Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have ac...Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).展开更多
BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in M...BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.展开更多
Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these ...Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.展开更多
Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant dispari...Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant disparities between male and female patients.The study revealed that women,particularly those in the premen-opausal and menopausal stages,exhibited higher sustained virologic response rates than men.However,postmenopausal women encounter unique challenges that merit attention.This letter emphasizes the necessity for healthcare providers to implement sex-sensitive approaches in the management of hepatitis C,acknow-ledging the impact of biological,hormonal,and psychosocial factors on treatment efficacy.By advocating tailored treatment strategies that address these disparities,we can improve patient outcomes and ensure equitable healthcare for all indi-viduals affected by hepatitis C.Furthermore,this letter calls for additional rese-arch to explore the underlying mechanisms driving these differences,ultimately contributing to more effective and personalized care of patients across diverse demographics.展开更多
Background:As a rare disease,male breast cancer(MBC)is of increasing concern in China.Whether health inequalities of disease burden and healthcare utilization exist by ethnicity in male breast cancer remains unclear.W...Background:As a rare disease,male breast cancer(MBC)is of increasing concern in China.Whether health inequalities of disease burden and healthcare utilization exist by ethnicity in male breast cancer remains unclear.We aim to measure disease burden and healthcare utilization by ethnicity among male breast cancer patients in China.Methods:A retrospective cohort study was established during 2012-2021 based on the Inner Mongolia Regional Health Information Platform.Disease burden,including incidence,5-year prevalence,mortality,survival rate,and medical cost were analyzed.Results:Among 630 participants(mean[SD]age,59.4[13.1]years),age-standardized rates of incidence were 1.2(95%CI:0.4-2.1)per 100,000.All-cause mortality was 50.8 per 1000 person-years(95%CI:42.4-60.4).Regarding ethnicity,Mongolian had a higher age-standardized 5-year prevalence rate than Han(3.2[95%CI:2.5-4.0]vs 2.3[95%CI:1.7-3.0],P=0.016),but no significant differences existed in incidence rates,survival rates,and risk of all-cause and breast cancer-specific mortality.Meanwhile,few significant disparities in healthcare utilization between Han and Mongolian were observed.Conclusions:This study revealed a moderate disease burden and relatively lower healthcare utilization for male breast cancer in Inner Mongolia,China.No significant ethnic disparities existed in disease burden and healthcare utilization.However,increased attention to male breast cancer is warranted due to the crucial influence of economic factors on potential ethnic disparities.展开更多
BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for pa...BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for patients with unresectable MASH-HCC,but not all patients have equal access to transplant.MASH-HCC disproportionately affects Hispanic patients,but minorities are less likely to undergo LT for HCC.Additionally,females also undergo LT at lower rates than males.AIM To investigate whether race/ethnicity and sex affect LT waitlist outcomes.METHODS Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.RESULTS Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic(NH)white(71.2%)or Hispanic(23.4%),with only 49(1.1%)NH Black candidates.Hispanics underwent LT at lower rates than NH whites(71.6%vs 78.4%,P<0.001),but race/ethnicity did not affect waitlist mortality(P=0.06).Patients with Hispanic[hazard ratio(HR)=0.85,95%CI:0.77-0.95,P=0.002]or Asian(HR=0.79,95%CI:0.63-0.98,P=0.04)race/ethnicity were less likely to undergo LT.Women were also less likely to receive LT(male:HR=1.16,95%CI:1.04-1.29,P=0.01).Patients in regions 1 and 9 were less likely to be transplanted as well(P=0.07).CONCLUSION Hispanic patients are less likely to undergo LT for MASH-HCC,concerning given their susceptibility to MASH and HCC.There were very few NH Black candidates.Disparities were also unequal across regions,which is particularly concerning in states where at-risk populations have rising cancer incidence.Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.展开更多
BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the ...BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmeno-pausal population.AIM To explore the prevalence of MHO and its relationship with hospitalization outcomes,including major adverse cardiac or cerebrovascular events(MACCE),in postmenopausal women.METHODS We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease,Tenth Revision,Clinical Modification codes for all admissions of postmenopausal women.We excluded patients with diabetes,hypertension,and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts.We used a 1:1 propensity score matching method to match patients with and without MHO based on age,and then we did a multivariable regression analysis for in-hospital MACCE.RESULTS In 2020,1304185 metabolically healthy postmenopausal women were admitted;148250(11.4%)had MHO.After propensity score matching for age,a statistically significant difference was observed in overall MACCE[odds ratio(OR):1.08,95%confidence interval(CI):1.01-1.16,P=0.028]among MHO and non-MHO cohorts,especially in patients of African-American ethnicity(OR:1.23,95%CI:1.01-1.49,P=0.035)and the lowermost income quartile(OR:1.24,95%CI:1.06-1.44,P=0.007).CONCLUSION Postmenopausal patients with MHO are at risk of MACCE,especially black patients and those with lower incomes.Larger prospective studies can demystify MHO’s impact on cardiovascular outcomes among postmenopausal women.展开更多
Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation conc...Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation concentration index(Q index).The results showed that the intensity of heavy precipitation exhibited an increasing trend across most regions of South China.The multi-year mean Q index for the stations ranged from 0.3 to 0.6,with an overall average of 0.375.Notably,significant upward trends in both the heavy precipitation and Q index were observed in the inland and western mountainous areas of South China,indicating a higher flood risk in these regions.Moreover,an analysis of precipitation duration showed that 2-day heavy rainfall events are increasing in the inland areas,western mountains,and eastern Guangdong,while 3-day and 4-day heavy rainfall events steadily increased primarily in coastal areas,with 3-day events also increasing in eastern Guangzhou.The observed rise of heavy precipitation during the pre-flood period across the western mountainous areas,eastern Guangdong,and southeastern coastal areas of South China is mainly attributed to an increase in long-duration heavy precipitation.展开更多
The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disp...The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.展开更多
BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not scr...BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.展开更多
AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed bet...AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White(White, n = 12710), Hispanic(n = 8500), Chinese(n = 2723), non-Hispanic Black(Black, n = 2609), Vietnamese(n = 2063), Filipino(n = 1479), Korean(n = 1099), Japanese(n = 658), American Indian/Alaskan Native(AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian(n = 233), South Asian(n = 190), Hawai`ian/Pacific Islander(n = 172), Thai(n = 95), and Other Asian(n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio(OR) = 0.30, 95%CI: 0.17-0.53], Cambodian(OR = 0.65, 95%CI: 0.45-0.96), AIAN(OR = 0.66, 95%CI: 0.46-0.93), Black(OR = 0.76, 95%CI: 0.67-0.86), and Hispanic(OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese(OR = 1.58, 95%CI: 1.42-1.77), Koreans(OR = 1.45, 95%CI: 1.24-1.70), Japanese(OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese(OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio(HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians(HR = 1.35, 95%CI: 1.16-1.58), and Blacks(HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese(HR = 0.82, 95%CI: 0.77-0.86), Filipinos(HR = 0.84, 95%CI: 0.78-0.90), Vietnamese(HR = 0.85, 95%CI: 0.80-0.90), Koreans(HR = 0.90, 95%CI: 0.83-0.97), and Hispanics(HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.展开更多
Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly...Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.展开更多
Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.T...Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.展开更多
BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles a...BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of cirrhosis.AIM To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.METHODS We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver cirrhosis.The outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these hospitalizations.Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.RESULTS The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in 2019.Cirrhosis related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other causes.Alcohol-and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders.Females had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to males.Blacks,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD when compared to the white race.CONCLUSION The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade.Females had a higher association with psychiatric disorders compared to males.Blacks,Hispanics,and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To ...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.展开更多
Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marke...Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors.展开更多
BACKGROUND Older patients represent a unique subgroup of the cancer patient population,for which the role of cancer therapy requires special consideration.However,the outcomes of radiation therapy(RT)in elderly patien...BACKGROUND Older patients represent a unique subgroup of the cancer patient population,for which the role of cancer therapy requires special consideration.However,the outcomes of radiation therapy(RT)in elderly patients with pancreatic ductal adenocarcinoma(PDAC)are not well-defined in the literature.AIM To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.METHODS Data from patients with PDAC aged≥65 years between 2004 and 2018 were collected from the Surveillance,Epidemiology,and End Results database.Multivariate logistic regression analysis was performed to determine factors associated with RT administration.Overall survival(OS)and cancer-specific survival(CSS)were evaluated using the Kaplan–Meier method with the log-rank test.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS.Propensity score matching(PSM)was applied to balance the baseline characteristics between the RT and non-RT groups.Subgroup analyses were performed based on clinical characteristics.RESULTS A total of 12245 patients met the inclusion criteria,of whom 2551(20.8%)were treated with RT and 9694(79.2%)were not.The odds of receiving RT increased with younger age,diagnosis in an earlier period,primary site in the head,localized disease,greater tumor size,and receiving chemotherapy(all P<0.05).Before PSM,the RT group had better outcomes than did the non-RT group[median OS,14.0 vs 6.0 mo;hazard ratio(HR)for OS:0.862,95%confidence interval(CI):0.819–0.908,P<0.001;and HR for CSS:0.867,95%CI:0.823–0.914,P<0.001].After PSM,the survival benefit associated with RT remained comparable(median OS:14.0 vs 11.0 mo;HR for OS:0.818,95%CI:0.768–0.872,P<0.001;and HR for CSS:0.816,95%CI:0.765–0.871,P<0.001).Subgroup analysis revealed that the survival benefits(OS and CSS)of RT were more significant in patients aged 65 to 80 years,in regional and distant stages,with no surgery,and receiving chemotherapy.CONCLUSION RT improved the outcome of elderly patients with PDAC,particularly those aged 65 to 80 years,in regional and distant stages,with no surgery,and who received chemotherapy.Further prospective studies are warranted to validate our results.展开更多
BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United States.Gastrointestinal bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and shock.Althou...BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United States.Gastrointestinal bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and shock.Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB,there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality.It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016.This study does not differentiate between acute and chronic LGIB and both are included in this study.The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds;the secondary outcome measures were in-hospital mortality,length of stay,and costs involved in those receiving colonoscopy for LGIB.Statistical analyses were all performed using STATA software.Logistic regression was used to analyze the utilization of colonoscopy and mortality,and a generalized linear model was used to analyze the length of stay and cost.RESULTS Our study found that 37.9%of LGIB patients at rural hospitals compared to approximately 45.1%at urban hospitals received colonoscopy,(OR=0.730,95%CI:0.705-0.7,P>0.0001).After controlling for covariates,colonoscopies were found to have a protective association with lower inhospital mortality[OR=0.498,95%CI:0.446-0.557,P<0.0001],but a longer length of stay by 0.72 d(95%CI:0.677-0.759 d,P<0.0001)and approximately$2199 in increased costs.CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals,patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality.In both settings,benefit came at a cost of extended stay,and higher total costs.展开更多
Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of ch...Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.Objective There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race,ethnicity,and socioeconomic status.The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race,ethnicity,education level,employment status,and income and poverty level.Search strategy Systematic searches were conducted in PubMed,Ovid MEDLINE,Cumulative Index of Nursing and Allied Health Literature(CINAHL),Cochrane Database of Systematic Reviews,and Index to Chiropractic Literature from inception to May 2021.Inclusion criteria Articles that reported race or ethnicity,education level,employment status,income or poverty level variables and chiropractic utilization rates for adults(≥18 years of age)were eligible for this review.Data extraction and analysis Data extracted from articles were citation information,patient characteristics,race and ethnicity,education level,employment status,income and poverty level,and chiropractic utilization rate.A descriptive numerical summary of included studies is provided.This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity,education level,income and poverty level,and employment status.Results A total of 69 articles were eligible for review.Most articles were published since 2003 and reported data from study populations in the United States.Of the race,ethnicity and socioeconomic categories that were most commonly reported,chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian(median 20.00%;interquartile range 2.70%-64.60%),those with employment as a main income source(median utilization 78.50%;interquartile range 77.90%-79.10%),individuals with an individual or household/family annual income between$40,001 and$60,000(median utilization 29.40%;interquartile range 25.15%-33.65%),and individuals with less than or equal to(12 years)high school diploma/general educational development certificate completion(median utilization 30.70%;interquartile range 15.10%-37.00%).Conclusion This comprehensive review of the literature on chiropractic utilization by race,ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations.Heterogeneity existed among definitions of key variables,including race,ethnicity,education level,employment status,and income and poverty level in the included studies,reducing clarity in rates of chiropractic utilization for these populations.展开更多
This paper attempts to summarize the disparities of Internet development in China spatially-temporally. The major objective is to measure the differences between Eastern, Central and Western China. Methods of map pres...This paper attempts to summarize the disparities of Internet development in China spatially-temporally. The major objective is to measure the differences between Eastern, Central and Western China. Methods of map presentation, correlation, Lorenz curve, Gini Coefficient and location quotient analysis arc conducted in this study. For convenience, the indicator of regional Internet development is simplified as the number of domain names registered under. CN in each province. The data used are collected from the semi-annual surveys of the Statistical Survey Report on the Intrenet Development in China since 1999. There are several findings: 1) The number of domain names in each province (city) declines gradually from the east to the west. 2) The gap between the highest growth provinces (cities) and the lowest ones is rather large. 3) Although the absolute differences between the eastern, central and western China have been enlarged, the relative differences in each province (city) have remained constant. 4) Provinces (cities) are classified into three types according to location quotient changes, namely, rising type, changeless type and declining type. Compared with industrial and economic growth, Internet sector in the eastern and western China is relatively ascending, while that in the central China is descending. 5) The number of domain names at provincial level is not statistically consistent with GDP.展开更多
文摘Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).
文摘BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.
基金supported by grants from the National Natural Science Foundation of China(Grant No.82470544)the Fundamental Research Funds for the Central Universities(Grant No.226-2024-00153).
文摘Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.
文摘Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant disparities between male and female patients.The study revealed that women,particularly those in the premen-opausal and menopausal stages,exhibited higher sustained virologic response rates than men.However,postmenopausal women encounter unique challenges that merit attention.This letter emphasizes the necessity for healthcare providers to implement sex-sensitive approaches in the management of hepatitis C,acknow-ledging the impact of biological,hormonal,and psychosocial factors on treatment efficacy.By advocating tailored treatment strategies that address these disparities,we can improve patient outcomes and ensure equitable healthcare for all indi-viduals affected by hepatitis C.Furthermore,this letter calls for additional rese-arch to explore the underlying mechanisms driving these differences,ultimately contributing to more effective and personalized care of patients across diverse demographics.
基金supported by the Natural Science Foundation of China(grant numbers:82173616,72342015).
文摘Background:As a rare disease,male breast cancer(MBC)is of increasing concern in China.Whether health inequalities of disease burden and healthcare utilization exist by ethnicity in male breast cancer remains unclear.We aim to measure disease burden and healthcare utilization by ethnicity among male breast cancer patients in China.Methods:A retrospective cohort study was established during 2012-2021 based on the Inner Mongolia Regional Health Information Platform.Disease burden,including incidence,5-year prevalence,mortality,survival rate,and medical cost were analyzed.Results:Among 630 participants(mean[SD]age,59.4[13.1]years),age-standardized rates of incidence were 1.2(95%CI:0.4-2.1)per 100,000.All-cause mortality was 50.8 per 1000 person-years(95%CI:42.4-60.4).Regarding ethnicity,Mongolian had a higher age-standardized 5-year prevalence rate than Han(3.2[95%CI:2.5-4.0]vs 2.3[95%CI:1.7-3.0],P=0.016),but no significant differences existed in incidence rates,survival rates,and risk of all-cause and breast cancer-specific mortality.Meanwhile,few significant disparities in healthcare utilization between Han and Mongolian were observed.Conclusions:This study revealed a moderate disease burden and relatively lower healthcare utilization for male breast cancer in Inner Mongolia,China.No significant ethnic disparities existed in disease burden and healthcare utilization.However,increased attention to male breast cancer is warranted due to the crucial influence of economic factors on potential ethnic disparities.
文摘BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for patients with unresectable MASH-HCC,but not all patients have equal access to transplant.MASH-HCC disproportionately affects Hispanic patients,but minorities are less likely to undergo LT for HCC.Additionally,females also undergo LT at lower rates than males.AIM To investigate whether race/ethnicity and sex affect LT waitlist outcomes.METHODS Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.RESULTS Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic(NH)white(71.2%)or Hispanic(23.4%),with only 49(1.1%)NH Black candidates.Hispanics underwent LT at lower rates than NH whites(71.6%vs 78.4%,P<0.001),but race/ethnicity did not affect waitlist mortality(P=0.06).Patients with Hispanic[hazard ratio(HR)=0.85,95%CI:0.77-0.95,P=0.002]or Asian(HR=0.79,95%CI:0.63-0.98,P=0.04)race/ethnicity were less likely to undergo LT.Women were also less likely to receive LT(male:HR=1.16,95%CI:1.04-1.29,P=0.01).Patients in regions 1 and 9 were less likely to be transplanted as well(P=0.07).CONCLUSION Hispanic patients are less likely to undergo LT for MASH-HCC,concerning given their susceptibility to MASH and HCC.There were very few NH Black candidates.Disparities were also unequal across regions,which is particularly concerning in states where at-risk populations have rising cancer incidence.Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.
文摘BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmeno-pausal population.AIM To explore the prevalence of MHO and its relationship with hospitalization outcomes,including major adverse cardiac or cerebrovascular events(MACCE),in postmenopausal women.METHODS We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease,Tenth Revision,Clinical Modification codes for all admissions of postmenopausal women.We excluded patients with diabetes,hypertension,and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts.We used a 1:1 propensity score matching method to match patients with and without MHO based on age,and then we did a multivariable regression analysis for in-hospital MACCE.RESULTS In 2020,1304185 metabolically healthy postmenopausal women were admitted;148250(11.4%)had MHO.After propensity score matching for age,a statistically significant difference was observed in overall MACCE[odds ratio(OR):1.08,95%confidence interval(CI):1.01-1.16,P=0.028]among MHO and non-MHO cohorts,especially in patients of African-American ethnicity(OR:1.23,95%CI:1.01-1.49,P=0.035)and the lowermost income quartile(OR:1.24,95%CI:1.06-1.44,P=0.007).CONCLUSION Postmenopausal patients with MHO are at risk of MACCE,especially black patients and those with lower incomes.Larger prospective studies can demystify MHO’s impact on cardiovascular outcomes among postmenopausal women.
基金Guangdong Major Project of Basic and Applied Basic Research(2020B0301030004)National Natural Science Foun-dation of China(U2142205,42075173)+1 种基金Meteorological Joint Fund of the Guangdong Basic and Applied Basic Research Foundation(2024A1515510011)Special Fund for Forecast Review and Summary of China Meteorological Administration(FPZJ2025-096).
文摘Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation concentration index(Q index).The results showed that the intensity of heavy precipitation exhibited an increasing trend across most regions of South China.The multi-year mean Q index for the stations ranged from 0.3 to 0.6,with an overall average of 0.375.Notably,significant upward trends in both the heavy precipitation and Q index were observed in the inland and western mountainous areas of South China,indicating a higher flood risk in these regions.Moreover,an analysis of precipitation duration showed that 2-day heavy rainfall events are increasing in the inland areas,western mountains,and eastern Guangdong,while 3-day and 4-day heavy rainfall events steadily increased primarily in coastal areas,with 3-day events also increasing in eastern Guangzhou.The observed rise of heavy precipitation during the pre-flood period across the western mountainous areas,eastern Guangdong,and southeastern coastal areas of South China is mainly attributed to an increase in long-duration heavy precipitation.
文摘The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.
文摘BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.
文摘AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White(White, n = 12710), Hispanic(n = 8500), Chinese(n = 2723), non-Hispanic Black(Black, n = 2609), Vietnamese(n = 2063), Filipino(n = 1479), Korean(n = 1099), Japanese(n = 658), American Indian/Alaskan Native(AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian(n = 233), South Asian(n = 190), Hawai`ian/Pacific Islander(n = 172), Thai(n = 95), and Other Asian(n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio(OR) = 0.30, 95%CI: 0.17-0.53], Cambodian(OR = 0.65, 95%CI: 0.45-0.96), AIAN(OR = 0.66, 95%CI: 0.46-0.93), Black(OR = 0.76, 95%CI: 0.67-0.86), and Hispanic(OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese(OR = 1.58, 95%CI: 1.42-1.77), Koreans(OR = 1.45, 95%CI: 1.24-1.70), Japanese(OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese(OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio(HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians(HR = 1.35, 95%CI: 1.16-1.58), and Blacks(HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese(HR = 0.82, 95%CI: 0.77-0.86), Filipinos(HR = 0.84, 95%CI: 0.78-0.90), Vietnamese(HR = 0.85, 95%CI: 0.80-0.90), Koreans(HR = 0.90, 95%CI: 0.83-0.97), and Hispanics(HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
文摘Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.
文摘Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.
文摘BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of cirrhosis.AIM To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.METHODS We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver cirrhosis.The outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these hospitalizations.Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.RESULTS The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in 2019.Cirrhosis related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other causes.Alcohol-and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders.Females had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to males.Blacks,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD when compared to the white race.CONCLUSION The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade.Females had a higher association with psychiatric disorders compared to males.Blacks,Hispanics,and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.
文摘Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors.
文摘BACKGROUND Older patients represent a unique subgroup of the cancer patient population,for which the role of cancer therapy requires special consideration.However,the outcomes of radiation therapy(RT)in elderly patients with pancreatic ductal adenocarcinoma(PDAC)are not well-defined in the literature.AIM To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.METHODS Data from patients with PDAC aged≥65 years between 2004 and 2018 were collected from the Surveillance,Epidemiology,and End Results database.Multivariate logistic regression analysis was performed to determine factors associated with RT administration.Overall survival(OS)and cancer-specific survival(CSS)were evaluated using the Kaplan–Meier method with the log-rank test.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS.Propensity score matching(PSM)was applied to balance the baseline characteristics between the RT and non-RT groups.Subgroup analyses were performed based on clinical characteristics.RESULTS A total of 12245 patients met the inclusion criteria,of whom 2551(20.8%)were treated with RT and 9694(79.2%)were not.The odds of receiving RT increased with younger age,diagnosis in an earlier period,primary site in the head,localized disease,greater tumor size,and receiving chemotherapy(all P<0.05).Before PSM,the RT group had better outcomes than did the non-RT group[median OS,14.0 vs 6.0 mo;hazard ratio(HR)for OS:0.862,95%confidence interval(CI):0.819–0.908,P<0.001;and HR for CSS:0.867,95%CI:0.823–0.914,P<0.001].After PSM,the survival benefit associated with RT remained comparable(median OS:14.0 vs 11.0 mo;HR for OS:0.818,95%CI:0.768–0.872,P<0.001;and HR for CSS:0.816,95%CI:0.765–0.871,P<0.001).Subgroup analysis revealed that the survival benefits(OS and CSS)of RT were more significant in patients aged 65 to 80 years,in regional and distant stages,with no surgery,and receiving chemotherapy.CONCLUSION RT improved the outcome of elderly patients with PDAC,particularly those aged 65 to 80 years,in regional and distant stages,with no surgery,and who received chemotherapy.Further prospective studies are warranted to validate our results.
文摘BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United States.Gastrointestinal bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and shock.Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB,there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality.It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016.This study does not differentiate between acute and chronic LGIB and both are included in this study.The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds;the secondary outcome measures were in-hospital mortality,length of stay,and costs involved in those receiving colonoscopy for LGIB.Statistical analyses were all performed using STATA software.Logistic regression was used to analyze the utilization of colonoscopy and mortality,and a generalized linear model was used to analyze the length of stay and cost.RESULTS Our study found that 37.9%of LGIB patients at rural hospitals compared to approximately 45.1%at urban hospitals received colonoscopy,(OR=0.730,95%CI:0.705-0.7,P>0.0001).After controlling for covariates,colonoscopies were found to have a protective association with lower inhospital mortality[OR=0.498,95%CI:0.446-0.557,P<0.0001],but a longer length of stay by 0.72 d(95%CI:0.677-0.759 d,P<0.0001)and approximately$2199 in increased costs.CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals,patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality.In both settings,benefit came at a cost of extended stay,and higher total costs.
文摘Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.Objective There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race,ethnicity,and socioeconomic status.The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race,ethnicity,education level,employment status,and income and poverty level.Search strategy Systematic searches were conducted in PubMed,Ovid MEDLINE,Cumulative Index of Nursing and Allied Health Literature(CINAHL),Cochrane Database of Systematic Reviews,and Index to Chiropractic Literature from inception to May 2021.Inclusion criteria Articles that reported race or ethnicity,education level,employment status,income or poverty level variables and chiropractic utilization rates for adults(≥18 years of age)were eligible for this review.Data extraction and analysis Data extracted from articles were citation information,patient characteristics,race and ethnicity,education level,employment status,income and poverty level,and chiropractic utilization rate.A descriptive numerical summary of included studies is provided.This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity,education level,income and poverty level,and employment status.Results A total of 69 articles were eligible for review.Most articles were published since 2003 and reported data from study populations in the United States.Of the race,ethnicity and socioeconomic categories that were most commonly reported,chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian(median 20.00%;interquartile range 2.70%-64.60%),those with employment as a main income source(median utilization 78.50%;interquartile range 77.90%-79.10%),individuals with an individual or household/family annual income between$40,001 and$60,000(median utilization 29.40%;interquartile range 25.15%-33.65%),and individuals with less than or equal to(12 years)high school diploma/general educational development certificate completion(median utilization 30.70%;interquartile range 15.10%-37.00%).Conclusion This comprehensive review of the literature on chiropractic utilization by race,ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations.Heterogeneity existed among definitions of key variables,including race,ethnicity,education level,employment status,and income and poverty level in the included studies,reducing clarity in rates of chiropractic utilization for these populations.
文摘This paper attempts to summarize the disparities of Internet development in China spatially-temporally. The major objective is to measure the differences between Eastern, Central and Western China. Methods of map presentation, correlation, Lorenz curve, Gini Coefficient and location quotient analysis arc conducted in this study. For convenience, the indicator of regional Internet development is simplified as the number of domain names registered under. CN in each province. The data used are collected from the semi-annual surveys of the Statistical Survey Report on the Intrenet Development in China since 1999. There are several findings: 1) The number of domain names in each province (city) declines gradually from the east to the west. 2) The gap between the highest growth provinces (cities) and the lowest ones is rather large. 3) Although the absolute differences between the eastern, central and western China have been enlarged, the relative differences in each province (city) have remained constant. 4) Provinces (cities) are classified into three types according to location quotient changes, namely, rising type, changeless type and declining type. Compared with industrial and economic growth, Internet sector in the eastern and western China is relatively ascending, while that in the central China is descending. 5) The number of domain names at provincial level is not statistically consistent with GDP.
