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Jones SMW, Briant KJ, Doody DR, Iachan R, Mendoza JA. A person-reported cumulative social risk measure does not show bias by income and education. J Patient Rep Outcomes 2024; 8:90. [PMID: 39133444 PMCID: PMC11319681 DOI: 10.1186/s41687-024-00772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/23/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Social risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing. METHODS We conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model. RESULTS Analyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible. CONCLUSIONS Results suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Mailstop M4-B402, Seattle, WA, 98109, USA.
| | - Katherine J Briant
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Mailstop M4-B402, Seattle, WA, 98109, USA
| | - David R Doody
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Mailstop M4-B402, Seattle, WA, 98109, USA
| | - Ronaldo Iachan
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Mailstop M4-B402, Seattle, WA, 98109, USA
- ICF International, Washington DC, United States
| | - Jason A Mendoza
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Mailstop M4-B402, Seattle, WA, 98109, USA
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Wagner JA, Bermúdez-Millán A, Feinn RS. Prevalence and Predictors of Food Insecurity among Adults with Type 1 Diabetes: Observational Findings from the 2022 Behavioral Risk Factor Surveillance System. Nutrients 2024; 16:2406. [PMID: 39125286 PMCID: PMC11313750 DOI: 10.3390/nu16152406] [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: 07/09/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
The majority of data on food insecurity in diabetes comes from samples of type 2 diabetes or youth with type 1 diabetes. This study screened for food insecurity among adults with type 1 diabetes in the 2022 Behavioral Risk Factor Surveillance Survey, which was the first year that respondents who endorsed diabetes were asked to indicate whether they had type 1 or type 2. One validated screening item asked, "During the past 12 months, how often did the food that you bought not last and you didn't have money to buy more?". Respondents who answered "always", "usually", "sometimes", or "rarely" were categorized as having a positive screen for food insecurity. Seventy-six percent of the sample was white/non-Hispanic. Over one-quarter screened positive for food insecurity. This prevalence is higher than some reports of food insecurity in type 1 diabetes but consistent with reports that include 'marginal' food security in the count of food-insecure individuals. White/non-Hispanics had a lower risk of a positive screen than minoritized respondents. Respondents reporting older age, lower educational attainment, not working, lower income, and receiving SNAP benefits had higher rates of a positive screen. Significant healthcare factors associated with a positive screen were receiving government insurance instead of private, not being able to afford to see a doctor, and worse general, physical, and mental health. In conclusion, rates of a positive screen for food insecurity among people with type 1 diabetes in this study were alarmingly high and associated with other socioeconomic indicators. Screening for food insecurity with appropriate instruments for samples with type 1 diabetes, across the U.S. and internationally, should be a priority.
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Affiliation(s)
- Julie Ann Wagner
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-3910, USA
| | - Angela Bermúdez-Millán
- Department of Public Health Sciences, School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-6325, USA;
| | - Richard S. Feinn
- Department of Medical Sciences, Quinnipiac University, Hamden, CT 06518, USA;
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Yeşil F, Çövener Özçelik Ç. The development of health literacy scale for acute complications of diabetes for children with type 1 diabetes (8-12 years). J Pediatr Nurs 2024:S0882-5963(24)00244-6. [PMID: 39003193 DOI: 10.1016/j.pedn.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This study aimed to develop a Health Literacy Scale for Acute Complications of Diabetes for Children with Type 1 Diabetes (8-12 years of age) and to test the instrument in terms of its psychometric properties. METHODS The study is of methodological design and was conducted with 222 children, aged 8 to 12 years, with type 1 diabetes who were registered at a training and research hospital's diabetes outpatient clinic. The item pool of the study consisted of 22 statements. Ten experts were asked to review the scale, and when content validity was confirmed, the scale items were amended until the draft scale had 22 items. The children themselves completed the "Diagnostic Form for Children with Diabetes" and "Health Literacy Scale for Acute Complications of Type 1 Diabetes for Children (8-12 years)" questionnaire between June 2021 and October 2022. Exploratory factor analysis (EFA), item-total correlation, and split-half reliability testing were employed for psychometric properties. RESULTS The scale comprised 19 items and 3 factors containing information on acute complications of diabetes and health literacy. CONCLUSION A valid and accurate instrument was developed to measure the acute complications of diabetes in children and their health literacy. As such, the scale can be used as a practical tool in evaluating the understanding and implementation skills of children with Type 1 diabetes regarding the management of acute complications of the disease and in assessing their health literacy.
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Affiliation(s)
- Fatma Yeşil
- Marmara University Institute of Health Sciences, Istanbul, Turkey
| | - Çağrı Çövener Özçelik
- Marmara University, Faculty of Nursing, Department Pediatric Nursing, Istanbul 34854, Turkey.
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James O, Abbou-Abbas L, Vijayasingham L. Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003027. [PMID: 38905318 PMCID: PMC11192347 DOI: 10.1371/journal.pgph.0003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024]
Abstract
Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.
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Affiliation(s)
- Oria James
- MSc Public Health Graduate Class of 2023, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linda Abbou-Abbas
- International Committee of the Red Cross, Beirut Delegation, Lebanon
- INSPECT-LB (Institut de Santé Publique, Epidemiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
| | - Lavanya Vijayasingham
- NCD in Humanitarian Settings Research Group and Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Malik FS, Liese AD, Ellyson A, Reid LA, Reboussin BA, Sauder KA, Frongillo EA, Pihoker C, Dabelea D, Reynolds K, Jensen ET, Marcovina S, Bowlby DA, Mendoza JA. Household food insecurity and associations with hemoglobin A 1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study. Diabetes Res Clin Pract 2024; 212:111608. [PMID: 38574894 PMCID: PMC11290462 DOI: 10.1016/j.diabres.2024.111608] [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: 11/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
AIMS To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. METHODS HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. RESULTS Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. CONCLUSIONS HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States.
| | | | - Alice Ellyson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | | | - Beth A Reboussin
- Wake Forest University School of Medicine, Winston-Salem, United States
| | | | | | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | - Dana Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Kristi Reynolds
- Kaiser Permanente Southern California, Pasadena, United States
| | | | | | | | - Jason A Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States; Fred Hutchinson Cancer Center, Seattle, United States
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Zenno A, Huang A, Roberts AJ, Pihoker C. Health-Care Utilization and Outcomes in Young Adults With Type 1 and Type 2 Diabetes. J Endocr Soc 2024; 8:bvae115. [PMID: 38939833 PMCID: PMC11210301 DOI: 10.1210/jendso/bvae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Indexed: 06/29/2024] Open
Abstract
Young adulthood can be a challenging time for individuals with diabetes mellitus (DM) as they experience increasing independence and life transitions, which can make it difficult to engage in DM self care. Compared to older adults, young adults are more likely to have higher glycated hemoglobin A1c (HbA1c). They also often have lower adherence to standards of care in DM, and higher utilization of emergency department (ED) visits and hospitalizations for diabetic ketoacidosis. This review describes health-care utilization and explores factors that may contribute to high HbA1c among young adults with DM. In addition, it discusses the unique health-care needs of young adults with DM, examines the role of technology in their DM care, and analyzes the effects of social determinants of health on their health-care utilization.
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Affiliation(s)
- Anna Zenno
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Department of Medicine, University of Washington, Seattle, WA 98105, USA
| | - Alyssa Huang
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Alissa J Roberts
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
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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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Mazurenko O, Hirsh AT, Harle CA, McNamee C, Vest JR. Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use. BMC Emerg Med 2024; 24:45. [PMID: 38500019 PMCID: PMC10949703 DOI: 10.1186/s12873-024-00959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations. METHODS We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach. RESULTS We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients' disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs. CONCLUSIONS In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University- Indianapolis, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Cassidy McNamee
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Julceus EF, Frongillo EA, Mendoza JA, Sauder KA, Malik FS, Jensen ET, Dolan LM, Bellatorre A, Dabelea D, Reboussin BA, Reynolds K, Pihoker C, Liese AD. Self-Reported Food Security in Adolescents with Type 1 Diabetes: Association with Hemoglobin A 1c and Mental Health Symptoms Independent of Household Food Security. J Nutr 2024; 154:543-553. [PMID: 38072157 PMCID: PMC10900134 DOI: 10.1016/j.tjnut.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Typically, child exposure to food insecurity is assessed by caregiver reports of household food security. Child report has the potential for greater accuracy because it pertains only to the child whose experiences may differ from caregiver reports. OBJECTIVE We assessed if adolescent-reported food insecurity was associated with levels of hemoglobin A1c (HbA1c), acute diabetes-related complications, depressive symptoms, and disordered eating behaviors in adolescents with type 1 diabetes, independently from household food security. METHODS In a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Cohort Study (phase 4, 2016-2019) including 601 adolescents aged 10-17 y with type 1 diabetes and their caregivers, household food security, and adolescent-reported food security were assessed using the 18-item Household Food Security Survey Module and the 6-item Child Food Security Assessment questionnaire. Age-stratified (10-13 and 14-17) regression models were performed to estimate independent associations, adjusting for sociodemographics, clinical factors, and household food security. RESULTS Food insecurity was reported by 13.1% (n = 79) of adolescents and 15.6% (n = 94) of caregivers. Among adolescent-caregiver dyads, 82.5% (n = 496) of reports were concordant and 17.5% (n = 105) discordant, Cohen's κ= 0.3. Adolescent-reported food insecurity was not independently associated with HbA1c, diabetic ketoacidosis, and severe hypoglycemia, including in age-stratified analyses. Adolescent-reported food insecurity was independently associated with elevated odds of depressive symptoms [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3, 10.3] and disordered eating behaviors (OR: 2.5, 95% CI: 1.4, 4.6) compared with adolescents reporting food security; these associations remained in both age groups for disordered eating behaviors and in the older group for depressive symptoms. CONCLUSIONS Adolescents with type 1 diabetes may experience food insecurity differently than caregivers. Adolescent-reported food insecurity was independently associated with depressive symptoms and disordered eating behaviors and thus may be an important attribute to assess in addition to household food security in adolescents with type 1 diabetes.
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Affiliation(s)
- Emmanuel F Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jason A Mendoza
- Fred Hutch Cancer Center, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Lawrence M Dolan
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
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11
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Chambers S, Machray K, Fergie G. Food insecurity in children and young people in Scotland. Proc Nutr Soc 2024:1-13. [PMID: 38250796 DOI: 10.1017/s0029665124000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.
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Affiliation(s)
- Stephanie Chambers
- School of Social and Political Sciences, University of Glasgow, 28 Bute Gardens, GlasgowG12 8RS, Scotland
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kathryn Machray
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Gillian Fergie
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Frim YG, Garvey KC, Gordon E, Rhodes ET. Screening for Food Insecurity in a Pediatric Diabetes Program: Provider and Parent/Guardian Perspectives. Clin Pediatr (Phila) 2024:99228231222987. [PMID: 38243651 DOI: 10.1177/00099228231222987] [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: 01/21/2024]
Abstract
Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens.
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Affiliation(s)
- Yonina G Frim
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin Gordon
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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13
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Reid LA, Geraci M, Mendoza JA, Merchant AT, Reboussin BA, Pate RR, Dolan LM, Sauder KA, Lustigova E, Kim G, Liese AD. Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study. J Phys Act Health 2024; 21:77-84. [PMID: 37922896 DOI: 10.1123/jpah.2022-0338] [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: 06/22/2022] [Revised: 07/13/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. METHODS HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. RESULTS YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. CONCLUSIONS Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.
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Affiliation(s)
- Lauren A Reid
- South College, Atlanta, GA, USA
- University of South Carolina, Columbia, SC, USA
| | - Marco Geraci
- University of South Carolina, Columbia, SC, USA
- Sapienza University of Rome, Rome, Italy
| | - Jason A Mendoza
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | | | | | | | - Eva Lustigova
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Grace Kim
- University of Washington School of Medicine, Seattle, WA, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Lee G, Liu R, McPeek Hinz ER, Bettger JP, Purakal J, Spratt SE. Leveraging Student Volunteers to Connect Patients with Social Risk to Resources On a Coordinated Care Platform: A Case Study with Two Endocrinology Clinics. Int J Integr Care 2024; 24:10. [PMID: 38370570 PMCID: PMC10870950 DOI: 10.5334/ijic.7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Although unmet social needs can impact health outcomes, health systems often lack the capacity to fully address these needs. Our study describes a model that organized student volunteers as a community-based organisation (CBO) to serve as a social referral hub on a coordinated social care platform, NCCARE360. Description Patients at two endocrinology clinics were systematically screened for social needs. Patients who screened positive and agreed to receive help were referred via NCCARE360 to student 'Help Desk' volunteers, who organised as a CBO. Trained student volunteers called patients to place referrals to resources and document them on the platform. The platform includes documentation at several levels, acting as a shared information source between healthcare providers, volunteer student patient navigators, and community resources. Navigators followed up with patients to problem-solve barriers and track referral outcomes on the platform, visible to all parties working with the patient. Discussion Of the 44 patients who screened positive for social needs and were given referrals by Help Desk, 41 (93%) were reached for follow-up. Thirty-six patients (82%) connected to at least one resource. These results speak to the feasibility and utility of organising undergraduate student volunteers into a social referral hub to connect patients to resources on a coordinated care platform. Conclusion Organising students as a CBO on a centralized social care platform can help bridge a critical gap between healthcare and social services, addressing health system capacity and ultimately improving patients' connections with resources.
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Affiliation(s)
- Grace Lee
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina, USA
| | - Rebecca Liu
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina, USA
| | | | - Janet Prvu Bettger
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - John Purakal
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Samuel Dubois Cook Center on Social Equity, Duke University, Durham, North Carolina, USA
| | - Susan E. Spratt
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Population Health Management Office, Duke University School of Medicine, Durham, North Carolina, USA
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Odugbesan O, Wright T, Jones NHY, Dei-Tutu S, Gallagher MP, DeWit E, Izquierdo RE, Desimone M, Rioles N, Ebekozien O. Increasing Social Determinants of Health Screening Rates Among Six Endocrinology Centers Across the United States: Results From the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2023; 42:49-55. [PMID: 38230332 PMCID: PMC10788654 DOI: 10.2337/cd23-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months.
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Affiliation(s)
| | | | | | | | | | - Emily DeWit
- Children’s Mercy Research Institute Hospital, Kansas City, MO
| | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Habteyohans BD, Hailu BS, Meseret F, Mohammed A, Berhanu Y, Alemu A, Tolosa G, Keneni M, Desalew A. Poor glycemic control and its associated factors among children with type 1 diabetes mellitus in Harar, eastern Ethiopia: A cross-sectional study. BMC Endocr Disord 2023; 23:208. [PMID: 37759193 PMCID: PMC10538014 DOI: 10.1186/s12902-023-01453-9] [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: 03/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Poor glycemic control increases the risk of acute metabolic derangements and long-term consequences, which are the main causes of morbidity and mortality. Maintaining adequate glycemic control is challenging for children with diabetes, particularly in resource-limited settings. There is a paucity of data on the magnitude of poor glycemic control and its predisposing factors in Ethiopian particularly in this study setting. Hence, we aimed to assess the magnitude of poor glycemic control and its associated factors among children and adolescents with type 1 diabetic mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals in Harar, eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among 231 children and adolescents with type 1 diabetes mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals. Participants were included consecutively in the follow-up clinic from November 15, 2022 to January 15, 2023. Data were collected through an interviewer-administered structured questionnaire and a review of medical records. A binary logistic regression model with an adjusted odds ratio (aOR) and a 95% confidence interval (CI) was used to identify the factors associated with poor glycemic control. Statistical significance was set at p < 0.05. RESULT A total of 231 children and adolescents with type 1 diabetes mellitus were included. The magnitude of poor glycemic control was 166 (71.9%) with 95% CI 66.0-77.7%). In multivariable analysis, the age of the child (aOR = 0.19, 95% CI: 0.05-0.83), education of the caregiver (aOR = 4.13;95% CI: 1.82-9.46), meal frequency less than three (aOR = 3.28; 95% CI: 1.25-8.62), and consumption of forbidden foods (aOR = 3.17; 95% CI: 1.21-8.29) were factors significantly associated with poor glycemic control. CONCLUSION Two-thirds of participants had poor glycemic control. There was a statistically significant association between the age of the child, education of the caregiver, meal frequency, and forbidden foods with poor glycemic control. To improve glycemic control, diabetes education on meal use and selection should be conducted during follow-up along with parent education.
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Affiliation(s)
- Betelhem Demeke Habteyohans
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Betre Shimelis Hailu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fentahun Meseret
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Ahmed Mohammed
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yeshi Berhanu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ayichew Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Gadissa Tolosa
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Mulualem Keneni
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Assefa Desalew
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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17
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Brown AD, Liese AD, Shapiro ALB, Frongillo EA, Wilkening G, Fridriksson J, Merchant AT, Henkin L, Jensen ET, Reboussin BA, Shah AS, Marcovina S, Dolan LM, Dabelea D, Pihoker C, Mendoza JA. Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes. Pediatr Diabetes 2023; 2023:6382663. [PMID: 38765732 PMCID: PMC11100256 DOI: 10.1155/2023/6382663] [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: 05/22/2024] Open
Abstract
Objective We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D). Design In this cross-sectional study, age-adjusted scores for composite Fluid Cognition, and sub-domain scores for Receptive Language and Inhibitory Control and Attention, were modeled stratified by diabetes-type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure composite Fluid Cognition score. The NIHT-CB Picture Vocabulary Test was used to assess Crystallized Cognition score and rapid identification of congruent versus noncongruent items were used to assess Inhibitory Control and Attention score. Setting The SEARCH for Diabetes in Youth study, representative of 5 U.S. states. Participants Included 1574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c). Results Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite Fluid Cognition score (β= -2.5, 95% confidence interval (CI)= -4.8, -0.1) and a lower Crystallized Cognition score (β= -3.4, CI= -5.6, -1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D effect modification by glycemic levels were found in the association between FI and composite Fluid Cognition score but adjustment for socioeconomic characteristics attenuated the interaction (p=0.0531). Conclusions Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.
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Affiliation(s)
- Andrea D. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Allison L. B. Shapiro
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street Columbia, SC, USA 29208
| | - Greta Wilkening
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
| | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, 1705 College Street Columbia, SC, USA 29208
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Leora Henkin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC, USA 27101
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC USA 27101
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC, USA 27101
| | - Amy S. Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Avenue, MLC 4002 Cincinnati, OH, USA 45229
| | - Santica Marcovina
- Medpace Reference Laboratories, 5365 Medpace Way, Cincinnati, OH, USA 45227
| | - Lawrence M. Dolan
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Avenue, MLC 4002 Cincinnati, OH, USA 45229
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, USA 80045
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Box 356320, Seattle WA, USA 98115-8160
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington, Box 356320, Seattle WA, USA 98115-8160
- Seattle Children’s Research Institute, PO Box 5371, Seattle, WA, USA 98145-5005
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18
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [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: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1269] [Impact Index Per Article: 1269.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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20
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Malik FS, Liese AD, Reboussin BA, Sauder KA, Frongillo EA, Lawrence JM, Bellatorre A, Pihoker C, Loots B, Dabelea D, Mayer-Davis E, Jensen E, Turley C, Mendoza JA. Prevalence and Predictors of Household Food Insecurity and Supplemental Nutrition Assistance Program Use in Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:278-285. [PMID: 34799431 PMCID: PMC9887610 DOI: 10.2337/dc21-0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of household food insecurity (HFI) and Supplemental Nutrition Assistance Program (SNAP) participation among youth and young adults (YYA) with diabetes overall and by type, and sociodemographic characteristics. RESEARCH DESIGN AND METHODS The study included participants with youth-onset type 1 diabetes and type 2 diabetes from the SEARCH for Diabetes in Youth study. HFI was assessed using the 18-item U.S. Household Food Security Survey Module (HFSSM) administered from 2016 to 2019; three or more affirmations on the HFSSM were considered indicative of HFI. Participants were asked about SNAP participation. We used χ2 tests to assess whether the prevalence of HFI and SNAP participation differed by diabetes type. Multivariable logistic regression models were used to examine differences in HFI by participant characteristics. RESULTS Of 2,561 respondents (age range, 10-35 years; 79.6% ≤25 years), 2,177 had type 1 diabetes (mean age, 21.0 years; 71.8% non-Hispanic White, 11.8% non-Hispanic Black, 13.3% Hispanic, and 3.1% other) and 384 had type 2 diabetes (mean age, 24.7 years; 18.8% non-Hispanic White, 45.8% non-Hispanic Black, 23.7% Hispanic, and 18.7% other). The overall prevalence of HFI was 19.7% (95% CI 18.1, 21.2). HFI was more prevalent in type 2 diabetes than type 1 diabetes (30.7% vs. 17.7%; P < 0.01). In multivariable regression models, YYA receiving Medicaid or Medicare or without insurance, whose parents had lower levels of education, and with lower household income had greater odds of experiencing HFI. SNAP participation was 14.1% (95% CI 12.7, 15.5), with greater participation among those with type 2 diabetes compared with those with type 1 diabetes (34.8% vs. 10.7%; P < 0.001). CONCLUSIONS Almost one in three YYA with type 2 diabetes and more than one in six with type 1 diabetes reported HFI in the past year-a significantly higher prevalence than in the general U.S. population.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
| | - Edward A. Frongillo
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | | | - Anna Bellatorre
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Beth Loots
- Seattle Children’s Research Institute, Seattle, WA
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | | | - Elizabeth Jensen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christine Turley
- Department of Pediatrics, University of South Carolina, Columbia, SC
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Wylie-Rosett J, DiMeglio LA. Strategies to Reduce Food Insecurity for People With Diabetes: A Call to Action. Diabetes Care 2023; 46:245-248. [PMID: 36701599 PMCID: PMC9887607 DOI: 10.2337/dci22-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Linda A. DiMeglio
- Division of Pediatric Endocrinology/Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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22
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Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, Baptista J, Chinchilla P, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1297-1321. [PMID: 36468223 DOI: 10.1111/pedi.13429] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- S Francesca Annan
- Paediatric Division, University College London Hospitals, London, UK
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Elisabeth Jelleryd
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara Hannon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shelley Rose
- Diabetes & Endocrinology Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, India
| | | | - Paula Chinchilla
- Women's and Children's Department, London North West Healthcare NHS Trust, London, UK
| | - Maria Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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23
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Weinstein JM, Kahkoska AR, Berkowitz SA. Food Insecurity, Missed Workdays, And Hospitalizations Among Working-Age US Adults With Diabetes. Health Aff (Millwood) 2022; 41:1045-1052. [PMID: 35787082 PMCID: PMC9840294 DOI: 10.1377/hlthaff.2021.01744] [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: 01/17/2023]
Abstract
Food insecurity is associated with poor clinical outcomes among adults with diabetes, but associations with nonclinical outcomes, such as missed work, have not been well characterized. Our objective was to assess the associations between food insecurity, health-related missed workdays, and overnight hospitalizations. We pooled National Health Interview Survey data from the period 2011-18 to analyze food insecurity among 13,116 US adults ages 18-65 who had diabetes. Experiencing food insecurity, compared with being food secure, was associated with increased odds of reporting any health-related missed workdays, more than twice the rate of health-related missed workdays, and increased odds of overnight hospitalization within the prior twelve months. There was no significant association between food insecurity and the number of nights spent hospitalized. These findings underscore the broad impacts of food insecurity on health and wellness for working-age adults with diabetes. When weighing the costs and benefits of proposed interventions to address food insecurity, policy makers should consider potential benefits related to productivity in addition to implications for health care use.
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Affiliation(s)
- Joshua M. Weinstein
- Department of Health Policy and Management, Gillings School
of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public
Health, University of North Carolina at Chapel Hill
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology,
Department of Medicine, University of North Carolina at Chapel Hill School of
Medicine, Chapel Hill, NC
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24
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Liese AD, Reboussin BA, Kahkoska AR, Frongillo EA, Malik FS, Imperatore G, Saydah S, Bellatorre A, Lawrence JM, Dabelea D, Mendoza JA. Inequalities in Glycemic Control in Youth with Type 1 Diabetes Over Time: Intersectionality Between Socioeconomic Position and Race and Ethnicity. Ann Behav Med 2022; 56:461-471. [PMID: 34570884 PMCID: PMC9116580 DOI: 10.1093/abm/kaab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Racial/ethnic health inequities have been well-documented among youth and young adults with type 1 diabetes (T1D), yet little is known about how socioeconomic position (SEP) intersects with the risk marker of race/ethnicity to predict inequities in longitudinal glycemic control. PURPOSE To identify patterns of SEP, race/ethnicity, and clinical characteristics that differentiate hemoglobin A1c (HbA1c) trajectories among youth and young adults after T1D diagnosis. METHODS The SEARCH for Diabetes in Youth cohort includes youth with diabetes diagnosed from 2002 to 2006 and 2008 who were followed through 2015. We analyzed data from 1,313 youth and young adults with T1D with ≥3 HbA1c measures. Classification tree analysis identified patterns of baseline demographic, SEP, and clinical characteristic that best predicted HbA1c trajectories over an average of 8.3 years using group-based trajectory modeling. RESULTS Two HbA1c trajectories were identified: Trajectory 1 (77%) with lower baseline HbA1c and mild increases (from mean 7.4% to 8.4%) and Trajectory 2 (23%) with higher baseline HbA1c and major increases (from 8.5% to 11.2%). Race/ethnicity intersected with different SEP characteristics among non-Hispanic white (NHW) than in non-whites. Public health insurance predicted high-risk Trajectory 2 membership in non-whites, whereas parental education, household structure, diagnosis age and glucose checking frequency predicted membership for NHW youth and young adults. Two characteristics, race/ethnicity and parental education alone identified 80% of the Trajectory 2 members. CONCLUSIONS Race/ethnicity intersects with multiple SEP and clinical characteristics among youth and young adults with T1D, which is associated with particularly high risk of poor long-term glycemic control.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna R Kahkoska
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Anna Bellatorre
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Dana Dabelea
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Mendoza
- Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children’s Research Institute, Seattle, WA, USA
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25
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Mendoza JA, Miller CA, Martin KJ, Resnicow K, Iachan R, Faseru B, McDaniels-Davidson C, Deng Y, Martinez ME, Demark-Wahnefried W, Leader AE, Lazovich D, Jensen JD, Briant KJ, Fuemmeler BF. Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings. Cancer Epidemiol Biomarkers Prev 2022; 31:1017-1025. [PMID: 35247884 PMCID: PMC9135358 DOI: 10.1158/1055-9965.epi-21-1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. METHODS Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. RESULTS The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). CONCLUSIONS FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. IMPACT Future studies should combine FI and cancer screening interventions to improve screening rates.
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Affiliation(s)
- Jason A. Mendoza
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carrie A. Miller
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | | | - Ken Resnicow
- University of Michigan Rogel Cancer Center and School of Public Health, Ann Arbor, MI
| | | | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | | | | | - Maria Elena Martinez
- Moores Cancer Center and Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | | | - Amy E. Leader
- Sidney Kimmel Cancer Center – Jefferson Health and Thomas Jefferson University
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Jakob D. Jensen
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Bernard F Fuemmeler
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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26
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2475] [Impact Index Per Article: 1237.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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27
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Kahkoska AR, Pokaprakarn T, Alexander GR, Crume TL, Dabelea D, Divers J, Dolan LM, Jensen ET, Lawrence JM, Marcovina S, Mottl AK, Pihoker C, Saydah SH, Kosorok MR, Mayer-Davis EJ. The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:108-118. [PMID: 34728528 PMCID: PMC8753766 DOI: 10.2337/dc21-0496] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate difference in population-level glycemic control and the emergence of diabetes complications given a theoretical scenario in which non-White youth and young adults (YYA) with type 1 diabetes (T1D) receive and follow an equivalent distribution of diabetes treatment regimens as non-Hispanic White YYA. RESEARCH DESIGN AND METHODS Longitudinal data from YYA diagnosed 2002-2005 in the SEARCH for Diabetes in Youth Study were analyzed. Based on self-reported race/ethnicity, YYA were classified as non-White race or Hispanic ethnicity (non-White subgroup) versus non-Hispanic White race (White subgroup). In the White versus non-White subgroups, the propensity score models estimated treatment regimens, including patterns of insulin modality, self-monitored glucose frequency, and continuous glucose monitoring use. An analysis based on policy evaluation techniques in reinforcement learning estimated the effect of each treatment regimen on mean hemoglobin A1c (HbA1c) and the prevalence of diabetes complications for non-White YYA. RESULTS The study included 978 YYA. The sample was 47.5% female and 77.5% non-Hispanic White, with a mean age of 12.8 ± 2.4 years at diagnosis. The estimated population mean of longitudinal average HbA1c over visits was 9.2% and 8.2% for the non-White and White subgroup, respectively (difference of 0.9%). Within the non-White subgroup, mean HbA1c across visits was estimated to decrease by 0.33% (95% CI -0.45, -0.21) if these YYA received the distribution of diabetes treatment regimens of the White subgroup, explaining ∼35% of the estimated difference between the two subgroups. The non-White subgroup was also estimated to have a lower risk of developing diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy with the White youth treatment regimen distribution (P < 0.05), although the low proportion of YYA who developed complications limited statistical power for risk estimations. CONCLUSIONS Mathematically modeling an equalized distribution of T1D self-management tools and technology accounted for part of but not all disparities in glycemic control between non-White and White YYA, underscoring the complexity of race and ethnicity-based health inequity.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - G. Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tessa L. Crume
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY
| | - Lawrence M. Dolan
- Division of Endocrinology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Santica Marcovina
- Department of Medicine, Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
| | - Amy K. Mottl
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Sharon H. Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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28
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Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for Young Adults With Diabetes: Addressing Social Determinants of Health. Diabetes Spectr 2021; 34:357-362. [PMID: 34866868 PMCID: PMC8603121 DOI: 10.2337/dsi21-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.
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Affiliation(s)
| | - Jennifer Fogel
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Mark Reid
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Daniel I. Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
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29
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Finnan M, Agarwal S. Identifying and Reducing Disparities in Young Adults With Diabetes. Diabetes Spectr 2021; 34:336-344. [PMID: 34866866 PMCID: PMC8603125 DOI: 10.2337/dsi21-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article outlines how social and health care determinants can affect young adults with diabetes. The authors provide a detailed description of each determinant's influence on diabetes self-management and offer solutions to help mitigate these harmful effects.
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Affiliation(s)
- Molly Finnan
- Department of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
| | - Shivani Agarwal
- Fleischer Institute of Diabetes and Metabolism, New York Regional Center for Diabetes Translation Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
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30
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Lee JM, Rusnak A, Garrity A, Hirschfeld E, Thomas IH, Wichorek M, Lee JE, Rioles NA, Ebekozien O, Corathers SD. Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes. JAMA Netw Open 2021; 4:e2131278. [PMID: 34709387 PMCID: PMC8554640 DOI: 10.1001/jamanetworkopen.2021.31278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE A low-burden electronic health record (EHR) workflow has been devised to systematize the collection and validation of 6 key diabetes self-management habits: (1) checks glucose at least 4 times/day or uses continuous glucose monitor (CGM); (2) gives at least 3 rapid-acting insulin boluses per day; (3) uses insulin pump; (4) delivers boluses before meals; (5) reviewed glucose data since last clinic visit, and (6) has changed insulin doses since the last clinic visit. OBJECTIVE To describe the performance of these habits and examine their association with hemoglobin A1c (HbA1c) levels and time in range (TIR). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included individuals with known type 1 diabetes who were seen in a US pediatric diabetes clinic in 2019. MAIN OUTCOMES AND MEASURES Habit performance, total habit score (sum of 6 habits per person), HbA1c levels, and TIR. RESULTS Of 1344 patients, 1212 (609 [50.2%] males; 66 [5.4%] non-Hispanic Black; 1030 [85.0%] non-Hispanic White; mean [SD] age, 15.5 [4.5] years) were included, of whom 654 (54.0%) were using CGM and had a TIR. Only 105 patients (8.7%) performed all 6 habits. Habit performance was lower among older vs younger patients (age ≥18 years vs ≤12 years: 17 of 411 [4.1%] vs 57 of 330 [17.3%]; P < .001), Black vs White patients (3 [4.5%] vs 95 [9.2%]; P < .001), those with public vs private insurance (14 of 271 [5.2%] vs 91 of 941 [9.7%]; P < .001), and those with lower vs higher parental education levels (<college degree vs ≥college degree: 35 of 443 [7.9%] vs 66 of 574 [11.5%]; P < .001). After adjustment for demographic characteristics and disease duration, for every 1-unit increase in total habit score, we found a mean (SE) 0.6% (0.05) decrease in HbA1c among all participants and a mean (SE) 2.86% (0.71) increase in TIR among those who used CGMs. Multiple regression models revealed that performing each habit was associated with a significantly lower HbA1c level (habit 1: -0.16% [95% CI, -1.91% to -1.37%]; habit 2: -1.01% [-1.34% to -0.69%]; habit 3: -0.71% [95% CI, -0.93% to -0.49%]; habit 4: -0.97% [95% CI, -1.21% to -0.73%]; habit 5: -0.44% [95% CI, -0.71% to -0.17%]; habit 6: -0.75% [95% CI, -0.96% to -0.53%]; all P < .001). There were differences in HbA1c according to race, insurance, and parental education, but these associations were attenuated with the inclusion of the 6 habits, which had more robust associations with HbA1c levels than the demographic characteristics. CONCLUSIONS AND RELEVANCE These findings suggest that a focus on increasing adherence to the 6 habits could be critical for improving disparities in glycemic outcomes; these metrics have been adopted by the Type 1 Diabetes Exchange Quality Improvement Collaborative for continuous quality improvement.
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Affiliation(s)
- Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Andrea Rusnak
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
| | - Inas H. Thomas
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Michelle Wichorek
- Brehm Center for Diabetes Research, University of Michigan, Ann Arbor
| | | | | | | | - Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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31
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Kerz A, Bell K, White M, Thompson A, Suter M, McKechnie R, Gallegos D. Development and preliminary validation of a brief household food insecurity screening tool for paediatric health services in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1538-1549. [PMID: 33170535 DOI: 10.1111/hsc.13219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
Children from food insecure households are more likely to have substandard food and nutritional intakes, and experience developmental delays, behaviour issues and increased use of health services. In Australia, screening for household food insecurity (HFI) within health services is not undertaken routinely, limiting opportunities to optimise nutrition and healthcare. This research aimed to (a) identify the prevalence, potential determinants and outcomes of HFI among paediatric outpatients in two Queensland hospitals; and (b) identify questions suitable for screening households at risk of HFI. A cross-sectional survey collected data from caregivers of children attending paediatric appointments at two hospitals in Brisbane, Australia (n = 148). Sociodemographic, health and household-related characteristics were collected, and food security status was assessed using four HFI measures. Chi-square, independent t-tests, ANOVA and logistic regression explored associations between HFI and health-related characteristics. A potential HFI screener was identified based on the most frequently endorsed questions from any HFI measure, and its validity was assessed through calculation of sensitivity and specificity. Prevalence of HFI was 41%, with 16% experiencing very low food security. Households with a child of 'fair/poor' health had 5.59 times greater odds of being food insecure than being food secure, compared to households with a child of 'excellent/good' health (aOR 5.59, 95% CI: 1.3-23.5). HFI was also positively associated with household chaos (p = .006). A combination of two questions was identified as a possible screening tool, with a sensitivity of 96% and a specificity of 90%. This study demonstrated HFI may be highly prevalent in a paediatric outpatient population, which may result in difficulties in being able to follow nutrition prescriptions. A highly sensitive and specific two-question screening tool was identified and may assist practitioners in paediatric healthcare settings in identifying clients who are at risk of HFI.
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Affiliation(s)
- Aria Kerz
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kristie Bell
- Dietetics and Food Services, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Melinda White
- Dietetics and Food Services, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Amy Thompson
- Department of Dietetics and Food Services, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, QLD, Australia
| | - Michelle Suter
- Department of Dietetics and Food Services, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, QLD, Australia
| | - Rebecca McKechnie
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Woolworths Centre for Child Nutrition Research, Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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32
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Dabelea D, Sauder KA, Jensen ET, Mottl AK, Huang A, Pihoker C, Hamman RF, Lawrence J, Dolan LM, Agostino RD, Wagenknecht L, Mayer-Davis EJ, Marcovina SM. Twenty years of pediatric diabetes surveillance: what do we know and why it matters. Ann N Y Acad Sci 2021; 1495:99-120. [PMID: 33543783 PMCID: PMC8282684 DOI: 10.1111/nyas.14573] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/23/2022]
Abstract
SEARCH for Diabetes in Youth (SEARCH) was initiated in 2000 as a multicenter study to address major gaps in the understanding of childhood diabetes in the United States. An active registry of youth diagnosed with diabetes at age <20 years since 2002 assessed prevalence, annual incidence, and trends by age, race/ethnicity, sex, and diabetes type. An observational cohort nested within the population-based registry was established to assess the natural history and risk factors for acute and chronic diabetes-related complications, as well as the quality of care and quality of life of children and adolescents with diabetes from diagnosis into young adulthood. SEARCH findings have contributed to a better understanding of the complex and heterogeneous nature of youth-onset diabetes. Continued surveillance of the burden and risk of type 1 and type 2 diabetes is important to track and monitor incidence and prevalence within the population. SEARCH reported evidence of early diabetes complications highlighting that continuing the long-term follow-up of youth with diabetes is necessary to further our understanding of its natural history and to develop the most appropriate approaches to primary, secondary, and tertiary prevention of diabetes and its complications. This review summarizes two decades of research and suggests avenues for further work.
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Affiliation(s)
- Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy K. Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Alyssa Huang
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Richard F. Hamman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jean Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lawrence M. Dolan
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ralph D’ Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lynne Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Te Vazquez J, Feng SN, Orr CJ, Berkowitz SA. Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research. Curr Nutr Rep 2021; 10:243-254. [PMID: 34152581 PMCID: PMC8216092 DOI: 10.1007/s13668-021-00364-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Purpose of Review To understand recent literature that examines associations between food insecurity and cardiometabolic conditions and risk factors. We included original research, systematic reviews, and meta-analyses on the topic of food insecurity and cardiometabolic risk published from January 1, 2017, to December 31, 2020. Editorials, perspectives, and case reports were excluded. After the initial search, 3 reviewers selected studies for inclusion based on relevance and methods. Ultimately, fifty studies were included. Recent Findings We included 35 studies of adults (20 cross-sectional observational studies, 5 longitudinal observational studies, 5 interventional studies, and 5 meta-analyses/reviews). In adults, food insecurity is associated with greater prevalence of overweight/obesity (especially for women). It is also associated with hypertension, diabetes (including worse glycemic control and more diabetes complications), coronary heart disease, congestive heart failure, stroke, and chronic kidney disease. We included 15 studies of children (11 cross-sectional observational studies and 4 longitudinal observational studies). In children, findings were more nuanced, and in particular, many studies did not find an association between food insecurity and overweight/obesity. However, authors noted that these conditions may not have had time to develop. With notable exceptions, many studies were cross-sectional, and there were few interventions. Summary There is a robust association between food insecurity and cardiometabolic conditions and risk factors in adults, but the picture is less clear in children. Overt cardiometabolic clinical conditions develop more rarely in children, but childhood experiences may set a trajectory for worse health later in life. Detailed life course epidemiologic studies are needed to better understand this relationship. Future interventions should examine how to reduce the prevalence of food insecurity, and how best to improve health for those who experience food insecurity.
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Affiliation(s)
- Jennifer Te Vazquez
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shi Nan Feng
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Nutrition Science Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth A Berkowitz
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3093] [Impact Index Per Article: 1031.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Butler AM, Hilliard ME, Titus C, Rodriguez E, Al-Gadi I, Cole-Lewis Y, Thompson D. Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents. J Pediatr Psychol 2021; 45:946-956. [PMID: 31995219 DOI: 10.1093/jpepsy/jsz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.
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Affiliation(s)
| | | | | | | | - Iman Al-Gadi
- Baylor College of Medicine/Texas Children's Hospital
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Sutherland MW, Ma X, Reboussin BA, Mendoza JA, Bell BA, Kahkoska AR, Sauder KA, Lawrence JM, Pihoker C, Liese AD. Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes. Pediatr Diabetes 2020; 21:1412-1420. [PMID: 32902080 PMCID: PMC8054269 DOI: 10.1111/pedi.13112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Health inequities persist in youth and young adults (YYA) with type 1diabetes in achieving optimal glycemic control. The purpose of this study was to assess the contribution of multiple indicators of social need to these inequities. RESEARCH DESIGN AND METHODS Two hundred and twenty two YYA withtype 1 diabetes enrolled in the SEARCH Food Insecurity Study in South Carolina and Washington between the years 2013 and 2015 were included. Latent class analysis was used to identify socioeconomic profiles based on household income, parental education, health insurance, household food insecurity, and food assistance. Profiles were evaluated in relation to glycemic control using multivariable linear and logistic regression, with HbA1c > 9%(75 mmol/mol) defined as high-risk glycemic control. RESULTS Two profiles were identified: a lower socioeconomic profile included YYA whose parents had lower income and/or education, and were more likely to be uninsured, receive food assistance, and be food insecure. A higher socioeconomic profile included YYA whose circumstances were opposite to those in the lower socioeconomic profile. Those with a lower socioeconomic profile were more likely to have high-risk glycemic control relative to those with a higher socioeconomic profile (OR = 2.24, 95%CI = 1.16-4.33). CONCLUSIONS Lower socioeconomic profiles are associated with high-risk glycemic control among YYA with type 1 diabetes. This supports recommendations that care providers of YYA with type 1 diabetes assess individual social needs in tailoring diabetes management plans to the social context of the patient.
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Affiliation(s)
- Melanie W. Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Xiaonan Ma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jason A. Mendoza
- Department of Pediatrics and Nutritional Sciences Program, University of Washington; Cancer Prevention Program, Fred Hutchinson Cancer Research Center; and Seattle Children’s Research Institute, Seattle, WA
| | - Bethany A. Bell
- College of Social Work, University of South Carolina, Columbia, SC
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Sauder KA, Stafford JM, The NS, Mayer-Davis EJ, Thomas J, Lawrence JM, Kim G, Siegel KR, Jensen ET, Shah AS, D'Agostino RB, Dabelea D. Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for diabetes in youth study. Pediatr Diabetes 2020; 21:1093-1101. [PMID: 32737919 PMCID: PMC7855046 DOI: 10.1111/pedi.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS Examine associations of dietary strategies used to manage diabetes over time with hemoglobin A1c in youth-onset type 1 or type 2 diabetes. METHODS The SEARCH for Diabetes in Youth observational study assessed dietary strategies used by 1814 participants with diabetes (n = 1558 type 1, n = 256 type 2) at two to three research visits over 5.5 years (range 1.7-12.2). Participants reported often, sometimes, or never using 10 different dietary strategies, and use over time was categorized into five mutually exclusive groups: often using across visits; started using at later visits; sometimes using across visits; stopped using at later visits; or never using across visits. General multivariable linear models evaluated most recent A1c by use category for each strategy. RESULTS In type 1 diabetes, A1c was lower among those who starting tracking calories (-0.4%, Tukey P < .05), often counted carbs (-0.8%, Tukey P < .001), or sometimes chose low glycemic index foods (-0.5%, Tukey P = .02) vs those with less use, while participants who never drank more milk had the lowest A1c (-0.5%, Tukey P = .04). In type 2 diabetes, A1c was lower among those who often limited high fat foods (-2.0%, Tukey P = .02) or started counting carbohydrates (-1.7%, Tukey P = .07) than those who did so less. CONCLUSIONS For several dietary strategies, more frequent use over time was related to lower A1c in youth-onset type 1 and type 2 diabetes, suggesting these strategies can likely support diabetes management for this population. Investigation into factors predicting receipt of advice for specific strategies and corresponding impact on intake might be considered.
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Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Natalie S The
- Department of Health Sciences, Furman University, Greenville, South Carolina, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joan Thomas
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Grace Kim
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Ritchie J, Tyler L, Wenzel T, Guo AA, Fowler L. Addressing Community Health Needs through the Development of a Student-Led Community Health Fair. MEDEDPUBLISH 2020; 9:175. [PMID: 38073783 PMCID: PMC10702671 DOI: 10.15694/mep.2020.000175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This article was migrated. The article was marked as recommended. PROBLEM Based on a specific community benefit analysis of Greenville, South Carolina, we identified the Dunean community with its increased prevalence of health inequities with respect to access to health care, poverty burden, and disease mortality on a county, state, and national level. The Dunean community's data reflect poorer health outcomes in terms of disease and unhealthy lifestyle as well as inadequate access to medical resources compared to other communities in South Carolina. APPROACH Students, residents, attendings, faculty, and staff from the University of South Carolina School of Medicine Greenville (UofSC SOMG) formed a task force to engage the community and combat the root causes of diseases. This task force built partnerships with community leaders to create Root Cause, a monthly health event designed to bring community members to a unified space, share a free community dinner, and provide a wide range of health and wellness resources to educate and inspire them to make healthy lifestyle choices. Outcomes: This report describes the formation of the community engagement task force and execution of Root Cause. In five Root Cause events, we partnered with 36 community agencies and our academic health center partners who shared their resources, served 207 Dunean neighborhood members, and facilitated 1,237 total interactions between community members and partners. CONCLUSION Under the Root Cause model, medical students and neighborhood partners have initiated a trusted, bidirectional dialogue to determine their specific needs with the desire to positively transform the health and wellness of the Dunean community. Our data suggests that based on our efforts, the neighborhood of Dunean, SC increased community cohesiveness and improved perceptions of access to health care. Additionally, participating medical students advanced their understanding of social health and economic challenges which helped to facilitate their development along the active citizen continuum, as well as increase empathy for their future patients in the local community.
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Affiliation(s)
- Jacob Ritchie
- University of South Carolina School of Medicine Greenville
| | - Lauren Tyler
- University of South Carolina School of Medicine Greenville
| | - T.J. Wenzel
- University of South Carolina School of Medicine Greenville
| | - Alyssa A. Guo
- University of South Carolina School of Medicine Greenville
| | - Lauren Fowler
- University of South Carolina School of Medicine Greenville
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Cox C, Alyahyawi N, Ornstein A, Cummings EA. Experience of Caring for a Child With Type 1 Diabetes Mellitus in a Food-Insecure Household: A Qualitative Evaluation. Can J Diabetes 2020; 45:64-70. [PMID: 32861605 DOI: 10.1016/j.jcjd.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES An earlier study from Nova Scotia showed that food insecurity (FI) is more prevalent (21.9%) in families of children with diabetes, yet little is known about its impact on these families. We aimed to describe the day-to-day experiences of families living with FI while caring for a child with type 1 diabetes (T1D). METHODS This investigation was a qualitative study with thematic analyses using semistructured interviews to explore perceptions of caregivers living with pediatric T1D and FI (N=13 households). RESULTS Three major themes emerged: 1) FI had a disproportionate impact on families after T1D diagnosis compared with before diagnosis. The cost of healthy food threatened food security before T1D; however, there is increased hardship once high-quality food and hypoglycemia supplies are required. 2) Sacrifices to combat FI have disproportionate impacts among family members. At times, caregivers sacrificed the needs (food, medicine) of other family members (including children) to prioritize the needs of the child with T1D. 3) Caregivers perceived T1D needs as posing unique barriers to traditional FI supports, such as school breakfast programs. CONCLUSIONS This study provides insight into the realities of life with pediatric T1D and FI. Living with T1D and FI poses challenges, and caregivers often cope by making difficult choices when providing for their family. Caregivers struggled to meet dietary recommendations while finding that T1D needs are often not met by traditional FI supports. This suggests that T1D clinicians should assess FI and help families in problem solving to mitigate its impact.
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Affiliation(s)
- Catherine Cox
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naseem Alyahyawi
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada; Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amy Ornstein
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Elizabeth A Cummings
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4842] [Impact Index Per Article: 1210.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Dush JL. Adolescent food insecurity: A review of contextual and behavioral factors. Public Health Nurs 2020; 37:327-338. [PMID: 31970826 PMCID: PMC9292303 DOI: 10.1111/phn.12708] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/03/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes. DESIGN A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase® , Pubmed, and the Cochrane Library. SAMPLE The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity. RESULTS Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized. CONCLUSION Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.
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Affiliation(s)
- Jennifer L Dush
- Instructor of Clinical Practice, The Ohio State University, Columbus, OH, USA
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Lauffenburger JC, Lewey J, Jan S, Lee J, Ghazinouri R, Choudhry NK. Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes. JAMA Netw Open 2020; 3:e1919645. [PMID: 31968115 PMCID: PMC6991273 DOI: 10.1001/jamanetworkopen.2019.19645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Numerous factors are associated with the ability of patients with type 2 diabetes to achieve optimal glycemic control. However, many of these factors are not modifiable by quality improvement interventions. In contrast, the structure of how diabetes care is delivered, such as whether patients visit an endocrinologist or how prescriptions are filled, is potentially modifiable, yet its associations with glycemic control have not been rigorously evaluated. OBJECTIVE To investigate the association of diabetes care delivery with glycemic control in patients with type 2 diabetes using insulin. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used baseline claims and laboratory insurer data within a large pragmatic trial to identify individuals with type 2 diabetes using insulin with data for at least 1 hemoglobin A1c (HbA1c) test result from before trial randomization (July 1, 2014, to October 5, 2016) and for key nonmodifiable patient factors as well as diabetes care delivery and behavioral factors measured before the HbA1c test. Analyses were conducted from February 4, 2017, to November 13, 2018. MAIN OUTCOMES AND MEASURES Multivariable modified Poisson regression was used to evaluate the independent associations of nonmodifiable patient factors and potentially modifiable diabetes care delivery and patient behavioral factors with achieving adequate diabetes control (ie, HbA1c level <8%). The extent of measured variation explained in glycemic control by these factors was also explored using pseudo R2 and C statistics. RESULTS Of 1423 patients included, 565 (39.7%) were women, and the mean (SD) age was 56.4 (9.0) years. In total, 690 (48.5%) had HbA1c levels less than 8%. Age (relative risk [RR] per 1-unit increase, 1.01; 95% CI, 1.00-1.02), persistent use of basal insulin (RR, 1.20; 95% CI, 1.00-1.43), more frequent filling of glucose self-testing supplies (RR, 1.01; 95% CI, 1.01-1.02), visiting an endocrinologist (RR, 1.41; 95% CI, 1.19-1.67), and receipt of insulin prescriptions by mail order (RR, 1.23; 95% CI, 1.03-1.48) were all independently associated with adequate control. Measured potentially modifiable diabetes care factors explained more variation in adequate glycemic control than measured nonmodifiable patient factors (C statistic, 0.661 vs 0.598; pseudo R2 = 0.11 vs 0.04). CONCLUSIONS AND RELEVANCE These findings suggest that for patients with type 2 diabetes using insulin, the way in which care is delivered may be more strongly associated with achieving adequate control of HbA1c levels than patient factors that cannot be altered are. Given the potential for intervention, these care delivery factors could be the focus of efforts to improve diabetes outcomes.
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Affiliation(s)
- Julie C. Lauffenburger
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Saira Jan
- Horizon Blue Cross Blue Shield, Newark, New Jersey
- Department of Pharmacy Practice and Administration, Rutgers State University of New Jersey, New Brunswick
| | - Jessica Lee
- Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Roya Ghazinouri
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K. Choudhry
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Frongillo EA. Advancing Knowledge of How and Why Food Insecurity Is Associated with Poor Well-Being in Families and Individuals across the Life Course. J Acad Nutr Diet 2019; 119:1621-1622. [DOI: 10.1016/j.jand.2019.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
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Liese AD, Ma X, Reid L, Sutherland MW, Bell BA, Eberth JM, Probst JC, Turley CB, Mayer-Davis EJ. Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina. Pediatr Diabetes 2019; 20:321-329. [PMID: 30666775 PMCID: PMC6456401 DOI: 10.1111/pedi.12822] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA1c (P = 0.048) compared to having specialist care, but HbA1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.
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MESH Headings
- Adolescent
- Adult
- Blood Glucose/analysis
- Blood Glucose/metabolism
- Child
- Child Health Services/statistics & numerical data
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Female
- Glycated Hemoglobin/analysis
- Glycated Hemoglobin/metabolism
- Health Services Accessibility/economics
- Health Services Accessibility/standards
- Health Services Accessibility/statistics & numerical data
- Humans
- Insurance Coverage
- Insurance, Health/classification
- Insurance, Health/legislation & jurisprudence
- Insurance, Health/statistics & numerical data
- Male
- Patient Protection and Affordable Care Act
- South Carolina/epidemiology
- Young Adult
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Xiaonan Ma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lauren Reid
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Melanie W Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Bethany A Bell
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Janice C Probst
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Christine B Turley
- Research Center for Transforming Health and Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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