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Background: Estimating the prevalence and number of people with Alzheimer's dementia in 50 U.S. states and 3142 counties can provide a better understanding of region‐specific disease burden. Method: We utilized cognitive data from the Chicago Health and Aging Project (CHAP), a population‐based study, and combined it with the National Center for Health Statistics (NHCS) 2020 bridged‐race population estimates and determined the state‐ and county‐specific prevalence of Alzheimer's dementia for adults 65 years and older. Result: A higher prevalence of Alzheimer's dementia was estimated in the East and Southeastern regions of the U.S., with the highest in Maryland (12.9%), New York (12.7%), Mississippi (12.5%), and Florida (12.5%). California and Illinois were also among the 10 states with a higher prevalence of Alzheimer's. U.S. states. California had the highest number of people with Alzheimer's dementia, with 719.7 (95%CI 665.0, 774.4) thousand, Texas with 579.9 (95%CI 539.9, 620.0) thousand, and Florida with 459.3 (95%CI 422.7, 496.0) thousand. The top 3 counties with the highest prevalence, 16.6%, respectively, were Miami‐Dade County in Florida, Baltimore city in Maryland, and Bronx County in New York Conclusion: The state‐ and county‐specific estimates could help public health officials to understand the burden of disease (e.g., demand for caregiver counseling and institutional care) and develop strategies for identifying and caring for people with Alzheimer's dementia [ABSTRACT FROM AUTHOR]

Aims: Anal cancer, despite its rarity, is a matter of serious concern in the United States, with an uptrend in recent years and marked racial disparities in mortality rates. The aim of this work was to investigate anal cancer mortality trends and sex race disparities in the United States from 1999 to 2020. Method: This is a retrospective study using data from the CDC WONDER database (1999–2020). We investigated deaths attributed to anal cancer, identified by the ICD‐10 code C21.1, and excluded individuals aged 14 years and under. The Mann–Kendall trend test was used to investigate temporal trends and a t‐test was used to compare continuous variables. Results: Both male and female age‐adjusted mortality attributed to anal cancer increased significantly during the study period across all subgroups, including race (Black and White), US Census region (Northeast, Midwest, South and West) and age (15–64 and ≥65 years) (p < 0.001 for all comparisons). For each subgroup, women demonstrated significantly higher rates of mortality than men, except in the Black population, where Black men had higher rates than Black women (0.40 vs. 0.29, p < 0.001). Additionally, Black men had significantly higher mean mortality rates than White men (0.40 vs. 0.27, p < 0.001). The highest rates of anal cancer mortality were among geriatric individuals, especially women aged ≥65 years, at 1.18 per 100 000. Conclusion: The rise in anal cancer mortality and racial and sex disparities present a significant challenge for healthcare providers and policy makers. Further studies are required to devise evidence‐based strategies to effectively tackle this challenge. [ABSTRACT FROM AUTHOR]

The National Center for Health Statistics (NCHS) is the principal health statistics agency for the United States. It seeks to provide accurate, relevant, and timely data on health status and utilization of health care. As such, the NCHS represents a tremendous repository of behavioral, biological, and clinical data that can be employed to identify issues and effect change in public policy related to liver health and disease. By providing an understanding of the rich, publicly available data systems within the NCHS, investigators may capitalize on an efficient means to shape current knowledge of liver disease.

Objective: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death., Design: Retrospective data analysis., Setting: A Médecins Sans Frontières (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children., Participants: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included., Interventions: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children., Outcome Measures: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program., Results: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program., Conclusions: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs.

The sexual health statistics around sexually transmitted infections (STIs) in Aotearoa (New Zealand) suggest two things: many STIs are increasing, and the STI rates are high compared to other 'similar' countries. What sense do ordinary New Zealanders make of these figures? Focusing on heterosexual sex, this paper discusses lay accounts that sought to make sense of Aotearoa's STI statistics. In total, 58 participants (38 women, 20 men) aged 16-36 years (mean age 25) took part in 15 focus group discussions related to sexual health. Participants were mostly Pakeha (of European ancestry) and heterosexual. Data were analysed thematically. The predominant category of explanation was national 'identity' accounts. National 'identity' explanations invoked a particular New Zealand persona to explain the sexual health statistics. New Zealanders were characterised, sometimes contradictorily, as binge drinkers: poor communicators; self-sufficient and stoic; conservative yet highly and complacently sexual: and 'laid back', which was associated with a lack of personal concern about sexual health risk. The emphasis on national identity shifts responsibility for sexual health from the individual, and suggests agency lies beyond the individual, who is fully embedded in their culture and acts according to its dictates. In terms of sexual health, this suggests a need to consider whether, and if so how, national 'identity' might be meaningfully invoked and deployed in sexual health promotion initiatives. Keywords: Aotearoa/New Zealand Sexually transmitted infections (STIs) Sexual health National identity Lay accounts

Background: Cancer mortality rates overall in the U.S. have decreased significantly; however, the rate of decline has not been uniform across sociodemographic groups. We aimed to compare trends in cancer mortality rates from 1999 to 2020 between rural and urban individuals and to examine whether any rural–urban differences are uniform across racial and ethnic groups. Methods: We used U.S.‐wide data from the National Center for Health Statistics, for all cancer deaths among individuals aged 25 years or older. We estimated average annual percentage change (AAPC) in age‐standardized cancer mortality rates in the U.S. by cancer type, rural–urban status, sex, and race and ethnicity. Results: There was a larger reduction in cancer mortality rates among individuals from urban (males: AAPC, −1.96%; 95% CI, −2.03, −1.90; females: AAPC, −1.56%; 95% CI, −1.64, −1.48) than rural (males: AAPC, −1.43%; 95% CI, −1.47, −1.39; females: AAPC, −0.93; 95% CI, −1.03, −0.82) areas. AAPCs for cancer types were uniformly higher among urban areas compared with rural areas. Despite overall decreases, deaths rates for liver and pancreas cancers increased, including in the most recent period among males (2012–2020, APC, 1.34; 95% CI, 0.49, 2.20) and females (2013–2020, APC, 1.52; 95% CI, 0.03, 3.02) in rural areas. Conclusions: Cancer death rates decreased in all racial and ethnic populations; however, the rural–urban differences varied by race/ethnicity. The rate of decline in mortality rates were lower in rural areas and death rates for liver and pancreas cancers increased, particularly for individuals living in rural America. [ABSTRACT FROM AUTHOR]

Background: Cholelithiasis is a common digestive system disease that imposes major burden on patients and society. Investigating the relationship between dietary factors and cholelithiasis risk can provide a basis for disease prevention. Previous studies on milk intake and cholelithiasis incidence have been limited.Therefore, the aim of our study was to assess the association between milk consumption and the incidence of cholelithiasis in males and females. Methods: We selected 14,722 adults (≥ 18 years old) from National Center for Health Statistics (NHANSE) 2017–2020, and collected general characteristics of patients in the database, such as age, gender, race and body mass index (BMI), as well as dietary information (milk consumption). The occurrence of cholelithiasis was used as the outcome event, and the group was divided into cholelithiasis and non-cholelithiasis groups according to the outcome event. We used logistic regression models in generalized linear model (GLM) functions, controlling for demographic, lifestyle, and dietary factors, to estimate the association between milk intake and the incidence of cholelithiasis in males and females. Results: A total of 14,722 adults were included. In the present study, the overall weighted prevalence of cholelithiasis was 10.96%, with 15.18% and 6.48% prevalence in females and males, respectively. Compared to infrequent milk intake, frequent milk intake (once a week or more) in females was associated with reduced cholelithiasis risk (OR 0.74, 95% CI 0.61–0.90). Daily milk intake in males was also related to lower cholelithiasis risk (OR 0.69–0.82). As adjusted variables increased in the models, predictive performance was improved (AUC 0.711 in females, 0.730 in males). Conclusions: Appropriate milk intake may correlate with decreased cholelithiasis risk. Our study provides a basis for dietary interventions against gallstones, but prospective studies are needed to verify the results. [ABSTRACT FROM AUTHOR]

Background Medicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates. Methods Nationwide state-level cancer data from 2001 to 2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs nonexpansion states using generalized estimating equations with robust standard errors. Mediation analyses were used to assess whether distant stage cancer incidence mediated changes in cancer mortality. Results There were 17 370 state-level observations. For all cancers combined, there were Medicaid expansion–associated decreases in distant stage cancer incidence (adjusted odds ratio = 0.967, 95% confidence interval  = 0.943 to 0.992; P  = .01) and cancer mortality (adjusted odds ratio = 0.965, 95% confidence interval = 0.936 to 0.995; P  = .022). This translates to 2591 averted distant stage cancer diagnoses and 1616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P  = .008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality. Conclusions Medicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses. [ABSTRACT FROM AUTHOR]

Background: Survival analysis methods are increasingly used to model the gestational age‐specific risk of perinatal phenomena such as stillbirth. Objectives: To compare two types of survival analysis models, and highlight differences by estimating the relationships between pre‐pregnancy BMI and gestational age‐specific rates of stillbirth. Methods: The study was based on singleton live births and stillbirths in the United States in 2016–2017, with data obtained from the natality and fetal death files of the National Center for Health Statistics. We compared Cox regression versus piecewise exponential additive mixed models (PAMMs) for modelling the relationship between BMI and stillbirth across gestational age. In a second analysis, we illustrated the performance of both models for assessing the relationship between the trimester‐specific number of cigarettes smoked, a time‐dependent covariate, and stillbirth. Results: The study population included 7,567,316 births, of which 42,739 were stillbirths (5.6 per 1000 total births). Stillbirth rates increased with increasing pre‐pregnancy BMI and increasing gestational age. In analyses with BMI as a categorical variable, the Cox model and PAMM models yielded similar results. Analyses of BMI as a continuous variable also showed similar results when BMI associations were assumed to be linear, and the changes in gestational age‐specific rates were modelled parametrically. However, results differed slightly when PAMMs, modelled with data‐driven approaches, were used to estimate changes in BMI effects across gestational age; PAMMs provided a more nuanced modelling of time‐varying effects. PAMM models showed an approximately linear increase in the effect of smoking on stillbirth with increasing gestational age. Conclusions: For survival analyses using the foetuses‐at‐risk approach, PAMMs provide a valuable alternative to the traditional Cox model, with increased modelling flexibility when proportional hazards assumptions are violated. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National Center for Health Statistics (NCHS) links data from surveys to administrative data sources, but privacy concerns make accessing new data sources difficult. Privacy-preserving record linkage (PPRL) is an alternative to traditional linkage approaches that may overcome this barrier. However, prior to implementing PPRL techniques it is important to understand their effect on data quality. METHODS: Results from PPRL were compared to results from an established linkage method, which uses unencrypted (plain text) identifiers and both deterministic and probabilistic techniques. The established method was used as the gold standard. Links performed with PPRL were evaluated for precision and recall. An initial assessment and a refined approach were implemented. The impact of PPRL on secondary data analysis, including match and mortality rates, was assessed. RESULTS: The match rates for all approaches were similar, 5.1% for the gold standard, 5.4% for the initial PPRL and 5.0% for the refined PPRL approach. Precision ranged from 93.8% to 98.9% and recall ranged from 98.7% to 97.8%, depending on the selection of tokens from PPRL. The impact of PPRL on secondary data analysis was minimal. DISCUSSION: The findings suggest PPRL works well to link patient records to the National Death Index (NDI) since both sources have a high level of non-missing personally identifiable information, especially among adults 65 and older who may also have a higher likelihood of linking to the NDI. CONCLUSION: The results from this study are encouraging for first steps for a statistical agency in the implementation of PPRL approaches, however, future research is still needed. [ABSTRACT FROM AUTHOR]

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