Racially/ethnic minoritised people with multiple long-term conditions (MLTCs) face inequalities across different dimensions of healthcare, yet little is known about how to improve their healthcare outcomes. This systematic review and narrative synthesis seeks to identify and describe healthcare interventions designed to improve health outcomes for racially/ethnic minoritised people with MLTCs and identify areas for further exploration. Given that primary care is considered the ideal setting to manage MLTCs, we focus on interventions targeted at healthcare providers/systems. We searched 9 bibliographic databases and one website and identified 6566 studies, 15 of which met the inclusion criteria. Given the heterogeneity of interventions, health conditions and outcomes of interest, we conducted a narrative synthesis. The studies were conducted in the US (n = 13), Canada (n = 1) and Australia (n = 1). Most studies recruited racially/ethnic minoritised people mainly of African American and Hispanic/Latinx descent with comorbid Depression and a physical condition (Diabetes (n = 3), Hypertension (n = 3), Cancer (n = 2). Depression/mental health outcomes, patient-reported outcomes, clinical outcomes, medication use, and adherence were the most frequently assessed outcomes. Few studies reported on provider-related outcomes. All interventions made socio-cultural adaptations, thereby, promoting equitable and inclusive care. Community actors/assets were considered key to improving health outcomes. Of the 15 interventions, five resulted in statistically significant improvements in all outcomes of interest and nine resulted in improvements in some outcomes. This review illustrates the feasibility of socio-culturally adapted interventions, many of which successfully integrate physical and mental healthcare, delivered through multidisciplinary teams working collaboratively, and leveraging community assets to improve health outcomes for racially/ethnic minoritised people with MLTCs. Future research is needed to assess the impact of these interventions beyond North America and Australia. Studies are also required to identify provider-related outcomes with the potential to improve outcomes for racially/ethnic minoritised people with MLTCs.
Sexual and gender minority youth of color (SGM YOC) face compounded mental health disparities due to oppression experienced at the intersection of racism, cissexism, and heterosexism. Parental responses to youth's sexual orientation and gender identity (SOGI) are critical in shaping youth mental health outcomes, yet prior research has often simplified these responses into a unidimensional acceptance-rejection continuum. Using data from the 2022 LGBTQ National Teen Survey (n = 3187 SGM YOC), this study challenged such an oversimplified conceptualization by exploring heterogeneous patterns of parental responses to children's SOGI among SGM YOC. Further, we also examined the distinct implications of each identified profile for SGM YOC's mental health problems and how the association between intersectional microaggressions and mental health problems might vary across the identified profiles. Three distinct SOGI-specific parental response profiles were found: High Rejection Low Acceptance Response (24.10%), Low Rejection Low Acceptance Response (50.30%), and Low Rejection High Acceptance Response (25.60%). Profile membership varied by race/ethnicity, sex assigned at birth, gender identity, sexual orientation, and caregiver education level. Youth in the High Rejection Low Acceptance Response profile reported significantly higher levels of mental health problems compared with those in the Low Rejection Low Acceptance Response and Low Rejection High Acceptance Response profiles. SOGI-specific parental response profile membership moderated the association between intersectional microaggressions and mental health problems. Intersectional microaggressions were more strongly associated with mental health problems among youth in the Low Rejection Low Acceptance Response profile than among those in the High Rejection Low Acceptance Response profile, with higher overall mental health problems in the latter profile. By identifying diverse patterns of SOGI-specific parental responses and the differential consequences for understanding how SGM YOC's intersectional minority stress relates to mental well-being, our findings underscore the importance of culturally responsive interventions that engage parental figures as active agents of affirmation, support, and socialization, ultimately fostering SGM YOC's positive development amid intersecting systems of oppression.
Telehealth may expand care access by reducing transportation barriers, yet little is known the extent to which cognitive difficulties impact telehealth usage. We analyzed cross-sectional data from the National Health Interview Survey (NHIS) from 2020 to 2023. Multivariate logistic regression assessed the association between cognitive difficulty and telehealth utilization, controlling for age, sex, race/ethnicity, education, insurance, and year. Among 72,611 adults (mean age 54.6 years ± 18.5 years, 57.0 % female, 11.1 % African American), telehealth use was higher among individuals with significant cognitive difficulty (51.1 %) than those without (32.7 %) (OR = 2.41, 95 % CI: 2.16-2.69). Age modified this association (interaction p < 0.001), with a weaker effect among adults ≥ 50 (OR = 1.33, 95 % CI: 1.26-1.40) than among younger adults (OR = 1.71, 95 % CI: 1.63-1.80). Participants with greater cognitive difficulty were more likely to use telehealth, though the association was attenuated in adults > 50 years.
Medical students face elevated health risks due to academic stress and a sedentary lifestyle. Given the geographical and ethnic diversity of Southwest China, it is particularly important to understand the factors associated with physical fitness and bone health in this population. However, evidence regarding the physical fitness and bone health of medical students in this region remains limited. This cross-sectional study included 334 medical students (99 males and 235 females; aged 17-24 years) from Southwest China, comprising both Han and ethnic minority students. Body mass index (BMI) was calculated, a composite physical fitness index (PFI) was derived from six standardized fitness tests, and calcaneal bone mineral density (BMD) was assessed using quantitative ultrasound. Gender-stratified analyses, partial correlations adjusted for age and BMI, and multiple regression models were performed. Male students showed higher prevalences of overweight/obesity (18.18% vs. 5.96%) and osteopenia (6.06% vs. 2.98%) than females. A nonlinear association was observed between BMI and physical fitness, with normal-weight students demonstrating the highest PFI. No significant differences were observed between Han and ethnic minority students in physical fitness or bone health indicators. Muscle strength emerged as the strongest predictor of BMD, with bent-leg sit-ups predicting BMD in females (B = 0.290, p = 0.020) and pull-ups predicting BMD in males (B = 0.543, p = 0.014). Physical fitness and bone health differed according to sex and BMI status among medical students in Southwest China. Muscle strength was identified as the most important modifiable factor associated with BMD. These findings support the development of sex-specific and culturally appropriate health promotion strategies to improve musculoskeletal health among ethnically diverse university populations.
While family income and neighborhood disadvantage have been associated with adolescent mental health, less is known about their independent associations with distinct, group-based patterns of change. Moreover, little is known about how school environments are associated with such mental health trajectory patterns, and if they serve as independent promotive factors or are protective factors that mitigate risk. Data come from the Adolescent Brain Cognitive Development StudySM(ABCD study®; n = 9769; baseline through year 2; ages 9-13). Internalizing and externalizing behaviors were measured with the Child Behavior Checklist. Growth mixture modeling was utilized to identify subgroups with distinct mental health trajectories, and logistic regression was used to examine the association between family income, neighborhood environment and trajectory group membership, and moderation by baseline school and school district characteristics, controlling for age, sex, race/ethnicity, and parental education. Two trajectory classes were identified for internalizing (91%; low-decreasing, 9%; high-increasing) and externalizing behaviors (92%; low-decreasing, 8%; high-stable). Lower family income was associated with a high-increasing trajectory pattern of internalizing and a high-stable pattern of externalizing behaviors. A more positive school climate predicted belonging to the low-decreasing trajectory group for internalizing and externalizing behaviors, though there was no evidence of moderation. Low family income, but not neighborhood disadvantage, was a risk factor for trajectories of internalizing and externalizing behavior elevated within a clinical range that persisted from age 9 through early adolescence. However, a positive school climate was a promotive, rather than a protective, factor for internalizing and externalizing trajectories. Supporting families with resources and enhancing the school context may improve adolescent mental health.
Health outcomes in children and young people are known to vary by ethnicity and socioeconomic position. In juvenile idiopathic arthritis (JIA), it is unclear whether this relates to differential changes following one of the most common treatments, TNF-inhibitors (TNFi). This study investigated these factors, disease activity and treatment persistence following initial TNFi therapy in patients with JIA in the UK. Patients with non-systemic JIA in the UK JIA Biologic Register starting their first TNFi biologic were included. Outcomes included change in disease activity between start of TNFi and 6 months, measured by JADAS-71.Multivariable linear regression was used to assess the association between ethnicity or socioeconomic position and change in JADAS. Treatment persistence was analysed using Kaplan-Meier estimates. Cox proportional hazards models compared TNFi drug persistence by ethnic group and by socioeconomic position. A total of 1,641 patients were included; 67% female, 90% White ethnic group (6% Asian, 2% Black, 2% Mixed), 25% in the most deprived socioeconomic group. JADAS-71 improved for all ethnic and socioeconomic groups by 6 months, with no difference in improvement by group.The proportion of patients remaining on TNFi at 12 months (67%) and the likelihood of stopping was similar between all ethnic and socioeconomic groups. Outcomes following TNFi initiation are similar between ethnic and socioeconomic groups. Based on the results of this study, ethnicity and socioeconomic position do not appear to be associated with differential change in disease activity, and there is no evidence that the effects of socioeconomic position are moderated by ethnicity or vice versa.
Cardiovascular disease (CVD) remains the leading cause of death among women, yet awareness has declined significantly among women of reproductive age. Risk underestimation may impede prevention efforts during this critical life stage. The objectives of the study were to evaluate concordance between perceived CVD and stroke risk and LE8-defined cardiovascular health status and to examine predictors of risk-cardiovascular health discordance among women of reproductive age. Cross-sectional study of 139 women aged 18 to 50 years in the Baltimore/Washington DC area. Participants assessed perceived CVD and stroke risk using 7-point Likert scales. Discordance was defined by cross-classifying perceived risk relative to peers with LE8-defined cardiovascular health status. Multivariable logistic regression examined predictors of underestimation. Among 139 women (mean age 32.01 years), over half underestimated both CVD (56.8%) and stroke (58.3%) risk. In multivariable models, racial/ethnic minority status was significantly associated with underestimation of both CVD (OR: 3.70; 95% CI: 1.58-8.68) and stroke risk (OR: 3.29; 95% CI: 1.44-7.51), as was medium polysocial risk (CVD: OR: 2.72; 95% CI: 1.02-7.24; stroke: OR: 2.70; 95% CI: 1.04-7.02). Low cardiovascular health literacy (OR: 5.91; 95% CI: 1.05-33.31) and older reproductive age (≥32 years; OR: 2.26; 95% CI: 1.02-5.00) were additionally associated with CVD risk underestimation. CVD and stroke risk underestimation is prevalent among women of reproductive age with marked racial and social disparities. Targeted, culturally sensitive risk communication strategies are needed to improve CVD and stroke risk perception accuracy.
Social and structural determinants of health (SSDH) are key drivers of disparities in cognitive aging and dementia risk, yet their collection in aging and dementia research remains inconsistent. We examined SSDH data collection practices across Canadian longitudinal cohorts of aging and dementia, aiming to identify which SSDH are collected and how they are operationalized. We conducted an environmental scan using three sources: (1) literature databases (Cochrane, Embase, Medline, PubMed, and Web of Science), 2) grey literature (e.g., Alzheimer Society of Canada's website), and 3) key informants. We included Canadian longitudinal cohorts of community-dwelling older adults that assessed at least one cognitive or dementia-related outcome, including seven key cohorts previously identified by our group. For each study, we extracted information from data collection instruments on whether specific SSDH were assessed, and which tools were used. From 1043 non-duplicated articles identified through database searches, fourteen unique cohorts met inclusion criteria, eleven of which provided data collection instruments. Five additional cohorts were identified from other sources, and together with 7 pre-identified key cohorts, yielded 23 included cohorts. Disability-related measures and ethnicity- and culture-related constructs were among the most comprehensively assessed domains, whereas literacy, environmental context, and economic conditions were among the least frequently assessed. SSDH that shape dementia risk and brain resilience, many modifiable at the community and policy levels, remain unevenly collected in Canadian aging and dementia cohorts. Strengthening and harmonizing SSDH measurement is a critical step toward equitable dementia prevention and reducing health disparities.
Use of continuous glucose monitors (CGM) improves glucose control and reduces hypoglycemia, but data are lacking for its possible role in reducing other serious clinical events. We conducted a target trial emulation (TTE) analysis in patients with type 1 diabetes (T1D) comparing all-cause mortality between CGM users and non-CGM users using observational health records from the Veterans Health Administration. Participants included adult T1D patients who had their second endocrine visit (time zero) during years 2017-2020. Each patient was cloned to both treatment strategies but was censored if observed care deviated from the assigned strategy (artificial censoring) during the 6-month grace period. Inverse probability weights accounted for artificial censoring, and negative outcomes examined residual confounding. Of the 8,423 individuals initially assigned to both treatment groups, 1,039 were prescribed CGM devices, while 7,399 were not censored or assigned CGM during the grace period. Mortality was lower with CGM initiation, yielding adjusted risk ratios of 0.90 (95% CI 0.71-0.97) to 0.84 (CI 0.72-0.97) over 1-4 years of follow-up. Similar risk ratios were seen with different grace periods (3 or 9 months). Those age >65 years or not on insulin pumps appeared to have greater benefit, but effects did not vary by HbA1c, race or ethnicity, or frailty. Risk ratios did not differ between groups for incident nondiabetes outcomes, including outpatient or inpatient musculoskeletal or gastrointestinal conditions. In this large TTE of CGM initiation in older T1D patients, CGM use was associated with reduced risk for all-cause mortality.
This study aims to investigate the relationship between political ideology and the awareness of human papillomavirus (HPV) and the HPV vaccine and the interaction with sex and race/ethnicity. This cross-sectional study is a secondary analysis of Health Information National Trends Survey data, based on responses from 3113 American households. The analysis used listwise deletion. Data included awareness of HPV and the HPV vaccine, political ideology, and demographic characteristics. Multivariable logistic regression models with interaction terms were used to examine the associations between political ideology, sex, race/ethnicity, and HPV awareness outcomes. Moderate and conservative populations were less likely to be aware of HPV and the HPV vaccine compared to liberal population. However, these differences were only observed among males. Black, Hispanic, Asian, and other populations were less aware of HPV and the HPV vaccine than the White populations. Younger age, higher educational level, and higher income were associated with awareness. The results of this study highlight the need for tailored outreach strategies for conservative males and racial/ethnic minority populations by tailoring approaches to increase awareness of the dangers of HPV and the benefits of vaccination. Nurses should play a critical role in delivering culturally appropriate education and strong vaccine recommendations to improve awareness and uptake by targeting conservative males and underserved racial and ethnic minority groups who consistently demonstrate lower levels of HPV-related knowledge.
Lung cancer screening (LCS) decreases lung cancer mortality, but patients must receive timely follow-up to realize these benefits. Unfortunately, real-world LCS follow-up adherence remains unacceptably low. LCS centralization into dedicated care teams and tracking resources (compared to decentralized, individual provider-led screening) may be a promising strategy for improving LCS adherence. However, it remains unclear if centralization's benefits are similar across patient demographics, and whether hybrid or fully-centralized programs' performance differ. To investigate if LCS centralization is associated with increased adherence to follow-up by comparing decentralized, hybrid, and fully-centralized programs, and assess if adherence varies among patient subgroups. We performed a retrospective, nationwide cohort study using Veterans Health Administration data via a difference-in-differences analysis of quarterly facility-level LCS adherence rates. We included Veterans aged 55-80 years old who entered screening from October 1, 2015 through September 30, 2021. The primary exposure was facility LCS program centralization status at time of Veteran entry into screening. The primary outcome was adherence to first follow-up recommendations for the initial screening study based on Lung CT Screening Reporting & Data System (Lung-RADS) score. 146,321 Veterans were analyzed. Average LCS adherence overall was 58.5%. Compared to decentralized programs, both hybrid and fully-centralized programs were associated with improved adherence, (hybrid programs OR 1.16 [95% CI 1.11, 1.22]; fully-centralized programs OR 1.13 [1.07, 1.20]) in models that additionally adjusted for race & ethnicity, sex, age, out-of-pocket cost, residential rurality, Area Deprivation Index, and medical comorbidity. There was no statistically significant difference between hybrid and fully-centralized programs. In subgroup analyses, improved adherence at centralized programs was primarily associated with Lung-RADS 1 & 2 scans. Compared with decentralized programs, Fully-centralized programs were associated with improved adherence for Black Veterans, hybrid programs for rural Veterans, and both for white Veterans and urban Veterans. However, certain sociodemographic groups had lower odds of adherence regardless of program centralization. Our large, retrospective nationwide cohort study suggests centralized LCS programs are associated with comparably higher odds of LCS adherence compared to decentralized programs, increasing the likelihood patients benefit from screening. However, adherence rates, even at centralized facilities, remain suboptimal.
This cross-sectional study estimates prevalence of suicidal thoughts and behaviors, mental health treatment rates, and racial and ethnic differences among transition-age youth (aged 18-25 years).
The association between social deprivation and cardiac valvular procedural outcomes is not well established. We sought to distinguish the relationship between social deprivation and outcomes after transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR). Demographics, patient comorbidities, procedural details, and outcomes for adults undergoing TAVR and SAVR between April 2017 and March 2022 were obtained from clinical and administrative databases and linked to neighbourhood-level measures of social deprivation using the Ontario Marginalization Index in Ontario, Canada. Our outcomes were 30-day mortality, 30-day readmission, 1-year mortality, and 1-year readmission. Separate Cox proportional hazard models for postprocedural mortality and cause-specific hazard models for postprocedural readmission were used to determine the association between social deprivation and postprocedural outcomes after TAVR vs SAVR. We identified 6218 TAVR procedures and 3342 isolated SAVR procedures within our study period. After multivariable adjustment, TAVR was associated with lower 30-day mortality (hazard ratio [HR] 0.58; 95% confidence interval [CI] [0.37, 0.92]; P = 0.02), lower 30-day readmission rates (HR 0.75; 95% CI [0.63, 0.89]; P = 0.001), and a higher 1-year readmission rate (HR 1.14; 95% CI [1.02, 1.27]; P = 0.01), compared to SAVR. When the 3 index domains by treatment interactions were included in the analysis, the associations between TAVR and SAVR and these outcomes were not modified by the degree of neighbourhood social deprivation. TAVR is associated with lower 30-day mortality and 30-day readmission rates and higher 1-year readmission compared to SAVR. These associations were not modified by markers of social deprivation. Le lien entre la précarité sociale et les résultats cliniques des interventions valvulaires cardiaques n'est pas clairement établi. Nous avons cherché à préciser la relation entre la précarité sociale et les résultats cliniques après un remplacement valvulaire aortique par cathéter (RVAC) par rapport à une chirurgie de remplacement valvulaire aortique. Les données démographiques, des comorbidités des patients, des détails des interventions et des résultats pour des patients adultes ayant subi un RVAC ou une chirurgie de remplacement valvulaire aortique entre avril 2017 et mars 2022 ont été obtenus à partir de bases de données cliniques et administratives, puis couplées à des mesures de la précarité sociale à l'échelle du quartier, à l'aide de l'indice de marginalisation de l'Ontario (ON-MARG) en Ontario, au Canada. Nos critères d'évaluation comprenaient la mortalité à 30 jours, la réadmission à 30 jours, la mortalité à 1 an et la réadmission à 1 an. Des modèles de risque proportionnel de Cox distincts pour la mortalité postopératoire et des modèles de risque spécifique à la cause de réadmission postopératoire ont été utilisés pour déterminer l'association entre la précarité sociale et les résultats post-interventionnels après un RVAC par rapport à une chirurgie de remplacement valvulaire aortique. Nous avons identifié 6 218 procédures de RVAC et 3 342 procédures de chirurgie de remplacement valvulaire aortique isolées au cours de notre période d'étude. Après ajustement multivarié, le RVAC était associé à une mortalité à 30 jours plus faible (rapport des risques instantanés [RRi] 0,58; intervalle de confiance [IC] à 95 % [0,37, 0,92]; p = 0,02), à des taux de réadmission à 30 jours plus faibles (RRi 0,75; IC à 95 % [0,63, 0,89]; p = 0,001) et un taux de réadmission à 1 an plus élevé (RRi 1,14; IC à 95 % [1,02, 1,27]; p = 0,01) par rapport à la chirurgie de remplacement valvulaire aortique. Lorsque les interactions entre les trois domaines de l'ON-MARG et le type de traitement ont été incluses dans l'analyse, les associations entre le RVAC versus la chirurgie de remplacement valvulaire aortique et ces résultats cliniques n'ont pas été modifiées par le degré de précarité sociale du quartier. Le RVAC est associé à une mortalité à 30 jours et à des taux de réadmission à 30 jours plus faibles, ainsi qu'à un taux de réadmission à 1 an plus élevé par rapport à la chirurgie de remplacement valvulaire aortique. Ces associations n'étaient pas été modifiées par les marqueurs de précarité sociale.
Research indicates public stigma about mental health has reduced. Less is known about severe mental health conditions, such as psychosis and personality disorders. This study evaluated public perceptions of psychosis and personality disorders. A survey was shared on social media. Anyone 18-years-old and over was eligible to participate. Knowledge, attitudes, beliefs, and behaviour were evaluated using the Mental Health Knowledge Scale, Attitudes to Mental Illness Scale, Perceived Devaluation and Discrimination Scale, and Reported and Intended Behaviour Scale. Multiple regressions explored their associations with demographic characteristics. Participants (N = 1413; over 50% 18-24-year-olds; 77% female; 80% White ethnicity; 70% university-educated) lacked direct familiarity with these conditions and their knowledge varied. Attitudes and behaviour were generally positive, open-minded, and unprejudiced. A minority reported stigmatising views, which were associated with minoritised ethnicities and lower education and familiarity. Most participants believed the public would find it unacceptable that people with these conditions would work in childcare or certain professional roles. Anti-stigma organisations could tailor campaigns regarding severe mental health conditions to focus on these demographic groups. However, aspects of the demographic characteristics of the sample may bias the findings and limit their generalisability. Larger, more representative surveys will strengthen these findings.
Childhood obesity is a growing public health concern with significant long-term implications for cardiometabolic health. Without effective intervention, the global burden of childhood and adolescent obesity is projected to increase substantially in the coming decades. This study aimed to synthesise current evidence on the epidemiology, pathophysiology, causal mechanisms, longitudinal outcomes, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease from a public health perspective. A narrative review was conducted and reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was identified through searches of PubMed/MEDLINE, Scopus, and Google Scholar from January 2000 to January 31, 2026. A total of 348 records were identified, of which 38 sources were retained for citation. Landmark pre-2000 studies were additionally identified through targeted hand searching. This review examined the epidemiology, pathophysiology, longitudinal tracking, causal mechanisms, metabolic phenotyping, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease. Consistent evidence was identified linking childhood obesity to elevated long-term cardiometabolic risk. Both metabolically healthy and metabolically unhealthy obesity phenotypes in childhood are associated with increased cardiometabolic risk in adulthood. Socioeconomic and ethnic inequalities in childhood obesity continue to widen across diverse settings, while emerging evidence highlights a growing dual burden of undernutrition and excess adiposity in transitional populations. Weight normalisation before adulthood appears to substantially reduce future cardiometabolic risk and remains an important clinical objective. Childhood obesity is associated with an increased risk of adult cardiometabolic disease through interconnected biological, social, environmental, and commercial pathways. Clinical practice should incorporate systematic cardiometabolic risk assessment in children with obesity regardless of current metabolic status. Future research should prioritise trans-ethnic causal studies, long-term cardiometabolic outcome trials in paediatric populations, and evaluation of structural policy interventions.
Despite universal health care coverage, Colombia remains among the most unequal countries worldwide, with disparities in cancer care. We evaluated inequities in breast cancer care across stage at diagnosis, timeliness of care, and survival by region, insurance scheme, and ethnicity. Longitudinal study including all adult women with primary invasive breast cancer diagnosed between 2021 and 2023, reported to the Colombian administrative cancer registry. Inequities were assessed between regions of residence, ethnicity, and health insurance schemes. Outcomes included stage at diagnosis, diagnostic delay (>60 days), treatment delay (>30 days), and overall survival. Survival was estimated using Kaplan-Meier methods, with group comparisons by log-rank tests. Crude hazard ratios for death were estimated using Cox model stratified by stage at diagnosis. Absolute and relative measures quantified inequalities. 63.3% of the 31,476 included cases were affiliated with the contributory insurance scheme. Localized-stage diagnosis was more frequent in the contributory than in the subsidized scheme (49.2% vs 33.8%). Median time to diagnosis was shorter in the contributory versus the subsidized scheme (25 vs 35 days). 2-year OS was lower in the subsidized than in the contributory scheme (86.0% vs 92.5%). Survival was poorer for locally advanced and metastatic disease, with additional disadvantages among Indigenous women and residents of the Amazonian region. Inequities were most pronounced by insurance scheme. Substantial inequities in breast cancer care persist in Colombia. Indigenous and Black women, and those in the subsidized scheme experience later-stage diagnosis and lower survival, reflecting ongoing barriers to timely and equitable access to cancer care despite universal health coverage.
Preventive dental care is recommended in children with congenital heart disease (CHD) to prevent infective endocarditis (IE). We examined average annual preventive dental care utilization and the association between preventive dental care and IE in children with CHD. We conducted a retrospective cohort study examining children (1-18-year-olds), covered by Georgia Medicaid, with at least one CHD-related ICD code and a healthcare encounter between 2008 and 2019. Preventive dental care encounters were based on Current Dental Terminology (CDT) codes (D1000-D1999). CHD native anatomy was captured based on ICD-9-and-10-CM codes. Log binomial regression estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for IE risk, controlling for sex, race and ethnicity, birth year cohort, rurality, and Social Deprivation Index. Of 61,024 children with CHD, 65.64% (n = 40,058) had at least one annual preventive dental visit on average, of which 0.30% (n = 181) had IE. For subgroups with valve or shunt lesions, having at least one annual preventive dental care visit showed a significantly lower risk of IE (aRR = 0.32; 95% CI = 0.18, 0.58, and aRR = 0.17; 95% CI = 0.07, 0.38, respectively) compared to no dental visits. No association was found between preventive dental care and IE in those with severe CHD (aRR = 0.81; 95% CI = 0.51, 1.26). Although dental health is important for patients with CHD, and despite universal dental coverage, many children with CHD do not seek annual preventive dental care. Integrating dental health assessments into routine CHD management protocols is imperative not only to promote oral health but also to prevent IE.
Stroke remains a leading cause of death and disability throughout the Americas, disproportionately impacting low-and middle-income countries and underserved populations. In this review, we examine the status of stroke prevention in the Americas. Prevention is essential, yet unequal access to healthcare has led to major disparities - especially among rural populations, ethnic minorities, and lower socioeconomic status. Models like the WHO HEARTS Program demonstrate that evidence-based programs can be tailored to local contexts. Telehealth and digital tools play a critical role in empowering patients, educating communities, and supporting healthcare workers. Despite growing efforts, challenges persist due to health inequities, gaps between policy and implementation, and underinvestment. Strengthening prevention will support countries in achieving the United Nations Sustainable Development Goals, targeting a one-third reduction in premature deaths from non-communicable diseases by 2030. This paper outlines effective strategies for implementing stroke prevention, emphasizing healthy lifestyles, early detection of risk factors, and system-level interventions. O Acidente Vascular Cerebral (AVC) permanece como uma das principais causas de morte e incapacidade em todas as Américas, impactando desproporcionalmente os países de baixa e média renda e as populações vulneráveis. Nesta revisão, examinamos o estado atual da prevenção do AVC nas Américas. A prevenção é essencial; contudo, o acesso desigual aos cuidados de saúde resultou em disparidades significativas – especialmente entre populações rurais, minorias étnicas e indivíduos de baixo nível socioeconômico. Modelos como o Programa HEARTS da OMS demonstram que programas baseados em evidências podem ser adaptados aos contextos locais. A telessaúde e as ferramentas digitais desempenham um papel fundamental na capacitação dos pacientes, na educação das comunidades e no apoio aos profissionais de saúde. Apesar dos esforços crescentes, os desafios persistem devido às iniquidades em saúde, às lacunas entre a política e a implementação, e ao subfinanciamento. O fortalecimento da prevenção apoiará os países no alcance dos Objetivos de Desenvolvimento Sustentável das Nações Unidas, visando uma redução de um terço nas mortes prematuras por doenças crônicas não transmissíveis até 2030. Este artigo apresenta estratégias eficazes para a implementação da prevenção do AVC, enfatizando estilos de vida saudáveis, a detecção precoce de fatores de risco e intervenções em nível sistêmico. El ataque cerebrovascular sigue siendo una de las principales causas de muerte y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos, así como a las poblaciones desatendidas. En esta revisión, examinamos el estado de la prevención del accidente cerebrovascular en las Américas. La prevención es esencial; sin embargo, el acceso desigual a la atención sanitaria ha provocado disparidades importantes, especialmente entre las poblaciones rurales, las minorías étnicas y los grupos de nivel socioeconómico bajo. Modelos como la Iniciativa HEARTS de la OMS demuestran que los programas basados en evidencia pueden adaptarse a los contextos locales. La telesalud y las herramientas digitales desempeñan un papel fundamental en el empoderamiento de los pacientes, la educación de las comunidades y el apoyo a los trabajadores de la salud. A pesar de los crecientes esfuerzos, persisten los desafíos debido a las inequidades en salud, las brechas entre la política y la implementación, y la inversión insuficiente. El fortalecimiento de la prevención apoyará a los países en el logro de los Objetivos de Desarrollo Sostenible de las Naciones Unidas, con la meta de reducir en un tercio las muertes prematuras por enfermedades no transmisibles para el año 2030. Este artículo describe estrategias efectivas para implementar la prevención del accidente cerebrovascular, enfatizando los estilos de vida saludables, la detección temprana de factores de riesgo y las intervenciones a nivel sistémico.
Nascent findings suggest that people with attention-deficit/hyperactivity disorder (ADHD) experience higher rates of mortality. To date, study samples have been insufficiently well-characterized to examine the mechanisms via which this neurodevelopmental condition elevates mortality risk. We used data from the 2007 and 2011 waves of the US National Health Interview Survey, a general population-based cohort study comprising 52097 adults (28675 women) aged 18 years or older at baseline. ADHD diagnosis and an array of demographic, socioeconomic, lifestyle, and co-morbidity (somatic and psychiatric) covariates were self-reported. At baseline, compared with unaffected individuals, participants with ADHD were more likely to be socioeconomically disadvantaged, smoke cigarettes, consume alcohol, and report symptoms of psychological distress. A median 7.75 years of mortality surveillance (range: 7.25-12.25) gave rise to 6597 deaths from all-causes. After adjustment for age, sex, ethnicity, and survey year, ADHD was associated with a markedly elevated risk of death (hazard ratio [95% confidence interval]: 1.58 [1.20-2.09]). Statistical adjustment for socioeconomic circumstances (11% attenuation), physical co-morbidities (15%), and lifestyle factors (17%) had only a modest impact on the ADHD-death gradient, with the greatest explanatory power apparent for symptoms of depression and anxiety (58%). The magnitude of the association of ADHD with mortality was commensurate to that for several well-established risk factors such as poverty (1.66 [1.55-1.78]), hypertension (1.41 [1.32-1.51]), and diabetes (1.71 [1.59-1.85]) but somewhat lower than cigarette smoking (2.51 [2.29-2.76]) after controlling for age, sex, ethnicity, and survey year. Associations between ADHD and cause-specific mortality from cardiovascular disease, cancer, and chronic respiratory disease were inconclusive. In the present study, the influence of ADHD on total mortality appears to be largely embodied via a series of malleable characteristics, particularly mental illness. If confirmed elsewhere, these results raise the possibility that risk factor modification via standard pharmacological and behavioral interventions could help reduce rates of premature mortality in this patient group. This paper received no direct funding. GDB is supported by the UK Medical Research Council (MR/P023444/1) and the US National Institute on Aging (1R56AG052519-01, 1R01AG052519-01A1). Evidence before this study: We searched the PubMed database (January 1947 to June 2026) using the terms 'attention-deficit/hyperactivity disorder ', 'ADHD', 'mortality', and 'death' with no language or date restrictions. We considered individual studies, systematic reviews, and meta-analyses. The most recent systematic review was published in 2022 and the majority of the eight non-overlapping studies found that ADHD was associated with a raised risk of mortality. Included cohort studies were typically generated from linked administrative health records and therefore insufficiently well characterized to comprehensively test how ADHD was embodied in order to elevate death rates. There was some suggestion of a role for mediation via socioeconomic position and mental illness but lifestyle factors such as obesity, smoking, physical inactivity, and alcohol intake had not been considered. A side-by-side comparison of the magnitude of the relationship of ADHD with conventional risk factors for mortality was also lacking.Added value of this study: This is the first prospective cohort study to systematically and comprehensively test the mechanisms via which ADHD elevates mortality and to contextualize the strength of this relationship against well-established risk factors. Socioeconomic circumstances, physical co-morbidities, and lifestyle factors mediated less than one fifth of the ADHD-death gradient, with the greatest explanatory power apparent for depression and anxiety. The impact of ADHD on mortality risk was commensurate to that apparent for several well-established risk factors for mortality such as poverty, hypertension, and diabetes but somewhat lower than estimates for cigarette smoking and physical inactivity.Implications of all the available evidence: While supporting evidence is required, our findings point to the possibility that modification of physical co-morbidities, lifestyle factors, and mental illness via pharmacological treatment and behavioral intervention may have utility in the avoidance of premature mortality in people with ADHD.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with evolving etiologic patterns. While viral hepatitis has historically been the predominant cause, non-infective etiologies such as alcohol-associated liver disease and metabolic dysfunction-associated fatty liver disease (MAFLD) are increasingly driving the disease burden. We evaluated long-term trends in HCC-related mortality in the United States by etiology and demographic subgroups. Mortality data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. HCC-related deaths were classified as infective (viral hepatitis-associated) or non-infective (liver disease and metabolic disorder) using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs) were extracted using CDC WONDER. Joinpoint regression was used to assess temporal trends and estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age, race/ethnicity, geographic region, and urbanization. Overall HCC-related mortality increased substantially from 1999 to 2020, driven predominantly by non-infective etiologies. Infective AAMRs rose from 1999 to 2013 followed by a significant decline, whereas non-infective AAMRs increased persistently from 1999 to 2020. Mortality rates were consistently higher in males than females. Infective mortality was highest among Asians, while non-infective mortality disproportionately affected Hispanic and American Indian populations. Western US states exhibited the highest mortality rates, and non-infective etiologies accounted for most deaths among individuals aged ≥ 65 years. HCC-related mortality in the United States has increased over the past two decades, largely driven by non-infective etiologies. Targeted public health strategies addressing metabolic risk factors, alcohol use, and demographic disparities are urgently needed to curb this growing burden.