An examination of geographic access to outpatient stroke rehabilitation services in Tennessee, a stroke belt state.

BACKGROUND: While over half of US stroke patients were discharged to home, estimates of geographic access to outpatient stroke rehab facilities are unavailable. The objective of our study was to assess distance and travel time to the nearest outpatient stroke rehab facility in Tennessee, a high stroke prevalence state. METHODS: We systematically scraped Google Maps with the terms "stroke", "rehabilitation", and "outpatient" to identify Tennessee stroke rehab facilities. We then averaged/aggregated Census block-level travel distance and travel time to determine the mean travel distance/time to a facility for each of the 95 Tennessee counties and the overall state. Comparisons of mean travel time/distance were made between rural and urban counties and between low, medium, and high stroke prevalence counties. RESULTS: We found that 79% of facilities were in urban areas. Significantly higher median of mean travel times and distances (p values both <0.001) were observed in rural (22.0 miles, 31.6 min) versus urban counties (10.5 miles, 18.4 min). High (21.5 miles, 32.5 min) and medium (18.7 miles, 28.3 minutes) stroke prevalence counties, which often overlap with rural counties, had significantly higher median of mean travel times and distance than low stroke prevalence counties (7.3 miles, 14.5 min). CONCLUSIONS: Rural Tennessee counties were faced with high stroke prevalence, inadequate facilities, and significantly greater travel distance and time to access care. Additional efforts to address transportation barriers and accelerate telerehabilitation implementation are crucial for improving equal access to stroke aftercare in these areas.

A cross-sectional examination of post-myocardial infarction physical activity levels among US rural and urban residents: Findings from the 2017-2019 Behavioral Risk Factor Surveillance System.

BACKGROUND: This study sought to examine the relationship between rural residence and physical activity levels among US myocardial infarction (MI) survivors. METHODS: We conducted a cross-sectional study using nationally representative Behavioral Risk Factor Surveillance System surveys from 2017 and 2019. We determined the survey-weighted percentage of rural and urban MI survivors meeting US physical activity guidelines. Logistic regression models were used to examine the relationship between rural/urban residence and meeting physical activity guidelines, accounting for sociodemographic factors. RESULTS: Our study included 22,732 MI survivors (37.3% rural residents). The percentage of rural MI survivors meeting physical activity guidelines (37.4%, 95% CI: 35.1%-39.7%) was significantly less than their urban counterparts (45.6%, 95% CI: 44.0%-47.2%). Rural residence was associated with a 28.8% (95% CI: 20.0%-36.7%) lower odds of meeting physical activity guidelines, with this changing to a 19.3% (95% CI: 9.3%-28.3%) lower odds after adjustment for sociodemographic factors. CONCLUSIONS: A significant rural/urban disparity in physical activity levels exists among US MI survivors. Our findings support the need for further efforts to improve physical activity levels among rural MI survivors as part of successful secondary prevention in US high-MI burden rural areas.

Estimates of short sleep duration among US rural and urban women with prediabetes.

BACKGROUND: Short sleep duration (SSD) (<7 hours/night) is linked with increased risk of prediabetes to diabetes progression. Despite a high diabetes burden in US rural women, existing research does not provide SSD estimates for this population. METHODS: We used national Behavioral Risk Factor Surveillance System surveys to conduct a cross-sectional study examining SSD estimates for US women with prediabetes by rural/urban residence between 2016-2020. We applied logistic regression models to the BRFSS dataset to ascertain associations between rural/urban residence status and SSD prior to and following adjustment for sociodemographic factors (age, race, education, income, health care coverage, having a personal doctor). RESULTS: Our study included 20,997 women with prediabetes (33.7% rural). SSD prevalence was similar between rural (35.5%, 95% CI: 33.0%-38.0%) and urban women (35.4%, 95% CI: 33.7%-37.1). Rural residence was not associated with SSD among US women with prediabetes prior to adjustment (Odds Ratio: 1.00, 95% CI: 0.87-1.14) or following adjustment for sociodemographic factors (Adjusted Odds Ratio: 1.06, 95% CI: 0.92-1.22). Among women with prediabetes, irrespective of rural/urban residence status, being Black, aged <65 years, and earning <$50,000 was linked with significantly higher odds of having SSD. CONCLUSIONS: Despite the finding that SSD estimates among women with prediabetes did not vary by rural/urban residence status, 35% of rural women with prediabetes had SSD. Efforts to reduce diabetes burden in rural areas may benefit from incorporating strategies to improve sleep duration along with other known diabetes risk factors among rural women with prediabetes from certain sociodemographic backgrounds.

Association of marital/partner status and patient-reported outcomes following myocardial infarction: a systematic review and meta-analysis.

Aims: Little is known about the relationship between marital/partner status and patient-reported outcome measures (PROMs) following myocardial infarction (MI). We conducted a systematic review/meta-analysis and explored potential sex differences. Methods and results: We searched five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) from inception to 27 July 2022. Peer-reviewed studies of MI patients that evaluated marital/partner status as an independent variable and reported its associations with defined PROMs were eligible for inclusion. Results for eligible studies were classified into four pre-specified outcome domains [health-related quality of life (HRQoL), functional status, symptoms, and personal recovery (i.e. self-efficacy, adherence, and purpose/hope)]. Study quality was appraised using Newcastle-Ottawa Scale, and data were synthesized by outcome domains. We conducted subgroup analysis by sex. We included 34 studies (n = 16 712), of which 11 were included in meta-analyses. Being married/partnered was significantly associated with higher HRQoL {six studies [n = 2734]; pooled standardized mean difference, 0.37 [95% confidence interval (CI), 0.12-0.63], I 2 = 51%} but not depression [three studies (n = 2005); pooled odds ratio, 0.72 (95% CI, 0.32-1.64); I 2 = 65%] or self-efficacy [two studies (n = 356); pooled ß, 0.03 (95% CI, -0.09 to 0.14); I 2 = 0%]. The associations of marital/partner status with functional status, personal recovery outcomes, and symptoms of anxiety and fatigue were mixed. Sex differences were not evident due to mixed results from the available studies. Conclusions: Married/partnered MI patients had higher HRQoL than unpartnered patients, but the associations with functional, symptom, and personal recovery outcomes and sex differences were less clear. Our findings inform better methodological approaches and standardized reporting to facilitate future research on these relationships.

Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke.

BACKGROUND: Long-term exposure to air pollutants is associated with increased stroke incidence, morbidity, and mortality; however, research on the association of pollutant exposure with poststroke hospital readmissions is lacking. METHODS: We assessed associations between average annual carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), particulate matter 2.5, and sulfur dioxide (SO2) exposure and 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age ≥65 years hospitalized for ischemic stroke in 2014 to 2015. We fit Cox models to assess 30-day readmissions as a function of these pollutants, adjusted for patient and hospital characteristics and ambient temperature. Analyses were then stratified by treating hospital performance on the Centers for Medicare and Medicaid Services risk-standardized 30-day poststroke all-cause readmission measure to determine if the results were independent of performance: low (Centers for Medicare and Medicaid Services rate for hospital <25th percentile of national rate), high (>75th percentile), and intermediate (all others). RESULTS: Of 448 148 patients with stroke, 12.5% were readmitted within 30 days. Except for tropospheric NO2 (no national standard), average 2-year CO, O3, particulate matter 2.5, and SO2 values were below national limits. Each one SD increase in average annual CO, NO2, particulate matter 2.5, and SO2 exposure was associated with an adjusted 1.1% (95% CI, 0.4-1.9%), 3.6% (95% CI, 2.9%-4.4%), 1.2% (95% CI, 0.2%-2.3%), and 2.0% (95% CI, 1.1%-3.0%) increased risk of 30-day readmission, respectively, and O3 with a 0.7% (95% CI, 0.0%-1.5%) decrease. Associations between long-term air pollutant exposure and increased readmissions persisted across hospital performance categories. CONCLUSIONS: Long-term air pollutant exposure below national limits was associated with increased 30-day readmissions after stroke, regardless of hospital performance category. Whether air quality improvements lead to reductions in poststroke readmissions requires further research.

The association of marital/partner status with patient-reported health outcomes following acute myocardial infarction or stroke: Protocol for a systematic review and meta-analysis.

INTRODUCTION: Marital/Partner support is associated with lower mortality and morbidity following acute myocardial infarction (AMI) and stroke. Despite an increasing focus on the effect of patient-centered factors on health outcomes, little is known about the impact of marital/partner status on patient-reported outcome measures (PROMs). OBJECTIVE: To synthesize evidence of the association between marital/partner status and PROMs after AMI and stroke and to determine whether associations differ by sex. METHODS AND ANALYSIS: We will search MEDLINE (via Ovid), Web of Science Core Collection (as licensed by Yale University), Scopus, EMBASE (via Ovid), and PsycINFO (via Ovid) from inception to July 15, 2022. Two authors will independently screen titles, abstracts, and then full texts as appropriate, extract data, and assess risk of bias. Conflicts will be resolved by discussion with a third reviewer. The primary outcomes will be the associations between marital/partner status and PROMs. An outcome framework was designed to classify PROMs into four domains (health-related quality of life, functional status, symptoms, and personal recovery). Meta-analysis will be conducted if appropriate. Subgroup analysis by sex and meta-regression with a covariate for the proportion of male participants will be performed to explore differences by sex. ETHICS AND DISSEMINATION: This research is exempt from ethics approval because the study will be conducted using published data. We will disseminate the results of the analysis in a related peer-reviewed journal. TRIAL REGISTRATION: PROSPERO registration number: CRD42022295975.

Rural Residence and Antihypertensive Medication Use in US Stroke Survivors.

Background Relatively greater increases in hypertension prevalence among US rural residents may contribute to geographic disparities in recurrent stroke. There is limited US information on poststroke antihypertensive medication use by rural/urban residence. We assessed antihypertensive use and lifestyle characteristics for US rural compared with urban stroke survivors and residence-based trends in use between 2005 and 2019. Methods and Results US stroke survivors with hypertension were identified in the 2005 to 2019 national Behavioral Risk Factor Surveillance System surveys. We ascertained the survey-weighted prevalence of reported antihypertensive use and lifestyle characteristics (ie, physical activity, diabetes, cholesterol, body mass index, and smoking) among respondents with hypertension in odd years over this period by rural/urban residence. Separate trend analyses were used to detect changes in use over time. Survey-weighted logistic regression was used to calculate unadjusted and adjusted (sociodemographic and lifestyle factors) odds ratios for antihypertensive use by year. Our study included 82 175 individuals (36.4% rural residents). Lifestyle characteristics were similar between rural and urban residents except for higher smoking prevalence among rural residents. Antihypertensive use was similar between rural and urban stroke survivors in unadjusted and adjusted analyses (>90% in both populations). Trend analyses showed a small but significant increase in antihypertensive use over time among urban (P=0.033) but not rural stroke survivors (P=0.587). Conclusions Our findings indicate that poststroke antihypertensive use is comparable in rural and urban residents with a reported history of hypertension, but additional work is merited to identify reasons for a trend for increased use of these drugs among urban residents.

Disparities in Internet Use Among US Stroke Survivors: Implications for Telerehabilitation During COVID-19 and Beyond.

Despite evidence-based guidelines,1 stroke rehabilitation remains underutilized, particularly among women and minorities.2 Telerehabilitation is a promising alternative to traditional in-person rehabilitation and offers a novel strategy to overcome access barriers,3 which intensified during the COVID-19 pandemic.4 A broadband connection is a prerequisite for its wide adoption but its availability varies across the United States (https://broadbandnow.com/national-broadband-map). Little is known about demographic and geographic variation in internet use among stroke survivors. In this study, we sought to compare internet use in a nationally representative sample of individuals with and without stroke.

A cross-sectional analysis of 2017 stroke symptoms recognition at the US regional level.

OBJECTIVES: Stroke symptom recognition is critical in reducing time to treatment, but it is not known whether the increased support for stroke education programs during the last several years has led to an improvement in regional stroke symptom recognition levels since they were last assessed in the mid-2010s. METHODS: We used the most current estimates of recognition from the 2017 National Health Interview Survey to examine regional recognition levels for individual stroke symptoms and correct identification of all five stroke symptoms. RESULTS: Recognition of individual stroke symptoms was ≥76% in all regions, but correct identification of all stroke symptoms was lower ranging from 68.8 to 70.2%. Recognition of sudden numbness or weakness of face, arm, or leg, especially on one side (Northeast: 94.9%, Midwest: 95.8%, South: 93.8%, West: 94.5%) was the highest and recognition of sudden headache with no known cause (Northeast: 77.6%, Midwest: 76.4%, South: 77.7%, West: 76.5%) was the lowest for all regions. DISCUSSION: We observed similar stroke symptom recognition levels in each US region with little improvement since the mid-2010s. Additional effort should be made to increase recognition of sudden headache with no known cause in US regions with current high prevalence of stroke risk factors.

Nonadherence in diabetes care among US adults with diabetes by stroke status.

OBJECTIVE: Effects of stroke (i.e., memory loss, paralysis) may make effective diabetes care difficult which can in turn contribute to additional diabetes related complications and hospitalization. However, little is known about US post-stroke diabetes care levels. This study sought to examine diabetes care levels among US adults with diabetes by stroke status. METHODS: Using 2015-2018 Behavioral Risk Factor Surveillance System surveys, the prevalence of nonadherence with the American Diabetes Association's diabetes care measures (<1 eye exam annually, <1 foot exam annually, <1 blood glucose check daily, <2 A1C tests annually, no receipt of annual flu vaccination) was ascertained in people with diabetes by stroke status. A separate logistic regression model was run for each diabetes care measure to determine if nonadherence patterns differed by stroke status after adjustment for stroke and diabetes associated factors. RESULTS: Our study included 72,630 individuals, with 9.8% having had a stroke. Nonadherence levels varied for each diabetes care measure ranging from 20.4-42.2% for stroke survivors and 22.8-44.0% for those who had never had stroke. By stroke status, nonadherence with diabetes management measures was comparable except for stroke survivors having both a lower prevalence (30.2% versus 40.1%) and odds of nonadherence (OR: 0.73, 95% CI: 0.65, 0.82) with daily blood glucose check than those who had never had stroke. CONCLUSION: While nonadherence with diabetes management does not vary by stroke status, considerable nonadherence still exists among stroke survivors with diabetes. Additional interventions to improve diabetes care may help to reduce risk of further diabetes complications in this population.

Impact of excluding nursing home COVID-19 cases when assessing the relationship between county-level social distancing behavior and COVID-19 cases across the US during the early phase of the pandemic, February 2020-May 2020.

OBJECTIVES: To conduct a cross-sectional nationwide study examining how exclusion of nursing home COVID-19 cases influences the association between county level social distancing behavior and COVID-19 cases throughout the US during the early phase of the pandemic (February 2020-May 2020). METHODS: Using county-level COVID-19 data and social distancing metrics from tracked mobile devices, we investigated the impact social distancing had on a county's total COVID-19 cases (cases/100,000 people) between when the first COVID-19 case was confirmed in a county and May 31st, 2020 when most statewide social distancing measures were lifted, representing the pandemic's exponential growth phase. We created a mixed-effects negative binomial model to assess how implementation of social distancing measures when they were most stringent (March 2020-May 2020) influenced total COVID-19 cases while controlling for social distancing and COVID-19 related covariates in two scenarios: (1) when COVID-19 nursing home cases are not excluded from total COVID-19 cases and (2) when these cases are excluded. Model findings were compared to those from February 2020, a baseline when social distancing measures were not in place. Marginal effects at the means were generated to further isolate the influence of social distancing on COVID-19 from other factors and determine total COVID-19 cases during March 2020-May 2020 for the two scenarios. RESULTS: Regardless of whether nursing home COVID-19 cases were excluded from total COVID-19 cases, a 1% increase in average % of mobile devices leaving home was significantly associated with a 5% increase in a county's total COVID-19 cases between March 2020-May 2020 and about a 2.5% decrease in February 2020. When the influence of social distancing was separated from other factors, the estimated total COVID-19 cases/100,000 people was comparable throughout the range of social distancing values (25%-45% of mobile phone devices leaving home between March 2020-May 2020) when nursing home COVID-19 cases were not excluded (25% of mobile phones leaving home: 163.84 cases/100,000 people (95% CI: 121.81, 205.86), 45% of mobile phones leaving home: 432.79 cases/100,000 people (95% CI: 256.91, 608.66)) and when they were excluded (25% of mobile phones leaving home: 149.58 cases/100,000 people (95% CI: 111.90, 187.26), 45% of mobile phones leaving home: 405.38 cases/100,000 people (95% CI: 243.14, 567.62)). CONCLUSIONS: Exclusion of nursing home COVID-19 cases from total COVID-19 case counts has little impact when estimating the relationship between county-level social distancing and preventing COVID-19 cases with additional research needed to see whether this finding is also observed for COVID-19 growth rates and mortality.

National, Regional, and State Employment Rates of U.S. Adults Who Are Deaf or Hard of Hearing.

Most information on geographic variations in the employment of U.S. adults who are deaf or hard of hearing comes from the American Community Survey (ACS), which includes few people who are DHH in sparsely populated states. Using nationally representative Behavioral Risk Factor Surveillance System surveys from 2016-2018, the authors examined national-, regional-, and state-level employment rates of U.S. adults who were DHH and compared these rates with ACS estimates for this population. It was found that the national employment rate for people who were DHH was 51.3%; regional rates ranged from 47.9% to 56.9%, state rates from 36.9% to 68.0%. These figures were comparable to ACS estimates at all geographic levels. These findings indicate that employment disparities are not uniform across the United States for people who are DHH and underscore the need for additional policies in areas where this population experiences low employment.

A Cross-Sectional Comparison of US Adult Diabetes Screening Levels by Disability Status.

Diabetes is a potentially life-threatening metabolic condition that disproportionately affects US adults with a disability. Diabetes screening is key to early disease detection and prompt treatment, but it is not known whether US adults with a disability receive similar levels of diabetes screening as individuals without a disability. We compared diabetes screening levels in US adults with a disability to those without one. Using national 2017 Behavioral Risk Factor Surveillance System surveys, we determined the prevalence of diabetes screening by disability status in US adults who fall under the American Diabetes Association's recommended screening guidelines: those younger than 45 years old with a body mass index (BMI) ≥ 25 kg/m2 and those aged 45 years and older. We used logistic regression modelling to examine the impact of disability status on diabetes screening while adjusting for diabetes associated sociodemographic and clinical factors. In people with a disability, around 50% of those younger than 45 years old with a BMI ≥ 25 kg/m2 and 33% of those 45 years or older did not receive screening. In the under 45 years with a BMI ≥ 25 kg/m2 screening group, individuals with a disability had a slightly higher but non-significant prevalence, but a lower adjusted odds of diabetes screening compared to those without a disability. People with a disability under age 45 had a slightly lower but again non-significant prevalence but a higher adjusted odds of diabetes screening than did those without a disability who were age 45 or older. Additional interventions are needed to improve diabetes screening levels among US adults with a disability at high risk of developing diabetes as screening is a critical initial step in the diabetes management process.

Stroke and Heart Attack Symptom Recognition in Older US Adults by Cognitive Impairment Status.

INTRODUCTION: Cognitive impairment may make stroke and heart attack symptom recognition difficult, potentially resulting in treatment delays for those with these cardiovascular diseases (CVDs). Despite cognitive impairment affecting large numbers of older US adults who are also at increased risk of stroke and heart attack, little is known about stroke and heart attack symptom recognition in this population. As a result, this study sought to determine the impact of cognitive impairment on stroke and heart attack symptom recognition among older US adults. METHODS: Using the 2014 and 2017 National Health Interview Surveys, we compared stroke and heart attack symptom recognition levels in US adults aged ≥65 years with cognitive impairment and those without cognitive impairment. Estimates of stroke and heart attack symptom recognition adjusted for CVD-related factors were assessed by cognitive impairment status. We also conducted analyses stratified by living arrangement and stroke and heart attack history for individuals with and without cognitive impairment. RESULTS: US adults aged ≥65 years with cognitive impairment were observed to be 3.0-6.7% and 1.6-4.9%, respectively, less likely to recognize an individual stroke and heart attack symptom than similarly aged individuals without cognitive impairment. Recognition of all 5 stroke/heart attack symptoms was also lower among those with cognitive impairment, with this group being 9.7% less likely to recognize all stroke symptoms and 6.7% less likely to recognize all 5 heart attack symptoms compared to people without cognitive impairment. Following adjustment, individuals with cognitive impairment continued to have slightly lower recognition of certain individual stroke and heart attack symptoms as well as of all 5 symptoms of these conditions (stroke OR: 0.70 [95% CI: 0.58-0.85]; heart attack OR: 0.88 [95% CI: 0.75, 1.03]) than those without cognitive impairment. For individuals with cognitive impairment, living with others was linked with slightly better recognition of all individual stroke symptoms and heart attack history with better recognition of all individual heart attack symptoms. CONCLUSIONS: Additional work is needed to address the challenge of improving recognition levels for specific stroke and heart attack symptoms in older US adults with cognitive impairment and especially for members of this group who live alone.

A comparison of post-stroke hypertension medication use between US Stroke Belt and Non-Stroke Belt residents.

Although hypertension is a contributing factor to higher stroke occurrence in the Stroke Belt, little is known about post-stroke hypertension medication use in Stroke Belt residents. Through the use of national Behavioral Risk Factor Surveillance System surveys from 2015, 2017, and 2019; we compared unadjusted and adjusted estimates of post-stroke hypertension medication use by Stroke Belt residence status. Similar levels of post-stroke hypertension medication use were observed between Stroke Belt residents (OR: 1.09, 95% CI: 0.89, 1.33) and non-Stroke Belt residents. After adjustment, Stroke Belt residents had 1.14 times the odds of post-stroke hypertension medication use (95% CI: 0.92, 1.41) compared to non-Stroke Belt residents. Findings from this study suggest that there is little difference between post-stroke hypertension medication use between Stroke Belt and non-Stroke Belt residents. However, further work is needed to assess whether use of other non-medicinal methods of post-stroke hypertension control differs by Stroke Belt residence status.

The Influence of Social Distancing on COVID-19 Mortality in US Counties: Cross-sectional Study.

BACKGROUND: Previous studies on the impact of social distancing on COVID-19 mortality in the United States have predominantly examined this relationship at the national level and have not separated COVID-19 deaths in nursing homes from total COVID-19 deaths. This approach may obscure differences in social distancing behaviors by county in addition to the actual effectiveness of social distancing in preventing COVID-19 deaths. OBJECTIVE: This study aimed to determine the influence of county-level social distancing behavior on COVID-19 mortality (deaths per 100,000 people) across US counties over the period of the implementation of stay-at-home orders in most US states (March-May 2020). METHODS: Using social distancing data from tracked mobile phones in all US counties, we estimated the relationship between social distancing (average proportion of mobile phone usage outside of home between March and May 2020) and COVID-19 mortality (when the state in which the county is located reported its first confirmed case of COVID-19 and up to May 31, 2020) with a mixed-effects negative binomial model while distinguishing COVID-19 deaths in nursing homes from total COVID-19 deaths and accounting for social distancing- and COVID-19-related factors (including the period between the report of the first confirmed case of COVID-19 and May 31, 2020; population density; social vulnerability; and hospital resource availability). Results from the mixed-effects negative binomial model were then used to generate marginal effects at the mean, which helped separate the influence of social distancing on COVID-19 deaths from other covariates while calculating COVID-19 deaths per 100,000 people. RESULTS: We observed that a 1% increase in average mobile phone usage outside of home between March and May 2020 led to a significant increase in COVID-19 mortality by a factor of 1.18 (P<.001), while every 1% increase in the average proportion of mobile phone usage outside of home in February 2020 was found to significantly decrease COVID-19 mortality by a factor of 0.90 (P<.001). CONCLUSIONS: As stay-at-home orders have been lifted in many US states, continued adherence to other social distancing measures, such as avoiding large gatherings and maintaining physical distance in public, are key to preventing additional COVID-19 deaths in counties across the country.

A cross-sectional analysis of binge drinking levels in US myocardial infarction survivors.

BACKGROUND: Although binge drinking is associated with higher myocardial infarction (MI) incidence, little is known about binge drinking patterns in US MI survivors, at elevated risk for recurrent MIs. OBJECTIVES: To determine the prevalence of and what factors are associated with binge drinking in US MI survivors. METHODS: We compared the prevalence of binge drinking between MI survivors and those without a MI history in 2016-2018 Behavioral Risk Factor Surveillance System data. Logistic regression was used to examine which sociodemographic factors are associated with binge drinking in these groups. RESULTS: 8.7% of MI survivors (1.1 million people nationwide) were binge drinkers. Among MI survivors; being young, male, Hispanic, having higher income, and having lower educational attainment were associated with increased binge drinking. CONCLUSIONS: The sizable number of US MI survivors who binge drink suggests interventions to reduce this behavior are warranted, especially among specific sociodemographic groups of this population.

Influence of sexual orientation on diabetes management in US adults with diabetes.

AIM: Although the risk of developing diabetes is high among US sexual minorities (SM) (lesbian, gay, bisexual), little is known about diabetes management in this population. We examined the impact of sexual orientation on current US diabetes management levels in a geographically diverse sample of people with diabetes (PWD). METHOD: Adult PWDs were identified from the 2015-2018 cross-sectional Behavioural Risk Factor Surveillance System surveys. We determined the unadjusted percentage and the adjusted odds ratios (OR) of noncompliance with American Diabetes Association (ADA) diabetes management measures (< 1 eye exam annually, < 1 foot exam annually, < 1 blood glucose check daily, < 2 A1C tests annually, no receipt of annual flu vaccination, never receiving pneumococcal vaccination, never taking a diabetes management course) in PWDs by SM status. RESULTS: Unadjusted analyses revealed a high level of noncompliance with diabetes management among SMs and especially for annual flu vaccination (40.1-52.3%) and diabetes management education (38.4-48.4%). Compared to heterosexuals, lesbian women were more noncompliant for most and bisexual men and bisexual women for all diabetes management measures. We observed that SMs had slightly higher adjusted levels of noncompliance than heterosexuals only for annual foot exams (OR: 1.09, 95% confidence interval (CI): 0.81-1.46) and diabetes management education (OR: 1.06, 95% CI: 0.81-1.41). CONCLUSIONS: High levels of noncompliance with ADA diabetes management guidelines in SM PWDs indicates a need for additional efforts to elucidate the factors that contribute to noncompliance in SMs, information that can be used to develop appropriate interventions to improve diabetes management for this population.

A cross-sectional analysis of electronic cigarette use in US adults by asthma status.

OBJECTIVE: Electronic cigarette (e-cigarette) use has been shown to worsen the asthma symptoms, but there is little information on current e-cigarette use patterns in the general US adult asthma population. We examined the unadjusted and adjusted estimates of current e-cigarette use in a nationally representative sample of US adults by asthma status and what factors influence this use. METHODS: We determined the prevalence of current e-cigarette use in adults with and without asthma using the 2016-2018 Behavioural Risk Factor Surveillance System datasets. A multinomial logistic regression model was used to obtain adjusted estimates of e-cigarette use by asthma status while also identifying which sociodemographic and clinical factors are associated with e-cigarette use in adults with asthma. RESULTS: Of the 23,071 adults with asthma in the study, 22.5% were currently using e-cigarettes. After adjusting for sociodemographic and clinical factors associated with asthma and current e-cigarette use, adults with asthma had similar odds of every day e-cigarette use (odds ratio (OR): 1.04, 95% confidence interval (CI): 0.93-1.15) but higher odds of e-cigarette use on some days (OR: 1.18, 95% CI: 1.10-1.27) compared to adults without asthma. Younger age, male sex and former or current traditional cigarette use were significantly associated with both e-cigarette use on some days and every day in adults with asthma. CONCLUSION: Current e-cigarette use estimates among US adults with asthma indicate a need for further e-cigarette education and cessation interventions that are specifically tailored to sociodemographic and clinical groups who are especially prone to e-cigarette use within this population.