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Walker RJ, Williams JS, Linde S, Egede LE. Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes. JAMA Netw Open 2024; 7:e2425996. [PMID: 39207760 PMCID: PMC11362860 DOI: 10.1001/jamanetworkopen.2024.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
Importance No clear process exists for categorizing social risks in a way that informs effective social risk screening and intervention development. Objective To investigate social risk profiles and associations of those profiles with clinical outcomes in adults with diabetes using latent profile analysis. Design, Setting, and Participants For this cross-sectional study, a latent profile analysis was conducted using data for adults with type 2 diabetes collected at 2 primary care clinics in the Southeastern US from 2013 to 2014. Data were analyzed from November to December 2023. Main Outcomes and Measures Participants completed validated questionnaires for 26 social risk factors within 5 domains of social determinants of health: socioeconomic, neighborhood, education, food, and social and community context. In addition, participants completed questions that assessed psychological risk and behavioral risk. A 3-step latent profile analysis was used to identify different subgroups within the sample. Profiles were then regressed on outcomes of hemoglobin A1c (HbA1c), blood pressure, and quality of life. Results A total of 615 participants (mean [SD] age, 61.3 [10.9] years; 379 men [61.6%]) were included. Five latent class profiles were identified. The lowest risk group had significantly higher mental health-related quality of life compared with a group with higher neighborhood risk (β, 1.11; 95% CI, 0.67 to 1.55). The second group had low economic risk but high neighborhood risk and served as the reference group. The third group had high economic and neighborhood risk and had significantly higher blood pressure (β, 8.08; 95% CI, 2.16 to 14.01) compared with the reference. The fourth group had high psychological and behavioral risks but low socioeconomic and neighborhood risks. This group had significantly higher HbA1c (β, 0.47; 95% CI, 0.01 to 0.92) and lower mental health-related quality of life (β, -1.83; 95% CI, -2.41 to -1.24) compared with the reference. The highest risk group indicated high risk in all domains, had significantly higher HbA1c (β, 1.07; 95% CI, 0.50 to 1.63), and had lower mental health-related quality of life (β, -2.15; 95% CI, -2.87 to -1.42) compared with the reference. Conclusions and Relevance These findings suggest that social risk profiles can be identified according to social, psychological, and behavioral risk domains and the health outcome of concern among adults with diabetes. Future work should consider the use of social risk profiles in intervention development and testing.
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Affiliation(s)
- Rebekah J. Walker
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station
| | - Leonard E. Egede
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Salgado MV, Penko J, Fernández A, Rios-Fetchko F, Coxson PG, Mejia R. The burden of premature coronary heart disease among adults with low socioeconomic status in Argentina: A modeling study. PLoS One 2024; 19:e0305948. [PMID: 38913678 PMCID: PMC11195980 DOI: 10.1371/journal.pone.0305948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 06/07/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors. OBJECTIVE To model the role SES plays in the burden of premature CHD in Argentina. MATERIALS AND METHODS We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk. RESULTS 56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6-84.9] vs 42.9 [95%CI 37.4-48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3-20.9]; CHD deaths: men 10.0 [95%CI 9.5-10.5] vs 6.0 [95%CI 5.6-6.4], women 3.2 [95%CI 3.0-3.4] vs 1.8 [95%CI 1.7-1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively. DISCUSSION CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.
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Affiliation(s)
- M. Victoria Salgado
- Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Unidad de Conocimiento Traslacional Hospitalaria Patagónica, Hospital SAMIC El Calafate, El Calafate, Santa Cruz, Argentina
| | - Joanne Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Alicia Fernández
- UCSF Latinx Center of Excellence, University of California San Francisco, San Francisco, California, United States of America
| | - Francine Rios-Fetchko
- UCSF Latinx Center of Excellence, University of California San Francisco, San Francisco, California, United States of America
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Raúl Mejia
- Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Hospital de Clínicas, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
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Huang J, Wu Y, Zheng J, Wang M, Goh GBB, Lin S. The prognostic role of diet quality in patients with MAFLD and physical activity: data from NHANES. Nutr Diabetes 2024; 14:4. [PMID: 38395952 PMCID: PMC10891170 DOI: 10.1038/s41387-024-00261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Dietary control and increased physical activity (PA) are recommended for patients with metabolic (dysfunction-) associated fatty liver disease (MAFLD). However, not all patients can sustain both exercise and a healthy diet. This study explored the interaction between dietary quality, PA levels, and mortality in MAFLD patients. METHODS The Third National Health and Nutrition Examination Survey and linked mortality data were used in this study. Diet quality was assessed with the Healthy Eating Index (HEI). PA level was calculated by multiply self-reported exercise frequency and its Metabolic Equivalent A high-quality diet was associated. A Cox proportional hazard model was used to explore risk factors for mortality in MAFLD patients. RESULTS In total, 3709 participants with MAFLD were included in the final analysis. The median follow-up time was 26.2 (interquartile range 19.3-28.1) years and 1549 (41.8%) deaths were recorded over follow-up. Cox multivariate regression was used to adjust for potential confounders of mortality. The results showed both HEI score and PA level were inversely correlated with all-cause mortality (P < 0.05). In the subgroup analysis stratified by PA level, higher diet quality decreased all-cause mortality, cardiovascular-related mortality and cancer-related mortality in PA inactive of MAFLD patients (P < 0.05), but these correlations were not present in active PA groups. CONCLUSION Healthy diet and physical activity may have different impact as lifestyle interventions for MAFLD. A high-quality diet is associated less mortality in inactive individuals with MAFLD but not in those with active PA levels. Sedentary individuals require healthier diet.
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Affiliation(s)
- Jiaofeng Huang
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Hepatopathy and Intestinal Diseases, Fuzhou, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yinlian Wu
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Hepatopathy and Intestinal Diseases, Fuzhou, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiaping Zheng
- Department of Rehabilitation Medicine, School of Health, Fujian Medical University, Fuzhou, China
| | - Mingfang Wang
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Hepatopathy and Intestinal Diseases, Fuzhou, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - George Boon-Bee Goh
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
- Fujian Clinical Research Center for Hepatopathy and Intestinal Diseases, Fuzhou, China.
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
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Racape J, Dauby N, Goffard JC, Abdellaoui K, Radulescu C, Coppieters Y, Rea A. Distinct socioeconomic profile of patients hospitalised with severe COVID-19 and prepandemic respiratory infections in Brussels's deprived areas: a case-control study. BMJ Open 2023; 13:e072914. [PMID: 37479511 PMCID: PMC10364187 DOI: 10.1136/bmjopen-2023-072914] [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] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Belgium has been hit harder by COVID-19 than other countries in Europe. While clinical risk factors are well studied, socioeconomic risk factors remained underexplored. This study's objective was to analyse the social and clinical profile of patients hospitalised for COVID-19 during the two waves of 2020, compared with a control population in 2019 in two hospitals located in Brussels' most deprived area. DESIGN AND METHODS We did a case-control study by using the minimal clinical data set in two Brussels hospitals. All patients hospitalised for COVID-19 in 2020, divided into two waves (n=3220), were compared with all patients hospitalised for viral pneumonia and respiratory diseases in 2019 (control population n=2950). Multinomial regression models were used to estimate the relative risk ratios of the association between the COVID-19 hospitalised populations (waves 1 and 2) and risk factors (social and clinical) stratified by age. RESULTS Patients under 65 years of age and hospitalised for COVID-19 presented significantly higher rates (relative rate ratio (95% CI)), especially for the first wave, of obesity 1.6 (1.2-2.2), African nationalities 1.4 (1.0-1.8), lack of health insurance 1.6 (1.3-2.1), living in high-density population areas 1.6 (1.3-2.1) and low incomes 1.7 (1.4-2.1), compared with the control population For patients over 65 years of age, we did not observe significant excess of COVID-19 hospitalisations for any risk factors, except diabetes during for the second wave but we have a significant excess mortality rate than the control population for both waves (p<0.002). CONCLUSIONS The social and clinical profile of patients hospitalised for COVID-19 compared with a population hospitalised for viral respiratory diseases differed between age groups and waves. For younger patients, risk factors were linked to patients' precarious situations. This study underlines the role of selected social health determinants and the importance of routinely collecting social data, along with clinical data, particularly among vulnerable populations.
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Affiliation(s)
- Judith Racape
- Chair in Health and Precarity, Faculty of Medicine, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Bruxelles, Belgium
- Environmental Health Research Center, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Kaoutar Abdellaoui
- Department of Minimal Clinical Data, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
| | - Cristina Radulescu
- Department of Minimal Clinical Data, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Andrea Rea
- Group for Research on Ethnic Relations, Migrations & Equality, Faculte de Philosophie et Sciences sociales, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
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Racape J, Noel AC, Lurel J, Dauby N, Coppieters Y, Goffard JC, Rea A. Social and clinical risk factors associated with hospitalized COVID-19 patients in Brussels's deprived and multiethnic areas. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002039. [PMID: 37450479 PMCID: PMC10348590 DOI: 10.1371/journal.pgph.0002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In Belgium, the Brussels-Capital region was severely affected by the COVID-19 epidemic. Various hypotheses were mentioned in order to explain Brussels' excess disease spreading and mortality rate, but socioeconomic risk factors are increasingly recognized. This study's objective was to analyze clinical and social profiles of patients hospitalized for COVID-19, by nationality groups, in two hospitals located in Brussels's deprived and multiethnic areas. METHODS Data covered hospitalized COVID-19 patients from two Brussels hospitals (n = 787) between the 1st of March 2020 and the 31st of June 2020. Social data was collected using hospital records, and clinical data was extracted from hospitals' COVID-19 databases. Multivariable logistic regression models were used to estimate the odds ratios (OR) of the association between two outcomes (Intensive Care Unit admission and mortality) and risk factors (social and clinical). RESULTS Patients from Sub-Saharan Africa were younger, had a higher prevalence of obesity, lacked health insurance, and had the highest proportion of Intensive Care Unit (ICU) admission (27.7%) but the lowest mortality rates than other nationality groups. Patients from North Africa had a higher prevalence of diabetes compared to other nationality groups and a high proportion of European patients came from nursing homes. Patients deprived of health insurance had a higher risk of ICU admission compared to those who had insurance (OR IC95%; 1,9 1.1-3.6, p = 0.03). Other risk factors as sex and obesity were significantly associated to ICU admission and, age and hypertension were significantly associated to mortality. CONCLUSION Social and clinical profile of the patients differs between the nationality groups, and some risk factors for Intensive Care Unit admission and mortality were linked to more patients' precarious situation as the availability of health insurance. This study underlines the role of selected social health determinants and the importance of routinely collecting social along with clinical data.
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Affiliation(s)
- Judith Racape
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite libre de Bruxelles (ULB), Brussels, Belgium
- Chair in Health and Precarity, Faculty of Medecine, Universite libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Cecile Noel
- Social Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jerome Lurel
- Department of Internal Medicine, Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Environmental Health Research Centre Public Health School, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Infectious Diseases, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Rea
- Group for Research on Ethnic Relations, Migrations & Equality, Faculty of Philosophy and Social Sciences, Universite libre de Bruxelles (ULB), Brussels, Belgium
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Minhas AMK, Jain V, Li M, Ariss RW, Fudim M, Michos ED, Virani SS, Sperling L, Mehta A. Family income and cardiovascular disease risk in American adults. Sci Rep 2023; 13:279. [PMID: 36609674 PMCID: PMC9822929 DOI: 10.1038/s41598-023-27474-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Socioeconomic status is an overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend greater CVD risk. Therefore, we assessed the association of family income with cardiovascular risk factor and disease burden in American adults. This retrospective analysis included data from participants aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In adjusted analyses, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥ 5) to lowest PIR (< 1). In adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Our study demonstrates a largely dose-dependent association of PIR with hypertension, diabetes mellitus, CHF, CAD and stroke prevalence as well as incident all-cause mortality and cardiac mortality in a nationally representative sample of American adults. Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in vulnerable groups with low family income.
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Affiliation(s)
- Abdul Mannan Khan Minhas
- grid.414961.f0000 0004 0426 4740Department of Medicine, Forrest General Hospital, Hattiesburg, MS USA
| | - Vardhmaan Jain
- grid.189967.80000 0001 0941 6502Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA USA
| | - Monica Li
- grid.189967.80000 0001 0941 6502Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Robert W. Ariss
- grid.62560.370000 0004 0378 8294Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Marat Fudim
- grid.189509.c0000000100241216Division of Cardiology, Duke University Medical Center, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Durham, NC USA
| | - Erin D. Michos
- grid.21107.350000 0001 2171 9311Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Salim S. Virani
- grid.39382.330000 0001 2160 926XMichael E. DeBakey Veterans Affair Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Laurence Sperling
- grid.189967.80000 0001 0941 6502Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA USA
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980036, Richmond, VA, 23298, USA.
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