Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Objectives: Increased social engagement in older adults has been linked to positive cognitive outcomes; however, it is unclear if the social engagement of husbands and wives influences their own cognition as well as each other’s cognition. Moreover, it is unknown if any such patterns persist in different country contexts. Methods: Data from the 2001 Mexican Health and Aging Study (MHAS) and the 2000 Health and Retirement Study (HRS) were combined, and comparable samples of married couples without cognitive impairment at baseline were drawn. Follow-up cognition data was obtained from the 2012 MHAS and the 2012 HRS. Structural equation models (SEM) were used to test the actor–partner interdependence model with moderating effect of country on the association of social engagement with cognition. Results: Significant actor effects were observed for wives in both countries. Actor effects for husbands were observed in the United States only. In Mexico, a significant partner effect was observed where wives’ social engagement benefited their own cognition as well as their husbands’, but not vice versa. Partner effects were not observed in the United States. No moderation effects of country were observed. Discussion: Our results suggest asymmetric patterns of actor–partner interdependence in Mexico, which may be reflective of the more traditional social role of women, and codependence within the couple. On the other hand, our results for the United States, where each spouse had significant actor effects but no partner effects, may suggest more independence within the couple.

Purpose: Examine disparities in survival for adolescents and young adults (AYAs) diagnosed with bone and soft tissue sarcomas in Texas compared with national estimates. Methods: AYAs with sarcomas diagnosed between 1995 and 2012 at ages 15–39 years were identified from the Texas Cancer Registry (TCR) and Surveillance, Epidemiology, and End Results (SEER) program. Patient demographic, treatment, and clinical characteristics were compared between TCR and SEER using chi-squared tests. Five-year survival was computed using the Kaplan–Meier method. Cox proportional hazards (CPH) models evaluated the factors associated with the risk of mortality between and within the two datasets. Results: Sarcoma patients in TCR were more likely to be Hispanic, uninsured, diagnosed at late stage, and have lower rates of surgery as the first line of treatment than those in SEER. In Texas, 5-year survival was 68.7% versus 72.2% in SEER (p < 0.001). However, after including surgery in our fully adjusted CPH model, survival differences between the two datasets were no longer observed. In these models, males, and those living in nonmetropolitan areas were more likely to die than their counterparts in both datasets. In TCR, those who lived in the U.S. and Mexico border had higher mortality. In SEER, Hispanics and non-Hispanic blacks had higher mortality. Conclusion: The adjusted AYA sarcoma survival in Texas was similar to that of SEER, but patients in Texas were more likely to be uninsured and have lower surgery rates. Those living in the U.S. and Mexico border in Texas faced lower survival. These results are important for delineating effective care for this high-risk patient group.

Introduction: Alternative Nicotine Delivery Systems (ANDS) such as e-cigarettes (EC) and oral nicotine pouches (ONP) may facilitate the substitution of smoking for those unwilling to quit. This pilot study assesses the harm-reduction potential of EC and ONP among smokers with low socioeconomic status (SES). Aims and Methods: Adults who smoked daily in the past 6 months, had a household income < 250% federal poverty level and had no intention of quitting smoking in the next 30 days were randomized 2:2:1 to 8 weeks of 5% nicotine EC; 4 mg ONP or assessment-only control (CC). The primary outcome was a within-group change in cigarettes per day (CPD) from Baseline to week 8. Results: Forty-five individuals were randomized (EC: N = 18; ONP: N = 18; CC: N = 9). Analyses included 33 participants who completed the week 8 visit. The mean age was 50.1 years (SD: 10.7) and the average CPD at baseline was 13.9 (SD: 10.1). For those randomized to EC, the average CPD decreased from 14.7 (95% CI: 10.3 to 19.1) at the Baseline to 2.9 (95% CI: .1 to 5.8) at week 8 (p-value < .001). For those randomized to ONP, average CPD decreased from 15.0 (95% CI: 5.0 to 24.9) to 8.3 (95% CI: 1.3 to 15.2) by week 8 (p-value = .01). In the EC and ONP groups, respectively, 4 (28.6%) and 1 (8.3%) participant fully switched from smoking to the ANDS product by week 8. Conclusions: Individuals with low SES who smoke had lower CPD after switching to EC or ONP. These findings show the potential of ANDS in helping smokers switch to less harmful devices. Implications: This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm-reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population. Clinical Trials Identifier: NCT05327439

PURPOSE: Health care costs are driven by a small proportion of patients, and it is important to identify their characteristics to effectively manage their health care needs. We examined characteristics associated with high-cost inpatient visits of elderly patients with cancer using a national sample.METHODS: We identified 574,367 inpatient visits of individuals age 65 years or older with a cancer diagnosis using the 2014 National Inpatient Sample data, an all-payer sample of inpatient stays in the United States. High-cost visits were defined as those with a total cost at or above the 90th percentile. The remaining visits were defined as the lower-cost group. We examined patients’ clinical characteristics and hospital characteristics for both groups. Logistic regression was used to identify characteristics associated with being in the high-cost group.RESULTS: The median visit cost in the high-cost group was $38,194 (interquartile range, $31,405 to $51,802), which was nearly five times the cost of the lower-cost group (median, $8,257; interquartile range, $5,032 to $13,335). Hematologic malignancies were the most common cancer in the high-cost group. Those in the high-cost group were more likely to have metastatic cancer. Compared with patients with no comorbidities, those with five or more comorbidities were four times more likely to be in the high-cost group (odds ratio, 4.08; 95% CI, 3.74 to 4.46). Patients with a greater number of procedures were also more likely to be in the high-cost group (odds ratio, 1.57; 95% CI, 1.52 to 1.61).CONCLUSION: High-cost cancer visits were five times more expensive than the remaining visits. Identification of high-cost visits and the associated factors may help provide tailored strategies to effectively manage costly inpatient admissions.