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Supplemental Digital Content is available in the text, Objective: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. Methods: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments’ daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. Results: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. Conclusions: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.

OBJECTIVES The objective of this study was to analyze factors associated with oral health-related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults. METHODS The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003-2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Multiple logistic regression models used dichotomous outcome variables OHIP-ADD and OHIP-SC. The cut-off values for poor OHRQoL were heuristically defined as OHIP-ADD ≥6 and as OHIP-SC > 0. RESULTS Poor OHRQoL was significantly (p

The objective of this study was to analyze the association between tooth loss and uncontrolled diabetes among US adults.The authors used National Health and Nutrition Examination Survey data from 2011 through 2018. The sample included 16,635 participants 20 years and older who represent 187,596,215 people in the United States in a probability weighted sample. The authors used bivariate analysis and multiple regressions to analyze factors associated with edentulism and number of missing teeth.The multiple logistic regression model significantly predicted edentulism using diabetes status (adjusted odds ratio controlled diabetes, 1.44 [95% CI, 1.12 to 1.86]; adjusted odds ratio uncontrolled diabetes, 2.26 [95% CI, 1.33 to 3.85]), missing annual dental visits, seeing a dentist only for treatment, family income below 200% of the federal poverty guideline, being female, being 65 years or older, tobacco smoking, and no college education. After controlling for the same covariates, multiple Poisson regression analysis showed that dentate adults with controlled and uncontrolled diabetes had higher relative risk of tooth loss than those without diabetes (adjusted risk ratio controlled diabetes, 1.52 [95% CI, 1.35 to 1.71]; adjusted risk ratio uncontrolled diabetes, 1.57 [95% CI, 1.35 to 1.83]).US adults with uncontrolled (glycated hemoglobin ≥ 9%) and controlled diabetes (glycated hemoglobin9%) were more likely to be edentulous and experience tooth loss than adults without diabetes.US health policy officials should adopt benefits policies to provide regular dental examinations to people who have diabetes, have low income (200% of the federal poverty guideline), or are 65 years or older to reduce tooth loss and improve their quality of life. Dentists should work with physicians to help patients control glycemic levels.

Background: The prevalence of overweight (OWT) and obesity (OB), defined by the body mass index (BMI, kg/m2) among children and youth has increased worldwide in the last 30–40 years.Aim: To evaluat...

Background The US COVID-19 epidemic impacted counties differently across space and time, though large-scale transmission dynamics are unclear. The study's objective was to group counties with similar trajectories of COVID-19 cases and deaths and identify county-level correlates of the distinct trajectory groups. Methods Daily COVID-19 cases and deaths were obtained from 3141 US counties from January through June 2020. Clusters of epidemic curve trajectories of COVID-19 cases and deaths per 100,000 people were identified with Proc Traj. We utilized polytomous logistic regression to estimate Odds Ratios for trajectory group membership in relation to county-level demographics, socioeconomic factors, school enrollment, employment and lifestyle data. Results Six COVID-19 case trajectory groups and five death trajectory groups were identified. Younger counties, counties with a greater proportion of females, Black and Hispanic populations, and greater employment in private sectors had higher odds of being in worse case and death trajectories. Percentage of counties enrolled in grades 1–8 was associated with earlier-start case trajectories. Counties with more educated adult populations had lower odds of being in worse case trajectories but were generally not associated with worse death trajectories. Counties with higher poverty rates, higher uninsured, and more living in non-family households had lower odds of being in worse case and death trajectories. Counties with higher smoking rates had higher odds of being in worse death trajectory counties. Discussion In the absence of clear guidelines and personal protection, smoking, racial and ethnic groups, younger populations, social, and economic factors were correlated with worse COVID-19 epidemics that may reflect population transmission dynamics during January–June 2020. After vaccination of high-risk individuals, communities with higher proportions of youth, communities of color, smokers, and workers in healthcare, service and goods industries can reduce viral spread by targeting vaccination programs to these populations and increasing access and education on non-pharmaceutical interventions., Graphical abstract Unlabelled Image

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities’ mask use behavior have mostly relied on self-report. This study’s objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14–20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.

Aims To analyse the causal relationships of nutrition intake and physical activity on haemoglobin A1c (HbA1C) in patients diagnosed with type 2 diabetes mellitus (T2DM) stratified by gender and ethnicity. Materials and Methods An historical cohort of patients with diagnosed T2DM (n = 2831) was extracted from the National Health and Nutrition Examination Survey (NHANES) 2011‐2014 public database, including but not limited to, measurements of physical activity, nutrition, body mass index (BMI) and HbA1c. Multivariate analyses and path analyses were employed to estimate the regression coefficients and path coefficients (ρ) of causal path models of physical activity and nutrition intake on HbA1c stratified by gender and three ethnicity groups (ie non‐Hispanic white, non‐Hispanic black and Mexican American). Results A significant causal path from increased physical activity to increased magnesium (Mg) intake to decreased HbA1c was found. In addition, increased physical activity significantly decreased BMI, which further decreased HbA1c. These results varied by gender and ethnicity but were directionally consistent. Physical activity decreased HbA1c through BMI for males and through Mg intake for females. Mexican American decreased HbA1c through Mg intake, while non‐Hispanic black had an increased HbA1c due to its ethnicity and through increased BMI. Conclusions The beneficial effects of physical activity on decreased HbA1c were mediated through the increased Mg intake and decreased BMI. This aligned with recent investigations of the inverse causal association of Mg intake with insulin resistance and with decreased inflammation., We applied causal path analyses to NHANES 2011‐2014 dataset to analyse the causal relationships of nutrition intake and physical activity on HbA1C in patients diagnosed with type 2 diabetes mellitus stratified by gender and ethnicity. We found that the beneficial effects of physical activity on decreased HbA1c were mediated through the increased Mg intake and decreased BMI across different gender and ethnicities.

Objective: To test the hypothesis that cadmium (Cd) exposure is associated with type 2 diabetes mellitus (T2DM). Materials and Methods: A two-phase health screening (physical examination and laboratory tests) was conducted in a lead smelter community following a Superfund Cleanup. Participants were African Americans aged &gt, 19 years to &lt, 89 years. Multiple logistic regression was used to analyze T2DM regressed on blood Cd level and covariates: body mass index (BMI), heavy metals (Ar, Cd, Hg, Pb), duration of residence, age, smoking status, and sex. Results: Of 875 subjects environmentally exposed to Cd, 55 were occupationally exposed to by-products of lead smelting and 820 were community residents. In addition, 109 T2DM individuals lived in the community for an average of 21.0 years, and 766 non-T2DM individuals for 19.0 years. T2DM individuals (70.3%) were &gt, 50 years old. Blood Cd levels were higher among T2DM subjects (p &lt, 0.006) compared to non-T2DM individuals. Logistic regression of T2DM status identified significant predictors: Cd level (OR = 1.85, 95% CI: 1.14&ndash, 2.99, p &lt, 0.01), age &gt, 50 years (OR = 3.10, 95% CI: 1.91&ndash, 5.02, p &lt, 0.0001), and BMI (OR = 1.07, CI: 1.04&ndash, 1.09, 0.0001). In meta-analysis of 12 prior studies and this one, T2DM risk was OR = 1.09 (95% CI: 1.03&ndash, 1.15, p &lt, 0.004) fixed effects and 1.22 (95% CI: 1.04&ndash, 1.44, p &lt, 0.02) random effects. Discussion: Chronic environmental Cd exposure was associated with T2DM in a smelter community, controlling for covariates. T2DM onset &lt, 50 years was significantly associated with Cd exposure, but &gt, 50 years was not. Meta-analysis suggests that Cd exposure is associated with a small, but significant increased risk for T2DM. Available data suggest Cd exposure is associated with an increased propensity to increased insulin resistance.

BACKGROUND: To evaluate the association of statins and co-morbidities with new onset type 2 diabetes mellitus (T2DM) in patients 65 years and older. METHODS: This retrospective study used de-identified administrative healthcare claims and enrolment data from a Medicare Advantage Prescription Drug (MAPD) health plan offered by a large multistate healthcare company. The plan covered >2.4 million individuals, of whom >1.7 million individuals were ≥65 years. Of these, 265 554 individuals had continuous MAPD enrolment January 2008 to December 2015. The unadjusted model assessed demographic, pharmacy and T2DM comorbidities as covariates. Significant variables (P < .05) in the unadjusted model were then included in the adjusted model. The adjusted model used Cox proportional hazards to evaluate covariate effects. Matched propensity score analysis was used to analyse the association of statins and T2DM onset. RESULTS: The cumulative rate of diagnosed T2DM onset in the study cohort was 4.82% (4314/89 390). Annualised incidence of T2DM diagnosis was 0.82%, 0.88%, 1.04% and 2.09% in 2012, 2013, 2014 and 2015, respectively. T2DM onset was associated with male sex, non-white (African American or Hispanic ethnicity), statin use, hypertension, hyperlipidaemia, heart failure, lower limb ulceration, atherosclerosis, other retinopathy, angina pectoris, poor vision and blindness and absence ischaemic heart disease (IHD). Matched propensity score analysis showed that statin use was significantly associated with T2DM onset (Odds Ratio = 1.26, 95% Confidence Interval: 1.12–1.41, P < .0001) in the adjusted model. CONCLUSIONS: Analyses indicated that statin usage was associated with new onset T2DM after adjusting for covariates.

Reduced vital capacity (VC) and forced vital capacity (FVC) are associated with lead (Pb) exposure.The objective of this study is to analyse the effects of Pb on FVC and the shuttle run performance.Data were available for 184 male and 189 female Polish schoolchildren aged 10-15 years. Regression analysis was performed of shuttle run performance (dependent) on Pb and FVC.Shuttle run time increased by 1.75 (± 0.77) and 1.97 (± 0.77) seconds for each 10 µg/dL increase in Pb blood among males and females, respectively. Higher shuttle run times indicate poorer performance. Average unadjusted blood Pb level in the sample was 5.27 μg/dL (± 0.19 SE) and 3.82 μg/dL (± 0.10 SE), respectively. Path analysis was used to assess the association of Pb level with shuttle run time. Blood Pb had a significant negative effect on VC (B= -13.60 ± 3.28 [SE], p 0.0001) and FVC (B = -13.08 ± 3.27, p 0.0001). FVC had a small but significant effect on shuttle run time (B = -0.04 ± 0.007, p 0.0001). Pb had a significant effect on the residual of shuttle run time among males (B = 1.59 ± 0.75, p 0.03) and females after the effect of FVC was removed (B = 1.49 ± 0.73, p 0.04).Thus, Pb had direct and indirect effects that increased shuttle run time, i.e. negatively affected performance.

Objective. To test the hypothesis that assortative mating for physical characteristics differs before and after major secular increases in height in an indigenous community in the Valley of Oaxaca, Mexico. Methods. Spouse pairs were identified in household and anthropometric surveys of a Zapotec-speaking community in 1978 (n = 68-70 pairs) and 2000 (n = 99-100 pairs). Height, weight, arm circumference, triceps skinfold and grip strength were measured. Assortative mating was calculated as Pearson correlations. Results. Husband-wife correlations for age were high in both years (r = 0.96, 0.95). Assortative mating for height was significant in 1978 (r = 0.35, p 0.05) when ages of spouses were controlled (r = -0.02 to 0.16). Conclusion. Assortative mating for physical characteristics did not differ between surveys conducted before (1978) and after (2000) major secular increases in height in the community, and any possible genetic effect of the secular trend on assortative was likely negligible.