We used US nationwide commercial insurance claims data (2011–2015) to study the effect of social deprivation on clinical and demographic risk factors for suicidal ideation (SI) and suicide attempts (SA) among US youth and adults < 65 years, after having a mental health or substance use disorder-related outpatient encounter. Neighborhood social deprivation level was summarized by the quintile of social deprivation index (SDI) at individuals’ zip code level. Cox proportional hazard models were used to evaluate the effect of social deprivation on demographic and clinical risk factors for SI and SA. The study cohort consisted of 317,383 individuals < 65 years, with 124,424 aged < 25 (youth) and 192,959 aged between 25 and 64 (adults). Neighborhood social deprivation impacted risk factors for SI and SA differently for youth and adults. Among youth, SDI interacted with multiple risk factors for both SI and SA. The effects of the risk factors were larger on youth from middle socioeconomic neighborhoods. Among adults, risk of SI was the strongest in the most deprived neighborhoods, but risk of SA did not vary by neighborhood deprivation level. Our findings suggest community-based suicide prevention initiatives should be tailored according to neighborhood deprivation level and the targeted individual’s age to maximize the impact.

Background: Objective performance criteria (OPC) is a novel method to provide minimum performance standards and improve the regulated introduction of original or incremental device innovations in order to prevent patients from being exposed to potentially inferior designs whilst allowing timely access to improvements. We developed 2-year safety and effectiveness OPC for total hip and knee replacement (THR and TKR). Methods: Analyses of large databases were conducted using various data sources: a systematic literature review; a direct data analysis from The Functional Outcomes Research for Comparative Effectiveness in Total Joint Replacement and Quality Improvement Registry (FORCE-TJR) and the Kaiser Permanente Implant Registry (KPIR); and claims data analyses from longitudinal discharge data in New York and California states. The literature review included U.S. patients (≥18 years) who received THR or TKR for primary end-stage osteoarthritis and prospectively collected data on patient-reported outcome measures (PROMs) from at least 100 subjects and/or 2-year implant survival for at least 250 implants. Random effects models were used for meta-analysis. Results: Data were available from a total of 951 100 patients. After screening of 7979 abstracts, 294 studies underwent full-text review and 31 studies contributed to the evidence synthesis (333 995 implants). Direct data analysis of FORCE-TJR contributed 9223 joint replacement patients to the construction of OPC for effectiveness; KPIR contributed 262 044 patients for the construction of OPC for safety. Claims database analysis contributed 345 838 patients to the construction of safety OPC. OPC for safety were constructed for cumulative incidences of 2-year all-cause and septic revision (THR/TKR 2.0%/1.6% and 0.6%/0.7%), and OPC for effectiveness were constructed based on four disease-specific and three general health-related quality of life PROMs (HOOS/KOOS 87.1/80.6; HSS/KSS function 94.4/90.6; SF-12/SF-36, PCS 46.5/41.9, EQ-5D 0.88/0.84). Conclusion: This study is the first to construct a 2-year OPC for the safety and effectiveness of THR and TKR based on U.S. real-world data. Based on these OPC, potential benchmarks for (single-arm study) evaluation of new device innovations are suggested for a regulated and safe introduction to the (commercial) market.

Emerging research suggests that the extent to which activity spaces—the collection of an individual’s routine activity locations—overlap provides important information about the functioning of a city and its neighborhoods. To study patterns of overlapping activity spaces, we draw on the notion of an ecological network, a type of two-mode network with the two modes being individuals and the geographic locations where individuals perform routine activities. We describe a method for detecting “ecological communities” within these networks based on shared activity locations among individuals. Specifically, we identify latent activity pattern profiles, which, for each community, summarize its members’ probability distribution of going to each location, and community assignment vectors, which, for each individual, summarize his or her probability distribution of belonging to each community. Using data from the Adolescent Health and Development in Context Study, we employ latent Dirichlet allocation to identify activity pattern profiles and communities. We then explore differences across neighborhoods in the strength and within-neighborhood consistency of community assignment. We hypothesize that these aspects of the neighborhood structure of ecological community membership capture meaningful dimensions of neighborhood functioning likely to covary with economic and racial composition. We discuss the implications of a focus on ecological communities for the conduct of “neighborhood effects” research more broadly.

Traditional research on adverse childhood experiences (ACEs) often retrospectively assesses ACEs and treats ACEs as a composite score, potentially overlooking the distinct effects of specific ACE patterns and their critical timing, which may influence health outcomes differently. It is crucial to explore variations in the patterns and timing of ACE exposure across racial/ethnic groups to improve ACE screening and intervention strategies. In 2023, this study analyzed data of the Future of Families and Child Wellbeing Study (FFCWS) initially conducted in 1998. FFCWS sampled children from three racial/ethnic groups (N_Black = 2,587; N_Latine = 1,577; N_White = 770). ACEs were assessed through seven indicators from ages three to 15, including physical and psychological abuse, neglect, witnessing maternal intimate partner violence (IPV), parental depression, separation, and material hardship. Using Longitudinal Latent Class Analysis (LLCA), this research aimed to identify distinctive patterns and timing of ACEs among White, Black, and Latine youth. The analysis revealed a 9-class model applicable to these three racial/ethnic youth groups. Classes combining material hardship with other ACEs and those featuring adolescent abuse were more prevalent among Black and Latine youth. This study also identified a class displaying a temporal pattern, such as early maternal IPV followed by late parental separation. This study highlights the necessity of analyzing diverse class structures and the timing of ACEs across different racial/ethnic groups. Understanding these nuances is vital for developing culturally tailored interventions to reduce health disparities.

Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011–2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event. At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%−10.26% for SI; 0.70%−2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46). To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.