs. 8.06). Black/African Americans had the highest rates (males: 12.17, females: 15.98), followed by American Indian/Alaska Natives (8.49, 9.02) and Whites (8.0, 8.0), while Asian/Pacific Islanders had the lowest (about 2.4-4.3). ConclusionsNational PCAD mortality has decreased, but disparities persist and are growing by region, race, sex, and urbanization. Concentration in the Southern and Midwestern states and among certain races highlights the need for further research using modern molecular methods and improved health care resources. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/25342435v1_ufig1.gif" ALT="Figure 1"> View larger version (45K): org.highwire.dtl.DTLVardef@5fa12dorg.highwire.dtl.DTLVardef@4eb887org.highwire.dtl.DTLVardef@34b48forg.highwire.dtl.DTLVardef@3a2be1_HPS_FORMAT_FIGEXP M_FIG C_FIG Clinical PerspectiveO_ST_ABSWhat is New?C_ST_ABSO_LIThe combined AAMR for PCAD in the U.S. is approximately 8.5 deaths per 100,000 population. C_LIO_LIPremature coronary artery disease-related mortality rates are higher in the Southern and Midwestern states, among non-Hispanic Black, Native American, and non-metro populations. C_LI What are the Clinical Implications?O_LIThe geographic and demographic clustering of cases strongly suggest contributions from underlying genetic, environmental, and dietary factors that warrant further investigation. C_LIO_LIEarly identification of at-risk individuals through precision-medicine approaches and the implementation of targeted, evidence-based preventive strategies could mitigate these regional and racial disparities. C_LI

Background: Out-of-hospital cardiac arrest (OHCA) survival depends on timely bystander cardiopulmonary resuscitation (CPR) and quick defibrillation via automated external defibrillator (AED). However, access to CPR education and willingness to intervene are not equitably distributed. Within the Muslim community, intersecting religious identity, language, immigration-related concerns, and other social determinants of health may affect CPR/AED education, bystander response, and ultimately OHCA outcomes, underscoring the need for culturally responsive, faith-based training models. Methods: A survey based cross sectional study was conducted to evaluate the perceived barriers to emergency response and lay rescuer cardiopulmonary resuscitation (CPR). Individuals aged 13 years and older were recruited between January and June 2025 through convenience sampling at free, non-certification public CPR/AED classes, where participants self-reported demographic characteristics and barriers to calling 9-1-1 or initiating CPR. Analyses compared Muslim and non-Muslim participants using Fisher exact tests and multivariable logistic regression models adjusted for demographic and socioeconomic factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results: Of the 651 surveys collected, 33% of participants identified as Muslim, and 46% reported no prior CPR/AED training, with a higher proportion among Muslim respondents (57% vs 41%). Religion was significantly associated with some perceived barriers, with Muslim participants more likely to report law enforcement as a barrier to calling 9-1-1 (OR: 0.53 for non-Muslims vs Muslims, p=0.04) and less likely to report ?no problem? starting CPR (OR: 0.91, p=0.04). Race and gender also influenced barriers, with non-white and female participants more likely to report immigration status, language, cost, and concern for violence as barriers to initiating CPR or calling 9-1-1. Conclusion: Muslim participants were more confident in performing CPR, but reported less confidence in calling 9-1-1, revealing gaps in emergency response readiness. This emphasizes the importance of culturally adapted CPR/AED training that addresses specific barriers within faith-based communities and to strengthen all links of the chain of survival.

BackgroundLoneliness is an emerging public health concern linked to adverse mental and physical outcomes. It may play a key role in cognitive aging, yet its population-level association with subjective cognitive decline (SCD) across demographic groups is not well characterized. We evaluated how the frequency of loneliness relates to SCD in U.S. adults and whether associations differ by sex, age and race/ethnicity. MethodsWe performed a cross-sectional analysis of adults aged [&ge;]16 years using nationally representative 2016-2023 Behavioral Risk Factor Surveillance System data (BFRSS). Loneliness was categorized as never, rarely, sometimes, usually or always. The primary outcome was self-reported SCD in the past year. Survey-weighted logistic regression models adjusted for sociodemographic factors, health insurance, metropolitan status and survey year were used to estimate adjusted marginal probabilities of SCD across loneliness categories. Interaction terms and stratified margins evaluated effect modification by sex, age group (16-44, 45-64 and [&ge;]65 years) and race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic). ResultsAmong 85,969 adults who reported loneliness, 13,879 (16.2%) experienced subjective cognitive decline (SCD), with a mean age of 65.7 {+/-} 10.6 years. Loneliness showed a strong dose-response relationship with SCD. Predicted probabilities of SCD increased from 9.9 % (95 % CI, 9.3-10.5 %) among respondents who never felt lonely to 15.0 % (14.1-15.9 %) for rarely, 24.9 % (23.6-26.1 %) for sometimes, 38.4 % (34.4-42.5 %) for usually and 45.7 % (41.0-50.4 %) for always lonely adults (p < 0.001). Women who were always lonely had an adjusted probability of SCD that was 10.7 percentage points higher than men; sex differences were negligible at lower loneliness levels. Age differences were minimal across most loneliness categories; however, among adults who were always lonely, those aged >64 years had significantly lower predicted cognitive function compared with adults aged 18-64 years (p < 0.001). Racial and ethnic differences were modest; the only significant contrast was a 1.7 percentage-point lower probability of SCD for non-Hispanic Black adults compared with Whites among those who never felt lonely. Other subgroup differences were not statistically significant. ConclusionsLoneliness is independently and strongly associated with higher likelihood of subjective cognitive decline among U.S. adults, and this relationship is most pronounced for chronic loneliness. While sex and age modified the effect of loneliness, racial/ethnic disparities were minimal. These findings identify loneliness as a modifiable social determinant of cognitive health, supporting the need for broad social connection initiatives and targeted efforts for women and mid-life adults with chronic loneliness.

BackgroundStroke is a leading cause of death and disability, particularly in underserved populations with limited healthcare access, where poor health literacy and low stroke awareness contribute to delayed symptom recognition and worse outcomes. Student-run free clinics serve high-risk patients with hypertension, diabetes, and dyslipidemia, which are key stroke risk factors, yet stroke awareness remains inadequate. This study aims to identify stroke knowledge gaps and develop a culturally relevant educational intervention. MethodsThe three-phase study includes baseline surveys, educational material development, and post-education evaluation. ResultsAfter participation in stroke education, significant improvements in stroke sign recognition were observed, with Spanish speakers showing gains in knowledge about balance and vision loss, and English speakers in balance, vision loss, and face drooping (p <0.01). Emergency response knowledge improved less consistently; calling 911 significantly increased among English speakers (p <0.01) but decreased significantly (p <0.01) among Spanish speakers. The intervention effectively closed specific risk factor gaps, such as alcohol recognition among Spanish speakers (p <0.01). ConclusionBy addressing knowledge gaps and empowering patients to act quickly, this intervention may reduce stroke-related morbidity and mortality in high-risk populations. The model could also serve as a framework for other student-run clinics to address health literacy gaps in underserved communities.

ObjectivesUnderstanding fertility desires is one of the key components for understanding total fertility rates. The study aims to explore how attitudes towards fertility and childbearing are associated with fertility desires. MethodsA cross-sectional online survey was conducted among 822 childfree, heterosexual women aged between 18 and 35 who were involved in a romantic relationship and were not diagnosed with infertility. The relationship between attitudes to fertility and childbearing and both (1) the desire to have children and (2) the preferred timing of childbearing was analyzed. ResultsWomen who had a higher score in the Fertility and the child as an important value subscale and Personal awareness and responsibility concerning having a child subscale were more likely to (1) want to have a child and (2) want to have a child sooner (within the next 5 years). Conversely, higher scores on the A child as a barrier subscale were associated with a decreased likelihood of desiring a child and an increased likelihood of planning to have a child later than in the next five years. ConclusionThe findings highlight the role of fertility-related attitudes in shaping reproductive intentions among women of reproductive age.

Nurses represent the largest segment of the United States healthcare workforce and played an instrumental role in the countrys response to the COVID-19 pandemic. Yet, little attention has been given to the contribution of this component of the U.S. medical personnel in the nations ability to face public health crisis. We present a cross-sectional, ecological analysis using cumulative annual reports from different national databases to assess the relationship between registered nurse (RN) density at a state level and age-adjusted COVID-19 mortality within the state, using data from 2021 when mortality rates were peaking in the U.S. At the state level, an increase of 1,000 RNs per 100,000 people, was associated with an estimated 24 to 44 fewer COVID-19 deaths per 100,000 residents (B= -0.024, {beta}= -0.146, 95% CI: -0.044 to -0.003, p = .024). In this multivariate analysis including medical co-morbidities, vaccination, health insurance, and poverty level, RN density explained nearly 11% of the variability in COVID-19 mortality among states. Our findings underscore the critical role played by nurses in responding to the COVID-19 pandemic, and the importance of incorporating nursing workforce data into planning for future public health emergencies.

BackgroundThe COVID-19 pandemic disrupted access to sexual and reproductive health (SRH) services, including contraception. Understanding contraceptive use during this period is critical for strengthening health system resilience in small developing states. ObjectiveTo identify factors associated with contraceptive use among reproductive-age women during the COVID-19 pandemic in Barbados. MethodsA cross-sectional online survey was conducted in Barbados between April 28 and May 3, 2020 among adults aged [&ge;]18 years. This analysis is restricted to women aged 18-49 years. Current contraceptive use (yes/no) was assessed among non-pregnant respondents. Associations with sociodemographic factors, relationship status, and psychosocial distress (Hospital Anxiety and Depression Scale [HADS] were examined using bivariate tests and logistic regression. Variables, alcohol and marijuana use had >15% missing data which limited. ResultsA total of 1,094 women aged 18-49 years completed the survey and were included in descriptive analyses. At the time of the survey, 2.7% (n=29) reported being pregnant and 7.3% (n=80) reported not being pregnant but planning pregnancy; the majority 89.7%, (n=981) were neither pregnant nor planning pregnancy. Among non-pregnant women with contraceptive data, 34.2% (n=333) reported current contraceptive use. Moderate-to-severe anxiety symptoms were reported by 36.5%, and moderate or clinically significant global distress by 39.0%. Contraceptive use was significantly associated with HADS anxiety (p=0.021) and HADS global distress (p=0.016), but not depression (p=0.211). Women who were partnered (p=0.014) or married/cohabitating (p<0.001) were more likely to report contraceptive use compared with single women. University education was strongly associated with contraceptive use (p<0.001). Women aged 26 - 39 years were more likely to use contraception relative to those aged 40 - 49 years, while women aged 18 - 25 years were less likely. ConclusionsDuring the early phase of the COVID-19 pandemic in Barbados, contraceptive use among non-pregnant reproductive-age women was associated with psychosocial distress (especially anxiety), relationship status, education, and age. Emergency preparedness in small developing states should prioritize continuity of SRH services, mental health integration, and access to self-managed contraceptive options.

ObjectiveHypertension is the leading cause of preventable cardiovascular disease (CVD) and is associated with obesity. Body mass index (BMI), the most common measure of obesity, does not distinguish between fat and muscle mass. By contrast, dual-energy X-ray absorptiometry (DXA) is the gold standard for measuring fat composition with high accuracy and minimal variability. To our knowledge, no United States studies have examined the association between BMI or fat-to-muscle-ratio (FTMR) (using DXA) and hypertension. MethodsWe analyzed NHANES data of adults aged 20-59 years from 5 consecutive cycles (2011-2012 through 2017-2018). The primary outcome was hypertension. Logistic regression was used to determine the associations between FTMR and odds of hypertension, and between BMI and hypertension. ResultsThe mean FTMR was higher in the hypertension compared to the non-hypertension group (0.57 {+/-} 0.01 vs. 0.53 {+/-} 0.004, p < 0.001), with a similar pattern observed for BMI (32.3 {+/-} 0.2 vs. 28.1 {+/-} 0.1, p < 0.001). Logistic regression analysis showed each one-unit increase in FTMR was associated with 2.80 times higher odds of hypertension, while each 1 kg/m{superscript 2} increase in BMI was associated with 1.08 times higher odds. The sex specific odds ratio (OR) for FTMR were even higher after adjusting for age (males 24.58 (11.74-51.46), females 8.77 (5.04-15.26), p<0.001). However, after adjusting for sex in a receiver operator curve (ROC) analysis, FTMR (Area Under the Curve [AUC] 0.63; 95% CI 0.62-0.64) did not outperform BMI (AUC 0.67; 95% CI 0.66-0.68) regarding their association with hypertension. ConclusionAlthough logistic regression showed a stronger relation of FTMR than BMI and the odds of hypertension, the ROC curve indicated no difference in association of hypertension and FTMR and BMI. Further research should examine the ability of FTMR compared to BMI to predict hypertension and CVD related-complications in high-risk subgroups.

BackgroundTobacco use among young people remains a major public health concern in Indonesia, where smoking prevalence is high and metabolic risk factors such as overweight and hypertension are increasing. Evidence linking smoking behavior, particularly e-cigarette use, to early cardiometabolic risk in low- and middle-income countries is still limited. This study examined overweight and hypertension profiles among young smokers using nationally representative data from Indonesia. MethodsThis secondary analysis used data from the Indonesian Health Survey 2023. Participants were young adults aged 18-25 years with complete information on smoking status, anthropometry, and blood pressure (n = 12,770). Smoking status was categorized as conventional smokers, e-smokers, and dual smokers. Outcomes included overweight/obesity (BMI [&ge;]23 kg/m2), central obesity (waist circumference [&ge;]90 cm for men and [&ge;]80 cm for women), and hypertension ([&ge;]130/80 mmHg). Logistic regression models estimated adjusted odds ratios (AOR) controlling for age, gender, smoking duration, residence, and socioeconomic proxy variables. ResultsMost respondents were conventional smokers (94%), followed by dual smokers (4%) and e-smokers (2%). E-smokers showed higher mean BMI and the greatest prevalence of overweight/obesity (40%) and central obesity (18%). After adjustment, e-smokers and dual smokers had higher odds of overweight/obesity (AOR = 1.37 and 1.41, respectively) and central obesity (AOR = 1.47 and 1.53, respectively) compared with conventional smokers. Hypertension prevalence (11-13%) did not differ significantly across smoking categories. ConclusionAmong young Indonesian smokers, e-cigarette and dual use were associated with higher odds of overweight and central obesity but not hypertension. These findings highlight the importance of integrating tobacco control with early metabolic risk prevention strategies targeting youth.

Prediabetes is a high-risk dysglycemic state. We used a real-world endocrine/diabetes clinic registry from Najaf, Iraq to characterize patients labeled as having pre-diabetes and to explore factors associated with follow-up engagement. We identified prediabetes visits using keyword-based case finding (English and Arabic terms including prediabetes/pre-diabetes, IFG, IGT, and impaired fasting glucose/tolerance) across semi-structured registry fields. Visit-level data were collapsed to patient-level records. Binary indicators of hypertension, dyslipidemia/statin use, obesity/weight management, smoking, and common glucose-lowering therapies were derived from registry text using keyword/brand-name matching. The primary outcome was follow-up engagement defined as [&ge;]2 recorded visits. The prediabetes subset comprised 242 unique patients and 302 visits. Median age was 45 years (IQR 35-55); 47 patients (19.4%) had [&ge;]2 visits. Median follow-up duration was 0 days (maximum 321). Obesity/weight-management indicators were frequent (71.1%), as were hypertension (43.4%) and dyslipidemia/statin indicators (46.3%). In multivariable logistic regression, no evaluated predictor reached conventional statistical significance for follow-up engagement. Registry enhancements to capture laboratory confirmation and standardized follow-up fields may improve the ability to evaluate diabetes prevention pathways.