Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery.

Background: There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations. Methods: This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with vs without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses. Results: Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% vs 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71-0.92; P=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% vs 5.26% (OR: 0.78; 95% CI: 0.66-0.94; P=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% vs 5.24% (OR: 0.80; 95% CI: 0.65-0.97; P=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% vs 2.15% (OR: 0.85; 95% CI: 0.70-1.02; P=0.089, nor any of the remaining three subgroups. Conclusions: Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (vs without) and among patients undergoing multivessel (vs single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.

Household food insecurity during the COVID-19 pandemic is associated with anxiety and depression among US- and foreign-born adults: Findings from a nationwide survey.

The COVID-19 pandemic led to significant disruptions to household food security with as many as 10.5 % of US households experiencing food insecurity during 2020. Food insecurity is associated with psychological distress including depression and anxiety. However, to the best of our knowledge, no study has analyzed the association between COVID-19 food insecurity and poor mental health outcomes by place of birth. The Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases national survey assessed the physical and psychosocial effects of social and physical distancing during the COVID-19 pandemic among a diverse population of US- and foreign-born adults. Multivariable logistic regression was used to assess the relationship between place of birth and food security status and anxiety (N = 4817) and depression (N = 4848) among US- and foreign-born individuals. Stratified models subsequently analyzed the associations between food security and poor mental health among US- and foreign-born populations separately. Model controls included sociodemographic and socioeconomic factors. Low and very low household food security were associated with greater odds of both anxiety (low: odds ratio (OR) [95 % confidence interval (CI)] = 2.07 [1.42-3.03]; very low: OR [95 % CI] = 3.35 [2.15-5.21]) and depression (low: OR [95 % CI] = 1.92 [1.33-2.78]; very low: OR [95 % CI] = 2.36 [1.52-3.65]). However, this relationship was attenuated among foreign-born individuals compared to US-born individuals in the stratified models. All models found a dose-response relationship between increasing levels of food insecurity and anxiety and depressive symptoms. Further research is needed to explore the factors that attenuated the relationship between food insecurity and poor mental health among foreign-born individuals.

Sociodemographic Factors and Health Insurance Coverage Are Associated with Invasive Breast Cancer in Tennessee: Appalachian and Non-Appalachian County Comparison.

Background: Tennessean women experience the 12th highest breast cancer (BC) mortality in the United States. Yet, few studies have examined BC outcomes among Tennessean women in and outside of Appalachia. We examined whether sociodemographic factors and health insurance status were associated with invasive BC in Tennessee by Appalachian and non-Appalachian county designation. Materials and Methods: Using the Tennessee Cancer Registry, we identified 52,187 women, aged ≥18, diagnosed with BC between 2005 and 2015. Multivariable logistic regression was performed to examine associations between invasive BC and sociodemographic characteristics, health insurance coverage, and county designation (Appalachian/non-Appalachian). Regression analyses stratified by county designation were subsequently performed. Results: In Tennessee, younger women had lower odds of invasive BC diagnosis (<45: odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.67-0.81; 55-64: OR = 0.91, 95% CI = 0.84-0.97) compared to women ≥65. Married Tennessean women had 12% (95% CI = 1.04-1.21) higher odds of invasive BC than single women. Further, both public (OR = 1.81, 95% CI = 1.41-2.33) and private (OR = 1.36, 95% CI = 1.06-1.76) health insurance were found to increase odds of invasive BC compared to no insurance/self-pay. Results from the subpopulation analyses were largely consistent with overall findings. In Appalachian counties, women on public health insurance had increased odds (OR = 1.42, 95% CI = 1.00-2.03) of invasive BC compared to uninsured/self-pay women, while in non-Appalachian counties, women insured both publicly (OR = 2.25, 95% CI = 1.57-3.24) and privately (OR = 1.68, 95% CI = 1.16-2.24) had increased odds of invasive BC. Conclusions: The results identify risk factors for Tennessean women in Appalachian and non-Appalachian counties whose malignancies evaded early detection, increasing risk of mortality.

A Socioecological Mixture Model of Asthma Prevalence Among Sexual Minority Adults in the United States.

Purpose: Sexual minority (SM) identity as well as sociodemographic and socioeconomic factors are associated with asthma prevalence. A syndemics framework analyzes disease conditions in a population and the social, economic, and environmental contexts in which they are found. We used a syndemic model of individual-level socioecological factors to identify profiles of asthma prevalence among SM adults. Methods: Latent class analysis (LCA) was conducted on a subpopulation of SM adults aged 18-59 years from the 2001 to 2016 National Health and Nutrition Examination Survey. Indicators in the LCA model included current asthma, gender, sexual identity, poverty-income ratio, education, and serum cotinine level. Multinomial logistic regression analyzed the effects of covariates (race/ethnicity, nativity, age, marital status, body mass index, lifetime smoking, and mental health care seeking) on identified profiles. Results: Four classes were identified among our sample of n = 1097 SM adults. Classes 1 and 2 had 19% and 18% conditional probabilities of current asthma, respectively, and were primarily female and bisexual. Classes 3 and 4 had 5% and 2% conditional probabilities of asthma, respectively, and were primarily male and gay. Classes 1 and 3 also had conditional probabilities of high income and educational attainment. Black individuals had higher odds than White individuals of being in Class 1 (odds ratio [OR] = 4.46, 95% confidence interval [CI] = 1.43-13.93), Class 2 (OR = 21.66, 95% CI = 7.50-62.60), and Class 4 (OR = 7.41, 95% CI = 2.05-26.71), relative to Class 3. Conclusion: Findings extend past literature that suggests within-group asthma disparities among SM adults. Informational campaigns on asthma management should target this community to avoid severe disease exacerbations.

Breast cancer screening among Hispanic and non-Hispanic White women by birthplace in the Sister Study.

BACKGROUND: Hispanic/Latina women are less likely to be diagnosed with local stage breast cancer than White women. Additionally, foreign-born women have lower mammography rates than US-born women. We evaluated the combined effect of birthplace and race/ethnicity on screening habits of women at higher-than-average risk of breast cancer. METHODS: Multinomial logistic regression was used to evaluate breast cancer screening in 44,524 women in the Sister Study cohort. Screening methods ascertained at enrollment (2003-2009) included mammography, ultrasound, and magnetic resonance imaging. Timing of screening was assessed as recently (≤2 years ago), formerly (>2 years ago), and never screened. Adjustments included sociodemographic, socioeconomic, and health variables. RESULTS: Most women in the sample were US-born non-Hispanic/Latina White (92%), were ≥50 years old (73%), had one first-degree female relative with breast cancer (73%), and were screened in the past two years (97%). US-born Hispanic/Latina women had higher odds (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.08-2.00) than US-born non-Hispanic/Latina White women of not having received a breast cancer screening in the past 2 years, relative to a recent screening. Similarly, foreign-born Hispanic/Latina women had higher odds (OR = 1.63, 95% CI = 1.10-2.41) than US-born non-Hispanic/Latina White women of never having received a breast cancer screening. CONCLUSION: We observed that Hispanic/Latina women have higher odds of never and dated breast cancer screenings compared to US-born White women. Birthplace and race/ethnicity each contribute to disparities in who receives preventative health care in the United States. It is critical to include birthplace when evaluating health behaviors in minority groups.