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Spada R, Spada N, Seon-Spada H. Geographic disparities persist despite decline in mortality from IHD in California's Central Valley 1999-2014. JRSM Cardiovasc Dis 2019; 8:2048004019866320. [PMID: 31391939 PMCID: PMC6669834 DOI: 10.1177/2048004019866320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/11/2019] [Accepted: 07/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nationally, ischemic heart disease mortality has declined significantly due to advancements in managing traditional risk factors of hypertension, diabetes, hyperlipidemia, smoking, and obesity and acute intervention. However geographic disparities persist that may, in part, be attributed to environmental effects. METHODS Ischemic heart disease age-adjusted mortality were obtained from the CDC database for years 1999 through 2014 by county, gender, race, and Hispanic origin for the Central Valley of California. RESULTS There was an increase in mortality from north to south of 14.9 (95% CI: 8.0-21.9, p value <0.0001) in time period 1, 7.9 (95% CI: 0.8-15, p value <0.05) in time period 2, and 9.2 (95% CI: 4.0-14.3, p value <0.001) in time period 3. In time period 1, the ambient particulate matter ≤2.5 micrometers (PM2.5) level increased from north to south by 0.84 µg/m³ (95% CI: 0.71-0.96), in time period 2 there was a 0.87 µg/m³ increase (95% CI: 0.74-1.0), and a 1.0 µg/m³ increase in time period 3 (95% CI: 0.87-1.1). PM2.5 level was correlated to IHD mortality in all time periods (Period 1 r2 = 0.46, p = 0.0001; Period 2, r2 = 0.34, p = 0.008; Period 3 r2 = 0.51, p value <0.0001). CONCLUSION Continued declines in ischemic heart disease mortality will depend on the concerted efforts of clinicians in continuing management of the traditional risk factors with appropriate medication use, acute interventions for coronary syndromes, the necessity of patient self-management of high risk behaviors associated with smoking and obesity, and the development of coordinated actions with policy makers to reduce environmental exposure in their respective communities.
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Affiliation(s)
- Ralph Spada
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nicholas Spada
- Crocker Nuclear Laboratory, University of California, Davis, CA, USA
| | - Hyosim Seon-Spada
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
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Schultz ASH, Dahl L, McGibbon E, Brownlie RJ, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Fransoo R. Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients. BMJ Open 2018; 8:e020856. [PMID: 29581209 PMCID: PMC5875607 DOI: 10.1136/bmjopen-2017-020856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. SETTING Population-based, secondary analysis of provincial administrative health data. PARTICIPANTS All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). RESULTS FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lindsey Dahl
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - R Jarvis Brownlie
- Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Cook
- Indigenous Health, Rady Faculty of Health Sciences (RFHS), First Nations, Métis and Inuit Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basem Elbarouni
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jo Ann Sawatzky
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Throndson
- Clinical Nurse Specialist Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
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Schmittdiel JA, Steiner JF, Adams AS, Dyer W, Beals J, Henderson WG, Desai J, Morales LS, Nichols GA, Lawrence JM, Waitzfelder B, Butler MG, Pathak RD, Hamman RF, Manson SM. Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) Study. BMJ Open Diabetes Res Care 2014; 2:e000043. [PMID: 25452877 PMCID: PMC4246918 DOI: 10.1136/bmjdrc-2014-000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/23/2014] [Accepted: 10/14/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare cardiovascular disease risk factor testing rates and intermediate outcomes of care between American Indian/Alaska Native (AI/AN) patients with diabetes and non-Hispanic Caucasians enrolled in nine commercial integrated delivery systems in the USA. RESEARCH DESIGN AND METHODS We used modified Poisson regression models to compare the annual testing rates and risk factor control levels for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP); number of unique diabetes drug classes; insulin use; and oral diabetes drug medication adherence between insured AI/AN and non-Hispanic white adults with diabetes aged ≥18 in 2011. RESULTS 5831 AI/AN patients (1.8% of the cohort) met inclusion criteria. After adjusting for age, gender, comorbidities, insulin use, and geocoded socioeconomic status, AI/AN patients had similar rates of annual HbA1c, LDL-C, and SBP testing, and LDL-C and SBP control, compared with non-Hispanic Caucasians. However, AI/AN patients were significantly more likely to have HbA1c >9% (>74.9 mmol/mol; RR=1.47, 95% CI 1.38 to 1.58), and significantly less likely to adhere to their oral diabetes medications (RR=0.90, 95% CI 0.88 to 0.93) compared with non-Hispanic Caucasians. CONCLUSIONS AI/AN patients in commercial integrated delivery systems have similar blood pressure and cholesterol testing and control, but significantly lower rates of HbA1c control and diabetes medication adherence, compared with non-Hispanic Caucasians. As more AI/ANs move to urban and suburban settings, clinicians and health plans should focus on addressing disparities in diabetes care and outcomes in this population.
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Affiliation(s)
- Julie A Schmittdiel
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado , Denver, Colorado , USA
| | - Alyce S Adams
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - Wendy Dyer
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - William G Henderson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - Jay Desai
- HealthPartners Institute for Education and Research , Minneapolis, Minnesota , USA
| | - Leo S Morales
- Group Health Research Institute , Seattle, Washington , USA
| | - Gregory A Nichols
- Kaiser Permanente Center for Health Research , Portland, Oregon , USA
| | - Jean M Lawrence
- Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA
| | | | - Melissa G Butler
- Kaiser Permanente Georgia Center for Health Research-Southeast , Atlanta , Georgia , USA
| | | | - Richard F Hamman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
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Moore K, Jiang L, Manson SM, Beals J, Henderson W, Pratte K, Acton KJ, Roubideaux Y. Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project. Am J Public Health 2014; 104:e158-64. [PMID: 25211728 DOI: 10.2105/ajph.2014.302108] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. METHODS Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. RESULTS A1c levels decreased an average of 0.2% (P < .001). Systolic and diastolic blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels decreased, with the largest significant reduction in LDL cholesterol (∆ = -5.29 mg/dL; P < .001). Average Framingham CHD risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. CONCLUSIONS SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts.
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Affiliation(s)
- Kelly Moore
- Kelly Moore, Spero M. Manson, Janette Beals, William Henderson, and Katherine Pratte are with the Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Denver, Aurora. Luohua Jiang is with the Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station. Kelly J. Acton is with the Office of the Assistant Secretary of Health, US Department of Health and Human Services, San Francisco, CA. Yvette Roubideaux is with the Office of the Director, Indian Health Service (IHS), Rockville, MD
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Davis LA, Mann A, Cannon GW, Mikuls TR, Reimold AM, Caplan L. Validation of Diagnostic and Procedural Codes for Identification of Acute Cardiovascular Events in US Veterans with Rheumatoid Arthritis. EGEMS 2014; 1:1023. [PMID: 25848582 PMCID: PMC4371488 DOI: 10.13063/2327-9214.1023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To assess the accuracy of International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes for identifying cardiovascular (CV) events (myocardial infarction [MI], stroke, coronary artery bypass graft [CABG], and percutaneous coronary intervention [PCI]) in enrollees of the Veterans Affairs Rheumatoid Arthritis (VARA) registry. Design: We performed a validation study from VARA enrollment until 6/1/2010 to compare the accuracy of CV events in those with and without CV-event coding in inpatient and outpatient records to evaluate for CV events +/− 3 months of the coding. The positive predictive value (PPV) was calculated, and codes with a PPV ≥50% were included in a composite coding algorithm. Results: We evaluated 107 individuals for 21 CV-event codes and 60 individuals without CV-event coding. The PPV varied between 0–100%. Composite coding algorithms’ PPV ranged from 70–100%. Conclusions: Validation of these algorithms allows for identification of acute CV events with known accuracy. The sensitivity and PPV of coding algorithms for CABG and PCI exceed that of stroke and MI.
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Affiliation(s)
- Lisa A Davis
- Denver Health and Hospital Authority ; Denver Veterans Affairs Medical Center (VAMC) ; University of Colorado School of Medicine
| | - Alyse Mann
- Denver Veterans Affairs Medical Center (VAMC)
| | | | - Ted R Mikuls
- Omaha VAMC and University of Nebraska Medical Center
| | | | - Liron Caplan
- Denver Veterans Affairs Medical Center (VAMC) ; University of Colorado School of Medicine
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Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples. Can J Cardiol 2013; 29:1629-36. [PMID: 23988340 DOI: 10.1016/j.cjca.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals. METHODS All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events. RESULTS CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals. CONCLUSIONS Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Best LG, Butt A, Conroy B, Devereux RB, Galloway JM, Jolly S, Lee ET, Silverman A, Yeh JL, Welty TK, Kedan I. Acute myocardial infarction quality of care: the Strong Heart Study. Ethn Dis 2011; 21:294-300. [PMID: 21942161 PMCID: PMC4151497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. DESIGN Case series. SETTING The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. PARTICIPANTS Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. OUTCOME MEASURES The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. RESULTS The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. CONCLUSION Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort.
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Affiliation(s)
- Lyle G Best
- Missouri Breaks Industries Research Inc., Timber Lake, South Dakota, USA.
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Brega AG, Noe T, Loudhawk-Hedgepeth C, Jim DM, Morse B, Moore K, Manson SM. Cardiovascular knowledge among urban American Indians and Alaska Natives: first steps in addressing cardiovascular health. Prog Community Health Partnersh 2011; 5:273-9. [PMID: 22080775 PMCID: PMC4443442 DOI: 10.1353/cpr.2011.0042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is common among American Indians/Alaska Natives (AI/ANs). Given limited access to health care, urban AI/ANs may be at particular risk. Lack of available data, however, limits our understanding of cardiovascular health in this population. OBJECTIVES We conducted a survey to characterize CVD-related knowledge, behavior, and risk of urban AI/ANs. Results related to knowledge are reported. METHODS In collaboration with the Indian clinics in two urban communities, we surveyed 298 AI/ANs. RESULTS Respondents recognized approximately half of the symptoms of heart attack and stroke, and were significantly less likely to recognize each symptom than reported in national studies using the same items. General CVD knowledge (e.g., risks of high blood pressure) was stronger, although areas for improvement were noted. CONCLUSIONS Urban AI/ANs would benefit from efforts to enhance CVD knowledge. These preliminary data are providing the foundation for community-based efforts to address CVD risk among urban AI/ANs.
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Affiliation(s)
- Angela G Brega
- Center for American Indian and Alaska Native Health, Colorado School of Public Health, University of Corolado Denver, USA
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