Background
Patients increasingly consult online resources and Artificial Intelligence (AI) chatbots for medical information. However, post pandemic aggravation of medical misinformation and recent blossom of AI has raised concerns about the quality and comprehensibility of such sources. Adequate, easy to understand, and accurate patient education is crucial in procedural outcome and prognosis, especially for procedures that warrant meticulous postoperative management, such as tracheostomy.
Methods
We evaluated five popular and high-ranking AI chatbots - ChatGPT, DeepSeek, Google Gemini, Microsoft Copilot, and Grok 3 - alongside responses from a senior otolaryngologist, addressing 12 Frequently Asked Questions (FAQs) on tracheostomy care. FAQ selection was guided by a combination of search-listening tools (Google Trends, KeywordsPeopleUse, AlsoAsked, AnswerThePublic, Kwrds.ai), manual Google searches, and clinician input to reflect authentic patient language. Three blinded, board-certified otolaryngologists independently rated each response’s accuracy, clarity, relevance, completeness, usefulness, and reference reliability using the Quality Analysis of Medical Artificial Intelligence (QAMAI), a standardized instrument developed to assess AI-generated contents. Overall preferences and reasons for suboptimal response ranking were also assessed by reviewers. Readability and descriptive text analysis were evaluated using Textstat and Natural Language Toolkit library in Python (Python Software Foundation), employing Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics.
Results
Across the 12 FAQs, there were no significant differences in accuracy between AI-generated and otolaryngologist-generated responses. Google Gemini has higher overall preference and QAMAI score compared to Microsoft Copilot (p&lt;0.05). In terms of completeness, Gemini (p&lt;0.001), DeepSeek (p&lt;0.05), Grok 3 (p&lt;0.05), and ChatGPT (p&lt;0.05) outperformed the otolaryngologist, and each provided content deemed of “good quality” by QAMAI standards. However, Gemini has the reading time (p&lt;.001), highest word (p&lt;.001), long word (p&lt;.001), and difficult word counts (p&lt;.001). Readability analyses revealed that all models have high reading level of at least 10th-13th grade. Inter rater reliability among the three reviewers was 78%.
Conclusion
AI chatbots are a promising tool for accurate, on-demand, and comprehensive health information for patient and families considering or managing tracheostomy care. Google Gemini demonstrated strength in content completeness and overall preference, highlighting the potential of AI to supplement time-limited physician-patient interactions. However, all AI and otolaryngologist generated responses surpassed the American Medical Association’s recommended 6th grade reading level, indicating a need for readability optimization. Future studies should focus on refining the readability of AI-generated content and assessing patient preferences across models. 


AMA Research Challenge 2025 

The Role of Artificial Intelligence in Addressing Patient Inquires on Tracheostomy Care

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background
Patients increasingly consult online resources and Artificial Intelligence (AI) chatbots for medical information. However, post pandemic aggravation of medical misinformation and recent blossom of AI has raised concerns about the quality and comprehensibility of such sources. Adequate, easy to understand, and accurate patient education is crucial in procedural outcome and prognosis, especially for procedures that warrant meticulous postoperative management, such as tracheostomy.
Methods
We evaluated five popular and high-ranking AI chatbots - ChatGPT, DeepSeek, Google Gemini, Microsoft Copilot, and Grok 3 - alongside responses from a senior otolaryngologist, addressing 12 Frequently Asked Questions (FAQs) on tracheostomy care. FAQ selection was guided by a combination of search-listening tools (Google Trends, KeywordsPeopleUse, AlsoAsked, AnswerThePublic, Kwrds.ai), manual Google searches, and clinician input to reflect authentic patient language. Three blinded, board-certified otolaryngologists independently rated each response’s accuracy, clarity, relevance, completeness, usefulness, and reference reliability using the Quality Analysis of Medical Artificial Intelligence (QAMAI), a standardized instrument developed to assess AI-generated contents. Overall preferences and reasons for suboptimal response ranking were also assessed by reviewers. Readability and descriptive text analysis were evaluated using Textstat and Natural Language Toolkit library in Python (Python Software Foundation), employing Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics.
Results
Across the 12 FAQs, there were no significant differences in accuracy between AI-generated and otolaryngologist-generated responses. Google Gemini has higher overall preference and QAMAI score compared to Microsoft Copilot (p<0.05). In terms of completeness, Gemini (p<0.001), DeepSeek (p<0.05), Grok 3 (p<0.05), and ChatGPT (p<0.05) outperformed the otolaryngologist, and each provided content deemed of “good quality” by QAMAI standards. However, Gemini has the reading time (p<.001), highest word (p<.001), long word (p<.001), and difficult word counts (p<.001). Readability analyses revealed that all models have high reading level of at least 10th-13th grade. Inter rater reliability among the three reviewers was 78%.
Conclusion
AI chatbots are a promising tool for accurate, on-demand, and comprehensive health information for patient and families considering or managing tracheostomy care. Google Gemini demonstrated strength in content completeness and overall preference, highlighting the potential of AI to supplement time-limited physician-patient interactions. However, all AI and otolaryngologist generated responses surpassed the American Medical Association’s recommended 6th grade reading level, indicating a need for readability optimization. Future studies should focus on refining the readability of AI-generated content and assessing patient preferences across models. 


poster

BACKGROUND: Surgical education often relies on costly task trainers or two-dimensional surgical videos. Photogrammetry, the process of constructing three-dimensional (3D) models from two-dimensional (2D) images, offers a cost-savings solution while providing a customizable 3D surgical experience. This technique for building photogrammetry-based 3D models allows for the creation of virtual teaching modules and aimed to enhance options for surgical education. While photogrammetry has been used to build models for teaching anatomy, its application in procedural simulation remains limited. Additionally, open carpal tunnel release (OCTR) achieves outcomes comparable to the endoscopic approach, yet virtual reality (VR) training simulations for this open technique have not been explored. This study introduces a low-cost VR OCTR surgical teaching module using photogrammetry to explore production feasibility and educational value across surgical disciplines.

METHODS: A VR OCTR module was created using photogrammetry to generate virtual hand and wrist models from intraoperative cadaveric dissections. Filming was conducted in an academic anatomy lab, demonstrating a five-step OCTR procedure on cadaveric right arms. Serial photographs were captured from multiple angles using a Nikon Z8 camera, with drapes placed to minimize visual distractions. 3D models were rendered via photogrammetry software and refined with open-source tools. The models were viewed through a Meta Quest 3 headset and the teaching module was narrated by a hand surgeon using the MedicalHolodeck Surgical and Anatomical VR application. Surgical trainees and faculty from plastic surgery, orthopedics, and neurosurgery provided feedback for further model development.

RESULTS: This VR module was built using accessible tools and software. High resolution photographs resulted in the anatomically accurate 3D models used to highlight essential anatomy and surgical landmarks in the teaching module. The seven-minute module was noted to be conceptually clear and appropriately concise. Feedback emphasized its usefulness in reinforcing anatomical knowledge, visualizing operative steps, and noting structures to avoid during surgery. In-house development of the modules highlights its customizability for institutional specific learning goals, cost-effectiveness and feasibility for broader institutional adoption, compared to commercial subspecialty specific private platforms for VR surgical training. These findings support the educational potential of photogrammetry-based VR and guide further pilot studies, expansion to medical students and an upcoming randomized trial comparing VR to standard 2D training.

CONCLUSION: Photogrammetry can produce low-cost 3D models for virtual reality teaching modules in surgical education and training. By leveraging accessible technology and cadaveric dissections, this method enhances educational access and sets the stage for wider implementation and outcomes-based research.


The Novel Application of Photogrammetry in Building Virtual Reality Modules for Surgical Education

Abstract Title: Reported Levels of Student Stress and Protective Nature of Resiliency Among First Year U.S. Medical Students - A Single Institution, Pilot Study

Background:
Medical training for M.D. candidates in the United States involves four years of combined didactic and clinical learning. Medical students often experience stressors related to academics and social life that can lead to burnout and clinical depression in medical school. This study aimed to identify key problem areas pertaining to stress and wellbeing among first-year medical students at one accredited M.D. institution by administering the Medical Student Stress Scale (MSSS), a survey that was calibrated and validated by researchers at a single institution looking to identify a precise measurement tool to evaluate medical student stress.

Methods
The MSSS, a 22-item questionnaire, was administered to first year medical students twice during 2024-2025 academic calendar, in the fall and spring. The MSSS questions were administered alongside a Brief Resilience Scale (BRS) and demographic questionnaire. The MSSS measures stress with a total score determined as a summation of the responses, where higher scores indicate greater stress. The BRS measures resiliency with a total score determined as a summation of the 6 item responses and can be categorized as being low (1-2.99), normal (3-4.3), or high (4.31-5).

Results
The overall response rate was 61% (107 out of 175) in the fall and 47% (87 out of 175) in the spring. Average student stress score in the fall and spring was 34.3 and 38.8, respectfully. The resiliency score in the fall and spring was 3.6 and 3.5, respectfully. The multivariable generalized linear model showed that student stress decreased by 10 points and 13 points with every 1-point increase on the BRS in the fall and spring, respectfully (p<0.001). Additionally, at both time points, males display a significantly lower estimated stress score than females (p=0.044 and p=0.016). In the spring, compared to students of Christian faith, Jewish students displayed an estimated 10-point increase in stress (p=0.024), and Islamic students displayed an estimated 17- point increase in stress (p=0.005). Additionally, students that reported they were low-income displayed an estimated 8-point increase in stress compared to non-low-income students (p=0.009).

Conclusion
The MSSS and BRS were feasible to implement and identified clear trends in stress based on demographic factors. High levels of stress are reported even early in the academic year suggesting the need for early and ongoing support. The second time point showed compounding effects, emphasizing the importance of longitudinal support. Resiliency emerged as a potential protective factor and a possible target for future interventions.

Reported Levels of Student Stress and Protective Nature of Resiliency Among First Year Medical Students - A Single Institution, Pilot Study

Background: 

In 2023, a tragic cardiac arrest during a high school basketball game in Detroit, where a student-athlete collapsed and later died despite bystander aid and EMS intervention. This event brought national attention to the lack of consistent sideline medical coverage in underserved urban public schools. Despite widespread advocacy for the presence of certified athletic trainers, Detroit’s public schools have faced systemic under-resourcing. To address this inequity, students at Wayne State University School of Medicine developed the Detroit Public School Health Corps (DPSHC), a student-led initiative that provides consistent sideline medical care through strategic partnerships and longitudinal volunteer engagement. 



Methods: 


Our organization formed a partnership between the Detroit Public Schools Community District, Wayne Pediatrics, and the Detroit Medical Center Orthopedics and Sports Medicine. The initiative recruited over 50 medical student volunteers over the 2024-2025 academic year to volunteer as sideline sports first responders at high school athletic events. Students completed several sport specific training courses led by physicians and residents in sports medicine and pediatrics. We utilized a combined didactic and hands-on instruction, adding up to over ten hours of curriculum across an academic year. Trained volunteers were deployed to 16 high schools in the Detroit Public School Community District. Each sporting season, we provide on-site triage and acute care, with escalation protocols involving on-call physicians and EMS for higher-acuity injuries. Our hospital partners also supported logistical coordination and physician oversight. 



Results: 


During the most recent academic year, our volunteers staffed: 156 of 250 home basketball games (boys and girls), 58 of 64 home football games, 50 of 185 home baseball/softball games, 10 of 14 home girls' soccer games, and 10 of 10 track meets. This totaled 598 hours of sideline coverage across all three sports seasons in 16 public high schools. Over 50 trained student volunteers provided consistent, supervised care, directly assisting thousands of student-athletes. The collaboration with on-call physicians through Wayne Pediatrics and the Detroit Medical Center Orthopedics and Sports Medicine enabled real-time consultation and emergency triage as needed. 



Conclusion: 


DPSHC demonstrates a sustainable, scalable model for addressing the absence of sideline medical personnel in under-resourced school systems. By leveraging medical student enthusiasm, structured clinical training, and institutional partnerships, this initiative has delivered meaningful healthcare access to student-athletes in Detroit. Looking ahead, we aim to expand the program’s impact through continued systematic data collection on injuries, hydration access, and volunteer experiences. These insights will guide ongoing improvements in both student-athlete well-being and the educational value for medical students.

Medical Student-Led Model for Sideline Sports Coverage in Underserved Detroit High Schools through the Detroit Public Schools Health Corp ​

Background: Direct acting antivirals (DAAs) are over 95% effective at curing hepatitis C virus (HCV) infection, yet treatment rates remain low among people who inject drugs (PWID), a priority population for HCV treatment. Given the high prevalence of HCV among PWID, this study looks to characterize treatment uptake and completion among PWID in a safety-net healthcare system in a large city.
Methods: We conducted a retrospective study to identify individuals with evidence of HCV (detectable HCV RNA) between 11/01/2021 to 10/31/2023 and evidence of possible or definite injection drug use (IDU) who accessed care within our integrated healthcare system. We then reviewed medical records of individuals we identified with HCV and IDU to determine demographic characteristics and progression through the HCV care continuum. We compared demographic characteristics at different stages of the care continuum to assess for factors associated with completion of each stage.
Results: 1165 individuals had positive HCV RNA results in our medical system during the study period. Of those, 149 individuals had evidence of definite (n=118, 80.3 %) or possible (n=29, 19%) IDU. 34.2% (n=51) of the study population met with a HCV treatment provider, 26.8% (n=40) started treatment, 25.5% (n=38) completed treatment, and 18.1% (n=27) had evidence of SVR12. Proportions of individuals linked to care did not differ significantly by gender, housing status, IDU status (definite vs. possible), or race/ethnicity.
Conclusions: Over a two-year period, only 26.8% of the 149 individuals with IDU and HCV started HCV treatment. The largest barrier in achieving cure was linking to a medical visit for HVC care after a positive HCV RNA test. Almost three quarters (74.5%) of those who met with a treatment provider completed treatment. No statistical difference was observed in linkage to care based on gender, race/ethnicity, age or housing status. Of those who did not complete HCV treatment, most were lost to follow up without a documented reason in the electronic medical record.

Hepatitis C Care Continuum among People Who Inject Drugs in a Safety-Net Healthcare System

Introduction: Food insecurity (FI) is associated with poor health outcomes, including obesity, diabetes, hypertension, and mental illness. While food voucher programs help address FI, their clinical impact is understudied. At Prisma Health, where 1 in 5 patients face barriers to healthy eating, we implemented a voucher program at a Family Medicine clinic to improve food access and assess health outcomes. 

Materials and Methods: Between February 1 and November 1, 2024, nurses and program coordinators recruited patients during routine visits if they met ≥1 of the following criteria: (1) positive screen on a validated FI questionnaire; (2) homelessness; (3) on Medicaid; (4) uncontrolled DM (A1c ≥8.0%), or (5) HTN (≥130/90 mmHg). Participants received one to three $15 vouchers per visit, redeemable for produce at a nearby market. Voucher use was tracked at the individual level, and clinical data were obtained through manual chart review. Analyses included descriptive statistics via SAS, negative binomial regression for redemption rates, and paired t-tests or Wilcoxon tests for clinical outcomes.

Results: We distributed 4,552 vouchers to 943 participants, with a 54.6% redemption rate. After exclusions, 877 were analyzed: 78% female, 85% Black, and 78% extremely low income. Diagnoses included DM (22%), HTN (52%), depression (19%), anxiety (23%), and overweight/obesity (61%; among 710 patients with BMI data). In multivariate analysis, HTN (IRR 1.26, p = 0.0018), age ≥45 (IRR 1.42, p = 0.0002), Black vs. White race (IRR 1.37, p = 0.0009), and Latino vs. Black race (IRR 1.39, p = 0.0339) were independently associated with higher redemption. In a pre-post analysis of 535 overweight/obese patients, BMI significantly decreased (mean difference -0.44, p = 0.0006). Among 136 patients with HTN who had a pre- systolic blood pressure ≥ 140, SBP decreased on average by 11.2 mmHg. In patients with uncontrolled DM, (pre- A1c ≥ 8, n=68) there was a 1.17 decrease in A1c. Patients with a PHQ-9 ≥ 10 experienced an 8.8-point decrease (p<0.0001) in their score. No significant changes were seen in GAD-7.

Conclusion: This study identified patients likely to engage in a food access program, including those with HTN, age ≥45, and Black or Latino race. BMI improved among overweight/obese participants; other clinical outcomes remained stable. As the first study of its kind in SC – one of seven states with FI prevalence above national average – future research is indicated to evaluate whether longer-term or higher-intensity programs improve clinical outcomes.

Physicians Fighting Food Insecurity

Background
To evaluate the effectiveness of 5 Rivers Heart Association's (5RHA) street medicine initiative via medical camps and mobile healthcare outreach in advancing cardiovascular disease prevention and treatment adherence while decreasing illness burden among vulnerable populations in India and the United States.
Methods
From 2019 to 2024, 5RHA organized 1,694 health outreach events, collecting comprehensive data from 395 sessions that examined 18,750 adults (18–80 years) throughout 5 Indian states and urban U.S. underserved communities. The program addressed high blood pressure, diabetes, joint disorders, psychological wellness, and malignancy prevention through standardized risk evaluation per AHA/ACC protocols, culturally appropriate health education focusing on lifestyle changes and medication consistency, adherence monitoring via mobile messaging, and integrated community psychological support. Measured parameters included systolic/diastolic pressure, glycated hemoglobin, body mass index, treatment compliance, and life satisfaction (SF-12 scale). Statistical analysis employed paired t-tests and logistic regression for pre and post comparisons.
Results
Following intervention, blood pressure management (≤140/90 mmHg) improved 35% in India (p<0.001) and 30% in the U.S. (p=0.002), while treatment adherence increased 45% (OR 1.92; 95% CI 1.73–2.15). Glycemic management was enhanced with 25% fewer patients having HbA1c >8% (p<0.01) and 30.4% decrease in LDL among high-risk cardiovascular patients (p<0.01). Psychological intervention improved cardiac self-care in 60% of anxious/depressed participants. Malignancy screening uptake rose 40%. Integrated physiotherapy and dietary counseling produced 68% better arthritis mobility measured by walking assessments. 87% of participants represented low-income families, with 95% of U.S. participants from ethnic minorities. Patient follow-up rates rose 48% due to team-generated reminders. Community collaborations decreased hospital re-admissions by 15%.
Conclusion
5 Rivers Heart Association's mobile health program substantially improves cardiovascular prevention, enhancing blood pressure control, glucose management, and psychological health while boosting treatment adherence in marginalized communities. This expandable approach, integrating education, digital tools, and health equity initiatives, advances AHA's 2030 disparity reduction objectives. Healthcare leaders should prioritize community-centered prevention strategies to maximize similar worldwide benefits.

Strenghthening Cardiovascular Health via Mobile Outreach: 5 Rivers Heart Association's Community Impact

Background
Breastfeeding provides optimal nutrition for infants with numerous health benefits, as recommended by the World Health Organization for the first six months exclusively and up to two years or beyond with complementary foods. Not breastfeeding results in substantial global economic losses, estimated at $341.3 billion annually (0.49% of global GDP). For mothers living with HIV in low and middle-income countries (LMICs), concerns about vertical transmission via breast milk and potential interactions with antiretroviral therapy create complex challenges that impact breastfeeding initiation and sustainment. However, concerns about HIV transmission via breast milk and negative interactions with antiretroviral therapy can impact breastfeeding initiation and sustainment in these populations.

Methods
A comprehensive systematic review of nine databases was conducted in March 2024 to identify studies comparing breastfeeding versus formula feeding cost-effectiveness outcomes in LMICs. Inclusion criteria encompassed primary research with economic outcomes related to both feeding methods in HIV-affected populations. Studies lacking economic data or direct comparisons between feeding methods were excluded. The review examined both quantitative and qualitative evidence on cost-effectiveness, healthcare costs, and socioeconomic barriers to breastfeeding.

Results
From 523 initially identified articles, nine studies conducted in Sub-Saharan African countries with high HIV prevalence were included in the final analysis. Two main themes emerged: 1) mothers living with HIV often engage in suboptimal breastfeeding practices due to fears of HIV transmission, economic pressures, social norms, and lack of support; and 2) breastfeeding coupled with antiretroviral treatment is a cost-effective infant feeding strategy compared to formula feeding in resource-limited settings. Breastfeeding with appropriate antiretroviral therapy was found to be cost-effective at traditional willingness-to-pay thresholds, reducing disability-adjusted life years (DALYs) and healthcare expenses related to infant morbidity and hospitalization. However, employment status, economic determinants, and workplace commitments significantly influenced feeding decisions, often resulting in lower breastfeeding rates among HIV-positive mothers compared to their HIV-negative counterparts.

Conclusion
This systematic review highlights the complex interplay between socioeconomic factors and health outcomes in breastfeeding decisions among mothers living with HIV in LMICs. Breastfeeding promotion represents not only a health-beneficial intervention, but also a cost-effective and potentially cost-saving investment for resource-limited healthcare systems when HIV is comprehensively managed through antiretroviral treatment. Future policies should incorporate supportive measures such as evidence-based counseling, educational campaigns, paid maternal leave, and enhanced healthcare infrastructure to overcome the economic and structural barriers to successful breastfeeding in HIV-affected populations.


Economic Implications of Breastfeeding Versus Formula Feeding in the Context of HIV in Low and Middle-Income Countries: A Systematic Review

Despite significant advancements in pharmaceuticals and medical interventions, heart disease remains the leading cause of death worldwide. Although much research has been dedicated to understanding its risk factors, significant gaps persist, particularly in understudied populations. Addressing these gaps is essential to developing more effective, personalized strategies for preventing and treating heart disease. Current research often analyzes risk factors independently, without considering their potential interactions. As a result, treatments that benefit one patient may be ineffective for another, yet providers frequently adopt a one-size-fits-all approach. We can move toward a more personalized healthcare model by analyzing how risk factors, outcomes, diagnostics, and treatments vary between individuals. Understanding the complex interplay between genetic, social, and psychological determinants will help improve outcomes and bring us closer to truly individualized care on a global scale. This study aims to investigate factors that predict or protect against myocardial infarction (MI) in patients with a known risk factor of hyperlipidemia. Using regression modeling and subsets, the analysis will evaluate individual variables and their interactions. 


Risk Factors for Myocardial Infarction in Patients with Hyperlipidemia: A Logistical Regression Analysis

Background 
Environmental degradation due to industrial groundwater contamination is an emerging 
cardiovascular disease (CVD) risk factor. Our study examines the elevated CVD prevalence, 
including heart failure (HF) risk factors, in rural Punjab, India, near which a private distillery was 
linked to long-term groundwater contamination and environmental degradation. Our team 
primarily focused on CVD prevalence and its associations with environmental toxins. We also 
explored the role of socio-economic disparities on health outcomes. 
Methods 
A cross-sectional study of 4,885 residents in three villages adjacent to the distillery (Mahianwala 
Kala, Ratol Rohi, Mansoorwaal Kalan) was conducted from October 2022 to August 2023. 
Health camps with follow-up door-to-door surveys by trained medical personnel collected 
medical histories, environmental exposure details, and socio-demographic data. Key outcomes 
included both communicable and non-communicable diseases, such as hypertension, ischemic 
heart disease, heart failure, and cancer. Logistic regression assessed associations between 
CVD prevalence, socio-economic status, and pollution exposure, with groundwater testing for 
heavy metals and chemical oxygen demand (COD). 
Results 
The cohort demonstrated a high CVD burden, with 39% having hypertension (exceeding 
national averages by more than 50%), 34% having diagnosed CVD, and 21.3% of households 
reporting an immediate family history of myocardial infarction. Adjusted models highlighted 
elevated odds of heart disease (OR 1.42; 95% CI 1.31–1.51) and stroke (OR 1.29; 95% CI 
1.16–1.38), with higher clustering in low-income families. Concurrent systemic toxicity was also 
evident, as 60.5% reported dermatological conditions, 10.5% familial cancer, 20.8% with no 
history of smoking cited COPD-related dyspnea. We also observed elevated miscarriage rates 
and developmental disabilities in the studied population. Groundwater analysis confirmed 
contamination with cyanide (0.3 mg/L), lead (0.16 mg/L), and COD (320 mg/L), correlating with 
self-reported water discoloration and irregularities in taste. Families with polluted water access 
had a 1.5-fold increased CVD risk. 
Conclusion 
Industrial contamination was linked to higher cardiovascular morbidity and multi-organ health 
effects in our study's cohort in rural India. The link was exacerbated by socio-economic 
inequities. These findings highlight the role of environmental degradation in rise in CVD, 
particularly in low-resource settings.

Impact of Environmental Toxins and Socio-Economic Disparities on Cardiovascular Disease Burden: Insights from a Rural Indian Cohort Exposed to long term Industrial Pollution

Background: Retinal vascular occlusions are known causes of acute visual impairment. Prior studies have found an increased risk of retinal vascular occlusion among individuals with human immunodeficiency virus (HIV). However, these studies were conducted between 1983 and 1998, prior to the establishment of antiretroviral therapy (ART), which has since significantly improved HIV-related morbidity and mortality. While more recent case reports suggest a continued disease burden, no large-scale studies have examined this association in the ART era. We aim to determine the incidence and risk of retinal vascular occlusion, including retinal artery occlusion (RAO) and retinal vein occlusion (RVO), in HIV patients since widespread ART access.

Methods: We conducted a retrospective cohort analysis of healthcare data from May 2005 to May 2025 within the TriNetX global network. Adults ages 18 to 65 with HIV were compared to age-matched controls with dry eye syndrome. All patients were assessed by an ophthalmologist and excluded if they had prior history of retinal vascular occlusion. Propensity score matching (PSM) was used to balance demographics and comorbidities, including hypertension, diabetes mellitus, hyperlipidemia, and nicotine dependence. Incidence and relative risk (RR) of RAO and RVO were compared between cohorts. We calculated hazard ratios (HR) with 95% confidence intervals (CI) to stratify risk according to CD4 count (<100/µL vs. >100/µL) and viral load (< 200 copies/mL vs. > 200 copies/mL).

Results: After PSM, 26,736 patients were included in each cohort. HIV patients had an increased risk of RAO compared to controls (0.25% vs. 0.15%, RR=1.72, p<0.01); however, there was no significant difference in RVO outcomes (0.27% vs. 0.27%, RR=0.99, p=0.99). Among HIV patients, CD4 count <100/µL was associated with increased RAO risk (HR=1.83, p=0.02, 95% CI 1.11-2.99), but not RVO risk (HR=1.43, p=0.12, 95% CI 0.91-2.24). CD4 count >100/uL was not found to increase the risk of either RAO (HR=0.87, p=0.45, 95% CI 0.60-1.26) or RVO (HR=0.95, p=0.78, 95% CI 0.68-1.33). Viral load <200 copies/mL was not associated with a significant risk of RAO (HR=0.66, p=0.14, 95% CI 0.38-1.14) or RVO (HR=1.19, p=0.45, 95% CI 0.76-1.86).

Conclusion: HIV infection was associated with an increased risk of RAO, but not RVO, compared to controls. Given that the elevated RAO risk was concentrated among those with severe immunosuppression, these findings support early initiation of ART to mitigate HIV-associated RAO risk. Additionally, HIV screening may be warranted in atypical or unexplained cases of RAO.

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