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Perng W, Galai N, Zhao Q, Litonjua A, Geiger S, Sauder KA, O'Shea TM, Hivert MF, Oken E, Dabelea D, Aris IM. Sociodemographic Correlates of High Cardiovascular Health Across Childhood and Adolescence: A Prospective Study Among 2 Cohorts in the ECHO Consortium. J Am Heart Assoc 2024; 13:e036279. [PMID: 39082419 DOI: 10.1161/jaha.124.036279] [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: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND This study seeks to characterize cardiovascular health (CVH) from early childhood to late adolescence and identify sociodemographic correlates of high CVH that serve as levers for optimizing CVH across early life. METHODS AND RESULTS Among 1530 youth aged 3 to 20 years from 2 cohorts in the ECHO (Environmental Influences on Child Health Outcomes) consortium, we first derived CVH scores on the basis of the Life's Essential 8 construct comprising 4 behavioral (nicotine use/exposure, physical activity, sleep, and diet) and 4 health factors (body mass index, blood pressure, non-high-density lipoprotein cholesterol, and fasting glucose) during early childhood (mean age, 3.5 years), middle childhood (8.0 years), early adolescence (13.3 years), and late adolescence (17.8 years). Next, we used generalized regression to estimate the probability of high (versus not high) CVH with respect to sociodemographic characteristics. Overall CVH score was stable across life stages: 81.2±7.6, 83.3±8.0, and 81.7±8.9 of 100 possible points in early childhood, middle childhood, and early adolescence, respectively. Accordingly, during these life stages, most children (63.3%-71.5%) had high CVH (80 to <100). However, CVH declined by late adolescence, with an average score of 75.5±10.2 and 39.4% high CVH. No children had optimal CVH (score=100) at any time. Correlates of high CVH include non-Hispanic White race and ethnicity, maternal college education, and annual household income >$70 000. These associations were driven by behavioral factors. CONCLUSIONS Although most youth maintained high CVH across childhood, the decline by late adolescence indicates that cardiovascular disease prevention should occur before the early teen years. Disparities in high CVH over time with respect to sociodemographic characteristics were explained by behavioral factors, pointing toward prevention targets.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora CO
- Department of Epidemiology Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora CO
| | - Noya Galai
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Qi Zhao
- Department of Preventive Medicine College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Augusto Litonjua
- Department of Pediatrics University of Rochester Medical Center Rochester NY
| | - Sarah Geiger
- Department of Kinesiology and Community Health College of Applied Health Sciences University of Illinois at Urbana-Champaign Champaign IL
| | - Katherine A Sauder
- Department of Implementation Science Wake Forest University School of Medicine Winston-Salem NC
| | - T Michael O'Shea
- Department of Pediatrics University of North Carolina School of Medicine Chapel Hill NC
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora CO
- Department of Epidemiology Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora CO
- Department of Pediatrics School of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
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Gomez SE, Dudum R, Rodriguez F. Inequities in atherosclerotic cardiovascular disease prevention. Prog Cardiovasc Dis 2024; 84:43-50. [PMID: 38734044 PMCID: PMC11176018 DOI: 10.1016/j.pcad.2024.05.002] [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: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
Atherosclerotic cardiovascular (CV) disease (ASCVD) prevention encompasses interventions across the lifecourse: from primordial to primary and secondary prevention. Primordial prevention begins in childhood and involves the promotion of ideal CV health (CVH) via optimizing physical activity, body mass index, blood glucose levels, total cholesterol levels, blood pressure, and sleep while minimizing tobacco use. Primary and secondary prevention of ASCVD thereafter centers around mitigating ASCVD risk factors via medical therapy and lifestyle interventions. Disparities in optimal preventive efforts exist among historically marginalized groups in each of these three prongs of ASCVD prevention. Children and adults with a high burden of social determinants of health also face inequity in preventive measures. Inadequate screening, risk factor management and prescription of preventive therapeutics permeate the care of certain groups, especially women, Black, and Hispanic individuals in the United States. Beyond this, individuals belonging to historically marginalized groups also are much more likely to experience other ASCVD risk-enhancing factors, placing them at higher risk for ASCVD over their lifetime. These disparities translate to worse outcomes, with higher rates of ASCVD and CV mortality among these groups. Possible solutions to promoting equity involve community-based youth lifestyle interventions, improved risk-factor screening, and increasing accessibility to healthcare resources and novel preventive diagnostics and therapeutics.
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Affiliation(s)
- Sofia E Gomez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, United States.
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de Brito JN, Pereira MA, Kelly AS, Erickson DJ, Sherwood NE, Mason SM, Loth KA, French SA, Evanoff NG, Dengel DR, Kunin-Batson AS. Body Mass Index Trajectories and Biomarkers of Cardiometabolic Risk in Children from Low-Income and Racially and Ethnically Diverse Households. Child Obes 2024; 20:243-253. [PMID: 37327058 PMCID: PMC11250839 DOI: 10.1089/chi.2022.0216] [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] [Indexed: 06/17/2023]
Abstract
Background: This study examined the associations between BMI trajectories and emerging cardiometabolic risk (CMR) in children living in low-income and racially and ethnically diverse households in the United States. Methods: Data were drawn from NET-Works randomized intervention trial and NET-Works 2 prospective follow-up study (N = 338). BMI was measured across 6 follow-up visits and biomarkers of cardiometabolic risk (CMR) at the sixth visit. Group-based trajectory modeling identified child BMI trajectories. Adjusted multivariable linear regressions evaluated the associations between BMI trajectories and CMR. Results: We identified two BMI trajectories: 25% followed a trajectory of steep BMI increase, and 75% followed a moderate decreasing BMI trajectory over time. Relative to children in the moderate decreasing trajectory, children in the increasing trajectory had higher adjusted mean levels of C-reactive protein [CRP; 3.3; 95% confidence interval (CI): 1.6 to 5.0], leptin (63.1; 95% CI: 44.3 to 81.8), triglycerides (35.4; 95% CI: 22.1 to 48.6), triglyceride/high-density lipoprotein (HDL) ratio (1.2; 95% CI: 0.8 to 1.6), hemoglobin A1c (HbA1C; 0.1; 95% CI: 0.03 to 0.2), fasting glucose (1.8; 0.1 to 3.5) and insulin (8.8; 95% CI: 6.5 to 11.0), overall CMR score (0.7; 95% CI: 0.5 to 0.9), and lower adiponectin (-1.3; 95% CI: -2.5 to -0.1) and HDL (-10.8; 95% CI: -14.3 to -7.4). Conclusions: Children with high BMIs early in childhood were more likely to maintain an accelerated BMI trajectory throughout childhood, which was associated with adverse CMR in pre-adolescence. To advance health equity and support children's healthy weight and cardiovascular health trajectories, public health efforts are needed to address persistent disparities in childhood obesity and CMR.
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Affiliation(s)
- Junia N. de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mark A. Pereira
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Darin J. Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nancy E. Sherwood
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Susan M. Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Katie A. Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Simone A. French
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicholas G. Evanoff
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Donald R. Dengel
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Alicia S. Kunin-Batson
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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L’Engle K, Trejo E, Landeros A, Zúñiga Sandoval E, Jauregui J, Yang S. Brief peer coaching complements daily digital messages for chronic disease prevention among young adult Latinas. Transl Behav Med 2024; 14:80-88. [PMID: 37339885 PMCID: PMC10849174 DOI: 10.1093/tbm/ibad036] [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: 06/22/2023] Open
Abstract
Young Latinas face multiple health challenges that place them at high risk for chronic diseases. Digital health promotion interventions can offer education and support to activate self-care and preventive behaviors. This pilot study evaluated a brief, theory-informed, culturally tailored intervention, Examen Tu Salud, that provided daily text and multimedia messages and weekly peer coaching via videoconference to improve health behaviors among young adult Latina women. Thirty-four participants who self-identified as Latina, female, and 18-29 years old were recruited from an urban college in Northern California to participate in a brief pilot test of the new intervention. Paired sample T-tests assessed health behavior and health activation changes from baseline to 1 month follow-up. Program participation and satisfaction were analyzed to assess feasibility of the intervention. Among 31 participants (91% completion), there were medium to large improvements in health outcomes. Confidence in preventing and managing one's health (t[30] = 5.18, p < .001, d = 0.93), days of moderate-intensity physical activity (t[30] = 3.50, p < .001, d = 0.63), and fruit (t[30] = 3.32, p = .001, d = 0.60) and vegetable (t[30] = 2.04, p = .025, d = 0.37) consumption in a typical day increased. Intervention satisfaction and engagement with health coaches was high. We found that a brief digital coaching intervention designed for young adult Latinas has the potential to improve health activation and behaviors. More attention is needed to prevent chronic conditions among a growing number of Latinos in the USA.
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Affiliation(s)
- Kelly L’Engle
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Evelin Trejo
- Department of Hematology Oncology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Landeros
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Erika Zúñiga Sandoval
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Jazmin Jauregui
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Susan Yang
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Roche KM, Ehrlich KB, Vaquera E, Little TD. Mental Health During Early Adolescence and Later Cardiometabolic Risk: A Prospective Study of US Latinx Youth. J Adolesc Health 2024; 74:71-77. [PMID: 37815772 PMCID: PMC10843259 DOI: 10.1016/j.jadohealth.2023.08.026] [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: 01/20/2023] [Revised: 06/04/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Rising rates of cardiometabolic risk and mental health problems are serious public health concerns for US adolescents, particularly those of Latinx origin. This research examines how Latinx youth's internalizing symptoms during early adolescence are related to sleep problems, overweight/obesity, sedentary behavior, physical activity, healthy diet, and hypertension or diabetes risk during middle and late adolescence. METHODS Participants included 547 adolescents listed as "Hispanic" on 2017-18 middle school enrollment lists in a suburban Atlanta, GA school district. Survey data collected at baseline (2018) and four years later (2022) were analyzed using Structural Equation Model. Path estimates from baseline internalizing symptoms to later health behaviors and physical health outcomes adjusted for demographics, the follow-up measure of internalizing symptoms, and correlations among outcome variables. Missing data were handled using Full Information Maximum Likelihood. RESULTS At baseline, the 244 (44.6%) male and 303 (55.4%) female participants had a mean (standard deviation) age in years of 13.31 (0.97). Early adolescent internalizing symptoms were associated positively with later sleep problems (ß = 0.36 [95% confidence interval (CI), 0.24-0.48]), overweight/obesity (adjusted odds ratio, 2.57; 95% CI, 1.29-5.15), sedentary behavior (ß = 0.19 [95% CI, 0.09-0.30]), and internalizing symptoms (ß = 0.48 [95% CI, 0.39-0.56]) and inversely with later physical activity (ß = -0.16 [95% CI, -0.27 to -0.05]) and a healthy diet (ß = -0.21 [95% CI, -0.32 to -0.09]). DISCUSSION Latinx youth's internalizing symptoms during early adolescence not only track into later adolescence, but they also relate to health behaviors and outcomes underlying cardiometabolic risk during middle and late adolescence.
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Affiliation(s)
- Kathleen M Roche
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C..
| | | | - Elizabeth Vaquera
- Department of Sociology and Trachtenberg School of Public Policy and Public Administration, George Washington University, NW, Washington, D.C
| | - Todd D Little
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, Texas; School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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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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Flores-Guillén E, Castro-Quezada I, Irecta-Nájera CA, Núñez-Ortega PE, Solís-Hernández R, García-Miranda R, Cruz-Cruz P, Medina-Gómez C, Sánchez-Chino XM, Olivo-Vidal ZE, Cruz M, Ochoa-Díaz-López H. Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas in Chiapas, Mexico. CAD SAUDE PUBLICA 2023; 39:e00024623. [PMID: 37970940 PMCID: PMC10644975 DOI: 10.1590/0102-311xen024623] [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] [Received: 02/14/2023] [Revised: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 11/19/2023] Open
Abstract
This study was aimed to determine the prevalence of cardiovascular risk factors among different sociodemographic groups of adolescents from indigenous communities in Chiapas, Mexico. A cross-sectional prevalence study was performed in urban and rural communities in the Tzotzil-Tzeltal and Selva regions of Chiapas. A sample of 253 adolescents was studied, of whom 48% were girls and 52% were boys. A descriptive analysis of quantitative variables was performed using measures of central tendency and dispersion. The prevalence of cardiovascular risk factors stratified by sex, geographical area, years of schooling, and ethnicity of the mothers was estimated. The prevalence of cardiovascular risk factors was analyzed in relation to the sociodemographic characteristics of the study population. Low HDL-c (51%) was the predominant cardiovascular risk factor. Girls had a higher prevalence of abdominal obesity, hypertriglyceridemia, and borderline total cholesterol than boys. High diastolic blood pressure was more prevalent in boys. Adolescents from urban areas had a higher prevalence of overweight/obesity and insulin resistance than adolescents from rural areas. The prevalence of overweight/obesity and abdominal obesity was higher in adolescents whose mothers had ≥ 7 years of schooling compared with adolescents with less educated mothers. Differences by maternal ethnicity also influenced the prevalence of insulin resistance. Among the main findings, this study associated sociodemographic and geographical inequalities with cardiovascular risk factors. Promoting a healthy lifestyle for this young population is absolutely necessary to prevent cardiovascular diseases in adulthood.
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Affiliation(s)
- Elena Flores-Guillén
- El Colegio de la Frontera Sur, San Cristóbal de Las Casas, México
- Universidad de Ciencias y Artes de Chiapas, Tuxtla Gutiérrez, México
| | | | | | | | | | - Rosario García-Miranda
- El Colegio de la Frontera Sur, San Cristóbal de Las Casas, México
- Escuelas de Lenguas, Universidad Autónoma de Chiapas, San Cristóbal de Las Casas, México
| | - Paola Cruz-Cruz
- El Colegio de la Frontera Sur, San Cristóbal de Las Casas, México
| | | | | | | | - Miguel Cruz
- Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Ciudad de México, México
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O’Brien MJ, Zhang Y, Bailey SC, Khan SS, Ackermann RT, Ali MK, Bowen ME, Benoit SR, Imperatore G, Holliday CS, McKeever Bullard K. Clinical performance and health equity implications of the American Diabetes Association's 2023 screening recommendation for prediabetes and diabetes. Front Endocrinol (Lausanne) 2023; 14:1279348. [PMID: 37900145 PMCID: PMC10611495 DOI: 10.3389/fendo.2023.1279348] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA's screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.
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Affiliation(s)
- Matthew J. O’Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stacy C. Bailey
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald T. Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Mohammed K. Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Michael E. Bowen
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stephen R. Benoit
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christopher S. Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Patel AI, Schmidt LA, McCulloch CE, Blacker LS, Cabana MD, Brindis CD, Ritchie LD. Effectiveness of a School Drinking Water Promotion and Access Program for Overweight Prevention. Pediatrics 2023; 152:e2022060021. [PMID: 37545466 PMCID: PMC10471511 DOI: 10.1542/peds.2022-060021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drinking water promotion and access shows promise for preventing weight gain. This study evaluated the impact of Water First, a school-based water promotion and access intervention on changes in overweight. METHODS Low-income, ethnically diverse elementary schools in California's Bay Area were cluster-randomized to intervention and control groups. Water First includes classroom lessons, water stations, and schoolwide water promotion over 1 school year. The primary outcome was overweight prevalence (BMI-for-age-and-sex ≥85th percentile). Students (n = 1249) in 56 fourth-grade classes in 18 schools (9 intervention, 9 control) from 2016 to 2019 participated in evaluation at baseline, 7, and 15 months. Data collection was interrupted in 8 additional recruited schools because of coronavirus disease 2019. RESULTS Of 1262 students from 18 schools, 1249 (47.4% girls; mean [SD] age, 9.6 [0.4] years; 63.4% Hispanic) were recruited. From baseline to 7 months, there was no significant difference in changes in overweight prevalence in intervention schools (-0.2%) compared to control schools (-0.4%) (adjusted ratio of odds ratios [ORs]: 0.7 [confidence interval (CI): 0.2-2.9] P = 0.68). From baseline to 15-months, increases in overweight prevalence were significantly greater in control schools (3.7%) compared to intervention schools (0.5%). At 15 months, intervention students had a significantly lower change in overweight prevalence (adjusted ratio of ORs: 0.1 [CI: 0.03-0.7] P = .017) compared to control students. There were no intervention effects for obesity prevalence. CONCLUSIONS Water First prevented increases in the prevalence of overweight, but not obesity, in elementary school students.
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Affiliation(s)
- Anisha I. Patel
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies
- Department of Humanities and Social Sciences
| | | | - Lauren S. Blacker
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Michael D. Cabana
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies
- Division of Adolescent and Young Adult Health, Department of Pediatrics, University of California, San Francisco, California
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Davis, California
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10
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Hidirsah A, Chai Y, Flores R, Vidmar AP, Borzutzky C, Espinoza J. Paediatric obesity: Documentation, screening, and pharmacotherapy in a national cohort. Pediatr Obes 2023; 18:e13032. [PMID: 37017271 DOI: 10.1111/ijpo.13032] [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: 10/28/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Multiple organizations have published guidelines for the screening and treatment of obesity and related comorbidities in youth, including the use of anti-obesity medications (AOM). This study aimed to determine which paediatric patients: (1) receive a diagnostic code for obesity; (2) are most likely to be screened for hyperlipidaemia, non-alcoholic fatty liver disease, and type 2 diabetes mellitus; and (3) are most likely to be prescribed AOM. METHODS A cohort of 35 898 patients 9 years 4 months to 17 years 6 months of age with a BMI > 30 or greater than the 95th% on three separate outpatient encounters was generated using the TriNetX database. Logistic regression models were used to estimate the associations between demographics in the study population and the likelihood of diagnosis of obesity, screening for comorbidities, and prescription of AOMs. RESULTS Asian, Black, and Hispanic youths had increased odds of having a diagnosis of obesity and being screened for all three comorbidities. Documentation of obesity was associated with increased odds of screening for all comorbidities. Female sex, documentation of obesity, and higher BMIs were associated with increased odds of being prescribed AOMs. Black and Native American races decreased the likelihood of being prescribed AOM. CONCLUSIONS Management of obesity in terms of documentation of disease, screening for comorbidities, and initiation of AOM continues to fall short of the guidelines put forth by multiple organizations. Race/ethnicity, sex, and BMI correlate with differences in care provided to obese paediatric patients. Further research is needed to identify the barriers to and causes of these disparities.
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Affiliation(s)
- Arek Hidirsah
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Yan Chai
- Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ryan Flores
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Alaina P Vidmar
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
- Center for Endocrinology, Diabetes and Metabolism, Los Angeles, California, USA
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Juan Espinoza
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Brousmiche D, Lanier C, Cuny D, Frevent C, Genin M, Blanc-Garin C, Amouyel P, Deram A, Occelli F, Meirhaeghe A. How do territorial characteristics affect spatial inequalities in the risk of coronary heart disease? THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161563. [PMID: 36640871 DOI: 10.1016/j.scitotenv.2023.161563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cardiovascular diseases remain the leading cause of death and disabilities worldwide, with coronary heart diseases being the most frequently diagnosed. Their multifactorial etiology involves individual, behavioral and territorial determinants, and thus requires the implementation of multidimensional approaches to assess links between territorial characteristics and the incidence of coronary heart diseases. CONTEXT AND OBJECTIVES This study was carried out in a densely populated area located in the north of France with multiple sources of pollutants. The aim of this research was therefore to establish complex territorial profiles that have been characterized by the standardized incidence, thereby identifying the influences of determinants that can be related to a beneficial or a deleterious effect on cardiovascular health. METHODS Forty-four variables related to economic, social, health, environment and services dimensions with an established or suspected impact on cardiovascular health were used to describe the multidimensional characteristics involved in cardiovascular health. RESULTS Three complex territorial profiles have been highlighted and characterized by the standardized incidence rate (SIR) of coronary heart diseases after adjustment for age and gender. Profile 1 was characterized by an SIR of 0.895 (sd: 0.143) and a higher number of determinants that revealed favorable territorial conditions. Profiles 2 and 3 were characterized by SIRs of respectively 1.225 (sd: 0.242) and 1.119 (sd: 0.273). Territorial characteristics among these profiles of over-incidence were nevertheless dissimilar. Profile 2 revealed higher deprivation, lower vegetation and lower atmospheric pollution, while profile 3 displayed a rather privileged population with contrasted territorial conditions. CONCLUSION This methodology permitted the characterization of the multidimensional determinants involved in cardiovascular health, whether they have a negative or a positive impact, and could provide stakeholders with a diagnostic tool to implement contextualized public health policies to prevent coronary heart diseases.
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Affiliation(s)
- Delphine Brousmiche
- Univ. Lille, Univ. Artois, IMT Lille Douai, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France; Association pour la Prévention de la Pollution Atmosphérique, F-59120 Loos, France.
| | - Caroline Lanier
- Univ. Lille, Univ. Artois, IMT Lille Douai, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France; Univ. Lille, UFR3S-Faculté d'Ingénierie et Management de la Santé (ILIS), F-59000 Lille, France
| | - Damien Cuny
- Univ. Lille, Univ. Artois, IMT Lille Douai, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France; Univ. Lille, UFR3S-Faculté de Pharmacie de Lille - LSVF, F-59000 Lille, France
| | - Camille Frevent
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Michael Genin
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Carine Blanc-Garin
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, Inserm UMR1167 RID-AGE (Risk Factors and Molecular Determinants of Aging-Related Diseases), F-59000 Lille, France
| | - Philippe Amouyel
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, Inserm UMR1167 RID-AGE (Risk Factors and Molecular Determinants of Aging-Related Diseases), F-59000 Lille, France
| | - Annabelle Deram
- Univ. Lille, Univ. Artois, IMT Lille Douai, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France; Univ. Lille, UFR3S-Faculté d'Ingénierie et Management de la Santé (ILIS), F-59000 Lille, France
| | - Florent Occelli
- Univ. Lille, Univ. Artois, IMT Lille Douai, JUNIA, ULR 4515 - LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France; Univ. Lille, UFR3S-Faculté d'Ingénierie et Management de la Santé (ILIS), F-59000 Lille, France
| | - Aline Meirhaeghe
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, Inserm UMR1167 RID-AGE (Risk Factors and Molecular Determinants of Aging-Related Diseases), F-59000 Lille, France
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12
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Lande MB, Herendeen NE, Little E, Halterman JS. School-Based Telemedicine for Hypertension Management in Urban Adolescents. J Adolesc Health 2023; 72:640-642. [PMID: 36528516 DOI: 10.1016/j.jadohealth.2022.10.035] [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: 08/30/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to determine if hypertensive adolescents from impoverished neighborhoods in Rochester, New York have improved blood pressure (BP) control with the use of school-based telemedicine. METHODS Adolescents receiving antihypertensive medication had monthly study telemedicine visits at school. BP was measured by a telehealth clinical assistant (CTA) at the school using standard procedures, followed in real time by a teleconferencing visit with the study physician. RESULTS Six participants were enrolled, and all completed school-based telemedicine visits prior to school closure due to the SARS-CoV-2 pandemic. Mean systolic and diastolic BP at baseline were 139 ± 5 and 75 ± 8 mmHg. All six participants had significant improvement in their blood pressure (final school mean BPs, 127 ± 4 and 67 ± 5 mmHg; systolic, baseline vs. final, p = .003). DISCUSSION In this pilot study, adolescents with very high levels of neighborhood disadvantage had consistent adherence with school-based telemedicine and significant improvement in hypertension (HTN) control.
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Affiliation(s)
- Marc B Lande
- Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, New York.
| | - Neil E Herendeen
- Division of General Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Erika Little
- Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, New York
| | - Jill S Halterman
- Division of General Pediatrics, University of Rochester Medical Center, Rochester, New York
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13
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Barcelona V, Flowers A, Caceres BA, Crusto CA, Taylor JY. Associations between Paternal Co-residence and Child Health among African American Children. West J Nurs Res 2023; 45:201-207. [PMID: 35897162 PMCID: PMC9880248 DOI: 10.1177/01939459221115152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated the associations between paternal co-residence and asthma, obesity, and blood pressure among children aged 3-5 years. Mother/child dyads (N = 250) self-identified as African American or Black. Mothers reported on father's co-residence and child's asthma diagnosis. Height, weight, and blood pressure were measured. Regression models were used to examine paternal co-residence with child health outcomes (i.e., asthma, obesity, and blood pressure). Confounders included maternal and child age, child sex, maternal smoking, and insurance status. Children who lived with their fathers were less likely to have asthma (OR = 0.39, 95% CI 0.18-0.79), though this association was not significant after adjustment for confounders (aOR = 0.47, 95% CI 0.22-1.01). Paternal co-residence was not significantly associated with child obesity (aOR = 0.78, 95% CI 0.35-1.73), systolic (β = 0.57, SE = 1.2, p = .64), or diastolic (β = 1.91, SE = 1.0, p = .07) blood pressure. More research is necessary to understand the diversity of family living situations and how they affect child health.
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Affiliation(s)
- Veronica Barcelona
- Columbia University School of Nursing, New York, NY, USA.,Center for Research on People of Color, Columbia University School of Nursing, New York, NY, USA
| | | | - Billy A Caceres
- Columbia University School of Nursing, New York, NY, USA.,Center for Research on People of Color, Columbia University School of Nursing, New York, NY, USA
| | - Cindy A Crusto
- Yale School of Medicine, New Haven, CT, USA.,University of Pretoria, Pretoria, South Africa
| | - Jacquelyn Y Taylor
- Columbia University School of Nursing, New York, NY, USA.,Center for Research on People of Color, Columbia University School of Nursing, New York, NY, USA
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14
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Burns RD, Fu Y. Parental Perceived Discrimination and Youth Participation in Out-Of-School Sports. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121808. [PMID: 36553252 PMCID: PMC9777264 DOI: 10.3390/children9121808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the associations between perceived parental discrimination and youth participation in out-of-school sports. We analyzed a representative sample of US children and adolescents from the 2020 National Survey of Children’s Health (N = 30,656; 6−17 years old; 49.0% female). The dependent variable was a (No/Yes) response item asking parents about their child’s participation in out-of-school sports. Two binary response items asked parents if they perceived that their child was ever treated or judged unfairly because of their race/ethnicity and because of their sexual orientation/gender identity. Weighted multiple logistic regressions examined correlations between the discrimination variables and out-of-school sports controlling for demographics covariates including family income. After covariate adjustment, perceived parental discrimination because of race/ethnicity associated with 1.57 times higher odds of child participation in sports (Adjusted Odds Ratio (AOR) = 1.57, 95%CI: 1.17−2.03, p = 0.002). Conversely, discrimination because of sexual orientation/gender identity correlated with 57% lower odds of child participation in sports (AOR (Adjusted Odds Ratio) = 0.43, 95%CI: 0.27−0.69, p < 0.001). After family income and other covariates were considered, perceived discrimination by parents because of their child’s race/ethnicity associated with higher probability of sports participation. Perceived discrimination by parents because of their child’s sexual orientation/gender identity associated with a lower probability of participating in sports.
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Affiliation(s)
- Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
- Correspondence: ; Tel.: +1-801-695-5035
| | - You Fu
- School of Public Health, University of Nevada, Reno, NV 89557, USA
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15
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Abstract
PURPOSE OF THE REVIEW Despite marked progress in cardiovascular disease management in the last several decades, there remain significant, persistent disparities in cardiovascular health in historically marginalized racial and ethnic groups. Here, we outline current state of health disparities in cardiovascular disease, discuss the interplay between social determinants of health, structural racism, and cardiovascular outcomes, and highlight strategies to address these issues. RECENT FINDINGS Across the continuum of atherosclerotic cardiovascular disease (ASCVD) prevention, there remain significant disparities in outcomes including morbidity and mortality by race, ethnicity, and socioeconomic status (SES). These disparities begin early in childhood (primordial prevention) and continue with a higher prevalence of cardiovascular risk factors (primary prevention), and in the uptake of evidence-based therapies (secondary prevention). These disparities are driven by social determinants of health and structural racism that disproportionately disadvantage historically marginalized populations. Structural racism and social determinants of health contribute to significant disparities in cardiovascular morbidity and mortality.
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Affiliation(s)
- Ankita Devareddy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashish Sarraju
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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16
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Agathis NT, Womack LS, Webber BJ, Choudhary R, Wanga V, Ko JY, Dupont H, Imperatore G, Koumans EH, Saydah S, Kimball AA, Siegel DA. Children, adolescents, and young adults hospitalized with COVID-19 and diabetes in summer 2021. Pediatr Diabetes 2022; 23:961-967. [PMID: 35876454 PMCID: PMC9349842 DOI: 10.1111/pedi.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION More information is needed to understand the clinical epidemiology of children and young adults hospitalized with diabetes and COVID-19. We describe the demographic and clinical characteristics of patients <21 years old hospitalized with COVID-19 and either Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) during peak incidence of SARS-CoV-2 infection with the B.1.617.2 (Delta) variant. METHODS This is a descriptive sub-analysis of a retrospective chart review of patients aged <21 years hospitalized with COVID-19 in six US children's hospitals during July-August 2021. Patients with COVID-19 and either newly diagnosed or known T1DM or T2DM were described using originally collected data and diabetes-related data specifically collected on these patients. RESULTS Of the 58 patients hospitalized with COVID-19 and diabetes, 34 had T1DM and 24 had T2DM. Of those with T1DM and T2DM, 26% (9/34) and 33% (8/24), respectively, were newly diagnosed. Among those >12 years old and eligible for COVID-19 vaccination, 93% were unvaccinated (42/45). Among patients with T1DM, 88% had diabetic ketoacidosis (DKA) and 6% had COVID-19 pneumonia; of those with T2DM, 46% had DKA and 58% had COVID-19 pneumonia. Of those with T1DM or T2DM, 59% and 46%, respectively, required ICU admission. CONCLUSION Our findings highlight the importance of considering diabetes in the evaluation of children and young adults presenting with COVID-19; the challenges of managing young patients who present with both COVID-19 and diabetes, particularly T2DM; and the importance of preventive actions like COVID-19 vaccination to prevent severe illness among those eligible with both COVID-19 and diabetes.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Lindsay S. Womack
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Bryant J. Webber
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Valentine Wanga
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Jean Y. Ko
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Hannah Dupont
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Giuseppina Imperatore
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion
| | - Emilia H. Koumans
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Sharon Saydah
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Anne A. Kimball
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - David A. Siegel
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - the Pediatric COVID‐19 Hospital Investigation TeamGerdesMegan E.MPHShiDallas S.MD, PhDDulskiTheresa M.MD, MPHHsuSophiaMSN, MPHIduborOsatohamwen I.MDWendelArthur M.MDAndersonKristiMDBoylesTriciaMHAChiuSophia K.MDClickEleanor S.MD, PhDDa SilvaJulianaMDEvansMaryMDGoldJeremy A. W.MD, MSHastonJuliaMDLoganPamelaMD, MPH, MAMaloneySusan A.MDMartinezMarisolPharmDNatarajanPavithraBMBSSpicerKevin B.MD, PhDSwancuttMarkMDStevensValerie A.BrownJessicaPhDChandraGyanMBALightMeganMPHSchweitzerBethMSMorrisSapna BamrahMDBarrFrederick E.MDSnowdenJessicaMDKociolekLarry K.MDMcHughMatthewMPHWesselDavid L.MDSimpsonJoelle N.MDGormanKathleen C.MSNBreslinKristen A.MD, MPHDeBiasiRoberta L.MD, MSThompsonAaronMDKlineMark W.MDBoomJulie A.MDSinghIla R.MD, PhDDowlinMichaelWietechaMarkMS, MBA
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17
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Unique Cardiovascular Disease Risk Factors in Hispanic Individuals. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:53-61. [PMID: 35669678 PMCID: PMC9161759 DOI: 10.1007/s12170-022-00692-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review summarizes contemporary data on unique cardiovascular disease (CVD) risk factors in Hispanic individuals in the USA, and how addressing these factors is important in addressing health equity. Recent Findings Recent studies have shown high rates of traditional CVD risk factors in Hispanic individuals such as obesity, hypertension, diabetes, hyperlipidemia, and emerging CVD risk factors like hypertensive disorders of pregnancy, psychological stress, and occupational exposures. However, most studies fail to consider the significant heterogeneity in risk factor burden and outcomes in atherosclerotic CVD by Hispanic subgroup. Heart failure and rhythm disorders are less well studied in Hispanic adults, making risk assessment for these conditions difficult. High levels of CVD risk factors in Hispanic youth given an aging Hispanic population overall highlight the importance of risk mitigation among these individuals. Summary In brief, these data highlight the significant, unique burden of CVD risk among Hispanic individuals in the USA and predict a rising burden of disease among this growing and aging population. Future CVD research should focus on including robust, diverse Hispanic cohorts as well as specifically delineating results for disaggregated Hispanic groups across CVDs. This will allow for better risk assessment, prevention, and treatment decisions to promote health equity for Hispanic patients.
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18
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Brotto LA, Galea LAM. Gender inclusivity in women's health research. BJOG 2022; 129:1950-1952. [PMID: 35596700 DOI: 10.1111/1471-0528.17231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Liisa A M Galea
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Parker MK, Davy BM, Hedrick VE. Current Knowledge Base of Beverage Health Impacts, Trends, and Intake Recommendations for Children and Adolescents: Implications for Public Health. Curr Nutr Rep 2021; 10:427-434. [PMID: 34797556 DOI: 10.1007/s13668-021-00376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Improving beverage patterns is important for promoting the health of children and adolescents. Food preferences can begin developing at a young age; thus, children and adolescents should be provided healthy beverages in accordance with current recommendations. The purpose of this review is to identify and summarize existing beverage recommendations for children and adolescents. This review also discusses the health impacts of beverages and how beverage consumption has changed among children and adolescents over time. RECENT FINDINGS The mean number of calories that children and adolescents are consuming from beverages on a given day has declined in recent years. However, sugar-sweetened beverages (SSB) are the primary source of added sugars in this population. Therefore, SSB consumption remains a concern, and reducing the intake of SSB is still considered a top priority for helping to improve dietary quality. This review uniquely compiles recommendations into one convenient table for the entire age range of 0-19 years and includes recommendations that can be more adequately individualized. Beverage categories where beverage recommendations from authoritative sources are lacking have also been identified. Potential methods that can be implemented to improve beverage patterns and current public policy recommendations have been discussed to provide actionable steps that public health professionals can utilize in practice. The comprehensive table of beverage recommendations could be useful for professionals promoting the health of children and adolescents in research, clinical, and public health settings.
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Affiliation(s)
- Molly K Parker
- Virginia Tech, 295 West Campus Drive, 337 Wallace Hall, Blacksburg, VA, 24061, USA
| | - Brenda M Davy
- Virginia Tech, 295 West Campus Drive, 266B Wallace Hall, Blacksburg, VA, 24061, USA
| | - Valisa E Hedrick
- Virginia Tech, 295 West Campus Drive, 335A Wallace Hall, Blacksburg, VA, 24061, USA.
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20
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Affiliation(s)
- Liisa A M Galea
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, Women's Health Research Cluster, University of British Columbia, Vancouver, BC, Canada.
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