Exercise and Income/Race/Gender in U.S.

Thanks again to Ben Gold for another good read: S Armstrong et al. JAMA Pediatr 2018; 172(8): 732-40.

This study provides a great deal of information on the physical activity of adolescents and young adults (age group 12-29) from 2007-2016 using NHANES data from 9472 participants.  The relationship of physical activity compared with income, race and gender is explored.

Background:

  • The current recommendation is for adolescents to engage in a minimum of 60 minutes of moderate to vigorous activity per day.  At age 20, adult guidelines recommend 150 minutes of moderate activity, 75 minutes of vigorous activity  or an equivalent combination of moderate and vigorous activity per week.
  • In previous studies, one-third of adults do not meet the recommended amount of physical activity

Key findings:

  • Percentage of individuals reporting any moderate or vigorous activity: 87.9% for age 12-17 y, 72.6% for age 18-24 y, and 70.7% for age 25-29 y.
  • Mean time for moderate or vigorous activity: For males: 71.1 min or age 12-17 y, 64.3 min for age 18-24 y, and 50.3 min for age 25-29 y. For females: 56.0 min or age 12-17 y, 44.9 min for age 18-24 y, and 39.2 min for age 25-29 y.
  • Younger age, white race, and higher income were associated with greater physical activity.  The breakdown on the specifics are listed in the five Tables.

The limitations of this study include that the data are cross-sectional and do not prove causality.  In addition, the data are self-reported and some groups may over- or under-report activity.

My take: This study shows that a lot of young individuals are not physically-active whihc increases the risk of some chronic diseases.  Examining the groups that have higher and lower physical activity may help understand ways towards improvement.

During a recent trip to Charlottesville, I came across this article. Someone is identifying dog poops with Nicholas Cage’s face –to highlight the problem?  Funny stuff.

Time-to-diagnosis of Biliary Atresia

A recent study (S Harpavat et al. JPGN 2018; 66: 850-6) identifies race/ethnicity as a factor affecting the timeliness of diagnosis.

Specifically, non-Hispanic white infants were diagnosed earlier than non-Hispanic black infants and Hispanic infants (P=.007); this was related to the timing of referral from the primary care physician.  The authors speculate that this could be related to three factors:

  • lighter colored skin could help identify jaundice more quickly
  • better access to health care
  • implicit bias leading to uneven treatment

The other finding in the study was that after referral, patients referred after 30 days of life had a more expedited diagnosis than those referred prior to 30 days of life.  The authors caution that the histology in these early cases is similar to those who present later, even if their aminotransferases are normal.  In addition, while physicians and parents want to avoid ‘over testing,’ prompt diagnosis, even prior to 30 days of life, may lead to improved outcomes.  Thus, the authors recommend proceeding with liver biopsy if there is clinical suspicion of biliary atresia.

My take: Obtaining objective evidence of cholestasis in infants that are jaundiced beyond 2 weeks of life is important.  This study highlights some of the reasons why the diagnosis is delayed in so many.

Related blog posts:

 

Race Associated with Outcomes in Intestinal Failure

The best preparation for tomorrow is to do today’s work superbly well”  –William Osler (quote cited in NEJM 2014; 371: 1565-66).

The quote above is not directly related to today’s post but I liked it a lot.

While race “encompasses social, economic, and cultural issues,” it is a marker for health outcomes including in children with intestinal failure (JPGN 2014; 59: 537-43). This Pediatric Intestinal Failure Consortium study retrospectively analyzed 272 subjects, though 22 did not have adequate data regarding race.  In this cohort, there were 204 white and 46 nonwhite children.

Key findings:

  • Nonwhite children were more likely to die without an intestinal transplant (P<0.001). At 48 months after entry criteria were met, cumulative probability of death without an intestinal transplant was 0.40 for nonwhite children compared with 0.16 for white children.
  • Nonwhite children were less likely to receive an intestinal transplant (P=0.003). At 48 months after entry criteria were met, cumulative probability of receiving an intestinal transplant was 0.07 for nonwhite children compared with 0.31 for white children.

These findings held up when examined for biological factors like low birth rate and reason for intestinal transplantation; other factors that were accounted for included evidence of liver disease, residual bowel length, and whether child had received care at an intestinal transplantation center.  Even factors like receiving breast milk in the nursery were similar between the two groups.

Bottomline: Nonwhite race appears to be a marker for poor outcomes in children with intestinal failure.  Based on this retrospective data which examined multiple factors, the reasons do not have a biological basis.  As such, issues like barriers to treatment/access to care, social support, parental education, and cultural differences need to be considered.