Prevalence and Outcomes of Hypertension in Pregnancy in Non-Metropolitan and Metropolitan Communities

Background: Hypertension during pregnancy is a leading cause of birthing parent mortality and adverse pregnancy outcomes. Since non-metropolitan communities face higher rates of several risk factors for hypertension in pregnancy and shortages in obstetrical services, persons residing in non-metropolitan areas may be at increased risk for adverse outcomes compared to those living in metropolitan areas. Our study objectives were to examine by county of birthing parent residence (1) the prevalence of chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP), and (2) the prevalence of adverse birthing parent and neonatal outcomes associated with hypertension. Methods: Using U.S. birth certificate data from 2016 to 2018, we described the prevalence of cHTN and HDP and the association of each with several birthing parent and neonatal outcomes, stratified by non-metropolitan versus metropolitan county of birthing parent residence. Multivariable Poisson regression models were used to calculate adjusted prevalence ratios for birthing parent and neonatal outcomes among individuals with cHTN or HDP who lived in non-metropolitan versus metropolitan U.S. counties. Results: The prevalence of cHTN and HDP for US live births was 2.2% and 7.4%, respectively, among non-metropolitan pregnant individuals and 1.8% and 6.6%, respectively, among metropolitan pregnant individuals. After adjusting for several sociodemographic characteristics among those with HDP, the prevalence ratio for an APGAR score \u3c 7 at 5 minutes (aPR 1.34, 95% CI 1.29-1.38) and neonatal death (aPR 1.36, 95% CI 1.15-1.62) was increased among offspring born to women who resided in non-metropolitan counties. Similar results were seen among those with cHTN. Conclusion: The prevalence of cHTN and HDP is modestly more prevalent in non-metropolitan areas, but most pregnancy outcomes were similar among those residing in non-metropolitan areas compared to metropolitan areas. Further research should investigate the robustness of these findings using alternate definitions of rural and urban areas and the possible link between low APGAR score, low NICU admission, and neonatal death in non-metropolitan counties

Association between Several Clinical and Radiological Determinants with Long-Term Clinical Progression and Good Prognosis of Lower Limb Osteoarthritis

OBJECTIVE: To investigate the factors associated with clinical progression and good prognosis in patients with lower limb osteoarthritis (OA). METHODS: Cohort study of 145 patients with OA in either knee, hip or both. Progression was defined as 1) new joint prosthesis or 2) increase in WOMAC pain or function score during 6-years follow-up above pre-defined thresholds. Patients without progression with decrease in WOMAC pain or function score lower than pre-defined thresholds were categorized as good prognosis. Relative risks (RRs) for progression and good prognosis with 95% confidence interval (95% CI) were calculated by comparing the highest tertile or category to the lowest tertile, for baseline determinants (age, sex, BMI, WOMAC pain and function scores, pain on physical examination, total range of motion (tROM), osteophytes and joint space narrowing (JSN) scores), and for worsening in WOMAC pain and function score in 1-year. Adjustments were performed for age, sex, and BMI. RESULTS: Follow-up was completed by 117 patients (81%, median age 60 years, 84% female); 62 (53%) and 31 patients (26%) showed progression and good prognosis, respectively. These following determinants were associated with progression: pain on physical examination (RR 1.2 (1.0 to 1.5)); tROM (1.4 (1.1 to 1.6); worsening in WOMAC pain (1.9 (1.2 to 2.3)); worsening in WOMAC function (2.4 (1.7 to 2.6)); osteophytes 1.5 (1.0 to 1.8); and JSN scores (2.3 (1.5 to 2.7)). Worsening in WOMAC pain (0.1 (0.1 to 0.8)) and function score (0.1 (0.1 to 0.7)), were negatively associated with good prognosis. CONCLUSION: Worsening of self-reported pain and function in one year, limited tROM and higher osteophytes and JSN scores were associated with clinical progression. Worsening in WOMAC pain and function score in 1- year were associated with lower risk to have good prognosis. These findings help to inform patients with regard to their OA prognosis

Aging and COVID-19 in Minority Populations: a Perfect Storm

Purpose of Review: COVID-19 is a major concern for the health and wellbeing of individuals worldwide. As COVID-19 cases and deaths continue to increase in the USA, aging Black and Hispanic populations have emerged as especially at-risk for increased exposure to COVID-19 and susceptibility to severe health outcomes. The current review discusses the weathering hypothesis and the influence of social inequality on the identified health disparities. Recent Findings: Aging minoritized populations have endured structural and social inequality over the lifecourse. Consequently, these populations experience weathering, a process that results in physiological dysregulation due to stress associated with persistent disadvantage. Through weathering and continued inequity, aging minoritized populations have an increased risk of exposure and poor health outcomes from COVID-19. Summary: Current literature and available data suggests that aging minoritized persons experience high rates of COVID-19 morbidity and mortality. The current review hypothesizes and supports that observed disparities are the result of inequalities that especially affect Black and Hispanic populations over the lifecourse. Future efforts to address these disparities should emphasize research that supports governments in identifying at-risk groups, providing accessible COVID-19-related information to those groups, and implementing policy that addresses the structural and social inequities that perpetuate current COVID-19 disparities

Determinants for clinical progression over 6 years of lower limb osteoarthritis.

<p>^<i>1</i>except for determinants age, sex and BMI themselves, adjustment was made for age, sex and BMI.</p><p>^<i>2</i>multivariate model using a backward selection (R² = 48.6%). The independent variables with univariate associations with a p-value ≤0.10 were included.</p><p>Both models are calculated using approximation formula of Zhang.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0025426#pone.0025426-Zhang1" target="_blank">[19]</a>.</p>‡<p>: statistically significant.</p><p>Abbreviations: WOMAC: Western Ontario and McMaster Universities, JSN: joint space narrowing, na: not applicable.</p

Baseline characteristics of 168 patients with knee and/or hip OA stratified by availability of follow-up.

<p>*Patients may have OA at multiple joints at one time and can have pain in the knee and hip joint simultaneously. Abbreviation: IQR: interquartile range; BMI: Body Mass Index.</p

Mean (standard deviation (SD)) baseline, follow-up (FU), and change scores on self-reported pain and function (WOMAC), physical health (PCS), and pain on physical examination (PE) for the total population and sub-groups.

‡<p>: statistically significant; the significance of physical health summary were tested by comparing the study sample with the norm based population (mean = 50, SD = 10).</p

Determinants of good prognosis of lower limb osteoarthritis over 6 years.

1<p>except for determinants age, sex and BMI themselves, adjustment was made for age, sex and BMI.</p>2<p>multivariate model using a backward selection (R² = 43.3%). The independent variables with univariate associations with a p-value ≤0.10 were included.</p><p>Both models are calculated using approximation formula of Zhang.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0025426#pone.0025426-Zhang1" target="_blank">[19]</a>.</p>‡<p>: statistically significant.</p><p>Abbreviations: WOMAC: Western Ontario and McMaster Universities, JSN: joint space narrowing, na: not applicable.</p

Cumulative probability plot of Western Ontario and McMaster Universities (WOMAC) scores change of patients without prosthesis during follow-up (n = 81) for WOMAC pain scores change (above) and WOMAC function scores change (below).

<p>The horizontal line above is the line set at minimal perceptible clinical improvement (MPCI) score which is used as the cut-off to define progression and the horizontal line below is the line set to define good prognosis.</p