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Wolf ER, Rivara FP, Orr CJ, Sen A, Chapman DA, Woolf SH. Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth. JAMA 2024; 331:1732-1740. [PMID: 38703403 PMCID: PMC11070063 DOI: 10.1001/jama.2024.3908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024]
Abstract
Importance Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.
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Affiliation(s)
- Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
- Editor, JAMA Network Open
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Anabeel Sen
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Derek A. Chapman
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Steven H. Woolf
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond
- Center on Society and Heath, Virginia Commonwealth University School of Population Health, Richmond
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Alur P, Holla I, Hussain N. Impact of sex, race, and social determinants of health on neonatal outcomes. Front Pediatr 2024; 12:1377195. [PMID: 38655274 PMCID: PMC11035752 DOI: 10.3389/fped.2024.1377195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.
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Affiliation(s)
- Pradeep Alur
- Penn State College of Medicine, Hampden Medical Center, Enola, PA, United States
| | - Ira Holla
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Naveed Hussain
- Department of Pediatrics, Connecticut Children’s, Hartford, CT, United States
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Ray JG, Fu L, Austin PC, Park AL, Brown HK, Grandi SM, Vandermorris A, Boblitz A, Cohen E. Teen Pregnancy and Risk of Premature Mortality. JAMA Netw Open 2024; 7:e241833. [PMID: 38483391 PMCID: PMC10940968 DOI: 10.1001/jamanetworkopen.2024.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Importance Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences. Objective To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy. Design, Setting, and Participants This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022. Exposures The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy. Main Outcomes and Measures The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality. Results Of 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury. Conclusions and Relevance In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.
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Affiliation(s)
- Joel G. Ray
- Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | | | | | - Hilary K. Brown
- ICES, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sonia M. Grandi
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Vandermorris
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Eyal Cohen
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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Eliason EL, Agostino J, Vivier P. Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic. Acad Pediatr 2024; 24:105-110. [PMID: 37487800 DOI: 10.1016/j.acap.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type. METHODS This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance. RESULTS Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries. CONCLUSIONS Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
| | - Jasmine Agostino
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI
| | - Patrick Vivier
- Department of Public Health and Community Medicine (P Vivier), Tufts University School of Medicine, Boston, Mass
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McCauley CJ, Purcell LN, Schiro SE, Nakayama DK, McLean SE. Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children. Am Surg 2023; 89:5858-5864. [PMID: 37220878 DOI: 10.1177/00031348231175455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. METHODS A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8 years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. RESULTS Inappropriately restrained patients were older (5.1 years v. 3.6 yrs, P < .001) and weighed more (44.1 lbs v. 35.3 lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. DISCUSSION African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.
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Affiliation(s)
| | - Laura N Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon E Schiro
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
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Qattea I, Burdjalov M, Quatei A, Agha KT, Kteish R, Aly H. Disparities in Neonatal Mortalities in the United States. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1386. [PMID: 37628385 PMCID: PMC10453382 DOI: 10.3390/children10081386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. DESIGN/METHOD We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the nine U.S. Census Division regions. RESULTS Neonatal mortality continues to be higher in Black populations: 21,975 (0.63%) than in White populations: 35,495 (0.28%). Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p < 0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. LOCATIONS In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, type of insurance, household income, and type of hospital, the mortality was consistently higher in Black groups throughout the study years. CONCLUSIONS Disparities in neonatal mortality continue to be higher in Black populations; there was a significant variation in mortality in different U.S. LOCATIONS In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.
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Affiliation(s)
- Ibrahim Qattea
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
- Department of Pediatrics, Nassau University Medical Center, New York, NY 11554, USA;
| | - Maria Burdjalov
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Amani Quatei
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
| | - Khalil Tamr Agha
- Department of Pediatrics, Upstate Golisano Children Hospital, Syracuse, NY 13210, USA;
| | - Rayan Kteish
- Department of Pediatrics, Nassau University Medical Center, New York, NY 11554, USA;
| | - Hany Aly
- Department of Neonatalogy, Cleveland Clinic Children’s, 9500 Euclid Avenue #M31-37, Cleveland, OH 44195, USA; (A.Q.); (H.A.)
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Coryell W, Horwitz A, Albucher R, Zheng K, Pistorello J, Eisenberg D, Favorite T, King C. Alcohol intake in relation to suicidal ideation and behavior among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1680-1684. [PMID: 34398708 DOI: 10.1080/07448481.2021.1950160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 06/13/2023]
Abstract
ObjectiveHeavy alcohol use has been clearly linked to risk for suicidal behaviors and is also prevalent on many American college campuses. This report uses a large sample of college students to explore relationships between alcohol use, depressive symptoms, and suicidality. Methods: A brief suicide screen was completed by 40,335 university students at four pariticipating sites. Assessments quantified recent depressive symptoms, alcohol use, suicidal ideation, and suicide attempts. Results: Problems from alcohol use were consistently associated with suicidal thoughts and attempts in the previous month, and in the previous year, but the quantity of alcohol used was not. Alcohol related problems exerted effects on the likelihood of both suicide ideation and attempts beyond those explained by their relationship with depressive symptoms. Conclusions: Screens for individuals at increased risk for suicidal ideation and behavior should emphasize alcohol-related problems over quantification of alcohol intake.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Adam Horwitz
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Albucher
- Department of Psychiatry, Stanford University, Stanford, California, USA
| | - Kai Zheng
- University of California, Irvine, Irvine, California, USA
| | | | - Daniel Eisenberg
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Todd Favorite
- Department of Psychiatry, University of Michigan Psychological Clinic, Ann Arbor, Michigan, USA
| | - Cheryl King
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Attridge MM, Heneghan JA, Akande M, Ramgopal S. Association of Pediatric Mortality With the Child Opportunity Index Among Children Presenting to the Emergency Department. Acad Pediatr 2023; 23:980-987. [PMID: 36682452 DOI: 10.1016/j.acap.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Child health and development is influenced by neighborhood context. The Child Opportunity Index (COI) is a multidimensional measure of neighborhood conditions. We sought to evaluate the association of COI with mortality among children presenting to the emergency department (ED). METHODS We performed a multicenter cross-sectional study of pediatric (<18 years) ED encounters from a statewide dataset from 2016 to 2020. We constructed a multivariable logistic regression model to evaluate the association between COI and in-hospital mortality after adjusting for sociodemographic characteristics and medical complexity. RESULTS Among 4,653,070 included encounters, in-hospital mortality occurred in 1855 (0.04%). There was a higher proportion of encounters with mortality in the lower COI categories relative to the higher COI categories (0.053%, 0.038%, 0.031%, 0.034%, 0.034% ranging from Very Low to Very High, respectively). In adjusted models, child residence in Low (adjusted odds ratio 1.26; 95% confidence interval [CI], 1.04-1.53) and Very Low (adjusted odds ratio 1.58; 95% CI, 1.31-1.90) COI neighborhoods was associated with mortality relative to residence in Very High COI neighborhoods. This association was noted across all domains of COI (education, health and environment, and social and economic), using an expanded definition of mortality, using nationally normed COI, and excluding patients with complex chronic conditions. Other factors associated with increased odds of mortality included age, medical complexity, payor status, age, and race and ethnicity. CONCLUSIONS Understanding the association of neighborhood context on child mortality can inform public health interventions to improve child mortality rates and reduce disparities.
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Affiliation(s)
- Megan M Attridge
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (MM Attridge and S Ramgopal), Chicago, Ill.
| | - Julia A Heneghan
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota (JA Heneghan), Minneapolis, Minn
| | - Manzilat Akande
- Section of Pediatric Critical Care, Oklahoma University Health Sciences Center (M Akande), Oklahoma City, Okla
| | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (MM Attridge and S Ramgopal), Chicago, Ill
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Rissmann A, Tan J, Glinianaia SV, Rankin J, Pierini A, Santoro M, Coi A, Garne E, Loane M, Given J, Reid A, Aizpurua A, Akhmedzhanova D, Ballardini E, Barisic I, Cavero-Carbonell C, de Walle HEK, Gatt M, Gissler M, Heino A, Jordan S, Urhoj SK, Klungsøyr K, Lutke R, Mokoroa O, Neville AJ, Thayer DS, Wellesley DG, Yevtushok L, Zurriaga O, Morris J. Causes of death in children with congenital anomalies up to age 10 in eight European countries. BMJ Paediatr Open 2023; 7:e001617. [PMID: 37353235 PMCID: PMC10367017 DOI: 10.1136/bmjpo-2022-001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/20/2022] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Congenital anomalies (CAs) increase the risk of death during infancy and childhood. This study aimed to evaluate the accuracy of using death certificates to estimate the burden of CAs on mortality for children under 10 years old. METHODS Children born alive with a major CA between 1 January 1995 and 31 December 2014, from 13 population-based European CA registries were linked to mortality records up to their 10th birthday or 31 December 2015, whichever was earlier. RESULTS In total 4199 neonatal, 2100 postneonatal and 1087 deaths in children aged 1-9 years were reported. The underlying cause of death was a CA in 71% (95% CI 64% to 78%) of neonatal and 68% (95% CI 61% to 74%) of postneonatal infant deaths. For neonatal deaths the proportions varied by registry from 45% to 89% and by anomaly from 53% for Down syndrome to 94% for tetralogy of Fallot. In children aged 1-9, 49% (95% CI 42% to 57%) were attributed to a CA. Comparing mortality in children with anomalies to population mortality predicts that over 90% of all deaths at all ages are attributable to the anomalies. The specific CA was often not reported on the death certificate, even for lethal anomalies such as trisomy 13 (only 80% included the code for trisomy 13). CONCLUSIONS Data on the underlying cause of death from death certificates alone are not sufficient to evaluate the burden of CAs on infant and childhood mortality across countries and over time. Linked data from CA registries and death certificates are necessary for obtaining accurate estimates.
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Affiliation(s)
- Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto von Guericke Universitat Magdeburg, Magdeburg, Germany
| | - Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | | | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Pierini
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Joanne Given
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Abigail Reid
- Population Health Research Institute, St George's University of London, London, UK
| | - Amaia Aizpurua
- Health Division of Gipuzkoa, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Diana Akhmedzhanova
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Dep. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Clara Cavero-Carbonell
- Rare Diseases Research Join Unit, Foundation for the Promotion of Health and Biomedical Research and Universitat de Valencia, Valencia, Spain
| | | | - Miriam Gatt
- Malta Congenital Anomalies Register, Directorate for Health Information and Research, Tal-Pietà, Malta
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
- Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry, Nasjonalt folkehelseinstitutt, Bergen, Norway
| | - Renee Lutke
- Department of Genetics, Groningen University, Groningen, The Netherlands
| | - Olatz Mokoroa
- Health Division of Gipuzkoa, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Amanda Julie Neville
- IMER Registry, Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitario di Ferrara, Ferrara, Italy
| | - Daniel S Thayer
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Diana G Wellesley
- University of Southampton and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Oscar Zurriaga
- Rare Diseases Research Join Unit, Foundation for the Promotion of Health and Biomedical Research and Universitat de Valencia, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Morris
- Population Health Research Institute, St George's University of London, London, UK
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10
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Gonzalves LC, Ferrer E, Robins RW, Guyer AE, Hastings PD. Psychosocial Predictors of Suicidal Thoughts and Behaviors in Mexican-Origin Youths: An 8-Year Prospective Cohort Study. Clin Psychol Sci 2023; 11:425-443. [PMID: 37197008 PMCID: PMC10184188 DOI: 10.1177/21677026221102924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022]
Abstract
Suicide is the second leading cause of death for youths in the United States. More Latino adolescents report suicidal thoughts and/or behaviors (STBs) than youths of most other ethnic communities. Yet few studies have examined multiple psychosocial predictors of STBs in Latino youths using multiyear longitudinal designs. In this study, we evaluated the progression of STBs in 674 Mexican-origin youths (50% female) from fifth grade (10 years old) to 12th grade (17 years old) and identified psychosocial predictors of changes in STBs across this period. Latent growth curve models revealed that being female and later-generation status were associated with increasing prevalence in STBs across adolescence. Family conflict and peer conflict predicted increased STBs, whereas greater familism predicted less STBs. Thus, interpersonal relationships and cultural values contribute to the development of STBs in Mexican-origin youths and may be key levers for decreasing suicidality in this understudied but rapidly growing portion of the U.S. adolescent population.
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Affiliation(s)
- Lauren C. Gonzalves
- Department of Psychology, University of California, Davis
- Center for Mind and Brain, University of California, Davis
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis
| | | | - Amanda E. Guyer
- Center for Mind and Brain, University of California, Davis
- Department of Human Ecology, University of California, Davis
| | - Paul D. Hastings
- Department of Psychology, University of California, Davis
- Center for Mind and Brain, University of California, Davis
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11
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Steelesmith DL, Lindstrom MR, Le HTK, Root ED, Campo JV, Fontanella CA. Spatiotemporal Patterns of Deaths of Despair Across the U.S., 2000-2019. Am J Prev Med 2023:S0749-3797(23)00093-4. [PMID: 36964010 DOI: 10.1016/j.amepre.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Deaths of despair (i.e., suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis) have been increasing over the past 2 decades. However, no large-scale studies have examined geographic patterns of deaths of despair in the U.S. This ecologic study identifies geographic and temporal patterns of individual and co-occurring clusters of deaths of despair. METHODS All individuals aged ≥10 years who died in the U.S. between 2000 and 2019 and resided within the 48 contiguous states and Washington, District of Columbia were included (N=2,171,105). Causes of death were limited to deaths of despair, namely suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis. Univariate and multivariate space-time scan statistics were used to identify individual and co-occurring clusters with excess risk of deaths of despair. County-level RRs account for heterogeneity within each cluster. Analyses were conducted from late 2021 to early 2022. RESULTS Six suicide clusters, 4 overdose clusters, 9 liver disease clusters, and 3 co-occurring clusters of all 3 types of deaths were identified. A large portion of the western U.S., southeastern U.S., and Appalachia/rust belt were contained within the co-occurring clusters. The co-occurring clusters had average county RRs ranging from 1.17 (p<0.001) in the southeastern U.S. to 4.90 (p<0.001) in the western U.S. CONCLUSIONS Findings support identifying and targeting risk factors common to all types of deaths of despair when planning public health interventions. Resources and policies that address all deaths of despair simultaneously may be beneficial for the areas contained within the co-occurring high-risk clusters.
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Affiliation(s)
- Danielle L Steelesmith
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Huyen T K Le
- Department of Geography, The Ohio State University, Columbus, Ohio
| | | | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A Fontanella
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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12
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Brenes F, Henriquez F, Cachon P. Call for Inclusive and Diverse Suicide Prevention Strategies Among Cuban Americans: A Brief Report. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:4-8. [PMID: 35291845 DOI: 10.1177/15404153221085959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Suicide is a leading cause of death in Hispanics globally and nationally. Intentional death rates were higher in Cuba than Mexico in 2016. In the United States (US), suicide mortality rates were greater among Hispanics in rural than urban areas from 2001 to 2015. Although the US lacks suicide research in undocumented Hispanics, few studies have reported increased risk in immigrants. Limited research also indicates higher intentional death rates in Cuban Americans compared with other Hispanic American subgroups. However, suicide prevention strategies for at-risk Cuban Americans are lacking due to a scarcity of research among diverse Hispanics. Researchers could collaborate with health care providers to develop effective suicide prevention methods for Cuban Americans with suicidal problems. This report provides an overview of suicidal behavior in Hispanic Americans with a focus on Cuban Americans. Gaps related to the research topic, as well as recommendations for practice, research, and health policy, are provided in this report.
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Affiliation(s)
- Francisco Brenes
- Florida International University, Nicole Wertheim College of Nursing and Health Sciences, North Miami, FL, USA
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13
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Brenes F, Beason F, Koncsol S, Umadhay T, Chin C, Cachon P, Scaccianoce M. Hispanic Suicides in Miami-Dade County, Florida, 2008-2018. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:9-13. [PMID: 36320167 DOI: 10.1177/15404153221137339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Suicide is a leading cause of death in Hispanic Americans. Although this population is growing rapidly, particularly in geographic areas such as Miami-Dade County, Florida, few studies have examined suicide in Hispanics. The purpose of this cross-sectional study was to examine associations between suicide and demographic characteristics among Hispanics in Miami-Dade County, Florida, between 2008 and 2018. A total of 1,601 Hispanics died from suicide. Cubans (n = 1,145) represented nearly three quarters of the suicides, while Central or South Americans (n = 119), Puerto Ricans (n = 59), and Mexicans (n = 29) accounted for lower intentional deaths. Furthermore, although no correlation between suicide and age was found, significantly more than half of the suicides were men, X2 (1, N = 1,600) = 361.894, p < .001 (p = .000). Hispanic male suicides were 4.52 more frequent than Hispanic female firearm suicides. Men were more likely to use firearms, while women were more likely to choose drugs, substances, or some other form of method. Intentional deaths were unequal across locations, Χ2 (3, N = 1,601) = 603.764, p < .001 (p = .000), with increased incidence occurring at the Hispanic's home. The second most common suicide location was health care facilities for drugs. Researchers should collaborate with health care providers to increase suicide research and eliminate disparities in at-risk Hispanic Americans.
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Affiliation(s)
- Francisco Brenes
- 15803Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Ferrona Beason
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | - Stephen Koncsol
- 218640Department of Psychology, Barry University, Miami, Florida, USA
| | - Tony Umadhay
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | - Claudette Chin
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | | | - Monica Scaccianoce
- 15803Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
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14
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Sabahi A, Asadi F, Rabiei R, Paydar S. Providing a Population Based Registry Model of Drug Poisoning in Iran. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2022; 21:e130124. [PMID: 36937211 PMCID: PMC10016136 DOI: 10.5812/ijpr-130124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
Background The prevalence of drug poisoning is on the rise in Iran due to the increased public access to drugs. A national drug poisoning registry system is a suitable tool for better management, control, and prevention of drug poisoning. Objectives This study aimed to propose a national drug poisoning registry model for Iran. Methods This was an applied research conducted in two major phases. In the first phase, all sources pertaining to drug poisoning registries were reviewed, and a national drug poisoning registry model was proposed. In the second phase, this model was validated and finalized using a researcher-made questionnaire and through a two-stage Delphi technique. Results The focus of national drug poisoning activities and registry management reached the 100% consensus of experts at the Drug and Poison Information Center of the Food and Drug Organization (Ministry of Health and Medical Education). Goals, data sources, registry system structure, data set, standards, data exchange, registry features, and processes of the proposed model also achieved unanimous expert consensus. Conclusions Given the importance of a national drug poisoning registry in gathering, storing, analyzing, and reporting the data of patients, it is essential to provide a framework for evaluating and controlling drug poisoning and for generating valuable data for decision-making. The model proposed herein can offer the information infrastructure for designing and implementing such a system.
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Affiliation(s)
- Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Farkhondeh Asadi
- Department of Health Information Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Health Information Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122737474, Fax: +98-2122754101,
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Paydar
- Department of Health Information Technology, School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Tilstra AM, Gutin I, Dollar NT, Rogers RG, Hummer RA. "Outside the Skin": The Persistence of Black-White Disparities in U.S. Early-Life Mortality. Demography 2022; 59:2247-2269. [PMID: 36367341 PMCID: PMC10155466 DOI: 10.1215/00703370-10346963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research on Black-White disparities in mortality emphasizes the cumulative pathways through which racism gets "under the skin" to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15-24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black-White disparities remain unchanged across several causes-especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs "outside the skin," reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults.
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16
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Venta A, Long T, Mercado A, Garcini LM, Cadenas GA. When the United States says you do not belong: Suicide-related thoughts and behaviors among immigrant young adults varying in immigration legal status. Suicide Life Threat Behav 2022; 52:876-886. [PMID: 35535011 PMCID: PMC9867935 DOI: 10.1111/sltb.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The number of immigrants in the United States and the risk of suicide among minoritized individuals have increased. Little research has examined the impact of immigration legal status on suicide-related thoughts and behaviors (SRTB), despite theoretical and empirical work suggesting that feelings of burdensomeness and failure to belong (prominent among immigrants) are risk factors. METHODS We examined a diverse sample of foreign-born young adults (18-25; N = 366). Data collection utilized the Suicide Behaviors Questionnaire Revised and items probing belongingness and immigration status (undocumented/Deferred Action for Childhood Arrivals (DACA), permanent, and citizen). RESULTS DACA/undocumented status was associated with increased SRTB compared with permanent and citizen categories. Increased SRTBs were associated with reduced feelings of acceptance in the United States, increased deportation fears, and increased fear of being harassed or hurt. Of these belongingness variables, only the interpersonal-not feeling welcome in the United States-partially mediated the risk relation between DACA/undocumented immigration legal status and SRTBs, whereas physical and legal threat, like deportation, did not. CONCLUSIONS Our results highlight the interpersonal nature of SRTB risk in DACA/undocumented immigrants and the need for targeted culture and context-appropriate interventions, as well as advocacy and policy to reduce risk in this historically marginalized population.
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Affiliation(s)
- Amanda Venta
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tessa Long
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas, USA
| | - Alfonso Mercado
- Department of Psychological Science, School of Medicine Psychiatry and Neurology Department, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Luz M. Garcini
- Division of Hospital Medicine, Department of Medicine, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Germán A. Cadenas
- Counseling Psychology Program, Lehigh University, Bethlehem, Pennsylvania, USA
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17
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Bisquera A, Harris C, Lunt A, Zivanovic S, Marlow N, Calvert S, Greenough A, Peacock JL. Longitudinal changes in lung function in very prematurely born young people receiving high-frequency oscillation or conventional ventilation from birth. Pediatr Pulmonol 2022; 57:1489-1496. [PMID: 35388626 PMCID: PMC9321071 DOI: 10.1002/ppul.25918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine changes in lung function over time in extremely prematurely born adolescents. WORKING HYPOTHESIS Changes in lung function during adolescence would vary by ventilation mode immediately after birth. STUDY DESIGN Longitudinal follow-up study. PATIENT SUBJECT SELECTION Participants from the United Kingdom Oscillation Study who were randomized at birth to high-frequency oscillation (HFO) or conventional ventilation (CV) were assessed at 11-14 years (n = 319) and at 16-19 years (n = 159). METHODOLOGY Forced expiratory flow (FEF), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and lung volumes including functional residual capacity (FRC) were reported as z-scores. The diffusion capacity of the lungs for carbon monoxide (DLCO) was measured. Lung function trajectories were compared by mode of ventilation using mixed models. Changes in z-scores were scaled to 5-year average follow-up. RESULTS There were significant changes in the mean FEF75, FEF50, FEF25, FEV1, FVC, and DLCO z-scores within the CV and HFO cohorts, but no significant differences in the changes between the two groups. The mean FRC z-score increased in both groups, with an average change of greater than one z-score. The mean FEV1/FVC z-score increased significantly in the CV group, but not in the HFO group (difference in slopes: p = 0.02). Across the population, deterioration in lung function was associated with male sex, white ethnicity, lower gestational age at birth, postnatal corticosteroids, oxygen dependency at 36 weeks postmenstrual age, and lower birth weight, but not ventilation mode. CONCLUSIONS There was little evidence that the mode of ventilation affected changes in lung function over time.
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Affiliation(s)
- Alessandra Bisquera
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Alan Lunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Sanja Zivanovic
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Neil Marlow
- Department of Neonatal Medicine, Elizabeth Garrett Anderson UCL Institute for Women's Health, University College, London, UK
| | - Sandy Calvert
- Department of Child Health, St George's Hospital, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,NIHR Biomedical Research Centre based at Guy's and St Thomas', NHS Foundation Trust and King's College London, London, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK.,Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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18
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Morgan ER, Rivara FP, Ta M, Grossman DC, Jones K, Rowhani-Rahbar A. Incarceration and subsequent risk of suicide: A statewide cohort study. Suicide Life Threat Behav 2022; 52:467-477. [PMID: 35092087 DOI: 10.1111/sltb.12834] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. METHODS Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models. RESULTS Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96). CONCLUSION Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.
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Affiliation(s)
- Erin Renee Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Myduc Ta
- Assessment, Policy Development and Evaluation Unit, Public Health - Seattle & King County, Seattle, Washington, USA
| | - David C Grossman
- Kaiser Permanente Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Karl Jones
- Washington State Department of Corrections, Tumwater, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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19
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Troya M, Spittal MJ, Pendrous R, Crowley G, Gorton HC, Russell K, Byrne S, Musgrove R, Hannah-Swain S, Kapur N, Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101399. [PMID: 35518122 PMCID: PMC9065636 DOI: 10.1016/j.eclinm.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. METHODS Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. FINDINGS A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. INTERPRETATION The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations. FUNDING No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- M.Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, 4.07 Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Grace Crowley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kirsten Russell
- School of Psychological Sciences and Health, Graham Hills Building, 40 George Street, Glasgow, UK
| | - Sadhbh Byrne
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Musgrove
- Centre for Mental Health and Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Navneet Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Corresponding author.
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20
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Chang JC, Sears C, Torres V, Son MB. Racial Disparities in Renal Outcomes over Time among Hospitalized Children with Systemic Lupus Erythematosus. Arthritis Rheumatol 2022; 74:1430-1439. [PMID: 35384383 PMCID: PMC9339464 DOI: 10.1002/art.42127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Racial and ethnic minority groups have excess morbidity related to renal disease in pediatric-onset systemic lupus erythematosus (SLE). We evaluated temporal trends in renal outcomes and racial disparities among hospitalized children with SLE over 14 years. METHODS We identified patients ≤21 years-old with discharge diagnoses of SLE in the Pediatric Health Information System® inpatient database (2006-2019). Adverse renal outcomes included end-stage renal disease (ESRD), dialysis, or transplant, analyzed as a composite and separately. We estimated the odds of adverse renal outcomes at any hospitalization, or the first occurrence of an adverse renal outcome, adjusted for calendar period, patient characteristics, and clustering by hospital. We tested whether racial disparities differed by calendar period. RESULTS There were 20,893 admissions for 7,434 SLE patients, of which 32%, 16%, 12% and 8% were Black, Hispanic White, Hispanic Other and Asian, respectively. Proportions of admissions with adverse renal outcomes decreased over time (p<0.01). Black children remained at highest risk of adverse renal outcomes at any admission (OR 2.5, 95% CI [1.8-3.5] vs. non-Hispanic White). Black and Asian children remained at higher risk of incident adverse renal outcomes, driven by ESRD among Black children (OR 1.6 [1.2-2.1]) and dialysis among Asians (OR 1.7 [1.1-2.7]). Relative disparities did not change significantly over time. CONCLUSION Significant reductions in ESRD and dialysis occurred over time for children with SLE across all racial and ethnic groups. The lack of corresponding reductions in racial disparities highlights the need for targeted interventions to achieve greater treatment benefit among higher risk groups.
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Affiliation(s)
- Joyce C Chang
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute.,Division of Immunology, Boston Children's Hospital and Harvard Medical School.,Division of Rheumatology, Children's Hospital of Philadelphia
| | - Cora Sears
- Division of Rheumatology, Children's Hospital of Philadelphia
| | | | - Mary Beth Son
- Division of Immunology, Boston Children's Hospital and Harvard Medical School
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21
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Walker JH, Venta A, Bechelli J, Brewer TM, Boisvert D, Bick J, Lewis R, Wells J, Armstrong T. Testing the role of inflammation in the relation of childhood maltreatment and suicidal ideation among young adults. J Clin Psychol 2022; 78:2484-2496. [PMID: 35302245 DOI: 10.1002/jclp.23347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/17/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND In recent years, the prevalence of suicidal ideation among young adults has been on the rise, with childhood maltreatment thought to partially explain this disparity. Systemic inflammation-a product of over-activation of the body's stress response system-has been hypothesized to play a predictive role in the development of suicidal ideation. Enduring childhood maltreatment can lead to systemic inflammation, possibly accounting for suicidal ideation's increased prevalence among young adults who have a history of childhood maltreatment. METHODS The current study sought to investigate the importance of childhood maltreatment as a static risk factor for downstream suicidal ideation in young adulthood with the immunological response (i.e., systemic inflammation) to childhood maltreatment serving as a mediating factor. RESULTS Systemic inflammation was found to be positively associated with suicidal ideation, supporting the unique role systemic inflammation may play in the pathogenesis of suicidal ideation, though hypotheses regarding childhood maltreatment were not supported. CONCLUSION This study provides novel insight into a potential immunobiological model for suicidal ideation development in young adult populations.
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Affiliation(s)
- Jesse H Walker
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Amanda Venta
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Jeremy Bechelli
- Department of Biological Sciences, Sam Houston State University, Huntsville, Texas, USA
| | - Trisha M Brewer
- Department of Biological Sciences, Sam Houston State University, Huntsville, Texas, USA
| | - Danielle Boisvert
- Department of Criminal Justice and Criminology, Sam Houston State University, Huntsville, Texas, USA
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Richard Lewis
- Department of Criminal Justice, University of Arkansas at Little Rock, Little Rock, Arkansas, USA
| | - Jessica Wells
- Department of Criminal Justice, Boise State University, Boise, Idaho, USA
| | - Todd Armstrong
- School of Criminology and Criminal Justice, University of Nebraska Omaha, Omaha, Nebraska, USA
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22
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Ray JG, Austin PC, Aflaki K, Guttmann A, Park AL. Comparison of Self-harm or Overdose Among Adolescents and Young Adults Before vs During the COVID-19 Pandemic in Ontario. JAMA Netw Open 2022; 5:e2143144. [PMID: 35019981 PMCID: PMC8756304 DOI: 10.1001/jamanetworkopen.2021.43144] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Self-harm and deaths among adolescents and young adults are notably related to drug poisonings and suicide. With the emergence of the COVID-19 pandemic, there are projections about a greater likelihood of such events arising among adolescents and young adults. OBJECTIVE To evaluate the risk of self-harm, overdose, and all-cause mortality among adolescents and young adults during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study took place in Ontario, Canada, where a universal health care system captures all emergency department (ED) visits, hospitalizations, and deaths. The participants included all adolescents and young adults born in Ontario between 1990 and 2006, who were aged 14 to 24 years between March 1, 2018, and June 30, 2021. EXPOSURES The COVID-19 pandemic era (April 1, 2020 to June 30, 2021), relative to the 2 years preceding the pandemic (March 1, 2018 to February 28, 2020). MAIN OUTCOMES AND MEASURES ED encounters or hospitalizations for self-harm or overdose. A secondary outcome was self-harm, overdose, or all-cause mortality. Cause-specific hazard models to estimate hazard ratios (HR) and 95% CIs were used for the primary outcome. Follow-up started at March 1, 2018, or the individual's 14th birthday, whichever was later, and age was used as the time scale. RESULTS In this study, 1 690 733 adolescents and young adults (823 904 [51.3%] female participants) were included with a median (IQR) age of 17.7 (14.1-21.4) years at start of follow-up. After 4 110 903 person-years of follow-up, 6224 adolescents and young adults experienced the primary outcome of self-harm or overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an HR of 0.78 (95% CI, 0.75-0.80). The risk of self-harm, overdose, or death was also lower during than before the pandemic (HR, 0.78; 95% CI, 0.76-0.81), but not all-cause mortality (HR, 0.95; 95% CI, 0.86-1.05). CONCLUSIONS AND RELEVANCE Among adolescents and young adults, the initial 15-month period of the COVID-19 pandemic was associated with a relative decline in hospital care for self-harm or overdose.
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Affiliation(s)
- Joel G. Ray
- Departments of Medicine and Obstetrics and Gynaecology, St Michael’s Hospital
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Peter C. Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kayvan Aflaki
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Department of Paediatrics, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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23
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Forte A, Orri M, Turecki G, Galera C, Pompili M, Boivin M, Tremblay RE, Côté SM, Geoffroy MC. Identifying environmental pathways between irritability during childhood and suicidal ideation and attempt in adolescence: findings from a 20-year population-based study. J Child Psychol Psychiatry 2021; 62:1402-1411. [PMID: 33721915 DOI: 10.1111/jcpp.13411] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Irritable children are at increased risk of suicidal ideation and suicide attempt, but the underlying environmental mechanisms accounting for these associations are largely unknown. We aimed to investigate the mediating role of peer victimization and harsh parenting in the association between childhood irritability and adolescent suicidal ideation and attempt. METHOD N = 1,483 participants from the Québec Longitudinal Study of Child Development followed up from 5 months until 20 years of age (2018) with annual or biannual assessments. Irritability was operationalized using assessments of teacher-reported temper tantrums and reactive aggression. Suicidal ideation and suicide attempt at ages 13, 15, 17, and 20 years were self-reported. Peer victimization (self-reported at age 13) and harsh parenting (mothers reported at age 13) were considered as potential mediators. RESULTS We identified four trajectories of teacher-reported irritability symptoms from 6 to 12 years: low (74.8%), rising (12.9%), declining (7.3%), and persistent (4.9%). In adjusted models, children in the persistent and rising trajectories had, respectively, 2.81-fold (CI, 1.27-6.22) and 2.14-fold (CI, 1.20-3.81) increased odds of suicide attempt in adolescence, but not suicidal ideation. We found that a significant proportion of the association between irritability trajectories and suicide attempt was mediated by peer victimization (33% and 35% for rising and persistent, respectively), but there was no mediation via harsh parenting. CONCLUSIONS Our findings suggest that peer victimization may be a key mechanism explaining the increased suicide attempt risk of children presenting with persistently high or increasing irritability. Interventions to reduce peer victimization may be helpful to reduce suicide risk among irritable children.
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Affiliation(s)
- Alberto Forte
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.,Department of Psychiatry and Substance Abuse, ASL Roma 5, Rome, Italy
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Cedric Galera
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Michel Boivin
- School of Psychology, Laval University, Quebec, QC, Canada
| | - Richard E Tremblay
- Departments of Pediatrics and Psychology, University of Montreal, Montreal, QC, Canada.,School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Sylvana M Côté
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
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24
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A Population-Based Examination of Suicide and Child Protection System Involvement. J Adolesc Health 2021; 69:465-469. [PMID: 33814278 DOI: 10.1016/j.jadohealth.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to provide a population-based analysis of child protection system (CPS) involvement among children and adolescents who died by suicide. METHODS We performed a case-control study of child and adolescent suicide and CPS involvement. Using linked birth, death, and CPS records, we longitudinally followed all children born in California in 1999 and 2000 (N = 1,052,333) in CPS and death records through 2017. Cases were defined as children who died in California and had a manner of death coded as suicide using the International Classification of Diseases, 10th revision (n = 170). Each suicide case was matched to four living controls, and children were classified based on CPS exposure: no history, reported for alleged child maltreatment, substantiated for child maltreatment, and placed in foster care. Crude suicide rates were documented, and conditional logistic regression models were used to estimate the adjusted odds of suicide. RESULTS Among children and adolescents who died by suicide, 56.5% had a history of past allegations of abuse or neglect. Children with any CPS history had three times the odds of suicide compared to children with no history. No additional risk was found for children substantiated or placed in foster care compared to children with only an allegation. CONCLUSIONS Suicide risk is not isolated to the relatively small group of children and youth placed in foster care. Findings reinforce the importance of increased attention to the experiences of the larger universe of children who remain at home after alleged or substantiated maltreatment.
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25
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Dixon G, Barqadle F, Gill E, Okoroafor W, Fromme B, Ganem J. Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs. Hosp Pediatr 2021; 11:779-785. [PMID: 34312213 DOI: 10.1542/hpeds.2020-004515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs' leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training. METHODS In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey. RESULTS There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows. CONCLUSIONS This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.
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Affiliation(s)
- Gabrina Dixon
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Fatuma Barqadle
- Children's Hospital Los Angeles and University of Southern California, Los Angeles, California
| | - Edward Gill
- Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | | | - Barrett Fromme
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Jorge Ganem
- Dell Children's Medical Center of Central Texas and 10 University of Texas-Austin Medical School, Austin, Texas
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26
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Chen C, Hu Y, Lyu L, Yin S, Yu Y, Jiang S, Zhou P. Incidence, demographics, and survival of patients with primary pituitary tumors: a SEER database study in 2004-2016. Sci Rep 2021; 11:15155. [PMID: 34312470 PMCID: PMC8313564 DOI: 10.1038/s41598-021-94658-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023] Open
Abstract
Comprehensive investigations on the incidence and prognosis of pituitary tumors are still lacking. The present study aims to summarize the incidence, demographics, and survival outcome of pituitary adenoma on a population-based level. This study includes all pituitary adenomas reported in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 in the United States. Extensive clinical and demographic characteristics were extracted and submitted to group comparisons. The standardized incidence rate was calculated and stratified by year at diagnosis, age/sex and age/treatment groups. The Kaplan–Meier analysis and multivariable regressions were performed to identify the factors associated with overall survival. A total of 47,180 pituitary tumors were identified, including 47,030 typical adenomas, 111 uncertain behavior pituitary adenomas, and 39 pituitary carcinomas. The overall standardized incidence rate was 4.8 cases per 100,000 person-years and the annual incidence rate continually trended upwards, with a peak seen in 2015. We noticed a bimodal age-related distribution in females and a unimodal distribution in males. In the multivariate regression analysis, the factors associated with prolonged survival included typical adenoma, younger age, and smaller tumor size. Whereas, black and male patients had worse overall survival. Our study provides a reliable estimate on the incidence of pituitary adenoma and confirms that the annual standardized incidence rate is increasing. Pituitary adenomas have a satisfactory long-term prognosis and age, tumor size, and tumor subtypes are related to overall survival. Though statistically significant, our inferential findings should be constrained within the limitations of SEER database.
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Affiliation(s)
- Cheng Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yu Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Liang Lyu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China.,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Senlin Yin
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yang Yu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China.,Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China. .,Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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27
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Mushunje R, Graves SL. Bibliometric Analysis of Suicide Research Among Black Youth. JOURNAL OF BLACK PSYCHOLOGY 2021. [DOI: 10.1177/00957984211032209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Historically, Black youth have had lower rates of suicide attempts in comparison to their peers; however, in recent years this rate has changed, with self-reported suicide attempts for Black adolescents rising by 73%. The purpose of this study was to analyze the characteristics of research on Black youth and suicide using bibliometric techniques. To conduct our analysis, we developed a search strategy utilizing the Scopus database for the time period from 1980 to 2020. Results indicated an increasing trend in the number of articles published each year related to Black youth and suicide. The most highly productive journals were the Suicide and Life Threatening Behavior, Pediatrics, and Journal of Youth and Adolescence. Authors who frequently published in this area include Nadine Kaslow, Rheeda Walker, and Sean Joe. While this research area is growing, there is a lack of published articles focused on interventions for suicide prevention and non-comparative race specific research focused on Black youth.
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28
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Wermine K, Gotewal S, Schober MA, Africa RE, Hallman T, Cuartas-Olarte A, Ko A, Torres MJM, Peterson JM, Golovko G, Song J, El Ayadi A, Wolf SE. Non-Survival Distributions in Paediatric Burn Patients; A Comparative Study of Two National Databases. J Burn Care Res 2021; 42:1087-1092. [PMID: 34137860 DOI: 10.1093/jbcr/irab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from TriNetX, a global federated health research network, and the American Burn Association's Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in the United States. Paediatric burn patients ages 0-20 between 2010-2020 were identified in TriNetX from 41 Health Care Organizations using ICD-10 codes (T.20-T.30) and identified as lived/died. These were compared to the non-survival data from 90 certified burn centers in NBR database between 2016-2018. The patient population was stratified by age into subgroups of 0-4, 5-9, 10-14, 15-20 years. Overall, mortality rates for paediatric burn patients were found to be .62% in NBR and .52% in TrinetX. Boys had a higher incidence of mortality than girls in both databases (0.34% vs. 0.28% NBR, p = 0.13; 0.31% vs. 0.21% TriNetX, p = <0.001). Comparison of ethnic cohorts between 2010-2015 and 2016-2020 subgroups showed that non-survival rates of African American children increased relative to White children (TriNetX, p = <0.001), however, evidence was insufficient to conclude that African American children die more frequently than other ethnicities (NBR, p=0.054). When analyzing subgroups in TriNetX, burned children ages 5-9 had significantly increased frequency of non-survival, (p = <0.001). However, NBR data suggested that children 0-4 experience the highest frequency of mortality (p = <0.001). The non-survival distributions between these two large databases accurately reflects non-survival rates in burned children.
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Affiliation(s)
- Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Marc A Schober
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Robert E Africa
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Taylor Hallman
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Andrew Ko
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Joshua M Peterson
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Georgiy Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, TX
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
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29
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Xiao Y, Cerel J, Mann JJ. Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991-2019. JAMA Netw Open 2021; 4:e2113513. [PMID: 34125218 PMCID: PMC8204211 DOI: 10.1001/jamanetworkopen.2021.13513] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
Importance Disparities by sex and racial/ethnic group in suicide death rates are present in US adolescents. Whether disparities in suicide death extend to groups targeted for suicide prevention efforts, namely, those with suicidal ideation or nonfatal suicide attempts, is unknown. Objective To examine differences in temporal trends between suicidal ideation and suicide attempts in US adolescents from 1991 through 2019 by sex and race/ethnicity subgroups. Design, Setting, and Participants A cross-sectional analysis of the national Youth Risk Behavior Survey, weighted to represent US adolescents from 1991 to 2019, included 183 563 US high-school students in grades 9 to 12. Data were analyzed from September 16, 2020, through April 12, 2021. Exposures Calendar year, sex, race/ethnicity, and interactions of sex and race/ethnicity. Main Outcomes and Measures Survey-weighted prevalence estimates, annual percentage changes (APCs) and average APC in the survey-weighted prevalence of suicidal ideation and nonfatal suicide attempts, constructed from self-reported suicidal ideation, plan, and attempts in each survey year, by sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian or Pacific Islander and Native Hawaiian, American Indian/Alaska Native), and their interactions (sex × race/ethnicity). Results In 183 563 (unweighted) included adolescents (mean [SD] age, 16.07 [1.23] years; 94 282 females [weighted percentage, 49.4%; 95% CI, 48.8%-50.1%]), the prevalence of suicidal ideation decreased from 1991 to 2019 (from 19.4% to 15.8%; 95% CI, 0.7%-0.9%), whereas the prevalence of nonfatal suicide attempts increased from 1991 to 2019 (from 7.3% to 8.9%; 95% CI, 1.0%-1.4%). Joinpoint regression indicated a -3.1% (95% CI, -3.7% to -2.6%) annual decrease in suicidal ideation between 1991 and 2009, followed by a 3.4% annual increase (95% CI, 1.9% -4.8%) between 2009 and 2019. Decreasing followed by increasing trends in suicidal ideation showed modestly different turning points in female (1991-2009, 2009-2019), White (1991-2009, 2009-2019), Hispanic (1991-2007, 2007-2019), and Black (1991-2005, 2005-2019) adolescents. Although no significant trends were observed in suicide attempts from 1991 through 2019, male (68.4% increase; 95% CI, 0.2% -1.2%) and Black (79.7% increase; 95% CI, 0.1%-1.5%) adolescents had greater increases in the prevalence of suicide attempts. Interaction of sex and race/ethnicity revealed increases in suicidal ideation in White females from 2009 to 2019 (APC, 4.3%; 95% CI, 1.5%-7.1%), Black females from 2005 to 2019 (APC, 3.4%; 95% CI, 1.4%-5.4%), and Hispanic females from 2009 to 2019 (APC, 3.3%; 95% CI, 1.0%-5.6%) and suicide attempts in White females from 2009 to 2019 (APC, 3.1%; 95% CI, 0.3%-6.0%). Conclusions and Relevance The findings of this study show apparent sex and racial/ethnic differences in trends in suicidal ideation and suicide attempts. Increases in suicidal ideation since 2009 were observed in female individuals; changes in male and Black adolescents represented the largest increase in the prevalence of suicide attempts between 1991 and 2019. Evidence-based suicide prevention programs need to be tailored by sex and race/ethnicity, calling for greater diversification of health care system, school, and community prevention approaches.
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Affiliation(s)
- Yunyu Xiao
- School of Social Work, Indiana University–Purdue University, Indianapolis
- School of Social Work, Indiana University, Bloomington
| | - Julie Cerel
- College Social Work, University of Kentucky, Lexington
| | - J. John Mann
- Department of Psychiatry and Radiology, Columbia University Irving Medical Center, Columbia University, New York, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
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30
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Chang DT, Abdo K, Bhatt JM, Huoh KC, Pham NS, Ahuja GS. Persistence of choking injuries in children. Int J Pediatr Otorhinolaryngol 2021; 144:110685. [PMID: 33819896 DOI: 10.1016/j.ijporl.2021.110685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts. OBJECTIVE To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics. METHODS A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses. RESULTS From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians. CONCLUSIONS Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.
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Affiliation(s)
- David T Chang
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA.
| | - Kaitlyn Abdo
- Chapman University, 1 University Dr., Orange, CA, 92866, USA
| | - Jay M Bhatt
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Kevin C Huoh
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Nguyen S Pham
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Gurpreet S Ahuja
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
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Inagaki K, Blackshear C, Burns PA, Hobbs CV. Racial/Ethnic Disparities in the Incidences of Bronchiolitis Requiring Hospitalization. Clin Infect Dis 2021; 72:668-674. [PMID: 32020165 DOI: 10.1093/cid/ciaa113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/04/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Race/ethnicity is currently not considered a risk factor for bronchiolitis, except for indigenous populations in Western countries. A better understanding of the potential impact of race/ethnicity can inform programs, policies, and practices related to bronchiolitis. METHODS We performed a population-based, longitudinal, observational study using the State Inpatient Database from New York State in the United States. Infants born between 2009 and 2013 at term without comorbidities were followed for the first 2 years of life, up to 2015. We calculated the cumulative incidences among different race/ethnicity groups, and evaluated the risks by developing logistic regression models. RESULTS Of 877 465 healthy, term infants, 10 356 infants were hospitalized with bronchiolitis. The overall cumulative incidence was 11.8 per 1000 births. The cumulative incidences in non-Hispanic White, non-Hispanic Black, Hispanic, and Asian infants were 8.6, 15.4, 19.1, and 6.5 per 1000 births, respectively. In a multivariable analysis adjusting for socioeconomic status, the risks remained substantially high among non-Hispanic Black (odds ratio, 1.42; 95% confidence interval [CI], 1.34-1.51) and Hispanic infants (odds ratio, 1.77; 95% CI, 1.67-1.87), whereas being of Asian race was protective (odds ratio, .62; 95% CI, .56-.69). CONCLUSIONS The risks of bronchiolitis hospitalization in the first 2 years of life were substantially different by race/ethnicity, with Hispanic and Black infants having the highest rates of hospitalization. Further research is needed to develop and implement culturally appropriate public health interventions to reduce racial and ethnic health disparities in bronchiolitis.
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Affiliation(s)
- Kengo Inagaki
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Chad Blackshear
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Charlotte V Hobbs
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Abstract
Among US geographic regions classified as rural, death rates are significantly higher for children and teens as compared with their urban peers; the disparity is even greater for Alaskan Native/American Indian and non-Hispanic black youth. Violence-related injuries and death contribute significantly to this finding. This article describes the epidemiology of violence-related injuries, with a limited discussion on child abuse and neglect and an in-depth analysis of self-inflicted injuries including unintentional firearm injuries and adolescent suicide. Potential interventions are also addressed, including strategies for injury prevention, such as firearm safe storage practices.
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Affiliation(s)
- James M Dodington
- Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA.
| | - Kathleen M O'Neill
- Investigative Medicine Program, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA
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33
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Forte A, Vichi M, Ghirini S, Orri M, Pompili M. Trends and ecological results in suicides among Italian youth aged 10-25 years: A nationwide register study. J Affect Disord 2021; 282:165-172. [PMID: 33418363 DOI: 10.1016/j.jad.2020.12.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Documenting current trends and sources of variation in youth suicide rates is critical to inform prevention strategies. We aimed to document suicide mortality trends among Italian youth from 1981 to 2016 and to describe age-, gender- and urbanization-specific suicide rates. METHODS We used official mortality data for the period 1981-2016 for adolescents and young adults aged 10-25 years. We estimated standardized all-cause and suicide mortality rates per 100,000 individuals and used joinpoint regression analyses to determine annual mortality trends and significant changes in rate trends. Analyses were reported according to gender, age group (10-17 and 18-25 years), urbanization and suicide method. RESULTS From 1981 to 2016, 1,752 suicides were identified among youth aged 10-17 years (boy/girl ratio of 5.80 in 2016) and 9,897 suicides among youth aged 18-25 years (boy/girl ratio of 3.97 in 2016). Overall suicide rates remained stable for boys and showed a small decrease for girls. Suicide was most common in rural areas for boys and in metropolitan areas for girls. We observed a significant decrease in the use of firearms and poisoning; the most common suicide method was hanging for boys and falls for girls. LIMITATIONS We did not control for regional-level sociodemographic, economic and health care system characteristics. CONCLUSIONS Youth suicides were either stable (for boys) or slightly declining (for girls). We found differences according to urban versus rural areas, suggesting the need for a broader view of the phenomenon. Factors influencing these trends and gender differences in the geographical areas are important in delivering suicide prevention strategies.
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Affiliation(s)
- Alberto Forte
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy; Department of Psychiatry and Substance Abuse, ASL Roma 5, Rome, Italy
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy, Via Giano della Bella 34, 00161 Rome, Italy, National Institute of Health (ISS).
| | - Silvia Ghirini
- National Center on Addictions and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada; Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Kong F, Wang A, He J, Xiong L, Xie D, Su J, Liu Z. Trend of unintentional suffocation death for infants under 1 year of age from 2009 to 2018 in Hunan, China: a cross-sectional study. BMJ Open 2020; 10:e038666. [PMID: 33293304 PMCID: PMC7722815 DOI: 10.1136/bmjopen-2020-038666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Few studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups, gender, rural versus urban locations and related healthcare services. DESIGN A cross-sectional study on unintentional suffocation death of infants under 1 year of age in Hunan Province from 2009 to 2018. SETTING Hunan Province, with a population of 74 million, has an area of 210 000 square kilometres and 123 counties/districts. PARTICIPANTS The total data of 4109 unintentional suffocation deaths of infants in Hunan Province from 2009 to 2018 was collected, including 2331 boys, 1766 girls, 12 infants of unknown gender, 2906 rural children and 1203 urban children. MAIN OUTCOME MEASURE The unintentional suffocation mortality rate of infants is defined as the number of unintentional suffocation deaths of children under 1 year of age per 100 000 live births in the same year. RESULTS The infant mortality rate showed a downward trend from 2009 to 2018. Infant unintentional suffocation death decreased first and then fluctuated. The proportion of unintentional suffocation death to infant death showed an upward trend in fluctuation. Boys and rural children had higher mortality rates than those of girls and urban children. A total of 43.5% of the deaths occurred in winter. Forty-eight per cent of the unintentional suffocations were infants between 1 and 4 months of age. A total of 46.4% of the deaths occurred at home, and 71.6% were not treated; approximately 81.8% of the untreated cases were mainly due to a lack of time to get to the hospital. A total of 65.2% of the deaths were diagnosed postmortem. CONCLUSION The mortality rate of unintentional suffocation among infants in Hunan Province should attract the attention of the population, and measures should be taken according to epidemiological investigations.
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Affiliation(s)
- Fanjuan Kong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Aihua Wang
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jian He
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Lili Xiong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Donghua Xie
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jinping Su
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Zhiyu Liu
- Information Management Section, Hunan Province, Changsha, Hunan, China
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Umberson D, Donnelly R, Xu M, Farina M, Garcia MA. Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities. J Gerontol B Psychol Sci Soc Sci 2020; 75:1983-1995. [PMID: 31760426 PMCID: PMC7566971 DOI: 10.1093/geronb/gbz154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk. METHODS We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000-2014. RESULTS Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time. DISCUSSION The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.
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Affiliation(s)
- Debra Umberson
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Rachel Donnelly
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
| | - Minle Xu
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Matthew Farina
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Michael A Garcia
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
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36
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Biernesser C, Sewall CJ, Brent D, Bear T, Mair C, Trauth J. Social Media Use and Deliberate Self-Harm Among Youth: A Systematized Narrative Review. CHILDREN AND YOUTH SERVICES REVIEW 2020; 116:105054. [PMID: 32773916 PMCID: PMC7413131 DOI: 10.1016/j.childyouth.2020.105054] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Suicide is now the 2nd leading cause of death among adolescents and young adults. Social media's influence on youth suicidal risk or attenuation of risk is a novel and rapidly expanding topic of research that requires attention from a broad range of mental health services professionals. We aimed to provide an updated review of social media-related risk and protective factors to youth deliberate-self harm (DSH) to guide mental health services professionals in offering care and support to youth vulnerable to suicide. METHODS Studies on which primary research was conducted that evaluated young people's use of social media platforms related to DSH were systematically searched via Scopus and identified through expert recommendation and the Association for Computing Machinery's digital library of conference materials. The search focused on the timeframe June 2014 to September 2019, to offer an update since the time the most recent systematic reviews on this topic concluded their literatures searches. Quality was reviewed using the Mixed Methods Appraisal Tool (MMAT). RESULTS A total of 38 articles were eligible, and 24 articles rated as high quality were included in a narrative review. Of the included articles, 19 explored DSH risk and 8 explored DSH protection. Most articles reported on cross-sectional quantitative or qualitative studies. Opportunities for both risks and benefits were explored, and potential influences of social media use were considered for subgroups of youth who may be especially vulnerable to suicide. CONCLUSIONS In the relatively short period of review, the association between social media use and youth DSH was tested in population-based studies, offering preliminary evidence for suicide prevention and treatment efforts. Further research is needed to understand the contribution of social media use to youth DSH, particularly among youth most vulnerable to suicidal risk.
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Affiliation(s)
- Candice Biernesser
- Department of Psychiatry, School of Medicine, University of
Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Craig J.R. Sewall
- School of Social Work, University of Pittsburgh, 2117
Cathedral of Learning, 4200 Fifth Ave., Pittsburgh, PA 15260
| | - David Brent
- Department of Psychiatry, School of Medicine, University of
Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213
| | - Todd Bear
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Christina Mair
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
| | - Jeanette Trauth
- Department of Behavioral and Community Health Sciences,
Graduate School of Public Health, University of Pittsburgh, 130 De Soto St.
6 Floor, Pittsburgh, PA 15261
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Ratnasiri AWG, Lakshminrusimha S, Dieckmann RA, Lee HC, Gould JB, Parry SS, Arief VN, DeLacy IH, DiLibero RJ, Basford KE. Maternal and infant predictors of infant mortality in California, 2007-2015. PLoS One 2020; 15:e0236877. [PMID: 32760136 PMCID: PMC7410301 DOI: 10.1371/journal.pone.0236877] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/15/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To identify current maternal and infant predictors of infant mortality, including maternal sociodemographic and economic status, maternal perinatal smoking and obesity, mode of delivery, and infant birthweight and gestational age. Methods This retrospective study analyzed data from the linked birth and infant death files (birth cohort) and live births from the Birth Statistical Master files (BSMF) in California compiled by the California Department of Public Health for 2007–2015. The birth cohort study comprised 4,503,197 singleton births including 19,301 infant deaths during the nine-year study period. A subpopulation to study fetal growth consisted of 4,448,300 birth cohort records including 13,891 infant deaths. Results The infant mortality rate (IMR) for singleton births decreased linearly (p <0.001) from 4.68 in 2007 to 3.90 (per 1,000 live births) in 2015. However, significant disparities in IMR were uncovered in different population groups depending upon maternal sociodemographic and economic characteristics and maternal characteristics during pregnancy. Children of African American women had almost twice the risk of infant mortality when compared with children of White women (AOR 2.12; 95% CI, 1.98–2.27; p<0.001). Infants of women with Bachelor’s degrees or higher were 89% less likely to die (AOR 1.89; 95% CI, 1.76–2.04; p<0.001) when compared to infants of women with education less than high school. Infants of maternal smokers were 75% more likely to die (AOR 1.75; 95% CI, 1.58–1.93; p<0.001) than infants of nonsmokers. Infants of women who were overweight and obese during pregnancy accounted for 55% of IMR over all women in the study. More than half of the infant deaths were to children of women with lower socioeconomic status; infants of WIC participants were 59% more likely to die (AOR 1.59; 95% CI, 1.52–1.67; p<0.001) than infants of non-WIC participants. With respect to infant predictors, infants born with LBW or PTB were more than six times (AOR 6.29; 95% CI, 5.90–6.70; p<0.001) and almost four times (AOR 3.95; 95% CI, 3.73–4.19; p<0.001) more likely to die than infants who had normal births, respectively. SGA and LGA infants were more than two times (AOR 2.03; 95% CI, 1.92–2.15; p<0.001) and 41% (AOR 1.41; 95% CI, 1.32–1.52; p<0.001) more likely to die than AGA infants, respectively. Conclusions While the overall IMR in California is declining, wide disparities in death rates persist in different groups, and these disparities are increasing. Our data indicate that maternal sociodemographic and economic factors, as well as maternal prepregnancy obesity and smoking during pregnancy, have a prominent effect on IMR though no causality can be inferred with the current data. These predictors are not typically addressed by direct medical care. Infant factors with a major effect on IMR are birthweight and gestational age—predictors that are addressed by active medical services. The highest value interventions to reduce IMR may be social and public health initiatives that mitigate disparities in sociodemographic, economic and behavioral risks for mothers.
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Affiliation(s)
- Anura W. G. Ratnasiri
- Benefits Division, California Department of Health Care Services, Sacramento, California, United States of America
- School of Agriculture and Food Sciences, Faculty of Science, The University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
| | - Satyan Lakshminrusimha
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, California, United States of America
| | - Ronald A. Dieckmann
- Pediatrics and Emergency Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Henry C. Lee
- Division of Neonatology, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Jeffrey B. Gould
- Division of Neonatology, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Steven S. Parry
- Benefits Division, California Department of Health Care Services, Sacramento, California, United States of America
| | - Vivi N. Arief
- School of Agriculture and Food Sciences, Faculty of Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian H. DeLacy
- School of Agriculture and Food Sciences, Faculty of Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Ralph J. DiLibero
- Benefits Division, California Department of Health Care Services, Sacramento, California, United States of America
| | - Kaye E. Basford
- School of Agriculture and Food Sciences, Faculty of Science, The University of Queensland, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Foster CC, Simon TD, Qu P, Holmes P, Chang JK, Ramos JL, Koutlas A, Rivara FP, Melzer SM, Mangione-Smith R. Social Determinants of Health and Emergency and Hospital Use by Children With Chronic Disease. Hosp Pediatr 2020; 10:471-480. [PMID: 32423995 DOI: 10.1542/hpeds.2019-0248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the association between caregiver-reported social determinants of health (SDOH) and emergency department (ED) visits and hospitalizations by children with chronic disease. METHODS This was a nested retrospective cohort study (December 2015 to May 2017) of children (0-18 years) receiving Supplemental Security Income and Medicaid enrolled in a case management program. Caregiver assessments were coded for 4 SDOH: food insecurity, housing insecurity, caregiver health concerns, and safety concerns. Multivariable hurdle Poisson regression was used to assess the association between SDOH with ED and hospital use for 1 year, adjusting for age, sex, and race and ethnicity. ED use was also adjusted for medical complexity. RESULTS A total of 226 children were included. Patients were 9.1 years old (SD: 4.9), 60% male, and 30% Hispanic. At least 1 SDOH was reported by 59% of caregivers, including food insecurity (37%), housing insecurity (23%), caregiver health concerns (18%), and safety concerns (11%). Half of patients had an ED visit (55%) (mean: 1.5 per year [SD: 2.4]), and 20% were hospitalized (mean: 0.4 per year [SD: 1.1]). Previously unaddressed food insecurity was associated with increased ED use in the subsequent year (odds ratio: 3.43 [1.17-10.05]). Among those who had ≥1 ED visit, the annualized ED rate was higher in patients with a previously unaddressed housing insecurity (rate ratio: 1.55 [1.14-2.09]) or a safety concern (rate ratio: 2.04 [1.41-2.96]). CONCLUSIONS Over half of caregivers of children with chronic disease enrolled in a case management program reported an SDOH insecurity or concern. Patients with previously unaddressed food insecurity had higher ED rates but not hospitalization rates.
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Affiliation(s)
- Carolyn C Foster
- Department of Pediatrics, School of Medicine and .,Centers for Child Health, Behavior and Development and
| | - Tamara D Simon
- Department of Pediatrics, School of Medicine and.,Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Pingping Qu
- Centers for Child Health, Behavior and Development and
| | - Paula Holmes
- Seattle Children's Hospital, Seattle, Washington; and
| | - Jason K Chang
- Seattle Children's Hospital, Seattle, Washington; and
| | | | | | - Frederick P Rivara
- Department of Pediatrics, School of Medicine and.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.,Centers for Child Health, Behavior and Development and.,Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Sanford M Melzer
- Department of Pediatrics, School of Medicine and.,Centers for Child Health, Behavior and Development and
| | - Rita Mangione-Smith
- Department of Pediatrics, School of Medicine and.,Centers for Child Health, Behavior and Development and
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Homicidal Ideation among Children and Adolescents: Evidence from the 2012-2016 Nationwide Emergency Department Sample. J Pediatr 2020; 219:216-222. [PMID: 32014280 DOI: 10.1016/j.jpeds.2019.12.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the prevalence and behavioral, sociodemographic, and psychiatric/psychological correlates of homicidal ideation among a sample of children and adolescents. STUDY DESIGN We employed descriptive and multivariate logit models of homicidal ideation using data from the 2012-2016 Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project. This study was conducted with data from emergency departments in the US, and we used a sample of (N = 17 041 346) children and adolescents between the ages of 5 and 17 years. RESULTS Pediatric homicidal ideation is rare with a prevalence estimate of 0.09%; however, its prevalence increases substantially from age 5 years to age 15 years when it peaks, and then declines through the end of adolescence. Conduct disorders conferred 1483% increased odds, attention deficit hyperactivity disorder conferred 616% increased odds, and other behavioral and emotional disorders increased a 2-fold to nearly 4-fold increased liability for homicidal ideation net the effects of sex, age, urban residence, insurance status, and zip code median household income. CONCLUSION In the wake of homicide tragedies, it is often the case that numerous behavioral and clinical red flags were present in the developmental history of the perpetrator, but these were overlooked. Identifying children and adolescents who present with homicidal ideation is a crucial pediatric and public health matter that can inform prevention and behavioral interventions that forestall lethal violence.
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40
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Rees CA, Monuteaux MC, Raphael JL, Michelson KA. Disparities in Pediatric Mortality by Neighborhood Income in United States Emergency Departments. J Pediatr 2020; 219:209-215.e3. [PMID: 31610934 DOI: 10.1016/j.jpeds.2019.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate emergency department (ED) pediatric mortality by patient neighborhood income. STUDY DESIGN We calculated the incidence of ED pediatric mortality via a cross-sectional study of children <18 years who died in an ED using the Nationwide Emergency Department Sample and US Census from 2012 to 2016. The main exposure was median income for the patient's zip code tabulation area quartile. To determine factors associated with ED mortality, we modeled mortality using negative binomial regression. We used an interaction term between neighborhood income and insurance type to evaluate their relationship to mortality. RESULTS There were 64 893 ED deaths during the study period (incidence 17.3 per 100 000 person-years). The incidence of ED mortality increased with decreasing neighborhood income: compared with the wealthiest income quartile, the poorest, second, and third quartiles had adjusted incidence rate ratios (aIRRs) of 1.79 (95% CI 1.63-1.96), 1.42 (95% CI 1.29-1.55), and 1.23 (95% CI 1.12-1.36), respectively. The incidence of ED mortality was greater among uninsured children (aIRR 4.96, 95% CI 4.55-5.41) and publicly insured children (aIRR 2.69, 95% CI 2.51-2.88) compared with privately insured children. The interaction term showed no consistent relationship between neighborhood income and insurance with ED mortality. CONCLUSIONS Children from poorer neighborhoods have greater ED mortality rates than children from greater-income neighborhoods. Improved access to health insurance in the US may lead to reduced pediatric mortality, as ED mortality was greatest in uninsured children. Development of interventions to improve upstream determinants of health that contribute to ED mortality are needed.
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Affiliation(s)
- Chris A Rees
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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41
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Donnelly R, Umberson D, Hummer RA, Garcia MA. Race, death of a child, and mortality risk among aging parents in the United States. Soc Sci Med 2020; 249:112853. [PMID: 32088513 PMCID: PMC7423689 DOI: 10.1016/j.socscimed.2020.112853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/20/2019] [Accepted: 02/11/2020] [Indexed: 11/19/2022]
Abstract
The death of a child is a stressful and traumatic life event that has been linked to increased mortality risk among parents. Tragically, black parents are significantly more likely than white parents to lose a child in the United States; however, prior research has not addressed this racial disadvantage in relation to parents' mortality risk. In this study, we focus on the racial context of the United States to suggest that black parents already face higher mortality rates compared to white parents, and the unequal burden of child death adds to their mortality risk. Using discrete-time event history models, we consider whether the death of a child by midlife is associated with increased mortality risk for black parents and for white parents in mid- to later-life using longitudinal data from the Health and Retirement Study (HRS; 1996-2016). Descriptive results show that by midlife, black parents, especially black mothers, experience substantially higher child mortality compared with white parents. At the same time, we find that losing a child prior to midlife is associated with heightened mortality risk for aging black mothers and white mothers. Controlling for educational attainment explains the association between child death and parental mortality risk among white mothers, whereas heightened biopsychosocial and behavioral risk factors explain the association for black mothers. Overall, the death of a child is associated with increased mortality risk for black mothers and for white mothers, but the processes linking child death to parental mortality seem to differ for black and white parents. These findings have implications for policies and interventions that address increased mortality risk for parents following the death of a child.
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Affiliation(s)
- Rachel Donnelly
- Department of Sociology, Vanderbilt University, United States.
| | - Debra Umberson
- Department of Sociology and Population Research Center, University of Texas at Austin, United States
| | - Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Michael A Garcia
- Department of Sociology and Population Research Center, University of Texas at Austin, United States
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42
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Ray JG, Guttmann A, Silveira J, Park AL. Mortality in a cohort of 3.1 million children, adolescents and young adults. J Epidemiol Community Health 2020; 74:260-268. [PMID: 31915240 PMCID: PMC7035693 DOI: 10.1136/jech-2019-213365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many youth deaths occur in the first year of life, from prematurity and anomalies. Detailing mortality after age 1 year may differentially guide preventive strategies in children, adolescents and young adults. METHODS A cohort study in Ontario, Canada comprised 3 139 698 children born from 1990 to 2016. Adjusted HR (aHR) for death between 1 and 24 years were generated, comparing demographic variables and parity. RESULTS After a median of 13.7 years of follow-up, 6930 deaths occurred between ages 1 and 24 years (incidence rate 17.0 per 100 000 person-years), peaking at age 23 years (43.7 per 100 000). The aHR for death was higher among males than females (1.44, 95% CI 1.37 to 1.51), rural versus urban areas (1.48, 95% CI 1.39 to 1.58), lowest versus highest income areas (1.39, 95% CI 1.29 to 1.51) and at parity 1 (1.16, 95% CI 1.10 to 1.23), parity 2 (1.34, 95% CI 1.23 to 1.45), parity 3+ (1.96, 95% CI 1.74 to 2.21), each relative to a child without an older sibling. Among males, the proportion of deaths due to injury jumped from 30% before age 15 years to 65% thereafter, and in females, from 28% to 51%. Intentional self-harm/assault explained 11% of injury-related deaths among males before age 15 years, and 20% thereafter, with respective figures of 18% and 17% for females. Deaths outside of hospital increased with age, from 35% at age 1 year, to 66% at age 22 years. CONCLUSION There is a heightened susceptibility of dying starting at age 15 years, especially among males, from injury, and arising outside of hospital.
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Affiliation(s)
- Joel G Ray
- Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada .,Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada.,Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jose Silveira
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
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43
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Rogers RG, Hummer RA, Vinneau JM, Lawrence EM. Greater mortality variability in the United States in comparison with peer countries. DEMOGRAPHIC RESEARCH 2020; 42:1039-1056. [PMID: 32943979 PMCID: PMC7494211 DOI: 10.4054/demres.2020.42.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past several decades, US mortality declines have lagged behind other high-income countries. However, scant attention has been devoted to how US mortality variability compares with other countries. OBJECTIVE We examine trends in mortality and mortality variability in the US and 16 peer countries from 1980 through 2016. METHODS We employ the Human Mortality Database and demographic techniques - with a focus on patterns in the interquartile (IQR), interdecile (IDR), and intercentile (ICR) ranges of survivorship - to better understand US mortality and mortality variability trends in comparative perspective. RESULTS Compared to other high-income countries, the US: (1) mortality ranking has slipped for nearly all age groups; (2) is losing its old age mortality advantage; (3) has seen growth in relative age-specific mortality gaps from infancy through midlife; and (4) exhibits greater concentrations of deaths from infancy through adulthood, resulting in much greater mortality variability. CONCLUSIONS We contribute to calls for renewed attention to the relatively low and lagging US life expectancy. The ICR draws particular attention to the comparatively high US early and midlife mortality. CONTRIBUTION We find comparatively high variability in US mortality. Further reductions in early and midlife mortality could diminish variability, reduce years of potential life lost, and increase life expectancy. Consistent with previous research, we encourage policymakers to focus on reducing the unacceptably high early and midlife mortality in the US. And we urge researchers to more frequently monitor and track mortality variation in conjunction with mortality rates and life expectancy estimates.
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Affiliation(s)
- Richard G Rogers
- Department of Sociology and Population Program, Institute of Behavioral Science (IBS), University of Colorado Boulder, USA
| | - Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Justin M Vinneau
- Department of Sociology and Population Program, Institute of Behavioral Science (IBS), University of Colorado Boulder, USA
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Probst J, Zahnd W, Breneman C. Declines In Pediatric Mortality Fall Short For Rural US Children. Health Aff (Millwood) 2019; 38:2069-2076. [DOI: 10.1377/hlthaff.2019.00892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Janice Probst
- Janice Probst is a distinguished professor emerita in the Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, in Columbia
| | - Whitney Zahnd
- Whitney Zahnd is a research assistant professor in the Rural and Minority Health Research Center of the University of South Carolina
| | - Charity Breneman
- Charity Breneman was a postdoctoral fellow in the Rural and Minority Health Research Center of the University of South Carolina at the time the study was performed
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45
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Wojcik MH, Schwartz TS, Thiele KE, Paterson H, Stadelmaier R, Mullen TE, VanNoy GE, Genetti CA, Madden JA, Gubbels CS, Yu TW, Tan WH, Agrawal PB. Infant mortality: the contribution of genetic disorders. J Perinatol 2019; 39:1611-1619. [PMID: 31395954 PMCID: PMC6879816 DOI: 10.1038/s41372-019-0451-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the proportion of infant deaths occurring in the setting of a confirmed genetic disorder. STUDY DESIGN A retrospective analysis of the electronic medical records of infants born from 1 January, 2011 to 1 June, 2017, who died prior to 1 year of age. RESULTS Five hundred and seventy three deceased infants were identified. One hundred and seventeen were confirmed to have a molecular or cytogenetic diagnosis in a clinical diagnostic laboratory and an additional seven were diagnosed by research testing for a total of 124/573 (22%) diagnosed infants. A total of 67/124 (54%) had chromosomal disorders and 58/124 (47%) had single gene disorders (one infant had both). The proportion of diagnoses made by sequencing technologies, such as exome sequencing, increased over the years. CONCLUSIONS The prevalence of confirmed genetic disorders within our cohort of infant deaths is higher than that previously reported. Increased efforts are needed to further understand the mortality burden of genetic disorders in infancy.
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Affiliation(s)
- Monica H. Wojcik
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Neonatal Genomics Program, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115.,The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - Talia S. Schwartz
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Katri E. Thiele
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Brody School of Medicine at East Carolina University, Greenville, NC, USA, 27834
| | - Heather Paterson
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Rachel Stadelmaier
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Thomas E. Mullen
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - Grace E. VanNoy
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - Casie A. Genetti
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Jill A. Madden
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Cynthia S. Gubbels
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - Timothy W. Yu
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115
| | - Pankaj B. Agrawal
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,Division of Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Manton Center for Orphan Disease Research, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115,The Neonatal Genomics Program, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, 02115.,The Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
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Gennuso KP, Blomme CK, Givens ML, Pollock EA, Roubal AM. Deaths of Despair(ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities. Am J Prev Med 2019; 57:585-591. [PMID: 31561921 DOI: 10.1016/j.amepre.2019.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Recent media coverage and research have emphasized increasing mortality rates for middle-aged white Americans. A concern is that this has shifted focus away from the health burden of other population subgroups. This cross-sectional study compares the magnitude of racial/ethnic mortality disparities across age groups and investigates how changing mortality trends have affected these disparities. METHODS Mortality data from 2007 to 2016 by race/ethnicity and age were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database in 2018‒2019. Absolute and relative racial/ethnic mortality disparities by age groups were determined by calculating between-group variance and mortality rate-adjusted between-group variance, respectively. Trends in disparities were analyzed using joinpoint regression modeling. Annual percentage change in rate-adjusted between-group variance was calculated for each trend segment as well as the relative contribution of each racial/ethnic group to the change. RESULTS The largest relative and absolute disparities were found in the youngest and oldest age groups, respectively. Trend analysis detected an inflection point between 2009 and 2012 for most age groups where a period of decreasing disparities changed to one of increasing disparities. Three quarters of the decreasing disparities in Period 1 were resultant of lowering mortality among the black subgroup. During Period 2, the increase in child disparities were due to increased mortality among blacks, whereas increased adult disparities were due to increased mortality among whites shifting the overall mean away from subgroups with lower rates. CONCLUSIONS Racial/ethnic mortality disparities persist and are widening for some age groups. It is imperative to maintain focus on the age groups where those with historically poorer health are contributing most to the increase.
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Affiliation(s)
- Keith P Gennuso
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Courtney K Blomme
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Marjory L Givens
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elizabeth A Pollock
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anne M Roubal
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin
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47
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Polanco-Roman L, Anglin DM, Miranda R, Jeglic EL. Racial/Ethnic Discrimination and Suicidal Ideation in Emerging Adults: The Role of Traumatic Stress and Depressive Symptoms Varies by Gender not Race/Ethnicity. J Youth Adolesc 2019; 48:2023-2037. [PMID: 31541372 DOI: 10.1007/s10964-019-01097-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/27/2019] [Indexed: 01/17/2023]
Abstract
Drawing from Race-Based Traumatic Stress theory, the present study examined whether traumatic stress and depressive symptoms differentially help explain the relation between racial/ethnic discrimination and suicidal ideation across gender and racial/ethnic groups. A racially/ethnically diverse group of emerging adults (N = 1344; Mage = 19.88, SD = 2.25; 72% female; 46% Hispanic) completed a battery of self-report measures. A cross-sectional design was employed with a series of hierarchical linear regression models and bootstrapping procedures to examine the direct and indirect relation between racial/ethnic discrimination and suicidal ideation through traumatic stress and depressive symptoms across gender and race/ethnicity. The findings suggest an indirect relation through depressive symptoms, but not traumatic stress, and a serial indirect relation through traumatic stress to depressive symptoms in young women and young men, the latter of which was stronger in young women. The indirect relations did not vary by racial/ethnic group. Cumulative experiences of racial/ethnic discrimination may impact suicide-related risk via increases in psychiatric symptomology (i.e., traumatic stress and depressive symptoms), particularly in young women. Racial/ethnic discrimination experiences should be accounted for as a potential source of psychological distress in the assessment, diagnosis, and treatment of suicidal thoughts and behavior, especially among young women endorsing traumatic stress and depressive symptoms. Further research is warranted to better understand the gender difference in the relation between racial/ethnic discrimination and suicide-related risk.
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Affiliation(s)
- Lillian Polanco-Roman
- The Graduate Center, CUNY, New York, NY, 10016, USA. .,City College of New York, CUNY, New York, NY, 10016, USA. .,Department of Child & Adolescent Psychiatry, Columbia University/New York State Psychiatric Institute, 1051, Riverside Drive, New York, NY, 10032, USA.
| | - Deidre M Anglin
- The Graduate Center, CUNY, New York, NY, 10016, USA.,City College of New York, CUNY, New York, NY, 10016, USA
| | - Regina Miranda
- The Graduate Center, CUNY, New York, NY, 10016, USA.,Hunter College, CUNY, New York, NY, 10016, USA
| | - Elizabeth L Jeglic
- The Graduate Center, CUNY, New York, NY, 10016, USA.,John Jay College of Criminal Justice, CUNY, New York, NY, 10016, USA
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Yan Y, Gomez-Lopez N, Basij M, Shahvari AV, Vadillo-Ortega F, Hernandez-Andrade E, Hassan SS, Romero R, MehrMohammadi M. Photoacoustic imaging of the uterine cervix to assess collagen and water content changes in murine pregnancy. BIOMEDICAL OPTICS EXPRESS 2019; 10:4643-4655. [PMID: 31565515 PMCID: PMC6757472 DOI: 10.1364/boe.10.004643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 05/11/2023]
Abstract
The uterine cervix plays a central role in the maintenance of pregnancy and in the process of parturition. Cervical remodeling involves dramatic changes in extracellular matrix composition and, in particular, of collagen and water content during cervical ripening (a term that describes the anatomical, biochemical, and physiologic changes in preparation for labor). Untimely cervical ripening in early gestation predisposes to preterm labor and delivery, the leading cause of infant death worldwide. Inadequate ripening of the cervix is associated with failure of induction or prolonged labor. The current approach to evaluate the state of the cervix relies on digital examination and sonographic examination. Herein, we present a novel imaging method that combines ultrasound (US) and photoacoustic (PA) techniques to evaluate cervical remodeling by assessing the relative collagen and water content of this organ. The method was tested in vitro in extracted collagen phantoms and ex vivo in murine cervical tissues that were collected in mid-pregnancy and at term. We report, for the first time, that our imaging approach provides information about the molecular changes in the cervix at different gestational ages. There was a strong correlation between the results of PA imaging and the histological assessment of the uterine cervix over the course of gestation. These findings suggest that PA imaging is a powerful method to assess the biochemical composition of the cervix and open avenues to non-invasively investigate the composition of this organ, which is essential for reproductive success.
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Affiliation(s)
- Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Biochemistry, Immunology, and, Microbiology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI 48201, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | | | - Felipe Vadillo-Ortega
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Unidad de Vinculación de la Facultad de Medicina,UNAM y Dirección de Investigación, Instituto Nacional de Medicina Genómica, CDMX, Mexico
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
- Detroit Medical Center, Detroit, MI 48201, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, FL 33199, USA
| | - Mohammad MehrMohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI 48202, USA
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Maternal characteristics associated with injury-related infant death in West Virginia, 2010-2014. PLoS One 2019; 14:e0220801. [PMID: 31404105 PMCID: PMC6690538 DOI: 10.1371/journal.pone.0220801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Abstract
Although injury-related deaths have been documented among children and adult populations, insufficient attention has been directed towards injury-related infant deaths. The objective of this retrospective study was to investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia. Birth and infant mortality data for 2010–2014 were sourced from the West Virginia Bureau for Public Health, Charleston. Relative risk was calculated using log-binomial regression utilizing generalized estimating equations. Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ( Xdf=22 = 7.48, p = .03), and smoking during pregnancy ( Xdf=12=13.1, p < .00). Risk of a Black Non-Hispanic infant suffering an injury-related death was 4.0 (95% CL 1.7, 9.3) times that of infants of other races/ethnicities. Risk of an infant dying from an injury-related cause, if the mother smoked during pregnancy, was 2.9 (95% CL 1.6, 5.0) times the risk of such a death if maternal smoking status during pregnancy is unknown or no smoking, controlling for race/ethnicity. This study provides important information to public health stakeholders at both the state and local levels in designing interventions for partial reduction or prevention of injury-related infant mortality in West Virginia.
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50
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Shiels MS, Berrington de González A, Best AF, Chen Y, Chernyavskiy P, Hartge P, Khan SQ, Pérez-Stable EJ, Rodriquez EJ, Spillane S, Thomas DA, Withrow D, Freedman ND. Premature mortality from all causes and drug poisonings in the USA according to socioeconomic status and rurality: an analysis of death certificate data by county from 2000-15. LANCET PUBLIC HEALTH 2019; 4:e97-e106. [PMID: 30655229 PMCID: PMC6392082 DOI: 10.1016/s2468-2667(18)30208-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND Increasing premature mortality among some groups of Americans has been largely driven by increases in drug poisoning deaths. However, to our knowledge, a formal descriptive study by race and ethnicity, socioeconomic status, rurality, and geography has not been done. In this study, we examined US trends in premature all-cause and drug poisoning mortality between 2000 and 2015 at the county level among white, black, and Latino people. METHODS We used US mortality data for the period Jan 1, 2000, to Dec 31, 2015, including underlying cause of death and demographic data, collected from death certificates by the Centers for Disease Control and Prevention National Center for Health Statistics, and ascertained county attributes from the 2011-15 Census American Community Survey. We categorised counties into quintiles on the basis of the percentage of people unemployed, the percentage of people with a bachelor's degree, median income, and rurality. We estimated premature (ie, deaths in those aged 25-64 years) age-standardised mortality for all causes (by race and ethnicity) and drug poisoning, by county, for the periods of 2000-03 and 2012-15. We estimated annual percentage changes in mortality (2000-15) by county-level characteristics. FINDINGS Premature mortality declined from 2000-03 to 2012-15 among black and Latino people, but increased among white people in many US counties. Drug poisoning mortality increased in counties throughout the country. Significant increases between 2000 and 2015 occurred across low and high socioeconomic status and urban and rural counties among white people aged 25-64 years (annual percentage change range 4·56% per year [95% CI 3·56-5·57] to 11·51% per year [9·41-13·65]), black people aged 50-64 years (2·27% per year [0·42-4·16] to 9·46% per year [7·02-11·96]), Latino women aged 25-49 years (2·43% per year [1·18-3·71] to 5·01% per year [3·80-6·23]), and Latino men aged 50-64 years (2·42% per year [0·53-4·34] to 5·96% per year [3·86-8·11]). Although drug poisoning mortality increased rapidly in counties with the lowest socioeconomic status and in rural counties, most deaths during 2012-15 occurred in the largest metropolitan counties (121 395 [76%] in metropolitan counties with ≥250 000 people vs 2175 [1%] in the most rural counties), reflecting population size. INTERPRETATION Premature mortality has declined among black and Latino people in the USA, and increased among white people, particularly in less affluent and rural counties. Increasing drug poisoning mortality was not limited to poor white people in rural areas. Rapid increases have occurred in communities throughout the USA regardless of race and ethnicity, socioeconomic status, or rurality. Widespread public health interventions are needed to addess this public health emergency. FUNDING National Institutes of Health.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | | | - Ana F Best
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Pavel Chernyavskiy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA; University of Wyoming, Department of Mathematics and Statistics, Laramie, WY, USA
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Sahar Q Khan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Susan Spillane
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - David A Thomas
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Diana Withrow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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