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Rosendale N, Wood AJ, Leung CW, Kim AS, Caceres BA. Differences in Cardiovascular Health at the Intersection of Race, Ethnicity, and Sexual Identity. JAMA Netw Open 2024; 7:e249060. [PMID: 38691360 PMCID: PMC11063800 DOI: 10.1001/jamanetworkopen.2024.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
Importance An understanding of the intersectional effect of sexual identity, race, and ethnicity on disparities in cardiovascular health (CVH) has been limited. Objective To evaluate differences in CVH at the intersection of race, ethnicity, and sexual identity using the American Heart Association's Life's Essential 8 measure. Design, Setting, and Participants This cross-sectional study was conducted from July 27 to September 6, 2023, using National Health and Nutrition Examination Survey data from 2007 to 2016. Participants were noninstitutionalized, nonpregnant adults (aged 18-59 years) without cardiovascular disease or stroke. Exposures Self-reported sexual identity, categorized as heterosexual or sexual minority (SM; lesbian, gay, bisexual, or "something else"), and self-reported race and ethnicity, categorized as non-Hispanic Black (hereafter, Black), Hispanic, non-Hispanic White (hereafter, White), and other (Asian, multiracial, or any other race and ethnicity). Main Outcome and Measures The primary outcome was overall CVH score, which is the unweighted mean of 8 CVH metrics, assessed from questionnaire, dietary, and physical examination data. Regression models stratified by sex, race, and ethnicity were developed for the overall CVH score and individual CVH metrics, adjusting for age, survey year, and socioeconomic status (SES) factors. Results The sample included 12 180 adults (mean [SD] age, 39.6 [11.7] years; 6147 [50.5%] male, 2464 [20.2%] Black, 3288 [27.0%] Hispanic, 5122 [42.1%] White, and 1306 [10.7%] other race and ethnicity). After adjusting for age, survey year, and SES, Black (β, -3.2; 95% CI, -5.8 to -0.6), Hispanic (β, -5.9; 95% CI, -10.3 to -1.5), and White (β, -3.3; 95% CI, -6.2 to -0.4) SM female adults had lower overall CVH scores compared with their heterosexual counterparts. There were no statistically significant differences for female adults of other race and ethnicity (β, -2.8; 95% CI, -9.3 to 3.7) and for SM male adults of any race and ethnicity compared with their heterosexual counterparts (Black: β, 2.2 [95% CI, -1.2 to 5.7]; Hispanic: β, -0.9 [95% CI, -6.3 to 4.6]; White: β, 1.5 [95% CI, -2.2 to 5.2]; other race and ethnicity: β, -2.2 [95% CI, -8.2 to 3.8]). Conclusions and Relevance In this cross-sectional study, CVH differed across race and ethnicity categories in SM females, suggesting that different communities within the larger SM population require tailored interventions to improve CVH. Longitudinal studies are needed to identify the causes of CVH disparities, particularly in Black and Hispanic SM females and inclusive of other racial and ethnic identities.
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Affiliation(s)
- Nicole Rosendale
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco
| | - Andrew J. Wood
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco
| | - Cindy W. Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anthony S. Kim
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco
| | - Billy A. Caceres
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
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Cook SH, Wood EP, Rodrigues M, Jachero Caldas J, Delorme M. Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study. JMIR Form Res 2024; 8:e52195. [PMID: 38373036 PMCID: PMC10912985 DOI: 10.2196/52195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). OBJECTIVE This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. METHODS Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. RESULTS The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one's finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=-0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. CONCLUSIONS Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples.
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Affiliation(s)
- Stephanie H Cook
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Erica P Wood
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Mariana Rodrigues
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Janice Jachero Caldas
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Maxline Delorme
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
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Delcuratolo E, Palazzuoli A, Coppi F, Mattioli AV, Severino P, Tramonte F, Fedele F. Risk Factors and Cellular Differences in Heart Failure: The Key Role of Sex Hormones. Biomedicines 2023; 11:3052. [PMID: 38002052 PMCID: PMC10669789 DOI: 10.3390/biomedicines11113052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with heart failure are conventionally stratified into phenotypic groups based on their ejection fraction. The aim of this stratification is to improve disease management with a more targeted therapeutic approach. A further subdivision based on patient gender is justified. It is recognized that women are underrepresented in randomized controlled clinical trials, resulting in limited clinical and molecular differentiation between males and females. However, many observational studies show that the onset, development, and clinical course of the disease may substantially differ between the two sexes. According to the emerging concept of precision medicine, investigators should further explore the mechanisms responsible for the onset of heart failure due to sex differences. Indeed, the synergistic or opposing effects of sex hormones on the cardiovascular system and underlying heart failure mechanisms have not yet been clarified. Sex hormones, risk factors impact, and cardiovascular adaptations may be relevant for a better understanding of the intrinsic pathophysiological mechanisms in the two sexes. Despite the differences, treatment for HF is similar across the whole population, regardless of sex and gender. In our review, we describe the main differences in terms of cardiovascular dysfunction, risk factors, and cellular signaling modifications related to the hormonal pattern.
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Affiliation(s)
- Elvira Delcuratolo
- Specialization School of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Francesca Coppi
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
| | - Anna Vittoria Mattioli
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Francesco Tramonte
- Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Francesco Fedele
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
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Duncan DT, Cook SH, Wood EP, Regan SD, Chaix B, Tian Y, Chunara R. Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men. Soc Sci Med 2023; 320:115755. [PMID: 36739708 PMCID: PMC10014849 DOI: 10.1016/j.socscimed.2023.115755] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Stephanie H Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA; Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Erica P Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Basile Chaix
- French National Institute of Health and Medical Research (INSERM), Sorbonne Université, Institut Pierre Louis D'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Yijun Tian
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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Khan SS, Beach LB, Yancy CW. Sex-Based Differences in Heart Failure: JACC Focus Seminar 7/7. J Am Coll Cardiol 2022; 79:1530-1541. [PMID: 35422249 DOI: 10.1016/j.jacc.2022.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
Sex-based differences exist in risk, symptoms, and management of heart failure (HF). Women have a higher incidence of HF with preserved ejection fraction compared with men. This may be partially caused by the cardiovascular effects of estrogen and sex-specific risk factors (eg, adverse pregnancy outcomes, premature menopause). Key gaps exist in understanding of gender-based differences in HF, which is a distinctly different concept than sex-based differences. Although evidence-based therapies for HF are available, only limited data address sex-specific efficacy, and no data address gender-based efficacy. Persistent shortcomings in representation of women and gender minority participants in clinical trials limit an actionable database. A comprehensive roadmap to close the sex/gender-based gap in HF includes the following: 1) sex/gender-specific personalized prevention; 2) sex/gender-neutral implementation of evidence-based therapies; and 3) sex/gender-appropriate policy-level initiatives to spur research assessing sex/gender-specific causes of HF; enhance sex/gender-specific subgroup reporting; and promote community engagement of these important patient cohorts.
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Affiliation(s)
- Sadiya S Khan
- Department of Preventive Medicine; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren B Beach
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Gibb JK, Shokoohi M, Salway T, Ross LE. Sexual orientation-based disparities in food security among adults in the United States: results from the 2003-2016 NHANES. Am J Clin Nutr 2021; 114:2006-2016. [PMID: 34551071 DOI: 10.1093/ajcn/nqab290] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Access to sufficient, safe, culturally appropriate, and nutritious food is essential for maintaining both physical and mental health. Despite a growing body of evidence suggesting that sexual minority (SM) people experience significant disparities in socioeconomic and material resource security, there remains a paucity of empirical studies examining the prevalence of food insecurity among SM people relative to their heterosexual peers. OBJECTIVES To determine the prevalence of adult and household food insecurity across sexual orientation groups in the United States after adjusting for multiple covariates. METHODS We combined 7 cycles of US NHANES, 2003-2016 (N = 21,300) to examine sexual orientation-based disparities in adult food security among lesbian/gay (n = 373), bisexual (n = 606), same-sex experienced (SSE, n = 693), other sexual minorities (OSMs, n = 88), and heterosexual (n = 19,540) people. Food (in)security was measured using the US Food Security Survey Module and categorized as secure, marginally insecure, moderately insecure, and severely insecure. RESULTS Severe adult food insecurity was higher among bisexuals (17.16%; 95% CI: 14.36, 20.38), SSE (13.71%; 95% CI: 11.34, 16.48), OSMs (12.50%; 95% CI: 7.04, 21.24), and lesbians/gays (13.14%; 95% CI: 10.07, 16.97) compared with heterosexuals (8.23%; 95% CI: 7.85, 8.62). Multivariable multinomial logistic regression analysis adjusting for gender, race/ethnicity, age, citizenship, education, household size, income, cycle year, emergency food use, and Supplemental Nutrition Assistance Program participation showed that bisexuals, OSMs, SSE, and lesbians/gays were more likely to experience moderate to severe food insecurity compared with heterosexuals. CONCLUSIONS SM people are significantly more likely to experience increased likelihood of food insecurity relative to their heterosexual peers.
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Affiliation(s)
- James K Gibb
- Department of Health & Society, University of Toronto, Scarborough, Ontario, Canada.,Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Lund EM, Burgess CM. Sexual and Gender Minority Health Care Disparities: Barriers to Care and Strategies to Bridge the Gap. Prim Care 2021; 48:179-189. [PMID: 33985698 DOI: 10.1016/j.pop.2021.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gender and sexual minority individuals face considerable physical and mental health disparities, health risk factors, and barriers to care. These disparities are rooted in systemic and interpersonal prejudice, discrimination, and violence toward lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) individuals and communities that place LGBTQ+ individuals at increased risk for negative social determinants of health. While also advocating for systemic change, individual providers and clinics have an ethical duty to promote an openly affirming, culturally competent health care environment that can help to address these disparities on an individual patient level.
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Affiliation(s)
- Emily M Lund
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, PO Box 870231, Tuscaloosa, AL 35487, USA.
| | - Claire M Burgess
- VA Boston Healthcare System, Harvard Medical School, 940 Belmont Street, Brockton, MA 02310, USA
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