Revisiting recent trends in stroke death rates, United States, 1999-2020.

BACKGROUND: Prior studies have reported a reversal or stalling of stroke mortality trends in the United States, but the literature has not been updated using recent data. A comprehensive examination of contemporary trends is crucial to informing public health intervention efforts, setting health priorities, and allocating limited health resources. This study assessed the temporal trends in stroke death rates in the United States from 1999 through 2020. METHODS: We used national mortality data from the Underlying Cause of Death files in the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER). Stroke decedents were identified using the International Classification of Diseases Codes, 10th Revision- I60-I69. Crude/age-adjusted mortality rates (AAMR) were abstracted overall and by age, sex, race/ethnicity, and US census region. Joinpoint analysis and five-year simple moving averages assessed mortality trends from 1999 through 2020. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence interval (CI). RESULTS: Stroke mortality trends declined from 1999 to 2012 but increased by 0.5% annually from 2012 through 2020. Rates increased by 1.3% per year among Non-Hispanic Blacks from 2012 to 2020, 1.7% per year among Hispanics from 2012 to 2020, and stalled among Non-Hispanic Whites (2012-2020), Asians/Pacific Islanders (2014-2020), and American Indians/Alaska Natives (2013-2020). Recent rates have stalled among females from 2012 to 2020 and increased among males at an annual rate of 0.7% during the same period. Based on age, trends have stabilized among older adults since 2012 and grew at an annual rate of 7.1% among persons <35 years and 5.2% among persons 35 to 64 years since 2018. Declining trends were sustained in the Northeastern region only, with rates stalling in the Midwest and increasing in the South and West. CONCLUSIONS: The decline in US stroke mortality trends recorded during previous decades has not been sustained in recent years. While the reasons are unclear, findings might be attributed to changes in stroke risk factors in the US population. Further research should identify social, regional, and behavioral drivers to guide medical and public health intervention efforts.

Sex Differences in the Association Between Cannabis Use and Diabetes Mellitus among U.S. Adults: The National Health and Nutritional Examination Survey, 2013-2018.

Background: Diabetes mellitus is an important public health problem in the United States, accounting for 87,647 deaths in 2019. This study aimed to assess the association between cannabis use and diabetes mellitus by sex among U.S. adults. Methods: Data were abstracted from the National Health and Nutrition Examination Survey (NHANES) from 2013 through 2018. Cannabis use was estimated using exposure status and frequency of use. Diabetes mellitus was assessed based on physician diagnosis or laboratory results, per the American Diabetes Association guidelines. A multivariable survey logistic regression model was fitted to estimate adjusted odds ratios (aOR) and confidence intervals (95% CIs). Results: A total of 15,062 participants were included in this study. The majority were female (n=7845; 51.1%), >40 years of age (n=8564; 56.3%), non-Hispanic white (n=4873; 61.5%), with at least a college-level education (n=8239; 62.5%). Female participants who used cannabis heavily were less likely to be diagnosed with diabetes mellitus than female noncannabis users (aOR=0.49; 95% CI: 0.30-0.81; aOR=0.51; 95% CI: 0.31-0.84). However, no significant association was found for female adults who engaged in light use of cannabis (aOR=0.98; 95% CI: 0.55-1.75; aOR=1.01; 95% CI: 0.57-1.79). Among male adults, cannabis use, irrespective of the degree of exposure, was not significantly associated with diabetes mellitus (heavy users: aOR=0.89; 95% CI=0.56-1.41; light users: aOR=0.53; 95% CI=0.22-1.29). Conclusions: Heavy cannabis use is inversely associated with diabetes mellitus in females but not males. Further studies are needed to explore the sex-based heterogeneity-and individual and contextual factors responsible-in the association between cannabis use and diabetes mellitus.

Sex differences in the association between short sleep duration and obesity among US adults: findings from NHANES, 2015-2020.

BACKGROUND: Obesity is an important public health problem in the United States. Identifying modifiable risk factors could guide public health intervention efforts. In this study, we leveraged a nationally representative sample of the US population to examine sex differences in the association between short sleep and obesity among US adults. METHODS: Publicly available cross-sectional national data were extracted from the National Health and Nutrition Examination Survey, 2015 through 2020. A multivariable survey logistic regression model was fitted for the association between short sleep (defined as less than 7 h of sleep in 24 h) and obesity, accounting for sample stratification, clustering, and weighing. Heterogeneity was assessed using interaction terms overall and by fitting a sex-stratified model. RESULTS: A total of 15,562 persons aged 18 years and older were included in the study. The majority were non-Hispanic whites, 18-44 years of age, with at most a high school education. Short sleepers tended to be female (55.9%; 95% CI: 53.9, 57.9) while long (59.6%; 95% CI: 57.4, 61.7) and normal sleepers (51.9%; 95% CI: 50.5, 53.2) tended to be male. As compared with normal sleep duration, 7-9 h, short sleep duration was not significantly associated with obesity in the study population overall (OR = 0.95; 95% CI: 0.83-1.08) or among males (OR = 0.98; 95% CI: 0.86-1.12). However, short sleep was associated with increased odds of obesity among females (OR = 1.22; 95% CI: 1.01-1.49). CONCLUSIONS: There is sex-based heterogeneity in the association between short sleep and obesity among US adults. Further research should explore the factors responsible, and investigate the underlying mechanism.