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Choi HL, Yoo JE, Kim M, Kim B, Park J, Chang WH, Lee H, Han K, Shin DW. Risk of Heart Disease in Patients With Amputation: A Nationwide Cohort Study in South Korea. J Am Heart Assoc 2024; 13:e033304. [PMID: 38726914 PMCID: PMC11179827 DOI: 10.1161/jaha.123.033304] [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: 10/26/2023] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Amputation confers disabilities upon patients and is linked to substantial morbidity and death attributed to heart disease. While some studies have focused on traumatic amputees in veterans, few studies have focused on traumatic amputees within the general population. Therefore, the present study aimed to assess the risk of heart disease in patients with traumatic amputation with disability within the general population using a large-scale nationwide population-based cohort. METHODS AND RESULTS We used data from the Korean National Health Insurance System. A total of 22 950 participants with amputation were selected with 1:3 age, sex-matched controls between 2010 and 2018. We used Cox proportional hazard models to calculate the risk of myocardial infarction, heart failure, and atrial fibrillation among amputees. Participants with amputation had a higher risk of myocardial infarction (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.14-1.47]), heart failure (aHR, 1.27 [95% CI, 1.17-1.38]), and atrial fibrillation (aHR, 1.17 [95% CI, 1.03-1.33]). The risks of myocardial infarction and heart failure were further increased by the presence of disability (aHR, 1.43 [95% CI, 1.04-1.95]; and aHR, 1.38 [95% CI, 1.13-1.67], respectively). CONCLUSIONS We demonstrate an increased risk of myocardial infarction, heart failure, and atrial fibrillation among individuals with amputation, and the risk further increased in those with disabilities. Clinicians should pay attention to the increased risk for heart disease in patients with amputation.
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Affiliation(s)
- Hea Lim Choi
- Department of Family Medicine/Executive Healthcare Clinic Severance Hospital, Yonsei University College of Medicine Seoul South Korea
- Department of Clinical Research Design & Evaluation Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University Seoul Republic of Korea
| | - Jung Eun Yoo
- Department of Family Medicine Healthcare System Gangnam Center, Seoul National University Hospital Seoul Republic of Korea
- Department of Family Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Miso Kim
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Bongsung Kim
- Department of Medical Statistics The Catholic University of Korea Seoul Republic of Korea
| | - Junhee Park
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Heesun Lee
- Division of Cardiology Seoul National University Hospital Healthcare System Gangnam Center Seoul Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea
| | - Dong Wook Shin
- Department of Clinical Research Design & Evaluation Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University Seoul Republic of Korea
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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2
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Li X, Jansåker F, Sundquist J, Sundquist K. Neighbourhood deprivation and type 2 diabetes in patients with bipolar disorder: A nationwide follow-up study. Stress Health 2024; 40:e3302. [PMID: 37565544 DOI: 10.1002/smi.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997-2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40-1.86) for men and 1.83 (1.60-2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17-1.56) in men and 1.39 (1.20-1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
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Burrows K, Anderson GB, Yan M, Wilson A, Sabath MB, Son JY, Kim H, Dominici F, Bell ML. Health disparities among older adults following tropical cyclone exposure in Florida. Nat Commun 2023; 14:2221. [PMID: 37076480 PMCID: PMC10115860 DOI: 10.1038/s41467-023-37675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.
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Affiliation(s)
- K Burrows
- Institute at Brown for Environment and Society, Brown University, Providence, RI, USA.
| | - G B Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - M Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- School of Ecology and Environment, Beijing Technology and Business University, Beijing, China
| | - A Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - M B Sabath
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J Y Son
- School of the Environment, Yale University, New Haven, CT, USA
| | - H Kim
- Division of Environmental and Occupational Health Sciences, School of Public Health, IL, Chicago, USA
| | - F Dominici
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - M L Bell
- School of the Environment, Yale University, New Haven, CT, USA
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4
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Jansåker F, Nymberg VM, Sundquist J, Okuyama K, Hamano T, Sundquist K, Li X. Neighborhood deprivation and coronary heart disease in patients with bipolar disorder. Sci Rep 2022; 12:16763. [PMID: 36202912 PMCID: PMC9537303 DOI: 10.1038/s41598-022-21295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997–2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07–1.44) for men and 1.31 (1.13–1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22–1.49) in men and 1.30 (1.19–1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden. .,Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Shimane, Japan
| | - Kenta Okuyama
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Shimane, Japan.,Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden.,Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
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Maksimov SA, Balanova YA, Shalnova SA, Muromtseva GA, Kapustina AV, Drapkina OM. Regional living conditions and the prevalence, awareness, treatment, control of hypertension at the individual level in Russia. BMC Public Health 2022; 22:202. [PMID: 35094684 PMCID: PMC8801098 DOI: 10.1186/s12889-022-12645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level.
Methods
Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions).
Results
The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension.
Conclusion
The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.
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Relationships among changes in walking and sedentary behaviors, individual attributes, changes in work situation, and anxiety during the COVID-19 pandemic in Japan. Prev Med Rep 2022; 24:101640. [PMID: 34976691 PMCID: PMC8684034 DOI: 10.1016/j.pmedr.2021.101640] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
Females, younger people, those living in the highest-density tended to be inactive. Inactivity was related to standby/work-from-home for higher socioeconomic people. Inactivity was related to decreased amount of work for lower socioeconomic people. Decreased physical activity was related to strong anxiety during the pandemic.
Studies from many countries, including Japan, have reported decreased physical activity during the coronavirus disease 2019 (COVID-19) pandemic. However, the individual attributes as related to changes in physical activity during the pandemic in Japan have been scarcely investigated. The present study explored the relationships among individual attributes including demographic, socioeconomic, and geographic characteristics, work situation changes, perception of anxiety, and changes in walking and sedentary behaviors, during the pandemic in Japan. To obtain data indicating individual circumstances during the first wave of the pandemic in Japan, we conducted a nationwide online survey from May 19 to May 23, 2020 (n = 1,200). To observe changes in walking behavior objectively and retrospectively, we collected data on the number of daily steps as measured by the iPhone’s Health application. Path analysis was employed to examine relationships between individual attributes and changes in walking and sedentary behaviors. Decreased physical activity, especially, decreased walking behavior among younger individuals and those living in highest-density neighborhoods were identified. There was increased sedentary behavior among females. Moreover, individuals with higher socioeconomic status (SES) tended to become inactive due to work-from-home/standby-at-home and individuals with lower SES tended to become inactive due to decreased amount of work. Decreased walking behavior and increased sedentary behavior were associated with a perception of strong anxiety related to the pandemic. Our findings would be helpful in considering measures to counteract health risks during the pandemic by taking into account individual backgrounds.
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Iyanda AE, Lu Y. 'Gentrification is not improving my health': a mixed-method investigation of chronic health conditions in rapidly changing urban neighborhoods in Austin, Texas. JOURNAL OF HOUSING AND THE BUILT ENVIRONMENT : HBE 2022; 37:77-100. [PMID: 33994893 PMCID: PMC8107018 DOI: 10.1007/s10901-021-09847-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/19/2021] [Indexed: 05/14/2023]
Abstract
UNLABELLED Though there are extensive studies on neighborhood effects on health, this relationship remains elusive and requires continuous empirical evidence to support existing findings. Gentrification is a process of neighborhood change that affects most longtime residents. This study examined the health impact of the rapidly changing physical and cultural environment using oral history interviews, electronic interviews, and a quantitative structured survey. The study draws on the social determinants of health framework to explain the self-reported chronic health conditions (SR-CHCs) among 331 residents in Austin, Texas. The study employed non-linear techniques suitable for Poisson distribution to estimate the association between gentrification and SR-CHCs and complemented by direct quotes from in-depth interviews (IDIs). Perceived gentrification score significantly vary by marital status (p < 0.001), educational attainment (p < 0.001), and gender (p < 0.01), while SR-CHCs only significantly varies by educational attainment, p = 0.015). Multivariate results show that gentrification was positively associated with SR-CHCs, after adjusting for socioeconomic variables. Compared to the Hispanics, blacks were 97% more likely to report multiple counts of SR-CHCs (IRR = 1.969, 95% CI 1.074-3.608), and participants with high household income were 8% less likely to report multiple CHCs (IRR = 0.920, 95% CI 0.870-0.973). Drawing from the empirical findings, this study recommends both area-based and individual-level policies to mitigate neighborhood change's impact on residents' health. Finally, this study further adds to the understanding of social determinants of health in understanding chronic health within the changing urban physical and socio-ecology systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10901-021-09847-8.
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Affiliation(s)
- Ayodeji Emmanuel Iyanda
- Department of Geography, Texas State University, 601 University Drive, San Marcos, TX 78666 USA
| | - Yongmei Lu
- Department of Geography, Texas State University, 601 University Drive, San Marcos, TX 78666 USA
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Abba MS, Nduka CU, Anjorin S, Mohamed SF, Agogo E, Uthman OA. Influence of contextual socioeconomic position on hypertension risk in low- and middle-income countries: disentangling context from composition. BMC Public Health 2021; 21:2218. [PMID: 34872517 PMCID: PMC8647420 DOI: 10.1186/s12889-021-12238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension has emerged as the single most significant modifiable risk factor for cardiovascular disease and death worldwide. Resource-limited settings are currently experiencing the epidemiological transition from infectious diseases to chronic non-communicable diseases, primarily due to modifications in diet and lifestyle behaviour. The objective of this study was to examine the influence of individual-, community- and country-level factors associated with hypertension in low- and middle-income countries (LMICs). Methods Multivariable multi-level logistic regression analysis was applied using 12 Demographic and Health Survey (DHS) datasets collected between 2011 and 2018 in LMICs. We included 888,925 respondents (Level 1) nested within 33,883 neighbourhoods (Level 2) from 12 LMICs (Level 3). Results The prevalence of hypertension ranged from 10.3% in the Kyrgyz Republic to 52.2% in Haiti. After adjusting for the individual-, neighbourhood- and country-level factors, we found respondents living in the least deprived areas were 14% more likely to have hypertension than those from the most deprived areas (OR = 1.14, 95% CI 1.10 to 1.17). We observed a significant variation in the odds of hypertension across the countries and the neighbourhoods. Approximately 26.3 and 47.6% of the variance in the odds of hypertension could be attributed to country- and neighbourhood-level factors, respectively. We also observed that respondents moving to a different neighbourhood or country with a higher risk of hypertension had an increased chance of developing hypertension, the median increase in their odds of hypertension was 2.83-fold (95% CI 2.62 to 3.07) and 4.04- fold (95% CI 3.98 to 4.08), respectively. Conclusions This study revealed that individual compositional and contextual measures of socioeconomic status were independently associated with the risk of developing hypertension. Therefore, prevention strategies should be implemented at the individual level and the socioeconomic and contextual levels to reduce the burden of hypertension.
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Affiliation(s)
- Mustapha S Abba
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Chidozie U Nduka
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Seun Anjorin
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Shukri F Mohamed
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, UK.,Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emmanuel Agogo
- Resolve to Save Lives, Country Office Nigeria, Abuja, Nigeria
| | - Olalekan A Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, CV4 7AL, UK.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Maksimov SA, Shalnova SA, Balanova YA, Kutsenko VA, Evstifeeva SE, Imaeva AE, Drapkina OM. What Regional Living Conditions Affect Individual Smoking of Adults in Russia. Int J Public Health 2021; 66:599570. [PMID: 34744565 PMCID: PMC8565254 DOI: 10.3389/ijph.2021.599570] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives: Our study evaluated the impact of a wide range of characteristics of large administrative regions on the individual level of cigarette smoking in the Russian adult population. Methods: The pool of participants included 20,303 individuals aged 25-64 years. We applied 64 characteristics of the 12 Russian regions under study for 2010-2014. Using principal component analysis, we deduced five evidence-based composite indices of the regions. We applied the generalized estimating equation to determine associations between the regional indices and the individual level of smoking. Results: The increased Industrial index in the region is associated with the probability of smoking (odds ratio = 1.15; 95% confidence interval = 1.06-1.24). The other indices show associations with smoking only in separate gender and educational groups. Surprisingly, it was found that the Economic index has no associations with the probability of smoking. Conclusion: We evaluated the key associations of the territorial indices with the individual probability of smoking, as well as the mutual influence between the territorial indices and individual factors.
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Affiliation(s)
- Sergey A Maksimov
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Svetlana A Shalnova
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Yulia A Balanova
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Vladimir A Kutsenko
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Svetlana E Evstifeeva
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Asiia E Imaeva
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Oksana M Drapkina
- Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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10
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Hu MD, Lawrence KG, Bodkin MR, Kwok RK, Engel LS, Sandler DP. Neighborhood Deprivation, Obesity, and Diabetes in Residents of the US Gulf Coast. Am J Epidemiol 2021; 190:295-304. [PMID: 33524122 DOI: 10.1093/aje/kwaa206] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Socioeconomic status has been associated with cardiovascular disease risk factors. However, few studies have examined this relationship among populations in the US Gulf Coast region. We assessed neighborhood deprivation in relation to obesity and diabetes in 9,626 residents participating in the Gulf Long-Term Follow-Up Study (2011-present) who completed a home visit (2011-2013) with height, weight, waist, and hip measurements. Obesity was categorized as body mass index of at least 30, and diabetes was defined by doctor's diagnosis or prescription medication. Participant home addresses were linked to an established Area Deprivation Index and categorized into 4 levels (1 = least deprived). In adjusted, modified Poisson regression models, participants with greatest deprivation were more likely to have obesity compared with those with least deprivation (adjusted prevalence ratio (aPR) = 1.21, 95% confidence interval (CI): 1.08, 1.35), central obesity (aPR = 1.11, 95% CI: 1.04, 1.19), and diabetes (aPR = 1.49, 95% CI: 1.03, 2.14). Repeated analyses among a subgroup of participants (n = 3,016) whose hemoglobin A1C values were measured 3 years later indicated the association with diabetes (defined as diagnosis, medications, or hemoglobin A1C ≥ 6.5) was similar (aPR = 1.46, 95% CI: 1.14, 1.86). Results suggest neighborhood deprivation is associated with obesity and diabetes in a US region with high baseline prevalence.
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11
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Bischops AC, De Neve JW, Awasthi A, Vollmer S, Bärnighausen T, Geldsetzer P. A cross-sectional study of cardiovascular disease risk clustering at different socio-geographic levels in India. Nat Commun 2020; 11:5891. [PMID: 33208739 PMCID: PMC7674456 DOI: 10.1038/s41467-020-19647-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Despite its importance for the targeting of interventions, little is known about the degree to which cardiovascular disease (CVD) risk factors cluster within different socio-geographic levels in South Asia. Using two jointly nationally representative household surveys, which sampled 1,082,100 adults across India, we compute the intra-cluster correlation coefficients (ICCs) of five major CVD risk factors (raised blood glucose, raised blood pressure, smoking, overweight, and obesity) at the household, community, district, and state level. Here we show that except for smoking, the level of clustering is generally highest for households, followed by communities, districts, and then states. On average, more economically developed districts have a higher household ICC in rural areas. These findings provide critical information for sample size calculations of cluster-randomized trials and household surveys, and inform the targeting of policies and prevention programming aimed at reducing CVD in India.
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Affiliation(s)
- Anne C Bischops
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital, Duesseldorf, Germany.
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
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12
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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13
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Clennin M, Brown A, Lian M, Dowda M, Colabianchi N, Pate RR. Neighborhood Socioeconomic Deprivation Associated with Fat Mass and Weight Status in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176421. [PMID: 32899280 PMCID: PMC7503851 DOI: 10.3390/ijerph17176421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30; 95% CI = 1.03-1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.
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Affiliation(s)
- Morgan Clennin
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO 80014, USA
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (M.D.); (R.R.P.)
- Correspondence:
| | - Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA;
| | - Min Lian
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Marsha Dowda
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (M.D.); (R.R.P.)
| | - Natalie Colabianchi
- School of Kinesiology & Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Russell R. Pate
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (M.D.); (R.R.P.)
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14
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Gripe I, Danielsson AK, Karlsson P, Thor S, Ramstedt M. Are the well-off youth in Sweden more likely to use cannabis? Drug Alcohol Rev 2020; 40:126-134. [PMID: 32776657 DOI: 10.1111/dar.13139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND AIMS Results from previous research are inconsistent regarding the association between socioeconomic status (SES) and cannabis use among adolescents. Since there are risks associated with cannabis use, a social gradient in cannabis use may contribute to reproducing socioeconomic differences in life opportunities. The aim of this study was to assess the association between childhood SES and cannabis use among youth in Sweden. DESIGN AND METHODS We used repeated cross-sectional data from three waves (2014-2016) of the Swedish national school survey among 11th graders. The analysis encompassed 9497 individuals in 668 school classes. Childhood SES was measured through parents' highest education, as reported by the students. Cannabis use was measured in terms of lifetime use and frequency of use. Data were analysed using multi-level mixed-effects Poisson regression. RESULTS Adolescents with at least 1 parent with university/college education had 17% (incidence rate ratio 1.17, confidence interval 1.05, 1.30) higher risk of lifetime use of cannabis compared with those whose parents had no university/college education, adjusting for sex, SES of the school environment, academic orientation, truancy, risk assessment and parental permissiveness. Among life-time users of cannabis, risk for frequent cannabis use was 28% (incidence rate ratio 0.72, confidence interval 0.53, 0.97) lower for those with at least 1 parent with university or college education. DISCUSSION AND CONCLUSIONS Childhood SES, in terms of parental education, was associated with cannabis use among Swedish adolescents. Adolescents from families with lower SES were less likely to ever try cannabis, but at higher risk for frequent use.
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Affiliation(s)
- Isabella Gripe
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | | | - Patrik Karlsson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Siri Thor
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | - Mats Ramstedt
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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15
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Hamad R, Öztürk B, Foverskov E, Pedersen L, Sørensen HT, Bøtker HE, White JS. Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and Events Among Refugees in Denmark. JAMA Netw Open 2020; 3:e2014196. [PMID: 32821923 PMCID: PMC7442927 DOI: 10.1001/jamanetworkopen.2020.14196] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Refugees are among the most disadvantaged individuals in society, and they often have elevated risks of cardiovascular risk factors and events. Evidence is limited regarding factors that may worsen cardiovascular health among this vulnerable group. OBJECTIVE To test the hypothesis that refugee placement in socioeconomically disadvantaged neighborhoods is associated with increased cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS The study population of this quasi-experimental, registry-based cohort study included 49 305 adults 18 years and older who came to Denmark as refugees from other countries during the years of Denmark's refugee dispersal policy from 1986 to 1998. Refugees were dispersed to neighborhoods with varying degrees of socioeconomic disadvantage in an arbitrary manner conditional on observed characteristics. The association of neighborhood disadvantage on arrival with several cardiovascular outcomes in subsequent decades was evaluated using regression models that adjusted for individual, family, and municipal characteristics. Health outcomes were abstracted from the inpatient register, outpatient specialty clinic register, and prescription drug register through 2016. Data analysis was conducted from May 2018 to July 2019. EXPOSURES A composite index of neighborhood disadvantage was constructed using 8 neighborhood-level socioeconomic characteristics derived from Danish population register data. MAIN OUTCOMES AND MEASURES Primary study outcomes included hypertension, hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke. Before data analysis commenced, it was hypothesized that higher levels of neighborhood disadvantage were associated with an increased risk of cardiovascular risk factors and events. RESULTS A total of 49 305 participants were included (median [interquartile range] age, 30.5 [24.9-39.8] years; 43.3% women). Participant region of origin included 6318 from Africa (12.8%), 7253 from Asia (14.7%), 3446 from Eastern Europe (7.0%), 5416 from Iraq (11.0%), 6206 from Iran (12.6%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian Territories; 11.3%), and 15 108 from Yugoslavia (30.6%). Adjusted models revealed an association between placement in disadvantaged neighborhoods and increased risk of hypertension (0.71 [95% CI, 0.30-1.13] percentage points per unit of disadvantage index; P < .01), hyperlipidemia (0.44 [95% CI, 0.06-0.83] percentage points; P = .01), diabetes (0.45 [95% CI, 0.09-0.81] percentage points; P = .01), and myocardial infarction (0.14 [95% CI, 0.03-0.25] percentage points; P = .01). No association was found for stroke. Individuals who arrived in Denmark before age 35 years had an increased risk of hyperlipidemia (1.16 [95% CI, 0.41-1.92] percentage points; P < .01), and there were no differences by sex. CONCLUSIONS AND RELEVANCE In this quasi-experimental cohort study, neighborhood disadvantage was associated with increased cardiovascular risk in a relatively young population of refugees. Neighborhood characteristics may be an important consideration when refugees are placed by resettlement agencies and host countries. Future work should examine additional health outcomes as well as potential mediating pathways to target future interventions (eg, neighborhood ease of walking, employment opportunities).
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Family & Community Medicine, University of California School of Medicine, San Francisco
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Else Foverskov
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Denmark
- Center for Population Health Science, Stanford University, Stanford, California
| | - Hans E. Bøtker
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco
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16
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Toms R, Mayne DJ, Feng X, Bonney A. Geographic variation in cardiometabolic risk factor prevalence explained by area-level disadvantage in the Illawarra-Shoalhaven region of the NSW, Australia. Sci Rep 2020; 10:12770. [PMID: 32728133 PMCID: PMC7391748 DOI: 10.1038/s41598-020-69552-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs; and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Data included objectively measured routine pathology test data between years 2012 and 2017 on: fasting blood sugar level; glycated haemoglobin; total cholesterol; high density lipoprotein; urinary albumin creatinine ratio; estimated glomerular filtration rate; and body mass index. The 2011 Australian census based Index of Relative Socioeconomic Disadvantage (IRSD) were the area-level study variables, analysed at its smallest geographic unit of reporting. A total of 1,132,029 CMRF test results from 256,525 individuals were analysed. After adjusting for individual-level covariates, all CMRFs significantly associated with IRSD and the probability of higher risk CMRFs increases with greater area-level disadvantage. Though the specific contribution of IRSD in the geographic variation of CMRF ranged between 57.8 and 14.71%, the general contextual effect of areas were found minimal (ICCs 0.6-3.4%). The results support universal interventions proportional to the need and disadvantage level of populations for the prevention and control of CMRFs, rather than any area specific interventions as the contextual effects were found minimal in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
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17
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Toms R, Feng X, Mayne DJ, Bonney A. Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra-Shoalhaven Region of NSW, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4297. [PMID: 32560149 PMCID: PMC7344656 DOI: 10.3390/ijerph17124297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. METHODS Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. RESULTS Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91-0.96) and obesity (OR 0.91, CI 0.88-0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4-1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. CONCLUSION The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong NSW 2500, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2033, Australia
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong NSW 2502, Australia
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
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18
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Sprung MR, Faulkner LMD, Evans MK, Zonderman AB, Waldstein SR. Neighborhood crime is differentially associated with cardiovascular risk factors as a function of race and sex. J Public Health Res 2019; 8:1643. [PMID: 31857988 PMCID: PMC6902308 DOI: 10.4081/jphr.2019.1643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Neighborhood crime may be an important factor contributing to cardiovascular health disparities, and these relations may vary by race and sex. The present investigation evaluated (a) potential differential associations between neighborhood crime and cardiovascular disease (CVD) risk factors within subgroups of African American (AA) and White men and women, and (b) potential mediation by negative affect. Design and Methods: Participants were 1,718 AAs and Whites (58% AA; 54% female; 59% above poverty; ages 30-64 years) living Baltimore, Maryland who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study from 2004-2009. CVD risk factors included body mass index, total serum cholesterol, glucose, and systolic and diastolic blood pressure. A negative affect composite was comprised of self-reported depression, anxiety, anger, vigilance, and perceived stress. Hierarchical multiple regression analyses were used to examine associations between per capita overall and violent crime rates, negative affect, and CVD risk factors. Results: There were significant associations of greater overall crime rate with higher fasting glucose (b=.192, P<0.05), and greater violent crime rate with higher systolic (b=86.50, P<0.05) and diastolic (b=60.12, P<0.05) blood pressure in AA women, but not men. These associations were not explained by negative affect. In Whites, there were no significant associations of overall or violent crime rates with cardiovascular risk factors. Conclusions: AA women may be particularly vulnerable to the negative impact of crime on cardiovascular risk. Preventative efforts aimed toward this group may help to deter the detrimental effects that living in a high crime area may have on one’s cardiovascular health. Significance for public health Neighborhood crime may be an important factor contributing to cardiovascular health disparities, and these relations may vary by race and sex. Among 1,718 AAs and Whites (58% AA; 54% female; 59% above poverty; ages 30-64 years) living Baltimore, Maryland who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study from 2004-2009, greater overall crime rate was related to higher fasting glucose levels, and greater violent crime rate was associated with higher systolic and diastolic blood pressure in AA women, but not men. No associations were found in Whites. Results indicate that AA women may be particularly vulnerable to the negative impact of crime on cardiovascular risk. Preventative efforts aimed toward this group may help to deter the detrimental effects that living in a high crime area may have on one’s cardiovascular health.
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Affiliation(s)
- Mollie R Sprung
- Veterans Affairs, Pittsburgh Healthcare System, University Drive, Pittsburg, PA.,Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Lauren M D Faulkner
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
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Mohammed SH, Habtewold TD, Birhanu MM, Sissay TA, Tegegne BS, Abuzerr S, Esmaillzadeh A. Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies. BMJ Open 2019; 9:e028238. [PMID: 31727643 PMCID: PMC6886990 DOI: 10.1136/bmjopen-2018-028238] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Low neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual's own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019. ELIGIBILITY CRITERIA Epidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included. DATA EXTRACTION AND SYNTHESIS Data extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran's Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger's regression test. RESULT A total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001). CONCLUSION NSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity. PROSPERO REGISTRATION NUMBER CRD42017063889.
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Affiliation(s)
- Shimels Hussien Mohammed
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | | | - Samer Abuzerr
- Department of Environmental Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Department of Community Nutrition, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
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20
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Walsan R, Bonney A, Mayne DJ, Pai N, Feng X, Toms R. Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature. J Prim Care Community Health 2019; 9:2150132718802025. [PMID: 30255730 PMCID: PMC6158606 DOI: 10.1177/2150132718802025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them.
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Affiliation(s)
- Ramya Walsan
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Bonney
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Darren J Mayne
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,3 Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, Warrawong, New South Wales, Australia
| | - Nagesh Pai
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,4 Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- 2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,5 Population Wellbeing and Environment Research Lab (Powerlab), School of Health and Society, University of Wollongong, New South Wales, Australia
| | - Renin Toms
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Walsan R, Mayne DJ, Feng X, Pai N, Bonney A. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203905. [PMID: 31618833 PMCID: PMC6843457 DOI: 10.3390/ijerph16203905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 individuals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI-T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42-7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our sample (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI-T2D comorbidity in disadvantaged communities.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
| | - Darren J Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong 2502, Australia.
- The University of Sydney, School of Public Health, Sydney 2006, Australia.
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong 2522, Australia.
- School of Public Health and Community Medicine, University of New South Wales, Kennington 2031, Australia.
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong 2500, Australia.
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
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22
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Kim JH, Lewis TT, Topel ML, Mubasher M, Li C, Vaccarino V, Mujahid MS, Sims M, Quyyumi AA, Taylor HA, Baltrus PT. Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Prev Chronic Dis 2019; 16:E57. [PMID: 31074715 PMCID: PMC6513475 DOI: 10.5888/pcd16.180505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area. METHODS We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area. Census tracts with substantially lower rates of cardiovascular events on the basis of neighborhood socioeconomic status were identified as resilient and those with higher rates were identified as at risk. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) of being classified as an at-risk versus resilient tract for differences in census-derived measures. RESULTS We identified 106 resilient and 121 at-risk census tracts, which differed in the rates per 5,000 person years of cardiovascular outcomes (mortality, 8.13 vs 13.81; ED visits, 32.25 vs 146.3; hospitalizations, 26.69 vs 130.0), despite similarities in their median black income ($46,123 vs $45,306). Tracts with a higher percentage of residents aged 65 or older (odds ratio [OR], 2.29; 95% CI, 1.41-3.85 per 5% increment) and those with incomes less than 200% of the federal poverty level (OR, 1.19; 95% CI, 1.02-1.39 per 5% increment) and greater Gini index (OR, 1.56; 95% CI, 1.19- 2.07 per 0.05 increment) were more likely to be classified as at risk than resilient neighborhoods. DISCUSSION Despite matching on median income level, at-risk neighborhoods for CVD among black populations were associated with a higher prevalence of socioeconomic indicators of inequality than resilient neighborhoods.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew L Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Peter T Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia.,Morehouse School of Medicine, National Center for Primary Care, Room 310, 720 Westview Dr, Atlanta, GA 30310.
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23
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Hamad R, Brown DM, Basu S. The association of county-level socioeconomic factors with individual tobacco and alcohol use: a longitudinal study of U.S. adults. BMC Public Health 2019; 19:390. [PMID: 30971249 PMCID: PMC6458796 DOI: 10.1186/s12889-019-6700-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/25/2019] [Indexed: 11/21/2022] Open
Abstract
Background Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use. Yet few studies examine the effects of county-level socioeconomic characteristics, despite the fact that social and public health policies are often implemented at the county level. In this study, we tested the hypothesis that county-level socioeconomic disadvantage was associated with individual tobacco and alcohol use. Methods The sample included a panel of participants from the National Longitudinal Survey of Youth (N = 9302). The primary predictors were three time-varying measures of socioeconomic disadvantage in an individual’s county of residence: educational attainment, percent unemployment, and per capita income. We first conducted traditional ordinary least squares (OLS) models, both unadjusted and adjusted for individual-level covariates. We then conducted fixed effects (FE) models to adjust for confounding by unmeasured time-invariant individual-level factors. Results OLS and FE models yielded contrasting results: higher county-level per capita income was associated with decreased drinking in OLS models and increased drinking in FE models, while decreased county-level educational attainment was associated with decreased smoking in OLS models and more cigarettes per day in FE models. The findings from FE models suggest that OLS models were confounded by unobserved time-invariant characteristics. Notably, the point estimates for the county-level measures were small, and in many cases they may not represent a clinically meaningful effect except at the population level. Conclusions These results suggest that county-level socioeconomic characteristics may modestly influence tobacco and alcohol use. Future work should examine the effects of specific county policies that might explain these findings. Electronic supplementary material The online version of this article (10.1186/s12889-019-6700-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rita Hamad
- Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA, 94110, USA.
| | - Daniel M Brown
- Environmental Health Sciences Division, University of California Berkeley, Berkeley, California, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University, Palo Alto, California, USA
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24
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Hawes AM, Smith GS, McGinty E, Bell C, Bower K, LaVeist TA, Gaskin DJ, Thorpe RJ. Disentangling Race, Poverty, and Place in Disparities in Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1193. [PMID: 30987098 PMCID: PMC6480690 DOI: 10.3390/ijerph16071193] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Abstract
Significant racial disparities in physical activity-a key protective health factor against obesity and cardiovascular disease-exist in the United States. Using data from the 1999-2004 National Health and Nutrition Examination Survey and the 2000 United States (US) Census, we estimated the impact of race, individual-level poverty, neighborhood-level poverty, and neighborhood racial composition on the odds of being physically active for 19,678 adults. Compared to whites, blacks had lower odds of being physically active. Individual poverty and neighborhood poverty were associated with decreased odds of being physically active among both whites and blacks. These findings underscore the importance of social context in understanding racial disparities in physical activity and suggest the need for future research to determine specific elements of the social context that drive disparities.
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Affiliation(s)
- Armani M Hawes
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Genee S Smith
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Emma McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Caryn Bell
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Kelly Bower
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Johns Hopkins School of Nursing, Baltimore, MD 21205, USA.
| | - Thomas A LaVeist
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
| | - Darrell J Gaskin
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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25
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Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature. Int J Health Geogr 2019; 18:1. [PMID: 30621786 PMCID: PMC6323718 DOI: 10.1186/s12942-018-0165-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/31/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing number of publications report variation in the distribution of cardiometabolic risk factors (CMRFs) at different geographic scales. A review of these variations may help inform policy and health service organisation. AIM To review studies reporting variation in the geographic distribution of CMRFs and its association with various proxy measures of area-level socioeconomic disadvantage (ASED) among the adult ( ≥ 18 years) population across the world. METHODS A systematic search for published articles was conducted in four databases (MEDLINE (Ovid), PubMed, Scopus and Web of Science) considering the interdisciplinary nature of the review question. Population-based cross-sectional and cohort studies on geographic variations of one or more biological proxies of CMRFs with/without an analysed contextual association with ASED were included. Two independent reviewers screened the studies and PRISMA guidelines were followed in the study selection and reporting. RESULT A total of 265 studies were retrieved and screened, resulting in 24 eligible studies. The review revealed reports of variation in the distribution of CMRFs, at varying geographic scales, in multiple countries. In addition, consistent associations between ASED and higher prevalence of CMRFs were demonstrated. The reports were mainly from industrialised nations and small area geographic units were frequently used. CONCLUSION Geographic variation in cardiometabolic risk exists across multiple spatial scales and is positively associated with ASED. This association is independent of individual-level factors and provides an imperative for area-based approaches to informing policy and health service organisation. The study protocol is registered in International prospective register of systematic reviews (Register No: CRD42018115294) PROSPERO 2018.
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26
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Finnvold JE. How social and geographical backgrounds affect hospital admission with a serious condition: a comparison of 11 immigrant groups with native-born Norwegians. BMC Health Serv Res 2018; 18:843. [PMID: 30409144 PMCID: PMC6225619 DOI: 10.1186/s12913-018-3670-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/31/2018] [Indexed: 11/17/2022] Open
Abstract
Background The foreign-born population in Norway displays considerable diversity in terms of source country, socioeconomic status and settlement experience. This study assessed the consequences of this diversity for the risk of being admitted to hospital with a serious condition. To what extent could variations between immigrant and native-born hospitalisation patterns be accounted for by variations in income, education and residential area characteristics? Methods The study linked information on socioeconomic and geographical level-of-living factors involving 2,820,283 individuals between 20 and 69 years old to hospital admissions recorded in Norway’s National Patient Registry. Immigrants from 11 of the most frequently represented countries were included. The outcome variable consisted of a selection of relatively serious diagnoses (neoplasms and endocrine, circulatory and respiratory diseases), totalling 548,140 admissions from 2008 to 2011. Age- and gender-adjusted admission rates were analysed using a Poisson regression. Results The adjustments for income and education reduced the hospitalisation rates of almost all immigrant groups. The groups whose previous rates were above native-born rates moved towards the Norwegian reference, whereas groups that initially had lower age- and gender-adjusted rates compared with the Norwegian-born population increased the distance to the Norwegian reference. The risk of hospitalisation among most immigrant groups decreased compared with the Norwegian-born population when their income and educational levels were accounted for. Particularly, immigrants with lower levels of income or education tended to have relatively low hospitalisation rates, indicating the possibility of a healthy immigrant effect. While many immigrant groups used less somatic healthcare than the native-born population did, higher educational or income levels did not prevent hospitalisation to the same extent as they did for the native-born population. Conclusions Although adjustments for socioeconomic factors tended towards lower hospitalisation rates for most immigrant groups, the adjustments did not reduce the considerable variations among individual countries.
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Affiliation(s)
- Jon Erik Finnvold
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Postboks 4. St. Olavs plass, 0130, Oslo, Norway.
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27
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Bilal U, Hill-Briggs F, Sánchez-Perruca L, Del Cura-González I, Franco M. Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study. BMJ Open 2018; 8:e021143. [PMID: 30287604 PMCID: PMC6173235 DOI: 10.1136/bmjopen-2017-021143] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain. SETTING Electronic health records of the primary-care system in four districts of Madrid (Spain). PARTICIPANTS 269 942 people aged 40 or older, followed from 2013 to 2014. EXPOSURE Neighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions. PRIMARY OUTCOME MEASURES Diagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %). RESULTS In regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15). CONCLUSIONS Diabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Social and Cardiovascular Epidemiology Research Group, Universidad de Alcalá, Madrid, Spain
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Felicia Hill-Briggs
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Hopkins Medical Institutions, Baltimore, Maryland, USA
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luis Sánchez-Perruca
- Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Isabel Del Cura-González
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Primary Care Research Unit, Primary Care Management. Madrid Health Service, Madrid, Spain
- Area of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Manuel Franco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Social and Cardiovascular Epidemiology Research Group, Universidad de Alcalá, Madrid, Spain
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28
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Claudel SE, Adu-Brimpong J, Banks A, Ayers C, Albert MA, Das SR, de Lemos JA, Leonard T, Neeland IJ, Rivers JP, Powell-Wiley TM. Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study. Am Heart J 2018; 204:109-118. [PMID: 30092412 PMCID: PMC6217793 DOI: 10.1016/j.ahj.2018.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 07/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiovascular disease is a leading economic and medical burden in the United States (US). As an important risk factor for cardiovascular disease, hypertension represents a critical point of intervention. Less is known about longitudinal effects of neighborhood deprivation on blood pressure outcomes, especially in light of new hypertension guidelines. METHODS Longitudinal data from the Dallas Heart Study facilitated multilevel regression analysis of the relationship between neighborhood deprivation, blood pressure change, and incident hypertension over a 9-year period. Factor analysis explored neighborhood perception, which was controlled for in all analyses. Neighborhood deprivation was derived from US Census data and divided into tertiles for analysis. Hypertension status was compared using pre-2017 and 2017 hypertension guidelines. RESULTS After adjusting for covariates, including moving status and residential self-selection, we observed significant associations between residing in the more deprived neighborhoods and 1) increasing blood pressure over time and 2) incident hypertension. In the fully adjusted model of continuous blood pressure change, significant relationships were seen for both medium (SBP: β = 4.81, SE = 1.39, P = .0005; DBP: β = 2.61, SE = 0.71, P = .0003) and high deprivation (SBP: β = 7.64, SE = 1.55, P < .0001; DBP: β = 4.64, SE = 0.78, P < .0001). In the fully adjusted model of incident hypertension, participants in areas of high deprivation had 1.69 higher odds of developing HTN (OR 1.69; 95% CI 1.02, 2.82), as defined by 2017 hypertension guidelines. Results varied based on definition of hypertension used (pre-2017 vs. 2017 guidelines). CONCLUSION These findings highlight the potential impact of adverse neighborhood conditions on cardiometabolic outcomes, such as hypertension.
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Affiliation(s)
- Sophie E Claudel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Joel Adu-Brimpong
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Colby Ayers
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michelle A Albert
- Division of Cardiovascular Medicine, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Sandeep R Das
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - James A de Lemos
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tammy Leonard
- Economics Department, University of North Texas, Denton, TX
| | - Ian J Neeland
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joshua P Rivers
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Shackleton N, Darlington-Pollock F, Norman P, Jackson R, Exeter DJ. Longitudinal deprivation trajectories and risk of cardiovascular disease in New Zealand. Health Place 2018; 53:34-42. [PMID: 30053650 DOI: 10.1016/j.healthplace.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/31/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023]
Abstract
We used longitudinal information on area deprivation status to explore the relationship between residential-deprivation mobility and Cardiovascular Disease (CVD). Data from 2,418,397 individuals who were: enrolled in any Primary Health Organisation within New Zealand (NZ) during at least 1 of 34 calendar quarters between 1st January 2006 and 30th June 2014; aged between 30 and 84 years (inclusive) at the start of the study period; had no prior history of CVD; and had recorded address information were analysed. Including a novel trajectory analysis, our findings suggest that movers are healthier than stayers. The deprivation characteristics of the move have a larger impact on the relative risk of CVD for younger movers than for older movers. For older movers any kind of move is associated with a decreased risk of CVD.
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Affiliation(s)
- Nichola Shackleton
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), Faculty of Arts, The University of Auckland, Auckland, New Zealand.
| | | | - Paul Norman
- School of Geography, University of Leeds, UK
| | - Rodney Jackson
- Section of Epidemiology & Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Daniel John Exeter
- Section of Epidemiology & Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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30
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Height, Weight, and Aerobic Fitness Level in Relation to the Risk of Atrial Fibrillation. Am J Epidemiol 2018; 187:417-426. [PMID: 28641376 PMCID: PMC6075081 DOI: 10.1093/aje/kwx255] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022] Open
Abstract
Tall stature and obesity have been associated with a higher risk of atrial fibrillation (AF), but there have been conflicting reports of the effects of aerobic fitness. We conducted a national cohort study to examine interactions between height or weight and level of aerobic fitness among 1,547,478 Swedish military conscripts during 1969-1997 (97%-98% of all 18-year-old men) in relation to AF identified from nationwide inpatient and outpatient diagnoses through 2012 (maximal age, 62 years). Increased height, weight, and aerobic fitness level (but not muscular strength) at age 18 years were all associated with a higher AF risk in adulthood. Positive additive and multiplicative interactions were found between height or weight and aerobic fitness level (for the highest tertiles of height and aerobic fitness level vs. the lowest, relative excess risk = 0.51, 95% confidence interval (CI): 0.40, 0.62; ratio of hazard ratios = 1.50, 95% CI: 1.34, 1.65). High aerobic fitness levels were associated with higher risk among men who were at least 186 cm (6 feet, 1 inch) tall but were protective among shorter men. Men with the combination of tall stature and high aerobic fitness level had the highest risk (for the highest tertiles vs. the lowest, adjusted hazard ratio = 1.70, 95% CI: 1.61, 1.80). These findings suggest important interactions between body size and aerobic fitness level in relation to AF and may help identify high-risk subgroups.
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Affiliation(s)
- Casey Crump
- Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jan Sundquist
- Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Primary Health Care Research, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Kristina Sundquist
- Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Primary Health Care Research, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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31
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McCann A, McNulty H, Rigby J, Hughes CF, Hoey L, Molloy AM, Cunningham CJ, Casey MC, Tracey F, O’Kane MJ, McCarroll K, Ward M, Moore K, Strain J, Moore A. Effect of Area‐Level Socioeconomic Deprivation on Risk of Cognitive Dysfunction in Older Adults. J Am Geriatr Soc 2018; 66:1269-1275. [DOI: 10.1111/jgs.15258] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Adrian McCann
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Jan Rigby
- National Centre for GeoComputationMaynooth UniversityMaynoothIreland
| | - Catherine F. Hughes
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Anne M. Molloy
- Institute of Molecular Medicine, School of Medicine, Trinity College DublinDublinIreland
| | | | - Miriam C. Casey
- Mercer's Institute for Research on Ageing, St James's HospitalDublinIreland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care TrustColeraineNorthern IrelandUnited Kingdom
| | - Maurice J. O’Kane
- Clinical Chemistry LaboratoryAltnagelvin Hospital, Western Health and Social Care TrustLondonderryNorthern IrelandUnited Kingdom
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's HospitalDublinIreland
| | - Mary Ward
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Katie Moore
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - J.J. Strain
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Adrian Moore
- School of Environmental SciencesUlster UniversityColeraineNorthern IrelandUnited Kingdom
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Liese AD, Lamichhane AP, Garzia SCA, Puett RC, Porter DE, Dabelea D, D'Agostino RB, Standiford D, Liu L. Neighborhood characteristics, food deserts, rurality, and type 2 diabetes in youth: Findings from a case-control study. Health Place 2018; 50:81-88. [PMID: 29414425 DOI: 10.1016/j.healthplace.2018.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 11/26/2022]
Abstract
Little is known about the influence of neighborhood characteristics on risk of type 2 diabetes (T2D) among youth. We used data from the SEARCH for Diabetes in Youth Case-Control Study to evaluate the association of neighborhood characteristics, including food desert status of the census tract, with T2D in youth. We found a larger proportion of T2D cases in tracts with lower population density, larger minority population, and lower levels of education, household income, housing value, and proportion of the population in a managerial position. However, most associations of T2D with neighborhood socioeconomic characteristics were attributable to differences in individual characteristics. Notably, in multivariate logistic regression models, T2D was associated with living in the least densely populated study areas, and this finding requires further exploration.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.
| | - Archana P Lamichhane
- Environmental Health Sciences, RTI International, Research Triangle Park, North Carolina and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara C A Garzia
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Robin C Puett
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Dwayne E Porter
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Ralph B D'Agostino
- School of Medicine, Division of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | | | - Lenna Liu
- Seattle Children's Hospital, Seattle, WA, USA
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den Braver NR, Lakerveld J, Rutters F, Schoonmade LJ, Brug J, Beulens JWJ. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med 2018; 16:12. [PMID: 29382337 PMCID: PMC5791730 DOI: 10.1186/s12916-017-0997-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.
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Affiliation(s)
- N R den Braver
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - J Lakerveld
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | | | - J Brug
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - J W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Forsberg PO, Ohlsson H, Sundquist K. Causal nature of neighborhood deprivation on individual risk of coronary heart disease or ischemic stroke: A prospective national Swedish co-relative control study in men and women. Health Place 2018; 50:1-5. [PMID: 29331785 DOI: 10.1016/j.healthplace.2017.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Abstract
We studied the association between neighborhood socioeconomic status (SES) and incidence of coronary heart disease (CHD) or ischemic stroke in the total population and in full- and half-siblings to determine whether these associations are causal or a result from familial confounding. Data were retrieved from nationwide Swedish registers containing individual clinical data linked to neighborhood of residence. After adjustment for individual SES, the association between neighborhood SES and CHD showed no decrease with increasing genetic resemblance, particularly in women. This indicates that the association between neighborhood SES and CHD incidence is partially causal among women, which represents a novel finding.
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Affiliation(s)
- Per-Ola Forsberg
- Center for Primary Health Care Research, Lund University, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Sweden
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Nobel L, Jesdale BM, Tjia J, Waring ME, Parish DC, Ash AS, Kiefe CI, Allison JJ. Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education). Med Care 2017; 55:1008-1016. [PMID: 29016395 PMCID: PMC5687991 DOI: 10.1097/mlr.0000000000000819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS). METHODS We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics. RESULTS Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above. CONCLUSIONS Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals.
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Affiliation(s)
- Lisa Nobel
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Bill M. Jesdale
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David C. Parish
- Department of Community Medicine, Mercer University, Macon GA
| | - Arlene S. Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jeroan J. Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Aerobic fitness, muscular strength and obesity in relation to risk of heart failure. Heart 2017; 103:1780-1787. [PMID: 28500243 DOI: 10.1136/heartjnl-2016-310716] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Low physical fitness and obesity have been associated with higher risk of developing heart failure (HF), but their interactive effects are unknown. Elucidation of interactions among these common modifiable factors may help facilitate more effective primary prevention. METHODS We conducted a national cohort study to examine the interactive effects of aerobic fitness, muscular strength and body mass index (BMI) among 1 330 610 military conscripts in Sweden during 1969-1997 (97%-98% of all 18-year-old men) on risk of HF identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years). RESULTS There were 11 711 men diagnosed with HF in 37.8 million person-years of follow-up. Low aerobic fitness, low muscular strength and obesity were independently associated with higher risk of HF, after adjusting for each other, socioeconomic factors, other chronic diseases and family history of HF. The combination of low aerobic fitness and low muscular strength (lowest vs highest tertiles) was associated with a 1.7-fold risk of HF (95% CI 1.6 to 1.9; p<0.001; incidence rates per 100 000 person-years, 43.2 vs 10.8). These factors had positive additive and multiplicative interactions (p<0.001) and were associated with increased risk of HF even among men with normal BMI. CONCLUSIONS Low aerobic fitness, low muscular strength and obesity at the age of 18 years were independently associated with higher risk of HF in adulthood, with interactive effects between aerobic fitness and muscular strength. These findings suggest that early-life interventions may help reduce the long-term risk of HF and should include both aerobic fitness and muscular strength, even among persons with normal BMI.
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Affiliation(s)
- Casey Crump
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Carlsson AC, Li X, Holzmann MJ, Ärnlöv J, Wändell P, Gasevic D, Sundquist J, Sundquist K. Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden. Int J Stroke 2017; 12:815-826. [PMID: 28387158 DOI: 10.1177/1747493017702663] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23). Conclusions In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.
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Affiliation(s)
- Axel C Carlsson
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,2 Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Xinjun Li
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Martin J Holzmann
- 4 Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.,5 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,6 School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Per Wändell
- 1 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Danijela Gasevic
- 7 Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jan Sundquist
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- 3 Center for Primary Health Care Research, Lund University, Malmö, Sweden
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38
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Huynh M, Spasojevic J, Li W, Maduro G, Van Wye G, Waterman PD, Krieger N. Spatial social polarization and birth outcomes: preterm birth and infant mortality - New York City, 2010-14. Scand J Public Health 2017; 46:157-166. [PMID: 28385056 DOI: 10.1177/1403494817701566] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This study assessed the relationship between spatial social polarization measured by the index of the concentration of the extremes (ICE) and preterm birth (PTB) and infant mortality (IM) in New York City. A secondary aim was to examine the ICE measure in comparison to neighborhood poverty. METHODS The sample included singleton births to adult women in New York City, 2010-2014 ( n=532,806). Three ICE measures were employed at the census tract level: ICE - Income (persons in households in the bottom vs top 20th percentile of US annual household income), ICE -Race/Ethnicity (black non-Hispanic vs white non-Hispanic populations), and ICE - Income + Race/Ethnicity combined. Preterm birth was defined as birth before 37 weeks' gestation. Infant mortality was defined as a death before one year of age. A two-level generalized linear model with random intercept was utilized adjusting for individual-level covariates. RESULTS Preterm birth prevalence was 7.1% and infant mortality rate was 3.4 per 1000 live births. Women who lived in areas with the least privilege were more likely to have a preterm birth or infant mortality as compared to women living in areas with the most privilege. After adjusting for covariates, this association remained for preterm birth (ICE - Income: Adjusted Odds Ratio (AOR) 1.16 (1.10-1.21); ICE - Race/Ethnicity: AOR 1.41 (1.34-1.49); ICE - Income + Race/Ethnicity: AOR 1.36 (1.29-1.43)) and IM (ICE - Race/Ethnicity (AOR 1.80 (1.43-2.28) and ICE - Income + Race/Ethnicity (AOR 1.54 (1.23-1.94)). High neighborhood poverty was associated with PTB only (AOR 1.09 (1.04-1.14). CONCLUSIONS These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes.
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Affiliation(s)
- M Huynh
- 1 Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, USA
| | - J Spasojevic
- 1 Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, USA
| | - W Li
- 1 Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, USA
| | - G Maduro
- 1 Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, USA
| | - G Van Wye
- 1 Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, USA
| | - P D Waterman
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - N Krieger
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nguyen QC, Acevedo-Garcia D, Schmidt NM, Osypuk TL. The effects of a housing mobility experiment on participants' residential environments. HOUSING POLICY DEBATE 2016; 27:419-448. [PMID: 28966541 PMCID: PMC5616217 DOI: 10.1080/10511482.2016.1245210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We used the Moving to Opportunity (MTO) housing experiment to inform how housing choice vouchers and housing mobility policies can assist families living in high-poverty areas to make opportunity moves to higher quality neighborhoods, across a wide range of neighborhood attributes. We compared the neighborhood attainment of the three randomly-assigned MTO treatment groups (Low Poverty voucher, Section 8 voucher, Control group) at 1997 and 2002 locations (4-7 years after baseline), by using survey reports, and by linking residential histories to numerous different administrative and population-based datasets. Compared to controls, families in Low-Poverty and Section 8 groups experienced substantial improvements in neighborhood conditions across diverse measures, including economic conditions, social systems (e.g., collective efficacy), physical features of the environment (e.g., tree cover) and health outcomes. The Low-poverty voucher group moreover achieved better neighborhood attainment compared to Section 8. Treatment effects were largest for New York and Los Angeles. We discuss the implications of our findings for expanding affordable housing policy.
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Affiliation(s)
- Quynh C. Nguyen
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah
| | - Dolores Acevedo-Garcia
- Institute for Child, Youth and Family Policy at the Heller School for Social Policy and Management, Brandeis University
| | | | - Theresa L. Osypuk
- Minnesota Population Center, University of Minnesota
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
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40
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Howard VJ, McClure LA, Kleindorfer DO, Cunningham SA, Thrift AG, Diez Roux AV, Howard G. Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites. Neurology 2016; 87:2340-2347. [PMID: 27742815 DOI: 10.1212/wnl.0000000000003299] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/19/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. METHODS The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003-2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. RESULTS After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05-1.56) in quartile 3 to 1.38 (1.13-1.68) in quartile 2 to 1.56 (1.26-1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. CONCLUSIONS Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants.
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Affiliation(s)
- Virginia J Howard
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia.
| | - Leslie A McClure
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Dawn O Kleindorfer
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Solveig A Cunningham
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Amanda G Thrift
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Ana V Diez Roux
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - George Howard
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
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Neighbourhood Deprivation, Individual-Level and Familial-Level Socio-demographic Factors and Risk of Congenital Heart Disease: A Nationwide Study from Sweden. Int J Behav Med 2016; 23:112-20. [PMID: 25929332 DOI: 10.1007/s12529-015-9488-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders. METHODS All children aged 0 to 11 years and living in Sweden (n = 748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level. RESULTS During the study period, among a total of 748,951 children, 1499 (0.2%) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95% confidence interval (CI) = 1.04-1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR = 3.03; maternal hypertension, OR = 2.01), and family history of CHD (OR = 3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR = 1.20, 95% CI = 0.99-1.45, p = 0.057). CONCLUSIONS This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.
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Diez Roux AV, Mujahid MS, Hirsch JA, Moore K, Moore LV. The Impact of Neighborhoods on CV Risk. Glob Heart 2016; 11:353-363. [PMID: 27741982 PMCID: PMC5098701 DOI: 10.1016/j.gheart.2016.08.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death and a major source of health disparities in the Unites States and globally. Efforts to reduce CVD risk and eliminate cardiovascular health disparities have increasingly emphasized the importance of the social determinants of health. Neighborhood environments have emerged as a possible target for prevention and policy efforts. Hence there is a need to better understand the role of neighborhood environments in shaping cardiovascular risk. The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provided a unique opportunity to build a comprehensive place-based resource for investigations of associations between specific features of neighborhood physical and social environments and cardiovascular risk factors and outcomes. This review summarizes the approaches used to characterize residential neighborhood environments in the MESA cohort, provides an overview of key findings to date, and discusses challenges and opportunities in neighborhood health effects research. Results to date suggest that neighborhood physical and social environments are related to behavioral and biomedical risk factors for CVD and that cardiovascular prevention efforts may benefit from taking neighborhood context into account.
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Affiliation(s)
- Ana V Diez Roux
- Department of Epidemiology and Biostatistics and Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Mahasin S Mujahid
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Jana A Hirsch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kari Moore
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Latetia V Moore
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Yen IH, Scherzer T, Cubbin C, Gonzalez A, Winkleby MA. Women's Perceptions of Neighborhood Resources and Hazards Related to Diet, Physical Activity, and Smoking: Focus Group Results from Economically Distinct Neighborhoods in a Mid-Sized U.S. City. Am J Health Promot 2016; 22:98-106. [DOI: 10.4278/0890-1171-22.2.98] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate women's perceptions of neighborhood resources and hazards associated with poor diet, physical inactivity, and cigarette smoking. Design. After interviewing city officials and analyzing visual assessments, three economically distinct neighborhoods in a mid-sized city were selected. Setting. Salinas, California, a predominantly Latino city. Methods. Eight focus groups, conducted in Spanish or English in the three neighborhoods. Thematic coding of focus group transcripts identified key concepts. Women also mapped their perceived neighborhood boundaries. Participants. Women who had at least one child under age 18 living with them. Results. Women identified food stores, parks, recreation areas, and schools as key resources in their neighborhoods. They identified fast food restaurants, convenience stores, violent crime, gangs, and drug-associated issues as “hazards.” Distinctions between resources and hazards were not always clear cut. For example, parks were sometimes considered dangerous, and fast food restaurants were sometimes considered a convenient and inexpensive way to feed one's family. Women's perceptions of their neighborhood boundaries differed greatly by type of neighborhood—the perceived neighborhood area (in acres) drawn by women in the lower-income neighborhood was one-fourth the size of the area drawn by women in the higher-income neighborhood. Conclusion. This qualitative, exploratory study illustrates how resources and hazards in one's neighborhood cannot be viewed as having solely one dimension—each may influence health behaviors both positively and negatively.
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Affiliation(s)
- Irene H. Yen
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Teresa Scherzer
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Catherine Cubbin
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Alma Gonzalez
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Marilyn A. Winkleby
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
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Calling S, Li X, Kawakami N, Hamano T, Sundquist K. Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up. BMC Public Health 2016; 16:634. [PMID: 27456491 PMCID: PMC4960746 DOI: 10.1186/s12889-016-3293-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources. Methods A nationwide sample of 2 040 826 men and 2 153 426 women aged 35–80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS). Results We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15–1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05–1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Conclusions This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3293-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanna Calling
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Xinjun Li
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Naomi Kawakami
- Waseda Institute of Sport Sciences, Waseda University, Tokorozawa Saitama, Japan
| | - Tsuyoshi Hamano
- Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
| | - Kristina Sundquist
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.,Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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Erickson AC, Ostry A, Chan HM, Arbour L. Air pollution, neighbourhood and maternal-level factors modify the effect of smoking on birth weight: a multilevel analysis in British Columbia, Canada. BMC Public Health 2016; 16:585. [PMID: 27784277 PMCID: PMC5080752 DOI: 10.1186/s12889-016-3273-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/11/2016] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Maternal smoking during pregnancy negatively impacts fetal growth, but the effect is not homogenous across the population. We sought to determine how the relationship between cigarette use and fetal growth is modified by the social and physical environment. Methods Birth records with covariates were obtained from the BC Perinatal Database Registry (N = 232,291). Maternal smoking status was self-reported as the number of cigarettes smoked per day usually at the first prenatal care visit. Census dissemination areas (DAs) were used as neighbourhood-level units and linked to individual births using residential postal codes to assign exposure to particulate air pollution (PM2.5) and neighbourhood-level attributes such as socioeconomic status (SES), proportion of post-secondary education, immigrant density and living in a rural place. Random coefficient models were used with cigarettes/day modeled with a random slope to estimate its between-DA variability and test cross-level interactions with the neighbourhood-level variables on continuous birth weight. Results A significant negative and non-linear association was found between maternal smoking and birth weight. There was significant between-DA intercept variability in birth weight as well as between-DA slope variability of maternal smoking on birth weight of which 68 and 30 % respectively was explained with the inclusion of DA-level variables and their cross-level interactions. High DA-level SES had a strong positive association with birth weight but the effect was moderated with increased cigarettes/day. Conversely, heavy smokers showed the largest increases in birth weight with rising neighbourhood education levels. Increased levels of PM2.5 and immigrant density were negatively associated with birth weight, but showed positive interactions with increased levels of smoking. Older maternal age and suspected drug or alcohol use both had negative interactions with increased levels of maternal smoking. Conclusion Maternal smoking had a negative and non-linear dose-response association with birth weight which was highly variable between neighbourhoods and evidence of effect modification with neighbourhood-level factors. These results suggest that focusing exclusively on individual behaviours may have limited success in improving outcomes without addressing the contextual influences at the neighbourhood-level. Further studies are needed to corroborate our findings and to understand how neighbourhood-level attributes interact with smoking to affect birth outcomes.
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Affiliation(s)
- Anders C Erickson
- Division of Medical Sciences, University of Victoria, Medical Science Bld. Rm-104, University of Victoria, PO Box 1700 STN CSC, Victoria, V8W 2Y2, BC, Canada.,Department of Geography, University of Victoria, David Turpin Bldg. Rm-B203, University of Victoria, PO Box 1700 STN CSC, Victoria, V8W 2Y2, BC, Canada
| | - Aleck Ostry
- Department of Geography, University of Victoria, David Turpin Bldg. Rm-B203, University of Victoria, PO Box 1700 STN CSC, Victoria, V8W 2Y2, BC, Canada
| | - Hing Man Chan
- Center for Advanced Research in Environmental Genomics, University of Ottawa, 20 Marie-Curie, Ottawa, K1N 6 N5, ON, Canada
| | - Laura Arbour
- Division of Medical Sciences, University of Victoria, Medical Science Bld. Rm-104, University of Victoria, PO Box 1700 STN CSC, Victoria, V8W 2Y2, BC, Canada. .,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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Forsberg PO, Li X, Sundquist K. Neighborhood socioeconomic characteristics and statin medication in patients with myocardial infarction: a Swedish nationwide follow-up study. BMC Cardiovasc Disord 2016; 16:146. [PMID: 27391128 PMCID: PMC4938992 DOI: 10.1186/s12872-016-0319-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/08/2016] [Indexed: 11/12/2022] Open
Abstract
Background Coronary heart disease (CHD) and myocardial infarction (MI) are associated with neighborhood-level socioeconomic status (SES). Statins are important drugs for secondary prevention of MI. However, no study has determined whether neighborhood-level SES is associated with statin medication in MI patients. We aimed to determine whether there is a difference in statin medication rate in MI patients across different levels of neighborhood SES. Methods All patients in Sweden, diagnosed with incident MI from January 1st, 2000 until December 31st 2010, were followed (n = 116,840). Of these, 89.7 % received statin medication. Data were analyzed by multilevel logistic regression, with individual-level characteristics (age, marital status, family income, educational attainment, country of origin, urban/rural status and comorbidities/chronic conditions related to MI) as covariates. Results Low neighborhood-level SES was significantly associated with low statin medication rate (Odds Ratio 0.80). In the full model, which took into account individual-level socioeconomic characteristics and MI comorbidities, the odds no longer remained significant. Conclusions Individual-level approaches may be most important in health care policies regarding statin medication in MI patients. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0319-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Per-Ola Forsberg
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, building 28, floor 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
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Unwin N, Hambleton IR. Neighbourhood of residence and the risk of type 2 diabetes. Lancet Diabetes Endocrinol 2016; 4:475-6. [PMID: 27131929 DOI: 10.1016/s2213-8587(16)30056-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Nigel Unwin
- Chronic Disease Research Centre, the University of the West Indies, Barbados; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Ian R Hambleton
- Chronic Disease Research Centre, the University of the West Indies, Barbados
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Kaiser P, Diez Roux AV, Mujahid M, Carnethon M, Bertoni A, Adar SD, Shea S, McClelland R, Lisabeth L. Neighborhood Environments and Incident Hypertension in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2016; 183:988-97. [PMID: 27188946 DOI: 10.1093/aje/kwv296] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022] Open
Abstract
We examined relationships between neighborhood physical and social environments and incidence of hypertension in a cohort of 3,382 adults at 6 sites in the United States over 10 years of follow-up (2000-2011), using data from the Multi-Ethnic Study of Atherosclerosis. The sample was aged 45-84 years (mean = 59 years) and free of clinical cardiovascular disease and hypertension at baseline. Of the participants, 51% were female, 44% white, 23% Hispanic, 21% black, and 13% Chinese-American; 39% of participants developed hypertension during an average of 7.2 years of follow-up. Cox models were used to estimate associations of time-varying cumulative average neighborhood features (survey-based healthy food availability, walking environment, social cohesion, safety, and geographic information system-based density of favorable food stores and recreational resources) with incident hypertension. After adjustment for individual and neighborhood-level covariates, a 1-standard-deviation increase in healthy food availability was associated with a 12% lower rate of hypertension (hazard ratio = 0.88, 95% confidence interval: 0.82, 0.95). Other neighborhood features were not related to incidence of hypertension. The neighborhood food environment is related to the risk of hypertension.
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Robson JC, Kiran A, Maskell J, Hutchings A, Arden N, Dasgupta B, Hamilton W, Emin A, Culliford D, Luqmani R. Which Patients with Giant Cell Arteritis Will Develop Cardiovascular or Cerebrovascular Disease? A Clinical Practice Research Datalink Study. J Rheumatol 2016; 43:1085-92. [DOI: 10.3899/jrheum.151024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 02/07/2023]
Abstract
Objective.To evaluate the risk of cerebrovascular disease and cardiovascular disease (CVD) in patients with giant cell arteritis (GCA), and to identify predictors.Methods.The UK Clinical Practice Research Datalink 1991–2010 was used for a parallel cohort study of 5827 patients with GCA and 37,090 age-, sex-, and location-matched controls. A multivariable competing risk model (non-cerebrovascular/CV-related death as the competing risk) determined the relative risk [subhazard ratio (SHR)] between patients with GCA compared with background controls for cerebrovascular disease, CVD, or either. Each cohort (GCA and controls) was then analyzed individually using the same multivariable model, with age and sex now present, to identify predictors of CVD or cerebrovascular disease.Results.Patients with GCA, compared with controls, had an increased risk SHR (95% CI) of cerebrovascular disease (1.45, 1.31–1.60), CVD (1.49, 1.37–1.62), or either (1.47, 1.37–1.57). In the GCA cohort, predictors of “cerebrovascular disease or CVD” included increasing age, > 80 years versus < 65 years (1.98, 1.62–2.42), male sex (1.20, 1.05–1.38), and socioeconomic status, most deprived quintile versus least deprived (1.34, 1.01–1.78). These predictors were also present within the non-GCA cohort.Conclusion.Patients with GCA are more likely to develop cerebrovascular disease or CVD than age-, sex-, and location-matched controls. In common with the non-GCA cohort, patients who are older, male, and from the most deprived compared with least deprived areas have a higher risk of cerebrovascular disease or CVD. Further work is needed to understand how this risk may be mediated by specific behavioral, social, and economic factors.
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Hamano T, Li X, Tanito M, Nabika T, Shiwaku K, Sundquist J, Sundquist K. Neighborhood Deprivation and Risk of Age-Related Eye Diseases: A Follow-up Study in Sweden. Ophthalmic Epidemiol 2016; 22:308-20. [PMID: 26395658 DOI: 10.3109/09286586.2015.1056537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine whether there is an association between neighborhood deprivation and age-related eye diseases, particularly macular degeneration, cataract, diabetes-related eye complications, and glaucoma. METHODS The study population comprised a nationwide sample of 2,060,887 men and 2,250,851 women aged 40 years or older living in Sweden who were followed from 1 January 2000 until the first hospitalization/outpatient registration for age-related eye disease during the study period, death, emigration, or the end of the study period on 31 December 2010. Multilevel logistic regression was used to estimate the association between neighborhood deprivation and age-related eye diseases. RESULTS In men, the odds ratio (OR) for age-related eye diseases for those living in high-deprivation neighborhoods compared to those living in low-deprivation neighborhoods remained significant after adjustment for potential confounding factors (macular degeneration, OR 1.08, 95% confidence interval [CI] 1.03-1.12; cataract, OR 1.31, 95% CI 1.26-1.35; diabetes-related eye complications, OR 1.36, 95% CI 1.30-1.43; glaucoma, OR 1.11, 95% CI 1.06-1.15). In women, similar patterns were observed (macular degeneration, OR 1.11, 95% CI 1.07-1.15; cataract, OR 1.36, 95% CI 1.31-1.40; diabetes-related eye complications, OR 1.50, 95% CI 1.42-1.59; glaucoma, OR 1.12, 95% CI 1.08-1.17). CONCLUSION Our results suggest that neighborhood deprivation is associated with age-related eye diseases in both men and women. These results implicate that individual- as well as neighborhood-level factors are important for preventing age-related eye diseases.
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Affiliation(s)
- Tsuyoshi Hamano
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan
| | - Xinjun Li
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden
| | - Masaki Tanito
- c Division of Ophthalmology , Matsue Red Cross Hospital , Matsue , Japan
| | - Toru Nabika
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,d Department of Functional Pathology , Shimane University School of Medicine , Izumo , Japan
| | - Kuninori Shiwaku
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,e Department of Environmental and Preventive Medicine , Shimane University School of Medicine , Izumo , Japan , and
| | - Jan Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
| | - Kristina Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
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