Search Results (163)

Background: Suicide remains a leading cause of death in the United States, with more than 49,000 fatalities in 2023. Rural counties consistently face higher suicide mortality rates than urban areas, reflecting deep-seated mental health inequities. Methods: This study analyzes 39 U.S. states with suicide mortality rates exceeding the national average, as defined by the Centers for Disease Control and Prevention (CDC) (>14.1 per 100,000), to examine rural–urban disparities and their intersectional demographic factors. Age-adjusted mortality data (2019–2023) from HDPulse were analyzed using IBM SPSS Statistics, version 31.0. Counties were classified by USDA Rural–Urban Continuum Codes and stratified by region, sex, age, and race. Subgroup differences were tested using a two-way ANOVA (p < 0.01). Results: Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001). The West reported the highest mortality and widest rural–urban gap (38.23 vs. 24.83), while the Northeast had the lowest. Men had higher rates than women, particularly in rural settings (37.12 vs. 11.77). The largest rural–urban gap occurred among young adults (20–39 years). American Indian/Alaska Native populations experienced the highest rates (rural: 58.73; urban: 35.15). The literature review highlighted limited healthcare access, social stigma, substance use, and economic hardship as variables commonly associated with rural–urban differences in suicide mortality. Conclusions: Suicide mortality is markedly elevated in rural America across all subgroups, with the greatest risks among young adults, men, and American Indian/Alaska Native populations. Tailored prevention strategies and expanded mental health infrastructure are critical for high-burden states. Full article

Background: Adjuvant radiation therapy for breast cancer improves survival but may expose thoracic organs to low-dose radiation, increasing the risk of second primary lung cancer (SPLC). Racial and ethnic disparities and social factors influencing SPLC risk remain underexplored. Objectives: We quantified racial and ethnic differences in SPLC incidence and survival among radiotherapy-treated breast cancer survivors and assessed the potential protective role of marital status. Methods: Using SEER-17 (2000–2022), we identified patients with first primary breast cancer receiving radiotherapy, excluding those who died within two months. Standardized incidence ratios (SIRs) assessed observed versus expected SPLC cases by race and ethnicity and marital status, and five-year overall survival (OS) after SPLC and mean age at death were calculated. Racial categories included White, Black, Asian or Pacific Islander (API), and American Indian or Alaska Native (AI/AN); ethnicity was categorized as Hispanic or non-Hispanic. Results: Among 558,493 patients, 6674 developed SPLC (1.19%). Risk varied significantly by race (p < 0.05). AI/AN patients had the highest overall risk (SIR 1.82), particularly 12–59 months and ≥120 months post-treatment. Black (SIR 1.21) and API (SIR 1.23) survivors had sustained elevated risk, while White survivors showed no overall increase (SIR 0.96) and Hispanic survivors had lower risk (SIR 0.72). Married individuals had 12% lower SPLC incidence (SIR 0.88). Five-year overall survival after SPLC was 28.0%, with significant variation by race and ethnicity (p = 0.002). API (32.2%) and AI/AN (32.5%) patients had the highest survival, followed by White (28.0%) and Black patients (25.6%). Married patients had higher five-year survival (31.8% vs. 25.0%) and older mean age at death (64.3 vs. 48.6 years) compared to unmarried patients. Conclusions: SPLC risk and prognosis after breast radiotherapy differ by race, ethnicity, and marital status. These findings highlight the importance of context-aware survivorship counseling and support the consideration of personalized lung cancer screening for breast cancer survivors. Full article

Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is increasing despite declining colorectal cancer (CRC) rates among older adults. Emerging evidence suggests widening racial and ethnic disparities. We aimed to characterize long-term EOCRC incidence and mortality trends across racial and ethnic groups in the United States with comparisons by tumor subtype. Methods: We conducted a population-based analysis using United States Cancer Statistics data (2001–2021) for EOCRC incidence and National Center for Health Statistics data (2000–2022) for mortality. Analyses were stratified by race/ethnicity and histology. Trends were quantified using average annual percent change (AAPC) with 95% confidence intervals (Cis). Results: Among 474,601 early-onset adenocarcinoma (EO-ADC) cases, incidence increased in all racial and ethnic groups except Non-Hispanic Black individuals, in whom incidence declined (AAPC = −0.35%, 95% CI −0.63 to −0.08; p = 0.01). The steepest incidence increases occurred among American Indian/Alaska Native (AIAN; AAPC = 3.39%, 95% CI 2.70–4.15), Hispanic (AAPC = 0.94%, 95% CI 0.61–1.30), and Asian/Pacific Islander populations (AAPC = 0.64%, 95% CI 0.37–0.95; all p < 0.001). EOCRC mortality increased among AIAN (AAPC = 2.67%, 95% CI 1.26–4.26; p = 0.001) and Hispanic populations (AAPC = 0.81%, 95% CI 0.39–1.27; p < 0.001), but declined among Black individuals (AAPC = −1.08%, 95% CI −1.29 to −0.77; p < 0.001). Neuroendocrine tumors increased more rapidly than adenocarcinomas across all groups. Conclusions: EOCRC incidence and mortality are rising most rapidly among AIAN and Hispanic populations. Distinct incidence trajectories of colorectal neuroendocrine tumors compared with adenocarcinomas highlight the importance of histology-specific analyses for accurate epidemiologic interpretation. Full article

This paper describes Alaska Native youth-identified community strengths that support young people’s well-being. Youth from three rural Alaska communities were engaged by the research team in digital storytelling and photovoice to explore their perspectives on what their communities were already undertaking to support youth. Each youth participant was then invited to complete an interview, which was then transcribed, coded, and qualitatively analyzed by the research team leads. The community strengths described by young people align with several community-level protective factors identified in a parent study as associated with reduced risk of youth suicide. Findings illustrate that protective communities help young people build and maintain supportive relationships with community members, family, and peers, and promote their connection to their culture, including by providing opportunities to learn their language, history, and culture; to be out on the land hunting and fishing; and to practice traditional ceremonies and spirituality. Communities implementing initiatives that support these factors may protect young people from youth suicide. Full article

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: −0.6%; 95% CI: −1.1 to −0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities. Full article

Background: Liver transplantation (LT) is the definitive treatment for end-stage liver disease, yet racial and ethnic disparities persist across the LT continuum. This study investigated the patient-level and system-level barriers to LT and evaluated racial disparities in access and outcomes. Methods: We conducted a retrospective cohort study (2012–2022) at Banner University Medical Center, Phoenix, analyzing adult LT-referred, evaluated, waitlisted, and transplanted patients. Primary outcomes included mortality and LT barriers, assessed using competing-risk and Cox regression analyses. Results: Among 2877 LT-referred patients, 61% were Non-Hispanic White (NHW), 26% Hispanic, 8.8% Native American/Alaska Native (NA/AN), 3% Black, and 1% Asian. Compared with NHW patients, lower rates of LT evaluation and listing were observed among NA/AN (39% and 53%) and Hispanic patients (56% and 63%) versus NHW patients (51% and 64%). Patient-level financial barriers were more common among NA/AN (15.5%) and Hispanic (19.81%) individuals. Waitlist mortality was significantly higher for NA/AN (sub-distribution hazard ratio [SHR]: 5.26; p < 0.01) and Hispanic (SHR: 2.92, p < 0.02) patients than for NHW patients, whereas graft survival did not differ significantly by race. Conclusions: Marked racial and ethnic disparities exist in LT access and waitlist mortality, particularly among NA/AN and Hispanic patients. Targeted interventions addressing financial and systemic barriers are critical to ensuring equitable LT access and improving transplant outcomes. Full article

Tularemia is a well-known zoonotic disease around the world, with particularly high rates in certain geographic areas of the U.S. Though the disease is regularly reported, it is classified as a rare condition owing to the relatively low number of cases detected annually. Interestingly, however, the number of cases in the U.S. has shown a positive upward trend through time. The aim of this study was to summarize, interpret, compare, and contextualize temporal trends in tularemia epidemiology at the national scale within the U.S. utilizing long-term data sets encompassing the 23-year span from 2000 to 2022. We used two secondary data sets: (1) case data reports from the National Notifiable Disease Surveillance System (NNDSS) of the Centers for Disease Control and Prevention (CDC) and (2) the National Inpatient Sample (NIS) of hospitalization discharge records. In addition to investigating patterns, we were interested in the utility of using hospital discharge records as a means of indirect epidemiological surveillance of this rare disease. Both data sets highlight the high variability in annual cases through time but underscore the highest risk of disease among patients classified as White and male, as well as the extraordinarily high rates among American Indian/Alaska Native populations, particularly those with pulmonary tularemia disease. Descriptive epidemiological summaries and statistical comparisons are provided across the time series for sex, age, ethnoracial identity, and geography; hospitalization characteristics are also described. Our desire to use case rates from hospitalization records as a surrogate for CDC case incidence rates did not provide the desired precision, though hospital discharge records do provide valuable and useful information necessary to estimate general high-risk groups for tularemia through time. Full article

Landfill contaminants pose significant risks to environmental and human health, particularly in rural Alaska. These communities are predominantly Alaska Native and face unique challenges in solid waste management due to geography, climate, and limited infrastructure. This scoping review assessed published research on the impacts of landfill contaminants in the Arctic (Aim 1) and Alaska specifically (Aim 2). Seventy-one studies met the inclusion criteria, all of which were used to develop a conceptual model of contaminant transport pathways. Thirty-nine studies included Alaska-specific research: thirty-three focused on environmental impacts, and six addressed human health (e.g., birth outcomes, cancer). Key topics included waste burning, heat generation, carbon release, leachate characterization, and water or sediment contamination. Evidence specific to Alaska suggested landfill leachate may contaminate surface water and groundwater, and that microbes can migrate beyond the landfill site boundaries in communities using honeybuckets (plastic bag-lined buckets that collect human waste). Landfill contaminants also impacted wildlife through consumption of garbage, which may have human health implications for subsistence-based communities. Major research gaps remain in understanding individual-level exposures, the effects of emerging contaminants, and the mechanisms of contaminant transport pathways. Further research designed for causal inference is needed to support improvements to public and environmental health. Full article

Background/Objectives: American Indian/Alaska Native individuals exhibit a higher prevalence of carriage of Streptococcus pneumoniae and are at increased risk of invasive pneumococcal disease compared with the general US population, driven by persistent inequities in health determinants. Although the use of pneumococcal vaccines has reduced carriage of vaccine serotypes, the prevalence of carriage of non-vaccine serotypes has increased. Methods: This study was a descriptive subgroup analysis of the PNEU-DAY study (NCT03547167; EudraCT 2017-004915-38). Safety, tolerability, and immunogenicity of sequential administration of either V114, a 15-valent pneumococcal conjugate vaccine (PCV), or 13-valent PCV (PCV13), followed 6 months later by 23-valent pneumococcal polysaccharide vaccine (PPSV23), were evaluated in pneumococcal vaccine-naïve American Indian adults with or without pre-defined risk factors for pneumococcal disease. Polymerase chain reaction testing assessed nasopharyngeal/oropharyngeal carriage of S. pneumoniae. Results: Following administration of PCV and PPSV23, the proportions of participants with adverse events were generally comparable between vaccination groups. V114 and PCV13 were immunogenic for all respective vaccine serotypes, with V114 inducing robust immune responses to the two additional serotypes not included in PCV13 (22F and 33F), based on opsonophagocytic activity geometric mean titers and immunoglobulin G geometric mean concentrations at 30 days post-vaccination. Sequential administration with PPSV23 was immunogenic in both vaccination groups. Nasopharyngeal/oropharyngeal carriage of S. pneumoniae was observed in 16.7% to 22.6% of American Indian participants across the study timepoints. Conclusions: V114 was well tolerated and immunogenic for the 15 serotypes in V114 when administered either alone or followed by PPSV23. Use of V114 has the potential to expand serotype coverage and protect against pneumococcal disease resulting from serotypes absent in PCV13 among American Indian adults. Full article

Refugees often face significant barriers to healthcare access and integration, contributing to poor health outcomes. Although perceptions of health are known predictors of self-reported health status, little is known about how refugees themselves conceptualize health. This study employed a community-engaged, transformative mixed-methods design to explore refugee health perceptions in the Denver-metro area. Data collection included 149 surveys and 27 interviews with refugees and asylum seekers conducted between November 2018 and March 2019. Hierarchical linear regression was used to assess associations between social determinants of health (SDoH) and self-reported health, while qualitative data were analyzed using a constant comparative approach. The final regression model explained 75.8% of the variance in self-reported health (R² = 0.758, p < 0.001). Significant predictors included country of origin (Burma: −3.419, p = 0.030; Somalia: −9.155, p < 0.001), age (1.901, p < 0.001), sex (male: −3.252, p < 0.001), and education level (−0.999, p < 0.001). Qualitative findings revealed themes such as health as the ability to live life and health as happiness, each shaped by cultural context, community connectedness, and perceptions of safety. Integrating these findings highlights how structural conditions and culturally rooted understandings of well-being intersect to shape refugee health after resettlement. This study underscores the need for public health and clinical interventions that center refugee-defined priorities and suggests future research should incorporate constructs, such as happiness and culturally grounded notions of safety, that emerged as central to health in this study. Full article

Native communities confronted Eurasian colonialism in ways that reflected their own unique histories, social organizations and cultural values. In this paper, we are interested in how such legacies shaped Indigenous survivance, the active presence of Indigenous peoples on the landscape or the refusal to disappear or assimilate into settler society. We seek to understand the climate changes that Native Alaskan Sugpiaq people faced during the Little Ice Age (LIA; ca. CE 1400–1850), how they responded to those changes prior to Russian incursion, and how new or renewed climate adaptations shaped Sugpiaq survivance. Drawing insight from a new multi-proxy analysis of climate change, ecological dynamics, human population history, archaeology, and ethnohistory of the Kodiak Archipelago, we argue that changes in climate variance during the LIA contributed to Sugpiaq cultural elaboration in the centuries prior to Russian colonialism. Persistent cultural values and relationships with marine resources, adaptations of those relationships under expanded levels of harvesting, and responses to evolving opportunities and political realities were key legacies carried into colonial circumstances by Sugpiaq people. In addition, we see the foundational role of Sugpiaq women in procuring and sharing subsistence foods and the development of regional Indigenous identities as important factors in Sugpiaq survivance in the Russian colonial period. While colonialism introduced novel threats, Sugpiaq people confronted those challenges with the tools and values they inherited from their past, and they persisted through the active deployment of creative and culturally appropriate responses to the co-crises of colonialism and climate unpredictability. Full article

Background: Aortic stenosis (AS) represents a prevalent valvular condition in older adults, associated with significant morbidity and mortality. The objective of the study was to examine trends in mortality related to AS in the United States (U.S.). Methods: The U.S. CDC WONDER dataset was analyzed, extracting age-adjusted mortality rates (AAMR) per 100,000 and calculating annual percentage change (APC) through Joinpoint regression. The results were stratified to identify temporal, sex-specific, racial/ethnic, and regional differences. Results: From 1999 to 2020, 267,515 deaths among older adults (>65 years old) were attributed to AS, with the AAMR declining from 28.00 to 23.69. Males had a higher AAMR (30.35) compared to females (27.42), though more deaths occurred in females (164,104 vs. 103,411). Non-Hispanic (NH) Whites exhibited the greatest AAMR (31.61), trailed by NH American Indian/Alaska Native individuals (16.62), whereas NH Asians/Pacific Islanders had the least (11.50). Significant state-wise variations were noted, with AAMRs ranging from 60.55 in Oregon to 17.23 in Mississippi, and 19 states depicting a concerning rise over the study duration. Regionally, the Northeast (32.09) had the highest AAMRs, while the South (23.06) had the lowest. Micropolitan (32.28) and noncore (28.43) areas reported higher AAMRs compared to large central metropolitan areas (24.32). Conclusions: While there is a trend towards decreased mortality due to AS in the U.S., significant disparities based on race, sex, and region persist and may be worsening. The underlying causes of these discrepancies require further investigation, and targeted strategies must be developed to address them effectively. Full article

Background/Objectives: The COVID-19 pandemic has impacted rural communities in unique ways. Those living in rural communities encounter several challenges in managing the effects of COVID-19, and exploring the perceptions of those from rural communities provides valuable information about rural health behaviors. This study aimed to explore the various reactions that individuals in a predominantly rural Midwestern state had regarding the COVID-19 pandemic and its impact on them at two time points (December 2020 and March 2021) during the initial rollout of the COVID-19 vaccination. Methods: Utilizing an inductive thematic approach to analyze data, researchers found several themes reflecting the participants’ reactions to COVID-19. Results: Participants described varying reactions to public health information around COVID-19 and how those reactions, and subsequent behaviors, were impacted by different rural values. The themes that emerged from the data were Vulnerability factors, Experiences of Emotions, Government Response, COVID-19 Guidelines, Politicization of Pandemic, and Hope/Optimism. Conclusions: The findings suggest the importance of a community-responsive approach to implementing public health interventions that align with community values and priorities. Using behaviorally based interventions that acknowledge individual experiences, beliefs, capacity/resources, and cultural norms may be effective in supporting promotive health behaviors in rural communities. Full article

Contemporary data on coccidioidomycosis death rates are sparse. Death certificate data for 2018–2023 from the US National Vital Statistics System were evaluated. Coccidioidomycosis deaths were identified using diagnosis codes B38.x listed anywhere on certificates. Deaths and age-adjusted mortality rates (AAMRs)/1,000,000 people, with 95% confidence intervals (CIs), were determined. We identified 1760 coccidioidomycosis-attributable deaths (AAMR = 0.75; 0.72–0.79). Most occurred in 55–74-year-olds (43.9%; corresponding AAMR = 1.72; 1.59–1.84). Males had a 2.69-fold increased AAMR versus females and American Indian or Alaska Native individuals had a 4.28-fold increased rate versus White individuals. Hispanics had a higher AAMR than the overall population (AAMR = 1.92; 1.76–2.08). AAMRs increased from 0.52 in 2019 to 0.79–0.94 in later years. Most (89.7%) death certificates were from endemic states, with Arizona having the highest AAMR. Seven hundred and thirteen certificates (40.5%) listed coccidioidomycosis as the primary cause of death, with 43.8% coded for pulmonary, 34.9% coded for disseminated, and 21.3% coded for unspecified coccidioidomycosis. Diabetes, COVID-19, and human immunodeficiency virus were more frequent on certificates with coccidioidomycosis versus without (RR range = 1.47–17.20). Mortality remained closely tied to demographic and geographic factors identified in prior studies, with county-level mapping revealing high-burden areas for targeted intervention. Coccidioidomycosis-attributable AAMRs rose over time, possibly influenced by concurrent COVID-19 infection. Only 40% of death certificates listed it as the primary cause, indicating that most patients experience chronic infection rather than death directly from the disease. These findings suggest the need for heightened clinical awareness of coccidioidomycosis, along with earlier diagnosis and prompt initiation of antifungal treatment in these high-risk groups. Full article

Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the socio-demographic factors associated with pain-reliever misuse across different racial and ethnic groups. Methods: This cross-sectional study utilizes data from the 2022 United States National Survey on Drug Use and Health (NSDUH). Participants were categorized into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (Hispanic), and Other (American Indian, Alaska Native, Asian, Native Hawaiian or other Pacific Islanders, and two or more races) groups. Comparisons were made between individuals regarding pain-reliever misuse, socio-demographic characteristics, SPD, suicidal thoughts, and World Health Organization Disability Assessment Schedule (WHODAS) scores, using Rao–Scott Chi-square tests. Stepwise multivariable logistic regression analyses were conducted to identify socio-demographic factors associated with pain-reliever misuse. Results: The study included 45,451 participants, with 27,551 (62.00 wt%) identified as NHW, 5186 (11.98 wt%) as NHB, 7795 (17.15 wt%) as Hispanic, and 4919 (8.87 wt%) as other racial and ethnic groups. The rate of pain-reliever misuse was 2.90% among NHWs, 3.40% among NHBs, 3.61% among Hispanics, and 2.05% among individuals of other races and ethnicities (p = 0.043). Among those who misused pain relievers, a significantly higher proportion experienced SPD (36.00% vs. 14.05%), suicidal thoughts (15.51% vs. 4.91%), and difficulties in performing daily activities (73.77% vs. 52.84%) compared to those who did not misuse pain relievers (p < 0.001). Socio-demographic factors associated with a lower risk of misuse included being female (AOR = 0.80, 95% CI 0.67–0.95, p = 0.013), being employed (AOR = 0.66, 95% CI 0.48–0.90, p = 0.010), and having a college or higher education (AOR = 0.54, 95% CI 0.37–0.79, p = 0.002). Conclusions: The prevalence of pain-reliever misuse varies across racial and ethnic groups, with Hispanic individuals demonstrating the highest rates of misuse. Pain-reliever misuse is strongly associated with SPD, suicidal thoughts, and impaired daily functioning. Socio-demographic factors are crucial in predicting the likelihood of pain-reliever misuse. These findings highlight the importance of culturally tailored prevention strategies and public health policies aimed at mitigating misuse, especially among vulnerable populations. Full article