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Wu B, Fan B, Qu Y, Li C, Chen J, Liu Y, Wang J, Zhang T, Chen Y. Trajectories of Blood Lipids Profile in Midlife Women: Does Menopause Matter? J Am Heart Assoc 2023; 12:e030388. [PMID: 37947109 PMCID: PMC10727300 DOI: 10.1161/jaha.123.030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023]
Abstract
Background It remains controversial whether changes of lipids over menopause transition (MT) are more age-related or more menopause-related. We aimed to classify women into different trajectory groups based on pattern and level of total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB), high-density lipoprotein cholesterol (HDL-C), triglyceride, and apolipoprotein A-I over the MT, as well as examine the effect of MT-related factors on lipid trajectory groups and levels. Methods and Results The cohort included 2582 subjects from the Study of Women's Health Across the Nation. Different trajectory patterns of lipids during the MT were determined using the latent class growth mixture model. The predictors of distinct blood lipids trajectory groups were determined by multiple linear regression models and multinomial logistic regression models. Women were categorized into either inverse U-shape or progressing trajectory group in each blood lipids measurement. The inverse U-shape total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, high-density lipoprotein cholesterol, log(TG), and apolipoprotein A-I trajectories showed an increasing trend before menopause but a decreasing trend after menopause. The U-shape total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B trajectories started to rise 5 years before menopause. Age at menopause, follicle-stimulating hormone, vasomotor symptoms, and estradiol predicted the shape and level of the women's lipids over the MT. Conclusions Distinct lipid trajectories were identified during the MT, and the existence of at least 1 trajectory in each lipid parameters suggested a contribution of menopause. Our study highlights the need for earlier and continuous surveillance of lipids during the MT.
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Affiliation(s)
- Bingjie Wu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Bingbing Fan
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Yanlin Qu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Chunxia Li
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jiahao Chen
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Ying Liu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jiali Wang
- Department of Emergency and Chest Pain CenterQilu Hospital, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
- Key Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital, Shandong UniversityJinanShandongChina
| | - Tao Zhang
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
| | - Yuguo Chen
- Department of Emergency and Chest Pain CenterQilu Hospital, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
- Key Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital, Shandong UniversityJinanShandongChina
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Gulanski BI, Butera NM, Krause-Steinrauf H, Lichtman JH, Harindhanavudhi T, Green JB, Suratt CE, AbouAssi H, Desouza C, Ahmann AJ, Wexler DJ, Aroda VR. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 2023; 11:e003159. [PMID: 37094945 PMCID: PMC10151943 DOI: 10.1136/bmjdrc-2022-003159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. RESULTS Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. CONCLUSIONS This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01794143).
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Section of Endocrinology, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nicole M Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Health, Minneapolis, Minnesota, USA
| | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Colleen E Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew J Ahmann
- Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
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Extensive Summary of the Important Roles of Indole Propionic Acid, a Gut Microbial Metabolite in Host Health and Disease. Nutrients 2022; 15:nu15010151. [PMID: 36615808 PMCID: PMC9824871 DOI: 10.3390/nu15010151] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Increasing evidence suggests that metabolites produced by the gut microbiota play a crucial role in host-microbe interactions. Dietary tryptophan ingested by the host enters the gut, where indole-like metabolites such as indole propionic acid (IPA) are produced under deamination by commensal bacteria. Here, we summarize the IPA-producing bacteria, dietary patterns on IPA content, and functional roles of IPA in various diseases. IPA can not only stimulate the expression of tight junction (TJ) proteins to enhance gut barrier function and inhibit the penetration of toxic factors, but also modulate the immune system to exert anti-inflammatory and antioxidant effects to synergistically regulate body physiology. Moreover, IPA can act on target organs through blood circulation to form the gut-organ axis, which helps maintain systemic homeostasis. IPA shows great potential for the diagnosis and treatment of various clinical diseases, such as NAFLD, Alzheimer's disease, and breast cancer. However, the therapeutic effect of IPA depends on dose, target organ, or time. In future studies, further work should be performed to explore the effects and mechanisms of IPA on host health and disease to further improve the existing treatment program.
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Cardiovascular Risk Screening among Women Veterans: Identifying Provider and Patient Barriers and Facilitators to Develop a Clinical Toolkit. Womens Health Issues 2022; 32:284-292. [PMID: 35115227 DOI: 10.1016/j.whi.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cardiovascular (CV) disease is the leading cause of death among women in the United States, making CV risk screening and management a women's health priority. Objectives were to elicit barriers and facilitators to CV risk identification and reduction among women veterans, and iteratively cocreate clinical tools to identify CV risk factors and promote goal-setting for lifestyle changes. METHODS We conducted three exploratory focus groups with 21 Veterans Health Administration primary care team members and piloted patient CV screeners with brief interviews with 19 patients from two Veterans Health Administration women's clinics to inform toolkit development. We then conducted two focus groups and one interview for feedback from a total of 12 staff on the proposed toolkit components. Transcripts were summarized, and a matrix analysis was used to synthesize qualitative findings. RESULTS Provider-identified barriers included difficulties disseminating CV information in clinic, limited patient knowledge, and lack of organized resources for provider communication and available referrals. Women's complex health needs were notable challenges to CV risk reduction. Facilitators included having a single place to track patient CV risks (e.g., an electronic template note), a patient screening worksheet, and aids to complete referrals. Patient-identified barriers included difficulties balancing health, finances, and physical and mental health concerns. Facilitators included resources for accountability and gender-specific information about CV risks and complications. Providers requested easy, accessible tools in the electronic record with gender-specific CV data and resources linked. Patients requested lifestyle change supports, including trustworthy sources vetted by providers. CONCLUSIONS Iteratively eliciting end-users' perspectives is critical to developing user-friendly, clinically relevant tools. CV risk reduction among women veterans will require multilevel tools and resources that meet providers' and women's needs.
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The Magnitude and Potential Causes of Sex Disparities in Statin Therapy in Veterans with Type 2 Diabetes: A 10-year Nationwide Longitudinal Cohort Study. Womens Health Issues 2021; 32:274-283. [PMID: 34949527 DOI: 10.1016/j.whi.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Past research has shown that women eligible for statin therapy are less likely than their male counterparts to receive any statin therapy or be prescribed a statin at the guideline-recommended intensity. We compared statin treatment in men and women veterans from a national cohort of older veterans with type 2 diabetes. METHODS The Veterans Health Administration Corporate Data Warehouse and Centers for Medicare and Medicaid Services data were used to create a unique dataset and perform a longitudinal study of veterans with type 2 diabetes from 2007 to 2016. Mixed-effects logistic regression was used to model the association between the primary exposure (sex) and statin use. RESULTS The study included 714,212 veterans with diabetes, including 9,608 women, with an overall mean age of 75.9 years. In the unadjusted model for any statin use, women veterans had a 14% significantly lower odds of having any statin use compared with men. After adjusting for all covariates, including markers of Veterans Administration care use (service-connected disability rating, Veterans Administration use, and primary care visits) that serve as proxies for access and mental health comorbidities (depression and psychiatric disorder), this disparity narrowed from 14% to 3% and was no longer statistically significant. In the model for high-intensity statin therapy (high-intensity vs. low or none), women were 10% less likely than men to use high-intensity statins in the base model that included only time and sex. After adjusting for all measured covariates, the direction of the association changed and women had 16% higher odds of high-intensity statin use compared with men (odds ratio, 1.16; 95% confidence interval, 1.03-1.31). CONCLUSIONS Consistent with prior research, in the unadjusted analysis a significant sex disparity was observed in statin use, with lower rates observed in women. For the outcome of any statin use, after adjustment for covariates that included variables that are proxies for access as well as psychiatric and depression comorbidities, this disparity lost statistical significance and narrowed. In the high-intensity statin versus low or none model, the direction of the association changed after controlling for measured covariates and women had a 16% higher odds of high-intensity statin use compared with men. This study highlights a persistent health disparity in lipid-lowering therapy for women veterans. Additional research is needed to further elucidate the reasons for and develop interventions to mitigate this persistent sex disparity in cholesterol management for veterans with diabetes.
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Thavam T, Devlin RA, Thind A, Zaric GS, Sarma S. The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1279-1293. [PMID: 32676753 DOI: 10.1007/s10198-020-01216-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician ineligible for DMI throughout the study period). Diabetes-related services was measured using the Diabetic Management Assessment (DMA) billing code claimed by patient's physician. The impact of DMI on diabetes-related services was assessed using difference-in-differences regression models. After adjusting for patient- and physician-level characteristics, patient fixed-effects and patient-specific time trend, we found that DMI increased the probability of having at least one DMA fee code claimed by patient's physician by 9.3% points, and the probability of having at least three DMA fee codes claimed by 2.1% points. Subgroup analyses revealed the impact of DMI was slightly larger in males compared to females. We found that Ontario's DMI was effective in increasing the diabetes-related services provided to patients diagnosed with diabetes in Ontario. Financial incentives for physicians help improve the provision of targeted diabetes-related services.
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Affiliation(s)
- Thaksha Thavam
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Ivey School of Business, University of Western Ontario, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada.
- ICES, Toronto, ON, Canada.
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Weeda ER, Bishu KG, Ward R, Axon RN, Taber DJ, Gebregziabher M. Joint effect of race/ethnicity or location of residence and sex on low density lipoprotein-cholesterol among veterans with type 2 diabetes: a 10-year retrospective cohort study. BMC Cardiovasc Disord 2020; 20:449. [PMID: 33059602 PMCID: PMC7558630 DOI: 10.1186/s12872-020-01730-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular (CV) disease is the leading cause of death among United States women. Rural residence and ethnic-minority status are individually associated with increased CV mortality. Managing dyslipidemia is important in the prevention of CV mortality. However, the impact of race/ethnicity and location of residence on sex differences in dyslipidemia management is not well understood. Therefore, we sought to understand the joint effects of race/ethnicity and location of residence on lipid management differences between veteran men and women with type 2 diabetes (T2D). METHODS Veterans Health Administration and Centers for Medicare and Medicaid Services data were used to perform a longitudinal cohort study of veterans with T2D (2007-2016). Mixed effects logistic regression with a random intercept was used to model the association between sex and low-density lipoprotein (LDL) > 100 mg/dL and its interaction with race/ethnicity and location of residence after adjusting for all measured covariates. RESULTS When female sex and rural location of residence were both present, they were associated with an antagonistic harmful effect on LDL. Similar antagonistic harmful effects on LDL were observed when the joint effect of female sex and several minority race/ethnicity groups were evaluated. After adjusting for measured covariates, the odds of LDL > 100 mg/dL were higher for urban women (OR = 2.66, 95%CI 2.48-2.85) and rural women (OR = 3.26, 95%CI 2.94-3.62), compared to urban men. The odds of LDL > 100 mg/dL was the highest among non-Hispanic Black (NHB) women (OR = 5.38, 95%CI 4.45-6.51) followed by non-Hispanic White (NHW) women (OR = 2.59, 95%CI 2.44-2.77), and Hispanic women (OR = 2.56, 95%CI 1.79-3.66). CONCLUSION Antagonistic harmful effects on LDL were observed when both female sex and rural location of residence were present. These antagonistic effects on LDL were also present when evaluating the joint effect of female sex and several minority race/ethnicity groups. Disparities were most pronounced in NHB and rural women, who had 5.4 and 3.3 times the odds of elevated LDL versus NHW and urban men after adjusting for important covariates. These striking effect sizes in a population at high cardiovascular risk (i.e., older with T2D) suggest interventions aimed at improving lipid management are needed for individuals falling into one or more groups known to face health disparities.
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Affiliation(s)
- Erin R. Weeda
- Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, USA
| | - Kinfe G. Bishu
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, USA
| | - Ralph Ward
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, USA
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425 USA
| | - R. Neal Axon
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, USA
- Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, USA
| | - David J. Taber
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, USA
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, USA
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425 USA
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The Gut Microbiota-Produced Indole-3-Propionic Acid Confers the Antihyperlipidemic Effect of Mulberry-Derived 1-Deoxynojirimycin. mSystems 2020; 5:5/5/e00313-20. [PMID: 33024047 PMCID: PMC7542557 DOI: 10.1128/msystems.00313-20] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hyperlipidemia is a worldwide epidemic with an obvious gender disparity in incidence. Modulations on gut microbiota by traditional Chinese medicines (TCM) are emerging as a potential rationale governing the profitable effects of drugs on hyperlipidemia. However, it is unclear how gut microbes regulate the progression of hyperlipidemia. Here, we found that mulberry leaf extract (MLE) and its active component 1-deoxynojirimycin (DNJ) diminished hyperglycemia and hypertriglyceridemia with similar efficacy in male and female mice but preferentially alleviated hypercholesterolemia in female mice. Further investigations showed that DNJ sex-specifically downregulated the expression of lipogenic genes, especially cholesterol-biosynthetic genes. Oral administration of DNJ imposed more profound modulation on gut microbiota in female mice than in male ones, as estimated by 16S rRNA metatranscriptomic analysis. DNJ markedly enriched Akkermansia and Clostridium group XIVa and promoted the production of indole-3-propionic acid (IPA) in a sexually dimorphic way. Importantly, IPA tightly associates with the antihyperlipidemic effect of DNJ and exhibited a potent lipid-lowering effect both in vitro and in vivo Together, our results have established a regulatory mechanism by which DNJ sex-specifically improves hyperlipidemia, offering an in-depth theoretical basis for therapeutic exploitation of DNJ as a sex-specific intervention against hyperlipidemia.IMPORTANCE Hyperlipidemia has been intensively focused on by researchers around the world owing to its major contribution to cardiovascular diseases. Various evidence reveals that women are more susceptible than male counterparts to dyslipidemia, making sex-dependent therapeutic strategies and drugs urgently needed. In the present work, we demonstrate that DNJ, the main active component of mulberry leaves, exerts an obvious female-preferential antihyperlipidemic effect through specifically enriching Akkermansia and Clostridium XIVa and elevating an active microbial metabolite, indole-3-propionic acid (IPA), in female mice. Moreover, we have corroborated the potent lipid-lowering efficacy of IPA both in vitro and in vivo These findings not only indicate a potential mechanism by which gut microbes and their metabolites confer the beneficial role of DNJ in ameliorating hyperlipidemia but also provide an in-depth theoretical basis for therapeutic exploitation of DNJ as a female-specific intervention against hyperlipidemia.
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Tran DT, Palfrey D, Lo TKT, Welsh R. Outcome and Cost of Optimal Control of Dyslipidemia in Adults With High Risk for Cardiovascular Disease. Can J Cardiol 2020; 37:66-76. [PMID: 32738207 DOI: 10.1016/j.cjca.2020.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND We assessed the impact of optimal dyslipidemia control on mortality and costs in adults at high risk for cardiovascular disease (HRCVD). METHODS We linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between April 2012 and March 2017. The first HRCVD event was considered the index event. Patients were categorized into (1) optimal control and (2) suboptimal control of dyslipidemia based on biomarkers and lipid-lowering therapy during the year post-index event. We measured the association between optimal dyslipidemia control and mortality and health care costs using difference-in-difference and propensity score-matching methods. RESULTS The study included 459,739 patients with HRCVD (43,776 [9.5%] optimal patients). The optimal patients were older (median age = 62 vs 55 years; P < 0.001), included fewer female patients (37.7% vs 52%; P < 0.001), and featured a higher proportion of secondary prevention patients (15.7% vs 1.7%; P < 0.001). Compared with suboptimal patients, the optimal patients had lower adjusted mortality (0.7% vs 1.9% at 1-year and 2.9% vs 5.1% at 3-year post-index event; both P < 0.001), and higher adjusted health care costs (CA$3758 and CA$6844 at 1-year and 3-year post-index event, respectively; both P < 0.001). Among the secondary prevention group, the optimal patients had lower adjusted mortality (2.4% and 5% absolute reduction at 1-year and 3-year post-index event, respectively; both P < 0.001) at no additional costs. The results were robust across 5 definitions of optimal dyslipidemia control. CONCLUSIONS Patients with optimal dyslipidemia control have lower mortality and incur modestly higher costs. However, secondary prevention patients experience lower mortality at no additional costs.
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Affiliation(s)
- Dat T Tran
- Institute of Health Economics, Edmonton, Alberta, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Dan Palfrey
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - T K T Lo
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Robert Welsh
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wright AK, Welsh P, Gill JMR, Kontopantelis E, Emsley R, Buchan I, Ashcroft DM, Rutter MK, Sattar N. Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA 1c and lipid levels at the diagnosis of type 2 diabetes relative to people without diabetes. Diabetologia 2020; 63:1542-1553. [PMID: 32435821 PMCID: PMC7351865 DOI: 10.1007/s00125-020-05169-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to determine how weight patterns together with blood glucose, BP and lipids vary at diagnosis of diabetes by age, sex and ethnicity. METHODS Using the UK Clinical Practice Research Datalink, we identified people with type 2 diabetes (n = 187,601) diagnosed in 1998-2015 and compared their weights, HbA1c, BP and lipid levels at diagnosis with age-matched people without diabetes (n = 906,182), by sex and ethnic group. RESULTS Younger age at diagnosis was associated with greater adjusted mean difference (95% CI) in weight between those with vs without type 2 diabetes: 18.7 (18.3, 19.1) kg at age 20-39 years and 5.3 (5.0, 5.5) kg at age ≥ 80 years. Weight differentials were maximal in white women, and were around double in white people compared with South Asian and black people. Despite lower absolute values, BP differences were also greater at younger age of diabetes onset: 7 (6, 7) mmHg at age 20-39 years vs -0.5 (-0.9, -0.2) at age ≥ 80 years. BP differences were greatest in white people, and especially in women. Triacylglycerol level differences were greatest in younger men. Finally, HbA1c levels were also higher with younger onset diabetes, particularly in black people. CONCLUSIONS/INTERPRETATION At diagnosis of type 2 diabetes, when compared with people without diabetes, weight and BP differentials were greater in younger vs older people, in women vs men and in white vs South Asian and black people. These differences were observed even though South Asian and black people tend to develop diabetes a decade earlier with either similar or greater dysglycaemia. These striking patterns may have implications for management and prevention. Graphical abstract.
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Affiliation(s)
- Alison K Wright
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Jason M R Gill
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain Buchan
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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Cavanagh CE, Rosman L, Chui PW, Bastian L, Brandt C, Haskell S, Burg MM. Barriers to cardiovascular disease preventive behaviors among OEF/OIF/OND women and men veterans. Health Psychol 2020; 39:298-306. [PMID: 31999178 PMCID: PMC7078021 DOI: 10.1037/hea0000844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE OEF/OIF/OND Veterans have an elevated risk for developing cardiovascular disease (CVD), but research suggests that engagement in CVD preventive behaviors is low even among at-risk individuals. It is critical to understand barriers to prevention engagement among Veterans to inform the development of tailored interventions addressing barriers and reducing CVD incidence. METHOD The Women Veterans Cohort Study survey of OEF/OIF/OND Veterans (586 women and 555 men) assessed patient, interpersonal, and systems level barriers to CVD risk prevention. Prevalence of barriers was determined, and chi-squares were conducted to examine sex differences. Multivariate logistic regressions were conducted to determine if sex differences remained when adjusting for demographic factors (age, marital status, education, employment status). RESULTS Despite a low response rate (11.5%), endorsement of barriers was high for both women and men, with most (56.8%) not perceiving themselves to be at CVD risk. More men preferred making no lifestyle change (40.9% vs. 29.1%). More women endorsed lack of confidence (42.4% vs. 36.1%), stress (36.9% vs. 27.8%) and depression (36.9% vs. 27.8%), and inadequate social support (26% vs. 20.9%), along with the belief that their clinician does not perceive them as at risk (57.8% vs. 32%) and has not explained CVD preventive behaviors (19% vs. 12.3%). Multivariate analyses reduced statistical significance of sex differences. CONCLUSIONS Given the low response rate, testing of efforts-for example, implementation science methods-to assess CVD risk reduction barriers in this population are needed, a task for which the Veterans Health Administration is well suited. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Casey E. Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lindsey Rosman
- Department of Medicine - Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip W. Chui
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew M. Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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12
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Harrington KM, Nguyen XMT, Song RJ, Hannagan K, Quaden R, Gagnon DR, Cho K, Deen JE, Muralidhar S, O'Leary TJ, Gaziano JM, Whitbourne SB. Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort. Womens Health Issues 2019; 29 Suppl 1:S56-S66. [PMID: 31253243 PMCID: PMC7061933 DOI: 10.1016/j.whi.2019.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.
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Affiliation(s)
- Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
| | - Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Keri Hannagan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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13
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Wright AK, Kontopantelis E, Emsley R, Buchan I, Mamas MA, Sattar N, Ashcroft DM, Rutter MK. Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes Mellitus: A Population-Based Cohort Study Assessing Sex Disparities. Circulation 2019; 139:2742-2753. [PMID: 30986362 DOI: 10.1161/circulationaha.118.039100] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With recent changes in the United Kingdom's clinical practice for diabetes mellitus care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed. METHODS In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79 985 patients with incident type 2 diabetes mellitus (T2DM) between 2006 to 2013 matched to 386 547 patients without diabetes mellitus. Sex-stratified Cox models were used to assess cardiovascular risk. RESULTS Compared with women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted hazard ratio, 1.20 [95% confidence interval, 1.12-1.28]) with similar corresponding data in men (hazard ratio, 1.12 [1.06-1.19]), leading to a nonsignificant higher relative risk in women (risk ratio, 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared with men with T2DM, women with T2DM were more likely to be obese, hypertensive, and have hypercholesterolemia, but were less likely to be prescribed lipid-lowering medication and angiotensin-converting enzyme inhibitors, especially if they had cardiovascular disease. CONCLUSIONS Compared with men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes mellitus care in women and men.
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Affiliation(s)
- Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (A.K.W., D.M.A.)
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences (A.K.W., M.K.R.)
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services, & Primary Care, School of Health Sciences, (E.K.)
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK (R.E.)
| | - Iain Buchan
- Health eResearch Center, Farr Institute, Division of Informatics, Imaging & Data Sciences, School of Health Sciences (I.B.), University of Manchester
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, UK (I.B.)
| | - Mamas A Mamas
- Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK (M.A.M.)
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, UK (N.S.)
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (A.K.W., D.M.A.)
| | - Martin K Rutter
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences (A.K.W., M.K.R.)
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre (M.K.R.), UK
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14
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Al-Salameh A, Chanson P, Bucher S, Ringa V, Becquemont L. Cardiovascular Disease in Type 2 Diabetes: A Review of Sex-Related Differences in Predisposition and Prevention. Mayo Clin Proc 2019; 94:287-308. [PMID: 30711127 DOI: 10.1016/j.mayocp.2018.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes mellitus is a major risk factor for cardiovascular disease. However, compiled data suggest that type 2 diabetes affects the risk of cardiovascular disease differentially according to sex. In recent years, large meta-analyses have confirmed that women with type 2 diabetes have a higher relative risk of incident coronary heart disease, fatal coronary heart disease, and stroke compared with their male counterparts. The reasons for these disparities are not completely elucidated. A greater burden of cardiometabolic risk in women was proposed as a partial explanation. Indeed, several studies suggest that women experience a larger deterioration in major cardiovascular risk factors and put on more weight than do men during their transition from normoglycemia to overt type 2 diabetes. This excess weight is associated with higher levels of biomarkers of endothelial dysfunction, inflammation, and procoagulant state. Moreover, sex differences in the prescription and use of some cardiovascular drugs may compound an "existing" disparity. We searched PubMed for articles published in English and French, by using the following terms: ("cardiovascular diseases") AND ("diabetes mellitus") AND ("sex disparity" OR "sex differences" OR "sex related differences" OR "sex-related differences" OR "sex disparities"). In this article, we review the available literature on the sex aspects of primary and secondary prevention of cardiovascular disease in people with type 2 diabetes, in the predisposition to cardiovascular disease in those people, and in the control of diabetes and associated cardiovascular risk factors.
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Affiliation(s)
- Abdallah Al-Salameh
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Centre de Recherche Clinique Paris-Sud, Le Kremlin-Bicêtre, France.
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France; Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM U1185, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Bucher
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; General Practice Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Virginie Ringa
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France
| | - Laurent Becquemont
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Sud, Université Paris-Saclay, INSERM, Villejuif, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Centre de Recherche Clinique Paris-Sud, Le Kremlin-Bicêtre, France; Pharmacology Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
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15
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Impact of Patient-Centered Medical Home Implementation on Diabetes Control in the Veterans Health Administration. J Gen Intern Med 2018; 33:1276-1282. [PMID: 29611089 PMCID: PMC6082213 DOI: 10.1007/s11606-018-4386-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/04/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Given its widespread dissemination across primary care, the Veterans Health Administration (VA) is an ideal setting to examine the impact of the patient-centered medical home (PCMH) on diabetes outcomes. OBJECTIVE To assess the impact of PCMH implementation on diabetes outcomes among patients receiving care in the Veterans Health Administration. DESIGN Retrospective cohort analysis and multilevel logistic regression. PATIENTS Twenty thousand eight hundred fifty-eight patients in one Midwest VA network who had a diabetes diagnosis in both 2009 and 2012 and who received primary care between October 1, 2008 and September 30, 2009. MAIN MEASURES Glycemic and lipid control using VA quality indicators [hemoglobin (Hb) A1c < 9%, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL]. KEY RESULTS Odds of glycemic control were lower in 2012 than 2009 (OR = 0.72, 95% CI = 0.67-0.77, p < 0.001), and this change in control over time varied by race (OR of the interaction between time and race = 1.18, 95% CI = 1.02-1.36, p = 0.028). While the disparity in glycemic control between white and black patients persisted post-PCMH, the magnitude of the disparity was smaller in 2012 compared to 2009 (2012: OR = 1.32, 95% CI = 1.18-1.47, p < 0.0001 and 2009: OR = 1.59, 95% CI = 1.39-1.82, p < 0.0001). Odds of lipid control did not significantly change between 2009 and 2012 and change did not vary by race and/or gender. CONCLUSIONS Although there were no significant improvements in odds of lipid control, and odds of glycemic control decreased following PCMH implementation, there was evidence of reduced racial disparities in glycemic control post-PCMH implementation.
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16
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Mapping the Gaps: Gender Differences in Preventive Cardiovascular Care among Managed Care Members in Four Metropolitan Areas. Womens Health Issues 2018; 28:446-455. [PMID: 29929865 DOI: 10.1016/j.whi.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/21/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prior research documents gender gaps in cardiovascular risk management, with women receiving poorer quality routine care on average, even in managed care systems. Although population health management tools and quality improvement efforts have led to better overall care quality and narrowing of racial/ethnic gaps for a variety of measures, we sought to quantify persistent gender gaps in cardiovascular risk management and to assess the performance of routinely used commercial population health management tools in helping systems narrow gender gaps. METHODS Using 2013 through 2014 claims and enrollment data from more than 1 million members of a large national health insurance plan, we assessed performance on seven evidence-based quality measures for the management of coronary artery disease and diabetes mellitus, a cardiac risk factor, across and within four metropolitan areas. We used logistic regression to adjust for region, demographics, and risk factors commonly tracked in population health management tools. FINDINGS Low-density lipoprotein (LDL) cholesterol control (LDL < 100 mg/dL) rates were 5 and 15 percentage points lower for women than men with diabetes mellitus (p < .0001), and coronary artery disease (p < .0001), respectively. Adjusted analyses showed women were more likely to have gaps in LDL control, with an odds ratio of 1.31 (95% confidence interval, 1.27-1.38) in diabetes mellitus and 1.88 (95% confidence interval, 1.65-2.10) in coronary artery disease. CONCLUSIONS Given our findings that gender gaps persist across both clinical and geographic variation, we identified additional steps health plans can take to reduce disparities. For measures where gaps have been consistently identified, we recommend that gender-stratified quality reporting and analysis be used to complement widely used algorithms to identify individuals with unmet needs for referral to population health and wellness behavior support programs.
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17
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Al-Zakwani I, Al-Mahruqi F, Al-Rasadi K, Shehab A, Al Mahmeed W, Arafah M, Al-Hinai AT, Al Tamimi O, Al Awadhi M, Santos RD. Sex disparity in the management and outcomes of dyslipidemia of diabetic patients in the Arabian Gulf: findings from the CEPHEUS study. Lipids Health Dis 2018; 17:25. [PMID: 29402296 PMCID: PMC5800019 DOI: 10.1186/s12944-018-0667-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/22/2018] [Indexed: 01/02/2023] Open
Abstract
Background Little is known about sex gap in the management and outcomes of dyslipidemia among diabetics in the Arabian Gulf. The aim if this study was to determine sex differences in the management and outcomes of dyslipidemia in diabetic patients in the Arabian Gulf. Methods This study was derived from the Centralized Pan-Middle-East Survey on the management of hypercholesterolemia. Patients recruited were aged ≥18 years on lipid lowering drugs for ≥3 months (stable medication for ≥6 weeks). Outcomes were based on the joint Consensus Statement of the American Diabetes Association and American College of Cardiology Foundation. Analyses were performed using univariate and multivariate logistic regression techniques. Results The mean age of the cohort (n = 3336) was 57 ± 11 years and 45% (n = 1486) were females. Females were less likely to be on rosuvastatin (7.6% vs 12%; P < 0.001), atorvastatin (41% vs 46%; P = 0.005) and combination hypolipidemic therapy (5.6% vs 2.8%; P < 0.001) but more likely to be on simvastatin (51% vs 39%; P < 0.001) than males. Females, especially those with very high atherosclerotic cardiovascular disease (ASCVD) risk status, were also less likely to achieve LDL-cholesterol [adjusted odds ratio (aOR), 0.58; 95% confidence interval (CI): 0.40–0.86; P = 0.006], non-HDL-cholesterol [aOR, 0.68; 95% CI: 0.46–0.99; P = 0.048] and apolipoprotein B [aOR, 0.64; 95% CI: 0.44–0.92; P = 0.016] lipid targets. Conclusions Diabetic women were less likely to be on optimal hypolipemic therapy and consequently less likely to attain lipid goals compared to men. This shows a sex gap on dyslipidemia treatment in the region. Diabetic women with very high ASCVD risk status need to be aggressively treated to lower their risk of cardiovascular events.
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Affiliation(s)
- Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, PO Box 38, PC-123, Al-Khodh, Sultanate of Oman. .,Gulf Health Research, Muscat, Oman.
| | - Fatma Al-Mahruqi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | | | | | | | | | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao, Paulo, Brazil
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18
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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19
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Incident Cardiovascular Risk Factors Among Men and Women Veterans After Return From Deployment. Med Care 2017; 55:948-955. [PMID: 28984707 DOI: 10.1097/mlr.0000000000000801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stressors associated with military service and reintegration may impact psychologic well-being and behaviors that result in increased incidence rates for cardiovascular (CV) risk factors. OBJECTIVE Using electronic health record data from the Veterans Health Administration we sought to measure the incidence of newly diagnosed CV risk factors and how these incident risks were moderated by race and mental health conditions. DESIGN A cohort study including Veterans whose end of last deployment was between October 1, 2001 and July 31, 2014. SUBJECTS A total of 267,305 Operations Iraqi Freedom, Enduring Freedom, and New Dawn Veterans were present. MAIN OUTCOME MEASURES Incident risk factors (hypertension, obesity, dyslipidemia, diabetes, or coronary artery disease), identified through new International Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes or measurement recordings at primary care visits. RESULTS The rate of developing at least 1 risk factor or coronary artery disease was 240 and 151 per 1000 person-years in men and women, respectively. Except for obesity, women were significantly less likely to develop any other CV risk factor compared with men (Crude hazard ratios ranging from 0.44 to 0.82). The impact of sex on hypertension (P<0.001) and obesity (P<0.001) was modified by race and the impact of sex on the combined event of any risk factor (P=0.007) and obesity (P<0.001) was modified by depression. CONCLUSIONS Compared with men, women Veterans were more likely to become obese after return from deployment, but less likely to develop any other risk . For black women, the protective effect of female sex on the combined event (any risk factor), and hypertension was lessened compared with white women. The increased risk of obesity for women was greater in black women, and those with depression.
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20
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Zhang X, Ji L, Ran X, Su B, Ji Q, Hu D. Gender Disparities in Lipid Goal Attainment among Type 2 Diabetes Outpatients with Coronary Heart Disease: Results from the CCMR-3B Study. Sci Rep 2017; 7:12648. [PMID: 28978912 PMCID: PMC5627285 DOI: 10.1038/s41598-017-13066-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/13/2017] [Indexed: 02/05/2023] Open
Abstract
Our study was aimed to investigate the gender disparities in lipid goal attainment among type 2 diabetes outpatients with concomitant coronary heart disease (CHD) and explore potential risk factors. We performed the present analysis using data from a nationally representative epidemiologic study. The therapeutic goal was defined as achieving a low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L. A total of 1721 male and 2072 female type 2 diabetes outpatients with established CHD were identified. Compared with men, women had higher levels of total cholesterol (4.98 vs. 4.46 mmol/L; p < 0.001), LDL-C (2.82 vs. 2.54 mmol/L; p < 0.001), and triglycerides (2.02 vs. 1.79 mmol/L; p < 0.001), but not hemoglobin A1c (7.47% vs. 7.50%; p = 0.597). The proportion of women received lipid-lowering therapy was lower (38.1% vs. 48.2%; p < 0.001). The percentages of patients who achieved the LDL-C goal were higher among men. Multivariable regression analysis indicated that the odds ratio for lipid goal attainment due to the gender difference was 0.61 after adjusting confounders. The inability to achieve LDL-C goals in women with type 2 diabetes and CHD is apparently greater than that in men. This finding underscores the importance of initiatives to establish a more aggressive lipid management strategy for women to overcome gender imbalances.
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Affiliation(s)
- Xiaomei Zhang
- Peking University International Hospital, Department of Endocrinology and Metabolism, Beijing, 102206, China
| | - Linong Ji
- Peking University People's Hospital, Department of Endocrinology and Metabolism, Beijing, 100044, China.
| | - Xingwu Ran
- West China Hospital, Sichuan University, Department of Endocrinology and Metabolism, Chengdu, 610041, China
| | - Benli Su
- The Second Affiliated Hospital of Dalian Medical University, Department of Endocrinology, Dalian, 116027, China
| | - Qiuhe Ji
- Xijing Hospital, Forth Military Medical University, Department of Endocrinology, Xi'an, 710032, China
| | - Dayi Hu
- Peking University People's Hospital, Department of Cardiology, Beijing, 100044, China
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22
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Goldstein KM, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Bastian LA, Batch BC, Bosworth HB. Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease. J Womens Health (Larchmt) 2017; 26:806-814. [PMID: 28192012 DOI: 10.1089/jwh.2016.5739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfaction with lipid control and confidence in ability to improve it vary by gender and (2) whether sociodemographic characteristics modify the association. MATERIALS AND METHODS We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia. RESULTS A total of 428 veterans (15% women) participated. Compared with men, women had higher low-density lipoprotein values at 141.2 versus 121.7 mg/dL, respectively (p < 0.05), higher health literacy, and were less likely to have someone to help track their medications (all p < 0.05). In an adjusted model, women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1-10 Likert scale (p < 0.05). There was no significant difference in confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 versus 7.2 (p < 0.05). CONCLUSIONS Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.
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Affiliation(s)
- Karen M Goldstein
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Karen M Stechuchak
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Leah L Zullig
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Eugene Z Oddone
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Maren K Olsen
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, North Carolina
| | - Felicia A McCant
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Lori A Bastian
- 4 VA Connecticut Healthcare System , West Haven, Connecticut.,5 Department of Medicine, Yale University , New Haven, Connecticut
| | - Bryan C Batch
- 6 Division of Endocrinology, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Hayden B Bosworth
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina.,7 School of Nursing, Duke University School of Medicine , Durham, North Carolina.,8 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, North Carolina
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Conard PL, Armstrong ML. Advocating for Deployed Women Veterans' Health Differences, Difficulties, and Disparities. Nurs Forum 2016; 51:225-232. [PMID: 26095248 DOI: 10.1111/nuf.12143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PROBLEM The preceding article presented a glimpse of deployed women veterans, their military culture, and their experiences in the Global War on Terror (Iraq and Afghanistan) to assist civilian nurses to gain significant rapport and provide important culturally sensitive care. METHODS Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS A confirmatory answer from the assessment question of "Have you served in the military?" and the use of the Military Health History Pocket Card for Clinicians (available at http://www.va.gov.oaa/pocketcard) will assist with revealing possible health risks from the increased amounts of military men and women veterans seeking (and/or returning to) a variety of community-based health services. This article about deployed women veterans examines their specific health differences (e.g., research literature, post-traumatic stress disorder, and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, suicide), and gender disparities (varied treatment patterns). CONCLUSION Understanding these gender situations, civilian nurses can better advocate with increasing evidence-based decisions that their physical and behavioral responses were different from their male counterparts. Continual assessment, knowledgeable care, ongoing literature review, interdisciplinary health team development, and the presence of resourceful community agencies should be a significant part of their holistic care. Conard Armstrong.
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Zhang H, Plutzky J, Shubina M, Turchin A. Drivers of the Sex Disparity in Statin Therapy in Patients with Coronary Artery Disease: A Cohort Study. PLoS One 2016; 11:e0155228. [PMID: 27148965 PMCID: PMC4858152 DOI: 10.1371/journal.pone.0155228] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/26/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Women are less likely to be prescribed statins than men. Existing reports explain only a fraction of this difference. We conducted a study to identify factors that account for sex differences in statin therapy among patients with coronary artery disease (CAD). METHODS AND RESULTS We retrospectively studied 24,338 patients with CAD who were followed for at least a year between 2000 and 2011 at two academic medical centers. Women (9,006 / 37% of study patients) were less likely to either have initiated statin therapy (81.9% women vs. 87.7% men) or to have persistent statin therapy at the end of follow-up (67.0% women vs. 71.4% men). Women were older (72.9 vs. 68.4 years), less likely to have ever smoked (49.8% vs. 65.6%), less likely to have been evaluated by a cardiologist (57.5% vs. 64.5%) and more likely to have reported an adverse reaction to a statin (27.1% vs. 21.7%) (p < 0.0001 for all). In multivariable analysis, patients with history of smoking (OR 1.094; p 0.017), younger age (OR 1.013 / year), cardiologist evaluation (OR 1.337) and no reported adverse reactions to statins (OR 1.410) were more likely (p < 0.0001 for all) to have persistent statin therapy. Together, these four factors accounted for 90.4% of the sex disparity in persistent statin therapy. CONCLUSIONS Several specific factors appear to underlie divergent statin therapy in women vs. men. Identifying such drivers may facilitate programmatic interventions and stimulate further research to overcome sex differences in applying proven interventions for cardiovascular risk reduction.
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Affiliation(s)
- Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jorge Plutzky
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Maria Shubina
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Alexander Turchin
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Clinical Research Institute, Boston, Massachusetts, United States of America
- * E-mail:
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Chhabra ST, Masson S, Kaur T, Gupta R, Sharma S, Goyal A, Singh B, Tandon R, Aslam N, Mohan B, Wander GS. Gender bias in cardiovascular healthcare of a tertiary care centre of North India. HEART ASIA 2016; 8:42-5. [PMID: 27326231 DOI: 10.1136/heartasia-2015-010710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse the gender bias in paediatric patients referred for free cardiac treatment as part of School Health Programme at a tertiary care centre in North India. METHODS A total of 537 children were referred for further management of congenital heart disease or rheumatic heart disease. Of these, 519 underwent cardiac intervention, and the data from their records were analysed retrospectively to determine any gender disparity in the utilisation of cardiac surgery. RESULTS Of the 519 children studied, only 195 (37.6%) were girls, while the remaining 324 (62.4%) were boys (male-to-female ratio of 1.66:1, p<0.0001), indicating a large gender divide. Gender bias was found to be prevalent across all the age groups irrespective of the type of cardiac ailment. Moreover, no statistically significant difference was found between the urban and rural populations (male-to-female ratio of 1.64:1 in rural and 1.71:1 in urban populations; p=0.823) in terms of gender disparity. CONCLUSIONS Significant gender discrepancies exist in healthcare-seeking behaviour of patients in North India despite the provision of free cardiac treatment. An equal prevalence of gender bias in urban and rural communities points towards deep-rooted social norms beyond just the economic constraints. Healthcare policies ensuring equal treatment of male and female children should be promulgated to ensure a complete eradication of this social evil.
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Affiliation(s)
- Shibba Takkar Chhabra
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarbjit Masson
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Tripat Kaur
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Rajiv Gupta
- Department of Cardiovascular and Thoracic Surgery , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarit Sharma
- Department of Community Medicine , Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Abishek Goyal
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bhupinder Singh
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Rohit Tandon
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Naved Aslam
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bishav Mohan
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Gurpreet Singh Wander
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
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Rodriguez F, Olufade TO, Ramey DR, Friedman HS, Navaratnam P, Heithoff K, Foody JM. Gender Disparities in Lipid-Lowering Therapy in Cardiovascular Disease: Insights from a Managed Care Population. J Womens Health (Larchmt) 2016; 25:697-706. [PMID: 26889924 DOI: 10.1089/jwh.2015.5282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Numerous studies have documented the strong inverse relationship between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic cardiovascular disease (ASCVD). However, women are less likely to be screened for hypercholesterolemia, receive lipid-lowering therapy (LLT), and achieve optimal LDL-C levels. MATERIALS AND METHODS Data were extracted from a U.S. administrative claims database between January 2008 and December 2012 for patients with established ASCVD. The earliest date of valid LDL-C value was defined as the index date. Patients were followed for ±12 months from the index date and were stratified by gender, by baseline LDL-C level, and whether they were initially treated with a LLT then propensity score matched by gender using demographic and clinical characteristics. Both descriptive statistics and logistic regression models were used to explore the association of gender with the frequency of LDL-C monitoring, LLT treatment initiation in initially untreated patients, and prescribing patterns in initially treated patients. RESULTS A total of 76,414 subjects with established ASCVD were identified; 42% of the sample was women. In the unmatched cohort, 50.3% of men and 32.0% of women were prescribed a preindex statin (p < 0.0001). Among matched patients (n = 51,764), women initially treated with LLT were significantly less likely to receive a prescription for a higher potency LLT. Even among those with LDL-C levels above 160 mg/dL, women were more likely to discontinue LLT, odds ratio (95% confidence interval) 1.8 (1.2-2.3). Female gender and older age were significant predictors of discontinuation, and the potency of the index medication was the strongest predictor of dose titration. Initially untreated women were less likely to initiate LLT treatment than men, irrespective of index LDL-C levels (p < 0.0001). CONCLUSIONS The observed disparities further reinforce the need for targeted efforts to reduce the gender gap for secondary prevention in women at high risk of cardiovascular disease.
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Affiliation(s)
- Fatima Rodriguez
- 1 Division of Cardiovascular Medicine, Stanford University , Stanford, California
| | | | - Dena R Ramey
- 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania
| | | | | | - Kim Heithoff
- 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania
| | - JoAnne M Foody
- 4 Division of Cardiovascular Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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Jain RK, Laiteerapong N. Strategies for improving cardiovascular health in women with diabetes mellitus: a review of the evidence. Curr Diab Rep 2015; 15:98. [PMID: 26391392 PMCID: PMC4886737 DOI: 10.1007/s11892-015-0665-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knowledge about cardiovascular (CV) disease in women with diabetes mellitus (DM) has changed substantially over the past 20 years. Coronary artery disease, strokes, and peripheral vascular disease affect women with DM at higher rates than the general population of women. Lifestyle therapies, such as dietary changes, physical activity, and smoking cessation, offer substantial benefits to women with DM. Of the pharmacotherapies, statins offer the most significant benefits but may not be well tolerated in some women. Aspirin may also benefit high-risk women. Other pharmacotherapies, such as fibrates, ezetimibe, niacin, fish oil, and hormone replacement therapy, remain unproven and, in some cases, potentially dangerous to women with DM. To reduce CV events, risks to women with DM must be better publicized and additional research must be done. Finally, advancements in health care delivery must target high-risk women with DM to lower risk factors and effectively improve cardiovascular health.
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Affiliation(s)
- Rajesh K Jain
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, 5841 S Maryland Ave, AMB M267-MC1027, Chicago, IL, 60637, USA.
| | - Neda Laiteerapong
- Department of General Internal Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA.
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Kummer BR, Bhave PD, Merkler AE, Gialdini G, Okin PM, Kamel H. Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation. J Am Heart Assoc 2015; 4:e002097. [PMID: 26396201 PMCID: PMC4599497 DOI: 10.1161/jaha.115.002097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/31/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter ablation is increasingly used for rhythm control in symptomatic atrial fibrillation (AF), but the demographic characteristics of patients undergoing this procedure are unclear. METHODS AND RESULTS We used data on all admissions at nonfederal acute care hospitals in California, Florida, and New York to identify patients discharged with a primary diagnosis of AF between 2006 and 2011. Our primary outcome was readmission for catheter ablation of AF, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Cox regression models were used to assess relationships between demographic characteristics and catheter ablation, adjusting for Elixhauser comorbidities. We identified 397 612 eligible patients. Of these, 16 717 (4.20%, 95% CI 0.41 to 0.43) underwent ablation. These patients were significantly younger, more often male, more often white, and more often privately insured, with higher household incomes and lower rates of medical comorbidity. In Cox regression models, the likelihood of ablation was lower in women than men (hazard ratio [HR] 0.83; 95% CI 0.80 to 0.86) despite higher rates of AF-related rehospitalization (HR 1.23; 95% CI 1.21 to 1.24). Compared to whites, the likelihood of ablation was lower in Hispanics (HR 0.60; 95% CI 0.56 to 0.64) and blacks (HR 0.68; 95% CI 0.64 to 0.73), even though blacks had only a slightly lower likelihood of AF-related rehospitalization (HR 0.97; 95% CI 0.94 to 0.99) and a higher likelihood of all-cause hospitalization (HR 1.38; 95% CI 1.37 to 1.39). Essentially the same pattern existed in Hispanics. CONCLUSIONS We found differences in use of catheter ablation for symptomatic AF according to sex and race despite adjustment for available data on demographic characteristics and medical comorbidities.
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Affiliation(s)
- Benjamin R Kummer
- Department of Neurology, Neurological Institute of New York, Columbia University College of Physicians and SurgeonsNew York, NY
| | - Prashant D Bhave
- Division of Cardiology, University of Iowa Carver College of MedicineIowa City, IA
| | | | - Gino Gialdini
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical CollegeNew York, NY
| | - Peter M Okin
- Division of Cardiology, Weill Cornell Medical CollegeNew York, NY
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical CollegeNew York, NY
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical CollegeNew York, NY
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Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015; 12:1406-12. [PMID: 25814418 PMCID: PMC4787261 DOI: 10.1016/j.hrthm.2015.03.031] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. OBJECTIVE We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. METHODS We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010-2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiologist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. RESULTS Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63-0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63-0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92-0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93-0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93-0.94; P < .001). CONCLUSION Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.
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Affiliation(s)
| | - Xin Lu
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Saket Girotra
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Hooman Kamel
- Feil Family Brain and Mind Research Institute, New York, New York; Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Mary S Vaughan Sarrazin
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
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Parrinello CM, Rastegar I, Godino JG, Miedema MD, Matsushita K, Selvin E. Prevalence of and Racial Disparities in Risk Factor Control in Older Adults With Diabetes: The Atherosclerosis Risk in Communities Study. Diabetes Care 2015; 38:1290-8. [PMID: 25852205 PMCID: PMC4477331 DOI: 10.2337/dc15-0016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/13/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Controversy surrounds appropriate risk factor targets in older adults with diabetes. We evaluated the proportion of older adults with diabetes meeting different targets, focusing on possible differences by race, and assessed whether demographic and clinical characteristics explained disparities. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study of 5,018 participants aged 67-90 years (1,574 with and 3,444 without diagnosed diabetes) who attended visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (2011-2013). Risk factor targets were defined using both stringent (and less stringent) goals: hemoglobin A1c (HbA1c) <7%, <53 mmol/mol (<8%, <64 mmol/mol); LDL cholesterol (LDL-c) <100 mg/dL (<130 mg/dL); and blood pressure (BP) <140/90 mmHg (<150/90 mmHg). We used Poisson regression to obtain prevalence ratios (PRs). RESULTS Most older adults with diabetes met stringent (and less stringent) targets: 72% (90%) for HbA1c, 63% (86%) for LDL-c, and 73% (87%) for BP; but only 35% (68%) met all three. A higher proportion of whites than blacks met targets, however defined. Among people treated for risk factors, racial disparities in prevalence of meeting stringent targets persisted even after adjustment: PRs (whites vs. blacks) were 1.03 (95% CI 0.91, 1.17) for HbA1c, 1.21 (1.09, 1.35) for LDL-c, 1.10 (1.00, 1.21) for BP, and 1.28 (0.99, 1.66) for all three. Results were similar but slightly attenuated using less stringent goals. Black women were less likely than white women to meet targets for BP and all three risk factors; this disparity was not observed in men. CONCLUSIONS Black-white disparities in risk factor control in older adults with diabetes were not fully explained by demographic or clinical characteristics and were greater in women than men. Further study of determinants of these disparities is important.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ina Rastegar
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Baltimore Polytechnic Institute, Baltimore, MD
| | - Job G Godino
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Department of Epidemiology and the Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Kunihiro Matsushita
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Sex differences in patient and provider response to elevated low-density lipoprotein cholesterol. Womens Health Issues 2015; 24:575-80. [PMID: 25213750 DOI: 10.1016/j.whi.2014.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite American Heart Association recommendations of diet/lifestyle modification and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women are less likely than men to be screened and achieve treatment goals. This study determined whether the provider and patient response to electronic medical record (EMR) notification of an elevated LDL varied by patient sex in veterans. METHODS Provider responses to EMR clinical reminders for an elevated LDL (≥100 mg/dL) were assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and September 2009. Responses were classified into four types: 1) Whether the patient refused medication, 2) the provider ordered or adjusted medication, 3) treatment was deferred/medications were not changed, or 4) medications were contraindicated. Logistic regression with generalized estimating equations was used to compare clinical reminder responses between men and women patients. FINDINGS Providers were less likely to order or adjust medications for women (adjusted odds ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified by degree of LDL elevation or use of lipid-lowering medications. CONCLUSION These results indicate that poorer cholesterol control in at risk women is likely a consequence of both provider and patient factors.
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Goldstein KM, Melnyk SD, Zullig LL, Stechuchak KM, Oddone E, Bastian LA, Rakley S, Olsen MK, Bosworth HB. Heart matters: Gender and racial differences cardiovascular disease risk factor control among veterans. Womens Health Issues 2015; 24:477-83. [PMID: 25213741 DOI: 10.1016/j.whi.2014.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 05/29/2014] [Accepted: 05/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality for U.S. women. Racial minorities are a particularly vulnerable population. The increasing female veteran population has an higher prevalence of certain cardiovascular risk factors compared with non-veteran women; however, little is known about gender and racial differences in cardiovascular risk factor control among veterans. METHODS We used analysis of variance, adjusting for age, to compare gender and racial differences in three risk factors that predispose to CVD (diabetes, hypertension, and hyperlipidemia) in a cohort of high-risk veterans eligible for enrollment in a clinical trial, including 23,955 men and 1,010 women. FINDINGS Low-density lipoprotein (LDL) values were higher in women veterans than men with age-adjusted estimated mean values of 111.7 versus 97.6 mg/dL (p < .01). Blood pressures (BPs) were higher among African-American than White female veterans with age-adjusted estimated mean systolic BPs of 136.3 versus 133.5 mmHg, respectively (p < .01), and diastolic BPs of 82.4 versus 78.9 mmHg (p < .01). African-American veterans with diabetes had worse BP, LDL values, and hemoglobin A1c levels, although the differences were only significant among men. CONCLUSIONS Female veterans have higher LDL cholesterol levels than male veterans and African-American veterans have higher BP, LDL cholesterol, and A1c levels than Whites after adjusting for age. Further examination of CVD gender and racial disparities in this population may help to develop targeted treatments and strategies applicable to the general population.
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Affiliation(s)
- Karen M Goldstein
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Ambulatory Care Services, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Duke University, Durham, North Carolina.
| | - S Dee Melnyk
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Ambulatory Care Services, Durham Veterans Affairs Medical Center, Durham, North Carolina; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Leah L Zullig
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
| | - Karen M Stechuchak
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Eugene Oddone
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Ambulatory Care Services, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Lori A Bastian
- VA Connecticut Healthcare System, Newington, Connecticut; University of Connecticut Health Center, Farmington, Connecticut
| | - Susan Rakley
- Ambulatory Care Services, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Maren K Olsen
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Hayden B Bosworth
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Duke University, Durham, North Carolina; Departments of Psychiatry and School of Nursing, Duke University, Durham, North Carolina
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deKleijn M, Lagro-Janssen AL, Canelo I, Yano EM. Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel. Med Care 2015; 53:S156-64. [PMID: 25767971 PMCID: PMC4379113 DOI: 10.1097/mlr.0000000000000307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. OBJECTIVES We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. RESEARCH DESIGN Modified Delphi expert panel process. SUBJECTS Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. MEASURES Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. RESULTS Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. CONCLUSIONS We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.
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Affiliation(s)
- Miriam deKleijn
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine L.M. Lagro-Janssen
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ismelda Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
| | - Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Bethel MA, Green JB, Milton J, Tajar A, Engel SS, Califf RM, Holman RR. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab 2015; 17:395-402. [PMID: 25600421 DOI: 10.1111/dom.12441] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 12/18/2022]
Abstract
AIMS To report baseline characteristics and cardiovascular (CV) risk management by region, age, sex and CV event type for 14 724 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, double-blind, placebo-controlled trial exploring whether sitagliptin added to usual type 2 diabetes (T2DM) care affects time to first event in the composite endpoint of CV death, non-fatal myocardial infarction (MI), non-fatal stroke or unstable angina hospitalization. METHODS TECOS enrolled patients aged ≥50 years, with T2DM and CV disease from 38 countries in five regions: North America, Eastern Europe, Western Europe, Asia Pacific and Latin America. Participants had a glycated haemoglobin concentration of 6.5-8.0% (48-64 mmol/mol) and were receiving oral and/or insulin-based antihyperglycaemic therapy. Analysis of variance or logistic regression was used to compare regional CV risk factors and treatments, referenced to North America. RESULTS Patients had a mean [1 standard deviation (SD)] age of 66 (8) years, a median (interquartile range) diabetes duration of 9.4 (4.9, 15.3) years, and a mean (SD) body mass index 30.2 (5.7) kg/m² . Compared with North America, blood pressure and lipids were higher in all regions. Statin use was lowest in Latin America (68%) and Eastern Europe (70%) and aspirin use was lower compared with North America in all regions except Asia Pacific. Achievement of treatment targets did not differ by age group or insulin usage, but men and participants with previous MI were more likely than women or those with previous stroke or peripheral arterial disease to reach most treatment goals. CONCLUSION The CV risk factors of participants in TECOS are reasonably controlled, but differences in CV risk management according to region, sex and history of disease exist. This diversity will enhance the generalizability of the trial results.
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Affiliation(s)
- M A Bethel
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Ballotari P, Ranieri SC, Luberto F, Caroli S, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in cardiovascular mortality in diabetics and nondiabetic subjects: a population-based study (Italy). Int J Endocrinol 2015; 2015:914057. [PMID: 25873959 PMCID: PMC4385659 DOI: 10.1155/2015/914057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 01/14/2023] Open
Abstract
The objective of this study is to assess the impact of diabetes on cardiovascular mortality, focusing on sex differences. The inhabitants of Reggio Emilia province on December 31, 2009, aged 20-84 were followed up for three years for mortality. The exposure was determined using Reggio Emilia diabetes register. The age-adjusted death rates were estimated as well as the incidence rate ratios using Poisson regression model. Interaction terms for diabetes and sex were tested by the Wald test. People with diabetes had an excess of mortality, compared with nondiabetic subjects (all cause: IRR = 1.68; 95%CI 1.60-1.78; CVD: IRR = 1.61; 95%CI 1.47-1.76; AMI: IRR = 1.59; 95%CI 1.27-1.99; renal causes: IRR = 1.71; 95%CI 1.22-2.38). The impact of diabetes is greater in females than males for all causes (P = 0.0321) and for CVD, IMA, and renal causes. Further studies are needed to investigate whether the difference in cardiovascular risk profile or in the quality of care delivered justifies the higher excess of mortality in females with diabetes compared to males.
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Affiliation(s)
- Paola Ballotari
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Sofia Chiatamone Ranieri
- Laboratorio Analisi Chimico Cliniche ed Endocrinologia, IRCCS Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Ferdinando Luberto
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Stefania Caroli
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Marina Greci
- Dipartimento Cure Primarie, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Valeria Manicardi
- Dipartimento di Medicina Interna, Ospedale di Montecchio, Azienda Unità Sanitaria Locale, Via Barilla 16, 42027 Montecchio, Italy
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Burkhart L, Hogan N. Being a Female Veteran: A Grounded Theory of Coping With Transitions. SOCIAL WORK IN MENTAL HEALTH 2015; 13:108-127. [PMID: 25745366 PMCID: PMC4337746 DOI: 10.1080/15332985.2013.870102] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Female veterans, the fastest growing segment in the military, have unique pre-military histories and military experiences that are associated with post-military physical and mental health service needs. Successful treatment is contingent on a clearer understanding of the processes underlying these experiences. Data from 20 female veterans who served post-Gulf War were analyzed to generate a substantive theory of the process of women who entered, served in, and transitioned out of the military. Coping with transitions emerged as the basic psychosocial process used by female veterans. The Coping with transitions process is comprised of seven categories: Choosing the Military, Adapting to the Military, Being in the Military, Being a Female in the Military, Departing the Military, Experiencing Stressors of Being a Civilian, and Making Meaning of Being a Veteran-Civilian. The results of this study provide a theoretical description of the process female veterans experience when transitioning from a civilian identity, through military life stressors and adaptations, toward gaining a dual identity of being a veteran-civilian.
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Affiliation(s)
- Lisa Burkhart
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
- Research Health Scientist, Center of Innovation for Complex Chronic Healthcare (CINNCH) at Hines VA Hospital, Hines, Illinois, USA
| | - Nancy Hogan
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
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Schwartz E, Charlotte M, Slade E, Medoff D, Li L, Dixon L, Kilbourne A, Kreyenbuhl J. Gender differences in antipsychotics prescribed to veterans with serious mental illness. Gen Hosp Psychiatry 2015; 37:347-51. [PMID: 25936673 PMCID: PMC5909972 DOI: 10.1016/j.genhosppsych.2015.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects. METHOD We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics. RESULTS Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk. CONCLUSIONS The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women.
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Affiliation(s)
- Elana Schwartz
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA
| | - Melanie Charlotte
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Eric Slade
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA
| | - Lisa Dixon
- Center for Practice Innovations, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - Amy Kilbourne
- Quality Enhancement Research Initiative, VA Health Services Research and Development (HSR&D) Program and Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
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Magee MF, Tamis-Holland JE, Lu J, Bittner VA, Brooks MM, Lopes N, Jacobs AK, Study Group BARI2D. Sex, Prescribing Practices and Guideline Recommended, Blood Pressure, and LDL Cholesterol Targets at Baseline in the BARI 2D Trial. Int J Endocrinol 2015; 2015:610239. [PMID: 25873955 PMCID: PMC4383496 DOI: 10.1155/2015/610239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/15/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men. Methods. We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial. Results. Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex. Conclusions. Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.
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Affiliation(s)
- Michelle F. Magee
- MedStar Health Research Institute at Washington Hospital Center and Georgetown University School of Medicine, MedStar Diabetes Institute, 100 Irving Street NW, No. 4114, Washington, DC 20010, USA
- *Michelle F. Magee:
| | | | - Jiang Lu
- University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Vera A. Bittner
- University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Neuza Lopes
- Heart Institute (InCor), 01238-000 São Paulo, SP, Brazil
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Billimek J, Malik S, Sorkin DH, Schmalbach P, Ngo-Metzger Q, Greenfield S, Kaplan SH. Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence after treatment intensification. Womens Health Issues 2015; 25:6-12. [PMID: 25442365 PMCID: PMC4275363 DOI: 10.1016/j.whi.2014.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity. METHODS Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol. FINDINGS Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048). CONCLUSIONS Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
| | - Shaista Malik
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Dara H Sorkin
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Priel Schmalbach
- School of Social Ecology, University of California, Irvine, California; School of Medicine, University of California, Irvine, California
| | - Quyen Ngo-Metzger
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sheldon Greenfield
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sherrie H Kaplan
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
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Bielawski MP, Goldstein KM, Mattocks KM, Bean-Mayberry B, Yano EM, Bastian LA. Improving care of chronic conditions for women veterans: identifying opportunities for comparative effectiveness research. J Comp Eff Res 2014; 3:155-66. [PMID: 24645689 DOI: 10.2217/cer.14.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This article aims to critically analyze research focused on the findings for five chronic conditions: chronic pain, diabetes, cardiovascular disease, HIV and cancer among women veterans to identify opportunities for comparative effectiveness research. We provide a descriptive analysis from the relevant articles in prior systematic reviews. In order to identify potential gaps in research for these specific conditions, we also conducted a literature search to highlight studies focusing on women veterans published since the last systematic review. While the scientific knowledge base has grown for these chronic conditions among women veterans, the vast majority of the published literature remains descriptive and/or observational, with only a few studies examining gender differences and even fewer clinical trials. There is a need to conduct comparative effectiveness research on chronic conditions among women veterans to improve health and healthcare.
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Affiliation(s)
- Mark P Bielawski
- Center of Excellence, VA Connecticut Healthcare System, Newington, CT, USA
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Rojo-Martínez G, Valdés S, Colomo N, Lucena MI, Gaztambide S, Gomis R, Casamitjana R, Carmena R, Catalá M, Martínez-Larrad MT, Serrano-Ríos M, Castaño L, Vendrell J, Girbés J, Franch J, Vázquez JA, Mora-Peces I, Urrutia I, Pascual-Manich G, Ortega E, Menéndez E, Delgado E, Bordiú E, Castell C, López-Alba A, Goday A, Calle A, Bosch-Comas A, Soriguer F. Use of drugs related to the treatment of diabetes mellitus and other cardiovascular risk factors in the Spanish population. The Di@bet.es study. ACTA ACUST UNITED AC 2014; 66:854-63. [PMID: 24773992 DOI: 10.1016/j.rec.2013.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/31/2013] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES To assess the patterns of use of 8 therapeutic drug groups for the treatment of diabetes mellitus and other cardiovascular risk factors, and to identify sociodemographic and health determinants of their use in the overall Spanish population. METHODS A representative sample of the Spanish population within the Di@bet.es study, a cross-sectional population-based survey, was included. STUDY VARIABLES sociodemographic, clinical, and lifestyle data; physical examination, and an oral glucose tolerance test in patients without known diabetes mellitus. Furthermore, patients were systematically queried about current medication use, and 8 pharmacotherapeutic groups were evaluated: lipid-lowering therapy, antihypertensives, oral hypoglycemic agents, insulin, thyroid hormone, uricosurics, psychoactive drugs, and nonsteroidal anti-inflammatory drugs. RESULTS Sixty-six percent of the Spanish population was taking at least one medication. Therapeutic drug use was associated with age, independently of the higher prevalence of diabetes mellitus, hypertension, or hyperlipidemia in older patients. Sex disparities were found in the use of lipid-lowering agents, allopurinol, levothyroxine, nonsteroidal anti-inflammatory drugs, and psychoactive drugs. Use of psychoactive drugs was related to education level, work status, physical activity, smoking, and alcohol consumption. Almost 30% of patients with diabetes mellitus were taking 6 or more medications daily. Diabetes mellitus was associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. CONCLUSIONS Age and sex are the most important factors determining therapeutic drug use. Lifestyle patterns and sociocultural factors have an impact only on psychoactive drug use. Diabetes mellitus is associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Gemma Rojo-Martínez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Sergio Valdés
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Natalia Colomo
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - M Isabel Lucena
- Departamento de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Sonia Gaztambide
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Grupo de Investigación de Diabetes, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Vizcaya, Spain
| | - Ramón Gomis
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Unidad de Endocrinología y Diabetes, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Roser Casamitjana
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Centro de Diagnóstico Biomédico, Hospital Clínic, Barcelona, Spain
| | - Rafael Carmena
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Departamento de Medicina y Endocrinología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Miguel Catalá
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Departamento de Medicina y Endocrinología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María T Martínez-Larrad
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Serrano-Ríos
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Castaño
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Grupo de Investigación de Diabetes, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Vizcaya, Spain
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Joan XXIII, Institut d'Investigacions Sanitàries Pere Virgili, Tarragona, Spain
| | - Juan Girbés
- Unidad de Diabetes, Hospital Arnau de Vilanova, Valencia, Spain
| | - Josep Franch
- EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, Atención Primaria, Unitat de Suport a la Recerca (IDIAP-Fundació Jordi Gol), Barcelona, Spain
| | - José A Vázquez
- Plan Nacional de Diabetes, Ministerio de Sanidad, Madrid, Spain
| | | | - Inés Urrutia
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Grupo de Investigación de Diabetes, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Vizcaya, Spain
| | - Gemma Pascual-Manich
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Emilio Ortega
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Unidad de Endocrinología y Diabetes, Hospital Clínic, Barcelona, Spain
| | - Edelmiro Menéndez
- Departamento de Medicina-Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Elias Delgado
- Departamento de Medicina-Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Elena Bordiú
- Laboratorio de Endocrinología, Hospital Universitario San Carlos, Madrid, Spain
| | - Conxa Castell
- Departament de Salut Pública, Conselleria de Sanitat, Generalitat de Catalunya, Barcelona, Spain
| | | | - Alberto Goday
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
| | - Alfonso Calle
- Servicio de Endocrinología y Nutrición, Hospital Universitario San Carlos, Madrid, Spain
| | - Anna Bosch-Comas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Federico Soriguer
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.
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Abstract
Gender-based discrimination is reported across the spectrum of paediatric healthcare including emergency, inpatient, outpatient and preventive care and is mostly reported from South Asia and China with sporadic reports from Africa and South America. Biases against young girls have been documented even in immunisation percentage, home food allocation, seeking medical care for childhood ailments and percentage of household healthcare expenditures allocated to them. Such gender discrimination in access to medical care is likely to have an influence on the overall health of female children. Over the last five decades, the under-5 sex ratios are worsening in India with declining number of girls. Deliberate parental neglect of girls' essential and life-saving medical care is also an important contributing factor apart from sex-selective abortions to the declining gender ratios. Corrective measures and focused action are needed.
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Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, , Iowa City, USA
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Rojo-Martínez G, Valdés S, Colomo N, Lucena MI, Gaztambide S, Gomis R, Casamitjana R, Carmena R, Catalá M, Martínez-Larrad MT, Serrano-Ríos M, Castaño L, Vendrell J, Girbés J, Franch J, Vázquez JA, Mora-Peces I, Urrutia I, Pascual-Manich G, Ortega E, Menéndez E, Delgado E, Bordiú E, Castell C, López-Alba A, Goday A, Calle A, Bosch-Comas A, Soriguer F. Consumo de fármacos relacionados con el tratamiento de la diabetes mellitus y otros factores de riesgo cardiovascular en la población española. Estudio Di@bet.es. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Rossi MC, Cristofaro MR, Gentile S, Lucisano G, Manicardi V, Mulas MF, Napoli A, Nicolucci A, Pellegrini F, Suraci C, Giorda C. Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative. Diabetes Care 2013; 36:3162-8. [PMID: 23835692 PMCID: PMC3781503 DOI: 10.2337/dc13-0184] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the quality of type 2 diabetes care according to sex. RESEARCH DESIGN AND METHODS Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated. RESULTS Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c>9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10-1.17]), 42% more likely to have LDL cholesterol (LDL-C)≥130 mg/dL (1.42 [1.38-1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI≥30 kg/m2 (1.50 [1.50-1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure. CONCLUSIONS Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.
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Clinical and economic burden of emergency department visits due to gastrointestinal diseases in the United States. Am J Gastroenterol 2013; 108:1496-507. [PMID: 23857475 DOI: 10.1038/ajg.2013.199] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/28/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) emergencies may cause substantial morbidity. Our aims were to characterize the national clinical and economic burden of GI visits to emergency departments (EDs) in the United States. METHODS We performed an observational cross-sectional study using the 2007 Nationwide Emergency Department Sample, the largest US all-payer ED database, to identify the leading causes for ED visits due to GI diseases and their associated charges, stratified by age and sex. Logistic regression was used to analyze predictors of hospitalization after an ED visit. RESULTS Of the 122 million ED visits in 2007, 15 million (12%) had a primary GI diagnosis. The leading primary GI diagnoses were abdominal pain (4.7 million visits), nausea and vomiting (1.6 million visits), and functional disorders of the digestive system (0.7 million visits). The leading diagnoses differed by age group. The fraction of ED visits resulting in hospitalization was 21.6% for primary GI diagnoses vs. 14.7% for non-GI visits. Women had more ED visits with a primary GI diagnosis than men (58.5 (95% CI 56.0-60.9) vs. 41.6 (95% CI 39.8-43.3) per 1000 persons), but lower rates of subsequent hospitalization (20.0% (95% CI 19.4-20.7%) vs. 24.0% (95% CI 23.3-24.6%)). There were no differences in hospitalization rates between sexes after adjustment by age, primary GI diagnosis, and Charlson Comorbidity Score. The total charges for ED visits with a primary GI diagnosis in 2007 were $27.9 billion. CONCLUSIONS GI illnesses account for substantial clinical and economic burdens on US emergency medical services.
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Rose DE, Farmer MM, Yano EM, Washington DL. Racial/ethnic differences in cardiovascular risk factors among women veterans. J Gen Intern Med 2013; 28 Suppl 2:S524-8. [PMID: 23807060 PMCID: PMC3695277 DOI: 10.1007/s11606-012-2309-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart disease is the leading cause of death for women in the United States, accounting for 24.5 % of all deaths among women. Earlier research has demonstrated racial/ethnic differences in prevalence of cardiovascular (CVD) risk factors. OBJECTIVE To empirically examine the prevalence of CVD risk factors among a national sample of women Veterans by race/ethnicity, providing the first portrait of women Veterans' cardiovascular care needs. DESIGN AND PARTICIPANTS Cross-sectional, national population-based telephone survey of 3,611 women Veterans. MEASUREMENTS Women Veterans were queried about presence of diabetes, hypertension, obesity, tobacco use and physical activity. Four racial/ethnic categories were created: Hispanic, Non-Hispanic White (White), Non-Hispanic Black (Black), and Other. Logistic regressions were conducted for each risk factor to test for racial/ethnic differences, controlling for age (under 40 vs. 40 and over). KEY RESULTS Racial/ethnic differences in CVD risk factors persisted after adjusting for age. Black women Veterans were more likely to report a diagnosis of diabetes (OR: 2.58, 95 % CI: 1.07, 6.21) or hypertension (OR: 2.31, 95 % CI: 1.10, 4.83) and be obese (OR: 2.06, 95 % CI: 1.05, 3.91) than White women Veterans. Hispanic women Veterans were more likely than White women Veterans to report diabetes (OR: 4.20, 95 % CI: 1.15, 15.39) and daily smoking (OR: 3.38, 95 % CI: 1.01, 11.30), but less likely to report a hypertension diagnosis (OR 0.21, 95% CI: 0.07, 0.64) or to be obese (OR: 0.39, 95 % CI: 0.18, 0.81). CONCLUSIONS Among women Veterans, CVD risks vary by race/ethnicity. Black women Veterans consistently face higher CVD risk compared to White women Veterans, while results are mixed for Hispanic women Veterans.
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Affiliation(s)
- Danielle E Rose
- VA Health Services Research and Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, Los Angeles, CA, USA.
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Accounting for clinical action reduces estimates of gender disparities in lipid management for diabetic veterans. J Gen Intern Med 2013; 28 Suppl 2:S529-35. [PMID: 23807061 PMCID: PMC3695267 DOI: 10.1007/s11606-013-2340-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women with diabetes have higher low-density lipoprotein (LDL) levels than men, resulting in apparent disparities between genders on quality indicators tied to LDL thresholds. OBJECTIVE To investigate whether gender disparities persist when accounting for clinical action with statins or cardiovascular risk. DESIGN Retrospective cohort study. PARTICIPANTS Veterans Health Administration patients (21,780 women and 646,429 men) aged 50-75 with diabetes. MAIN MEASURES Threshold measure: LDL < 100 mg/dL; clinical action measure: LDL < 100 mg/dL; or LDL ≥ 100 mg/dL and the patient was prescribed a moderate or high-dose statin at the time of the test; or LDL ≥ 100 mg/dL and the patient received other appropriate clinical action within 90 days; adherence: continuous multiple interval measure of gaps in dispensed medication (CMG). KEY RESULTS Women were much less likely to have LDL < 100 mg/dL than were men (55 % vs. 68 %). This disparity narrowed from 13 % to 6 % for passing the clinical action measure (79 % vs. 85 %). These gender differences persisted among those with ischemic heart disease (IHD). Women had a lower odds of passing the clinical action measure (odds ratio 0.68, 95 % confidence interval 0.66-0.71). Among those with IHD, the gender gap increased with age. Differences in pass rates were explained by women's higher LDL levels, but not by their slightly worse adherence (3 % higher CMG). CONCLUSIONS Women and men veterans receive more similar quality of care for lipids in diabetes than previously indicated. Less reassuringly, the remaining gender differences appear to be as common in women at high cardiovascular risk as in those at low risk. Rather than focus on simply improving LDL levels in all women with diabetes, future efforts should ensure that patients with high cardiovascular risk are appropriately treated with statins when clinically indicated, feasible, and concordant with patient preferences.
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Bhattacharjee S, Findley PA, Sambamoorthi U. Understanding Gender Differences in Statin Use among Elderly Medicare Beneficiaries. Drugs Aging 2012; 29:971-80. [DOI: 10.1007/s40266-012-0032-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chang YH, Chen RCY, Lee MS, Wahlqvist ML. Increased medical costs in elders with the metabolic syndrome are most evident with hospitalization of men. GENDER MEDICINE 2012; 9:348-360. [PMID: 23000153 DOI: 10.1016/j.genm.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Little is known about health care costs associated with the metabolic syndrome (MetS). OBJECTIVE We assessed annualized health care costs and health outcomes for both genders in different health care settings among representative Taiwanese elders. METHODS The Nutrition and Health Survey in Taiwan (1999-2000) provided 1378 individuals aged 65 years or older with known MetS status. Nutrition and Health Survey in Taiwan files were linked to National Health Insurance records (1999-2006). Student t tests and multiple regression models were used to assess expenditures in total and in 6 services: inpatient, ambulatory care, dental care, traditional Chinese medicine, emergency care, and contracted pharmacy. The Cox model was used to assess gender effect on all-cause mortality and cardiovascular disease mortality, whereas logistic regression was used for that on cardiovascular disease hospitalization. The 5 MetS component costs were evaluated by multiple regressions. RESULTS MetS affected 29% of men and 48% of women. After full adjustment, those with MetS had 1.30 (95% CI, 1.11-1.52), men had 1.43 (95% CI, 1.20-1.70), and women had 1.19 (95% CI, 0.93-1.52) times higher costs than those without MetS. Compared with no MetS, MetS costs were increased 2.94-fold for inpatient care (95% CI, 1.23-7.10) and 1.30-fold for ambulatory care for men (95% CI, 1.12-1.52), whereas ambulatory MetS costs were increased 1.28-fold for women (95% CI, 1.05-1.57). MetS was associated with higher risk of cardiovascular disease hospitalization in men (adjusted odds ratio, 1.76; 95% CI, 1.20-2.58) but not in women (adjusted odds ratio, 1.08; 95% CI, 0.67-1.75). Among those with MetS, all-cause and cardiovascular mortality were comparable between men and women. Of the MetS components, low HDL cholesterol had the greatest affect on costs, more so in men (2.23-fold) than women (1.58-fold). CONCLUSIONS In people with MetS, service costs were greater overall, significantly for men, but not women, and these increased costs were evident for men who experienced hospitalization, but not women. At the same time, cardiovascular and all-cause mortalities were not significantly different by gender in regard to MetS in Taiwanese elders.
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Affiliation(s)
- Yu-Hung Chang
- Division of Health Policy Translation, National Health Research Institutes, Miaoli County, Taiwan, Republic of China
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