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Jones GM, Ricard JA, Nock MK. Race and ethnicity moderate the associations between lifetime psilocybin use and past year hypertension. Front Psychiatry 2024; 15:1169686. [PMID: 38979507 PMCID: PMC11228763 DOI: 10.3389/fpsyt.2024.1169686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/09/2024] [Indexed: 07/10/2024] Open
Abstract
Background Hypertension is a major source of morbidity and mortality worldwide, particularly for racial and ethnic minorities who face higher rates of hypertension and worse health-related outcomes. Recent research has reported on protective associations between classic psychedelics and hypertension; however, there is a need to explore how race and ethnicity may moderate such associations. Methods We used data from the National Survey on Drug Use and Health (2005-2014) to assess whether race and ethnicity moderate the associations between classic psychedelic use - specifically psilocybin - and past year hypertension. Results Hispanic identity moderated the associations between psilocybin use and past year hypertension. Furthermore, individuals who used psilocybin and identified as Non-Hispanic White had reduced odds of hypertension (aOR: 0.83); however, these associations were not observed for any other racial or ethnic groups in our study for individuals who used psilocybin. Conclusion Overall, our results demonstrate that the associations between psychedelics and hypertension may vary by race and ethnicity. Longitudinal studies and clinical trials can further advance this research and determine whether such differences exist in causal contexts. Project registration https://osf.io/xsz2p/?view_only=0bf7b56749034c18abb2a3f8d3d4bc0b.
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Affiliation(s)
- Grant M Jones
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Jocelyn A Ricard
- Department of Neuroscience, Stanford University, Stanford, CA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Gago C, De Leon E, Mandal S, de la Calle F, Garcia M, Colella D, Dapkins I, Schoenthaler A. "Hypertension is such a difficult disease to manage": federally qualified health center staff- and leadership-perceived readiness to implement a technology-facilitated team-based hypertension model. Implement Sci Commun 2024; 5:49. [PMID: 38698497 PMCID: PMC11067286 DOI: 10.1186/s43058-024-00587-8] [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: 07/27/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Despite decades of evidence demonstrating the efficacy of hypertension care delivery in reducing morbidity and mortality, a majority of hypertension cases remain uncontrolled. There is an urgent need to elucidate and address multilevel facilitators and barriers clinical staff face in delivering evidence-based hypertension care, patients face in accessing it, and clinical systems face in sustaining it. Through a rigorous pre-implementation evaluation, we aimed to identify facilitators and barriers bearing the potential to affect the planned implementation of a multilevel technology-facilitated hypertension management trial across six primary care sites in a large federally qualified health center (FQHC) in New York City. METHODS During a dedicated pre-implementation period (3-9 months/site, 2021-2022), a capacity assessment was conducted by trained practice facilitators, including (1) online anonymous surveys (n = 124; 70.5% of eligible), (2) hypertension training analytics (n = 69; 94.5% of assigned), and (3) audio-recorded semi-structured interviews (n = 67; 48.6% of eligible) with FQHC leadership and staff. Surveys measured staff sociodemographic characteristics, adaptive reserve, evidence-based practice attitudes, and implementation leadership scores via validated scales. Training analytics, derived from end-of-course quizzes, included mean score and number attempts needed to pass. Interviews assessed staff-reported facilitators and barriers to current hypertension care delivery and uptake; following audio transcription, trained qualitative researchers employed a deductive coding approach, informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS Most survey respondents reported moderate adaptive reserve (mean = 0.7, range = 0-1), evidence-based practice attitudes (mean = 2.7, range = 0-4), and implementation leadership (mean = 2.5, range = 0-4). Most staff passed training courses on first attempt and demonstrated high scores (means > 80%). Findings from interviews identified potential facilitators and barriers to implementation; specifically, staff reported that complex barriers to hypertension care, control, and clinical communication exist; there is a recognized need to improve hypertension care; in-clinic challenges with digital tool access imposes workflow delays; and despite high patient loads, staff are motivated to provide high-quality cares. CONCLUSIONS This study serves as one of the first to apply the CFIR to a rigorous pre-implementation evaluation within the understudied context of a FQHC and can serve as a model for similar trials seeking to identify and address contextual factors known to impact implementation success. TRIAL REGISTRATION ClinicalTrials.gov NCT03713515 , date of registration: October 19, 2018.
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Affiliation(s)
- Cristina Gago
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Elaine De Leon
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Soumik Mandal
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Franze de la Calle
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Masiel Garcia
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | | | - Isaac Dapkins
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
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Formagini T, Brooks JV, Roberts A, Bullard KM, Zhang Y, Saelee R, O'Brien MJ. Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults. Front Public Health 2023; 11:1277657. [PMID: 38164446 PMCID: PMC10758124 DOI: 10.3389/fpubh.2023.1277657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment. Methods This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as "aware" or "unaware" based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics. Results In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]). Discussion Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.
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Affiliation(s)
- Taynara Formagini
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- University of Kansas Cancer Center, Kansas City, KS, United States
- Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Andrew Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- Aetion Inc., New York, NY, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Ryan Saelee
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Matthew James O'Brien
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Davis KM, Knauft K, Lewis L, Petriello M, Petrick L, Luca F, Joseph NT, Fritz H, Cutchin M, Rappaport L, Levy P, Engeland CG, Zilioli S. The heart of Detroit study: a window into urban middle-aged and older African Americans' daily lives to understand psychosocial determinants of cardiovascular disease risk. BMC Psychiatry 2023; 23:766. [PMID: 37853373 PMCID: PMC10585810 DOI: 10.1186/s12888-023-05148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Cardiovascular disease disproportionately affects African Americans. Psychosocial factors, including the experience of and emotional reactivity to racism and interpersonal stressors, contribute to the etiology and progression of cardiovascular disease through effects on health behaviors, stress-responsive neuroendocrine axes, and immune processes. The full pathway and complexities of these associations remain underexamined in African Americans. The Heart of Detroit Study aims to identify and model the biopsychosocial pathways that influence cardiovascular disease risk in a sample of urban middle-aged and older African American adults. METHODS The proposed sample will be composed of 500 African American adults between the ages of 55 and 75 from the Detroit urban area. This longitudinal study will consist of two waves of data collection, two years apart. Biomarkers of stress, inflammation, and cardiovascular surrogate endpoints (i.e., heart rate variability and blood pressure) will be collected at each wave. Ecological momentary assessments will characterize momentary and daily experiences of stress, affect, and health behaviors during the first wave. A proposed subsample of 60 individuals will also complete an in-depth qualitative interview to contextualize quantitative results. The central hypothesis of this project is that interpersonal stressors predict poor cardiovascular outcomes, cumulative physiological stress, poor sleep, and inflammation by altering daily affect, daily health behaviors, and daily physiological stress. DISCUSSION This study will provide insight into the biopsychosocial pathways through which experiences of stress and discrimination increase cardiovascular disease risk over micro and macro time scales among urban African American adults. Its discoveries will guide the design of future contextualized, time-sensitive, and culturally tailored behavioral interventions to reduce racial disparities in cardiovascular disease risk.
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Affiliation(s)
- Kristin M Davis
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, Detroit, MI, 48202, USA
| | - Katherine Knauft
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, Detroit, MI, 48202, USA
| | - Lena Lewis
- College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Michael Petriello
- Institute of Environmental Health Sciences, Department of Pharmacology, Wayne State University, Detroit, MI, 48201, USA
| | - Lauren Petrick
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Francesca Luca
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA
| | - Nataria T Joseph
- Department of Psychology, Pepperdine University, Malibu, CA, 90265, USA
| | - Heather Fritz
- School of Occupational Therapy, Pacific Northwest University of Health Sciences, Yakima, WA, 98901, USA
| | - Malcolm Cutchin
- School of Occupational Therapy, Pacific Northwest University of Health Sciences, Yakima, WA, 98901, USA
| | - Lance Rappaport
- Department of Psychology, University of Windsor, Windsor, ON, N9B 1B4, Canada
| | - Phillip Levy
- Departments of Emergency Medicine and Physiology, Wayne State University, Detroit, MI, 48201, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, 16802, USA
| | - Samuele Zilioli
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, Detroit, MI, 48202, USA.
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48201, USA.
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Vriz O, Mushtaq AH, Elshaer AN, Shaik A, Landi I, Alzahrani T. Takotsubo Syndrome in Black Americans: Insights From the National Inpatient Sample. Tex Heart Inst J 2023; 50:e228055. [PMID: 37853912 PMCID: PMC10658156 DOI: 10.14503/thij-22-8055] [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: 10/20/2023]
Abstract
BACKGROUND Data on race-related differences in the clinical outcomes of Takotsubo syndrome are limited, particularly for Black patients. This study aimed to assess whether race and sex may have an additional impact on the inpatient mortality of patients with Takotsubo syndrome. METHODS A total of 4,628 patients from the United States' National Inpatient Sample from 2012 to 2016 were identified; propensity score analysis revealed a similar propensity score between Black patients (n = 2,314) and White patients (n = 2,314), which was used to balance observed covariates. Sex and age distributions were identical between the 2 groups. The groups were also similar in baseline characteristics, including cardiovascular risk factors. White patients were compared with Black patients on in-hospital outcomes and inpatient mortality. A logistic regression analysis was conducted to measure the difference in mortality based on race and sex. RESULTS Compared with White patients, Black patients had a higher percentage of in-hospital complications, including cerebrovascular accidents (4.9% vs 2.5%, P ≤ .01), acute kidney injury (25% vs 19%, P ≤ .01); longer lengths of stay (8 vs 7 days, P ≤ .01); and higher inpatient mortality (6.1% vs 4.5%, P < .01). When analysis was conducted with race and sex combined, inpatient mortality was higher among Black men than among White women (odds ratio, 2.7 [95% CI, 1.80-3.95]; P ≤ .01). CONCLUSION This study showed that Black patients with Takotsubo syndrome have higher in-hospital complications and inpatient mortality rates. When race and sex were combined, inpatient mortality was significantly higher among Black men than among either White men and women or Black women.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Cardiology and Sport Medicine, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Ali Hassan Mushtaq
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed Nahid Elshaer
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Talal Alzahrani
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
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6
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Ullah S, Khan S, Bazargan-Hejazi S, Ramirez E, Teklehaimanot S, Diab S, Bangash M, Shaheen M. Use and outcomes of antihypertensive medication treatment in the US hypertensive population: A gender comparison. Health Promot Perspect 2023; 13:140-146. [PMID: 37600544 PMCID: PMC10439450 DOI: 10.34172/hpp.2023.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although effective antihypertensive medications have existed for decades, only about half of the hypertensive individuals are considered to have controlled blood pressure. Limited research studies have investigated gender disparity in the utilization and effectiveness of antihypertensive medications treatment. To examine the gender difference in antihypertensive medications' use and the effect of using antihypertensive medication treatment on blood pressure control among the U.S. adult with hypertension. Methods Analysis of National Health and Nutrition Examination Survey (NHANES) data from (1999-2012) including individuals≥18 years old with hypertension. Study variables included gender, age, race/ethnicity, obesity, smoking, comorbidities, treatment medication type, and continuity of care. We used multivariate logistic regression in STATA V14. The data is presented as adjusted odds ratios (ORs) and 95% confidence interval (CI). Results Of the 15719 participants, 52% were female. 49% of the antihypertensive medication users had their blood pressure under control (95% CI). In the adjusted logistic regression analysis, use of antihypertensive medications was found to be 12% greater in females as compared to males (OR=1.12; CI=1.02-1.22; P<0.05). No association between gender and blood pressure control was found. Blood pressure control was less likely achieved among 50 years or younger individuals, Blacks and Hispanics, obese, and those taking calcium channel blocker (CCB). Conclusion Hypertensive females are more likely than males to use antihypertensive medications. The effectiveness of treatment to control blood pressure is equal across males and females. Our findings have implications for practitioners to account gender-specific approaches when discussing adherence to hypertension medication treatment with their patients.
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Affiliation(s)
- Shakir Ullah
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Shahbaz Khan
- Ayub Medical College and Teaching Hospital, Abbottabad, Pakistan
| | - Shahrzad Bazargan-Hejazi
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Ernesto Ramirez
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Senait Teklehaimanot
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Sara Diab
- University of California, Irvine, CA, USA
| | - Maria Bangash
- Southern California University of Health and Sciences, CA, USA
| | - Magda Shaheen
- Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science and David Geffen School of Medicine, University of California at Los Angeles, CA, USA
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7
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Blecker S, Gannon M, De Leon S, Shelley D, Wu WY, Tabaei B, Magno J, Pham-Singer H. Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial. Contemp Clin Trials 2023; 129:107177. [PMID: 37037392 PMCID: PMC10871131 DOI: 10.1016/j.cct.2023.107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Only half of patients with hypertension have adequately controlled blood pressure. Clinical decision support (CDS) has the potential to overcome barriers to delivering guideline-recommended care and improve hypertension management. However, optimal strategies for scaling CDS have not been well established, particularly in small, independent primary care practices which often lack the resources to effectively change practice routines. Practice facilitation is an implementation strategy that has been shown to support process changes. Our objective is to evaluate whether practice facilitation provided with hypertension-focused CDS can lead to improvements in blood pressure control for patients seen in small primary care practices. METHODS/DESIGN We will conduct a cluster randomized control trial to compare the effect of hypertension-focused CDS plus practice facilitation on BP control, as compared to CDS alone. The practice facilitation intervention will include an initial training in the CDS and a review of current guidelines along with follow-up for coaching and integration support. We will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. All patients with hypertension seen at these practices will be included in the evaluation. We will also assess implementation of CDS in all practices and practice facilitation in the intervention group. DISCUSSION The results of this study will inform optimal implementation of CDS into small primary care practices, where much of care delivery occurs in the U.S. Additionally, our assessment of barriers and facilitators to implementation will support future scaling of the intervention. CLINICALTRIALS gov Identifier: NCT05588466.
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Affiliation(s)
- Saul Blecker
- NYU Grossman School of Medicine, New York, NY, United States of America.
| | - Matthew Gannon
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Samantha De Leon
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Donna Shelley
- NYU School of Global Public Health, New York, NY, United States of America
| | - Winfred Y Wu
- University of Miami - Miller School of Medicine, Miami, FL, United States of America
| | - Bahman Tabaei
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Janice Magno
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Hang Pham-Singer
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
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8
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Arafa A, Kashima R, Kokubo Y. New 2019 JSH guidelines and the risk of incident cardiovascular disease: The Suita Study. Hypertens Res 2023; 46:583-588. [PMID: 36564587 DOI: 10.1038/s41440-022-01142-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Hypertension is the most critical risk factor for cardiovascular disease (CVD). Since the definition of hypertension varies across guidelines, identifying blood pressure (BP) categories that should be targeted to prevent CVD is needed. Herein, we investigated the association between BP per the 2019 Japanese Society of Hypertension (JSH) guidelines and the risk of CVD, stroke, and coronary heart disease (CHD) using data from 7,643 participants (30-84 years) registered in the Suita Study. Within 113,838 person-years (16.6 median years of follow-up), 690 participants developed CVD (411 cases of stroke and 279 cases of CHD). Compared to normal BP (Systolic BP (SBP) < 120 and diastolic BP (DBP) < 80 mmHg), elevated BP (SBP 130-139 and/or DBP 80-89 mmHg) and hypertension (SBP ≥ 140 and/or DBP ≥ 90 mmHg) were associated with a higher risk of CVD, stroke, and CHD. High-normal BP (SBP 120-129 and DBP < 80 mmHg) was associated with a higher risk of CVD and CHD. In conclusion, CVD preventive interventions should begin at lower BP levels than those applied in the 2019 JSH guidelines.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan. .,Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Cardiovascular Pathophysiology and Therapeutics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
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Identifying the Social Determinants of Treated Hypertension in New and Established Latino Destination States. J Immigr Minor Health 2023; 25:50-61. [PMID: 35794448 DOI: 10.1007/s10903-022-01376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/09/2023]
Abstract
Little is known about the influence of social and environmental contexts on Latino hypertension-related disparities. This study examined the influence of social determinants of cardiovascular health on medically treated hypertension, contrasting established vs. new Latino destination states. Logistic regression models were fitted to analyze 2017 Behavioral Risk Factors Surveillance Survey data from 8,999 Latinos. Overall, 70.4% indicated having treated hypertension. History of diabetes (OR = 2.60) and access to healthcare (OR = 2.38) were associated with treated hypertension, regardless of destination state. In established destinations, Latinos who graduated high school (OR = 1.19) or attended college (OR = 1.32) had higher odds of treated hypertension; whereas those who completed college were less likely to have treated hypertension (OR = 0.80). In contrast, in both new and non-destination states, the odds of treated hypertension were consistently lower across levels of educational attainment. Results highlight the need for cardiovascular-risk reduction interventions to incorporate the social and environmental context in the development process.
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Kamin Mukaz D, Guo B, Long DL, Judd SE, Plante TB, McClure LA, Wolberg AS, Zakai NA, Howard G, Cushman M. D-dimer and the risk of hypertension: The REasons for Geographic And Racial Differences in Stroke Cohort Study. Res Pract Thromb Haemost 2023; 7:100016. [PMID: 36760775 PMCID: PMC9903654 DOI: 10.1016/j.rpth.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/17/2022] [Indexed: 01/21/2023] Open
Abstract
Background Reasons for increased risk of hypertension in Black compared with White people are only partly understood. D-dimer, a thrombo-inflammatory marker higher in Black individuals, is also higher in people with hypertension. However, the impact of D-dimer on racial disparities in risk of incident hypertension has not been studied. Objectives To assess whether D-dimer is associated with the risk of incident hypertension, whether the association between D-dimer and the risk of incident hypertension differs by race, and whether the biology reflected by D-dimer explains racial disparities in the risk of incident hypertension. Methods This study included 1867 participants in the REasons for Geographic And Racial Differences in Stroke cohort study without baseline hypertension and with a second visit 9.4 years after baseline. Risk ratios of incident hypertension by baseline D-dimer level were estimated, a D-dimer-by-race interaction was tested, and the mediating effect of D-dimer (which represents underlying biological processes) on the association of race and hypertension risk was assessed. Results The risk of incident hypertension was 47% higher in persons in the top quartile than in those in the bottom quartile of D-dimer (risk ratio [RR]: 1.47; 95% CI: 1.23-1.76). The association was partly attenuated after adjusting for sociodemographic and adiposity-related risk factors (RR: 1.22; 95% CI: 1.02-1.47). The association of D-dimer and hypertension did not differ by race, and D-dimer did not attenuate the racial difference in the risk of incident hypertension. Conclusion D-dimer concentration reflects pathophysiology related to the development of hypertension. Specific mechanisms require further study and may involve adiposity.
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Affiliation(s)
- Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Boyi Guo
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Timothy B. Plante
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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11
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Nichols OI, Fuller-Rowell TE, Robinson AT, Eugene D, Homandberg LK. Neighborhood Socioeconomic Deprivation in Early Childhood Mediates Racial Disparities in Blood Pressure in a College Student Sample. J Youth Adolesc 2022; 51:2146-2160. [PMID: 35852667 PMCID: PMC9744188 DOI: 10.1007/s10964-022-01658-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
The influence of childhood contexts on adult blood pressure is an important yet understudied topic. Using a developmental perspective, this study examines the association between neighborhood socioeconomic disadvantage in early childhood (0-5 yrs), middle childhood (6-12 yrs) and adolescence (13-18 yrs) on subsequent blood pressure in young adulthood. Data were from 263 college students (52% Black; Mage = 19.21 years) and neighborhood socioeconomic disadvantage was measured using a tract-level Area Deprivation Index. Neighborhood disadvantage in early childhood was significantly associated with diastolic blood pressure and explained 22% of the race difference between Black and White adults. The findings are consistent with the notion that early childhood may be a sensitive period for the effects of neighborhood disadvantage on blood pressure.
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Affiliation(s)
- Olivia I Nichols
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA.
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA
| | - Austin T Robinson
- School of Kinesiology, Auburn University, 301 Wire Road, Auburn, AL, 36849, USA
| | - DaJuandra Eugene
- Center for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Lydia K Homandberg
- Sociology Department, Cornell University, 323 Uris Hall, Ithaca, NY, 14853, USA
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12
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Kianoush S, Al Rifai M, Merchant AT, Jia X, Samad Z, Bhalla A, Khan A, Zhu D, Virani S. Heterogeneity in the prevalence of premature hypertension among Asian American populations compared with white individuals: A National Health Interview Survey study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200147. [PMID: 36039164 PMCID: PMC9418798 DOI: 10.1016/j.ijcrp.2022.200147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
Background Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations. Methods We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and 'other Asians' (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (age <50 years old). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease. Results We studied 99,864 participants with history of hypertension (mean age, 59.3 ± 0.1; 50% women, 90% US born). Asian Indians had higher prevalence of premature hypertension (37%) compared with Filipinos (27%), 'other Asians' (26%), Whites (25%), and Chinese (21%). Compared with Whites, Chinese individuals had lower odds of premature hypertension (aOR = 0.79, 0.63-0.98), but Asian Indians had higher odds (aOR = 1.85, 1.48-2.31). Compared with Chinese, odds of premature hypertension was higher for Asian Indians (aOR = 2.39, 1.74-3.27), Filipinos (aOR = 1.53, 1.16-2.04), and 'other Asians' (OR = 1.32, 1.03-1.70; aOR = 1.59, 1.20-2.10). Overall prevalence of hypertension was lower among Asian Indians (aOR = 0.52, 0.46-0.58) and 'other Asians' (aOR = 0.74, 0.68-0.79) compared with Whites. Conclusions There is heterogeneity in the risk of hypertension across Asian Americans by age. Asian Indians and 'other Asians' had higher prevalence of premature hypertension and lower prevalence of overall hypertension, which may call for earlier screening for risk factors among these populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan Aga Khan University, Karachi, Pakistan
| | - Aneil Bhalla
- Section of Cardiovascular Medicine, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ayesha Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan Aga Khan University, Karachi, Pakistan
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Salim Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX, USA
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13
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Fernandez JR, Montiel Ishino FA, Williams F, Slopen N, Forde AT. Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis. J Am Heart Assoc 2022; 11:e024594. [PMID: 35699190 PMCID: PMC9238649 DOI: 10.1161/jaha.121.024594] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time. Methods and Results Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively). Conclusions Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.
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Affiliation(s)
- Jessica R. Fernandez
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Francisco A. Montiel Ishino
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Faustine Williams
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Natalie Slopen
- Department of Social and Behavioral SciencesHarvard University T. H. Chan School of Public HealthBostonMA
| | - Allana T. Forde
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
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Kho A, Daumit GL, Truesdale KP, Brown A, Kilbourne AM, Ladapo J, Wali S, Cicutto L, Matthews AK, Smith JD, Davis PD, Schoenthaler A, Ogedegbe G, Islam N, Mills KT, He J, Watson KS, Winn RA, Stevens J, Huebschmann AG, Szefler SJ. The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance. Health Serv Res 2022; 57 Suppl 1:20-31. [PMID: 35383917 PMCID: PMC9108215 DOI: 10.1111/1475-6773.13983] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease. STUDY SETTING NHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma. STUDY DESIGN The initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration. CONCLUSIONS The DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.
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Affiliation(s)
- Abel Kho
- Center for Health Information Partnerships (CHiP)Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly P. Truesdale
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Arleen Brown
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Amy M. Kilbourne
- Department of Learning Health SciencesUniversity of Michigan MedicineAnn ArborMichiganUSA
- Quality Enhancement Research Initiative (QUERI)U.S. Department of Veterans AffairsWashington, D.C.USA
| | - Joseph Ladapo
- Department of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Soma Wali
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Lisa Cicutto
- Department of MedicineNational Jewish Health, Community Outreach and ResearchDenverColoradoUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Paris D. Davis
- Total Resource Community Development OrganizationNorthwestern UniversityChicagoIllinoisUSA
| | - Antoinette Schoenthaler
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Gbenga Ogedegbe
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Nadia Islam
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Katherine T. Mills
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Karriem S. Watson
- NIH All of Us Bethesda, MD; FormerlyUniversity of Illinois in Chicago Hospital and Health Sciences System, Mile Square Health Center ChicagoIllinoisUSA
| | - Robert A. Winn
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Amy G. Huebschmann
- Department of Medicine, Division of General Internal MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Stanley J. Szefler
- Department of PediatricsUniversity of Colorado Denver School of MedicineDenverColoradoUSA
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15
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Sun S, Goldberg SB, Loucks EB, Brewer JA. Mindfulness-based interventions among people of color: A systematic review and meta-analysis. Psychother Res 2022; 32:277-290. [PMID: 34098859 PMCID: PMC8648858 DOI: 10.1080/10503307.2021.1937369] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
Objective In the United States, people of color (POC) are disproportionately affected by various sources of stress and prevalent mental and physical health issues that may benefit from Mindfulness-based Interventions (MBIs). However, effects of MBIs for POC are unclear. This meta-analysis examines the efficacy of MBIs through randomized controlled trials (RCTs) that included predominately POC (≥75% of the sample). Method: Random effects models were used to synthesize effect sizes. A total of 24 RCT samples were analyzed. Results: Samples were on average 94.4% POC and predominantly from low-income backgrounds (total N = 2,156). At post-treatment, MBIs yielded small but statistically superior outcomes to active controls (Hedges' g = 0.11) and inactive controls (g = 0.26). Compared to active controls, MBIs' effects on well-being were smaller than their effects on other outcome types. Compared to inactive controls, MBIs that focused on non-clinical populations and had higher proportion of POC had larger effect sizes. Attrition rates of MBIs did not differ from other active conditions in outpatient settings. Conclusion: Findings provide modest, preliminary empirical support for MBIs among POC. We discuss main findings, limitations, and implications for future MBI research for health promotion among POC.
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Affiliation(s)
- Shufang Sun
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
| | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric B. Loucks
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
| | - Judson A. Brewer
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Mindfulness Center, Brown University, Providence, RI, USA
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16
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Dougherty EC, Burse N, Butzner M, Wu H, Stuckey HL, Allison JJ, Cuffee YL. Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study. Pilot Feasibility Stud 2021; 7:209. [PMID: 34809710 PMCID: PMC8607626 DOI: 10.1186/s40814-021-00930-z] [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: 01/07/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. Methods In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. Results Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. Conclusion This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.
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Affiliation(s)
- Emily C Dougherty
- General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Natasha Burse
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Michael Butzner
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Hongke Wu
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Heather L Stuckey
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Jeroan J Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA
| | - Yendelela L Cuffee
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, DE, USA.
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17
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Alnakhi WK, Mamdouh H, Hussain HY, Ibrahim GM, Ahmad AS, Ali R, Abdulle A. The Socio-Demographic Characteristics Associated with Non-Communicable Diseases among the Adult Population of Dubai: Results from Dubai Household Survey 2019. Healthcare (Basel) 2021; 9:1139. [PMID: 34574913 PMCID: PMC8471096 DOI: 10.3390/healthcare9091139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and the sociodemographic characteristics among the adult population of Dubai. METHODS The study used secondary data from the Dubai Household Health Survey (DHHS), 2019. DHHS is a cross-sectional complex design, stratified by geographic area, and uses multistage probability sampling. In this survey, 2247 families were interviewed and only adults aged 18+ were included for the analysis. The quasi-binomial distribution was used to identify the socio-demographic characteristics association with NCDs. RESULTS The prevalence of NCDs among the adult population of Dubai was 15.01%. Individuals aged 60+, local Arabs (Emirati), divorced and widowed individuals, and individuals who were not currently working reported NCDs more than the other groups. In the regression analysis, the association with NCDs were reported among elderly people, males, unmarried individuals, older individuals who are unmarried, and Emiratis. CONCLUSION The study identified several socio-demographic characteristics associated with reporting NCDs. This is one of the few studies related to NCDs in Dubai. Allocating appropriate resources to the population groups identified is crucial to reduce the incidence of NCDs in the Emirate.
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Affiliation(s)
- Wafa K. Alnakhi
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Heba Mamdouh
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Hamid Y. Hussain
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
| | - Gamal M. Ibrahim
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- High Institute for Management Sciences, Belqas 35631, Egypt
| | - Amar Sabri Ahmad
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
| | - Raghib Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
| | - Abdishakur Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
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18
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Osakwe ZT, Barrón Y, McDonald MV, Feldman PH. Effect of Nurse Practitioner Interventions on Hospitalizations in the Community Transitions Intervention Trial. Nurs Res 2021; 70:266-272. [PMID: 34160182 PMCID: PMC8231736 DOI: 10.1097/nnr.0000000000000508] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite improvements in hypertension treatment in the United States, Black and Hispanic individuals experience poor blood pressure control and have worse hypertension-related outcomes compared to Whites. OBJECTIVE The aim of the study was to determine the effect on hospitalization of supplementing usual home care (UHC) with two hypertension-focused transitional care interventions-one deploying nurse practitioners (NPs) and the other NPs plus health coaches. METHODS We examined post hoc the effect of two hypertension-focused NP interventions on hospitalizations in the Community Transitions Intervention trial-a three-arm, randomized controlled trial comparing the effectiveness of (a) UHC with (b) UHC plus a 30-day NP transitional care intervention or (c) UHC plus NP plus 60-day health coach intervention. RESULTS The study comprised 495 participants: mean age = 66 years; 57% female; 70% Black, non-Hispanic; 30% Hispanic. At the 3- and 12-month follow-up, all three groups showed a significant decrease in the average number of hospitalizations compared to baseline. The interventions were not significantly different from UHC. CONCLUSION The results of this post hoc analysis show that, during the study period, decreases in hospitalizations in the intervention groups were comparable to those in UHC, and deploying NPs provided no detectable value added. Future research should focus on testing ways to optimize UHC services.
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Affiliation(s)
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
| | - Penny H. Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
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Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry. Clin Res Cardiol 2021; 111:186-196. [PMID: 34013386 PMCID: PMC8816760 DOI: 10.1007/s00392-021-01857-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/12/2021] [Indexed: 01/08/2023]
Abstract
Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers. Trial Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01947621. Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01857-4.
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20
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Chan GC, Teo BW, Tay JC, Chen C, Cheng H, Wang T, Turana Y, Kario K, Chia Y, Tsoi K, Sogunuru GP, Nailes J. Hypertension in a multi-ethnic Asian population of Singapore. J Clin Hypertens (Greenwich) 2021; 23:522-528. [PMID: 33340436 PMCID: PMC8029544 DOI: 10.1111/jch.14140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/17/2020] [Accepted: 12/05/2020] [Indexed: 12/16/2022]
Abstract
The prevalence of hypertension varies by country and region, but it remains a leading yet modifiable risk factor of cardiovascular disease. There are many factors that contribute to the burden of hypertension in Asia, a region with diverse ethnicity. It has been shown that sociodemographic variability is related to ethnic differences, thereby emphasizing the importance of hypertension screening and educating at-risk or vulnerable groups. In this review, we describe the ethnic differences in genetic variants, dietary choice, and lifestyle habits, as well as its association with sociodemographic differences, hypertension awareness, and treatment control.
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Affiliation(s)
- Gek Cher Chan
- Division of NephrologyDepartment of MedicineNational University HospitalSingapore CitySingapore
| | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineNational University HospitalSingapore CitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Chen‐Huan Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of MedicineNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
| | - Hao‐Min Cheng
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of MedicineNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Department of Medical EducationCenter for Evidence‐based MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Tzung‐Dau Wang
- Division of CardiologyNational Taiwan University HospitalTaipeiTaiwan
| | - Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Kelvin Tsoi
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongHong Kong
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jennifer Nailes
- Department of Preventive and Community MedicineUniversity of the East Ramon Magsaysay Memorial Medical Center IncQuezon CityPhilippines
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21
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Forde AT, Sims M, Muntner P, Lewis T, Onwuka A, Moore K, Diez Roux AV. Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study. Hypertension 2020; 76:715-723. [PMID: 32605388 PMCID: PMC8359680 DOI: 10.1161/hypertensionaha.119.14492] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States. One possible explanation for this disparity is discrimination. Few studies have examined the association between discrimination and incidence of hypertension. We examined whether everyday discrimination, lifetime discrimination, and stress from discrimination were associated with incident hypertension and whether these associations differed by gender, age, discrimination attribution, and coping responses to discrimination among African Americans in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed 2 follow-up study visits from 2005 to 2008 and 2009 to 2013. We used Cox proportional hazards regression to estimate associations of discrimination with incident hypertension. Overall, 52% (n=954) of the participants developed hypertension over the follow-up period. After adjustment for age, gender, socioeconomic status and hypertension risk factors, medium versus low levels of lifetime discrimination (hazard ratio, 1.49 [95% CI, 1.18-1.89]), and high versus low levels of lifetime discrimination (hazard ratio, 1.34 [95% CI, 1.07-1.68]) were associated with a higher incidence of hypertension. No statistically significant interactions with gender, age, attribution, or coping were present. Higher stress from lifetime discrimination was associated with higher hypertension risk after adjustment for demographics (hazard ratio for high versus low, 1.19 [95% CI, 1.01-1.40]), but the association was attenuated after adjustment for hypertension risk factors (hazard ratio, 1.14 [95% CI, 0.97-1.35]). Lifetime discrimination may increase the risk of hypertension in African Americans.
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Affiliation(s)
- Allana T Forde
- From the Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA (A.T.F., K.M., A.V.D.R.)
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (A.T.F)
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS (M.S.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (P.M.)
| | - Tené Lewis
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (T.L.)
| | | | - Kari Moore
- From the Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA (A.T.F., K.M., A.V.D.R.)
| | - Ana V Diez Roux
- From the Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA (A.T.F., K.M., A.V.D.R.)
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22
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Abstract
INTRODUCTION There have been recent mounting concerns regarding multiple reports stating a significantly elevated relative-risk of COVID-19 mortality amongst the Black and Minority Ethnic (BAME) population. An urgent national enquiry investigating the possible reasons for this phenomenon has been issued in the UK. Inflammation is at the forefront of COVID-19 research as disease severity appears to correlate with pro-inflammatory cytokine dysregulation. This narrative review aims to shed light on the novel, pathophysiological role of inflammation in contributing towards the increased COVID-19 mortality risk amongst the BAME population. METHODS Searches in PubMed, Medline, Scopus, medRxiv and Google Scholar were performed to identify articles published in English from inception to 18th June 2020. These databases were searched using keywords including: 'COVID-19' or 'Black and Minority Ethnic' or 'Inflammation'. A narrative review was synthesized using these included articles. RESULTS We suggest a novel pathophysiological mechanism by which acute inflammation from COVID-19 may augment existing chronic inflammation, in order to potentiate a 'cytokine storm' and thus the more severe disease phenotype observed in the BAME population. Obesity, insulin resistance, cardiovascular disease, psychological stress, chronic infections and genetic predispositions are all relevant factors which may be contributing to elevated chronic systemic inflammation amongst the BAME population. CONCLUSION Overall, this review provides early insights and directions for ongoing research regarding the pathophysiological mechanisms that may explain the severe COVID-19 disease phenotype observed amongst the BAME population. We suggest 'personalization' of chronic disease management, which can be used with other interventions, in order to tackle this.
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Affiliation(s)
- Abhinav Vepa
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK.
| | - Joseph P Bae
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
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23
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Juarez PD, Hood DB, Song MA, Ramesh A. Use of an Exposome Approach to Understand the Effects of Exposures From the Natural, Built, and Social Environments on Cardio-Vascular Disease Onset, Progression, and Outcomes. Front Public Health 2020; 8:379. [PMID: 32903514 PMCID: PMC7437454 DOI: 10.3389/fpubh.2020.00379] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments "get under the skin" to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.
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Affiliation(s)
- Paul D Juarez
- Meharry Medical College, Nashville, TN, United States
| | - Darryl B Hood
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Min-Ae Song
- College of Public Health, The Ohio State University, Columbus, OH, United States
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24
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Boykin A, Demirci J, Miller E. Investigating the Relationship Between Fatherhood and Provider Weight-Related Practices and Counseling in Clinical Settings. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:713-718. [PMID: 32646598 PMCID: PMC7369002 DOI: 10.1016/j.jneb.2020.03.002] [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] [Received: 11/14/2019] [Revised: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess whether weight-related practices and counseling between men and their medical providers are associated with the patient's fatherhood status. METHODS Using the 2015-2017 National Survey of Family Growth, logistic regression models were constructed to examine the odds of men being weighed, told a weight status, or referred for nutrition/exercise counseling during a medical visit in the previous year. RESULTS The sample included 2,562 men and 1,272 fathers. Overall, 90%, 76%, and 49% of fathers were weighed by a provider, told their weight status, and referred for nutrition/exercise counseling, respectively. There were no associations between fatherhood status and being weighed or provider weight status communication. Fathers were more likely to be referred for nutrition/exercise counseling compared with those without children during a medical (adjusted odds ratio, 1.61; 95% confidence interval, 1.003-2.583) or routine visit (adjusted odds ratio, 1.81; 95% confidence interval, 1.04-3.16). CONCLUSIONS AND IMPLICATIONS The increased likelihood of nutrition or exercise counseling referrals among fathers presents an opportunity to address obesity within families.
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Affiliation(s)
- Alicia Boykin
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Jill Demirci
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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25
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Juarez PD, Tabatabai M, Burciaga Valdez R, Hood DB, Im W, Mouton C, Colen C, Al-Hamdan MZ, Matthews-Juarez P, Lichtveld MY, Sarpong D, Ramesh A, Langston MA, Rogers GL, Phillips CA, Reichard JF, Donneyong MM, Blot W. The Effects of Social, Personal, and Behavioral Risk Factors and PM 2.5 on Cardio-Metabolic Disparities in a Cohort of Community Health Center Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3561. [PMID: 32438697 PMCID: PMC7277630 DOI: 10.3390/ijerph17103561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
(1) Background: Cardio-metabolic diseases (CMD), including cardiovascular disease, stroke, and diabetes, have numerous common individual and environmental risk factors. Yet, few studies to date have considered how these multiple risk factors together affect CMD disparities between Blacks and Whites. (2) Methods: We linked daily fine particulate matter (PM2.5) measures with survey responses of participants in the Southern Community Cohort Study (SCCS). Generalized linear mixed modeling (GLMM) was used to estimate the relationship between CMD risk and social-demographic characteristics, behavioral and personal risk factors, and exposure levels of PM2.5. (3) Results: The study resulted in four key findings: (1) PM2.5 concentration level was significantly associated with reported CMD, with risk rising by 2.6% for each µg/m3 increase in PM2.5; (2) race did not predict CMD risk when clinical, lifestyle, and environmental risk factors were accounted for; (3) a significant variation of CMD risk was found among participants across states; and (4) multiple personal, clinical, and social-demographic and environmental risk factors played a role in predicting CMD occurrence. (4) Conclusions: Disparities in CMD risk among low social status populations reflect the complex interactions of exposures and cumulative risks for CMD contributed by different personal and environmental factors from natural, built, and social environments.
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Affiliation(s)
- Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208, USA;
| | - Robert Burciaga Valdez
- RWJF Professor, Department of Family & Community Medicine AND Economics, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Darryl B. Hood
- Department of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA;
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Charles Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Cynthia Colen
- Department of Sociology, Ohio State University, Columbus, OH 43210, USA;
| | - Mohammad Z. Al-Hamdan
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA;
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Maureen Y. Lichtveld
- Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA;
| | - Daniel Sarpong
- Department of Biostatistics, Xavier University, Cincinnati, OH 45207, USA;
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - Gary L. Rogers
- National Institute for Computational Sciences, University of Tennessee, Knoxville, TN 37996, USA;
| | - Charles A. Phillips
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - John F. Reichard
- Department of Environmental Health, Risk Science Center, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - William Blot
- Center for Population-based Research, Vanderbilt University, Nashville, TN 37235, USA;
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26
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Kutzler HL, Peters J, O’Sullivan DM, Williamson A, Cheema F, Ebcioglu Z, Einstein M, Rochon C, Ye X, Sheiner P, Singh JU, Sotil EU, Swales C, Serrano OK. Disparities in End-Organ Care for Hispanic Patients with Kidney and Liver Disease: Implications for Access to Transplantation. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00248-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Michaels EK, Reeves AN, Thomas MD, Price MM, Hasson RE, Chae DH, Allen AM. Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4759. [PMID: 31783683 PMCID: PMC6935759 DOI: 10.3390/ijerph16234759] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 12/23/2022]
Abstract
Racial discrimination, a psychosocial stressor, may contribute to disproportionate rates of hypertension among African American women. Coping moderates the effects of psychosocial stress on health. Coping dispositions describe stable personality characteristics, whereas contextual frameworks emphasize flexible coping behaviors in response to specific stressful encounters. Using data from the African American Women's Heart and Health Study-a non-probability cross-section of 208 midlife African American women in Northern California-we estimated the association between everyday racial discrimination (Everyday Discrimination Scale, EDS) and prevalence of hypertension (HTN), and evaluated moderation by coping disposition (John Henryism Active Coping scale, JH) versus context-specific active coping behavior (Active Coping with Racism scale, ACR). There were no main associations between EDS, JH, or ACR on HTN prevalence. There was evidence of statistical interaction between EDS and ACR (p-int = 0.05), but not JH (p-int = 0.90). Among those with high levels of ACR, reporting monthly (prevalence ratio (PR) = 2.35, 95% confidence interval (CI) = 1.13, 4.87), weekly (PR = 2.15, 95% CI = 1.01, 4.61), or daily (PR = 2.36, 95% CI = 1.14, 4.88) EDS was associated with higher HTN prevalence, versus reporting racial discrimination yearly or less. In contrast, among those with low levels of ACR, reporting more chronic racial discrimination was associated with lower hypertension prevalence, although results were less precise. Findings suggest that ongoing active coping with chronic racial discrimination may contribute to hypertension risk among African American women.
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Alexis N. Reeves
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Marilyn D. Thomas
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Melisa M. Price
- Division of Community Health Sciences, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
| | - Rebecca E. Hasson
- Schools of Kinesiology and Public Health, University of Michigan, 2110 Observatory Lodge/1402 Washington Heights, Ann Arbor, MI 48109-2029, USA;
| | - David H. Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, 210 Spidle Hall, Auburn, GA 36849, USA;
| | - Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
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Apekey TA, Copeman J, Kime NH, Tashani OA, Kittaneh M, Walsh D, Maynard MJ. Nutrient Composition of Popularly Consumed African and Caribbean Foods in The UK. Foods 2019; 8:E500. [PMID: 31618872 PMCID: PMC6835955 DOI: 10.3390/foods8100500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022] Open
Abstract
(1) Background: Traditional foods are important in the diets of Black Africans and Caribbeans and, more widely, influence UK food culture. However, little is known about the nutritional status of these ethnic groups and the nutrient composition of their traditional foods. The aim was to identify and analyse African and Caribbean dishes, snacks and beverages popularly consumed in the UK for energy, macronutrients and micronutrients. (2) Methods: Various approaches including focus group discussions and 24-h dietary recalls were used to identify traditional dishes, snacks, and beverages. Defined criteria were used to prioritise and prepare 33 composite samples for nutrient analysis in a UK accredited laboratory. Quality assurance procedures and data verification were undertaken to ensure inclusion in the UK nutrient database. (3) Results: Energy content ranged from 60 kcal in Malta drink to 619 kcal in the shito sauce. Sucrose levels did not exceed the UK recommendation for adults and children. Most of the dishes contained negligible levels of trans fatty acid. The most abundant minerals were Na, K, Ca, Cu, Mn and Se whereas Mg, P, Fe and Zn were present in small amounts. (4) Conclusion: There was wide variation in the energy, macro- and micronutrients composition of the foods analysed.
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Affiliation(s)
- Tanefa A Apekey
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
| | - June Copeman
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
| | - Nichola H Kime
- School of Sport, Leeds Beckett University, Leeds LS6 3QQ, UK.
| | - Osama A Tashani
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
| | - Monia Kittaneh
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
| | - Donna Walsh
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
| | - Maria J Maynard
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK.
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Madden AM, Mashanova A, Amirabdollahian F, Ghuman S, Makda M, Collinson A, Dean F, Hirsz M, Lennie S, Maynard MJ, Power B. Improved prediction equations for estimating height in adults from ethnically diverse backgrounds. Clin Nutr 2019; 39:1454-1463. [PMID: 31285079 DOI: 10.1016/j.clnu.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/26/2019] [Accepted: 06/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. METHODS Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). RESULTS UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (Hp) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (Hp (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was -0.6 (-2.4, +1.2); Asian women, (Hp = 3.26 UL + 77.62), mean difference +0.5 (-1.4, 2.4) cm. For Black men, Hp = 3.14 UL + 85.80, -0.4 (-2.4, 1.7); Black women, Hp = 3.14 UL + 79.55, -0.8 (-2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. CONCLUSIONS The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations.
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Affiliation(s)
- Angela M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK.
| | - Alla Mashanova
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | | | - Sandeep Ghuman
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Munibah Makda
- School of Health Sciences, Liverpool Hope University, Liverpool, L16 9JD, UK
| | - Avril Collinson
- School of Health Professions, University of Plymouth, Plymouth, PL6 8BH, UK
| | - Frances Dean
- School of Health Professions, University of Plymouth, Plymouth, PL6 8BH, UK
| | - Malgorzata Hirsz
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Susan Lennie
- School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG, UK
| | - Maria J Maynard
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Brian Power
- Institute for Liver and Digestive Health, University College London, London, NW3 2PF, UK
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30
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Liew SJ, Lee JT, Tan CS, Koh CHG, Van Dam R, Müller-Riemenschneider F. Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: a cross-sectional study. BMJ Open 2019; 9:e025869. [PMID: 31110091 PMCID: PMC6530395 DOI: 10.1136/bmjopen-2018-025869] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Literature suggested that multi-ethnic Western populations experienced differential hypertension outcomes, but evidence is limited in Asia. This study was aimed to determine sociodemographic correlates of hypertension and its awareness, treatment and control among a multi-ethnic Asian population living in Singapore. SETTING We used cross-sectional data of participants from the Multi-Ethnic Cohort (MEC) (n=14 530) recruited in Singapore between 2004 and 2010. PARTICIPANTS Participants who completed questionnaire and attended health examination, without cardiovascular diseases, cancer, stroke, renal failure, asthma and mental illnesses were included in the study. Multivariable logistic regression models were used to determine sociodemographics factors associated with hypertension, unawareness of having hypertension, untreated and uncontrolled hypertension. RESULTS Among 10 215 participants (47.2% Chinese, 26.0% Malay and 26.8% Indian), hypertension prevalence was estimated to be 31.1%. Older age, Malay ethnicity, male, lower educational level and being homemaker or retired/unemployed were factors significantly associated with hypertension. Stratified analysis suggested that age and education were consistently associated with hypertension across all ethnic groups. The proportions of being unaware, untreated and uncontrolled were 49.0%, 25.2% and 62.4%, respectively. Ethnicity and younger age were associated with unawareness; younger age, male and lower educational level were associated with untreated hypertension and older age was associated with uncontrolled hypertension. CONCLUSIONS In this study, ethnic differences in relation to hypertension were associated with sociodemographic variability in ethnic groups. Age and educational level were consistent correlates of hypertension in all ethnic groups. Unawareness and uncontrolled hypertension were common in this Asian population and associated with sociodemographic factors. More targeted strategies may be required to overcome the observed disparities.
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Affiliation(s)
- Seaw Jia Liew
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
| | - John Tayu Lee
- School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chuen Seng Tan
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Choon Huat Gerald Koh
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Rob Van Dam
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Falk Müller-Riemenschneider
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
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Apekey T, Copeman J, Kime N, Tashani O, Kittana M, Walsh D, Maynard M. Methods of producing new nutrient data for popularly consumed multi ethnic foods in the UK. J Food Compost Anal 2019. [DOI: 10.1016/j.jfca.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cummings DM, Adams A, Halladay J, Hinderliter A, Donahue KE, Cene CW, Li Q, Miller C, Garcia B, Tillman J, Little E, DeWalt D. Race-Specific Patterns of Treatment Intensification Among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study. Ann Pharmacother 2018; 53:333-340. [PMID: 30282468 DOI: 10.1177/1060028018806001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Racial disparities in blood pressure (BP) control persist, but whether differences by race in antihypertensive medication intensification (AMI) contribute is unknown. OBJECTIVE To compare AMI by race for patients with elevated home BP readings. METHODS This prospective cohort study followed adult patients from 6 rural primary care practices who used home BP monitoring (HBPM) and recorded/reported values. For providers, AMI was encouraged when mean HBPM systolic blood pressure (SBP) values were ⩾135 mm Hg; patients received phone-based coaching on HBPM technique and sharing HBPM findings. AMI was assessed between baseline and 12 months using defined daily dose (DDD) and summed to create a total antihypertensive DDD value. RESULTS A total of 217 patients (mean age = 61.4 ± 10.2 years; 66% female; 57% black) provided usable HBPM data. Among 90 (41%) intensification-eligible hypertensive patients (ie, mean HBPM SBP values for 6-months ⩾135 mm Hg), mean total antihypertensive DDD was increased in 61% at 12 months. Blacks had significantly higher mean DDD at baseline and 12 months, but intensification (+0.72 vs +0.65; P = 0.83) was similar by race. However, intensification was greater in males than females (+1.1 vs +0.39; P = 0.031). Reduction in mean SBP following intensification was greater in white versus black patients (-8.2 vs -3.9 mm Hg; P = 0.14). Conclusion/Relevance: Treatment intensification in HBPM users was similar by race, differed significantly by gender, and may produce a greater response in white patients. Differential AMI in HBPM users does not appear to contribute to persistent racial disparities in BP control.
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Affiliation(s)
| | | | | | | | | | | | - Quefeng Li
- 2 University of North Carolina-Chapel Hill, NC, USA
| | | | | | - Jim Tillman
- 3 Open Water Consulting, Cape Carteret, NC, USA
| | - Edwin Little
- 4 Kinston Medical Specialists, Pink Hill, NC, USA
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Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, Ferdinand KC, Fleg JL, Gulati M, Isiadinso I, Itchhaporia D, Light-McGroary K, Lindley KJ, Mieres JH, Rosser ML, Saade GR, Walsh MN, Pepine CJ. Hypertension Across a Woman's Life Cycle. J Am Coll Cardiol 2018; 71:1797-1813. [PMID: 29673470 PMCID: PMC6005390 DOI: 10.1016/j.jacc.2018.02.033] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 01/17/2023]
Abstract
Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.
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Affiliation(s)
- Nanette K Wenger
- Division of Cardiology, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Anita Arnold
- Lee Health System, Florida State University School of Medicine, Fort Myers, Florida
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, Florida; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Keith C Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martha Gulati
- Department of Medicine (Cardiology), University of Arizona-Phoenix, Phoenix, Arizona
| | - Ijeoma Isiadinso
- Division of Cardiology, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - KellyAnn Light-McGroary
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer H Mieres
- Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York
| | - Mary L Rosser
- Division of General Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York
| | - George R Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Mary Norine Walsh
- Heart Failure and Cardiac Transplantation Program, St. Vincent Heart Center, Indianapolis, Indiana
| | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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Still CH, Rodriguez CJ, Wright JT, Craven TE, Bress AP, Chertow GM, Whelton PK, Whittle JC, Freedman BI, Johnson KC, Foy CG, He J, Kostis JB, Lash JP, Pedley CF, Pisoni R, Powell JR, Wall BM. Clinical Outcomes by Race and Ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): A Randomized Clinical Trial. Am J Hypertens 2017; 31:97-107. [PMID: 28985268 PMCID: PMC5861531 DOI: 10.1093/ajh/hpx138] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups. METHODS We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death. RESULTS Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57-0.86), 0.71 (0.51-0.98), 0.62 (0.33-1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29-0.81), 0.77 (0.37-1.57), and 0.17 (0.01-1.08). All-cause mortality HRs were 0.61 (0.47-0.80), 0.92 (0.63-1.35), and 1.58 (0.73-3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons. CONCLUSION Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications. CLINICAL TRIALS REGISTRATION Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA
| | - Carlos J Rodriguez
- Wake Forest School of Medicine/Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, USA
| | - Jackson T Wright
- School of Medicine, Case Western Reserve University, USA
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, USA
| | - Timothy E Craven
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Adam P Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, USA
| | - Glenn M Chertow
- Stanford University School of Medicine, Division of Nephrology, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA
| | - Jeffrey C Whittle
- Department of Medicine, Medical College of Wisconsin, Milwaukee and Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, USA
| | - Capri G Foy
- Department Social Sciences and Health Policy, School of Medicine, Wake Forest University, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, USA
| | - James P Lash
- Department of Medicine, University of Illinois Chicago, USA
| | | | - Roberto Pisoni
- Department of Medicine, Medical University of South Carolina, USA
| | - James R Powell
- Division of General Internal Medicine, Brody School of Medicine, East Carolina University, USA
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Graham G, Xiao YYK, Taylor T, Boehm A. Analyzing cardiovascular treatment guidelines application to women and minority populations. SAGE Open Med 2017; 5:2050312117721520. [PMID: 28804635 PMCID: PMC5533259 DOI: 10.1177/2050312117721520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 06/27/2017] [Indexed: 01/13/2023] Open
Abstract
Despite nearly 30 years of treatment guidelines for cardiovascular diseases and risk factors and a parallel growth in the understanding of cardiovascular disease disparities by sex and race/ethnicity, such disparities persist. The goals of this review are to consider the possible role of three factors: the one-size-fits-all approach of most treatment guidelines, adoption of guideline-recommended treatments in clinical practice, and patient adherence to recommended practice, especially the relationship between adherence and patient perceptions. Guideline authors repeatedly call for more inclusion of women and minorities in the clinical trials that make guidelines possible, but despite challenges, guidelines are largely effective when implemented, as shown by a wealth of post hoc analyses. However, the data also suggest that one-size-fits-all treatment guidelines are not sufficiently generalizable and there is evidence of a distinct lag time between definitive clinical evidence and its widespread implementation. Patient perspectives may also play both a direct and indirect role in adherence to treatments. What emerges from the literature is an important continuing need for increased inclusion of women and minority subgroups in clinical trials to allow analyses that can provide evidence for differential treatments when needed. Increased effort is needed to implement definitive clinical improvements more rapidly. Patient input and feedback may also help inform clinical practice and clinical research with a better understanding of how to enhance patient adherence, but evidence for this is lacking for the groups most affected by disparities.
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Affiliation(s)
- Garth Graham
- School of Medicine, University of Connecticut, Farmington, CT, USA.,Aetna Foundation, Hartford, CT, USA
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Gyamfi J, Butler M, Williams SK, Agyemang C, Gyamfi L, Seixas A, Zinsou GM, Bangalore S, Shah NR, Ogedegbe G. Blood pressure control and mortality in US- and foreign-born blacks in New York City. J Clin Hypertens (Greenwich) 2017; 19:956-964. [DOI: 10.1111/jch.13045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Joyce Gyamfi
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Mark Butler
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Stephen K. Williams
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Charles Agyemang
- Department of Public Health; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Lloyd Gyamfi
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Azizi Seixas
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Grace Melinda Zinsou
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology; New York University School of Medicine; New York NY USA
| | - Nirav R. Shah
- Kaiser Permanente Southern California; Pasadena NY USA
| | - Gbenga Ogedegbe
- Department of Population Health; NYU School of Medicine; Center for Healthful Behavior Change; NYU Langone Medical Center; New York NY USA
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Goosby BJ, Straley E, Cheadle JE. Discrimination, Sleep, and Stress Reactivity: Pathways to African American-White Cardiometabolic Risk Inequities. POPULATION RESEARCH AND POLICY REVIEW 2017. [DOI: 10.1007/s11113-017-9439-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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38
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Maynard M, Baker G, Harding S. Exploring childhood obesity prevention among diverse ethnic groups in schools and places of worship: Recruitment, acceptability and feasibility of data collection and intervention components. Prev Med Rep 2017; 6:130-136. [PMID: 28316908 PMCID: PMC5345967 DOI: 10.1016/j.pmedr.2017.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 01/21/2017] [Accepted: 02/18/2017] [Indexed: 11/22/2022] Open
Abstract
Small-scale, detailed exploration of the recruitment, assessment, and evaluation processes of obesity intervention among minority ethnic children. The study took place in schools and places of worship during 2008–2010 in London, UK. Measures included 3-day food diaries, 24 h dietary recalls, the Youth Physical Activity Questionnaire, accelerometry, and diet and physical activity self-efficacy questionnaires. Potential intervention components were evaluated via observation, questionnaires, and focus group discussions. Schools and places of worship that reflected the ethnic and religious diversity of inner city London populations (Hindus, Muslims and Christians) were targeted. Telephone invitations to 12 schools achieved recruitment of five schools (42% response); 181 invitations to 94 places of worship, recruited eight organisations (9%). Multi-strategy approaches were required to build relationships with faith organisations. Sixty-five children aged 8–13 years participated in the testing of measures. High completion rates were achieved for 24 h recalls, diet and PA self-efficacy questionnaires (ranging from 89% to 100%), with more consistent quality in schools. Dietary assessment highlighted inadequacies in composition data for minority ethnic foods. Intervention sessions were tested among 155 children in all five schools, and 33 children in a church, temple and mosque. Evaluation coverage was more consistent in these places of worship than in schools. Schools may logistically be more straightforward settings for delivery of interventions but, despite complex issues (engagement strategies; cultural foodways), places of worship provide opportunities for effective reach of children, families and communities. We suggest community based participatory research between researchers, schools and community organisations to harness culturally-specific support. Diverse strategies were required to recruit places of worship. Schools were logistically more straightforward for intervention delivery. Evaluation coverage was more consistent in places of worship. Places of worship also provide opportunities to reach children's families. Findings will be built on in a pilot trial in school-faith organisation coalitions.
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Affiliation(s)
- Maria Maynard
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
| | - Graham Baker
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
| | - Seeromanie Harding
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
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Kressin NR, Chapman SE, Magnani JW. A Tale of Two Patients: Patient-Centered Approaches to Adherence as a Gateway to Reducing Disparities. Circulation 2017; 133:2583-92. [PMID: 27297350 DOI: 10.1161/circulationaha.116.015361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disparate effects of social determinants of health on cardiovascular health status and health care have been extensively documented by epidemiology. Yet, very little attention has been paid to how understanding and addressing social determinants of health might improve the quality of clinical interactions, especially by improving patients' adherence to recommended therapies. We present a case and suggested approach to illustrate how cardiovascular clinicians can use patient-centered approaches to identify and address social determinants of health barriers to adherence and reduce the impact of unconscious clinician biases. We propose that cardiovascular clinicians (1) recognize that patients may have different belief systems about illnesses' cause and treatment, which may influence their actions, and not assume they share one's experiences or explanatory model; (2) Endeavor to understand the individual patient before you; (3) based on that understanding, tailor your approach to that individual. We suggest a previously-developed mnemonic for an approach to RESPECT the patient: First, show Respect; then elicit patients' understandings of their illness by asking about their Explanatory model. Ask about the patient's Social context, share Power in the interaction, show Empathy, ask about Concerns or fears, and work to develop Trust by building the relationship over time. We provide additional clinical resources to support these efforts, including lay descriptions of cardiovascular conditions, challenges to adherence, and suggested strategies to address them.
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Affiliation(s)
- Nancy R Kressin
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.).
| | - Sheila E Chapman
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
| | - Jared W Magnani
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
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Mensah GA, Galis ZS, Fine LJ, Garcia ME, Levy DF, Gibbons GH. Building on a Legacy of Hypertension Research: Charting Our Future Together. Hypertension 2017; 69:5-10. [PMID: 27849567 PMCID: PMC5145749 DOI: 10.1161/hypertensionaha.116.06582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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41
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Oh HG, Rhee EJ. Blood Pressure Is the Determinant for the Increased Risk for Intracranial Arterial Stenosis in Subjects with Elevated Glycated Hemoglobin Levels: The Kangbuk Samsung Health Study. J Stroke Cerebrovasc Dis 2016; 25:2729-2734. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/03/2016] [Accepted: 07/16/2016] [Indexed: 12/01/2022] Open
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Spector SA, Brummel SS, Nievergelt CM, Maihofer AX, Singh KK, Purswani MU, Williams PL, Hazra R, Van Dyke R, Seage GR. Genetically determined ancestry is more informative than self-reported race in HIV-infected and -exposed children. Medicine (Baltimore) 2016; 95:e4733. [PMID: 27603370 PMCID: PMC5023893 DOI: 10.1097/md.0000000000004733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Pediatric HIV/AIDS Cohort Study (PHACS), the largest ongoing longitudinal study of perinatal HIV-infected (PHIV) and HIV-exposed, uninfected (PHEU) children in the United States, comprises the Surveillance Monitoring of Antiretroviral Therapy [ART] Toxicities (SMARTT) Study in PHEU children and the Adolescent Master Protocol (AMP) that includes PHIV and PHEU children ≥7 years. Although race/ethnicity is often used to assess health outcomes, this approach remains controversial and may fail to accurately reflect the backgrounds of ancestry-diverse populations as represented in the PHACS participants.In this study, we compared genetically determined ancestry (GDA) and self-reported race/ethnicity (SRR) in the PHACS cohort. GDA was estimated using a highly discriminative panel of 41 single nucleotide polymorphisms and compared to SRR. Because SRR was similar between the PHIV and PHEU, and between the AMP and SMARTT cohorts, data for all unique 1958 participants were combined.According to SRR, 63% of study participants identified as Black/African-American, 27% White, and 34% Hispanic. Using the highest percentage of ancestry/ethnicity to identify GDA, 9.5% of subjects were placed in the incorrect superpopulation based on SRR. When ≥50% or ≥75% GDA of a given superpopulation was required, 12% and 25%, respectively, of subjects were placed in the incorrect superpopulation based on SRR, and the percent of subjects classified as multiracial increased. Of 126 participants with unidentified SRR, 71% were genetically identified as Eurasian.GDA provides a more robust assessment of race/ethnicity when compared to self-report, and study participants with unidentified SRR could be assigned GDA using genetic markers. In addition, identification of continental ancestry removes the taxonomic identification of race as a variable when identifying risk for clinical outcomes.
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Affiliation(s)
- Stephen A. Spector
- University of California, San Diego, La Jolla
- Rady Children's Hospital-San Diego, San Diego, CA
- Correspondence: Stephen A. Spector, University of California, San Diego, 9500 Gilman Drive, Stein Clinical Research Building, MC 0672, La Jolla, CA 92093-0672 (e-mail: )
| | - Sean S. Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | - Murli U. Purswani
- Albert Einstein College of Medicine, Bronx Lebanon Hospital, Bronx, New York, NY
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
- Departments of Biostatistics
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - George R. Seage
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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