Trends in the Utilization of Metabolic and Bariatric Surgery (MBS) Procedures by Race and Ethnicity in Florida (2006-2017)

Abstract Metabolic and bariatric surgery (MBS) is an increasingly common treatment option for individuals with severe obesity, but utilization disparities remain with race and ethnic minority groups completing the procedure less frequently than non-Hispanic Whites. We examined the trends in MBS procedure types and prevalence of utilization by race and ethnicity among Florida inpatients. Discharge records with any MBS using the International Classification of Diseases 9th or 10th edition Procedure Coding System (ICD-PCS), were extracted from the Florida Agency for Health Care Administration (AHCA) inpatients’ data (2006 to 2017). Those who completed either Laparoscopic Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), LAGB Revision and Repair (LAGBREV), or LAGB Removal (LAGBREM) were included in the analysis. Cochran-Mantel-Haenszel tests evaluated the trend over time for MBS procedure by race and ethnicity. The sample (n = 90,845) was predominantly non-Hispanic White (NHW, 61.7%), female (75.5%), had a commercial insurance carrier (50.0%), and severe obesity (92.3%). Significant trends (p \u3c 0.05) in three MBS procedures were observed: decreasing trends for LAGB (36.2% in 2008 to 0.3% in 2017) and for RYGB (52.2% in 2009 to 20.3% in 2017) and an increasing trend for SG (18.7% in 2010 to 75.3% in 2017). Regardless of procedure type, NHW had the highest proportion of MBS in all years. More non-Hispanic Blacks received LAGB compared to Hispanics in 2006 through 2016. From 2009 to 2017, more Hispanics received RYGB compared to the NHB inpatients. RYGB was the prevalent procedure from 2006 to 2012 but was later (2013-2017) replaced by SG in Florida hospitals. The diversity in MBS procedures among race-ethnic groups in Florida may indicate social-cultural drivers and should be further investigated

Perinatal Factors Associated with Cardiovascular Disease Risk among Preschool-Age Children in the United States: An Analysis of 1999–2008 NHANES Data

We examined the relationships between selected perinatal and early infancy factors (maternal smoking during pregnancy, infant low birthweight, breastfeeding, and early introduction of solid foods [<6 months of age] and increased BMI [≥85th, ≥95th percentiles for age, sex]), waist circumference (WC), C-reactive protein (CRP), triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (HDL) cholesterol, and decreased HDL cholesterol during early childhood. The population-based sample included 3,644 3-to-6-year-old Non-Hispanic White (NHW), Hispanic, and Non-Hispanic Black (NHB) children who participated in the 1999–2008 National Health and Nutrition Examination Surveys. Analysis showed that breastfeeding was significantly protective against early childhood obesity (OR 0.43, 95% CI, 0.27–0.69) and the highest quintile for WC (OR 0.58, 95% CI, 0.37–0.32) among NHW, and against the highest quintile of non-HDL cholesterol among NHB (OR 0.56, 95% CI, 0.32–0.98). Additionally, NHW children were significantly more likely to be obese (OR 2.22, 95% CI 1.30–3.78) and have higher CRP levels (OR 1.63, 95% CI, 1.05–2.51) if their mothers smoked during pregnancy. These results support the observation that breastfeeding may be protective against early childhood obesity while maternal smoking during pregnancy is a risk factor for obesity and increased CRP levels among NHW young children

Sociodemographic Correlates of Bariatric Surgery by Procedure Type among a Statewide Ethnically Diverse Patient Population

Florida Agency for Health Care Administration (AHCA) 2013 inpatient data was used to conduct a retrospective review using International Classification of Diseases 9th edition (ICD-9) procedure codes to examine the sociodemographic correlates of three bariatric procedures [Laparoscopic Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Gastric Banding (LAGB), and Sleeve Gastrectomy (SG)]. Race-ethnic groups included non-Hispanic white (NHW), non- Hispanic black (NHB), Hispanic, and other. The sample (n=6,424, mean age 46 years) was predominantly NHW (57.4%), female (74.9%), commercial-insurance carriers (51.2%), and severely obese (98.8%). SG was the most common procedure (57.9%) followed by RYGB (39.3%), and LAGB (2.8%). Regardless of bariatric procedure type, over 40% were covered by commercial insurance. The relationship between insurance status and bariatric procedure type was statistically significant (p\u3c0.01). However, race-ethnicity and bariatric procedure relationship was not significant after adjusting for age, sex, and insurance status. Despite the current high obesity frequencies across all demographics in the state of Florida, NHW women (compared to their sex-ethnic-specific counterparts) in our sample received the highest proportion of bariatric surgeries. Further research should examine why this finding continues despite obesity and its health-related consequences affecting all sex- ethnic groups

Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis

Background: The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. Purpose: To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents. Study design: Cross-sectional study; Level of evidence, 3. Methods: Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. Results: A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. Conclusion: Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses

Adverse Drug Events Related to Common asthma Medications in Us Hospitalized Children, 2000-2016

BACKGROUND: The reduction in adverse drug events is a priority in healthcare. Medications are frequently prescribed for asthmatic children, but epidemiological trends of adverse drug events related to anti-asthmatic medications have not been described in hospitalized children. OBJECTIVE: The objective of this study was to report incidence trends, risk factors, and healthcare utilization of adverse drug events related to anti-asthmatic medications by major drug classes in hospitalized children in the USA from 2000 to 2016. METHODS: A population-based temporal analysis included those aged 0-20 years who were hospitalized with asthma from the 2000 to 2016 Kids Inpatient Database. Age-stratified weighted temporal trends of the inpatient incidence of adverse drug events related to anti-asthmatic medications (i.e., corticosteroids and bronchodilators) were estimated. Stepwise multivariate logistic regression models generated risk factors for adverse drug events. RESULTS: From 2000 to 2016, 12,640 out of 698,501 pediatric asthma discharges (1.7%) were associated with adverse drug events from anti-asthmatic medications. 0.83% were adverse drug events from corticosteroids, resulting in a 1.14-fold increase in the length of stay (days) and a 1.42-fold increase in hospitalization charges (dollars). The overall incidence (per 1000 discharges) of anti-asthmatic medication adverse drug events increased from 5.3 (95% confidence interval [CI] 4.6-6.1) in 2000 to 21.6 (95% CI 18.7-24.6) in 2016 (p-trend = 0.024). Children aged 0-4 years had the most dramatic increase in the incidence of bronchodilator adverse drug events from 0.2 (95% CI 0.1-0.4) to 19.3 (95% CI 15.2-23.4) [p-trend ≤ 0.001]. In general, discharges among asthmatic children with some comorbidities were associated with an approximately two to five times higher odds of adverse drug events. CONCLUSIONS: The incidence of adverse drug events from common anti-asthmatic medications quadrupled over the past decade, particularly among preschool-age children who used bronchodilators, resulting in substantial increased healthcare costs. Those asthmatic children with complex medical conditions may benefit the most from adverse drug event monitoring

Assessing Latent Effects of Prenatal Cocaine Exposure on Growth and Risk of Cardiometabolic Disease in Late Adolescence: Design and Methods

Prenatal cocaine exposure has been linked to neurocognitive and developmental outcomes throughout childhood. The cardiovascular toxicity of cocaine is also markedly increased in pregnancy, but it is unknown whether this toxicity affects anthropometric growth and the development of cardiometabolic disease risk factors in the offspring across the lifespan. During the early 1990s, the Miami Prenatal Cocaine Study enrolled a cohort of 476 African American children (253 cocaine-exposed, 223 non-cocaine-exposed) and their biological mothers at delivery in a prospective, longitudinal study. The MPCS has collected 12 prior waves of multidomain data on over 400 infants and their mothers/alternate caregivers through mid-adolescence and is now embarking on an additional wave of data collection at ages 18-19 years. We describe here the analytical methods for examining the relationship between prenatal cocaine exposure, anthropometric growth, and cardiometabolic disease risk factors in late adolescence in this minority, urban cohort. Findings from this investigation should inform both the fields of substance use and cardiovascular research about subsequent risks of cocaine ingestion during pregnancy in offspring

Associations between neighborhood opportunity and Indicators of physical fitness for New York City public school youth

Background: Fewer than 1/4th of US children and adolescents meet physical activity (PA) guidelines, leading to health disparities that track into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to improve fitness attainment and reduce these disparities. We drew data from the Child Opportunity Index to examine associations between neighborhood indicators of opportunity for PA and multiple fitness indicators among New York City public school youth. Methods: Multilevel generalized linear mixed models were used to estimate the overall and sex-stratified associations between neighborhood indicators (green space, healthy food, walkability, commute time) and indicators for physical fitness [curl-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER), sit-and-reach] using the New York City FITNESSGRAM data set.Results: The analytic sample [n = 299,839; median (interquartile range) age = 16 (12-17)] was 50.1% female, 37.5% Hispanic, 26.2% non-Hispanic Black, and most (69.5%) qualified for free/reduced price school meals. Neighborhood indicators were positively associated with higher values of indicators for physical fitness. The strongest associations were observed between walkability and both BMI and PACER, and commute time with BMI, push-ups, and PACER. For example, walkability had the greatest magnitude of effects for BMI and muscular strength and endurance (BMI: β: −0.75, 95% confidence interval, CI: −1.01 to −0.49; PACER: β: 1.98, 95% CI: 1.59 to 2.37), and particularly for girls compared with boys (BMI, girls: β: −0.91, 95% CI: −1.22 to −0.66); BMI, boys: β: −0.56, 95% CI: −0.86 to −0.25); PACER, girls: β: 2.11, 95% CI: 1.68 to 2.54; push-ups, boys: β: 1.71, 95% CI: 1.31 to 2.12).Conclusion: Neighborhood indicators were associated with multiple measures of youth fitness. Continued research on neighborhood opportunity and youth fitness may better inform place-based public health interventions to reduce disparities.</p

Application of inverse weighting analysis to assess the association of youth perceptions with the age of initiation of tobacco products

IntroductionTo examine if perceptions of harmfulness and addictiveness of hookah and cigarettes impact the age of initiation of hookah and cigarettes, respectively, among US youth. Youth (12-17 years old) users and never users of hookah and cigarettes during their first wave of PATH participation were analyzed by each tobacco product (TP) independently. The effect of perceptions of (i) harmfulness and (ii) addictiveness at the first wave of PATH participation on the age of initiation of ever use of hookah was estimated using interval-censoring Cox proportional hazards models.MethodsUsers and never users of hookah at their first wave of PATH participation were balanced by multiplying the sampling weight and the 100 balance repeated replicate weights with the inverse probability weight (IPW). The IPW was based on the probability of being a user in their first wave of PATH participation. A Fay’s factor of 0.3 was included for variance estimation. Crude hazard ratios (HR) and 95% confidence intervals (CIs) are reported. A similar process was repeated for cigarettes.ResultsCompared to youth who perceived each TP as “a lot of harm”, youth who reported perceived “some harm” had younger ages of initiation of these tobacco products, HR: 2.53 (95% CI: 2.87-4.34) for hookah and HR: 2.35 (95% CI: 2.10-2.62) for cigarettes. Similarly, youth who perceived each TP as “no/little harm” had an earlier age of initiation of these TPs compared to those who perceived them as “a lot of harm”, with an HR: 2.23 (95% CI: 1.82, 2.71) for hookah and an HR: 1.85 (95% CI: 1.72, 1.98) for cigarettes. Compared to youth who reported each TP as “somewhat/very likely” as their perception of addictiveness, youth who reported “neither likely nor unlikely” and “very/somewhat unlikely” as their perception of addictiveness of hookah had an older age of initiation, with an HR: 0.75 (95% CI: 0.67-0.83) and an HR: 0.55 (95% CI: 0.47, 0.63) respectively.DiscussionPerceptions of the harmfulness and addictiveness of these tobacco products (TPs) should be addressed in education campaigns for youth to prevent early ages of initiation of cigarettes and hookah

Cluster randomized trial of the impact of an obesity prevention intervention on child care center nutrition and physical activity environment over two years

Objective: The prevalence of obesity among preschool-aged children in the United States remains unacceptably high. Here we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a child care center (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over two school years. Design: This was a cluster randomized trial with 12 CCC receiving the HC2 intervention arm and 12 in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over two school years (Fall-2015, Spring-2016 and Spring-2017). Changes in EPAO physical activity and nutrition score were analyzed via a (1) random effects mixed models and (2) mixed models to determine the effect of HC2 versus control. Setting: The study was conducted in 24 CCCs serving low-income, ethnically diverse families in Miami-Dade County. Participants: Intervention CCCs received (1) teachers/parents/children curriculum; (2) snack, beverage, physical activity, and screen time policies; and (3) menu modifications. Results: Two-year EPAO nutrition score changes in intervention CCCs were almost twice that of control CCCs. The EPAO physical activity environment scores only slightly improved in intervention CCCs versus control CCCs. Intervention CCCs showed higher combined EPAO physical activity and nutrition scores compared to control CCCs over the 2-year study period (β=0.09, P=0.05). Conclusions: Obesity prevention programs can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCCs may need consistent support to improve the physical activity environment to ensure the policies remain intact