Association Between Racial Segregation of Labor and Delivery Services and Utilization of Trial of Labor and Vaginal Birth After Cesarean

Obstetrics and Gynecology · 2026-05-14

OBJECTIVE: Trial of labor after cesarean (TOLAC) offers an opportunity to mitigate maternal morbidity disparities, which are associated with cesarean delivery rates as well as with racial segregation in obstetric care. This study sought to assess the association between the proportion of births to Black individuals at a hospital and the likelihood of low-risk patients undergoing TOLAC and achieving vaginal birth after cesarean (VBAC). METHODS: This is a retrospective cohort study of 2017-2019 Nationwide Inpatient Sample deliveries with a history of prior cesarean delivery. We categorized hospitals by the proportion of births to Black individuals: high (top 5%), medium (6-25%), or low (reference), urban-rural status, and teaching status. Primary outcomes were TOLAC and VBAC odds. We used propensity score-matching and performed weighted hierarchical logistic regressions adjusting for maternal age, race and ethnicity, ZIP code median household income quartile, obstetric comorbidity index, hospital delivery volume, and bed size. RESULTS: A total of 1,734,919 deliveries to low-risk individuals with prior cesarean deliveries were included. One-fifth of these patients (19.7%, n=341,165) attempted labor, among whom 81.4% (n=227,775) delivered vaginally. Compared with low Black-serving hospitals, patients at high Black-serving hospitals had higher TOLAC (adjusted odds ratio [aOR] 1.51, 95% CI, 1.36-1.67) and VBAC odds (aOR 1.24, 95% CI, 1.07-1.43). Black (vs White) patients had lower VBAC odds (aOR 0.88, 95% CI, 0.78-0.98). Among urban teaching hospitals, the TOLAC and VBAC probabilities at high Black-serving hospitals were 25% (95% CI, 22-28%) and 75% (95% CI, 72-78%), respectively, compared with 18% (95% CI, 16-19%) and 70% (95% CI, 67-72%), respectively, at low Black-serving hospitals. Black patients at high Black-serving hospitals had a 72% (95% CI, 69-74%) VBAC probability compared with 67% (95% CI, 64-70%) at low Black-serving hospitals. CONCLUSION: Low-risk patients with prior cesarean deliveries had higher odds of TOLAC and VBAC at high Black-serving hospitals. Black (vs White) patients remained less likely to deliver vaginally but had higher chances at high Black-serving hospitals compared with low Black-serving hospitals. Future work should investigate institutional factors that may reduce cesarean deliveries and increase TOLAC and VBAC success, given the significant contribution of cesarean delivery to disparities in maternal morbidity.

Impact of COVID-19 on Incident Depression and Anxiety: A Population-Based Observational Study Using Statewide Claims Data

Healthcare · 2025-07-08 · 1 citations

Objectives: Evidence suggests that COVID-19 infection contributes to elevated risks of psychiatric disorders, including depression and anxiety, however, this association remains underexplored. This study aimed to examine the incidence of depression and anxiety in individuals with COVID-19 compared to those without any infection. Method: Using the Utah All Payers Claims Database (2019 to 2021), we examined adult patients with continuous insurance enrollment. Individuals with pre-existing depression or anxiety were excluded. COVID-19 infection in 2020 was identified using diagnostic and procedural codes. The Least Absolute Shrinkage and Selection Operator (LASSO) method was applied to select covariates, followed by entropy balancing to adjust for baseline differences. Weighted logistic regression models were used to estimate the association between COVID-19 infection and incident mental health diagnoses in 2021. Results: Among 356,985 adults included in the final analytic sample for depression analysis, 37.6 percent had a documented COVID-19 infection in 2020. Individuals with prior infection had significantly higher odds of receiving a depression diagnosis in 2021 compared to those without infection (OR = 1.48, p < 0.01). A similar pattern was observed for anxiety: among 371,491 adults, 38.1 percent had a COVID-19 infection, and infected individuals had 46 percent greater odds of receiving an anxiety diagnosis (OR = 1.46, p < 0.01), after adjusting for demographic and clinical characteristics. Conclusions: This study highlights the elevated risk of depression and anxiety among patients who had been infected with COVID-19, emphasizing the importance of addressing the mental health needs of individuals affected by the virus.

A Framework to Identify the Catalog of Important Tasks Reflecting Interorganizational Characteristics Regarding the Deployment of Portable Equipment

IEEE Access · 2025-01-01

One key difference between the traditional probabilistic safety assessment (PSA) and multi-unit PSA (MU-PSA) is that the MU-PSA must consider interorganizational characteristics arising from deploying portable equipment. In this study, a systematic framework is proposed for the detailed sub-task analysis of human failure events (HFEs) involving portable equipment through utilization of STAMP (Systems-Theoretic Accident Model and Processes) and STPA (Systems-Theoretic Process Analysis). A case study was performed for a typical multi-unit emergency response involving a portable diesel generator. Through the proposed framework, detailed sub-tasks were identified for the HFE (“Failure of deploying the portable diesel generator”) in a form of unsafe control actions through a systemic approach. The results showed that the potential hazards that may not currently be analyzed in the traditional HRA enough include failed convocation of offsite workers, interorganizational communication between important EROs, and multi-unit decision making error on installing PDGs if there are conflict due to limited number of PDGs available. Results of the detailed HFE analysis using the proposed framework may be used as a basis to allow more realistic application of the HRA involving deployment of portable equipment (e.g., multi-unit accidents and beyond design-basis external events) that are better representative of the interorganizational characteristics.

Race and Ethnicity as Factors in Healthcare Discrimination in the United States: A Cross-Sectional Study

Journal of Racial and Ethnic Health Disparities · 2025-01-28 · 2 citations

Disparities in Long-Term Mortality Following Bariatric Surgery Between Hispanic and Non-Hispanic White Patients

Journal of Racial and Ethnic Health Disparities · 2025-09-26

COVID-19 and risk of self-harm, suicidal ideation, and poisoning in children and adolescents

Annals of Medicine · 2025-06-09 · 2 citations

OBJECTIVE: This study examined the association between COVID-19 and the risk of self-harm, suicidal ideation and poisoning in school-aged children and adolescents. MATERIALS AND METHODS: We utilized the 2019-2021 Utah All Payers Claims Database (APCD) to identify school-age children and adolescents aged 6-15 years in 2019. COVID-19 diagnosis, self-harm, suicidal ideation and poisoning were identified using ICD-10 diagnosis codes. Baseline characteristics were assessed, and Inverse Probability Weighting (IPW) was applied to balance these characteristics between the two groups (those with COVID-19 and those without). Weighted logistic regression was employed to identify factors associated with these outcomes in 2021. RESULTS: < 0.01). CONCLUSION: Our findings suggest a significant association between diagnosed COVID-19 and self-harming behaviours in children and adolescents.

Differences in opioid prescriptions between subjects with and without intellectual and developmental disability during the COVID-19 pandemic

Journal of Substance Use · 2025-04-20 · 1 citations

NOVEMBER, A Phase 2 Trial of a 9-Day Course of Whole Breast Radiation Therapy With a Simultaneous Lumpectomy Boost for Early-Stage Breast Cancer

International Journal of Radiation Oncology*Biology*Physics · 2025-05-02

Long-COVID is associated with increased absenteeism from work

PLoS ONE · 2025-06-06 · 3 citations

Long-COVID, defined as COVID-19 symptoms persisting for more than 3 months, may lead to persistent health issues requiring extensive medical care. Despite its long-term health impact, the economic impact of long-COVID remains understudied. This study examined whether individuals with long-COVID had more missed workdays compared to those without long-COVID. Adults (≥18 years old) with full-time jobs were identified from the 2022 Full-Year Population Characteristics file of the Medical Expenditure Panel Survey (MEPS). A weighted two-part model was used to identify factors associated with missed workdays due to illness. The total population analyzed included 131,685,516 adults (unweighted n = 8,210), with an average (SD) age of 43 (14) years. Among them, 46% were female and 62% were non-Hispanic White. Approximately 7% of the population experienced long-COVID. Individuals with long-COVID reported an average of 8 days missed from work (SD: 12 days), while those without long-COVID reported an average of 4 days missed (SD: 9 days). The two-part model revealed that individuals with long-COVID had 2.54 more missed workdays compared to those without long-COVID (p < 0.01), after controlling for relevant variables. These results underscore significant productivity losses associated with long-COVID, highlighting the need for policymakers and employers to implement effective strategies to address this condition.

Associations Between Length of US Residency and Participation in Child Nutrition Assistance Programs Among Immigrant Families

Journal of the Academy of Nutrition and Dietetics · 2025-04-21 · 1 citations

BACKGROUND: Children in US immigrant families experience high rates of food insecurity. Participation in federal child nutrition assistance programs can reduce food insecurity. What remains unknown is whether there are disparities in the participation in these programs among immigrant families based on the length of US residency (LOR). This is an important knowledge gap because there are multiple potential pathways between LOR and common barriers to accessing federal child nutrition assistance programs. OBJECTIVE: To determine the association between LOR and participation in federal child nutrition assistance programs among low-income immigrant families in the United States. DESIGN: Cross-sectional analysis. PARTICIPANTS/SETTING: Nationally representative data from the 2019-2022 National Health Interview Survey. The National Health Interview Survey contains information about participation in federal child nutrition assistance programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and school meal programs, including the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). There were 3488 potentially eligible immigrant families for WIC and 2426 unequivocally eligible immigrant families for NSLP/SBP, according to each program's eligibility criteria, such as income and age. MAIN OUTCOME MEASURES: Participation in WIC and NSLP/SBP. STATISTICAL ANALYSIS: Two weighted multivariable logistic regression models were developed to determine the association between LOR and participation in WIC and NSLP/SBP. LOR was categorized into <5 years and ≥5 years. Analysis was adjusted for other important risk factors. RESULTS: Results suggest that immigrant families with an LOR ≥5 years were less likely to use WIC (adjusted odds ratio, 0.59; 95% CI, 0.42 to 0.84) compared with those with an LOR <5 years. No association was found between LOR and participation in NSLP/SBP. CONCLUSIONS: Future research should investigate barriers in accessing WIC and whether the nature of barriers differs by LOR. This information can inform interventions to support families in accessing this source of nutritious food.