Disparities in the risk of heart disease death among people with chronic lower respiratory disease.

BACKGROUND: Heart disease remains the leading cause of death in the United States, while chronic lower respiratory diseases (CLRD) are the sixth leading cause of death. Patients with CLRD have been shown to have an elevated risk of heart disease death. However, less is known regarding how this risk varies across demographic groups. METHODS: We used the Multiple Cause of Death database from the Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research to obtain 1999-2020 information on deaths with heart disease as a primary cause of death and CLRD as a contributing cause. We calculated age-adjusted mortality rates (AAMR) over time and for demographic subgroups. RESULTS: During 1999-2020, there were 1,178,048 heart disease deaths related to CLRD among people aged 45+. The AAMR for CLRD-associated heart disease deaths was 45.713 per 100,000 people. AAMR was highest among those aged 65+ (108.56 per 100,000). Elevated rates were seen among males (AAMR ratio = 1.744, 95% CI: 1.741-1.748), people living in the Midwest (AAMR ratio = 1.196, 95% CI: 1.190-1.202), and among people in rural areas (AAMR ratio = 1.309, 95% CI: 1.304-1.313) compared to their corresponding counterparts. Between 1999 and 2004 and 2016-2020 rates decreased among all demographic subgroups, except for among people aged 45-64, among whom deaths increased (AAMR ratio = 1.016, 95% CI: 1.003-1.030). CONCLUSION: Rates of CLRD-associated heart disease deaths have declined over time, but significant disparities remain. Enhanced interventions particularly among older people (65+), people living in rural areas, people living in the Midwest, and men may reduce CLRD-associated heart disease deaths in the United States.

A Comprehensive Analysis of Leadership Attributes, Discrepancies, and Implications for Gender Equity in Vascular Surgery.

OBJECTIVE: Well-developed leadership skills have been associated with a better understanding of healthcare context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. While studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in Vascular Surgery. The goal of this study was to characterize current leadership attributes of vascular surgeons and understand demographic influences on leadership patterns. METHODS: This retrospective cohort study was a descriptive analysis of vascular surgeons and their observers who took the leadership practice inventory (LPI) from 2020 to 2023. The LPI is a 30 question inventory that measures the frequency of specific leadership behaviors across five practices of leadership. RESULTS: A total of 110 vascular surgeons completed the LPI. The majority of participants were white (56%) and identified as male (60%). Vascular surgeons most frequently observed the "enabling others to act" leadership practice style (8.90 ± 0.74) by all evaluators. Vascular surgeons were most frequently above the 70th percentile in the "challenge the process" leadership practice style (49%) compared to the average of other leaders world-wide. Observers rated vascular surgeons as displaying significantly more frequent leadership behaviors than vascular surgeons rated themselves in every leadership practice style (P-value < 0.01). The only demographic variable associated with a significantly increased occurrence of achieving 70th percentile across all five leadership practice styles was the male gender: a multivariable model adjusting for objective experience showed men were at least 3.5 times more likely to be rated above the 70th percentile than women. CONCLUSIONS: Vascular surgeons under report the frequency at which they practice leadership skills across all five leadership practice styles and should recognize their strengths of enabling others to act and challenging the process. Men are recognized as exhibiting all five leadership practices more frequently than women, regardless of current position or experience level. This observation may reflect the limited leadership positions available for women, thereby restricting their opportunities to demonstrate leadership practices as frequently or recognizably as their male counterparts.

The Impact of Sex on Antiplatelet and Anticoagulant Thromboprophylaxis in Patients with Peripheral Artery Disease Post-revascularization.

OBJECTIVE: The aim of this prospective study was to 1) objectively quantify the impact of sex on platelet function in patients with PAD taking antiplatelet and anticoagulant medications and 2) to develop and test a personalized, iterative algorithm which personalizes thromboprophylaxis that incorporates platelet function testing. SUMMARY BACKGROUND DATA: Women with Peripheral Artery Disease (PAD) have worse outcomes as compared to their male counterparts in spite of having lower risk factors. This health disparity may be mitigated by personalizing thromboprophylaxis regimens. METHODS: Patients undergoing revascularization were enrolled. Serial thromboelastography (TEG) and TEG with Platelet Mapping (TEG-PM) was performed up to 6-months post-operatively to determine objective coagulation profiles. In a subset of patients, the Antiplatelet Coagulation Exactness (ACE) algorithm was implemented where patients were iteratively evaluated with TEG and given antiplatelet medications to maintain platelet inhibition at >29%. Statistical analysis was performed using unpaired t-test, ANOVA and Fisher's exact test. RESULTS: One hundred and eighty-one patients met study criteria. 58(32%) patients were females and 123(68%) were males. In the Aspirin cohort, females showed significantly greater clot strength as Maximum Amplitude - Arachidonic Acid (MAAA) and significantly lower platelet inhibition than males: [37.26 vs.32.38, P<0.01] and [52.95% vs.61.65%, P<0.05], respectively. In the Clopidogrel cohort, females showed higher Maximum Amplitude - Adenosine Diphosphate (MAADP) [42.58 vs.40.35, P=NS] compared to males. Females on dual antiplatelet therapy had higher MAADP [39.74 vs.35.07, P=NS] and lower platelet inhibition [45.25% vs.54.99%, P=NS] than males. The incidence of thrombosis of the revascularized segment, defined as thrombotic event, was objectively identified on an arterial duplex. Women showed significantly higher thrombotic events than men [22.95% vs.10.57%, P<0.05] on the same medication. In our pilot study, implementation of the ACE algorithm led to a significant decrease in the thrombosis rate (3%), including non-thrombotic events for females, vs. the historic thrombotic rate (22%) from our institution. CONCLUSIONS: Women with PAD exhibited higher platelet reactivity, clot strength, and reduced platelet inhibition in response to antiplatelet therapy. The use of the ACE algorithm to tailor antiplatelet medication in patients with PAD post-revascularization, resulted in a significant decrease in thrombotic event rates. This may serve as an opportune way to mitigate outcome sex-specific disparities caused by inadequate thromboprophylaxis in women.

Life and Disability Insurance for People with or at Risk of HIV: Aligning Policy with Evidence.

Antiretroviral medications have substantially improved life expectancy for people with HIV. These medications are also highly effective in preventing HIV acquisition in people who do not have HIV, a strategy known as HIV preexposure prophylaxis (PrEP). Despite these advances, some life and disability insurers continue to deny or limit coverage for people with HIV, and some have even refused to cover people who are using PrEP to protect themselves. These policies unfairly deny people with HIV, PrEP users, and their families the peace of mind and financial protection that can come with life and disability insurance coverage. This article summarizes the current evidence on HIV treatment and prevention, arguing that underwriting decisions by life and disability insurers should not be made based on HIV status or use of PrEP.

Racial/Ethnic Differences in Food Allergy.

Immunoglobulin E-mediated food allergy is an increasingly prevalent public health concern globally. In North America, particularly in the United States, racial and ethnic differences in food allergy prevalence and rates of sensitization have become apparent. Black and Hispanic children in the United States have been estimated to have the highest rates of food allergy. Beyond rates of prevalence, food allergy outcomes, such as health care utilization, psychosocial outcomes, and economic burden, also vary considerably by race and ethnicity. It is important to consider socioeconomic status in conjunction with race and ethnicity in studying differences in food allergy outcomes.