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Brewer LC, Cyriac J, Kumbamu A, Burke LE, Jenkins S, Hayes SN, Jones C, Cooper LA, Patten CA. Sign of the times: Community engagement to refine a cardiovascular mHealth intervention through a virtual focus group series during the COVID-19 Pandemic. Digit Health 2022; 8:20552076221110537. [PMID: 35874864 PMCID: PMC9297470 DOI: 10.1177/20552076221110537] [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] [Received: 01/17/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background African-Americans are underrepresented in mobile health intervention research studies which can perpetuate health inequities and the digital divide. A community-based, user-centered approach to designing mobile health interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the coronavirus disease 2019 pandemic. We aimed to refine an existing mobile health intervention via a virtual focus group series. Methods African-American community members (n = 15) from churches in Minneapolis-St. Paul and Rochester, Minnesota were enrolled in a virtual (via videoconferencing), three-session focus group series over five months to refine a cardiovascular health-focused mobile health application (FAITH! [Fostering African-American Improvement in Total Health!] App). Participants accessed the app via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia cardiovascular health-focused education modules, a sharing board for social networking, and diet/physical activity self-monitoring. Participant feedback on app features prompted iterative revisions to the FAITH! App. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale range: 0–5) and user satisfaction. Results Participants (mean age [SD]: 56.9 [12.3] years, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). The revised FAITH! App exceeded the goal Health Information Technology Usability Evaluation Scale score threshold of ≥4 (mean: 4.39, range: 3.20–4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and refinement of the moderated sharing board were identified as areas for future improvement. Conclusions Community-partnered, virtual focus groups can optimize usability and increase participant satisfaction of mobile health lifestyle interventions that aim to promote cardiovascular health in African-Americans.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Jissy Cyriac
- Department of Internal Medicine, Mayo Clinic Graduate School of Medical Education, Rochester, MN, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lora E. Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Jenkins
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christi A. Patten
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Zhu Z, Bundy JD, Mills KT, Bazzano LA, Kelly TN, Zhang Y, Chen J, He J. Secular Trends in Cardiovascular Health in US Adults (from NHANES 2007 to 2018). Am J Cardiol 2021; 159:121-128. [PMID: 34656312 DOI: 10.1016/j.amjcard.2021.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022]
Abstract
Deceleration in the decline of cardiovascular disease mortality has been observed recently in the US. We aimed to examine the recent secular trends of cardiovascular health metrics in the US general population. A total of 32,832 adults aged ≥20 years from the National Health and Nutrition Examination Surveys 2007 to 2018 were included in this analysis. Cardiovascular health included 7 health metrics: smoking status, body mass index, physical activity, healthy diet score, total cholesterol, blood pressure, and fasting plasma glucose. Age-standardized mean of overall cardiovascular health score did not significantly change during 2007 to 2010, 2011 to 2014, and 2015 to 2018 in the US adult population (7.88, 8.03, and 7.91, respectively, P-trend = 0.85). The age-standardized proportions of ideal smoking status (P-trend = 0.003), ideal physical activity (P-trend = 0.03), and untreated total cholesterol <200 mg/dL (P-trend <0.001) were significantly increased but the proportions of body mass index <25.0 kg/m2 (P-trend <0.001), systolic/diastolic blood pressure <120/80 mmHg (P-trend = 0.02), and fasting plasma glucose <100 mg/dL (P-trend <0.001) were significantly decreased during the same period of time in the US adults. In conclusion, from 2007 to 2018, overall cardiovascular health did not change in the US general adult population. Of note, body mass index, blood pressure, and fasting plasma glucose significantly worsened during the same period.
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Affiliation(s)
- Zhengbao Zhu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana.
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53
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Hardy ST, Chen L, Cherrington AL, Moise N, Jaeger BC, Foti K, Sakhuja S, Wozniak G, Abdalla M, Muntner P. Racial and Ethnic Differences in Blood Pressure Among US Adults, 1999-2018. Hypertension 2021; 78:1730-1741. [PMID: 34719937 DOI: 10.1161/hypertensionaha.121.18086] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Shakia T Hardy
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | - Ligong Chen
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | | | - Nathalie Moise
- Department of Medicine, Columbia University, New York, NY (N.M., M.A.)
| | - Byron C Jaeger
- Department of Biostatistics (B.C.J.), University of Alabama at Birmingham
| | - Kathryn Foti
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (K.F.)
| | - Swati Sakhuja
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | | | - Marwah Abdalla
- Department of Medicine, Columbia University, New York, NY (N.M., M.A.)
| | - Paul Muntner
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
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A demographic approach to assess elevated blood pressure and obesity in prepubescent children: the ExAMIN Youth South Africa study. J Hypertens 2021; 39:2190-2199. [PMID: 34620809 DOI: 10.1097/hjh.0000000000002917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity and hypertension prevalence among children are a concern, with limited evidence available on sex and ethnic differences in childhood blood pressure. We aimed to determine the number of children with hypertension and obesity to identify unique adiposity and blood pressure characteristics by sex and ethnicity, and to estimate the odds of having elevated blood pressure with increasing adiposity. METHODS We included 1062 healthy children (5-9 years of age) in an observational school-based study in South Africa. Pediatric validated automated devices were used to measure brachial blood pressure and performed pulse wave analysis to assess central hemodynamics. Standard anthropometry was carried out to determine body composition and demographic questionnaires were completed. RESULTS Almost 20% of children were overweight/obese and 14.1% had elevated blood pressure or hypertension (22.8%). Ethnic differences included greater adiposity in white compared with black children (all P < 0.0001), but higher DBP and total vascular resistance in black compared with white children (both P < 0.05). DBP and total vascular resistance were also higher in girls than boys (both P < 0.01). A 51-60% increased risk of developing elevated blood pressure was observed for 1SD (standard deviation) increase of sex-specific BMI [1.60 (1.4-1.8); P < 0.0001] and waist/height ratio [1.51 (1.3-1.7); P < 0.0001]. CONCLUSION Unique sex and ethnic differences in body composition and blood pressure exist in prepubescent children, with overweight/obesity increasing the risk of elevated blood pressure. Our findings support primary prevention strategies to combat the growing burden of hypertension and obesity-related diseases in youth. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov (NCT04056377).
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Divergent Trends in Emergency Department Presentations Amid the Novel Coronavirus Disease 2019 Pandemic in Chicago, Illinois. J Card Fail 2021; 27:1472-1475. [PMID: 34628016 PMCID: PMC8498775 DOI: 10.1016/j.cardfail.2021.09.011] [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] [Received: 07/12/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
Excess deaths during the coronavirus disease 2019 (COVID-19) pandemic have been largely attributed to cardiovascular disease (CVD); however, patterns in CVD hospitalizations after the first surge of the pandemic have not well-documented. Our brief report, examining trends in health care avoidance documents that CVD hospitalizations decreased in Chicago before significant burden of COVID-19 cases or deaths and normalized during the first COVID-19 surge. These data may help to inform health care systems responses in the coming months while mobilizing vaccinations to the population at large.
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Teitler J, Wood BM, Zeng W, Martinson ML, Plaza R, Reichman NE. Racial-ethnic inequality in cardiovascular health in the United States: Does it mirror socioeconomic inequality? Ann Epidemiol 2021; 62:84-91. [PMID: 33991659 PMCID: PMC8941185 DOI: 10.1016/j.annepidem.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To document gender-specific racial-ethnic disparities in cardiovascular (CV) conditions and risk factors net of socioeconomic status (SES) across the lifespan. METHODS Using pooled data from the 1999 to 2016 U.S. National Health and Nutrition Examination Survey, we document gender-specific proportions of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics ages 12-69 years with various socioeconomic characteristics and CV conditions. We then further disaggregate into 10-year age groups and present unadjusted and SES-adjusted prevalence of each CV condition for each gender/racial-ethnic/age group. RESULTS Racial-ethnic differences in the prevalence of CV conditions are large for some conditions, emerge early in adulthood, and remain relatively constant though age 69. Only small proportions of the differences can be attributed to differences in SES across groups; attenuation after adjusting for income, education, and available measures of wealth ranged from 0 to 2.3 percentage points. Black-White differences in prevalence of CV conditions differ substantially and systematically by gender; White females have larger advantages or smaller disadvantages (depending on indicator) relative to Black females than White males do relative to Black males. CONCLUSIONS Racial-ethnic disparities in CV conditions are rooted early in the life course, do not mirror socioeconomic disparities, and vary considerably by gender. Explanations likely involve early life experiences such as racial discrimination and entrenched inequality.
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Affiliation(s)
- Julien Teitler
- The School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA
| | - Bethany M Wood
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, USA..
| | - Weiwen Zeng
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, USA
| | - Melissa L Martinson
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, USA
| | - Rayven Plaza
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, USA
| | - Nancy E Reichman
- Robert Wood Johnson Medical School, Rutgers University, Child Health Institute of New Jersey, 89 French Street, Room 1348, New Brunswick, NJ 08903, USA
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Khatib R, Glowacki N, Lauffenburger J, Siddiqi A. Race/Ethnic Differences in Atherosclerotic Cardiovascular Disease Risk Factors Among Patients With Hypertension: Analysis From 143 Primary Care Clinics. Am J Hypertens 2021; 34:948-955. [PMID: 33876823 PMCID: PMC8457428 DOI: 10.1093/ajh/hpab053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/13/2020] [Accepted: 04/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND While it is known that sex and race/ethnic disparities persist for atherosclerotic cardiovascular disease (ASCVD), disparities in risk factor control have not been well-described in primary care where ASCVD can be prevented. METHODS Adult patients with a hypertension diagnosis without ASCVD were included in this analysis of electronic health records from a large US healthcare system from 2018. Patients were categorized based on risk factor control defined as blood pressure (BP) <130/80 mm Hg; statin prescription among patients with indications, HbA1c of <7%, and not smoking. Multivariable Poisson regressions were developed to explore associations with race/ethnicity. Results are presented as relative risk (RR), 95% confidence intervals (CIs). RESULTS Among 5,227 patients, 55.8% women and 60.0% men had uncontrolled BP, 47.3% women and 46.4% men with statin therapy indication did not have a prescription, 34.9% women and 40.9% men had uncontrolled HbA1c values, and 9.3% women and 13.7% men were smokers. African Americans were more likely to have uncontrolled BP (women: RR 1.18, 95% CI 1.07-1.30; men: RR 1.20, 95% CI 1.05-1.34) and more likely to lack a statin prescription (women: RR 1.23, 95% CI 1.05-1.45; men: RR 1.25, 95% CI 1.03-1.51) compared to Caucasians. Differences in HbA1c control were not statistically significant among Hispanic/Latino compared to Caucasians (women: RR 1.28, 95% CI 0.86-1.90; men: RR 1.20, 95% CI 0.72-1.97). CONCLUSIONS Disparities in controlling ASCVD risk factors in primary care persist and were not fully explained by demographic or clinical characteristics. Monitoring changes in disparities is important to ensure equity as interventions to prevent ASCVD in primary care are developed and implemented.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois, USA
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois, USA
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Aurora Health, Downers Grove, Illinois, USA
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Zheng Y, Wen X, Bian J, Zhao J, Lipkind HS, Hu H. Racial, Ethnic, and Geographic Disparities in Cardiovascular Health Among Women of Childbearing Age in the United States. J Am Heart Assoc 2021; 10:e020138. [PMID: 34431309 PMCID: PMC8649299 DOI: 10.1161/jaha.120.020138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background In the United States, large disparities in cardiovascular health (CVH) exist in the general population, but little is known about the CVH status and its disparities among women of childbearing age (ie, 18–49 years). Methods and Results In this cross‐sectional study, we examined racial, ethnic, and geographic disparities in CVH among all women of childbearing age in the United States, using the 2011 to 2019 Behavioral Risk Factor Surveillance System. Life's Simple 7 (ie, blood pressure, glucose, total cholesterol, smoking, body mass index, physical activity, and diet) was used to examine CVH. Women with 7 ideal CVH metrics were determined to have ideal CVH. Among the 269 564 women of childbearing age, 13 800 (4.84%) had ideal CVH. After adjusting for potential confounders, non‐Hispanic Black women were less likely to have ideal CVH (odds ratio, 0.54; 95% CI, 0.46–0.63) compared with non‐Hispanic White women, and with significantly lower odds of having ideal metrics of blood pressure, blood glucose, body mass index, and physical activity. No significant difference in CVH was found between non‐Hispanic White and Hispanic women. Large geographic disparities with temporal variations were observed, with the age‐ and race‐adjusted ideal CVH prevalence ranging from 4.05% in the District of Columbia (2011) to 5.55% in Maine and Montana (2019). States with low ideal CVH prevalence and average CVH score were mostly clustered in the southern United States. Conclusions Large racial, ethnic, and geographic disparities in CVH exist among women of childbearing age. More efforts are warranted to understand and address these disparities.
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Affiliation(s)
- Yi Zheng
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Xiaoxiao Wen
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics College of Medicine University of Florida Gainesville FL
| | - Jinying Zhao
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
| | - Heather S Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences School of Medicine Yale University New Haven CT
| | - Hui Hu
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville FL
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Smith NC. Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors. SOCIAL SCIENCE RESEARCH 2021; 99:102593. [PMID: 34429206 DOI: 10.1016/j.ssresearch.2021.102593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 05/18/2023]
Abstract
Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.
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Affiliation(s)
- Nicholas C Smith
- Indiana University - Bloomington, Department of Sociology Ballantine Hall 744, 1020 East Kirkwood Avenue Bloomington, IN, 47405, USA.
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60
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Oye-Somefun A, Blyuss E, Ardern CI. Trends in Serum AST-to-ALT Ratio Among U.S. Adults: Analysis of the U.S. National Health and Nutrition Examination Survey. Metab Syndr Relat Disord 2021; 19:498-506. [PMID: 34348039 DOI: 10.1089/met.2021.0049] [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: 11/13/2022] Open
Abstract
Background: Using nationally representative data, we examined the age-, sex-, and ethnic-specific variation in the ratio of serum aspartate aminotransferase and alanine aminotransferase (AST-to-ALT ratio or AAR) of U.S. adults (20+ years). Understanding these subgroup differences in AAR will provide insight into population patterns of these ratios, which provide a basis for normative comparisons for the application of personalized diagnostic information to patients in the clinical setting. Methods: Data for this analysis are based on continuous cycles (1999-2016) of the National Health and Nutrition Examination Survey (NHANES). Results: Within the complete sample (n = 13,731), mean AST and ALT values were similar (∼25 U/L), with higher absolute values, but lower AAR, in males compared with females. From 1999-2000 to 2015-2016 there were consistent sex, age, and ethnic differences in the AAR. Specifically, the AAR for individuals 65+ years was markedly higher in all survey years, with subtle ethnic variation [Mexican Americans (0.95-1.04) Other Hispanic (1.0-1.09), Non-Hispanic White (1.05-1.11), Non-Hispanic Black (1.12-1.22), and Other Ethnicity (1.01-1.17)]. Sex-specific analysis reveals that the lower AAR observed among Mexican Americans is almost entirely accounted for by the markedly lower AAR in men. Conclusion: Future work is necessary to understand these subgroup variations in longer term studies with incident disease.
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Affiliation(s)
| | - Eli Blyuss
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Chris I Ardern
- School of Kinesiology and Health Science, York University, Toronto, Canada
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Diaz CL, Shah NS, Lloyd-Jones DM, Khan SS. State of the Nation's Cardiovascular Health and Targeting Health Equity in the United States: A Narrative Review. JAMA Cardiol 2021; 6:963-970. [PMID: 34009231 DOI: 10.1001/jamacardio.2021.1137] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Cardiovascular disease is the leading cause of death in the US. The burden of cardiovascular disease morbidity and mortality disproportionately affects racial/ethnic minority groups, who now compose almost 40% of the US population in aggregate. As part of the 2010 American Heart Association (AHA) Strategic Impact Goal, the AHA established 7 cardiovascular health (CVH) metrics (also known as Life's Simple 7) with the goal to improve the CVH of all individuals in the US by 20% by 2020. National estimates of CVH are important to track and monitor at the population level but may mask important differences across and within racial/ethnic minority groups. It is critical to understand how CVH may differ between racial/ethnic minority groups and consider how these differences in CVH may contribute to disparities in cardiovascular disease burden and overall longevity. Observations This narrative review summarizes the available literature on individual CVH metrics and composite CVH scores across different race/ethnic minority groups (specifically Hispanic/Latino, Asian, and non-Hispanic Black individuals) in the US. Disparities in CVH persist among racial/ethnic groups, but key gaps in knowledge exist, in part, owing to underrepresentation of these racial/ethnic groups in research or misrepresentation of CVH because of aggregation of race/ethnicity subgroups. A comprehensive, multilevel approach is needed to target health equity and should include (1) access to high-quality health care, (2) community-engaged approaches to adapt disruptive health care delivery innovations, (3) equitable economic investment in the social and built environment, and (4) increasing funding for research in racial/ethnic minority populations. Conclusions and Relevance Significant differences in CVH exist within racial/ethnic groups. Given the rapid growth of diverse, minority populations in the US, focused investigation is needed to identify strategies to optimize CVH. Opportunities exist to address inequities in CVH and to successfully achieve both the interim (AHA 2024) and longer-term (AHA 2030) Impact Goals in the coming years.
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Affiliation(s)
- Celso L Diaz
- Division of Cardiology, Department of Medicine, University of California, Los Angeles
| | - Nilay S Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ngo Nkondjock VR, Cheteu Wabo TM, Kosgey JC, Zhang Y, Amporfro DA, Adnan H, Shah I, Li Y. Insulin Resistance, Serum Calcium and Hypertension: A Cross-Sectional Study of a Multiracial Population, and a Similarity Assessment of Results from a Single-Race Population's Study. Diabetes Metab Syndr Obes 2021; 14:3361-3373. [PMID: 34335037 PMCID: PMC8318711 DOI: 10.2147/dmso.s259409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent research suggests the need to assess more ethnic disparities in hypertension (HTN). On the other hand, studies reveal impressive mortality rates due to cardiovascular diseases for some race and ethnic groups compared to others. METHODS We referred to a recent study on serum calcium (SC) and insulin resistance associated with HTN incidence to compare different race groups in the latter found relationship. We compare the current study outcomes with those from the Wu et al study. RESULTS From 425 participants of the National Health and Nutrition Examination Survey (NHANES) data, we found a significant association between race and hypertension; Cramer's V (0.006) = 0.21 when adjusted with non-hypertensives and hypertensives. Mc Auley index (McA) was negatively related to hypertension, r (355) = -0.24, p < 0.0001. SC associated with HTN in all race groups significance persisted only in non-Hispanic Whites after multivariate adjustments R 2 of 74.1 (p = 0.03). McA was a mediator on SC-HTN in non-Hispanic Whites (NHW) (CoefIE = 13.25, [CI] = 1.42-32.13), and a moderator in other Hispanics interaction (0.04) = 0.27 and NHW interaction (0.001) = 0.028. CONCLUSION SC was associated with hypertension, similarly to the baseline study. SC and HTN association persisted in NHW compared to other race groups. Homeostasis model assessment (HOMA-IR) was not a mediator on SC-HTN, but with McA, this in NHW only. McA played a moderator role in OH and NHW. We suggest that race is a factor implicated in our findings, which may be investigated further in future research.
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Affiliation(s)
- Victorine Raïssa Ngo Nkondjock
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Thérèse Martin Cheteu Wabo
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | | | - Yunlong Zhang
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Daniel Adjei Amporfro
- Department of Social Medicine and Health Services Management, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Humara Adnan
- Department of Biostatistics and Epidemiology, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Imran Shah
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Ying Li
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
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Boyer WR, Bassett DR, Fitzhugh EC, Milano AN, Churilla JR, Toth LP, Richardson MR. Accelerometer-Measured Physical Activity and Cardiometabolic Risk Factors by Race-Ethnicity: 2003-2006 NHANES. J Racial Ethn Health Disparities 2021; 9:1607-1615. [PMID: 34292527 DOI: 10.1007/s40615-021-01100-w] [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] [Received: 03/11/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Previous studies suggest that the magnitude of morbidity/mortality reduction may differ between race-ethnic groups despite equated dose of physical activity (PA). The purpose of this study was to compare the potential racial-ethnic differences in cardiometabolic risk factors (CMRF) across quartiles of accelerometer-derived total activity counts/day (TAC/d) among US adults. The final sample (n=4144) included adults who participated in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). CMRF included fasting glucose (FG), fasting insulin (FI), HOMA-IR, resting systolic (SBP) and diastolic blood pressure (DBP), waist circumference (WC), BMI, CRP, HDL-C, LDL-C, and triglycerides. Race-ethnic groups examined included non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican American (MA). In the highest quartile, NHW had significantly lower values of HOMA-IR, FI, SBP, BMI, WC, and HDL-C when compared to NHB. Compared to MA in the highest quartile, NHW had significantly lower values of HOMA-IR, FI, BMI, and triglycerides. Significant race-ethnic differences were found for several CMRF, especially among those who were in the top quartile of PA (e.g., the most active adults). It is probable that the protective effect of higher volumes of PA on CMRF is moderated by other non-PA factors distinct to NHB and MA.
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Affiliation(s)
- William R Boyer
- Department of Kinesiology, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA.
| | - David R Bassett
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN, 37996, USA
| | - Eugene C Fitzhugh
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN, 37996, USA
| | - Allison N Milano
- Department of Kinesiology, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - James R Churilla
- Department of Clinical and Applied Movement Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Lindsay P Toth
- Department of Clinical and Applied Movement Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Michael R Richardson
- Department of Clinical and Applied Movement Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
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A precision medicine approach to sex-based differences in ideal cardiovascular health. Sci Rep 2021; 11:14848. [PMID: 34290276 PMCID: PMC8295282 DOI: 10.1038/s41598-021-93966-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease risk factor profiles and health behaviors are known to differ between women and men. Sex-based differences in ideal cardiovascular health were examined in the My Research Legacy study, which collected cardiovascular health and lifestyle data via Life’s Simple 7 survey and digital health devices. As the study overenrolled women (n = 1251) compared to men (n = 310), we hypothesized that heterogeneity among women would affect comparisons of ideal cardiovascular health. We identified 2 phenogroups of women in our study cohort by cluster analysis. The phenogroups differed significantly across all 7 cardiovascular health and behavior domains (all p < 0.01) with women in phenogroup 1 having a lower Life’s Simple 7 Health Score than those in phenogroup 2 (5.9 ± 1.3 vs. 7.6 ± 1.3, p < 0.01). Compared to men, women in phenogroup 1 had a higher burden of cardiovascular disease risk factors, exercised less, and had lower ideal cardiovascular health scores (p < 0.01). In contrast, women in phenogroup 2 had fewer cardiovascular risk factors but similar exercise habits and higher ideal cardiovascular health scores than men (p < 0.01). These findings suggest that heterogeneity among study participants should be examined when evaluating sex-based differences in ideal cardiovascular health.
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Phillips II G, Xu J, Ruprecht MM, Costa D, Felt D, Wang X, Glenn EE, Beach LB. Associations with COVID-19 Symptoms, Prevention Interest, and Testing Among Sexual and Gender Minority Adults in a Diverse National Sample. LGBT Health 2021; 8:322-329. [PMID: 34115955 PMCID: PMC8672109 DOI: 10.1089/lgbt.2021.0002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: Sexual and gender minority (SGM) and racial/ethnic minority populations may differ in coronavirus disease 2019 (COVID-19) prevention, testing, and vaccine interest, although little research has explored these disparities. It is critical to understand the differential experiences within minoritized communities to ensure effective intervention and vaccine rollout. Methods: In a national online survey of U.S. adult SGM individuals, conducted between April and August 2020, 932 participants responded about COVID-19 testing, symptoms, interest in vaccination, and interest in at-home testing. Bivariate associations between these outcomes and demographic factors, including sexual orientation, gender identity, endorsing intersex traits, gender modality, race/ethnicity, and HIV status were calculated. Results: Despite 24% of the sample reporting COVID-19 symptoms, testing was relatively low at 13.3%. Transgender and bisexual/pansexual individuals were more likely to be interested in a COVID-19 vaccine and an at-home test compared with cisgender and gay/lesbian respondents, respectively. Compared with cisgender individuals, transgender individuals were nearly twice as likely to report COVID-19 symptoms. Latinx individuals were less likely to be interested in a future COVID-19 vaccination and Black individuals were less likely to be interested in an at-home COVID-19 test compared with White participants. Both respondents who endorsed intersex traits and people with HIV were less likely to be interested in an at-home test compared with those who did not endorse having intersex traits and people without HIV, respectively. Conclusions: These results show critical disparities in COVID-19 symptomology and prevention interest within SGM populations that must be taken into account when designing or tailoring effective COVID-19 interventions.
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Affiliation(s)
- Gregory Phillips II
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Megan M. Ruprecht
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diogo Costa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erik Elías Glenn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Porhcisaliyan VD, Wang Y, Tan NC, Jafar TH. Socioeconomic status and ethnic variation associated with type 2 diabetes mellitus in patients with uncontrolled hypertension in Singapore. BMJ Open Diabetes Res Care 2021; 9:e002064. [PMID: 34301679 PMCID: PMC8728350 DOI: 10.1136/bmjdrc-2020-002064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/30/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The burden of type 2 diabetes mellitus (T2DM) and related vascular complications is particularly high in Asians and ethnic minorities living in the West. However, the association of T2DM with socioeconomic status (SES) and ethnicity has not been widely studied in populations living in Asia. Therefore, we investigated these associations among the multiethnic population with uncontrolled hypertension in Singapore. RESEARCH DESIGN AND METHODS In a cross-sectional study using baseline data of a 2-year randomized trial in Singapore, we obtained demographic, SES, lifestyle and clinical factors from 915 patients aged ≥40 years with uncontrolled hypertension. T2DM was defined as having either: (i) self-reported 'physician-diagnosed diabetes confirmed through medical records' or taking antidiabetes medications, (ii) fasting blood glucose levels ≥7.0 mmol/dL or (iii) hemoglobin A1c ≥6.5%. The SES proxies included education, employment status, housing ownership and housing type, and the ethnicities were Chinese, Malays and Indians. Logistic regression analyses were used to evaluate the association of T2DM with SES and ethnicity. RESULTS Higher proportion of T2DM was observed in Malays (40.0%) and Indians (56.0%) than Chinese (26.8%) (p<0.001), and in patients with lower SES (ranging from 25.7% to 66.2% using different proxies) than those with higher SES (19.4% to 32.0%). In a multivariate model comprising age, gender, ethnicity and SES, Malay ethnicity (OR 1.59; 95% CI 1.04 to 2.44, p=0.031) or Indian ethnicity (OR 3.65; 95% CI 2.25 to 5.91, p<0.001) versus Chinese and housing type (residing in one to three rooms (OR 2.00; 95% CI 1.16 to 3.43, p=0.012) or four to five rooms public housing (OR 1.86; 95% CI 1.13 to 3.04, p=0.013) vs private housing) were associated with higher T2DM odds. The associations of Indians and one to three rooms public housing with T2DM met the significance after accounting for multiple testing (p≤0.0125). CONCLUSION Our study suggests that housing type and ethnic variation are independently associated with higher T2DM risk in patients with uncontrolled hypertension in Singapore. Further studies are needed to validate our results. TRIAL REGISTRATION NUMBER NCT02972619.
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Affiliation(s)
| | - Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Academic Clinical Program, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Meta-analysis and machine learning-augmented mixed effects cohort analysis of improved diets among 5847 medical trainees, providers and patients. Public Health Nutr 2021; 25:281-289. [PMID: 34176552 PMCID: PMC8883775 DOI: 10.1017/s1368980021002809] [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] [Indexed: 11/18/2022]
Abstract
Objective: We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition. Design: (Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world’s largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients. Settings: (A) Medical educational institutions. (B) Teaching kitchens. Participants: (A) Medical trainees. (B) Trainees, providers and patients. Results: (A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML. Conclusions: The current study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.
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Gordon NP, Hsueh L. Racial/ethnic, gender, and age group differences in cardiometabolic risks among adults in a Northern California health plan: a cross-sectional study. BMC Public Health 2021; 21:1227. [PMID: 34172022 PMCID: PMC8235804 DOI: 10.1186/s12889-021-11011-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 01/09/2023] Open
Abstract
Background In the U.S., the prevalence of diabetes and hypertension are higher among African American/Black (Black), Latinx, and Filipino adults than non-Hispanic White (White) and Chinese adults. We compared the racial/ethnic-specific prevalence of several modifiable cardiometabolic risks in an insured adult population to identify behaviors that may drive racial/ethnic differences in cardiometabolic health. Methods This cross-sectional study used data for middle-aged (35–64) and older (65–79) Kaiser Permanente Northern California (KPNC) adult health plan members. Smoking status and BMI were derived from electronic health record data. Weighted pooled self-reported data from the 2014/2015 and 2017 KPNC Member Health Survey cycles were used to estimate daily number of servings of fruits/vegetables, general sodium avoidance, sugar-sweetened beverage (SSB) consumption frequency, alcohol use within daily recommended limit, weekly exercise frequency, and number of hours of sleep daily. Age-standardized estimates of all cardiometabolic risks were produced for middle-aged and older-aged women and men in the five racial/ethnic groups. Analyses focused on racial/ethnic differences within age-gender groups and gender and age group differences within racial/ethnic groups. Results In both age groups, Black, Latinx, and Filipino adults were more likely than White and Chinese adults to have overweight and obesity and were less likely to engage in health promoting dietary (fruit/vegetable and SSB consumption, sodium avoidance (women only)) and sleep behaviors. Middle-aged Black and Filipino men were more likely than White men to be current smokers. Less racial/ethnic variation was seen in exercise frequency. Significant gender differences were observed for dietary behaviors overall and within racial/ethnic groups, especially among middle-aged adults; however, these gender differences were smaller for sleep and exercise. Age differences within gender and racial/ethnic groups were less consistent. Racial/ethnic and gender differences in these behaviors were also seen in the subsample of adults with diabetes and/or hypertension and in the subsample of adults who reported they were trying to engage in health promoting behaviors. Conclusions Black, Latinx, and Filipino adults were more likely than White and Chinese adults to report dietary and sleep behaviors associated with development and worsening of cardiometabolic conditions, with men exhibiting poorer dietary behaviors than women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11011-4.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
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69
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Michos ED, Khan SS. Further understanding of ideal cardiovascular health score metrics and cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:607-617. [PMID: 34053373 DOI: 10.1080/14779072.2021.1937127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The American Heart Association (AHA) introduced the construct of 'cardiovascular health (CVH)', to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor. AREAS COVERED In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends. EXPERT OPINION Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.
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Affiliation(s)
- Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lee C, Park S, Boylan JM. Cardiovascular Health at the Intersection of Race and Gender: Identifying Life-Course Processes to Reduce Health Disparities. J Gerontol B Psychol Sci Soc Sci 2021; 76:1127-1139. [PMID: 33249466 DOI: 10.1093/geronb/gbaa208] [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] [Received: 02/18/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Cardiovascular health (CVH) is associated with reductions in age-related disease and later-life mortality. Black adults, particularly Black women, are less likely to achieve ideal CVH. Guided by intersectionality and life-course approaches, we examine to what degree (a) disparities in CVH exist at the intersection of race and gender and (b) CVH disparities would be reduced if marginalized groups had the same levels of resources and adversities as privileged groups. METHODS We used biomarker subsamples from the Midlife in the United States Core and Refresher studies (N = 1,948). Causal decomposition analysis was implemented to test hypothetical interventions to equalize the distribution of early-life adversities (ELAs), perceived discrimination, or midlife socioeconomic status (SES) between marginalized and privileged groups. We conducted sensitivity analyses to determine to what degree unmeasured confounders would invalidate our findings. RESULTS White women have the highest CVH score, followed by White men, Black men, and Black women. Intervening on ELAs would reduce the disparities: White men versus Black women (30% reduction) and White women versus Black women (15%). Intervening on perceived discrimination would not substantially change initial disparities. Intervening on midlife SES would yield large disparity reductions: White men versus Black men (64%), White men versus Black women (60%), and White women versus Black women (27%). These reductions are robust to unmeasured confounders. DISCUSSION Providing economic security in adulthood for Blacks may help reduce racial disparities in CVH. Preventing exposure to ELAs among Black women may reduce their vulnerability to cardiovascular disease, compared to White adults.
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Affiliation(s)
- Chioun Lee
- Department of Sociology, University of California, Riverside, USA
| | - Soojin Park
- Graduate School of Education, University of California, Riverside, USA
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Moore JX, Bevel MS, Aslibekyan S, Akinyemiju T. Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018. Prev Med 2021; 147:106483. [PMID: 33640399 PMCID: PMC8826516 DOI: 10.1016/j.ypmed.2021.106483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malcolm S Bevel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Katz SF, Rodriguez F, Knowles JW. Health disparities in cardiometabolic risk among Black and Hispanic youth in the United States. Am J Prev Cardiol 2021; 6:100175. [PMID: 34327498 PMCID: PMC8315636 DOI: 10.1016/j.ajpc.2021.100175] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/10/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiometabolic risk factors in children and adolescents track into adulthood and are associated with increased risk of atherosclerotic cardiovascular disease. The purpose of this review is to examine the pervasive race and ethnic disparities in cardiometabolic risk factors among Black and Hispanic youth in the United States. We focus on three traditional cardiometabolic risk factors (obesity, type 2 diabetes mellitus, and dyslipidemia) as well as on the emerging cardiometabolic risk factor of non-alcoholic fatty liver disease. Additionally, we highlight interventions aimed at improving cardiometabolic health among these minority pediatric populations. Finally, we advocate for continued research on effective prevention strategies to reduce cardiometabolic risk and avert further disparities in cardiovascular morbidity and mortality.
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Affiliation(s)
- Sophia Figueroa Katz
- Stanford Department of Medicine, Cardiovascular Medicine, Cardiovascular Institute, Prevention Research Center, Stanford University, Room CV273, MC 5406, 300 Pasteur Drive, Stanford, CA 94305, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue NA21, Cleveland, OH 44195, USA
| | - Fatima Rodriguez
- Stanford Department of Medicine, Cardiovascular Medicine, Cardiovascular Institute, Prevention Research Center, Stanford University, Room CV273, MC 5406, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Joshua W. Knowles
- Stanford Department of Medicine, Cardiovascular Medicine, Cardiovascular Institute, Prevention Research Center, Stanford University, Room CV273, MC 5406, 300 Pasteur Drive, Stanford, CA 94305, USA
- The FH Foundation, Pasadena, CA 91101, USA
- Stanford Diabetes Research Center, Stanford, CA 94305, USA
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Rosati F, Williams DP, Juster RP, Thayer JF, Ottaviani C, Baiocco R. The Cardiovascular Conundrum in Ethnic and Sexual Minorities: A Potential Biomarker of Constant Coping With Discrimination. Front Neurosci 2021; 15:619171. [PMID: 34093107 PMCID: PMC8170077 DOI: 10.3389/fnins.2021.619171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background: A paradoxical profile of greater elevated sympathetic vasoconstriction (increased total peripheral resistance, TPR) and increased vagally-mediated heart rate variability (HRV) -the so-called Cardiovascular Conundrum- has been reported in African Americans (AAs) both at rest and in response to orthostasis. Whereas some authors have attributed this pattern to genetic factors, others have pointed to the potential role of coping with repeated racial discrimination. Objective: To disentangle between these alternative explanations, we have examined the hemodynamic profile of another population that is likely to be exposed to episodes of discrimination, i.e., sexual minorities. Methods: The first study was conducted on a sample of AAs and European Americans (EAs) with the aim of replicating previous results on the Cardiovascular Conundrum. In the second study, lesbian, gay, and bisexual (LGB) people, matched by age and sex with heterosexual participants, underwent a hemodynamic and autonomic assessment at rest and during an emotional (in the experimental group, both LGB-related and non LGB related), and a cognitive stressor. Results: The first study confirmed a pattern of higher resting HRV, paired with higher TPR, in AAs compared to EAs. In the second study, compared to heterosexuals, the LGB group showed the Cardiovascular Conundrum pattern, characterized by greater HRV and higher TPR at baseline and a more vascular hemodynamic profile and prominent compensation deficit in response to both tasks, and particularly during the LGB-related emotional task. However, in LGB only, the vascular response was negatively correlated with perceived discrimination. Conclusion: Present preliminary results are discussed in terms of maladaptive physiological consequences of exposure to chronic stress and the chronic use of dysfunctional emotion regulation strategies such as suppression.
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Affiliation(s)
- Fausta Rosati
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Cristina Ottaviani
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Functional Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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George KM, Gilsanz P, Peterson RL, Barnes LL, DeCarli CS, Mayeda ER, Mungas DM, Whitmer RA. Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans. J Gerontol A Biol Sci Med Sci 2021; 76:1692-1698. [PMID: 34387334 DOI: 10.1093/gerona/glab143] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Midlife cardiovascular risk factors (CVRFs) increase risk of dementia. Black Americans experience an elevated prevalence of CVRFs and dementia. However, little is known of how CVRFs prior to midlife affect late-life cognition. We examined CVRFs in adolescence, young adulthood, and midlife with late-life cognition in the Study of Healthy Aging in African Americans (STAR). METHOD STAR assesses cognitive aging among 764 Black Americans aged ≥50 (mean age = 69; SD = 9; range = 53-95). Participants' body mass index, blood pressure, glucose, and total cholesterol were collected during Multiphasic Health Checkups (MHC; 1964-1985). At STAR baseline (2018-2019), executive function, verbal episodic memory, and semantic memory were measured using the Spanish and English Neuropsychological Assessment Scales. Linear regression models examined associations between CVRFs and cognition adjusting for demographics and years since MHC. RESULTS At MHC, 36% of participants had 1 CVRF and 26% had ≥2. Twenty-two percent of participants were adolescents (age 12-20), 62% young adults (age 21-34), and 16% midlife adults (age 35-56). Overweight/obesity was not associated with cognition. Hypertension was associated with worse executive function (β [95% CI]: -0.14 [-0.28, -0.0003]) and verbal episodic memory (β [95% CI]: -0.22 [-0.37, -0.07]) compared to normotension. Diabetes was associated with worse executive function (β [95% CI]: -0.43 [-0.83, -0.03]). Having ≥2 CVRFs (vs 0) was associated with worse executive function (β [95% CI]: -0.19 [-0.34, -0.03]) and verbal episodic memory (β [95% CI]: -0.25 [-0.41, -0.08]). Adolescents with hypertension had lower late-life executive function compared to normotensive adolescents (β [95% CI]: -0.39 [-0.67, -0.11]). Young adulthood hypertension (β [95% CI]: -0.29 [-0.49, -0.09]) and midlife hyperlipidemia (β [95% CI]: -0.386 [-0.70, -0.02]) were associated with lower verbal episodic memory. CONCLUSIONS Among Black Americans, life-course CVRFs were associated with poorer executive function and verbal episodic memory emphasizing the importance of cardiovascular health on the aging brain.
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Affiliation(s)
- Kristen M George
- Department of Neurology, University of California Davis School of Medicine, Sacramento, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Rachel L Peterson
- Department of Neurology, University of California Davis School of Medicine, Sacramento, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush Medical College, Chicago, Illinois, USA
| | - Charles S DeCarli
- Department of Neurology, University of California Davis School of Medicine, Sacramento, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Dan M Mungas
- Department of Neurology, University of California Davis School of Medicine, Sacramento, USA
| | - Rachel A Whitmer
- Department of Neurology, University of California Davis School of Medicine, Sacramento, USA.,Kaiser Permanente Division of Research, Oakland, California, USA.,Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, USA
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McClain AC, Gallo LC, Mattei J. Subjective Social Status and Cardiometabolic Risk Markers by Intersectionality of Race/Ethnicity and Sex Among U.S. Young Adults. Ann Behav Med 2021; 56:442-460. [PMID: 33942845 DOI: 10.1093/abm/kaab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships. PURPOSE To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex. METHODS Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24-32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1-10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification. RESULTS SSS-race/ethnicity-sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: -1.2 (0.4), p < .05) and BMI (-0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males. CONCLUSIONS SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk.
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Affiliation(s)
- Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Josiemer Mattei
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Kruger R, Gafane-Matemane LF, Kagura J. Racial differences of early vascular aging in children and adolescents. Pediatr Nephrol 2021; 36:1087-1108. [PMID: 32444927 DOI: 10.1007/s00467-020-04593-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
The prevalence of non-communicable disease (NCDs) is rising globally, with a large burden recorded in sub-Saharan countries and populations of black race/ethnicity. Accelerated vascular deterioration, otherwise known as early vascular aging (EVA), is the underlying factor for highly prevalent NCDs such as hypertension. The etiology of EVA is multifactorial with a central component being arterial stiffness with subsequent development of hypertension and cardiovascular complications. Although arterial stiffness develops with increasing age, many children and adolescents are subjected to the premature development of arterial stiffness, due to genetic or epigenetic predispositions, lifestyle and behavioral risk factors, and early life programming. Race/ethnic differences in pediatric populations have also been reported with higher aortic stiffness in black (African American) compared with age-matched white (European American) counterparts independent of blood pressure, body mass index, or socioeconomic status. With known evidence of race/ethnic differences in EVA, the pathophysiological mechanisms underlying graded differences in the programming of EVA are still sparse and rarely explored. This educational review aims to address the early life determinants of EVA in children and adolescents with a particular focus on racial or ethnic differences.
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Trends and patterns in sugar-sweetened beverage consumption among children and adults by race and/or ethnicity, 2003-2018. Public Health Nutr 2021; 24:2405-2410. [PMID: 33843567 DOI: 10.1017/s1368980021001580] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sugar-sweetened beverage (SSB) consumption has declined steadily. This study uses the latest national data to examine trends in SSB consumption among children and adults by race and/or ethnicity and to document whether long-standing disparities in intake remain. DESIGN Trend analyses of demographic and dietary data measured by 24-h dietary recall from the National Health and Nutrition Examination Survey (NHANES). SETTING Data from the 2003-2004 through 2017-2018 NHANES survey cycles were analysed in 2020. PARTICIPANTS The study sample included 21 156 children aged 2-19 years and 32 631 adults aged 20+ years. RESULTS From 2003-2004 to 2017-2018, the prevalence of drinking any amount of SSB on a given day declined significantly among all race and/or ethnicity groups for children (non-Hispanic (NH) White: 81·6 % to 72·7 %; NH Black: 83·2 % to 74·8 %, Hispanic: 86·9 % to 77·2 %) and most race and/or ethnicity groups for adults (NH White: 72·3 % to 65·3 %; Hispanic: 84·6 % to 77·8 %). Consumption declined at a higher rate among NH Black and Hispanic children aged 12-19 years compared with their NH White peers; among NH Black children aged 6-11 years, the rate of decline was lower. Despite significant declines in per capita SSB energy consumption from soda and fruit drinks, consumption of sweetened coffee/tea beverages increased among older children and nearly all adults and consumption of sweetened milk beverages increased among NH White and Hispanic children. CONCLUSIONS SSB consumption has declined steadily for children and adults of all race and/or ethnicity groups, but disparities persist, and overall intake remains high.
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Bundy JD, Zhu Z, Ning H, Zhong VW, Paluch AE, Wilkins JT, Lloyd‐Jones DM, Whelton PK, He J, Allen NB. Estimated Impact of Achieving Optimal Cardiovascular Health Among US Adults on Cardiovascular Disease Events. J Am Heart Assoc 2021; 10:e019681. [PMID: 33761755 PMCID: PMC8174373 DOI: 10.1161/jaha.120.019681] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Background Better cardiovascular health (CVH) scores are associated with lower risk of cardiovascular disease (CVD). However, estimates of the potential population-level impact of improving CVH on US CVD event rates are not currently available. Methods and Results Using data from the National Health and Nutrition Examination Survey 2011 to 2016 (n=11 696), we estimated the proportions of US adults in CVH groups. Levels of 7 American Heart Association CVH metrics were scored as ideal (2 points), intermediate (1 point), or poor (0 points), and summed to define overall CVH (low, 0-8 points; moderate, 9-11 points; or high, 12-14 points). Using individual-level data from 7 US community-based cohort studies (n=30 447), we estimated annual incidence rates of major CVD events by levels of CVH. Using the combined data sources, we estimated population attributable fractions of CVD and the number of CVD events that could be prevented annually if all US adults achieved high CVH. High CVH was identified in 7.3% (95% CI, 6.3%-8.3%) of US adults. We estimated that 70.0% (95% CI, 56.5%-79.9%) of CVD events were attributable to low and moderate CVH. If all US adults attained high CVH, we estimated that 2.0 (95% CI, 1.6-2.3) million CVD events could be prevented annually. If all US adults with low CVH attained moderate CVH, we estimated that 1.2 (95% CI, 1.0-1.4) million CVD events could be prevented annually. Conclusions The potential benefits of achieving high CVH in all US adults are considerable, and even a partial improvement in CVH scores would be highly beneficial.
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Affiliation(s)
- Joshua D. Bundy
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Science InstituteNew OrleansLA
| | - Zhengbao Zhu
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | - Hongyan Ning
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Victor W. Zhong
- Department of Epidemiology and BiostatisticsSchool of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Amanda E. Paluch
- Department of KinesiologyUniversity of Massachusetts AmherstAmherstMA
| | - John T. Wilkins
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Donald M. Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Paul K. Whelton
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Science InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Science InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Norrina B. Allen
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
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Carl AE, Taillie LS, Grummon AH, Lazard AJ, Higgins ICA, Sheldon JM, Hall MG. Awareness of and reactions to the health harms of sugary drinks: An online study of U.S. parents. Appetite 2021; 164:105234. [PMID: 33823230 DOI: 10.1016/j.appet.2021.105234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 01/10/2023]
Abstract
Evidence about the health problems associated with sugary drink consumption is well-established. However, little is known about which sugary drink health harms are most effective at changing consumers' behavior. We aimed to identify which harms people were aware of and most discouraged them from wanting to buy sugary drinks. Participants were a national convenience sample of diverse parents (n = 1,058), oversampled for Latino parents (48%). Participants rated a list of sugary drink-related health harms occurring in children (7 harms) and in adults (15 harms). Outcomes were awareness of each harm and how much each harm discouraged parents from wanting to purchase sugary drinks. Most participants were aware that sugary drinks contribute to tooth decay in children (75%) and weight gain in both children (73%) and adults (69%). Few participants were aware that sugary drinks contribute to adult infertility (16%), arthritis (18%), and gout (18%). All health harms were rated highly in terms of discouraging parents from wanting to buy sugary drinks (range: 3.59-4.11 on a 1-5 scale), with obesity, pre-diabetes, and tooth decay eliciting the highest discouragement ratings. Harm-induced discouragement was higher for participants who were aware of more health harms (B = 0.05, p < 0.0001), identified as female (B = 0.15 compared to male, p = 0.02), or had an annual household income of $50,000 or more (B = 0.16 compared to less than $50,000, p = 0.03). These findings suggest health messages focused on a variety of health harms could raise awareness and discourage sugary drink purchases.
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Affiliation(s)
- Alexandra E Carl
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr., Chapel Hill, NC, 27599, United States.
| | - Lindsey Smith Taillie
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Nutrition, 135 Dauer Dr., Chapel Hill, NC, 27599, United States; University of North Carolina at Chapel Hill, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC, 27516, United States.
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, 9 Bow Street, Cambridge, MA 02138, United States.
| | - Allison J Lazard
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States; University of North Carolina at Chapel Hill, Hussman School of Journalism and Media, Carroll Hall, CB 3365, Chapel Hill, NC, 27599, United States.
| | - Isabella C A Higgins
- University of North Carolina at Chapel Hill, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC, 27516, United States.
| | - Jennifer Mendel Sheldon
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States.
| | - Marissa G Hall
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr., Chapel Hill, NC, 27599, United States; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 101 Manning Dr., Chapel Hill, NC, 27514, United States.
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Evaluating associations between area-level Twitter-expressed negative racial sentiment, hate crimes, and residents' racial prejudice in the United States. SSM Popul Health 2021; 13:100750. [PMID: 33665332 PMCID: PMC7901034 DOI: 10.1016/j.ssmph.2021.100750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/27/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background The objective of the current study is to investigate whether an area-level measure of racial sentiment derived from Twitter data is associated with state-level hate crimes and existing measures of racial prejudice at the individual-level. Methods We collected 30,977,757 tweets from June 2015-July 2018 containing at least one keyword pertaining to specific groups (Asians, Arabs, Blacks, Latinos, Whites). We characterized sentiment of each tweet (negative vs all other) and averaged at the state-level. These racial sentiment measures were merged with other measures based on: hate crime data from the FBI Uniform Crime Reporting Program; implicit and explicit racial bias indicators from Project Implicit; and racial attitudes questions from General Social Survey (GSS). Results Living in a state with 10% higher negative sentiment in tweets referencing Blacks was associated with 0.57 times the odds of endorsing a GSS question that Black-White disparities in jobs, income, and housing were due to discrimination (95% CI: 0.40, 0.83); 1.64 times the odds of endorsing the belief that disparities were due to lack to will (95% CI: 0.95, 2.84); higher explicit racial bias (β: 0.11; 95% CI: 0.04, 0.18); and higher implicit racial bias (β: 0.09; 95% CI: 0.04, 0.14). Twitter-expressed racial sentiment was not statistically-significantly associated with incidence of state-level hate crimes against Blacks (IRR: 0.99; 95% CI: 0.52, 1.90), but this analysis was likely underpowered due to rarity of reported hate crimes. Conclusion Leveraging timely data sources for measuring area-level racial sentiment can provide new opportunities for investigating the impact of racial bias on society and health.
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81
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Kibria GMA, Crispen R, Chowdhury MAB, Rao N, Stennett C. Disparities in absolute cardiovascular risk, metabolic syndrome, hypertension, and other risk factors by income within racial/ethnic groups among middle-aged and older US people. J Hum Hypertens 2021:10.1038/s41371-021-00513-8. [PMID: 33674704 DOI: 10.1038/s41371-021-00513-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022]
Abstract
This cross-sectional study determined income disparities in age-adjusted prevalence and trends of 10-year high absolute cardiovascular disease (CVD) risk, metabolic syndrome, hypertension, diabetes, obesity, chronic kidney disease (CKD), leisure-time physical activity (LTPA), and current tobacco smoking within racial/ethnic groups in the US. National Health and Nutrition Examination Survey 2001-2016 data of 40-79-year-old people were analyzed. Survey periods were grouped as 2001-2006, 2007-2012, and 2013-2016. Race/ethnicity was grouped as non-Hispanic whites, non-Hispanic blacks, and other races/ethnicities. Three equal-sized strata (low-, middle-, and high income) were made from the family income-to-poverty ratio. Of the 25,777 participants (mean age: 55.6 years, 48% males), a majority of the studied prevalence was higher in most survey years among non-Hispanic blacks compared to non-Hispanic whites. Most studied prevalence was also higher among low-income people than middle-/high-income people. Within racial/ethnic groups, the prevalence also differed by income for high CVD risk, metabolic syndrome, hypertension, diabetes, obesity, CKD, LTPA, and tobacco smoking (P < 0.05) in most survey periods. After stratifying by race/ethnicity, the prevalence of many conditions remained disproportionately higher among low- and middle-income people, compared to those with high income during most survey periods in all racial/ethnic groups. These results reveal income in addition to race/ethnicity to be an important correlate of cardiovascular health and underscore the need to consider each when controlling for risk factors.
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Affiliation(s)
| | - Reese Crispen
- University of Maryland School of Medicine, Baltimore, MD, USA
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Hassan S, Oladele C, Galusha D, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M. Anthropometric measures of obesity and associated cardiovascular disease risk in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study. BMC Public Health 2021; 21:399. [PMID: 33632164 PMCID: PMC7905572 DOI: 10.1186/s12889-021-10399-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/05/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. METHODS Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. RESULTS Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively. CONCLUSION Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA.
- Emory University School of Medicine, Emory Rollins School of Public Health, Atlanta, GA, 30319, USA.
| | - Carol Oladele
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
| | - Deron Galusha
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
| | | | - Rohan G Maharaj
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
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O'Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. J Am Heart Assoc 2021; 10:e019259. [PMID: 33629868 PMCID: PMC8174244 DOI: 10.1161/jaha.120.019259] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Risk of coronavirus disease 2019 (COVID-19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID-19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS We used the best available estimates of independent associations of cardiometabolic conditions with a risk of COVID-19 hospitalization; nationally representative data on cardiometabolic conditions from the National Health and Nutrition Examination Survey 2015 to 2018; and US COVID-19 hospitalizations stratified by age, sex, and race/ethnicity from the Centers for Disease Control and Prevention's Coronavirus Disease 2019-Associated Hospitalization Surveillance Network database and from the COVID Tracking Project to estimate the numbers and proportions of COVID-19 hospitalizations attributable to diabetes mellitus, obesity, hypertension, and heart failure. Inputs were combined in a comparative risk assessment framework, with probabilistic sensitivity analyses and 1000 Monte Carlo simulations to jointly incorporate stratum-specific uncertainties in data inputs. As of November 18, 2020, an estimated 906 849 COVID-19 hospitalizations occurred in US adults. Of these, an estimated 20.5% (95% uncertainty interval [UIs], 18.9-22.1) of COVID-19 hospitalizations were attributable to diabetes mellitus, 30.2% (UI, 28.2-32.3) to total obesity (body mass index ≥30 kg/m2), 26.2% (UI, 24.3-28.3) to hypertension, and 11.7% (UI, 9.5-14.1) to heart failure. Considered jointly, 63.5% (UI, 61.6-65.4) or 575 419 (UI, 559 072-593 412) of COVID-19 hospitalizations were attributable to these 4 conditions. Large differences were seen in proportions of cardiometabolic risk-attributable COVID-19 hospitalizations by age and race/ethnicity, with smaller differences by sex. CONCLUSIONS A substantial proportion of US COVID-19 hospitalizations appear attributable to major cardiometabolic conditions. These results can help inform public health prevention strategies to reduce COVID-19 healthcare burdens.
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Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy Tufts University Boston MA
| | - Junxiu Liu
- Friedman School of Nutrition Science and Policy Tufts University Boston MA.,Population Health Science and Policy Icahn School of Medicine Mount Sinai NY
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy Tufts University Boston MA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy Tufts University Boston MA
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Gu Y, Guo J, Moshfegh AJ. Race/ethnicity and gender modify the association between diet and cognition in U.S. older adults: National Health and Nutrition Examination Survey 2011-2014. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12128. [PMID: 33614896 PMCID: PMC7882526 DOI: 10.1002/trc2.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION It is unclear whether the association between Mediterranean-type Diet (MeDi) and cognition is similar across different racial/ethnic groups or between women and men. METHODS The current study included 2435 participants (≥60 years of age) of the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Linear regression models were applied to examine the association between diet and cognition, adjusted for multiple demographic variables. Interaction between MeDi and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), and between MeDi and gender, were examined, followed by stratified analyses. RESULTS One score increase in MeDi was associated with 0.039 (95%confidence interval [CI] = 0.016-0.062) higher global cognitive z-score. Significant associations between MeDi and global cognition and between MeDi and immediate recall were found in the non-Hispanic Whites only (P-interaction = 0.057 and 0.059, respectively). MeDi was associated with increased score of animal fluency score in men but not in women (P-interaction = 0.082). DISCUSSION The positive association between MeDi and cognition might be dependent on race/ethnicity and gender.
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Affiliation(s)
- Yian Gu
- Taub Institute for Research in Alzheimer's Disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Gertrude H. Sergievsky CenterColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyJoseph P. Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Jing Guo
- Taub Institute for Research in Alzheimer's Disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
| | - Alanna J Moshfegh
- Beltsville Human Nutrition Research CenterAgricultural Research ServiceUSDABeltsvilleMarylandUSA
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85
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Ruprecht MM, Wang X, Johnson AK, Xu J, Felt D, Ihenacho S, Stonehouse P, Curry CW, DeBroux C, Costa D, Phillips Ii G. Evidence of Social and Structural COVID-19 Disparities by Sexual Orientation, Gender Identity, and Race/Ethnicity in an Urban Environment. J Urban Health 2021; 98:27-40. [PMID: 33259027 PMCID: PMC7706696 DOI: 10.1007/s11524-020-00497-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
Abstract
The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago's initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations.
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Affiliation(s)
- Megan M Ruprecht
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy K Johnson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Siobhan Ihenacho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick Stonehouse
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine DeBroux
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diogo Costa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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86
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Abstract
Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved.
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Affiliation(s)
- Juanita J. Chinn
- Population Dynamics Branch, Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Iman K. Martin
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Nicole Redmond
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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87
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Castiel J, Chen-Tournoux A, Thanassoulis G, Goldfarb M. A Patient-Led Referral Strategy for Cardiovascular Screening of Family and Household Members at the Time of Cardiac Intensive Care Unit Admission. CJC Open 2020; 2:506-513. [PMID: 33305210 PMCID: PMC7710948 DOI: 10.1016/j.cjco.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background Screening relatives of patients with ischemic heart disease can identify over half of the population with poorly controlled cardiovascular (CV) risk factors. Family or household members (FMs) may be highly motivated to undergo CV primary prevention screening at the time of their relative’s admission to the Cardiovascular Intensive Care Unit (CICU). Methods Patients aged ≤ 70 years admitted to a tertiary CICU for an acute coronary event were given a letter to refer FMs for CV screening. Interested FMs underwent CV risk-factor assessment and primary prevention counselling. The objectives were to identify FMs with an intermediate or high modified 10-year Framingham risk score (FRS) and to evaluate whether a family-oriented primary prevention strategy improved CV risk. Results There were 51 CV probands who referred 101 FMs (62 family, 39 household; mean age: 44.8 ± 15.3; 65 (64.4%) female) for screening. One-third of FMs aged ≥ 30 years (n = 28 of 84; 32.1%) had a new diagnosis of either hypertension, diabetes, or dyslipidemia. Nearly half of FMs (n = 38; 45.2%) had an intermediate or high modified Framingham 10-year CV risk. In FMs aged ≥ 30 years attending the 6-month follow-up (51 of 84; 60.7%), the mean FRS decreased by 4.6% (from 13.2% ± 12.7 to 8.6% ± 10.0, P < 0.001), and 30.4% (7 of 23) of FMs had a low FRS who had initially had an intermediate or high FRS. Conclusions A patient-led referral strategy at the time of CICU admission led to a high rate of identification of previously undiagnosed CV risk factors in FMs. Implementing a similar referral program on a larger scale could identify a considerable burden of CV risk.
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Affiliation(s)
| | - Annabel Chen-Tournoux
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - George Thanassoulis
- Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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88
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Montvida O, Verma S, Shaw JE, Paul SK. Cardiometabolic risk factor control in black and white people in the United States initiating sodium-glucose co-transporter-2 inhibitors: A real-world study. Diabetes Obes Metab 2020; 22:2384-2397. [PMID: 32744394 DOI: 10.1111/dom.14164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/19/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023]
Abstract
AIMS To explore cardiometabolic risk profiles, the probability of sustainable control, and the effectiveness of treatment with sodium-glucose co-transporter-2 (SGLT2) inhibitors in black and white adults in the United States with type 2 diabetes. MATERIALS AND METHODS Using nationally representative US electronic medical records, 72 690 white and 10 004 black adults diagnosed with type 2 diabetes initiating SGLT2 inhibitors during the period 2013 to 2018, continuing it for ≥6 months, and with follow-up of ≥12 months, were identified. Glycated haemoglobin (HbA1c), body weight, systolic blood pressure (SBP) and lipid changes at 6 months, and sustainability of control over 18 months post SGLT2 inhibitor initiation were explored, separately in those with and without atherosclerotic cardiovascular disease (ASCVD). RESULTS The white group was older (58 years) with lower mean HbA1c (8.5%), compared to the black group (age 54 years, HbA1c 9.0%). Body mass index distribution was similar. The proportions of people with uncontrolled SBP, LDL cholesterol, non-HDL cholesterol and triglyceride levels were 24%, 42%, 51% and 62%, respectively, in white patients, and 31%, 51%, 49% and 32%, respectively, in black patients. At 6-month follow-up white and black patients had similar adjusted reductions in HbA1c (1.1%), SBP (8-10 mmHg), LDL cholesterol (0.26 - 0.34 mmol / L) and body weight (1.1-1.4 kg). However, over 18 months' follow-up, compared to white patients, black patients were significantly less likely to achieve sustainable control in HbA1c (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.63-0.72), body weight (OR 0.81, 95% CI 0.72-0.91), SBP (OR 0.67, 95% CI 0.61-0.74) and LDL cholesterol (OR 0.77, 95% CI 0.67-0.89). Triglyceride control was significantly better among black patients. Black patients had a significantly higher risk factor burden, irrespective of ASCVD status. CONCLUSIONS While the effectiveness of SGLT2 inhibitors was similar among black and white patients, irrespective of ASCVD status, black patients continued to have worse cardiometabolic risk factor burden after SGLT2 inhibitor initiation.
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Affiliation(s)
- Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, St. Michael' Hospital, Toronto, Canada
| | | | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
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89
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Razavi AC, Dyer A, Jones M, Sapin A, Caraballo G, Nace H, Dotson K, Razavi MA, Harlan TS. Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education. Nutrients 2020; 12:E3632. [PMID: 33255901 PMCID: PMC7761274 DOI: 10.3390/nu12123632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.
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Affiliation(s)
- Alexander C. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Matthew Jones
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Graciela Caraballo
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Heather Nace
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Kerri Dotson
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Michael A. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Timothy S. Harlan
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
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90
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Collyer TA, Smith KE. An atlas of health inequalities and health disparities research: "How is this all getting done in silos, and why?". Soc Sci Med 2020; 264:113330. [PMID: 32971486 PMCID: PMC7449896 DOI: 10.1016/j.socscimed.2020.113330] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 10/27/2022]
Abstract
Research on health inequalities and health disparities has grown exponentially since the 1960s, but this expansion has not been matched by an associated sense of progress. Criticisms include claims that too much research addresses well-trodden questions and that the field has failed to gain public and policy traction. Qualitative studies have found researchers partly attribute these challenges to fragmentation resulting from disciplinary and methodological differences. Yet, empirical investigation ('research on research') is limited. This study addresses this gap, employing mixed-methods to examine, at scale, how and why this field is defined by insular research clusters. First, bibliometric analysis identifies and visualizes the 250 most-connected authors. Next, an algorithm was used to identify clustering via citation links between authors. We used researcher profiling to ascertain authors' geographical and institutional locations and disciplinary training, examining how this mapped onto clusters. Finally, causes of siloing were investigated via semi-structured interviews with 45 researchers. The resulting 'atlas' of health inequalities and health disparities research identifies eight clusters of authors with varying degrees of connectedness. No single factor neatly describes observed fragmentation, health equity scholars exhibit a diverse disciplinary backgrounds, and geographical, institutional, and historical factors appear to intersect to explain siloed citation patterns. While the configuration of research activity within clusters potentially helps render questions scientifically manageable, it affirms perceptions of the field as fragmented. We draw on Thomas Kuhn and Sheila Jasanoff to position results within theoretical pictures of scientific progress. Newcomers to the field can use our findings to orient themselves within the many streams of health equity scholarship, and existing health equity scholars can use the atlas to move beyond existing geo-disciplinary networks. However, although stronger cross-cluster engagement would be likely to improve insights, the complex nexus of factors underlying the field's structure will likely make this challenging in practice.
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Affiliation(s)
- Taya A Collyer
- University of Edinburgh, School of Social and Political Science, 15a George Square, Edinburgh, EH8 9LD, United Kingdom; Monash University, Peninsula Clinical School, 2 Hastings Rd, Frankston, Victoria, Australia.
| | - Katherine E Smith
- University of Strathclyde, School of Social Work and Social Policy, Lord Hope Building 141 St James Road, Glasgow, G4 0LT, UK.
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91
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Parekh N, Khalife G, Hellmers N, D'Eramo Melkus G. The Healthy Eating and Living Against Noncommunicable Diseases Study: An Innovative Family-Based Intervention. DIABETES EDUCATOR 2020; 46:569-579. [PMID: 33124519 DOI: 10.1177/0145721720965491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Inadequate nutrition literacy within families is a barrier for healthy dietary choices and influences chronic disease risk. This pilot study examined the feasibility of providing an in-person nutrition intervention for families at high risk of developing prediabetes or type 2 diabetes and cardiovascular risk-factors. METHODS Eligible families had at least one member with a non-communicable disease (NCD) or metabolic risk factor, fluency in English, willingness to attend all three educational sessions and complete questionnaires as a family unit. Sessions included didactic and experiential activities on food label reading, portion sizing, physical activity and modifiable lifestyle factors to reduce NCD risk. Demographics and fruit and vegetable screeners were collected from all participants at baseline and after completion of sessions. Families participated in focus groups to evaluate the program. RESULTS Twelve families (n=35;17 adults;18 children) were recruited from New York City. Participants self-identified as Asian, Hispanic or Black. Adults had a mean age of 40y, BMI of 32.29kg/m2, household income of $35,000-$49,000y, and 13 of 17 adult participants had college degrees. Children ranged from 1-17y. Based on focus group feedback, three sessions were acceptable, families reported enjoying interactive activities and group learning and requested child-friendly activities. They reported improved knowledge of food labels, strategies for grocery shopping, portion-sizing, and increased awareness of the links between diet quality and NCDs. CONCLUSIONS AND IMPLICATIONS The study met recruitment goals within 4 months. The educational intervention was acceptable and may be scaled-up for future studies on NCD prevention, particularly prediabetes and type 2 diabetes.
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Affiliation(s)
- Niyati Parekh
- From NYU School of Global Public Health, New York University, New York, New York
| | - Gabrielle Khalife
- From NYU School of Global Public Health, New York University, New York, New York
| | - Natalie Hellmers
- NYU Rory Meyers College of Nursing, New York University, New York, New York
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92
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Cammack AL, Gazmararian JA, Suglia SF. History of child maltreatment and excessive dietary and screen time behaviors in young adults: Results from a nationally representative study. Prev Med 2020; 139:106176. [PMID: 32592792 PMCID: PMC7494614 DOI: 10.1016/j.ypmed.2020.106176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 12/14/2022]
Abstract
Child maltreatment is common and has been associated with substance use addictions, yet few studies have examined associations with potentially addictive dietary and screen time behaviors. The goal of this study was to assess associations between retrospectively self-reported child maltreatment (sexual abuse, physical abuse, emotional abuse, and neglect) and excessive self-reported dietary (sugar sweetened beverage and fast food consumption) and screen time behaviors (television/video watching and leisure time computer use) in early adulthood, overall and by sex and race/ethnicity. Associations were examined using data from 10,813 participants 24-32 years old from the National Longitudinal Study of Adolescent to Adult Health. We used predicted marginal proportions accounting for the complex sample design to obtain prevalence ratios (PRs) and adjusted for demographic characteristics and physical activity. In females, exposure to poly-maltreatment (2+ types of child maltreatment) was associated with excessive sugar sweetened beverage consumption, television/video watching, and leisure time computer use; in males, exposure to poly-maltreatment was associated with excessive sugar sweetened beverage consumption, television/video watching, and fast food consumption. Some associations were particularly strong in racial/ethnic minorities, especially Latina females (poly-maltreatment-sugar sweetened beverage association: aPR = 6.14, 95% CI:2.12, 17.75; poly-maltreatment-computer use association: aPR = 3.08, 95% CI:1.44, 6.58). These findings show that child maltreatment is associated with excessive dietary and screen time behaviors into adulthood, and these associations are present in racial/ethnic groups at high risk of cardiometabolic disease. Extension of an addiction paradigm to include dietary and screen time behaviors may inform health risks and disease prevention efforts in child maltreatment survivors.
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Affiliation(s)
- Alison L Cammack
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States of America.
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States of America
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States of America
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93
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Farrell MC, Giza RJ, Shibao CA. Race and sex differences in cardiovascular autonomic regulation. Clin Auton Res 2020; 30:371-379. [PMID: 32894376 PMCID: PMC7584374 DOI: 10.1007/s10286-020-00723-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
Racial and ethnic differences in cardiovascular morbidity and mortality persist despite advances in risk factor identification and implementation of evidence-based treatment strategies. African American men and women are disproportionately affected by cardiovascular risk factors, particularly hypertension. In this context, previous studies have identified sex and racial differences in autonomic cardiovascular regulation which may contribute to the development of hypertension and its high morbidity burden among African Americans. In this review, we provide a comprehensive evaluation of the potential pathophysiological mechanisms of blood pressure control and their differences based on sex and race. These mechanisms include obesity-induced sympathetic activation, sympatho-vascular transduction, baroreflex sensitivity and adrenoreceptor vascular sensitivity, which have been the subjects of prior investigation in this field. Understanding the racial differences in the pathophysiology of hypertension and its co-morbid conditions would allow us to implement better treatment strategies tailored to African Americans, with the ultimate goal of reducing cardiovascular mortality in this population.
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Affiliation(s)
| | - Richard J Giza
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, 506 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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94
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Westgard B, Martinson BC, Maciosek M, Brown M, Xu Z, Farah F, Ahmed O, Dalmar A, Dubois D, Sanka L, Pryce D. Prevalence of Cardiovascular Disease and Risk Factors Among Somali Immigrants and Refugees. J Immigr Minor Health 2020; 23:680-688. [PMID: 32940817 DOI: 10.1007/s10903-020-01078-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) risks are of concern among immigrants and refugees settling in affluent host countries. The prevalence of CVD and risk factors among Somali African immigrants to the U.S. has not been systematically studied. METHODS In 2015-2016, we surveyed 1156 adult Somalis in a Midwestern metropolitan area using respondent-driven sampling to obtain anthropometric, interview, and laboratory data about CVD and associated risk factors, demographics, and social factors. RESULTS The prevalence of diabetes and low physical activity among men and women was high. Overweight, obesity, and dyslipidemia were also particularly prevalent. Levels of calculated CVD risk across the community were greater for men than women. CONCLUSION Though CVD risk is lower among Somalis than the general U.S. population, our results suggest significant prevalence of risk factors among Somali immigrants. Comparison with prior research suggests that CVD risks may be increasing, necessitating thoughtful intervention to prevent adverse population outcomes.
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Affiliation(s)
- Bjorn Westgard
- HealthPartners Institute for Education and Research, 8170 33rd Avenue S., MS23301A, Minneapolis, MN, 55425, USA.
| | - Brian C Martinson
- HealthPartners Institute for Education and Research, 8170 33rd Avenue S., MS23301A, Minneapolis, MN, 55425, USA
| | - Michael Maciosek
- HealthPartners Institute for Education and Research, 8170 33rd Avenue S., MS23301A, Minneapolis, MN, 55425, USA
| | - Morgan Brown
- HealthPartners Institute for Education and Research, 8170 33rd Avenue S., MS23301A, Minneapolis, MN, 55425, USA
| | - Zhiyuan Xu
- HealthPartners Institute for Education and Research, 8170 33rd Avenue S., MS23301A, Minneapolis, MN, 55425, USA
| | - Farhiya Farah
- Saint Mary University of Minnesota, Minneapolis, MN, USA
| | - Osman Ahmed
- East Africa Health Project, Minneapolis, MN, USA
| | - Ahmed Dalmar
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA
| | | | - Laura Sanka
- Wellshare International, Minneapolis, MN, USA
| | - Douglas Pryce
- Hennepin County Medical Center, Minneapolis, MN, USA
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95
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Russell HA, Sanders M, Moll L, Murphy M, Lanigan AM, Carroll JK. Using a group medical visit model to promote healthy behaviour change with an underserved population. Fam Pract 2020; 37:507-512. [PMID: 32222769 DOI: 10.1093/fampra/cmaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Models of care are needed to address physical activity, nutrition promotion and weight loss in primary care settings, especially with underserved populations who are disproportionately affected by chronic illness. Group medical visits (GMVs) are one approach that can help overcome some of the barriers to behaviour change in underserved populations, including the amount of time required to care for these patients due to socio-economic stressors and psychosocial complexities (1). GMVs have been shown to improve care in coronary artery disease and diabetes, but more evidence is needed in underserved settings. OBJECTIVE This project sought to evaluate a GMV incorporating a physical activity component in an underserved patient population, measuring biometric and motivation outcome measures. METHODS This project used a pre-post intervention study design through patient surveys at baseline and 12 weeks. We included validated motivational measures along with self-reported demographic information. A GMV intervention promoting physical activity and nutrition to promote weight loss was delivered by an interdisciplinary primary care team and community partners in a Federally Qualified Health Center in Rochester, NY. The intervention consisted of six, 2-hour sessions that occurred every other week at the clinic site. RESULTS Participants lost a significant amount of weight and maintained the weight loss at 6 months. In addition, there was a significant improvement in motivation measures. CONCLUSION This study provides preliminary evidence that our GMV model can improve weight loss and autonomous motivation in an underserved population. This project has potential for scalability and sustainability.
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Affiliation(s)
- Holly Ann Russell
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Lynn Moll
- Department of Family Medicine, Anthony L. Jordan Health Center, Rochester, NY, USA
| | - Melanie Murphy
- Department of Family Medicine, Anthony L. Jordan Health Center, Rochester, NY, USA
| | - Angela M Lanigan
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
| | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, KS, USA.,Department of Family Medicine, University of Colorado, Aurora, CO, USA
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96
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Warrior L, Kim CY, Burdick DJ, Ackerman DJ, Bartolini L, Cagniart KR, Dangayach NS, Dawson ET, Orjuela KD, Gordon Perue GL, Cutsforth-Gregory JK, Bahouth MN, McClean JC, DeLuca GC. Leading with inclusion during the COVID-19 pandemic. Neurology 2020; 95:537-542. [DOI: 10.1212/wnl.0000000000010641] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Inclusion is the deliberate practice of ensuring that each individual is heard, all personal traits are respected, and all can make meaningful contributions to achieve their full potential. As coronavirus disease 2019 spreads globally and across the United States, we have viewed this pandemic through the lens of equity and inclusion. Here, we discuss how this pandemic has magnified preexisting health and social disparities and will summarize why inclusion is an essential tool to traverse this uncertain terrain and discuss strategies that can be implemented at organizational and individual levels to improve inclusion and address inequities moving forward.
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97
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Shah NS, Molsberry R, Rana JS, Sidney S, Capewell S, O'Flaherty M, Carnethon M, Lloyd-Jones DM, Khan SS. Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics. BMJ 2020; 370:m2688. [PMID: 32816805 PMCID: PMC7424397 DOI: 10.1136/bmj.m2688] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. DESIGN Serial cross sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography. SETTING United States, 1999-2018. PARTICIPANTS 12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old). MAIN OUTCOME MEASURES Age adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change. RESULTS Deaths from total heart disease fell from 752 192 to 596 577 between 1999 and 2011, and then increased to 655 381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost. CONCLUSIONS Trends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.
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Affiliation(s)
- Nilay S Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
| | - Rebecca Molsberry
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Jamal S Rana
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Stephen Sidney
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Simon Capewell
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
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98
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Abstract
Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.
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Affiliation(s)
- Aditi Nayak
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.N., A.A.M.)
| | - Albert J Hicks
- Division of Cardiology, Baylor Scott & White, Temple, TX (A.J.H.)
| | - Alanna A Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.N., A.A.M.)
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99
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Boehm JK, Chen Y, Qureshi F, Soo J, Umukoro P, Hernandez R, Lloyd-Jones D, Kubzansky LD. Positive emotions and favorable cardiovascular health: A 20-year longitudinal study. Prev Med 2020; 136:106103. [PMID: 32348855 PMCID: PMC7246158 DOI: 10.1016/j.ypmed.2020.106103] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/07/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
No studies have examined whether positive emotions lead to favorable cardiovascular health (CVH) early in the lifespan, before cardiovascular disease is diagnosed. Moreover, the direction of the association has not been thoroughly investigated. Among younger adults, we investigated whether baseline positive emotions were associated with better CVH over 20 years. We also considered whether baseline CVH was associated with subsequent positive emotions during the same period. Participants included 4196 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Positive emotions and cardiovascular-related parameters were each assessed in 1990 (this study's baseline), with repeated assessment through 2010. CVH was defined by blood pressure, lipids, body mass index, diabetes, and smoking status. Primary analyses used linear mixed effects models adjusting for potential confounders; secondary analyses stratified by race and sex. Controlling for sociodemographic factors, greater baseline positive emotions were associated with better CVH across time (β = 0.03, 95% confidence interval = 0.007-0.06). However, positive emotions were unrelated to rate of change in CVH across time. Baseline CVH was also associated with greater average positive emotions across time (β = 0.09, 95% confidence interval = 0.02-0.15), but not rate of change. Positive emotions' association with CVH was stronger for women than men, but race did not modify associations. Positive emotions in early to middle adulthood were associated with better CVH across several decades. Baseline CVH was also associated with greater positive emotions during follow-up. Future research may be able to disentangle these relationships by assessing positive emotions and CVH earlier in life.
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Affiliation(s)
- Julia K Boehm
- Department of Psychology, Chapman University, 1 University Drive, Orange, CA 92866, USA.
| | - Ying Chen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Farah Qureshi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Lee Kum Sheung Center for Health and Happiness, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Jackie Soo
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Peter Umukoro
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada Street, Urbana, IL 61801, USA.
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, IL 60611, USA.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Lee Kum Sheung Center for Health and Happiness, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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100
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Berg MT, Lei MK, Beach SR, Simons RL, Simons LG. Childhood Adversities as Determinants of Cardiovascular Disease Risk and Perceived Illness Burden in Adulthood: Comparing Retrospective and Prospective Self-Report Measures in a Longitudinal Sample of African Americans. J Youth Adolesc 2020; 49:1292-1308. [PMID: 32080780 PMCID: PMC7981841 DOI: 10.1007/s10964-020-01207-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/01/2020] [Indexed: 01/13/2023]
Abstract
A large body of evidence suggests that exposure to childhood adversities increases risk for poor quality physical health in adulthood. Much of this evidence is based on retrospective measures which are believed to be contaminated by the limitations and biases of autobiographical memory. Using longitudinal data on 454 African Americans (61 percent female) this study examines the corroboration between prospective and retrospective measures of childhood adversities gathered approximately two decades apart, and the relative ability of the measures to predict self-reported illnesses and a biomarker of 30-year cardiovascular disease risk. Comparisons indicated that the retrospective and prospective measures demonstrated weak convergence and did not provide completely equivalent information about self-reported adverse childhood experiences. A series of regression models indicated that the two measures of adversities exhibited similar associations with the cardiovascular disease biomarker but divergent associations with self-reported illnesses. Furthermore, both the prospective and retrospective measures simultaneously predicted cardiovascular disease risk in adulthood. That the prospective measure did not significantly predict perceived illnesses after adjusting for the retrospective measure is evidence that childhood adversities predict self-reported health burden insofar as respondents remember those adversities as adults. The findings provide evidence that retrospective self-report measures of childhood adversities do not closely converge with prospective measures, and that retrospective measures may not provide valid estimates of the association between childhood adversities and perceived illnesses in adulthood.
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Affiliation(s)
- Mark T Berg
- Department of Sociology and Criminology, University of Iowa, Iowa City, IA, 52242, USA.
| | - Man-Kit Lei
- Department of Sociology, University of Georgia, Athens, GA, USA
| | - Steven R Beach
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA, USA
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