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Altawalbeh SM, Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, Zimmerman RK, Smith KJ. Cost-effectiveness of an in-development adult-formulated 21-valent pneumococcal conjugate vaccine in US adults aged 50 years or older. Vaccine 2024; 42:3024-3032. [PMID: 38580515 DOI: 10.1016/j.vaccine.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Indirect effects of childhood pneumococcal conjugate vaccines (PCV) have diminished the cost-effectiveness of current adult vaccine recommendations. An in-development adult-formulated 21-valent pneumococcal conjugate vaccine (PCV21) may play a critical role in reducing pneumococcal illness by targeting a larger number of serotypes responsible for adult pneumococcal infections. This study assesses the cost-effectiveness of PCV21 in US adults aged 50 years or older compared with currently recommended pneumococcal vaccines, from both the societal and healthcare perspectives. A Markov model evaluated the lifetime cost-effectiveness of PCV21 (given at age 50 years only, at ages 50/65 years, and risk-based at ages < 65 years plus age-based at age 65 years) compared to no vaccination and to currently recommended pneumococcal vaccines given either as currently recommended or routinely at ages 50/65 years. The analysis was conducted in hypothetical Black and non-Black cohorts aged 50 years or older, with and without considering childhood pneumococcal vaccination indirect effects. Model parameters were based on US data. Parameter uncertainty was assessed using 1-way and probabilistic sensitivity analyses. From the societal perspective, PCV21 at ages 50/65 years compared to PCV21 at age 50 years cost $7,410 per quality adjusted life year (QALY) gained in Black cohort analyses and $85,696/QALY gained in the non-Black cohort; PCV21 at ages 50/65 years had the most favorable public health outcomes. From the healthcare perspective, compared to no vaccination, PCV21 at age 50 years cost $46,213/QALY gained in the Black cohort and $86,629/QALY in non-Blacks. All other strategies were dominated in both cohorts and from both perspectives. When considering childhood pneumococcal vaccination indirect effects, costs of PCV21 at ages 50/65 years remained less than $140,000/QALY gained from the societal perspective in both populations. PCV21 is potentially cost-effective compared to currently approved pneumococcal vaccines in adults aged 50 years or older from both the societal and healthcare perspectives.
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Affiliation(s)
- Shoroq M Altawalbeh
- Jordan University of Science and Technology, Faculty of Pharmacy, Irbid, Jordan.
| | - Angela R Wateska
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | | | - Chyongchiou J Lin
- The Ohio State University College of Nursing, Columbus, OH, United States.
| | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, TN, United States.
| | | | - Kenneth J Smith
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Forrester SN, Baek J, Hou L, Roger V, Kiefe CI. A Comparison of 5 Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study. J Am Heart Assoc 2024; 13:e032847. [PMID: 38606769 DOI: 10.1161/jaha.123.032847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Accelerated biological aging is an increasingly popular way to track the acceleration of biology over time that may not be captured by calendar time. Biological aging has been linked to external and internal chronic stressors and has the potential to be used clinically to understand a person's personalized functioning and predict future disease. We compared the association of different measures of biological aging and incident cardiovascular disease (CVD) overall and by race. METHODS AND RESULTS We used multiple informants models to compare the strength of clinical marker-derived age acceleration, 5 measures of epigenetic age acceleration (intrinsic and extrinsic epigenetic age acceleration, GrimAge acceleration, and PhenoAge acceleration), and 1 established clinical predictor of future CVD, Framingham 10-year risk score, with incident CVD over an 11-year period (2007-2018). Participants were 913 self-identified Black or White (41% and 59%, respectively) female or male (51% and 49%, respectively) individuals enrolled in the US-based CARDIA (Coronary Artery Risk Development in Young Adults) cohort study. The analytic baseline for this study was the 20-year follow-up examination (2005-2006; median age 45 years). We also included race-specific analysis. We found that all measures were modestly correlated with one another. However, clinical marker-derived age acceleration and Framingham 10-year risk score were more strongly associated with incident CVD than all the epigenetic measures. Clinical marker-derived age acceleration and Framingham 10-year risk score were not significantly different than one another in their association with incident CVD. CONCLUSIONS The type of accelerated aging measure should be taken into consideration when comparing their association with clinical outcomes. A multisystem clinical composite shows associations with incident CVD equally to a well-known clinical predictor.
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Affiliation(s)
- Sarah N Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL
| | - Veronique Roger
- Laboratory of Heart Disease Phenomics National Heart, Lung, and Blood Institute Bethesda MD
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
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Cho J, Allore H, Rahimighazikalayeh G, Vaughn I. Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01929-x. [PMID: 38381325 DOI: 10.1007/s40615-024-01929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUNDS Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity. METHODS Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively. RESULTS Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality. CONCLUSIONS Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.
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Affiliation(s)
- Jinmyoung Cho
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring SLUCare Academic Pavilion 3rd Floor, 63110, St. Louis, MO, USA.
- Baylor Scott & White Research Institute, Temple, TX, USA.
| | - Heather Allore
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | | | - Ivana Vaughn
- Henry Ford Health + Michigan State University Health Science, Detroit, MI, USA
- Department of Public Health Sciences , Henry Ford Health , Detroit, MI, USA
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Altawalbeh SM, Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, Zimmerman RK, Smith KJ. Societal Cost of Racial Pneumococcal Disease Disparities in US Adults Aged 50 Years or Older. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:61-71. [PMID: 37966698 PMCID: PMC10894512 DOI: 10.1007/s40258-023-00854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE This study aimed to estimate the societal cost of racial disparities in pneumococcal disease among US adults aged ≥ 50 years. METHODS In a model-based analysis, societal costs of invasive pneumococcal disease (IPD) and hospitalized nonbacteremic pneumococcal pneumonia (NBP) were estimated using (1) direct medical costs plus indirect costs of acute illness; (2) indirect costs of pneumococcal mortality; and (3) direct and indirect costs of related disability. Disparities costs were calculated as differences in average per-person pneumococcal disease cost between Black and non-Black adults aged ≥ 50 years multiplied by the Black population aged ≥ 50 years. Costs were in 2019 US dollars (US$), with future costs discounted at 3% per year. RESULTS Total direct and indirect costs per IPD case were US$186,791 in Black populations and US$182,689 in non-Black populations; total hospitalized NBP costs per case were US$100,632 (Black) and US$96,781 (non-Black). The difference in population per-person total pneumococcal disease costs between Black and non-Black adults was US$47.85. Combined societal costs of disparities for IPD and hospitalized NBP totaled US$673.2 million for Black adults aged ≥ 50 years. Disease and disability risks, life expectancy, and case-fatality rates were influential in one-way sensitivity analyses, but the lowest cost across all analyses was US$194 million. The 95% probability range of racial disparity costs were US$227.2-US$1156.9 million in a probabilistic sensitivity analysis. CONCLUSIONS US societal cost of racial pneumococcal disease disparities in persons aged ≥ 50 years is substantial. Successful pneumococcal vaccination policy and programmatic interventions to mitigate these disparities could decrease costs and improve health.
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Affiliation(s)
- Shoroq M Altawalbeh
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Angela R Wateska
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Kenneth J Smith
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Shipeolu BA, Marie Ahlin K, Fuller-Thomson E. Black-White Racial Disparities in Disabilities Among Older Americans Between 2008 and 2017: Improvements in Cognitive Disabilities but no Progress in Activities of Daily Living or Functional Limitations. Int J Aging Hum Dev 2024; 98:84-102. [PMID: 37643122 PMCID: PMC10699102 DOI: 10.1177/00914150231196092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The objectives of this study were to examine the prevalence of race-based disparities in cognitive problems, functional limitations (FLs), and activity of daily living (ADL) limitations between US Black and White older adults in 2008 and 2017, to explore how age, sex, income, and education attenuate these racial disparities, and to determine if Black-White health disparities are narrowing. Secondary analysis of the nationally representative American Community Surveys including 423,066 respondents aged ≥65 (388,602 White, 34,464 Black) in 2008 and 536,984 (488,483 White, 48,501 Black) in 2017. Findings indicate that Black-White racial disparities were apparent for all three outcomes in 2008 and 2017. Approximately half of the racial disparities was attenuated when adjustments were made for education and income. Racial disparities in cognition declined between 2008 and 2017 (p < .001) but persisted unabated in FLs and ADL limitations. Further exploration on the mechanisms of racial disparities is warranted.
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Affiliation(s)
| | - Katherine Marie Ahlin
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Esme Fuller-Thomson
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine & Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Baxter SLK, Zare H, Thorpe RJ. Race Disparities in Hypertension Prevalence Among Older Men. Int J Aging Hum Dev 2024; 98:10-26. [PMID: 37150878 DOI: 10.1177/00914150231172119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR = 1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.
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Affiliation(s)
- Samuel L K Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD, USA
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Reeves A, Elliott MR, Karvonen-Gutierrez CA, Harlow SD. Systematic exclusion at study commencement masks earlier menopause for Black women in the Study of Women's Health Across the Nation (SWAN). Int J Epidemiol 2023; 52:1612-1623. [PMID: 37382579 PMCID: PMC10555828 DOI: 10.1093/ije/dyad085] [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: 07/04/2022] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Shorter average lifespans for minoritized populations are hypothesized to stem from 'weathering' or accelerated health declines among minoritized individuals due to systemic marginalization. However, evidence is mixed on whether racial/ethnic differences exist in reproductive ageing, potentially due to selection biases in cohort studies that may systematically exclude 'weathered' participants. This study examines racial/ethnic disparities in the age of menopause after accounting for differential selection 'into' (left truncation) and 'out of' (right censoring) a cohort of midlife women. METHODS Using data from the Study of Women's Health Across the Nation (SWAN) cross-sectional screener (N = 15 695) and accompanying ∼20-year longitudinal cohort (N = 3302) (1995-2016), we adjusted for potential selection bias using inverse probability weighting (left truncation) to account for socio-demographic/health differences between the screening and cohort study, and multiple imputation (right censoring) to estimate racial/ethnic differences in age at menopause (natural and surgical). RESULTS Unadjusted for selection, no Black/White differences in menopausal timing [hazard ratio (HR)=0.98 (0.86, 1.11)] were observed. After adjustment, Black women had an earlier natural [HR = 1.13 (1.00, 1.26)] and surgical [HR= 3.21 (2.80, 3.62)] menopause than White women with natural menopause-corresponding to a 1.2-year Black/White difference in menopause timing overall. CONCLUSIONS Failure to account for multiple forms of selection bias masked racial/ethnic disparities in the timing of menopause in SWAN. Results suggest that there may be racial differences in age at menopause and that selection particularly affected the estimated menopausal age for women who experienced earlier menopause. Cohorts should consider incorporating methods to account for all selection biases, including left truncation, as they impact our understanding of health in 'weathered' populations.
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Affiliation(s)
- Alexis Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Michael R Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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Thomas Tobin CS, Huynh J, Farmer HR, Israel Cross R, Barve A, Robinson M, Leslie EP, Thorpe RJ. Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources. J Aging Health 2023; 35:660-676. [PMID: 35657773 PMCID: PMC10478356 DOI: 10.1177/08982643221100789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.
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Affiliation(s)
| | - James Huynh
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Rebekah Israel Cross
- Department of Health Behavior/ Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Apurva Barve
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Millicent Robinson
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, MD, USA
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Kuzmik A, Boltz M, BeLue R, Resnick B, Scott J, Mogle J, Leslie D, Galvin JE. The Modified Caregiver Strain Index in Black and White Dementia Caregivers at Hospital Discharge. Clin Gerontol 2023; 46:574-584. [PMID: 35916440 PMCID: PMC9892362 DOI: 10.1080/07317115.2022.2106927] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to examine psychometric properties of the Modified Caregiver Strain Index (MCSI) in Black and White caregivers of persons living with dementia at hospital discharge. METHODS This was a cross-sectional study using baseline data of 423 family caregivers recruited from a cluster randomized clinical control trial. Factor structure, measurement invariance, and concurrent validity of the MCSI were analyzed. The moderating role of race on the relationship between MCSI score and anxiety, depression, and burden was also examined. RESULTS The two-factor model fits the data best and was invariant across race. Regarding concurrent validity, higher MCSI scores were significantly associated with higher scores on the (HADS-A; anxiety), (HADS-D; depression), and (ZBI; burden). Race moderated the relationship between MCSI score and anxiety, depression, and burden. CONCLUSIONS The MCSI is a valid tool to assess caregiver strain in Black and White caregivers of persons living with dementia during hospital discharge. Results suggest that the effect of MCSI score on anxiety, depression, and burden varies by race. CLINICAL IMPLICATIONS MCSI can be used by clinicians and service providers to help support the needs of Black and White caregivers of people living with dementia during post-hospital transition.
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Affiliation(s)
- Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Rhonda BeLue
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Joanie Scott
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jacqueline Mogle
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Douglas Leslie
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
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Brown A, Wilson DK, Sweeney AM, van Horn ML, Zarrett N, Pate RR. Buffering effects of protective factors on light and moderate-to-vigorous physical activity among african american women. J Behav Med 2023; 46:405-416. [PMID: 36260160 PMCID: PMC10113398 DOI: 10.1007/s10865-022-00360-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: 01/23/2022] [Accepted: 08/22/2022] [Indexed: 10/24/2022]
Abstract
Physical activity (PA) plays an integral role in reducing risk for the leading causes of death and has also been shown to buffer stress. Based on the stress-buffering hypothesis, the present study examined whether protective factors (self-efficacy and informal social control) buffered the effects of perceived stress on PA over time. Secondary data analyses of female African American caregivers (N = 143) were conducted using data from the Families Improving Together (FIT) trial. Validated measures of stressors and protective factors were assessed at baseline. Light PA and moderate-to-vigorous PA were assessed using seven-day accelerometry estimates over sixteen weeks. Multilevel growth modeling was used to assess whether protective factors moderated the effects of perceived stress on PA outcomes across 16 weeks. There was a significant two-way interaction between informal social control and time (B = 0.40, SE = 0.17, p = .019) such that higher informal social control was positively associated with MVPA over time. There was a marginal three-way interaction (B = -18.90, SE = 10.31, p = .067) such that stress was associated with greater LPA at baseline under conditions of high but not low self-efficacy. This study provides preliminary support that social factors may be important for maintaining MVPA regardless of stress levels, while cognitive resources may be more important to target for influencing LPA engagement under conditions of high stress.
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Affiliation(s)
- Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - M Lee van Horn
- Department of Educational Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Russell R Pate
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Taylor JY, Huang Y, Zhao W, Wright ML, Wang Z, Hui Q, Potts‐Thompson S, Barcelona V, Prescott L, Yao Y, Crusto C, Kardia SLR, Smith JA, Sun YV. Epigenome-wide association study of BMI in Black populations from InterGEN and GENOA. Obesity (Silver Spring) 2023; 31:243-255. [PMID: 36479596 PMCID: PMC10107734 DOI: 10.1002/oby.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Obesity is a significant public health concern across the globe. Research investigating epigenetic mechanisms related to obesity and obesity-associated conditions has identified differences that may contribute to cellular dysregulation that accelerates the development of disease. However, few studies include Black women, who experience the highest incidence of obesity and early onset of cardiometabolic disorders. METHODS The association of BMI with epigenome-wide DNA methylation (DNAm) was examined using the 850K Illumina EPIC BeadChip in two Black populations (Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure [InterGEN], n = 239; and The Genetic Epidemiology Network of Arteriopathy [GENOA] study, n = 961) using linear mixed-effects regression models adjusted for batch effects, cell type heterogeneity, population stratification, and confounding factors. RESULTS Cross-sectional analysis of the InterGEN discovery cohort identified 28 DNAm sites significantly associated with BMI, 24 of which had not been previously reported. Of these, 17 were replicated using the GENOA study. In addition, a meta-analysis, including both the InterGEN and GENOA cohorts, identified 658 DNAm sites associated with BMI with false discovery rate < 0.05. In a meta-analysis of Black women, we identified 628 DNAm sites significantly associated with BMI. Using a more stringent significance threshold of Bonferroni-corrected p value 0.05, 65 and 61 DNAm sites associated with BMI were identified from the combined sex and female-only meta-analyses, respectively. CONCLUSIONS This study suggests that BMI is associated with differences in DNAm among women that can be identified with DNA extracted from salivary (discovery) and peripheral blood (replication) samples among Black populations across two cohorts.
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Affiliation(s)
- Jacquelyn Y. Taylor
- Center for Research on People of ColorColumbia University School of NursingNew YorkNew YorkUSA
| | - Yunfeng Huang
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Wei Zhao
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | | | - Zeyuan Wang
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Qin Hui
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | | | - Veronica Barcelona
- Center for Research on People of ColorColumbia University School of NursingNew YorkNew YorkUSA
| | - Laura Prescott
- Center for Research on People of ColorColumbia University School of NursingNew YorkNew YorkUSA
| | - Yutong Yao
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Cindy Crusto
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Sharon L. R. Kardia
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Jennifer A. Smith
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
- Survey Research CenterInstitute for Social Research, University of MichiganAnn ArborMichiganUSA
| | - Yan V. Sun
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
- Atlanta VA Healthcare SystemDecaturGeorgiaUSA
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Turney IC, Lao PJ, Rentería MA, Igwe KC, Berroa J, Rivera A, Benavides A, Morales CD, Rizvi B, Schupf N, Mayeux R, Manly JJ, Brickman AM. Brain Aging Among Racially and Ethnically Diverse Middle-Aged and Older Adults. JAMA Neurol 2023; 80:73-81. [PMID: 36374494 PMCID: PMC9664371 DOI: 10.1001/jamaneurol.2022.3919] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
Importance Neuroimaging studies have documented racial and ethnic disparities in brain health in old age. It remains unclear whether these disparities are apparent in midlife. Objective To assess racial and ethnic disparities in magnetic resonance imaging (MRI) markers of cerebrovascular disease and neurodegeneration in midlife and late life. Design, Setting, and Participants Data from 2 community-based cohort studies, Washington Heights-Inwood Columbia Aging Project (WHICAP) and the Offspring Study of Racial and Ethnic Disparities in Alzheimer Disease (Offspring), were used. Enrollment took place from March 2011 and June 2017, in WHICAP and Offspring, respectively, to January 2021. Of the 822 Offspring and 1254 WHICAP participants approached for MRI scanning, 285 and 176 refused participation in MRI scanning, 36 and 76 were excluded for contraindications/ineligibility, and 4 and 32 were excluded for missing key variables, respectively. Main Outcomes and Measures Cortical thickness in Alzheimer disease-related regions, white matter hyperintensity (WMH) volume. Results The final sample included 1467 participants. Offspring participants (497 [33.9%]) had a mean (SD) age of 55 (10.7) years, had a mean (SD) of 13 (3.5) years of education, and included 117 Black individuals (23.5%), 348 Latinx individuals (70%), 32 White individuals (6.4%), and 324 women (65.2%). WHICAP participants (970 [66.1%]) had a mean (SD) age of 75 (6.5) years, had a mean (SD) of 12 (4.7) years of education, and included 338 Black individuals (34.8%), 389 Latinx individuals (40.1%), 243 White individuals (25.1%), and 589 women (65.2%). Racial and ethnic disparities in cerebrovascular disease were observed in both midlife (Black-White: B = 0.357; 95% CI, 0.708-0.007; P = .046) and late life (Black-Latinx: B = 0.149, 95% CI, 0.068-0.231; P < .001; Black-White: B = 0.166; 95% CI, 0.254-0.077; P < .001), while disparities in cortical thickness were evident in late life only (Black-Latinx: B = -0.037; 95% CI, -0.055 to -0.019; P < .001; Black-White: B = -0.064; 95% CI -0.044 to -0.084; P < .001). Overall, Black-White disparities were larger than Latinx-White disparities for cortical thickness and WMH volume. Brain aging, or the association of age with MRI measures, was greater in late life compared with midlife for Latinx (cortical thickness: B = 0.006; 95% CI, 0.004-0.008; P < .001; WMH volume: B = -0.010; 95% CI, -0.018 to -0.001; P = .03) and White (cortical thickness: B = 0.005; 95% CI, 0.002-0.008; P = .001; WMH volume: B = -0.021; 95% CI -0.043 to 0.002; P = .07) participants but not Black participants (cortical thickness: B = 0.001; 95% CI, -0.002 to 0.004; P =.64; WMH volume: B = 0.003; 95% CI, -0.010 to 0.017; P = .61), who evidenced a similarly strong association between age and MRI measures in midlife and late life. Conclusions and Relevance In this study, racial and ethnic disparities in small vessel cerebrovascular disease were apparent in midlife. In Latinx and White adults, brain aging was more pronounced in late life than midlife, whereas Black adults showed accelerated pattern of brain aging beginning in midlife.
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Affiliation(s)
- Indira C. Turney
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Patrick J. Lao
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kay C. Igwe
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joncarlos Berroa
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Andres Rivera
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Andrea Benavides
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Clarissa D. Morales
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Batool Rizvi
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
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Staben OE, Infurna FJ, Lachman ME, Gerstorf D. Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States. J Gerontol B Psychol Sci Soc Sci 2022; 77:1978-1989. [PMID: 34928351 PMCID: PMC9683502 DOI: 10.1093/geronb/gbab232] [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: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time. METHODS Multilevel models were applied to longitudinal data on middle-aged (ages 40-65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health. RESULTS Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes. DISCUSSION Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.
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Affiliation(s)
- Omar E Staben
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Frank J Infurna
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts, USA
| | - Denis Gerstorf
- Department of Psychology, Humboldt University, Berlin, Germany
- Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, USA
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Forrester SN, Whitfield KE, Kiefe CI, Thorpe RJ. Navigating Black Aging: The Biological Consequences of Stress and Depression. J Gerontol B Psychol Sci Soc Sci 2022; 77:2101-2112. [PMID: 34875069 PMCID: PMC9683493 DOI: 10.1093/geronb/gbab224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Black persons in the United States are more likely to suffer from social inequality. Chronic stress caused by social inequality and racial discrimination results in weathering of the body that causes physiological dysregulation and biological age being higher than chronological age (accelerated aging). Depression has been linked to both racial discrimination and accelerated aging and accelerated aging has been demonstrated to be higher in Black than White persons, on average. However, we know little about accelerated aging across the life course in Black Americans. METHODS We used mixed-effects growth models to measure biological age acceleration, measured with cardiometabolic markers, over a 20-year period in Black participants of the Coronary Artery Risk Development in Young Adults Study who were aged 27-42 years at analytic baseline. We included an interaction between depressive symptoms and time to determine whether risk of depression was associated with a faster rate of biological aging. RESULTS We found that the rate of biological aging increased over a 20-year span and that those at risk for depression had a faster rate of biological aging than those not at risk. We also found that various social factors were associated with biological age acceleration over time. DISCUSSION Given the known association between perceived racial discrimination and depressive symptoms, we provide a novel instance of the long-term effects of social inequality. Specifically, biological age acceleration, a marker of physiological dysregulation, is associated with time among Black persons and more strongly associated among those with depressive symptoms.
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Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Reeves A, Elliott MR, Lewis TT, Karvonen-Gutierrez CA, Herman WH, Harlow SD. Study Selection Bias and Racial or Ethnic Disparities in Estimated Age at Onset of Cardiometabolic Disease Among Midlife Women in the US. JAMA Netw Open 2022; 5:e2240665. [PMID: 36342714 PMCID: PMC9641536 DOI: 10.1001/jamanetworkopen.2022.40665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Importance Racial disparities in cardiometabolic health are consistently observed in cohort studies. However, most studies neither evaluate differences in age at onset nor account for systematic exclusion stemming from "weathering" (accelerated health declines for minoritized groups due to structural social and economic marginalization). Objective To evaluate racial or ethnic disparities in age at onset of 4 cardiometabolic outcomes (hypertension, isolated systolic hypertension [ISH], insulin resistance [IR], and diabetes), accounting for multiple forms of potential selection bias. Design, Setting, and Participants This cohort study used data from the Study of Women's Health Across the Nation longitudinal cohort (1995-2016) and a cross-sectional screening sample (1995-1997). Data were analyzed from July 2019 to October 2021. Participants were eligible for the cohort if they were aged 42 to 52 years, had not received hormone therapy in the past 3 months, were not pregnant, had an intact uterus and at least 1 ovary, and were premenopausal or early perimenopausal (most recent menses ≤3 months). Exposures Self-reported racial or ethnic group (Black, Chinese, Hispanic, Japanese, or White). Main Outcomes and Measures The main outcomes were hypertension (systolic blood pressure [BP] ≥140 mm Hg and diastolic BP ≥90 mm Hg or use of antihypertensive medication), ISH (systolic BP ≥140 mm Hg and diastolic BP <90 mm Hg or use of antihypertensive medication), IR (homeostasis model assessment for IR value >5.9 or insulin use), and diabetes (fasting serum glucose level ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555], use of insulin or oral antidiabetic medication, or physician diagnosis). Selection into the cohort was addressed via inverse probability weighting and interval-censored survival models and selection out via multiple imputation. Accelerated failure time models were used to examine racial or ethnic differences in age at disease onset and estimate the median age at onset. Results A total of 3302 women were included in the study, with a median age of 46.2 years (range, 42-52 years) at baseline. In the sample, 42.6% had a bachelor's degree or higher and 36.3% self-rated their health as "very good" at baseline; 23.9% had hypertension, 43.7% had ISH, 13.5% had IR, and 4.6% had diabetes at baseline. Hypertension occurred a median of 5.0 years (95% CI, 5.4-5.5 years) earlier and metabolic outcomes (diabetes and IR) a median of 11.3 years (95% CI, 9.7-12.9 years) earlier for Black and Hispanic women vs White women; ISH occurred a median of 7.7 years (95% CI, 7.3-8.1 years) earlier for Black women vs White women. Adjustment for selection was associated with a mean 20-year decrease in estimated median age at onset, with greater decreases among Black and Hispanic women. Conclusions and Relevance In this multiracial cohort of midlife women, failure to account for selection biases, especially at study onset, was associated with falsely high estimates of age at cardiometabolic onset, with greater misestimation among Black and Hispanic women. The results suggest that hypertension and metabolic interventions, particularly for Black and Hispanic women, should be targeted to women aged as young as 30 years for hypertension and 40 years for metabolic interventions. Considering the timing of disease and fully addressing inherent selection biases in research are critical to understanding aging and disease risk, especially for racial and ethnic minoritized populations.
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Affiliation(s)
- Alexis Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Michael R. Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - William H. Herman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor
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Progression to Severe Chronic Hypertension 5-7 Years After a Pregnancy With Mild Chronic Hypertension. Obstet Gynecol 2022; 140:546-553. [PMID: 36075064 DOI: 10.1097/aog.0000000000004925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/26/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To estimate the incidence of severe chronic hypertension (cHTN) within 5-7 years after a pregnancy complicated by mild cHTN. METHODS This was a retrospective cohort study of women with mild cHTN during an index pregnancy between 2012 and 2014. Women were included if they received prenatal care at a single academic center and had mild cHTN during their pregnancy. Women with severe cHTN, type 1 diabetes, systemic lupus erythematosus, cardiomyopathy, proteinuria, or creatinine level greater than 1.1 mg/dL before 23 weeks of gestation at baseline were excluded. The primary outcome was a composite of severe cHTN (defined as new-onset of two or more severe blood pressures) or new-onset cardiovascular disease complications more than 12 weeks after the index delivery. RESULTS A total of 647 women with mild cHTN met inclusion criteria. Of these, 236 (36.5%, 95% CI 32.8-40.2%) women experienced the primary composite outcome of severe cHTN within 5-7 years of the index pregnancy. Black women progressed more rapidly than White women (adjusted hazard ratio [aHR] 1.99, 95% CI 1.43-2.76). Smoking tobacco was also associated with more rapid progression to severe cHTN (aHR 1.47, 95% CI 1.13-1.90). CONCLUSION In this cohort, one in three women with mild cHTN in an index pregnancy progressed to severe cHTN within 5-7 years. Prospective studies to validate this finding are needed.
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Hall A, Lee D, Campbell R, Palm J, Tucker B, Pepe M, Tjoumakaris F. The Shoulder Function “Tipping-Point” for Elective Rotator Cuff Repair: Demographic and Longitudinal Trends. JSES Int 2022; 6:828-832. [PMID: 36081700 PMCID: PMC9446187 DOI: 10.1016/j.jseint.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background A patient's decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the “tipping point.” The primary aim of this study is to determine the relationship between demographic parameters and the tipping point for elective rotator cuff repair. The secondary aim is to investigate if the tipping point is associated with mental health. The tertiary aim is to determine if the tipping point changes over time. Methods Retrospective chart review was used to identify all patients who underwent primary arthroscopic rotator cuff repair between January 1, 2015, to January 1, 2020, with 1 of 3 board-certified orthopedic surgeons. Exclusion criteria included age <18 years, revision surgery, or incomplete datasets (American Shoulder and Elbow Surgeons [ASES], 12-item short form, demographic information, and surgical history). Preoperative ASES score was designated as the tipping point for an individual patient, with a lower score representing worse shoulder function and therefore a higher tipping point and vice versa. Demographic parameters (age, sex, body mass index [BMI], race, and insurance), hand dominance, and surgical history extracted from chart review were analyzed to determine associations with tipping point. Results A total of 2153 patients were identified from chart review, with 1731 included in the final analysis. The patients had a mean age of 58.6 ± 9.66 years and a mean BMI of 29.2 ± 6.02 kg/m2. There was no significant difference in mean preoperative ASES score by year for the duration of this study (2015-2019, P = .27). Worker's compensation patients had a significantly lower mean preoperative ASES score than patients with commercial or government insurance (P < .01). Spearman's rank correlations showed no relationship between ASES score and patient demographics (age, sex, BMI, race, and hand dominance) or between ASES and previous orthopedic surgery. Preoperative ASES showed a weakly positive correlation (ρ = 0.26) with 12-item short form mental component score. Multivariate linear regression showed male sex is predictive of a lower tipping point (P < .01), whereas higher BMI, African American race, and history of arthroplasty are predictive of a higher tipping point (P ≤ .02). Conclusion The tipping point was not demonstrated to change over time in our analysis. Male sex is predictive of a lower tipping point for arthroscopic rotator cuff repair, whereas elevated BMI, African American race, worker's compensation insurance, and prior arthroplasty are predictive of a higher tipping point. Also, better mental health function is associated with a lower tipping point.
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Thomas Tobin CS, Gutiérrez Á, Bell CN, Thorpe RJ. Early Life Racial Discrimination, Racial Centrality, and Allostatic Load Among African American Older Adults. THE GERONTOLOGIST 2022; 62:721-731. [PMID: 34922345 PMCID: PMC9154246 DOI: 10.1093/geront/gnab185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior research documents accelerated physiological aging among African Americans due to their greater lifetime exposure to social and economic adversity. Yet, less is known about the mechanisms through which early life stressors, such as early life racial discrimination (ELRD), and later life psychosocial resources, such as racial centrality (i.e., importance of Black identity to one's sense of self), interact to shape allostatic load (AL) in adulthood. We evaluate the life course processes linking ELRD, adult racial centrality, and adult AL among older African Americans. RESEARCH DESIGN AND METHODS Data from the Nashville Stress and Health Study included African Americans aged 50 and older (N = 260). Poisson regression models assessed the links between ELRD, adult centrality, and adult AL. Interactions determined whether ELRD conditions the centrality-AL association in adulthood. RESULTS Adolescent ELRD conferred significantly higher levels of adult centrality and 32% increased risk of high adult AL. Greater adult centrality was linked to high adult AL, but the ELRD-adult AL association was not explained by centrality. However, ELRD and centrality interact to shape adult AL, such that racial centrality was protective against high adult AL for those who experienced racial discrimination as children or adolescents. DISCUSSION AND IMPLICATIONS Findings highlight the multiple pathways through which racism-related stressors and psychosocial resources interact to shape physiological dysregulation in later life and underscore the health significance of racial identity for older African Americans. Clinicians and public health professionals should assess early life stressors and foster psychosocial resilience to promote healthy aging.
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Affiliation(s)
- Courtney S Thomas Tobin
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ángela Gutiérrez
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bonds Johnson K, Brewster GS, Cicero E, Hepburn K, Clevenger CK, Daniel G, Pak V, Paul S, Epps F. Promoting Caregiver Mastery in Black American Dementia Caregivers. THE GERONTOLOGIST 2022; 62:685-693. [PMID: 34610111 PMCID: PMC9154278 DOI: 10.1093/geront/gnab147] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
Over 6 million older Americans live with Alzheimer's disease and related dementias; Black American older adults' prevalence is more than twice that of non-Hispanic White older adults. The Black American dementia caregiving experience can be encapsulated within the Black Family Socioecological Context Model, which provides a conceptual basis for examining social determinants of health at individual, family, community, and societal levels with careful consideration for how the intersection of race, gender, and class of Black American dementia caregivers influences the multiple dimensions of their caregiving experiences. Family dynamics, community setting, and health care systems have a potentially bidirectional influence on these caregivers, which is shaped by historical and ongoing systemic and institutional racism and general disenfranchisement. This Forum article outlines how the Social Cognitive Theory offers ways for Black American dementia caregivers to achieve a sense of mastery within the complicated and fraught ecology within which their caregiving occurs. We propose a research agenda to create programs and interventions for enhancing a sense of mastery among Black American dementia caregivers. Two concepts in particular, "constraints" and "efficacy expectations," provide ways to create a systematic approach to developing successful coping strategies for the constraints perceived by individuals as they undertake and function in the caregiving role. The recognition of the complexity of the caregiving ecosystem and intersectionality of caregivers' experience and identity emphasize the importance of individualization: Each caregiver's experience of this ecosystem-and therefore each Black American dementia caregiver's way to mastery within it-will be uniquely shaped and experienced.
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Affiliation(s)
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Gaea Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Victoria Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Barton AW, Yu T, Gong Q, Miller GE, Chen E, Brody GH. Childhood poverty, immune cell aging, and African Americans' insulin resistance: A prospective study. Child Dev 2022; 93:1616-1624. [PMID: 35596670 PMCID: PMC9427675 DOI: 10.1111/cdev.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
The present study investigated developmental pathways that can contribute to chronic disease among rural African Americans. With a sample of 342 African American youth (59% female) from the southeastern United States followed for nearly two decades (2001–2019), we examined the prospective association between family poverty during adolescence (ages 11–18) and insulin resistance (IR) in young adulthood (ages 25–29) as well as underlying biological and psychosocial mechanisms. Results indicated family poverty during adolescence forecast higher levels of IR in young adulthood, with accelerated immune cell aging at age 20 partially mediating this association. Serial mediational models confirmed the hypothesized pathway linking family poverty, perceived life chances, cellular aging, and IR. Findings provide empirical support for theorized developmental precursors of chronic disease.
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Affiliation(s)
- Allen W Barton
- Human Development and Family Studies, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, Georgia, USA
| | - Qiujie Gong
- Human Development and Family Studies, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Gregory E Miller
- Institute for Policy Research & Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Edith Chen
- Institute for Policy Research & Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Gene H Brody
- Center for Family Research, University of Georgia, Athens, Georgia, USA
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Abstract
OBJECTIVES African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population. METHODS Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults. RESULTS Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress. DISCUSSION Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.
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Affiliation(s)
- Dawne M Mouzon
- Department of Sociology Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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22
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Childhood adversity predicts black young adults' DNA methylation-based accelerated aging: A dual pathway model. Dev Psychopathol 2022; 34:689-703. [PMID: 34924087 PMCID: PMC9207155 DOI: 10.1017/s0954579421001541] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We expand upon prior work (Gibbons et al., ) relating childhood stressor effects, particularly harsh childhood environments, to risky behavior and ultimately physical health by adding longer-term outcomes - deoxyribonucleic acid (DNA) methylation-based measures of accelerated aging (DNAm-aging). Further, following work on the effects of early exposure to danger (McLaughlin et al., ), we also identify an additional pathway from harsh childhood environments to DNAm-aging that we label the danger/FKBP5 pathway, which includes early exposure to dangerous community conditions that are thought to impact glucocorticoid regulation and pro-inflammatory mechanisms. Because different DNAm-aging indices provide different windows on accelerated aging, we contrast effects on early indices of DNAm-aging based on chronological age with later indices that focused on predicting biological outcomes. We utilize data from Family and Community Health Study participants (N = 449) from age 10 to 29. We find that harshness influences parenting, which, in turn, influences accelerated DNAm-aging through the risky cognitions and substance use (i.e., behavioral) pathway outlined by Gibbons et al. (). Harshness is also associated with increased exposure to threat/danger, which, in turn, leads to accelerated DNAm-aging through effects on FKBP5 activity and enhanced pro-inflammatory tendencies (i.e., the danger/FKBP5 pathway).
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23
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Farmer HR, Thomas Tobin CS, Thorpe RJ. Correlates of Elevated C-Reactive Protein Among Black Older Adults: Evidence From the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2022; 77:1964-1977. [PMID: 35147674 PMCID: PMC9683501 DOI: 10.1093/geronb/gbac033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Substantial evidence documents gender and racial disparities in C-reactive protein (CRP), a measure of systemic inflammation, among older adults. Yet, the comparative approaches of these studies may obscure distinct risk and protective factors associated with elevated CRP among older Black Americans. To pinpoint opportunities for intervention, this study utilizes a "within-group approach" to identify the sociodemographic, psychosocial, behavioral, and health-related correlates of elevated CRP among older Black women and men. METHOD The sample consisted of 2,420 Black respondents aged 51 and older in the Health and Retirement Study (2006-2016). Gender-stratified, random effects logistic regression models were used to examine correlates of elevated CRP (>3.0 mg/L). RESULTS More than 50% of Black women had elevated CRP, and younger age, Medicaid, lower mastery, religiosity, overweight/obesity, physical inactivity, and activities of daily living (ADLs) contributed to elevated CRP among this group. In contrast, elevated CRP was reported among only 37.25% of Black men, for whom financial distress was associated with lower odds of elevated CRP; religiosity, less neighborhood cohesion, current smoking, overweight/obesity, ADLs, and more chronic conditions were associated with greater odds of elevated CRP among this group. DISCUSSION Sociodemographic factors had a limited association with elevated CRP among older Black Americans. Rather, a range of psychosocial, behavioral, and health-related factors were more influential determinants of elevated CRP among older Black Americans. Most notably, findings demonstrate distinct correlates of CRP among Black women and men, underscoring the critical need to further evaluate the risk and protective mechanisms undergirding disparities among this aging population.
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Affiliation(s)
- Heather R Farmer
- Address correspondence to: Heather R. Farmer, PhD, Department of Human Development and Family Sciences, University of Delaware, Newark, DE 19716, USA. E-mail:
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Roland J Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, Maryland, USA
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Opoku-Acheampong AA, Rosenkranz RR, Adhikari K, Muturi N, Logan C, Kidd T. Tools for Assessing Cardiovascular Disease Risk Factors in Underserved Young Adult Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413305. [PMID: 34948914 PMCID: PMC8707965 DOI: 10.3390/ijerph182413305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease (CVD, i.e., disease of the heart and blood vessels) is a major cause of death globally. Current assessment tools use either clinical or non-clinical factors alone or in combination to assess CVD risk. The aim of this review was to critically appraise, compare, and summarize existing non-clinically based tools for assessing CVD risk factors in underserved young adult (18–34-year-old) populations. Two online electronic databases—PubMed and Scopus—were searched to identify existing risk assessment tools, using a combination of CVD-related keywords. The search was limited to articles available in English only and published between January 2008 and January 2019. Of the 10,383 studies initially identified, 67 were eligible. In total, 5 out of the 67 articles assessed CVD risk in underserved young adult populations. A total of 21 distinct CVD risk assessment tools were identified; six of these did not require clinical or laboratory data in their estimation (i.e., non-clinical). The main non-clinically based tools identified were the Heart Disease Fact Questionnaire, the Health Beliefs Related to CVD-Perception measure, the Healthy Eating Opinion Survey, the Perception of Risk of Heart Disease Scale, and the WHO STEPwise approach to chronic disease factor surveillance (i.e., the STEPS instrument).
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Affiliation(s)
- Audrey A. Opoku-Acheampong
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
| | - Richard R. Rosenkranz
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
| | - Koushik Adhikari
- Department of Food Science and Technology, College of Agricultural & Environmental Sciences, University of Georgia, Griffin, GA 30223, USA;
| | - Nancy Muturi
- A. Q. Miller School of Journalism and Mass Communication, Kansas State University, Manhattan, KS 66506, USA;
| | - Cindy Logan
- Academic Services, Hale Library, Kansas State University, Manhattan, KS 66506, USA;
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
- Correspondence: ; Tel.: +1-(785)-532-0154
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25
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Skrine Jeffers K, Walton QL, Robinson MN, Thomas Tobin CS. Lifetime Major Discrimination Experiences Moderate the Impact of Depressive Symptoms on Chronic Conditions among Black Americans. Healthcare (Basel) 2021; 9:1528. [PMID: 34828574 PMCID: PMC8620289 DOI: 10.3390/healthcare9111528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
To clarify the ways in which Black Americans' experiences of structural racism may influence their mental and physical health in distinct ways, the present study evaluated whether major discrimination moderates the association between depressive symptoms and chronic physical health conditions among this population. t-tests and chi-squared tests of significance were used to determine significant differences between women and men. The association between major discrimination and depressive symptoms was examined by assessing mean depressive symptoms scores across levels of major discrimination. ANOVA tests indicated whether there were significant differences in symptom scores across each discrimination category. Additional t-tests determined significant gender differences within each level of discrimination. Gender-stratified negative binomial models were used, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the relationship between depressive symptoms, major discrimination, and chronic conditions. Our findings indicated that the association between depressive symptoms and chronic conditions depends on lifetime experiences of major discrimination among Black Americans and varies significantly between women and men. Considering that major discrimination conditioned the depressive symptom-chronic conditions association among our sample, this provides insight into potential pathways for intervention in efforts to offset the detrimental mental and physical consequences of experiencing racism.
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Affiliation(s)
- Kia Skrine Jeffers
- School of Nursing, University of California, 700 Tiverton Ave., Box 956918, Los Angeles, CA 90095, USA
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd., Houston, TX 77204-4013, USA;
| | - Millicent N. Robinson
- Fielding School of Public Health, University of California, 650 Charles E. Young Dr., Los Angeles, CA 90095, USA; (M.N.R.); (C.S.T.T.)
| | - Courtney S. Thomas Tobin
- Fielding School of Public Health, University of California, 650 Charles E. Young Dr., Los Angeles, CA 90095, USA; (M.N.R.); (C.S.T.T.)
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26
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Beach SRH, Ong ML, Lei MK, Carter SE, Simons RL, Gibbons FX, Philibert RA. Methylation of FKBP5 is associated with accelerated DNA methylation ageing and cardiometabolic risk: replication in young-adult and middle-aged Black Americans. Epigenetics 2021; 17:982-1002. [PMID: 34533092 PMCID: PMC9487733 DOI: 10.1080/15592294.2021.1980688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Methylation of FKBP5 is involved in the regulation of the stress response and is influenced by early stress exposure. Two CpG sites, cg20813374 and cg00130530, have been identified as potential reporters of early stress. We examined whether FKBP5 methylation was associated with accelerated DNA methylation ageing and indirectly predicted poorer cardiovascular health among both young adult and middle-aged Black Americans. Four hundred and forty-nine young adults, with a mean age of 28.67 and N = 469 middle-age parents and their current partners with a mean age of 57.21, provided self-reports, biometric assessments, and blood draws. Methylation values were obtained using the Illumina Epic Array. Cardiometabolic risk was calculated by summing the standardized log-transformed scores for the body mass index, mean arterial blood pressure, and HbA1c. We also used a more standard index of risk, the Framingham 10-year cardiometabolic risk index, as an alternative measure of cardiometabolic risk. To measure accelerated ageing, four widely used indices of accelerated, DNA methylation-based ageing were used controlling sex, age, other variation in FKBP5, and cell-type. Exposure to community danger was associated with demethylation of FKBP5. FKBP5 methylation was significantly associated with accelerated ageing for both young-adult and middle-aged samples, with significant indirect effects from FKBP5 methylation to cardiometabolic risk through accelerated ageing for both. Early exposure to danger may influence FKBP5 methylation. In turn, FKBP5 methylation may help explain intrinsic accelerated ageing and elevated cardiometabolic risk in adulthood for Black Americans.
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Affiliation(s)
- Steven R H Beach
- Department of Psychology and the Center for Family Research, University of Georgia, Athens, GA, USA.,Center for Family Research, University of Georgia, Athens, GA, USA
| | - Mei Ling Ong
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Man-Kit Lei
- Department of Sociology, University of Georgia, Athens, GA, USA
| | - Sierra E Carter
- Department of Psychology, Georgia State University, AtlantaAG, GA, USA
| | - Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA, USA
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Robert A Philibert
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA.,Behavioral Diagnostics, Coralville, IA, USA
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27
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Proximity to mother over the life course in the United States: Overall patterns and racial differences. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.45.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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28
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Mark NDE. Whither weathering? The variable significance of age in Black-White low birth weight disparities. SSM Popul Health 2021; 15:100806. [PMID: 34169136 PMCID: PMC8207231 DOI: 10.1016/j.ssmph.2021.100806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
This paper uses birth certificate data to provide novel estimates of the age-specific risk of a low birth weight birth (LBW, an infant born weighting <2500 g) for U.S.-born non-Hispanic Black and White mothers, and finds that patterns vary markedly over space and time. Notably, risk of an LBW birth for Black mothers increased much more steeply with age in 1991-94 than in 2014-17. This decline in LBW risks among older Black mothers led to a decline in the Black-White LBW gap of more than half a percentage point. Both patterns and changes were regional; while age gradients on the Black-White LBW gap were lowest in the South in 1991-94, by 2014-17 they had increased in the South and declined in the rest of the country. These descriptive data allow a new examination of hypotheses regarding the causes of age-specific racial LBW gaps. Research has found that racial disparities in a number of health outcomes, including LBW, increase with age, leading some to speculate that this increase is due to the cumulative effects of exposure to disadvantage. The large degree of variability in Black-White LBW disparities suggests that age-specific causes may also play a role. A series of counterfactual trend analyses explore the roles of two specific mechanisms, smoking and hypertension, and compares these to a more fundamental indicator of socioeconomic status: education.
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Affiliation(s)
- Nicholas D E Mark
- Department of Sociology, New York University, Puck Building 4th Floor, 295 Lafayette Street, New York, NY, 10012-9605, USA
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29
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Baxter SLK, Chung R, Frerichs L, Thorpe RJ, Skinner AC, Weinberger M. Racial Residential Segregation and Race Differences in Ideal Cardiovascular Health among Young Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157755. [PMID: 34360047 PMCID: PMC8345482 DOI: 10.3390/ijerph18157755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Background: Race disparities in cardiovascular disease (CVD) related morbidity and mortality are evident among men. While previous studies show health in young adulthood and racial residential segregation (RRS) are important factors for CVD risk, these factors have not been widely studied in male populations. We sought to examine race differences in ideal cardiovascular health (CVH) among young men (ages 24–34) and whether RRS influenced this association. Methods: We used cross-sectional data from young men who participated in Wave IV (2008) of the National Longitudinal Survey of Adolescent to Adult Health (N = 5080). The dichotomous outcome, achieving ideal CVH, was defined as having ≥4 of the American Heart Association’s Life’s Simple 7 targets. Race (Black/White) and RRS (proportion of White residents in census tract) were the independent variables. Descriptive and multivariate analyses were conducted. Results: Young Black men had lower odds of achieving ideal CVH (OR = 0.67, 95% CI = 0.49, 0.92) than young White men. However, RRS did not have a significant effect on race differences in ideal CVH until the proportion of White residents was ≥55%. Conclusions: Among young Black and White men, RRS is an important factor to consider when seeking to understand CVH and reduce future cardiovascular risk.
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Affiliation(s)
- Samuel L. K. Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
- Correspondence: ; Tel.: +1-864-722-2004
| | - Richard Chung
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, NC 27710, USA;
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, SC 27599, USA; (L.F.); (M.W.)
| | - Roland J. Thorpe
- Hopkins Center for Health Disparities Solutions, Program for Research on Men’s Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, SC 27599, USA; (L.F.); (M.W.)
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30
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Thomas Tobin CS, Hargrove TW. Race, Lifetime SES, and Allostatic Load among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:347-356. [PMID: 34081108 DOI: 10.1093/gerona/glab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prior research demonstrates that Black Americans receive fewer health benefits at high levels of SES relative to Whites. Yet, few studies have considered the role of lifetime SES (i.e. changes in SES from childhood to adulthood) in shaping these patterns among older adults. This study investigates the extent to which racial disparities in allostatic load (AL), an indicator of accelerated physiological aging, vary across levels of lifetime SES among Black and White adults aged 50+. METHODS With data from the Nashville Stress and Health Study, modified Poisson regression models were used to assess racial differences in the odds of high AL (4+ high-risk biomarkers) among Black and White older adults (N=518) within each level of lifetime SES (i.e., stable low SES, upward mobility, downward mobility, stable high SES). RESULTS Stable high SES was associated with greater odds of high AL; there was not a significant association between other lifetime SES trajectories and AL. However, the magnitude of racial disparities varied across levels of lifetime SES, with a significant Black-White difference in AL observed only among upwardly mobile (OR=1.76, 95% CI=1.24-2.51) and high SES groups (OR=2.22, 95% CI=1.37-3.58). CONCLUSIONS Our study demonstrates that racial disparities in AL among older adults depends on individuals' lifetime SES trajectories, and that older Black Americans receive fewer health benefits for achieving higher SES. These findings underscore the need to evaluate socioeconomic resources across the life course to clarify the extent of racial disparities among aging populations.
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31
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Moore JX, Bevel MS, Aslibekyan S, Akinyemiju T. Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018. Prev Med 2021; 147:106483. [PMID: 33640399 PMCID: PMC8826516 DOI: 10.1016/j.ypmed.2021.106483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malcolm S Bevel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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32
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Viviano NA, Galik E, Resnick B. Racial differences in physical activity in nursing home residents with cognitive impairment. Appl Nurs Res 2021; 60:151445. [PMID: 34247786 DOI: 10.1016/j.apnr.2021.151445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nursing home (NH) residents with moderate-to-severe cognitive impairment experience mostly sedentary lifestyles. AIM Previous research has examined racial differences in physical activity (PA) levels in community-dwelling older adults but not in NH residents with cognitive impairment, and the current study aimed to examine these differences. METHODS This was a secondary data analysis of baseline data from the Function and Behavior Focused Care Intervention (FBFC) study. The sample included 247 cognitively impaired residents from 12 NHs who wore an ActiGraph to measure PA. RESULTS The residents' mean age was 82.6 (SD = 10.1) and had an average MMSE score of 7.8 (SD = 5.0). The sample (N = 247) was 41% African American and 59% White. African American and White residents engaged in only 50.6 and 46.2 min of light- and 1.5 and 1.1 min of moderate-level PA, respectively. Based on a multivariate analysis of covariance (MANCOVA), there was not a statistically significant difference between African American and White residents on combined dependent PA measures [F (8, 237) = 1.067, p = .387, Wilks' Λ = 0.962]. There was a trend that direct care providers subjectively reported that White residents engaged in more PA than their African American counterparts [F(8, 237) = 2.741, p = .09]. CONCLUSIONS These findings are not consistent with prior research. However, these findings indicate severely low levels of PA in NH residents, regardless of racial group. Future research should prioritize PA interventions that make accommodations for all NH residents, and especially consider their underlying physical comorbidities and cognitive function.
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Affiliation(s)
- Nicole A Viviano
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Division of Gerontology, 660 W. Redwood Street, Howard Hall 222, Baltimore, MD 21201, United States of America.
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21210, United States of America
| | - Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21210, United States of America
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33
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Clark LR, Zuelsdorff M, Norton D, Johnson SC, Wyman MF, Hancock LM, Carlsson CM, Asthana S, Flowers-Benton S, Gleason CE, Johnson HM. Association of Cardiovascular Risk Factors with Cerebral Perfusion in Whites and African Americans. J Alzheimers Dis 2021; 75:649-660. [PMID: 32310160 DOI: 10.3233/jad-190360] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Midlife cardiovascular risk factors increase risk for Alzheimer's disease (AD). Despite disproportionately high cardiovascular disease and dementia rates, African Americans are under-represented in studies of AD risk and research-based guidance on targeting vascular risk factors is lacking. OBJECTIVE This study investigated relationships between specific cardiovascular risk factors and cerebral perfusion in White and African American adults enriched for AD risk. METHODS Participants included 397 cognitively unimpaired White (n = 330) and African American (n = 67) adults enrolled in the Wisconsin Alzheimer's Disease Research Center who underwent pseudo-continuous arterial spin labeling MRI. Multiple linear regression models examined independent relationships between cardiovascular risk factors and mean cerebral perfusion. Subsequent interaction and stratified models assessed the role for APOE genotype and race. RESULTS When risk factor p-values were FDR-adjusted, diastolic blood pressure was significantly associated with mean perfusion. Tobacco use, triglycerides, waist-to-hip ratio, and a composite risk score were not associated with perfusion. Without FDR adjustment, a relationship was also observed between perfusion and obesity, cholesterol, and fasting glucose. Neither APOE genotype nor race moderated relationships between risk factors and perfusion. CONCLUSION Higher diastolic blood pressure predicted lower perfusion more strongly than other cardiovascular risk factors. This relationship did not vary by racial group or genetic risk for AD, although the African American sample had greater vascular risk burden and lower perfusion rates. Our findings highlight the need to prioritize inclusion of underrepresented groups in neuroimaging studies and to continue exploring the link between modifiable risk factors, cerebrovascular health, and AD risk in underrepresented populations.
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Affiliation(s)
- Lindsay R Clark
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin School of Nursing, Madison, WI, USA
| | - Derek Norton
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Mary F Wyman
- Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura M Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Susan Flowers-Benton
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carey E Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Heather M Johnson
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Walubita T, Beccia A, Boama-Nyarko E, Goulding M, Herbert C, Kloppenburg J, Mabry G, Masters G, McCullers A, Forrester S. Aging and COVID-19 in Minority Populations: a Perfect Storm. CURR EPIDEMIOL REP 2021; 8:63-71. [PMID: 33747713 PMCID: PMC7959878 DOI: 10.1007/s40471-021-00267-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW COVID-19 is a major concern for the health and wellbeing of individuals worldwide. As COVID-19 cases and deaths continue to increase in the USA, aging Black and Hispanic populations have emerged as especially at-risk for increased exposure to COVID-19 and susceptibility to severe health outcomes. The current review discusses the weathering hypothesis and the influence of social inequality on the identified health disparities. RECENT FINDINGS Aging minoritized populations have endured structural and social inequality over the lifecourse. Consequently, these populations experience weathering, a process that results in physiological dysregulation due to stress associated with persistent disadvantage. Through weathering and continued inequity, aging minoritized populations have an increased risk of exposure and poor health outcomes from COVID-19. SUMMARY Current literature and available data suggests that aging minoritized persons experience high rates of COVID-19 morbidity and mortality. The current review hypothesizes and supports that observed disparities are the result of inequalities that especially affect Black and Hispanic populations over the lifecourse. Future efforts to address these disparities should emphasize research that supports governments in identifying at-risk groups, providing accessible COVID-19-related information to those groups, and implementing policy that addresses the structural and social inequities that perpetuate current COVID-19 disparities.
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Affiliation(s)
- Tubanji Walubita
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Ariel Beccia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Esther Boama-Nyarko
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Melissa Goulding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Jessica Kloppenburg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Guadalupe Mabry
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Grace Masters
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Asli McCullers
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
| | - Sarah Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605 USA
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Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Accelerated aging: A marker for social factors resulting in cardiovascular events? SSM Popul Health 2021; 13:100733. [PMID: 33532540 PMCID: PMC7823205 DOI: 10.1016/j.ssmph.2021.100733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medicine and public health are shifting away from a purely "personal responsibility" model of cardiovascular disease (CVD) prevention towards a societal view targeting social and environmental conditions and how these result in disease. Given the strong association between social conditions and CVD outcomes, we hypothesize that accelerated aging, measuring earlier health decline associated with chronological aging through a combination of biomarkers, may be a marker for the association between social conditions and CVD. METHODS We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA). Accelerated aging was defined as the difference between biological and chronological age. Biological age was derived as a combination of 7 biomarkers (total cholesterol, HDL, glucose, BMI, CRP, FEV1/h2, MAP), representing the physiological effect of "wear and tear" usually associated with chronological aging. We studied accelerated aging measured in 2005-06 as a mediator of the association between social factors measured in 2000-01 and 1) any incident CVD event; 2) stroke; and 3) all-cause mortality occurring from 2007 through 18. RESULTS Among 2978 middle-aged participants, mean (SD) accelerated aging was 3.6 (11.6) years, i.e., the CARDIA cohort appeared to be, on average, 3 years older than its chronological age. Accelerated aging partially mediated the association between social factors and CVD (N=219), stroke (N=36), and mortality (N=59). Accelerated aging mediated 41% of the total effects of racial discrimination on stroke after adjustment for covariates. Accelerated aging also mediated other relationships but to lesser degrees. CONCLUSION We provide new evidence that accelerated aging based on easily measurable biomarkers may be a viable marker to partially explain how social factors can lead to cardiovascular outcomes and death.
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Affiliation(s)
- Sarah N. Forrester
- University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - Pamela J. Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - David R. Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - Veronique L. Roger
- Mayo Clinic, Division of Circulatory Failure, Department of Cardiovascular Medicine, USA
| | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, USA
| | - Catarina I. Kiefe
- University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, USA
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Abstract
Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved.
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Affiliation(s)
- Juanita J. Chinn
- Population Dynamics Branch, Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Iman K. Martin
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Nicole Redmond
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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McClendon J, Essien UR, Youk A, Ibrahim SA, Vina E, Kwoh CK, Hausmann LRM. Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination. Arthritis Care Res (Hoboken) 2021; 73:11-17. [PMID: 33026710 DOI: 10.1002/acr.24481] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain. METHODS We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel's test of mediation to examine hypotheses. RESULTS The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P < 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P < 0.001) as well as pain severity (Z = 2.24, P = 0.025). CONCLUSION Perceived discrimination is an important psychosocial stressor that contributes to worsening OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.
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Affiliation(s)
- Juliette McClendon
- National Center for PTSD, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - Utibe R Essien
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Ada Youk
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Said A Ibrahim
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania, School of Medicine, Philadelphia, and Weill Cornell Medicine, New York, New York
| | - Ernest Vina
- University of Arizona, College of Medicine, and University of Arizona Arthritis Center, Tucson
| | - C Kent Kwoh
- University of Arizona, College of Medicine, and University of Arizona Arthritis Center, Tucson
| | - Leslie R M Hausmann
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
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Clouston SAP, Natale G, Link BG. Socioeconomic inequalities in the spread of coronavirus-19 in the United States: A examination of the emergence of social inequalities. Soc Sci Med 2021; 268:113554. [PMID: 33308911 DOI: 10.1016/j.socscimed.2020.11355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To quantify the contribution variation in socioeconomic status in predicting the distribution of COVID-19 cases and deaths. METHODS Analyses used incidence data on daily COVID + case counts from all counties from the initial wave of infections, merged with data from the U.S. census data to measure county-level SES and confounders. Multivariable analyses relied on survival analyses and Poisson regression to examine timing of county-level index cases and of COVID-19 incidence and mortality in infected counties to examine the spread and severity of COVID-19 while adjusting for adjusted for Black race, Hispanic ethnicity, age, gender, and urbanicity. Effect moderation by social distancing parameters was examined. RESULTS Results indicate that higher SES was associated with earlier incidence of index cases, but that as social distancing took place inequalities in SES inverted so that growth in incidence was slower in higher SES counties, where case-fatality rates were lower. CONCLUSIONS This study is the first to date to show what happens when an opportunistic disease that could affect anyone meets the American system of inequality and is powerfully shaped by it.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Ginny Natale
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Bruce G Link
- Department of Sociology and Public Policy, University of California at Riverside, Riverside, CA, USA.
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Clouston SAP, Natale G, Link BG. Socioeconomic inequalities in the spread of coronavirus-19 in the United States: A examination of the emergence of social inequalities. Soc Sci Med 2020; 268:113554. [PMID: 33308911 PMCID: PMC7703549 DOI: 10.1016/j.socscimed.2020.113554] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
Objectives To quantify the contribution variation in socioeconomic status in predicting the distribution of COVID-19 cases and deaths. Methods Analyses used incidence data on daily COVID + case counts from all counties from the initial wave of infections, merged with data from the U.S. census data to measure county-level SES and confounders. Multivariable analyses relied on survival analyses and Poisson regression to examine timing of county-level index cases and of COVID-19 incidence and mortality in infected counties to examine the spread and severity of COVID-19 while adjusting for adjusted for Black race, Hispanic ethnicity, age, gender, and urbanicity. Effect moderation by social distancing parameters was examined. Results Results indicate that higher SES was associated with earlier incidence of index cases, but that as social distancing took place inequalities in SES inverted so that growth in incidence was slower in higher SES counties, where case-fatality rates were lower. Conclusions This study is the first to date to show what happens when an opportunistic disease that could affect anyone meets the American system of inequality and is powerfully shaped by it. Socioeconomic inequalities in health emerge and change predictably as they infect communities. This study found that higher socioeconomic status was associated with earlier COVID-19 exposure. Lower socioeconomic status was associated with higher incidence and mortality rates. Despite being a new disease, social inequalities emerged alongside prevention implementation.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Ginny Natale
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Bruce G Link
- Department of Sociology and Public Policy, University of California at Riverside, Riverside, CA, USA.
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Barker KM, Dunn EC, Richmond TK, Ahmed S, Hawrilenko M, Evans CR. Cross-classified multilevel models (CCMM) in health research: A systematic review of published empirical studies and recommendations for best practices. SSM Popul Health 2020; 12:100661. [PMID: 32964097 PMCID: PMC7490849 DOI: 10.1016/j.ssmph.2020.100661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022] Open
Abstract
Recognizing that health outcomes are influenced by and occur within multiple social and physical contexts, researchers have used multilevel modeling techniques for decades to analyze hierarchical or nested data. Cross-Classified Multilevel Models (CCMM) are a statistical technique proposed in the 1990s that extend standard multilevel modeling and enable the simultaneous analysis of non-nested multilevel data. Though use of CCMM in empirical health studies has become increasingly popular, there has not yet been a review summarizing how CCMM are used in the health literature. To address this gap, we performed a scoping review of empirical health studies using CCMM to: (a) evaluate the extent to which this statistical approach has been adopted; (b) assess the rationale and procedures for using CCMM; and (c) provide concrete recommendations for the future use of CCMM. We identified 118 CCMM papers published in English-language literature between 1994 and 2018. Our results reveal a steady growth in empirical health studies using CCMM to address a wide variety of health outcomes in clustered non-hierarchical data. Health researchers use CCMM primarily for five reasons: (1) to statistically account for non-independence in clustered data structures; out of substantive interest in the variance explained by (2) concurrent contexts, (3) contexts over time, and (4) age-period-cohort effects; and (5) to apply CCMM alongside other techniques within a joint model. We conclude by proposing a set of recommendations for use of CCMM with the aim of improved clarity and standardization of reporting in future research using this statistical approach.
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Affiliation(s)
- Kathryn M Barker
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Tracy K Richmond
- Department of Medicine, Division of Adolescent Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah Ahmed
- Department of Sociology, University of Oregon, Eugene, OR, USA
| | - Matthew Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA
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Parker LJ, Fabius CD. Racial Differences in Respite Use among Black and White Caregivers for People Living with Dementia. J Aging Health 2020; 32:1667-1675. [DOI: 10.1177/0898264320951379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine racial differences in respite utilization among a nationally representative sample of caregivers for persons living with dementia (PLwD). A secondary aim identified factors associated with respite utilization. Methods: Using data from the 2015 National Health and Aging Trends Study and National Study of Caregiving, we conducted binary logistic regression to examine racial difference in respite use among Black and white caregivers ( n = 750). Results: 22% of the sample used respite for PLwD. Black dementia caregivers were 69% less likely (odds ratio: .31, p = .001) to use respite compared to white caregivers. Other factors associated with utilization included education, receiving help with caregiving, and providing care for more self-care/mobility tasks or to a Medicaid-enrollee. Discussion: Findings suggest that Black dementia caregivers may be at risk for less frequent use of respite and highlight the need to identify factors that promote respite use.
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Abstract
Ethn Dis. 2020;30(3):369-372; doi:10.18865/ed.30.3.369
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Affiliation(s)
- Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health
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Shah-Williams E, Levy KD, Zang Y, Holmes AM, Stoughton C, Dexter P, Skaar TC. Enrollment of Diverse Populations in the INGENIOUS Pharmacogenetics Clinical Trial. Front Genet 2020; 11:571. [PMID: 32670350 PMCID: PMC7330082 DOI: 10.3389/fgene.2020.00571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Recruitment of diverse populations and subjects living in Medically Underserved Areas and Populations (MUA/P's) into clinical trials is a considerable challenge. Likewise, representation of African-Americans in pharmacogenetic trials is often inadequate, but critical for identifying genetic variation within and between populations. To identify enrollment patterns and variables that predict enrollment in a diverse underserved population, we analyzed data from the INGENIOUS (Indiana GENomics Implementation and Opportunity for the UnderServed), pharmacogenomics implementation clinical trial conducted at a community hospital for underserved subjects (Safety net hospital), and a statewide healthcare system (Academic hospital). We used a logistic regression model to identify patient variables that predicted successful enrollment after subjects were contacted and evaluated the reasons that clinical trial eligible subjects refused enrollment. In both healthcare systems, African-Americans were less likely to refuse the study than non-Hispanic Whites (Safety net, OR = 0.68, and p < 0.002; Academic hospital, OR = 0.64, and p < 0.001). At the Safety net hospital, other minorities were more likely to refuse the study than non-Hispanic Whites (OR = 1.58, p < 0.04). The odds of refusing the study once contacted increased with patient age (Safety net hospital, OR = 1.02, p < 0.001, Academic hospital, OR = 1.02, and p < 0.001). At the Academic hospital, females were less likely to refuse the study than males (OR = 0.81, p = 0.01) and those not living in MUA/P's were less likely to refuse the study than those living in MUA/P's (OR = 0.81, p = 0.007). The most frequent barriers to enrollment included not being interested, being too busy, transportation, and illness. A lack of trust was reported less frequently. In conclusion, African-Americans can be readily recruited to pharmacogenetic clinical trials once contact has been successfully initiated. However, health care initiatives and increased recruitment efforts of subjects living in MUA/Ps are needed. Enrollment could be further enhanced by improving research awareness and knowledge of clinical trials, reducing time needed for participation, and compensating for travel.
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Affiliation(s)
- Ebony Shah-Williams
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, United States
| | - Kenneth D. Levy
- Department of Medicine, Indiana University, Indianapolis, IN, United States
| | - Yong Zang
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Ann M. Holmes
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University–Purdue University Indianapolis, Indianapolis, IN, United States
| | - Christa Stoughton
- Department of Urology, Indiana University Hospital, Indianapolis, IN, United States
| | - Paul Dexter
- Department of Medicine, Indiana University, Indianapolis, IN, United States
- Regenstrief Institute for Health Care, Indianapolis, IN, United States
| | - Todd C. Skaar
- Department of Medicine, Indiana University, Indianapolis, IN, United States
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Racial Discrimination, Inflammation, and Chronic Illness Among African American Women at Midlife: Support for the Weathering Perspective. J Racial Ethn Health Disparities 2020; 8:339-349. [PMID: 32488825 DOI: 10.1007/s40615-020-00786-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022]
Abstract
It is widely accepted that socioeconomic status (SES) is a fundamental cause of health inequality. There is evidence, however, that race is also a fundamental cause of disparities in health. Based on this idea, the weathering hypothesis developed by Geronimus and her colleagues views the elevated rates of illness and disability seen among Black Americans as a physiological response to the structural barriers, daily slights, and other threats to identity that comprise the Black experience. The current study tests the weathering hypothesis using chronic inflammation as an indicator of biological weathering. Specifically, we examine the extent to which persistent exposure to racial discrimination predicts elevated inflammation and, in turn, diagnosed chronic illness, after taking into account SES and several control variables. This mediation model was tested using zero-inflated Poisson path modeling with five waves of data collected from 391 African American women participating in the Family and Community Health Study (FACHS). A 13-item index was used to assess exposure to racial discrimination across 8 years. ELISA blood assays of seven cytokines central to the inflammatory response were used to construct an inflammatory index. Respondents reported their diagnosed chronic diseases. Consonant with the weathering hypothesis, persistent exposure to discrimination predicted inflammation which, in turn, predicted number of chronic diseases. This indirect effect was statistically significant. SES predicted having a chronic disease and the various controls showed no effect. The findings support the idea that race, like SES, is a fundamental cause of health inequalities.
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Forrester SN, Taylor JL, Whitfield KE, Thorpe RJ. Advances in Understanding the Causes and Consequences of Health Disparities in Aging Minorities. CURR EPIDEMIOL REP 2020; 7:59-67. [PMID: 33868898 PMCID: PMC8045783 DOI: 10.1007/s40471-020-00234-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose was to discuss appropriate methods for advancing our understanding of health disparities or minority aging including life-course perspectives, biological measures, pain measurement, and generational approaches. RECENT FINDINGS Life course perspectives provide an orientation for studying older minorities that concomitantly captures exposures and stressors that may lead to earlier onset of disease and premature mortality. The use of biological markers to study health disparities in older minorities is necessary in order to identify pathways between psychosocial factors and health outcomes. Work focusing on pain disparities should include explorations of relationships between psychosocial factors, and subjective and objective measures of pain. Studying families can provide insight into genetic associations and coping styles in older minorities. SUMMARY Methodological approaches that take life course, biology, and social factors into account may help identify causal pathways between social determinants of health and health outcomes among older minorities. Once these causal pathways have been identified, more strategies and interventions that strive toward health equity across older adults of all race/ethnic groups can be developed.
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Affiliation(s)
- Sarah N Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
| | | | | | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health
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Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes. THE GERONTOLOGIST 2019; 59:1017-1023. [PMID: 30169640 PMCID: PMC6858824 DOI: 10.1093/geront/gny104] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.
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Affiliation(s)
- Sarah N Forrester
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Roland J Thorpe
- Departmnet of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gillespie SL, Anderson CM, Zhao S, Tan Y, Kline D, Brock G, Odei J, O'Brien E, Sims M, Lazarus SA, Hood DB, Williams KP, Joseph JJ. Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study. Psychoneuroendocrinology 2019; 109:104369. [PMID: 31307010 PMCID: PMC7232849 DOI: 10.1016/j.psyneuen.2019.06.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022]
Abstract
African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.
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Affiliation(s)
- Shannon L Gillespie
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States.
| | - Cindy M Anderson
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Songzhu Zhao
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Yubo Tan
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - David Kline
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Guy Brock
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - James Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Emily O'Brien
- Duke Clinical Research Institute and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Sophie A Lazarus
- Department of Psychology, The Ohio State University, United States
| | - Darryl B Hood
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Keiser AM, Salinas YD, DeWan AT, Hawley NL, Donohue PK, Strobino DM. Risks of preterm birth among non-Hispanic black and non-Hispanic white women: Effect modification by maternal age. Paediatr Perinat Epidemiol 2019; 33:346-356. [PMID: 31365156 PMCID: PMC6993282 DOI: 10.1111/ppe.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preterm birth (PTB) disproportionately affects African American compared with Caucasian women, although reasons for this disparity remain unclear. Some suggest that a differential effect of maternal age by race/ethnicity, especially at older maternal ages, may explain disparities. OBJECTIVE To determine whether the relationship between maternal age and preterm birth varies by race/ethnicity among primiparae non-Hispanic blacks (NHB) and non-Hispanic whites (NHW). METHODS A cross-sectional study of 367 081 singleton liveborn first births to NHB and NHW women in California from 2008 to 2012 was conducted. Rate ratios (RR) were estimated for PTB and its subtypes-spontaneous and clinician-initiated-after adjusting for confounders through Poisson regression. Universal age/race reference groups (NHW, 25-29 years) and race-specific reference groups (NHW or NHB, 25-29 years) were used for comparisons. RESULTS Among all women, RR of PTB was highest at the extremes of age (<15 and ≥40 years). Among NHBs, the risk of PTB was higher than among NHWs at all maternal ages (adjusted RR of PTB 1.38-2.93 vs 0.98-2.38). However, using race-specific reference groups, the risk of PTB for NHB women (RR 0.91-1.88) vs NHW women (RR 0.98-2.39) was nearly identical at all maternal ages, with overlapping confidence intervals. Analyses did not demonstrate substantial divergence of risk with advancing maternal age. PTB, spontaneous PTB, and clinician-initiated PTB demonstrated similar risk patterns at younger but not older maternal ages, where risk of clinician-initiated PTB increased sharply for all women. CONCLUSIONS Primiparae NHBs demonstrated increased risk of PTB, spontaneous PTB, and clinician-initiated PTB compared with NHWs at all maternal ages. However, RRs using race-specific reference groups converged across maternal ages, indicating a similar independent effect of maternal age on PTB by race/ethnicity. A differential effect of maternal age does not appear to explain disparities in preterm birth by race/ethnicity.
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Affiliation(s)
- Amaris M. Keiser
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yasmmyn D. Salinas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Andrew T. DeWan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Pamela K. Donohue
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Donna M. Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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49
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Hill CV. At the Intersection of Rigor and Equity: Health Disparities Research Related to Aging. Gerontol Geriatr Med 2019; 5:2333721419857858. [PMID: 31321254 PMCID: PMC6610397 DOI: 10.1177/2333721419857858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
Aging in the United States will be defined by differences in health and longevity among
populations. Diversity among the aged population is expected to increase. While
investigators must contend with generalizability to enhance rigor, biomedical research
holds great promise in exploring determinants of health for populations groups. Biomedical
research explores the impact of various determinants on health and longevity. Health
disparities research related to aging serves as an important scientific approach for
researchers to maintain clarity in generalizability, with a focus on a breadth of
determinants in multiple levels of analysis. Moreover, health disparities research related
to aging holds the biomedical research enterprise accountable to principles of equity for
understanding and addresing the health and aging of disproportionately affected population
groups in society.
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Affiliation(s)
- Carl V Hill
- U.S. Department of Health and Human Services, Bethesda, MD, USA
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50
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McClendon J, Bogdan R, Jackson JJ, Oltmanns TF. Mechanisms of Black–White disparities in health among older adults: Examining discrimination and personality. J Health Psychol 2019; 26:995-1011. [DOI: 10.1177/1359105319860180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We tested whether personality traits help explain the association between discrimination and racial health disparities in a sample of 1033 Black and White older adults. Participants completed measures of discrimination, personality, and self-reported physical and mental health. Elevated discrimination among Black participants was indirectly linked to worse physical and mental health outcomes through elevated neuroticism and lower agreeableness, controlling income, education, and gender. The specific facets of depression, impulsiveness, and trust were the most robust intervening personality factors. Interventions that target cognitive, emotional, and behavioral sequelae of discrimination may lessen its impact on health disparities.
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