OBJECTIVE:Major successes in improving health in the United States during the past century have occurred as our nation moved through the epidemiologic transition from high infectious disease mortality to predominantly chronic disease mortality. The objective of this study was to identify successes in improving America's health in the first 2 decades of the 21st century. METHODS:We identified leading causes of death among US adults with age-adjusted mortality rates that declined by ≥20% from 2000 to 2019. RESULTS:Eleven disease categories achieved a ≥20% mortality reduction, including the leading causes of death in the United States (heart disease, stroke, cancer) and 2 infectious diseases. Seven of the 11 "success" conditions were forms of cancer, showing progress in screening, early diagnosis, treatment, and cure. A cautionary note is warranted for conditions with increasing cause-specific mortality, such as brain diseases, suicide, drug overdose, accidental deaths, and liver disease. CONCLUSIONS:The impact of research innovation translated into prevention and medical care is clearer with each passing decade. Similar strategies that prioritize behavioral health will be needed to reverse conditions with worsening mortality. Successful public health strategies have continued to reduce mortality from somatic "below-the-neck" causes, but parallel strategies are needed to address mental health, substance use, health behaviors, and healthy aging.

Deaths of despair (15+ years) are described for two peer county groups. Each county experienced competitive, transitional, or monopoly governance based on the duration of one political party's control. Highest mortality among non-Hispanic Black (Black) people occurred in monopolies, affecting all age-sex-specific groups from 15-19 to 65-69. Transition to Democratic or Republican party monopolies produced similar overall trends. Governance by the same political party produced different rates depending on the length of one-party control. Black: White mortality rate ratios were reduced or reached 1.0 in competitive counties, and 51,801 fewer Black deaths might have occurred in monopoly counties based on competitive rates. The association between duration of one-party control and death rates was statistically significant and independent of state gun law strength. The data generate a hypothetical framework for structural racism based on political privilege/political monopoly rather than racial privilege/political affiliation. Analytic epidemiologic research is needed for testing.

Firearm homicides are a leading cause of death among American teens. While the impact of gun laws has received attention, the effects of political election outcomes over time as a determinant of health have received far less attention. Teen firearm homicide rates for 2001-2020 are therefore described according to race/ethnicity and mayoral political competition in two peer county groups, each matched for 19 socio-demographic factors. Non-Hispanic Black (Black) teen firearm homicides were highest in counties with political monopolies (one-party governance for >24 years throughout) compared to politically competitive counties. If competitive county rates had occurred in monopoly counties, estimated Black teen firearm homicide deaths would have declined from 6,912 to 3,424, independent of state gun law strength. Results generate a hypothetical framework for structural racism affecting teen homicide in these counties based primarily on political privilege and monopoly governance rather than racial privilege and political affiliation. An analytic epidemiologic study is needed to test these hypotheses.

To date, much of the local, state, and federal policy designed and implemented regarding violent crime has followed principles of retributive justice, with a punitive approach toward offenders. This approach stands in contrast to restorative justice, which emphasizes inclusion of victims' rights and relationships between offender, victim, and community. To address the effectiveness of these policies, we use state-level panel data to test the impact of one such restorative policy, victim-offender dialogue, on the violent crimes of homicide, assault, and robbery. Using a doubly robust difference-in-difference model, we find little support for victim-offender dialogue policy's ability to reduce violence. While states that passed this legislation saw an uptick in crime prior to the policy's enactment, this trend was not mitigated with the introduction of victim-offender policies.

When we think about violence in America, what typically comes to mind is the kinetic type of violence, committed by individuals, that takes the form of mass killings. This type of violence is horrific and generates universal revulsion, but there is another type of violence that is less noticeable, and neither captures the full attention of the media nor is a topic that involves policy discussions in a way that mass violence sometimes does. This is an insidious, lethal kind of violence known as structural violence that manifests itself in the premature death of numerous Americans. We demonstrate the widespread lethality associated with structural violence by examining the life expectancies of residents of Texas’ 254 counties, where we highlight the disparities that exist in how long different groups of county residents are likely to live. We also show that this is a problem that can be solved, or at least ameliorated, with uncontroversial policy actions, and these include not enacting policies that reduce political competition and the likelihood of political change because the results we present show clearly that political competition and change are conditions that improve public health outcomes.

The impact of political competition on opioid-related mortality in the United States is examined in urban metropolitan counties (2001 to 2024). County groups were matched for 19 socio-demographic factors, and each county was categorized as having competitive, transitional, or monopoly mayoral governance based on duration of one-party control. There is higher opioid mortality in Black people versus White people from both prescription and non-prescription opioids in monopoly versus competitive counties. Rather than bringing health stability, mayoral political monopolies potentially harm vulnerable populations and strengthen structural racism based on political privilege. Interestingly, the political party itself is not the factor; duration of party control drives the observed disparate opioid mortality. We hypothesize a framework for understanding structural racism in opioid mortality based on political privilege and monopoly rather than racial privilege and political party affiliation. Analytic epidemiologic studies are needed to test the extent to which political control affects opioid outcomes.

BACKGROUND:In the United States (US) and worldwide alcohol is a major contributor to premature mortality and morbidity. We explored US trends in alcohol related mortality from 1999 to 2020 overall and by age, gender, race, and region METHODS: Publicly available US Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) and the underlying cause of death file from CDC WONDER using ICD-10 codes. RESULTS:In 1999, there were 19,356 alcohol-related deaths, a mortality rate of 10.7 per 100,000. By 2020, deaths increased to 48,870 or 21.6 per 100,000. Overall, the mortality rate ratio (MRR) was significantly increased by about 2.0-fold. There were significant increases in all 10-year age groups with the largest 3.8-fold in those 25 to 34. Women experienced a 2.5-fold increase; Asians and Pacific Islanders had the largest increase of 2.4-fold; and the Midwest showed the largest regional increase of 2.5-fold. CONCLUSIONS:During the last 20 years there have been significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity, and diabetes, alcohol, overweight and obesity all cause liver damage which may be additive and lead to earlier onset of alcohol related mortality. In addition, health providers should also consider demographic shifts and regional differences. Targeted interventions by health care providers may reduce this increasing US epidemic of alcohol related mortality. These data also generate many hypotheses testable in analytic studies designed a priori to do so.

Objectives We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022.Methods We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death.Results In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364 days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning due to exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics.Conclusions Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations.

Background: The use of electronic vapor products (EVPs) increases the risks of nicotine addiction, drug-seeking behavior, mood disorders, and avoidable premature morbidities and mortality. We explored temporal trends in EVP use among US adolescents. Methods: We used data from the Youth Risk Behavior Survey for school grades 9 through 12 from 2015 (earliest available data) to 2021 (the most recently available data) from the US Centers for Disease Control and Prevention (n=57,006). Results: Daily use of EVPs increased from 2.0% in 2015 to 7.2% in 2019, a greater than 3.5-fold increase. Although the percentage decreased to 5.0% in 2021, it was still a >2.5-fold increase since 2015. In 2015, the percentage of EVP use was significantly higher in boys (2.8%) than girls (1.1%). By 2021, the percentage of EVP use was higher in girls (5.6%) than boys (4.5%), a 1.24-fold increase. In addition, the percentage of EVP use in 2021 was higher in White youth (6.5%) vs Black (3.1%), Asian (1.2%), and Hispanic/Latino (3.4%) youth compared to 2015, but White and Black adolescents had the highest increases of approximately 3.0-fold between 2015 and 2021. Adolescents in grade 12 had the highest percentages of EVP use at all periods. Conclusion: These data show alarming statistically significant and clinically important increases in EVP use in US adolescents in school grades 9 through 12. The magnitude of the increases may have been blunted by coronavirus disease 2019, a hypothesis that requires direct testing in analytic studies. These trends create clinical and public health challenges that require targeted interventions such as mass media campaigns and peer interventions to combat the influences of social norms that promote the adoption of risky health behaviors during adolescence.

In this original research we present new emerging data in COVID-19 that create urgent challenges for health providers in prevention and treatment. Health providers should be aware that COVID-19 cases, hospitalizations, and deaths have increased markedly in August 2023. Further, recent data demonstrate a new emerging strain resistant to prior natural and vaccine immunity. The most recent emerging data show that only this updated COVID-19 vaccine produces the same immune response as previous vaccines that reduced mortality by over 95 % and morbidity by over 99 %. This recommendation encompasses all adults and children aged 6 months and older, regardless of whether they have had a prior COVID-19 infection or even if they have never received a prior vaccination. This updated COVID-19 vaccine, approved in September 2023, will be the best means to prevent COVID-19 during this upcoming season of respiratory viruses. In the meanwhile, all members of the US population regardless of previous natural infection, vaccines, or boosters are equally susceptible. At present, health providers should counsel all their patients about masking, social distancing, and avoiding crowds, especially indoors where regions of extreme weather conditions are keeping people indoors in closed quarters. In the treatment of COVID-19 the major clinical challenge to health providers, especially in their Black patients, is to prescribe Paxlovid during the first 5 days after onset of symptoms and a positive test.

We explored temporal trends and geographic variations in United States of America (US) mortality rates from smoking and firearms from 1999 to 2019. To do so, we used the publicly available Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research (WONDER) with Multiple Cause of Death files from 1999 to 2019. Using age-specific rates and ArcGIS Pro Advanced software for Optimized Hot Spot Analyses from Esri, we generated maps of statistically significant spatial clusters with 90-99% confidence intervals with the Getis-Ord Gi* statistic for mortality from smoking-related causes and firearms. These data show temporal trends and geographic variations in mortality from smoking and firearms in the US. Smoking and firearm-related mortality from assault and suicide increased throughout the US and clustered in the Southeast. Firearm-related suicide also clustered in the continental West and Alaska. These descriptive data generate many hypotheses which are testable in analytic epidemiologic studies designed a priori to do so. The trends suggest smoking and firearm-related causes pose particular challenges to the Southeast and firearms also to the West and Alaska. These data may aid clinicians and public health authorities to implement evidence-based smoking avoidance and cessation programs as well as address firearm mortality, with particular attention to the areas of highest risks. As has been the case with cigarettes, individual behavior changes as well as societal changes are likely to be needed to achieve decreases in premature mortality.

OBJECTIVE: Our objective was to explore evolving trends in US drug overdose mortality, overall and by age, sex, race, urbanization, and geography from 1999-2020. METHODS: This is a descriptive epidemiologic study. We used the US Centers for Disease Control and Pre-vention Wide-ranging Online Data for Epidemiologic Research and Multiple Cause of Death files from the National Center for Health Statistics. We used crude and age-adjusted cause of death and mortality rate ratios as measures of effects and 95% confidence limits to test for significance. RESULTS: From 1999-2020, drug overdoses caused 1,013,852 deaths and 4.3-fold increase in mortality rate ratios. Subgroup findings were sex (4.5 men, 4.0 women), race (4.6 White, 3.9 Black or African American, 4.0 Asian or Pacific Islanders, 5.1 Native Americans or Alaskan Natives), age (highest 5.6 in 25-34 years, lowest 1.1 in 75-84, and 0.77 in 85+), geography (highest 6.0 in Midwest, lowest 2.6 in West), and urbani-zation (highest 6.2 in non-metro, lowest 3.7 in metro). CONCLUSIONS: Drug overdoses in the United States from 1999-2020 increased 4.3-fold, with the highest increase in White and Native American or Alaskan Native populations, and Midwest and non-metro areas. The data create preventive and therapeutic challenges, including restrictions on pharmaceutical industries and enhanced efforts by health care providers in safer prescribing. Addiction care should be integrated into all clinical practices, regardless of specialty, and into undergraduate, graduate, and continuing medical education. Targeted interventions are needed to adequately assess patients and provide care. Analytic stud-ies designed a priori are necessary to test hypotheses formulated from these data.(c) 2023 Elsevier Inc. All rights reserved.

Background: Cigarette smoking remains the leading avoidable cause of premature death in the United States, accounting for approximately 500,000, or 1 in 5, deaths annually. We explored trends in cigarette smoking among US adolescents. Methods: We used data for adolescents in grades 9 through 12 from 1991 to 2021 from the Youth Risk Behavior Survey provided by the US Centers for Disease Control and Prevention. We explored trends overall as well as by sex, race/ethnicity, and school grade. Results: All cigarette use-assessed as ever, occasional, frequent, or daily-among adolescents declined markedly from 1991 to 2021. Specifically, ever use significantly decreased from 70.1% in 1991 to 17.8% in 2021 (P<0.05), an almost 4-fold decline. Occasional use significantly decreased from 27.5% in 1991 to 3.8% in 2021 (P<0.05), a greater than 7-fold decline. Frequent use significantly decreased from 12.7% to 0.7%, a greater than 18-fold decline. Daily use declined from 9.8% in 1991 to 0.6% in 2021, a greater than 16-fold decline. Cigarette smoking significantly decreased from 1999 to 2021 across sex, race/ethnicity, and school grade (P<0.05). In 2021, daily use was higher in boys vs girls; Hispanic/Latino and White youth vs Black and Asian youth; and 12th graders vs 9th, 10th, and 11th graders. Conclusion: These data show large and significant decreases in cigarette use among US adolescents in high school grades 9 through 12 from 1991 to 2021. Nonetheless, the data also suggest residual clinical and public health challenges that will require targeted interventions.

Background: Geographic patterns of lung cancer mortality rate differ in the region bordering Mexico in contrast to the US. This study compares lung cancer mortality between border and non-border counties by race/ethnicity and gender.Methods: This study utilized population-level death certificate data from US Centers for Disease Control and Prevention Public Internet Wide-Ranging Online Data for Epidemiologic Research dataset between 1999 and 2020. Established algorithms were implemented to examine lung cancer deaths among US residents. We analyzed the age-adjusted data by year, race/ethnicity, gender, and geographic region. Joinpoint regression was used to determine mortality trends across time.Results: Lung cancer mortality rates were lower in border counties compared to non-border counties across time (p < 0.05). Hispanic lung cancer mortality rates were not different in border counties compared to non-border counties during the same period (p > 0.05). Lung cancer mortality among non-Hispanic White living in border counties was lower than non-Hispanic White residing in non-border counties (p < 0.01), and non-Hispanic Black living in border counties had lower lung cancer mortality than non-Hispanic Black in non-border counties in all but three years (p < 0.05). Both female and male mortality rates were lower in border counties compared to nonborder counties (p < 0.05).Conclusion: Differences in lung cancer mortality between border counties and non-border counties reflect lower mortality in Hispanics overall and a decline for non-Hispanic White and non-Hispanic Black living in border counties experiencing lower lung cancer mortality rates than non-border counties. Further studies are needed to identify specific causes for lower mortality rates in border counties.

BACKGROUND: Alcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States, between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C. METHODS: We utilized the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database to compare trends in mortality from alcoholic cirrhosis in the United States in 1999 and 2019. We defined mortality from alcoholic cirrhosis as International Classification of Diseases code K70.3 (alcoholic cirrhosis of liver). We calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from 25 to 85+ as measures of effect and 95% confidence intervals to test for significance. RESULTS: In 1999, there were 6007 deaths from alcoholic cirrhosis among 180,408,769 aged 25-85+ years, yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 aged 25-85+ years, yielding a mortality rate of 10.6 per 100,000. The overall MRR of 3.2 was statistically significant. (P < .001), and was apparent in each 10-year age group. CONCLUSIONS: These alarming trends in mortality from alcoholic cirrhosis in the United States contribute to the formulation of many hypotheses. These require testing in analytic studies designed a priori to do so. Meanwhile, clinical and public health efforts are necessary to curb the epidemics of heavy alcohol consumption and overweight and obesity in the United States that may be contributing to these alarming trends. (C) 2022 Elsevier Inc. All rights reserved.

In the United States (US), morbidity and mortality from pediatric asthma are increasing. We explored racial inequities using the Multiple Causes of Death Files of the US National Center for Health Statistics and the Wide-ranging Online Data for Epidemiologic Research (WONDER) for 1-14year-olds from 1999 to 2018. We obtained mortality rates, Black:White mortality rate ratios (MRRs) and Annual Percent Change (APC). We tested for significance with 95% confidence intervals and joinpoint regression. Of 2,731 deaths from asthma, Blacks comprised 65.25% and 21.25% of the population. Black:White MRRs were 6.43 for 1-4, 7.54 for 5-9 and 6.88 for 10-14-year-olds of 6.88. The APC decline of -2.56 (p < 0.05) was significant among Whites but not Blacks. MRRs increased significantly from 4.23 in 2000 to16.57 in 2015 and declined to 6.69 in 2018. Among Black boys and girls, mortality rates were highest in Large Central Metropolitan areas. For Whites, rates were similar by urbanization in girls but were highest in Non-core, Non-metropolitan rural areas in boys. These descriptive data demonstrate statistically significant racial inequities in mortality from pediatric asthma in the US. They generate hypotheses, including, but not limited to, those related to under-resourced families and communities as well as economic and social marginalization. These and other plausible hypotheses require direct testing in analytic epidemiologic studies designed a priori to do so. In the meanwhile, efforts are necessary to strengthen community-driven initiatives and focus attention on inequitable systems, hierarchies, social structure and institutional practices. These include multifactorial interventions for individual, environmental and societal risk factors and educational efforts toward health-care providers and their patients about structural racism; these may combat, at least in part, vulnerabilities in US children and youth and improve racial inequities overall and from pediatric asthma.

Background: Coronavirus disease 2019 (COVID-19) produces a wide array of deleterious consequences, some of which are unintended. Data are sparse on whether, and if so, how, current cigarette smoking habits are affected by COVID-19. We describe changes to smoking habits and their correlates during the COVID-19 pandemic among participants in a tobacco cessation and lung cancer screening program. Methods: Between June and October 2020, we conducted a cross-sectional survey of a convenience sample of 150 participants in a lung cancer screening and tobacco cessation program. The survey consisted of 3 parts: (1) changes in tobacco use, (2) impact and coping strategies toward COVID-19, and (3) COVID-19 exposure and use of protective measures. Demographic variables included age, sex, race/ethnicity, and marital status. Results: All 150 participants who were contacted agreed to participate in this cross-sectional survey. The statistically significant correlates of increased tobacco use were high uncertainty about the future (P<0.001), loneliness because of social distancing or self-isolating (P<0.001), anger or frustration with how the pandemic has disrupted daily life (P<0.001), boredom resulting from inability to work or engage in regular daily activities/routines (P<0.001), desire to cope using alcohol or drugs (P=0.002), sadness or feelings of hopelessness (P=0.003), and worry or fear about challenges to securing basic needs such as groceries or medication (P<0.001). In contrast, those who smoked less were more likely to practice social distancing (P=0.002) and use protective measures (P=0.005). Conclusion: Among those who decreased or stopped smoking, correlates included greater use of protective measures for COVID-19, including social distancing and testing. These data may aid healthcare providers to identify and provide counsel to cigarette smokers at greater risks for increasing tobacco consumption during stresses such as COVID-19.