INTRODUCTION:This study examined cardiovascular disease (CVD)-related emergency department (ED) visits among children aged 0-17 years using data from the 2017-2021 National Emergency Department Sample (NEDS). METHODS:CVD-related primary diagnoses were classified at ED admissions into 14 clinically meaningful primary diagnosis categories. Unweighted counts, weighted counts, percentages, and rankings were stratified by diagnosis categories, sex, and age group. RESULTS:Among 126,376 pediatric ED visits for CVD-related primary diagnoses, the most common diagnoses were cardiac arrhythmias (48,279 ED visits; 38.2%, 95% confidence interval [CI] [36.6%, 39.8%]), essential hypertension (17,767; 14.1%, 95% CI [13.3%, 14.8%]), and congenital heart disease (14,488; 11.5%, 95% CI [10.0%, 12.9%]). Males had more CVD-related ED visits than females. Children under 5 years primarily presented with congenital heart disease and cardiac arrhythmia, while children aged 5 years and older presented with cardiac arrhythmias and essential hypertension. DISCUSSION:These findings highlight the need for targeted CVD management strategies in pediatric emergency care.

OBJECTIVE:To examine telehealth care utilization during pregnancy and in the 6 months postpartum during the COVID-19 pandemic. RESEARCH DESIGN:We used a repeated cross-sectional design to assess aggregated and standardized electronic health records (EHR) from 28 participating US health systems in the PCORnet®, National Patient-Centered Clinical Research Network. SUBJECTS:We studied women aged 18-55 years with delivery records from 2018 to 2019 (prepandemic), 2020-2021 (early pandemic), and 2022-2023 (late/postpandemic). Women with hypertension in pregnancy (HTN-PREG) were identified as those with documented hypertension 1 year prepregnancy or during pregnancy (40 wk predelivery). MEASURES:We used the International Classification of Disease Clinical Modification/Procedure Classification codes, a normalized naming system for drug names (RXnorm), and the Current Procedural Terminology/Healthcare Common Procedure Coding System to identify deliveries, hypertension, and telehealth visits. RESULTS:We examined 1,028,426 deliveries, of which 108,606 had HTN-PREG. The proportion of women with 1+ pregnancy telehealth use was higher in the early pandemic (15.8%) and late/postpandemic (16.4%) periods compared with prepandemic (0.2%). Telehealth use among HTN-PREG women was higher than among all women (0.24% prepandemic, 24.9% early pandemic, 26.8% late/postpandemic).. Among HTN-PREG women, telehealth use was lower among Hispanic women (19.2% and 23.2%) compared with NH Black (26.5% and 29.3%) or NH White (24.5% and 26.1%) women during the early and late/postpandemic periods, respectively. We observed similar patterns postpartum. All P values for comparisons were <0.001. CONCLUSIONS:These findings underscore the value of aggregate PCORnet® data infrastructure and other standardized electronic health records in analyzing health care utilization trends and racial and ethnic differences among pregnant women.

Both hypertension and polycystic ovary syndrome (PCOS) are risk factors for future cardiovascular diseases among women of reproductive age (18–44 years). We constructed an electronic health record (EHR)-based PCOS phenotype, reported PCOS prevalence, and investigated the association of PCOS and hypertension in the United States (US). This cross-sectional study used 2022 IQVIA’s Ambulatory Electronic Medical Record (AEMR)-US data (May 2023 release). We constructed a phenotype for PCOS and reported PCOS prevalence for eligible women. We then described hypertension prevalence and hypertension control estimates stratified by PCOS status. Lastly, we calculated adjusted prevalence ratios (aPR) for hypertension and hypertension control by PCOS status, adjusting for age, race, and body mass index (BMI). We analyzed records for 1,301,425 eligible women, with mean (standard deviation) age of 31.5 (7.9) years. The prevalence of PCOS was 2.1

BACKGROUND Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States. OBJECTIVES The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets. METHODS We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates. RESULTS The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged >= 40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively). CONCLUSIONS Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Cardiovascular diseases are among the leading causes of maternal morbidity and mortality in the United States. During 2010-2020, 1 in 10 severe maternal morbidities (SMMs) during delivery hospitalization was heart disease (HD)-related. This report synthesizes science, including methodologies, challenges, and opportunities, and summarizes national estimates on HD during pregnancy, focusing on congenital heart disease (CHD), cardiomyopathies (CM), valvular heart disease (VHD), arrhythmias (ARR), and heart failure (HF).Methods and Results: We analyzed large nationwide databases, including the National Inpatient Sample and the Nationwide Readmissions Database. The prevalence of HD complicating deliveries ranges from approximately 20-40 cases per 10,000 deliveries. Increasing trends were observed in CHD, ARR, and HF. HF, particularly peripartum CM, is a leading cause of adverse maternal outcomes, including in-hospital mortality and SMM. VHD prevalence has declined, whereas ARR has become the most prevalent HD during pregnancy hospitalizations. Significant gaps exist due to inconsistent definitions and methodologies, limiting comparability and clinical utility. Proposed solutions include adopting standardized definitions, developing a core outcome set, improving data quality through structured documentation and standardized data models, and using validated algorithms and indices. Collaboration among multidisciplinary teams is essential to enhance research quality.Conclusion: The efforts aligning definitions of HD, outcomes, and indices with public health measures and initiatives present an opportunity to create a unifying framework that connects patient-level data to system-wide improvements. This integration helps ensure that advances in methodology translate into better care delivery, billing accuracy, research quality, and public health surveillance, and ultimately enhance outcomes for pregnant women with HD.

Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States. The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets. We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates. The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged ≥40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively). Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity.

Introduction:Hypertensive disorders in pregnancy, including chronic and pregnancy-induced hypertension, pose significant risks to maternal health. This study evaluated the association of New York State (NYS)'s Paid Family Leave (PFL) law, implemented in 2018, with postpartum healthcare utilization among women with hypertensive disorders in pregnancy. Methods:Using commercial claims data (2017-2022) for 312 470 employed women aged 15-45 years with live births, we assessed postpartum outpatient visits, hospital admissions, and medication adherence. Results:The PFL law was associated with a 3.7%-point increase in outpatient visits within 7 days postpartum for women with chronic hypertension (from 25.9% to 29.6% in NYS, P < 0.001) and an 8.6%-point increase for women with pregnancy-induced hypertension (from 26.3% to 35.0%) in NYS, P < 0.001). The PFL law was associated with a 1.5%-point reduction in inpatient admissions for women with chronic hypertension (from 3.6% to 2.1% in NYS, P < 0.001), and a 7.1%-point improvement in antihypertensive medication adherence for women with chronic hypertension (from 26.6% to 33.8% in NYS, P < 0.001). Conclusion:Study findings suggest that PFL laws may enhance postpartum hypertension management, providing useful insights for policymakers aiming to improve maternal health outcomes through workplace policies.

Introduction: Extensive evidence shows that social inequities create health disparities. However, limited information exists on how demographic and clinical factors are associated with social inequities among older patients hospitalized with acute ischemic stroke (AIS) during COVID-19. Methods: We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS from April 1, 2020, to December 31, 2021. All patients were followed until March 31, 2023. We used US Centers for Disease Control and Prevention’s 2020 Social Vulnerability Index (SVI) and compared demographic and clinical features by SVI tertiles (low 0-0.33, moderate 0.34-0.66, high 0.67-1.0). Results: Among 249299 Medicare FFS beneficiaries with AIS, there were 57814 (23.2%) with low, 88565 (35.5%) moderate, and 102920 (41.3%) high SVI. Demographic and clinical features differed significantly across SVI tertiles. Compared to AIS patients living in low SVI communities, patients living in high SVI areas were significantly younger (median age 79.0 vs 79.9 years), more likely to be non-Hispanic Black (15.4% vs 4.3%), had more severe stroke at admission per National Institutes of Health Stroke Scale (NIHSS) score (9.4% NIHSS ≥20 vs 8.4%), more history of COVID-19 (7.7% vs 6.3%), higher proportion of death at the end of follow-up (40.4% vs 38.2%), and more comorbidities. Conclusion: Medicare patients with AIS hospitalizations live in communities with higher SVI. These data identified racial disparities and more severe outcomes among AIS patients living in areas with higher social vulnerabilities, signaling a need for multisectoral interventions and policies that impact AIS outcomes.

Introduction: Hypertension is a risk factor for cardiovascular disease, a leading cause of death among women of reproductive age (women aged 18-44 years). This study estimated hypertension prevalence and control among women of reproductive age at the national and state levels using electronic health record data. Methods: Nonpregnant women of reproductive age were included in this cross-sectional study using 2019 IQVIA Ambulatory Electronic Medical Records - U.S. national data (analyzed in 2023). Suspected hypertension was identified using any of these criteria: >= 1 hypertension diagnosis code, >= 2 blood pressure readings >= 140/90 mmHg on separate days, or >= 1 antihypertensive medication. Among women of reproductive age with hypertension, the latest blood pressure in 2019 was used to identify hypertension control (blood pressure <140/90 mmHg). Estimates were age standardized and stratified by race or Hispanic ethnicity, region, and states with sufficient data. Tukey tests compared estimates by race or Hispanic ethnicity, region, and comorbidities. Results: Among 2,125,084 women of reproductive age (62.1% White, 8.8% Black, and 29.1% other [including Hispanic, Asian, other, or unknown]) with a mean age of 31.7 years, hypertension prevalence was 14.5%. Of those with hypertension, 71.9% had controlled blood pressure. Black women of reproductive age had a higher hypertension prevalence (22.3% vs 14.4%, p<0.05) but lower control (60.6% vs 74.0%, p<0.05) than White women of reproductive age. State -level hypertension prevalence ranged from 13.7% (Massachusetts) to 36% (Alabama), and control ranged from 82.9% (Kansas) to 59.2% (the District of Columbia). Conclusions: This study provides the first state -level estimates of hypertension control among women of reproductive age. Electronic health record data complements traditional hypertension surveillance data and provides further information for efforts to prevent and manage hypertension among women of reproductive age. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Introduction: Peripartum cardiomyopathy (PPCM) is cardiomyopathy of unknown etiology occurring in pregnant people shortly before or following delivery. Cardiovascular diseases are a large contributor to maternal morbidity in the US. We estimated PPCM prevalence to understand its contribution to this burden. Methods: We used National Inpatient Sample (NIS) data, a nationally representative sample of US hospital discharge records, from 2010-2020. We identified PPCM and deliveries among people aged 15-55 years using ICD and DRG codes. We excluded discharges missing age and race or ethnicity (n=512,639), and those with other cardiomyopathy codes (n=1010), leaving 7,820,420 delivery discharges. Using NIS survey weights, we calculated PPCM prevalence by age, race and ethnicity, comorbidities, and neighborhood income and adjusted prevalence ratios (aPR) using Poisson regression. Results: After weighting, our analytic set represented 38,672,513 delivery discharges and 41,182 PPCM cases. The overall PPCM prevalence was 109.4 (95% CI: 106.0-112.7) cases per 100,000 delivery discharges (Figure). Overall, PPCM prevalence remained steady from 2010-2020, but increased with advancing maternal age and decreasing neighborhood income. The prevalence in the lowest income quartile was more than double that of the highest income quartile (aPR: 2.4, 95% CI: 2.2-2.6). Compared to non-Hispanic (NH) White people, NH Black people had the highest prevalence (aPR: 3.7, 95% CI: 3.4-3.9), followed by Native American people (aPR: 1.9, 95% CI: 1.5-2.4). Hispanic and NH Asian people both had an aPR of 0.7 (95% CI: 0.6-0.8). Compared to those with no comorbidities, PPCM prevalence was significantly higher among those with certain comorbidities, notably diabetes (aPR: 5.6, 95% CI: 5.1-6.1) and chronic hypertension (aPR: 17.1, 95% CI: 16.0-18.2). Discussion: PPCM prevalence presents significant racial and ethnic, and economic disparities. The higher PPCM prevalence among those with diabetes and hypertension emphasizes the need to strengthen management of chronic conditions. Intensification of efforts to address root causes of these disparities and to enhance cardiovascular health before and during pregnancy may be needed.

Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.

Objective: To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates. Research Design and Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program (MVP) participants with adult-onset diabetes 2011–2021, who had T1D genetic risk scores (GRS) defined as low (0-<45%), medium (45-<90%), high (90-<95%), or highest (≥95%). Results: T1D characteristics increased progressively with higher genetic risk (p<0.001 for trend). A GRS ≥90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and they resembled T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared to the low risk group, the highest risk group was more likely to have diabetic ketoacidosis (DKA) (low 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase (GAD) antibodies (6.9% vs. 45.2%), all p<0.001. Conclusions: Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates

BACKGROUND:The use of correctly sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. METHODS:This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large (>34 to ≤44 cm), and extra-large (XL) (>44 cm). RESULTS:Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. CONCLUSION:Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Background Inequities in stroke outcomes have existed for decades, and the COVID-19 pandemic amplified these inequities. Objectives This study examined the association between social vulnerability and all-cause mortality among Medicare beneficiaries hospitalized with acute ischemic stroke (AIS) during COVID-19 pandemic periods. Methods We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS between April 1, 2020, and December 31, 2021 (followed until December 31, 2023) merged with county-level data from the 2020 Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry’s Social Vulnerability Index (SVI). We used a Cox proportional hazard model to examine the association between SVI quartile and all-cause mortality. Results Among 176,123 Medicare fee-for-service beneficiaries with AIS, 29.9% resided in the most vulnerable counties (SVI quartile 4), while 14.9% resided in counties with least social vulnerability (SVI quartile 1). AIS Medicare beneficiaries living in the most vulnerable counties had the highest proportions of adults aged 65 to 74 years, non-Hispanic Black or Hispanic, severe stroke at admission, a history of COVID-19, and more prevalent comorbidities. Compared to those living in least vulnerable counties, AIS Medicare beneficiaries living in most vulnerable counties had significantly higher all-cause mortality (adjusted HR: 1.11, 95% CI: 1.08-1.14). The pattern of association was largely consistent in subgroup analyses by age group, sex, and race and ethnicity. Conclusions Higher social vulnerability levels were associated with increased all-cause mortality among AIS Medicare beneficiaries. To improve outcomes and address disparities, it may be important to focus efforts toward addressing social vulnerability.

Objective: To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates. Research Design and Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program (MVP) participants with adult-onset diabetes 2011–2021, who had T1D genetic risk scores (GRS) defined as low (0-<45%), medium (45-<90%), high (90-<95%), or highest (≥95%). Results: T1D characteristics increased progressively with higher genetic risk (p<0.001 for trend). A GRS ≥90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and they resembled T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared to the low risk group, the highest risk group was more likely to have diabetic ketoacidosis (DKA) (low 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase (GAD) antibodies (6.9% vs. 45.2%), all p<0.001. Conclusions: Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates

Objectives: To (1) determine associations between maternal risk conditions and severe adverse outcomes that may benefit from risk-appropriate care and (2) assess whether associations between risk conditions and outcomes vary by level of maternal care (LoMC).Methods: We used the 2017-2019 National Inpatient Sample (NIS) to calculate associations between maternal risk conditions and severe adverse outcomes. Risk conditions included severe preeclampsia, placenta accreta spectrum (PAS) conditions, and cardiac conditions. Outcomes included disseminated intravascular coagulation (DIC) with blood products transfusion or shock, pulmonary edema or acute respiratory distress syndrome (ARDS), stroke, acute renal failure, and a composite cardiac outcome. Then we used 2019 delivery hospitalization data from five states linked to hospital LoMC. We calculated associations between risk conditions and outcomes overall and stratified by LoMC and assessed for effect modification by LoMC.Results: We found positive measures of association between risk conditions and outcomes. Among patients with severe preeclampsia or PAS, the magnitudes of the associations with DIC with blood products transfusion or shock, pulmonary edema or ARDS, and acute renal failure were lower in Level III/IV compared with <Level III facilities. Among patients with cardiac conditions, the magnitudes of the associations with these outcomes, along with stroke, were also lower in Level III/IV compared with <Level III facilities. The proportion of patients with risk conditions that delivered in <Level III facilities was 19.8-46.8%.Conclusions: Odds of severe adverse outcomes among women with selected risk conditions were lower for births occurring at higher-level facilities, supporting the benefit of risk-appropriate care.

Objective: To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates. Research Design and Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program (MVP) participants with adult-onset diabetes 2011–2021, who had T1D genetic risk scores (GRS) defined as low (0-<45%), medium (45-<90%), high (90-<95%), or highest (≥95%). Results: T1D characteristics increased progressively with higher genetic risk (p<0.001 for trend). A GRS ≥90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and they resembled T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared to the low risk group, the highest risk group was more likely to have diabetic ketoacidosis (DKA) (low 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase (GAD) antibodies (6.9% vs. 45.2%), all p<0.001. Conclusions: Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates

BACKGROUND:Hypertension is an important risk factor for cardiovascular diseases. Electronic health records (EHRs) may augment chronic disease surveillance. We aimed to develop an electronic phenotype (e-phenotype) for hypertension surveillance. METHODS:We included 11,031,368 eligible adults from the 2019 IQVIA Ambulatory Electronic Medical Records-US (AEMR-US) dataset. We identified hypertension using three criteria, alone or in combination: diagnosis codes, blood pressure (BP) measurements, and antihypertensive medications. We compared AEMR-US estimates of hypertension prevalence and control against those from the National Health and Nutrition Examination Survey (NHANES) 2017-18, which defined hypertension as BP ≥130/80 mm Hg or ≥1 antihypertensive medication. RESULTS:The study population had a mean (SD) age of 52.3 (6.7) years, and 56.7% were women. The selected three-criteria e-phenotype (≥1 diagnosis code, ≥2 BP measurements of ≥130/80 mm Hg, or ≥1 antihypertensive medication) yielded similar trends in hypertension prevalence as NHANES: 42.2% (AEMR-US) vs. 44.9% (NHANES) overall, 39.0% vs. 38.7% among women, and 46.5% vs. 50.9% among men. The pattern of age-related increase in hypertension prevalence was similar between AEMR-US and NHANES. The prevalence of hypertension control in AEMR-US was 31.5% using the three-criteria e-phenotype, which was higher than NHANES (14.5%). CONCLUSIONS:Using an EHR dataset of 11 million adults, we constructed a hypertension e-phenotype using three criteria, which can be used for surveillance of hypertension prevalence and control.

Growing evidence suggests an increased risk of incident chronic diseases such as cardiovascular diseases (CVDs) after COVID-19. We evaluated the risk of CVDs >30 days after a COVID-19 diagnosis and compared it to a contemporaneous control group without a COVID-19 diagnosis. We included adults ≥20 years with a COVID-19 diagnosis from March 1, 2020 through December 1, 2021 from the IQVIA insurance claims database. The contemporaneous control group comprised adults with ≥1 healthcare encounter and without diagnoses for COVID-19 or other acute respiratory infections. Control group index dates were randomly selected to match the distribution of COVID-19 diagnosis dates. All diagnoses were ascertained from ICD-10 codes. Individuals with diagnostic codes of CVDs within 2 years prior to the index date were excluded. We used Cox regression models (adjusted for age, sex, health insurance type, U.S. Census division, Charlson comorbidity score) to assess the risk of incident CVDs, stratifying by diabetes status. The analytic sample included 13,078,827 adults (mean age 49.4 years [SD: 15.7], 50.2% female, and mean follow-up 8.5 months [SD: 5.8]). Among patients with and without diabetes, COVID-19 diagnosis was significantly associated with increased risk of each CVD outcome (See Figure). Regardless of diabetes status, monitoring for incident CVD may be pertinent beyond the first 30 days of COVID-19. Disclosure A.Koyama: None. M.E.Pavkov: None. G.Imperatore: None. D.B.Rolka: None. E.A.Lundeen: None. R.Rutkowski: None. S.Jackson: None. S.He: None. E.V.Kuklina: None. S.Park: None.