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García-Villarino M, Lambert C, De la Hera JM, Torre ELM, Rodríguez-Lacín JMF, Delgado-Álvarez E. Use of electronic health records for the management of diabetes and its risk factors in the Principality of Asturias from 2014 to 2018. ENDOCRINOL DIAB NUTR 2024; 71:208-215. [PMID: 38897704 DOI: 10.1016/j.endien.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND In recent years, the implementation of electronic health records across all hospitals and primary care centres within the National Health System has significantly enhanced access to patients' clinical data. This study aims to estimate the prevalence of type 2 diabetes (T2DM) in primary care settings and to outline its associated cardiovascular risk factors (CVRF) and epidemiological characteristics. METHODS An observational cross-sectional study was conducted including 89,679 patients diagnosed with T2DM who attended the primary health care system from 2014 to 2018. Data was provided by the Primary Health Care System of the Principality of Asturias (SESPA). RESULTS The estimated prevalence of diagnosed T2DM was 8.01% (95% Confidence Interval [CI]: 7.96-8.06) of the total population. Additionally, it was more prevalent in males compared to females (9.90% [95% CI: 9.81-9.99] vs. 6.50% [95% CI: 6.44-6.57]) and increased with age in both sexes. People with T2DM had an average age of 74 years, 52.3% were male, and the most frequently associated CVRF were: dyslipidaemia (47.90%) and hypertension (62.20%). Glycaemic control improved during the 2014-2018 period (31.69%), as did lipid control (23.66%). However, the improvement in blood pressure control (9.34%) was less pronounced for the same period. Regarding the multifactorial control of diabetes (measured by LDL-cholesterol, HbA1C and blood pressure) the overall degree of control improved by 11.55% between 2014 and 2018. CONCLUSION In this 5-year retrospective population-based study, the utilisation of data from electronic medical records provides insights into the prevalence of T2DM in a large population, as well as real-time CVRFs. Leveraging this data facilitates the development of targeted health policies.
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Affiliation(s)
- Miguel García-Villarino
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain.
| | - Carmen Lambert
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain
| | - Jesús M De la Hera
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Luis Menéndez Torre
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José María Fernández Rodríguez-Lacín
- Grupo de Cronicidad, Envejecimiento, Fragilidad y Continuidad Asistencial, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elías Delgado-Álvarez
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
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Kezios KL, Zimmerman SC, Zhang A, Calonico S, Jawadekar N, Glymour MM, Zeki Al Hazzouri A. Propensity Scores in Health Disparities Research: The Example of Cognitive Aging and the Hispanic Paradox. Epidemiology 2023; 34:495-504. [PMID: 36976729 PMCID: PMC11304344 DOI: 10.1097/ede.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups. METHODS We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994-2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting. RESULTS In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions. CONCLUSIONS Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study.
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Affiliation(s)
- Katrina L Kezios
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Scott C Zimmerman
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA
| | - Adina Zhang
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Sebastian Calonico
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | - Neal Jawadekar
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA
| | - Adina Zeki Al Hazzouri
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Walker BS, Waitzman NJ. The Fading of Protective Roots: A Multivariate Analysis of the Risk of Hypertension among Hispanics by Nativity. J Aging Health 2023:8982643221149810. [PMID: 36606346 DOI: 10.1177/08982643221149810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the effects of Hispanic nativity on the risk and severity of hypertension relative to US-born non-Hispanic whites. METHODS The analytic sample (n = 34,007) was comprised of cross-sectional data drawn from twenty years of the National Health and Nutrition Examination Survey, 1999-2018. RESULTS Foreign-born Hispanics aged 65 years and older had a greater risk of severe hypertension compared to non-Hispanic Whites. When examined by length of residency in the US, elderly foreign-born Hispanics with less than 10 years of residency were at greater risk of hypertension and severe hypertension, while those with 20 or more years of residency had similar risks compared to non-Hispanic Whites. CONCLUSION The "Hispanic Paradox" of better health despite lower socioeconomic status, was not observed in foreign-born or US-born Hispanics aged 65 years and older. Among elderly immigrants, those with fewer years of residency had the greatest hypertensive risk.
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Affiliation(s)
- Brandon S Walker
- Department of Population Health Sciences, 14434University of Utah, Salt Lake City, UT, USA
| | - Norman J Waitzman
- Department of Economics, 14434University of Utah, Salt Lake City, UT, USA
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Álvarez-Aguilar C, González-Palomo E, Bertadillo-Mendoza OM, Figueroa-Suárez ME, Vargas-Hernández F, Herrera-Olvera IG, Cruz-Toledo JE, Cruz-Arce MA, Serafín-Méndez B, Muñoz-Cortés G, Morfin-Macias CJ. Prevalence and characterization of undiagnosed arterial hypertension in the eastern zone of Mexico. J Clin Hypertens (Greenwich) 2021; 24:131-139. [PMID: 34962058 PMCID: PMC8845470 DOI: 10.1111/jch.14414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
Arterial hypertension is considered a public health problem with severe consequences at an individual and public health levels. However, there is a lack of information regarding its characterization in Mexico. The objective of this study is to estimate the proportion of undiagnosed arterial hypertension (UAH) and the overall prevalence and clinical management of arterial hypertension within the Eastern Zone of Mexico. Additionally, we explore associated factors related with both UAH and uncontrolled arterial hypertension. We obtained information from the May Measure Month (MMM) 2019 study. People were asked for cardiovascular risk factors and blood pressure was measured according to the protocols of the European Society of Hypertension (ESH). Data from 5901 subjects were extracted: 76.04% from the Eastern Zone of the State of Mexico. The overall prevalence of hypertension was 32.4% (95% CI 31.2-33.6). From all subjects living with hypertension, 28.3% had UAH, 22.1% had previous diagnosis but were untreated; 29.3% were treated but had uncontrolled hypertension. Younger men adults living in the State of Michoacán had increased proportion of UAH and untreated hypertension. We observed that male sex, age, obesity, living at Michoacán were risk factors for UAH. Finally, male sex, diabetes, and living at Michoacán were related risk conditions for having uncontrolled arterial hypertension. In summary, there is a high proportion of UAH in Easter Zone of Mexico. Younger adults had higher proportion of UAH and untreated hypertension profiles. Efficient actions are required to make a timely diagnosis in the young adult population to prevent long-term complications.
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Affiliation(s)
- Silvia Palomo-Piñón
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México.,Programa de Posgrado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Estado de México Oriente, México
| | - Cleto Álvarez-Aguilar
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Morelia, Michoacán, México
| | | | | | - María Eugenia Figueroa-Suárez
- Coordinación Clínica de Educación e Investigación en Salud (CCEIS), Unidad de Medicina Familiar (UMF) No. 52, IMSS, Estado de México Oriente, México
| | | | | | | | - Maria Adriana Cruz-Arce
- CCEIS, Unidad Médica de Atención Ambulatoria con UMF No. 198, IMSS, Estado de México Oriente, México
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Murchland AR, Zeki Al Hazzouri A, Zhang L, Elfassy T, Grasset L, Riley AR, Wong R, Haan MN, Jones RN, Torres JM, Glymour MM. Estimating the effects of Mexico to U.S. migration on elevated depressive symptoms: evidence from pooled cross-national cohorts. Ann Epidemiol 2021; 64:53-66. [PMID: 34438024 PMCID: PMC11429580 DOI: 10.1016/j.annepidem.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/16/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health. METHODS We pooled data from the Mexican Health and Aging Study (N = 17,771) and Mexican-born U.S. Health and Retirement Study (N = 898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration. RESULTS Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count = 1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood. CONCLUSIONS In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms.
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Affiliation(s)
- Audrey R Murchland
- Department of Epidemiology and Biostatistics, University of California, Los Angeles, CA; Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Harvard University, Cambridge, MA.
| | - A Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lanyu Zhang
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, MIA
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, MIA
| | - Leslie Grasset
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inserm, CIC1401-EC, F-33000 Bordeaux, France
| | - Alicia R Riley
- Department of Epidemiology and Biostatistics, University of California, Los Angeles, CA
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Mary N Haan
- Department of Epidemiology and Biostatistics, University of California, Los Angeles, CA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI; Department of Neurology, Alpert Medical School, Brown University, Providence, RI
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, Los Angeles, CA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, Los Angeles, CA
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Al Hazzouri AZ, Zhang L, Murchland AR, Grasset L, Torres JM, Jones RN, Wong R, Glymour MM. Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States. Epidemiology 2021; 32:50-60. [PMID: 33009250 PMCID: PMC7708448 DOI: 10.1097/ede.0000000000001266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health. METHODS We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW. RESULTS Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models. CONCLUSIONS Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.
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Affiliation(s)
| | - Lanyu Zhang
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami
| | - Audrey R. Murchland
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Leslie Grasset
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France, Inserm, CIC1401-EC, F-33000 Bordeaux, France
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Rhode Island
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Hunter LM, Simon DH. Might Climate Change the "Healthy Migrant" Effect? GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2017; 47:133-142. [PMID: 29430082 PMCID: PMC5802421 DOI: 10.1016/j.gloenvcha.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lori M Hunter
- University of Colorado Boulder, Institute of Behavioral Science, CU Population Center, Department of Sociology, Campus Box UCB 483, Boulder, CO 80309
| | - Daniel H Simon
- University of Colorado Boulder, Institute of Behavioral Science, CU Population Center, Department of Sociology, Campus Box UCB 483, Boulder, CO 80309
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Beltrán-Sánchez H, Palloni A, Riosmena F, Wong R. SES Gradients Among Mexicans in the United States and in Mexico: A New Twist to the Hispanic Paradox? Demography 2017; 53:1555-1581. [PMID: 27655408 DOI: 10.1007/s13524-016-0508-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent empirical findings have suggested the existence of a twist in the Hispanic paradox, in which Mexican and other Hispanic foreign-born migrants living in the United States experience shallower socioeconomic status (SES) health disparities than those in the U.S. POPULATION In this article, we seek to replicate this finding and test conjectures that could explain this new observed phenomenon using objective indicators of adult health by educational attainment in several groups: (1) Mexican-born individuals living in Mexico and in the United States, (2) U.S.-born Mexican Americans, and (3) non-Hispanic American whites. Our analytical strategy improves upon previous research on three fronts. First, we derive four hypotheses from a general framework that has also been used to explain the standard Hispanic paradox. Second, we study biomarkers rather than self-reported health and related conditions. Third, we use a binational data platform that includes both Mexicans living in Mexico (Mexican National Health and Nutrition Survey 2006) and Mexican migrants to the United States (NHANES 1999-2010). We find steep education gradients among Mexicans living in Mexico's urban areas in five of six biomarkers of metabolic syndrome (MetS) and in the overall MetS score. Mexican migrants living in the United States experience similar patterns to Mexicans living in Mexico in glucose and obesity biomarkers. These results are inconsistent with previous findings, suggesting that Mexican migrants in the United States experience significantly attenuated health gradients relative to the non-Hispanic white U.S. POPULATION Our empirical evidence also contradicts the idea that SES-health gradients in Mexico are shallower than those in the United States and could be invoked to explain shallower gradients among Mexicans living in the United States.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Department of Community Health Sciences, Fielding School of Public Health, California Center for Population Research, University of California, Los Angeles, 650 Charles E. Young Drive South, Room 41-257 CHS, Los Angeles, CA, 90095-1772, USA.
| | - Alberto Palloni
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Fernando Riosmena
- Population Program, Institute of Behavioral Science and Geography Department, University of Colorado at Boulder, Boulder, CO, USA
| | - Rebeca Wong
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Handley MA, Sudhinaraset M. The Important Role of Binational Studies for Migration and Health Research: A Review of US-Mexico Binational Studies and Design Considerations for Addressing Critical Issues in Migrant Health. INTERNATIONAL MIGRATION 2017. [DOI: 10.1111/imig.12306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giuntella O. Why does the health of Mexican immigrants deteriorate? New evidence from linked birth records. JOURNAL OF HEALTH ECONOMICS 2017; 54:1-16. [PMID: 28349864 DOI: 10.1016/j.jhealeco.2017.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/01/2017] [Accepted: 03/08/2017] [Indexed: 06/06/2023]
Abstract
This study uses a unique dataset linking the birth records of two generations of children born in California and Florida (1970-2009) to analyze the mechanisms behind the generational decline observed in birth outcomes of children of Mexican origin. Calibrating a simple model of intergenerational transmission of birth weight, I show that modest positive selection on health at the time of migration can account for the initial advantage in birth outcomes of second-generation Mexicans. Moreover, accounting for the socioeconomic differences between second-generation Mexicans and white natives and the observed intergenerational correlation in birth weight, the model predicts a greater deterioration than that observed in the data. Using a subset of siblings and holding constant grandmother quasi-fixed effects, I show that the persistence of healthier behaviors among second-generation Mexican mothers can explain more than half of the difference between the model prediction and the observed birth outcomes of third-generation Mexicans.
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Bacon E, Riosmena F, Rogers RG. Does the Hispanic health advantage extend to better management of hypertension? The role of socioeconomic status, sociobehavioral factors, and health care access. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2017; 63:262-277. [PMID: 29035106 PMCID: PMC5864248 DOI: 10.1080/19485565.2017.1353407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hispanics in the United States (and foreign-born Hispanics in particular) have relatively favorable health given their lower socioeconomic status compared to, for example, non-Hispanic whites. This phenomenon is often called the Hispanic health paradox (HHP). This study examines whether the previously documented HHP in hypertension prevalence extends to its management using clinical and self-reported measures from the 2007-2012 National Health and Nutrition Examination Surveys. Multivariate models adjusting for demographic, socioeconomic, and sociobehavioral characteristics show an advantage among foreign-born Mexicans in hypertension prevalence relative to non-Hispanic whites (adjusted OR = 0.85). However, compared to non-Hispanic whites, foreign-born Mexicans were 38% less likely to receive treatment recommendations and, when advised to undergo treatment, were 60% less likely to adhere to treatment. Adjusting for health care access and utilization dramatically reduces disparities in hypertension control between foreign-born Mexicans and non-Hispanic whites, suggesting that insufficient systematic access to and use of quality health care erodes the HHP and contributes to the deterioration of health throughout the immigrant experience. Without appropriate interventions, particularly in health care access and utilization, poorer hypertension management among foreign-born Mexicans may negatively affect the Hispanic health profile, increase risk of cardiovascular disease-related mortality, and erode the Hispanic health advantage in the future.
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Affiliation(s)
- Emily Bacon
- a Department of Sociology and Population Program , Institute of Behavioral Science, University of Colorado Boulder , Boulder , Colorado , USA
| | - Fernando Riosmena
- b Department of Geography and Population Program , Institute of Behavioral Science, University of Colorado Boulder , Boulder , Colorado , USA
| | - Richard G Rogers
- a Department of Sociology and Population Program , Institute of Behavioral Science, University of Colorado Boulder , Boulder , Colorado , USA
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Abstract
We use data from three rounds of the Mexican Family Life Survey to examine whether migrants in the United States returning to Mexico in the period 2005-2012 have worse health than those remaining in the United States. Despite extensive interest by demographers in health-related selection, this has been a neglected area of study in the literature on U.S.-Mexico migration, and the few results to date have been contradictory and inconclusive. Using five self-reported health variables collected while migrants resided in the United States and subsequent migration history, we find direct evidence of higher probabilities of return migration for Mexican migrants in poor health as well as lower probabilities of return for migrants with improving health. These findings are robust to the inclusion of potential confounders reflecting the migrants' demographic characteristics, economic situation, family ties, and origin and destination characteristics. We anticipate that in the coming decade, health may become an even more salient issue in migrants' decisions about returning to Mexico, given the recent expansion in access to health insurance in Mexico.
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Galvez-Olortegui JK, Condor-Rojas Y, Galvez-Olortegui TV, Camacho-Saavedra L. [SPRINT on clinical practice: It's time to change the management of arterial hypertension in Latin America?]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:367-373. [PMID: 27460521 DOI: 10.1016/j.acmx.2016.06.004] [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: 01/14/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 11/30/2022] Open
Abstract
This paper analyzes the feasibility of the implementation of SPRINT trial results, the need to rethink the clinical practice guidelines(CPG) for the management of arterial hypertension and associated costs with daily practice applicability. SPRINT is a clinical trial comparing systolic blood pressure control <120mmHg and <140mmHg over cardiovascular complications, generating a great worldwide impact followed by publication of several studies that addressed relevance, usefulness, applicability and controversial aspects of SPRINT from different perspectives. Achieving blood pressure goals is one of the most discussed issue in widely used hypertension CPG around the world and in Latin American. SPRINT has generated and will generate a great impact on CPG, being necessary the reassessment of blood pressure goals and inclusion in future CPG, as has been considered in 2016 Canadian guideline and will be considered in NICE guideline update scheduled for June. The SPRINT trial raises new evidence for the management of hypertension, useful in people over 50 years, from urban populations, with defined cardiovascular risk without associated comorbidities. The applicability of SPRINT in Latin America is limited by increased costs associated with hypertensive patients' integrated health care, low care coverage, and lack of integrated care programs.
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Affiliation(s)
- José Kelvin Galvez-Olortegui
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Centro Médico - 32.° Brigada de Infantería-Ejército del Perú, Trujillo, Perú; Guidelines International Network (G-I-N), Escocia; Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú.
| | - Yudy Condor-Rojas
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Tomas Vladimir Galvez-Olortegui
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú
| | - Luis Camacho-Saavedra
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Servicio de Medicina Interna, Hospital I «Florencia de Mora», Trujillo, Perú
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14
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Fox M, Entringer S, Buss C, DeHaene J, Wadhwa PD. Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective. Am J Public Health 2015; 105 Suppl 3:S409-23. [PMID: 25905831 PMCID: PMC4455494 DOI: 10.2105/ajph.2015.302571] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/04/2022]
Abstract
We propose a transdisciplinary, life span framework for examining the underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation-related processes in first-generation Hispanic immigrant mothers may affect the intrauterine development of an unborn child, via the process of fetal programming, to produce phenotypic effects that may alter the susceptibility for noncommunicable chronic diseases. In this manner, an intergenerational cascade of perpetuation may become established. Our framework may shed light on the biological, behavioral, and social causes of intergenerational cycles of vulnerability among immigrant minority groups, with public health and policy implications for primary prevention and intervention.
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Affiliation(s)
- Molly Fox
- Molly Fox is with the Early Human and Lifespan Development Program and the Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine. Sonja Entringer and Claudia Buss are with the UCI Development, Health, and Disease Research Program, School of Medicine, University of California, Irvine, and the Department of Medical Psychology, Charité Universitätsmedizin, Berlin, Germany. Jessica DeHaene and Pathik D. Wadhwa are with the UCI Development, Health, and Disease Research Program, School of Medicine, University of California, Irvine
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15
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Abstract
Hispanics are the largest and fastest-growing minority population in the United States, currently comprising about 16.3% (52 million) of the total population. With an increased prevalence of metabolic risk factors in this population, the rate of uncontrolled hypertension (HTN) in Hispanics significantly exceeds the rates observed among non-Hispanic blacks and whites. Unfortunately, data on HTN in Hispanics remains limited due to the under-representation of Hispanics in clinical trials; with most of the data primarily restricted to observational and retrospective subgroup analyses. This article aims to review the available data on prevalence, awareness and control of HTN, risk factors and some of the challenges unique to the Hispanics population. We also discuss treatment strategies derived from large HTN trials that included Hispanics.
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16
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Goldman N, Pebley AR, Creighton MJ, Teruel GM, Rubalcava LN, Chung C. The consequences of migration to the United States for short-term changes in the health of Mexican immigrants. Demography 2014; 51:1159-73. [PMID: 24788391 PMCID: PMC4165490 DOI: 10.1007/s13524-014-0304-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Although many studies have attempted to examine the consequences of Mexico-U.S. migration for Mexican immigrants' health, few have had adequate data to generate the appropriate comparisons. In this article, we use data from two waves of the Mexican Family Life Survey (MxFLS) to compare the health of current migrants from Mexico with those of earlier migrants and nonmigrants. Because the longitudinal data permit us to examine short-term changes in health status subsequent to the baseline survey for current migrants and for Mexican residents, as well as to control for the potential health selectivity of migrants, the results provide a clearer picture of the consequences of immigration for Mexican migrant health than have previous studies. Our findings demonstrate that current migrants are more likely to experience recent changes in health status-both improvements and declines-than either earlier migrants or nonmigrants. The net effect, however, is a decline in health for current migrants: compared with never migrants, the health of current migrants is much more likely to have declined in the year or two since migration and not significantly more likely to have improved. Thus, it appears that the migration process itself and/or the experiences of the immediate post-migration period detrimentally affect Mexican immigrants' health.
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Affiliation(s)
- Noreen Goldman
- Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ, 08544, USA,
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17
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Zallman L, Himmelstein DH, Woolhandler S, Bor DH, Ayanian JZ, Wilper AP, McCormick D. Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US. J Immigr Minor Health 2014; 15:858-65. [PMID: 22915055 DOI: 10.1007/s10903-012-9695-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cardiovascular disease is a major cause of mortality and disability. We analyzed the National Health and Nutrition Examination Survey (1998-2008). We used logistic regression analysis to compare the odds of having undiagnosed and uncontrolled hypertension and hyperlipidemia among FB and US born adults sequentially adjusting for (1) age and gender, (2) income and education, and (3) insurance status. Among FB individuals, we identified factors independently associated with having each outcome using logistic regression analyses. Of 27,596 US adults, 22.6 % were foreign-born. In age- and -gender adjusted analyses, FB were more likely to have undiagnosed hypertension (OR 1.35, 95 % CI 1.13-1.63, p < 0.001), uncontrolled hypertension (OR 1.37, 95 % CI 1.15-1.64, p < 0.001), and uncontrolled hyperlipidemia (OR 1.35, 95 % CI 1.11-1.63, p = 0.002), while undiagnosed hyperlipidemia approached significance (OR 1.24, 95 % CI 0.99-1.56, p = 0.057). Having insurance was associated with a 5-15 % decrease in FB-US born disparities. Immigrants are at increased risk of undiagnosed and uncontrolled hypertension and hyperlipidemia.
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Affiliation(s)
- Leah Zallman
- Department of Medicine, Cambridge Health Alliance, and Harvard Medical School, Cambridge, MA 02139, USA.
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18
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The effect of migration on hypertension and other cardiovascular risk factors: A review. ACTA ACUST UNITED AC 2014; 8:171-91. [DOI: 10.1016/j.jash.2013.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/27/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
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Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes Metab Syndr Obes 2013; 6:327-38. [PMID: 24082791 PMCID: PMC3785394 DOI: 10.2147/dmso.s51325] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension and obesity are known to contribute, directly or indirectly, to the development of long-term complications of type 2 diabetes mellitus (T2DM). Knowing the prevalence of these comorbidities is important for determining the size of the population that may benefit from strategies that reduce blood pressure and weight while controlling blood glucose. METHODS In this systematic literature review, electronic searches of PubMed, Embase, and the Cochrane Library were conducted to identify observational studies of hypertension and/or obesity prevalence in patients with T2DM throughout the world. The searches were limited to studies reported in English from January 1, 2001 to February 16, 2012. RESULTS From a total of 2,688 studies, 92 observational studies provided prevalence rates for hypertension and/or obesity specifically in adults with T2DM. Fifteen studies of specific subtypes of hypertension or subpopulations with T2DM were subsequently excluded, leaving 78 studies (in 77 articles) for inclusion in this article. Of these, 61studies reported hypertension prevalence, 44 reported obesity prevalence, and 12 reported the prevalence of hypertension with obesity. Most studies had a low risk of bias regarding diagnosis of T2DM (70/78), hypertension (59/69), or obesity (45/47). The continental regions with the most observational studies of hypertension or obesity prevalence were Europe (n = 30) and Asia (n = 26). Hypertension rates typically were high in all regions; most studies presented rates above 50%, and many presented rates above 75%. Obesity rates exceeded 30% in 38 of 44 studies and 50% in 14 of 44 studies, especially those assessing central obesity (based on waist circumference). Among obese adults, hypertension rates were at or above 70% in Asia and above 80% in Europe; rates were lower in North and South America but still above 30%. CONCLUSION Around the world, hypertension and obesity, separately or together, are common comorbidities in adults with T2DM.
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Affiliation(s)
- Ann D Colosia
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Ann D Colosia, RTI Health Solutions, 3040 Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, USA, Tel +1 919 541 6000, Fax +1 919 541 7222, Email
| | | | - Shahnaz Khan
- RTI Health Solutions, Research Triangle Park, NC, USA
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20
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Riosmena F, Wong R, Palloni A. Migration selection, protection, and acculturation in health: a binational perspective on older adults. Demography 2013; 50:1039-64. [PMID: 23192395 PMCID: PMC3613435 DOI: 10.1007/s13524-012-0178-9] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the "salmon bias," emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.
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21
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Aguila E, Escarce J, Leng M, Morales L. Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. J Aging Health 2012; 25:136-58. [PMID: 23264441 DOI: 10.1177/0898264312468155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status. METHOD Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome. RESULTS The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators. DISCUSSION Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.
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Affiliation(s)
- Emma Aguila
- RAND Corporation, Santa Monica, CA 90407, USA.
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22
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Riosmena F, Frank R, Akresh IR, Kroeger RA. U.S. Migration, Translocality, and the Acceleration of the Nutrition Transition in Mexico. ANNALS OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS. ASSOCIATION OF AMERICAN GEOGRAPHERS 2012; 102:1209-1218. [PMID: 22962496 PMCID: PMC3435101 DOI: 10.1080/00045608.2012.659629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Migrant flows are generally accompanied by extensive social, economic, and cultural links between origins and destinations, transforming the former's community life, livelihoods, and local practices. Previous studies have found a positive association between these translocal ties and better child health and nutrition. We contend that focusing on children only provides a partial view of a larger process affecting community health, accelerating the nutrition transition in particular. We use a Mexican nationally-representative survey with socioeconomic, anthropometric, and biomarker measures, matched to municipal-level migration intensity and marginalization measures from the Mexican 2000 Census to study the association between adult body mass and community migration intensity. Our findings from multi-level models suggest a significant and positive relationship between community-level migration intensity and the individual risk of being overweight and obese, with significant differences by gender and with remittance intensity playing a preponderant role.
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Affiliation(s)
- Fernando Riosmena
- Department of Geography and Population Program University of Colorado at Boulder
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Ventura H, Piña IL, Lavie CJ. Hypertension and antihypertensive therapy in Hispanics and Mexican Americans living in the United States. Postgrad Med 2012; 123:46-57. [PMID: 22104453 DOI: 10.3810/pgm.2011.11.2494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension is a major independent risk factor for cardiovascular diseases, which are the most frequent cause of death worldwide. In addition, the risk of hypertension has been associated with racial and/or ethnic background. Hispanics are the largest and fastest-growing minority population in the United States, currently comprising about 16.3% (50.5 million) of the total population; these numbers will continue to increase into the next 10 years. The rate of uncontrolled hypertension in Hispanics significantly exceeds the rates observed among non-Hispanic blacks and whites. The reasons for these racial and ethnic differences in blood pressure control may include factors such as lack of access to health care, low socioeconomic status, language barriers, degree of acculturation, poor doctor-patient communication, and genetic factors. This article provides an up-to-date summary of epidemiological and treatment aspects of high blood pressure in the US Hispanic population. Because Mexican Americans constitute approximately 66% of US Hispanics, data sources that focus on Mexican Americans are also discussed.
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Affiliation(s)
- Hector Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
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24
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A potential calcium antagonist and its antihypertensive effects. Fitoterapia 2011; 82:988-96. [DOI: 10.1016/j.fitote.2011.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/22/2011] [Accepted: 05/28/2011] [Indexed: 11/17/2022]
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Zhang Y, Cao Y, Zhan Y, Duan H, He L. Furanocoumarins-imperatorin inhibits myocardial hypertrophy both in vitro and in vivo. Fitoterapia 2010; 81:1188-95. [DOI: 10.1016/j.fitote.2010.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 01/08/2023]
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Gillum RF, Albertorio-Díaz JR, Alpert JS. Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border. Am J Med 2010; 123:625-30. [PMID: 20609685 DOI: 10.1016/j.amjmed.2010.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/12/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region. METHODS Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties. RESULTS Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery. CONCLUSIONS Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.
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Evaluation of the Omron MX3 Plus monitor for blood pressure measurement in adolescents. Eur J Pediatr 2009; 168:1349-54. [PMID: 19221789 DOI: 10.1007/s00431-009-0936-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
Abstract
This study analyzed the accuracy/agreement of the Omron MX3 monitor on 165 adolescents. Blood pressure was measured by the automatic monitor connected in Y with the mercury column (three consecutive and simultaneous measures). The independent measures were analyzed, and the mean differences between systolic and diastolic measures for both methods were calculated and compared with British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) criteria. The automatic monitor received the highest degree of BHS recommendations for systolic and diastolic blood pressures according to the BHS. The median (25th and 75th) difference between the observer and the monitor measurements was -2 (-6 and 1) mmHg for systolic and 0 (-3 and 1) mmHg for diastolic pressures. The monitor also satisfies the AAMI standard for the studied population. In conclusion, the Omron MX3 Plus monitor can be considered reliable and valid for clinical practice and is in accordance with BHS and AAMI criteria.
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