Jay J. Shen

Background: The independent and joint associations of waist circumference (WC), body mass index (BMI), and smoking with bladder cancer risk in postmenopausal women remain unclear. We investigated these associations in a nationwide cohort. Methods: This study included 1,336,820 postmenopausal Korean women without prior cancer from the national health screening program in 2009 who were followed until 2022. Abdominal obesity was defined as WC ≥85 cm and general obesity as BMI ≥25 kg/m2, according to the Korean criteria. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI). Results: Over a median follow-up of 12.4 years, 2,315 incident bladder cancer cases were identified. Smoking was independently associated with an increased risk of bladder cancer (HR, 1.83; 95% CI, 1.53–2.19), compared with never smoking. Among individuals who never smoked, abdominal obesity and general obesity were associated with increased risk (HR, 1.17; 95% CI, 1.07–1.28, and HR, 1.09; 95% CI, 1.005–1.19). In joint-effect analyses, individuals who ever smoked and had obesity exhibited the highest risk compared with individuals who never smoked without obesity (abdominal: HR, 2.27; 95% CI, 1.71–3.01; general: HR, 2.36; 95% CI, 1.81–3.09). Conclusions: Both abdominal and general obesity were associated with higher bladder cancer risk in postmenopausal women, with substantially greater risk among those with concurrent smoking exposure. These findings emphasize the importance of obesity prevention and smoking cessation in reducing risk in this under-recognized population. Impact: Targeting abdominal and general obesity, particularly among individuals who smoked, may meaningfully lower bladder cancer risk in postmenopausal women.

Background: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization for pediatric neurologic and neuromuscular illnesses in hospital settings. Methods: This study analyzed the National Inpatient Sample (NIS) database, covering hospitalizations of children under 18 years with neurologic and neuromuscular diagnoses from 2016 to 2020, to examine associations of palliative care with sociodemographic, clinical, and hospital factors. Results: Out of 139,598 pediatric patients, 4273 (3.1%) received palliative care. Palliative care recipients were younger (mean age 5.3 vs. 6.4 years), had more diagnoses (17.8 vs. 10.9) and procedures (4.0 vs. 2.4), higher illness severity scores (3.4 vs. 2.6), longer LOS (18.7 vs. 9.9 days), and higher hospital charges ($332,559 vs. $150,727). In-hospital mortality was significantly higher among palliative care recipients (32.9% vs. 2.4%). The utilization of palliative care increased annually (OR = 1.08, 95% CI [1.05, 1.11]). Black patients had lower odds (OR = 0.90, 95% CI [0.81, 1.00]). Higher severity scores (OR = 2.09, 95% CI [1.99, 2.20]) were positively associated with palliative care. Smaller hospitals and urban nonteaching hospitals were inversely associated with palliative care utilization. Conclusions: Palliative care utilization for pediatric neurologic and neuromuscular illnesses remains low, with significant disparities based on sociodemographic and hospital-related factors. Enhanced awareness and integration of palliative care in pediatric practice, especially in underutilized settings, are crucial for improving outcomes and quality of life for these patients.

Background: Sociodemographic and structural inequities shape the risk of alcohol-related harms among underage individuals. This study assessed disparities in alcohol-related emergency department (ED) visits, using the COVID-19 pandemic as a contextual backdrop to examine how these inequities shifted during a period of widespread disruption. Methods: This repeated cross-sectional study used pooled Nationwide Emergency Department Sample (NEDS) data (January 2019–December 2021) for individuals aged 12–20, comparing pre-COVID-19 (January 2019–March 2020) and during-COVID-19 (April 2020–December 2021) periods. Alcohol-related visits were identified via ICD-10-CM codes. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and geographic factors, with interaction terms assessing period-related changes in disparities. Results: Sociodemographic disparities were the primary drivers of alcohol-related ED visits. Native American youth had markedly higher odds than White youth (OR = 3.68, 95% CI: 3.52–3.86), while Black, Hispanic, and Asian youth had lower odds. Uninsured (OR = 1.43) and charity-care youth also showed elevated odds. COVID-19 itself was not significantly associated with overall visits (OR = 1.03, p = 0.053), but disparities widened for Native American youth (OR = 1.20) and narrowed modestly for Black (OR = 1.04) and Medicaid-insured (OR = 1.05) youth, while other disparities remained unchanged. Conclusions: Persistent structural disparities, particularly by race/ethnicity and insurance status, drive underage alcohol-related ED utilization far more than the pandemic itself, underscoring the need for equity-focused prevention strategies targeting systemic barriers to care.

PURPOSE: The incidence of young-onset pancreatic cancer has increased rapidly; however, the dose-response relationship between alcohol consumption and the risk of incident young-onset pancreatic cancer remains unclear. METHODS: A nationwide cohort of 6,263,770 individuals age 20 to 39 years who underwent national health screening in Korea between 2009 and 2012 was followed until December 2020. Heavy alcohol consumption was defined as ≥30 g/day for men and ≥16 g/day for women. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% CIs. RESULTS: A total of 1,515 cases of young-onset pancreatic cancer were identified. The cumulative incidence was consistently higher among heavy drinkers compared with nondrinkers or light-to-moderate drinkers (log-rank P < .001). Heavy alcohol consumption was significantly associated with an increased risk of young-onset pancreatic cancer (aHR, 1.19 [95% CI, 1.004 to 1.42]), whereas light-to-moderate consumption was not (aHR, 1.04 [95% CI, 0.92 to 1.17]). In addition, alcohol consumption ≥3 times per week was associated with an increased risk (aHR, 1.23 [95% CI, 1.01 to 1.51]). No significant interactions were observed across most subgroups, including age, sex, obesity, smoking status, diabetes, and pancreatitis (all P for interaction > .05), except for physical activity ( P = .011). CONCLUSION: Heavy alcohol consumption was significantly associated with an increased risk of young-onset pancreatic cancer in a threshold dose-response manner. These findings suggest that early public health strategies to reduce heavy alcohol consumption among young adults may help mitigate the growing burden of young-onset pancreatic cancer.

Supplementary Table 1 lists the self-reported questionnaire items included in the 2009 Korean National Health Screening Program, covering lifestyle and medical history variables.

Supplementary Table 2 presents sex-stratified hazard ratios for the association between the severity of non-alcoholic fatty liver disease and the risk of early-onset kidney cancer.

Supplementary Table 3 shows the association between non-alcoholic fatty liver disease and early-onset kidney cancer risk, with body mass index analyzed as a continuous variable.

Background:The global incidence of kidney cancer has significantly increased among individuals less than 50 years of age. However, genetic predisposition alone does not account for this trend. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and the risk of early-onset kidney cancer.Methods:We conducted a nationwide cohort study of 5,606,357 Korean individuals, ages 20 to 39 years, who underwent national health screening between 2009 and 2012, with follow-up until December 2020. NAFLD was defined using the fatty liver index. Cox proportional hazards models were used to estimate HRs for early-onset kidney cancer, adjusting for potential confounders, including age, sex, smoking, alcohol intake, physical activity, diabetes, hypertension, obesity, and chronic kidney disease (CKD).Results:During 52.4 million person-years of follow-up, 2,956 cases of early-onset kidney cancer were identified. NAFLD was associated with a higher cumulative incidence (log-rank test P < 0.01) and an increased risk of early-onset kidney cancer [adjusted HR (aHR), 1.46; 95% confidence interval (CI), 1.32–1.61]. The association remained consistent across subgroups stratified by age, sex, smoking status, alcohol consumption, obesity, and CKD (all P for interactions > 0.05). The risk was highest among individuals with both NAFLD and obesity (aHR, 2.12; 95% CI, 1.95–2.32; synergy index = 1.34, P < 0.01).Conclusions:NAFLD may serve as an independent risk factor for early-onset kidney cancer.Impact:Given that NAFLD is a modifiable condition, its early detection and management may be a potential strategy to reduce the burden of early-onset kidney cancer, warranting further investigation.

Background: The global incidence of kidney cancer has significantly increased among individuals less than 50 years of age. However, genetic predisposition alone does not account for this trend. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and the risk of early-onset kidney cancer. Methods: We conducted a nationwide cohort study of 5,606,357 Korean individuals, ages 20 to 39 years, who underwent national health screening between 2009 and 2012, with follow-up until December 2020. NAFLD was defined using the fatty liver index. Cox proportional hazards models were used to estimate HRs for early-onset kidney cancer, adjusting for potential confounders, including age, sex, smoking, alcohol intake, physical activity, diabetes, hypertension, obesity, and chronic kidney disease (CKD). Results: During 52.4 million person-years of follow-up, 2,956 cases of early-onset kidney cancer were identified. NAFLD was associated with a higher cumulative incidence (log-rank test P < 0.01) and an increased risk of early-onset kidney cancer [adjusted HR (aHR), 1.46; 95% confidence interval (CI), 1.32–1.61]. The association remained consistent across subgroups stratified by age, sex, smoking status, alcohol consumption, obesity, and CKD (all P for interactions > 0.05). The risk was highest among individuals with both NAFLD and obesity (aHR, 2.12; 95% CI, 1.95–2.32; synergy index = 1.34, P < 0.01). Conclusions: NAFLD may serve as an independent risk factor for early-onset kidney cancer. Impact: Given that NAFLD is a modifiable condition, its early detection and management may be a potential strategy to reduce the burden of early-onset kidney cancer, warranting further investigation.

Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two Geriatrics Workforce Enhancement Programs delivered training to primary care providers on using telehealth to provide ACP. Using electronic health records data from 6344 dual-eligible Medicare/Medicaid patients receiving telehealth primary care from trained providers in an urban safety net system, persons living with dementia (n = 401) were identified by extracting ICD-10 codes. The primary outcome was the estimated hospitalization-associated cost, with a key independent variable of ACP billing status. Multiple linear regressions and machine learning techniques estimated the impact of telehealth ACP on hospitalization-associated costs with a differential analysis by race. Compared to non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40. Costs for non-English speakers or those having increased comorbidities were higher by USD 27,346.60 and USD 26,072.70, respectively. Overall, receiving ACP was associated with lower costs of USD 23,928.84. Dementia patients seen by primary care providers in a system receiving training to offer ACP via telehealth realized significant cost savings, with marked differences among those of non-White racial backgrounds.