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Alter DA, Austin PC, Rosenfeld A. The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review. Can J Cardiol 2024; 40:989-999. [PMID: 38309464 DOI: 10.1016/j.cjca.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024] Open
Abstract
Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at 2 or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrhythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighbourhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. Seven percent of socioeconomic cardiovascular outcome studies have measured socioeconomic status at 2 or more points in time throughout the follow-up period, hypothesized mechanisms by which dynamic socioeconomic measures affected outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data can be better used methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root causes, interventions, and health-system designs if health equity is to be improved.
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Affiliation(s)
- David A Alter
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Peter C Austin
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Rosenfeld
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Park YMM, Baek JH, Lee HS, Elfassy T, Brown CC, Schootman M, Narcisse MR, Ko SH, McElfish PA, Thomsen MR, Amick BC, Lee SS, Han K. Income variability and incident cardiovascular disease in diabetes: a population-based cohort study. Eur Heart J 2024; 45:1920-1933. [PMID: 38666368 DOI: 10.1093/eurheartj/ehae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/07/2024] [Accepted: 02/19/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). METHODS Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. RESULTS High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. CONCLUSIONS Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.
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Affiliation(s)
- Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jong-Ha Baek
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
| | - Hong Seok Lee
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clare C Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mario Schootman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Marie-Rachelle Narcisse
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Pearl A McElfish
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Michael R Thomsen
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, South Korea
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Zhu AL, Le AD, Li Y, Palaniappan LP, Srinivasan M, Shah NS, Wong SS, Valero-Elizondo J, Elfassy T, Yang E. Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. J Am Heart Assoc 2024; 13:e032509. [PMID: 38567660 DOI: 10.1161/jaha.123.032509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. METHODS AND RESULTS We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. CONCLUSIONS Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.
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Affiliation(s)
- Alicia L Zhu
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- College of Arts and Sciences, School of Global Public Health New York University New York NY
| | - Austin D Le
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Environmental Health Sciences Division University of California, Berkeley, School of Public Health Berkeley CA
| | - Yuemeng Li
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Latha P Palaniappan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Malathi Srinivasan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Nilay S Shah
- Departments of Medicine (Cardiology) and Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sally S Wong
- American Heart Association, Office of Science, Medicine, and Health Dallas TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Tali Elfassy
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Department of Medicine, Division of Nephrology and Hypertension University of Miami Miller School of Medicine Miami FL
| | - Eugene Yang
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Cardiology University of Washington School of Medicine Seattle WA
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Henry CM, Oseran AS, Zheng Z, Dong H, Wadhera RK. Cardiovascular hospitalizations and mortality among adults aged 25-64 years in the USA. Eur Heart J 2024; 45:1017-1026. [PMID: 37952173 PMCID: PMC10972685 DOI: 10.1093/eurheartj/ehad772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND AIMS Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income. METHODS Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. RESULTS Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. CONCLUSIONS There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.
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Affiliation(s)
- Chantal M Henry
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Meharry Medical College, Nashville,
TN, USA
| | - Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Huaying Dong
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel
Deaconess Medical Center and Harvard Medical School, 375
Longwood Ave, 4th Floor, Boston, MA 02215, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Avenue, Boston, MA
02215, USA
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Cai A, Chen C, Wang J, Ou Y, Nie Z, Feng Y. Social Determinants of Health, Cardiovascular Health, and Outcomes in Community-Dwelling Adults Without Cardiovascular Disease. JACC. ASIA 2024; 4:44-54. [PMID: 38222255 PMCID: PMC10782398 DOI: 10.1016/j.jacasi.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 01/16/2024]
Abstract
Background Limited data exist regarding the prognostic implications of social determinants of health (SDOH) and cardiovascular health (CVH) in Chinese community populations. Objectives The aim of this study was to evaluate the associations of SDOH and CVH with major adverse cardiovascular events (MACE) and all-cause death. Methods Individuals without cardiovascular disease were obtained from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project. SDOH (educational attainment, economic stability, health care access, social support, and neighborhood) and CVH components were extracted. Participants were divided into groups with low and high burden of unfavorable SDOH and groups with poor, intermediate, and ideal CVH. MACE (a composite of coronary heart disease or myocardial infarction, stroke, heart failure, and cardiovascular death) and all-cause death were identified by linking hospital records with resident identity card number. Results Among the cohort (n = 38,571, median age 54 years, 60.5% women), the proportion of individuals with a high burden of unfavorable SDOH was 68.9%, and that with poor CVH was 30.7%. In reference to the group with a low burden of unfavorable SDOH, the adjusted HRs for MACE and all-cause death in the high burden group were 1.18 (95% CI: 1.08-1.30) and 1.35 (95% CI: 1.09-1.68), respectively. In reference to the group with ideal CVH, poor CVH was associated with higher risks for MACE and all-cause death. A high burden of unfavorable SDOH and poor CVH exerted joint effects on all-cause death (HR: 2.20; 95% CI: 1.08-4.48). Conclusions A high burden of unfavorable SDOH and poor CVH were associated with increased risks for MACE and mortality. Dedicated efforts are needed to address these health disparities.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Chaolei Chen
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jiabin Wang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Epidemiology, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Epidemiology, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Chen G, Guo H, Lin J, Luo S, Xu S. Competing risk analysis of cardiovascular mortality in multiple myeloma survivors. Transl Cancer Res 2023; 12:3314-3326. [PMID: 38197077 PMCID: PMC10774068 DOI: 10.21037/tcr-23-1213] [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] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024]
Abstract
Background The survival of multiple myeloma (MM) patients has significantly improved, and several factors increase the risk of cardiovascular death (CVD) mortality in MM. This study aims to determine the prognostic significance of factors associated with long-term CVD risk in MM survivors. Methods The data of MM survivors whose survival time was longer than 36 months were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database between 2000 and 2015. Cox proportional hazards regressions and competing risk survival analyses were utilized to assess the CVD-associated risk factors. Propensity score matching (PSM) was further conducted to ensure the comparability of cardiovascular risk factors. The nomogram was based on these epidemiological factors to estimate individualized CVD probabilities for MM survivors, and its performance was assessed by Harrell's concordance index (C-index) and calibration curve. Results A total of 32,528 survivors with MM were enrolled, and 2,061 (6.34%) suffered from CVD. In Cox proportional hazards regressions and competing risk survival analyses, age, period of diagnosis, sex, race, married status, income, chemotherapy, and radiotherapy were the independent risk factors for CVD. After PSM, there was a significant difference in cumulative incidence curves, using a competing-risks method, between the following matched groups: male vs. female group, white vs. non-white group, married vs. unmarried group, income <$75,000 vs. income ≥$75,000 group, chemotherapy vs. non-chemotherapy group, and radiotherapy vs. non-radiotherapy group. The nomogram predicted CVD probabilities with a training C-index of 0.700 and a validation C-index of 0.726. Calibration curves validated that the nomograms could accurately predict the CVD probabilities both in the training and validation group. Conclusions Among MM survivors, the mortality risk of cardiovascular diseases differs with age, sex, period at diagnosis, race/ethnicity, marital status, chemotherapy, and radiotherapy. Our nomograms, based on epidemiological variables, may be used to predict 5-, 10-, and 15-year cardiovascular disease outcomes of MM survivors.
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Affiliation(s)
- Ganxiao Chen
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Hongdou Guo
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Jiayi Lin
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Shunxiang Luo
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Shanghua Xu
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
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Zhang Z, Zeng C, Chen Z, Liu P, Gao J, Guo Q, Wu M, He W, Gao Q, Guo D, Liang X, Huang Z, Wang J, Zhang H, Chen Y. Age at job initiation and risk of coronary heart disease: findings from the UK biobank cohort study. BMC Public Health 2023; 23:2123. [PMID: 37899473 PMCID: PMC10614325 DOI: 10.1186/s12889-023-17034-3] [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: 06/09/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Commencing work at an early age has been linked to various risk factors for coronary heart disease (CHD), such as shift work and intensive job strain. However, the relationship between starting work too early and CHD risk remains largely unclear. We examined the association between age at job initiation and the risk of CHD. METHODS UK Biobank participants aged 38 to 70 years without cardiovascular disease who provided data on their age at job initiation were included. The primary outcome was CHD, which was ascertained using hospital and death records. The hazard ratios (HRs) and 95% confidence interval (CIs) for the association between age at job initiation and CHD were calculated using multivariable Cox regression. RESULTS Of the 501,971 participants, 114,418 eligible participants were included in the final analysis. The median age at job initiation was 19.0 years. During the mean follow-up of 12.6 years, 6,130 (5.4%) first CHD events occurred. We observed that age at job initiation was inversely associated with CHD (HR 0.98, 95% CI 0.97-0.99), and the association was potentially J-shaped. The HRs for the < 17-year, 17-18-year, and 19-21-year age groups were 1.29 (95%CI 1.18-1.41), 1.12 (95% CI 1.03-1.22) and 1.05 (95% CI 0.97-1.14), respectively, compared with those of the ≥ 22-year group. CONCLUSIONS Age at job initiation was associated with incident CHD, which was independent of socioeconomic status. Participants who commenced employment before the age of 19 years exhibited a higher risk of developing CHD later in adulthood.
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Affiliation(s)
- Zenghui Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuanrui Zeng
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiteng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pinming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingwei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Maoxiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanbing He
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingyuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dachuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaotian Liang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zegui Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Haifeng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat- sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Gupta R, Yang L, Lewey J, Navathe AS, Groeneveld PW, Khatana SAM. Association of High-Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease. J Am Heart Assoc 2023; 12:e030730. [PMID: 37750565 PMCID: PMC10727247 DOI: 10.1161/jaha.123.030730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
Background By increasing cost sharing, high-deductible health plans (HDHPs) aim to reduce low-value health care use. The association of HDHPs with health care use and costs in patients with chronic cardiovascular disease is unknown. Methods and Results This longitudinal cohort study analyzed 57 690 privately insured patients, aged 18 to 64 years, from a large commercial claims database with chronic cardiovascular disease from 2011 to 2019. Health care entities in which all or most beneficiaries switched from being in a traditional plan to an HDHP were identified. A difference-in-differences design was used to account for differences between individuals who remained in traditional plans and those who switched to HDHPs and to assess changes in health care use and costs. Among the 934 individuals in the HDHP group and the 56 756 in the traditional plan group, switching to an HDHP was not associated with statistically significant changes in annual outpatient visits, hospitalizations, or emergency department visits (-8.3% [95% CI, -16.8 to 1.1], -28.5% [95% CI, -62.1 to 34.6], and 11.2% [95% CI, -20.9 to 56.5], respectively). Switching to an HDHP was associated with an increase of $921 (95% CI, $743-$1099) in out-of-pocket costs but no statistically significant difference in total health care costs. Conclusions Among commercially insured patients with chronic cardiovascular disease, switching to an HDHP was not associated with a change in health care use but was associated with an increase in out-of-pocket costs. Although health care use by individuals with chronic cardiovascular disease may not be sensitive to higher cost sharing associated with HDHP enrollment, there may be a significant increase in patients' financial burden.
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Affiliation(s)
- Ravi Gupta
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Hopkins Business of Health Initiative, Johns Hopkins UniversityBaltimoreMD
| | - Lin Yang
- Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphiaPA
- Center for Cardiovascular Outcomes, Quality and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
| | - Jennifer Lewey
- Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphiaPA
- Center for Cardiovascular Outcomes, Quality and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Amol S. Navathe
- Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphiaPA
- Division of General Internal Medicine, Perelman School of MedicineUniversity of PennsylvaniaPAPhiladelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical CenterPAPhiladelphia
- Department of Medical Ethics and Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Peter W. Groeneveld
- Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphiaPA
- Center for Cardiovascular Outcomes, Quality and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Division of General Internal Medicine, Perelman School of MedicineUniversity of PennsylvaniaPAPhiladelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical CenterPAPhiladelphia
| | - Sameed Ahmed M. Khatana
- Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphiaPA
- Center for Cardiovascular Outcomes, Quality and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
- Corporal Michael J. Crescenz Veterans Affairs Medical CenterPAPhiladelphia
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Dark HE, Huang A, Cordon J, Deal JA, Palta P, Windham BG, Barnes LL, Kucharska-Newton A, Mosley T, Gottesman RF, Sims M, Griswold M, Rentería MA, Manly JJ, Walker KA. The association of perceived discrimination with dementia risk in Black older adults. Alzheimers Dement 2023; 19:4346-4356. [PMID: 37218405 PMCID: PMC10734390 DOI: 10.1002/alz.13135] [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: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Non-Hispanic Black, compared to non-Hispanic White, older adults are at increased risk for dementia. This may be due partly to greater exposure to psychosocial stressors, such as discrimination; however, few studies have examined this association. METHODS We examined the association of perceived discrimination (e.g., everyday, lifetime, and discrimination burden) with dementia risk in 1583 Black adults co-enrolled in the Atherosclerosis Risk in Communities (ARIC) Study and the Jackson Heart Study (JHS). Perceived discrimination (defined continuously and using tertiles) was assessed at JHS Exam 1 (2000-2004; mean age ± SD:66.2 ± 5.5) and related to dementia risk through ARIC visit 6 (2017) using covariate-adjusted Cox proportional hazards models. RESULTS Associations of perceived everyday, lifetime, and burden of discrimination with dementia risk were not supported in age-adjusted models or demographic- and cardiovascular health-adjusted models. Results were similar across sex, income, and education. DISCUSSION In this sample, associations between perceived discrimination and dementia risk were not supported. HIGHLIGHTS In Black older adults perceived discrimination not associated with dementia risk. Younger age and greater education linked to greater perceived discrimination. Older age and less education among factors associated with dementia risk. Factors increasing exposure to discrimination (education) are also neuroprotective.
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Affiliation(s)
- Heather E. Dark
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Jenifer Cordon
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Jennifer A. Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, 10032, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences at Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer’s Disease Center at Rush University Medical Center, Chicago, IL, 60612, USA
| | - Anna Kucharska-Newton
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, NIH, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Michael Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
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Park JC, Nam GE, Yu J, McWhorter KL, Liu J, Lee HS, Lee SS, Han K. Association of Sustained Low or High Income and Income Changes With Risk of Incident Type 2 Diabetes Among Individuals Aged 30 to 64 Years. JAMA Netw Open 2023; 6:e2330024. [PMID: 37603333 PMCID: PMC10442710 DOI: 10.1001/jamanetworkopen.2023.30024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Importance Evidence of the association between income fluctuation and risk of type 2 diabetes (T2D) is scarce. Objective To investigate whether sustained low or high income and income changes are associated with incidence of T2D. Design, Setting, and Participants In this population-based cohort study, more than 7.8 million adults without T2D aged 30 to 64 years from a nationally representative sample from the Korean Health Insurance Service database were enrolled in 2012 and followed up to 2019 (median follow-up, 6.3 years [IQR, 6.1-6.6 years]). Exposures Twenty quantiles of monthly health insurance premiums determined income levels. Income quartiles were annually analyzed from 2008 to 2012. Beneficiaries of the Medical Aid Program were regarded as those with very low income. A decrease in income was indicated as a reduction of 25% or more in income compared with income in the previous year. Main Outcomes and Measures The primary outcome was incident T2D based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes E11 to E14, 1 or more claims of antidiabetic medication, or a fasting glucose level of 126 mg/dL or higher. Multivariable Cox proportional hazards models were used to assess the association of low- or high-income status and income changes with incidence of T2D. Results Of 7 821 227 participants (mean [SD] age, 46.4 [9.3] years; 54.9% men), 359 931 (4.6%) developed T2D at least 1 year after enrollment. Individuals who repeatedly experienced low and very low income for 5 years showed 22% (hazard ratio [HR], 1.22 [95% CI, 1.21-1.23]) and 57% (1.57 [95% CI, 1.53-1.62]) higher T2D risk compared with those who never experienced low and very low income, respectively. In contrast, individuals who were repeatedly in high-income quartiles showed lower T2D risk compared with those who never experienced high income (HR, 0.86 [95% CI, 0.85-0.86]). The number of income decreases was associated with elevated T2D risk (≥2 vs 0 income decreases: HR, 1.08 [95% CI, 1.06-1.11]; P < .001 for trend). When income quartile status was compared between 2008 and 2012, individuals who experienced an income increase had lowered T2D risk, while those who experienced an income decrease had elevated T2D risk in each income quartile group. Conclusions and Relevance This cohort study found that individuals who experienced sustained low-income status or an income decrease had elevated T2D risk, while those who had sustained high-income status or an income increase had lowered T2D risk.
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Affiliation(s)
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jinna Yu
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Ketrell L. McWhorter
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hong Seok Lee
- Division of Cardiology, Banner University Medical Group, Sarver Heart Center, University of Arizona, Tucson
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
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Stone KL, Zhong J, Lyu C, Chodosh J, Blachman NL, Dodson JA. Does Incident Cardiovascular Disease Lead to Greater Odds of Functional and Cognitive Impairment? Insights From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2023; 78:1179-1188. [PMID: 36996314 PMCID: PMC10329231 DOI: 10.1093/gerona/glad096] [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: 10/04/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Although studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts. METHODS We analyzed longitudinal data from 16 679 U.S. Health and Retirement Study participants who were aged ≥65 years at study entry. Primary endpoints were physical impairment (activities of daily living impairment) or cognitive impairment (Langa-Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD free, both in the short term (<2-year postdiagnosis) and long term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed the effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, and stroke) and age-at-diagnosis (65-74, 75-84, and ≥85). RESULTS Over a median follow-up of 10 years, 8 750 participants (52%) developed incident CVD. Incident CVD was associated with significantly higher adjusted odds (aOR) of short-term and long-term physical and cognitive impairment. The oldest (≥85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95% confidence interval [CI]: 2.40-3.77) and cognitive impairment (aOR 1.96, 95% CI: 1.55-2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke. CONCLUSIONS Incident CVD was associated with an increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (≥85 years) who should therefore remain a target for prevention efforts.
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Affiliation(s)
- Katherine L Stone
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, New York, USA
| | - Chen Lyu
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, New York, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Nina L Blachman
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - John A Dodson
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, New York, USA
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York, USA
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12
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Onizuka H, Fukuda H. Associations between income changes and the risk of herpes zoster: LIFE study. Soc Sci Med 2023; 328:115981. [PMID: 37269744 DOI: 10.1016/j.socscimed.2023.115981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
Economic stability is thought to be associated with health outcomes. Income changes may affect the occurrence of herpes zoster (HZ), which is a neurocutaneous disease caused by the varicella-zoster virus. This retrospective cohort study aimed to examine the associations between annual income changes and incident HZ in a Japanese population. The analysis was conducted using a database of public health insurance claims data linked with administrative data containing income levels. The study population comprised 48,317 middle-aged persons aged 45-64 years from five municipalities, and participants were followed-up from April 2016 until March 2020. Income changes were categorized as income unchanged (income in the year of interest remained within 50% of income in the previous year), income rise (income increased by more than 50% from the previous year to the year of interest), and income drop (income decreased by more than 50% from the previous year to the year of interest). Cox proportional hazards regression analyses were performed to calculate the hazard ratios of HZ for income drop and income rise (reference: income unchanged) as time-varying variables. Covariates included age, sex, and immune-related conditions. The results showed that income drop was significantly associated with a higher hazard ratio (1.15, 95% confidence interval: 1.00-1.31) for HZ. In contrast, income rise was not associated with HZ. A subgroup analysis revealed that the lowest baseline income group had a significantly higher risk of HZ when experiencing an income drop (HR: 1.56, 95% CI: 1.13-2.15). As zoster vaccination is voluntary and vaccination coverage in middle-aged persons is low in Japan, our findings indicate that it may be advantageous to promote and subsidize voluntary vaccinations for middle-aged people with low baseline income who have experienced substantial income reductions in order to reduce the risk of HZ.
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Affiliation(s)
- Hiroaki Onizuka
- Department of Interdisciplinary Science and Innovation, School of Interdisciplinary Science and Innovation, Kyushu University, Fukuoka, Japan; Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Zheng X, Yang Y, Chen J, Lu B. Dissecting the causal relationship between household income status and genetic susceptibility to cardiovascular-related diseases: Insights from bidirectional mendelian randomization study. BMC Public Health 2023; 23:749. [PMID: 37095467 PMCID: PMC10124030 DOI: 10.1186/s12889-023-15561-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/29/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Observational studies have revealed that socioeconomic status is associated with cardiovascular health. However, the potential causal effect remains unclear. Hence, we aimed to investigate the causal relationship between household income status and genetic susceptibility to cardiovascular-related diseases using a bidirectional Mendelian randomization (MR) study. METHODS An MR study based on a large-sample cohort of the European population from a publicly available genome-wide association study datasets was conducted using a random-effects inverse-variance weighting model as the main standard. Simultaneously, MR-Egger regression, weighted median, and maximum likelihood estimation were used as supplements. Sensitivity analysis, consisting of a heterogeneity test and horizontal pleiotropy test, was performed using Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to ensure the reliability of the conclusion. RESULTS The results suggested that higher household income tended to lower the risk of genetic susceptibility to myocardial infarction (OR: 0.503, 95% CI = 0.405-0.625, P < 0.001), hypertension (OR: 0.667, 95% CI = 0.522-0.851, P = 0.001), coronary artery disease (OR: 0.674, 95% CI = 0.509-0.893, P = 0.005), type 2 diabetes (OR: 0.642, 95% CI = 0.464-0.889, P = 0.007), heart failure (OR: 0.825, 95% CI = 0.709-0.960, P = 0.013), and ischemic stroke (OR: 0.801, 95% CI = 0.662-0.968, P = 0.022). In contrast, no association was evident with atrial fibrillation (OR: 0.970, 95% CI = 0.767-1.226, P = 0.798). The reverse MR study suggested a potentially negative trend between heart failure and household income status. A sensitivity analysis verified the reliability of the results. CONCLUSIONS The results revealed that the population with higher household income tended to have a lower risk of genetic susceptibility to myocardial infarction and hypertension.
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Affiliation(s)
- Xifeng Zheng
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, No.57 South of Renming Road, Zhanjiang, Guangdong, China
| | - Yu Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, No.57 South of Renming Road, Zhanjiang, Guangdong, China
| | - Jianying Chen
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, No.57 South of Renming Road, Zhanjiang, Guangdong, China
| | - Bing Lu
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, No.57 South of Renming Road, Zhanjiang, Guangdong, China.
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Carotid intima media thickness (CIMT) in adults in the AWI-Gen Nairobi site study: Profiles and predictors. HIPERTENSION Y RIESGO VASCULAR 2023; 40:5-15. [PMID: 36153304 DOI: 10.1016/j.hipert.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Carotid intima media thickness (CIMT) is used as a marker of subclinical and asymptomatic atherosclerotic vascular disease. Increased CIMT is associated with future cerebrovascular and cardiovascular events. There is limited data on the profile and correlates of CIMT in Africa. The aim of this study was to describe the profile and correlates of CIMT in apparently normal younger-age adults in an urban setting in Kenya. METHODS This study used population-based data collected from 2003 adults between the ages of 40 and 60 years in two slums of Nairobi as part of a genetic study. CIMT was measured using LOGIQ e (GE Healthcare, CT, USA) ultrasound on both left and right carotid arteries, whereby maximum, mean, and minimum values were recorded. Age- and sex-specific CIMT measurements were calculated and their association with basic sociodemographic, behavioral and body composition indicators were investigated. RESULTS The median (IQR) CIMT were 0.58 (0.51, 0.66) and 0.59 (0.53, 0.66) in men and women, respectively. About 16% of the study population had CIMT greater than 0.7mm, the cut off for higher CIMT. Nearly 60% had CIMT values ≥75th percentile. Age, current use of alcohol, systolic blood pressure, subcutaneous fat thickness, pulse rate and pulse pressure were found to be the main predictors of CIMT in our study population. CONCLUSION This study provided population-based reference values and predictors for CIMT for an adult population living in urban poor settings in Kenya. Future studies need to consider biochemical and genetic predictors of CIMT in this population.
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Explainable machine learning framework for predicting long-term cardiovascular disease risk among adolescents. Sci Rep 2022; 12:21905. [PMID: 36536006 PMCID: PMC9763353 DOI: 10.1038/s41598-022-25933-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Although cardiovascular disease (CVD) is the leading cause of death worldwide, over 80% of it is preventable through early intervention and lifestyle changes. Most cases of CVD are detected in adulthood, but the risk factors leading to CVD begin at a younger age. This research is the first to develop an explainable machine learning (ML)-based framework for long-term CVD risk prediction (low vs. high) among adolescents. This study uses longitudinal data from a nationally representative sample of individuals who participated in the Add Health study. A total of 14,083 participants who completed relevant survey questionnaires and health tests from adolescence to young adulthood were chosen. Four ML classifiers [decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost), and deep neural networks (DNN)] and 36 adolescent predictors are used to predict adulthood CVD risk. While all ML models demonstrated good prediction capability, XGBoost achieved the best performance (AUC-ROC: 84.5% and AUC-PR: 96.9% on testing data). Besides, critical predictors of long-term CVD risk and its impact on risk prediction are obtained using an explainable technique for interpreting ML predictions. The results suggest that ML can be employed to detect adulthood CVD very early in life, and such an approach may facilitate primordial prevention and personalized intervention.
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Koohi F, Khalili D, Soori H, Nazemipour M, Mansournia MA. Longitudinal effects of lipid indices on incident cardiovascular diseases adjusting for time-varying confounding using marginal structural models: 25 years follow-up of two US cohort studies. GLOBAL EPIDEMIOLOGY 2022; 4:100075. [PMID: 37637024 PMCID: PMC10445971 DOI: 10.1016/j.gloepi.2022.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022] Open
Abstract
Background This study assesses the effect of blood lipid indices and lipid ratios on cardiovascular diseases (CVDs) using inverse probability-of-exposure weighted estimation of marginal structural models (MSMs). Methods A pooled dataset of two US representative cohort studies, including 16736 participants aged 42-84 years with complete information at baseline, was used. The effect of each lipid index, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), ratios of TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C on coronary heart disease (CHD) and stroke were estimated using weighted Cox regression. Results There were 1638 cases of CHD and 1017 cases of stroke during a median follow-up of 17.1 years (interquartile range: 8.5 to 25.7). Compared to optimal levels, the risk of CVD outcomes increased substantially in high levels of TC, LDL-C, TC/HDL-C, and LDL-C/HDL-C. If everyone had always had high levels of TC (≥240 mg/dL), risk of CHD would have been 2.15 times higher, and risk of stroke 1.35 times higher than if they had always had optimal levels (<200 mg/dL). Moreover, if all participants had been kept at very high (≥190 mg/dL) levels of LDL-C, risk of CHD would have been 2.62 times higher and risk of stroke would have been 1.92 times higher than if all participants had been kept at optimal levels, respectively. Our results suggest that high levels of HDL-C may be protective for CHD, but not for stroke. There was also no evidence of an adverse effect of high triglyceride levels on stroke. Conclusions Using MSM, this study highlights the effect of TC and LDL-C on CVD, with a stronger effect on CHD than on stroke. There was no evidence for a protective effect of high levels of HDL-C on stroke. Besides, triglyceride was not found to affect stroke.
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Affiliation(s)
- Fatemeh Koohi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Matilla-Santander N, Muntaner C, Kreshpaj B, Gunn V, Jonsson J, Kokkinen L, Selander J, Baron SL, Orellana C, Östergren PO, Hemmingsson T, Wegman DH, Bodin T. Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100314. [PMID: 35169764 PMCID: PMC8829810 DOI: 10.1016/j.lanepe.2022.100314] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. METHODS This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. FINDINGS Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. INTERPRETATION The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. FUNDING The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.
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Affiliation(s)
- Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Unit of Occupational Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm.
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing and Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Virginia Gunn
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto & MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Johanna Jonsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jenny Selander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sherry L Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York City, USA
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Tomas Hemmingsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Sweden
| | | | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
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Khatana SAM, Illenberger N, Werner RM, Groeneveld PW, Mitra N. Changes in Supplemental Nutrition Assistance Program Policies and Diabetes Prevalence: Analysis of Behavioral Risk Factor Surveillance System Data From 2004 to 2014. Diabetes Care 2021; 44:2699-2707. [PMID: 34607835 PMCID: PMC8669531 DOI: 10.2337/dc21-1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Food insecurity is associated with diabetes. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. government food assistance program. Whether such programs impact diabetes trends is unclear. The objective of this study was to evaluate the association between changes in state-level policies affecting SNAP participation and county-level diabetes prevalence. RESEARCH DESIGN AND METHODS We evaluated the association between change in county-level diabetes prevalence and changes in the U.S. Department of Agriculture SNAP policy index-a measure of adoption of state-level policies associated with increased SNAP participation (higher value indicating adoption of more policies associated with increased SNAP participation; range 1-10)-from 2004 to 2014 using g-computation, a robust causal inference methodology. The study included all U.S. counties with diabetes prevalence data available from the Centers for Disease Control and Prevention's U.S. Diabetes Surveillance System. RESULTS The study included 3,135 of 3,143 U.S. counties. Mean diabetes prevalence increased from 7.3% (SD 1.3) in 2004 to 9.1% (SD 1.8) in 2014. The mean SNAP policy index increased from 6.4 (SD 0.9) to 8.2 (SD 0.6) in 2014. After accounting for changes in demographic-, economic-, and health care-related variables and the baseline SNAP policy index, a 1-point absolute increase in the SNAP policy index between 2004 and 2014 was associated with a 0.050 (95% CI 0.042-0.057) percentage point lower diabetes prevalence per year. CONCLUSIONS State policies aimed at increasing SNAP participation were independently associated with a lower rise in diabetes prevalence between 2004 and 2014.
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Affiliation(s)
- Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA .,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Nicholas Illenberger
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel M Werner
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Nandita Mitra
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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19
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Passos LCS, Viana TT, Carvalho W, Grimaldi A, Roriz P, Figueiredo C, Nascimento T, Vieira de Melo RM. Judgement of the multidisciplinary team is an important predictor of mortality after cardiac resynchronization therapy. ESC Heart Fail 2021; 8:5275-5281. [PMID: 34647430 PMCID: PMC8712906 DOI: 10.1002/ehf2.13611] [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] [Received: 04/28/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) in appropriately selected patients with heart failure improves symptoms and survival. It is necessary to correctly identify patients who will benefit most from this therapy. We aimed to assess the predictive power of the multidisciplinary team's clinical judgement in the short‐term death after CRT implantation. Methods and results Patients with heart failure and referred for the first CRT implant were prospectively included. Prior to implantation, all patients underwent a systematic assessment with a team composed of social work, nurse, psychologist, nutritionist, and clinical cardiologist. Based on this assessment, patients could be contraindicated to CRT or referred to the procedure as favourable or unfavourable. All patients should complete 12 months of follow‐up; 172 patients were referred for CRT, 21 (12.2%) were contraindicated after the multidisciplinary team evaluation, 71 (47%) referred to CRT as non‐favourable implants, and 80 (53%) as favourable implants. All‐cause mortality occurred in only 2 (2.5%) patients in the favourable group and in 30 (42.3%) in the non‐favourable group, P < 0.001 (log rank). Among the 20 variables used as possible predictors of worse prognosis by the multidisciplinary team, four were independently associated with mortality in the follow‐up after the multivariate analysis: 1 year MAGGIC score between 40% and 49%, relative risk (RR) 5.0, 95% confidence interval (CI) 1.3–18.6, P = 0.016; poor pharmacological adherence, RR 4.9, 95% CI 1.6–15.6, P = 0.007; glomerular filtration rate <35 mL/min/1.73 m2, RR 3.0, 95% CI 1.1–8.5, P = 0.041; and right ventricular dysfunction, RR 2.6, 95% CI 1.2–5.7, P = 0.018. Conclusions The clinical judgement before the CRT implantation performed by a multidisciplinary team through the analysis of clinical and psychosocial variables is a strong predictor of short‐term mortality.
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Affiliation(s)
| | - Tainá Teixeira Viana
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
| | - William Carvalho
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
| | - Aline Grimaldi
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
| | - Pollianna Roriz
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
| | - Clara Figueiredo
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
| | - Thais Nascimento
- Hospital Ana Nery, R. Saldanha Marinho, s/n-Caixa D'agua, Salvador, Bahia, CEP 40301-155, Brazil
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20
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Lee DW, Youn HM, Kang SH, Jang SI, Park EC. Household income changes and suicidal ideation in South Korea: Findings from a longitudinal study. Suicide Life Threat Behav 2021; 51:795-806. [PMID: 33724531 DOI: 10.1111/sltb.12748] [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] [Received: 05/07/2020] [Revised: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to provide evidence for the need for social and welfare support in suicide prevention. METHODS Data were collected from the Korean Welfare Panel Study, 2011-2016. The study sample consisted of 7504 people (male: 3080 and female: 4424; mean age: 54.4 ± 16.6), with annual follow-ups until 2016. A generalized linear mixed-effects model using a logit link function with random intercept for longitudinal binary data was employed to identify the association between household income change and suicidal ideation status. RESULTS Suicidal ideation was found in 279 (3.7%) people at the baseline year. A drastic reduction in household income was associated with an increased probability of having suicidal ideation (adjusted odds ratio: 2.205, 95% confidence interval: 1.326-3.666). Using interaction analyses, those who had a drastic reduction in household income and were married, males, aged 40-49, and previously in a middle- to high-income group showed a higher probability of having suicidal ideation. CONCLUSION A drastic reduction in household income was associated with a higher probability of suicidal ideation, with specific differences according to gender, age, previous household income level, and marital status. This study reinforces the need for social and welfare support in suicide prevention policies and programs.
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Affiliation(s)
- Doo Woong Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Hin Moi Youn
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Soo Hyun Kang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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21
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Financial burden, distress, and toxicity in cardiovascular disease. Am Heart J 2021; 238:75-84. [PMID: 33961830 DOI: 10.1016/j.ahj.2021.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/25/2021] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease (CVD) is a major source of financial burden and distress, which has 3 main domains: (1) psychological distress; (2) cost-related care non-adherence or medical care deferral, and (3) tradeoffs with basic non-medical needs. We propose 4 ways to reduce financial distress in CVD: (1) policymakers can expand insurance coverage and curtail underinsurance; (2) health systems can limit expenditure on low-benefit, high-cost treatments while developing services for high-risk individuals; (3) physicians can engage in shared-decision-making for high-cost interventions, and (4) community-based initiatives can support patients with system navigation and financial coping. Avenues for research include (1) analysis of how healthcare policies affect financial burden; (2) comparative effectiveness studies examining high and low-cost strategies for CVD management; and (3) studying interventions to reduce financial burden, financial coaching, and community health worker integration.
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22
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Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity. Curr Atheroscler Rep 2021; 23:55. [PMID: 34308497 DOI: 10.1007/s11883-021-00949-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW We sought to examine the role of social and environmental conditions that determine an individual's behaviors and risk of disease-collectively known as social determinants of health (SDOH)-in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US). RECENT FINDINGS Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. We examined existing evidence of the association between SDOH-organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context-and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.
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23
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Faselis C, Safren L, Allman RM, Lam PH, Brar V, Morgan CJ, Ahmed AA, Deedwania P, Alagiakrishnan K, Sheikh FH, Fonarow GC, Ahmed A. Income disparity and incident cardiovascular disease in older Americans. Prog Cardiovasc Dis 2021; 71:92-99. [PMID: 34320387 DOI: 10.1016/j.pcad.2021.07.010] [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] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the association between income and cardiovascular disease (CVD) in community-dwelling older adults. METHODS Of the 5795 Medicare-eligible community-dwelling older Americans aged 65-100 years in the Cardiovascular Health Study (CHS), 4518 (78%) were free of baseline CVD, defined as heart failure, acute myocardial infarction, stroke, or peripheral arterial disease. Of them, 1846 (41%) had lower income, defined as a total annual household income <$16,000. Using propensity scores for lower income, estimated for each of the 4518 participants, we assembled a matched cohort of 1078 pairs balanced on 42 baseline characteristics. Outcomes included centrally adjudicated incident CVD and mortality. RESULTS Matched participants (n = 2156) had a mean age of 73 years, 63% were women, and 13% African American. During an overall follow-up of 23 years, incident CVD, all-cause mortality and the combined endpoint of incident CVD or mortality occurred in 1094 (51%), 1726 (80%) and 1867 (87%) individuals, respectively. Compared with the higher income group, hazard ratio (HR) for time to the first occurrence of incident CVD in the lower income group was 1.16 with a 95% confidence interval of 1.03 to 1.31. A lower income was also associated with a significantly higher risk of all-cause mortality (HR, 1.19; 95% CI, 1.08-1.30), and consequently a higher risk of the combined endpoint of incident CVD or death (HR, 1.20; 95% CI, 1.09-1.31). CONCLUSION Among community-dwelling older Americans free of baseline CVD, an annual household income <$16,000 is independently associated with significantly higher risks of new-onset CVD and death.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Uniformed Services University, Washington, DC, United States of America; University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Lowell Safren
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Richard M Allman
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Vijaywant Brar
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Charity J Morgan
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Amiya A Ahmed
- University of Maryland, Baltimore, MD, United States of America
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC, United States of America; University of California, San Francisco, CA, United States of America
| | | | - Farooq H Sheikh
- Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Gregg C Fonarow
- University of California, Los Angeles, CA, United States of America
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America.
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24
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Reeves RM, Christensen L, Brown JR, Conway M, Levis M, Gobbel GT, Shah RU, Goodrich C, Ricket I, Minter F, Bohm A, Bray BE, Matheny ME, Chapman W. Adaptation of an NLP system to a new healthcare environment to identify social determinants of health. J Biomed Inform 2021; 120:103851. [PMID: 34174396 DOI: 10.1016/j.jbi.2021.103851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022]
Abstract
Social determinants of health (SDoH) are increasingly important factors for population health, healthcare outcomes, and care delivery. However, many of these factors are not reliably captured within structured electronic health record (EHR) data. In this work, we evaluated and adapted a previously published NLP tool to include additional social risk factors for deployment at Vanderbilt University Medical Center in an Acute Myocardial Infarction cohort. We developed a transformation of the SDoH outputs of the tool into the OMOP common data model (CDM) for re-use across many potential use cases, yielding performance measures across 8 SDoH classes of precision 0.83 recall 0.74 and F-measure of 0.78.
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Affiliation(s)
- Ruth M Reeves
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, TN, United States.
| | - Lee Christensen
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jeremiah R Brown
- Department of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Michael Conway
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Maxwell Levis
- Department of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Glenn T Gobbel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, TN, United States
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Christine Goodrich
- Department of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Iben Ricket
- Department of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Freneka Minter
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew Bohm
- Department of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH, United States
| | - Bruce E Bray
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, TN, United States
| | - Wendy Chapman
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States; Centre for Clinical and Public Health Informatics, University of Melbourne, Melbourne, Australia
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Tomé-Carneiro J, Crespo MC, López de Las Hazas MC, Visioli F, Dávalos A. Olive oil consumption and its repercussions on lipid metabolism. Nutr Rev 2021; 78:952-968. [PMID: 32299100 DOI: 10.1093/nutrit/nuaa014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Consumption of highly processed foods, such as those high in trans fats and free sugars, coupled with sedentarism and chronic stress increases the risk of obesity and cardiometabolic disorders, while adherence to a Mediterranean diet is inversely associated with the prevalence of such diseases. Olive oil is the main source of fat in the Mediterranean diet. Data accumulated thus far show consumption of extra virgin, (poly)phenol-rich olive oil to be associated with specific health benefits. Of note, recommendations for consumption based on health claims refer to the phenolic content of extra virgin olive oil as beneficial. However, even though foods rich in monounsaturated fatty acids, such as olive oil, are healthier than foods rich in saturated and trans fats, their inordinate use can lead to adverse effects on health. The aim of this review was to summarize the data on olive oil consumption worldwide and to critically examine the literature on the potential adverse effects of olive oil and its main components, particularly any effects on lipid metabolism. As demonstrated by substantial evidence, extra virgin olive oil is healthful and should be preferentially used within the context of a balanced diet, but excessive consumption may lead to adverse consequences.
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Affiliation(s)
- João Tomé-Carneiro
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, Campus of International Excellence UAM + CSIC, Madrid, Spain
| | - María Carmen Crespo
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, Campus of International Excellence UAM + CSIC, Madrid, Spain
| | - María Carmen López de Las Hazas
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, Campus of International Excellence UAM + CSIC, Madrid, Spain
| | - Francesco Visioli
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, Campus of International Excellence UAM + CSIC, Madrid, Spain.,Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Alberto Dávalos
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, Campus of International Excellence UAM + CSIC, Madrid, Spain
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Zuma BZ, Parizo JT, Valencia A, Spencer-Bonilla G, Blum MR, Scheinker D, Rodriguez F. County-Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity. J Am Heart Assoc 2021; 10:e018835. [PMID: 33653083 PMCID: PMC8174200 DOI: 10.1161/jaha.120.018835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation (R2) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.
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Affiliation(s)
| | - Justin T Parizo
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | | | | | - Manuel R Blum
- Department of General Internal Medicine Bern University HospitalUniversity of Bern Switzerland
| | - David Scheinker
- Department of Pediatrics Stanford University School of Medicine Stanford CA.,Department of Management Science and Engineering Stanford University School of Engineering Stanford CA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA
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Khatana SAM, Venkataramani AS, Nathan AS, Dayoub EJ, Eberly LA, Kazi DS, Yeh RW, Mitra N, Subramanian SV, Groeneveld PW. Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults. JAMA 2021; 325:445-453. [PMID: 33528535 PMCID: PMC7856543 DOI: 10.1001/jama.2020.26141] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear. OBJECTIVE To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010). EXPOSURES Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]). MAIN OUTCOMES AND MEASURES Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity. RESULTS Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year. CONCLUSIONS AND RELEVANCE In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.
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Affiliation(s)
- Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Atheendar S. Venkataramani
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Elias J. Dayoub
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Lauren A. Eberly
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Nandita Mitra
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Yin M, Lu J, Guo Z, Zhang Y, Liu J, Wu T, Guo K, Luo T, Guo Z. Reduced SULT2B1b expression alleviates ox-LDL-induced inflammation by upregulating miR-148-3P via inhibiting the IKKβ/NF-κB pathway in macrophages. Aging (Albany NY) 2021; 13:3428-3442. [PMID: 33428590 PMCID: PMC7906218 DOI: 10.18632/aging.202273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/06/2020] [Indexed: 01/27/2023]
Abstract
Atherosclerosis is a lipid-driven chronic inflammatory disease in which lipid-laden macrophage foam cells lead to inflamed lesions in arteries. Previous studies have proven that sulfotransferase 2B1b (SULT2B1b) has several roles in the regulation of lipid metabolism and the inflammatory response. However, little is known about the functions of SULT2B1b in ox-LDL-induced inflammation in macrophages. In this study, after treatment with either ox-LDL alone or combined with transfection of siRNAs targeting SULT2B1b, IL-6, TNF-α, NF-κB, IKKβ and IκB mRNA and protein expression were determined in Raw264.7 cells by real-time PCR and Western blot, respectively. The proliferative capacity was determined by EdU staining and Cell Counting Kit-8. Our data demonstrated that SULT2B1b knockdown could reduce phosphorylated NF-κB levels and downregulate IKKβ protein levels. Additionally, IκB levels were increased and the proliferation of ox-LDL stimulated cells was inhibited after SULT2B1b silencing. Downregulation of SULT2B1b expression was found to upregulate miR-148a-3p expression by microarray assay, while IKKβ was a miR-148a-3p target gene. Our study suggests that SULT2B1b knockdown could promote miR148a-3p expression and inhibit activation of the IKKβ/NF-κB signalling pathway, which suppressed the inflammatory response in macrophages. Therefore, targeting the SULT2B1b gene might be potentially beneficial for atherosclerosis prevention by decreasing the inflammatory response.
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Affiliation(s)
- Mengzhuo Yin
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Jianwen Lu
- Department of Endocrinology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Zhongzhou Guo
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Yanan Zhang
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Jichen Liu
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Tongwei Wu
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Kai Guo
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Tiantian Luo
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Zhigang Guo
- Department of Cardiology, Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
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Hung CL, Chao TF, Su CH, Liao JN, Sung KT, Yeh HI, Chiang CE. Income level and outcomes in patients with heart failure with universal health coverage. Heart 2020; 107:208-216. [PMID: 33082175 PMCID: PMC7815895 DOI: 10.1136/heartjnl-2020-316793] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
Objective We aimed to investigate the influence of income level on guideline-directed medical therapy (GDMT) prescription rates and prognosis of patients with heart failure (HF) following implementation of a nationwide health insurance programme. Methods A total of 633 098 hospitalised patients with HF from 1996 to 2013 were identified from Taiwan National Health Insurance Research Database. Participants were classified into low-income, median-income and high-income groups. GDMT utilisation, in-hospital mortality and postdischarge HF readmission, and mortality rates were compared. Results The low-income group had a higher comorbidity burden and was less likely to receive GDMT than the other two groups. The in-hospital mortality rate in the low-income group (5.07%) was higher than in the median-income (2.47%) and high-income (2.51%) groups. Compared with the high-income group, the low-income group had a significantly higher risk of postdischarge HF readmission (adjusted HR (aHR): 1.29, 95% CI 1.27 to 1.31), all-cause mortality (aHR: 1.98, 95% CI 1.95 to 2.02) and composite HF readmission/all-cause mortality (aHR: 1.54, 95% CI 1.52 to 1.56). These results were generally consistent among the population after propensity matching (low vs high: HR=2.08 for mortality and 1.36 for HF readmission; median vs high: HR=1.23 for mortality and 1.12 for HF readmission; all p<0.001) and after inverse probability of treatment weighting (low-income vs high-income group: HR: 2.19 for mortality and 1.16 for HF readmission; median-income vs high-income group: HR: 1.53 for mortality and 1.09 for HF readmission; all p<0.001). Lower utilisation of GDMT and poorer prognosis in lower-income hospitalised patients with HF appeared to mitigate over time. Conclusions Low-income patients with HF had nearly a twofold increase in the risk of in-hospital mortality and postdischarge events compared with the high-income group, partly due to lower GDMT utilisation. The differences between postdischarge HF outcomes among various income groups appeared to mitigate over time following the implementation of nationwide universal health coverage.
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Affiliation(s)
- Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
| | - Chern-En Chiang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan .,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Drapkina OM, Samorodskaya IV, Larina VN. [Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes in Primary Health Care - the Issue of Acceptability for the Russian Federation]. ACTA ACUST UNITED AC 2020; 60:130-136. [PMID: 32394867 DOI: 10.18087/cardio.2020.4.n1000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.
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Affiliation(s)
- O M Drapkina
- National Medical Research Centre for Preventive Medicine, Ministry of Health of Russia
| | - I V Samorodskaya
- National Medical Research Centre for Preventive Medicine, Ministry of Health of Russia
| | - V N Larina
- Pirogov National Research Medical University, Ministry of Health of Russia
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eo. [Not Available]. MMW Fortschr Med 2019; 161:9. [PMID: 31691246 DOI: 10.1007/s15006-019-1034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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