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Objective: To explore and evaluate the value of chromosomal microarray analysis (CMA) in prenatal diagnosis of fetuses with ultrasound abnormalities. Methods: A retrospective analysis was performed on 370 fetuses with ultrasound abnormalities received invasive prenatal diagnosis at Meizhou People's Hospital from October 2022 to December 2023. Fetal specimens were analyzed by CMA, and the detection rates of aneuploidy and pathogenic (P)/likely pathogenic (LP) copy number variations (CNVs) in ultrasound structural abnormalities (malformations of fetal anatomy) and non-structural abnormalities (abnormalities of fetal nonanatomical structure) were analyzed. Results: There were 114 (30.8%) cases with isolated ultrasound structural abnormalities, 226 (61.1%) cases with isolated non-structural abnormalities (182 isolated ultrasound soft markers abnormalities, 30 isolated fetal growth restriction (FGR), and 8 isolated abnormalities of amniotic fluid volume), and 30 (8.1%) cases with both structural and non-structural abnormalities. The overall detection rate of aneuploidy and P/LP CNVs in isolated ultrasonic structural abnormalities was 5.3%, among which cardiovascular system abnormalities were the highest. In addition, the largest number of fetuses with non-structural abnormalities was nuchal translucency (NT) thickening (n = 81), followed by ventriculomegaly (n = 29), and nasal bone dysplasia (n = 24). The detection rate of chromosomal abnormalities of fetuses with abnormal ultrasound soft markers was 9.9%, and the detection rate in single abnormal ultrasound soft marker, and multiple ultrasound soft markers abnormalities was 9.7% (16/165) and 11.8% (2/17), respectively. Moreover, the detection rate of chromosomal abnormalities of fetuses with FGR and structural abnormalities combined with non-structural abnormalities was 6.7% (2/30), and 13.3% (4/30), respectively. Conclusion: The incidence of chromosomal abnormalities (aneuploidy and P/LP CNVs) varies among different fetal ultrasound abnormalities.
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Cation-doped cubic Li7La3Zr2O12 is regarded as a promising solid electrolyte for safe and energy-dense solid-state lithium batteries. However, it suffers from the formation of Li2CO3 and high electronic conductivity, which give rise to an unconformable Li/Li7La3Zr2O12 interface and lithium dendrites. Herein, composite AlF3-Li6.4La3Zr1.4Ta0.6O12 solid electrolytes were created based on thermal AlF3 decomposition and F/O displacement reactions under a high-temperature sintering process. When the AlF3 is thermally decomposed, it leaves Al2O3/AlF3 meliorating the grain boundaries and F- ions partially displacing O2- ions in the grains. Due to the higher electronegativity of F- in the grains and the grain-boundary modification, these AlF3-Li6.4La3Zr1.4Ta0.6O12 deliver optimized electronic conduction and chemical stability against the formation of Li2CO3. The Li/AlF3-Li6.4La3Zr1.4Ta0.6O12/Li cell exhibits a low interfacial resistance of â¼16 Ω cm2 and an ultrastable long-term cycling behavior for 800 h under a current density of 200 µA/cm2, leading to Li//LiCoO2 solid-state batteries with good rate performance and cycling stability.
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The application of terahertz time-domain spectroscopy (THz-TDS) in the quantitative analysis of major minerals in Bayan Obo magnetite ore was explored. The positive correlation between the optical parameters of the original ore and its iron content is confirmed. The detections of three main iron containing minerals, including magnetite, pyrite, and hematite, were simulated using corresponding reagents. The random forest algorithm is used for quantitative analysis, and FeS2 is detected with precision of R2 = 0.7686 and MAE = 0.6307% in ternary mixtures. The experimental results demonstrate that THz-TDS can distinguish specific iron containing minerals and reveal the potential application value of this testing method in exploration and mineral processing fields.
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This study investigated the effects of ultrasound-assisted soybean lecithin (SL) on the rehydration behavior and physical properties of egg white protein powder (EWPP) and its ability to enhance the efficacy of EWPP instant solubility. The results of rehydration, including wettability and dispersibility, indicated that ultrasound (200 W)-assisted SL (5 g/L) addition had the shortest wetting time and dispersion time, which were 307.14 ± 7.00 s and 20.95 ± 2.27 s, respectively. In terms of powder properties, the EWPP with added SL had lower lightness, moisture content and bulk density. In addition, the increase in average particle size, net negative charge, free sulfhydryl group content and surface hydrophobicity indicated that ultrasound treatment facilitated the protein structures unfolding and promoted the formation of SL-EWP complexes. Overall, our study provided a new perspective for the food industry regarding using ultrasound technology to produce instant EWPP with higher biological activity and more complete nutritional value.
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Stimuli-responsive drug delivery carriers, particularly those exhibiting pH sensitivity, have attracted significant scholarly interest due to their promising potential in anticancer therapeutic applications. This phenomenon can primarily be ascribed to the inherently acidic nature of tumor microenvironments. However, pH-responsive carriers frequently require the incorporation of functional groups or materials sensitive to pH changes. Given the pH-sensitive characteristics of metal coordination with natural small-molecule drugs, organometallic supramolecules present a facile and effective strategy for integrating pH-responsive behavior into these systems. Meanwhile, utilizing the natural compound luteolin in conjunction with iron ions (Fe3+) through the advanced engineering technique of flash nanoprecipitation (FNP) results in the synthesis of stable, highly loaded nanoparticles (NPs) exhibiting a supramolecular photothermal effect. Our experimental findings substantiate that the photothermal effect persists over time, even after the pH-responsive release phase has ended. Consequently, these polymeric pH-responsive metallic supramolecular nanoparticles integrate chemotherapy and photothermal therapy, creating a synergistic approach to cancer treatment. This bifunctional platform, which exhibits both pH-responsive and photothermal properties, presents a highly promising avenue for biomedical applications, particularly in the area of tumor therapies. Its dual function offers a potentially efficacious approach to tumor treatment.
Subject(s)
Metal Nanoparticles , Hydrogen-Ion Concentration , Humans , Metal Nanoparticles/chemistry , Polymers/chemistry , Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacology , Photothermal Therapy/methods , Drug Carriers/chemistry , Drug Carriers/radiation effects , Iron/chemistryABSTRACT
This publisher's note serves to correct errors in Appl. Opt.63, 2528 (2024)APOPAI0003-693510.1364/AO.517400.
ABSTRACT
Photoacoustic tomography (PAT) regularly operates in limited-view cases owing to data acquisition limitations. The results using traditional methods in limited-view PAT exhibit distortions and numerous artifacts. Here, a novel limited-view PAT reconstruction strategy that combines model-based iteration with score-based generative model was proposed. By incrementally adding noise to the training samples, prior knowledge can be learned from the complex probability distribution. The acquired prior is then utilized as constraint in model-based iteration. The information of missing views can be gradually compensated by cyclic iteration to achieve high-quality reconstruction. The performance of the proposed method was evaluated with the circular phantom and in vivo experimental data. Experimental results demonstrate the outstanding effectiveness of the proposed method in limited-view cases. Notably, the proposed method exhibits excellent performance in limited-view case of 70° compared with traditional method. It achieves a remarkable improvement of 203% in PSNR and 48% in SSIM for the circular phantom experimental data, and an enhancement of 81% in PSNR and 65% in SSIM for in vivo experimental data, respectively. The proposed method has capability of reconstructing PAT images in extremely limited-view cases, which will further expand the application in clinical scenarios.
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The effect of crystal-water contents on the optical properties and dielectric characteristics of calcium sulfate in the THz band is investigated. The complex dielectric constant and conductivity are analyzed using the Drude-Smith model. The refractive index and absorption coefficient are linearly increased with the content of crystal-water, and the corresponding linear fitting lines of R2 over 0.97 are obtained. The dielectric properties of calcium sulfate are significantly affected by the crystal-water content. These results indicate that a new method to quantitative measurement of the crystal-water content in hydrous minerals is provided.
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Mesenchymal stromal/stem cells (MSCs), which are distributed in many tissues including bone marrow, have been reported to play a critical role in tumor development. While bone marrow, the primary site for hematopoiesis, is important for establishing the immune system, whether MSCs in the bone marrow can promote tumor growth via influencing hematopoiesis remains unclear. We observed that the numbers of MSCs and neutrophils were increased in bone marrow in tumor-bearing mice. Moreover, co-culture assay showed that MSCs strongly protected neutrophils from apoptosis and induced their maturation. G-CSF and GM-CSF have been well-documented to be associated with neutrophil formation. We found a remarkably increased level of G-CSF, but not GM-CSF, in the supernatant of MSCs and the serum of tumor-bearing mice. The G-CSF expression can be enhanced with inflammatory cytokines (IFNγ and TNFα) stimulation. Furthermore, we found that IFNγ and TNFα-treated MSCs enhanced their capability of promoting neutrophil survival and maturation. Our results indicate that MSCs display robustly protective effects on neutrophils to contribute to tumor growth in bone niches.
Subject(s)
Cytokines , Mesenchymal Stem Cells , Neutrophils , Animals , Mesenchymal Stem Cells/immunology , Mesenchymal Stem Cells/metabolism , Neutrophils/immunology , Neutrophils/metabolism , Mice , Cytokines/metabolism , Mice, Inbred C57BL , Coculture Techniques , Granulocyte Colony-Stimulating Factor/metabolism , Apoptosis , Tumor Necrosis Factor-alpha/metabolism , Cell Line, Tumor , Neoplasms/immunology , Neoplasms/pathologyABSTRACT
Herein, corundum-structured Ga2O3(α-Ga2O3) nanorod array/fluorine-doped SnO2(FTO) structures have been fabricated by hydrothermal and thermal annealing processes with different precursor concentrations from 0.01 to 0.06 M. The diameter and length of the nanorod arrays are much larger with increasing precursor concentrations due to more nucleation sites and precursor ions participating in the reaction procedures. The optical bandgap decreases from 4.75 to 4.47 eV because of the tensile stress relieving with increasing the precursor concentrations. Based on self-powered photoelectrochemical (PEC) photodetectors, the peak responsivity is improved from â¼0.33 mA W-1for 0.06 M to â¼1.51 mA W-1for 0.02 M. Schottky junctions can be formed in PEC cells. More photogenerated carriers can be produced in wider depletion region. From Mott-Schottky plots, the depletion regions become much wider with decreasing the precursor concentrations. Therefore, the enhance responsivity is owing to the wider depletion regions. Due to the reduced possibility of photogenerated holes captured by traps ascribed from fewer green and yellow luminescence defects, smaller charge transfer resistance, and shorter transportation route, the decay time becomes much faster through decreasing the precursor concentrations. Compared with the other self-poweredα-Ga2O3-nanorod-array-based PEC photodetectors, it shows the fastest response time (decay time of 0.005 s/0.026 s) simply modulated by precursor concentrations for the first time without employing complex precursors, seed layers or special device designs. Compared with other high-responsivity monoclinic Ga2O3(ß-Ga2O3) self-powered photodetectors, our devices also show comparable response speed with simple control and design. This work provides the realization of fast-speed self-powered Ga2O3based solar-blind ultraviolet photodetectors by simple modulation processes and design, which is a significant guidance for their applications in warnings, imaging, computing, communication and logic circuit, in the future.
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Aqueous Zn-ion hybrid supercapacitors (ZHSs) are attracting significant attention as a promising electrochemical energy storage system. However, carbon cathodes of ZHSs exhibit unsatisfactory ion storage performance due to the large size of hydrated Zn-ions (e.g., [Zn(H2O)6]2+), which encumbers compact ion arrangement and rapid ion transport at the carbon-electrolyte interfaces. Herein, a porous carbon material (HMFC) with abundant sub-nanopores is synthesized to optimize the ion storage performance of the carbon cathode in ZHSs, in which the sub-nanopores effectively promote the dehydration of hydrated Zn-ions and thus optimize the ion storage performance of the carbon cathode in ZHSs. A novel strategy is proposed to study the dehydration behaviors of hydrated Zn-ions in carbon cathodes, including quantitatively determining the desolvation activation energy of hydrated Zn-ions and in-situ monitoring active water content at the carbon-electrolyte interface. The sub-nanopores-induced desolvation effect is verified, and its coupling with large specific surface area and hierarchically porous structure endows the HMFC cathode with improved electrochemical performance, including a 53 % capacity increase compared to the carbon cathode counterpart without sub-nanopores, fast charge/discharge ability that can output 46.0 Wh/kg energy within only 4.4 s, and 98.2 % capacity retention over 20,000 charge/discharge cycles. This work provides new insights into the rational design of porous carbon cathode materials toward high-performance ZHSs.
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Land use transition and its impact on ecosystem service value (ESV) are the foundation for optimizing the layout of territorial space and ecological civilization construction. With the acceleration of industrialization and urbanization, the area of construction land expands in China. To accurately estimate the ESV in industrial counties, the impact of construction land on the ecological environment should be fully considered. This paper took Gangcheng District, Jinan City, a steel base in the Shandong Province of China as an example, then the value coefficients of "three wastes" factors (waste gas, wastewater, and waste) were introduced, and an improved calculation method of ESV was put forward for industrial counties in combination with remote sensing and land use data. Finally, the land use transition and its ESV effect in typical industrial counties were analyzed using geo-informatic Tupu and grid method. The results showed that the most important land use transitions were from grassland and forestland to cultivated land, from cultivated land and forestland to construction land in 1990-2010, and from cultivated land transformed to forestland in 2010-2021. The types of land use transition were mainly repetitive and continuous. The ESV first decreased and then increased, with a slight overall decline for more than 30 years, showing a spatial distribution characteristic of "low in the south-central and high around." Land use transition had the impact on ESV with the negative contribution rate of 68.28% in 1990-2000 and 73.16% in 2000-2010, mainly caused by the transition from forestland and grassland to cultivated land and construction land, and the positive contribution rate of 81.72% in 2010-2021, mainly caused by the transition from cultivated land to forestland. Compared with the ESV calculation method without introducing the "three wastes" factor and Xie Gaodi's method, the improved method in this paper considered the inevitable impact of construction land on ESV in industrial counties and made the ESV calculated more accurate according to the regional nature. This paper cannot only enrich the theories and technical methods of land use transition and its effects, and provide a case reference for similar industrial counties, but also provide data and decision-making support for the spatial layout and ecological protection in the study area.
Subject(s)
Ecosystem , China , Conservation of Natural Resources , Urbanization , Forests , Environmental MonitoringABSTRACT
BACKGROUND: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health-related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. METHODS: Adult cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2-3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. RESULTS: Among cancer survivors 18-64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65-79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18-64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36-2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65-79 years old, 2-3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13-2.20, p = .007; reference = 0 domain). CONCLUSIONS: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.
Subject(s)
Cancer Survivors , Financial Stress , Humans , Cancer Survivors/psychology , Cancer Survivors/statistics & numerical data , Middle Aged , Female , Male , Adult , Aged , Financial Stress/psychology , Young Adult , Adolescent , Food Insecurity , Neoplasms/mortality , Neoplasms/psychology , Neoplasms/economics , United States/epidemiologyABSTRACT
Terahertz time-domain spectroscopy was first used to establish a correlation with the whole-rock iron (TFe) content in different depths of the Bayan Obo protolith. Compared with element content obtained by the traditional method of X-ray fluorescence spectroscopy (XRF), a similar tendency of the absorption coefficient and refractive index is presented. Furthermore, three machine learning algorithms, namely, partial least squares regression (PLSR), random forest (RF), and multi-layer perceptron (MLP), were used to develop a quantitative analytical model for TFe content of the protolith minerals. Among the three algorithms, MLP has the highest detection accuracy, with a model coefficient of determination R 2 reaching up to 0.945. These findings demonstrate that terahertz time-domain spectroscopy can be used to rapidly quantify the TFe elemental content of protolith, providing a method of detecting the content of mineral components.
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Objective: To study the effects of acupuncture combined with the formula of Yi Qi Yang Yin and blood activating (A-YBF) on blood glucose levels and renal function in patients with early diabetic nephropathy. Methods: 96 patients with early diabetic nephropathy treated in our hospital from April 2021 to April 2022 were included in the study and divided into the control group (conventional medical treatment) and the study group (A-YBF), with 48 cases in each group. The efficacy and adverse effects were recorded by comparing the Chinese medicine symptom points, blood glucose level, renal function, and inflammatory factor level between the two groups before and after the treatment. Results: The clinical efficacy of the study group was significantly higher than that of the control group (P < .05). Before treatment, no difference was found between the primary and secondary symptom scores of the two groups (P > .05); after treatment, the primary and secondary symptom scores of the study group were lower than those of the control group (P < .05). Before treatment, there was no difference in fasting blood glucose (FPG) and 2h postprandial glucose (2hPG) levels; 24h urine protein quantification, cystatin C (Cys-C), urinary albumin excretion rate (UAER), and estimated glomerular filtration rate (eGFR) levels; and growth differentiation factor-15 (GDF-15), interleukin-1ß (IL-1ß), interleukin-17 (IL-17), and serum amyloid A (SAA) levels between the two groups (P > .05). After treatment, FPG and 2hPG levels; 24h urine protein quantification, Cys-C and UAER levels; and GDF-15, IL-1ß, IL-17, and SAA levels were lower in the study group than in the control group, while eGFR levels were higher than those in the control group (P < .05). Conclusion: A-YBF can effectively reduce blood glucose levels and improve renal function in patients with early diabetic nephropathy and can be promoted in clinical application.
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The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.
Subject(s)
Employment , Financial Stress , Insurance Coverage , Neoplasms , Humans , United States , Employment/statistics & numerical data , Insurance Coverage/statistics & numerical data , Insurance Coverage/economics , Neoplasms/therapy , Neoplasms/economics , Neoplasms/diagnosis , Adult , Middle Aged , Female , Male , Insurance, Health/statistics & numerical data , Insurance, Health/economics , Income/statistics & numerical data , Cancer Survivors/statistics & numerical dataABSTRACT
BACKGROUND: Patellofemoral osteoarthritis (PFJOA) is a subtype of knee OA, which is one of the main causes of anterior knee pain. The current study found an increased prevalence of OA in postmenopausal women, called postmenopausal OA. Therefore, we designed the ovariectomized rat model of patella baja-induced PFJOA. Alendronate (ALN) inhibits osteoclast-mediated bone loss, and has been reported the favorable result of a potential intervention option of OA treatment. However, the potential effects of ALN treatment on PFJOA in the ovariectomized rat model are unknown and need further investigation prior to exploration in the clinical research setting. In this study, the effects of ALN on articular cartilage degradation and subchondral bone microstructure were assessed in the ovariectomized PFJOA rat model for 10 weeks. METHODS: Patella baja and estrogen withdrawal were induced by patellar ligament shortening (PLS) and bilateral ovariectmomy surgeries in 3-month-old female Sprague-Dawley rats, respectively. Rats were randomly divided into five groups (n = 8): Sham + V; OVX + V, Sham + PLS + V, OVX + PLS + V, OVX + PLS + ALN (ALN: 70 µg/kg/week). Radiography was performed to evaluate patellar height ratios, and the progression of PFJOA was assessed by macroscopic and microscopic analyses, immunohistochemistry and micro-computed tomography (micro-CT). RESULTS: Our results found that the patella baja model prepared by PLS can successfully cause degeneration of articular cartilage and subchondral bone, resulting in changes of PFJOA. OVX caused a decrease in estrogen levels in rats, which aggravated the joint degeneration caused by PFJOA. Early application of ALN can delay the degenerative changes of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent, improve and maintain the micrometabolism and structural changes of cartilage and subchondral bone. CONCLUSION: The early application of ALN can delay the destruction of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent.
Subject(s)
Bone Resorption , Cartilage, Articular , Osteoarthritis, Knee , Humans , Rats , Female , Animals , Infant , Alendronate/pharmacology , Rats, Sprague-Dawley , Patella/diagnostic imaging , X-Ray Microtomography , Osteoarthritis, Knee/diagnostic imaging , Osteoarthritis, Knee/drug therapy , Osteoarthritis, Knee/metabolism , Cartilage, Articular/metabolism , Bone Resorption/drug therapy , Disease Models, Animal , EstrogensABSTRACT
Importance: Medical debt is increasingly common in the US. Little is known regarding its association with population health. Objective: To examine the associations of medical debt with health status, premature death, and mortality at the county level in the US. Design, Setting, and Participants: This cross-sectional study was conducted at the US county level using 2018 medical debt data from the Urban Institute Debt in America project linked with 2018 data on self-reported health status and premature death from the County Health Rankings & Roadmaps and with 2015 to 2019 mortality data from the National Center for Health Statistics. Data analysis was performed from August 2022 to May 2023. Exposure: Share of population with any medical debt in collections and median amount of medical debt. Main Outcomes and Measures: Health status was measured as (1) the mean number of physically and mentally unhealthy days in the past 30 days per 1000 people, (2) the mean number of premature deaths measured as years of life lost before age 75 years per 1000 people, and (3) age-adjusted all-cause and 18 cause-specific mortality rates (eg, malignant cancers, heart disease, and suicide) per 100â¯000 person-years. Multivariable linear models were fitted to estimate the associations between medical debt and health outcomes. Results: A total of 2943 counties were included in this analysis. The median percentage of the county population aged 65 years or older was 18.3% (IQR, 15.8%-20.9%). Across counties, a median 3.0% (IQR, 1.2%-11.9%) of the population were Black residents, 4.3% (IQR, 2.3%-9.7%) were Hispanic residents, and 84.5% (IQR, 65.7%-93.3%) were White residents. On average, 19.8% (range, 0%-53.6%) of the population had medical debt. After adjusting for county-level sociodemographic characteristics, a 1-percentage point increase in the population with medical debt was associated with 18.3 (95% CI, 16.3-20.2) more physically unhealthy days and 17.9 (95% CI, 16.1-19.8) more mentally unhealthy days per 1000 people during the past month, 1.12 (95% CI, 1.03-1.21) years of life lost per 1000 people, and an increase of 7.51 (95% CI, 6.99-8.04) per 100â¯000 person-years in age-adjusted all-cause mortality rate. Associations of medical debt and elevated mortality rates were consistent for all leading causes of death, including cancer (1.12 [95% CI, 1.02-1.22]), heart disease (1.39 [95% CI, 1.21-1.57]), and suicide (0.09 [95% CI, 0.06-0.11]) per 100â¯000 person-years. Similar patterns were observed for associations between the median amount of medical debt and the aforementioned health outcomes. Conclusions and Relevance: These findings suggest that medical debt is associated with worse health status, more premature deaths, and higher mortality rates at the county level in the US. Therefore, policies increasing access to affordable health care, such as expanding health insurance coverage, may improve population health.
Subject(s)
Heart Diseases , Mortality, Premature , Humans , Academies and Institutes , Black People , Cross-Sectional Studies , Health Status , United States/epidemiology , Aged , Black or African AmericanABSTRACT
Importance: People with a history of incarceration may experience barriers in access to and receipt of health care in the US. Objective: To examine the associations of incarceration history and access to and receipt of care and the contribution of modifiable factors (educational attainment and health insurance coverage) to these associations. Design, Setting, and Participants: Individuals with and without incarceration history were identified from the 2008 to 2018 National Longitudinal Survey of Youth 1979 cohort. Analyses were conducted from October 2022 to December 2023. Main Measures and Outcomes: Access to and receipt of health care were measured as self-reported having usual source of care and preventive service use, including physical examination, influenza shot, blood pressure check, blood cholesterol level check, blood glucose level check, dental check, and colorectal, breast, and cervical cancer screenings across multiple panels. To account for the longitudinal study design, we used the inverse probability weighting method with generalized estimating equations to evaluate associations of incarceration history and access to care. Separate multivariable models examining associations between incarceration history and receipt of each preventive service adjusted for sociodemographic factors; sequential models further adjusted for educational attainment and health insurance coverage to examine their contribution to the associations of incarceration history and access to and receipt of health care. Results: A total of 7963 adults with 41â¯614 person-years of observation were included in this study; of these, 586 individuals (5.4%) had been incarcerated, with 2800 person-years of observation (4.9%). Compared with people without incarceration history, people with incarceration history had lower percentages of having a usual source of care or receiving preventive services, including physical examinations (69.6% vs 74.1%), blood pressure test (85.6% vs 91.6%), blood cholesterol level test (59.5% vs 72.2%), blood glucose level test (61.4% vs 69.4%), dental check up (51.1% vs 66.0%), and breast (55.0% vs 68.2%) and colorectal cancer screening (65.6% vs 70.3%). With additional adjustment for educational attainment and health insurance, the associations of incarceration history and access to care were attenuated for most measures and remained statistically significant for measures of having a usual source of care, blood cholesterol level test, and dental check up only. Conclusions and Relevance: The results of this survey study suggest that incarceration history was associated with worse access to and receipt of health care. Educational attainment and health insurance may contribute to these associations. Efforts to improve access to education and health insurance coverage for people with an incarceration history might mitigate disparities in care.