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Abreu TC, Mackenbach JD, Heuvelman F, Schoonmade LJ, Beulens JW. Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis. SSM Popul Health 2024; 25:101559. [PMID: 38148999 PMCID: PMC10749911 DOI: 10.1016/j.ssmph.2023.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD). Methods We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses. Results From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
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Affiliation(s)
- Taymara C. Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Joreintje D. Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
| | - Linda J. Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, Noord-Holland, the Netherlands
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Pichardo CM, Chambers EC, Sanchez-Johnsen LAP, Pichardo MS, Gallo L, Talavera GA, Pirzada A, Roy A, Castañeda SF, Durazo-Arvizu RA, Perreira KM, Teng Y, Rodriguez CB, Allison M, Carlson JA, Daviglus ML, Plascak JJ. Association of census-tract level gentrification and income inequality with 6-year incidence of metabolic syndrome in the Hispanic Community Health Study/Study of Latinos, an epidemiologic cohort study. Soc Sci Med 2023; 336:116222. [PMID: 37776783 PMCID: PMC11185427 DOI: 10.1016/j.socscimed.2023.116222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Metabolic syndrome varies by socio-demographic characteristics, with younger (18-29 years) and older (50-69 years) Hispanic/Latino having higher prevalence compared to other groups. While there is substantial research on neighborhood influences on cardiometabolic health, there are mixed findings regarding the effects of gentrification and few studies have included Hispanic/Latinos. The role of neighborhood income inequality on metabolic health remains poorly understood. OBJECTIVES Examined associations of neighborhood gentrification and income inequality with metabolic syndrome (MetSyn) using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). DESIGN, SETTING AND PARTICIPANTS The HCHS/SOL is a community-based cohort of adults of Hispanic/Latinos (aged 18-74). Analyses included 6710 adults who did not meet criteria for MetsS at baseline (2008-2011) and completed the visit 2 examination (2014-2017). Poisson regressions estimated odds ratios (IRR) and 95% confidence intervals (CI) for neighborhood gentrification and change in income inequality with MetSyn incidence. MAIN OUTCOME AND EXPOSURE MEASURES Gentrification was measured with an index that included changes (2000 to 2006-2010) in education, poverty, and income. Change in neighborhood income inequality (2005-2009 to 2012-2016) was measured using the Gini coefficient of income distribution. MetSyn was defined using National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS Among 6647 Hispanic/Latino adults, 23% (N = 1530) had incident MetSyn. In models adjusted for socio-demographic, health insurance status, and neighborhood characteristics, gentrification (IRR, 1.00, 95%CI, 0.96-1.03) and income inequality change (IRR, 1.00, 95%CI, 0.99-1.00) were not associated with MetSyn at visit 2. There was no association between cross-sectional income inequality (2005-2009) and MetSyn at visit 2 (IRR, 0.97, 95%CI, 0.82-1.15). CONCLUSION Neighborhood gentrification and income inequality change were not associated with incidence of MetSyn over 6 years among Hispanic/Latino adults. This study demonstrated that income-based residential changes alone may not be sufficient to explain neighborhood influences on health outcomes among this population.
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Affiliation(s)
- Catherine M Pichardo
- National Cancer Institute, National Institute of Health, 9609 Medical Center Drive, Rockville, MD 20815, USA; University of Illinois at Chicago, Department of Psychology, 1007 W Harrison St, Chicago, IL, 60607, USA.
| | - Earle C Chambers
- Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY, 1046, USA
| | - Lisa A P Sanchez-Johnsen
- University of Illinois at Chicago, Department of Psychology, 1007 W Harrison St, Chicago, IL, 60607, USA; Medical College of Wisconsin (MCW), Institute for Health and Equity, Department of Psychiatry and Behavioral Medicine, and MCW Cancer Center, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Margaret S Pichardo
- Hospital of the University of Pennsylvania, Department of Surgery, 3400 Spruce St # 4, Philadelphia, PA, 19104, USA
| | - Linda Gallo
- San Diego State University, Department of Psychology, 5500 Campanile Drive; San Diego, CA, 92182-4611, USA
| | - Gregory A Talavera
- San Diego State University, Department of Psychology, 5500 Campanile Drive; San Diego, CA, 92182-4611, USA
| | - Amber Pirzada
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine West (MC 764) 1819 West Polk Street, Suite 246, Chicago, IL, 60612, USA
| | - Amanda Roy
- University of Illinois at Chicago, Department of Psychology, 1007 W Harrison St, Chicago, IL, 60607, USA
| | - Sheila F Castañeda
- San Diego State University, Department of Psychology, 5500 Campanile Drive; San Diego, CA, 92182-4611, USA
| | - Ramon A Durazo-Arvizu
- Children's Hospital Los Angeles, Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Krista M Perreira
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27599, USA
| | - Yanping Teng
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 123 W. Franklin Street, Suite 450 CB #8030 Chapel Hill, NC, 27516, USA
| | - Carmen B Rodriguez
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Matthew Allison
- University of California San Diego, School of Health Sciences, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jordan A Carlson
- Children's Mercy Kansas City Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Martha L Daviglus
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine West (MC 764) 1819 West Polk Street, Suite 246, Chicago, IL, 60612, USA
| | - Jesse J Plascak
- Ohio State University Comprehensive Cancer Center, Starling-Loving Hall, 320 W 10th Ave b302, Columbus, OH, 43210, USA
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1190] [Impact Index Per Article: 1190.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Meyer OL, Besser L, Tobias M, George KM, Gavett B, Farias ST, Bhagat N, Pham ML, Chrisphonte S, Whitmer RA. Neighborhood socioeconomic status and segregation linked to cognitive decline. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12401. [PMID: 36788980 PMCID: PMC9909261 DOI: 10.1002/dad2.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
Introduction Few longitudinal studies have examined the joint impact of neighborhood segregation and neighborhood socioeconomic status (NSES) in cognitive decline over time. Methods This study included non-Hispanic White (NHW, n = 209) and Black participants (n = 118) whose cognition was evaluated as part of an ongoing longitudinal study. Four distinct categories of segregation and NSES were evaluated for their association with cognitive outcomes (episodic memory, semantic memory, executive function, and spatial ability) using race-specific mixed-effects models. Results Compared to Black participants living in higher segregation-lower NSES areas, Black participants living in lower segregation-lower NSES areas or higher segregation-higher NSES areas experienced slower decline in episodic memory over time. Compared to NHW participants living in higher segregation-lower NSES areas, NHWs living in lower segregation-higher NSES areas experienced faster decline in spatial ability. Discussion Segregation and NSES are differentially associated with cognition depending on participant race. Further research is needed to replicate study results.
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Affiliation(s)
- Oanh L. Meyer
- Department of NeurologyUniversity of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Lilah Besser
- Department of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | - Michele Tobias
- DataLab: Data Science & InformaticsUniversity of California DavisDavisCaliforniaUSA
| | - Kristen M. George
- Department of Public Health SciencesUniversity of California, Davis School of MedicineDavisCaliforniaUSA
| | - Brandon Gavett
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Nishi Bhagat
- DataLab: Data Science & InformaticsUniversity of California DavisDavisCaliforniaUSA
| | - My Le Pham
- DataLab: Data Science & InformaticsUniversity of California DavisDavisCaliforniaUSA
| | - Stephanie Chrisphonte
- Department of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | - Rachel A. Whitmer
- Department of Public Health SciencesUniversity of California, Davis School of MedicineDavisCaliforniaUSA
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2414] [Impact Index Per Article: 1207.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Meyer OL, Besser L, Mitsova D, Booker M, Luu E, Tobias M, Farias ST, Mungas D, DeCarli C, Whitmer RA. Neighborhood racial/ethnic segregation and cognitive decline in older adults. Soc Sci Med 2021; 284:114226. [PMID: 34303293 PMCID: PMC8656323 DOI: 10.1016/j.socscimed.2021.114226] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/20/2021] [Accepted: 07/11/2021] [Indexed: 11/22/2022]
Abstract
Social determinants of health, including neighborhood factors, play a key role in the health of diverse older adults. However, few longitudinal studies have examined the role of neighborhood racial/ethnic segregation on cognitive decline in diverse samples. We examined older non-Hispanic White (NHW), Black, and Latino participants evaluated at an Alzheimer's Disease Research Center. Neighborhood racial/ethnic segregation was measured using the Getis-Ord Gi* statistic, a spatial measure of clustering that was created for Latino and Black clustering separately. Cognitive outcomes included episodic memory, semantic memory, and executive function. We used mixed effects multivariable regression models to evaluate associations between segregation and cognitive function and decline. We had 452 individuals: 46% NHW, 26% Black, and 21% Latino in 309 census tracts with an average of 5.2 years of follow-up data (range 0.6-15.0). In analyses that adjusted for a variety of covariates (including neighborhood SES), individuals in neighborhoods with a higher clustering of Latino residents (higher Gi* statistic) had slower declines over time on semantic memory and those in neighborhoods with a higher clustering of Black residents had slower declines over time on episodic memory. In race/ethnicity-stratified adjusted analyses: for Black participants, the association between clustering and cognition was present for episodic memory and executive function, showing lower baseline scores in highly clustered Black and Latino neighborhoods, respectively. There was no association with cognitive change. Among Latino participants, highly clustered Latino neighborhoods were associated with lower baseline scores in semantic memory, but slower declines in episodic memory; Latinos living in neighborhoods with a greater clustering of Black residents also had slower declines in episodic memory. Among NHWs, residing in neighborhoods with a higher clustering of Latino residents was associated with slower declines over time on semantic memory. Segregated neighborhoods may be differentially associated with cognitive outcomes depending on individual race/ethnicity.
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Affiliation(s)
- Oanh L Meyer
- University of California, Davis School of Medicine, Sacramento, CA, United States.
| | - Lilah Besser
- Florida Atlantic University, Boca Raton, FL, United States
| | - Diana Mitsova
- Florida Atlantic University, Boca Raton, FL, United States
| | - Michaela Booker
- University of California, Davis School of Medicine, Sacramento, CA, United States
| | - Elaine Luu
- University of California Davis, Davis, CA, United States
| | - Michele Tobias
- University of California Davis, Davis, CA, United States
| | | | - Dan Mungas
- University of California, Davis School of Medicine, Sacramento, CA, United States
| | - Charles DeCarli
- University of California, Davis School of Medicine, Sacramento, CA, United States
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3047] [Impact Index Per Article: 1015.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4793] [Impact Index Per Article: 1198.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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