Outcome of pregnancy oral glucose tolerance test and preterm birth.

BACKGROUND: Gestational diabetes is associated with adverse outcomes such as preterm birth (<37 weeks). However, there is no international consensus on screening criteria or diagnostic levels for gestational diabetes, and it is unknown whether body mass index (BMI) or obesity modifies the relation between glucose level and preterm birth. METHODS: We studied a pregnancy cohort restricted to two Danish regions from the linked Danish Medical Birth Register to study associations between glucose measurements from the 2-hour post-load 75-gram oral glucose tolerance test (one-step approach) and preterm birth from 2004-2018. In Denmark, gestational diabetes screening is a targeted strategy for mothers with identified risk factors. We used Poisson regression to estimate rate ratios (RR) of preterm birth with z-standardized glucose measurements. We assessed effect measure modification by stratifying analyses and testing for heterogeneity. RESULTS: Among 11,337 pregnancies (6.2% delivered preterm), we observed an adjusted preterm birth RR of 1.2 (95% CI: 1.1-1.3) for a 1 standard deviation glucose increase of 1.4 mmol/L from the mean 6.7 mmol/L. There was evidence for effect measure modification by obesity, e.g., adjusted RR for non-obese (BMI <30): 1.2 (95%CI: 1.1-1.3) vs. obese (BMI ≥30): 1.3 (95%CI: 1.2-1.5), P=0.05 for heterogeneity. CONCLUSIONS: Among mothers screened for gestational diabetes, increased glucose levels, even those below the diagnostic level for gestational diabetes in Denmark, were associated with increased preterm birth risk. Obesity (BMI ≥30) may be an effect measure modifier, not just a confounder, of the relation between blood glucose and preterm birth risk.

Report on the Joint Workshop on the Relations between Health Inequalities, Ageing and Multimorbidity, Iceland, May 3-4, 2023.

This paper is a summary of key presentations from a workshop in Iceland on May 3-4, 2023 arranged by Aarhus University and with participation of the below-mentioned scientists. Below you will find the key messages from the presentations made by: Professor Jan Vandenbroucke, Department of Clinical Epidemiology, Aarhus University, Emeritus Professor, Leiden University; Honorary Professor, London School of Hygiene & Tropical Medicine, UKProfessor, Chair Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, DenmarkProfessor David H. Rehkopf, Director, the Stanford Center for Population Health Sciences, Stanford University, CA., USProfessor Jaimie Gradus, Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Johan Mackenbach, Emeritus Professor, Department of Public Health, Erasmus University Rotterdam, HollandProfessor, Chair M Maria Glymour, Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USProfessor, Dean Sandro Galea, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Victor W. Henderson, Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, US; Department of Clinical Epidemiology, Aarhus University, Aarhus, DK.

Changes in leukocyte telomere length among children with obesity participating in a behavioural weight control program.

OBJECTIVE: To examine changes in leukocyte telomere length (LTL) during and after a behavioural weight control program for children with obesity. METHODS: We measured LTL among a cohort of 158 children 8-12 years of age with a body mass index greater than or equal to the 95th percentile for age and sex. Children were 55% female, 29% white, 52% Latinx, 8% Asian and 11% Pacific Islander, other or multiethnic. All children participated in a 6-month, family-based, group behavioural weight control program and were assessed before treatment, after treatment and 1 year after the end of treatment. To test the sample population slope of LTL over the intervention and maintenance time periods, we fit spline mixed-effect regression models. RESULTS: LTL increased an average of 0.09 T/S units per year (95% confidence interval [CI] 0.04 to 0.13; p = 0.0001) during the weight control program intervention period, followed by an average decline of -0.05 T/S units per year (95% CI -0.08 to -0.03; p < 0.0001) during the 1 year of follow-up after the completion of the intervention. Among 26 social, psychological, behavioural and physiological factors we examined, we did not find any predictors of these changes. CONCLUSIONS: LTL increased in response to a behavioural weight control program among children with obesity, suggesting an impact on biological health and cellular aging from participation in a behavioural weight control intervention. LTL may be a useful biomarker for assessing changes in response to behavioural interventions.

Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality.

The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, -1004 to -81) and 21 fewer deaths per 100,000 population (95% CI, -32 to -10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective.

COVID-19 Vaccine Strategy Left Small Primary Care Practices On The Sidelines.

We report on the experience of small primary care practices participating in a national clinical registry with COVID-19 vaccines and vaccination data. At the end of 2021, 11.2 percent of these practices' 3.9 million patients had records of COVID-19 vaccination; 43.1 percent of clinics had no record of patients' COVID-19 vaccinations, but 93.4 percent of clinics had provided or recorded other routine vaccinations.

Association of Adverse Childhood Experiences With Accelerated Epigenetic Aging in Midlife.

Importance: Adverse childhood experiences (ACEs) are associated with the risk of poorer health, and identifying molecular mechanisms may lay the foundation for health promotion in people with ACEs. Objective: To investigate the associations of ACEs with changes in epigenetic age acceleration (EAA), a biomarker associated with various health outcomes in middle-aged adults, in a population with balanced race and sex demographics. Design, Setting, and Participants: Data for this cohort study were from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants in CARDIA underwent 8 follow-up exams from baseline (year 0 [Y0]; 1985-1986) to Y30 (2015-2016), and participant blood DNA methylation information was obtained at Y15 (2000-2001) and Y20 (2005-2006). Individuals from Y15 and Y20 with available DNA methylation data and complete variables for ACEs and covariates were included. Data were analyzed from September 2021 to August 2022. Exposures: Participant ACEs (general negligence, emotional negligence, physical violence, physical negligence, household substance abuse, verbal and emotional abuse, and household dysfunction) were obtained at Y15. Main Outcomes and Measures: The primary outcome consisted of results from 5 DNA methylation-based EAA measurements known to be associated with biological aging and long-term health: intrinsic EAA (IEAA), extrinsic EAA (EEAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), and Dunedin Pace of Aging Calculated From the Epigenome (DunedinPACE), measured at Y15 and Y20. Linear regression and generalized estimating equations were used to assess associations of the burden of ACEs (≥4 vs <4 ACEs) with EAA adjusting for demographics, health-related behaviors, and early life and adult socioeconomic status. Results: A total of 895 participants for Y15 (mean [SD] age, 40.4 [3.5] years; 450 males [50.3%] and 445 females [49.7%]; 319 Black [35.6%] and 576 White [64.4%]) and 867 participants for Y20 (mean [SD] age, 45.4 [3.5] years; 432 males [49.8%] and 435 females [50.2%]; 306 Black [35.3%] and 561 White [64.7%]) were included after excluding participants with missing data. There were 185 participants with (20.7%) vs 710 participants without (79.3%) 4 or more ACEs at Y15 and 179 participants with (20.6%) vs 688 participants without (79.4%) 4 or more ACEs at Y20. Having 4 or more ACEs was positively associated with EAA in years at Y15 (EEAA: ß = 0.60 years; 95% CI, 0.18-1.02 years; PhenoAA: ß = 0.62 years; 95% CI = 0.13-1.11 years; GrimAA: ß = 0.71 years; 95% CI, 0.42-1.00 years; DunedinPACE: ß = 0.01; 95% CI, 0.01-0.02) and Y20 (IEAA: ß = 0.41 years; 95% CI, 0.05-0.77 years; EEAA: ß = 1.05 years; 95% CI, 0.66-1.44 years; PhenoAA: ß = 0.57 years; 95% CI, 0.08-1.05 years; GrimAA: ß = 0.57 years; 95% CI, 0.28-0.87 years; DunedinPACE: ß = 0.01; 95% CI, 0.01-0.02) after adjusting for demographics, health-related behaviors, and socioeconomic status. Conclusions and Relevance: In this cohort study, ACEs were associated with EAA among middle-aged adults after controlling for demographics, behavior, and socioeconomic status. These findings of the associations between early life experience and the biological aging process in midlife may contribute to health promotion in a life course perspective.

The Neighborhood Atlas Area Deprivation Index And Recommendations For Area-Based Deprivation Measures.

Edward Hannan and colleagues found that a lack of standardization of input variables to the Area Deprivation Index (ADI) available from the Neighborhood Atlas overweights the index for median home value and thus potentially further disadvantages already disadvantaged communities. We recommend that a revised ADI be created that addresses the error, and we offer five steps to avoid future errors in the creation of area deprivation measures.

Centenarian clocks: epigenetic clocks for validating claims of exceptional longevity.

Claims surrounding exceptional longevity are sometimes disputed or dismissed for lack of credible evidence. Here, we present three DNA methylation-based age estimators (epigenetic clocks) for verifying age claims of centenarians. The three centenarian clocks were developed based on n = 7039 blood and saliva samples from individuals older than 40, including n = 184 samples from centenarians, 122 samples from semi-supercentenarians (aged 105 +), and 25 samples from supercentenarians (aged 110 +). The oldest individual was 115 years old. Our most accurate centenarian clock resulted from applying a neural network model to a training set composed of individuals older than 40. An epigenome-wide association study of age in different age groups revealed that age effects in young individuals (age < 40) are correlated (r = 0.55) with age effects in old individuals (age > 90). We present a chromatin state analysis of age effects in centenarians. The centenarian clocks are expected to be useful for validating claims surrounding exceptional old age.

Associations between pregnancy glucose measurements and risk of preterm birth: a retrospective cohort study of commercially insured women in the United States from 2003 to 2021.

PURPOSE: To investigate associations between glucose measurements during pregnancy and risk of preterm birth (PTB). METHODS: Retrospective cohort study of commercially insured women with singleton live births in the United States from 2003 to 2021 using longitudinal medical claims, socioeconomic data, and eight glucose results from different fasting and post-load tests performed between 24 and 28 weeks of gestation for gestational diabetes screening. Risk ratios of PTB (<37 weeks) were estimated via Poisson regression for z-standardized glucose measures. Non-linear relationships for continuous glucose measures were examined via generalized additive models. RESULTS: Elevations in all eight glucose measures were associated with increased risk (adjusted risk ratio point estimates: 1.05-1.19) of PTB for 196,377 women with non-fasting 50-g glucose challenge test (one glucose result), 31,522 women with complete 100-g, 3-hour fasting oral glucose tolerance test (OGTT) results (four glucose results), and 10,978 women with complete 75-g, 2-hour fasting OGTT results (three glucose results). Associations were consistent after adjusting for and stratifying by sociodemographic and clinical factors. Substantial non-linear relationships (U-, J-, and S-shaped) were observed between several glucose measurements and PTB. CONCLUSIONS: Elevations in various glucose measures were linearly and non-linearly associated with increased PTB risk, even before diagnostic thresholds for gestational diabetes.

Does educational attainment modify the causal relationship between adiposity and cardiovascular disease? A Mendelian randomization study.

A greater risk of cardiovascular disease is associated with low educational attainment and high adiposity. Despite the correlation between low educational attainment and high adiposity, whether educational attainment modifies the risk of CVD caused by high adiposity remains poorly understood. We investigated the effect of adiposity (body mass index [BMI] and waist-to-hip ratio adjusted for BMI [WHRadjBMI]) on incident CVD among individuals with varying education levels, using associational and one-sample Mendelian randomization (MR) survival analyses. Data were collected from 2006 to 2021, and sample sizes were 254,281 (27,511 CVD cases) for BMI and 253,968 (27,458 CVD cases) for WHRadjBMI. In the associational model, a standard deviation (SD) higher BMI was associated with 19.81 (95% CI: 18.55-21.06) additional cases of incident CVD per 10,000 person-years for individuals with a secondary education, versus 32.96 (95% CI: 28.75-37.17) for those without. When university degree served as the education variable, education group differences attenuated, with 18.26 (95% CI: 16.37-20.15) cases from a one SD higher BMI for those with a university degree versus 23.18 [95% CI: 21.56-24.72] for those without. For the MR model, an SD higher BMI resulted in 11.75 (95% CI: -0.84-24.38) and 29.79 (95% CI: 17.20-42.44) additional cases of incident CVD per 10,000 person-years for individuals with versus without a university degree. WHRadjBMI exhibited no effect differences by education. While the associational model showed evidence of educational attainment modifying the relationship between adiposity and incident CVD, it does not modify the association between adiposity and incident CVD in the MR models. This suggests either less education does not cause greater risk of incident CVD from high adiposity, or MR models cannot detect the effect difference. The associational point estimates exist within the MR models' confidence intervals in all BMI analyses, so we cannot rule out the effect sizes in the associational models.

Manmade earthquakes and healthcare visits for anxiety disorders in Oklahoma, 2010-2019.

Since 2010, seismicity in Oklahoma has increased from wastewater injection. It remains unknown if these earthquakes have resulted in increased treatment seeking for mental healthcare services. Methods: Using data from a nationwide United States patient-level commercial and Medicare Advantage claims database from 2010 to 2019, we identified healthcare encounters for anxiety disorders using diagnostic codes and subclassified them as adjustment reaction; anxiety-related disorders; physical symptoms of anxiety; and stress disorders. With U.S. Geological Survey Advanced National Seismic System data, we generated county-level 6-month rolling counts of felt earthquakes (≥M 4) and linked them to patient residential county at the time of the healthcare visit. In this repeated measures, individual-level analysis we used generalized estimating equations to estimate the odds of monthly anxiety-related healthcare visits as a function of the frequency of ≥M 4 earthquakes in the previous 6 months. Results: We identified 4,594 individuals in Oklahoma observed from 2010 to 2019. For every additional five ≥M 4 earthquakes in the preceding 6 months, the odds of healthcare visits for stress disorders increased (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.03, 1.57). We found no evidence of an association with adjustment reaction (OR = 1.05; 95% CI = 0.89, 1.23), anxiety-related disorders (OR = 0.96; 95% CI = 0.90, 1.03), or physical symptoms of anxiety (OR = 1.03; 95% CI = 0.98, 1.09). Conclusions: We report an association between increased frequency of felt earthquakes and treatment seeking for stress disorders. This finding should motivate ongoing study of the potential consequences of the oil and gas industry for mental health outcomes including anxiety disorders.

Socioeconomic inequalities in the risk of suicide attempts among sexual minority adolescents: Findings from the UK's Millennium Cohort Study.

Background: Both sexual minority and socioeconomically deprived young people are at an increased risk of making a suicide attempt. Intersectionality theory predicts these risk factors will interact synergistically to create unique vulnerabilities. We investigated the risk of suicide attempts in sexual minority socioeconomically deprived young people in a contemporary national cohort. Methods: The Millennium Cohort Study (MCS) is a birth cohort study in the UK following children born 2000-2002. Children in the MCS have been followed up over seven sweeps to date at ages 9 months, 3, 5, 7, 11, 14 and 17 years. The relative risk (RR) of self-reported suicide attempts at 17 years by sexual minority status and parental unemployment was estimated using multivariable log-binomial regression. Additive interaction, representing the synergistic effect, was estimated using the relative excess risk due to interaction (RERI). Findings: Between January, 2018 and March, 2019, 10,247 adolescents provided their sexuality and parents their employment status. 758 (7.4%) of 10,247 adolescents had made a suicide attempt. Relative to heterosexual young people living with no unemployed parents, the RR for sexual minorities living with no unemployed parents/carers was 2.93 (95% CI 2.26-3.79), one unemployed was 4.46 (95% CI 2.94-6.77), and two was 6.35 (95% CI 3.62-11.14). There was evidence of a positive additive interaction. The RERI for having one unemployed parent was 1.08 (95% CI -0.54 to 2.69) and two was 3.10 (95% CI -1.58 to 7.78). Sensitivity analyses using housing tenure and in a sample with no missing data generated comparable results. Interpretation: To our knowledge, this is the first evidence that socioeconomically deprived sexual minority adolescents are uniquely vulnerable to making a suicide attempt. Health and educational practitioners need to be aware of the increased risk of suicide attempts in socioeconomically deprived sexual minority adolescents. Funding: Economic and Social Research Council (ESRC).

Associations of local area level new deal employment in childhood with late life cognition: evidence from the census-linked health and retirement study.

BACKGROUND: Emergency employment programmes during the 1930s and 1940s invested income, infrastructure and social services into communities affected by the Great Depression. We estimate the long-term associations of growing up in an area exposed to New Deal emergency employment in 1940 with cognitive functioning in later life. METHODS: Members of the Health and Retirement Study cohort (N=5095; mean age 66.3 at baseline) who were age 0-17 in 1940 were linked to their census record from that year, providing prospective information about childhood contextual and family circumstances. We estimated the association between subcounty-level emergency employment participation in 1940 and baseline cognition and rate of cognitive decline between 1998 and 2016. RESULTS: Compared with those living in the lowest emergency employment quintile in 1940, those who were exposed to moderate levels of emergency employment (third quintile) had better cognitive functioning in 1998 (b=0.092 SD, 95% CI 0.011 to 0.173), conditional on sociodemographic factors. This effect was modestly attenuated after adjusting for respondents' adult education, finances and health factors. There were no significant effects of area-level emergency employment on rate of cognitive decline. CONCLUSIONS: Exposure to New Deal employment policies during childhood is associated with long-term cognitive health benefits. This is partially explained by increases in educational attainment among those with greater levels of emergency employment activity in the place where they were raised. Future research should investigate which types of New Deal investments may most be related to long-term cognitive health, or if the associations we observe are due to co-occurring programmes.

Trends and inequities in the diagnosis and treatment of poststroke depression: a retrospective cohort study of privately insured patients in the USA, 2003-2020.

BACKGROUND: Depression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression. METHODS: Retrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race/ethnicity and age using negative binomial regression analysis. RESULTS: Annual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trend<0.001). Diagnosis rates were higher in women than men (HR 1.53, 95% CI 1.51 to 1.55), lower among members of racial/ethnic minorities (vs white patients: Asian HR 0.63, 95% CI 0.60 to 0.66; Black HR 0.76, 95% CI 0.74 to 0.78; Hispanic HR 0.88, 95% CI 0.86 to 0.90) and varied by age. Among individuals diagnosed with poststroke depression, 69.8% were prescribed an antidepressant. Rates of treatment were higher in women vs men (rate ratio, RR=1.19, 95% CI: 1.17 to 1.21), lower among members of racial/ethnic minorities (vs white patients: Asian RR 0.85, 95% CI 0.80 to 0.90; Black RR 0.92, 95% CI 0.89 to 0.94; Hispanic RR 0.96, 95% CI 0.93 to 0.99) and higher among older patients. CONCLUSIONS: In this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race/ethnicity and age that may reflect barriers other than access to healthcare.

Sex differences in epigenetic age in Mediterranean high longevity regions.

Sex differences in aging manifest in disparities in disease prevalence, physical health, and lifespan, where women tend to have greater longevity relative to men. However, in the Mediterranean Blue Zones of Sardinia (Italy) and Ikaria (Greece) are regions of centenarian abundance, male-female centenarian ratios are approximately one, diverging from the typical trend and making these useful regions in which to study sex differences of the oldest old. Additionally, these regions can be investigated as examples of healthy aging relative to other populations. DNA methylation (DNAm)-based predictors have been developed to assess various health biomarkers, including biological age, Pace of Aging, serum interleukin-6 (IL-6), and telomere length. Epigenetic clocks are biological age predictors whose deviation from chronological age has been indicative of relative health differences between individuals, making these useful tools for interrogating these differences in aging. We assessed sex differences between the Horvath, Hannum, GrimAge, PhenoAge, Skin and Blood, and Pace of Aging predictors from individuals in two Mediterranean Blue Zones and found that men displayed positive epigenetic age acceleration (EAA) compared to women according to all clocks, with significantly greater rates according to GrimAge (ß = 3.55; p = 1.22 × 10-12), Horvath (ß = 1.07; p = 0.00378) and the Pace of Aging (ß = 0.0344; p = 1.77 × 10-08). Other DNAm-based biomarkers findings indicated that men had lower DNAm-predicted serum IL-6 scores (ß = -0.00301, p = 2.84 × 10-12), while women displayed higher DNAm-predicted proportions of regulatory T cells than men from the Blue Zone (p = 0.0150, 95% Confidence Interval [0.00131, 0.0117], Cohen's d = 0.517). All clocks showed better correlations with chronological age in women from the Blue Zones than men, but all clocks showed large mean absolute errors (MAE >30 years) in both sexes, except for PhenoAge (MAE <5 years). Thus, despite their equal survival to older ages in these Mediterranean Blue Zones, men in these regions remain biologically older by most measured DNAm-derived metrics than women, with the exception of the IL-6 score and proportion of regulatory T cells.

Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance.

Importance: It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear. Objective: To describe and quantify social disparities in the treatment patterns of otitis media in children in the US. Design, Setting, and Participants: This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4 831 408 children with otitis media. Exposures: Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score. Main Outcomes and Measures: Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes. Results: Among 4 831 408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994 921 (20.59%) were treated for recurrent otitis media, 717 978 (14.86%) were treated for suppurative otitis media, 335 949 (6.95%) received tympanostomy tubes, and 10 975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37). Conclusions and Relevance: The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.

Mapping of machine learning approaches for description, prediction, and causal inference in the social and health sciences.

Machine learning (ML) methodology used in the social and health sciences needs to fit the intended research purposes of description, prediction, or causal inference. This paper provides a comprehensive, systematic meta-mapping of research questions in the social and health sciences to appropriate ML approaches by incorporating the necessary requirements to statistical analysis in these disciplines. We map the established classification into description, prediction, counterfactual prediction, and causal structural learning to common research goals, such as estimating prevalence of adverse social or health outcomes, predicting the risk of an event, and identifying risk factors or causes of adverse outcomes, and explain common ML performance metrics. Such mapping may help to fully exploit the benefits of ML while considering domain-specific aspects relevant to the social and health sciences and hopefully contribute to the acceleration of the uptake of ML applications to advance both basic and applied social and health sciences research.

Epigenome-wide association study and epigenetic age acceleration associated with cigarette smoking among Costa Rican adults.

Smoking-associated DNA methylation (DNAm) signatures are reproducible among studies of mostly European descent, with mixed evidence if smoking accelerates epigenetic aging and its relationship to longevity. We evaluated smoking-associated DNAm signatures in the Costa Rican Study on Longevity and Healthy Aging (CRELES), including participants from the high longevity region of Nicoya. We measured genome-wide DNAm in leukocytes, tested Epigenetic Age Acceleration (EAA) from five clocks and estimates of telomere length (DNAmTL), and examined effect modification by the high longevity region. 489 participants had a mean (SD) age of 79.4 (10.8) years, and 18% were from Nicoya. Overall, 7.6% reported currently smoking, 35% were former smokers, and 57.4% never smoked. 46 CpGs and five regions (e.g. AHRR, SCARNA6/SNORD39, SNORA20, and F2RL3) were differentially methylated for current smokers. Former smokers had increased Horvath's EAA (1.69-years; 95% CI 0.72, 2.67), Hannum's EAA (0.77-years; 95% CI 0.01, 1.52), GrimAge (2.34-years; 95% CI1.66, 3.02), extrinsic EAA (1.27-years; 95% CI 0.34, 2.21), intrinsic EAA (1.03-years; 95% CI 0.12, 1.94) and shorter DNAmTL (- 0.04-kb; 95% CI - 0.08, - 0.01) relative to non-smokers. There was no evidence of effect modification among residents of Nicoya. Our findings recapitulate previously reported and novel smoking-associated DNAm changes in a Latino cohort.

A US State Index of Successful Aging: Differences Between States and Over Time.

Policy Points The focus of successful aging is on the social contexts that enable individuals to be productively engaged and secure, with an emphasis on equity. There is currently no index to measure progress towards this goal at the US state level. We developed an empirical index for the evaluation of US state adaptation to societal aging across five critical domains that support successful population aging: (1) productivity and engagement, (2) security, (3) equity, (4) cohesion, and (5) well-being. Our index shows substantial variability over time and is not overly influenced by the performance of an individual domain. This suggests that it can be used to monitor state progress over time toward the goal of supporting successful aging. Rather than a major national trend, there are large between-state differences and changes in our index over time. This suggests individual US state policies and programs, as well as local economic conditions, may have a substantial impact on adaptations to societal aging. CONTEXT: Although it is recognized that aspects of US state environments impact the likelihood that older adults age successfully, there is currently no reliable and comprehensive measure of contexts that best support successful aging at a state level. The current project adapts a multidimensional index previously used to assess adaptation to successful aging in developed countries and applies it to the 50 US states and the District of Columbia. METHODS: We obtained data from multiple sources for all 50 US states and the District of Columbia from 2003 to 2017 in order to measure five distinct domains that define successful population aging: (1) productivity and engagement, (2) security, (3) equity, (4) cohesion, and (5) well-being. We created a ranking of states for the year 2017 based on these domains, and also examined how individual US state rankings changed over time from 2003 to 2017. FINDINGS: The level of adaptation to successful aging varied substantially between states and over time. The highest-ranked states in 2017 were Vermont, Hawaii, Iowa, Colorado, and New Hampshire, and the lowest-ranked states were Louisiana, Arkansas, Kentucky, West Virginia, and Mississippi. Mississippi, South Carolina, Iowa, Arizona, and Delaware had the greatest improvement in their ranking over the period of 2003 to 2017. Our findings were generally robust to the weighting scheme used and were not overly influenced by any particular domain. CONCLUSIONS: The US State Index of Successful Aging can be used to monitor US state progress in promoting the well-being and health of aging populations. Factors driving the changes in the index remain to be elucidated.

Explaining the Variance in Cardiovascular Disease Risk Factors: A Comparison of Demographic, Socioeconomic, and Genetic Predictors.

BACKGROUND: Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors. METHODS: Data were drawn from the Health and Retirement Study (N = 8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained. RESULTS: The variance explained by models including all predictors ranged from 3.7% to 14.3%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to the prediction of CVD-related outcomes. Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, UCSF. CONCLUSIONS: Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings. See video abstract at, http://links.lww.com/EDE/B879.