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Bansal E, Patel K, Lacossade S, Gue B, Acceme K, Robinson O, Kwan GF, Wilentz JR. Population health and sociodemographic variables as predictors of access to cardiac medicine and surgery in Haiti. Glob Health Res Policy 2023; 8:27. [PMID: 37468963 PMCID: PMC10354940 DOI: 10.1186/s41256-023-00308-z] [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: 10/07/2022] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND In Haiti, cardiovascular disease is a leading cause of morbidity and mortality, with congenital and rheumatic heart disease comprising a large portion of disease burden. However, domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood. We analyzed population-level sociodemographic variables to predict cardiac care outcomes across the 10 Haitian administrative departments. METHODS This cross-sectional study combined data from a 2016-17 Haitian national survey with aggregate outcomes from the Haiti Cardiac Alliance (HCA) database (n = 1817 patients). Using univariate and multivariable regression analyses, the proportion of HCA patients belonging to each of three clinical categories (active treatment, lost to follow-up, deceased preoperatively) was modeled in relation to six population-level variables selected from national survey data at the level of the administrative department. RESULTS In univariate analysis, higher department rates of childhood growth retardation were associated with a lower proportion of patients in active care (OR = 0.979 [0.969, 0.989], p = 0.002) and a higher proportion of patients lost to follow-up (OR = 1.016 [1.006, 1.026], p = 0.009). In multivariable analysis, the proportion of department patients in active care was inversely associated with qualified prenatal care (OR = 0.980 [0.971, 0.989], p = 0.005), and child growth retardation (OR = 0.977 [0.972, 0.983]), p = 0.00019). Similar multivariable results were obtained for department rates of loss to follow-up (child growth retardation: OR = 1.018 [1.011, 1.025], p = 0.002; time to nearest healthcare facility in an emergency: OR = 1.004 [1.000, 1.008, p = 0.065) and for preoperative mortality (prenatal care: OR = 0.989 [0.981, 0.997], p = 0.037; economic index: OR = 0.996 [0.995, 0.998], p = 0.007; time to nearest healthcare facility in an emergency: OR = 0.992 [0.988, 0.996], p = 0.0046). CONCLUSIONS Population-level survey data on multiple variables predicted domestic disparities in HCA clinical outcomes by region. These findings may help to identify underserved areas in Haiti, where increased cardiac care resources are required to improve health equity. This approach to analyzing clinical outcomes through the lens of population-level survey data may inform future health policies and interventions designed to increase cardiac care access in Haiti and other low-income countries.
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Affiliation(s)
- Esha Bansal
- Arnhold Institute of Global Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA.
| | - Krishna Patel
- Arnhold Institute of Global Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
| | - Samantha Lacossade
- Saint Damien Pediatric Hospital, Nos Petits Frères et Sœurs, Port-au-Prince, Haiti
- Haiti Cardiac Alliance, 47 Maple Street, Suite 213, Burlington, VT, 05401, USA
| | - Bennisoit Gue
- Saint Damien Pediatric Hospital, Nos Petits Frères et Sœurs, Port-au-Prince, Haiti
- Haiti Cardiac Alliance, 47 Maple Street, Suite 213, Burlington, VT, 05401, USA
| | - Kessy Acceme
- Saint Damien Pediatric Hospital, Nos Petits Frères et Sœurs, Port-au-Prince, Haiti
- Haiti Cardiac Alliance, 47 Maple Street, Suite 213, Burlington, VT, 05401, USA
| | - Owen Robinson
- Haiti Cardiac Alliance, 47 Maple Street, Suite 213, Burlington, VT, 05401, USA
| | - Gene F Kwan
- Section of Cardiovascular Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 808, USA
| | - James R Wilentz
- Arnhold Institute of Global Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA
- Haiti Cardiac Alliance, 47 Maple Street, Suite 213, Burlington, VT, 05401, USA
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Polsinelli VB, Dantil KR, DeGennaro V, Fénelon DL, Louis DP, Izzo JL, Kwan GF. Cardiovascular Health in a Single Community in Rural Haiti: A Cross-sectional Study. CARIBBEAN MEDICAL JOURNAL 2021; 83. [PMID: 34621104 PMCID: PMC8494238 DOI: 10.48107/cmj.2021.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction There is a growing burden of cardiovascular disease in low- and middle-income countries and assessment of cardiovascular health (CVH) may identify populations at risk for poor CVH. Methods Between July 2014 and August 2014, we performed a household survey from a convenience sample among adult community members in rural northern Haiti. We used a modified World Health Organization STEPwise approach to chronic disease questionnaire to capture self-reported data on tobacco, diet, physical activity, and diabetes, and measured blood pressure and body mass index. We used an adapted American Heart Association definition and thresholds for determining ideal, intermediate, and poor cardiovascular health. We used linear and logistic regression to examine associations between socio-demographic characteristics with CVH score and ideal CVH. Results Among 540 participants (mean [SD] age = 40.3 [17.1] years, 67% women), there was a high prevalence of poor CVH (n=476, 88.1%) compared with intermediate (n=56, 10.4%) and ideal (n=41, 7.6%) CVH. Ideal metrics for blood pressure (47%) and diet (26%) were least often met, while body weight (84%), physical activity (83%), and smoking (90%) were most often met. Men were associated with better CVH score (0.31, [0.04–0.59]; P=0.03), and being a farmer was associated with ideal CVH (P=0.006). Conclusion In this community-based sample of a farming community in rural Haiti, very few adults had ideal CVH. Higher CVH score was associated with male sex, and farming as a primary occupation. Women and non-farmers may represent at-risk subgroups within this population. Blood pressure and diet may represent possible areas for improvement.
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Affiliation(s)
- Vincenzo B Polsinelli
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Friends of Fontaine, Fontaine, Haiti
| | | | | | | | | | - Joseph L Izzo
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Gene F Kwan
- Section of Cardiovascular Medicine, Boston University Medical Center, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Yan LD, Pierre-Louis D, Isaac BD, Jean-Baptiste W, Vertilus S, Fenelon D, Hirschhorn LR, Hibberd PL, Benjamin EJ, Bukhman G, Kwan GF. Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti. BMC Public Health 2020; 20:1545. [PMID: 33054756 PMCID: PMC7556963 DOI: 10.1186/s12889-020-09652-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. METHODS We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. RESULTS We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. CONCLUSIONS Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.
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Affiliation(s)
- Lily D Yan
- Boston Medical Center, 72 East Concord St., Boston, MA, 02118, USA
| | - Dufens Pierre-Louis
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | - Waking Jean-Baptiste
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Serge Vertilus
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patricia L Hibberd
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Emelia J Benjamin
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Gene Bukhman
- Partners In Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Gene F Kwan
- Boston Medical Center, 72 East Concord St., Boston, MA, 02118, USA.
- Boston University School of Medicine, Boston, MA, USA.
- Partners In Health, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Ajayi AA, Sofowora GG, Ladipo GO. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. J Natl Med Assoc 2020; 112:141-157. [PMID: 32165009 DOI: 10.1016/j.jnma.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). A clustering of adverse genetic single nucleotide polymorphisms (SNP) predisposing to hypertension and/or left ventricular hypertrophy (LVH) in the black diaspora may contribute. A higher prevalence of HF with reduced Ejection Fraction (HF r EF) phenotype, which is associated with greater mortality is more common in SSA nations. Additionally, a worse co-morbidity burden, especially valvular regurgitations causing LV remodeling (LVR), chronic kidney disease (CKD), anemia, lung disease, infections, late presentation in NYHA III/IV, right ventricular disease (RVD) were also common in SSA. Geographic variation in SSA, HF risk factors and co-morbidity was observed. There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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Affiliation(s)
- Adesuyi A Ajayi
- Adjunct Professor, Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, 77060, USA.
| | - Gbemiga G Sofowora
- Associate Professor of Cardiology, Cardiovascular Medicine Division, Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Gani O Ladipo
- Retired Professor of Cardiology, Obafemi Awolowo University, Ile -ife, Osun State, Nigeria
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Kwan GF, Yan LD, Isaac BD, Bhangdia K, Jean-Baptiste W, Belony D, Gururaj A, Martineau L, Vertilus S, Pierre-Louis D, Fenelon DL, Hirschhorn LR, Benjamin EJ, Bukhman G. High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti. Glob Heart 2020; 15:7. [PMID: 32489780 PMCID: PMC7218772 DOI: 10.5334/gh.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.
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Affiliation(s)
- Gene F. Kwan
- Boston University School of Medicine, Boston, MA, US
- Boston Medical Center, Boston, MA, US
- Partners In Health, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | | | | | | | | | | | - Louine Martineau
- Zanmi Lasante, HT
- Tufts New England Medical Center, Boston, MA, US
| | - Serge Vertilus
- Zanmi Lasante, HT
- Hôpital Universitaire de Mirebalais, HT
| | | | | | | | - Emelia J. Benjamin
- Boston University School of Medicine, Boston, MA, US
- Boston University School of Public Health, Boston, MA, US
| | - Gene Bukhman
- Harvard Medical School, Boston, MA, US
- Brigham and Women’s Hospital, Boston, MA, US
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Freiberg MS, Chang CCH, Skanderson M, Patterson OV, DuVall SL, Brandt CA, So-Armah KA, Vasan RS, Oursler KA, Gottdiener J, Gottlieb S, Leaf D, Rodriguez-Barradas M, Tracy RP, Gibert CL, Rimland D, Bedimo RJ, Brown ST, Goetz MB, Warner A, Crothers K, Tindle HA, Alcorn C, Bachmann JM, Justice AC, Butt AA. Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study. JAMA Cardiol 2019; 2:536-546. [PMID: 28384660 DOI: 10.1001/jamacardio.2017.0264] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance With improved survival, heart failure (HF) has become a major complication for individuals with human immunodeficiency virus (HIV) infection. It is unclear if this risk extends to different types of HF in the antiretroviral therapy (ART) era. Determining whether HIV infection is associated with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or both is critical because HF types differ with respect to underlying mechanism, treatment, and prognosis. Objectives To investigate whether HIV infection increases the risk of future HFrEF and HFpEF and to assess if this risk varies by sociodemographic and HIV-specific factors. Design, Setting, and Participants This study evaluated 98 015 participants without baseline cardiovascular disease from the Veterans Aging Cohort Study, an observational cohort of HIV-infected veterans and uninfected veterans matched by age, sex, race/ethnicity, and clinical site, enrolled on or after April 1, 2003, and followed up through September 30, 2012. The dates of the analysis were October 2015 to November 2016. Exposure Human immunodeficiency virus infection. Main Outcomes and Measures Outcomes included HFpEF (EF≥50%), borderline HFpEF (EF 40%-49%), HFrEF (EF<40%), and HF of unknown type (EF missing). Results Among 98 015 participants, the mean (SD) age at enrollment in the study was 48.3 (9.8) years, 97.0% were male, and 32.2% had HIV infection. During a median follow-up of 7.1 years, there were 2636 total HF events (34.6% were HFpEF, 15.5% were borderline HFpEF, 37.1% were HFrEF, and 12.8% were HF of unknown type). Compared with uninfected veterans, HIV-infected veterans had an increased risk of HFpEF (hazard ratio [HR], 1.21; 95% CI, 1.03-1.41), borderline HFpEF (HR, 1.37; 95% CI, 1.09-1.72), and HFrEF (HR, 1.61; 95% CI, 1.40-1.86). The risk of HFrEF was pronounced in veterans younger than 40 years at baseline (HR, 3.59; 95% CI, 1.95-6.58). Among HIV-infected veterans, time-updated HIV-1 RNA viral load of at least 500 copies/mL compared with less than 500 copies/mL was associated with an increased risk of HFrEF, and time-updated CD4 cell count less than 200 cells/mm3 compared with at least 500 cells/mm3 was associated with an increased risk of HFrEF and HFpEF. Conclusions and Relevance Individuals who are infected with HIV have an increased risk of HFpEF, borderline HFpEF, and HFrEF compared with uninfected individuals. The increased risk of HFrEF can manifest decades earlier than would be expected in a typical uninfected population. Future research should focus on prevention, risk stratification, and identification of the mechanisms for HFrEF and HFpEF in the HIV-infected population.
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Affiliation(s)
- Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee2Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Melissa Skanderson
- Research Division, Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven
| | - Olga V Patterson
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City6Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City6Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Cynthia A Brandt
- Research Division, Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven7Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kaku A So-Armah
- Division of General Internal Medicine, Boston University, Boston, Massachusetts
| | - Ramachandran S Vasan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Kris Ann Oursler
- Department of Medicine, University of Maryland School of Medicine, Baltimore11Division of Infectious Diseases, Baltimore Veterans Affairs Health Care System, Baltimore, Maryland12Division of Cardiology, Baltimore Veterans Affairs Health Care System, Baltimore, Maryland
| | - John Gottdiener
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Stephen Gottlieb
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - David Leaf
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Maria Rodriguez-Barradas
- Department of Medicine, Baylor College of Medicine, Houston, Texas15Division of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington
| | - Cynthia L Gibert
- Department of Medicine, George Washington University School of Medicine, Washington, DC18Division of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - David Rimland
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia20Division of Infectious Diseases, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Roger J Bedimo
- Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas
| | - Sheldon T Brown
- Division of Infectious Diseases, James J. Peters Veterans Affairs Medical Center, Bronx, New York23Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew Bidwell Goetz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles24Division of Infectious Diseases, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Alberta Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles25Division of Cardiology, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Charles Alcorn
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Justin M Bachmann
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amy C Justice
- Research Division, Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven29Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Adeel A Butt
- Department of Medicine, Weill Cornell Medical College, New York, New York
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Tymejczyk O, McNairy ML, Petion JS, Rivera VR, Dorélien A, Peck M, Seo G, Walsh KF, Fitzgerald DW, Peck RN, Joshi A, Pape JW, Nash D. Hypertension prevalence and risk factors among residents of four slum communities: population-representative findings from Port-au-Prince, Haiti. J Hypertens 2019; 37:685-695. [PMID: 30817448 PMCID: PMC7680636 DOI: 10.1097/hjh.0000000000001966] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the prevalence of hypertension and its risk factors among adults in four slum communities in Port-au-Prince. METHODS Cluster area random sampling was used to select adults for a health and demographic survey, including anthropometric measurements. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg, or current hypertension treatment, and was age-standardized to WHO world population. Correlates of hypertension were tested using sex-stratified logistic regression. RESULTS Overall, 20.3% of adults had hypertension (28.5% age-standardized), including 22.3% of men and 18.9% of women. Three percent of participants reported current hypertension treatment, and 49.5% of them had their hypertension controlled. Overweight/obesity (BMI ≥25) was the most common risk factor (20.6% among men, 48.5% among women), while smoking was less common (11.8 and 3.9%, respectively). Increasing age and hypertension prevalence in immediate surroundings were associated with greater odds of hypertension. Among men, having in-migrated in the 3 years prior (versus ≥3 years) was also associated with hypertension [adjusted odds ratio (aOR)=3.32, 95% confidence interval (95% CI): 1.79-6.17], as was overweight and obesity (aOR = 1.90, 95% CI: 1.09-3.33, and aOR = 5.73, 95% CI: 2.49-13.19, respectively) and nonreceipt of needed medical care in the preceding 6 months (aOR = 2.82, 95% CI: 1.35-5.88) among women. CONCLUSION Hypertension prevalence was high across the age spectrum, in addition to substantial levels of overweight/obesity and unmet healthcare needs. It is important to better understand the possible effects of intraurban migration and environmental risk factors on hypertension and ensure that the benefits of increasingly cost-effective prevention and treatment programmes extend to slum residents.
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Affiliation(s)
- Olga Tymejczyk
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
| | - Margaret L McNairy
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jacky S Petion
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R Rivera
- Center for Global Health
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Audrey Dorélien
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota
| | - Mireille Peck
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Kathleen F Walsh
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Daniel W Fitzgerald
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Robert N Peck
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
- Departments of Medicine and Pediatrics, Weill Bugando School of Medicine
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
| | - Ashish Joshi
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
| | - Jean W Pape
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Denis Nash
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
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Heart Failure in Late Pregnancy and Postpartum: Incidence and Long-Term Mortality in Sweden From 1997 to 2010. J Card Fail 2017; 23:370-378. [PMID: 28069474 DOI: 10.1016/j.cardfail.2016.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Heart failure (HF) in late pregnancy and postpartum (HFPP), of which peripartum cardiomyopathy (PPCM) constitutes the larger part, is still a rare occurrence in Sweden. Population-based data are scarce. Our aim was to characterize HFPP and determine the incidence and mortality in a Swedish cohort. METHODS AND RESULTS Through merging data from the National Inpatient, Cause of Death, and Medical Birth Registries, we identified ICD-10 codes for HF and cardiomyopathy within 3 months before delivery to 6 months postpartum. Each case was assigned 5 age-matched control subjects from the Medical Birth Registry. From 1997 to 2010, 241 unique HFPP case subjects and 1063 matched control subjects were identified. Mean incidence was 1 in 5719 deliveries. HFPP was strongly associated with preeclampsia (odds ratio [OR] 11.91, 95% confidence interval [CI] 7.86-18.06), obesity (OR 2.5, 95% CI 1.7-3.7), low- and middle-income country (LMIC) of origin (OR 1.73, 95% CI 1.14-2.63), and twin deliveries (OR 4.39 CI 95% 2.24-8.58). By the end of the study period deaths among cases were >35-fold those of controls: 9 cases (3.7 %) and 1 control (0.1 %; P < .0001). Among control subjects, 17.9% of mortalities occurred within 3 years, of diagnosis compared with 100% among cases. CONCLUSIONS The mean incidence and mortality among women with HFPP in Sweden from 1997 to 2010 was low but carried a marked excess risk of death compared with control subjects and was strongly linked to preeclampsia, obesity, multifetal births, and LMIC origin of the mother.
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