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Rony M, Quintero-Arias C, Osorio M, Ararso Y, Norman EM, Ravenell JE, Wall SP, Lee DC. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J Racial Ethn Health Disparities 2023; 10:3150-3158. [PMID: 36520369 PMCID: PMC10267290 DOI: 10.1007/s40615-022-01488-z] [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: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system. RESEARCH DESIGN AND METHODS We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis. RESULTS Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans. CONCLUSION To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.
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Affiliation(s)
- Melissa Rony
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | | | - Marcela Osorio
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Yonathan Ararso
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Elizabeth M Norman
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Stephen P Wall
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - David C Lee
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA.
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA.
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Lee DC, Orstad SL, Kanchi R, Adhikari S, Rummo PE, Titus AR, Aleman JO, Elbel B, Thorpe LE, Schwartz MD. Demographic, social and geographic factors associated with glycaemic control among US Veterans with new onset type 2 diabetes: a retrospective cohort study. BMJ Open 2023; 13:e075599. [PMID: 37832984 PMCID: PMC10582880 DOI: 10.1136/bmjopen-2023-075599] [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: 05/12/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES This study evaluated whether a range of demographic, social and geographic factors had an influence on glycaemic control longitudinally after an initial diagnosis of diabetes. DESIGN, SETTING AND PARTICIPANTS We used the US Veterans Administration Diabetes Risk national cohort to track glycaemic control among patients 20-79-year old with a new diagnosis of type 2 diabetes. PRIMARY OUTCOME AND METHODS We modelled associations between glycaemic control at follow-up clinical assessments and geographic factors including neighbourhood race/ethnicity, socioeconomic, land use and food environment measures. We also adjusted for individual demographics, comorbidities, haemoglobin A1c (HbA1c) at diagnosis and duration of follow-up. These factors were analysed within strata of community type: high-density urban, low-density urban, suburban/small town and rural areas. RESULTS We analysed 246 079 Veterans who developed a new type 2 diabetes diagnosis in 2008-2018 and had at least 2 years of follow-up data available. Across all community types, we found that lower baseline HbA1c and female sex were strongly associated with a higher likelihood of within-range HbA1c at follow-up. Surprisingly, patients who were older or had more documented comorbidities were more likely to have within-range follow-up HbA1c results. While there was variation by community type, none of the geographic measures analysed consistently demonstrated significant associations with glycaemic control across all community types.
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Affiliation(s)
- David C Lee
- Emergency Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Stephanie L Orstad
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
| | - Rania Kanchi
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Samrachana Adhikari
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Pasquale E Rummo
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Andrea R Titus
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jose O Aleman
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
| | - Brian Elbel
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Wagner Graduate School of Public Service, NYU, New York City, New York, USA
| | - Lorna E Thorpe
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Mark D Schwartz
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
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Coy T, Brinza E, DeLozier S, Gornik HL, Webel AR, Longenecker CT, White Solaru KT. Black men's awareness of peripheral artery disease and acceptability of screening in barbershops: a qualitative analysis. BMC Public Health 2023; 23:46. [PMID: 36609297 PMCID: PMC9821364 DOI: 10.1186/s12889-022-14648-x] [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: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) disproportionately burdens Black Americans, particularly Black men. Despite the significant prevalence and high rate of associated morbidity and mortality, awareness of and treatment initiation for PAD remains low in this demographic group. Given the well-established social cohesion among barbershops frequently attended by Black men, barbershops may be ideal settings for health screening and education to improve awareness, early detection, and treatment initiation of PAD among Black men. METHODS A qualitative study involving 1:1 participant interviews in Cleveland, Ohio assessed perspectives of Black men about barbershop-based screening and education about PAD. Inductive thematic analysis was performed to derive themes directly from the data to reflect perceived PAD awareness and acceptability of screening in a barbershop setting. RESULTS Twenty-eight African American/Black, non-Hispanic men completed a qualitative interview for this analysis. Mean age was 59.3 ± 11.2 years and 93% of participants resided in socioeconomically disadvantaged zip codes. Several themes emerged indicating increased awareness of PAD and acceptability of barbershop-based screenings for PAD, advocacy for systemic changes to improve the health of the community, and a desire among participants to increase knowledge about cardiovascular disease. CONCLUSIONS Participants were overwhelmingly accepting of PAD screenings and reported increased awareness of PAD and propensity to seek healthcare due to engagement in the study. Participants provided insight into barriers and facilitators of health and healthcare-seeking behavior, as well as into the community and the barbershop as an institution. Additional research is needed to explore the perspectives of additional stakeholders and to translate community-based screenings into treatment initiation.
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Affiliation(s)
- Tyler Coy
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Ellen Brinza
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Heather L Gornik
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, WA, USA
| | - Christopher T Longenecker
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- School of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Khendi T White Solaru
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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White Solaru KT, Coy T, DeLozier S, Brinza E, Ravenell J, Longenecker CT, Wright JT, Gornik HL. Findings of a Novel Barbershop-Based Peripheral Artery Disease Screening Program for Black Men. J Am Heart Assoc 2022; 11:e026347. [PMID: 36250671 DOI: 10.1161/jaha.122.026347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Peripheral artery disease (PAD) increases the risk of cardiovascular events and limb events including amputations. PAD is twice as prevalent in Black compared with non-Hispanic White individuals, especially among men. Screening for PAD using the ankle-brachial index in community settings, such as the barbershop, could lead to earlier diagnosis and treatment. Methods and Results A pilot study was conducted at 2 barbershops in Cleveland, OH from June to December 2020 to assess the feasibility of screening for PAD in the barbershop setting and the effect of an educational intervention on PAD awareness. After screening with both automated and Doppler ankle-brachial index, PAD was identified in 5/31 (16.1%) of participants. Baseline systolic blood pressure, low-density lipoprotein cholesterol, and random blood glucose were higher in participants who screened positive for PAD (P<0.001). PAD awareness was low overall. There was a significant improvement in PAD awareness assessment scores obtained at the initial and exit visits (9.93±4.23 to 12.50±4.41, P=0.004). An association was found between PAD awareness at baseline and highest education level achieved: compared with those with some college/associate's degree or higher, non-high school graduates scored lower on PAD awareness (P=0.022), as did those who only had a high school diploma or tests of General Educational Development (P=0.049). Conclusions In a pilot study, barbershop-based screening for PAD among Black men revealed a higher than expected PAD prevalence and low PAD awareness. An educational video was effective at increasing PAD awareness. Ankle-brachial index screening and educational outreach in the barbershop may be a feasible and effective tool to diagnose PAD and reduce PAD disparities among Black men at highest risk.
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Affiliation(s)
- Khendi T White Solaru
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Tyler Coy
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH
| | - Sarah DeLozier
- Clinical Research Center University Hospitals Cleveland OH
| | - Ellen Brinza
- Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Joseph Ravenell
- Langone's Departments of Population Health and Medicine New York University School of Medicine New York NY
| | - Christopher T Longenecker
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Jackson T Wright
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Heather L Gornik
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
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Kerkhoff AD, Rojas S, Black D, Ribeiro S, Rojas S, Valencia R, Lemus J, Payan J, Schrom J, Jones D, Manganelli S, Bandi S, Chamie G, Tulier-Laiwa V, Petersen M, Havlir D, Marquez C. Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program. JAMA Netw Open 2022; 5:e2214163. [PMID: 35616939 PMCID: PMC9136625 DOI: 10.1001/jamanetworkopen.2022.14163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Community-based COVID-19 testing and vaccination programs play a crucial role in mitigating racial and ethnic disparities in COVID-19 service delivery. They also represent a platform that can be leveraged to expand access to testing for chronic diseases, including diabetes, that disproportionately affect the Latinx community and other marginalized communities. OBJECTIVE To evaluate outcomes associated with a diabetes testing strategy designed to reach low-income Latinx persons by leveraging COVID-19 testing infrastructure and community trust developed during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This health care improvement study was conducted from August 1 to October 5, 2021, at an outdoor, community-based COVID-19 testing site at a transport hub in the Mission Neighborhood in San Francisco, California. Because the program was designed to expand access to diabetes screening to the local community, all individuals presenting for on-site testing were eligible. Data were analyzed in November 2021. INTERVENTIONS Integration of rapid, point-of-care hemoglobin A1c screening as a testing option in an existing low-barrier COVID-19 testing program. MAIN OUTCOMES AND MEASURES Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and utilized programmatic data and structured surveys among clients and staff. RESULTS Of 6631 individuals tested (median [IQR] age 39.3 [29.7-51.3] years; 3417 [52.3%] female, 4348 [65.6%] Latinx), 923 (13.9%) underwent hemoglobin A1c testing with or without COVID-19 testing and 5708 (86.1%) underwent COVID-19 testing only. Individuals tested for diabetes were more likely to be Latinx (763 of 923 individuals [82.7%] who underwent testing were Latinx vs 3585 of 5708 [62.8%] not undergoing testing), have an annual household income of less than $50 000 (450 individuals [81.2%] vs 2409 individuals [66.0%]), and not have health insurance (381 individuals [47.2%] vs 1858 individuals [39.9%]), and 206 (48.0%) had never tested for diabetes before. Overall, 313 (33.9%) and 113 (12.2%) individuals had prediabetes and diabetes, respectively; only 141 of 354 of these individuals (39.8%) had a primary care clinician whom they had seen in the prior 12 months, which was lower among Latinx individuals (113 of 307 individuals [36.8%] vs 28 of 47 [59.6%]). Acceptability of the rapid testing program was high-98% were satisfied with their visit and 96% said they would return for future services; key factors underpinning acceptability included friendly staff, efficiency, and a convenient location. CONCLUSIONS AND RELEVANCE In this health care improvement study conducted within an existing community-based COVID-19 testing program, integrating rapid testing for diabetes was feasible, reached low-income Latinx individuals, and identified many persons with prediabetes and diabetes, most of whom lacked access to services in formal health care settings. Leveraging pandemic-related public health responses represents an important opportunity for engaging socioeconomically disadvantaged populations into care for diabetes.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Susana Rojas
- San Francisco Latino Task Force–Response to COVID-19, San Francisco, California
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, California
| | | | | | | | - John Schrom
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | | | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | - Maya Petersen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
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Egede LE, Ozieh MN, Campbell JA, Williams JS, Walker RJ. Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care. Diabetes Spectr 2022; 35:313-319. [PMID: 36082007 PMCID: PMC9396714 DOI: 10.2337/dsi22-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity. As a result, partnerships between health and nonhealth sectors have emerged as a crucial component for increasing health equity in diabetes care and achieving health equity. The purpose of this article is to discuss cross-sector collaborations between health care systems and nonhealth partners that target health equity in diabetes care.
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Affiliation(s)
- Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Corresponding author: Leonard E. Egede,
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI
| | - Jennifer A. Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Kazi DS, Ogedegbe O, Bibbins-Domingo K. Addressing the Last-Mile Problem in Blood Pressure Control—Scaling Up Community-Based Interventions. JAMA HEALTH FORUM 2021; 2:e212022. [DOI: 10.1001/jamahealthforum.2021.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Olugbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York
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Bryant KB, Moran AE, Kazi DS, Zhang Y, Penko J, Ruiz-Negrón N, Coxson P, Blyler CA, Lynch K, Cohen LP, Tajeu GS, Fontil V, Moy NB, Ebinger JE, Rader F, Bibbins-Domingo K, Bellows BK. Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops. Circulation 2021; 143:2384-2394. [PMID: 33855861 PMCID: PMC8206005 DOI: 10.1161/circulationaha.120.051683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected. METHODS A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants. Program costs, total direct health care costs (2019 US dollars), and quality-adjusted life-years (QALYs) were estimated for the LABBPS intervention and control arms from a health care sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50 000 and <$150 000 per QALY gained, respectively. RESULTS At 10 years, the intervention was projected to cost an average of $2356 (95% uncertainty interval, -$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01-0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42 717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17 162 per QALY gained. The LABBPS intervention would be only intermediately cost-effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mm Hg or if pharmacist weekly time driving to barbershops increased. CONCLUSIONS Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.
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Affiliation(s)
- Kelsey B. Bryant
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Andrew E. Moran
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Yiyi Zhang
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Joanne Penko
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | | | - Pamela Coxson
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Ciantel A. Blyler
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Kathleen Lynch
- Providence Saint John’s Health Center, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Laura P. Cohen
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Gabriel S. Tajeu
- Temple University, College of Public Health, Philadelphia, PA, USA
| | - Valy Fontil
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Norma B. Moy
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Joseph E. Ebinger
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Brandon K. Bellows
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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9
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Cardiovascular health care and health literacy among immigrants in Europe: a review of challenges and opportunities during the COVID-19 pandemic. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:1285-1291. [PMID: 33134037 PMCID: PMC7592128 DOI: 10.1007/s10389-020-01405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
Objectives Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk distribution and outcomes, as well as health literacy, are likely to differ from the host population. Challenges related to migrant health status, cardiovascular risk distribution and health literacy are compounded by the ongoing coronavirus disease 2019 (COVID-2019) crisis. Methods We performed a narrative review of available evidence on migrant CV and health literacy in Europe. Results Health literacy is lower in migrants but can be improved through targeted interventions. In some subgroups of migrants, rates of cardiovascular disease (CVD) risk factors, most importantly hypertension and diabetes, are higher. On the other hand, there is strong evidence for a so-called healthy migrant effect, describing lower rates of CV risk distribution and mortality in a different subset of migrants. During the COVID-19 pandemic, CV risk factors, as well as health literacy, are key elements in optimally managing public health responses in the ongoing pandemic. Conclusions Migrants are both an opportunity and a challenge for public health in Europe. Research aimed at better understanding the healthy migrant effect is necessary. Implementing the beneficial behaviors of migrants could improve outcomes in the whole population. Specific interventions to screen for risk factors, manage chronic disease and increase health literacy could improve health care for migrants. This pandemic is a challenge for the whole population, but active inclusion of immigrants in established health care systems could help improve the long-term health outcomes of migrants in Europe.
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10
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Bryant KB, Blyler CA, Fullilove RE. It's Time for a Haircut: a Perspective on Barbershop Health Interventions Serving Black Men. J Gen Intern Med 2020; 35:3057-3059. [PMID: 32180133 PMCID: PMC7572982 DOI: 10.1007/s11606-020-05764-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
Black men in the USA experience disproportionate cardiovascular disease mortality compared to their white counterparts, in part due to an excess of uncontrolled hypertension. A promising intervention to address these disparities involves the direct pharmacologic management of hypertension by clinical pharmacists in Black male patrons of barbershops, as demonstrated in the Los Angeles Barbershop Blood Pressure Study (LABBPS). Despite the observed reduction in systolic blood pressure of > 20 mmHg after 1 year, the feasibility of scaling up such an intervention to a regional or national platform remains uncertain. Here we explore the success of LABBPS in the context of prior barbershop interventions and theorize the most important aspects driving the observed reductions. We further make a case for prioritizing preventive care in nontraditional settings in an effort to reduce health disparities.
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Affiliation(s)
- Kelsey B Bryant
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - C Adair Blyler
- Hypertension Center of Excellence, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert E Fullilove
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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11
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Sattar N, Gill JMR, Alazawi W. Improving prevention strategies for cardiometabolic disease. Nat Med 2020; 26:320-325. [DOI: 10.1038/s41591-020-0786-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
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