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Mendez DD, Christian SN, Casas A, Scott S, Hardy H, Harris R, Wilkerson A, Gary-Webb TL. Instituting Racial Equity: The Allegheny County Racial and Ethnic Approaches to Community Health Initiative. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:391-397. [PMID: 36263958 DOI: 10.1177/2752535x221135301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. METHODS Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. RESULTS Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization's mission, goals and subsequent actions. DISCUSSION As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work.
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Affiliation(s)
- Dara D Mendez
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie N Christian
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea Casas
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samantha Scott
- Chronic Disease and Injury Prevention Program, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Hannah Hardy
- Chronic Disease and Injury Prevention Program, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Roderick Harris
- Chronic Disease and Injury Prevention Program, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Aja Wilkerson
- Chronic Disease and Injury Prevention Program, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Lalika M, McCoy CR, Jones C, Bancos I, Cooper LA, Hayes SN, Johnson MP, Kullo IJ, Kumbamu A, Noseworthy PA, Patten CA, Singh R, Wi CI, Brewer LC. Rationale, design, and participant characteristics of the FAITH! Heart Health+ study: An exploration of the influence of the social determinants of health, stress, and structural racism on African American cardiovascular health. Contemp Clin Trials 2024; 143:107600. [PMID: 38851481 DOI: 10.1016/j.cct.2024.107600] [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: 10/09/2023] [Revised: 04/16/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND African Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs. METHODS Using a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February-December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life. RESULTS Participants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5). CONCLUSION This study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations.
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Affiliation(s)
- Mathias Lalika
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Carrie R McCoy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Clarence Jones
- Hue-Man Partnership, 2400 Park Ave, Minneapolis, MN 55404, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite#2-500, Baltimore, MD 21205, USA.
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Matthew P Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Ravinder Singh
- Division of Clinical Biochemistry & Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA; Center for Health Equity and Community Engagement Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Nair L, Asuzu P, Dagogo-Jack S. Ethnic Disparities in the Risk Factors, Morbidity, and Mortality of Cardiovascular Disease in People With Diabetes. J Endocr Soc 2024; 8:bvae116. [PMID: 38911352 PMCID: PMC11192623 DOI: 10.1210/jendso/bvae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Indexed: 06/25/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in people with diabetes. Compared with European Americans, African Americans have more favorable lipid profiles, as indicated by higher high-density lipoprotein cholesterol, lower triglycerides, and less dense low-density lipoprotein particles. The less atherogenic lipid profile translates to lower incidence and prevalence of CVD in African Americans with diabetes, despite higher rates of hypertension and obesity. However, African Americans with CVD experience worse clinical outcomes, including higher mortality, compared with European Americans. This mini-review summarizes the epidemiology, pathophysiology, mechanisms, and management of CVD in people with diabetes, focusing on possible factors underlying the "African American CVD paradox" (lower CVD incidence/prevalence but worse outcomes). Although the reasons for the disparities in CVD outcomes remain to be fully elucidated, we present a critical appraisal of the roles of suboptimal control of risk factors, inequities in care delivery, several biological factors, and psychosocial stress. We identify gaps in current knowledge and propose areas for future investigation.
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Affiliation(s)
- Lekshmi Nair
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Peace Asuzu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Yang Q, Chang A, Tong X, Jackson SL, Merritt RK. Long-term cardiovascular disease outcomes in non-hospitalized medicare beneficiaries diagnosed with COVID-19: Population-based matched cohort study. PLoS One 2024; 19:e0302593. [PMID: 38743728 PMCID: PMC11093379 DOI: 10.1371/journal.pone.0302593] [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: 11/06/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND SARS-CoV2, the virus that causes coronavirus disease 2019 (COVID-19), can affect multiple human organs structurally and functionally, including the cardiovascular system and brain. Many studies focused on the acute effects of COVID-19 on risk of cardiovascular disease (CVD) and stroke especially among hospitalized patients with limited follow-up time. This study examined long-term mortality, hospitalization, CVD and stroke outcomes after non-hospitalized COVID-19 among Medicare fee-for-service (FFS) beneficiaries in the United States. METHODS This retrospective matched cohort study included 944,371 FFS beneficiaries aged ≥66 years diagnosed with non-hospitalized COVID-19 from April 1, 2020, to April 30, 2021, and followed-up to May 31, 2022, and 944,371 propensity score matched FFS beneficiaries without COVID-19. Primary outcomes were all-cause mortality, hospitalization, and incidence of 15 CVD and stroke. Because most outcomes violated the proportional hazards assumption, we used restricted cubic splines to model non-proportional hazards in Cox models and presented time-varying hazard ratios (HRs) and Bonferroni corrected 95% confidence intervals (CI). RESULTS The mean age was 75.3 years; 58.0% women and 82.6% non-Hispanic White. The median follow-up was 18.5 months (interquartile range 16.5 to 20.5). COVID-19 showed initial stronger effects on all-cause mortality, hospitalization and 12 incident CVD outcomes with adjusted HRs in 0-3 months ranging from 1.05 (95% CI 1.01-1.09) for mortality to 2.55 (2.26-2.87) for pulmonary embolism. The effects of COVID-19 on outcomes reduced significantly after 3-month follow-up. Risk of mortality, acute myocardial infarction, cardiomyopathy, deep vein thrombosis, and pulmonary embolism returned to baseline after 6-month follow-up. Patterns of initial stronger effects of COVID-19 were largely consistent across age groups, sex, and race/ethnicity. CONCLUSIONS Our results showed a consistent time-varying effects of COVID-19 on mortality, hospitalization, and incident CVD among non-hospitalized COVID-19 survivors.
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Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Anping Chang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Robert K. Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Woodruff RC, Tong X, Wadhera RK, Loustalot F, Jackson SL, Vaughan AS. Cardiovascular Disease Mortality Disparities in Black and White Adults, 2010‒2022. Am J Prev Med 2024; 66:914-916. [PMID: 38101465 PMCID: PMC11034707 DOI: 10.1016/j.amepre.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Rishi K Wadhera
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
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Borkowski P, Borkowska N, Mangeshkar S, Adal BH, Singh N. Racial and Socioeconomic Determinants of Cardiovascular Health: A Comprehensive Review. Cureus 2024; 16:e59497. [PMID: 38826910 PMCID: PMC11143437 DOI: 10.7759/cureus.59497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally. Their prevalence and mortality rates continue to rise. This narrative review explores well-known risk factors for CVDs such as dyslipidemia, hypertension, diabetes, obesity, and smoking, and their prevalence among different racial and ethnic groups. In addition, we expand the discussion to include the impact of socioeconomic status (SES) on cardiovascular outcomes. The data demonstrate that non-Hispanic Black and Hispanic populations not only exhibit higher rates of hypertension, obesity, diabetes, and smoking but also face systemic barriers linked to lower SES, which worsen their cardiovascular outcomes. These barriers include a lack of education, lower income, higher rates of unemployment, and poor living conditions. Beyond these commonly studied factors, these groups also suffer from higher levels of food and housing insecurity and a lack of adequate insurance coverage, all of which contribute to poorer health. Additionally, there is a higher prevalence of mental health disorders, such as depression and anxiety, among these populations. This further compounds the risks and adverse outcomes associated with CVDs. It is essential to conduct further research into how SES and race influence cardiovascular health and to refine risk assessment methods. Concentrating on these aspects would make it possible to create interventions designed to meet the needs of diverse communities and strategies that could potentially reduce morbidity and mortality from CVD across populations. Moreover, this review advocates for integrating comprehensive socioeconomic data into cardiovascular health strategies, which is crucial for developing effective public health initiatives.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Borkowska
- Pediatrics, SPZOZ (Samodzielny Publiczny Zakład Opieki Zdrowotnej) Krotoszyn, Krotoszyn, POL
| | - Shaunak Mangeshkar
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Bisrat H Adal
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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Tang WL, Rodriguez F. Racial and Ethnic Disparities in the Management of Chronic Coronary Disease. Med Clin North Am 2024; 108:595-607. [PMID: 38548466 PMCID: PMC10979033 DOI: 10.1016/j.mcna.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.
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Affiliation(s)
- Wilson Lay Tang
- Department of Medicine, Stanford University, 300 Pasteur Drive, L154, Stanford, CA 94305-5133, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Center for Academic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Woodruff RC, Tong X, Khan SS, Shah NS, Jackson SL, Loustalot F, Vaughan AS. Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010-2022. Am J Prev Med 2024; 66:582-589. [PMID: 37972797 PMCID: PMC10957309 DOI: 10.1016/j.amepre.2023.11.009] [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: 09/07/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) mortality increased during the initial years of the COVID-19 pandemic, but whether these trends endured in 2022 is unknown. This analysis describes temporal trends in CVD death rates from 2010 to 2022 and estimates excess CVD deaths from 2020 to 2022. METHODS Using national mortality data from the National Vital Statistics System, deaths among adults aged ≥35 years were classified by underlying cause of death International Classification of Diseases 10th Revision codes for CVD (I00-I99), heart disease (I00-I09, I11, I13, I20-I51), and stroke (I60-I69). Analyses in Joinpoint software identified trends in CVD age-adjusted mortality rates (AAMR) per 100,000 and estimated the number of excess CVD deaths from 2020 to 2022. RESULTS During 2010-2022, 10,951,403 CVD deaths occurred (75.6% heart disease, 16.9% stroke). The national CVD AAMR declined by 8.9% from 2010 to 2019 (456.6-416.0 per 100,000) and then increased by 9.3% from 2019 to 2022 to 454.5 per 100,000, which approximated the 2010 rate (456.7 per 100,000). From 2020 to 2022, 228,524 excess CVD deaths occurred, which was 9% more CVD deaths than expected based on trends from 2010 to 2019. Results varied by CVD subtype and population subgroup. CONCLUSIONS Despite stabilization of the public health emergency, declines in CVD mortality rates reversed in 2020 and remained high in 2022, representing almost a decade of lost progress and over 228,000 excess CVD deaths. Findings underscore the importance of prioritizing prevention and management of CVD to improve outcomes.
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Affiliation(s)
- Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
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Perera S, Zheng Z, Wadhera RK. Cardiovascular Health, Lifestyle Factors, and Social Determinants in Asian Subpopulations in the United States. Am J Cardiol 2024; 216:77-86. [PMID: 38369173 DOI: 10.1016/j.amjcard.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
Asian Americans are often aggregated in national public health surveillance efforts, which may conceal important differences in the health status of subgroups that are included in this highly diverse population. Little is known about how cardiovascular health varies across Asian subpopulations and the extent to which lifestyle and social risk factors contribute to any observed differences. This national study used data from the National Health Interview Survey to evaluate the burden of cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and cardiovascular diseases (heart attack, coronary heart disease, angina, stroke) across Asian groups (Chinese, Asian Indian, Filipino, Other Asian), and determine whether differences are related to lifestyle factors and/or social determinants of health. The weighted study population included 13,592,178 Asian adults. Filipino adults were more likely to have hypertension than Chinese adults (29.4% vs 15.4%; adjusted odds ratio [OR] 2.40, 95% confidence interval [1.91 to 3.02]), as were Asian Indians (15.7%; OR 1.59 [1.25 to 2.02]). These patterns were similar for hyperlipidemia and diabetes mellitus. For cardiovascular diseases, Filipino adults were significantly more likely to have coronary heart disease (4.2% vs 1.9%; OR 2.19 [1.32 to 3.56]), heart attack (2.6% vs 0.9%; OR 2.79 [1.44 to 5.41]), angina (1.8% vs 0.9%; OR 2.15 [1.06 to 4.32]), and stroke (2.1% vs 0.8%; OR 2.54 [1.42 to 4.55]) compared with Chinese adults, whereas there were no differences compared with Asian Indian adults. Adjustments for lifestyle factors and social determinants completely attenuated differences in coronary heart disease, heart attack, and angina among subpopulations. In conclusion, these findings demonstrate that cardiovascular risk factors and diseases vary significantly across Asian subpopulations, with Filipino adults experiencing the highest burden and Chinese adults the lowest, and that differences in cardiovascular disease are largely attenuated after adjustment for lifestyle and social determinants.
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Affiliation(s)
- Sudheesha Perera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Sarraju A, Yan X, Huang Q, Dudum R, Palaniappan L, Rodriguez F. Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity. Am J Prev Cardiol 2024; 17:100647. [PMID: 38525197 PMCID: PMC10958062 DOI: 10.1016/j.ajpc.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objective There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.
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Affiliation(s)
- Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaowei Yan
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Qiwen Huang
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Latha Palaniappan
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
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Blegen MB, Rook JM, Jackson NJ, Maggard-Gibbons M, Li R, Russell MM, Russell TA, de Virgilio C, Tsugawa Y. Changes in surgical mortality during COVID-19 pandemic by patients' race, ethnicity and socioeconomic status among US older adults: a quasi-experimental event study model. BMJ Open 2024; 14:e079825. [PMID: 38365289 PMCID: PMC10882376 DOI: 10.1136/bmjopen-2023-079825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES To examine changes in the 30-day surgical mortality rate after common surgical procedures during the COVID-19 pandemic and investigate whether its impact varies by urgency of surgery or patient race, ethnicity and socioeconomic status. DESIGN We used a quasi-experimental event study design to examine the effect of the COVID-19 pandemic on surgical mortality rate, using patients who received the same procedure in the prepandemic years (2016-2019) as the control, adjusting for patient characteristics and hospital fixed effects (effectively comparing patients treated at the same hospital). We conducted stratified analyses by procedure urgency, patient race, ethnicity and socioeconomic status (dual-Medicaid status and median household income). SETTING Acute care hospitals in the USA. PARTICIPANTS Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 14 common surgical procedures from 1 January 2016 to 31 December 2020. MAIN OUTCOME MEASURES 30-day postoperative mortality rate. RESULTS Our sample included 3 620 689 patients. Surgical mortality was higher during the pandemic, with peak mortality observed in April 2020 (adjusted risk difference (aRD) +0.95 percentage points (pp); 95% CI +0.76 to +1.26 pp; p<0.001) and mortality remained elevated through 2020. The effect of the pandemic on mortality was larger for non-elective (vs elective) procedures (April 2020: aRD +0.44 pp (+0.16 to +0.72 pp); p=0.002 for elective; aRD +1.65 pp (+1.00, +2.30 pp); p<0.001 for non-elective). We found no evidence that the pandemic mortality varied by patients' race and ethnicity (p for interaction=0.29), or socioeconomic status (p for interaction=0.49). CONCLUSIONS 30-day surgical mortality during the COVID-19 pandemic peaked in April 2020 and remained elevated until the end of the year. The influence of the pandemic on surgical mortality did not vary by patient race and ethnicity or socioeconomic status, indicating that once patients were able to access care and undergo surgery, surgical mortality was similar across groups.
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Affiliation(s)
- Mariah B Blegen
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- National Clinician Scholars Program, UCLA, Los Angeles, California, USA
| | - Jordan M Rook
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- National Clinician Scholars Program, UCLA, Los Angeles, California, USA
| | - Nicholas J Jackson
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Melinda Maggard-Gibbons
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Ruixin Li
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Marcia M Russell
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Tara A Russell
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Christian de Virgilio
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
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12
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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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Berisha DE, Rizvi B, Chappel-Farley MG, Tustison N, Taylor L, Dave A, Sattari NS, Chen IY, Lui KK, Janecek JC, Keator D, Neikrug AB, Benca RM, Yassa MA, Mander BA. Cerebrovascular pathology mediates associations between hypoxemia during rapid eye movement sleep and medial temporal lobe structure and function in older adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.28.577469. [PMID: 38328085 PMCID: PMC10849660 DOI: 10.1101/2024.01.28.577469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Obstructive sleep apnea (OSA) is common in older adults and is associated with medial temporal lobe (MTL) degeneration and memory decline in aging and Alzheimer's disease (AD). However, the underlying mechanisms linking OSA to MTL degeneration and impaired memory remains unclear. By combining magnetic resonance imaging (MRI) assessments of cerebrovascular pathology and MTL structure with clinical polysomnography and assessment of overnight emotional memory retention in older adults at risk for AD, cerebrovascular pathology in fronto-parietal brain regions was shown to statistically mediate the relationship between OSA-related hypoxemia, particularly during rapid eye movement (REM) sleep, and entorhinal cortical thickness. Reduced entorhinal cortical thickness was, in turn, associated with impaired overnight retention in mnemonic discrimination ability across emotional valences for high similarity lures. These findings identify cerebrovascular pathology as a contributing mechanism linking hypoxemia to MTL degeneration and impaired sleep-dependent memory in older adults.
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Affiliation(s)
- Destiny E. Berisha
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Batool Rizvi
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Miranda G. Chappel-Farley
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Nicholas Tustison
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Lisa Taylor
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
| | - Negin S. Sattari
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Kitty K. Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92093, USA
| | - John C. Janecek
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - David Keator
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ariel B. Neikrug
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ruth M. Benca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, 53706, WI, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, 27109, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Neurology, University of California Irvine, Irvine CA, 92697, USA
| | - Bryce A. Mander
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine CA, 92697, USA
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14
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Wadhera RK. The Paradoxical Decline in Cardiovascular Hospitalizations in the US. JAMA HEALTH FORUM 2024; 5:e234334. [PMID: 38180768 DOI: 10.1001/jamahealthforum.2023.4334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- Rishi K Wadhera
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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15
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Feng L, Liu Y, Li P, Wan H, Deng X, Wang T, Fu H, Duan X. Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study. Int J Surg 2024; 110:353-360. [PMID: 37916928 PMCID: PMC10793752 DOI: 10.1097/js9.0000000000000842] [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: 07/09/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Previous studies have shown that patients with cerebrovascular disease (CVD) have a significantly increased risk of cognitive decline or dementia; however, the association between preoperative CVD and perioperative neurocognitive disorders (PNDs) remains unclear. This study aimed to explore the correlation between preoperative CVD and PNDs, as well as combine logistic regression and receiver operating characteristic (ROC) curves to construct a clinical prediction PND model. MATERIALS AND METHODS This retrospective cohort study evaluated 13 899 surgical patients of a large-scale comprehensive hospital between January 2021 and January 2022 to explore the association between preoperative CVD and PNDs, with follow-up to monitor postoperative survival until 28 February 2023, unless the patient died. The study participants comprised all inpatients from the Bone and Joint Surgery, Spine Surgery, Urology, Hepatobiliary Surgery, Gastrointestinal Surgery, and Thoracic Surgery departments. Patients were classified into two groups: the CVD group with a confirmed diagnosis and the noncerebrovascular disease group. The incidence of PNDs was measured, and potential associations between patient demographic information, preoperative comorbidities, and CVD, as well as the correlation between preoperative CVD and PNDs, were investigated by multivariate logistic regression analysis. Next, the authors constructed a clinical prediction PND model by drawing the ROC curve. The postoperative survival of all patients was tracked, and a survival curve was constructed and incorporated into the Cox proportional hazard regression model to analyze the relationship between preoperative CVD and the overall postoperative survival rate. RESULTS Of the included 13 899 patients, propensity score matching yielded 1006 patient pairs. Multivariate logistic regression analysis revealed that CVD was an independent risk factor for PNDs [odds ratio: 10.193; 95% CI: 7.454-13.938; P <0.001]. Subsequently, the authors developed a clinical prediction model for PNDs by multivariate logistic regression analysis. The area under the ROC curve was 0.798 (95% CI: 0.765-0.830). The survival of 11 702 patients was followed up. Multivariate Cox hazard ratio regression analysis revealed that CVD affected the overall postoperative survival rate (hazard ratio, 1.398; 95% CI: 1.112-1.758; P <0.001). CONCLUSION CVD was an independent risk factor for PNDs and affected the overall postoperative survival rate of surgical patients with preoperative CVD.
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Affiliation(s)
- Lan Feng
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, People’s Republic of China
| | - Yuanhui Liu
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - PengFei Li
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Hengjun Wan
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Xiren Deng
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
| | - Tingting Wang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University
| | - Hong Fu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, People’s Republic of China
| | - Xiaoxia Duan
- Department of Anesthesiology
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province
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Hui Yeo Y, Zhang Y, He X, Lv F, Patel JK, Ji F, Cheng S. Temporal trend of acute myocardial infarction-related mortality and associated racial/ethnic disparities during the omicron outbreak. J Transl Int Med 2023; 11:468-470. [PMID: 38130642 PMCID: PMC10732487 DOI: 10.2478/jtim-2023-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yue Zhang
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xinyuan He
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jignesh K. Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fanpu Ji
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, Shaanxi Province, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi’an, Shaanxi Province, China
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Marinacci LX, Bartlett V, Zheng Z, Mein S, Wadhera RK. Health Care Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic. Circ Cardiovasc Qual Outcomes 2023; 16:e010516. [PMID: 37929572 PMCID: PMC10872901 DOI: 10.1161/circoutcomes.123.010516] [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: 09/07/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Low-income working-age US adults disproportionately experienced health care disruptions at the onset of the coronavirus disease 2019 pandemic. Little is known about how health care access and cardiovascular risk factor management changed as the pandemic went on or if patterns differed by state Medicaid expansion status. METHODS Cross-sectional data from the behavioral risk factor surveillance system were used to compare self-reported measures of health care access and cardiovascular risk factor management among US adults aged 18 to 64 years in 2021 (pandemic) to 2019 (prepandemic) using multivariable Poisson regression models. We assessed differential changes between low-income (<138% federal poverty level) and high-income (>400% federal poverty level) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus nonexpansion states using a similar approach. RESULTS The unweighted study population included 80 767 low-income and 184 136 high-income adults. Low-income adults experienced improvements in insurance coverage (relative risk [RR], 1.10 [95% CI, 1.08-1.12]), access to a provider (RR, 1.12 [95% CI, 1.09-1.14]), and ability to afford care (RR, 1.07 [95% CI, 1.05-1.09]) in 2021 compared with 2019. While these measures also improved for high-income adults, gains in coverage and ability to afford care were more pronounced among low-income adults. However, routine visits (RR, 0.96 [95% CI, 0.94-0.98]) and cholesterol testing (RR, 0.93 [95% CI, 0.91-0.96]) decreased for low-income adults, while diabetes screening (RR, 1.01 [95% CI, 0.95-1.08]) remained stable. Treatment for hypertension (RR, 1.05 [95% CI, 1.02-1.08]) increased, and diabetes-focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus nonexpansion states. CONCLUSIONS In this national study of working-age adults in the United States, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return to prepandemic levels, while risk factor treatment remained stable. As many coronavirus disease-era safety net policies come to an end, targeted strategies are needed to protect health care access and improve cardiovascular risk factor screening for working-age adults.
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Affiliation(s)
- Lucas X. Marinacci
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Victoria Bartlett
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - ZhaoNian Zheng
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stephen Mein
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rishi K. Wadhera
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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18
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He W, Xu K, Ni L, Wu J, Zhang Y, Miao K, Wang L, Wang DW. Myocardial injury and related mortality in hospitalized patients with COVID-19 during the Omicron pandemic: new perspectives and insights. Virol Sin 2023; 38:940-950. [PMID: 37839550 PMCID: PMC10786663 DOI: 10.1016/j.virs.2023.10.005] [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: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
Myocardial injury is one of the most common comorbidity in SARS-CoV-2 infected patients, and has poor prognosis. However, the incidence of myocardial injury in patients with SARS-CoV-2 infection has not been sufficiently investigated during the Omicron wave. We conducted a retrospective study of 2690 patients with confirmed SARS-CoV-2 Omicron infection from Tongji Hospital. The results indicated that the myocardial injury accounted for 30.8% of the total patients with SARS-CoV-2 infection and was associated with higher in-hospital mortality than those without injury before and after propensity score matching (PSM) [adjusted hazard ratio (HR), 10.61; 95% confidence interval (CI), 7.76-14.51; P < 0.001; adjusted HR, 2.70; 95% CI, 1.86-3.93; P < 0.001; respectively]. Further, the levels of cytokines (IL-1β, IL-6, IL-10, and TNF-α) in patients with myocardial injury were higher than those without injury, and the higher levels of cytokines in the myocardial injury group were associated with increased mortality. Administration of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) could significantly reduce the mortality in patients with myocardial injury (adjusted HR, 0.52; 95% CI, 0.38-0.71; P < 0.001). Additionally, the level of angiotensin II increased in patients with SARS-CoV-2 infection was even higher in myocardial injury group compared to those without injury. Collectively, the study summarized the clinical characteristic and outcome of SARS-CoV-2 infected patients with myocardial injury during the Omicron wave in China, and validated the protective role of ACEI/ARB in improving the survival of those with myocardial injury.
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Affiliation(s)
- Wu He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Ke Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Li Ni
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Junfang Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Yuxuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Kun Miao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Luyun Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China.
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Hong X, Rosenberg AZ, Heymann J, Yoshida T, Waikar SS, Ilori TO, Wang G, Rebuck H, Pearson C, Wang M, Winkler CA, Kopp JB, Wang X. Joint Associations of Pregnancy Complications and Postpartum Maternal Renal Biomarkers With Severe Cardiovascular Morbidities: A US Racially and Ethnically Diverse Prospective Birth Cohort Study. J Am Heart Assoc 2023; 12:e029311. [PMID: 37947096 PMCID: PMC10727285 DOI: 10.1161/jaha.122.029311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/25/2023] [Indexed: 11/12/2023]
Abstract
Background Pregnancy complications are risk factors for cardiovascular disease (CVD). Little is known about the role of renal biomarkers measured shortly after delivery, individually or in combination with pregnancy complications, in predicting subsequent severe maternal CVD. Methods and Results This study included 566 mothers of diverse races and ethnicities from the Boston Birth cohort, enrolled at delivery and followed prospectively. Plasma creatinine and CysC (cystatin C) were measured 1 to 3 days after delivery. CVD during follow-up was defined by physician diagnoses in electronic medical records. Associations of renal biomarkers and pregnancy complications with time-to-CVD events were assessed using Cox proportional hazards models. During an average of 10.3±3.2 years of follow-up, 30 mothers developed 1 or more CVDs. Only a modest association was observed between creatinine and risk of CVD. In comparison, we found that per 0.1 mg/L increase of CysC was associated with a hazard ratio (HR) of 1.2 (95% CI, 1.1-1.4) for CVD after adjusting for covariates. Compared with those without preeclampsia and with normal CysC level (≤75th percentile), mothers with preeclampsia and elevated CysC (>75th percentile) had the highest risk of CVD (HR, 4.6 [95% CI, 1.7-17.7]), whereas mothers with preeclampsia only or with elevated CysC only did not have significantly increased CVD risk. Similar synergistic effects for CVD were observed between CysC and preterm delivery. Conclusions In this sample of US, traditionally underrepresented multiracial and multiethnic high-risk mothers, elevated maternal plasma CysC, independently and jointly with pregnancy complications, increased risk of CVD later in life. These findings warrant further investigation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03228875.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Jurgen Heymann
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Teruhiko Yoshida
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Sushrut S. Waikar
- Section of Nephrology, Department of MedicineBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Titilayo O. Ilori
- Section of Nephrology, Department of MedicineBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | - Heather Rebuck
- Clinical Chemistry Research LabUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Colleen Pearson
- Department of PediatricsBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Mei‐Cheng Wang
- Department of BiostatisticsJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | - Cheryl A. Winkler
- Cancer Innovation Laboratory, Center for Cancer ResearchNational Cancer Institute and Basic Research Program, Frederick National LaboratoryFrederickMDUSA
| | - Jeffrey B. Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
- Division of General Pediatrics & Adolescent Medicine, Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMDUSA
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20
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Herrmann AA, Chrenka EA, Seth S, Nyamao TM, Niemioja GM, Hanson LR, Hussein HM. Potentially Preventable Readmissions After Acute Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:1014-1019. [PMID: 37104643 DOI: 10.1097/phm.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. DESIGN Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days ( n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls ( n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. RESULTS Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. CONCLUSIONS Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.
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Affiliation(s)
- Amanda A Herrmann
- From the HealthPartners Institute, Bloomington, Minnesota (AAH, EAC, LRH); HealthPartners Neuroscience Center, St Paul, Minnesota (AAH, EAC, SS, TMN, GMN, LRH); Regions Hospital, St Paul, Minnesota (GMN); and University of Minnesota, Minneapolis, Minnesota (HMH)
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21
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Duhan S, Kundan P, Keisham B, Asgar JA, Walia N. Effect of COVID-19 Pandemic on PCI Outcomes: A Single-center Retrospective Race and Gender-based Study. Curr Probl Cardiol 2023; 48:101909. [PMID: 37402422 DOI: 10.1016/j.cpcardiol.2023.101909] [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: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
African Americans (AAs) have a higher risk for postpercutaneous coronary intervention (PCI) ischemic events and worse Coronavirus Disease 2019 (COVID-19)-related events than non-AAs. Race and gender-related post-PCI events before and during the COVID-19 pandemic in a community hospital setup are unknown. Demographics and one-year adverse events in patients undergoing PCI immediately before (2018-2020) and during (2020-2021) pandemic were compared. About 291 and 292 non-AAs and 220 and 219 AAs who underwent PCI before and during the pandemic, respectively, were included. AAs were younger than non-AAs and had a higher prevalence of diabetes and acute coronary syndrome during the pandemic (P < 0.01 for all). Although total ischemic events were the same, cardiovascular death and myocardial infarction were higher during COVID-19 (P < 0.05) and were more prevalent among AAs. The highest ischemic events were observed in AA women during the pandemic compared to other gender and races. These data highlight the high intrinsic thrombogenicity phenotype in AA women.
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Affiliation(s)
- Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD.
| | - Parshotam Kundan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Juzer Ali Asgar
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Naval Walia
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
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22
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Contreras J, Tinuoye EO, Folch A, Aguilar J, Free K, Ilonze O, Mazimba S, Rao R, Breathett K. Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker: Unmasking Racial and Ethnic Inequities During a Pandemic. Cardiol Clin 2023; 41:491-499. [PMID: 37743072 PMCID: PMC10267502 DOI: 10.1016/j.ccl.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart failure and SDOH. The pandemic presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.
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Affiliation(s)
- Johanna Contreras
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Elizabeth O Tinuoye
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Alejandro Folch
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Jose Aguilar
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908-0158, USA
| | - Roopa Rao
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
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23
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Chouairi F, Pinsker B, Miller PE, Fudim M. Effects of COVID-19 on heart failure admissions. Am Heart J 2023; 263:183-187. [PMID: 37156331 PMCID: PMC10163787 DOI: 10.1016/j.ahj.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Despite significant investigation into the effects of COVID-19 on cardiovascular disease, there is a paucity of national data specifically examining its effects on heart failure (HF) hospitalizations. Previous cohort study data demonstrate worsened outcomes in HF patients with recent COVID-19 infection. To better understand this association, this study aimed to utilize a nationally representative database to examine demographics, outcomes, and health care utilization in hospitalizations for HF with a codiagnosis of COVID-19.
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Affiliation(s)
- Fouad Chouairi
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Bret Pinsker
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
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24
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Thamman R, Yong CM, Tran AH, Tobb K, Brandt EJ. Role of Artificial Intelligence in Cardiovascular Health Disparities: The Risk of Greasing the Slippery Slope. JACC. ADVANCES 2023; 2:100578. [PMID: 38939488 PMCID: PMC11198264 DOI: 10.1016/j.jacadv.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Ritu Thamman
- University of Pisburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Celina M. Yong
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California, USA
| | - Andrew H. Tran
- Department of Pediatric Cardiology, Nationwide Children's Hospital Heart Center, Columbus, Ohio, USA
| | - Kardie Tobb
- Cone Health Medical Group, Greensboro, North Carolina, USA
| | - Eric J. Brandt
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
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25
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Woolf SH, Chapman DA, Lee JH, Johnston KC, Benson RT, Trevathan E, Smith WR, Gaskin DJ. The Lives Lost to Inequities: Avertable Deaths From Neurologic Diseases in the Past Decade. Neurology 2023; 101:S9-S16. [PMID: 37580146 PMCID: PMC10605951 DOI: 10.1212/wnl.0000000000207561] [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: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality rates for neurologic diseases are increasing in the United States, with large disparities across geographical areas and populations. Racial and ethnic populations, notably the non-Hispanic (NH) Black population, experience higher mortality rates for many causes of death, but the magnitude of the disparities for neurologic diseases is unclear. The objectives of this study were to calculate mortality rates for neurologic diseases by race and ethnicity and-to place this disparity in perspective-to estimate how many US deaths would have been averted in the past decade if the NH Black population experienced the same mortality rates as other groups. METHODS Mortality rates for deaths attributed to neurologic diseases, as defined by the International Classification of Diseases, were calculated for 2010 to 2019 using death and population data obtained from the Centers for Disease Control and Prevention and the US Census Bureau. Avertable deaths were calculated by indirect standardization: For each calendar year of the decade, age-specific death rates of NH White persons in 10 age groups were multiplied by the NH Black population in each age group. A secondary analysis used Hispanic and NH Asian populations as the reference groups. RESULTS In 2013, overall age-adjusted mortality rates for neurologic diseases began increasing, with the NH Black population experiencing higher rates than NH White, NH American Indian and Alaska Native, Hispanic, and NH Asian populations (in decreasing order). Other populations with higher mortality rates for neurologic diseases included older adults, the male population, and adults older than 25 years without a high school diploma. The gap in mortality rates for neurologic diseases between the NH Black and NH White populations widened from 4.2 individuals per 100,000 in 2011 to 7.0 per 100,000 in 2019. Over 2010 to 2019, had the NH Black population experienced the neurologic mortality rates of NH White, Hispanic, or NH Asian populations, 29,986, 88,407, or 117,519 deaths, respectively, would have been averted. DISCUSSION Death rates for neurologic diseases are increasing. Disproportionately higher neurologic mortality rates in the NH Black population are responsible for a large number of excess deaths, making research and policy efforts to address the systemic causes increasingly urgent.
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Affiliation(s)
- Steven H Woolf
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Derek A Chapman
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jong Hyung Lee
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Karen C Johnston
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Richard T Benson
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Edwin Trevathan
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Wally R Smith
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Darrell J Gaskin
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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26
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Chugh HS, Sargsyan A, Nakamura K, Uy-Evanado A, Dizon B, Norby FL, Young C, Hadduck K, Jui J, Shepherd D, Salvucci A, Chugh SS, Reinier K. Sudden cardiac arrest during the COVID-19 pandemic: A two-year prospective evaluation in a North American community. Heart Rhythm 2023; 20:947-955. [PMID: 36965652 PMCID: PMC10035806 DOI: 10.1016/j.hrthm.2023.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Early during the coronavirus disease 2019 (COVID-19) pandemic, higher sudden cardiac arrest (SCA) incidence and lower survival rates were reported. However, ongoing effects on SCA during the evolving pandemic have not been evaluated. OBJECTIVE The purpose of this study was to assess the impact of COVID-19 on SCA during 2 years of the pandemic. METHODS In a prospective study of Ventura County, California (2020 population 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first 2 years of the COVID-19 pandemic to the prior 4 years. RESULTS Of 2222 out-of-hospital SCA cases identified, 907 occurred during the pandemic (March 2020 to February 2022) and 1315 occurred prepandemic (March 2016 to February 2020). Overall age-standardized annual SCA incidence increased from 39 per 100,000 (95% confidence [CI] 37-41) prepandemic to 54 per 100,000 (95% CI 50-57; P <.001) during the pandemic. Among Hispanics, incidence increased by 77%, from 38 per 100,000 (95% CI 34-43) to 68 per 100,000 (95% CI 60-76; P <.001). Among non-Hispanics, incidence increased by 26%, from 39 per 100,000 (95% CI 37-42; P <.001) to 50 per 100,000 (95% CI 46-54). SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15% to 10%; P <.001), and Hispanics were less likely than non-Hispanics to receive bystander cardiopulmonary resuscitation (45% vs 55%; P = .005) and to present with shockable rhythm (15% vs 24%; P = .003). CONCLUSION Overall SCA rates remained consistently higher and survival outcomes consistently lower, with exaggerated effects during COVID infection peaks. This longer evaluation uncovered higher increases in SCA incidence among Hispanics, with worse resuscitation profiles. Potential ethnicity-specific barriers to acute SCA care warrant urgent evaluation and intervention.
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Affiliation(s)
- Harpriya S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Arayik Sargsyan
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Bernadine Dizon
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | | | - Katy Hadduck
- Ventura County Health Care Agency, Ventura, California
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | | | | | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
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27
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Deb S, Sud M, Wijeysundera HC. If You Can't Measure It, You Can't Improve It: Data Collection and Standards in the Evaluation of Racial and Ethnic Disparities in Cardiovascular Disease. Can J Cardiol 2023; 39:933-935. [PMID: 37178760 DOI: 10.1016/j.cjca.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Saswata Deb
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maneesh Sud
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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28
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Dauerman HL. Primary PCI, Thrombus, and COVID-19: Remembrance of Things Past. J Am Coll Cardiol 2023; 81:2417-2419. [PMID: 37344043 DOI: 10.1016/j.jacc.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Harold L Dauerman
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
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29
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Birditt KS, Turkelson A, Javaid S, Gonzalez R, Antonucci T. Implications of Cumulative Life Event Stress for Daily Stress Exposure and Cardiovascular Reactivity Among Black and White Americans. J Gerontol B Psychol Sci Soc Sci 2023; 78:1224-1235. [PMID: 37057965 PMCID: PMC10292837 DOI: 10.1093/geronb/gbad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Daily stress and cardiovascular reactivity may be important mechanisms linking cumulative life event stress with cardiovascular health and may help to explain racial health disparities. However, studies have yet to examine links between exposure to life event stress, daily stress exposure, and cardiovascular reactivity. This study assessed links between trajectories of life event stress exposure, daily stressors, and cardiovascular reactivity among Black and White individuals. METHODS Participants are from the Stress and Well-being in Everyday Life Study in which 238 individuals (109 Black 129 White; ages 33-93), drawn from the longitudinal Social Relations Study, reported life event stress in 1992, 2005, 2015, and 2018. Of those individuals, 169 completed an ecological momentary assessment study in which they reported stress exposure every 3 hr, and 164 wore a heart rate monitor for up to 5 days. RESULTS Latent class growth curve models revealed 2 longitudinal trajectories of life event stress: moderate-increasing and low-decreasing. Individuals in the moderate-increasing stress trajectory reported greater daily stress exposure and links did not vary by race. Black individuals in the low-decreasing trajectory and White individuals in the moderate-increasing trajectory showed positive associations between daily stress and heart rate (i.e., were reactive to daily stress exposure). The link between daily stress and heart rate was not significant among Black individuals in the moderate-increasing trajectory and White individuals in the low-decreasing trajectory. DISCUSSION Individuals who experience more life events across the adult life course report greater daily stress exposure which has important implications for daily cardiovascular health. Black individuals with moderate-increasing life event stress show evidence of blunted daily stress reactivity (nonsignificant association between daily stress and heart rate) whereas Black individuals with low-decreasing life event stress show evidence of stress reactivity (positive association between daily stress and heart rate). White individuals showed the opposite pattern (albeit marginally). These findings expand the weathering hypothesis and indicate that chronic life event stress may be associated with blunted stress reactivity among Black individuals.
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Affiliation(s)
- Kira S Birditt
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Turkelson
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Javaid
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toni Antonucci
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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30
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Patel SR, Suero-Abreu GA, Ai A, Ramachandran MK, Meza K, Florez N. Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations. Front Oncol 2023; 13:1124447. [PMID: 37361603 PMCID: PMC10289233 DOI: 10.3389/fonc.2023.1124447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.
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Affiliation(s)
- Shruti Rajesh Patel
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | | | - Angela Ai
- Olive View-University of California, Los Angeles Medical Center, Los Angeles, CA, United States
| | - Maya K. Ramachandran
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | - Kelly Meza
- Dana Farber Cancer Institute, Boston, MA, United States
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31
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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32
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Cefalu WT. COVID-19 and Rising Incidence of Diabetes: Despite Evolving Data, an Enigma Still to Be Solved. Diabetes Care 2023; 46:913-915. [PMID: 37185693 DOI: 10.2337/dci22-0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Affiliation(s)
- William T Cefalu
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Chouairi F, Pinsker B, Fudim M, Miller PE. Trends in outcomes and resource utilization for acute myocardial infarction admissions during the COVID-19 pandemic. Am Heart J 2023; 258:114-118. [PMID: 36646197 PMCID: PMC9839385 DOI: 10.1016/j.ahj.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 05/11/2023]
Abstract
During the early COVID-19 pandemic, resources were at times rationed, and as a result, cardiovascular outcomes may have suffered, however despite this, there is a paucity of national data specifically examining the relationship between COVID-19 and acute myocardial infarction (AMI). Some of the most robust previous cohort studies suggest the risk of AMI is increased in patients with COVID-19 infection, and disproportionately so in certain patient populations. To better define national trends in the associations between COVID-19 and AMI, this study aimed to examine demographics, outcomes, and health care utilization in hospitalizations for AMI with a codiagnosis of COVID-19 using a nationally representative database.
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Affiliation(s)
- Fouad Chouairi
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Bret Pinsker
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
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Ghasemzadeh N, Kim N, Amlani S, Madan M, Shavadia JS, Chong AY, Bagherli A, Bagai A, Saw J, Singh J, Dehghani P. A Review of ST-Elevation Myocardial Infarction in Patients with COVID-19. Heart Fail Clin 2023; 19:197-204. [PMID: 36863811 PMCID: PMC9973551 DOI: 10.1016/j.hfc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in worldwide morbidity and mortality. Patients with COVID-19 are at risk for developing a variety of cardiovascular conditions including acute coronary syndromes, stress-induced cardiomyopathy, and myocarditis. Patients with COVID-19 who develop ST-elevation myocardial infarction (STEMI) are at a higher risk of morbidity and mortality when compared with their age- and sex-matched STEMI patients without COVID-19. We review current knowledge on the pathophysiology of STEMI in patients with COVID-19, clinical presentation, outcomes, and the effect of the COVID-19 pandemic on overall STEMI care.
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Affiliation(s)
| | - Nathan Kim
- Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Shy Amlani
- William Osler Health System, Brampton, 2100 Bovaird Drive East, Ontario L6R 3J7, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Jay S Shavadia
- Royal University Hospital, Saskatchewan Health, University of Saskatchewan Saskatoon, 103 Hospital Drive, Saskatchewan S7N 0W8, Canada
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Alireza Bagherli
- Windsor Regional Hospital, 1030 Ouellette Avenue, Windsor, Ontario N9A 1E1, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada.
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Allen N, Wilkins JT. The Urgent Need to Refocus Cardiovascular Disease Prevention Efforts on Young Adults. JAMA 2023; 329:886-887. [PMID: 36871231 DOI: 10.1001/jama.2023.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Norrina Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John T Wilkins
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Aggarwal R, Yeh RW, Joynt Maddox KE, Wadhera RK. Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020. JAMA 2023; 329:899-909. [PMID: 36871237 PMCID: PMC9986841 DOI: 10.1001/jama.2023.2307] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
Importance Declines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years. Objective To determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity. Design, Setting, and Participants Serial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017-March 2020). Main Outcomes and Measures National trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment. Results Among 12 924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% [95% CI, 2.2%-3.7%] to 4.1% [95% CI, 3.5%-4.7%]) and obesity (from 32.7% [95% CI, 30.1%-35.3%] to 40.9% [95% CI, 37.5%-44.3%]) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% [95% CI, 38.6%-42.3%] to 36.1% [95% CI, 33.5%-38.7%]). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% [95% CI, 14.0%-18.4%]; 2017-2020: 20.1% [95% CI, 16.8%-23.3%]), and significant increases in hypertension were observed among Mexican American adults (from 6.5% [95% CI, 5.0%-8.0%] to 9.5% [95% CI, 7.3%-11.7%]) and other Hispanic adults (from 4.4% [95% CI, 2.1%-6.8%] to 10.5% [95% CI, 6.8%-14.3%]), while Mexican American adults had a significant rise in diabetes (from 4.3% [95% CI, 2.3%-6.2%] to 7.5% [95% CI, 5.4%-9.6%]). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% [95% CI, 55.8%-74.2%] in 2009-2010 to 74.8% [95% CI, 67.5%-82.1%] in 2017-2020], while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% [95% CI, 27.7%-63.3%]) to 2017-2020: 56.6% [95% CI, 39.2%-73.9%]). Conclusions and Relevance In the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.
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Affiliation(s)
- Rahul Aggarwal
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Heart and Vascular Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
- Associate Editor, JAMA
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Hong X, Rosenberg AZ, Heymann J, Yoshida T, Waikar SS, Ilori TO, Wang G, Rebuck H, Pearson C, Wang MC, Winkler CA, Kopp JB, Wang X. Joint associations of pregnancy complications and postpartum maternal renal biomarkers with severe cardiovascular morbidities: A US racially diverse prospective birth cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.14.23287276. [PMID: 36993418 PMCID: PMC10055449 DOI: 10.1101/2023.03.14.23287276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Rationale & Objective Pregnancy complications are risk factors for cardiovascular diseases (CVD). Little is known about the role of renal biomarkers measured shortly after delivery, individually or in combination with pregnancy complications, in predicting subsequent severe maternal CVD. Methods This study included 576 mothers of diverse ethnicities from the Boston Birth cohort, enrolled at delivery and followed prospectively. Plasma creatinine and cystatin C were measured 1-3 days after delivery. CVD during follow-up was defined by physician diagnoses in electronic medical records. Associations of renal biomarkers and pregnancy complications with time-to-CVD events were assessed using Cox proportional hazards models. Results During an average of 10.3±3.2 years of follow-up, 34 mothers developed one or more CVD events. Although no significant associations were found between creatinine and risk of CVD, per unit increase of cystatin C (CysC) was associated with a hazard ratio (HR) of 5.21 (95%CI = 1.49-18.2) for CVD. A borderline significant interactive effect was observed between elevated CysC (≥75th percentile) and preeclampsia. Compared to those without preeclampsia and with normal CysC level (<75 th percentile), mothers with preeclampsia and elevated CysC had the highest risk of CVD (HR=3.8, 95%CI = 1.4-10.2), while mothers with preeclampsia only or with elevated CysC only did not have significantly increased CVD risk. Similar synergistic effects for CVD were observed between CysC and preterm delivery. Conclusions In this sample of US, traditionally under-represented multi-ethnic high-risk mothers, elevated maternal plasma cystatin C and pregnancy complications synergistically increased risk of CVD later in life. These findings warrant further investigation. Clinical Perspectives What is new?Maternal postpartum elevated levels of cystatin C are independently associated with higher risk of cardiovascular diseases (CVD) later in life.Maternal pregnancy complications coupled with postpartum elevated levels of cystatin C synergistically increased future risk of CVD.What are the clinical implications?These findings, if further confirmed, suggest that women with pregnancy complications and elevated postpartum cystatin C may be at particular high risk for CVD later in life compared to women without these risk factors.
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Sossou CW, Fakhra S, Batra K, Nouthe B, Okoh A, Phillips-Wilson T, Kuria CN, Hawwass D, Ogunniyi MO, Singh A, Cohen M, Dawn B, Ahsan CH. Diversity in U.S. Cardiovascular Trainees and Leadership Where we are and What the Future Holds. Curr Probl Cardiol 2023; 48:101518. [PMID: 36464014 PMCID: PMC10082418 DOI: 10.1016/j.cpcardiol.2022.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
Cardiovascular (CV) outcomes can be improved with commonality between provider and patient regarding gender and race/ethnicity. Slow growth in CV care provider diversity is an obstacle for women and underrepresented groups. The hope for more equitable outcomes is unlikely to be realized unless trends change in selection of CV fellows and program directors (PDs). We investigate longitudinal trends of gender and racial/ethnic composition of CV FITs. De-identified demographic data were compiled in a descriptive cross-sectional study from AAMC of internal medicine (IM) residents and CV FITs from 2011 through 2021 to evaluate gender and race/ethnicity trends among CV trainees. Trends of CV fellows who later became program directors were analyzed. In the US between 2011 and 2021, 53% of IM residents were male while 40% female (7% unreported). Among CV FITs, 78% were male and 21% female. Races/ethnicities among CV FITs consisted of 36% non-Hispanic white, 28% non-Hispanic Asian, 5% Hispanic, 4%Black, and 25% were classified within other race/ethnicity categories. The proportion who became CV program directors followed similarly: 79% of PDs were male and 21% female. Demographic profiles for CV FITs have not significantly changed over the past decade despite increased diversity among IM residents. Efforts to improve diversity of CV FITs and PDs need to be analyzed. Slow growth of diversity in CV FITs is outpaced by rising patient diversity, leading to disparities in care and poorer CV outcomes for women and underrepresented minorities. Recruiting, training, and retaining diverse CV FITs is necessary.
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Affiliation(s)
- Christoph W Sossou
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | - Sadaf Fakhra
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV.
| | - Kavita Batra
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | - Brice Nouthe
- Department of Internal Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alexis Okoh
- Department of Medicine, Emory University, Atlanta, GA
| | - Tasha Phillips-Wilson
- Department of Internal Medicine, St. George's University School of Medicine, True Bule, Greneda
| | - Carolyne N Kuria
- Department of Internal Medicine, Arrowhead Regional Medical Center, Arrowhead, CA, United States
| | - Dalia Hawwass
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | | | - Aditi Singh
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | - Marc Cohen
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, United States
| | - Buddhadeb Dawn
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | - Chowdhury H Ahsan
- Las Vegas-Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
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Nguyen TB, Lac Q, Abdi L, Banerjee D, Deng Y, Zhang Y. Harshening stem cell research and precision medicine: The states of human pluripotent cells stem cell repository diversity, and racial and sex differences in transcriptomes. Front Cell Dev Biol 2023; 10:1071243. [PMID: 36684445 PMCID: PMC9848738 DOI: 10.3389/fcell.2022.1071243] [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: 10/16/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
In vitro investigation on human development, disease modeling, and drug discovery has been empowered by human induced pluripotent stem cell (hiPSC) technologies that form the foundation of precision medicine. Race and sex genetic backgrounds have become a major focus of many diseases modeling and drug response evaluation in the pharmaceutical industry. Here, we gathered data from major stem cell repositories to analyze the diversity with respect to ethnicity, sex, and disease types; and we also analyzed public datasets to unravel transcriptomics differences between samples of different ethnicities and sexes. We found a lack of diversity despite the large sample size of human induced pluripotent stem cells. In the ethnic comparison, the White group made up the majority of the banked hiPSCs. Similarly, for the organ/disease type and sex comparisons, the neural and male hiPSCs accounted for the majority of currently available hiPSCs. Bulk RNA-seq and single-cell transcriptomic analysis coupled with Machine Learning and Network Analysis revealed panels of gene features differently expressed in healthy hiPSCs and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) of different races and sexes. The data highlights the current ethnic and sex inequality in stem cell research and demonstrates the molecular biological diversity of hiPSCs and cardiomyocytes from different races and genders. We postulate that future efforts in stem cell biology, regenerative and precision medicine should be guided towards an inclusive, diverse repository reflecting the prevalence of diseases across racial and ethnic groups and the sexes, important for both common and rare disease modeling, drug screening, and cell therapeutics.
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Affiliation(s)
- Thong Ba Nguyen
- Department of Anatomy, Biochemistry and Physiology, Honolulu, HI, United States
- Center for Cardiovascular Research, Honolulu, HI, United States
| | - Quan Lac
- Department of Anatomy, Biochemistry and Physiology, Honolulu, HI, United States
- Center for Cardiovascular Research, Honolulu, HI, United States
| | - Lovina Abdi
- Department of Anatomy, Biochemistry and Physiology, Honolulu, HI, United States
- Center for Cardiovascular Research, Honolulu, HI, United States
| | - Dipanjan Banerjee
- Center for Cardiovascular Research, Honolulu, HI, United States
- Department of Medicine, Honolulu, HI, United States
| | - Youping Deng
- Department of Quantitative Health Sciences, Honolulu, HI, United States
- Genomics and Bioinformatics Shared Resource, Honolulu, HI, United States
| | - Yiqiang Zhang
- Department of Anatomy, Biochemistry and Physiology, Honolulu, HI, United States
- Center for Cardiovascular Research, Honolulu, HI, United States
- Diabetes Research Center, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
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Marlow EC, Jemal A, Thomson B, Wiese D, Zhao J, Siegel RL, Islami F. Mortality by Education Before and During the COVID-19 Pandemic, U.S., 2017-2020. Am J Prev Med 2023; 64:105-116. [PMID: 36528352 PMCID: PMC9556603 DOI: 10.1016/j.amepre.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Mortality disparities by SES, including education, have steadily increased in the U.S. over the past decades. This study examined whether these disparities overall and for 7 major causes of death were exacerbated in 2020, coincident with the emergence of the COVID-19 pandemic. METHODS Using data on 7,123,254 U.S. deaths from 2017 to 2020, age-standardized death rates and mortality rate differences per 100,000 population and rate ratios comparing least with most educated were calculated by sex and race/ethnicity. RESULTS All-cause death rates were approximately 2 times higher among adults with least than among those with most education. Disparities in all-cause mortality by educational attainment slightly increased from 2017 (rate ratio=1.97; 95% CI=1.95, 1.98; rate difference=739.9) to 2019 (rate ratio=2.04; 95% CI=2.03, 2.06; rate difference=761.3) and then greatly increased in 2020 overall (rate ratio=2.32; 95% CI=2.30, 2.33; rate difference=1,042.9) and when excluding COVID-19 deaths (rate ratio=2.27; 95% CI=2.25, 2.28; rate difference=912.3). Similar patterns occurred across race/ethnicity and sex, although Hispanic individuals had the greatest relative increase in disparities for all-cause mortality from 2019 (rate ratio=1.47; 95% CI=1.43, 1.51; rate difference=282.4) to 2020 overall (rate ratio=2.00; 95% CI=1.94, 2.06; rate difference=652.3) and when excluding COVID-19 deaths (rate ratio=1.84; 95% CI=1.79, 1.90; rate difference=458.7). Disparities in cause-specific mortality by education were generally stable from 2017 to 2019, followed by a considerable increase from 2019 to 2020 for heart disease, cancer, cerebrovascular disease, and unintentional injury. Among these causes of death, the relative increase in rate ratio from 2019 to 2020 was greatest for unintentional injury (24.8%; from 3.41 [95% CI=3.23, 3.60] to 4.26 [95% CI=3.99, 4.53]). CONCLUSIONS Mortality disparities by education widened in the U.S. in 2020, during the COVID-19 pandemic. Further research is warranted to understand the reasons for these widened disparities.
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Affiliation(s)
- Emily C Marlow
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Daniel Wiese
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Farhad Islami
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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Cunningham MC, Royster J, McCall TC. Interruptions in Routine Blood Pressure Screening Services Among Local Health Departments During the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:108-111. [PMID: 36448764 PMCID: PMC9718291 DOI: 10.1097/phh.0000000000001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Margaret C. Cunningham
- National Association of County and City Health Officials, Washington, District of Columbia (Ms Cunningham, Mr Royster, and Dr McCall) and Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr McCall)
| | - Jordan Royster
- National Association of County and City Health Officials, Washington, District of Columbia (Ms Cunningham, Mr Royster, and Dr McCall) and Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr McCall)
| | - Timothy C. McCall
- National Association of County and City Health Officials, Washington, District of Columbia (Ms Cunningham, Mr Royster, and Dr McCall) and Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr McCall)
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Katsouras CS, Papafaklis MI, Giannopoulos S, Karapanayiotides T, Tsivgoulis G, Michalis LK. Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction? J Clin Neurol 2023; 19:1-11. [PMID: 36606641 PMCID: PMC9833878 DOI: 10.3988/jcn.2023.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
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Affiliation(s)
- Christos S Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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Yeo YH, Wang M, He X, Lv F, Zhang Y, Zu J, Li M, Jiao Y, Ebinger JE, Patel JK, Cheng S, Ji F. Excess risk for acute myocardial infarction mortality during the COVID-19 pandemic. J Med Virol 2023; 95:e28187. [PMID: 36176195 PMCID: PMC9839603 DOI: 10.1002/jmv.28187] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/17/2023]
Abstract
The COVID-19 pandemic has had a detrimental impact on the healthcare system. Our study armed to assess the extent and the disparity in excess acute myocardial infarction (AMI)-associated mortality during the pandemic, through the recent Omicron outbreak. Using data from the CDC's National Vital Statistics System, we identified 1 522 669 AMI-associated deaths occurring between 4/1/2012 and 3/31/2022. Accounting for seasonality, we compared age-standardized mortality rate (ASMR) for AMI-associated deaths between prepandemic and pandemic periods, including observed versus predicted ASMR, and examined temporal trends by demographic groups and region. Before the pandemic, AMI-associated mortality rates decreased across all subgroups. These trends reversed during the pandemic, with significant rises seen for the youngest-aged females and males even through the most recent period of the Omicron surge (10/2021-3/2022). The SAPC in the youngest and middle-age group in AMI-associated mortality increased by 5.3% (95% confidence interval [CI]: 1.6%-9.1%) and 3.4% (95% CI: 0.1%-6.8%), respectively. The excess death, defined as the difference between the observed and the predicted mortality rates, was most pronounced for the youngest (25-44 years) aged decedents, ranging from 23% to 34% for the youngest compared to 13%-18% for the oldest age groups. The trend of mortality suggests that age and sex disparities have persisted even through the recent Omicron surge, with excess AMI-associated mortality being most pronounced in younger-aged adults.
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Affiliation(s)
- Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maggie Wang
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xinyuan He
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yue Zhang
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,The Eighth Hospital of Xi’an City, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jian Zu
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Mei Li
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yang Jiao
- Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh K. Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fanpu Ji
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PRC
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44
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Kipp R, Kalscheur M, Sheehy AM, Bartels CM, Kind AJH, Powell WR. Race, Sex, and Neighborhood Socioeconomic Disparities in Ablation of Ventricular Tachycardia Within a National Medicare Cohort. J Am Heart Assoc 2022; 11:e027093. [PMID: 36515242 PMCID: PMC9798800 DOI: 10.1161/jaha.122.027093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Ventricular tachycardia (VT) ablation significantly improves our ability to control VT, yet little is known about whether disparities exist in delivery of this technology. Methods and Results Using a national 100% Medicare inpatient data set of beneficiaries admitted with VT from January 1, 2014, through November 30, 2014, multivariable logistic regression techniques were used to examine the sociodemographic and clinical characteristics associated with receiving ablation. Census block group-level neighborhood socioeconomic disadvantage was measured for each patient by the Area Deprivation Index, a composite measure of socioeconomic disadvantage consisting of education, income, housing, and employment factors. Among 131 645 patients admitted with VT, 2190 (1.66%) received ablation. After adjustment for comorbidities, hospital characteristics, and sociodemographics, female sex (odds ratio [OR], 0.75 [95% CI, 0.67-0.84]), identifying as Black race (OR, 0.75 [95% CI, 0.62-0.90] compared with identifying as White race), and living in a highly socioeconomically disadvantaged neighborhood (national Area Deprivation Index percentile of >85%) (OR, 0.81 [95% CI, 0.69-0.95] versus Area Deprivation Index ≤85%) were associated with significantly lower odds of receiving ablation. Conclusions Female patients, patients identifying as Black race, and patients living in the most disadvantaged neighborhoods are 19% to 25% less likely to receive ablation during hospitalization with VT. The cause of and solutions for these disparities require further investigation.
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Affiliation(s)
- Ryan Kipp
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI,William S. Middleton Memorial Veterans HospitalMadisonWI
| | - Matthew Kalscheur
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI,William S. Middleton Memorial Veterans HospitalMadisonWI
| | - Ann M. Sheehy
- Division of Hospitalist Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Christie M. Bartels
- Division of Rheumatology, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Amy J. H. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public HealthMadisonWI,Division of Geriatric Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public HealthMadisonWI
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45
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Coronado F, Melvin SC, Bell RA, Zhao G. Global Responses to Prevent, Manage, and Control Cardiovascular Diseases. Prev Chronic Dis 2022; 19:E84. [PMID: 36480801 DOI: 10.5888/pcd19.220347] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Fátima Coronado
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-1, Atlanta GA 30341
| | - Sandra Carr Melvin
- Institute for the Advancement of Minority Health, Ridgeland, Mississippi
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Guixiang Zhao
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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46
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Obi K, Effron MB. Racial Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic: Time for a Solution. Mayo Clin Proc 2022; 97:2180-2183. [PMID: 36464458 PMCID: PMC9618427 DOI: 10.1016/j.mayocp.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, University of Queensland-Ochsner Clinical School, New Orleans, LA.
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47
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Zhang M, Brady TM, Buckley JP, Appel LJ, Hong X, Wang G, Liang L, Wang X, Mueller NT. Metabolome-Wide Association Study of Cord Blood Metabolites With Blood Pressure in Childhood and Adolescence. Hypertension 2022; 79:2806-2820. [PMID: 36111548 PMCID: PMC9649875 DOI: 10.1161/hypertensionaha.122.20139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND No studies have examined whether the cord blood metabolome-a reflection of in utero metabolism-influences blood pressure (BP) in children. OBJECTIVES To examine prospective associations of cord blood metabolites with systolic BP (SBP), diastolic BP (DBP), and risk of elevated BP in childhood and adolescence. METHODS In the Boston Birth Cohort, we measured metabolites in cord blood plasma, and SBP and DBP at clinic visits between 3 and 18 years. We examined associations of cord metabolites with SBP and DBP percentiles using linear mixed models and with elevated BP using mixed-effects Poisson regression. RESULTS Our study included 902 mother-child dyads (60% Black, 23% Hispanic, 45% female). Children were followed for a median of 9.2 (interquartile range, 6.7-11.7) years, and the median number of BP observations per child was 7 (interquartile range, 4-11). After false discovery rate correction, 3 metabolites were associated with SBP, 96 with DBP, and 24 with elevated BP; 2 metabolites (1-methylnicotinamide, dimethylguanidino valeric acid) were associated with all 3 outcomes, and 21 metabolites were associated with both DBP and elevated BP. After multivariable adjustment, 48 metabolites remained significantly associated with DBP. Metabolites that showed the strongest associations with SBP, DBP, and elevated BP included nucleotides (eg, xanthosine, hypoxanthine, xanthine) and acylcarnitines (eg, C6 and C7 carnitines), which represent fatty acid oxidation and purine metabolism pathways. CONCLUSIONS In our urban and predominantly racial/ethnic minority cohort, we provide evidence that metabolomic alterations in utero, in particular, acylcarnitine- and purine-metabolism metabolites, may be involved in the early life origins of hypertension.
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Affiliation(s)
- Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Tammy M Brady
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessie P Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xiaobin Wang
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
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48
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Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic. Mayo Clin Proc 2022; 97:2206-2214. [PMID: 36336516 PMCID: PMC9300586 DOI: 10.1016/j.mayocp.2022.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the patterns and demographic features of cardiovascular disease (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure in the pre-COVID-19 era (2018-2019) vs during the COVID-19 pandemic (2020-2021) in the United States. METHODS In this cross-sectional study, we used the US Multiple Cause of Death files for 2018 to 2021 to examine the trend of excess cause-specific deaths using International Classification of Diseases, Tenth Revision codes for CVD (I00 to I99), MI (I21 and I22), stroke (I60 to I69), and heart failure (I42 and I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and heart failure) between prepandemic (2018-2019) and pandemic (2020-2021) years. We performed a subgroup analysis on race and month-to-month and year-to-year variation using χ2 analysis to test statistical significance. RESULTS Overall, 3,598,352 CVD deaths were analyzed during the study period. There was a 6.7% excess CVD mortality, 2.5% MI mortality, and 8.5% stroke mortality during the COVID-19 pandemic (2020-2021) compared with the prepandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) than White individuals (5.1%; P<.001). This remained consistent across subtypes of CVD, including MI (9.6% vs 1.0%; P<.001), stroke (14.5% vs 6.9%; P<.001), and heart failure (5.1% vs -1.2%; P<.001). CONCLUSION There has been a significant rise in CVD and subtype-specific mortality during the COVID-19 pandemic that has been persistent despite 2 years since the onset of the pandemic. Excess CVD mortality has disproportionately affected Black compared with White individuals. Further studies targeting and eliminating health care disparities are necessary.
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Affiliation(s)
- Scott E Janus
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mohamed Makhlouf
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Issam Motairek
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sadeer G Al-Kindi
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH.
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49
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Bullock-Palmer RP, Bravo-Jaimes K, Mamas MA, Grines CL. Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions. Eur Cardiol 2022; 17:e19. [PMID: 36643068 PMCID: PMC9820075 DOI: 10.15420/ecr.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.
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Affiliation(s)
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Internal Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of CaliforniaLos Angeles, CA, US
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityKeele, UK
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Northside Cardiovascular Institute, Northside HospitalAtlanta, GA, US
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50
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Chugh HS, Sargsyan A, Nakamura K, Uy-Evanado A, Dizon B, Norby FL, Young C, Hadduck K, Jui J, Shepherd D, Salvucci A, Chugh SS, Reinier K. Ethnicity-Specific Effects on Cardiac Arrest During the COVID-19 Pandemic: A Two-Year Prospective Evaluation in a North American Community. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.10.15.22281071. [PMID: 36299424 PMCID: PMC9603830 DOI: 10.1101/2022.10.15.22281071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Background Out-of-hospital sudden cardiac arrest (SCA) is a major public health problem with mortality >90%, and incidence has increased during the COVID-19 pandemic. Information regarding ethnicity-specific effects on SCA incidence and survival is lacking. Methods In a prospective, population-based study of Ventura County, CA residents (2020 Pop. 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first two years of the COVID-19 pandemic to the prior four years, overall and by ethnicity (Hispanic vs non-Hispanic). Findings Of 2,222 OHCA cases identified, 907 occurred during the pandemic (March 2020 - Feb 2022) and 1315 occurred pre-pandemic (March 2016 - Feb 2020). Overall age-standardized annual SCA incidence increased from 38.9/100,000 [95% CI 36.8-41.0] pre-pandemic to 53.8/100,00 [95% CI 50.3 - 57.3, p<0.001] during the pandemic. Among Hispanics, incidence increased by 77%, from 38.2/100,00 [95% CI 33.8-42.5] to 67.7/100,00 [95% CI 59.5- 75.8, p<0.001]. Among non-Hispanics, incidence increased by 26% from 39.4/100,000 [95% CI 36.9-41.9, p<0.001] to 49.8/100,00 [95% CI 45.8-53.8]. SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15.3% to 10.0%, p<0.001) and Hispanics were less likely than non-Hispanics to have bystander CPR (44.6% vs. 54.7%, p=0.005) and shockable rhythm (15.3% vs. 24.1%, p=0.003). Interpretation Hispanic residents experienced higher SCA rates during the pandemic with less favorable resuscitation profiles. These findings implicate potential ethnicity-specific barriers to acute care and represent an urgent call to action at the community and health-system levels. Funding National Heart Lung and Blood Institute Grants R01HL145675 and R01HL147358.
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