Racial and ethnic disparities in short interval pregnancy following delivery in Catholic vs non-Catholic hospitals among California Medicaid enrollees.

OBJECTIVES: We examined the impact of Catholic hospital delivery on short interval pregnancy in the California 2010-2014 Medicaid population. STUDY DESIGN: We used Cox regression to estimate the association between hospital affiliation and short interval pregnancy, adjusting for patient factors. RESULTS: Catholic hospital delivery had increased the risk of pregnancy within 6 months for Black (hazard ratio [HR] 1.11, 95% CI 1.06, 1.17) and Hispanic (HR 1.07, 95% CI 1.05, 1.09) but not for White women (HR 1.02, 95% CI 0.98, 1.05). CONCLUSIONS: Among California women with Medicaid, Catholic hospital delivery was associated with short interval pregnancy only among women of color.

Racial and ethnic disparities in the observed COVID-19 case fatality rate among the U.S. population.

PURPOSE: During the initial 12 months of the pandemic, racial and ethnic disparities in COVID-19 death rates received considerable attention but it has been unclear whether disparities in death rates were due to disparities in case fatality rates (CFRs), incidence rates or both. We examined differences in observed COVID-19 CFRs between U.S. White, Black/African American, and Latinx individuals during this period. METHODS: Using data from the COVID Tracking Project and the Centers for Disease Control and Prevention COVID-19 Case Surveillance Public Use dataset, we calculated CFR ratios comparing Black and Latinx to White individuals, both overall and separately by age group. We also used a model of monthly COVID-19 deaths to estimate CFR ratios, adjusting for age, gender, and differences across states and time. RESULTS: Overall Black and Latinx individuals had lower CFRs than their White counterparts. However, when adjusting for age, Black and Latinx had higher CFRs than White individuals among those younger than 65. CFRs varied substantially across states and time. CONCLUSIONS: Disparities in COVID-19 case fatality among U.S. Black and Latinx individuals under age 65 were evident during the first year of the pandemic. Understanding racial and ethnic differences in COVID-19 CFRs is challenging due to limitations in available data.

Are U.S. older adults getting lonelier? Age, period, and cohort differences.

Media portrayals of a loneliness "epidemic" are premised on an increase in the proportion of people living alone and decreases in rates of civic engagement and religious affiliation over recent decades. However, loneliness is a subjective perception that does not correspond perfectly with objective social circumstances. In this study, we examined whether perceived loneliness is greater among the Baby Boomers-individuals born 1948-1965-relative to those born 1920-1947 and whether older adults have become lonelier over the past decade (2005-2016). We used data from the National Social Life, Health and Aging Project and from the Health and Retirement Study collected during 2005-2016 to estimate differences in loneliness associated with age, birth year, and survey time point. Overall, loneliness decreased with age through the early 70s, after which it increased. We found no evidence that loneliness is substantially higher among the Baby Boomers or that it has increased over the past decade. Loneliness is, however, associated with poor health, living alone or without a spouse-partner, and having fewer close family and friends, which together accounted for the overall increase in loneliness after age 75. Although these data do not support the idea that older adults are becoming lonelier, the actual number of lonely individuals may increase as the Baby Boomers age into their 80s and beyond. Our results suggest that attention to social factors and improving health may help to mitigate this. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention.

OBJECTIVES: To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. METHODS: A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record-generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. RESULTS: At 3 months, there was no difference between groups in mental (-1.03; 95% confidence interval [CI] = -3.02, 0.96) or physical HRQOL (0.59; 95% CI = -0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. CONCLUSIONS: CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02435511.

Assessment of social network change in a national longitudinal survey.

OBJECTIVES: This article describes new longitudinal data on older adults' egocentric social networks collected by the National Social Life, Health, and Aging Project (NSHAP). We describe a novel survey technique that was used to record specific personnel changes that occurred within respondents' networks during the 5-year study period, and we make recommendations regarding usage of the resulting data. METHOD: Descriptive statistics are presented for measures of network size, composition, and structure at both waves, respondent-level summary measures of change in these characteristics between waves, as well as measures that distinguish between changes associated with losses of Wave 1 network members, additions of new ones, and changes in relationships with network members who were present at both waves. RESULTS: The NSHAP network change module was successful in providing reliable information about specific changes that occurred within respondents' confidant networks. Most respondents lost at least one confidant from W1 and added at least one new confidant between waves as well. Network growth was more common than network shrinkage. Both lost and new ties were weaker than ties that persisted throughout the study period. DISCUSSION: These data provide new insight into the dynamic nature of networks in later life, revealing norms of network turnover, expansion, and weakening. Data limitations are discussed.

Assessment of sensory function in the National Social Life, Health, and Aging Project.

OBJECTIVES: The National Social Life, Health, and Aging Project assessed functioning of all 5 senses using both self-report and objective measures. We evaluate the performance of the objective measures and model differences in sensory function by gender and age. In the process, we demonstrate how to use and interpret these measures. METHODS: Distance vision was assessed using a standard Sloan eye chart, and touch was measured using a stationary 2-point discrimination test applied to the index fingertip of the dominant hand. Olfactory function (both intensity detection and odor identification) was assessed using odorants administered via felt-tip pens. Gustatory function was measured via identification of four taste strips. RESULTS: The performance of the objective measures was similar to that reported for previous studies, as was the relationship between sensory function and both gender and age. DISCUSSION: Sensory function is important in studies of aging and health both because it is an important health outcome and also because a decline in functioning can be symptomatic of or predict other health conditions. Although the objective measures provide considerably more precision than the self-report items, the latter can be valuable for imputation of missing data and for understanding differences in how older adults perceive their own sensory ability.

Assessment of reliability and validity of IBD phenotyping within the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) IBD Genetics Consortium (IBDGC).

BACKGROUND: The NIDDK IBD Genetics Consortium (IBDGC) collects DNA and phenotypic data from inflammatory bowel disease (IBD) subjects to provide a resource for genetic studies. No previous studies have been performed on the reliability and validity of phenotypic determinations in either Crohn's disease (CD) or ulcerative colitis (UC) using primary records. Our aim was to determine the reliability and validity of these phenotypic assessments. METHODS: The de-identified records of 30 IBD patients were reviewed by 2 phenotypers per center using a standard protocol for phenotypic assessment. Each phenotyper evaluated 10 charts on 2 occasions 5 months apart. Reliability was expressed as the kappa (kappa) statistic. Performance characteristics were determined by comparison to a consensus-derived "gold standard" and by generation of receiver operating characteristic (ROC) curves. RESULTS: Agreement for diagnosis was excellent (kappa = 0.82; 95% confidence interval [CI]: 0.71-0.92). Agreement for CD location was good for jejunal, ileal, colorectal, and perianal disease with kappa between 0.60 and 0.74 but was fair for esophagogastroduodenal (kappa = 0.36). Agreement for UC extent (kappa = 0.67; 95% CI: 0.48-0.85), and CD behavior (kappa = 0.67; 95% CI: 0.49-0.83) were very good. Area under the ROC curves was greater than 0.84 for diagnosis, CD behavior, UC extent, and ileal and colonic CD location. CONCLUSIONS: IBD phenotype classification using a standard protocol exhibited very good to excellent inter- and intrarater agreement and validity. This study highlights the importance of standard protocols in generating reliable and valid phenotypic assessments. The data will facilitate estimates of phenotyping misclassification rates that should be considered when making inferences from IBD genotype-phenotype studies.