The coronavirus disease 2019 (COVID-19) pandemic has required a shift in health care delivery platforms, necessitating a new reliance on telemedicine.
To evaluate whether inequities are present in ...telemedicine use and video visit use for telemedicine visits during the COVID-19 pandemic.
In this cohort study, a retrospective medical record review was conducted from March 16 to May 11, 2020, of all patients scheduled for telemedicine visits in primary care and specialty ambulatory clinics at a large academic health system. Age, race/ethnicity, sex, language, median household income, and insurance type were all identified from the electronic medical record.
A successfully completed telemedicine visit and video (vs telephone) visit for a telemedicine encounter. Multivariable models were used to assess the association between sociodemographic factors, including sex, race/ethnicity, socioeconomic status, and language, and the use of telemedicine visits, as well as video use specifically.
A total of 148 402 unique patients (86 055 women 58.0%; mean SD age, 56.5 17.7 years) had scheduled telemedicine visits during the study period; 80 780 patients (54.4%) completed visits. Of 78 539 patients with completed visits in which visit modality was specified, 35 824 (45.6%) were conducted via video, whereas 24 025 (56.9%) had a telephone visit. In multivariable models, older age (adjusted odds ratio aOR, 0.85 95% CI, 0.83-0.88 for those aged 55-64 years; aOR, 0.75 95% CI, 0.72-0.78 for those aged 65-74 years; aOR, 0.67 95% CI, 0.64-0.70 for those aged ≥75 years), Asian race (aOR, 0.69 95% CI, 0.66-0.73), non-English language as the patient's preferred language (aOR, 0.84 95% CI, 0.78-0.90), and Medicaid insurance (aOR, 0.93 95% CI, 0.89-0.97) were independently associated with fewer completed telemedicine visits. Older age (aOR, 0.79 95% CI, 0.76-0.82 for those aged 55-64 years; aOR, 0.78 95% CI, 0.74-0.83 for those aged 65-74 years; aOR, 0.49 95% CI, 0.46-0.53 for those aged ≥75 years), female sex (aOR, 0.92 95% CI, 0.90-0.95), Black race (aOR, 0.65 95% CI, 0.62-0.68), Latinx ethnicity (aOR, 0.90 95% CI, 0.83-0.97), and lower household income (aOR, 0.57 95% CI, 0.54-0.60 for income <$50 000; aOR, 0.89 95% CI, 0.85-0.92, for $50 000-$100 000) were associated with less video use for telemedicine visits. These results were similar across medical specialties.
In this cohort study of patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older patients, Asian patients, and non-English-speaking patients had lower rates of telemedicine use, while older patients, female patients, Black, Latinx, and poorer patients had less video use. Inequities in accessing telemedicine care are present, which warrant further attention.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with ...type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status.
To assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US.
This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis.
Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use.
Of 934 737 patients with type 2 diabetes (mean SD age, 65.4 12.9 years; 50.7% female; 57.6% White), 81 007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio aOR, 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income (≥$100 000: aOR, 1.08 95% CI, 1.05-1.10; $50 000-$99 999: aOR, 1.05 95% CI, 1.03-1.07 vs <$50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD.
In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.
The theta rhythm—a slow (6–12 Hz) oscillatory component of the local field potential—plays a critical role in spatial navigation and memory by coordinating the activity of neuronal ensembles within ...the medial temporal lobe (MTL). Although theta has been extensively studied in freely moving rodents, its presence in humans has been elusive and primarily investigated in stationary subjects. Here we used a unique clinical opportunity to examine theta within the human MTL during untethered, real-world ambulatory movement. We recorded intracranial electroencephalographic activity from participants chronically implanted with the wireless NeuroPace responsive neurostimulator (RNS) and tracked their motion with sub-millimeter precision. Our data revealed that movement-related theta oscillations indeed exist in humans, such that theta power is significantly higher during movement than immobility. Unlike in rodents, however, theta occurs in short bouts, with average durations of ∼400 ms, which are more prevalent during fast versus slow movements. In a rare opportunity to study a congenitally blind participant, we found that both the prevalence and duration of theta bouts were increased relative to the sighted participants. These results provide critical support for conserved neurobiological characteristics of theta oscillations during ambulatory spatial navigation, while highlighting some fundamental differences across species in these oscillations between humans and rodents.
•Movement-related 8 Hz theta oscillations occur in the human medial temporal lobe•Theta occurs in short bouts that are more prevalent during fast versus slow movements•The duration and prevalence of theta are higher in a congenitally blind participant•Combined motion capture and iEEG allow for future studies of ambulatory behavior
Aghajan et al. record deep brain activity, during untethered freely moving behavior, from participants chronically implanted with depth electrodes. They demonstrate that 8 Hz theta oscillations, the hallmark of spatial navigation in rodents, also occur in humans, albeit in shorter bouts that are more prevalent during fast versus slow movements.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center ...studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age OR = 0.995 (95% CI 0.993, 0.997); p<0.001, non-Hispanic Black race OR = 0.88 (95% CI 0.84, 0.93); p<0.001, and English as primary language OR = 0.78 (95% CI 0.74, 0.83); p<0.001 were associated with a lower odds of telemedicine utilization. Female gender OR = 1.24 (95% CI 1.22, 1.27); p<0.001, Hispanic ethnicity or non-Hispanic other race OR = 1.40 (95% CI 1.33, 1.46);p<0.001 and 1.29 (95% CI 1.20, 1.38); p<0.001, respectively were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions ...vary by region or cause of hospitalization is unknown.
Objective
Evaluate the association of homelessness with readmission rates across multiple US states.
Design
Retrospective analysis of administrative claims
Patients
All inpatient hospitalizations in Florida, Massachusetts, and New York from January 2010 to October 2015
Main Measures
Thirty- and 90-day readmission rates
Key Results
Out of a total of 23,103,125 index hospitalizations, 515,737 were for patients who were identified as homeless at the time of discharge. After adjusting for cause of index hospitalization, state, demographics, and clinical comorbidities, 30-day and 90-day readmission rates were higher for index hospitalizations in the homeless compared with those in the housed group. The difference in 30-day readmission rates between homeless and housed groups was the largest in Florida (30.4% vs. 19.3%;
p
< 0.001), followed by Massachusetts (23.5% vs. 15.2%;
p
< 0.001) and New York (15.7% vs. 13.4%;
p
< 0.001) (combined 17.3% vs. 14.0%;
p
< 0.001). Among the most common causes of hospitalization, 30-day readmission rates were 4.1 percentage points higher for the homeless group for mental illness, 4.9 percentage points higher for diseases of the circulatory system, and 2.4 percentage points higher for diseases of the digestive system.
Conclusions
After adjusting for demographic and clinical characteristics, homelessness is associated with significantly higher 30- and 90-day readmission rates, with a significant variation across the three states. Interventions to reduce the burden of readmissions among individuals experiencing homelessness are urgently needed. Differences across states point to the potential of certain public policies to impact health outcomes for individuals experiencing homelessness.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The number of extreme heat events is increasing because of climate change. Previous studies showing an association between extreme heat and higher mortality rates generally have been limited to urban ...areas, and whether there is heterogeneity across different populations is not well studied; understanding whether this association varies across different communities, particularly minoritized racial and ethnic groups, may allow for more targeted mitigation efforts.
To the assess the association between extreme heat and all-cause mortality rates in the US.
This cross-sectional study involved a longitudinal analysis of the association between the number of extreme heat days in summer months from 2008 to 2017 (obtained from the Centers for Disease Control and Prevention's Environmental Public Health Tracking Program) and county-level all-cause mortality rates (obtained from the National Center for Health Statistics), using a linear fixed-effects model across all counties in the contiguous US among adults aged 20 years and older. Data analysis was performed from September 2021 to March 2022.
The number of extreme heat days per month. Extreme heat was identified if the maximum heat index was greater than or equal to 90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979 to 2007).
County-level, age-adjusted, all-cause mortality rates.
There were 219 495 240 adults aged 20 years and older residing in the contiguous US in 2008, of whom 113 294 043 (51.6%) were female and 38 542 838 (17.6%) were older than 65 years. From 2008 to 2017, the median (IQR) number of extreme heat days during summer months in all 3108 counties in the contiguous US was 89 (61-122) days. After accounting for time-invariant confounding, secular time trends, and time-varying environmental and economic measures, each additional extreme heat day in a month was associated with 0.07 additional death per 100 000 adults (95% CI, 0.03-0.10 death per 100 000 adults; P = .001). In subgroup analyses, greater increases in mortality rates were found for older vs younger adults (0.19 death per 100 000 individuals; 95% CI, 0.04-0.34 death per 100 000 individuals), male vs female adults (0.12 death per 100 000 individuals; 95% CI, 0.05-0.18 death per 100 000 individuals), and non-Hispanic Black vs non-Hispanic White adults (0.11 death per 100 000 individuals; 95% CI, 0.02-0.20 death per 100 000 individuals).
These findings suggest that from 2008 to 2017, extreme heat was associated with higher all-cause mortality in the contiguous US, with a greater increase noted among older adults, men, and non-Hispanic Black individuals. Without mitigation, the projected increase in extreme heat due to climate change may widen health disparities between groups.
Identifying the potential for SARS-CoV-2 reinfection is crucial for understanding possible long-term epidemic dynamics. We analysed longitudinal PCR and serological testing data from a prospective ...cohort of 4,411 United States employees in 4 states between April 2020 and February 2021. We conducted a multivariable logistic regression investigating the association between baseline serological status and subsequent PCR test result in order to calculate an odds ratio for reinfection. We estimated an odds ratio for reinfection ranging from 0.14 (95% CI: 0.019 to 0.63) to 0.28 (95% CI: 0.05 to 1.1), implying that the presence of SARS-CoV-2 antibodies at baseline is associated with around 72% to 86% reduced odds of a subsequent PCR positive test based on our point estimates. This suggests that primary infection with SARS-CoV-2 provides protection against reinfection in the majority of individuals, at least over a 6-month time period. We also highlight 2 major sources of bias and uncertainty to be considered when estimating the relative risk of reinfection, confounders and the choice of baseline time point, and show how to account for both in reinfection analysis.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Racial residential segregation is associated with racial health inequities, but it is unclear if segregation may exacerbate Black-White disparities in cardiovascular disease (CVD) mortality. This ...study aimed to assess associations between Black-White residential segregation, CVD mortality rates among non-Hispanic (NH) Black and NH White populations, and Black-White disparities in CVD mortality.
This cross-sectional study analyzed Black-White residential segregation, as measured by county-level interaction index, of US counties, county-level CVD mortality among NH White and NH black adults aged 25 years and older, and county-level Black-White disparities in CVD mortality in years 2014 to 2017. Age-adjusted, county-level NH Black CVD mortality rates and NH White cardiovascular disease mortality rates, as well as group-level relative risk ratios for Black-White cardiovascular disease mortality, were calculated. Sequential generalized linear models adjusted for county-level socioeconomic and neighborhood factors were used to estimate associations between residential segregation and cardiovascular mortality rates among NH Black and NH White populations. Relative risk ratio tests were used to compare Black-White disparities in the most segregated counties to disparities in the least segregated counties.
We included 1,286 counties with ≥5% Black populations in the main analysis. Among adults aged ≥25 years, there were 2,611,560 and 408,429 CVD deaths among NH White and NH Black individuals, respectively. In the unadjusted model, counties in the highest tertile of segregation had 9% higher (95% CI, 1%-20% higher, P = .04) rates of NH Black CVD mortality than counties in the lowest tertile of segregation. In the multivariable adjusted model, the most segregated counties had 15% higher (95% CI, 0.5% to 38% higher, P = .04) rates of NH Black CVD mortality than the least segregated counties. In the most segregated counties, NH Black individuals were 33% more likely to die of CVD than NH White individuals (RR 1.33, 95% CI 1.32 to 1.33, P < .001).
Counties with increased Black-White residential segregation have higher rates of NH Black CVD mortality and larger Black-White disparities in CVD mortality. Identifying the causal mechanisms through which racial residential segregation widens disparities in CVD mortality requires further study.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In 1928, Dirac published an equation
that combined quantum mechanics and special relativity. Negative-energy solutions to this equation, rather than being unphysical as initially thought, represented ...a class of hitherto unobserved and unimagined particles-antimatter. The existence of particles of antimatter was confirmed with the discovery of the positron
(or anti-electron) by Anderson in 1932, but it is still unknown why matter, rather than antimatter, survived after the Big Bang. As a result, experimental studies of antimatter
, including tests of fundamental symmetries such as charge-parity and charge-parity-time, and searches for evidence of primordial antimatter, such as antihelium nuclei, have high priority in contemporary physics research. The fundamental role of the hydrogen atom in the evolution of the Universe and in the historical development of our understanding of quantum physics makes its antimatter counterpart-the antihydrogen atom-of particular interest. Current standard-model physics requires that hydrogen and antihydrogen have the same energy levels and spectral lines. The laser-driven 1S-2S transition was recently observed
in antihydrogen. Here we characterize one of the hyperfine components of this transition using magnetically trapped atoms of antihydrogen and compare it to model calculations for hydrogen in our apparatus. We find that the shape of the spectral line agrees very well with that expected for hydrogen and that the resonance frequency agrees with that in hydrogen to about 5 kilohertz out of 2.5 × 10
hertz. This is consistent with charge-parity-time invariance at a relative precision of 2 × 10
-two orders of magnitude more precise than the previous determination
-corresponding to an absolute energy sensitivity of 2 × 10
GeV.
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KISLJ, NUK, SBMB, UL, UM, UPUK
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