Neither Words nor Images: Health Departments' and Hospitals' Use of Twitter During COVID-19 Had Limited Racial Representation and Content on Disparities Decreased Over Time.

OBJECTIVE: To determine the degree to which hospitals and state health departments used written content or visual representation on social media to draw attention to racial disparities during the COVID-19 pandemic. STUDY DESIGN: A retrospective analysis, using Twitter content (words and images) between May-June 2020 and May-June 2021 from organizations in the 5 states with the largest documented racial disparities in COVID-19-related mortality. MAIN OUTCOMES: All tweets and retweets (n = 6790) were coded along several lines. For May-June 2020 and May-June 2021, posts were coded as pandemic related (yes/no) and disparities related (yes/no). Open-coding methods categorized pandemic-related content into content areas, including COVID-19 education, hospital or public policy, and addressing misinformation. After self-identifying their own race/ethnicity, survey respondents (n = 100) coded pandemic-related Twitter images (n = 198) as including individuals of a similar race/ethnicity (yes/no). RESULTS: In May-June 2020, health departments posted more pandemic-related content than hospitals (µ = 204 and 71 tweets, respectively; P = .03), including more about health disparities (µ = 14.3% and 2.11% of tweets, respectively; P = .03). Between May-June 2020 and May-June 2021, content addressing health disparities decreased for both groups (47% decrease for health departments and 69% decrease for hospitals). Black respondents were more likely to feel represented in images from health departments than in those from hospitals (44.3% and 23.7% of images, respectively; P = .05). Both hospitals and health departments were more likely to use images where White respondents felt represented (hospitals = 76.1% of images; health departments = 59.7%) than images where respondents from racial/ethnic minorities felt represented (hospitals = 19.3% of images; health departments = 21.4%) ( P ≤ .001 for hospitals; P = .004 for health departments). CONCLUSIONS: Health education ideally comes in a variety of ways. Hospitals used social media for this purpose less than health departments, and neither group increased such content during the COVID-19 pandemic even as evidence of racial disparities grew.

Anxiety disorders, benzodiazepine prescription, and incident dementia.

BACKGROUND: Prescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent. It is unknown if anxiety treated with a benzodiazepine, compared to anxiety disorder alone is associated with dementia risk. METHODS: A retrospective cohort study (n = 72,496) was conducted using electronic health data from 2014 to 2021. Entropy balancing controlled for bias by indication and other confounding factors. PARTICIPANTS: Eligible patients were ≥65 years old, had clinic encounters before and after index date and were free of dementia for 2 years prior to index date. Of the 72,496 eligible patients, 85.6% were White and 59.9% were female. Mean age was 74.1 (SD ± 7.1) years. EXPOSURE: Anxiety disorder was a composite of generalized anxiety disorder, anxiety not otherwise specified, panic disorder, and social phobia. Sustained benzodiazepine use was defined as at least two separate prescription orders in any 6-month period. MAIN OUTCOME AND MEASURES: ICD-9 or ICD-10 dementia diagnoses. RESULTS: Six percent of eligible patients had an anxiety diagnosis and 3.6% received sustained benzodiazepine prescriptions. There were 6640 (9.2%) incident dementia events. After controlling for confounders, both sustained benzodiazepine use (HR 1.28, 95% CI: 1.11-1.47) and a diagnosis of anxiety (HR 1.19, 95% CI: 1.06-1.33) were associated with incident dementia in patients aged 65-75. Anxiety disorder with sustained benzodiazepine, compared to anxiety disorder alone, was not associated with incident dementia (HR 1.18, 95% CI: 0.92-1.51) after controlling for confounding. Results were not significant when limiting the sample to those ≥75 years of age. CONCLUSIONS: Benzodiazepines and anxiety disorders are associated with increased risk for dementia. In patients with anxiety disorders, benzodiazepines were not associated with additional dementia risk. Further research is warranted to determine if benzodiazepines are associated with a reduced or increased risk for dementia compared to other anxiolytic medications in patients with anxiety disorders.