Objective: To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate. Design: Retrospective cohort. Exposure: Initial infertility evaluation and treatment utilization. Main Outcome Measures: The prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult vs. census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index (ADI) were considered determinants of treatment utilization in regression analysis. Results: A total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared with census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared with the NH Asian reference group (35.7 +/- 5.1 vs. 34.6 +/- 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared with 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23% and 21%, respectively) compared with 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (odds ratio [OR]: 0.79 [95% confidence interval 0.71-0.87], for other vs. private insurance; OR: 0.62 [0.53-0.72], for ADI quintile 5 vs. 1, OR: 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR: 0.96 [0.93-1.00] for each 5-year increase). Conclusions: Relative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization. (Fertil Steril (R) 2025;123:709-17. (c) 2024 by American Society for Reproductive Medicine.)

It has been hypothesized that ultraviolet (UV) radiation can lead to depletion of plasma folate and B12 vitamin, but few studies have investigated effects of other parameters of solar and geomagnetic activity (SGA). We investigated the association between four SGA parameters—interplanetary magnetic field (IMF), sunspot number (SSN), Kp index, and ground shortwave solar radiation (SWR)—and three plasma B-complex vitamins—folate, B6, and B12—in 910 participants from the Normative Aging Study (NAS) between 1998 and 2017. Mixed-effects regression models were used for 1- to 28-moving day averages of SGA exposure, adjusted for covariates. We compared the impact of SGA in individuals under higher and lower B-complex supplementation (> or < 50th quartile). Our findings show that increases in solar activity variables IMF and SSN were found to be significantly associated with decreases in B12 vitamin. IMF and SSN were associated with decrease in folate levels, especially in individuals under higher levels of B-complex supplementation. No associations were found for SWR and Kp index. To our knowledge, this is the first study that demonstrated the detrimental impact of solar activity on plasma B12 and folate in a large cohort. These findings have clinical implications during periods of high solar activity.

We examined the effect of annual exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), on the rate of first hospitalization with a PD-related diagnosis (hospitalization with PD) among Medicare Fee-for-Service beneficiaries (2001-2016). Machine learning-derived annual air pollution concentrations were linked to residential ZIP codes. For each exposure, we fitted four models: 1) traditional outcome stratification, 2) marginal structural, 3) doubly robust, and 4) generalized propensity score matching Poisson regression models, adjusted for sociodemographic and meteorological confounders and long-term trends. Among 49,121,026 beneficiaries, incidence rate ratios of 1.08 (95% CI: 1.07, 1.10), 1.07 (95% CI: 1.05, 1.08), and 1.03 (95% CI: 1.02, 1.05) for an interquartile range increase in PM2.5 (3.72 mu g/m3), NO2 (13.84 ppb), and O3 (10.09 ppb), respectively, were estimated from doubly robust models. Results were similar across modeling approaches. In this nationwide study, higher air pollution exposure increased the rate of hospitalizations with PD.

Background: Radon (222Rn) decay products can attach to particles in the air, be inhaled, and potentially cause airway damage.Research question: Is short-term exposure to particle radioactivity (PR) attributable to radon decay products emitted from particulate matter <= 2.5 mu m in diameter (PM2.5) associated with pulmonary function in chronic obstructive pulmonary disease (COPD) patients? Study design and methods: In this cohort study, 142 elderly, predominantly male patients with COPD from Eastern Massachusetts each had up to 4 one-week long seasonal assessments of indoor (home) and ambient (central site) PR and PM2.5 over the course of a year (467 assessments). Ambient and indoor PR were measured as alpha-activity on archived PM2.5 filter samples. Ratios of indoor/ambient PR were calculated, with higher ratios representing PR from an indoor source of radon decay. We also considered a measure of outside air infiltration that could dilute the concentrations of indoor radon decay products, the indoor/ambient ratio of sulfur concentrations in PM2.5 filter samples. Spirometry pre-and post-bronchodilator (BD) forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were conducted following sampling. Generalized additive mixed models were adjusted for meteorologic variables, seasonality, and individual-level determinants of pulmonary function. We additionally adjusted for indoor PM2.5 and black carbon (BC).Results: PR exposure metrics indicating radon decay product exposure from an indoor source were associated with a reduction in FEV1 and FVC. Patients in homes with high indoor PR (>= median) and low air infiltration (26.9 (95% CI: -61.4, 7.7) mL and -75.4 (95% CI: -128.6, -22.2) mL reduction in post-BD FEV1 and FVC, respectively. These associations remained similar after PM2.5 and BC adjustment. Interpretation: Our findings raise concern about the harmful effects of PR exposures attributable to residential radon on pulmonary function in patients with COPD.

BACKGROUND:Solar activity has been linked to biological mechanisms important to pregnancy, including folate and melatonin levels and inflammatory markers. Thus, we aimed to investigate the association between gestational solar activity and pregnancy loss. METHODS:Our study included 71,963 singleton births conceived in 2002-2016 and delivered at an academic medical center in Eastern Massachusetts. We studied several solar activity metrics, including sunspot number, Kp index, and ultraviolet radiation, with data from the NASA Goddard Space Flight Center and European Centre for Medium-Range Weather Forecasts. We used a novel time series analytic approach to investigate associations between each metric from conception through 24 weeks of gestation and the number of live birth-identified conceptions (LBICs) -the total number of conceptions in each week that result in a live birth. This approach fits distributed lag models to data on LBICs, adjusted for time trends, and allows us to infer associations between pregnancy exposure and pregnancy loss. RESULTS:Overall, the association between solar activity during pregnancy and pregnancy loss varied by exposure metric. For sunspot number, we found that an interquartile range increase in sunspot number (78·7 sunspots) in all of the first 24 weeks of pregnancy was associated with 14·0 (95% CI: 6·5, 21·3) more pregnancy losses out of the average 92 LBICs in a week, and exposure in weeks ten through thirteen was identified as a critical window. Although not statistically significant, higher exposure to Kp index and to UV radiation across all 24 weeks of pregnancy was associated with more and less pregnancy losses, respectively. CONCLUSION:While exposure to certain metrics of solar activity (i.e., sunspot number) throughout the first 24 weeks of pregnancy may be associated with pregnancy losses, exposure to other metrics were not. Solar activity is a complex phenomenon, and more studies are needed to clarify underlying pathways.

The radioactive component of particulate matter (PM), particle radioactivity (PR), can continue to emit radiation after inhalation. While PR has been associated with other adverse pregnancy outcomes, no studies have examined the association with fetal growth. Our retrospective cohort included singleton pregnancies that underwent obstetric ultrasounds at an academic medical center in Massachusetts from 2011 through 2016. PR was represented by particle gross β-activity estimated from an ensemble model and was assigned based on residential zip code. We considered the cumulative (conception until date of fetal growth measurement) and first 16 weeks of gestation PR exposure windows. Standardized z-scores were constructed for biparietal diameter (BPD), head circumference, femur length (FL), abdominal circumference (AC), and birth weight. We used linear mixed regression models adjusted for PM ≤2.5 μm exposure, maternal sociodemographic factors, meteorological variables, and long-term trends. Among 9404 pregnancies, an interquartile range increase in cumulative PR exposure was associated with reduced BPD (−0.06 [95

To examine sociodemographic factors associated with access to infertility services based on race/ethnicity in a state with a comprehensive infertility mandate. This is a retrospective cohort study of women 20-44 years old presenting for an initial infertility evaluation from January 2010 – December 2021 at an academic-affiliated fertility center. Women residing outside Massachusetts were excluded. The prevalence ratio of women presenting for initial consult over census-based estimates of the number of reproductive-aged women in each racial/ethnic group living in the state was calculated. Age at time of initial consult and insurance coverage status were obtained. Distance to nearest affiliated fertility center and area deprivation index (ADI) were determined based on residential address. Regression analysis was then performed to determine which factors impacted treatment utilization. A total of 16,160 women presenting for an infertility consult over this period met inclusion criteria. Racial/ethnic groups with <20 individuals were suppressed for privacy protection. The prevalence ratios of initial consults demonstrated that the Non-Hispanic Asian and Non-Hispanic White populations were consistently overrepresented, relative to Non-Hispanic Black and Hispanic populations. The prevalence ratio of women with Two or More Races notably increased over time (1.2 in 2010 to 1.9 in 2021). The mean age of presentation was higher in Non-Hispanic Black women compared to the overall population (35.7 +/- 5.1 vs 34.9 +/- 4.7 years old). A lower proportion of Hispanic and Non-Hispanic Black women had private insurance (78 and 79% respectively, compared to 84% overall). Over a fifth of Hispanic and Non-Hispanic Black women lived in the most disadvantaged ADI quintile (23 and 21%, respectively) compared to 8% of the overall population. In the regression analysis, the absence of private insurance and a high ADI (more disadvantaged) was negatively correlated with overall treatment utilization (OR 0.79 95% Confidence Interval [CI] 0.71-0.87 for no private insurance vs. private insurance; OR 0.62 95% CI 0.53-0.72 for ADI 5 vs. 1), whereas driving distance to nearest affiliated fertility center did not appear to have an impact (OR 1.08 95% CI 0.93-1.26). Non-Hispanic Black and Hispanic women are the most underrepresented racial/ethnic groups seen for an infertility evaluation at our center. These populations are less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization.

Background: Solar and geomagnetic activity have been shown to suppress melatonin and to degrade folate levels, important hormones for fetal development. We examined whether solar and geomagnetic activity were associated with fetal growth.Methods: We included 9573 singleton births with 26,879 routine ultrasounds at an academic medical center in Eastern Mas-sachusetts from 2011 through 2016. Sunspot number and Kp index were obtained from the NASA Goddard Space Flight Center. Three exposure windows were considered, including the first 16 weeks of pregnancy, one month prior to fetal growth measurement, and conception until fetal growth measurement (cumulative). Ultrasound scans from which we ex-tracted biparietal diameter, head circumference, femur length, and abdominal circumference measurements were catego-rized as anatomic (<24 weeks' gestation) or growth scans (>= 24 weeks' gestation) based on clinical practice. Ultrasound parameters and birth weight were standardized, and linear mixed models adjusted for long-term trends were fitted.Results: Prenatal exposures were positively associated with larger head parameters measured <24 weeks' gestation, nega-tively associated with smaller fetal parameters measured >= 24 weeks' gestation, and not associated with birth weight. The strongest associations were observed for cumulative exposure in growth scans, where an interquartile range increase in sunspot number (32.87 sunspots) was associated with a -0.17 (95 % CI: -0.26, -0.08), -0.25 (-0.36, -0.15), and -0.13 (95 % CI: -0.23, -0.03) difference in mean biparietal diameter, head circumference, and femur length z-score, respectively. An interquartile range increase in cumulative Kp index (0.49) was associated with a -0.11 (95 % CI: -0.22, -0.01) and -0.11 (95 % CI: -0.20, -0.02) difference in mean head circumference and abdominal circumfer-ence z-score, respectively, in growth scans.Conclusions: Solar and geomagnetic activity were associated with fetal growth. Future studies are needed to better under -stand the impact of these natural phenomena on clinical endpoints.

This study investigated the associations between solar and geomagnetic activity and circulating biomarkers of systemic inflammation and endothelial activation in the Normative Aging Study (NAS) cohort. Mixed effects models with moving day averages from day 0 to day 28 were used to study the associations between solar activity (sunspot number (SSN), interplanetary magnetic field (IMF)), geomagnetic activity (planetary K index (K p index), and various inflammatory and endothelial markers. Biomarkers included intracellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), C-reactive protein (CRP), and fibrinogen. After adjusting for demographic and meteorological variables, we observed significant positive associations between sICAM-1 and sVCAM-1 concentrations and solar and geomagnetic activity parameters: IMF, SSN, and K p . Additionally, a negative association was observed between fibrinogen and K p index and a positive association was observed for CRP and SSN. These results demonstrate that solar and geomagnetic activity might be upregulating endothelial activation and inflammation.

BACKGROUND AND AIM: Solar activity, which induces disturbances of the Earth's magnetic field, periodically oscillates between minimum and maximum sunspot activity in cycles of approximately 11-years. Exposure to broad-spectrum electromagnetic solar activity can adversely affect human physiology, leading to adverse health outcomes. Recent epidemiological studies have shown that solar and geomagnetic activity are associated with chronic diseases, including cardiovascular diseases (CVD). However, the impact of solar activity on biomarkers for CVD, including biomarkers for endothelial function and inflammation in a large cohort, has not been previously studied. This study investigated the associations between solar and geomagnetic activity and circulating biomarkers of systemic inflammation and endothelial activation in the Normative Aging Study (NAS) cohort. METHODS: Mixed effects models with moving day averages from day 0 to day 28 were used to study the associations between solar activity [sunspot number (SSN) and interplanetary magnetic field (IMF)], geomagnetic activity [planetary K index (Kp index)] and various inflammatory and endothelial markers. Biomarkers included intracellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), C-reactive protein (CRP), and fibrinogen. RESULTS: After adjusting for demographic and meteorological variables, we observed significantly positive associations between sICAM-1 and sVCAM-1 concentrations and solar and geomagnetic activity parameters: IMF, SSN, and Kp index. Additionally, a negative association was observed between fibrinogen and Kp index and a positive association was observed for CRP and SSN. CONCLUSION: These results demonstrate that solar and geomagnetic activity might be upregulating endothelial activation and inflammation. KEYWORDS: Endothelial Activation, Inflammation, Solar Activity, Geomagnetic Activity, Geomagnetic Disturbance

Background and aim: Solar and geomagnetic activity have been previously shown to suppress melatonin, which is an important hormone for fetal development. We explored whether solar and geomagnetic activity were associated with fetal growth. Methods: We included singleton births with routine ultrasounds at an academic medical center in Eastern Massachusetts from 2011 through 2016. Sunspot number (SSN), interplanetary magnetic field (IMF), and Kp index were obtained from the NASA Goddard Space Flight Center. Three exposure windows were considered, including the first 16 weeks of pregnancy, one month prior to fetal growth measurement, and conception until fetal growth measurement (cumulative). Ultrasound scans from which we extracted biparietal diameter (BPD), head circumference (HC), femur length (FL), and abdominal circumference measurements were categorized as anatomic (<24 weeks' gestation) or growth scans (≥24 weeks' gestation). Ultrasound parameters and birth weight were standardized, and linear mixed models adjusted for seasonality, long-term trends, meteorological factors, and maternal characteristics were fitted. Results: Among 9,428 pregnancies, prenatal exposure was negatively associated with ultrasound parameters among growth scans. Associations varied by exposure window, solar metric, and fetal growth parameter. Cumulative exposure to solar and geomagnetic activity was important across exposure metrics, where an interquartile range (IQR) increase in SSN was associated with a -0.20 (95% CI: -0.30, -0.11), -0.28 (95% CI: -0.39, -0.17), and -0.16 (95% CI: -0.26, -0.06) difference in average BDP, HC, and FL z-scores, respectively. Cumulative IMF and Kp index were also associated with reduced average HC, -0.23 (95% CI: -0.36, -0.10) and -0.14 (95% CI: -0.24, -0.03) z-score difference per IQR increase, respectively. Conclusions: Solar and geomagnetic activity were associated with reduced fetal growth. Future studies are needed to better understand the impact of these natural phenomena on clinical endpoints. Keywords: fetal growth, solar activity, pregnancy

Background: Increased solar and geomagnetic activity (SGA) may alter sympathetic nervous system activity, reduce antioxidant activity, and modulate physiochemical processes that contribute to atmospheric aerosols, all which may reduce pulmonary function. Objectives: Investigate associations between forced expiratory volume at 1 s (FEV1) and forced vital capacity (INC) with SGA, and assess whether SGA enhances adverse effects of particulate pollution, black carbon (BC) and particulate matter <= 2.5 mu m in diameter (PM2.5). Methods: We conducted a repeated measures analysis in 726 Normative Aging Study participants (Boston, Massachusetts, USA) between 2000 and 2017, using interplanetary magnetic field (IMF), planetary K index (Kp) sunspot number (SSN) as SGA measures. Linear mixed effects models were used to assess exposure moving averages up to 28 days for both SGA and pollution. Results: Increases in IMF, Kp Index and SSN from the day of the pulmonary function test averaged through day 28 of were associated with a significant decrement in FEV1 and FVC, after adjusting for potential confounders. There were greater effects for longer moving averages and enhanced effects of PM2.5 and BC on FEV1. and FVC with increased SGA. For example, for each inter-quartile increase (4.55 mu g/m3) in average PM2.5 28 days before testing, low IMF (10th percentile: 3.2 nT) was associated with a -21.4 ml (95 % CI: -60.8,18.1) and -7.1 ml (95 %CI: - 37.7, 23.4) decrease in FVC and FEV1, respectively; high IMF (90th percentile: 9.0 nT) was associated with a -120.7 ml (95 % CI:166.5, -74.9) and -78.6 ml (95 % CI: -114.3, - 42-8) decrease in FVC and FEV1, respectively. Discussion: Increased periods of solar and geomagnetic activity may directly contribute to impaired pulmonary function and also enhance effects of PM2.5 and BC. Since exposure to solar activity is ubiquitous, stricter measures in reducing air pollution exposures arc warranted, particularly in elderly populations.

It has been hypothesized that solar and geomagnetic activity can affect the function of the autonomic nervous system (ANS) and melatonin secretion, both of which may influence immune response. We investigated the association between solar geomagnetic activity and white blood cell counts in the Normative Aging Study (NAS) Cohort between 2000 and 2013. Linear mixed effects models with moving day averages ranging from 0 to 28 days were used to evaluate the effects of solar activity measures, interplanetary magnetic field (IMF), and sunspot number (SSN), and a measure of geomagnetic activity, K Index (K), on total white blood cell (WBC), neutrophil, monocytes, lymphocyte, eosinophil, and basophil concentrations. After adjusting for demographic and health-related factors, there were consistently significant associations between IMF, SSN, and Kp index, with reductions in total WBC, neutrophils, and basophil counts. These associations were stronger with longer moving averages. The associations were similar after adjusting for ambient air particulate pollution and particle radioactivity. Our findings suggest that periods of increased solar and geomagnetic activity result in lower WBC, neutrophil, and basophil counts that may contribute to mil mild immune suppression.

Background Since solar activity and related geomagnetic disturbances modulate autonomic nervous system activity, we hypothesized that these events would be associated with blood pressure (BP). Methods and Results We studied 675 elderly men from the Normative Aging Study (Boston, MA) with 1949 BP measurements between 2000 and 2017. Mixed‐effects regression models were used to investigate the association of average 1‐day (ie, day of BP measurement) to 28‐day interplanetary magnetic field intensity, sunspot number, and a dichotomized measure of global geomagnetic activity (Kp index) in 4‐day increments with diastolic and systolic BP. We adjusted for meteorological conditions and other covariates associated with BP, and in additional models adjusted for ambient air pollutants (particulate matter with an aerodynamic diameter ≤2.5 µm, black carbon, and particle number) and ambient particle radioactivity. There were positive associations between interplanetary magnetic field, sunspot number, and Kp index and BP that were greatest with these exposures averaged over 16 through 28 days before BP measurement. An interquartile range increase of 16‐day interplanetary magnetic field and sunspot number and higher Kp index were associated with a 2.5 (95% CI, 1.7‒3.2), 2.8 (95% CI, 2.1‒3.4), and 1.7 (95% CI, 0.8‒2.5) mm Hg increase, respectively, for diastolic BP as well as a 2.1 (95% CI, 0.7‒3.6), 2.7 (95% CI, 1.5‒4.0), and 0.4 (95% CI, −1.2 to 2.1) mm Hg increase, respectively, for systolic BP. Associations remained after adjustment for ambient air pollutants and ambient particle radioactivity. Conclusions Solar activity and solar‐driven geomagnetic disturbances were positively associated with BP, suggesting that these natural phenomena influence BP in elderly men.