Accuracy of self-reported hypertension: Effect of age, gender, and history of alcohol dependence

Validation of self-reported hypertension in young adults in the US-based Growing Up Today Study (GUTS)

BACKGROUND

Self-reporting is often used in large epidemiologic research to identify hypertensive participants, but its validity in young adults has not been sufficiently assessed. We aimed to validate self-reported hypertension diagnosis from questionnaires by using medical records among a sample of young adults aged 22-39 years in the Growing Up Today Study (GUTS), during a time of transition in national hypertension definitions.

METHODS

A sample of 1,000 GUTS participants were asked for permission to access their medical records, to confirm their self-reported hypertension status on questionnaires from 2010 to 2019. Paired self-reported and medical record information was available for 318 participants. Medical records were reviewed by a clinical hypertension specialist. We evaluated agreement, kappa statistic, sensitivity and specificity of self-reporting. We assessed the correlations between blood pressure measurements self-reported on the 2019 questionnaire and those from medical records and compared the measurements using paired t-tests.

RESULTS

The selected sample was generally representative of the full GUTS cohort. Agreement, kappa coefficient, sensitivity and specificity of self-reported hypertension were 85.5%, 0.72, 100%, and 75.3%. Although the absolute differences in blood pressure measurements between self-report and medical records were small (e.g., the average difference in typical recent blood pressures was 3.5/1.2 mm Hg), these measures were only moderately correlated.

CONCLUSIONS

Validity of self-reported hypertension was high in GUTS, ensuring use as an endpoint in future studies with confidence. We demonstrated that young adults likely without formal medical training are able to report hypertension status with reasonable accuracy.

Awareness of Hypertension, Hypercholesterolemia, and Diabetes Mellitus and Associated Characteristics in Russian Adults

Russia has higher cardiovascular disease (CVD) mortality compared to other European countries. The major CVD risk factors are age, male sex, and three conditions, namely hypertension, hypercholesterolemia, and diabetes mellitus (DM). This study aimed to assess awareness of these three conditions among Russian adults (N = 3803) and the associated socio-demographic, lifestyle, and health characteristics. We used cross-sectional data from a randomly drawn population-based sample of Russians aged 35-69 years, who participated in the Know Your Heart (KYH) study conducted in Arkhangelsk and Novosibirsk between 2015-2018. Participants' self-reported awareness of hypertension, hypercholesterolemia, and DM was assessed against the measures at the KYH health check (blood pressure, cholesterol, HbA1c and/or use of medication for each condition). Prevalence estimates for the awareness were age- and sex-standardized to the Standard European Population. Socio-demographic, lifestyle, and health-related correlates of the awareness were investigated using logistic regression modelling. Among participants with hypertension (N = 2206), hypercholesterolemia (N = 3171), and DM (N = 329) recorded at a health check, 79%, 45%, and 61% self-reported these conditions, respectively. Higher awareness of hypercholesterolemia and hypertension was associated with older age, female sex, nonsmoking status, obesity, and history of CVD diagnoses. Low household income and history of CVD diagnoses were associated with being aware of DM. The awareness rates of hypertension were relatively high, whereas awareness rates of hypercholesterolemia and DM were relatively low. CVD prevention and early intervention could be improved in Russia through increasing the awareness of the risk factors.

Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System

Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension).

PURPOSE

Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other.

METHODS

We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables.

RESULTS

One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05).

DISCUSSION

Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).

Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study

OBJECTIVE

Electronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known about their health effects. The aim of the present study was to examine the prospective association between cigarette and ENDS use on self-reported incident hypertension.

DESIGN

Longitudinal cohort study.

SETTING

Nationally representative sample of the civilian, non-institutionalised population in the USA.

PARTICIPANTS

17 539 adults aged 18 or older who participated at follow-up and had no self-reported heart condition or previous diagnosis of hypertension or high cholesterol at baseline.

MEASURES

We constructed a time-varying tobacco exposure, lagged by one wave, defined as no use, exclusive established use (every day or some days) of ENDS or cigarettes, and dual use. We controlled for demographics (age, sex, race/ethnicity and household income), clinical risk factors (family history of heart attack, obesity, diabetes and binge drinking) and smoking history (cigarette pack-years).

OUTCOMES

Self-reported incident hypertension diagnosis.

RESULTS

The self-reported incidence of hypertension was 3.7% between wave 2 and wave 5. At baseline, 18.0% (n=5570) of respondents exclusively smoked cigarettes; 1.1% (n=336) exclusively used ENDS; and 1.7% (n=570) were dual users. In adjusted models, exclusive cigarette use was associated with an increased risk of self-reported incident hypertension compared with non-use (adjusted HR (aHR) 1.21, 95% CI 1.06 to 1.38), while exclusive ENDS use (aHR 1.00, 95% CI 0.68 to 1.47) and dual use (aHR 1.15, 95% CI 0.87 to 1.52) were not.

CONCLUSIONS

We found that smoking increased the risk of self-reported hypertension, but ENDS use did not. These results highlight the importance of using prospective longitudinal data to examine the health effects of ENDS use.

Psychotic-like experiences are associated with physical disorders in general population: A cross-sectional study from the NESARC II

BACKGROUND

Psychotic-like experiences (PLEs) constitute subthreshold symptoms of psychotic disorders, and belong to five distinct dimensions: Positive, Negative, Depressive, Mania and Disorganization. PLEs are associated with various psychiatric disorders. However, few studies examined their association with physical disorders.

OBJECTIVE

Our aims were (1) to assess the associations between various physical disorders and PLEs in a U.S. representative sample, and (2) to examine these associations according to the five dimensions of PLEs.

METHOD

We used data from the wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II), a large national sample representative of the US population (N = 34,653). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule 4. Twenty-two PLEs were examined. Lifetime prevalence and adjusted Odds-Ratio (aOR) reflecting the association of sixteen physical disorders (including notably metabolic conditions and heart diseases) with PLEs were calculated.

RESULTS

All studied physical disorders were associated with the presence of PLEs. Particularly the presence of any physical condition, any heart disease and diabetes were more frequent in participants with at least one PLE compared with the group without any PLE (aOR = 1.74, 95% CI = 1.62-1.87, aOR = 1.44, 95% CI = 1.33-1.55 and aOR = 1.38, 95% CI = 1.24-1.54, respectively). Almost all physical disorders were associated with the five dimensions of PLEs.

CONCLUSIONS

PLEs were associated with a large range of physical disorders, with a gradual dose effect. To assess PLEs in the general population could help with the screening of subjects with physical disorders.

Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

Factors influencing COVID-19 Infection in older individuals: History of Alcohol Use Disorder, Major Depressive illness, genetic variation and current use of alcohol

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic continues to be a major public health problem. Vulnerable populations include older individuals with presumed weakening of the immune response. Identification of factors influencing COVID-19 infection could provide an additional means for protecting such individuals.

Methods

Members of a family study previously interviewed as middle aged individuals were re-contacted and asked to participate in extended phone interview (2-3 hours) covering past and current mental health issues, physical health diagnoses, use of alcohol and drugs, and exposure to anyone with COVID-19. The average follow-up period was 32 years. Detailed medication use was collected to confirm medical diagnoses and to reveal possible protective effects of particular drug classes currently prescribed for the participant by their physician. Serology was available for red cell antigens (ABO, Kell, Duffy, Kidd, Rhesus) and HLA subtypes. Analyses were conducted to contrast COVID-19 + and COVID-19 - individuals for physical and mental health diagnoses, use of alcohol and drugs, and red cell and HLA serology. Additionally, analyses were conducted to contrast these groups with a group reporting known exposure but absence of COVID-19 symptoms or diagnosis by a health professional.

Results

Interviews were completed between September 2020 and November 2021. A total of 42 of the 90 individuals interviewed had been vaccinated at the time of interview. At the time of interview, 11.1% reported having developed COVID-19.Using quantity per occasion (QPO) and quantity by frequency (QXF) totals in the past month by type of alcohol consumed, we found a significant association between QPO for liquor (p=0.017) and marginal effects for QXF for liquor consumption (p=0.06). Exposed individuals who were COVID-19 negative tended to drink more liquor than those who were positive, an average of about one drink per day. Beer and wine consumption were not statistically significant. A diagnosis of alcohol use disorder at baseline evaluation was not a significant predictor of being COVID positive or negative.Self-reported current depression or depression in the past only was not a predictor of COVID-19 status based on a single question "Are you depressed currently or only in the past?". In contrast, completion of a clinical interview designed to elicit depressed mood and concurrent symptoms for determination of the lifetime presence or absence of a depressive episode did reveal a significant effect. Comparison of responses at baseline to follow-up showed those most resilient to developing COVID-19 were those without evidence of a depressive episode by lifetime history at both points in time.Physical health issues were analyzed for those that were frequently occurring in our sample such as hypertension but not found to be significant. BMI was analyzed and found to be statistically non-significant.Analysis of HLA variation across the whole sample did not reveal a significant association but among males two variants, A1 and B8, did show significant variation associated with COVID-19+ and COVID-19- status. Analyses of the red cell antigens revealed one significant red cell effect; Kidd genotypic variation was associated with COVID-19 status.

Interpretation

We tentatively conclude that use of specific types of alcohol, namely liquor, is associated with reduced frequency of COVID-19. However, the amount is low, averaging about 1 drink per day. Enlarged samples are needed to confirm these results. The finding that past history of alcohol use disorder does not increase likelihood of developing COVID-19 is important. It should be noted that the 34 individuals diagnosed with AUD at baseline had survived an average of 32 years in order to participate in the current interview suggesting they may be especially resilient to adverse health conditions. The finding that a single question designed to elicit the presence or absence of depressed mood either currently or in the past was not a risk factor for COVID-19 in contrast to report of a clinically significant past history of a depressive episode based on more extensive examination using DSM criteria is important. Results for the KIDD blood group are novel and warrant further investigation.