American Journal of Preventive Medicine最新文献

{"title":"Racial Equity in Facial Laceration Repair: Evaluating a Pediatric Plastic Surgery Consult Guideline.","authors":"David Mills, Isabella G Steidley, Elizabeth M Waltman, Amir A Kimia, Michael C Monuteaux, Todd W Lyons, Andrew F Miller, Chris A Rees, Assaf Landschaft, Amanda M Stewart, Ingrid Ganske, Eric W Fleegler","doi":"10.1016/j.amepre.2026.108364","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108364","url":null,"abstract":"<p><strong>Introduction: </strong>Facial lacerations are of particular concern to families due to the potential for long-term cosmetic outcomes. Plastic surgery consultation may be requested for facial laceration repair at specialized centers, yet multiple factors may drive inequitable access to care. The objective of this study was to evaluate whether racial and ethnic inequities existed in plastic surgery consultation rates for facial laceration repair.</p><p><strong>Methods: </strong>Retrospective cross-sectional study of facial laceration repairs between 2016 and 2022 at a single center, urban quaternary care freestanding children's hospital. All patients aged 0 to 18 years who received a facial laceration repair in the pediatric emergency department were included. A clinical practice guideline (CPG) for plastic surgery consultation was implemented in March 2020.</p><p><strong>Results: </strong>6,938 unique laceration encounters were included in the study. Unadjusted plastic surgery repair rates in the pre-guideline period were: Hispanic 8.5% (n=71/832), non-Hispanic Black 6.7% (n=31/462) and non-Hispanic White 28.5% (639/2,241) and following guideline implementation: Hispanic 5.9% (n=17/286), non-Hispanic Black 7.3% (n=9/124) and non-Hispanic White 11.9% (103/867). Prior to the CPG implementation, non-Hispanic Black patients had significantly lower odds of plastics repair compared to non-Hispanic White patients (aOR 0.18 [95% CI 0.11, 0.29]). Following CPG implementation, no statistically significant difference was detected (aOR 0.63 [95% CI 0.30, 1.31]).</p><p><strong>Conclusion: </strong>Previously unrecognized health inequities in plastic surgery consultation rates existed prior to and resolved after implementation of a consultation guideline for facial laceration repair. The study provides insight into the potential secondary benefits of guideline implementation to reduce health inequities.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108364"},"PeriodicalIF":4.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the preventable burden of cardiovascular disease attributable to ultra-processed dietary patterns in Canada: A modeling study.","authors":"Hamel V, Nilson E, Wahrhaftig J, Rezende Lfm, Polsky Jy, Iglesies-Grau J, Flexner N, Moubarac Jc","doi":"10.1016/j.amepre.2026.108363","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108363","url":null,"abstract":"<p><strong>Introduction: </strong>The consumption of ultra-processed foods (UPF) has been associated with increased risks of chronic diseases, particularly cardiovascular diseases (CVD). However, specific data on the CVD burden attributable to UPF intake remains limited. This study aimed to estimate the burden of CVD attributable to ultra-processed dietary patterns among adults in Canada.</p><p><strong>Methods: </strong>This study applied a comparative risk assessment model to estimate the burden of CVD, specifically, incident cases of heart disease and stroke, CVD-related deaths, and disability-adjusted life-years (DALYs) related to CVD, attributable to ultra-processed dietary patterns in adults aged 20 and older. Model inputs included nationally representative dietary intake data from 2015, national health statistics on CVD, and Canadian data on CVD outcomes sourced from the Global Burden of Disease Study for 2019.</p><p><strong>Results: </strong>In 2015, UPF constituted 43.4% of Canadian adults' total daily energy intake. Between 23% and 38% of all CVD events in 2019 were attributable to UPF intake, corresponding to 58,200 to 96,000 new cases of CVD, 10,600 to 17,400 CVD-related deaths, and 235,800 to 388,700 DALYs. Modeling counterfactual scenarios suggests that reducing UPF consumption by 20% to 50% may have prevented 16,800 to 45,900 new CVD cases, 3,100 to 8,300 CVD-related deaths, and 67,800 to 185,200 DALYs in 2019 in Canada.</p><p><strong>Conclusions: </strong>UPF consumption may account for a substantial and potentially preventable burden of CVD in Canada. These findings reinforce the need for clinical and public health interventions aimed at reducing UPF intake as a key component of CVD prevention.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108363"},"PeriodicalIF":4.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of substance-specific preventive care receipt and its time varying relationship with substance use from mid-adolescence to young adulthood.","authors":"Arik V Marcell, Xingyun Wu, Morayo Akande, Pamela A Matson, Elizabeth Ozer, Kathryn Van Eck","doi":"10.1016/j.amepre.2026.108369","DOIUrl":"10.1016/j.amepre.2026.108369","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known whether adolescents, let alone those with substance use, report substance-specific preventive care receipt (PCR) from mid-adolescence through young adulthood.</p><p><strong>Methods: </strong>Analyses conducted in 2024 used longitudinal NEXT Generation Health Study data (2010-2017) from 2,586 respondents reporting smoking, alcohol, and drug PCR, and annual smoking, alcohol, marijuana, and other drug use from ages 15-23. Substance-specific PCR measure was categorized as-no PCR, asked only, and asked and advised (\"advised\"). Longitudinal multinomial logistic regressions, stratified by sex, examined associations of each substance-specific PCR with age and prior-year substance-specific use, unadjusted and adjusted for background characteristics.</p><p><strong>Results: </strong>Analyses demonstrated smoking, alcohol, and drug advice versus no PCR significantly increased over time until age 20-21 for females and 19-20 for males, then decreased through age 23 for both. At any age, only one-third of both sexes reported substance-specific advice. Compared to non-users, females with any cigarette or frequent marijuana use were significantly more likely to get substance-specific advice than no PCR over time; males with frequent alcohol or other drug use were significantly less likely to be asked only than get no PCR; and both sexes with any cigarette or frequent alcohol use and females with frequent marijuana or other drug use were significantly more likely to get substance-specific advice than asked only.</p><p><strong>Conclusions: </strong>Substance-specific PCR gaps over time from mid-adolescence through young adulthood for all adolescents and among those with substance use highlight the need to improve all adolescents' longitudinal substance-specific PCR and especially for those with substance use.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108369"},"PeriodicalIF":4.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anal cancer screening prevalence in US cities and factors associated with screening.","authors":"Alan G Nyitray, Jennifer L Walsh, Ashish A Deshmukh, Elizabeth Y Chiao, Bridgett Brzezinski, Timothy J Ridolfi, Sarah Lundeen, Jenna Nitkowski, Aniruddha Hazra","doi":"10.1016/j.amepre.2026.108373","DOIUrl":"10.1016/j.amepre.2026.108373","url":null,"abstract":"<p><strong>Introduction: </strong>Annual anal cancer screening for sexual minority men and transgender women with HIV has been recommended by experts for more than 15 years and is now endorsed by the United States Department of Health and Human Services. The prevalence of anal cancer screening in these populations was estimated in the Chicago, Houston, and Milwaukee metropolitan areas which are in US regions with the highest anal cancer incidence among people with HIV (PWH).</p><p><strong>Methods: </strong>Survey responses collected in 2020-2022 from individuals in the Prevent Anal Cancer studies were analyzed. The prevalence of anal cytology within the prior year and any history of high-resolution anoscopy (HRA) was stratified by HIV status in individuals of screening age (≥ 35 years for people with HIV and ≥ 45 years if HIV-negative). Factors associated with cytology and HRA were assessed using logistic regression. Barriers to anal cancer screening were assessed and stratified by HIV status.</p><p><strong>Results: </strong>A total of 540 individuals were of screening age and reported HIV status and anal cytology screening within the prior year. Most participants (84.4%, 456/540) were aged 45 years or older, and 52.0% (281/540) reported having HIV. The prevalence of anal cytology in the prior year was 8.3% (45/540) and did not differ by HIV status. Only a history of anal warts was associated with cytology (adjusted odds ratio, aOR 2.57, 95% CI 1.31-5.06). A history of undergoing HRA among PWH differed by metropolitan area: 35.9% (28/78) in Chicago, 18.1% (27/149) in Houston, and 20.8% (11/53) in Milwaukee (p = 0.001). PWH had more than double the odds of reporting a history of HRA (aOR 2.36, 95% CI 1.32-4.22) than HIV-negative people.</p><p><strong>Conclusions: </strong>Among communities highly vulnerable to anal cancer, screening uptake was low and differed by metropolitan area. Interventions are urgently needed at clinical, provider, and individual levels to increase uptake.</p><p><strong>Trial registration: </strong>NCT04090060 and NCT03489707.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108373"},"PeriodicalIF":4.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Florida's Opioid Prescribing Law Associated with Halt in Declining Opioid Fills Among New Users.","authors":"Emma B Dean, Mallick Hossain, Daniel Kaliski","doi":"10.1016/j.amepre.2026.108367","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108367","url":null,"abstract":"<p><strong>Background: </strong>The opioid crisis has increased morbidity and mortality in the United States. In response, states have implemented policies targeting excessive opioid prescribing. Florida's House Bill 21, enacted in 2018, required prescribers to participate in prescription drug monitoring programs and limited acute opioid prescriptions to a 3-to-7-day supply.</p><p><strong>Methods: </strong>This study used a quasi-experimental interrupted time-series analysis of Florida Medicaid claims from 2016-2019 to evaluate whether House Bill 21 was associated with changes in opioid prescribing. The study included 2,813,775 Medicaid Managed Care enrollees with a pain-related medical claim during the study period. Analyses were stratified by prior opioid use and pain chronicity, and the primary outcome was the proportion of monthly non-cancer pain-related claims linked to an opioid prescription fill.</p><p><strong>Results: </strong>Prior to Florida's House Bill 21, opioid fill rates were declining. Among opioid-naïve patients, the Bill was associated with a positive trend change in opioid fills per month (95% CI: 0.0030 to 0.0034, P≤0.001), while patients with a history of opioid use did not have a statistically significant change in trend (0.02 percentage points per month, 95% CI: -0.0002 to 0.0006, P=0.68). This pattern held for patients with acute pain and for those with chronic pain. By the end of the study period, opioid fills for opioid-naïve patients exceeded what would have been predicted if pre-Bill trends had continued, for both acute and chronic pain patients. The opposite pattern was observed for patients with prior opioid use.</p><p><strong>Conclusions: </strong>Florida House Bill 21 was associated with significant reductions in overall opioid prescribing, but impacts differed by patient opioid history. For patients with no recent opioid use, fills increased compared to prior trends. These findings suggest that opioid prescribing policies may have differential impacts across patient groups.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108367"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Isolation and Loneliness Among U.S. Adults with Self-Reported Hospitalization.","authors":"Ronald Anguzu, Mukul Sharda, Tasmia Amjad, Adam Pfankuch, Sandra Iregbu, Pinky Jha, Sara Kohlbeck, Sanjay Bhandari","doi":"10.1016/j.amepre.2026.108371","DOIUrl":"10.1016/j.amepre.2026.108371","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to examine the prevalence and factors associated with social isolation and loneliness among U.S. adults with self-reported hospitalization.</p><p><strong>Methods: </strong>Cross-sectional survey data from adults aged ≥18 years in the 2021 Medical Expenditure Panel Survey who reported at least one hospitalization were obtained and analyzed in 2025-2026. Weighted descriptive analyses and multivariable logistic regression models were conducted to identify factors independently associated with social isolation and loneliness.</p><p><strong>Results: </strong>Social isolation and isolation were present in 22.6% and 26.6% of the study participants, respectively. Factors independently associated with higher odds of social isolation were middle income (aOR 2.35, 95%CI 1.43-3.86) and low income (aOR 4.50, 95%CI 2.82-7.18), public insurance (aOR 2.02, 95%CI 1.44-2.85), depression (aOR 2.27, 95%CI 1.49-3.46), and prior hospitalizations (aOR 1.21, 95%CI 1.01-1.45). Adults aged 45-64 years (aOR 0.45, 95%CI 0.29-0.69) and ≥65 years (aOR 0.49, 95%CI 0.31-0.77), and Non-Hispanic Black individuals (aOR 0.52, 95%CI 0.32-0.84) had lower odds of social isolation. Factors independently associated with higher odds of loneliness were being widowed, divorced, or separated (aOR 2.03, 95%CI 1.31-3.15) or never married (aOR 2.58, 95%CI 1.57-4.24), depression (aOR 3.86, 95%CI 2.48-5.99), and having fair or poor perceived health status (aOR 1.92, 95%CI 1.34-2.75). Adults aged ≥65 years had lower odds of loneliness (aOR 0.55, 95%CI 0.31-0.95) compared to those aged 18-44 years.</p><p><strong>Conclusions: </strong>Over one in five US adults with self-reported hospitalization experienced social isolation and one in four reported loneliness. Routine screening during hospitalization may help identify at-risk individuals.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108371"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing disadvantage in childhood and health: A systematic review.","authors":"Yuxi Li, Ankur Singh, Ludmila Fleitas Alfonzo, Rebecca Bentley","doi":"10.1016/j.amepre.2026.108376","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108376","url":null,"abstract":"<p><strong>Introduction: </strong>Housing is an important determinant of health that is amenable to intervention. While the negative health effect of living in unaffordable, insecure, and unsuitable housing has been well-established for adults, little is known of the causal effect of housing disadvantage in childhood and health across the life course. This review aims to synthesise evidence from longitudinal studies on housing disadvantage in childhood and health.</p><p><strong>Methods: </strong>Longitudinal studies (2000-2025) were systematic reviewed to examine the impact of insecure, unaffordable, or poor-quality housing experienced during childhood (ages 0-18 years) on subsequent physical, mental, or behavioural health outcomes. Risk of bias was assessed with ROBINS-E, and evidence graded using causal criteria including study design, temporality, confounder control, and measurement validity.</p><p><strong>Results: </strong>Sixty-three studies were included, spanning 16 countries and follow-up periods ranging from one to 68 years. Registry and quasi-experimental studies provided the strongest evidence, showing that insecure housing was associated with later mental illness, substance misuse, and premature mortality. Poor housing quality was linked to respiratory outcomes and general health, with suggestive causal signals in studies with extended follow-up and robust adjustment. Evidence for effects of overcrowding and housing affordability was inconsistent, limited by measurement error and confounding.</p><p><strong>Discussion: </strong>Living in disadvantaged housing in childhood may impact health later in life. While some studies offer suggestive causal signals, many lacked formal life-course modelling or designs that enable causal inference. Greater methodological integration and longitudinal investment will be critical to clarify pathways and inform policy responses.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108376"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in associations between substance use and suicidality and patterns of current substance use in US adolescents: A repeated cross-sectional study.","authors":"Caroline Andy, Xiafei Wang, Jacob Parquet, Adriel Strickland, Fabiola Etienne, Veer Vekaria, Wenna Xi","doi":"10.1016/j.amepre.2026.108375","DOIUrl":"10.1016/j.amepre.2026.108375","url":null,"abstract":"<p><strong>Introduction: </strong>Substance use and suicidal thoughts and behaviors (STB) among U.S. adolescents are both major public health concerns. Despite extensive research establishing a link between substance use and STB, little is known about how this relationship may be evolving over time. Understanding the changes in substance use and STB associations may illuminate factors driving the rise in adolescent STB and guide public health interventions.</p><p><strong>Methods: </strong>The 1991-2021 national survey data from the Youth Risk Behavior Surveillance System were analyzed. Race/ethnicity-specific changes in the associations between each of the 12 substance use variables and 4 STB outcomes (suicidal ideation, suicide planning, suicide attempts, injurious suicide attempts) were assessed, by fitting logistic regression models with three-way interactions between time, substance use, and race/ethnicity, while adjusting for age and sex and accounting for the complex survey design. Current (2017-2021) adolescent substance use patterns were then identified using an unsupervised clustering approach, UMAP-HDBSCAN.</p><p><strong>Results: </strong>Temporal trends varied by race/ethnicity for 36 of the 48 substance-STB combinations. Electronic vaping was unique in its non-decreasing association with all STB measures across all racial/ethnic groups (slopes [annual log-odds change] varied between 0.03-0.36). While cigarette use showed declining associations with STB among White adolescents, alcohol, heroin, injected, and methamphetamine use showed divergent trends across racial/ethnic groups. Clustering analysis identified five substance use behavioral phenotypes, including non-users (45.51%), poly/illicit users (20.84%), and other specific usage patterns (33.65%), with poly/illicit users reporting the highest rates of STB (31% suicidal ideation, 26% suicide planning, 16% suicide attempts, 6.3% injurious attempts).</p><p><strong>Conclusions: </strong>The finding that electronic vaping consistently showed an increasing association with all STB measures highlights the urgency of implementing suicidal prevention programs targeting adolescents who vape. Future research is needed to unveil the specific substance or combination of substances that contributed to the elevated risk of STB among poly/illicit users.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108375"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative and Spatial Associations of Disability-Populated Areas and Extreme Heat with Stroke Disparities in Chicago.","authors":"Babu Gounder, Ting Hu, Rachel Loftus, Japhia Ramkumar, Holly Rosencranz","doi":"10.1016/j.amepre.2026.108362","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108362","url":null,"abstract":"<p><strong>Introduction: </strong>Compared to individuals without disabilities, people with physical, sensory, intellectual, and psychological disabilities have increased stroke risk and when exposed to extreme heat they are more vulnerable to adverse effects, including heat-related illness, CVD, poststroke conditions, and mortality. The purpose of this study is to investigate the association of populations with disabilities and the co-location of extreme heat with geographic patterns of stroke mortality.</p><p><strong>Method: </strong>Data for community areas in Chicago were collected and analyzed in 2024-25. OLS and spatial regression models were used to identify significant predictors with sociodemographics and Empirical Bayes rates for stroke mortality. Spatial clustering and co-location analysis were used to identify retrospective high stroke mortality rate clusters and cluster exposure to recent extreme heat data, originating from community heat sensors.</p><p><strong>Results: </strong>The spatial error model performed the best in explaining stroke mortality rate, evidenced by the lowest AIC and BIC values, and with a spatial pseudo r² = .60. Significant predictor variables (p-value <.05), controlling for sociodemographics and income, were middle-aged disability populations (40 - 64 years old) with a positive association, and non-Hispanic White and Hispanic with negative associations. A significant local cluster for high stroke mortality was found in the Chicago Southside. Roughly half of the community areas in the high stroke mortality cluster overlapped with exposure to the highest quartile of mean heat index measures (>89.54°F), which is near the 90°F threshold for extreme heat and risks of heat-related illnesses, including epidemiological risks of stroke and cardiovascular disease.</p><p><strong>Conclusions: </strong>This study identifies novel and relevant community risk factors-middle-aged population ability status and extreme heat-that have been overlooked in lowering stroke mortality. Findings suggest measures addressing these socio-environmental factors in public health campaigns, including Chicago's action plan for cardiovascular diseases, are needed for stroke prevention and community health.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108362"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Disorder and Risk of Dementia: The Mediating Role of Cardiometabolic Risk.","authors":"Jiao Yu, Yi Wang, Thomas M Gill, Xi Chen","doi":"10.1016/j.amepre.2026.108374","DOIUrl":"10.1016/j.amepre.2026.108374","url":null,"abstract":"<p><strong>Introduction: </strong>Neighborhood environments are important social determinants of cognitive health, yet the potential mechanisms underlying neighborhood environments and dementia risk remain poorly understood. This study investigates whether cardiometabolic risk mediates the association between neighborhood disorder and subsequent dementia risk.</p><p><strong>Methods: </strong>This cohort study analyzed data from the Health and Retirement Study (HRS, 2006-2020), a nationally representative sample of community-dwelling adults aged 51 years or older. Dementia status was identified using the validated Langa-Weir classification algorithm. Neighborhood disorder was assessed with an interviewer-reported checklist. Cardiometabolic risk was quantified as a composite score derived from seven biomarkers across inflammatory, cardiovascular, and metabolic systems. Inverse probability-weighted Cox proportional hazards models were employed to examine the association between neighborhood disorder and time to dementia. Mediation analyses were performed to assess the mediating effects of cardiometabolic risk. Data were collected in 2006-2020 and analyzed in 2025.</p><p><strong>Results: </strong>Among the 9,426 participants, 1,747 (18.5%) developed dementia over a 14-year follow-up. After adjustment for covariates, living in disordered neighborhoods was associated with a higher risk of dementia (Hazard Ratio (HR): 1.37; 95% CI: 1.08-1.74) and cognitive impairment no dementia (CIND, HR: 1.50; 95% CI: 1.22-1.85). Cardiometabolic risk mediated 16.2% of the association between neighborhood disorder and dementia, and 19.3% of the association with CIND.</p><p><strong>Conclusions: </strong>Neighborhood disorder could be a significant risk factor for dementia, and this relationship is partially mediated by cardiometabolic health. Community initiatives that address neighborhood stressors and cardiometabolic risk may reduce dementia risk and support healthy aging in place.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108374"},"PeriodicalIF":4.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}