1
|
Krishnan K, Beishon L, Berge E, Christensen H, Dineen RA, Ozturk S, Sprigg N, Wardlaw JM, Bath PM. Relationship between race and outcome in Asian, Black, and Caucasian patients with spontaneous intracerebral hemorrhage: Data from the Virtual International Stroke Trials Archive and Efficacy of Nitric Oxide in Stroke trial. Int J Stroke 2017; 13:362-373. [PMID: 29165060 DOI: 10.1177/1747493017744463] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and purpose Although poor prognosis after intracerebral hemorrhage relates to risk factors and hematoma characteristics, there is limited evidence for the effect of race-ethnicity. Methods Data from 1011 patients with intracerebral hemorrhage enrolled into hyperacute trials and randomized to control were obtained from the Virtual International Stroke Trials Archive and Efficacy of Nitric Oxide in Stroke Trial. Clinical characteristics and functional outcome were compared among three racial groups - Asians, Blacks, and Caucasians. Results The majority of patients were Caucasian (78.1%) followed by Asians (14.5%) and Blacks (5.5%). At baseline, Caucasians were older and had larger hematoma volumes; Blacks had lower Glasgow Coma Scale and higher systolic blood pressure (all p < 0.05). Although the primary outcome of modified Rankin Scale did not differ at 90 days (p = 0.14), there were significant differences in mortality (p < 0.0001) and quality of life (EQ-5D p < 0.0001; EQ-VAS p 0.015). In test of multiple comparisons, Caucasians were more likely to die (p = 0.0003) and had worse quality of life (EQ-5D p = 0.003; EQ-VAS p < 0.0001) as compared to Asians. Conclusion Race-ethnicity appears to explain some of the variation in clinical characteristics and outcomes after acute intracerebral hemorrhage. Factors that explain this variation need to be identified.
Collapse
Affiliation(s)
- Kailash Krishnan
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lucy Beishon
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Eivind Berge
- 2 Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Robert A Dineen
- 4 Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Serefnur Ozturk
- 5 Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Nikola Sprigg
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Joanna M Wardlaw
- 6 Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, UK
| | - Philip M Bath
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
2
|
Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315-53. [PMID: 24309587 PMCID: PMC5995123 DOI: 10.1161/01.str.0000437068.30550.cf] [Citation(s) in RCA: 555] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden. METHODS Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. CONCLUSIONS The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.
Collapse
|
3
|
Judd SE, Gutiérrez OM, Newby PK, Howard G, Howard VJ, Locher JL, Kissela BM, Shikany JM. Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans. Stroke 2013; 44:3305-11. [PMID: 24159061 PMCID: PMC3898713 DOI: 10.1161/strokeaha.113.002636] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/18/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Black Americans and residents of the Southeastern United States are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. METHODS Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30 239 black and white Americans aged≥45 years. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox-proportional hazards models were used to examine risk of stroke. RESULTS During 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the plant-based pattern was associated with lower stroke risk (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; Ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84), with a significant (P=0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. CONCLUSIONS These data suggest that adherence to a Southern style diet may increase the risk of stroke, whereas adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary effect on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke.
Collapse
Affiliation(s)
- Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Orlando M. Gutiérrez
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - PK Newby
- Program in Gastronomy, Culinary Arts, and Wine Studies, Boston University
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Julie L Locher
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Brett M Kissela
- Department of Neurology, School of Medicine, University of Cincinnati, Cincinnati, OH
| | - James M Shikany
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
4
|
Abstract
Telemedicine allows prompt assessment of acute stroke patients. This new technology has increased the administration of intravenous recombinant tissue plasminogen activator (rtPA) to eligible patients. In addition, telemedicine is being utilized in the rehabilitation of patients with cerebrovascular disease. This article will review the use of telemedicine in patients with acute ischemic stroke and its implementation in telerehabilitation to patients with residual neurologic deficits.
Collapse
Affiliation(s)
- Sarkis Morales-Vidal
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | | |
Collapse
|
5
|
Howard VJ, McClure LA, Glymour MM, Cunningham SA, Kleindorfer DO, Crowe M, Wadley VG, Peace F, Howard G, Lackland DT. Effect of duration and age at exposure to the Stroke Belt on incident stroke in adulthood. Neurology 2013; 80:1655-61. [PMID: 23616168 DOI: 10.1212/wnl.0b013e3182904d59] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether there are differences in the strength of association with incident stroke for specific periods of life in the Stroke Belt (SB). METHODS The risk of stroke was studied in 24,544 black and white stroke-free participants, aged 45+, in the Reasons for Geographic and Racial Differences in Stroke study, a national population-based cohort enrolled 2003-2007. Incident stroke was defined as first occurrence of stroke over an average 5.8 years of follow-up. Residential histories (city/state) were obtained by questionnaire. SB exposure was quantified by combinations of SB birthplace and current residence and proportion of years in SB during discrete age categories (0-12, 13-18, 19-30, 31-45, last 20 years) and entire life. Proportional hazards models were used to establish association of incident stroke with indices of exposure to SB, adjusted for demographic, socioeconomic (SES), and stroke risk factors. RESULTS In the demographic and SES models, risk of stroke was significantly associated with proportion of life in the SB and with all other exposure periods except birth, ages 31-45, and current residence. The strongest association was for the proportion of the entire life in SB. After adjustment for risk factors, the risk of stroke remained significantly associated only with proportion of residence in SB in adolescence (hazard ratio 1.17, 95% confidence interval 1.00-1.37). CONCLUSIONS Childhood emerged as the most important period of vulnerability to SB residence as a predictor of future stroke. Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies in the SB.
Collapse
Affiliation(s)
- Virginia J Howard
- Departments of Epidemiology, School of Medicine, University of Alabama at Birmingham, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Ducey TF, Miller JO, Busscher WJ, Lackland DT, Hunt PG. An analysis of the link between strokes and soils in the South Carolina coastal plains. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2012; 47:1104-1112. [PMID: 22506703 DOI: 10.1080/10934529.2012.668064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Stroke Belt is a geographical region of the Southeastern United States where resident individuals suffer a disproportionately higher rate of strokes than the rest of the population. While the "buckle" of this Stroke Belt coincides with the Southeastern Coastal Plain region of North and South Carolina and Georgia, there is a paucity of information pinpointing specific causes for this phenomenon. A number of studies posit that an exposure event-potentially microbial in nature-early in life, could be a risk factor. The most likely vector for such an exposure event would be the soils of the Southeastern Coastal Plain region. These soils may have chemical and physical properties which are conducive to the growth and survival of microorganisms which may predispose individuals to stroke. To this aim, we correlated SC stroke mortality data to soil characteristics found in the NRCS SSURGO database. In statewide comparisons, depth to water table (50 to 100 cm, R = 0.62) and soil drainage class (poorly drained, R = 0.59; well drained, R = -0.54) both showed statistically significant relationships with stroke rate. In a 20 county comparison, depth to water table, drainage class, hydric rating (hydric soils, R = 0.56), and pH (very strongly acid, R = 0.66) all showed statistically significant relationships with stroke rate. These data should help direct future research and epidemiology efforts to pinpoint the exact exposure events which predispose individuals to an increased stroke rate.
Collapse
Affiliation(s)
- Thomas F Ducey
- Coastal Plains Soil, Water, and Plant Research Center, Agricultural Research Service, USDA, Florence, South Carolina, USA.
| | | | | | | | | |
Collapse
|
7
|
Grosche B, Lackland DT, Land CE, Simon SL, Apsalikov KN, Pivina LM, Bauer S, Gusev BI. Mortality from cardiovascular diseases in the Semipalatinsk historical cohort, 1960-1999, and its relationship to radiation exposure. Radiat Res 2011; 176:660-9. [PMID: 21787182 PMCID: PMC3866702 DOI: 10.1667/rr2211.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The data on risk of mortality from cardiovascular disease due to radiation exposure at low or medium doses are inconsistent. This paper reports an analysis of the Semipalatinsk historical cohort exposed to radioactive fallout from nuclear testing in the vicinity of the Semipalatinsk Nuclear Test Site, Kazakhstan. The cohort study, which includes 19,545 persons of exposed and comparison villages in the Semipalatinsk region, had been set up in the 1960s and comprises 582,656 person-years of follow-up between 1960 and 1999. A dosimetric approach developed by the U.S. National Cancer Institute (NCI) has been used. Radiation dose estimates in this cohort range from 0 to 630 mGy (whole-body external). Overall, the exposed population showed a high mortality from cardiovascular disease. Rates of mortality from cardiovascular disease in the exposed group substantially exceeded those of the comparison group. Dose-response analyses were conducted for both the entire cohort and the exposed group only. A dose-response relationship that was found when analyzing the entire cohort could be explained completely by differences between the baseline rates in exposed and unexposed groups. When taking this difference into account, no statistically significant dose-response relationship for all cardiovascular disease, for heart disease, or for stroke was found. Our results suggest that within this population and at the level of doses estimated, there is no detectable risk of radiation-related mortality from cardiovascular disease.
Collapse
Affiliation(s)
- Bernd Grosche
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Oberschleissheim, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Dodani S, Fields JZ. Implementation of the fit body and soul, a church-based life style program for diabetes prevention in high-risk African Americans: a feasibility study. DIABETES EDUCATOR 2010; 36:465-72. [PMID: 20508263 DOI: 10.1177/0145721710366756] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of a behavioral faith-based diabetes prevention program called the Fit Body and Soul program in a semi-urban African-American church using a community-based participatory approach. METHODS The 12-session Fit Body and Soul program was modified from the group lifestyle balance intervention that was modified from the successful National Institute of Health (NIH) funded Diabetes Prevention Program. The Fit Body and Soul program was implemented in a semi-urban African-American church community. Based on the results of physical examinations and increased body mass index (BMI > or = 25), 40 adult members of the church were identified as being at high risk for diabetes. Four church ministers, after receiving Fit Body and Soul program training for 2 days, served as study interventionists. The primary objective was weight loss of at least 5% by the end of the 12-session Fit Body and Soul intervention. RESULTS Screening of church participants was conducted at the Gospel Water Branch Baptist Church in Augusta, Georgia. A total of 40 individuals having a BMI > or = 25 were selected. Of the 40, a total of 35 (87.5%) attended at least 10 sessions and provided information required for the study. Of the 35, a total of 48% lost at least 5% of baseline weight, 26% lost 7% or more, and 14% lost >10% of baseline weight. CONCLUSIONS This pilot trial suggests that carrying out a larger Fit Body and Soul study in a faith-based setting, using behavioral lifestyle interventions, in the context of a diabetes prevention program for African American communities is feasible, as is the possibility that subjects in that larger study will achieve a clinically significant degree of weight loss.
Collapse
Affiliation(s)
- S Dodani
- The Center for Outcome Research and Education, School of Medicine, Kansas University Medical Center, Kansas City, KS (Dr Dodani)
| | | |
Collapse
|
9
|
Howard VJ, Woolson RF, Egan BM, Nicholas JS, Adams RJ, Howard G, Lackland DT. Prevalence of hypertension by duration and age at exposure to the stroke belt. ACTA ACUST UNITED AC 2010; 4:32-41. [PMID: 20374949 DOI: 10.1016/j.jash.2010.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 01/22/2023]
Abstract
Geographic variation in hypertension is hypothesized as contributing to the stroke belt, an area in the southeastern United States with high stroke mortality. No study has examined hypertension by lifetime exposure to the stroke belt. This association was studied in 19,385 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national population-based cohort. Prevalent hypertension was defined as systolic blood pressure >/=140, diastolic blood pressure >/=90, or use of antihypertensive medications. Stroke belt exposure was assessed by residence at birth, currently, early childhood, adolescence, early adulthood, mid-adulthood, and recently. After adjustment for age, race, sex, physical activity level, body mass index, smoking, alcohol, education, and income, the prevalence of hypertension was significantly more strongly related (P < .0001) with lifetime exposure, adolescence, or early adulthood exposure than exposures at other times. Birthplace and current residence were independently associated with hypertension; however, lifetime, adolescence, or early adulthood exposures were more predictive than joint model with both birthplace and current residence. That adolescence and early adulthood periods are more predictive than residence in the stroke belt for most recent 20-year period suggests community and environmental strategies to prevent hypertension need to start earlier in life.
Collapse
Affiliation(s)
- Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Glymour MM, Kosheleva A, Boden-Albala B. Birth and adult residence in the Stroke Belt independently predict stroke mortality. Neurology 2009; 73:1858-65. [PMID: 19949032 DOI: 10.1212/wnl.0b013e3181c47cad] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Understanding how the timing of exposure to the US Stroke Belt (SB) influences stroke risk may illuminate mechanisms underlying the SB phenomenon and factors influencing population stroke rates. METHODS Stroke mortality rates for United States-born black and white people aged 30-80 years were calculated for 1980, 1990, and 2000 for strata defined by birth state, state of adult residence, race, sex, and birth year. Four SB exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group). We estimated age-, sex-, and race-adjusted odds ratios for stroke mortality associated with timing of SB exposure. RESULTS Elevated stroke mortality was associated with both SB birth and, independently, SB adult residence, with the highest risk among those who lived in the SB at birth and adulthood. Compared to those living outside the SB at birth and adulthood, odds ratios for SB residence at birth and adulthood for black subjects were 1.55 (95% confidence interval 1.28, 1.88) in 1980, 1.47 (1.31, 1.65) in 1990, and 1.34 (1.22, 1.48) in 2000. Comparable odds ratios for white subjects were 1.45 (95% confidence interval 1.33, 1.58), 1.29 (1.21, 1.37), and 1.34 (1.25, 1.44). Patterns were similar for every race, sex, and age subgroup examined. CONCLUSION Stroke Belt birth and adult residence appear to make independent contributions to stroke mortality risk.
Collapse
Affiliation(s)
- M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
| | | | | |
Collapse
|
11
|
Lackland DT, Barker DJP. Birth weight: a predictive medicine consideration for the disparities in CKD. Am J Kidney Dis 2009; 54:191-3. [PMID: 19619841 DOI: 10.1053/j.ajkd.2009.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 04/16/2009] [Indexed: 11/11/2022]
|
12
|
Glymour MM, Avendaño M, Haas S, Berkman LF. Lifecourse social conditions and racial disparities in incidence of first stroke. Ann Epidemiol 2009; 18:904-12. [PMID: 19041589 DOI: 10.1016/j.annepidem.2008.09.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 08/15/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities. METHODS Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models. RESULTS Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28). CONCLUSIONS Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.
Collapse
Affiliation(s)
- M Maria Glymour
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.
| | | | | | | |
Collapse
|
13
|
Glymour MM, Defries TB, Kawachi I, Avendano M. Spousal smoking and incidence of first stroke: the Health and Retirement Study. Am J Prev Med 2008; 35:245-8. [PMID: 18692737 PMCID: PMC2796850 DOI: 10.1016/j.amepre.2008.05.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 04/02/2008] [Accepted: 05/13/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke. METHODS Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged >or=50 years and married at baseline (n=16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1,130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse's smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birthstate; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease. RESULTS Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio=1.42, 95% CI=1.05, 1.93) and former smokers (hazard ratio=1.72, 95% CI=1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked. CONCLUSIONS Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.
Collapse
Affiliation(s)
- M Maria Glymour
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA.
| | | | | | | |
Collapse
|
14
|
Jamerson KA. The Disproportionate Impact of Hypertensive Cardiovascular Disease in African Americans: Getting to the Heart of the Issue. J Clin Hypertens (Greenwich) 2007; 6:4-10. [PMID: 15073461 PMCID: PMC8109647 DOI: 10.1111/j.1524-6175.2004.03563.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The prevalence of hypertension in African Americans is among the highest in the world. Persons in this group develop hypertension at a younger age than non-African Americans and develop more severe complications, including stroke, cardiovascular disease, and renal failure. The factors that impart this high risk to this population remain poorly understood and, undoubtedly, environmental factors overshadow genetic predisposition. While identifying the pathophysiologic and environmental factors that contribute to ethnic disparity in disease is important, finding a long-term solution is crucial. Steps that can have an important impact on health outcomes of African Americans are presently available. Awareness of ethnicity as a risk factor for hypertension can allow health care providers to identify persons who are likely to benefit most from early, aggressive intervention. Modifiable factors such as smoking, diet, and sedentary lifestyle, as well as undertreatment of hypertension by physicians, can be targeted immediately.
Collapse
Affiliation(s)
- Kenneth A Jamerson
- Department of Internal Medicine, University of Michigan Health Systems, 3918 Taubman Center, Box 0356, Ann Arbor, MI 48109-0356, USA.
| |
Collapse
|
15
|
Dickson BK, Blackledge J, Hajjar IM. The Impact of Lifestyle Behavior on Hypertension Awareness, Treatment, and Control in a Southeastern Population. Am J Med Sci 2006; 332:211-5. [PMID: 17031248 DOI: 10.1097/00000441-200610000-00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We were interested in determining the rates of hypertension awareness, treatment, and control in individuals living in the southeastern United States and evaluating the impact of lifestyle behaviors on these rates. METHODS This is a cross-sectional survey of a sample of community dwellers in the greater Columbia, South Carolina area. The survey was developed from validated community-based survey questionnaires to evaluate demographic and social history (age, gender, race-ethnicity, income, and education), hypertension history (diagnosis and treatment), and lifestyle behavior (servings of fruits and vegetables [FV] and physical activity [PA] duration and frequency), as well as blood pressure measurement. RESULTS A total of 763 people (mean +/- standard error age 52.4 +/- 0.7 years; 68% women, 53% African American) agreed to be screened. Of all participants with hypertension (438 [58%]), 82% were aware of their illness and 79% were on treatment. Of all hypertensive participants, 39% had their hypertension controlled below 140/90 mm Hg at the time of the survey. Only 11% reported consuming five or more FV per day and 18% reported PA five or more times per week. African-Americans consumed less FV (P < 0.001) and performed less PA (P < 0.001). Those consuming more FV and exercising more frequently had lower hypertension prevalence and tended to have better control rates. CONCLUSIONS In a sample of southeastern residents, the control rate was suboptimal despite a relatively high rate of treatment. Low levels of FV consumption and PA were noted especially in African-American patients and may explain this rate.
Collapse
Affiliation(s)
- Brandy K Dickson
- Division of Geriatrics, Center for Senior Hypertension, Palmetto Health Richland/University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | | | | |
Collapse
|
16
|
Gregory PC, Han E, Morozova O, Kuhlemeier KV. Do Racial Disparities Exist in Access to Inpatient Stroke Rehabilitation in the State of Maryland? Am J Phys Med Rehabil 2006; 85:814-9. [PMID: 16998428 DOI: 10.1097/01.phm.0000237870.07136.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Black patients tend to have a greater number and severity of stroke cases. The literature on access to rehabilitative services shows mixed results ranging from no disparities to limited access among minority populations. This study evaluated the association of race and acute discharge to inpatient stroke rehabilitation in Maryland, a diagnostic related group-and postacute care prospective payment system-exempt state. DESIGN Data from the Maryland Health Services and Cost Review Commission database for 2000 was used to conduct a cross sectional retrospective review to determine the rate of disposition to inpatient rehabilitation facilities (IRF). Multiple logistic regression analyses evaluated factors associated with discharge to IRF in this population. RESULTS There were a total of 12,208 patients hospitalized with stroke in the year 2000. Compared with urban-dwelling white patients, black patients who lived in urban dwellings were more likely to be discharged to IRF, OR 1.42, 95% CI (1.06, 1.91). CONCLUSION In the state of Maryland, urban-dwelling black stroke patients were more likely to be discharged to IRF acutely after stroke. Future studies should assess whether this trend persists in states that have larger rural populations.
Collapse
Affiliation(s)
- Patricia C Gregory
- Department of Physical Medicine and Rehabilitation, The University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA
| | | | | | | |
Collapse
|
17
|
Jackson FLC. Illuminating cancer health disparities using ethnogenetic layering (EL) and phenotype segregation network analysis (PSNA). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:S69-79. [PMID: 17020506 DOI: 10.1207/s15430154jce2101s_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Resolving cancer health disparities continues to befuddle simplistic racial models. The racial groups alluded to in biomedicine, public health, and epidemiology are often profoundly substructured. METHODS EL and PSNA are computational assisted techniques that focus on microethnic group (MEG) substructure. RESULTS Geographical variations in cancer may be due to differences in MEG ancestry or similar environmental exposures to a recognized carcinogen. Examples include breast and prostate cancers in the Chesapeake Bay region and Bight of Biafra biological ancestry, hypertension and stroke in the Carolina Coast region and Central African biological ancestry, and pancreatic cancer in the Mississippi Delta region and dietary/medicinal exposure to safrol from Sassafras albidum.
Collapse
Affiliation(s)
- Fatimah L C Jackson
- Department of Anthropology, Genomic Models Research Group, Biological Anthropology Research Laboratory, MD 20742, USA.
| |
Collapse
|
18
|
Abstract
Low-income rural southern African American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African American women continue to die at a disproportionately higher rate, and at earlier ages than do Caucasian women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.
Collapse
Affiliation(s)
- Susan J Appel
- School of Nursing, University of Alabama at Birmingham, 35294, USA.
| | | | | |
Collapse
|
19
|
Abstract
Disease epidemics have influenced world history throughout time. Although disease patterns such as the plague and smallpox historically have been infectious in nature, chronic diseases such as cardiovascular disease, stroke, congestive heart failure, and end-stage renal disease have become the new global epidemics. The effects of these conditions affect nearly all populations of the world. Although high blood pressure has been implicated as the common link of these pandemic patterns only for less than half a century, the impact of hypertension treatment and control has become a documented population-based response with the greatest potential for global impact. For example, an estimated 45% of the deaths among African-American men could be prevented with treatment of high blood pressure to goal level. However, population demographics and risk factors predict a worsening effect as the populations of the world increase in age, racial disparities in access to medical care widen, and comorbid conditions such as obesity and metabolic syndrome continue to increase at epidemic rates. The economic impact of hypertension-related conditions, end-stage renal disease, and congestive heart failure is staggering, such that health care delivery systems will fail if the current trends are not changed. Hospitalization rates of hypertension-related conditions are increasing along with an aging population. The number of at-risk individuals in the population also is increasing. As the definition of hypertension changes with lower levels of blood pressure, the proportion of the population considered to have hypertension increases substantially. These trends and disease patterns clearly identify the essential need to implement population and clinical strategies for high blood pressure prevention, treatment, and control.
Collapse
Affiliation(s)
- Daniel T Lackland
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA.
| |
Collapse
|
20
|
Smith SL, Quandt SA, Arcury TA, Wetmore LK, Bell RA, Vitolins MZ. Aging and eating in the rural, southern United States: beliefs about salt and its effect on health. Soc Sci Med 2005; 62:189-98. [PMID: 15990209 DOI: 10.1016/j.socscimed.2005.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
This paper draws upon qualitative research conducted among older adults in the rural, southern United States in which they articulated their beliefs and experiences with nutrition and foods, and lay models of the connection of diet with chronic disease. Salt emerged as a focus of contention. The goals of the paper are to (1) present the culturally constructed meaning of salt, (2) contrast the cultural meaning with biomedical views, and (3) discuss how these findings can be applied to health education and better doctor-patient communication. Data were collected in two rural communities characterized by high rates of poverty and a high proportion of minority residents. A total of 116 African American, Native American and white adults aged 60 years and older participated in 55 in-depth interviews or seven focus groups. A systematic analysis of text showed that salt was a highly contested component of food. While valued for its role in traditional foods and cuisine, it also held negative connotations because of biomedical links to chronic diseases prevalent in the population. We suggest that attempts to control salt intake are made difficult by the changes in taste perceptions that accompany aging. Respondents' articulation of salt's role in health and disease shows cross-over among different chronic diseases and a lay interpretation of blood as the medium through which salt affects disease. These older adults' narratives demonstrate their attempts to reconcile the important role of traditional foods in their identity as Southerners with their attempts to meet medical recommendations for healthy eating.
Collapse
Affiliation(s)
- Shannon L Smith
- Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, USA
| | | | | | | | | | | |
Collapse
|
21
|
Collins TC, Petersen NJ, Menke TJ, Souchek J, Foster W, Ashton CM. Short-term, intermediate-term, and long-term mortality in patients hospitalized for stroke. J Clin Epidemiol 2003; 56:81-7. [PMID: 12589874 DOI: 10.1016/s0895-4356(02)00570-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cerebrovascular disease is the third leading cause of death and the primary cause of long-term disability in the United States. Although the risk factors for stroke have been well defined, less is known about stroke mortality over varying time periods within the same cohort of patients. The purpose of this study is to define rates of short-term, intermediate-term, and long-term stroke mortality among patients experiencing a first-ever hemorrhagic or ischemic stroke between 1994 and 1998. Patients were identified from the Patient Treatment Files of the Department of Veterans Affairs (VA). We included all patients who were discharged from a VA inpatient facility with a diagnosis of acute stroke. Patients were excluded from the study if they had an admission within the previous 5 years for stroke or hemiplegia. We obtained information on the patient's age, gender, and coexisting illnesses. Unadjusted and adjusted 30-day mortality rates were computed using Kaplan-Meier analyses and Cox proportional hazards regression models. The survival-dependent Cox proportional hazards regression models were run for 31-90 days and 91-365 days from the index admission date, for patients who had survived to the start of each of these time periods. Separate models were run for ischemic (n = 34,866 patients) and hemorrhagic (n = 5,442 patients) strokes. Unadjusted 30-day mortality was 8.2 and 20.5% for ischemic and hemorrhagic strokes, respectively. The adjusted 30-day mortality rate was 7.4 and 18.8% for ischemic and hemorrhagic strokes, respectively. For ischemic stroke, age 65 years and older was associated with an increased risk for short-term, intermediate-term, and long-term mortality, while chronic heart failure was associated with an increased risk for short-term and long-term mortality. For hemorrhagic stroke, age 75 years and older, malignancy, and chronic heart failure were associated with increased mortality during all three time periods. Thirty-day mortality is over two times greater following hemorrhagic stroke vs. ischemic stroke. For patients who survive 30 days after an ischemic stroke, the risk factor that remains significantly associated with long-term mortality, which may be improved with appropriate process of care, is chronic heart failure. For patients with a hemorrhagic stroke, variables that remain significantly associated with increased short-term and long-term mortality include malignant neoplasm and chronic heart failure. Information on stroke mortality is important for patients, physicians, and researchers. In addition to stroke treatment, clinicians must be able to provide families of stroke victims with appropriate prognostic information. Further work is needed to assess the impact of actual care patterns, for the above identified risk factors, on stroke prognosis over varying time periods.
Collapse
Affiliation(s)
- Tracie C Collins
- Houston Center for Quality Care & Utilization Studies, 2002 Holcombe Blvd. (152), Houston, TX 77030, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Flack JM, Ferdinand KC, Nasser SA. Epidemiology of hypertension and cardiovascular disease in African Americans. J Clin Hypertens (Greenwich) 2003; 5:5-11. [PMID: 12556667 PMCID: PMC8101861 DOI: 10.1111/j.1524-6175.2003.02152.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hypertension is a major cause of cardiovascular-renal morbidity and mortality and all-cause mortality. It is a highly significant problem for African Americans; about 30% of all deaths in this population are attributable to hypertension. Compared with whites, hypertension in African Americans is more prevalent, occurs earlier in life, is more severe, and is more often associated with target organ injury such as left ventricular hypertrophy and other cardiovascular complications. Only 25% of all African Americans with hypertension and fewer than 50% of those receiving drug treatment attain a blood pressure <140/90 mm Hg. These control rates are somewhat less than in white Americans. Enhanced awareness and understanding of the epidemiologic patterns of hypertension, other cardiovascular risk factors, risk-factor control rates, and factors influencing these control rates should lead to better approaches to risk-factor control. This most likely would result in a reduction of cardiovascular disease complications.
Collapse
Affiliation(s)
- John M Flack
- Department of Internal Medicine, Cardiovascular Epidemiology and Clinical Applications Program, Wayne State University, Detroit, MI 48201, USA.
| | | | | |
Collapse
|
23
|
Kaufman JS, Hall SA. The slavery hypertension hypothesis: dissemination and appeal of a modern race theory. Epidemiology 2003; 14:111-8. [PMID: 12500059 DOI: 10.1097/00001648-200301000-00027] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jay S Kaufman
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill 27599, USA.
| | | |
Collapse
|
24
|
Egan BM, Lackland DT, Williams B, Gunter N, Tocharoen A, Beardon L. Health care improvement and cost reduction opportunities in hypertensive Medicaid beneficiaries. J Clin Hypertens (Greenwich) 2001; 3:279-82, 318. [PMID: 11588405 PMCID: PMC8101810 DOI: 10.1111/j.1524-6175.2001.00477.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2000] [Accepted: 03/01/2001] [Indexed: 11/28/2022]
Abstract
Hypertension and its complications are more frequent and occur about a decade earlier in life among high-risk groups, especially in the Southeast. Moreover, socioeconomic status is inversely related to hypertension and cardiovascular complications. Low-income, young and middle-aged adults living in the Southeast may be at especially high risk. Data on inpatient admissions among hypertensive Medicaid beneficiaries living in this region may provide insights on the burden of hypertension-related disease and on opportunities for successful intervention. A study of hospitalization rates and costs among 44,440 hypertensive Medicaid beneficiaries in South Carolina from 1993-1996 showed that 16,883 (38%) were continuously enrolled in Medicaid. Of this group, 63% were African American and 74% were women. Among the continuously enrolled patients, 7637, or about 45%, were hospitalized during the 4-year period. These 7637 individuals accounted for 20,698 hospital admissions, i.e., 2.7 admissions per person, over the 4-year interval. Nearly two thirds of the hospitalizations included a cardiovascular or renal diagnosis. Hospital claims paid reached nearly $90 million for the 7637 hypertensive Medicaid recipients during the 4-year period. Among patients discharged from the hospital with congestive heart failure, 33% filled a prescription for an angiotensin-converting enzyme inhibitor within 90 days; 13% of patients discharged with an acute myocardial infarction filled a prescription for a beta blocker within 90 days. The data confirm that hypertensive Medicaid beneficiaries in the Southeast are hospitalized at high rates. Cardiovascular and renal morbidity account for the majority of the inpatient admissions. The findings suggest that the application of evidence-based guidelines would improve health, avoid cost, and reduce racial disparities in health outcomes.
Collapse
Affiliation(s)
- B M Egan
- Department of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | | | | | |
Collapse
|