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Ciantar J, Marttila S, Rajić S, Kostiniuk D, Mishra PP, Lyytikäinen LP, Mononen N, Kleber ME, März W, Kähönen M, Raitakari O, Lehtimäki T, Raitoharju E. Identification and functional characterisation of DNA methylation differences between East- and West-originating Finns. Epigenetics 2024; 19:2397297. [PMID: 39217505 PMCID: PMC11382697 DOI: 10.1080/15592294.2024.2397297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Eastern and Western Finns show a striking difference in coronary heart disease-related mortality; genetics is a known contributor for this discrepancy. Here, we discuss the potential role of DNA methylation in mediating the discrepancy in cardiometabolic disease-risk phenotypes between the sub-populations. We used data from the Young Finns Study (n = 969) to compare the genome-wide DNA methylation levels of East- and West-originating Finns. We identified 21 differentially methylated loci (FDR < 0.05; Δβ >2.5%) and 7 regions (smoothed FDR < 0.05; CpGs ≥ 5). Methylation at all loci and regions associates with genetic variants (p < 5 × 10-8). Independently of genetics, methylation at 11 loci and 4 regions associates with transcript expression, including genes encoding zinc finger proteins. Similarly, methylation at 5 loci and 4 regions associates with cardiometabolic disease-risk phenotypes including triglycerides, glucose, cholesterol, as well as insulin treatment. This analysis was also performed in LURIC (n = 2371), a German cardiovascular patient cohort, and results replicated for the association of methylation at cg26740318 and DMR_11p15 with diabetes-related phenotypes and methylation at DMR_22q13 with triglyceride levels. Our results indicate that DNA methylation differences between East and West Finns may have a functional role in mediating the cardiometabolic disease discrepancy between the sub-populations.
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Affiliation(s)
- Joanna Ciantar
- Molecular Epidemiology (MOLE), Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Saara Marttila
- Molecular Epidemiology (MOLE), Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Gerontology Research Center, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
| | - Sonja Rajić
- Molecular Epidemiology (MOLE), Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Daria Kostiniuk
- Molecular Epidemiology (MOLE), Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Tays Research Services, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Tays Research Services, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Tays Research Services, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, Heidelberg University, Mannheim, Germany
- SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, Heidelberg University, Mannheim, Germany
- Synlab Academy, SYNLAB Holding Deutschland GmbH, Mannheim, Germany
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Tays Research Services, Fimlab Laboratories, and Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Emma Raitoharju
- Molecular Epidemiology (MOLE), Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
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Martin-Fernandez J, Alonso-Safont T, Gestri-Mora PE, Polentinos-Castro E, Rodríguez-Martínez G, Bilbao A, del Cura-Gonzalez MI. Association of socioeconomic status with prognosis in hypertensive patients over age 65: a cohort study in the community setting. BMJ Open 2024; 14:e075188. [PMID: 39209777 PMCID: PMC11367320 DOI: 10.1136/bmjopen-2023-075188] [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: 04/28/2023] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To examine whether socioeconomic status is associated with prognosis after the diagnosis of hypertension (HTN), in a population older than 65 years, in the community setting. DESIGN Retrospective cohort study. SETTING All the primary care centres of the Community of Madrid (n=392). PARTICIPANTS All patients (>65 years) with a new diagnosis of HTN in 2007-08, without previous kidney or cardiovascular (K/CV) events (n=21 754).Patient records from primary care electronic health records and Spanish mortality database were analysed from January 2007 through December 2018. Sociodemographic data such as age, gender, Area Deprivation Index (MEDEA-Mortalidad en áreas pequeñas Españolas y Desigualdades Socioeconómicas y Ambientales-Index in quintiles), and characteristics, such as smoking, type 2 diabetes mellitus and hypercholesterolaemia, were collected at the time of enrolment. PRIMARY AND SECONDARY OUTCOME MEASURES The occurrence of K/CV events (including mortality from these causes) and total mortality were evaluated using Cox regression. RESULTS Patients had a mean age of 73.5 (SD 6.5) years, and 63.5% were women. The median follow-up was 128.7 months (IQR: 110.6-136.7 months). There were 10 648 first K/CV events, including 1508 deaths from these causes and 4273 deaths from other causes. Adjusted for age, gender, smoking, diabetes and hypercholesterolaemia, when comparing the third, fourth and last quintiles (less affluent) of the Deprivation Index with respect to the first quintile, the hazard of K/CV events increased by 14.8% (95% CI: 3.3 to 27.6%), 16.0% (95% CI: 6.4 to 26.4%) and 19.1% (95% CI: 8.9 to 30.2%), respectively. The MEDEA Index was not associated with differences in adjusted total mortality. CONCLUSION Living in a low socioeconomic status area is associated with an increase in kidney or cardiovascular events in hypertensive patients diagnosed after age 65 years, which will result in a significant increase in disease burden even if not related to an increase in total mortality.
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Affiliation(s)
- Jesus Martin-Fernandez
- UDM Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos - Campus de Alcorcon, Alcorcon, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Tamara Alonso-Safont
- Dirección Técnica de Sistemas de Información, Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
- Universidad Rey Juan Carlos - Campus de Alcorcon, Alcorcon, Spain
| | | | - Elena Polentinos-Castro
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos - Campus de Alcorcon, Alcorcon, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
- Unidad de Investigación de Atención Primaria, Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
| | - Gemma Rodríguez-Martínez
- Consultorio Infante Don Luis, Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
| | - Amaia Bilbao
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
- Hospital Universitario Basurto, Bilbao, Spain
- Biosistemak. Instituto de Investigación en Sistemas de Salud, Baracaldo, Spain
| | - Mª Isabel del Cura-Gonzalez
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos - Campus de Alcorcon, Alcorcon, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
- Unidad de Investigación de Atención Primaria, Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
- Ageing Research Center, Karolinska Institute, Stockholm, Sweden
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Beks H, Walsh SM, Wood S, Clayden S, Alston L, Coffee NT, Versace VL. Application of the Australian Bureau of Statistics Socio-Economic Indexes for Areas in cardiovascular disease research: a scoping review identifying implications for research. AUST HEALTH REV 2024; 48:414-454. [PMID: 38616107 DOI: 10.1071/ah23239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Objective To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods The Joanna Briggs Institute's scoping review methodology was used. Results The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Sandra M Walsh
- Department of Rural Health, University of South Australia, Whyalla, SA, Australia
| | - Sarah Wood
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Suzanne Clayden
- Specialist Physicians Clinic, Southwest Healthcare, Warrnambool, Vic., Australia
| | | | - Neil T Coffee
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
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Wilder B, Pinedo A, Abusin S, Ansell D, Bacong AM, Calvin J, Cha SW, Doukky R, Hasan F, Luo S, Oktay AA, Palaniappan L, Rana N, Rivera FB, Fayaz B, Suliman AA, Volgman AS. A Global Perspective on Socioeconomic Determinants of Cardiovascular Health. Can J Cardiol 2024:S0828-282X(24)00583-X. [PMID: 39095016 DOI: 10.1016/j.cjca.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in the world. From 2005 to 2008, the World Health Organization (WHO) planned an initiative to reduce the mortality rate of CVD by 2030 by addressing health, finance, transport, education, and agriculture in these communities. Plans were underway by many countries to meet the goals of the WHO initiative. However, in 2020, the COVID-19 pandemic derailed these goals, and many health systems suffered as the world battled the viral pandemic. The pandemic made health inequities even more prominent and necessitated a different approach to understanding and improving the socioeconomic determinants of health (SDOH). WHO initiated a special initiative to improve SDOH globally. This paper is an update on what other regions across the globe are doing to decrease, more specifically, the impact of socioeconomic determinants of cardiovascular health. Our review highlights how countries and regions such as Canada, the United States, India, Southeast Asia, the Middle East, and Africa are uniquely affected by various socioeconomic factors and how these countries are attempting to counter these obstacles by creating policies and protocols to facilitate an infrastructure that promotes screening and treatment of CVD. Ultimately, interventions directed toward populations that have been economically and socially marginalized may aid in reducing the disease and financial burden associated with CVD.
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Affiliation(s)
- Bart Wilder
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Pinedo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Salaheldin Abusin
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - David Ansell
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Adrian Matias Bacong
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA; Stanford Center for Asian Health Research and Education (CARE), Stanford University, Palo Alto, California, USA
| | - James Calvin
- Stanford Center for Asian Health Research and Education (CARE), Stanford University, Palo Alto, California, USA; Department of Medicine, Western University, London, Ontario, Canada
| | | | - Rami Doukky
- Division of Cardiology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Faisal Hasan
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shengyuan Luo
- Section of Cardiology, Department of Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Ahmet Afşin Oktay
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Latha Palaniappan
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Natasha Rana
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Basmah Fayaz
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Annabelle Santos Volgman
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
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Lu F, Wong CKH, Ng APP, Li L, Fong DYT, Ip P, Tse ETY, Lam CLK. Effectiveness of a 5-year health empowerment programme on promoting cardiovascular health for adults from low-income families in Hong Kong. PATIENT EDUCATION AND COUNSELING 2024; 124:108240. [PMID: 38547639 DOI: 10.1016/j.pec.2024.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a health empowerment programme (HEP) to enhance cardiovascular health for adults from low-income families. METHODS A prospective cohort study (N = 219, Intervention group: n = 103, comparison group: n = 116) was conducted with participants recruited from January 2013 to November 2015 and followed up until January 2022. Throughout the study duration, intervention group were invited to participate in the HEP. The cardiovascular health status of both groups at baseline and follow-up were assessed using the adapted Ideal Cardiovascular Health Index (ICHI) defined by the American Heart Association. After inverse propensity score weighting, multiple linear regression and Poisson regression were employed to examine the effects of the HEP. RESULTS The HEP was associated with a greater increase in ICHI total score (B = 0.33, p < 0.001), and the increase of proportion of people achieving a normal blood pressure (Incidence rate ratio: 3.39, p < 0.05). CONCLUSION HEP can be an effective and sustainable strategy to reduce social disparities in cardiovascular health of adults from low-income families, as indicated by improvement in the ICHI total score and blood pressure status. PRACTICAL IMPLICATIONS The sustainable HEP in the community setting has potential for generalizability and scalability to other financially challenged families.
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Affiliation(s)
- Fangcao Lu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lanlan Li
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Satti DI, Chan JSK, Dee EC, Lee YHA, Wai AKC, Dani SS, Virani SS, Shapiro MD, Sharma G, Liu T, Tse G. Associations Between Social Determinants of Health and Cardiovascular Health of U.S. Adult Cancer Survivors. JACC CardioOncol 2024; 6:439-450. [PMID: 38983373 PMCID: PMC11229543 DOI: 10.1016/j.jaccao.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/11/2024] Open
Abstract
Background Relationships between the social determinants of health (SDOH) and cardiovascular health (CVH) of cancer survivors are underexplored. Objectives This study sought to investigate associations between the SDOH and CVH of adult cancer survivors. Methods Data from the U.S. National Health Interview Survey (2013-2017) were used. Participants reporting a history of cancer were included, excluding those with only nonmelanotic skin cancer, or with missing data for any domain of SDOH or CVH. SDOH was quantified with a 6-domain, 38-item score, consistent with the Centers for Disease Control and Prevention recommendations (higher score indicated worse deprivation). CVH was quantified based on the American Heart Association's Life's Essential 8, but due to unavailable detailed dietary data, a 7-item CVH score was used, with a higher score indicating worse CVH. Survey-specific multivariable Poisson regression was used to test associations between SDOH quartiles and CVH. Results Altogether, 8,254 subjects were analyzed, representing a population of 10,887,989 persons. Worse SDOH was associated with worse CVH (highest vs lowest quartile: risk ratio 1.30; 95% CI: 1.25-1.35; P < 0.001), with a grossly linear relationship between SDOH and CVH scores. Subgroup analysis found significantly stronger associations in younger participants (P interaction = 0.026) or women (P interaction = 0.001) but without significant interactions with race (P interaction = 0.051). Higher scores in all domains of SDOH were independently associated with worse CVH (all P < 0.001). Higher SDOH scores were also independently associated with each component of the CVH score (all P < 0.05 for highest SDOH quartile). Conclusions An unfavorable SDOH profile was independently associated with worse CVH among adult cancer survivors in the United States.
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Affiliation(s)
- Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong SAR
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong SAR
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong SAR
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Comparative Effective Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Garima Sharma
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR
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Tremblay JO, Nahodyl L, Mesa RA, Vilchez L, Elfassy T. Low income and education are associated with greater ASCVD risk scores among adults in the US. Prev Med Rep 2024; 41:102720. [PMID: 38623580 PMCID: PMC11017042 DOI: 10.1016/j.pmedr.2024.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Social determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults. Methods Utilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999-2018 and included participants aged 40-79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design. Results Mean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K-<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K-<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education. Conclusion We found strong graded associations between lower income and lower educational attainment with greater CVD risk.
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Affiliation(s)
- Julien O. Tremblay
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Nahodyl
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Robert A. Mesa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lilliana Vilchez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tali Elfassy
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
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Chan JSK, Chan RNC, Lee YHA, Satti DI, Dee EC, Ng K, Achim A, Ng CF, Liu T, Matthews GDK, Tse G, Vassiliou VS. Cardiovascular health of patients with cancer: Challenges abound. Trends Cardiovasc Med 2024:S1050-1738(24)00036-7. [PMID: 38657744 DOI: 10.1016/j.tcm.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Patients with cancer have elevated cardiovascular risks compared to those without cancer. As cancer incidence increases and cancer-related mortality decreases, cardiovascular diseases in patients with a history of cancer will become increasingly important. This in turn is reflected by the exponentially increasing amount of cardio-oncology research in recent years. This narrative review aims to summarize the key existing literature in several main areas of cardio-oncology, including the epidemiology, natural history, prevention, management, and determinants of the cardiovascular health of patients with cancer, and identify relevant gaps in evidence for further research.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Raymond Ngai Chiu Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenrick Ng
- Department of Medical Oncology, Barts Cancer Centre, London, UK
| | - Alexandru Achim
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary; Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Gareth D K Matthews
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China; Kent and Medway Medical School, Canterbury, Kent CT2 7NT, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, PR China.
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
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Pasokh Z, Seif M, Ghaem H, Rezaianzadeh A, Johari MG. Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study. Health Sci Rep 2024; 7:e2042. [PMID: 38650726 PMCID: PMC11033488 DOI: 10.1002/hsr2.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases. Methods This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount. Results The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034). Conclusions In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.
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Affiliation(s)
- Zahra Pasokh
- Student Research Committee, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Mozhgan Seif
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Haleh Ghaem
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Masoumeh Ghoddusi Johari
- Breast Diseases Research Center, Community Medicine DepartmentShiraz University of Medical SciencesShirazIran
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Kumar A, Iqbal K, Shariff M, Majmundar M, Kalra A. Social associations and cardiovascular mortality in the United States counties, 2016 to 2020. BMC Cardiovasc Disord 2024; 24:127. [PMID: 38408898 PMCID: PMC10898153 DOI: 10.1186/s12872-024-03749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The positive aspects of social interaction on health have been described often, with considerably less attention to their negative aspect. This study aimed to assess the impact of social associations on cardiovascular mortality in the United States. METHODS The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data sets from 2016 to 2020 were used to identify death records due to cardiovascular disease in the United States population aged 15 years and older. The social association rate defined as membership associations per 10,000 population, accessed from the 2020 County Health Rankings data was used as a surrogate for social participation. All United States counties were grouped into quartiles based on their social association rate; Q1 being the lowest quartile of social association, and Q4 the highest quartile. Age-adjusted mortality rate (AAMR) was calculated for each quartile. County health factor rankings for the state of Texas were used to adjust the AAMR for baseline comorbidities of county population, using Gaussian distribution linear regression. RESULTS Overall, the AAMR was highest in the 4th social association rate quartile (306.73 [95% CI, 305.72-307.74]) and lowest in the 1st social association rate quartile (266.80 [95% CI, 266.41-267.20]). The mortality rates increased in a linear pattern from lowest to highest social association rate quartiles. After adjustment for the county health factor ranks of Texas, higher social association rate remained associated with a significantly higher AAMR (coefficient 15.84 [95% CI, 12.78-18.89]). CONCLUSIONS Our study reported higher cardiovascular AAMR with higher social associations in the United States, with similar results after adjustment for County Health Rankings in the state of Texas.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariam Shariff
- Department of Surgery, Mayo Clinic, Rochester, Minneapolis, USA
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Hu M, Yang T, Yang Y. Causal Associations of Education Level With Cardiovascular Diseases, Cardiovascular Biomarkers, and Socioeconomic Factors. Am J Cardiol 2024; 213:76-85. [PMID: 38199144 DOI: 10.1016/j.amjcard.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 06/11/2023] [Indexed: 01/12/2024]
Abstract
An inverse association of education level with cardiovascular diseases has been documented in observational studies, yet the causality and potential mechanisms remain to be determined. To systematically investigate the causal associations of education level with cardiovascular diseases, cardiovascular biomarkers, and socioeconomic factors, a 2-sample Mendelian randomization was performed. The results revealed that higher genetically determined education level was associated with lower risks of type 2 diabetes mellitus (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.47 to 0.61, p = 3.04 × 10-23), peripheral artery disease (OR 0.62, 95% CI 0.51 to 0.76, p = 2.14 × 10-06), hypertension (OR 0.62, 95% CI 0.56 to 0.70, p = 4.22 × 10-16), coronary heart disease (OR 0.62, 95% CI 0.56 to 0.69, p = 3.50 × 10-19), myocardial infarction (OR 0.62, 95% CI 0.55 to 0.69, p = 2.58 × 10-16), ischemic stroke (OR 0.67, 95% CI 0.62 to 0.74, p = 6.00 × 10-19), deep vein thrombosis (OR 0.69, 95% CI 0.55 to 0.87, p = 0.0017), atrial fibrillation (OR 0.70, 95% CI 0.57 to 0.86, p = 0.0007), cardiac death (OR 0.71, 95% CI 0.60 to 0.86, p = 0.0003), heart failure (OR 0.72, 95% CI 0.65 to 0.79, p = 6.37 × 10-12), transient ischemic attack (OR 0.76, 95% CI 0.64 to 0.90, p = 0.0010), and venous thromboembolism (OR 0.79, 95% CI 0.67 to 0.92, p = 0.0028). Systolic blood pressure, diastolic blood pressure, C-reactive protein, body mass index, waist circumference, and triglycerides were decreased, whereas telomere length was increased. Subjects with higher education were less likely to smoke, intake salt, or be exposed to air pollution and depression state. They were more likely to take physical activity and possess more household income. In conclusion, higher education may causally decrease cardiovascular diseases through socioeconomic factors and cardiovascular biomarkers. Reducing education inequality is important in the management of cardiovascular diseases.
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Affiliation(s)
- Mengjin Hu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Magnani JW, Ning H, Wilkins JT, Lloyd-Jones DM, Allen NB. Educational Attainment and Lifetime Risk of Cardiovascular Disease. JAMA Cardiol 2024; 9:45-54. [PMID: 37910110 PMCID: PMC10620672 DOI: 10.1001/jamacardio.2023.3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Importance Education is a social determinant of health. Quantifying its association with lifetime cardiovascular disease (CVD) risk has public health importance. Objective To calculate lifetime risk estimates of incident CVD and CVD subtypes and estimate years lived with and without CVD by education. Design, Setting, and Participants Included community-based cohort studies with adjudicated cardiovascular events used pooled individual-level data from 1985 to 2015 of 6 prospective cohort studies. The study team assessed the association between education and lifetime CVD risk with modified Kaplan-Meier and Cox models accounting for competing risk of noncardiovascular death. The study team estimated years lived with and without CVD by education with the Irwin restricted mean and the utility of adding educational attainment to CVD risk assessment. Participants (baseline 40 to 59 years old and 60 to 79 years old) were without CVD at baseline and had complete education, cardiovascular risk factors, and prospective CVD outcomes data. Data were analyzed from January 2022 to September 2022. Exposures Educational attainment (less than high school, high school completion, some college, or college graduate). Main outcome and measures Cardiovascular events (fatal and nonfatal coronary heart disease, heart failure, and stroke; CVD-related deaths; and total CVD encompassing any of these events). Results There were 40 998 participants (23 305 female [56.2%]) with a mean (SD) age of 58.1 (9.7) years for males and 58.3 (9.9) years for females. Compared with college graduates, those with less than high school or high school completion had higher lifetime CVD risks. Among middle-aged men, the competing hazard ratios (HRs) for a CVD event were 1.58 (95% CI, 1.38-1.80), 1.30 (95% CI, 1.10-1.46), and 1.16 (95% CI, 1.00-1.34) in those with less than high school, high school, and some college, respectively, compared with those with college completion. Among women, these competing HRs were 1.70 (95% CI, 1.49-1.95), 1.19 (95% CI, 1.05-1.35), and 0.98 (95% CI, 0.83-1.15). Individuals with higher education had longer duration of life prior to incident CVD. Education provided limited contribution toward enhancing CVD risk prediction. Conclusions and relevance Lower education was associated with lifetime CVD risk across adulthood; higher education translated to healthy longevity. Educational policy initiatives may associate with long-term health benefits.
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Affiliation(s)
- Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T. Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Hjern A, Brannstrom L, Vinnerljung B, Batty GD. WITHDRAWN: Cardiovascular disease in individuals with a history of out-of-home care: a Swedish national cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.20.23284828. [PMID: 36711699 PMCID: PMC9882626 DOI: 10.1101/2023.01.20.23284828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The authors have withdrawn their manuscript owing to errors apparent in the results. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
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Yamada M, Sekine M, Tatsuse T. Prevalence of coronary heart disease and its risk factors by working environment among Japanese male workers. INDUSTRIAL HEALTH 2023; 61:395-405. [PMID: 36261338 PMCID: PMC10731413 DOI: 10.2486/indhealth.2022-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Work is a major social determinant of health. We conducted a cross-sectional study to explore the association between coronary heart disease (CHD), its risk factors, and the working environment among Japanese male workers. We collected data from 10,572 workers (mean age 49.9 yr) who underwent annual medical check-ups in Toyama, Japan, in 2016. This study included data from health check-ups and questionnaires on medical history of CHD, hypertension, and diabetes, and the use of medication. The working environment included company size and industry categories. Company size was classified into 4 categories according to the number of full-time workers (1-20, 21-100, 101-300, 301-). The industry category was classified into 10 categories. Logistic regression analysis was performed to explore the association. In total, 1.5% of patients had a history of CHD and 31.5% and 11.0% of participants were suffering from hypertension and diabetes, respectively. Compared to workers in a large company, those in a smaller company were more likely to have CHD. Moreover, there was a significant association between CHD's risk factors and working in the transportation industry. Health providers, including medical doctors, should consider employee working environment as a potential risk factor for CHD.
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Affiliation(s)
- Masaaki Yamada
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Japan
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Japan
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Japan
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Fullin K, Keen S, Harris K, Magnani JW. Impact of Neighborhood on Cardiovascular Health: A Contemporary Narrative Review. Curr Cardiol Rep 2023; 25:1015-1027. [PMID: 37450260 DOI: 10.1007/s11886-023-01919-1] [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] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW This review summarizes approaches towards neighborhood characterization in relation to cardiovascular health; contemporary investigations relating neighborhood factors to cardiovascular risk and disease; and initiatives to support community-based interventions to address neighborhood-based social determinants related to cardiovascular health. RECENT FINDINGS Neighborhoods may be characterized by Census-derived measures, geospatial data, historical databases, and metrics that incorporate data from electronic medical records and health information exchange databases. Current research has examined neighborhood determinants spanning racial segregation, access to healthcare and food, educational opportunities, physical and built environment, and social environment, and their relations to cardiovascular health and associated outcomes. Community-based interventions have potential to alleviate health disparities but remain limited by implementation challenges. Consideration of neighborhood context is essential in the design of interventions to prevent cardiovascular disease (CVD) and promote health equity. Partnership with community stakeholders may enhance implementation of programs addressing neighborhood-based health determinants.
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Affiliation(s)
- Kerianne Fullin
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Susan Keen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathryn Harris
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jared W Magnani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Center for Research On Health Care, Department of Medicine, University of Pittsburgh, 3609 Forbes Avenue, Second Floor, Pittsburgh, PA, 15213, USA.
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Huang J, He Z, Xu M, Du J, Zhao YT. Socioeconomic status may affect association of vegetable intake with risk of ischemic cardio-cerebral vascular disease: a Mendelian randomization study. Front Nutr 2023; 10:1161175. [PMID: 37599701 PMCID: PMC10436213 DOI: 10.3389/fnut.2023.1161175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Previous studies found that increasing vegetable intake benefits are reduced after adjustment for socioeconomic factors. Using genetic variation as an instrumental variable for vegetable intake and socioeconomic status, we investigated the relationship between vegetable intake and ischemic cardio-cerebral vascular diseases and focused on whether socioeconomic status was a possible confounder. Methods From three independent genome-wide association studies, we extracted instrumental variables reflecting raw and cooked vegetable intake, which were used to perform Mendelian randomization analysis. To evaluate the effects of socioeconomic factors on vegetable intake, univariate and multivariate Mendelian randomization analyses were performed using single nucleotide polymorphisms representing education attainment and household income reported in the literature. We also performed outlier assessment and a series of sensitivity analyses to confirm the results. Results Genetically predicted raw and cooked vegetable intake were not associated with any ischemic cardio-cerebral vascular diseases and lipid components after Bonferroni correction. Univariate Mendelian randomized analysis revealed that raw vegetable intake was positively correlated with education attainment (β = 0.04, p = 0.029) and household income (β = 0.07, p < 0.001). Multivariate Mendelian randomized model showed a positive correlation between household income and raw vegetable intake (β = 0.06, p = 0.004). Socioeconomic status was closely associated with eating habits and lifestyle related to the risk of cardiovascular diseases. Conclusion Genetically determined raw and cooked vegetable intake was not associated with significant benefits in terms of ischemic cardio-cerebral vascular diseases while genetically determined socioeconomic status may have an impact on vegetable intake. Socioeconomic status, which was closely associated with other eating habits and lifestyle, may affect the association between vegetable intake and ischemic cardio-cerebral vascular diseases.
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Affiliation(s)
- Jiutian Huang
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ziyi He
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Minhui Xu
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jianing Du
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yun-tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
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Vallée A. Association between socio-economic status and estimated atherosclerotic cardiovascular disease risk: results from a middle-aged population-based study. Public Health 2023; 221:1-9. [PMID: 37331308 DOI: 10.1016/j.puhe.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The association between cardiovascular disease (CVD) risk and socio-economic status (SES) remains poorly studied. The purpose of this study was to investigate the relationship between SES and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among the general UK Biobank population. STUDY DESIGN This was a population-based study. METHODS Among 311,928 volunteers (47.7% men) of the UK Biobank population, SES was assessed by a questionnaire, and ASCVD risk was calculated using pooled cohort equation models. Associations between SES and ASCVD risk were estimated using multiple gender-specific regressions. RESULTS The findings from this study showed that men had higher estimated 10-year ASCVD risk than women (8.6% vs 2.7%; P < 0.001), higher education level (38.3% vs 36.2%; P < 0.001), higher income level (31.0% vs 25.1%; P < 0.001), higher levels of employment (65.4% vs 60.5%; P < 0.001) and higher scores of Townsend deprivation (P < 0.001). Using the multiple logistic regression model, a decreased 10-year ASCVD risk in men was associated with high income level (odds ratio [OR] = 0.64 [95% confidence interval {CI} 0.61-0.68]; P < 0.001), high educational level (OR = 0.71 [95% CI 0.68-0.74]; P < 0.001), higher Townsend deprivation quintile (OR = 0.81 [95% CI 0.78-0.85]; P < 0.001) and employed status (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001). The same results were observed in women, with high income level (OR = 0.68 [95% CI 0.55-0.68]; P < 0.001), high educational level (OR = 0.87 [95% CI 0.82-0.93]; P < 0.001), higher Townsend deprivation quintile (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001) and employed status (OR = 0.53 [95% CI 0.45-0.63]; P < 0.001) being associated with a lower 10-year ASCVD risk. When considering the false discovery rate logworth analysis, SES factors presented a similar contribution to CVD risk as lifestyle factors. CONCLUSIONS Health policies should consider the SES factors identified in this study, in addition to traditional risk factors, when designing prevention campaigns for CVD. Further research is required to improve the ASCVD risk prediction models among different SES variables.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Foch Hospital, Suresnes, 92150, France.
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Muthalaly RG, Nelson AJ, Baradi A, Mehta OH, Wilson AM, Nasis A. Socioeconomic determinants of health, traditional risk factors and cardiovascular outcomes in Australia. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200184. [PMID: 37131952 PMCID: PMC10149219 DOI: 10.1016/j.ijcrp.2023.200184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/04/2023] [Accepted: 03/28/2023] [Indexed: 05/04/2023]
Abstract
Background Cardiovascular disease burden is decreasing, but these reductions have not been distributed equally amongst socioeconomic groups. Objectives The aim of this study was to define the relationships between different domains of socioeconomic health, traditional cardiovascular risk factors and cardiovascular events. Methods This was a cross-sectional study of local government areas (LGAs) in Victoria, Australia. We used data from a population health survey combined with cardiovascular event data derived from hospital and government data. Four socioeconomic domains: educational attainment, financial wellbeing, remoteness, and psychosocial health, were generated from 22 variables. The primary outcome was a composite of non-STEMI, STEMI, heart failure and cardiovascular deaths per 10,000 persons. Linear regression and cluster analysis were used to assess the relationships between risk factors and events. Results Across 79 LGAs there were 33,654 interviews conducted. All socioeconomic domains were associated with burden of traditional risk factors, including hypertension, smoking, poor diet, diabetes, and obesity. Financial wellbeing, educational attainment and remoteness were all correlated with cardiovascular events on univariate analysis. After multivariate adjustment for age and sex, financial wellbeing, psychosocial wellbeing, and remoteness were associated with cardiovascular events, while educational attainment was not. After including traditional risk factors only financial wellbeing and remoteness remained correlated with cardiovascular events. Conclusions Financial wellbeing and remoteness independently be associated with cardiovascular events, while educational attainment and psychosocial wellbeing are attenuated by traditional cardiovascular risk factors. Poor socioeconomic health is clustered in certain areas, which have high cardiovascular event rates.
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Affiliation(s)
- Rahul G. Muthalaly
- SaferCare Victoria, Department of Health and Human Services, Victoria, Australia
- Monash Heart, Clayton, Victoria, Australia
- Corresponding author. Monash Heart, 246 Clayton Road, Victoria, 3168, Australia.
| | | | - Arul Baradi
- SaferCare Victoria, Department of Health and Human Services, Victoria, Australia
| | - Ojas H. Mehta
- SaferCare Victoria, Department of Health and Human Services, Victoria, Australia
| | - Andrew M. Wilson
- SaferCare Victoria, Department of Health and Human Services, Victoria, Australia
- St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Arthur Nasis
- SaferCare Victoria, Department of Health and Human Services, Victoria, Australia
- Monash Heart, Clayton, Victoria, Australia
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Cathro CJ, Brenn T, Chen SLF. Education Level and Self-Reported Cardiovascular Disease in Norway-The Tromsø Study, 1994-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5958. [PMID: 37297563 PMCID: PMC10252247 DOI: 10.3390/ijerph20115958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. METHODS This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994-1995 and 2015-2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87-0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92-1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79-0.94) than men (OR = 0.91, 95% CI: 0.86-0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87-1.04; men: OR = 0.97, 95% CI: 0.91-1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84-0.96), but not stroke (OR = 0.97, 95% CI: 0.90-1.05) or angina (OR = 0.98, 95% CI: 0.90-1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91-1.05; stroke: OR = 1.01, 95% CI: 0.93-1.09; angina: OR = 1.04, 95% CI: 0.95-1.14). CONCLUSIONS Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.
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Affiliation(s)
- Celina Janene Cathro
- Department of Community Medicine, UiT—The Arctic University of Norway, 9019 Tromsø, Norway
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Bonnesen K, Pedersen L, Ehrenstein V, Grønkjær MS, Sørensen HT, Hallas J, Lash TL, Schmidt M. Impact of Lifestyle and Socioeconomic Position on the Association Between Non-steroidal Anti-inflammatory Drug Use and Major Adverse Cardiovascular Events: A Case-Crossover Study. Drug Saf 2023; 46:533-543. [PMID: 37131013 DOI: 10.1007/s40264-023-01298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION It is unknown whether the cardiovascular risks associated with non-steroidal anti-inflammatory drug (NSAID) use differ according to lifestyle and socioeconomic position. OBJECTIVE We examined the association between NSAID use and major adverse cardiovascular events (MACE) within subgroups defined by lifestyle and socioeconomic position. METHODS We conducted a case-crossover study of all adult first-time respondents to the Danish National Health Surveys of 2010, 2013, or 2017, without previous cardiovascular disease, who experienced a MACE from survey completion through 2020. We used a Mantel-Haenszel method to obtain odds ratios (ORs) of the association between NSAID use (ibuprofen, naproxen, or diclofenac) and MACE (myocardial infarction, ischemic stroke, heart failure, or all-cause death). We identified NSAID use and MACE via nationwide Danish health registries. We stratified the analyses by body mass index, smoking status, alcohol consumption, physical activity level, marital status, education, income, and employment. RESULTS Compared with non-use, the OR of MACE was 1.34 (95% confidence interval: 1.23-1.46) for ibuprofen, 1.48 (1.04-2.43) for naproxen, and 2.18 (1.72-2.78) for diclofenac. When comparing NSAID use with non-use or the individual NSAIDs with each other, we observed no notable heterogeneity in the ORs within subgroups of lifestyle and socioeconomic position for any NSAID. Compared with ibuprofen, diclofenac was associated with increased risk of MACE in several subgroups with high cardiovascular risk, e.g., individuals with overweight (OR 1.52, 1.01-2.39) and smokers (OR 1.54, 0.96-2.46). CONCLUSIONS The relative increase in cardiovascular risk associated with NSAID use was not modified by lifestyle or socioeconomic position.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Marie Stjerne Grønkjær
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Timothy Lee Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Favorable Neighborhood Walkability is Associated With Lower Burden of Cardiovascular Risk Factors Among Patients Within an Integrated Health System: The Houston Methodist Learning Health System Outpatient Registry. Curr Probl Cardiol 2023; 48:101642. [PMID: 36773946 DOI: 10.1016/j.cpcardiol.2023.101642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
This is the first study to investigate the relationship between neighborhood walkability and cardiovascular (CV) risk factors in the United States using a large population-based database. Cross-sectional study using data from 1.1 million patients over the age of 18 in the Houston Methodist Learning Health System Outpatient Registry (2016-2022). Using the 2019 WalkScore, patients were assigned to one of the 4 neighborhood walkability categories. The burden of CV risk factors (hypertension, diabetes, obesity, dyslipidemia, and smoking) was defined as poor, average, or optimal (>3, 1-2, 0 risk factors, respectively). We included 887,654 patients, of which 86% resided in the two least walkable neighborhoods. The prevalence of CV risk factors was significantly lower among participants in the most walkable neighborhoods irrespective of ASCVD status. After adjusting for age, sex, race/ethnicity, and socioeconomic factors, we found that adults living in the most walkable neighborhoods were more likely to have optimal CV risk profile than those in the least walkable ones (RRR 2.77, 95% CI 2.64-2.91). We observed an inverse association between neighborhood walkability and the burden of CV risk factors. These findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating the growing burden of modifiable CV risk factors.
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ZELENINA ANASTASIA. Russian subject-level index of multidimensional deprivation and its association with all-cause and infant mortality. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E533-E540. [PMID: 36890998 PMCID: PMC9986986 DOI: 10.15167/2421-4248/jpmh2022.63.4.2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 11/10/2022] [Indexed: 03/10/2023]
Abstract
Background Social and environmental inequalities in public health are recognized as global problems of our time. From the point of view of the theory of deprivation, social and environmental determinants identified as deprivation indicators, which help to detect health inequality. Indices are one of the most practical and powerful tools for measuring the level of deprivation. Objectives The aims of our study are (1) to develop a Russian derivation index to measure the levels of deprivation and (2) to analyze its associations with total and infant mortality. Material and methods Deprivation indicators were obtained from the Federal State Statistics Service of Russia. All mortality data were taken from the official website of the Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation from 2009 to 2012. Principal components analysis with varimax rotation was used to (1) select suitable deprivation indicators and (2) create the index. A Spearman's correlation was run to determine the relationship of deprivation with all-cause and infant mortality. Ordinary least squares (OLS) regression was used to assess the relationship between deprivation and infant mortality. Development of the index and statistical analysis were carried out using R and SPSS software. Results There is not a statistically significant correlation between deprivation and all-cause mortality. OLS regression showed a significant relationship between deprivation and infant mortality (p = 0.02). For every one-unit increase in the index score, infant mortality rate increases by about 20%.
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Affiliation(s)
- ANASTASIA ZELENINA
- Correspondence: Anastasia Zelenina, Department of Epidemiology of Chronic Non-Communicable Diseases, National Medical Research Center for Therapy and Preventive Medicine, 10, Petroverigskiy per., Moscow 101990, Russia. E-mail:
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Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study. BMC Womens Health 2022; 22:278. [PMID: 35794595 PMCID: PMC9261019 DOI: 10.1186/s12905-022-01805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women. Methods This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models. Results During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005). Conclusions Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01805-y.
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Garcia R, Rajan D, Warming PE, Svane J, Vissing C, Weeke P, Barcella CA, Jabbari R, Gislason GH, Torp-Pedersen C, Petersen JH, Folke F, Tfelt-Hansen J. Ethnic disparities in out-of-hospital cardiac arrest: A population-based cohort study among adult Danish immigrants. Lancet Reg Health Eur 2022; 22:100477. [PMID: 35957808 PMCID: PMC9361311 DOI: 10.1016/j.lanepe.2022.100477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Ethnicity might impact out-of-hospital cardiac arrest (OHCA) risk, but it has scarcely been studied in Europe. We aimed to assess whether ethnicity influenced the risk of OHCA of cardiac cause in Danish immigrants and its interplay with risk factors for OHCA and socioeconomic status. Methods This nationwide study included all immigrants between 18 and 80 years present in Denmark at some point between 2001 and 2020. Regions of origin were defined as Africa, Arabic countries, Asia, Eastern Europe, Latin America, and Western countries. OHCAs with presumed cardiac cause were identified from the Danish Cardiac Arrest Registry. Findings Overall, among 1,011,565 immigrants, a total of 1,801 (0.2%) OHCAs (median age 64 (Q1-Q3 53–72) years, 72% males) occurred. The age- and sex- standardized (reference: Western countries) incidence of OHCA (/1,00,000 person-years) was 34.6 (27.8–43.4) in African, 34.1 (30.4–38.4) in Arabic, 33.5 (29.3–38.2) in Asian, 35.6 (31.9–39.6) in Eastern European, and 16.2 (9.0–27.2) in Latin American immigrants. When selecting Western origin as a reference, and after adjusting on OHCA risk factors, Arabic (HR 1.18, 95%CI 1.04–1.35; P=0.01), Eastern European (HR 1.28, 95%CI 1.13–1.46; P<0.001), and African origin (HR 1.34, 95%CI 1.10–1.63; P<0.01) were associated with higher risk of OHCA, whereas Latin American origin (HR 0.58, 95%CI 0.35–0.0.96; P=0.03) was associated with lower risk of OHCA. Comparable results were observed when adjusting on education level and economic status. Interpretation This study emphasizes that ethnicity is associated with OHCA risk, even when considering traditional cardiac arrest risk factors. Funding R Garcia received a grant from the Fédération Française de Cardiologie for his post-doctoral fellowship and this work was supported by the Novo Nordisk Foundation Tandem Programme 2022 (grant# 31364).
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Meng L, Xu J, Li J, Hu J, Xu H, Wu D, Hu X, Zeng X, Zhang Q, Li J, Gong T, Liu D. Self-reported prevalence and potential factors influencing cardio-cerebral vascular disease among the Chinese elderly: A national cross-sectional study. Front Cardiovasc Med 2022; 9:979015. [PMID: 36337863 PMCID: PMC9630358 DOI: 10.3389/fcvm.2022.979015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Aging is an essential national condition throughout China in the 21st century. Cardio-cerebral vascular disease (CCVD) is a common chronic vascular disease in the elderly. Despite aging becoming an increasingly pressing issue, there has been no comprehensive national investigation into the risk factors, prevalence, and management of CCVD among the elderly population in China. MATERIALS AND METHODS Through the 4th Survey of the Aged Population in Urban and Rural China (SSAPUR), a nationally representative sample of 224,142 adults aged more than 60 years was surveyed using a multistage, stratified sampling method. The 4th SSAPUR was used to investigate CCVD in the elderly. Univariate and multivariate logistic proportional regression analyses explored the risk factors. These risk factors were then entered into a multivariate linear regression model to identify independent predictive factors for CCVD. Disease management was assessed from the self-reported history of physician diagnosis, treatments, and hospital visits among individuals with CCVD. RESULTS After excluding samples with missing information, 215,041 individuals were included in the analysis. The overall prevalence of CCVD was 26%. Living in a rural area, being older, being female, having low literacy, smoking, getting little sleep, losing a spouse, being single, not getting enough exercise, having a bad financial situation, and not taking part in public welfare programs were the main risk factors for CCVD among the elderly in China (P < 0.05). In the multivariate linear regression model, holding all other variables at any fixed value, CCVD remained associated with "urban and rural" (β = 0.012, P < 0.001), "age" (β = -0.003, P < 0.001), "sex" (β = -0.022, P < 0.001), "education level" (β = -0.017, P < 0.001), "marriage" (β = 0.004, P = 0.047), "smoking" (β = 0.012, P = 0.003), "drinking" (β = -0.015, P = 0.001), and "sleep" (β = 0.008, P = 0.005). There were no collinearity problems among these factors. CONCLUSION Major risk factors for prevalent CCVD among the elderly in China include the following: rural residence, female, low literacy level, poor sleep quality, bereavement, non-marriage, living alone, lack of exercise, poor financial situation, and non-participation in public welfare activities. Chinese national policies for preventing, controlling, and managing risk factors for CCVD in the elderly must be urgently developed.
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Affiliation(s)
- Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiapei Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, China
| | - Jianyi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dishan Wu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Low educational status correlates with a high incidence of mortality among hypertensive subjects from Northeast Rural China. Front Public Health 2022; 10:951930. [PMID: 36091501 PMCID: PMC9453591 DOI: 10.3389/fpubh.2022.951930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Cumulative evidence indicates that education plays a major role in predicting cardiovascular risk factors. In this study, we intend to examine the possible relationship between education status and mortality in a large general subject from rural China. Methods Adult hypertensive subjects (n = 5,227, age = 57.22 ± 10.18 years; 49.1% men) were recruited from general population surveys (Northeast China Rural Cardiovascular Health Study). Their educational status was categorized into two groups as follows: (1) Low education (illiterate or lower than primary school) and (2) medium-high education (higher than primary school). Cardiometabolic comorbidities, related cardiovascular risk factors, and echocardiographic measurements were analyzed in both groups. Results Less educated hypertensive subjects had significantly higher prevalence of obesity, diabetes, dyslipidemia, and left ventricular hypertrophy than medium-high educated hypertensive subjects. In the medium-high educated subjects, a significant increase in left ventricular ejection fraction and lower rate of antihypertensive medication was found. Cox proportional hazards analysis indicated that medium-high education was independently associated with all-cause mortality (hazard ratio = 0.76; 95% confidence interval, 0.58, 0.99; P = 0.043) and cardiovascular mortality (hazard ratio = 0.65; 95% confidence interval, 0.44, 0.96; P = 0.028). Conclusion Education may act as the best predictor of all-cause and cardiovascular mortality in rural hypertensive subjects. This finding suggests that in rural areas, education is likely to represent a cardiovascular specific risk factor and should be evaluated in the strategies of hypertension.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - GuangXiao Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, First Hospital of China Medical University, Shenyang, China
| | - Hongmei Yang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China,*Correspondence: Yingxian Sun
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Apiyasawat S, Thongsri T, Jongpiputvanich K, Krittayaphong R. Outcome disparities in patients with atrial fibrillation based on insurance plan and educational attainment: a nationwide, multicenter and prospective cohort trial. BMJ Open 2022; 12:e053166. [PMID: 35948379 PMCID: PMC9379473 DOI: 10.1136/bmjopen-2021-053166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare. OBJECTIVES To explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan. DESIGN A nationwide, prospective, multicenter, cohort trial. SETTING National registry of 3402 patients with non-valvular AF in Thailand. PARTICIPANTS All patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed. PRIMARY OUTCOMES Incidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1-6), secondary (grade 7-12) and higher education (tertiary education). RESULTS The educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan. CONCLUSION Educational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand. TRIAL REGISTRATION NUMBER Thai Clinical Trial Registration; Study ID: TCTR20160113002.
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Affiliation(s)
- Sirin Apiyasawat
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tomon Thongsri
- Buddhachinaraj Hospital Medical School, Phitsanulok, Thailand
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Lisboa CS, da Mota Santana J, de Cássia Ribeiro-Silva R, de Araújo EM, Lima da Silva CA, Barreto ML, Pereira M, dos Santos DB. Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5345. [PMID: 35564740 PMCID: PMC9105772 DOI: 10.3390/ijerph19095345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46-5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53-2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.
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Affiliation(s)
- Cinthia Soares Lisboa
- Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana State University, Av. Transnordestina, s/n, Feira de Santana, Novo Horizonte 44036-900, BA, Brazil; (E.M.d.A.); (C.A.L.d.S.)
| | - Jerusa da Mota Santana
- Center of Health Sciences, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus 44574-490, BA, Brazil;
| | | | - Edna Maria de Araújo
- Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana State University, Av. Transnordestina, s/n, Feira de Santana, Novo Horizonte 44036-900, BA, Brazil; (E.M.d.A.); (C.A.L.d.S.)
| | - Carlos Alberto Lima da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana State University, Av. Transnordestina, s/n, Feira de Santana, Novo Horizonte 44036-900, BA, Brazil; (E.M.d.A.); (C.A.L.d.S.)
| | - Mauricio Lima Barreto
- Collective Health Institute, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Salvador 40110-040, BA, Brazil;
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador 41745-715, BA, Brazil
| | - Marcos Pereira
- Collective Health Institute, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Salvador 40110-040, BA, Brazil;
| | - Djanilson Barbosa dos Santos
- Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana State University, Av. Transnordestina, s/n, Feira de Santana, Novo Horizonte 44036-900, BA, Brazil; (E.M.d.A.); (C.A.L.d.S.)
- Center of Health Sciences, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus 44574-490, BA, Brazil;
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van Raalte AA. What have we learned about mortality patterns over the past 25 years? Population Studies 2021; 75:105-132. [PMID: 34902283 DOI: 10.1080/00324728.2021.1967430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this paper, I examine progress in the field of mortality over the past 25 years. I argue that we have been most successful in taking advantage of an increasingly data-rich environment to improve aggregate mortality models and test pre-existing theories. Less progress has been made in relating our estimates of mortality risk at the individual level to broader mortality patterns at the population level while appropriately accounting for contextual differences and compositional change. Overall, I find that the field of mortality continues to be highly visible in demographic journals, including Population Studies. However much of what is published today in field journals could just as easily appear in neighbouring disciplinary journals, as disciplinary boundaries are shrinking.
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Differential educational patterning of cardiometabolic risks between women and men among community-dwelling Chinese adults in Hong Kong: the mediating role of obesity. Public Health Nutr 2021; 24:4245-4256. [PMID: 34036931 DOI: 10.1017/s1368980021002044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Educational inequalities in cardiometabolic diseases (CMD) are globally recognised; nonetheless, the evidence on potential explanatory mechanisms and effective strategies for CMD prevention and inequality reduction is relatively scarce in Asia. Therefore, the current study examined the extent and potential mediators of the association of education level with CMD conditions (i.e., hypertension and diabetes) in an advanced economy in Asia. DESIGN A cross-sectional study. SETTING This territory-wide cross-sectional Population Health Survey in 2014-2015 was performed in Hong Kong. Demographic, socio-economic and lifestyle factors were collected via questionnaire, while clinical data on blood pressure and glucose levels, lipid profiles and anthropometric measures were obtained during health examination. Hypertension and diabetes statuses were objectively defined by both clinical data and the use of relevant medications. PARTICIPANTS 2297 community-dwelling adults aged between 15-84 years recruited via systematic replicated sampling of living quarters. RESULTS Multivariable binary logistic regression analysis showed that lower education level was significantly associated with hypertension among women but not men, whereas similar pattern was also observed for diabetes and other related clinical risk factors. Also, general and abdominal obesity were independently associated with hypertension and diabetes among both women and men, and substantially mediated the observed inequalities across education levels among women. Specifically, abdominal obesity was a particularly strong risk factor and mediator for diabetes. CONCLUSION Educational patterning of CMD was more apparent among women in Hong Kong. Obesity control appears to be important for both overall CMD prevention and reduction of educational inequalities in CMD among women.
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Mountantonakis SE, Epstein LM, Coleman K, Martinez J, Saleh M, Kvasnovsky C, Brown RM, McCulloch E, Kuvin J, Richardson S, Makker P, Lesser M, Mieres JH, Davidson KW, Roswell RO. The Association of Structural Inequities and Race With Out-of-Hospital Sudden Death During the COVID-19 Pandemic. Circ Arrhythm Electrophysiol 2021; 14:e009646. [PMID: 33835821 PMCID: PMC8136460 DOI: 10.1161/circep.120.009646] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Stavros E Mountantonakis
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Laurence M Epstein
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Kristie Coleman
- Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Johanna Martinez
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Center for Equity of Care, Northwell Health, Lake Success (J.M., E.M., J.H.M., R.O.R.)
| | - Moussa Saleh
- Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Charlotte Kvasnovsky
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Division of Pediatric Surgery, Cohen's Children's Hospital, Northwell Health, New Hyde Park (C.K.)
| | - Rachel-Maria Brown
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Elizabeth McCulloch
- Center for Equity of Care, Northwell Health, Lake Success (J.M., E.M., J.H.M., R.O.R.)
| | - Jeffrey Kuvin
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Safiya Richardson
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.)
| | - Parth Makker
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.)
| | - Martin Lesser
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY (M.L.)
| | - Jennifer H Mieres
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.).,Center for Equity of Care, Northwell Health, Lake Success (J.M., E.M., J.H.M., R.O.R.)
| | - Karina W Davidson
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.)
| | - Robert O Roswell
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead (S.E.M., L.M.E., J.M., C.K., R.-M.B., J.K., S.R., P.M., J.H.M., K.W.D., R.O.R.).,Department of Cardiology, Northwell Health, New York (S.E.M., L.M.E., K.C., M.S., R.-M.B., J.K., P.M., J.H.M., R.O.R.).,Center for Equity of Care, Northwell Health, Lake Success (J.M., E.M., J.H.M., R.O.R.)
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Teng THK, Tay WT, Richards AM, Chew TSM, Anand I, Ouwerkerk W, Chandramouli C, Huang W, Lawson CA, Kadam UT, Yap J, Lim S, Hung CL, MacDonald MR, Loh SY, Shimizu W, Tromp J, Lam CSP. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia. Circ Cardiovasc Qual Outcomes 2021; 14:e006962. [PMID: 33757307 DOI: 10.1161/circoutcomes.120.006962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. METHODS We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). RESULTS Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status (Pinteraction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. CONCLUSIONS These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01633398.
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Affiliation(s)
- Tiew-Hwa K Teng
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,School of Population & Global Health, University of Western Australia (T.-H.K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Arthur Mark Richards
- National University Heart Centre, Singapore (A.M.R., S.L.).,University of Otago, New Zealand (A.M.R.)
| | | | - Inder Anand
- Veterans Affairs Medical Center, University of Minnesota, Minneapolis (I.A.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Department of Dermatology, Amsterdam Medical Center, the Netherlands (W.O.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Weiting Huang
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | | | - Umesh T Kadam
- University of Leicester, United Kingdom (C.A.L., U.T.K.)
| | - Jonathan Yap
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.)
| | - Shirlynn Lim
- National University Heart Centre, Singapore (A.M.R., S.L.)
| | | | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Jasper Tromp
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).,Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands (J.T., C.S.P.L.)
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Granberg Y, Lundgren KT, Lindqvist EK. Socioeconomic position is associated with surgical treatment of open fractures of the lower limb: results from a Swedish population-based study. Acta Orthop 2020; 91:439-443. [PMID: 32285734 PMCID: PMC8023872 DOI: 10.1080/17453674.2020.1751418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - High-energy trauma to the lower limbs can result in open fractures, treated by reconstructive surgery or amputation. We examined whether socioeconomic position is associated with choice of primary treatment.Patients and methods - We performed a nationwide population-based study using the Swedish National Patient Register to identify all adult patients who between 1998 and 2013 underwent reconstruction or amputation after an open fracture below the knee. Information on socioeconomic position was collected from Statistics Sweden.Results - Of 275 individuals undergoing surgery after an open fracture below the knee during the study period, the 1st surgery was reconstructive in 58% of the patients and amputation in 42%. The chance of having an initial reconstruction was lower for women than for men (OR 0.5, 95% CI 0.3-0.9), lower with age (OR 0.97, CI 0.96-0.99), and lower for individuals without employment compared with individuals in employment (OR 0.3, CI 0.2-0.5). Primary treatment was in women associated with family composition, whereas in men it was associated with level of education.Interpretation - Choice of primary treatment after open fracture in the lower limb is affected by socioeconomic position including sex, age, employment, family composition, level of education, and income.
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Affiliation(s)
- Yamin Granberg
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm; ,Correspondence:
| | - Kalle T Lundgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm; ,Craniofacial Diseases, Karolinska University Hospital, Stockholm;
| | - Ebba K Lindqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm; ,Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
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le Roux CW, Hartvig NV, Haase CL, Nordsborg RB, Olsen AH, Satylganova A. Obesity, cardiovascular risk and healthcare resource utilization in the UK. Eur J Prev Cardiol 2020; 28:1235-1241. [PMID: 34551077 DOI: 10.1177/2047487320925639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/21/2020] [Indexed: 12/29/2022]
Abstract
Abstract
Aims
Obesity and cardiovascular diseases (CVDs) often co-occur, likely increasing the intensity of healthcare resource utilization (HCRU). This retrospective, observational database study examined the joint effect of obesity and cardiovascular risk status on HCRU and compared HCRU between body mass index (BMI) categories and CVD-risk categories in the UK.
Methods
Patient demographics and data on CVD and BMI were obtained from the UK Clinical Practice Research Datalink. Cardiovascular risk status, calculated using the Framingham Risk Equation, was used to categorize people into high-risk and low-risk groups, while a CVD diagnosis was used to define the established CVD group. Patients were split into BMI categories using the standard World Health Organization classifications. For each CVD and BMI category, mean number and costs of general practitioner contacts, hospital admissions and prescriptions were estimated.
Results
The final study population included 1,600,709 patients. Data on CVD status were available on just over one-quarter of the sample (28.6%) and BMI data for just less than half (43.2%). The number of general practitioner contacts and prescriptions increased with increasing BMI category for each of the three CVD-risk groups. The group with established CVD had the greatest utilization of all components of healthcare resource, followed by high CVD risk then low CVD-risk groups.
Conclusion
Increasing BMI category and CVD-risk status both affected several HCRU components. These findings highlight the importance of timely obesity management and treatment of CVD-risk factors as a means of preventing increasing HCRU.
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Affiliation(s)
- Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
- Investigative Science, Imperial College London, UK
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Niakouei A, Tehrani M, Fulton L. Health Disparities and Cardiovascular Disease. Healthcare (Basel) 2020; 8:E65. [PMID: 32235705 PMCID: PMC7151140 DOI: 10.3390/healthcare8010065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
The number one leading cause of death in 2017 for Americans was cardiovascular disease (CVD), and health disparities can exacerbate risks. This study evaluates the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 437,436) to estimate population risks for behavioral, socio-economic, psychological, and biological factors. A general linear model with a quasi-binomial link function indicated higher risks for the following groups: smokers (odds ratio, OR = 0.688), individuals with higher body mass index scores (OR = 1.023), persons unable to work (OR = 2.683), individuals with depression (OR = 1.505), workers who missed more days due to mental issues (OR = 1.12), the elderly, males (OR = 1.954), those in race categories "indigenous Americans, Alaskan non-Hispanics", "Black Hispanics," or "other, non-Hispanic," and individuals with lower income. Surprisingly, increased consumption of alcohol was not found to be a risk factor as in other studies. Additional study of alcohol risk factors is needed. Further, Black non-Hispanics were associated with lower rates of CVD/MI (myocardial infarction), a finding that is supported by recent evidence of more unhealthy behaviors in other races. The results of this study highlight 2018 CVD/MI disparities based on the BRFSS and suggest the need for additional policy interventions including education and providing increased access to health care for the disadvantaged. The principles of beneficence and justice require policy interventions such as these.
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Affiliation(s)
- Ava Niakouei
- College of Liberal Arts & Sciences, University of North Carolina Charlotte, Charlotte, NC 28223, USA;
| | - Minoo Tehrani
- Mario J. Gabelli School of Business, Roger Williams University, Bristol, RI 02809, USA;
| | - Lawrence Fulton
- Health Administration, Texas State University, San Marcos, TX 78666, USA
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Maduka O, Ojimah C. Predictors of cardiovascular disease among judiciary staff in South-South Nigeria: Implications for prevention efforts. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2019.e00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chung GKK, Dong D, Wong SYS, Wong H, Chung RYN. Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong. Int J Equity Health 2020; 19:13. [PMID: 31992307 PMCID: PMC6986077 DOI: 10.1186/s12939-020-1127-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. METHODS Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. RESULTS In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. CONCLUSIONS The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
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Affiliation(s)
- Gary Ka-Ki Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
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Thompson SC, Nedkoff L, Katzenellenbogen J, Hussain MA, Sanfilippo F. Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5126. [PMID: 31847490 PMCID: PMC6950682 DOI: 10.3390/ijerph16245126] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Abstract
This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.
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Affiliation(s)
- Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia;
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
| | - Judith Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
| | - Mohammad Akhtar Hussain
- Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia;
- Menzies Institute for Medical Research, University of Tasmania, 15-17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
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Hamad R, Nguyen TT, Glymour MM, Vable A, Manly JJ, Rehkopf DH. Quality and quantity: The association of state-level educational policies with later life cardiovascular disease. Prev Med 2019; 126:105750. [PMID: 31195021 PMCID: PMC6697595 DOI: 10.1016/j.ypmed.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Education is a powerful predictor of cardiovascular morbidity and mortality. While the majority of the literature has focused on years of educational attainment or degree attainment, fewer studies examine the role of educational quality in the prevention of cardiovascular disease (CVD). We tested the hypothesis that average state-level educational quality was associated with CVD, linking state-level data on educational quality with individual demographic and health data from multiple waves of the National Health and Nutrition Examination Survey (N = 34,770). We examined thirteen CVD-related outcomes-including blood pressure, cholesterol, and heart attack-to understand the multiple pathways through which educational quality may influence CVD. The primary predictor was a composite index of educational quality, combining state-level measures of student-teacher ratios, per-pupil expenditures, and school term length. We fit multivariable models, regressing each outcome on the educational quality composite index and adjusting for individual- and state-level covariates. We also assessed whether the association between state educational quality and CVD differed for less educated individuals. Overall, higher educational quality was associated with less smoking (OR = 0.86, 95%CI: 0.77, 0.97), but there was no statistically significant association for the other 12 outcomes. Interaction tests indicated that less educated individuals benefited less from higher educational quality relative to those with more education for several outcomes. Our study suggests that state-level educational quality is not strongly associated with CVD, and that this null association overall may mask heterogeneous benefits that accrue disproportionately to those with higher levels of education.
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anusha Vable
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Wu HH, Chang YY, Kuo SC, Chen YT. Influenza vaccination and secondary prevention of cardiovascular disease among Taiwanese elders-A propensity score-matched follow-up study. PLoS One 2019; 14:e0219172. [PMID: 31260487 PMCID: PMC6602195 DOI: 10.1371/journal.pone.0219172] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
Abstract
The present study aimed to evaluate the association between influenza vaccination and the secondary prevention of cardiovascular disease (CVD) among elderly persons. This retrospective cohort study used the Geriatric Dataset of Taiwan’s National Health Insurance Research Database (2000–2013). Patients aged ≥ 65 years who had been hospitalized for the first episodes of myocardial infarction were eligible. The vaccinated cohort comprised patients who received one dose of influenza vaccine within 180 days after discharge. The unvaccinated cohort included those who did not receive influenza vaccination and was propensity score–matched (1:1) for known CVD risk factors. All-cause death, acute myocardial infarction or cardiovascular death, and hospitalization for heart failure were assessed 1 year after the 181st day after hospital discharge. Compared with the matched cohort (n = 4,350), the vaccinated cohort (n = 4,350) had significantly lower incidences of all-cause death (hazard ratios [HR] 0.82, 95% CI [confidence interval] 0.73–0.92), myocardial infarction or cardiovascular death (HR 0.84, 95% CI 0.74–0.96), and hospitalization for heart failure (HR 0.83, 95% CI 0.74–0.92). The association between influenza vaccination and reduction of CVDs was similar across different subgroups. Cumulative incidence curves of the CVDs of interest for the two cohorts separated within the initial 3 months of follow-up (P < 0.05). Influenza vaccination was associated with a reduced risk of CVD in the elderly population with previous myocardial infarction.
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Affiliation(s)
- Hao-Hsin Wu
- Division of Infection Control and Biosafety, Centers for Disease Control, Taipei, Taiwan
| | - Yea-Yuan Chang
- Division of Infectious Diseases, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan County, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
- * E-mail: (S-CK); (Y-TC)
| | - Yung-Tai Chen
- Divisions of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
- * E-mail: (S-CK); (Y-TC)
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Lim KK, Lim C, Kwan YH, Chan SY, Fong W, Low LL, Tay HY, Østbye T, Tan CS. Association between access to health-promoting facilities and participation in cardiovascular disease (CVD) risk screening among populations with low socioeconomic status (SES) in Singapore. Prim Health Care Res Dev 2019; 20:e98. [PMID: 32800019 PMCID: PMC6609976 DOI: 10.1017/s1463423619000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is a barrier for cardiovascular disease (CVD) risk screening and a determinant of poor CVD outcomes. This study examined the associations between access to health-promoting facilities and participation in a CVD risk screening program among populations with low SES residing in public rental flats in Singapore. METHODS Data from Health Mapping Exercises conducted from 2013 to 2015 were obtained, and screening participation rates of 66 blocks were calculated. Negative binomial regression was used to test for associations between distances to four nearest facilities (i.e., subsidized private clinics, healthy eateries, public polyclinics, and parks) and block participation rate in CVD screening. We also investigated potential heterogeneity in the association across regions with an interaction term between distance to each facility and region. RESULTS The analysis consisted of 2069 participants. The associations were only evident in the North/North-East region for subsidized private clinic and park. Specifically, increasing distance to the nearest subsidized private clinic and park was significantly associated with lower [incidence rate ratio (IRR) = 0.88, 95% confidence interval (CI): 0.80-0.98] and higher (IRR = 1.93, 95%CI: 1.15-3.25) screening participation rates respectively. CONCLUSIONS Our findings could potentially inform the planning of future door-to-door screenings in urban settings for optimal prioritization of resources. To increase participation rates in low SES populations, accessibility to subsidized private clinics and parks in a high population density region should be considered.
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Affiliation(s)
- Ka Keat Lim
- Programme in Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Charmaine Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Programme in Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Sui Yung Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Lian Leng Low
- Duke-NUS Medical School, Singapore, Republic of Singapore
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore
| | - Hung Yong Tay
- Singapore Heart Foundation, Singapore, Republic of Singapore
| | - Truls Østbye
- Programme in Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
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Harrison S, Couillard C, Robitaille J, Vohl MC, Bélanger M, Desroches S, Provencher V, Rabasa-Lhoret R, Bouchard L, Langlois MF, Houle J, Lemieux S, Lamarche B. Assessment of the American Heart Association's "Life's simple 7" score in French-speaking adults from Québec. Nutr Metab Cardiovasc Dis 2019; 29:684-691. [PMID: 31078363 DOI: 10.1016/j.numecd.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/15/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score. METHODS AND RESULTS A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score. CONCLUSION Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions.
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Affiliation(s)
- S Harrison
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - C Couillard
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - J Robitaille
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - M-C Vohl
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - M Bélanger
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - S Desroches
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - V Provencher
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - R Rabasa-Lhoret
- Montreal Clinical Research Institute, Université de Montréal, Montréal, QC, H2W 1R7, Canada
| | - L Bouchard
- ECOGENE-21 Biocluster, Chicoutimi, Qc, G7H 7K9, Canada; Faculté de médecine et des Sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - M-F Langlois
- Faculté de médecine et des Sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - J Houle
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, G9A 5H7, Canada
| | - S Lemieux
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - B Lamarche
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada.
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Okuda N, Kadota A, Nishi N, Miura K, Ohkubo T, Miyagawa N, Satoh A, Kita Y, Hayakawa T, Takashima N, Fujiyoshi A, Okayama A, Okamura T, Ueshima H. Association of Work Situation With Cardiovascular Disease Mortality Risk Among Working-Age Japanese Men ― A 20-Year Follow-up of NIPPON DATA90 ―. Circ J 2019; 83:1506-1513. [DOI: 10.1253/circj.cj-18-1067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
- Department of Public Health, Shiga University of Medical Science
| | - Nobuo Nishi
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
- Department of Public Health, Shiga University of Medical Science
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Naoko Miyagawa
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | | | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community, Ritsumeikan University
| | | | | | | | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
- Department of Public Health, Shiga University of Medical Science
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Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, Avezum A, Bengtsson Boström K, Chifamba J, Gulec S, Gupta R, Igumbor EU, Iqbal R, Ismail N, Joseph P, Kaur M, Khatib R, Kruger IM, Lamelas P, Lanas F, Lear SA, Li W, Wang C, Quiang D, Wang Y, Lopez-Jaramillo P, Mohammadifard N, Mohan V, Mony PK, Poirier P, Srilatha S, Szuba A, Teo K, Wielgosz A, Yeates KE, Yusoff K, Yusuf R, Yusufali AH, Attaei MW, McKee M, Yusuf S. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. LANCET GLOBAL HEALTH 2019; 7:e748-e760. [PMID: 31028013 DOI: 10.1016/s2214-109x(19)30045-2] [Citation(s) in RCA: 308] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. METHODS In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. FINDINGS Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96-1·58) for high-income countries, 1·59 (1·42-1·78) in middle-income countries, and 2·23 (1·79-2·77) in low-income countries (pinteraction<0·0001). We observed similar results for all-cause mortality, with HRs of 1·50 (1·14-1·98) for high-income countries, 1·80 (1·58-2·06) in middle-income countries, and 2·76 (2·29-3·31) in low-income countries (pinteraction<0·0001). By contrast, we found no or weak associations between wealth and these two outcomes. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries (pinteraction<0·0001). Medical care (eg, management of hypertension, diabetes, and secondary prevention) seemed to play an important part in adverse cardiovascular disease outcomes because such care is likely to be poorer in people with the lowest levels of education compared to those with higher levels of education in low-income countries; however, we observed less marked differences in care based on level of education in middle-income countries and no or minor differences in high-income countries. INTERPRETATION Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology and University Santo Amaro, São Paulo, Brazil
| | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Sadi Gulec
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Ehi U Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Norhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, Maywood, IL, USA
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Pablo Lamelas
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chuangshi Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Deren Quiang
- Wujin District Center for Disease Control and Prevention, Changzhou, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Research Institute, FOSCAL International Clinic, Bucaramanga, Colombia; Eugenio Espejo Medical School, Universidad UTE, Quito, Ecuador
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada
| | | | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia; UCSI University, Kuala Lumpur, Malaysia
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afzalhusein H Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Marjan W Attaei
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
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Laursen UB, Johansen MB, Joensen AM, Lau CJ, Overvad K, Larsen ML. Educational level and living arrangements are associated with dietary intake of red meat and fruit/vegetables: A Danish cross-sectional study. Scand J Public Health 2019; 47:557-564. [PMID: 30632902 DOI: 10.1177/1403494818821482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To evaluate the association between education and living arrangements and the intake of fish, red meat and fruit and vegetables.Methods: The study design was cross-sectional and conducted in Denmark in 2013. Participants filled in questionnaires about their educational level and living arrangements (living alone or with others) and dietary intake including fish, red meat, fruit and vegetables. Regression analyses were performed to assess the associations within 85,456 randomly sampled healthy men and women who were at least 25 years old.Results: Length of education was statistically significant and positively associated with the intake of fruit and vegetables and negatively associated with the intake of red meat for both men and women. Men with a high level of education had a 187g/week (95% confidence interval: 199-175g/week) lower intake of red meat and a 109g/day (95% confidence interval: 102-117g/day) higher intake of fruit and vegetables than men with a low level of education. Women with a high level of education had a 175g/week (95% confidence interval: 186-164g/week) lower intake of red meat and a 106g/day (95% confidence interval: 97-114g/day) higher intake of fruit and vegetables than women with a low level of education. Living with others was statistically significant and positively associated with the intake of red meat, and fruit and vegetables. There were no clear associations between education, living arrangements and intake of fish.Conclusions: Men and women with a high educational level ate more fruit and vegetables but less red meat than men and women with a low educational level. Men and women living with others ate more red meat, fruit and vegetables than men and women living alone.
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Affiliation(s)
| | | | | | - Cathrine Juel Lau
- 3 Research Centre for Prevention and Health, Rigshospitalet - Glostrup University Hospital, Denmark
| | - Kim Overvad
- 1 Department of Cardiology, Aalborg University Hospital, Denmark.,4 Department of Public Health, Aarhus University, Denmark
| | - Mogens Lytken Larsen
- 1 Department of Cardiology, Aalborg University Hospital, Denmark.,5 Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Al-Zakwani I, M Mabry R, Zubaid M, Alsheikh-Ali AA, Almahmeed W, Shehab A, Rashed W. Association between education and major adverse cardiac events among patients with acute coronary syndrome in the Arabian Gulf. BMJ Glob Health 2019; 4:e001278. [PMID: 30687526 PMCID: PMC6326284 DOI: 10.1136/bmjgh-2018-001278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/24/2018] [Accepted: 12/03/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction The objective of this study was to evaluate the association between education and major adverse cardiac events in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods Data were analysed from 3874 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013. Education was defined as any type of formal training from primary school and above. MACE included stroke/transient ischaemic attack (TIA), myocardial infarction (MI), all-cause mortality and readmissions for cardiac reasons. Results The overall mean age was 60±13 years and 67% (n=2579) were men. A total of 53% (n=2039) of the patients had some form of school education. Adjusting for demographic and clinical characteristics as well as socioeconomic measures (insurance type and employment), at 12-month follow-up, educated patients were significantly less likely to have had MACE (adjusted OR (aOR): 0.55; 95% CI 0.44 to 0.68; p<0.001) than those with no formal education. The lower rate of events was also consistent across all MACE components: stroke/TIA (aOR: 0.56; 95% CI 0.33 to 0.94; p=0.030), MI (aOR: 0.58; 95% CI 0.38 to 0.86; p=0.008), all-cause mortality (aOR: 0.58; 95% CI 0.39 to 0.87; p=0.009) and readmissions for cardiac reasons (aOR: 0.61; 95% CI 0.48 to 0.77; p<0.001). MACE outcomes were consistent across men and women and across countries. Conclusions Education was associated with lower MACE events in patients with ACS in the Arabian Gulf. Interventions promoting healthy lifestyles and management of clinical risk factors for patients with low health literacy are urgently required.
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Affiliation(s)
- Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ruth M Mabry
- Office of the Regional Director, WHO Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Abdullah Shehab
- Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, UAE
| | - Wafa Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Safat, Kuwait
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Paige E, Welsh J, Agostino J, Calabria B, Banks E, Korda RJ. Socioeconomic variation in absolute cardiovascular disease risk and treatment in the Australian population. Prev Med 2018; 114:217-222. [PMID: 30026118 DOI: 10.1016/j.ypmed.2018.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease (CVD), preventable through appropriate management of absolute CVD risk, disproportionately affects socioeconomically disadvantaged individuals. The aim of this study was to estimate absolute and relative socioeconomic inequalities in absolute CVD risk and treatment in the Australian population using cross-sectional representative data on 4751 people aged 45-74 from the 2011-12 Australian Health Survey. Poisson regression was used to calculate prevalence differences (PD) and ratios (PR) for prior CVD, high 5-year absolute risk of a primary CVD event and guideline-recommended medication use, in relation to socioeconomic position (SEP, measured by education). After adjusting for age and sex, the prevalence of high absolute risk of a primary CVD event among those of low, intermediate and high SEP was 12.6%, 10.9% and 7.7% (PD, low vs. high = 5.0 [95% CI: 2.3, 7.7], PR = 1.6 [1.2, 2.2]) and for prior CVD was 10.7%, 9.1% and 6.7% (PD = 4.0 [1.4, 6.6], PR = 1.6 [1.1, 2.2]). The proportions using preventive medication use among those with high primary risk were 21.3%, 19.5% and 29.4% for low, intermediate and high SEP and for prior CVD, were 37.8%, 35.7% and 17.7% (PD = 20.1 [9.7, 30.5], PR = 2.1 [1.3, 3.5]). Proportions at high primary risk and not using medications among those of low, intermediate and high SEP were 10.6%, 8.8% and 4.7% and with prior CVD and not using medications were 8.5%, 6.3% and 4.1%. Findings indicate substantial potential to prevent CVD and reduce inequalities through appropriate management of high absolute risk in the population.
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Affiliation(s)
- Ellie Paige
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Jason Agostino
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Bianca Calabria
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia; Sax Institute, Sydney, NSW, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
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48
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Kareem H, Shetty PN, Devasia T, Karkala YR, Paramasivam G, Guddattu V, Singh A, Chauhan S. Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study. HEART ASIA 2018; 10:e010960. [PMID: 29942357 DOI: 10.1136/heartasia-2017-010960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 12/29/2022]
Abstract
Background Socioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary intervention (PCI). Methods We determined SES based on educational, economic and occupational parameters for 630 consecutive patients who underwent PCI at our centre between 01 June 2015 and 01 June 2016. The patients were divided into low and high SES groups, and they were followed up for 12 months. Patients were matched at baseline for demographic and procedural characteristics; multivariate analysis was used to adjust for baseline and procedural variables. Postprocedure compliance to medications was analysed. At 12 months, the primary composite end point of major adverse cardiac events (MACE) - consisting of death, non-fatal myocardial infarction, target lesion revascularisation, target vessel revascularisation - was compared between the groups. Results The high SES group had a higher prevalence of diabetes mellitus (p=0.03; OR 0.74%, 95% CI 0.53% to 1.03%) and a stronger family history of ischaemic heart disease (p=0.003; OR 0.53%, 95% CI 0.33% to 0.84%). Low SES was associated with lower compliance with medication (p=0.01; OR 2.22%, 95% CI 1.19% to 4.15%). At 12 months, the primary composite end point of MACE was found to be higher in the low SES group (p=0.01); higher MACE was primarily driven by cardiac mortality (p<0.001). Low SES was found to be an independent predictor of MACE (HR 1.84%, 95% CI 1.16% to 2.96%). Conclusion Low SES was associated with a higher incidence of major adverse cardiac events in patients undergoing PCI and was an independent predictor of MACE at 12 months.
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Affiliation(s)
- Hashir Kareem
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Prasad Narayana Shetty
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Yeshwanth Rao Karkala
- Department of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Vasudev Guddattu
- Department of Statistics Prasanna school of Public Health, Manipal University, Manipal, India
| | - Ajit Singh
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Sheetal Chauhan
- Department of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, India
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49
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Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018; 137:2166-2178. [PMID: 29760227 PMCID: PMC5958918 DOI: 10.1161/circulationaha.117.029652] [Citation(s) in RCA: 750] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
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Affiliation(s)
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | | | - Jia Shen
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | - Martha Gulati
- University of Arizona-Phoenix College of Medicine (M.G.)
| | - John G Harold
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.G.H.)
| | | | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
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50
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Seikkula HA, Kaipia AJ, Ryynänen H, Seppä K, Pitkäniemi JM, Malila NK, Boström PJ. The impact of socioeconomic status on stage specific prostate cancer survival and mortality before and after introduction of PSA test in Finland. Int J Cancer 2018; 142:891-898. [PMID: 29044563 DOI: 10.1002/ijc.31109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/01/2017] [Accepted: 10/05/2017] [Indexed: 11/07/2022]
Abstract
Socioeconomic status (SES) has an impact on prostate cancer (PCa) outcomes. Men with high SES have higher incidence and lower mortality of PCa versus lower SES males. PCa cases diagnosed in Finland in 1985-2014 (N = 95,076) were identified from the Finnish Cancer Registry. Information on education level (EL) was obtained from Statistics Finland. EL was assessed with three-tiered scale: basic, upper secondary and higher education. PCa stage at diagnosis was defined as localized, metastatic or unknown. Years of diagnosis 1985-1994 were defined as pre-PSA period and thereafter as post-PSA period. We report PCa-specific survival (PCSS) and relative risks (RR) for PCa specific mortality (PCSM) among cancer cases in Finland, where healthcare is 100% publicly reimbursed and inequality in healthcare services low. Men with higher EL had markedly better 10-year PCSS: 68 versus 63% in 1985-1994 and 90 versus 85% in 1995-2004 compared to basic EL in localized PCa. The RR for PCSM among men with localized PCa and higher EL compared to basic EL was 0.76(95%confidence interval (CI) 0.66-0.88) in 1985-1994 and 0.61(95%CI 0.53-0.70) in 1995-2004. Variation in PCSS and PCSM between EL categories was evident in metastatic PCa, too. The difference in PCSM between EL categories was larger in the first 10-year post-PSA period than before that but decreased thereafter in localized PCa, suggesting PSA testing became earlier popular among men with high EL. In summary, higher SES/EL benefit PCa survival both in local and disseminated disease and the effect of EL was more pronounced in early post-PSA period.
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Affiliation(s)
- Heikki A Seikkula
- Department of Surgery, Central Finland Healthcare District, Jyväskylä, Finland
- Department of Urology, Turku University Hospital, Turku, Finland, Department of Urology, University of Turku, Turku, Finland
| | | | | | | | - Janne M Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea K Malila
- Finnish Cancer Registry, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland, Department of Urology, University of Turku, Turku, Finland
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