Search Results (1,063)

Background/Objectives: Myopia is a major global public health concern, particularly in East Asia. Taiwan’s exceptionally high prevalence of childhood myopia provides a valuable population model for investigating refractive development and prevention. This study examined geographic disparities in visual acuity, refractive errors, and optometric resources among Taiwanese elementary school children. Methods: This retrospective nationwide study analyzed anonymized screening data from 10,610 elementary school children collected from 2014 to 2023. Children were classified as urban, rural, remote, or especially/extremely remote according to governmental criteria. Comprehensive vision examinations were performed by licensed optometrists. Refraction was assessed using autorefraction and retinoscopy without cycloplegia. Refractive errors and healthcare resources were compared across regions using multivariable logistic and linear regression analyses. Results: Myopia was present in 86.4% of male and 87.0% of female children, while measurable astigmatism (≥0.25 D) was present in 98.4% of both sexes. High myopia and high astigmatism affected 2.3% and 4.5% of children, respectively. Myopia prevalence varied across grade levels and was 88.9% among sixth-grade children. Compared with urban children, those living in especially or extremely remote areas and rural areas had higher odds of measurable astigmatism (OR = 2.81 and 1.63, respectively; p < 0.01). Rural children had significantly lower odds of myopia, while no significant association with myopia was observed among children living in specially or extremely remote areas. Optometry clinics were more concentrated in urban areas, and a higher density of optometry clinics was associated with lower odds of myopia. Conclusions: Taiwan provides a valuable model population for understanding geographic, environmental, and healthcare-related factors in childhood myopia. Better visual acuity does not necessarily indicate lower refractive risk. Region-specific strategies should strengthen comprehensive screening and referral, improve optometric access and affordable correction in remote areas, and promote lifestyle and environmental interventions in urban settings. Full article

Diabetes disproportionately affects African American and Native American populations in the United States; however, diabetes disparities are frequently examined either collectively across minority populations or within individual groups, limiting understanding of the distinct mechanisms that drive inequities. This narrative review compares differences in diabetes diagnosis, culturally grounded management, diabetes self-management education and support (DSMES), and diabetes-related complications among African American and Native American adults in the United States to identify both shared and population-specific pathways contributing to disparities. A narrative review of peer-reviewed literature published between 2010 and 2025 was conducted using PubMed, Scopus, and Google Scholar. Studies addressing diabetes diagnosis, management, diabetes education, or complications among African American and Native American adults were included and synthesized using a comparative thematic approach. Disparities were evident across the continuum of diabetes care, but their underlying drivers differed substantially between populations. Among African Americans, diagnostic challenges reflected both structural inequities and limitations of commonly used glycemic markers such as hemoglobin A1c. Among Native Americans, delayed diagnosis was more closely associated with geographic isolation and under-resourced healthcare systems. Culturally grounded management also differed, with Native American communities demonstrating greater integration of Indigenous frameworks and traditional practices, whereas African American communities relied more heavily on family- and faith-based support systems. DSMES remained underutilized in both populations because of referral gaps, structural barriers, and limited cultural tailoring, with access barriers particularly pronounced in rural and tribal settings. Both populations experienced disproportionately high rates of diabetes-related complications, although Native Americans frequently exhibited earlier onset while African Americans often experienced greater severity of outcomes. Findings suggest that similar diabetes disparities emerge through different structural, cultural, and healthcare system pathways. Recognizing these differences can inform the development of more targeted clinical interventions, community-based programs, and health policies aimed at reducing diabetes inequities in underserved populations. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly applied across spinal pain care, by improving diagnostic accuracy, optimizing clinical workflow, and advancing translational research. However, AI’s role and its integration into rural spine care face challenges. Therefore, the current narrative review synthesizes the role of AI in rural spine care, spanning diagnosis, clinical decision support, imaging, natural-language processing, and remote monitoring. Methods: We searched the peer-reviewed literature on AI in spinal pain care across six databases from inception to June 2026. Results: In the United States, AI models have shown promise in strengthening clinical decision support that assists clinicians in identifying spinal pain disorders and providing evidence-based treatment recommendations; however, most were developed and validated in urban healthcare settings. Additionally, evidence on external validation, dataset representativeness, robustness to incomplete or low-quality data, interoperability, prospective clinical utility, and implementation feasibility in rural spine care remains limited. Therefore, we propose a translational framework in which de-identified data from rural and urban healthcare settings are aggregated, harmonized, and used to develop a multimodal AI model. AI models further require rigorous technical and external validation, prospective validation in rural settings, explainability, and continuous post-implementation monitoring. Despite its benefits, key limitations, including data scarcity and algorithmic bias, are also highlighted. Conclusions: AI has emerged as a promising tool for strengthening clinical decision support in spinal pain disorders in rural settings. The most realistic role of AI in rural settings is not to replace specialist expertise, but to act as one component of a multidisciplinary care team. Full article

Background: Equitable access to kidney replacement therapy (KRT) remains a major challenge for patients living in geographically isolated, rural, and underserved settings. Organizational approaches, including tele-nephrology, remote patient monitoring, decentralized dialysis services, home dialysis support, rural outreach programs, and emergency preparedness strategies, have been increasingly used to address geographic and organizational barriers to KRT delivery. This review summarizes the available evidence on organizational approaches supporting remote and decentralized KRT delivery and examines their reported implications for healthcare accessibility, continuity of care, and service delivery. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library for studies published between January 2016 and January 2026. Publications considered relevant addressed organizational, healthcare delivery, implementation, or health-system approaches supporting KRT accessibility, continuity, or delivery in geographically isolated, rural, underserved, disaster-affected, humanitarian, or resource-limited settings. Studies describing conventional facility-based dialysis without an organizational or healthcare delivery component were excluded. Relevant information on study characteristics, KRT modality, organizational approaches, implementation components, healthcare accessibility, continuity of care, and reported barriers and outcomes was extracted and narratively synthesized. Results: A total of 749 records were identified, and 12 publications were retained for detailed synthesis. The publications addressed tele-nephrology, remote monitoring, home dialysis support, rural outreach, decentralized and community-based dialysis, and emergency preparedness. Study designs, settings, organizational models, and outcomes varied substantially. Reported findings concerned specialist access, home and decentralized dialysis pathways, dialysis continuity, healthcare utilization, and implementation feasibility. Most publications were observational, pilot, implementation-based, or qualitative, limiting causal inference and direct comparison across settings. Conclusions: The literature describes organizational approaches that may address specific barriers to KRT access and continuity. However, heterogeneous and predominantly non-comparative evidence is insufficient to establish causal effectiveness or superiority of any specific model. Multicenter comparative studies with standardized organizational, patient-centered, and economic outcomes are needed to assess effectiveness, scalability, and sustainability. Full article

The COVID-19 pandemic exposed critical fragilities in health systems, particularly regarding the equitable distribution of resources and the logistical capacity of early warning systems. This study addresses the optimization of the Sentinel Surveillance Network in Andalusia, Spain, proposing a shift from traditional efficiency-based models to an equity-oriented approach. The facility location problem is formulated using a Capacitated Vertex-Restricted P-center model, which aims to minimize the maximum access time for the most remote population, thereby preventing the creation of “healthcare deserts” common in P-median approaches that minimize average distance or total travel cost. To solve this NP-hard combinatorial problem, a hybrid metaheuristic, named the ACME-GA (Acceleration by Clustering and Memetic Exploitation) refined with Simulated Annealing, is introduced. Using real-Andalusia demographic data and road travel times across 406 municipalities and 133 candidate hospitals, the proposed method is compared against standard evolutionary schemes. The results demonstrate that ACME-GA consistently yields superior solution quality and stability. Furthermore, the analysis confirms that the P-center approach significantly enhances territorial equity compared to density-focused models, ensuring that even sparsely populated rural areas maintain robust access to epidemiological surveillance. This work provides a resilient methodological framework for public health planning in post-pandemic scenarios. Full article

Ticks are among the most important arthropod vectors affecting human and animal health worldwide. We present a set of globally harmonized indicators integrating hazard, exposure, and vulnerability associated with human-biting ticks and with two major tick-borne pathogens, Borrelia burgdorferi sensu lato (Lyme borreliosis), and Orthonairovirus haemorrhagiae (Crimean–Congo haemorrhagic fever virus, CCHFV). Hazard indices were derived from the distributions of confirmed vector tick species. Exposure was incorporated through rural human population density, livestock density, and the abundance of competent vertebrate reservoirs and/or amplification hosts, as applicable. Vulnerability was assessed using country-level indicators related to healthcare accessibility, socioeconomic development, and demographic dependency. The indices show spatially structured global patterns. Tick hazard is concentrated in eastern North America, Europe, Central and East Asia; Africa displays fragmented but substantial hotspots. The B. burgdorferi s.l. index is restricted to the Northern Hemisphere, following the distribution of Ixodes spp. and associated reservoir communities, with highest exposure in Europe and North America. The CCHFV index is confined to the Old World, extending from the Mediterranean region through the Middle East and Central Asia into Sub-Saharan Africa, reflecting the distribution of Hyalomma ticks and ungulates. The vulnerability indicators highlight regional patterns of high exposure and limited adaptive capacity, particularly in Sub-Saharan Africa and parts of the Middle East. Our framework provides the first global set of harmonized, high-resolution indices integrating vector ecology, reservoir communities, exposure, and vulnerability for major tick-borne diseases of humans. It offers a flexible platform for comparative epidemiology, surveillance prioritization, and public health decision-making at multiple administrative scales. Full article

Background/Objectives: Rural populations in the United States experienced consistently lower COVID-19 vaccination rates than urban populations during the pandemic. While barriers to vaccination have been well documented, less is known about facilitators of uptake in rural settings. This study aimed to identify facilitators of COVID-19 vaccination in rural communities from the perspectives of Washington State University (WSU) Extension personnel and to examine these factors using the Consolidated Framework for Implementation Research (CFIR) Outer Setting domain. Methods: A qualitative descriptive study was conducted using semi-structured key informant interviews with WSU Extension personnel. Twenty-one participants representing 34 of 40 Extension offices across Washington State were interviewed in Fall 2023. Interviews were transcribed, de-identified, and analyzed using deductive thematic analysis. Findings were organized into the seven CFIR Outer Setting constructs: critical incidents, local attitudes, local conditions, partnerships and connections, policies and laws, financing, and external pressures. Results: Perceived facilitators of COVID-19 vaccination were identified across all CFIR Outer Setting constructs. Trust emerged as a central theme, with participants reporting that vaccine acceptance was higher when information was delivered by trusted local sources, including Extension personnel, healthcare providers, community leaders, and informal networks. Participants described leveraging partnerships with public health agencies, schools, faith-based organizations, and community groups as enhancing outreach and information dissemination. Additional facilitators identified by participants included no-cost vaccine and personal protective equipment availability, accessible community-based vaccination sites, culturally appropriate educational materials, and coordinated communication systems. Conclusions: Rural vaccination efforts were supported by trust, strong community partnerships, and locally tailored strategies. These findings may inform future public health emergency responses in rural communities. Full article

Background/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher’s exact test substituted where expected cell counts were below 5, with significance set at p < 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher’s exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher’s exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice. Full article

Despite longstanding vaccine availability, human papillomavirus (HPV) remains the most common sexually transmitted infection in the United States and a leading cause of preventable cancers. Additionally, HPV vaccination rates remain below other routinely recommended adolescent immunizations, particularly in rural populations. This study aimed to identify barriers related to healthcare access, socioeconomic conditions, cultural beliefs, and provider–patient communication in rural communities. A bibliographical review of articles published in English from 2020 to 2025 and an analysis of national datasets were conducted to establish trends in HPV vaccination rates. State-level HPV vaccination data for adolescents aged 13–17 years were obtained from America’s Health Rankings and the Centers for Disease Control and Prevention National Immunization Survey-Teen. States were classified as predominantly rural or urban using Rural–Urban Continuum Codes, and mean vaccination completion rates were compared. The mean HPV vaccination completion rate was lower in rural states (60.55%) compared to urban states (67.31%); however, this difference did not meet the selected threshold for statistical significance (p = 0.025). Barriers identified in the literature included reduced access to healthcare, differences in provider communication, socioeconomic constraints, and limited health literacy in rural communities. Of the identified barriers, healthcare provider recommendations emerged as one of the strongest predictors of vaccine acceptance. These findings highlight multilevel determinants contributing to differences in HPV vaccine uptake and underscore the need for targeted, evidence-based strategies to improve vaccine access and coverage in underserved adolescent populations. Full article

Background/Objectives: Human papillomavirus (HPV) causes several cancers in both females and males. In France, HPV vaccination coverage among adolescents remains suboptimal, particularly among boys, and knowledge about HPV infection and vaccination is limited. This study assessed HPV-related knowledge, attitudes, and vaccination uptake among adolescents attending Rural Family Homes (RFHs). Methods: A sequential mixed-methods study was conducted between September 2023 and June 2024 among 895 adolescents aged 15–19 years attending 19 RFHs in France. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, general vaccination knowledge, HPV-related knowledge, vaccination status, and determinants of vaccine uptake. Focus groups involving 59 adolescents explored perceptions of, barriers to, and information needs regarding HPV vaccination. Quantitative data were analyzed using chi-square tests and multivariable logistic regression; qualitative data were analyzed thematically. Results: Overall, 44% of participants had received at least one HPV vaccine dose and 31% received at least two doses. Coverage was significantly higher among girls than boys (55% vs. 28%, p < 0.001). Only 35% demonstrated adequate HPV-related knowledge. Parents and general practitioners were the main information sources. Vaccination uptake was associated with favorable subjective norms, female sex, and the belief that vaccination reduces cancer risk. Qualitative findings revealed persistent misconceptions about HPV-related risks, particularly among boys, and a substantial need for reliable information. Conclusions: Adolescents attending RFHs showed limited HPV-related knowledge and suboptimal vaccination coverage, particularly boys. Parental support and healthcare professional recommendations were associated with vaccine uptake. Targeted educational interventions and catch-up vaccination strategies among this population are needed to improve coverage and reduce the burden of HPV-related diseases. Full article

Ebola virus disease (EVD) remains one of the most severe viral hemorrhagic fevers, with recurrent outbreaks challenging global healthcare systems. This narrative review traces the evolving epidemiology of EVD from the first recognized outbreaks in 1976 to the ongoing 2026 Bundibugyo virus public health emergency in the Democratic Republic of the Congo (DRC) and Uganda. Over nearly five decades, the recognized range of Ebola outbreak contexts and amplification mechanisms has broadened considerably: rural zoonotic spillovers remain the predominant mode of emergence, but the scale and reach of subsequent transmission increasingly depend on where introductions occur, on delays in detection, on population mobility, on ecological disruption, on armed conflict, on healthcare-associated transmission, and on viral persistence in survivors. Major advances in molecular epidemiology and genomic surveillance have improved outbreak investigation, enabling real-time transmission reconstruction and detection of survivor-linked resurgence. Vaccination, particularly ring vaccination with rVSV-ZEBOV, has shown high effectiveness against Zaire ebolavirus, yet vaccine equity gaps and the absence of licensed vaccines for Sudan virus and Bundibugyo virus remain critical vulnerabilities, though new candidate vaccines and therapeutics for Bundibugyo virus entered clinical evaluation in mid-2026. Artificial intelligence and digital technologies, including AI-assisted early warning systems, portable sequencing, drones, blockchain, and mobile health platforms, offer promising tools for outbreak preparedness, but robust evidence of their real-world operational impact during filovirus outbreaks remains limited, and their deployment in low-resource settings faces substantial barriers related to infrastructure, literacy, data costs, and governance. Integrated preparedness frameworks that combine ecological surveillance, resilient healthcare systems, community engagement, and international coordination under a One Health umbrella are increasingly viewed as a strategic necessity. The 2026 Bundibugyo outbreak reaffirms that despite decades of lessons, structural weaknesses in surveillance, response timeliness, and community trust continue to recur. Sustainable, multi-year financing, diversified vaccine platforms, regional manufacturing, and local co-design of digital tools are essential to translate lessons into lasting change. Preparedness is best understood as a continuous process rather than a reactive state. Full article

Background/Objectives: Primary healthcare in Hungary faces acute physician shortages; in the Heves district, eight general practices are permanently vacant, leaving 11,191 residents without continuous care. In September 2025, the Hungarian Charity Service of the Order of Malta launched the Heves Haziorvosi Pilot (HHP), combining on-site nurse triage with remote telemedicine consultations. This study qualitatively evaluated its implementation and early operation. Methods: Three focus group discussions were held in two rounds, before and after implementation, with all 19 professionals delivering the programme (10 practice nurses, 4 general practitioners, 5 degreed professionals). Verbatim Hungarian transcripts were analysed in NVivo 15 (Lumivero, Denver, CO, USA) using the thematic analysis framework of Braun and Clarke with hybrid deductive-inductive coding by three independent researchers until full consensus. Results: Daily physician availability rose from approximately 2 to 8 h, and one remote physician concurrently supported four practices. Participants reported reduced professional isolation among nurses, longer and more focused consultations, and perceived, though unquantified, decreases in non-urgent ambulance use. Implementation was constrained by duplicate paper and digital documentation, patients’ limited familiarity with triage, and unresolved software interoperability and IT ergonomic problems. Conclusions: The hybrid model was perceived as operationally feasible; national scaling would require nursing curriculum reform, administrative simplification, interoperable medical software, and community health literacy programmes. Full article

Background/Objectives: Rural populations remain underrepresented in genomic research and may face unique barriers to accessing genetic and precision medicine services. This study evaluated knowledge, attitudes, beliefs, and perceived barriers related to genetics and precision medicine among rural participants enrolled in OneDukeGen (ODG), a large academic biobank and precision medicine research initiative. Methods: This mixed-methods study included rural ODG participants identified using U.S. Census Bureau rural classification code. Participants completed an online survey assessing genetics knowledge, attitudes toward genetic testing and precision medicine, healthcare utilization, and internet use. Semi-structured interviews were conducted with a subset of survey participants to further explore perceptions of genetics research, barriers to care, privacy concerns, and educational needs. Results: Among 10,305 ODG participants, 3268 (31.7%) were classified as rural, representing 97 of North Carolina’s 100 counties. A total of 111 rural participants completed surveys and 14 participated in qualitative interviews. Participants generally demonstrated favorable attitudes toward genetics and precision medicine despite moderate genetics knowledge scores. Most participants believed genetic testing could improve disease prevention and treatment selection, particularly for cancer care and pharmacogenomics applications. Qualitative interviews identified three major thematic domains: (1) perceived value and promise of genetics, (2) concerns regarding privacy, trust, and misuse of genetic information, and (3) barriers and facilitators to accessing genetic services. Participants generally viewed genetics research positively but expressed concerns regarding cost, insurance coverage, privacy, and genetic discrimination. Conclusions: Rural participants generally expressed positive attitudes toward genetics and precision medicine; however, substantial barriers related to cost, trust, privacy, awareness, and digital access remain. Community-engaged approaches emphasizing accessibility, provider education, and culturally appropriate communication may be critical for equitable implementation of precision medicine in rural communities. Full article

Background and Objectives: Trauma is a frequent cause of emergency healthcare requests that requires timely intervention and transport to definitive care, ideally within the first 60 min. On-scene time is considered a modifiable component of the prehospital phase and holds the greatest potential for optimizing prehospital operational time. However, factors contributing to on-scene delays are emerging across different trauma systems, highlighting the need to optimize operational efforts. Data on these factors vary across settings and have rarely been explored in Europe. Romania is an Eastern European country with a distinct demographic distribution and a unique emergency healthcare system. This study aims to evaluate compliance with the golden hour of prehospital trauma care and factors associated with on-scene and total prehospital operational time in Iasi County, Romania. Materials and Methods: A retrospective analysis of data from the electronic dispatch registry from Iasi County was performed for cases dating from January 2025 to February 2026. Data regarding demographics, trauma characteristics, and operational data were retrieved. Generalized linear modeling was used to investigate associations of total prehospital time or on-scene time with demographic and case-specific factors. Multivariable logistic regression was used to evaluate factors associated with total prehospital time exceeding 60 min and on-scene time of 20 min or more. Further sensitivity analyses were performed to account for scene complexity. Age association with operational time was assessed for non-linearity using restricted cubic splines. Results: Of the 8553 included trauma cases, 33.1% presented with on-scene delays, and 59.5% presented with total prehospital time above 60 min. Factors associated with on-scene time were age, rural environment, nature of trauma and severity, and scene-related complexity factors such as number of performed interventions and multiple victim incidents, while for total prehospital time the moment of intervention was also a relevant factor. Age displayed a non-linear association with on-scene time (p < 0.001), with a more pronounced increase after approximately 60 years of age, while for total prehospital time no evidence of non-linearity was observed (time ratio: 1.0024, 95% CI:1.0019–1.0029, p < 0.001). Rural environment was also a factor associated with both operational measurements (time ratio:1.17, 95%CI:1.15–1.2, p < 0.001 for on-scene time and time ratio:1.42, 95% CI:1.38–1.45, p < 0.001 for total prehospital time) and was associated with higher odds of on-scene time ≥ 20 min (OR:1.74, 95% CI:1.58–1.92, p < 0.001) and total prehospital time >60 min (OR:4.91, 95% CI:4.45–5.43, p < 0.001). Conclusions: The large proportion of cases identified with delayed operational times supports the need for further exploration of modifiable factors. The study highlights that, beyond case-specific factors and scene complexity, age and rural environment are relevant to prehospital operational time in Romanian trauma care settings. Further studies are needed to determine the underlying mechanisms of these associations and find targeted strategies to improve operational efficiency. Full article

Background: Individuals with inflammatory bowel disease (IBD) are at substantially increased risk for Clostridioides difficile infection (CDI), which leads to significantly higher morbidity and mortality compared to the general population. However, comprehensive national-level analyses of long-term mortality trends in this population remain limited. This study examines mortality trends associated with IBD and CDI in the United States from 1999 to 2023. Methods: This descriptive study utilized the CDC WONDER Multiple Cause-of-Death database. Deaths involving IBD (ICD-10: K50, K51) and CDI (A04.7) were identified among adults aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated with 95% confidence intervals and stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was applied to estimate the annual percent change (APC) in mortality. Results: Between 1999 and 2023, 76,084 deaths were recorded. Medical facilities accounted for 46% of deaths, followed by decedents’ homes (28.3%) and nursing home/long-term care facilities (16.5%). Overall mortality declined gradually from 1999 to 2018 (APC: −0.23, p < 0.05), increased sharply through 2021 (APC: +12.75, p < 0.05), and was then followed by a non-significant change through 2023 (APC: −2.69; 95% CI: −8.24 to 3.19), consistent with a plateau. Men consistently exhibited higher AAMRs than women. Non-Hispanic White individuals had the highest AAMRs (1.844 in 2023), while Non-Hispanic Black individuals experienced a sustained increase from 2016 onward (APC: +7.11, p < 0.05). Hispanic mortality increased steadily throughout the study period (APC: +1.31, p < 0.05). Rural populations had higher overall AAMRs than urban populations. The Midwest recorded the highest regional AAMRs by 2023 (1.867). Conclusions: Mortality increased significantly between 2018 and 2021, coinciding with the COVID-19 pandemic, though our study design cannot prove causation. Disparities by race/ethnicity, urbanization, and region persisted. These findings underscore the need for ongoing antibiotic stewardship, equitable healthcare access, and targeted public health interventions for this vulnerable population. Full article