We assessed sex-specific disparities in HCC risk according to detailed race/ethnicity with a multi-institutional, electronic health record (EHR)-based cohort. We linked an EHR-based cohort of adult patients at Sutter Health, Kaiser Permanente Hawai'i, and San Francisco Health Network from 2000 to 2016/2017 to population-based cancer registry data for incident HCC. Race and ethnicity data were operationalized into 17 detailed categories. We used sex-stratified Cox regression to assess racial/ethnic disparities in HCC. A secondary analysis explored cirrhosis-stratified disparities, with cirrhosis defined as occurrence of one or more ICD-9/ICD-10 codes indicating cirrhosis or complication thereof. Among 4,248,553 patients, 2,916 developed HCC. Vietnamese American females (HR=5.5; 95% CI=2.3, 13.2) and males (HR=5.4; 95% CI=3.1, 9.6) had highest HCC risk compared to non-Hispanic (NH) White counterparts. For both sexes, those who were Native Hawaiian, Chinese or Korean American, had another single Asian ethnicity or multiple Asian ethnicities, or were Black or Hispanic had greater HCC risk than NH White. Filipino and Japanese American females and males who were American Indian/Alaska Native or had multiple races/ethnicities also had greater risk. Exploratory analyses showed that, for both sexes, racial/ethnic disparities were mitigated within the context of EHR-documented cirrhosis but not without. Our innovative use of EHR data on race and ethnicity advances disparities research methodology, yielding findings on HCC disparities not apparent with broad categories. More persistent racial/ethnic disparities among those without EHR-documented cirrhosis suggest racial/ethnic differences in coordinated hepatitis screening and treatment, cirrhosis recognition/documentation, or healthcare delivery and thus informs efforts to reduce HCC disparities.
Like other positive health behaviors, researchers have documented large racial and ethnic disparities in breastfeeding initiation and continuation rates. Understanding contributing factors to these disparities is important for designing effective interventions. To examine whether sociodemographic and pregnancy-related factors explain racial and ethnic disparities in breastfeeding outcomes. We conducted a cross-sectional, secondary analyses of the Pregnancy Assessment Monitoring Survey Phase 8, 2016-2022. We first examined breastfeeding outcomes (breastfeeding initiation, breastfeeding continuation at 8 weeks, and breastfeeding continuation at 8 weeks among those who initiated) across racial and ethnic groups (N = 193,917). Multivariable logistic regressions were used to examine these associations, adjusting for sociodemographic (race, age, insurance, marital status, and income) and pregnancy-related factors (WIC participation, adequacy of prenatal care, delivery type, and number of resources from which participants received breastfeeding information). A total of 87% of the sample initiated breastfeeding, with 68% still breastfeeding at 8 weeks. Non-Hispanic Black participants were less likely to initiate breastfeeding (aOR = .73; CI [.68, .78]) or be breastfeeding at 8 weeks (aOR = .90; CI [.86, .95]) compared to Non-Hispanic White participants, even after adjusting for sociodemographic and pregnancy-related factors. However, the association between Black race and continuation of breastfeeding to 8 weeks postpartum among those who initiated was completely attenuated after adjustment. Hispanic participants also had lower rates of continuation, but this was reversed when adjusting for sociodemographic and pregnancy-related factors. Sociodemographic and pregnancy-related factors contribute to, but do not fully explain, breastfeeding disparities. Efforts are needed to further understand and address breastfeeding disparities, especially breastfeeding initiation among Black mothers.
Disruptions to the US criminal legal system during the SARS-CoV-2 pandemic temporarily reduced the numbers of people in prisons while exacerbating racial disparities in their populations, increasing the percentage of incarcerated people who are Black. Less is known about jail populations, including disparate impacts by race. We used web-scraped data from the publicly available rosters of North Carolina (NC) jails to examine their population sizes, admission and release rates, and racial composition during 2020-2022. Data were available from 45 jails (of 93 total in NC) representing 194,230 incarcerations. Relative to pre-pandemic (January-February 2020) sizes, populations decreased to a median of 66% (IQR = 60%-72%) in March-April 2020 as releases outpaced admissions (median 124 releases per 100 admissions per week) and rebounded to a median of 86% (IQR = 81%-97%) by March 2022. Black, Indigenous, and People of Color (BIPOC) were over-represented in jail incarcerations (44%) relative to the general population (26%), with the rate of incarceration for BIPOC increasing from 2.4 to 3.0 times the rate for White people in the early pandemic period. Overall, the initial decreases to jail populations resulted from high release rates and were not sustained. Consistent with observations in prison populations, pandemic-related disruptions to the criminal legal system may have worsened racial disparities in jail incarceration rates and the resulting percentage of BIPOC in jail populations.
Vicariously experienced racism-related stress is a key social determinant of child depression, yet national data on racial/ethnic and income disparities in this relationship are limited. This study tested whether non-Hispanic Black (NHB) children and children from lower income households experience more frequent depression linked to parent-experienced racism-related stress than other groups. In the 2023 National Health Interview Survey (NHIS), 1712 parents of racial/ethnic minority children aged 5-17 years (weighted N = 37.7 million) reported their own experiences of racism-related stress and their child's depression. Multivariable ordinal weighted least squares regression assessed associations between parent-experienced racism-related stress and child depression, with moderation by income and race/ethnicity. Parent-experienced racism-related stress was significantly associated with more frequent child depression. This relationship was stronger among children from middle- and lowest-income households and among NHB children compared with Hispanic children. Children from lower income families and NHB children are more vulnerable to depression associated with parental racism-related stress. These findings highlight the need to consider both direct and vicarious racism-related stressors in child mental health research and interventions.
Parastomal hernia repair is technically complex and associated with substantial morbidity, yet disparities in outcomes among racial groups have not been evaluated. Identifying inequalities in this population may inform strategies to improve access and perioperative care. The ACS-NSQIP database from 2013 to 2023 was queried for adults undergoing parastomal hernia repair. Demographics, comorbidities, and operative details were compared among White patients, Black patients, and Hispanic patients. Primary outcomes included 30-day morbidity, infectious complications, and length of stay (LOS). Multivariable logistic and linear regression models were performed using a two step forward selection model adjusting for comorbidities and surgical details. A total of 3,513 patients were included (White 85, Black 8, Hispanic 7%). Black patients had higher unadjusted rates of morbidity (38 vs 30 White, 32% Hispanic; p = 0.023), serious complications (20 vs 13% white vs 13% Hispanic, p = 0.008), infectious complications (20 vs 13 White, 15% Hispanic; p = 0.004), and longer median LOS (6 vs 5 days White, 6 days Hispanic; p = 0.005). On multivariable analysis, Black race remained independently associated with increased odds of overall morbidity (aOR 1.31, 95% CI 1.01-1.70; p = 0.043), serious complications (aOR 1.65; CI 1.15-2.34, p = 0.006), and infectious complications (OR 1.44, 95% CI 1.04-1.98, p = 0.026) compared to white patients. This is the first national study to characterize racial disparities in parastomal hernia repair. Black patients experienced higher morbidity, infectious complications, and length of stay compared to White patients, while Hispanic patients did not differ from White patients. Disparities were emphasized in emergent cases, suggesting that barriers to timely elective repair possible drive imbalances in parastomal hernia repair, warranting interventions for underserved populations, with early referral, equal access, and tailored perioperative support.
Black women have twice the endometrial cancer mortality of White women, and studies suggest that differences in ultrasound diagnostic accuracy partially contribute to this disparity. To evaluate racial and ethnic differences in the diagnostic performance of transvaginal ultrasound for detecting endometrial neoplasia. A prospective cohort study of 1833 women aged 50 years or older at risk of endometrial neoplasia, conducted at a large urban academic medical center from February 2014 to August 2022, with follow-up through March 2023. The statistical analyses were conducted from March 2024 to December 2025. Women underwent endometrial assessment via transvaginal ultrasound followed by sonohysterogram-directed biopsy and follow-up observation to establish final outcome. Assessment of transvaginal ultrasound diagnostic performance for detecting endometrial cancer and hyperplasia across racial and ethnic groups, measured by: (1) completion rate (endometrial accessibility) and (2) accuracy of completed scans. To assess any association with fibroids, analyses were repeated after excluding women with fibroids. Subgroup analyses were conducted among women with endometrial cancer, those with postmenopausal bleeding, and those without prior exposure to estrogen or tamoxifen. A total of 1833 women met inclusion criteria (mean [SD] age, 60.3 [8.1] years). Most were postmenopausal (1218 women [87.4%]), and 832 (45.4%) were Black, 705 (38.5%) were Hispanic, and 253 (13.8%) were White. Black women had significantly lower completion rates (adequate endometrial visibility) for transvaginal ultrasound compared with White women (75.7% vs 88.9%; relative risk, 0.85; 95% CI, 0.80-0.90; P < .001). Accuracy of completed transvaginal ultrasound was slightly lower among Black women compared with White women (sensitivity, 96.3%; 95% CI, 91.3%-100% vs 100%; negative predictive value, 97.9%; 95% CI, 95.0%-100% vs 100%). After excluding women with fibroids, differences in completion and accuracy between Black and White women disappeared. Similar findings were observed in subgroup analyses of women with a final diagnosis of endometrial cancer, those presenting with postmenopausal bleeding, and those without prior exposure to estrogen or tamoxifen. In this cohort study of a diverse population of women, ultrasound completion rates were lower among Black women, primarily due to fibroids impairing endometrial visibility. Nevertheless, transvaginal sonography demonstrated a 76% completion rate and retained excellent ability to exclude cancer in Black women, regardless of fibroid presence.
Although school quality is associated with greater educational attainment and better health in population-wide studies, it remains unclear whether these effects are experienced similarly across racial and ethnic groups in the USA. To explore this question, we used the nationally representative National Longitudinal Study of Adolescent to Adult Health to examine the association between four individual school quality indicators (student promotion rates, teacher retention, average daily attendance, parental involvement) in Wave I (grades 7-12th, age 12-19), with adult health outcomes in Wave V (age 32-42), stratified by race/ethnicity (White, Black, Latinx). The primary outcomes were self-rated health and depressive symptoms. Regression models adjusted for baseline health, individual, family, and school characteristics. Of 10,724 participants, approximately 50% identified as female, 63% White, 21% Black, 17% Latinx. School quality indicators were not statistically associated with adult depressive symptoms for White participants. Teacher retention was unrelated to self-rated health for any group, but was associated with greater depression symptoms in adulthood for Black and Latinx participants (β = 0.42-point higher score per 1 SD increase in teacher retention, 95% CI [0.153, 0.690], p = 0.002; β = 0.23-point higher score per 1 SD increase in teacher retention, 95% CI [0.003, 0.466], p = 0.047, respectively). Some conventional school quality indicators were associated with worse adult mental health for Black and Latinx participants. The findings suggest that more research is needed to understand what aspects of school quality may best promote life course health development for minoritized groups.
Racial and ethnic disparities in percutaneous coronary intervention (PCI) persist despite major advances in contemporary acute coronary syndrome (ACS) care and represent an important challenge in achieving equitable cardiovascular outcomes. In this State-of-the-Art Review, we propose a PCI care-continuum framework demonstrating how inequities emerge sequentially across multiple stages of care, including baseline cardiovascular risk, prehospital triage and emergency medical services access, invasive coronary angiography and PCI decision-making, procedural optimization, and post-procedural outcomes. Contemporary evidence from randomized trials, large PCI registries, administrative datasets, and systems-of-care analyses demonstrates that Black, Hispanic, and certain Asian populations experience higher cardiometabolic burden, delayed presentation, reduced access to invasive management, and persistent disparities in clinical outcomes compared with White populations. These inequities are further amplified by structural determinants including residential segregation, unequal distribution of PCI-capable facilities, insurance-related barriers, and variation in healthcare delivery processes. Addressing these disparities requires coordinated multi-level interventions focused on standardized prehospital pathways, equitable access to invasive care, reduction of structural barriers, and implementation of equity-focused quality metrics. Improving PCI equity will require health systems to move beyond procedural excellence alone and address disparities across the entire cardiovascular care pathway.
Gender-sexuality alliances (GSAs) provide critical support for 2SLGBTQ+ youth, yet the role of advisors-particularly in their self-efficacy to address race-, ethnicity-, and immigration-related issues, including how these intersect with sexual and gender identity, a construct we term racial-ethnic, immigration, and intersectional self-efficacy (REISE)-remains understudied. This study examined (a) which advisor-, GSA-, and school-related factors are associated with advisors' REISE, and (b) how this efficacy relates to youth members' socioemotional experiences. Data were collected from 627 GSA members at three time points and from 64 advisors at one time point from 51 GSAs in Massachusetts, New York City, and California. Advisors' REISE was associated with personal, advisor-related, contextual, GSA-related, and school-related factors, and with GSA youth members' reported school experiences. Advisors of color and those who felt more confident in supporting GSA members-particularly regarding 2SLGBTQ+ issues-reported higher REISE. Higher REISE was also observed in advisors of GSAs with a greater proportion of members of color, in schools offering culturally responsive curricula and race/ethnicity-focused events, and of GSAs characterized by open and inclusive climates. The extent to which advisors felt more efficacious was unrelated to how long they had served as a GSA advisor or to the frequency of GSA meetings. Moreover, random-intercept multilevel models showed that members with advisors who reported higher REISE perceived their GSAs and advisors to be more supportive at that same time point. Beyond the GSA itself, advisors' higher REISE also predicted higher positive affect and lower victimization among members, with these benefits lasting for several months. These associations did not vary by GSA members' race/ethnicity or victimization, suggesting that advisor REISE may serve as a universal protective resource for diverse youth.
In a nationally representative US survey, markers of household poverty explained up to 38% and 18% of the excess risk of upper respiratory infection (the predominant trigger of asthma exacerbations) among Black and Mexican American children with asthma, respectively.
The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019. The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Bureau Division, state and local levels. Geographic patterns were visualized with maps and plots. PSG rates were modeled by Rural-Urban Commuting Area (RUCA) classification and race-ethnicity composition at the ZIP code level. Data quality concerns resulted in exclusion of Rhode Island and Vermont. There were 478,568 PSGs identified among eligible children in the claims data, resulting in a national rate of 50.1 PSGs per 10,000 Medicaid enrolled children per year. There was a fourfold difference in rates at the state level, ranging from 23 PSGs per 10,000 person-years (Kansas) to 93 per 10,000 (Michigan). New England and the Great Lakes regions had the highest local levels, while the Pacific and West South Central divisions had the lowest. ZIP codes with higher percent White population (> 90%) and those in metropolitan areas had the highest PSG rates. This descriptive study of pediatric PSG utilization in the USA can inform efforts to provide more equitable access to PSG and refinement of practice guidelines for referral to PSG. Polysomnography provides a definitive diagnosis for obstructive sleep apnea and other sleep problems. Although there are concerns about variation in access, the utilization patterns of pediatric polysomnography in the USA is unknown. At the state level, polysomnography among children enrolled in Medicaid exhibited a fourfold difference in rates. ZIP codes in metropolitan areas and those with a high proportion of White non-Hispanic population had the highest utilization rates. These data can inform consensus among professional groups and healthcare policy researchers to improve equitable utilization.
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Pediatricians play an essential role in breastfeeding care and are uniquely positioned to help reduce racial disparities in breastfeeding. Evidence-based solutions include partnerships between pediatricians and community health workers, implementation of culturally centered hospital practices, securing fair payment for lactation services and supplies, practices that discourage commercial milk formula marketing in clinical settings, and ongoing learning about breastfeeding in different cultures. Pediatricians can avail themselves of resources that may elevate their role in achieving equitable breastfeeding care throughout the US.
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Native Hawaiian and Pacific Islander (NHPI) individuals are an underrepresented population with a disproportionate burden of ESKD. Many NHPI individuals are of multiple races, yet studies frequently aggregate them into other racial and ethnic groups, masking important differences in outcomes. We conducted a retrospective cohort study of all adult, kidney-only, waitlisted candidates in the Organ Procurement and Transplantation Network (OPTN) dataset (December 2014 - December 2022) comparing NHPI individuals, including multiracial individuals with NHPI ancestry, with White and other racial and ethnic groups on their waitlist and transplant outcomes. Waiting time to transplantation was assessed using competing risk analyses, accounting for waitlist removal. Death-censored graft survival and transplant survival were assessed using the Kaplan-Meier method and Cox proportional hazards model. Among 313,033 candidates, 1800 were of NHPI ancestry (1521 single race, 279 multiracial). NHPI candidates were younger, had higher body mass index, and were more likely to have diabetes. Most were listed in OPTN regions 5 (50%) and 6 (25%). Compared to White and other racial and ethnic groups, NHPI candidates were more likely to be inactive on the waitlist (NHPI candidates: 19% vs. White candidates: 12%; P<0.001). Taking into account the competing risk of waitlist removal, NHPI had longer waiting time to transplant (estimated time to transplant 50% of the waitlisted NHPI candidates: 9.9 [8.5, 12.3] years vs. waitlisted White candidates: 5.7 [5.7, 5.8] years; P<0.001), and one the lowest rates of being transplanted (cause-specific HR 0.60 [0.55, 0.65], P<0.001 in reference to White candidates). Once transplanted, NHPI recipients had similar graft and patient survival compared with White recipients. NHPI individuals demonstrated unique demographic and geographic characteristics associated with reduced transplant access but comparable post-transplant outcomes. Further work is needed to improve transplant access in this unique and underrepresented population.
Social distancing and health care rationing during the COVID-19 pandemic exacerbated cancer disparities. It is important to understand the impact of ethnic representation in clinical trials. We investigated how COVID-19 disease influenced racial/ethnic representation in radiation oncology (RO) trials in a large integrated academic satellite, hypothesizing that the pandemic significantly affected minority participation. We conducted an institutional review board-approved retrospective analysis of patients 18 years and older who enrolled in RO trials from March 2018 to August 2024 in a five-campus integrated academic satellite. Chi-square testing was used to compare variables across the COVID-19 periods. Statistical significance was considered for P values <.05, and statistical trends were considered for P values of .05-.1. A total of 1,702 patients were enrolled in RO trials: 531 (31.2%) pre-COVID-19, 843 (49.5%) during COVID-19, and 328 (19.3%) post-COVID-19. Racial/ethnic makeup was 79% White and 21% non-White. There was an increase in minority participation during COVID-19 (147 [17.5%]) compared with pre-COVID-19 (71 [12.5%]) and post-COVID-19 (46 [14.0%]) although this increase was not statistically significant (P = .06). The average distance from participants' homes to the treatment centers was significantly lower during COVID-19 (122 miles) compared with pre-COVID-19 (174 miles) and post-COVID-19 (187 miles; P < .01). Despite abundant literature suggesting the exacerbation of racial disparities in trials during COVID-19, we observed an increase in minority representation. Travel restrictions and regionally focused recruitment might have played a role. Future research should explore strategies focused on expanding outreach initiatives and integrating telehealth and patient education to enhance participation. By prioritizing equitable access to trials, we can improve cancer care and enhance the distribution of benefits and risks and the generalizability of research.
Children and youth in immigrant families benefit from the health immigrant paradox, in which immigrants display a mental health advantage over U.S.-born Americans in spite of increased socioeconomic risk. This study examined whether hostile state immigration policy contexts are associated with a weakening of this advantage and whether racial spillover effects are present for racially and ethnically minoritized youth beyond immigration background. Data were drawn from the 2023 National Survey of Children's Health and the 2022 Immigration Policy Climate index. Survey-weighted logistic regression models indicated that children with immigrant parents demonstrated a mental health advantage relative to children with U.S.-born parents. State-level immigration policy contexts moderated this association, such that children with immigrant parents experienced a modest but statistically significant increase in the likelihood of mental health problems as policy hostility increased compared to nonimmigrant children. Evidence for a racial spillover effect was present for Asian and Pacific Islander children who experienced a modest increase in odds of mental health issues as policy hostility increased, regardless of their own immigration status. Overall, these findings suggest the presence of the healthy immigrant advantage for child and youth mental health while complicating this narrative by finding that this advantage modestly decreases as state-level immigration policy hostility increases. Findings highlight the need for a more contextualized understanding of child mental health and for greater attention to political environments in clinical mental health care. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Advances in breast cancer care have improved survival, making it vital to assess long-term patient perceptions and well-being post-breast reconstruction. Although evaluating patient-reported outcomes (PRO's) has become increasingly crucial to breast reconstruction care, differences among racial groups have not been studied extensively. A prospective cohort study including BREAST-Q survey results of 234 patient after breast reconstruction found significant differences between racial groups for distinct outcome categories of "Confidence," "Sensitivity," and "Sexual Well-being" across various time points. However, no differences were found in the choice of reconstructive method or outcome domain "How Clothes Fit." There are distinct racial disparities in PROs post-breast reconstruction; however, these differences did not extend to the choice of the reconstruction method. These findings highlight the need to address potential barriers to ensure equitable representation of diverse patient populations in PRO assessments.
PurposeTo examine demographic, socioeconomic, and health related correlates of the combined behavioral pattern of high screen time and physical inactivity among Texas high school students.DesignCross-sectional study using Youth Risk Behavior Survey data.SettingTexas high schools.Sample32 227 students in grades 9-12 from 2001-2023.MeasuresScreen time was dichotomized as high (≥3 hours/day) vs low (<3 hours/day). Physical activity was categorized as low (0-3 days/week) vs high (>3 days/week of ≥60 minutes/day). Demographic, body mass index, mental health, substance use, and dietary variables were assessed.AnalysisWeighted prevalence estimates and multivariable logistic regression models were used, adjusting for potential confounders.ResultsApproximately 25% of students exhibited both high screen time and low physical activity. Female students had 75% higher odds (95% CI: 1.54-2.00) of this behavioral combination compared to males. Black, Hispanic, and Other/Multiracial students had 2-3 times higher odds compared to White students. Students perceiving themselves as very overweight had 2.5 times higher odds of both high screen time and low physical activity (95% CI: 1.82-3.50) compared to those who perceived themselves as having about the right weight. Depression and drug use were associated with increased odds, while fruit and vegetable consumption showed protective effects.ConclusionComprehensive, culturally tailored interventions targeting both behaviors simultaneously are needed, particularly among underrepresented racial/ethnic groups and students with mental health challenges.
Little is known about dementia incidence and its risk factors in people older than 90 years, particularly in heterogeneous populations. We evaluated dementia incidence and examined the associations of sex, race and ethnicity, and APOE genotype with dementia risk after age 90 years using data from LifeAfter90, an ongoing prospective cohort study. LifeAfter90 is a prospective cohort study that enrolled Kaiser Permanente Northern California members, who were at least 90 years old, from the San Francisco Bay Area and Sacramento, USA. Participants were clinically evaluated every 6 months from July 17, 2018, to Nov 9, 2024, in person or remotely. Incident all-cause dementia was diagnosed by a combination of physician assessment, Clinical Dementia Rating, and a Functional Activities Questionnaire. Sex, race and ethnicity, and education were captured during in-person assessments; APOE genotyping was performed using salivary DNA. We estimated age-standardised dementia incidence rates and used age-adjusted Cox and Fine-Gray competing-risk models to study the association between sex, race and ethnicity, APOE genotype, and dementia. The Fine-Gray subdistribution hazard ratio (sHR) models treated death as a competing risk. Models were adjusted for age (time-scale) and individuals were followed until dementia diagnosis or end of follow-up. Of 1120 individuals initially available, 96 with prevalent dementia and 219 with only one clinical evaluation were excluded; 805 participants were included. Median age was 92 years (range 90-103), 494 (61%) were female, 209 (26%) Asian, 191 (24%) African American or Black, 157 (20%) Hispanic or Latinx, 228 (28%) White, and 20 (2%) from other racial or ethnic groups; 413 had APOE data. During mean follow-up of 2 years (SD 1·7), 138 (17%) developed dementia and 295 (37%) died. The age-standardised incidence rate was 116·82 cases per 1000 person-years (95% CI 93·69-139·96). In Fine-Gray models, dementia risk was higher in female than in male participants (subdistribution hazard ratio [sHR] 1·89, 95% CI 1·30-2·76) and Black than Asian participants (sHR 1·75, 1·07-2·88), lower in APOE ε2 carriers than in non-carriers (sHR 0·39, 0·17-0·88), and not significantly higher in APOE ε4 carriers than in non-carriers (sHR 1·51, 0·92-2·47). No significant differences were found by education. Ethnoracial disparities in dementia risk appear to persist after 90 years, and the association between APOE ε4 and dementia might differ by sex. These findings reinforce the importance of dementia screening and surveillance, even among people with exceptional longevity. National Institute on Aging.