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Vallée A. The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension. J Public Health Policy 2024:10.1057/s41271-024-00491-4. [PMID: 38831023 DOI: 10.1057/s41271-024-00491-4] [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: 04/22/2024] [Indexed: 06/05/2024]
Abstract
The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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Descarpentrie A, Poquet D, Brugailleres P, Sauvegrain P, Frenoy P, Richard E, Bernard JY, de Lauzon-Guillain B, Vandentorren S, Lioret S. Is breastfeeding duration related to the health of migrant mother-child dyads experiencing homelessness? The ENFAMS cross-sectional survey. Eur J Public Health 2023; 33:796-802. [PMID: 37339520 PMCID: PMC10567129 DOI: 10.1093/eurpub/ckad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Literature from the general population shows a consensus about the health benefits associated with breastfeeding for both mothers and children. However, studies investigating these issues in the context of homelessness and migration are rare. This research aimed to examine the relations of any breastfeeding duration with health outcomes among migrant mother-child dyads experiencing homelessness. METHODS Data were collected among sheltered and mainly foreign-born mothers experiencing homelessness, and their children aged 6 months to 5 years, from the ENFAMS cross-sectional survey (n = 481, 2013-Great Paris area). Any breastfeeding duration, along with various health outcomes of both the mother and her child, was ascertained by face-to-face questionnaires administered by trained interviewers to mothers (perceived physical and emotional health and maternal depression) or by trained psychologists to children (adaptive behaviours). Nurses measured weight and height [thus allowing them to calculate body mass index (BMI)] and haemoglobin concentration (mother-child dyad) and maternal blood pressure. Multivariable linear and modified Poisson regression analyses were performed to examine outcome-wide associations between any breastfeeding duration ≥6 months and the various mother-child outcomes. RESULTS Any breastfeeding ≥6 months was associated with lower systolic blood pressure in mothers (B = -0.40, 95% confidence interval = -0.68 to -0.12). No association was observed with the other outcomes. CONCLUSIONS The relevance of supporting breastfeeding to improve mothers' physical health holds true in the context of migration and homelessness. It is therefore important to support breastfeeding in these settings. Moreover, given the documented social complexity of breastfeeding practices, interventions should take mothers' socio-cultural heritage and the structural barriers they face into account.
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Affiliation(s)
- Alexandra Descarpentrie
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Delphine Poquet
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | - Priscille Sauvegrain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Sorbonne Université, Midwifery Unit, Paris, France
- Institut Convergences Migrations/CNRS, Aubervilliers, France
| | - Pauline Frenoy
- Université Paris Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, “Exposome and Heredity” Team, CESP, Villejuif, France
| | - Elodie Richard
- CIFRE Fnasat, Université Bordeaux, Inserm, UMR1219, Bordeaux, France
| | - Jonathan Y Bernard
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Stéphanie Vandentorren
- Université Bordeaux, Inserm, UMR1219, PHARes Team, Bordeaux, France
- Institut Convergences Migrations/CNRS, Aubervilliers, France
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
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Wang L, Yi Z. Marital status and all-cause mortality rate in older adults: a population-based prospective cohort study. BMC Geriatr 2023; 23:214. [PMID: 37016371 PMCID: PMC10074686 DOI: 10.1186/s12877-023-03880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Living with a partner and separation is becoming more common among older people. Mortality disparities associated with marital status are significant in increasingly diverse aging populations. The link between marital status and all-cause mortality risk in older adults remains uncertain. METHODS This prospective cohort study included data from the US National Health and Nutrition Examination Survey (NHANES). We included NHANES participants ≥ 60 years of age (data from 1999 to 2014). Data for mortality follow-up beginning from the commencement date of survey participation to the last day of December 2015. Univariate- and multivariate-adjusted Cox proportional hazard models for marital status were estimated, and the findings were presented as regression coefficients and 95% confidence intervals (CI). Kaplan-Meier curves were reported. RESULTS Compared to never married individuals, the risk of all-cause mortality was 0.77 (0.50-1.18), 0.72 (0.56-0.93), 0.56 (0.36-0.88), and 0.84 (0.67-1.07) in those people living with a partner, married, separated, and divorced, respectively, after adjusting for demographics, socioeconomics, behavior, anthropometric variables, and medical history. The risk of all-cause mortality was 1.24 (0.97-1.59) in widowed participants. CONCLUSION This population-based cohort study included a large sample size followed by long-term follow-up. The association between marriage, health, and reduced mortality in older individuals has been illustrated in this study. Being married or separated was associated with a lower risk of mortality.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049, Beijing, PR China
| | - Zhong Yi
- Department of Geriatric Medicine, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049, Beijing, PR China.
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Makutonin M, Dare J, Heekin M, Salancy A, Hood C, Dominguez LW. Remote Patient Monitoring for Hypertension: Feasibility and Outcomes of a Clinic-Based Pilot in a Minority Population. J Prim Care Community Health 2023; 14:21501319231204586. [PMID: 37815085 PMCID: PMC10563450 DOI: 10.1177/21501319231204586] [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: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population. METHODS In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs. RESULTS A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, P = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, P = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, P < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, P = .135). Financially, the program generated margins of $29 per patient at 90 days. CONCLUSIONS Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.
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Affiliation(s)
| | - Justin Dare
- Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Heekin
- The George Washington University, Washington, DC, USA
| | | | - Colton Hood
- The George Washington University, Washington, DC, USA
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Dierx JAJ, Kasper HDP. The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group. Front Public Health 2022; 10:849013. [PMID: 36324452 PMCID: PMC9618935 DOI: 10.3389/fpubh.2022.849013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.
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Affiliation(s)
- John A. J. Dierx
- Department of Caring Society, Research Group Living in Motion, Avans University of Applied Science, Breda, Netherlands,*Correspondence: John A. J. Dierx
| | - Hans D. P. Kasper
- Department of Marketing and Market Research, Maastricht University School of Business and Economics, Maastricht University, Maastricht, Netherlands
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Hartley M, Fyfe CL, Wareham NJ, Khaw KT, Johnstone AM, Myint PK. Association between Legume Consumption and Risk of Hypertension in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk Cohort. Nutrients 2022; 14:nu14163363. [PMID: 36014869 PMCID: PMC9415844 DOI: 10.3390/nu14163363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023] Open
Abstract
Hypertension is a significant and preventable cardiovascular disease risk factor. Growing evidence suggests legumes have blood-pressure (BP) lowering properties. However, there is little population-based research on legume intake and hypertension risk in Western populations. The objective was to investigate the relationship between legume intake and blood pressure by using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk cohort. Further, to identify any potential legume intake that confers benefits in relation to blood pressure. We included participants who completed both 7-day food diaries to assess legume intake and undertook a first (1993−1997) and second (1998−2000) health check from the EPIC-Norfolk prospective study. Legume consumption was categorized using percentile cut off values. We used multivariate logistic regression models to calculate the odds ratio of hypertension (defined as >140 mmHg systolic and/or >90 mmHg diastolic blood pressure) at the second health check, stratified by legume intake, adjusting for antihypertensive medication use and demographic, socioeconomic and lifestyle covariates. A total of 7522 participants were included with mean age (± SD) of 58.0 ± 8.9 years. The follow-up time was 3.7 years (range: 2.1−6.6 years). Mean legume consumption was 17.3 ± 16.3 g/day. Participants in the 97th percentile of legume intake had the lowest odds of subsequent hypertension (OR: 0.71; 95% CI: 0.52, 0.96). Legume consumption between 55−70 g/day was associated with reduced odds of hypertension (OR: 0.57; 95% CI: 0.37, 0.88); sex-specific values for men and women were 0.64 (0.38, 1.03) and 0.32 (0.12, 0.88), respectively. In this UK population, legume intake of 55−70 g/day was associated with a lower subsequent risk of hypertension. Given the low legume intake in the UK and Western countries, dietary guidance to increase intake above 55 g/day may lower the burden of hypertension and associated diseases.
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Affiliation(s)
- Michael Hartley
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Claire L. Fyfe
- The Rowett Institute, University of Aberdeen, Ashgrove Road West, Aberdeen AB25 2ZD, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, Gonville and Caius College, Cambridge CB2 1TA, UK
| | | | - Phyo K. Myint
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
- Aberdeen Cardiovascular & Diabetes Centre, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
- Correspondence: ; Tel.: +44-(0)-1224-437841
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Liu Y, Ma J, Zhang N, Xiao JY, Wang JX, Li XW, Wang J, Zhang Y, Gao MD, Zhang X, Wang Y, Wang JX, Xu SB, Gao J. Latent class cluster analysis of knowledge on acute myocardial infarction in community residents: a cross-sectional study in Tianjin, China. BMJ Open 2022; 12:e051952. [PMID: 35697448 PMCID: PMC9196158 DOI: 10.1136/bmjopen-2021-051952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Public knowledge of early onset symptoms and risk factors (RF) of acute myocardial infarction (AMI) is very important for prevention, recurrence and guide medical seeking behaviours. This study aimed to identify clusters of knowledge on symptoms and RFs of AMI, compare characteristics and the awareness of the need for prompt treatment. DESIGN Multistage stratified sampling was used in this cross-sectional study. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes of the knowledge on AMI symptoms or modifiable RFs. Multivariable logistic regression was performed to identify factors that predicted high knowledge membership. PARTICIPANTS A structured questionnaire was used to interview 4200 community residents aged over 35 in China. 4122 valid questionnaires were recovered. RESULTS For AMI symptoms and RFs, the knowledge levels were classified into two or three distinct clusters, respectively. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most of the symptoms and modifiable RFs. Respondents who were highly educated, had higher monthly household income, were insured, had regular physical examinations, had a disease history of AMI RFs, had AMI history in immediate family member or acquaintance or had received public education on AMI were observed to have higher probability of knowledge on symptoms and RFs. There was significant difference in awareness of the prompt treatment in case of AMI occurs among different clusters. 'Calling an ambulance' was the most popular option in response of seeing others presenting symptoms of AMI. CONCLUSIONS A moderate or relatively low knowledge on AMI symptoms and modifiable RFs was observed in our study. Identification of Knowledge Clusters could be a way to detect specific targeted groups with low knowledge of AMI, which may facilitate health education, further reduce the prehospital delay in China and improve patient outcomes.
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Affiliation(s)
- Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
- Thoracic Clinical College, Tianjin Medical University, Tianjin, Tianjin, China
| | - Jing Ma
- Tianjin Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Ji-Xiang Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Xiao-Wei Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Jing Wang
- Department of Nursing, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Yan Zhang
- Department of Nursing, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Xu Zhang
- Tianjin Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, Tianjin, China
| | - Yuan Wang
- Thoracic Clinical College, Tianjin Medical University, Tianjin, Tianjin, China
| | - Jing-Xian Wang
- Thoracic Clinical College, Tianjin Medical University, Tianjin, Tianjin, China
| | - Shi-Bo Xu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, Tianjin, China
| | - Jing Gao
- Thoracic Clinical College, Tianjin Medical University, Tianjin, Tianjin, China
- Tianjin Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, Tianjin, China
- Chest Hospital, Tianjin University, Tianjin, Tianjin, China
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Keetile M, Letamo G, Navaneetham K. The influence of childhood socioeconomic status on non-communicable disease risk factor clustering and multimorbidity among adults in Botswana: a life course perspective. Int Health 2022; 15:1-9. [PMID: 35512692 PMCID: PMC9808520 DOI: 10.1093/inthealth/ihac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/18/2022] [Accepted: 04/16/2022] [Indexed: 01/07/2023] Open
Abstract
Childhood socioeconomic circumstances have a great influence on the health of individuals in adult life. We used cross-sectional data from a non-communicable disease (NCD) survey conducted in 2016, and respondents aged ≥15 y were selected from 3 cities/towns, 15 urban villages and 15 rural areas using a multistage probability-sampling technique. The total sample for the study was 1178. Two multinomial logistic regression models were fitted to data to ascertain the association between childhood socioeconomic status (SES) and NCD risk factor clustering and multimorbidity, using SPSS version 27. All comparisons were considered to be statistically significant at a 5% level. The prevalence of multiple NCD risk factors and multimorbidity was 30.1 and 5.3%, respectively. The odds of reporting NCD risk factor clustering were significantly high among individuals who reported low (adjusted OR [AOR]=1.88, 95% CI 1.21 to 2.78) and middle (AOR=1.22, 95% CI 1.02 to 2.05) childhood SES compared with high childhood SES. Conversely, individuals from a low SES background were more likely to report both single (AOR=1.17, 95% CI 1.00 to 2.01) and multiple NCD conditions (AOR=1.78, 95% CI 1.11 to 2.68) compared with those with a high childhood SES background. There is a need to stimulate policy debate and research to take cognisance of childhood socioeconomic circumstances in health policy planning.
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Affiliation(s)
| | - Gobopamang Letamo
- Department of Population Studies, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
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Yuan Z, Liu L, Guo P, Yan R, Xue F, Zhou X. Likelihood-based Mendelian randomization analysis with automated instrument selection and horizontal pleiotropic modeling. SCIENCE ADVANCES 2022; 8:eabl5744. [PMID: 35235357 PMCID: PMC8890724 DOI: 10.1126/sciadv.abl5744] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/05/2022] [Indexed: 05/03/2023]
Abstract
Mendelian randomization (MR) is a common tool for identifying causal risk factors underlying diseases. Here, we present a method, MR with automated instrument determination (MRAID), for effective MR analysis. MRAID borrows ideas from fine-mapping analysis to model an initial set of candidate single-nucleotide polymorphisms that are in potentially high linkage disequilibrium with each other and automatically selects among them the suitable instruments for causal inference. MRAID also explicitly models both uncorrelated and correlated horizontal pleiotropic effects that are widespread for complex trait analysis. MRAID achieves both tasks through a joint likelihood framework and relies on a scalable sampling-based algorithm to compute calibrated P values. Comprehensive and realistic simulations show that MRAID can provide calibrated type I error control and reduce false positives while being more powerful than existing approaches. We illustrate the benefits of MRAID for an MR screening analysis across 645 trait pairs in U.K. Biobank, identifying multiple lifestyle causal risk factors of cardiovascular disease-related traits.
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Affiliation(s)
- Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Lu Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Ping Guo
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Ran Yan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiang Zhou
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA
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Payseur DK, Belhumeur JR, Curtin LA, Moody AM, Collier SR. The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:509-516. [PMID: 32369424 DOI: 10.1080/07448481.2020.1756826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.
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Affiliation(s)
- Daniel K Payseur
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | | | - Lisa A Curtin
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Anne M Moody
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | - Scott R Collier
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
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Meydanlioglu A, Akcan A, Oncel S, Adibelli D, Cicek Gumus E, Sarvan S, Kavla I. Prevalence of obesity and hypertension in children and determination of associated factors by CHAID analysis. Arch Pediatr 2021; 29:30-35. [PMID: 34955305 DOI: 10.1016/j.arcped.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of obesity and hypertension in children is associated with an increased risk of cardiovascular disease and increases the prevalence of heart failure and associated morbidity and mortality. This study aimed to determine the prevalence of obesity and hypertension, as well as the associated risk factors, in school-age children. METHODS This cross-sectional study was conducted in 21 schools in Antalya, Turkey. A total of 5160 students between the ages of 5 and 15 years participated in the study. The data were collected using a questionnaire, and students' height, weight, and blood pressure were measured. The data were evaluated using numbers, percentages, mean, and chi-squared automatic interaction detector (CHAID) analysis. RESULTS In all, 11.4% of children were overweight, 11.8% were obese, 6.8% had prehypertension, and 5.7% had hypertension. School level, school location, and father's educational status were determined as factors associated with overweight and obesity; BMI, school level, school location, and mother's working status were determined as factors related to hypertension in the children. CONCLUSION The prevalence of hypertension, overweight, and obesity was found to be significantly high in the children, especially those living in rural areas. Therefore, it is recommended that these health issues be monitored in children and that necessary measures be taken by considering regional differences.
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Affiliation(s)
- Ayse Meydanlioglu
- Akdeniz University, Faculty of Nursing, Department of Community Health Nursing, Antalya, Turkey
| | - Arzu Akcan
- Akdeniz University, Faculty of Nursing, Department of Community Health Nursing, Antalya, Turkey
| | - Selma Oncel
- Akdeniz University, Faculty of Nursing, Department of Community Health Nursing, Antalya, Turkey
| | - Derya Adibelli
- Akdeniz University, Kumluca Faculty of Health Sciences, Department of Community Health Nursing, Antalya, Turkey
| | - Ecem Cicek Gumus
- Gaziantep University, Faculty of Health Sciences, Department of Public Health Nursing, Gaziantep, Turkey.
| | - Sureyya Sarvan
- Akdeniz University, Faculty of Nursing, Department of Pediatric Nursing, Antalya, Turkey
| | - Ilkay Kavla
- Akdeniz University, Faculty of Nursing, Department of Nursing Management, Antalya, Turkey
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Bhattarai S, Tandstad B, Shrestha A, Karmacharya B, Sen A. Socioeconomic Status and Its Relation to Hypertension in Rural Nepal. Int J Hypertens 2021; 2021:5542438. [PMID: 34497724 PMCID: PMC8419497 DOI: 10.1155/2021/5542438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. METHODS This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. RESULTS Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. CONCLUSIONS Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.
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Affiliation(s)
- Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Birgit Tandstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Chronic Disease Epidemiology Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, USA
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, (TkMidt), Trondheim, Norway
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13
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Astutik E, Puspikawati SI, Dewi DMSK, Mandagi AM, Sebayang SK. Prevalence and Risk Factors of High Blood Pressure among Adults in Banyuwangi Coastal Communities, Indonesia. Ethiop J Health Sci 2021; 30:941-950. [PMID: 33883839 PMCID: PMC8047239 DOI: 10.4314/ejhs.v30i6.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Hypertension is a disease that still a problem in the world. Hypertension is a risk factor for heart disease and stroke mortality. Economic development and an emphasis on coastal tourism may have an impact on public health conditions, such as hypertension. This study aimed to determine risk factors related to hypertension among adults in coastal communities in Indonesia. Methods This was a cross-sectional study of 123 respondents between the age of 18–59 years old selected by cluster sampling. This study was conducted among coastal communities in Banyuwangi District, East Java, Indonesia. Data was analyzed using multivariate logistic regression. Results Our study showed that the prevalence of systolic and diastolic hypertension among residents of coastal communities were as high as 33.33% and 31.71%, respectively. Increasing age was associated with systolic and diastolic hypertension (ORsystolic=1.11; 95% CI=1.03–1.19, p=0.01 and ORdiastolic=1.07; 95% CI=1.01–1.15, p=0.03) after controlling other variables. Respondents with the poorest and richer socio-economic status had higher odds of having systolic and diastolic hypertension compared to respondents with the richest socio-economic status (ORsystolic-poorest =12.78; 95% CI=1.61–101.54, p=0.02; ORsystolic-richer=10.74; 95% CI =1.55–74.37, p=0.02 and ORdiastolic-poorest=10.36; 95% CI= 1.40–76.74, p=0.02;ORdiastolic-richer=6.45; 95% CI=1.01–41.43, p=0.05) after controlling other variables. Conclusion Being of older age and of the lower in socioeconomic status are significantly associated with increasing risk for systolic and diastolic hypertension in these coastal communities. More studies need to be done in these and other coastal village to help design appropriate health promotion and counseling strategies for coastal community.
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Affiliation(s)
- Erni Astutik
- Research Group for Health and Wellbeing of Women and Children, Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Septa Indra Puspikawati
- Research Group for Health and Wellbeing of Women and Children, Department of Public Health Nutrition, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Indonesia
| | - Desak Made Sintha Kurnia Dewi
- Research Group for Health and Wellbeing of Women and Children, Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Indonesia
| | - Ayik Mirayanti Mandagi
- Research Group of Tobacco Control, Department of Epidemiology, Universitas Airlangga, Faculty of Public Health, Banyuwangi Campus, Indonesia
| | - Susy Katikana Sebayang
- Research Group for Health and Wellbeing of Women and Children, Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Indonesia
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14
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van der Linden EL, Collard D, Beune EJAJ, Nieuwkerk PT, Galenkamp H, Haafkens JA, Moll van Charante EP, van den Born BJH, Agyemang C. Determinants of suboptimal blood pressure control in a multi-ethnic population: The Healthy Life in an Urban Setting (HELIUS) study. J Clin Hypertens (Greenwich) 2021; 23:1068-1076. [PMID: 33675159 PMCID: PMC8678779 DOI: 10.1111/jch.14202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
Among ethnic minority groups in Europe, blood pressure (BP) control is often suboptimal. We aimed to identify determinants of suboptimal BP control in a multi‐ethnic population. We analyzed cross‐sectional data of the Healthy Life in an Urban Setting (HELIUS) study, including 3571 participants aged 18‐70 with prescribed antihypertensive medication, of various ethnic backgrounds (500 Dutch, 1052 African Surinamese, 656 South‐Asian Surinamese, 637 Ghanaian, 433 Turkish, and 293 Moroccan) living in Amsterdam, the Netherlands. 53.3% of the population had suboptimal BP control, defined as BP ≥140/90 mmHg despite prescribed antihypertensives. Using multivariate logistic regression analysis, female sex (OR 0.50, 95%CI 0.43‐0.59), being married (0.83, 0.72‐0.96), smoking (0.78, 0.65‐0.94), alcohol intake (0.80, 0.66‐0.96), obesity (1.67, 1.35‐2.06), cardiovascular disease (CVD) history (0.56, 0.46‐0.68), non‐adherence to antihypertensives (1.26, 1.00‐1.58), and family history of hypertension (1.19, 1.02‐1.38) were identified to be independently associated with suboptimal BP control in the total population. In the ethnic‐stratified analysis, factors associated with better BP control were female sex (all ethnic groups), smoking (Turks), and CVD history (Dutch, South‐Asian Surinamese, and African Surinamese), whereas factors associated with suboptimal BP control were older age (Turks), obesity (Dutch, African Surinamese, Ghanaian, and Turks), and non‐adherence to antihypertensives (Dutch). In conclusion, our analysis identifies several key determinants that are independently associated with suboptimal BP control in a multi‐ethnic population, with some important variations between ethnic groups. Targeting these determinants may help to improve BP control.
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Affiliation(s)
- Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Erik J A J Beune
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Joke A Haafkens
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 451] [Impact Index Per Article: 150.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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16
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Matos Fialho PM, Dragano N, Reuter M, Metzendorf MI, Richter B, Hoffmann S, Diehl K, Wachtler B, Sundmacher L, Herke M, Pischke C. Mapping the evidence regarding school-to-work/university transition and health inequalities among young adults: a scoping review protocol. BMJ Open 2020; 10:e039831. [PMID: 33268415 PMCID: PMC7713198 DOI: 10.1136/bmjopen-2020-039831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION School-to-work/university transition is a sensitive period that can have a substantial impact on health and health behaviour over the life course. There is some indication that health and health behaviour is socially patterned in the age span of individuals in this transition (16-24 years) and that there are differences by socioeconomic position (SEP). However, evidence regarding this phenomenon has not been systematically mapped. In addition, little is known about the role of institutional characteristics (eg, of universities, workplaces) in the development of health and possible inequalities in health during this transition. Hence, the first objective of this scoping review is to systematically map the existing evidence regarding health and health behaviours (and possible health inequalities, for example, differences by SEP) in the age group of 16-24 years and during school-to-work transition noted in Germany and abroad. The second objective is to summarise the evidence on the potential effects of contextual and compositional characteristics of specific institutions entered during this life stage on health and health behaviours. Third, indicators and measures of these characteristics will be summarised. METHODS AND ANALYSIS We will systematically map the evidence on health inequalities during school-to-work-transitions among young adults (aged 16-24 years), following the methodological framework proposed by Arksey and O'Malley. The literature search is performed in Ovid MEDLINE, Web of Science, International Labour Organization and National Institute for Occupational Safety and Health, using a predetermined search strategy. Articles published between January 2000 and February 2020 in English or German are considered for the review. The selection process follows a two-step approach: (1) screening of titles and abstracts, and (2) screening of full texts, both steps by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Data extraction will be performed using a customised data extraction sheet. The results will be presented in tabular and narrative form. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. The results will be published in a peer-reviewed scientific journal and presented at international conferences and project workshops.
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Affiliation(s)
- Paula Mayara Matos Fialho
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Duesseldorf, Germany
| | - Bernd Richter
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Duesseldorf, Germany
| | - Stephanie Hoffmann
- Department of Public Health, Faculty for Social Work, Health, and Music, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Wachtler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - L Sundmacher
- Department of Health Services Management, Ludwig Maximilians University Munich, Munich, Germany
| | - Max Herke
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
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17
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Syndemic thinking in large-scale studies: Case studies of disability, hypertension, and diabetes across income groups in India and China. Soc Sci Med 2020; 295:113503. [DOI: 10.1016/j.socscimed.2020.113503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
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18
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Gooding HC, Gidding SS, Moran AE, Redmond N, Allen NB, Bacha F, Burns TL, Catov JM, Grandner MA, Harris KM, Johnson HM, Kiernan M, Lewis TT, Matthews KA, Monaghan M, Robinson JG, Tate D, Bibbins-Domingo K, Spring B. Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc 2020; 9:e016115. [PMID: 32993438 PMCID: PMC7792379 DOI: 10.1161/jaha.120.016115] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long-term health. These changes demand a repositioning of existing evidence-based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.
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Affiliation(s)
- Holly C Gooding
- Division of General Pediatrics and Adolescent Medicine Emory UniversityChildren's Healthcare of Atlanta Atlanta GA
| | | | - Andrew E Moran
- Division of General Medicine Columbia University New York NY
| | | | - Norrina B Allen
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Fida Bacha
- Division of Pediatric Endocrinology and Diabetes Texas Children's HospitalBaylor College of Medicine Houston TX
| | - Trudy L Burns
- Department of Epidemiology University of Iowa Iowa City IA
| | - Janet M Catov
- Department of Obstetrics, Gynecology & Reproductive Sciences Department of Epidemiology University of Pittsburgh Pittsburgh PA
| | | | | | - Heather M Johnson
- Blechman Center for Specialty Care and Preventive Cardiology Boca Raton Regional Hospital/Baptist Health South Florida Boca Raton FL
| | - Michaela Kiernan
- Department of Medicine Stanford University School of Medicine Stanford CA
| | - Tené T Lewis
- Department of Epidemiology Emory University, Children's Healthcare of Atlanta Atlanta GA
| | | | - Maureen Monaghan
- Department of Psychiatry and Behavioral Sciences Department of Pediatrics Children's National Health System George Washington University School of Medicine Washington DC
| | | | - Deborah Tate
- Department of Sociology University of North Carolina at Chapel Hill Chapel Hill NC
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | - Bonnie Spring
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
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Abstract
OBJECTIVE This study aimed to study the association between maternal history of childhood adversity and blood pressure in pregnancy. METHODS A total of 127 pregnant women completed measures of adverse childhood experiences (ACE) and prenatal stress between June 2015 and April 2019. At 11 weeks' gestation (range, 6-17 weeks), we measured 24-hour ambulatory blood pressure. All women were considered to be at risk for pregnancy complications due to elevated body mass index and self-reporting snoring in pregnancy. RESULTS Women were, on average, 30 years old (range, 19-40 years), and average (standard deviation) body mass index in this sample was 34 (7) kg/m (range, 27-55 kg/m). Higher ACE scores were associated with higher nighttime blood pressure (systolic blood pressure: β = 0.23, p = .013; diastolic blood pressure: β = 0.22, p = .028). There were no significant associations between the ACE score and daytime blood pressure. Women with four or more ACEs were more likely to display nocturnal blood pressure nondipping (odds ratio = 3.97, 95% confidence interval = 1.38-11.40). Associations between ACE and nocturnal blood pressure remained significant after adjusting for symptoms of prenatal stress. CONCLUSIONS Results indicate that experiences of childhood adversity are associated with elevated nocturnal blood pressure and loss of a typical decline in blood pressure between day and night.
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20
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Möller C, Schutte AE, Smith W, Botha-Le Roux S. Von Willebrand factor, its cleaving protease (ADAMTS13), and inflammation in young adults: The African-PREDICT study. Cytokine 2020; 136:155265. [PMID: 32927287 DOI: 10.1016/j.cyto.2020.155265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of inflammation in the early development of vascular dysfunction remains complex. Interleukin-6 (IL-6) and C-reactive protein (CRP) can cause an acute imbalance in the von Willebrand factor (vWF)-ADAMTS13 interaction, indicating a possible link between markers of haemostasis and low-grade inflammation. To better understand these inter-relationships in the early phases of disease development, we investigated whether vWF and ADAMTS13 associate with the pro-inflammatory markers, IL-6 and CRP in healthy young adults. We considered the role of blood types, sex and race on these relationships. METHODS In healthy black and white men and women (n = 1113; 24 ± 5 years; no previous diagnosis or medication use for chronic diseases) we analysed von Willebrand factor antigen (vWFag), ADAMTS13, IL-6 and CRP, and grouped blood types as non-O (A, B and AB) and O. Covariates included socioeconomic status, age, estimated glomerular filtration rate, 24-hour systolic blood pressure, waist circumference, glucose, total cholesterol, platelet count, γ-glutamyl transferase and total energy expenditure. RESULTS In the total group, vWFag was highest in the third tertile of both IL-6 and CRP (p ≤ 0.014), while ADAMTS13 was lowest in the third compared to the first IL-6 tertile (p = 0.006). In multivariate regression, vWFag associated positively with IL-6 (Adj R2 = 0.169; β = 0.123; p = 0.001) and CRP (Adj R2 = 0.163; β=0.094; p = 0.019) in the total group, in the O blood group (all p ≤ 0.051) and white men (all p ≤ 0.035). ADAMTS13 associated negatively with IL-6 (Adj R2 = 0.053; β = -0.154; p = 0.015) and CRP (Adj R2 = 0.055; β = -0.177; p = 0.009), only in the O blood group. CONCLUSIONS Markers of haemostasis associated independently with low-grade inflammation in the O type blood group and white men. An interplay between the haemostatic and inflammatory systems may already exist in young healthy adults and is dependent on blood groups, sex and race. This extends our understanding on the role of inflammation in the early development of vascular dysfunction prior to cardiovascular compromise.
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Affiliation(s)
- Christine Möller
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Faculty of Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Shani Botha-Le Roux
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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Eriksson M, Carlberg B, Pennlert J, Söderberg S, Eliasson M. Time trends and socioeconomic differences in blood pressure levels: The Northern Sweden MONICA study 1994–2014. Eur J Prev Cardiol 2020; 24:1473-1481. [DOI: 10.1177/2047487317722263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
People with low socioeconomic status have higher blood pressure (BP), increasing their risk of myocardial infarction and stroke. We hypothesized that the gap in systolic (SBP) and diastolic (DBP) BP, according to educational level, has decreased over time but, that economical vulnerability would confer higher BP.
Methods
A total of 4564 women and 4363 men aged 25–74 years participated in five population-based surveys in the Northern Sweden MONICA study between 1994 and 2014 (participation rate 76.8–62.5%).
Results
SBP decreased by 10 mmHg in women and 4 mmHg in men, while DBP was unchanged. Treatment with antihypertensives increased in all but the youngest men. The prevalence of BP control in the population (<140/90 mmHg) increased and in 2014 reached 75% among women and 70% among men. The decrease in SBP was more pronounced in people without university education than in people with university education and DBP showed the same pattern, regardless of education.
After adjustment for confounding factors, age, male sex, higher body mass index, and being born in a Nordic country were related to higher SBP and DBP. University education was related to lower SBP, while variables mirroring economic vulnerability were not associated with BP levels.
Conclusions
BP levels as well as the socioeconomic gap in BP has decreased in Sweden but people with a lower level of education still have higher SBP. Lacking economic resources is not associated with high BP.
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Affiliation(s)
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Sweden
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Zheng S, Zhu W, Wang M, Shi Q, Luo Y, Miao Q, Nie Y, Kang F, Mi X, Bai Y. The effect of diurnal temperature range on blood pressure among 46,609 people in Northwestern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 730:138987. [PMID: 32428804 DOI: 10.1016/j.scitotenv.2020.138987] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A large number of studies have found a positive association between diurnal temperature range (DTR) and cardiovascular diseases (CVDs) incidence and mortality. Few studies regarding the effects of DTR on blood pressure (BP) are available. OBJECTIVE To investigate the effects of DTR on BP in Jinchang, northwestern China. METHODS Based on a prospective cohort research, a total of 46,609 baseline survey data were collected from 2011 to 2015. The meteorological observation data and environmental monitoring data were collected in the same period. The generalized additive model (GAM) was used to estimate the relationship between DTR and BP after adjusting for confounding variables. RESULTS Our study found that there was a positive linear correlation between DTR and systolic blood pressure (SBP) and plus pressure (PP), and a negative linear correlation between DTR and diastolic blood pressure (DBP). With a 1 °C increase of DTR, SBP and PP increased 0.058 mmHg (95%CI: 0.018-0.097) and 0.114 mmHg (95%CI: 0.059-0.168) respectively, and DBP decreased 0.039 mmHg (95%CI:-0.065 ~ -0.014). There was a significant interaction between season and DTR on SBP and PP. DTR had the greatest impact on SBP and PP in hot season. The association between DTR and BP varied significantly by education level. CONCLUSION There was a significant association between DTR and BP in Jinchang, an area with large temperature change at high altitudes in northwestern China. These results provide new evidence that DTR is an independent risk factor for BP changes among general population. Therefore, effective control and management of BP in the face of temperature changes can help prevent CVDs.
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Affiliation(s)
- Shan Zheng
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China.
| | - Wenzhi Zhu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
| | - Minzhen Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
| | - Qin Shi
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
| | - Yan Luo
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
| | - Qian Miao
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
| | - Yonghong Nie
- Jinchang Center for Disease Prevention and Control, Jinchang 737100, China
| | - Feng Kang
- Workers' Hospital of Jinchuan Group Co., Ltd., Jinchang 737103, China
| | - Xiuying Mi
- Jinchang Meteorological Service, Jinchang 737100, China
| | - Yana Bai
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 73000, China
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Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men. Sci Rep 2020; 10:13355. [PMID: 32770136 PMCID: PMC7414842 DOI: 10.1038/s41598-020-70399-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Chronically blunted nocturnal blood pressure (BP) dipping has been shown to increase the future risk of cardiovascular diseases. In the present cross-sectional study, we investigated whether self-reported insomnia symptoms were associated with an altered 24-h BP profile and blunted nocturnal BP dipping (night-to-day BP ratio > 0.90) in older men. For the analysis, we used 24-h ambulatory blood pressure data and reports of insomnia symptoms (difficulty initiating sleep, DIS; and early morning awakenings, EMA) from 995 Swedish men (mean age: 71 years). Compared to men without DIS, those reporting DIS (10% of the cohort) had a higher odds ratio of diastolic non-dipping (1.85 [1.15, 2.98], P = 0.011). Similarly, men who reported EMA (19% of the cohort) had a higher odds ratio of diastolic non-dipping than those without EMA (1.57 [1.09, 2.26], P = 0.015). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+ 1.4 mmHg, P = 0.042), no other statistically significant differences in BP and heart rate were found between men with and those without insomnia symptoms. Our findings suggest that older men reporting difficulty initiating sleep or early morning awakenings may have a higher risk of nocturnal diastolic non-dipping. Our findings must be replicated in larger cohorts that also include women.
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Nishida W, Ziersch A, Zanelatto C, Wagner KJP, Boing AF, Bastos JLD. Education across the life-course and hypertension in adults from Southern Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:3063-3074. [DOI: 10.1590/1413-81232020258.31152018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/12/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract The present study examines the association between life-course socioeconomic position (SEP) and hypertension (SAH), focusing on the health impacts of childhood SEP (SEPc), adult SEP (SEPa), as well as SEP mobility. Data from the Brazilian EpiFloripa Cohort Study (n = 1,720; 56% women; 55% <= 30 years) were analyzed. SAH was determined by the average of two measures of systolic and diastolic blood pressure, previous medical diagnosis or use of anti-hypertensive medication (43% of the sample was hypertensive). The main independent variables were: SEPa – participants’ level of education; SEPc – parental educational attainment; and SEP mobility – the socio-economic trajectories from SEPc to SEPa. Five logistic regressions models were adjusted for sex, age or income, and were compared among each other. High SEPa was associated with a 37% reduction in the odds of SAH compared to low SEPa. High SEP over the life course was associated with 34-37% lower odds of SAH compared to persistent low SEP. Mobility models explained more of the outcome variance than the sensitive period model. The results reinforce the importance of education in the risk of SAH and the relevance of a socioeconomic mobility approach for the analysis of social inequalities in health.
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25
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Perceived Discrimination, Psychological Distress and Cardiovascular Risk in Migrants in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124601. [PMID: 32604844 PMCID: PMC7345483 DOI: 10.3390/ijerph17124601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/29/2023]
Abstract
The aim of the present study is to determine the effect of discrimination and psychological distress on the cardiovascular health of immigrants, as well as to analyse potential differences based on age, gender, length of residence in host country and geographic origin. The sample was formed by 1714 immigrants from Africa, Eastern Europe and Latin America. Of the sample, 48.7% were men and 51.3% were women. Most relevant results show that discrimination (t = 4.27; p = 0.000) and psychological distress (t = 4.35; p = 0.000) experienced by immigrants predict their cardiovascular risk. Furthermore, psychological distress mediates the relation between discrimination and risk (t = 4.03; p = 0.000). Significant differences between men and women were found, as well as differences based on ethnicity, although to a lesser extent. Age affects the relation between discrimination, psychological distress and arterial hypertension and hypercholesterolemia. Results are notably relevant for the design of preventive health programmes for immigrants and intervention strategies in order to prevent diseases that may imply cardiovascular risks and seriously affect immigrants' health.
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26
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Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines. J Hum Hypertens 2020; 35:280-289. [PMID: 32346124 DOI: 10.1038/s41371-020-0334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/08/2022]
Abstract
The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure (BP) thresholds to 130/80 mmHg to define hypertension while the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg. Both guidelines recommend adapting management for older patients with complex health conditions, without however clear indications on how to adapt. Our aims were to assess the impact of lowering BP thresholds on the prevalence of elevated BP and BP control, as well as the proportion of participants with a complex health condition across these BP categories. We used data from 3210 participants in the Lausanne cohort Lc65+ aged between 67 and 80 years. Hypertension diagnosis and antihypertensive medication use were self-reported. BP was measured three times at one visit. Some 51% of participants reported having hypertension and 44% reported taking antihypertensive medication. Compared with ESC/ESH thresholds, the prevalence of measured elevated BP was 24% percentage points higher and BP control was 24% percentage points lower using ACC/AHA thresholds. About one out of two participants with elevated BP and four out of five participants with uncontrolled BP had a complex health condition, i.e., frailty, multimorbidity, or polypharmacy. To comply with ACC/AHA guidelines, considerable effort would be required to reach BP control. This is a serious challenge because a large share of hypertensive older adults has complex health conditions, a type of patients for whom there is no strong evidence on how to manage hypertension.
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27
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Jacobson M, Crossa A, Liu SY, Locke S, Poirot E, Stein C, Lim S. Residential mobility and chronic disease among World Trade Center Health Registry enrollees, 2004-2016. Health Place 2020; 61:102270. [PMID: 32329735 DOI: 10.1016/j.healthplace.2019.102270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
Residential mobility is hypothesized to impact health through changes to the built environment and disruptions in social networks, and may vary by neighborhood deprivation exposure. However, there are few longitudinal investigations of residential mobility in relation to health outcomes. This study examined enrollees from the World Trade Center Health Registry, a longitudinal cohort of first responders and community members in lower Manhattan on September 11, 2001. Enrollees who completed ≥2 health surveys between 2004 and 2016 and did not have diabetes (N = 44,089) or hypertension (N = 35,065) at baseline (i.e., 2004) were included. Using geocoded annual home addresses, residential mobility was examined using two indicators: moving frequency and displacement. Moving frequency was defined as the number of times someone was recorded as living in a different neighborhood; displacement as any moving to a more disadvantaged neighborhood. We fit adjusted Cox proportional hazards models with time-dependent exposures (moving frequency and displacement) and covariates to evaluate associations with incident diabetes and hypertension. From 2004 to 2016, the majority of enrollees never moved (54.5%); 6.5% moved ≥3 times. Those who moved ≥3 times had a similar hazard of diabetes (hazard ratio (HR) = 0.78; 95% Confidence Interval (CI): 0.40, 1.53) and hypertension (HR = 0.99; 95% CI: 0.68, 1.43) compared with those who never moved. Similarly, displacement was not associated with diabetes or hypertension. Residential mobility was not associated with diabetes or hypertension among a cohort of primarily urban-dwelling adults.
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Affiliation(s)
- Melanie Jacobson
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA; New York University School of Medicine, Department of Pediatrics, Division of Environmental Pediatrics, New York, NY 10016, USA.
| | - Aldo Crossa
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Sze Yan Liu
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Sean Locke
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA
| | - Eugenie Poirot
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Cheryl Stein
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
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28
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Thrift AG, Ragavan RS, Riddell MA, Joshi R, Thankappan KR, Chow C, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Mini GK, Ismail J, Gamage DG, Hasan A, Srikanth VK, Thomas N, Maulik PK, Guggilla RK, Evans RG. Hypertension in Rural India: The Contribution of Socioeconomic Position. J Am Heart Assoc 2020; 9:e014486. [PMID: 32223389 PMCID: PMC7428634 DOI: 10.1161/jaha.119.014486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross‐sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high‐income countries. Why this effect is absent in rural India merits investigation.
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Affiliation(s)
- Amanda G Thrift
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Michaela A Riddell
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Rohina Joshi
- The George Institute for Global Health University of New South Wales Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India
| | - Clara Chow
- The George Institute for Global Health University of New South Wales Australia.,Department of Cardiology Westmead Hospital Sydney Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Ajay S Mahal
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Nossal Institute for Global Health Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia.,Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - G K Mini
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India.,Global Institute of Public Health Ananthapuri Hospitals and Research Institute Trivandrum Kerala India
| | - Jordan Ismail
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Aniqa Hasan
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Velandai K Srikanth
- Peninsula Clinical School Central Clinical School Monash University Frankston Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India
| | - Pallab K Maulik
- George Institute for Global Health New Delhi India.,George Institute for Global Health-Oxford University Oxford United Kingdom
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention Faculty of Medicine With the Division of Dentistry and Division of Medical Education in English Medical University of Bialystok Bialystok Poland
| | - Roger G Evans
- Cardiovascular Disease Program Biomedicine Discovery Institute, and Department of Physiology Monash University Melbourne Australia
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29
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Association between childhood socioeconomic status and adult health in Botswana: a cross-sectional study. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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30
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Maksimova ZV, Maksimov DM. [Hypertension in working age population: influence of gender and education]. ACTA ACUST UNITED AC 2019; 60:24-32. [PMID: 32345195 DOI: 10.18087/cardio.2020.2.n441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/13/2019] [Indexed: 11/18/2022]
Abstract
Introduction Hypertension is the most common cardiovascular disease (CVD) and a major cause of premature death. Study of age/gender-related and social aspects of the disease, and the assessment of the efficacy of antihypertensive treatment are essential elements of the epidemiological monitoring of hypertension and support a reasonable approach to planning further therapeutic and preventive interventions.Objective Assess the prevalence of hypertension in the working-age population, examine the relationship between hypertension patterns and level of education of respondents taking into account age, gender, and the main aspects of lifestyle.Materials and Methods The study included industrial workers who underwent a routine medical examination in September-November 2015. A total of 2432 subjects (59% males and 41% of females) were surveyed. The study design is cross-sectional, analytic. Methods used: anonymous questionnaire surveys using the WHO STEPS questionnaire, anthropometric measurements, BP measurement. Questions about hypertension included awareness of the presence of the disease and the administration of antihypertensive drugs. Hypertension was diagnosed with systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, or in the case of the administration of antihypertensive drugs. The efficacy of treatment was assessed by the percentage of patients who had reached the target BP values (<140/90 mm Hg), including treated with antihypertensive drugs. The control of hypertension was judged by the percentage of patients with the target BP levels among all respondents with hypertension.Results Hypertension was diagnosed in 40% of the study subjects. The disease was more prevalent in males (odds ratio (OR) = 1.21), overweight, and obese patients (OR = 2.5) and less prevalent in subjects with higher education (OR = 0.6). No significant association of lifestyle (smoking, alcohol abuse, eating fruits and vegetables, physical activity) with the prevalence of hypertension was revealed. 76% of respondents with hypertension knew about their disease (51% among those who did not take antihypertensive drugs). Awareness was higher in patients with severe hypertension (OR = 2.5), overweight and obese patients (OR = 1.96), and respondents with higher education (OR = 1.55), being significantly lower in males (OR = 0.44). 50% of respondents with hypertension (52% of those with severe hypertension) took antihypertensive drugs with males twice less often than females (OR = 0.49). The target BP levels were detected in 39% of patients taking antihypertensive drugs, less frequently in males (OR = 0.63) and overweight patients (OR = 0.48), and significantly more frequently in patients with higher education (OR = 2.28), regardless their lifestyle.Conclusion The prevalence of hypertension in working patients was 40%. Males were more likely to suffer hypertension and less aware of their disease. The target blood pressure levels were less frequently observed in males during the treatment. On the other hand, patients with higher education had a lower prevalence of hypertension, significantly higher awareness of the disease and efficacy of the treatment than those who had secondary or primary school education. Overall, the study confirmed that the sample of industrial workers could be a reliable source for monitoring hypertension. The significant gender differences and an independent protective effect of the level of education were identified in the epidemiology of hypertension, which should be taken into account in further studies.
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31
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Choi PM, Tscharke B, Samanipour S, Hall WD, Gartner CE, Mueller JF, Thomas KV, O'Brien JW. Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology. Proc Natl Acad Sci U S A 2019; 116:21864-21873. [PMID: 31591193 PMCID: PMC6815118 DOI: 10.1073/pnas.1910242116] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.
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Affiliation(s)
- Phil M Choi
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia;
| | - Benjamin Tscharke
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | | | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Herston, QLD 4029, Australia
| | - Coral E Gartner
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Brummett BH, Babyak MA, Jiang R, Huffman KM, Kraus WE, Singh A, Hauser ER, Siegler IC, Williams RB. Systolic Blood Pressure and Socioeconomic Status in a large multi-study population. SSM Popul Health 2019; 9:100498. [PMID: 31650001 PMCID: PMC6804683 DOI: 10.1016/j.ssmph.2019.100498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
The present study used harmonized data from eight studies (N = 28,891) to examine the association between socioeconomic status (SES) and resting systolic blood pressure (SBP). The study replicates and extends our prior work on this topic by examining potential moderation of this association by race and gender. We also examined the extent to which body mass index (BMI), waist circumference (WC), and smoking might explain the association between SES and SBP. Data were available from six race/gender groups: 9200 Black women; 2337 Black men; 7248 White women; 6519 White men; 2950 Hispanic women; and 637 Hispanic men. Multivariable regression models showed that greater annual household income was associated with lower SBP in all groups except Hispanic men. The magnitude and form of this negative association differed across groups, with White women showing the strongest linear negative association. Among Black men and Hispanic women, the association was curvilinear: relatively flat among lower income levels, but then negative among higher income ranges. Education also was independently, negatively related to SBP, though evidence was weaker for race and gender differences in the strength of the association. Higher BMI and WC were associated with higher SBP, and current smoking with lower SBP. Inclusion of these risk factors resulted in only a modest change in the magnitude of the SBP and SES relation, accounting on average about 0.4 mmHg of the effect of income and 0.2 mmHg of the effect of education—effects unlikely to be clinically significant. Further understanding of mechanisms underlying the association between SBP and SES may improve risk stratification in clinical settings and potentially inform interventions aimed at reductions in social disparities in health. Harmonized data (n = 28,291) examined association between blood pressure and socioeconomic status. Replication and extension of prior work by examining potential moderation of this association by race and gender. Further understanding of this association inform interventions aimed at reductions in social disparities in health.
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Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA
| | - Michael A Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Abanish Singh
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ilene C Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA
| | - Redford B Williams
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C, 27710, USA
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33
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South AM, Palakshappa D, Brown CL. Relationship between food insecurity and high blood pressure in a national sample of children and adolescents. Pediatr Nephrol 2019; 34:1583-1590. [PMID: 31025108 PMCID: PMC6660989 DOI: 10.1007/s00467-019-04253-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the relationship between food insecurity (FI) and high blood pressure (BP) in a national cohort of children and adolescents. METHODS A cross-sectional analysis of children aged 8-17 years in the 2007-2014 National Health and Nutrition Examination Survey (NHANES; unweighted N = 7125). FI over the preceding 12 months was assessed using the USDA Household Food Security Scale in NHANES. We defined high BP as (i) systolic or diastolic BP ≥ 90% for age < 13 years or ≥ 120/80 mmHg for age ≥ 13 years measured at one visit or (ii) reported hypertension diagnosis or current antihypertensive medication use. We used multivariable logistic regression to determine the association between household and child-specific FI and high BP, controlling for age, sex, race, and household income, accounting for the complex NHANES survey design. RESULTS The study population was 14.4% black, 21.3% Hispanic, and 49.4% female with a mean age of 12.6 years (SD 2.9). 20.3% had FI and 12.8% had high BP. High BP was more common in household FI vs. food-secure subjects (15.3% vs. 12.1%, p = 0.003). Adjusted analysis confirmed that household FI and child FI were associated with high BP (OR 1.26, 95% CI 1.04-1.54; OR 1.42, 95% CI 1.03-1.96, respectively). CONCLUSIONS Household and child FI were associated with an increased likelihood of high BP in a large nationally representative cohort of children and adolescents. FI may have a significant impact on cardiovascular health during childhood. Further research is warranted to better define how FI contributes to health disparities.
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Affiliation(s)
- Andrew M. South
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine,Cardiovascular Sciences Center, Wake Forest School of Medicine
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine,Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine
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Soni M, Rodriguez VJ, Babayigit S, Jones DL, Kumar M. Blood Pressure, HIV, and Cocaine Use Among Ethnically and Racially Diverse Individuals. South Med J 2019; 111:643-648. [PMID: 30391997 DOI: 10.14423/smj.0000000000000893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Racial minorities are at greater risk of cardiovascular disease (CVD), and CVD is the primary cause of mortality among human immunodeficiency virus (HIV)-infected individuals. Cocaine use also has been associated with hypertension. This study examined the contribution of lifestyle factors to systolic, diastolic, and mean arterial pressure (MAP) among people living with HIV and cocaine users from racially and ethnically diverse backgrounds. METHODS Participants (N = 401: 213 men, 188 women) aged 18 to 50 years with no history of CVD were recruited from South Florida. A total of 200 participants were HIV-cocaine-infected, 100 were HIV-infected individuals with no history of cocaine use, and 101 were HIV-uninfected individuals with cocaine abuse or dependence. Carotid intima-media thickness and plaque, blood pressure (BP), and lifestyle risk were assessed. RESULTS Mean age was 36 years (standard deviation 9.33); the majority (62%) were African American. Carotid plaques were identified in 23% of participants; 42% were obese, 68% engaged in ≥150 minutes of weekly exercise, and 68% were smokers. Sex, body mass index (BMI), and diet were associated with systolic BP. Age, BMI, cannabis use, and diet were associated with diastolic BP and MAP. CONCLUSIONS Age, BMI, cannabis use, and diet were associated with increased diastolic BP and MAP. Cocaine did not emerge as a significant predictor of CVD after controlling for cannabis dependence. Cocaine and HIV lacked significant association with CVD, possibly because the majority of the sample was younger than age 40. Lifestyle modifications and substance abuse counseling may be important in preventing CVD among those without a history of CVD.
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Affiliation(s)
- Manasi Soni
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Violeta J Rodriguez
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Suat Babayigit
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah L Jones
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mahendra Kumar
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Pourmoghddas A, Gharipour M, Garakyaraghi M, Nouri F, Taheri M, Sadeghi M. Association of socioeconomic status and hypertension based on habitual smoking among Iranian population: IHHP study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 89:498-504. [PMID: 30657118 PMCID: PMC6502090 DOI: 10.23750/abm.v89i4.5169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/23/2022]
Abstract
Background: Along with tripartiteclose relationship of socioeconomic level, smoking, and prevalence of hypertension, the present study aimed to assess the relationship between socioeconomic status (SES) and hypertension based on habitual smoking in Iranian population. Methods: The present study analyzed the individuals subsample consisted of 9623 subjects, out of all people resident in Isfahan province in Iran of the wave of the Isfahan Heart Health Project (IHHP) in three cities in Iran: Isfahan, Najafabad and Arak. Systolic and diastolic blood pressures were measured in supine position using an automated blood pressure monitor. Smokers were defined as persons who were smoked prior to the survey and never smokers were defined as a person who had never smoked. Results: Those individuals who experienced cigarette smoking, SES class was significantly lower in hypertensive patients compared with normotensive subject so 7.8% of hypertensive patients and 92.2% of normotensive ones classified in SES class IV (p<0.001). Univariate analysis showed hypertension was related to lower SES class when compared with normotension status in both smoker and nonsmoker groups (p<0.001). In stepwise logistic regression models adjusting sex, age, global dietary index and leisure time physical activity, hypertension could be predicted by lower SES in nonsmoker group, while this predictive role for SES could not be reveal in smoker group. Conclusion: The significant SES-smoking association may determinate in the increasing blood pressure even adjusted for other covariates such as demographics as well as dietary behaviors and leisure time physical activity. (www.actabiomedica.it)
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Affiliation(s)
- Ali Pourmoghddas
- . .,Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Gharipour
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Garakyaraghi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Hypertension research center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Prevalence, Awareness, and Control of Hypertension in Greater Beirut Area, Lebanon. Int J Hypertens 2018; 2018:5419861. [PMID: 30729041 PMCID: PMC6343155 DOI: 10.1155/2018/5419861] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/04/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hypertension (HTN) has been identified as the leading risk factor for mortality and the third cause of disability worldwide. Lebanon has witnessed a threefold increase in the prevalence of HTN in the past decade. The timely exploration and detection of the factors contributing to a higher prevalence of the disease among the Lebanese population is fundamental. The objectives of this study were to assess the prevalence, awareness, and control rates of HTN in Greater Beirut Area in Lebanon and to identify their respective predictors. Methods A representative sample of 501 participants aged 18-79 years residing in Greater Beirut Area was examined. Data collection form was filled up, through interviews, physical exams, and lab tests. The analysis was done for three defined outcomes: blood pressure status (normotensive, prehypertension, and hypertension), unaware HTN, and uncontrolled HTN. These were compared for the various associated predictors. Results The sample consisted of 64.3% women and mean age 45.4 ± 15 years and the subjects were predominantly from low educational income levels. The results showed that 36.4% of the study participants were hypertensive, 25.3% were prehypertensive, and 38.2% had optimal blood pressure, while the awareness rate was 65.4% and control rate was 61%. The independent predictors of HTN were age, gender, marital status, T2D, body fat, triglyceride (positive correlates), and income level (negative correlate). Moreover, unawareness of HTN was common among older age, men, single participants, and the obese. We could not identify any factor related to uncontrolled HTN. Conclusion The trend in the prevalence of HTN in Greater Beirut Area is found to be consistent and relatively high, yet there was an observed improvement in the awareness and control of the disease. Public health measures on a national level are urgently needed to curb the increasing prevalence of HTN, achieve primary prevention, and better control the disease.
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Munthali RJ, Manyema M, Said-Mohamed R, Kagura J, Tollman S, Kahn K, Gómez-Olivé FX, Micklesfield LK, Dunger D, Norris SA. Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis. BMJ Open 2018; 8:e023404. [PMID: 30573484 PMCID: PMC6303607 DOI: 10.1136/bmjopen-2018-023404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. SETTING Rural and urban South Africa. DESIGN Cross-sectional. PARTICIPANTS Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study. RESULTS The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). CONCLUSIONS Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.
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Affiliation(s)
- Richard J Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercy Manyema
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Alhassan BA, Liu Y, Slawson D, Peterson JM, Marrs JA, Clark WA, Alamian A. The influence of maternal body mass index and physical activity on select cardiovascular risk factors of preadolescent Hispanic children. PeerJ 2018; 6:e6100. [PMID: 30581681 PMCID: PMC6295326 DOI: 10.7717/peerj.6100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Maternal obesity and physical inactivity have been identified as correlates of overweight and obesity and physical inactivity in older preadolescents; however, no study has explored this relationship in Hispanic preadolescents. Furthermore, the relation between maternal physical activity (PA) and blood pressure (BP) in Hispanic preadolescents has not been examined. PURPOSE This study aimed to assess the associations between Hispanic mothers' PA and body mass index (BMI) and their preadolescents' PA, screen time, BP, and BMI. METHODS Data of 118 mother-child (aged 2-10 years) dyads enrolled in a cross-sectional study of metabolic syndrome in Hispanic preadolescents at a community health center in Johnson City, TN were used. Parent and child questionnaires were used to ascertain mothers' BMI and PA and preadolescents' PA and screen time. Preadolescents' height, weight, and BP were measured. Multiple logistic regression was used to examine the association between child and maternal variables, adjusting for mother's education and the child's sex and age. RESULTS Pradolescents of obese mothers were more likely than preadolescents of mothers with normal weight to engage in less than three days of at least 60 min of vigorous PA per week (OR: 6.47, 95% CI [1.61-26.0]). Preadolescents whose mothers did not engage in moderate PA were more likely to engage in less than three days of at least 60 min of vigorous PA per week (OR: 2.92, CI [1.18-7.24]); and have elevated BP (OR: 2.50, 95% CI [1.02-4.53]) than preadolescents whose mothers engaged in moderate PA. DISCUSSION Our results show a negative relationship between maternal obesity and preadolescent PA, and a positive relationship between lower maternal PA and elevated BP and lower PA in Hispanic preadolescents. This suggests that interventions aimed at improving Hispanic preadolescents' PA and BP may use maternal PA and maternal BMI (for preadolescent PA) as a modification strategy to improve health in Hispanic preadolescents.
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Affiliation(s)
- Basil A. Alhassan
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
| | - Deborah Slawson
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
| | - Jonathan M. Peterson
- Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
| | - Jo-Ann Marrs
- College of Nursing, East Tennessee State University, Johnson City, TN, United States of America
| | - William A. Clark
- College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, Johnson City, TN, United States of America
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
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Clemow LP, Pickering TG, Davidson KW, Schwartz JE, Williams VP, Shaffer JA, Williams RB, Gerin W. Stress management in the workplace for employees with hypertension: a randomized controlled trial. Transl Behav Med 2018; 8:761-770. [PMID: 30202927 PMCID: PMC6128963 DOI: 10.1093/tbm/iby018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.
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Affiliation(s)
- Lynn P Clemow
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
- Department of Family and Community Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas G Pickering
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Karina W Davidson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Joseph E Schwartz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | | | - Jonathan A Shaffer
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Redford B Williams
- Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - William Gerin
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
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Banu Z, Lim KK, Kwan YH, Yap KZ, Ang HT, Tan CS, Fong W, Thumboo J, Lee KH, Ostbye T, Low LL. Anti-hypertensive medications and injurious falls in an older population of low socioeconomic status: a nested case-control study. BMC Geriatr 2018; 18:195. [PMID: 30153807 PMCID: PMC6114512 DOI: 10.1186/s12877-018-0871-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to determine whether the number of anti-hypertensive medication classes or any change in anti-hypertensive medication were associated with injurious fall among the community-dwelling older population of low socioeconomic status. Methods Using data from electronic medical records, we performed a nested case-control study among older Singapore residents (≥60) of low socioeconomic status (N = 210). Controls (n = 162) were matched to each case (n = 48) by age and gender. Variables with p < 0.10 in univariate analysis were included in multivariate analysis. We used conditional logistic regression to assess the associations of the number of anti-hypertensive medication classes and change in anti-hypertensive medication with injurious falls. We also performed stepwise regressions as sensitivity analyses. p < 0.05 was considered statistically significant. Results The mean (±SD) age of participants was 78.1 (± 8.33) years; 127 (60.4%) were female, 189 (90.0%) were Chinese. Those on ≥2 anti-hypertensive medication classes had an increased risk of experiencing an injurious fall compared to those not on any anti-hypertensive medication (OR = 5.45; CI:1.49–19.93; p = 0.01). Among those who were taking anti-hypertensive medication, those who had a change in the medication 180-day prior to injurious fall had a significantly increased risk of experiencing an injurious fall compared to those that did not report any change in anti-hypertensive medication (OR = 3.88; CI:1.23–12.19; p = 0.02). Sensitivity analyses generated consistent findings. Conclusion Both ≥2 anti-hypertensive medication classes and change in anti-hypertensive medication were associated with an increased risk of experiencing an injurious fall among the older population of low socioeconomic status. Our findings could guide prescribers to exercise caution in the initiation of anti-hypertensive medications or in making medication changes, especially among the older population of low socioeconomic status. Electronic supplementary material The online version of this article (10.1186/s12877-018-0871-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zafirah Banu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Ka Keat Lim
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Hui Ting Ang
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore.,Duke-NUS Medical School, Singapore, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore.,Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Truls Ostbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore. .,Duke-NUS Medical School, Singapore, Republic of Singapore.
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Prevalence and Correlates of Hypertension among Japanese Adults, 1975 to 2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081645. [PMID: 30081485 PMCID: PMC6121905 DOI: 10.3390/ijerph15081645] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/17/2018] [Accepted: 07/28/2018] [Indexed: 01/13/2023]
Abstract
We investigated the prevalence and factors associated with hypertension, its treatment, and control using individual-level data from 300,249 respondents aged 20 years and older from the Japanese National Health and Nutrition Survey for the period of 1975–2010. We applied multivariate random effects logistic regression to assess associations between the risk factors and the prevalence of hypertension, the proportion of uncontrolled hypertension, and the proportions of respondents seeking treatment and controlling hypertension. The trends in the effect of the birth cohort on uncontrolled hypertension were also examined. Having hypertension was associated with being male, older, obese, drinking alcohol, and working in the primary industry and a higher proportion of middle-aged men than women were found being obese and drinking alcohol. Seeking treatment was associated with being older, obese, drinking alcohol, working in a primary industry and exercising. Controlling hypertension was associated with being younger, underweight and exercising. The proportion of individuals with uncontrolled hypertension declined for cohorts born in later years with a steeper decline for women than men. Raising awareness in the hypertensive population, especially among men, could help further reduce the prevalence of hypertension in Japan.
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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Singh A, Babyak MA, Brummett BH, Kraus WE, Siegler IC, Hauser ER, Williams RB. Developing a synthetic psychosocial stress measure and harmonizing CVD-risk data: a way forward to GxE meta- and mega-analyses. BMC Res Notes 2018; 11:504. [PMID: 30041705 PMCID: PMC6057001 DOI: 10.1186/s13104-018-3595-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/12/2018] [Indexed: 01/13/2023] Open
Abstract
Objectives Among many challenges in cardiovascular disease (CVD) risk prediction are interactions of genes with stress, race, and/or sex and developing robust estimates of these interactions. Improved power with larger sample size contributed by the accumulation of epidemiological data could be helpful, but integration of these datasets is difficult due the absence of standardized phenotypic measures. In this paper, we describe the details of our undertaking to harmonize a dozen datasets and provide a detailed account of a number of decisions made in the process. Results We harmonized candidate genetic variants and CVD-risk variables related to demography, adiposity, hypertension, lipodystrophy, hypertriglyceridemia, hyperglycemia, depressive symptom, and chronic psychosocial stress from a dozen studies. Using our synthetic stress algorithm, we constructed a synthetic chronic psychosocial stress measure in nine out of twelve studies where a formal self-rated stress measure was not available. The mega-analytic partial correlation between the stress measure and depressive symptoms while controlling for the effect of study variable in the combined dataset was significant (Rho = 0.27, p < 0.0001). This evidence of the validity and the detailed account of our data harmonization approaches demonstrated that it is possible to overcome the inconsistencies in the collection and measurement of human health risk variables. Electronic supplementary material The online version of this article (10.1186/s13104-018-3595-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abanish Singh
- Behavioral Medicine Research Center, Duke University School of Medicine, Durham, NC, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA. .,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Michael A Babyak
- Behavioral Medicine Research Center, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Beverly H Brummett
- Behavioral Medicine Research Center, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ilene C Siegler
- Behavioral Medicine Research Center, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Redford B Williams
- Behavioral Medicine Research Center, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Harris KM, Schorpp KM. Integrating Biomarkers in Social Stratification and Health Research. ANNUAL REVIEW OF SOCIOLOGY 2018; 44:361-386. [PMID: 30918418 PMCID: PMC6433161 DOI: 10.1146/annurev-soc-060116-053339] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article provides an overview of the integration of biomarkers and biological mechanisms in social science models of stratification and health. The goal in reviewing this literature is to highlight research that identifies the social forces that drive inequalities over the life course and across generations. The article is structured in the following way. First, descriptive background information on biomarkers is presented, followed secondly by a review of the general theoretical paradigms that lend themselves to an integrative approach. Third, the biomarkers used to capture several biological systems that are most responsive to social conditions are described. Fourth, research that explicates how social exposures "get under the skin" to affect physiological functioning and downstream health is discussed, using socioeconomic disadvantage as an illustrative social exposure. The review ends with emerging directions in the use of biomarkers in social science research. This article endeavors to encourage sociologists to embrace biosocial approaches in order to elevate the importance of social factors in biomedical processes and to intervene on the social conditions that create inequities.
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Amugsi DA, Dimbuene ZT, Asiki G, Kyobutungi C. Quantile regression analysis of modifiable and non-modifiable drivers' of blood pressure among urban and rural women in Ghana. Sci Rep 2018; 8:8515. [PMID: 29867184 PMCID: PMC5986854 DOI: 10.1038/s41598-018-26991-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/23/2018] [Indexed: 12/01/2022] Open
Abstract
High blood pressure is an increasingly problematic public health concern in many developing countries due to the associated cardiovascular and renal complications. This study set out to investigate the drivers of blood pressure among urban and rural women using the 2014 Ghana Demographic and Health Survey data. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were the outcomes of interest. Our findings showed that body mass index (BMI) had a significant positive effect on DBP and SBP in both urban and rural settings, with the largest effect occurring among women in the 75th quantile. Arm circumference also had a positive effect on DBP and SBP across all quantiles in both settings. Age had an increasing positive effect along the entire conditional DBP and SBP distribution in both settings. Women who were pregnant had lower DBP and SBP relative to those who were not pregnant in both settings. These results highlight the important drivers of DBP and SBP, and the differential effects of these drivers on blood pressure (BP) among women in urban and rural settings. To increase their effectiveness, interventions to address high BP should take into account these differential effects.
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Affiliation(s)
- Dickson A Amugsi
- African Population and Health Research Center (APHRC), Nairobi, Kenya.
| | - Zacharie T Dimbuene
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Statistics Canada, Social Analysis and Modeling Division, Ottawa, K1A 0T6, Canada
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
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Ludwig‐Walz H, Schmidt M, Günther ALB, Kroke A. Maternal prepregnancy BMI or weight and offspring's blood pressure: Systematic review. MATERNAL & CHILD NUTRITION 2018; 14:e12561. [PMID: 29171150 PMCID: PMC6865974 DOI: 10.1111/mcn.12561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/31/2017] [Accepted: 10/05/2017] [Indexed: 12/13/2022]
Abstract
Emerging evidence suggests that maternal prepregnancy body mass index or weight (MPBW) may be associated with offspring's blood pressure (BP). Therefore, we conducted a systematic review-following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement-to assess and judge the evidence for an association between MPBW with offspring's later BP. Five data bases were searched without limits. Risk of bias was assessed using the "Tool to Assess Risk of Bias in Cohort Studies," and an evidence grade was allocated following the World Cancer Research Fund criteria. Of 2,011 publications retrieved, 16 studies (all cohort studies) were included in the systematic review; thereof, 5 studies (31%) were rated as good-quality studies. Overall, data from 63,959 participants were enclosed. Systolic BP was analysed in 15 (5 good quality), diastolic BP in 12 (3 good quality), and mean arterial pressure in 3 (no good quality) studies. Five good-quality studies of MPBW with offspring's systolic BP as the outcome and 1 good-quality study with offspring's diastolic BP as the outcome observed a significant association. However, after adding offspring's anthropometry variables to the statistical model, the effect attenuated in 4 studies with systolic BP to nonsignificance, the study with diastolic BP remained significant. No good-quality studies were found with respect to offspring's later mean arterial pressure. In conclusion, this systematic review found suggestive, but still limited, evidence for an association between MPBW with offspring's later BP. The available data suggest that the effect might be mainly mediated via offspring's anthropometry.
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Affiliation(s)
- Helena Ludwig‐Walz
- Department of Nutritional, Food and Consumer SciencesFulda University of Applied SciencesFuldaGermany
| | - Milan Schmidt
- Department of Nutritional, Food and Consumer SciencesFulda University of Applied SciencesFuldaGermany
| | - Anke L. B. Günther
- Department of Nutritional, Food and Consumer SciencesFulda University of Applied SciencesFuldaGermany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer SciencesFulda University of Applied SciencesFuldaGermany
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Koman PD, Hogan KA, Sampson N, Mandell R, Coombe CM, Tetteh MM, Hill-Ashford YR, Wilkins D, Zlatnik MG, Loch-Caruso R, Schulz AJ, Woodruff TJ. Examining Joint Effects of Air Pollution Exposure and Social Determinants of Health in Defining "At-Risk" Populations Under the Clean Air Act: Susceptibility of Pregnant Women to Hypertensive Disorders of Pregnancy. WORLD MEDICAL & HEALTH POLICY 2018; 10:7-54. [PMID: 30197817 PMCID: PMC6126379 DOI: 10.1002/wmh3.257] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pregnant women are uniquely susceptible to adverse effects of air pollution exposure due to vulnerabilities and health consequences during pregnancy (e.g., hypertensive disorders of pregnancy [HDP]) compared to the general population. Because the Clean Air Act (CAA) creates a duty to protect at-risk groups, the regulatory assessment of at-risk populations has both policy and scientific foundations. Previously, pregnant women have not been specially protected in establishing the margin of safety for the ozone and particulate matter (PM) standards. Due to physiological changes, pregnant women can be at greater risk of adverse effects of air pollution and should be considered an at-risk population. Women with preexisting conditions, women experiencing poverty, and groups that suffer systematic discrimination may be particularly susceptible to cardiac effects of air pollutants during pregnancy. We rigorously reviewed 11 studies of over 1.3 million pregnant women in the United States to characterize the relationship between ozone or PM exposure and HDP. Findings were generally mixed, with a few studies reporting a joint association between ozone or PM and social determinants or pre-existing chronic health conditions related to HDP. Adequate evidence associates exposure to PM with an adverse effect of HDP among pregnant women not evident among non-gravid populations.
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Affiliation(s)
- Patricia D Koman
- University of Michigan School of Public Health, Environmental Health Sciences Department in Ann Arbor, Michigan
| | - Kelly A Hogan
- University of Michigan School of Public Health, Environmental Health Sciences Department in Ann Arbor, Michigan, and presently a research fellow in the Department of Biochemistry and Molecular Biology and the Robert and Arlene Kogod Center on Aging at Mayo Clinic, Rochester, Minnesota
| | - Natalie Sampson
- University of Michigan-Dearborn, Department of Health & Human Services in Dearborn, Michigan
| | - Rebecca Mandell
- Arbor Research Collaborative for Health in Ann Arbor, Michigan
| | - Chris M Coombe
- University of Michigan School of Public Health, Department of Health Behavior & Health Education in Ann Arbor, Michigan
| | - Myra M Tetteh
- University of Michigan School of Public Health, Department of Health Behavior & Health Education in Ann Arbor, Michigan
| | | | | | - Marya G Zlatnik
- University of California San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences in San Francisco, California
| | - Rita Loch-Caruso
- University of Michigan School of Public Health, Environmental Health Sciences Department and director of the Michigan Center on Lifestage Environmental Exposures and Disease and director of the Environmental Toxicology and Epidemiology Program in Ann Arbor, Michigan
| | - Amy J Schulz
- Department of Health Behavior and Health Education, associate director for the Center for Research on Ethnicity, Culture and Health, and co-lead for the Community Engagement Core for the Michigan Center on Lifestage Environmental Exposures and Disease at the University of Michigan School of Public Health
| | - Tracey J Woodruff
- University of California, San Francisco in the Department of Obstetrics, Gynecology, and Reproductive Sciences and Philip R. Lee Institute for Health Policy Studies and the director of the Program on Reproductive Health and the Environment in San Francisco, California
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African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey. J Racial Ethn Health Disparities 2017; 5:995-1002. [PMID: 29234990 DOI: 10.1007/s40615-017-0446-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
Abstract
In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010-2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77-0.96) and ACs (aOR 0.55, 95% CI 0.37-0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68-0.92) and college graduates (aOR 0.62, 95% CI 0.53-0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04-2.42) and diabetes (aOR 3.22, 95% CI 1.29-8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.
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Association of Socioeconomic Status with Chronic Graft-versus-Host Disease Outcomes. Biol Blood Marrow Transplant 2017; 24:393-399. [PMID: 29032275 DOI: 10.1016/j.bbmt.2017.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023]
Abstract
Chronic graft-versus host disease (GVHD) is a chronic and disabling complication after hematopoietic cell transplantation (HCT). It is important to understand the association of socioeconomic status (SES) with health outcomes in patients with chronic GVHD because of the impaired physical health and dependence on intensive and prolonged health care utilization needs in these patients. We evaluated the association of SES with survival and quality of life (QOL) in a cohort of 421 patients with chronic GVHD enrolled on the Chronic GVHD Consortium Improving Outcomes Assessment study. Income, education, marital status, and work status were analyzed to determine the associations with patient-reported outcomes at the time of enrollment, nonrelapse mortality (NRM), and overall mortality. Higher income (P = .004), ability to work (P < .001), and having a partner (P = .021) were associated with better mean Lee chronic GVHD symptom scores. Higher income (P = .048), educational level (P = .044), and ability to work (P < .001) also were significantly associated with better QOL and improved activity. In multivariable models, higher income and ability to return to work were both significantly associated with better chronic GVHD Lee symptom scores, but income was not associated with activity level, QOL, or physical/mental functioning. The inability to return to work (hazard ratio, 1.82; P = .019) was associated with worse overall mortality, whereas none of the SES indicators were associated with NRM. Income, race, and education did not have statistically significant associations with survival. In summary, we did not observe an association between SES variables and survival or NRM in patients with chronic GVHD, although we found some association with patient-reported outcomes, such as symptom burden. Higher income status was associated with less severe chronic GVHD symptoms. More research is needed to understand the psychosocial, biological, and environmental factors that mediate this association of SES with major HCT outcomes.
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Kwok MK, Schooling CM, Subramanian SV, Leung GM, Kawachi I. Pathways from parental educational attainment to adolescent blood pressure. J Hypertens 2017; 34:1787-95. [PMID: 27348520 DOI: 10.1097/hjh.0000000000001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring. METHODS In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI. RESULTS We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP. CONCLUSION Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.
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Affiliation(s)
- Man Ki Kwok
- aSchool of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China bCity University of New York School of Public Health and Hunter College, New York, New York cDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States
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