We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia by using 2017-2018 Behavioral Risk Factor Surveillance System data. Among adults without reported COPD, the 3 respiratory symptoms indicating COPD (chronic cough, phlegm or mucus production, shortness of breath) were common (each >10%). About 15.0% were at higher COPD risk (based on the number of symptoms, age, and smoking status); 41.4% of adults at higher risk reported receipt of a breathing test. Patient-provider recognition and communication of risk symptoms, appropriate screening, and follow-up are important for early diagnosis and treatment.

This editorial aims to highlight the complex interplay among sleep, mental health, and chronic disease, emphasizing the critical role that sleep plays in health outcomes and overall well-being. With the mounting evidence linking sleep to numerous health problems — from mental health disorders to chronic diseases — it is paramount that we shift our focus toward understanding sleep not as a passive state but as a vital process for brain restoration and regulation. Recognizing and addressing sleep disturbances and disorders, along with promoting comprehensive strategies for improving sleep health, is a national imperative with far-reaching economic and health implications. | | The articles in this collection in Preventing Chronic Disease (PCD) — Sleep Deprivation, Sleep Disorders, and Chronic Disease — provide valuable insights into the bidirectional relationships between sleep, mental health, and chronic disease throughout the lifespan. Furthermore, the articles shed light on key themes — starting from childhood to young adulthood — while considering the role of parents and sociodemographic factors, the effect of sleep health on various racial and ethnic groups, and the geographic variation in the prevalence of short sleep duration.

INTRODUCTION/OBJECTIVES: The Centers for Disease Control and Prevention recognizes routine vaccination, sufficient sleep, and adequate physical activity as behavioral approaches to reduce the incidence of influenza. We aimed to determine the joint national prevalence of these health behaviors among U.S. adults, which has not been reported. METHODS: We used the 2020 National Health Interview Survey to assess prevalence of receiving influenza vaccination in the past 12 months, obtaining sufficient sleep, and achieving adequate physical activity among U.S. adults (n = 30,312). We calculated the joint prevalence overall and by sociodemographic and health-related variables. RESULTS AND CONCLUSIONS: The overall joint prevalence was 8.5% (95% CI, 8.0-9.0). Prevalence was lower among older persons (vs younger); Hispanic and non-Hispanic Black persons (vs non-Hispanic White); current and former smokers (vs never smokers); postpartum women (vs neither pregnant nor postpartum); and those with a history of coronary heart disease, hypertension, stroke, diabetes, and chronic obstructive pulmonary disease (vs not having those respective condition). In addition to recommending annual vaccination, primary care providers might encourage sufficient sleep and adequate physical activity-especially among patients who have increased risk for influenza complications and are less likely to achieve these behaviors.

INTRODUCTION: Many children and adolescents experience insufficient sleep, which poses risks for their short- and long-term health and development. This study examined the concurrent associations of contextual factors, including child, demographic, neighborhood, and family factors, with short sleep duration. METHODS: We combined data on children aged 3 to 17 years from the 2016-2019 National Survey of Children's Health (N = 112,925) to examine the association of parent-reported child short sleep duration (ages 3-5 y, <10 h; 6-12 y, <9 h; 13-17 y, <8 h) with mental, behavioral, and developmental disorders (MBDDs); selected physical health conditions; and demographic, neighborhood, and family factors. RESULTS: Overall, 34.7% of children experienced short sleep duration. The prevalence was highest among children aged 6 to 12 years (37.5%); children from racial and ethnic minority groups, especially non-Hispanic Black children (50.0%); children from low-income households (44.9%); children with an MBDD (39.6%); children experiencing negative neighborhood factors (poor conditions and lack of safety, support, and amenities, 36.5%); and family factors such as inconsistent bedtime (57.3%), poor parental mental (47.5%) and physical health (46.0%), and adverse childhood experiences (44.1%). The associations between sleep and demographic, neighborhood, and family factors, and MBDD remained significant after controlling for all other factors. CONCLUSION: This study identified several individual, family, and community factors that may contribute to children's short sleep duration and can be targeted to improve healthy development, particularly among children with an MBDD, from households with low socioeconomic status, or from racial and ethnic minority groups who are at increased risk for short sleep duration.

We estimated the prevalence of short sleep duration (<7 hours per day) among US adults aged 18 years or older by using 2020 Behavioral Risk Factor Surveillance System data. Nationally, 33.2% of adults reported short sleep duration. We identified disparities across sociodemographic characteristics, including age, sex, race and ethnicity, marital status, education, income, and urbanicity. Counties with the highest model-based estimates of short sleep duration clustered in the Southeast and along the Appalachian Mountains. These findings identified subgroups and geographic areas in which tailored strategies for promotion of optimal sleep duration (≥7 hours per night) are most needed.

We estimated the prevalence of short sleep duration (<8 h/average school night) among high school students (grades 9-12) during the COVID-19 pandemic by using data from the Adolescent Behaviors and Experiences Survey (January-June 2021; N = 7,705). An adjusted logistic regression model predicted prevalence ratios for more difficulty doing schoolwork during the pandemic compared with before the pandemic. Most (76.5%) students experienced short sleep duration, and two-thirds perceived more difficulty doing schoolwork. Students who slept less than 7 hours per school night or experienced poor mental health were more likely to report increased difficulty doing schoolwork. Addressing students' sleep duration could complement efforts to bolster their mental health and learning.

Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the fourth leading cause of death in the United States in 2019.* COPD mortality rates are decreasing overall. Although rates in men remain higher than those in women, declines have occurred among men but not women (1). To examine the geographic variation in sex-specific trends in age-adjusted COPD mortality rates among adults aged ≥25 years, CDC analyzed 1999-2019 death certificate data, by urban-rural status,(†) U.S. Census Bureau region,(§) and state. Among women, no significant change in overall COPD mortality occurred during this period; however, rates increased significantly in small metropolitan (average annual percent change [AAPC] = 0.6%), micropolitan (1.2%), and noncore (1.9%) areas and in the Midwest (0.6%). Rates decreased significantly in large central (-0.9%) and fringe metropolitan (-0.4%) areas (and in the Northeast (-0.5%) and West (-1.2%). Among men, rates decreased significantly overall (-1.3%), in all urban-rural areas (range = -1.9% [large central metropolitan] to -0.4% [noncore]) and in all regions (range = -2.0% [West] to -0.9% [Midwest]). Strategies to improve the prevention, treatment, and management of COPD are needed, especially to address geographic differences and improve the trend in women, to reduce COPD deaths.

BACKGROUND: The internet has become an increasingly popular medium for parents to obtain health information. More studies investigating the impact of paid digital marketing campaigns for parents on promoting children's healthy development are needed. OBJECTIVE: This study aims to explore the outcomes of a paid digital marketing campaign, which occurred from 2018 to 2020, to promote messages about parent-engaged developmental monitoring and ultimately direct parents to the Centers for Disease Control and Prevention's (CDC's) Milestone Tracker app, a mobile health (mHealth) app developed by the CDC. METHODS: The paid digital marketing campaign occurred in 3 phases from 2018 to 2020. In each phase, 24 to 36 marketing messages, in English and Spanish, were created and disseminated using Google's Universal App Campaigns and Facebook Ads Manager. Outcomes were measured using impressions, clicks, and install data. Return on investment was measured using click-through rate (CTR), cost per click, and cost per install metrics. RESULTS: The Google-driven marketing messages garnered a total of 4,879,722 impressions (n=1,991,250, 40.81% for English and n=2,888,472, 59.19% for Spanish). The messages resulted in a total of 73,956 clicks (n=44,328, 59.94% for English and n=29,628, 40.06% for Spanish), with a total average CTR of 1.52% (2.22% for English and 1.03% for Spanish). From these clicks, there were 13,707 installs (n=9765, 71.24% for English and n=3942, 28.76% for Spanish) of the CDC's Milestone Tracker app on Google Play Store. The total average cost per install was US $0.93 across all phases. The phase 3 headline "Track your child's development" generated the highest CTR of 3.23% for both English and Spanish audiences. The Facebook-driven marketing messages garnered 2,434,320 impressions (n=1,612,934, 66.26% for English and n=821,386, 33.74% for Spanish). The messages resulted in 44,698 clicks (n=33,353, 74.62% for English and n=11,345, 25.38% for Spanish), with an average CTR of 1.84% (2.07% for English and 1.38% for Spanish). In all 3 phases, animated graphics generated the greatest number of clicks among both English and Spanish audiences on Facebook when compared with other types of images. CONCLUSIONS: These paid digital marketing campaigns can increase targeted message exposure about parent-engaged developmental monitoring and direct a parent audience to an mHealth app. Digital marketing platforms provide helpful metrics that can be used to assess the reach, engagement, and cost-effectiveness of this effort. The results from this study suggest that paid digital marketing can be an effective strategy and can inform future digital marketing activities to promote mHealth apps targeting parents of young children.

BACKGROUND: Patients with inflammatory bowel disease (IBD) have higher health services use than those without IBD. We investigated patient and hospital characteristics of major ambulatory surgery encounters for Crohn's disease (CD) or ulcerative colitis (UC) vs non-IBD patients. METHODS: We conducted a cross-sectional study using 2017 Nationwide Ambulatory Surgery Sample. Major ambulatory surgery encounters among patients aged ≥18 years with CD (n = 20,635) or UC (n = 9,894) were compared to 9.4 million encounters among non-IBD patients. Weighted percentages of patient characteristics (age, sex, median household income, primary payers, patient location, selected comorbidities, discharge destination, type of surgeries) and hospital-related characteristics (hospital size, ownership, location and teaching status, region) were compared by IBD status (CD, UC, and no IBD). Linear regression was used to estimate mean total charges, controlling for these characteristics. RESULTS: Compared with non-IBD patients, IBD patients were more likely to have private insurance, reside in urban areas and higher income zip codes, and undergo surgeries in hospitals that were private not-for-profit, urban teaching, and in the Northeast. Gastrointestinal surgeries were more common among IBD patients. Some comorbidities associated with increased risk of surgical complications were more prevalent among IBD patients. Total charges were 9% lower for CD patients aged <65 years (Median: $16,462 vs $18,106) and 6% higher for UC patients aged ≥65 years (Median: $16,909 vs $15,218) compared to their non-IBD patient counterparts. CONCLUSIONS: Differences in characteristics of major ambulatory surgery encounters by IBD status may identify opportunities for efficient resource allocation and positive surgical outcomes among IBD patients.

Sleep disorder symptoms (trouble falling asleep or staying asleep, unintentionally falling asleep, snoring loudly, and episodes of having stopped breathing) among US adults (N = 59,108) from 8 states and the District of Columbia were analyzed by using data from the 2017 Behavioral Risk Factor Surveillance System. We conducted a multivariable logistic regression to assess the association between the 4 symptoms and sociodemographic characteristics, risk behaviors, and chronic conditions. The 4 symptoms were prevalent and more likely to be reported among adults with any chronic condition(s) than their counterparts without symptoms and among those who slept fewer than 7 hours compared with those who slept 7 to 9 hours.

OBJECTIVES: To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. METHODS: Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. RESULTS: Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. DISCUSSION: Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Infants, children, and adolescents who do not get sufficient sleep are at increased risk for injuries, obesity, type 2 diabetes, poor mental health, attention and behavior problems, and poor cognitive development (1). The American Academy of Sleep Medicine (AASM) provides age-specific sleep duration recommendations to promote optimal health (1). CDC analyzed data from the 2016-2018 National Survey of Children's Health (NSCH) to assess the prevalence of short sleep duration among persons in the United States aged 4 months-17 years. Overall, on the basis of parent report, 34.9% of persons aged 4 months-17 years slept less than recommended for their age. The prevalence of short sleep duration was higher in southeastern states and among racial and ethnic minority groups, persons with low socioeconomic status, and those with special health care needs. The prevalence of short sleep duration ranged from 31.2% among adolescents aged 13-17 years to 40.3% among infants aged 4-11 months. Persons aged 4 months-17 years with a regular bedtime were more likely to get enough sleep. Public health practitioners, educators, and clinicians might advise parents on the importance of meeting recommended sleep duration and implementing a consistent bedtime for healthy development.

BACKGROUND: Epilepsy is associated with a high prevalence of sleep disturbance. However, population-based studies on the burden of sleep disturbance in people with epilepsy are limited. This study assessed sleep duration and sleep quality by epilepsy status in the general U.S. adult population aged ≥ 18 years. METHODS: We pooled data of cross-sectional National Health Interview Surveys in 2013, 2015, and 2017 to compare the prevalence of sleep duration and quality among those without epilepsy (N = 93,126) with those with any epilepsy (a history of physician-diagnosed epilepsy) (N = 1774), those with active epilepsy (those with a history of physician-diagnosed epilepsy who were currently taking medication to control it, had one or more seizures in the past year, or both) (N = 1101), and those with inactive epilepsy (those with a history of physician-diagnosed epilepsy who were neither taking medication for epilepsy nor had had a seizure in the past year) (N = 673). We also compared these measures between those with active and those with inactive epilepsy. The prevalences were adjusted for sociodemographics, behaviors, and health covariates, with multivariable logistic regression. We used Z-tests to compare prevalences of sleep duration and quality at the statistical significance level of 0.05. RESULTS: Adults with any epilepsy reported significantly higher adjusted prevalences of short sleep duration (<7 h) (36.0% vs. 31.8%) and long sleep duration (>9 h per day) (6.7% vs. 3.7%) but a lower prevalence of healthy sleep duration (7-9 h per day) (57.4% vs.64.6%) than those without epilepsy. In the past week, adults with any epilepsy reported significantly higher adjusted prevalences than adults without epilepsy of having trouble falling asleep (25.0% vs. 20.3%), staying asleep (34.4% vs. 26.3%), nonrestorative sleep (adults did not wake up feeling well rested) (≥3days) (50.3% vs. 44.3%), and taking medication to help themselves fall asleep or stay asleep (≥1 times) (20.9% vs. 13.5%). However, adults with active epilepsy did not differ from adults with inactive epilepsy with respect to these sleep duration and quality measures. CONCLUSIONS: Adults with epilepsy reported more short or long sleep duration and worse sleep quality than those without epilepsy. Neither seizure occurrence nor antiepileptic drug use accounted for these differences in sleep duration and quality. Careful screening for sleep complaints as well as identifying and intervening on the modifiable risk factors associated with sleep disturbances among people with epilepsy could improve epilepsy outcomes and quality of life.

The COVID-19 pandemic has spread across the world. In the United States, more than 26 million cases with COVID-19 were reported as of February 1, 2021 (https://covid.cdc.gov/covid-data-tracker/#cases_totalcases). People infected with SARS-CoV-2 have a broad range of outcomes, from being asymptomatic or having mild symptoms to having severe illnesses that can result in hospitalization or death.1 Patients with Crohn’s disease (CD) or ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are often under immunosuppressive treatment that makes them more susceptible to opportunistic infections, and this risk is especially high for patients aged 50 years or older.2 Patients with IBD are also more likely to have comorbidities than those without IBD,3 and certain chronic medical conditions are known to be risk factors for developing severe COVID-19.4 To date, no studies have found that patients with IBD are at a higher risk of SARS-CoV-2 infection compared with the general population.5 However, given the complexity of IBD, health providers need to know whether older patients with IBD are more likely to develop severe illness so that they can better manage these patients during the COVID-19 pandemic.

OBJECTIVE: To assess the prevalence of migraine or severe headache among US adults by inflammatory bowel disease (IBD) status. BACKGROUND: Emerging evidence in clinical settings suggests a higher prevalence of migraine among patients with IBD than those without IBD. METHODS: Data from 60,436 US adults aged ≥18 years participating in the 2015 and 2016 National Health Interview Survey (NHIS) were analyzed. The relationship between IBD status and migraine or severe headache was assessed overall and stratified by levels of selected characteristics including sex, age, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status. RESULTS: Overall, the age-adjusted prevalence of migraine or severe headache was 15.4% (n = 9062) and of IBD was 1.2% (n = 862). A higher age-adjusted migraine or severe headache prevalence was reported among participants with IBD than those without IBD (28.1% vs. 15.2%, p < 0.0001). The association of migraine or severe headache with IBD remained significant overall [adjusted prevalence ratio (95% CI) = 1.59 (1.35-1.86)] and within the levels of most other selected characteristics after controlling for all other covariates. CONCLUSIONS: Our results confirmed a higher prevalence of migraine or severe headache among US adults with IBD than those without. Healthcare providers might assess migraine or severe headache among patients with IBD to improve management and quality of life.

The potential for a population at a given location to utilize a health service can be estimated using a newly developed measure called the supply-concentric demand accumulation (SCDA) spatial availability index. Spatial availability is the amount of demand at the given location that can be satisfied by the supply of services at a facility, after discounting the intervening demand among other populations that are located nearer to a facility location than the given population location. This differs from spatial accessibility measures which treat absolute distance or travel time as the factor that impedes utilization. The SCDA is illustrated using pulmonary rehabilitation (PR), which is a treatment for people with chronic obstructive pulmonary disease (COPD). The spatial availability of PR was estimated for each Census block group in Georgia using the 1105 residents who utilized one of 45 PR facilities located in or around Georgia. Data was provided by the Centers for Medicare & Medicaid Services. The geographic patterns of the SCDA spatial availability index and the two-step floating catchment area (2SFCA) spatial accessibility index were compared with the observed PR utilization rate using bivariate local indicators of spatial association. The SCDA index was more associated with PR utilization (Morans I = 0.607, P < 0.001) than was the 2SFCA (Morans I = 0.321, P < 0.001). These results suggest that the measures of spatial availability may be a better way to estimate the health care utilization potential than measures of spatial accessibility.

BACKGROUND: Patients with inflammatory bowel disease (IBD) have a higher risk of hip fracture, but lower likelihood of having arthroplasties than non-IBD patients in Nationwide Inpatient Sample. Little is known about hip fracture-associated hospitalization outcomes. AIMS: We assessed the trends in hip fracture hospitalization rates from 2000 to 2017 and estimated 30-day readmission, 30-day mortality, and length of stay in 2016 and 2017. METHODS: We estimated trends of age-adjusted hospitalization rates using a piecewise linear regression. Medicare beneficiaries aged ≥ 66 years with Crohn's disease (CD, n = 2014) or ulcerative colitis (UC, n = 2971) hospitalized for hip fracture were identified. We performed propensity score matching to create 1:3 matched samples on age, race/ethnicity, sex, and chronic conditions and compared hospitalization outcomes between matched samples. RESULTS: In 2017, the age-adjusted hospitalization rates (per 100) were 1.15 [95% CI = (1.07-1.24)] for CD, 0.86 [95% CI = (0.82-0.89)] for UC, and 0.59 [95% CI = (0.59-0.59)] for no IBD. The hospitalization rates for CD and UC decreased from 2000 to 2012 and then increased from 2012 to 2017. Compared to matched cohorts, CD patients had longer hospital stays (5.55 days vs. 5.30 days, p = 0.01); UC patients were more likely to have 30-day readmissions (17.27% vs. 13.71%, p < 0.001), longer hospital stays (5.59 days vs. 5.40 days, p = 0.02), and less likely to have 30-day mortality (3.77% vs. 5.15%, p = 0.003). CONCLUSIONS: Prevention of hip fracture is important for older adults with IBD, especially CD. Strategies that improve quality of inpatient care for IBD patients hospitalized for hip fracture should be considered.

BACKGROUND: Among U.S. adults, over 4 million report a history of epilepsy, and more than 15 million report a history of chronic obstructive pulmonary disease (COPD); Chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, is a common somatic comorbidity of epilepsy. This study assessed the relationship between self-reported physician-diagnosed epilepsy and COPD in a large representative sample of the U.S. adult population and explored possible mechanisms. METHODS: Cross-sectional National Health Interview Surveys for 2013, 2015, and 2017 were aggregated to compare the prevalence of COPD between U.S. respondents aged >/=18years with a history of physician-diagnosed epilepsy (n=1783) and without epilepsy (n=93,126). We calculated prevalence of COPD by age-standardized adjustment and prevalence ratios of COPD overall adjusted for sociodemographic and risk factors, by using multivariable logistic regression analyses. A Z-test was conducted to compare the prevalence between people with and without epilepsy at the statistical significance level of 0.05. Prevalence ratios whose 95% confidence intervals did not overlap 1.00 were considered statistically significant. RESULTS: The overall age-standardized prevalence was 5.7% for COPD and 1.8% for epilepsy. Age-standardized prevalence of COPD among respondents with epilepsy (15.4%) exceeded that among those without epilepsy (5.5%). The association remained significantly different among all sociodemographic and risk factor subgroups (p<.05). In the adjusted analyses, epilepsy was also significantly associated with COPD, overall (adjusted prevalence ratio=1.8, 95% confidence interval=1.6-2.1) and in nearly all subgroups defined by selected characteristics. CONCLUSIONS: Epilepsy is associated with a higher prevalence of COPD in U.S. adults. Public health interventions targeting modifiable behavioral and socioeconomic risk factors among people with epilepsy may help prevent COPD and related premature death.

INTRODUCTION: Caregiving, providing regular care or assistance to family members or friends with health problems or disabilities, may affect caregivers' sleep. This study examined self-reported short sleep duration by caregiving status among US adults. METHODS: Data of 114,496 respondents aged >/=18 years in 19 states, the District of Columbia, and Puerto Rico from the 2016 Behavioral Risk Factor Surveillance System were analyzed. Prevalence of short sleep duration (<7 hours per 24-hour period) by caregiving status was calculated, and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were derived from a multivariable logistic regression model with adjustment for potential covariates. RESULTS: Nearly 1 of 5 adults reported caregiving within the past month. A higher prevalence of short sleep duration was reported among caregivers (39.5%) than among non-caregivers (34.2%, adjusted PR [95% CI] = 1.12 [1.06-1.19]). Caregivers who reported prolonged caregiving (>/=5 years) reported a higher prevalence of short sleep duration than those with <2 years of caregiving. Similarly, caregivers who provided 20-39 hours of caregiving per week reported a higher prevalence of short sleep duration than those with <20 hours caregiving per week. CONCLUSIONS: Caregivers had a higher prevalence of short sleep duration than noncaregivers. Providing information and community-based resources and supports for caregiving may minimize caregiver stress and improve sleep particularly for those with prolonged or more intense caregiving.

BACKGROUND: Short sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities. OBJECTIVE: To examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged >/=18 years. METHODS: Data from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as <7 h per 24-h period. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for socioeconomic and health-related characteristics. RESULTS: Adults with any disability had a higher prevalence of short sleep duration than those without disability (43.8% vs. 31.6%; p < .001). After controlling for selected covariates, short sleep was most prevalent among adults with multiple disabilities (PR 1.40, 95% CI: 1.36-1.43), followed by adults with a single disability type (range: PR 1.13, 95% CI: 1.03-1.24 [for independent living disability] to PR 1.25, 95% CI: 1.21-1.30 [for mobility disability]) compared to adults without disability. CONCLUSIONS: People with disabilities had a higher likelihood of reporting short sleep duration than those without disabilities. Assessment of sleep duration may be an important component in the provision of medical care to people with disabilities.

Crohn's disease and ulcerative colitis, collectively referred to as inflammatory bowel disease (IBD), are conditions characterized by chronic inflammation of the gastrointestinal tract. The incidence and prevalence of IBD is increasing globally, and although the disease has little impact on mortality, the number of older adults with IBD is expected to increase as the U.S. population ages (1). Older adults with IBD have worse hospitalization outcomes than do their younger counterparts (2). CDC analyzed Medicare Provider Analysis and Review (MedPAR) data to estimate IBD-related hospitalization rates and hospitalization outcomes in 2017 among Medicare fee-for-service beneficiaries aged >/=65 years, by selected demographics and trends in hospitalization rates and by race/ethnicity during 1999-2017. In 2017, the age-adjusted hospitalization rate for Crohn's disease was 15.5 per 100,000 Medicare enrollees, and the IBD-associated surgery rate was 17.4 per 100 hospital stays. The age-adjusted hospitalization rate for ulcerative colitis was 16.2 per 100,000 Medicare enrollees, and the surgery rate was 11.2 per 100 stays. During 1999-2017, the hospitalization rate for both Crohn's disease and ulcerative colitis decreased among non-Hispanic white (white) beneficiaries, but not among non-Hispanic black (black) beneficiaries. Health care utilization assessment is needed among black beneficiaries with IBD. Disease management for older adults with IBD could focus on increasing preventive care and preventing emergency surgeries that might result in further complications.

INTRODUCTION: More than 54 million US adults have arthritis, and more than 15 million US adults have chronic obstructive pulmonary disease (COPD). Arthritis and COPD share many risk factors, such as tobacco use, asthma history, and age. The objective of this study was to assess the relationship between self-reported physician-diagnosed COPD and arthritis in the US adult population. METHODS: We analyzed data from 408,774 respondents aged 18 or older in the 2016 Behavioral Risk Factor Surveillance System to assess the association between self-reported physician-diagnosed COPD and arthritis in the US adult population by using multivariable logistic regression analyses. RESULTS: Overall crude prevalence was 6.4% for COPD and 25.2% for arthritis. The prevalence of age-adjusted COPD was higher among respondents with arthritis than among respondents without arthritis (13.7% vs 3.8%, P < .001). The association remained significant among most subgroups (P < .001) particularly among adults aged 18 to 44 (11.5% vs 2.0%) and never smokers (7.6% vs 1.7%). In multivariable logistic regression analyses, arthritis status was significantly associated with COPD status after controlling for sociodemographic characteristics, risk behaviors, and health-related quality of life measures (adjusted prevalence ratio = 1.5, 95% confidence interval, 1.4-1.5, P < .001). CONCLUSION: Our results confirmed that arthritis is associated with a higher prevalence of COPD in the US adult population. Health care providers may assess COPD and arthritis symptoms for earlier detection of each condition and recommend that patients with COPD and/or arthritis participate in pulmonary rehabilitation and self-management education programs such as the Chronic Disease Self-Management Program, the proven benefits of which include increased aerobic activity and reduced shortness of breath, pain, and depression.

CONTEXT: Adults with unmet health care needs (UHCN) due to cost have fewer opportunities to receive behavioral counseling in clinical settings, which may be associated with a higher likelihood of having health-risk behaviors. OBJECTIVE: This study assessed associations between UHCN and health-risk factors. DESIGN/SETTING: We used 2016 Behavioral Risk Factor Surveillance System data to calculate age-adjusted weighted prevalence of 5 health-risk factors by UHCN and insurance status and to assess the association of UHCN with these factors using multivariable logistic regression. PARTICIPANTS: US adults aged 18 to 64 years who participated in the survey (N = 301 035). MAIN OUTCOME MEASURES: Five health-risk factors: obesity, current cigarette smoking, excessive alcohol use, sleeping less than 7 hours per 24-hour period, and no leisure-time physical activity within the past month. RESULTS: In 2016, among adults aged 18 to 64 years, 11.2% of those with insurance and 40.1% of those without insurance (both age-adjusted) had UHCN. In both study populations, compared with adults with no UHCN, adults reporting UHCN were more likely to be a current cigarette smoker, report excessive alcohol use, and sleep less than 7 hours per 24-hour period. The prevalence of 3 or more health-risk factors was higher among adults with UHCN than among adults without UHCN (adults with insurance: adjusted prevalence ratio = 1.40; 95% confidence interval = 1.33-1.48; adults without insurance: adjusted prevalence ratio = 1.39; 95% confidence interval = 1.27-1.53). CONCLUSIONS: Unmet health care needs was associated with more health-risk factors regardless of insurance status. Addressing cost barriers to behavioral counseling may be one approach to consider when seeking to reduce health-risk behaviors among high-risk populations.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) in the United States; however, an estimated one fourth of adults with COPD have never smoked (1). CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD. The age-adjusted prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. Higher prevalences of COPD were observed in southeastern and Appalachian states, regardless of smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who had never smoked suggests secondhand smoke exposure as a potential risk factor for COPD. Continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not.

A spatially adaptive floating catchment is a circular area that expands outward from a provider location until the estimated demand for services in the nearest population locations exceeds the observed number of health care services performed at the provider location. This new way of creating floating catchments was developed to address the change of spatial support problem (COSP) by upscaling the availability of the service observed at a provider location to the county-level so that its geographic association with utilization could be measured using the same spatial support. Medicare Fee-for-Service claims data were used to identify beneficiaries aged >/=65 years who received outpatient pulmonary rehabilitation (PR) in the Southeastern United States in 2014 (n=8798), the number of PR treatments these beneficiaries received (n=132,508), and the PR providers they chose (n=426). The positive correlation between PR availability and utilization was relatively low, but statistically significant (r=0.619, p<0.001) indicating that most people use the nearest available PR services, but some travel long distances. SAFCs can be created using data from health care systems that collect claim-level utilization data that identifies the locations of providers chosen by beneficiaries of a specific health care procedure.

BACKGROUND: Previous reports suggest that adults with inflammatory bowel disease (IBD) receive suboptimal preventive care. AIMS: The population-based study compared the receipt of these services by US adults with and without IBD. METHODS: Adults aged >/= 18 years with IBD (1.2%) and without IBD were identified from the 2015 and 2016 National Health Interview Survey (n = 66,610). Age-standardized prevalence of doctor visits, receipt of medical advice, and selected preventive care was calculated for adults with and without IBD. The model-adjusted prevalence ratios were estimated for receipt of preventive care associated with IBD. RESULTS: The prevalence of a doctor visit in the past 12 months was significantly higher among adults with IBD than those without. IBD was also associated with significantly higher prevalence of receiving medical advice about smoking cessation (83.9% vs. 66.4%) and diet (42.9% vs. 32.1%), having colon cancer screening in the past 12 months (44.0% vs. 26.7%), having ever had an HIV test (51.5% vs. 45.4%) or pneumococcal vaccine (75.3% vs. 64.0%), having received a tetanus vaccine in the past 10 years (72.0% vs. 61.8%), and having received a flu vaccine in the past 12 months (48.4% vs. 41.0%), but was not significantly associated with receiving cervical cancer screening and hepatitis A and B vaccines. CONCLUSIONS: Adults with IBD were more likely to receive many types of preventive care than adults without IBD. The findings can inform healthcare policy makers to make strategic decisions that enhance multidisciplinary coordination from various medical specialties to ensure optimal preventive care for IBD patients.

BACKGROUND: Few studies have addressed recent trends in hospitalization costs for inflammatory bowel disease (IBD). OBJECTIVE: We explored trends and described patient and hospital factors associated with hospitalization costs for IBD. METHODS: Using data from the 2003-2014 National Inpatient Sample for adults aged >/= 18 years, we estimated costs using multivariable linear models and assessed linear trends by time periods using piecewise linear regressions. RESULTS: In 2014, there were an estimated 56,290 hospitalizations for Crohn's disease (CD), with a mean cost of US$11,345 and median cost of US$7592; and 33,585 hospitalizations for ulcerative colitis (UC), with a mean cost of US$13,412 and median cost of US$8873. Higher costs were observed among Hispanic [adjusted cost ratio (ACR) = 1.07; 95% confidence interval (CI) = 1.00-1.14; p = 0.04] or other non-Hispanic (ACR = 1.09; 95% CI = 1.02-1.17; p = 0.01) CD patients than for non-Hispanic White CD patients. For UC patients, higher costs were observed among men (ACR = 1.09; 95% CI = 1.05-1.13; p < 0.001) compared with women and among patients aged 35-44 years, 45-54 years, and 55-64 years compared with those aged 18-24 years. Among all patients, factors associated with higher costs included higher household income, more comorbidities, and hospitals that were government nonfederal versus private, were large versus small, and were located in the West versus Northeast regions. From 2003 to 2008, total costs increased annually by 3% for CD (1.03; 95% CI = 1.02-1.05; p < 0.001) and 4% for UC (1.04; 95% CI = 1.02-1.06; p < 0.001), but remained unchanged from 2008 to 2014. CONCLUSIONS: The findings are important to identify IBD patients with higher hospitalization costs and to inform policy plans on hospital resource allocation.

Objectives: Insufficient sleep negatively impacts the cardiovascular system. No study has examined the association between sleep duration and heart age (person's predicted vascular age based on cardiovascular disease [CVD] risk profile). This study examines association between sleep duration and excess heart age (EHA; difference between heart age and chronological age) among US adults. Design and participants: Cross-sectional 2007-2014 National Health and Nutrition Examination Survey data for respondents aged 30-74 years without CVD or stroke (n = 12,775). Measurements: Self-reported sleep duration was classified into 5 categories (≤5, 6, 7, 8, and ≥9 hours). We used sex-specific Framingham heart age algorithm to calculate heart age and multivariable linear regression to examine association between sleep duration and EHA. Results: A total of 13.4% (95% confidence interval 12.5-14.3), 24.2% (23.1-25.2), 31.0% (29.8-32.3), 25.9% (25.0-26.9), and 5.5% (5.0-6.1) reported sleeping ≤5, 6, 7, 8, and ≥9 hours, respectively. We observed a nonlinear relationship between sleep duration and EHA using 7 hours as reference: EHA (adjusted for sociodemographics, body mass index, physical activity, Healthy Eating Index-2010, sleep disorder, and depression status) was 5.1 (4.8-5.8), 4.5 (3.9-5.1), 3.7 (3.3-4.0), 4.5 (4.1-5.0), and 4.1 (3.3-4.9) years for sleep durations of ≤5, 6, 7, 8 and ≥9 hours, respectively (P =.015 for quadratic trend). EHA was significantly higher among participants with lower education, lower income, and obesity. Conclusion: Mean adjusted EHA was lowest among adults who reported sleeping 7 hours per night and increased as adults reported sleeping fewer or more hours. Discussing sleep duration in the context of EHA may be helpful for patients and clinicians.

Objectives: To assess the association between sleep duration and health-related quality of life (HRQOL) among adults with or without chronic conditions. Methods: Using the 2014 Behavioral Risk Factor Surveillance System, we analyzed self-reported data from adult respondents aged ≥18 years with (n = 277,757, unhealthy group) and without (n = 172,052. healthy group) reported history of any of nine chronic conditions (coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease, diabetes, asthma, arthritis, depression, chronic kidney disease). Multivariable logistic regressions were separately constructed to assess the associations between sleep duration and four self-reported HRQOL measures after adjustment for sociodemographics, leisure-time physical activity, body mass index, and smoking status among unhealthy and healthy adults. Results: The prevalence of poor/fair health, frequent physical distress, frequent mental distress, frequent activity limitation, and short sleep duration was 27.9%, 19.3%, 17.0%, 13.6%, and 38.3% in the unhealthy group and 6.9%, 4.0%, 5.3%, 2.1%, and 31.0% in the healthy group, respectively. U-shaped relationships of sleep duration to all four HRQOL indicators were observed among the unhealthy group and to poor/fair health, frequent mental distress, and frequent activity limitation among the healthy group. The relationships further varied by sex, age, race/ethnicity, and BMI category among the healthy group. Conclusions: Relationships between extreme sleep duration and HRQOLs were observed among both healthy and unhealthy groups. These results can help inform public awareness campaigns and physician-counseling regarding the importance of sleep for mental health and well-being.

Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the third leading cause of death in the United States in 2015 and the fourth leading cause in 2016. Major risk factors include tobacco exposure, occupational and environmental exposures, respiratory infections, and genetics.(dagger) State variations in COPD outcomes (1) suggest that it might be more common in states with large rural areas. To assess urban-rural variations in COPD prevalence, hospitalizations, and mortality; obtain county-level estimates; and update state-level variations in COPD measures, CDC analyzed 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS), Medicare hospital records, and death certificate data from the National Vital Statistics System (NVSS). Overall, 15.5 million adults aged >/=18 years (5.9% age-adjusted prevalence) reported ever receiving a diagnosis of COPD; there were approximately 335,000 Medicare hospitalizations (11.5 per 1,000 Medicare enrollees aged >/=65 years) and 150,350 deaths in which COPD was listed as the underlying cause for persons of all ages (40.3 per 100,000 population). COPD prevalence, Medicare hospitalizations, and deaths were significantly higher among persons living in rural areas than among those living in micropolitan or metropolitan areas. Among seven states in the highest quartile for all three measures, Arkansas, Kentucky, Mississippi, and West Virginia were also in the upper quartile (>/=18%) for rural residents. Overcoming barriers to prevention, early diagnosis, treatment, and management of COPD with primary care provider education, Internet access, physical activity and self-management programs, and improved access to pulmonary rehabilitation and oxygen therapy are needed to improve quality of life and reduce COPD mortality.