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INTRODUCTION: Non-Hodgkin's Lymphoma (NHL) accounts for a substantial number of cancer cases in the United States, with a significant prevalence and mortality rate. The implementation of the Affordable Care Act (ACA) has the potential to impact cancer-specific survival among NHL patients by improving access to healthcare services and treatments. OBJECTIVE: This study aims to assess the impact of the implementation of the ACA on cancer-specific survival among patients diagnosed with NHL. METHODOLOGY: In this retrospective analysis, we leveraged data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of the ACA on cancer-specific survival among NHL patients. The study covered the years 2000-2020, divided into pre-ACA (2000-2013) and post-ACA (2017-2020) periods, with a three-year washout (2014-2016). Using a Difference-in-Differences approach, we compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014). We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. RESULTS: Among 74,762 patients, 56.2% were in New Jersey (42,005), while 43.8% were in Georgia (32,757). The pre-ACA period included 32,851 patients (51.7% in Georgia and 56.7% in New Jersey), and 27,447 patients were in the post-ACA period (48.3% in Georgia and 43.4% in New Jersey). The post-ACA period exhibited a 34% survival improvement (OR=0.66, 95% CI 0.58-0.75). ACA implementation was associated with a 16% survival boost among NHL patients in New Jersey (OR=0.84, 95% CI 0.74-0.95). Other factors linked to improved survival included surgery (OR=0.86, 95% CI 0.81-0.91), radiotherapy (OR=0.77, 95% CI 0.72-0.82), and married status (OR=0.67, 95% CI 0.64-0.71). CONCLUSION: The study underscores the ACA's potential positive impact on cancer-specific survival among NHL patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.
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Introduction Despite a notable reduction in infant mortality over recent decades, the United States, with a rate of 5.8 deaths per 1,000 live births, still ranks unfavorably compared to other developed countries. This improvement appears inadequate when contrasted with the country's healthcare spending, the highest among developed nations. A significant proportion of this infant mortality rate can be attributed to neonatal fatalities. Objective The present study aimed to determine the risk factors associated with neonatal deaths in the United States. Method Using the United States Vital Statistics records, we conducted a retrospective study on childbirths between 2015 and 2019 to identify risk factors for neonatal mortality. Our final multivariate analysis included maternal parameters like age, insurance type, education level, cesarean section rate, pregnancy inductions and augmentations, weight gain during pregnancy, birth weight, number of prenatal visits, pre-existing conditions like chronic hypertension and prediabetes, and pregnancy complications like gestational diabetes mellitus (GDM). These variables were incorporated to enhance our model's sensitivity and specificity. Result There were 51,174 neonatal mortalities. Mothers with augmentation of labor had a 25% reduction in neonatal mortalities (NM) (OR=0.75; 95% CI 0.72-0.79), while labor induction was associated with a 31% reduction in NM (OR=0.69; 95% CI 0.66-0.72). Women above 40 years had a 29% increase in NM rate (OR=1.29;95% CI 1.15-1.44). Women without prenatal care have a 22% increase in the risk of NM (OR=1.22; 95% CI 1.14-1.30). The present model has a 60.7% sensitivity and a 99.9% specificity. Conclusion In the present study, significant interventions such as labor induction, augmentation, and prenatal care were associated with improved neonatal outcomes. These findings could serve as an algorithm for improving neonatal outcomes in the United States.
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Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.
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INTRODUCTION: Penile cancer, while relatively rare in developed nations, presents substantial disparities in outcomes among different demographic groups. Previous research has shown race/ethnicity and socioeconomic status, often proxied by household median income, to be critical determinants of health outcomes across various diseases. OBJECTIVE: This study examines the association of race/ethnicity and household median income with survival among penile cancer patients in the United States. METHODS: We utilized the Surveillance, Epidemiology, and End Results (SEER) Registry to identify patients with a primary diagnosis of penile malignancies from 2000 to 2019. Our primary outcome of interest was the hazard of death following a diagnosis of penile cancer. We utilized the Cox regression model to explore the association between race/ethnicity and median household income and how this influences survival among these patients. We adjusted for patients' characteristics, disease stage at presentation, and treatment modalities. RESULT: Of the 6,520 penile cancer patients identified, 5,242 (80.4%) had primary malignancies. The distribution of patients was as follows: 64.1% non-Hispanic Whites, 8.9% non-Hispanic Blacks, 20.8% Hispanics, and 6.2% from other racial/ethnic groups. The median diagnosis age was 66 years (interquartile range: 56-74). Survival rates at 5, 10, and 15 years showed racial disparities: 76.4%, 72.5%, and 69.7% for non-Hispanic Whites; 70.6%, 64.1%, and 61.1% for non-Hispanic Blacks; and 70.5%, 67.4%, and 65.6% for Hispanics. Multivariate Cox regression revealed worst survival for Black (HR=1.40; 95% CI=1.08-1.81, p=0.01) and Hispanic patients (HR=1.24; 95% CI=1.01-1.52, p=0.04). No association was found between median household income and survival. Interaction analysis indicated that the poorest Black men had worse outcomes than the poorest Whites did (HR=2.08; 95% CI=1.27-3.41, p=0.003). CONCLUSION: Survival rates for non-Hispanic Black and Hispanic patients are significantly lower than those for non-Hispanic Whites. Furthermore, survival is worse for low-income Black patients than their White counterparts in the same income bracket.
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AIM: To determine the relationship between obesity and depression among female undergraduate students at Western Illinois University (WIU), Macomb, Illinois. METHODS: A cross-sectional study using self-reported questionnaires were conducted between August 15, 2019, and December 15, 2019. A cohort of 434 female undergraduate students was retrieved from the study. We determined the association between self-reported diagnosis of depression within the last year and body mass index (BMI) among female students. RESULTS: The prevalence of depression among female undergraduates at WIU was 33.2%. Obese and overweight female undergraduate students had a higher likelihood of being diagnosed with depression than students with normal BMI (reference), overweight (OR= 1.91; 95% CI 1.11-3.31), obese (OR= 2.20; 95% CI 1.30-3.80). Latino and black students were less likely to report depression than white students, Latino (OR=0.37 95% CI 0.15-0.92), and Black (OR= 0.40; 95% CI 0.18-0.86). There was also a positive association between chronic back pain and development of the diagnosis of depression, (OR=2.26; 95% CI 1.45-3.52). CONCLUSION: Depression among female undergraduate students is very common in the USA. Obese and overweight female students are more likely to be depressed than students with normal BMI. There is a need for urgent public health interventions to reduce the obesity rate among university students.
