Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm.

Importance: Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective: To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants: In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures: Premature birth (<37 weeks' gestation). Main Outcomes and Measures: The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results: Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance: These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.

Glycemic status and risk of prostate cancer.

BACKGROUND: To examine the risk of prostate cancer and glucose tolerance in a large, racially diverse cohort. METHODS: We conducted a cohort study of 47,209 male members of Kaiser Permanente Northern California who had completed at least one Multiphasic Health Checkup (MHC) between 1964 and 1973. The MHC provided information on diabetes, serum glucose 1 h after a 75-g oral glucose challenge test, demographics, and other health conditions. Cox proportional hazards were used to estimate relative risks (RR) while adjusting for confounders. RESULTS: During a median follow-up of 18.4 years, a total of 2,833 men developed prostate cancer. At baseline, 4.6% (n = 2,159) of the cohort had diabetes and 33% had serum glucose of >or=200 mg/dL. After adjusting for age, race, birth year, and body mass index, RR (95% confidence interval) of prostate cancer associated with 1-h serum glucose >or=200 mg/dL and diabetes were 0.90 (0.81-1.01) and 0.71 (0.62-0.79), respectively, when compared with those with serum glucose <140 mg/dL. During the first 10 years of follow-up, risk was increased among those with serum glucose >or=200 mg/dL or diabetes [RR (95% confidence interval), 1.42 (0.95-2.13) and 1.56 (0.91-2.67), respectively]. In contrast, inverse associations between serum glucose >or=200 mg/dL and diabetes and prostate cancer risk were observed [0.87 (0.77-0.97) and 0.68 (0.52-0.88), respectively] when follow-up began 10 years after MHC. CONCLUSION: Our findings are consistent with the hypothesis that prostate cancer risk differs by time since diabetes diagnosis or occurrence of metabolic aberrations associated with impaired glucose tolerance.