1
|
Edwards A, Monroe R, Amram O, Kumar A. Distance to endoscopy services amplifies racial inequities in colorectal cancer mortality in Washington state. Am J Surg 2024; 235:115732. [PMID: 38670835 DOI: 10.1016/j.amjsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This study evaluates relationships among race, access to endoscopy services, and colorectal cancer (CRC) mortality in Washington state (WA). METHODS We overlayed the locations of ambulatory endoscopy services with place of residence at time of death, using Department of Health data (2011-2018). We compared CRC mortality data within and outside a 10 km buffer from services. We used linear regression to assess the impact of distance and race on age at death while adjusting for gender and education level. RESULTS Age at death: median 72.9y vs. 68.2y for white vs. non-white (p < 0.001). The adjusted model showed that non-whites residing outside the buffer died 6.9y younger on average (p < 0.001). Non-whites residing inside the buffer died 5.2y younger on average (p < 0.001), and whites residing outside the buffer died 1.6y younger (p < 0.001). We used heatmaps to geolocate death density. CONCLUSIONS Results suggest that geographic access to endoscopy services disproportionately impacts non-whites in Washington. These data help identify communities which may benefit from improved access to alternative colorectal cancer screening methods.
Collapse
Affiliation(s)
- Ashley Edwards
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachel Monroe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Providence Hood River Family Medicine Residency Program, Hood River, OR, USA
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Community Health and Spatial Epidemiology Lab, Washington State University, Spokane, WA, USA
| | - Anjali Kumar
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| |
Collapse
|
2
|
Carr CP, Tate AD, Trofholz A, de Brito JN, Trejo AN, Troy MF, Berge JM, Kunin-Batson A. Associations Between Neighborhood Racialized Economic Segregation with Cardiometabolic Health and Cortisol in a Racially/Ethnically Diverse Sample of Children from Minneapolis-St. Paul. Health Equity 2024; 8:355-359. [PMID: 39011073 PMCID: PMC11249125 DOI: 10.1089/heq.2023.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Past research shows that structural racism contributes to disparities in cardiometabolic health among racially/ethnically minoritized populations. Methods This cross-sectional study examined the correlation between census tract-level racialized economic segregation and child health metrics among a racially and ethnically diverse cohort of 350 children (ages 6.5-13.8) from Minneapolis-St. Paul, MN. Results A consistent cardiometabolic and cortisol outcome gradient was observed across the index of concentration at the extremes tertiles, such that health risk factors increased as tract privilege decreased. Conclusion Racialized economic segregation was associated with less favorable child health outcomes, underscoring the potential importance of place-based interventions for promoting children's health.
Collapse
Affiliation(s)
- Christopher P Carr
- Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Allan D Tate
- Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrea N Trejo
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | | | - Jerica M Berge
- Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Alicia Kunin-Batson
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
McCullough LE, Collin LJ, Statman M. Unravelling race inequities in cardiovascular disease mortality among cancer survivors: new insights and future directions. Int J Epidemiol 2024; 53:dyae049. [PMID: 38684341 DOI: 10.1093/ije/dyae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Muriel Statman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
4
|
Skiba MB, Lind KE, Felion CM, Krupnik C, Segrin C. Connected Community Classification (C3): Development, Validation, and Geospatial Application for Population Health Promotion and Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E74-E83. [PMID: 38271113 DOI: 10.1097/phh.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Social determinants of health (SDOH) impact population health. Leveraging community-level strengths related to SDOH through a social infrastructure perspective can optimize health behaviors and health outcomes to promote health equity. OBJECTIVE Our aims were to develop, validate, and apply the Connected Community Classification (C3) as comprehensive community-level measure of protective SDOH and structural factors in the Four Corners states region of the United States. DESIGN C3 was developed using an iterative principal component analysis of publicly available data mapped to 5 SDOH domains. Regional clustering of C3 by zip code tabulation area (ZCTA) was identified using spatial autocorrelation methods. MAIN OUTCOMES In adjusted spatial autoregressive models, we analyzed the association of C3 with high-risk health behaviors and chronic disease prevalence using publicly available data for population-level estimates of fruit and vegetable intake, physical activity, obesity, smoking, alcohol use, coronary heart disease (CHD), diabetes, and cancer. RESULTS C3 was found to be reliable and valid; a C3 value of 10 indicates communities with greater connection (high), while a value of 1 indicates communities with greater separation (low) to social infrastructure. Lower connection, as measured by C3, was significantly inversely associated with lower fruit and vegetable intake, lower physical activity, and higher rates of obesity, smoking, CHD, diabetes, and cancer. C3 was significantly positively associated with heavy alcohol use. CONCLUSIONS These findings demonstrate that communities connected to social infrastructure have better population health outcomes. C3 captures protective community attributes and can be used in future applications to assist health researchers, practitioners, nonprofits, and policymakers to advance social connection and health equity in geographically diverse underserved regions.
Collapse
Affiliation(s)
- Meghan B Skiba
- Advanced Nursing Practice and Science Division, College of Nursing (Dr Skiba and Ms Felion), University of Arizona Cancer Center (Drs Skiba and Lind), Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health (Dr Lind), Department of Mining and Geological Engineering, College of Engineering (Mr Krupnik), and Department of Communication, College of Social and Behavioral Sciences (Dr Segrin), University of Arizona, Tucson, Arizona
| | | | | | | | | |
Collapse
|
5
|
Kunnath AJ, Sack DE, Wilkins CH. Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis. BMC Public Health 2024; 24:405. [PMID: 38326799 PMCID: PMC10851469 DOI: 10.1186/s12889-024-17834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality. METHODS We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression. RESULTS Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors. CONCLUSIONS Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.
Collapse
Affiliation(s)
- Ansley J Kunnath
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Daniel E Sack
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 600, Nashville, TN, 37203, USA.
| |
Collapse
|
6
|
Kim SJ, Medina M, Zhong L, Chang J. Factors Associated With In-Hospital Death Among Pneumonia Patients in US Hospitals From 2016~2019. Int J Health Policy Manag 2023; 12:7390. [PMID: 37579357 PMCID: PMC10702393 DOI: 10.34172/ijhpm.2023.7390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Pneumonia is one of the leading causes of hospital admission in the United States with a global health burden of about 6.8 million hospitalizations and 1.1 million deaths in patients over 65 years old in 2015. This study aimed to identify possible patient and hospital-related risk factors for in-hospital pneumonia death across US hospitals. METHODS The National Inpatient Sample (NIS) was used to identify nationwide pneumonia patients (n=374 766, weighted n=1 873 828) from 2016 to 2019. We examined the characteristics of the study sample and their association with in-hospital death. Multivariate survey logistic regression models were used to identify risk factors. RESULTS During the study periods, in-hospital death rates continuously decreased (2.45% in 2016 to 2.19% in 2019). Descriptive statistics showed that patient and hospital factors had varied in-hospital death rates. Survey logistic regression results suggested that male, very low income, non-Medicare, government hospitals, rural hospitals, and specific hospital regions were associated with higher in-hospital death rates than their reference groups. CONCLUSION Socioeconomic factors, including income and insurance, are associated with pneumonia mortality. Census region, hospital ownership, and rural location are also related to in-hospital mortality. Such findings in underserved, impoverished, and rural areas to identify possible health disparities.
Collapse
Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Lixian Zhong
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
| |
Collapse
|
7
|
Ahlberg CD, Wallam S, Tirba LA, Itumba SN, Gorman L, Galiatsatos P. Linking Sepsis with chronic arterial hypertension, diabetes mellitus, and socioeconomic factors in the United States: A scoping review. J Crit Care 2023; 77:154324. [PMID: 37159971 DOI: 10.1016/j.jcrc.2023.154324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
RATIONALE Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host immune response to infection. Social risk factors including location and poverty are associated with sepsis-related disparities. Understanding the social and biological phenotypes linked with the incidence of sepsis is warranted to identify the most at-risk populations. We aim to examine how factors in disadvantage influence health disparities related to sepsis. METHODS A scoping review was performed for English-language articles published in the United States from 1990 to 2022 on PubMed, Web of Science, and Scopus. Of the 2064 articles found, 139 met eligibility criteria and were included for review. RESULTS There is consistency across the literature of disproportionately higher rates of sepsis incidence, mortality, readmissions, and associated complications, in neighborhoods with socioeconomic disadvantage and significant poverty. Chronic arterial hypertension and diabetes mellitus also occur more frequently in the same geographic distribution as sepsis, suggesting a potential shared pathophysiology. CONCLUSIONS The distribution of chronic arterial hypertension, diabetes mellitus, social risk factors associated with socioeconomic disadvantage, and sepsis incidence, are clustered in specific geographical areas and linked by endothelial dysfunction. Such population factors can be utilized to create equitable interventions aimed at mitigating sepsis incidence and sepsis-related disparities.
Collapse
Affiliation(s)
- Caitlyn D Ahlberg
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sara Wallam
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lemya A Tirba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Stephanie N Itumba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Linda Gorman
- Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| |
Collapse
|
8
|
The impact of race/ethnicity and county-level upward economic mobility on textbook outcomes in hepatopancreatic surgery. Surgery 2023; 173:1192-1198. [PMID: 36842910 DOI: 10.1016/j.surg.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The impact of upward economic mobility and race/ethnicity on achieving quality metrics such as textbook outcomes remains ill-defined. As such, we sought to define the impact of race and county-level upward economic mobility on the ability to achieve a textbook outcome among patients undergoing hepatic and pancreatic surgery. METHODS Patients who underwent hepatic or pancreatic procedures between 2013 and 2017 were identified from the Medicare Standard Analytic Files. The primary outcomes of interest were textbook outcome and its components. RESULTS Among 35,403 patients, 17,923 (50.6%) patients were classified as living in a low upward economic mobility county, whereas 17,480 (49.4%) lived in a high upward economic mobility county. Furthermore, 32,981 (93.1%) patients were White, and 2,422 (6.8%) were Black. Overall, a textbook outcome was achieved in 45.6% of patients (n = 16,139), with textbook outcome most likely in patients from a high upward economic mobility county compared with a low upward economic mobility county (low: 44.6% vs high: 46.6%, P < .001). On multivariable analysis, patients in a low upward economic mobility county had 6% lower odds of achieving a textbook outcome compared with a high upward economic mobility county (odds ratio 0.94, 95% confidence interval 0.90-0.98). Furthermore, Black patients were less likely to achieve a textbook outcome (odds ratio 0.91, 95% confidence interval 0.84-0.99) and had 17% and 15% higher odds of developing a complication (odds ratio 1.17, 95% confidence interval 1.07-1.28) and extended length of stay (odds ratio 1.15, 95% confidence interval 1.05-1.27), respectively. Within races, White patients in a high upward economic mobility county had 7% higher odds of achieving a textbook outcome compared with White patients in a low upward economic mobility county (odds ratio 1.07, 95% confidence interval 1.02-1.12), although no such effect was observed in Black patients (odds ratio 0.94, 95% confidence interval 0.77-1.15). Furthermore, Black patients in a high upward economic mobility county had similar odds of achieving a textbook outcome compared with White patients in a low upward economic mobility county (odds ratio 0.92, 95% confidence interval 0.77-1.09). CONCLUSION These results highlight the differential impact of upward economic mobility and race on postoperative outcomes. Due to the health care implications of socioeconomic status, future policy initiatives should target economic mobility as a means to ensure greater health care equity.
Collapse
|
9
|
Examining Between-Group Differences in Social Network Density and High-Sensitivity C-Reactive Protein in Older Adults: Implications for the Hispanic Mortality Paradox. Psychosom Med 2023; 85:165-174. [PMID: 36729601 PMCID: PMC9924960 DOI: 10.1097/psy.0000000000001157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hispanic/Latino(x) and African American/Black older adults experience disproportionate cardiometabolic disease burdens when compared with their non-Hispanic White counterparts. Sources of resilience such as social networks have been found to mitigate the risk of this disease and its end points like high-sensitivity C-reactive protein (hs-CRP). However, little is known about the social network infrastructure among these groups. Moreover, existing work has largely ignored the degree to which members of one's network are connected to one another (network density), which may be important for navigating structural barriers within interdependent groups. The objective of this study was to understand the association between network density and 5-year hs-CRP (blood spot) and whether this association was moderated by race-ethnicity. METHODS A subsample of Hispanic/Latino(x), African American/Black, and non-Hispanic White older adults ( N = 1431) from the National Social Life Health and Aging Project was used. Multivariable regression was used to estimate the association between network density and its interaction with race-ethnicity, with hs-CRP 5 years later. RESULTS Although no main effect of network density on 5-year hs-CRP was found, results revealed a significant network density by race-ethnicity interaction (Wald χ2 (2, 1242) = 3.31, p = .037). Simple slopes analyses revealed that Hispanic/Latino(x) older adults with high network density had significantly lower hs-CRP levels when compared with their same-ethnic counterparts with low network density ( b = -0.73, standard error = 0.31, 95% confidence interval = -1.33 to -0.13, p = .018). CONCLUSIONS Results demonstrate population-level differences in social network structure and differential associations of this infrastructure with health. Implications for the Hispanic Mortality Paradox are discussed.
Collapse
|
10
|
Baptiste DL, Turkson-Ocran RA, Ogungbe O, Koirala B, Francis L, Spaulding EM, Dennison Himmelfarb C, Commodore-Mensah Y. Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among White, African American, African Immigrant, and Afro-Caribbean Adults: Insights From the 2010-2018 National Health Interview Survey. J Am Heart Assoc 2022; 11:e025235. [PMID: 36073627 DOI: 10.1161/jaha.122.025235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In the United States, Black adults have higher rates of cardiovascular disease (CVD) risk factors than White adults. However, it is unclear how CVD risk factors compare between Black ethnic subgroups, including African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans, and White people. Our objective was to examine trends in CVD risk factors among 3 Black ethnic subgroups and White adults between 2010 and 2018. Methods and Results A comparative analysis of the National Health Interview Survey was conducted among 452 997 participants, examining sociodemographic characteristics and trends in 4 self-reported CVD risk factors (hypertension, diabetes, overweight/obesity, and smoking). Generalized linear models with Poisson distribution were used to obtain predictive probabilities of the CVD risk factors. The sample included 82 635 Black (89% AAs, 5% AIs, and 6% Afro-Caribbeans) and 370 362 White adults. AIs were the youngest, most educated, and least insured group. AIs had the lowest age- and sex-adjusted prevalence of all 4 CVD risk factors. AAs had the highest prevalence of hypertension (2018: 41.9%) compared with the other groups. Overweight/obesity and diabetes prevalence increased in AAs and White adults from 2010 to 2018 (P values for trend <0.001). Smoking prevalence was highest among AAs and White adults, but decreased significantly in these groups between 2010 and 2018 (P values for trend <0.001), as compared with AIs and Afro-Caribbeans. Conclusions We observed significant heterogeneity in CVD risk factors among 3 Black ethnic subgroups compared with White adults. There were disparities (among AAs) and advantages (among AIs and Afro-Caribbeans) in CVD risk factors, suggesting that race alone does not account for disparities in CVD risk factors.
Collapse
Affiliation(s)
| | - Ruth-Alma Turkson-Ocran
- Division of General Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | | | - Binu Koirala
- Johns Hopkins University School of Nursing Baltimore MD
| | | | - Erin M Spaulding
- The Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Bloomberg School of Public Health Baltimore MD
| | | | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing Baltimore MD.,Johns Hopkins Bloomberg School of Public Health Baltimore MD
| |
Collapse
|
11
|
Saadatmand F, Abbas M, Apprey V, Tailor K, Kwabi-Addo B. Sex differences in saliva-based DNA methylation changes and environmental stressor in young African American adults. PLoS One 2022; 17:e0273717. [PMID: 36067197 PMCID: PMC9447871 DOI: 10.1371/journal.pone.0273717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Low socioeconomic status neighborhood exposure to stress and violence may be sources of negative stimuli that poses significant health risks for children, adolescents and throughout the life course of an individual. The study aims to investigate if aberrant epigenetic DNA methylation changes may be a potential mechanism for regulating neighborhood exposures and health outcomes. METHODS Exposure to environmental stressors identified in 98 young African American (AA) adults aged 18-25 years old from the Washington D.C., area were used in the study. We correlated the association between stress markers; cortisol, CRP, IgG, IGA, IgM, and self-reported exposure to violence and stress, with quantitative DNA methylation changes in a panel of gene-specific loci using saliva DNA. RESULTS In all participants studied, the exposure to violence was significant and negatively correlated with DNA methylation of MST1R loci (p = 0.032; r = -0.971) and nominally significant with NR3C1 loci (p = 0.053; r = -0.948). In addition, we observed significant and negative correlation of DNA methylation changes of LINE1 (p = 0.044; r = -0.248); NR3C1 (p = 0.017; r = -0.186); MSTR1 (p = 0.022; r = -0.192); and DRD2 (p = 0.056; r = -0.184; albeit nominal significant correlation) with IgA expression. On the other hand, we observed a significant and position correlation of DNA methylation changes in DRD2 (p = 0.037; r = 0.184) with IgG expression. When participants were stratified by sex, we observed in AA young male adults, significant DNA methylation changes of MST1R (p< 0.05) and association with exposure to violence and IgG level. We also observed significant DNA methylation levels of DRD2 (p< 0.05) and association with IgA, IgG, and cortisol level. Furthermore, we observed significant DNA methylation changes of NR3C1 (p< 0.05) with stress, IgA, and IgG in the male participants only. On the other hand, we only observed significant and a positive association of IgG with DNA methylation levels of ESR1 (p = 0.041) in the young AA female participants. CONCLUSION Our preliminary observation of significant DNA methylation changes in neuronal and immune genes in saliva samples supports our recently published genome-wide DNA methylations changes in blood samples from young AA male adults indicating that saliva offers a non-invasive means for DNA methylation prediction of exposure to environmental stressors in a gender-specific manner.
Collapse
Affiliation(s)
- Forough Saadatmand
- Department of Pediatrics, Howard University, Washington, D.C., United States of America
| | - Muneer Abbas
- Department of Microbiology & The National Human Genome Center, Howard University, Washington, D.C., United States of America
| | - Victor Apprey
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, D.C., United States of America
| | - Krishma Tailor
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, D.C., United States of America
| | - Bernard Kwabi-Addo
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, D.C., United States of America
- * E-mail:
| |
Collapse
|
12
|
Hao W, Jia Y, Wang C, Wang X. Preparation, chemical characterization and determination of the antioxidant, cytotoxicity and therapeutic effects of gold nanoparticles green-synthesized by Calendula officinalis flower extract in diabetes-induced cardiac dysfunction in rat. INORG CHEM COMMUN 2022. [DOI: 10.1016/j.inoche.2022.109931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Gaglioti AH, Rivers D, Ringel JB, Judd S, Safford MM. Individual and Neighborhood Influences on the Relationship Between Waist Circumference and Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke Study. Prev Chronic Dis 2022; 19:E20. [PMID: 35446759 PMCID: PMC9044900 DOI: 10.5888/pcd19.210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe how the relationship between waist circumference and incident coronary heart disease (CHD) is influenced by individual and neighborhood factors in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. METHODS REGARDS is a cohort study of 30,239 US adults. The primary exposure was sex-specific quartiles of waist circumference. Individual covariates included sociodemographic characteristics, health status, health behavior, and usual source of care. Neighborhood (ie, zip code-level) covariates included access to primary care, poverty, rurality, and racial segregation. The main outcome was incident CHD from baseline (2003) through 2017. We used descriptive statistics, Kaplan-Meier curves, and Cox proportional hazard models to analyze the overall sample and race-sex subgroups. RESULTS During the study period, 23,042 study participants had 1,499 CHD events. We found a higher risk of incident CHD in the upper quartile of waist circumference compared with the first quartile in all 4 race-sex subgroups except African American men, among whom we found no relationship between waist circumference and incident CHD. Covariates did not attenuate these relationships. CONCLUSION In all groups except African American men, waist circumference in the highest quartile was associated with increased risk of incident CHD. Individual and neighborhood factors did not influence the relationship between waist circumference and development of CHD but differentially influenced incident CHD among race-sex subgroups.
Collapse
Affiliation(s)
- Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr SW; Atlanta, GA 30310.
| | - Desiree Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Joanna Bryan Ringel
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| |
Collapse
|
14
|
Racial and Socioeconomic Disparities in CKD in the Context of Universal Health Care Provided by the Military Health System. Kidney Med 2022; 4:100381. [PMID: 35072045 PMCID: PMC8767122 DOI: 10.1016/j.xkme.2021.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rationale & Objective Health-impeding social determinants of health—including reduced access to care—contribute to racial and socioeconomic disparities in chronic kidney disease (CKD). The Military Health System (MHS) provides an opportunity to assess a large, diverse population for CKD disparities in the context of universal health care. Study Design Cross-sectional study. Setting & Participants MHS beneficiaries aged 18 to 64 years receiving care between October 1, 2015, and September 30, 2018. Predictors Race, sponsor’s rank (a proxy for socioeconomic status and social class), median household income by sponsor’s zip code, and marital status. Outcome CKD prevalence, defined by International Classification of Diseases, Tenth Revision codes and/or a validated, laboratory value-based electronic phenotype. Analytical Approach Multivariable logistic regression compared CKD prevalence by predictors, controlling separately for confounders (age, sex, active-duty status, sponsor’s service branch, and depression) and mediators (hypertension, diabetes, HIV, and body mass index). Results Of 3,330,893 beneficiaries, 105,504 (3.2%) had CKD. In confounder-adjusted models, the CKD prevalence was higher in Black versus White beneficiaries (OR, 1.67; 95% CI, 1.64-1.70), but lower in single versus married beneficiaries (OR, 0.77; 95% CI, 0.76-0.79). The prevalence of CKD was increased among those with a lower military rank and among those with a lower median household income in a nearly dose-response fashion (P < 0.0001). Associations were attenuated when further adjusting for suspected mediators. Limitations The cross-sectional design prevents causal inferences. We may have underestimated the CKD prevalence, given a lack of data for laboratory tests conducted outside the MHS and the use of a specific CKD definition. The transient nature of the MHS population may limit the accuracy of zip code–level median household income data. Conclusions Racial and socioeconomic CKD disparities exist in the MHS despite universal health care coverage. The existence of CKD disparities by rank and median household income suggests that social risks may contribute to both racial and socioeconomic disparities despite access to universal health care coverage.
Collapse
|
15
|
Corona G, Dubowitz T, Troxel WM, Ghosh-Dastidar M, Rockette-Wagner B, Gary-Webb TL. Neighborhood Food Environment Associated with Cardiometabolic Health among Predominately Low-income, Urban, Black Women. Ethn Dis 2021; 31:537-546. [PMID: 34720557 DOI: 10.18865/ed.31.4.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pressure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was associated with lower odds of overweight/obesity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population.
Collapse
Affiliation(s)
- Gabrielle Corona
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tamara Dubowitz
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | - Wendy M Troxel
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | | | - Bonny Rockette-Wagner
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tiffany L Gary-Webb
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| |
Collapse
|
16
|
Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Mølsted Alvesson H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients 2021; 13:3862. [PMID: 34836116 PMCID: PMC8618573 DOI: 10.3390/nu13113862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants' needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.
Collapse
Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Ida Karlsson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22 Uppsala, Sweden
| | - Helle Mølsted Alvesson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| |
Collapse
|
17
|
An Examination of History for Promoting Diversity in Neuroscience. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:202-213. [PMID: 34393663 PMCID: PMC8349702 DOI: 10.1007/s40140-021-00464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Purpose of Review A review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in the Stroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change. Recent Findings A diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination on health, proactive strategies to promote inclusion and equity to support diversity in perioperative neuroscience is warranted. Summary Public policy rooted in structural racism has left marginalized groups economically and educationally disadvantaged with less access to health care. Mistrust and fear from ongoing discrimination compels the neuroscience community to broaden their approach for developing a more reassuring and supportive educational environment for patients and trainees.
Collapse
|
18
|
Diaz A, Dalmacy D, Hyer JM, Tsilimigras D, Pawlik TM. Intersection of social vulnerability and residential diversity: Postoperative outcomes following resection of lung and colon cancer. J Surg Oncol 2021; 124:886-893. [PMID: 34196009 DOI: 10.1002/jso.26588] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While the impact of demographic factors on postoperative outcomes has been examined, little is known about the intersection between social vulnerability and residential diversity on postoperative outcomes following cancer surgery. METHODS Individuals who underwent a lung or colon resection for cancer were identified in the 2016-2017 Medicare database. Data were merged with the Centers for Disease Control and Prevention social vulnerability index and a residential diversity index was calculated. Logistic regression models were utilized to estimate the probability of postoperative outcomes. RESULTS Among 55 742 Medicare beneficiaries who underwent lung (39.4%) or colon (60.6%) resection, most were male (46.6%), White (90.2%) and had a mean age of 75.3 years. After adjustment for competing risk factors, both social vulnerability and residential diversity were associated with mortality and other postoperative outcomes. In assessing the intersection of social vulnerability and residential diversity, synergistic effects were noted as patients from counties with low social vulnerability and high residential diversity had the lowest probability of 30-day mortality (3.2%, 95% confidence interval [CI]: 3.0-3.5) while patients from counties with high social vulnerability and low diversity had a higher probability of 30-day postoperative death (5.2%, 95% CI: 4.6-5.8; odds ratio: 1.02, 95% CI: 1.01-1.03). CONCLUSION Social vulnerability and residential diversity were independently associated with postoperative outcomes. The intersection of these two social health determinants demonstrated a synergistic effect on the risk of adverse outcomes following lung and colon cancer surgery.
Collapse
Affiliation(s)
- Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA.,National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Djhenne Dalmacy
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| |
Collapse
|
19
|
Diaz A, Pawlik TM. ASO Author Reflections: County-Level Racial Diversity is Associated with Textbook Outcomes for Pancreatic Surgery. Ann Surg Oncol 2021; 28:8085-8086. [PMID: 34145504 DOI: 10.1245/s10434-021-10320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Adrian Diaz
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.,IHPI Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
20
|
Diaz A, Dalmacy D, Herbert C, Mirdad RS, Hyer JM, Pawlik TM. Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery. Ann Surg Oncol 2021; 28:8076-8084. [PMID: 34143339 PMCID: PMC8212582 DOI: 10.1245/s10434-021-10316-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/01/2021] [Indexed: 12/29/2022]
Abstract
Introduction Residential racial desegregation has demonstrated improved economic and education outcomes. The degree of racial community segregation relative to surgical outcomes has not been examined. Patients and Methods Patients undergoing pancreatic resection between 2013 and 2017 were identified from Medicare Standard Analytic Files. A diversity index for each county was calculated from the American Community Survey. Multivariable mixed-effects logistic regression with a random effect for hospital was used to measure the association of the diversity index level with textbook outcome (TO). Results Among the 24,298 Medicare beneficiaries who underwent a pancreatic resection, most patients were male (n = 12,784, 52.6%), White (n = 21,616, 89%), and had a median age of 72 (68–77) years. The overall incidence of TO following pancreatic surgery was 43.3%. On multivariable analysis, patients who resided in low-diversity areas had 16% lower odds of experiencing a TO following pancreatic resection compared with patients from high-diversity communities (OR 0.84, 95% CI 0.72–0.98). Compared with patients who resided in the high-diversity areas, individuals who lived in low-diversity areas had higher odds of 90-day readmission (OR 1.16, 95% CI 1.03–1.31) and had higher odds of dying within 90 days (OR 1.85, 95% CI 1.45–2.38) (both p < 0.05). Nonminority patients who resided in low-diversity areas also had a 14% decreased likelihood to achieve a TO after pancreatic resection compared with nonminority patients in high-diversity areas (OR 0.86, 95% CI 0.73–1.00). Conclusion Patients residing in the lowest racial/ethnic integrated counties were considerably less likely to have an optimal TO following pancreatic resection compared with patients who resided in the highest racially integrated counties. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10316-3.
Collapse
Affiliation(s)
- Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. .,National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
| | - Djhenne Dalmacy
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chelsea Herbert
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | | | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| |
Collapse
|
21
|
De Rubeis V, Lee J, Anwer MS, Yoshida-Montezuma Y, Andreacchi AT, Stone E, Iftikhar S, Morgenstern JD, Rebinsky R, Neil-Sztramko SE, Alvarez E, Apatu E, Anderson LN. Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review. BMJ Open 2021; 11:e047152. [PMID: 33941635 PMCID: PMC8098961 DOI: 10.1136/bmjopen-2020-047152] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course. DESIGN A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools. RESULTS A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters. CONCLUSIONS The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk. PROSPERO REGISTRATION NUMBER CRD42020186074.
Collapse
Affiliation(s)
- Vanessa De Rubeis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jinhee Lee
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Saqib Anwer
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandra T Andreacchi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Erica Stone
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Saman Iftikhar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason D Morgenstern
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Reid Rebinsky
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
22
|
Rubinfeld G, Driggin E, Woolf K, Slater J, Newman JD, Heffron S, Shah B. Factors associated with participation in a short-term dietary intervention study among patients with established coronary artery disease: insights from the EVADE CAD trial. Coron Artery Dis 2021; 32:258-260. [PMID: 32639244 PMCID: PMC7779744 DOI: 10.1097/mca.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Optimal management of patients with coronary artery disease (CAD) includes a heart healthy diet. We evaluated associations between patient characteristics with the decision to enroll in a dietary intervention study. The EVADE CAD trial was a randomized trial assessing the impact of eight weeks of a vegan versus AHA-recommended diet on inflammatory and glucometabolic profiles in patients with angiographically-defined CAD. Characteristics of subjects who provided informed consent to participate in EVADE CAD but did not attend the initial visit and were not enrolled (n=40) were compared to those who were compliant with the visit and enrolled in the trial (n=100). After multivariable adjustment, lower body mass index (OR 0.89 [0.81–0.97)], p=0.01), active tobacco use (OR 6.0 [1.5–24.9], p=0.01), and greater number of vessels with CAD (OR 1.8 [1.1–3.0], p=0.03) were independent predictors of non-enrollment. These results identify discrete characteristics that may be predictive of lower engagement in dietary interventions.
Collapse
Affiliation(s)
- Gregory Rubinfeld
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Elissa Driggin
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Kathleen Woolf
- Department of Nutrition and Food Studies, New York University Steinhardt School of Culture, Education and Human Development, New York, NY
| | - James Slater
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jonathan D. Newman
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Sean Heffron
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Binita Shah
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System (Manhattan Campus), New York, NY
| |
Collapse
|
23
|
Kazemi M, Kim JY, Parry SA, Azziz R, Lujan ME. Disparities in cardio metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224:428-444.e8. [PMID: 33316275 DOI: 10.1016/j.ajog.2020.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to summarize and quantitatively pool evidence on cardiometabolic health disparities between Black and White women with polycystic ovary syndrome in the United States in response to the call for further delineation of these disparities in the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. DATA SOURCES Databases of MEDLINE, Web of Science, and Scopus were searched initially through March 05, 2020, and confirmed on September 11, 2020. STUDY ELIGIBILITY CRITERIA Observational studies documenting cardiometabolic risk profile (glucoregulatory, lipid profile, anthropometric, and blood pressure status) in Black and White women with polycystic ovary syndrome were included. Studies on children (<17 years old) and pregnant or menopausal-aged women (>50 years) were excluded. The primary outcome was fasting glucose. Furthermore, data on major cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) were evaluated. METHODS Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Studies were weighted based on the inverse of the variance. Heterogeneity was evaluated by Cochran Q and I2 statistics. Study methodologic quality was assessed by the Newcastle-Ottawa scale. RESULTS A total of 11 studies (N=2851 [652 Black and 2199 White]) evaluated cardiometabolic risk profile and all had high quality (Newcastle-Ottawa scale score of ≥8). No studies reported on cardiovascular events and mortality rate. Black women had comparable fasting glucose (-0.61 [-1.69 to 2.92] mg/dL; I2=62.5%), yet exhibited increased fasting insulin (6.76 [4.97-8.56] μIU/mL; I2=59.0%); homeostatic model assessment of insulin resistance (1.47 [0.86-2.08]; I2=83.2%); systolic blood pressure (3.32 [0.34-6.30] mm Hg; I2=52.0%); and decreased triglyceride (-32.56 [-54.69 to -10.42] mg/dL; I2=68.0%) compared with White women (all, P≤.03). Groups exhibited comparable total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and diastolic blood pressure (all, P≥.06). CONCLUSIONS Black women with polycystic ovary syndrome have a greater tendency for an adverse cardiometabolic risk profile (increased insulin, homeostatic model assessment of insulin resistance, and systolic blood pressure) despite lower triglycerides than White women. Our observations support the consideration of these disparities for diagnostic, monitoring, and management practices in Black women and for future guideline recommendations. Given the heterogeneity among studies, future research should address the relative contributions of biologic, environmental, socioeconomic, and healthcare factors to the observed disparities. Furthermore, longitudinal research is required to address patient-pressing complications, including cardiovascular events and mortality rate in Black women with polycystic ovary syndrome as a high-risk yet understudied population.
Collapse
Affiliation(s)
- Maryam Kazemi
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| | - Joy Y Kim
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY
| | - Ricardo Azziz
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, NY
| | - Marla E Lujan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| |
Collapse
|
24
|
Ruiz-Castell M, Samouda H, Bocquet V, Fagherazzi G, Stranges S, Huiart L. Estimated visceral adiposity is associated with risk of cardiometabolic conditions in a population based study. Sci Rep 2021; 11:9121. [PMID: 33907272 PMCID: PMC8079669 DOI: 10.1038/s41598-021-88587-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Visceral adiposity is a major risk factor of cardiometabolic diseases. Visceral adipose tissue (VAT) is usually measured with expensive imaging techniques which present financial and practical challenges to population-based studies. We assessed whether cardiometabolic conditions were associated with VAT by using a new and easily measurable anthropometric index previously published and validated. Data (1529 participants) came from the European Health Examination Survey in Luxembourg (2013–2015). Logistic regressions were used to study associations between VAT and cardiometabolic conditions. We observed an increased risk of all conditions associated with VAT. The total adjusted odds ratio (AOR, [95% CI]) for hypertension, prediabetes/diabetes, hypercholesterolemia, and hypertriglyceridemia for the fourth quartile of VAT compared to the lowest were 10.22 [6.75, 15.47]), (5.90 [4.02, 8.67]), (3.60 [2.47, 5.25]) and (7.67 [5.04, 11.67]. We observed higher odds in women than in men for all outcomes with the exception of hypertension. Future studies should investigate the impact of VAT changes on cardiometabolic health and the use of anthropometrically predicted VAT as an accurate outcome when no biomedical imaging is available.
Collapse
Affiliation(s)
- Maria Ruiz-Castell
- Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg.
| | - Hanen Samouda
- Nutrition and Health Research Group, Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
| | - Valery Bocquet
- Competence Centre for Methodology and Statistics, Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
| | - Saverio Stranges
- Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1465 Richmond St, London, ON, N6G 2M1, Canada
| | - Laetitia Huiart
- Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
| |
Collapse
|
25
|
Paro A, Dalmacy D, Madison Hyer J, Tsilimigras DI, Diaz A, Pawlik TM. Impact of Residential Racial Integration on Postoperative Outcomes Among Medicare Beneficiaries Undergoing Resection for Cancer. Ann Surg Oncol 2021; 28:7566-7574. [PMID: 33895902 DOI: 10.1245/s10434-021-10034-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION While social determinants of health may adversely affect various populations, the impact of residential segregation on surgical outcomes remains poorly defined. OBJECTIVE The objective of the current study was to examine the association between residential segregation and the likelihood to achieve a textbook outcome (TO) following cancer surgery. METHODS The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent resection of lung, esophageal, colon, or rectal cancer between 2013 and 2017. Shannon's integration index, a measure of residential segregation, was calculated at the county level and its impact on composite TO [no complications, no prolonged length of stay (LOS), no 90-day readmission, and no 90-day mortality] was examined. RESULTS Among 200,509 patients who underwent cancer resection, the overall incidence of TO was 56.0%. The unadjusted likelihood of achieving a TO was lower among patients in low integration areas [low integration: n = 19,978 (55.0%) vs. high integration: n = 18,953 (59.3%); p < 0.001]. On multivariable analysis, patients residing in low integration areas had higher odds of complications [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03-1.11], extended LOS (OR 1.13, 95% CI 1.09-1.18), and 90-day mortality (OR 1.29, 95% CI 1.22-1.38) and, in turn, lower odds of achieving a TO (OR 0.87, 95% CI 0.84-0.90) versus patients from highly integrated communities. CONCLUSION Patients who resided in counties with a lower integration index were less likely to have an optimal TO following resection of cancer compared with patients who resided in more integrated counties. The data highlight the importance of increasing residential racial diversity and integration as a means to improve patient outcomes.
Collapse
Affiliation(s)
- Alessandro Paro
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Djhenne Dalmacy
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
| |
Collapse
|
26
|
Vaughan AS, George MG, Jackson SL, Schieb L, Casper M. Changing Spatiotemporal Trends in County-Level Heart Failure Death Rates in the United States, 1999 to 2018. J Am Heart Assoc 2021; 10:e018125. [PMID: 33538180 PMCID: PMC7955349 DOI: 10.1161/jaha.120.018125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Amid recently rising heart failure (HF) death rates in the United States, we describe county‐level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older. Methods and Results Applying a hierarchical Bayesian model to National Vital Statistics data representing all US deaths, ages 35 years and older, we estimated annual age‐standardized county‐level HF death rates and percent change by age group, racial/ethnic group, and sex from 1999 through 2018. During 1999 to 2011, ~30% of counties experienced increasing HF death rates among adults ages 35 to 64 years. However, during 2011 to 2018, 86.9% (95% CI, 85.2–88.2) of counties experienced increasing mortality. Likewise, for ages 65 years and older, during 1999 to 2005 and 2005 to 2011, 27.8% (95% CI, 25.8–29.8) and 12.6% (95% CI, 11.2–13.9) of counties, respectively, experienced increasing mortality. However, during 2011 to 2018, most counties (67.4% [95% CI, 65.4–69.5]) experienced increasing mortality. These temporal patterns by age group held across racial/ethnic group and sex. Conclusions These results provide local context to previously documented recent national increases in HF death rates. Although county‐level declines were most common before 2011, some counties and demographic groups experienced increasing HF death rates during this period of national declines. However, recent county‐level increases were pervasive, occurring across counties, racial/ethnic group, and sex, particularly among ages 35 to 64 years. These spatiotemporal patterns highlight the need to identify and address underlying clinical risk factors and social determinants of health contributing to these increasing trends.
Collapse
Affiliation(s)
- Adam S Vaughan
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Mary G George
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Sandra L Jackson
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Linda Schieb
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Michele Casper
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| |
Collapse
|
27
|
Baptiste DL, Turkson-Ocran RA, Han HR, Himmelfarb CD, Commodore-Mensah Y. Social Determinants of Emergency Department Visits among Persons Diagnosed with Coronary Heart Disease and Stroke. Ethn Dis 2021; 31:41-46. [PMID: 33519154 DOI: 10.18865/ed.31.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Social determinants of health (SDOH) are associated with a variety of health outcomes, yet their relation to emergency department (ED) visits among individuals with coronary heart disease (CHD) or stroke is unclear. Methods We performed a cross-sectional analysis of the 2010-2018 National Health Interview Survey, examining ED visits among individuals who self-reported CHD or stroke diagnosis. The outcome was defined as reporting ≥1 ED visit in the previous 12 months vs none. The SDOH examined were race, employment status, poverty, insurance status, marital status, and educational status. Results We included N=14,925 participants with a diagnosis of CHD or stroke. The mean (±SD) age was 68 (±.14) years. After adjusting for age and sex, non-Hispanic Blacks were more likely (adjusted odds ratio [AOR]: 1.29; 95%CI: 1.15-1.44) to report having ≥1 ED visits than Whites. Compared with Whites, Asians had lower odds of having ≥1 ED visit in the previous 12 months (AOR: .63, 95%CI: .49-.82). Those who were unmarried (AOR: 1.21, 95%CI: 1.12 - 1.31), unemployed (AOR: 1.53, 95%CI: 1.36- 1.72) and had a poverty income ratio of <1 (AOR: 1.47, 95%CI: 1.31-1.67) had higher odds of having ≥1 ED visits. Conclusion Being Black, unmarried, unemployed, and having lower income levels were associated with a higher likelihood of having ≥1 ED visits in the prior 12 months among individuals with a CHD or stroke diagnosis. SDOH should be considered when developing systematic interventions to prevent costly ED visits.
Collapse
Affiliation(s)
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Dennison Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
28
|
Ornelas C, Fadadu RP, Richardson MA, Agboghidi OH, Davis JD. Bridge the Gap: Reducing Inequity in Hospital Readmissions for African American Patients with Heart Failure Through Quality Improvement Initiatives. Health Equity 2021; 5:30-34. [PMID: 33564738 PMCID: PMC7868575 DOI: 10.1089/heq.2020.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: Heart failure (HF) disproportionately impacts African Americans. We evaluated existing quality improvement (QI) initiatives and patient and provider perceptions of barriers to HF care to develop equity-centered QI recommendations. Methods: We performed a literature review, interviewed providers and patients (N=11), and conducted a root cause analysis at a safety net hospital in San Francisco, California. Results: We have identified four elements to foster a more equitable HF care model: screening for social determinants of health, technological innovation, optimization of space, and implicit bias training. Conclusion: QI initiatives for HF should integrate health equity elements in their design and implementation.
Collapse
Affiliation(s)
- Carolina Ornelas
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Raj P. Fadadu
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Morrise A. Richardson
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Omonivie H. Agboghidi
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jonathan D. Davis
- Department of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| |
Collapse
|
29
|
Brown JM, Hajjar-Nejad MJ, Dominique G, Gillespie M, Siddiqi I, Romine H, Odonkor P, Dawood M, Gammie JS. A Failed Cardiac Surgery Program in an Underserved Minority Population County Reimagined: The Power of Partnership. J Am Heart Assoc 2020; 9:e018230. [PMID: 33213254 PMCID: PMC7763790 DOI: 10.1161/jaha.120.018230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Prince George's County Maryland, historically a medically underserved region, has a population of 909 327 and a high incidence of cardiometabolic syndrome and hypertension. Application of level I evidence practices in such areas requires the availability of highly advanced cardiovascular interventions. Donabedian principles of quality of care were applied to a failing cardiac surgery program. We hypothesized that a multidisciplinary application of this model supported by partnership with a university hospital system could result in improved quality care outcomes. Methods and Results A 6‐month assessment and planning process commenced in July 2014. Preoperative, intraoperative, and postoperative protocols were developed before program restart. Staff education and training was conducted via team simulation and rehearsal sessions. A total of 425 patients underwent cardiac surgical procedures. Quality tracking of key performance measures was conducted, and 323 isolated coronary artery bypass grafting procedures were performed from July 2014 to December 2019. Key risk factors in our patient demographic were higher than the Society of Thoracic Surgeons national mean. Risk‐adjusted outcome data yielded a mortality rate of 0.3% versus 2.2% nationally. The overall major complication rate was lower than expected at 7.1% compared with 11.5% nationally. Readmission rate was less than the Society of Thoracic Surgeons mean for isolated coronary artery bypass grafting (4.0% versus 10.1%, P<0.0001). Significant differences in 6 key performance outcomes were noted, leading to a 3‐star Society of Thoracic Surgeons designation in 7 of 8 tracking periods. Conclusions Excellent outcomes in cardiac surgery are attainable following program renovation in an underserved region in the setting of low volume. The principles and processes applied have potential broad application for any quality improvement effort.
Collapse
Affiliation(s)
- James M Brown
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - M J Hajjar-Nejad
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Guerda Dominique
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Malinda Gillespie
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Imran Siddiqi
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Heather Romine
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Patrick Odonkor
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - Murtaza Dawood
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| | - James S Gammie
- University of Maryland School of Medicine and University of Maryland Capital Region Health Baltimore MD
| |
Collapse
|
30
|
Nierenberg AA. A Difficult Conversation About Race, Racism, and Anti-Racism. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20201006-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
31
|
Vennu V, Abdulrahman TA, Alenazi AM, Bindawas SM. Associations between social determinants and the presence of chronic diseases: data from the osteoarthritis Initiative. BMC Public Health 2020; 20:1323. [PMID: 32867751 PMCID: PMC7461338 DOI: 10.1186/s12889-020-09451-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Some studies investigated the relationship between musculoskeletal conditions and chronic diseases. However, no study examined the association between social determinants and chronic diseases among people at high risk for knee osteoarthritis. Thus, the current study was aimed to address this gap. METHODS A secondary data analysis was conducted on a total of 3280 men and women aged 45 to 79 who were recruited in the Osteoarthritis Initiative. RESULTS Multivariable logistic regression analyses show that age ≥ 65 years was associated with 1.98, 1.96, and 1.46 times odds of the presence of diabetes, heart attack, and multi-morbidity, respectively than age ≤ 64 years. Men were associated with 1.39, 1.41, 1.76, and 2.24 times odds of the presence of arthritis, cancer, diabetes, and heart attack, respectively than women. African American/Asian/ non-Caucasian was associated with 2.71, 2.56, and 1.93 times odds of the presence of arthritis, diabetes, and heart attack, respectively than Caucasian. Primary school/less education was associated with twice or more times the odds of arthritis and chronic obstructive pulmonary disease (COPD) than ≥high school education. Unemployment was associated with 1.41-, 1.73-, 1.58-, and 1.70-time odds of the presence of arthritis, cancer, COPD, and heart attack, respectively, then employed. Unmarried/widowed/separated was associated with 1.41, 1.75, 2.77, 2.76, 1.86, and 3.34 times odds of the presence of arthritis, asthma, cancer, COPD, diabetes, and heart attack, respectively than married. Annual income < 50,000 was associated with 1.33-, 1.44-, and 1.38-time odds of the presence of arthritis, diabetes, and multi-morbidity, respectively, then annual income ≥50,000. Overweight/obese was associated with 2.28 times the odds of the presence of diabetes than healthy weight. Current/former smoker was associated with 1.57, 2.47, 2.53, 1.63, and 1.24 times odds of the presence of arthritis, cancer, COPD, heart attack, and multi-morbidity, respectively than a nonsmoker. Consuming alcohol was associated with 1.32-, 1.65-, 1.50-, and 1.24-time odds of the presence of arthritis, COPD, diabetes, and multi-morbidity, respectively, then nonalcoholic. CONCLUSIONS Social determinants are associated with the presence of chronic diseases. Some of the social determinants are modifiable or treatable. Thus, these findings can inform public health strategies in the United States.
Collapse
Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia.
| | - Tariq A Abdulrahman
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Rehabilitation Sciences and Physical Therapy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 10219, Saudi Arabia
| |
Collapse
|
32
|
Idris IO, Oguntade AS, Mensah EA, Kitamura N. Prevalence of non-communicable diseases and its risk factors among Ijegun-Isheri Osun residents in Lagos State, Nigeria: a community based cross-sectional study. BMC Public Health 2020; 20:1258. [PMID: 32811462 PMCID: PMC7437062 DOI: 10.1186/s12889-020-09349-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid epidemiologic transition of diseases has adverse implications for low-and middle-income countries (LMICs) like Nigeria due to their limited healthcare, weaker health systems and the westernization of lifestyle. There is a need to evaluate the enormity or otherwise of non-communicable diseases (NCDs) burden in such low resource settings. We performed this survey to determine the prevalence of NCDs and its risk factors among the Ijegun- Isheri Osun community residents of Lagos, Nigeria. METHODS A community-based cross-sectional survey was performed on 215 respondents recruited consecutively during a population preventive health campaign. Prevalence of three NCDs (hypertension, diabetes and dyslipidaemia) were calculated. Associations between each of these NCDs and selected risk factors were determined using chi square test. Multivariable logistic regression was used to estimate the risk factors of each of the three NCDs. RESULTS The prevalence of hypertension was 35.3% (95% CI 29.0-42.1), diabetes 4.6% (95% CI 2.2-8.4) and dyslipidaemia 47.1% (95% CI 41.1-54.8). Among the NCD risk factors, the prevalence of smoking was 41.3% (95% CI 34.2-48.6), alcohol consumption 72.5% (95% CI 65.5-78.7), and physical activity 52.9 (95% CI 45.5-60.2). The independent significant predictors of hypertension were age ≥ 60 years (aOR 4.56; 95% CI: 1.72-12.09) and dyslipidaemia (aOR 5.01; 95% CI: 2.26-11.13). Age ≥ 60 years (aOR 8.83; 95% CI: 1.88-41.55) was an independent predictor of diabetes. Age ≥ 60 years (aOR 29.32; 95% CI: 4.78-179.84), being employed (aOR 11.12; 95% CI: 3.10-39.92), smoking (aOR 2.34; 95% CI: 1.03-5.33) and physical activity (aOR 0.34; 95% CI: 0.15-0.76) were independent predictors of having dyslipidaemia. CONCLUSIONS The prevalence of hypertension, diabetes and dyslipidaemia and their associated risk factors are high among the respondents of Ijegun-Isheri Osun community of Lagos state, Nigeria. This highlights the need for further implementation research and policy directions to tackle NCD burden in urban communities in Nigeria. These strategies must be community specific, prioritizing the various risk factors and addressing them accordingly.
Collapse
Affiliation(s)
- Israel Oluwaseyidayo Idris
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Department of Social and Preventive Medicine, V. N Karazin Kharkiv National University, Kharkiv, Ukraine
- Health Policy and Governance Unit, Department of State Management and Public Administration, Kharkiv National University of Economics, Kharkiv, Ukraine
| | - Ayodipupo Sikiru Oguntade
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria.
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Institute of Cardiovascular Science, University College London, London, UK.
| | - Ekow Adom Mensah
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Department of Family Medicine, Korle-Bu Polyclinic, Accra, Ghana
| | - Noriko Kitamura
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
- Disease Control and Surveillance Team, Department of Primary Health Programmes, NAIJAHEALTH Initiative, Lagos, Nigeria
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Disease Control, Graduate School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| |
Collapse
|
33
|
Barath D, Amaize A, Chen J. Accountable Care Organizations and Preventable Hospitalizations Among Patients With Depression. Am J Prev Med 2020; 59:e1-e10. [PMID: 32334954 PMCID: PMC7458155 DOI: 10.1016/j.amepre.2020.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Accountable care organizations have been successful in improving quality of care, but little is known about who is benefiting from accountable care organizations and through what mechanism. This study examined variation of potentially preventable hospitalizations for chronic conditions with coexisting depression in adults by hospital accountable care organization affiliation and care coordination strategies by race/ethnicity. METHODS Data files of 11 states from 2015 State Inpatient Databases were used to identify potentially preventable hospitalizations for chronic conditions with coexisting depression by race/ethnicity; the 2015 American Hospital Association's Annual Survey was used to identify hospital accountable care organization affiliation; and American Hospital Association's Survey of Care Systems and Payment (collected from January to August 2016) was used to identify hospital Accountable care organizations affiliation and hospital-based care coordination strategies, such as telephonic outreach, and chronic care management. In 2019, multiple logistic regressions was used to test the probability of potentially preventable hospitalization by accountable care organization affiliation and race/ethnicity. The test was repeated on a subsample analysis of accountable care organization-affiliated hospitals by care coordination strategy. RESULTS Preventable hospitalizations were significantly lower among accountable care organization-affiliated hospitals than accountable care organization-unaffiliated hospitals. Lower preventable hospitalization rates were observed among white, African American, Native American, and Hispanic patients. Effective care coordination strategies varied by patients' race. Results also showed variation of the adoption of specific care coordination strategies among accountable care organization-affiliated hospitals. Analysis further indicated effective care coordination strategies varied by patients' race. CONCLUSIONS Accountable care organizations and specifically designed care coordination strategies can potentially improve preventable hospitalization rates and racial disparities among patients with depression. Findings support the integration of mental and physical health services and provide insights for Centers for Medicare and Medicaid Services risk adjustment efforts across race/ethnicity and socioeconomic status.
Collapse
Affiliation(s)
- Deanna Barath
- Department of Health Policy and Management, University of Maryland, College Park, Maryland.
| | - Aitalohi Amaize
- Department of Health Policy and Management, University of Maryland, College Park, Maryland
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland, College Park, Maryland
| |
Collapse
|
34
|
Zeraatkar D, Duku E, Bennett T, Guhn M, Forer B, Brownell M, Janus M. Socioeconomic gradient in the developmental health of Canadian children with disabilities at school entry: a cross-sectional study. BMJ Open 2020; 10:e032396. [PMID: 32350007 PMCID: PMC7213855 DOI: 10.1136/bmjopen-2019-032396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities. DESIGN Cross-sectional study using population-level database of children's developmental health at school entry (2002-2014). SETTING 12 of 13 Canadian provinces/territories. MEASURES Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains. ANALYSIS Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health. RESULTS All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (β (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (β (SE): 0.12 (0.01)). CONCLUSIONS The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes.
Collapse
Affiliation(s)
- Dena Zeraatkar
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
35
|
|
36
|
Singh M, Hall KA, Reynolds A, Palmer LJ, Mukherjee S. The Relationship of Sleep Duration with Ethnicity and Chronic Disease in a Canadian General Population Cohort. Nat Sci Sleep 2020; 12:239-251. [PMID: 32346318 PMCID: PMC7167267 DOI: 10.2147/nss.s226834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES Sleep duration is an important marker of sleep quality and overall sleep health. Both too little and too much sleep are associated with poorer health outcomes. We hypothesized that ethnicity-specific differences in sleep duration exist. METHODS This cross-sectional study utilized questionnaire data from the Ontario Health Study (OHS), a multi-ethnic population-based cohort of Canadian adult residents aged 18 to 99 years, who provided medical, socio-demographic, and sleep information. Generalised linear models were used to investigate the association of sleep duration with ethnicity. RESULTS The study sample consisted of 143,307 adults (60.4% women). The sample was multi-ethnic, including self-identified Aboriginal, Arab, Black, Chinese, Filipino, Hispanic, Japanese, Korean, Mixed (>1 ethnicity), South Asian, South-East Asian, West Asian, and White ethnicities. Univariate analyses found that mean sleep duration compared to the White reference group (7.34 hours) was shorter in the Filipino (6.93 hours, 25 min less), Black (6.96 hours, 23 min less), Japanese (7.02 hours, 19 min less), Chinese (7.23 hours, 7 min less), and Mixed (7.27 hours, 4 min less) groups (all P<0.001). Mean sleep duration was shorter in men (7.25 hours) compared to women (7.37 hours) in the cohort as a whole (P<0.001), and in all ethnic groups (P<0.001). Multivariate analyses, adjusted for a wide range of potential risk factors, and analysis of sleep duration as a categorical variable ("short", "average", and "long" sleepers) confirmed these relationships. Both sleep duration and ethnicity were independent significant predictors of a range of physician-diagnosed morbidities including diabetes, stroke, and depression. CONCLUSION Important differences exist in sleep duration between ethnic groups and may contribute to observed health disparities. Our results highlight the need for ethnicity-specific targeted education on the importance of prioritizing sleep for good health, and the need to account appropriately for ethnicity in future epidemiological, clinical, and translational research into sleep and related conditions.
Collapse
Affiliation(s)
- Mandeep Singh
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, Canada.,Department of Anaesthesiology and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Canada
| | - Kelly A Hall
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Amy Reynolds
- Appleton Institute, CQ University Australia, Wayville, SA, Australia
| | - Lyle J Palmer
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
37
|
Abstract
Precision medicine is a new health care concept intended to hasten progress toward individualized treatment and, in so doing, to improve everyone's opportunity to enjoy good health. Yet, this concept pays scant attention to opportunities for change in the social determinants that are the major drivers of health. Precision medicine research is likely to generate improvements in medical care but may have the unintended consequence of worsening existing disparities in health care access. For prevention, precision medicine emphasizes comprehensive risk prediction and individual efforts to accomplish risk reduction. The application of the precision medicine vision to type 2 diabetes, a growing threat to population health, fails to acknowledge collective responsibility for a health-promoting society.
Collapse
Affiliation(s)
- Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | | | - David Schenck
- Ethics Program, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
38
|
Zhao H, Wang C, Pan Y, Guo Y, Yao N, Wang H, Jin L, Li B. Niacin, lutein and zeaxanthin and physical activity have an impact on Charlson comorbidity index using zero-inflated negative binomial regression model: National Health and Nutrition Examination Survey 2013-2014. BMC Public Health 2019; 19:1589. [PMID: 31779602 PMCID: PMC6883694 DOI: 10.1186/s12889-019-7906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Combined with the increasing life expectancy, chronic medical conditions have gradually become the dominant cause of death and disability, and multimorbidity became an increasingly serious public health challenge. However, most existing studies have focused on the coexistence of specific diseases or relatively few diseases. Given one person may have multiple diseases at the same time, we applied Charlson Comorbidity Index (CCI) to systematically evaluate one's 10-year mortality. In this study, we explored the effects of nutrients and physical activity on CCI using National Health and Nutrition Examination Survey (NHANES) 2013-2014 data. METHODS The study sample consists of one continuous cycle (2013-2014) of NHANES, and 4386 subjects were included in the study. Nutrients intake was measured by dietary recall, and physical activity was evaluated by the Global Physical Activity Questionnaire respectively. Besides, CCI was the sum of the scores assigned for each medical condition. We utilized zero-inflated negative binomial (ZINB) model to investigate the effects in nutrients intake and physical activity on CCI by adjusting for seven sociodemographic characteristics, smoking and drinking. RESULTS Among the 4386 participants, 2018 (68.7%) are Non-Hispanic White, over half participants (78.6%) drink. In count part (CCI ≥ 0), holding other variables constant, the expected change in CCI for a one-unit increase in niacin is 1.621(RR = 1.621, p = 0.016), in lutein + zeaxanthin is 0.974 (RR = 0.974, p = 0.031), and in sedentary time is 1.035 (RR = 1.035, p = 0.005). Moreover, those who do not have vigorous work activity would be more likely to have higher CCI than those who have (RR = 1.275, P = 0.045). In logit part (CCI = 0), the log odds of having CCI equals zero would increase by 0.541 and 0.708 for every additional vigorous recreational activity (OR = 0.541, p = 0.004) and moderate recreational activity (OR = 0.708, p = 0.017) respectively. CONCLUSIONS Lutein and zeaxanthin intake, vigorous work activity, vigorous recreational activity and moderate recreational activity may be good for one's health. Rather, increasing niacin intake and sedentary activity may be likely to raise 10-year mortality. Our findings may be significant for preventing diseases and improving health, furthermore, reducing people's financial burden on healthcare.
Collapse
Affiliation(s)
- Hantong Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Changcong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Yingan Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Yinpei Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Han Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China.
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People's Republic of China.
| |
Collapse
|
39
|
Hall LL, Puckrein GA, Davidson JA. Comment on Riddle et al. Diabetes Care Editors' Expert Forum 2018: Managing Big Data for Diabetes Research and Care. Diabetes Care 2019;42:1136-1146. Diabetes Care 2019; 42:e183. [PMID: 31636150 DOI: 10.2337/dc19-1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Jaime A Davidson
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX.,Diabetes Working Group and Equity Task Force, Sustainable Healthy Communities, Washington, DC
| |
Collapse
|
40
|
Langford AT, Williams SK, Applegate M, Ogedegbe O, Braithwaite RS. Partnerships to Improve Shared Decision Making for Patients with Hypertension - Health Equity Implications. Ethn Dis 2019; 29:97-102. [PMID: 30906156 PMCID: PMC6428173 DOI: 10.18865/ed.29.s1.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Shared decision making (SDM) has increasingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hypertension is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds promise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hypertension. These options include medication and/or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on "the best" plan of action for hypertension management can be challenging because patients have different goals and preferences for treatment. As hypertension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient preferences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.
Collapse
Affiliation(s)
- Aisha T. Langford
- NYU School of Medicine, Department of Population Health, New York, NY
| | | | - Melanie Applegate
- NYU School of Medicine, Department of Population Health, New York, NY
| | | | | |
Collapse
|
41
|
Cardiovascular Health Disparities in Underserved Populations. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
42
|
Gielen S. The envirome and coronary atherosclerosis: The role of socioeconomic conditions. Eur J Prev Cardiol 2018; 25:1752-1755. [DOI: 10.1177/2047487318797731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephan Gielen
- Klinikum Lippe, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Detmold, Germany
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Halle/Saale, Germany
| |
Collapse
|
43
|
Fernandes DM, Pantangi V, Azam M, Salomao M, Iuga AC, Lefkowitch JH, Gill J, Morotti R, Lavine JE, Mencin AA. Pediatric Nonalcoholic Fatty Liver Disease in New York City: An Autopsy Study. J Pediatr 2018; 200:174-180. [PMID: 29903531 DOI: 10.1016/j.jpeds.2018.04.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/26/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the prevalence and severity of nonalcoholic liver disease (NAFLD) in children in a diverse population sample in New York City. STUDY DESIGN Liver specimens were examined from children 2-19 years old who died of unexpected causes within 48 hours of medical presentation and underwent autopsy in New York City from 2005 to 2010. Records were reviewed for age, sex, weight, height, and race. Two hepatopathologists evaluated each liver specimen to determine pathologic diagnosis. RESULTS The final study cohort (n = 582) was 50% black, 33% Hispanic, 12% white, 3% Asian, and 2% other; 36% had a body mass index >85%. There were 26 cases of NAFLD (4.5%) of which 10 had nonalcoholic steatohepatitis (1.7%). There were no cases with severe fibrosis or cirrhosis. One percent (3/290) of black children had NAFLD and none had nonalcoholic steatohepatitis. White and Hispanic children had the highest percentages of NAFLD at 8.3% and 7.9%, respectively. In multiple logistic regression models, we observed that body mass index z-score (P < .001) was associated with NAFLD, and that white (P = .003) and Hispanic (P = .005) children had higher odds of having NAFLD compared with black children. CONCLUSIONS This review of liver tissue demonstrates a lower prevalence and severity of NAFLD in black children compared with the general obese pediatric population. Hispanic children did not have a significantly increased rate of NAFLD compared with white children, most likely related to the large proportion of Caribbean Hispanic children in New York City.
Collapse
Affiliation(s)
| | | | - Muhammad Azam
- St. George's University Hospital, London, United Kingdom
| | | | - Alina C Iuga
- Columbia University Medical Center, New York, NY
| | | | - James Gill
- Office of the Chief Medical Examiner, Farmington, CT
| | | | | | - Ali A Mencin
- Columbia University Medical Center, New York, NY.
| |
Collapse
|
44
|
Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
Collapse
Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
45
|
Brewer LC, Redmond N, Slusser JP, Scott CG, Chamberlain AM, Djousse L, Patten CA, Roger VL, Sims M. Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study. J Am Heart Assoc 2018; 7:e008855. [PMID: 29871857 PMCID: PMC6015384 DOI: 10.1161/jaha.118.008855] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. METHODS AND RESULTS Using a community-based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative stress scores were associated with decreased odds (odds ratio [OR]) of achieving intermediate/ideal levels for smoking (OR [95% confidence interval], 0.80 [0.73-0.88], 0.84 [0.75-0.94], and 0.81 [0.74-0.90], respectively). Participants with more major life events had decreased odds of achieving intermediate/ideal levels for smoking (OR, 0.84; 95% confidence interval, 0.76-0.92) and fasting plasma glucose (OR, 0.90; 95% confidence interval, 0.82-0.98). Those with higher scores for minor stressors and major life events were less likely to achieve intermediate or ideal LS7 composite scores (OR [95% confidence interval], 0.89 [0.81-0.97] and 0.91 [0.84-0.98], respectively). CONCLUSIONS Blacks with higher levels of multiple stress measures are less likely to achieve intermediate or ideal levels of overall cardiovascular health (LS7 composite score), specific behaviors (smoking), and biological factors (fasting plasma glucose).
Collapse
Affiliation(s)
| | - Nicole Redmond
- National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Luc Djousse
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| |
Collapse
|
46
|
Walker RJ, Neelon B, Davis M, Egede LE. Racial differences in spatial patterns for poor glycemic control in the Southeastern United States. Ann Epidemiol 2018; 28:153-159. [PMID: 29398299 PMCID: PMC5828989 DOI: 10.1016/j.annepidem.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/11/2017] [Accepted: 01/08/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Evidence consistently shows poor outcomes in racial minorities, but there is limited understanding of differences that are explained by spatial variation. The goal of this analysis was to examine contribution of spatial patterns on disparities in diabetes outcomes in the Southeastern United States. METHODS Data on 64,022 non-Hispanic black (NHB) and non-Hispanic white (NHW) veterans with diabetes living in Georgia, Alabama, and South Carolina were analyzed for 2014. Hemoglobin A1c (HbA1c) was categorized as controlled (less than 8%) and uncontrolled (greater than or equal to 8%). Logistic regression was used to understand the additional explanatory capability of spatial random effects over covariates such as demographics, service connectedness, and comorbidities. Data aggregated at the county level were used to identify hotspots in distribution of uncontrolled HbA1c and tested using local Moran's I test. RESULTS Overall percent uncontrolled HbA1c was 36.5% (40.8% in NHB and 33.4% in NHW). In unadjusted analyses, NHB had 37% higher odds of uncontrolled HbA1c (odds ratio [OR]: 1.37, 95% confidence interval, 1.32, 1.41). After adjusting for demographics and comorbidities, the OR decreased to 1.09 but remained significant (95% confidence interval, 1.05, 1.13). The OR further decreased after incorporating spatial effects (OR: 1.07, 95% confidence interval, 1.03, 1.11) but remained statistically significant. Hotspots of high HbA1c were detected, and spatial patterns differed across racial groups. CONCLUSIONS Differences in spatial patterns in glycemic control exists between NHB and NHW veterans with type 2 diabetes. Incorporating spatial effects helps explain more of the disparity in uncontrolled HbA1c than adjusting only for demographics and comorbidities, but significant differences in uncontrolled HbA1c remained.
Collapse
Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee; Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee
| | - Brian Neelon
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Melanie Davis
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee; Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee.
| |
Collapse
|
47
|
Popescu I, Duffy E, Mendelsohn J, Escarce JJ. Racial residential segregation, socioeconomic disparities, and the White-Black survival gap. PLoS One 2018; 13:e0193222. [PMID: 29474451 PMCID: PMC5825109 DOI: 10.1371/journal.pone.0193222] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association. DESIGN This was a cross sectional study of White and Black men and women aged 35-75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009-2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009-2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White-Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators. RESULTS Black men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated. CONCLUSION White-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.
Collapse
Affiliation(s)
- Ioana Popescu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Erin Duffy
- The RAND Corporation, Santa Monica, CA, United States of America
| | | | - José J. Escarce
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States of America
| |
Collapse
|
48
|
Beach LB, Elasy TA, Gonzales G. Prevalence of Self-Reported Diabetes by Sexual Orientation: Results from the 2014 Behavioral Risk Factor Surveillance System. LGBT Health 2018; 5:121-130. [PMID: 29377760 PMCID: PMC5833244 DOI: 10.1089/lgbt.2017.0091] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aimed to compare the prevalence of self-reported diabetes and diabetes risk factors among adult sexual minority and heterosexual populations in the United States. METHODS Data from the 2014 Behavioral Risk Factor Surveillance System for 3776 lesbian, gay, and bisexual (LGB) adults and 142,852 heterosexual adults aged 18 years and older were used to estimate the prevalence of diabetes. Binomial logistic regression models were used to compare the odds of diabetes by sexual orientation. RESULTS Sexual minorities were younger and more racially diverse than heterosexuals. Gay men less often and lesbian and bisexual women more often reported a body mass index of 30 kg/m2 or higher than heterosexuals. Overall, 14.2% of bisexual men, 11.4% of gay men, and 10.8% of heterosexual men reported a lifetime diabetes diagnosis, as did 8.5% of lesbian women, 5.7% of bisexual women, and 10.2% of heterosexual women. After controlling for multiple factors, gay (odds ratio [OR] = 1.50; confidence interval [95% CI] = 1.09-2.07) and bisexual men [OR = 1.55; 95% CI = 1.00-2.07] were more likely to report a lifetime diabetes diagnosis than heterosexual men. Similar differences were not found for lesbian [OR = 1.22; 95% CI = 0.76-1.95] or bisexual women [OR = 0.88; 95% CI = 0.62-1.26]. CONCLUSION Sexual minorities may be at increased risk for diabetes than their heterosexual peers. This may be due partly to the chronic stressors associated with being a member of a marginalized population. Future research should explore the underlying causes and consequences of LGB diabetes disparities and elucidate best practices to improve diabetes screening and care for these vulnerable patient populations.
Collapse
Affiliation(s)
- Lauren B. Beach
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tom A. Elasy
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gilbert Gonzales
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
49
|
Springer AE, Evans AE, Ortuño J, Salvo D, Varela Arévalo MT. Health by Design: Interweaving Health Promotion into Environments and Settings. Front Public Health 2017; 5:268. [PMID: 29043248 PMCID: PMC5632521 DOI: 10.3389/fpubh.2017.00268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/19/2017] [Indexed: 01/06/2023] Open
Abstract
The important influence of the environmental context on health and health behavior—which includes place, settings, and the multiple environments within place and settings—has directed health promotion planners from a focus solely on changing individuals, toward a focus on harnessing and changing context for individual and community health promotion. Health promotion planning frameworks such as Intervention Mapping provide helpful guidance in addressing various facets of the environmental context in health intervention design, including the environmental factors that influence a given health condition or behavior, environmental agents that can influence a population’s health, and environmental change methods. In further exploring how to harness the environmental context for health promotion, we examine in this paper the concept of interweaving of health promotion into context, defined as weaving or blending together health promotion strategies, practices, programs, and policies to fit within, complement, and build from existing settings and environments. Health promotion interweaving stems from current perspectives in health intervention planning, improvement science and complex systems thinking by guiding practitioners from a conceptualization of context as a backdrop to intervention, to one that recognizes context as integral to the intervention design and to the potential to directly influence health outcomes. In exploring the general approach of health promotion interweaving, we examine selected theoretical and practice-based interweaving concepts in relation to four key environments (the policy environment, the information environment, the social/cultural/organizational environment, and the physical environment), followed by evidence-based and practice-based examples of health promotion interweaving from the literature. Interweaving of health promotion into context is a common practice for health planners in designing health promotion interventions, yet one which merits further intentionality as a specific health promotion planning design approach.
Collapse
Affiliation(s)
- Andrew E Springer
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health-Austin, Michael & Susan Dell Center for Healthy Living, Austin, TX, United States
| | - Alexandra E Evans
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health-Austin, Michael & Susan Dell Center for Healthy Living, Austin, TX, United States
| | - Jaquelin Ortuño
- St. Edward's University, Austin, TX, United States.,Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health-Austin, Austin, TX, United States
| | - Deborah Salvo
- Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health-Austin/Michael & Susan Dell Center for Healthy Living, Austin, TX, United States.,Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | |
Collapse
|
50
|
Sajatovic M, Gunzler DD, Kanuch SW, Cassidy KA, Tatsuoka C, McCormick R, Blixen CE, Perzynski AT, Einstadter D, Thomas CL, Lawless ME, Martin S, Falck-Ytter C, Seeholzer EL, McKibben CL, Bauer MS, Dawson NV. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus. Psychiatr Serv 2017; 68:883-890. [PMID: 28502243 PMCID: PMC5675044 DOI: 10.1176/appi.ps.201600377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.
Collapse
Affiliation(s)
- Martha Sajatovic
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas D Gunzler
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Stephanie W Kanuch
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Kristin A Cassidy
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Curtis Tatsuoka
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Richard McCormick
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Carol E Blixen
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Adam T Perzynski
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas Einstadter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Charles L Thomas
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mary E Lawless
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Siobhan Martin
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Corinna Falck-Ytter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Eileen L Seeholzer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Christine L McKibben
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mark S Bauer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Neal V Dawson
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| |
Collapse
|