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Bergstein VE, O'Sullivan LR, Levy KH, Vulcano E, Aiyer AA. Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00004. [PMID: 38437055 PMCID: PMC10906581 DOI: 10.5435/jaaosglobal-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. METHODS The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. RESULTS Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. CONCLUSIONS Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
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Affiliation(s)
- Victoria E. Bergstein
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Lucy R. O'Sullivan
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Kenneth H. Levy
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Ettore Vulcano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Amiethab A. Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
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Lee S, Ryu S, Lee GE, Redline S, Morey BN. Risk of Sleep Apnea Is Associated with Abdominal Obesity Among Asian Americans: Comparing Waist-to-Hip Ratio and Body Mass Index. J Racial Ethn Health Disparities 2024; 11:157-167. [PMID: 36622567 PMCID: PMC9838535 DOI: 10.1007/s40615-022-01507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants. METHODS The dataset included Chinese and Korean participants aged 50-75 who were recruited from primary care physicians' clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area (n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors. RESULTS Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity (PR = 1.31, 95% CI: 1.17-1.47) and general obesity (PR = 2.19, 95% CI: 0.90-5.32), marginally significant at p < 0.1). CONCLUSIONS Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans. INFORMATION ON CLINICAL TRIAL Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.
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Affiliation(s)
- Sunmin Lee
- Department of Medicine, School of Medicine, University of California-Irvine, 1001 Health Sciences Road, Bldg835, Ste 231, Irvine, CA, USA.
| | - Soomin Ryu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Grace E Lee
- Department of Medicine, School of Medicine, University of California-Irvine, 1001 Health Sciences Road, Bldg835, Ste 231, Irvine, CA, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Brittany N Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, CA, USA
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Shetty NS, Patel N, Gaonkar M, Kalra R, Li P, Pavela G, Arora G, Arora P. Trends of cardiovascular health in Asian American individuals: A national health and nutrition examination survey study. Am J Prev Cardiol 2023; 14:100509. [PMID: 37334161 PMCID: PMC10273280 DOI: 10.1016/j.ajpc.2023.100509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US. Methods The Life's Essential 8 (LE8) score and its components were calculated in self-reported Asian American individuals ≥20 years of age and free of cardiovascular disease in the NHANES cycles from 2011-March 2020. Multivariable adjusted linear and logistic regression models were used for analysis. Results Among 2,059 Asian American individuals, the weighted mean LE8 score was 69.1 (0.4) with US-born [69.0 (0.8)] and foreign-born individuals [69.1 (0.4)] having similar CVH. From 2011 to March 2020, CVH in the overall population [69.7 (0.8) to 68.1 (0.8); Ptrend: 0.009] and foreign-born individuals [69.7 (0.8) to 67.7 (0.8); Ptrend: 0.005] declined. Decreasing trends were noted in the body mass index score irrespective of stratification and in the blood pressure scores in the overall population and foreign-born Asian American individuals. Compared with US-born individuals, the odds of ideal levels of smoking [ORadj:<5 years: 2.23 (95%CI: 1.45-3.44); 5-15 years: 1.97 (95%CI: 1.27-3.05); 15-30 years: 1.61 (95%CI: 1.11-2.34); ≥30 years: 1.69(95%CI:1.20-2.36)] and diet [ORadj: <5 years: 1.87 (95%CI: 1.26-2.79); 5-15 years: 2.00 (95%CI: 1.38-2.89); 15-30 years: 1.74 (95%CI: 1.14-2.68)] were higher in foreign-born individuals. Foreign-born individuals had lower odds of ideal physical activity levels [ORadj: 5-15 years: 0.55 (95%CI: 0.39-0.79); 15-30 years: 0.68 (95%CI: 0.49-0.95)] and ideal cholesterol levels [ORadj: 5-15 years: 0.59 (95%CI: 0.42-0.82); 15-30 years: 0.54 (95%CI :0.38-0.76); ≥30 years: 0.52 (95%CI: 0.38-0.76)]. Conclusion The CVH in Asian American individuals declined from 2011 to March 2020. The odds of ideal CVH decreased with increasing duration of stay in the US, with foreign-born individuals residing in the US for ≥30 years having ∼28% lower odds of ideal CVH compared with US-born individuals.
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Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mokshad Gaonkar
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States of America
| | - Peng Li
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Han JY, Kwon JH, Kim SH, Lee H. Hepatitis Risk in Diabetes Compared to Non-Diabetes and Relevant Factors: A Cross-Sectional Study with National Health and Nutrition Examination Survey (NHANES), 2013-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4962. [PMID: 36981870 PMCID: PMC10049568 DOI: 10.3390/ijerph20064962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to identify the development of hepatitis B or C infection in diabetes patients compared to those without and to elucidate factors associated with the prevalence of hepatitis B or C infection in diabetes. We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. As evaluation factors, we included variables such as age, race, illicit drug use, and poverty. The diabetic group had a significantly higher prevalence of hepatitis B or C infection than the non-diabetic group (odds ratio (OR) = 1.73; 95% confidence interval (CI), 1.36-2.21, p < 0.01). In multivariate Cox regression, non-poverty and non-illicit drug use were lower risk factors contributing to hepatitis development in diabetes (hazard ratio (HR) = 0.50; 95% CI, 0.32-0.79, p < 0.01, and HR = 0.05; 95% CI, 0.03-0.08, p < 0.01, respectively). Logistic regression also showed that these factors were significant contributors to hepatitis development in the diabetic group (p < 0.01). In patients with diabetes, the development of hepatitis was higher than that in those without, and hepatitis development was influenced by poverty and illicit drug use. This may provide supporting evidence of response strategies for diabetes to care for hepatitis development in advance.
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Affiliation(s)
- Ja-Young Han
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan 32992, Republic of Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Jae-Hee Kwon
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan 32992, Republic of Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Sun-Hwa Kim
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan 32992, Republic of Korea
| | - Heeyoung Lee
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan 32992, Republic of Korea
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Deshpande A, Shah NS, Kandula NR. Obesity and Cardiovascular Risk among South Asian Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:73-82. [PMID: 37009309 PMCID: PMC10063226 DOI: 10.1007/s12170-023-00714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 02/05/2023]
Abstract
Purpose of review South Asian Americans experience higher cardiometabolic risk and disproportionately high rates of cardiovascular disease (CVD) compared to other racial and ethnic groups in the United States. The purpose of this review is to summarize recent evidence about the role of obesity in CVD risk in South Asian Americans and identify key evidence gaps and future directions for research and interventions for obesity in this group. Recent findings South Asian Americans are predisposed to abdominal obesity and have a higher distribution of visceral fat, intermuscular fat, and intrahepatic fat compared to adults of other race and ethnic groups. In this population, the risk for cardiometabolic disease appears to be elevated even at a normal body mass index. Social, cultural, religious, interpersonal, and environmental factors are related to obesity and obesity-related behaviors among South Asian Americans. Summary There is a relatively high prevalence of obesity in South Asian-origin populations in the United States, who have unique socio-cultural determinants of overweight and obesity. Future research should clarify why the risk for metabolic disease and CVD is elevated at normal BMI in the South Asian American population, and environmental and other structural factors that may influence obesity in this group. Interventions must be adapted to the social and cultural context of South Asian Americans to improve effectiveness and implementation.
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Affiliation(s)
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Namratha R. Kandula
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine (General Internal Medicine), Northwestern University Feinberg School of Medicine, Chicago, IL
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Immigration and Blood Lead Levels Among Asian Populations in the United States: NHANES 2011-2018. J Occup Environ Med 2023; 65:e113-e118. [PMID: 36729686 DOI: 10.1097/jom.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to explore determinants of high BLLs among the Asian population in the United States. METHODS We used the US nationally representative National Health and Nutrition Examination Survey (NHANES), 2011-2018. We conducted stratified analyses to compare the BLLs of US-born and non-US-born Asians. We used adjusted linear regression to find predictors of high BLLs. RESULTS Among 12,563 participants in our analysis, the length of stay in the United States is a predictor of the gradual decrease in BLL among Asian immigrants ( P < 0.05). BLLs of immigrants who stayed in the United States for over 50 years were 0.36 μg/dL (95% confidence interval, 0.07 to 0.66) lower than new immigrants, but still higher than their US-born counterparts. SIGNIFICANCE Asian population in the US has the highest BLLs among all ethnic groups, and the exposure outside of the US among immigrants is likely the driver.
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Bowden RG, Richardson KA, Richardson LT. Uric acid and metabolic syndrome: Findings from national health and nutrition examination survey. Front Med (Lausanne) 2022; 9:1039230. [PMID: 36590930 PMCID: PMC9795410 DOI: 10.3389/fmed.2022.1039230] [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: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Hyperuricemia commonly associated with Gout has been proposed as an independent risk factor for Metabolic Syndrome (MetS). Objective The purpose of the study was to determine if there is a relationship between hyperuricemia and MetS. Methods An analysis of cross-sectional data was conducted using the 2013-2018 National Health and Nutrition Examination Survey (NHANES) datasets. Sample weights were assigned by NHANES researchers to each participant allowing researchers to generalize results to all non-institutionalized United States (US) civilians. The analysis included 6,432 individuals, which were representative of 94,729,059 US citizens. Results Pearson's correlations, chi-square tests, and logistic regression equations were calculated to determine the association between hyperuricemia and MetS. In an unadjusted regression analysis, individuals with hyperuricemia (above 7.0 mg/dL in males and 6.0 mg/dL in females) were 3.19 times more likely to have MetS compared to those with normal uric acid (UA) levels. When controlling for various confounding variables those with hyperuricemia were 1.89 and 1.34 times more likely to have MetS than those with normal UA levels in two additional logistic regression models. Conclusion In this large cross-sectional study, hyperuricemia was found to be associated with MetS. Additional analyses that controlled for various risk factors previously identified as predictive of MetS still demonstrated hyperuricemia independently associated with MetS. The results of this study suggest a need to understand the metabolic pathways of UA more clearly to further explain the contribution to MetS. Additional research should include prospective clinical trials assessing the effects of UA and the control of UA on MetS and concomitant medical outcomes.
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Affiliation(s)
- Rodney G. Bowden
- Department of Public Health, Baylor University, Waco, TX, United States,*Correspondence: Rodney G. Bowden,
| | - Kathleen A. Richardson
- Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, United States
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Ledbetter MK, Tabacu L, Leroux A, Crainiceanu CM, Smirnova E. Cardiovascular mortality risk prediction using objectively measured physical activity phenotypes in NHANES 2003-2006. Prev Med 2022; 164:107303. [PMID: 36244522 PMCID: PMC10159260 DOI: 10.1016/j.ypmed.2022.107303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/03/2022] [Accepted: 10/07/2022] [Indexed: 11/28/2022]
Abstract
Increased physical activity (PA) has been associated with a decreased risk of cardiovascular disease (CVD) and mortality. However, most previous studies use self-reported PA instead of objectively measured PA assessed by wearable accelerometers. To the best of our knowledge, there have not been studies that quantified the univariate and multivariate ability of objectively measured PA summaries to predict the risk of CVD mortality. We investigate the ability of objectively measured PA summary variables to predict CVD mortality: as individual predictors, as part of the best multivariate model incorporating traditional predictors, and as additions to the best multivariate model using only traditional CVD predictors. Data were collected in the National Health and Nutrition Examination Survey 2003-2006 waves for US participants aged 50-85. The predictive ability was measured using Concordance, sometimes referred to as the C-statistic. Specifically, we calculated 10-fold cross-validated concordance (CVC) in survey-weighted Cox proportional hazard models. The best univariate predictor of CVD mortality was total activity count (outperformed age). In multivariate models, two of the eight predictors identified using the improvement in CVC threshold of 0.001 were PA measures (CVC = 0.844). The best model without physical activity (7 predictors) had CVC of 0.830. The addition of PA measures to the best traditional model was significantly better at predicting CVD mortality (P < 0.001). Accelerometer-derived PA measures have excellent cardiovascular mortality prediction performance. Wearable accelerometers have a potential for assessment of individuals' CVD mortality risks.
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Affiliation(s)
| | - Lucia Tabacu
- Department of Mathematics and Statistics, Old Dominion University, VA, USA
| | - Andrew Leroux
- Department of Biostatistics, University of Colorado Anschutz Medical Campus, CO, USA
| | | | - Ekaterina Smirnova
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
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Guduguntla V, Durant RW. Lessons From Asian Subgroups About Disparities in Ischemic Heart Disease-Improving Studies of Minority Health. JAMA Intern Med 2022; 182:1103-1104. [PMID: 36036922 DOI: 10.1001/jamainternmed.2022.3620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vinay Guduguntla
- Department of Medicine, University of California, San Francisco.,Editorial Fellow, JAMA Internal Medicine
| | - Raegan W Durant
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham.,Associate Editor, JAMA Internal Medicine
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Sheng J, Abshire DA, Heiney SP, Wirth MD. Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults. J Transcult Nurs 2022; 33:675-684. [PMID: 35924549 DOI: 10.1177/10436596221114150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship. METHOD Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS. RESULTS About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only. CONCLUSION MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.
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Shah NS, Xi K, Kapphahn KI, Srinivasan M, Au T, Sathye V, Vishal V, Zhang H, Palaniappan LP. Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups. Circ Cardiovasc Qual Outcomes 2022; 15:e008651. [PMID: 35535589 PMCID: PMC9117444 DOI: 10.1161/circoutcomes.121.008651] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. METHODS Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. RESULTS Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). CONCLUSIONS There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.
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Affiliation(s)
- Nilay S Shah
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Cardiology) (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin Xi
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | | | - Malathi Srinivasan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
| | - Timothy Au
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vedant Sathye
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vaibhav Vishal
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Han Zhang
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Latha P Palaniappan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
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Ali SH, Yi SS, Kranick J, Lee M, Thorpe LE, Rummo PE. Disentangling the roles of generational status and acculturation on dietary behaviors in disaggregated Asian American subgroups. Appetite 2022; 171:105903. [DOI: 10.1016/j.appet.2021.105903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
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13
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Nagasaka M, Molife C, Cui ZL, Stefaniak V, Li X, Kim S, Lee HY, Beyrer J, Blumenschein G. Generalizability of ORIENT-11 trial results to a US standard of care cohort with advanced non-small-cell lung cancer. Future Oncol 2022; 18:1963-1977. [PMID: 35354280 DOI: 10.2217/fon-2022-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: This retrospective study estimated efficacy and safety of sintilimab + pemetrexed + platinum (SPP) versus placebo + pemetrexed + platinum (PPP) in untreated locally advanced/metastatic, nonsquamous non-small-cell lung cancer (NSCLC), after adjusting each ORIENT-11 trial patient's contribution to ORIENT-11 data based on characteristics of a target US population. Materials & methods: The target US population (n = 557) was selected from a real-world deidentified advanced NSCLC database based on key ORIENT-11 eligibility criteria. Inverse probability weights for ORIENT-11 patients (n = 397) relative to US patients were calculated. Efficacy and safety of SPP versus PPP were adjusted by inverse probability weights. Results: After adjustment, progression-free survival remained superior for SPP. Other efficacy and safety outcomes were consistent. Conclusion: These results provide evidence on how the effects observed with SPP in ORIENT-11 could translate to a US population with untreated locally advanced/metastatic nonsquamous NSCLC.
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Affiliation(s)
- Misako Nagasaka
- Division of Hematology & Oncology Department of Medicine, University of California Irvine, Orange County, CA 92868, USA
| | - Cliff Molife
- Value, Evidence, & Outcomes, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Zhanglin Lin Cui
- Real World Analytics, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | | | - Xiaohong Li
- Real World Analytics, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Sangmi Kim
- Global Patient Safety, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Hsui-Yung Lee
- Global Statistical Sciences, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Julia Beyrer
- Value, Evidence, & Outcomes, Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - George Blumenschein
- Department of Thoracic & Head & Neck Medical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
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14
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Levea SLL, Albin JL. Living Kidney Donation, Obesity, and Dietary Change: Investing in those who give the "gift of life". J Ren Nutr 2022; 32:268-274. [PMID: 35341990 DOI: 10.1053/j.jrn.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Swee-Ling L Levea
- Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center.
| | - Jaclyn L Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center
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15
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Morey BN, Valencia C, Lee S. Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants. J Community Health 2022; 47:425-436. [PMID: 35103847 PMCID: PMC8805138 DOI: 10.1007/s10900-022-01069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Abstract
Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.
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Affiliation(s)
- Brittany N Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA.
| | - Connie Valencia
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
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16
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Adair KE, Ylitalo KR, Forsse JS, Funderburk LK, Bowden RG. Metabolic Constellations, Clusters, and Renal Function: Findings from the 2013-2018 National Health and Nutrition Examination Surveys. Life (Basel) 2021; 11:904. [PMID: 34575053 PMCID: PMC8469449 DOI: 10.3390/life11090904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022] Open
Abstract
Metabolic syndrome (MetS) is associated with decreased renal function and chronic kidney disease (CKD). To date, no research regarding the sixteen possible constellations resulting in the diagnosis of MetS has been elucidated. The purpose of this study is to report renal function in sixteen metabolic constellations grouped into four metabolic clusters. Individuals (n = 2767; representing 86,652,073 individuals) from the 2013-2018 National Health and Nutrition Examination Surveys who met the criteria for MetS were included. Sixteen possible constellations of three or more risk factors were analyzed for renal function. Four metabolic clusters representing MetS with hyperglycemia (Cluster I), MetS with hypertension (Cluster II), MetS with hyperglycemia and hypertension (Cluster III), or MetS with normoglycemia and normotension (Cluster IV) were assessed for renal function and CKD status. Cluster III had the highest odds of CKD (OR = 2.57, 95% CL = 1.79, 3.68). Clusters II and III had the lowest renal function and were not different from one another (87.82 and 87.28 mL/min/1.73 m2, p = 0.71). The constellation with the lowest renal function consisted of hypertension, high triglycerides, and a large waist circumference (82.86 mL/min/1.73 m2), whereas the constellation with the highest renal function consisted of hyperglycemia, low HDL, and a large waist circumference (107.46 mL/min/1.73 m2). The sixteen constellations of MetS do not have the same effects on renal function. More research is needed to understand the relationship between the various iterations of MetS and renal function.
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Affiliation(s)
- Kathleen E. Adair
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA; (J.S.F.); (L.K.F.)
| | - Kelly R. Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA;
| | - Jeffrey S. Forsse
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA; (J.S.F.); (L.K.F.)
| | - LesLee K. Funderburk
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA; (J.S.F.); (L.K.F.)
| | - Rodney G. Bowden
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA;
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17
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Adair KE, Bowden RG, Funderburk LK, Forsse JS, Ylitalo KR. Metabolic Health, Obesity, and Renal Function: 2013-2018 National Health and Nutrition Examination Surveys. Life (Basel) 2021; 11:888. [PMID: 34575037 PMCID: PMC8470801 DOI: 10.3390/life11090888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022] Open
Abstract
Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have prompted further investigation into the association between metabolic phenotypes and CKD. Purpose: To report the frequency of strictly defined metabolic phenotypes, renal function within each phenotype, and individual risk factors associated with reduced renal function. We utilized the 2013-2018 National Health and Nutrition Examination Surveys (NHANES) and complex survey sample weighting techniques to represent 220 million non-institutionalized U.S. civilians. Metabolic health was defined as having zero of the risk factors defined by the National Cholesterol Education Program with the exception of obesity, which was defined as BMI ≥ 30 kg/m2 in non-Asians and BMI ≥ 25 kg/m2 in Asians. The metabolically healthy normal (MUN) phenotype comprised the highest proportion of the population (38.40%), whereas the metabolically healthy obese (MHO) was the smallest (5.59%). Compared to the MHN reference group, renal function was lowest in the strictly defined MUN (B = -9.60, p < 0.001) and highest in the MHO (B = 2.50, p > 0.05), and this persisted when an increased number of risk factors were used to define metabolic syndrome. Systolic blood pressure had the strongest correlation with overall eGFR (r = -0.25, p < 0.001), and individuals with low HDL had higher renal function compared to the overall sample. The MUN phenotype had the greatest association with poor renal function. While the MHO had higher renal function, this may be due to a transient state caused by renal hyperfiltration. Further research should be done to investigate the association between dyslipidemia and CKD.
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Affiliation(s)
- Kathleen E Adair
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97313, Waco, TX 76798, USA
| | - Rodney G Bowden
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97343, Waco, TX 76798, USA
| | - LesLee K Funderburk
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97313, Waco, TX 76798, USA
| | - Jeffrey S Forsse
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97313, Waco, TX 76798, USA
| | - Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97343, Waco, TX 76798, USA
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18
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Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis. PLoS One 2021; 16:e0255959. [PMID: 34379696 PMCID: PMC8357101 DOI: 10.1371/journal.pone.0255959] [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: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Background In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH. Methods A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics. Results This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics. Conclusions To the best of our knowledge, this is the first systematic review on the relationship between participants’ socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.
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19
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Devaraj SM, Rockette-Wagner B, Miller RG, Arena VC, Napoleone JM, Conroy MB, Kriska AM. The Impact of a Yearlong Diabetes Prevention Program-Based Lifestyle Intervention on Cardiovascular Health Metrics. J Prim Care Community Health 2021; 12:21501327211029816. [PMID: 34236004 PMCID: PMC8274083 DOI: 10.1177/21501327211029816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The American Heart Association created “Life’s Simple Seven” metrics to estimate progress toward improving US cardiovascular health in a standardized manner. Given the widespread use of federally funded Diabetes Prevention Program (DPP)-based lifestyle interventions such as the Group Lifestyle Balance (DPP-GLB), evaluation of change in health metrics within such a program is of national interest. This study examined change in cardiovascular health metric scores during the course of a yearlong DPP-GLB intervention. Methods Data were combined from 2 similar randomized trials offering a community based DPP-GLB lifestyle intervention to overweight/obese individuals with prediabetes and/or metabolic syndrome. Pre/post lifestyle intervention participation changes in 5 of the 7 cardiovascular health metrics were examined at 6 and 12 months (BMI, blood pressure, total cholesterol, fasting plasma glucose, physical activity). Smoking was rare and diet was not measured. Results Among 305 participants with complete data (81.8% of 373 eligible adults), significant improvements were demonstrated in all 5 risk factors measured continuously at 6 and 12 months. There were significant positive shifts in the “ideal” and “total” metric scores at both time points. Also noted were beneficial shifts in the proportion of participants across categories for BMI, activity, and blood pressure. Conclusion AHA-metrics could have clinical utility in estimating an individual’s cardiovascular health status and in capturing improvement in cardiometabolic/behavioral risk factors resulting from participation in a community-based translation of the DPP lifestyle intervention.
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Affiliation(s)
- Susan M Devaraj
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Rachel G Miller
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Vincent C Arena
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jenna M Napoleone
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Molly B Conroy
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea M Kriska
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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20
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Diaz CL, Shah NS, Lloyd-Jones DM, Khan SS. State of the Nation's Cardiovascular Health and Targeting Health Equity in the United States: A Narrative Review. JAMA Cardiol 2021; 6:963-970. [PMID: 34009231 DOI: 10.1001/jamacardio.2021.1137] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Cardiovascular disease is the leading cause of death in the US. The burden of cardiovascular disease morbidity and mortality disproportionately affects racial/ethnic minority groups, who now compose almost 40% of the US population in aggregate. As part of the 2010 American Heart Association (AHA) Strategic Impact Goal, the AHA established 7 cardiovascular health (CVH) metrics (also known as Life's Simple 7) with the goal to improve the CVH of all individuals in the US by 20% by 2020. National estimates of CVH are important to track and monitor at the population level but may mask important differences across and within racial/ethnic minority groups. It is critical to understand how CVH may differ between racial/ethnic minority groups and consider how these differences in CVH may contribute to disparities in cardiovascular disease burden and overall longevity. Observations This narrative review summarizes the available literature on individual CVH metrics and composite CVH scores across different race/ethnic minority groups (specifically Hispanic/Latino, Asian, and non-Hispanic Black individuals) in the US. Disparities in CVH persist among racial/ethnic groups, but key gaps in knowledge exist, in part, owing to underrepresentation of these racial/ethnic groups in research or misrepresentation of CVH because of aggregation of race/ethnicity subgroups. A comprehensive, multilevel approach is needed to target health equity and should include (1) access to high-quality health care, (2) community-engaged approaches to adapt disruptive health care delivery innovations, (3) equitable economic investment in the social and built environment, and (4) increasing funding for research in racial/ethnic minority populations. Conclusions and Relevance Significant differences in CVH exist within racial/ethnic groups. Given the rapid growth of diverse, minority populations in the US, focused investigation is needed to identify strategies to optimize CVH. Opportunities exist to address inequities in CVH and to successfully achieve both the interim (AHA 2024) and longer-term (AHA 2030) Impact Goals in the coming years.
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Affiliation(s)
- Celso L Diaz
- Division of Cardiology, Department of Medicine, University of California, Los Angeles
| | - Nilay S Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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21
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Kim JHJ, Lu Q, Stanton AL. Overcoming constraints of the model minority stereotype to advance Asian American health. AMERICAN PSYCHOLOGIST 2021; 76:611-626. [PMID: 34410738 PMCID: PMC8384115 DOI: 10.1037/amp0000799] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
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22
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Stokes N, Herbert B, Johnson A, Magnani JW. The effect of the lone parent household on cardiovascular health (National Health and Nutrition Examination Survey, 2015-2016). AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 3:100015. [PMID: 34458881 PMCID: PMC8389735 DOI: 10.1016/j.ahjo.2021.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE Single parenthood is associated with adverse health outcomes. How cardiovascular risk differs by parenthood status has had limited study. We hypothesized that single parents would have worse cardiovascular risk profiles compared to those in partnered-parent households. DESIGN We compared associations of parenthood status and the American Heart Association's Life Simple 7 (LS7), an established metric measuring modifiable components of cardiovascular health (smoking status, body mass index, physical activity, diet, cholesterol, glycohemoglobin, and blood pressure) in multivariable-adjusted models. PARTICIPANTS We selected adults (age ≥ 25) from the National Health and Nutrition Examination Survey (NHANES) 2015-16 cycle. We defined single parenthood as reporting a child <18 years residing in the home and marital status other than married or living with partner. MAIN OUTCOME MEASURES LS7, continuous (range 0-14) and categorized as poor (0-4), intermediate (5-9), or ideal (10-14). RESULTS In total, 2180 NHANES participants identified as parents and 1782 (82%) had complete LS7 scores. Of these, 462 identified as single parents, of whom 356 (74.9%) were women. Single parents were more likely to smoke, have poor physical activity, and have high blood pressure (p < 0.01) than partnered parents. Single parents had 1.3-fold greater likelihood of poor cardiovascular health compared with partnered parents, adjusting for age, sex, race/ethnicity, health insurance, healthcare access, poverty index, educational attainment and number of children (95% confidence interval [CI] 1.01-1.71). CONCLUSIONS We identified an association between single parenthood and adverse cardiovascular health. Our results demonstrate the importance of considering household composition in risk assessment and cardiovascular disease prevention.
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Affiliation(s)
- Natalie Stokes
- University of Pittsburgh Medical Center, Heart and Vascular Institute, United States of America
| | - Brandon Herbert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States of America
| | - Amber Johnson
- University of Pittsburgh Medical Center, Heart and Vascular Institute, United States of America
- Department of Medicine, School of Medicine, University of Pittsburgh, United States of America
| | - Jared W. Magnani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States of America
- Department of Medicine, School of Medicine, University of Pittsburgh, United States of America
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, United States of America
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23
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Alam MT, Echeverria SE, DuPont-Reyes MJ, Vasquez E, Murillo R, Gonzalez T, Rodriguez F. Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041480. [PMID: 33557415 PMCID: PMC7914420 DOI: 10.3390/ijerph18041480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (<high school diploma, high school diploma, some college, and college degree+) was associated with CVH and if this varied by time in the United States (U.S.). Our study population included Asian Americans 20+ years of age sampled in the 2011-16 National Health and Nutrition Examination Survey (n = 1634). Ideal cardiovascular health was based on a composite score of adiposity, total cholesterol, blood pressure, blood glucose, smoking, physical activity, and diet. We fit sequential weighted multivariate logistic regression models for all analyses. The prevalence of ideal cardiovascular (CV) health was 17.1% among those living in the U.S. <10 years, 7.1% for those living in the U.S. >10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.
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Affiliation(s)
- Md Towfiqul Alam
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA;
- Correspondence:
| | - Sandra E. Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA;
| | - Melissa J. DuPont-Reyes
- Department of Epidemiology & Biostatistics, Texas A&M University, College Station, TX 77843, USA;
| | - Elizabeth Vasquez
- Department of Epidemiology & Biostatistics, University at Albany, Albany, NY 12144, USA;
| | - Rosenda Murillo
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX 77204, USA;
| | - Tailisha Gonzalez
- Department of Community Health, CUNY Graduate School of Public Health & Health Policy, New York, NY 10027, USA;
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University, Quarry Road, Falk CVRC, Stanford, CA 94305, USA;
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24
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Fang J, Luncheon C, Patel A, Ayala C, Gillespie C, Greenlund KJ, Loustalot F. Self-Reported Prevalence of Hypertension and Antihypertensive Medication Use Among Asian Americans: Behavioral Risk Factor Surveillance System 2013, 2015 and 2017. J Immigr Minor Health 2021; 23:26-34. [PMID: 32451693 PMCID: PMC10880142 DOI: 10.1007/s10903-020-01032-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Asian Americans are one of the fastest growing races in the US. The objectives of this report were to assess self-reported hypertension prevalence and treatment among Asian Americans. Merging 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System data, we estimated self-reported hypertension and antihypertensive medication use among non-Hispanic Asian Americans (NHA) and compared estimates between NHA and non-Hispanic whites (NHW), and by NHA subgroup (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese/other). The prevalence of hypertension was 20.8% and 33.5%, respectively, for NHAs and NHWs (p < 0.001). Among those with hypertension, the prevalence of antihypertensive medication use was 71.6% and 78.2%, respectively, for NHAs and NHWs (p < 0.001). Among NHA subgroups, a wide range of hypertension prevalence and medication use was found. Overall NHA had a lower reported prevalence of hypertension and use of antihypertensive medication than NHW. Certain NHA subgroups had a burden comparable to high-risk disparate populations.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA.
| | - Cecily Luncheon
- Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA
- IHRC, Inc., Atlanta, GA, 30346, USA
| | - Ashruta Patel
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Carma Ayala
- Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA
| | - Cathleen Gillespie
- Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Fleetwood Loustalot
- Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, USA
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25
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Kwon S, Wang-Schweig M, Kandula NR. Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6187. [PMID: 32858944 PMCID: PMC7504455 DOI: 10.3390/ijerph17176187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Meme Wang-Schweig
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL 60607, USA;
| | - Namratha R. Kandula
- Department of Medicine and Preventive Medicine, Northwestern University, Chicago, IL 60611, USA;
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26
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Ali Shah SI, Dhaifullah E, Al-Maweri SA, Koppolu P. Comment on "Body mass index and periodontal health status among young Saudi adults: Reassessing the risk with population specific measures". Ann Saudi Med 2020; 40:259. [PMID: 32493104 PMCID: PMC7270614 DOI: 10.5144/0256-4947.2020.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Syed Imran Ali Shah
- From the Department of Biochemistry, College of Pharmacy, University of Hafr Al-Batin, Hafr Al-Batin, Eastern Province 31991, Saudi Arabia
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27
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Barinas-Mitchell E, Duan C, Brooks M, El Khoudary SR, Thurston RC, Matthews KA, Jackson EA, Lewis TT, Derby CA. Cardiovascular Disease Risk Factor Burden During the Menopause Transition and Late Midlife Subclinical Vascular Disease: Does Race/Ethnicity Matter? J Am Heart Assoc 2020; 9:e013876. [PMID: 32063114 PMCID: PMC7070180 DOI: 10.1161/jaha.119.013876] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The extent to which cardiovascular disease (CVD) risk factors across the menopause explain racial/ethnic differences in subclinical vascular disease in late midlife women is not well documented and was explored in a multi‐ethnic cohort. Methods and Results Participants (n=1357; mean age 60 years) free of clinical CVD from the Study of Women's Health Across the Nation had common carotid artery intima‐media thickness, interadventitial diameter, and carotid plaque presence assessed by ultrasonography on average 13.7 years after baseline visit. Early to late midlife time‐averaged cumulative burden of traditional CVD risk factors calculated using serial measures from baseline to the ultrasound visit were generally less favorable in black and Hispanic women compared with white and Chinese women, including education and smoking status and time‐averaged cumulative blood pressure, high‐density lipoprotein cholesterol, and fasting insulin. Independent of these risk factors, BMI, and medications, common carotid artery intima‐media thickness was thicker in black women, interadventitial diameter was wider in Chinese women, yet plaque presence was lower in black and Hispanic women compared with white women. CVD risk factor associations with subclinical vascular measures did not vary by race/ethnicity except for high‐density lipoprotein cholesterol on common carotid artery intima‐media thickness; an inverse association between high‐density lipoprotein cholesterol and common carotid artery intima‐media thickness was observed in Chinese and Hispanic but not in white or black women. Conclusions Race/ethnicity did not particularly moderate the association between traditional CVD risk factors measured across the menopause transition and late midlife subclinical vascular disease. Unmeasured socioeconomic, cultural, and nontraditional biological risk factors likely play a role in racial/ethnic differences in vascular health and merit further exploration.
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Affiliation(s)
| | - Chunzhe Duan
- Department of Epidemiology University of Pittsburgh PA
| | - Maria Brooks
- Department of Epidemiology University of Pittsburgh PA
| | | | | | - Karen A Matthews
- Departments of Psychiatry and Psychology University of Pittsburgh PA
| | - Elizabeth A Jackson
- Division of Cardiovascular Medicine Department of Internal Medicine University of Alabama at Birmingham AL
| | - Tené T Lewis
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Carol A Derby
- Departments of Neurology and Epidemiology & Population Health Albert Einstein College of Medicine Bronx NY
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Fang J, Zhang Z, Ayala C, Thompson‐Paul AM, Loustalot F. Cardiovascular Health Among Non-Hispanic Asian Americans: NHANES, 2011-2016. J Am Heart Assoc 2019; 8:e011324. [PMID: 31238768 PMCID: PMC6662346 DOI: 10.1161/jaha.118.011324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/24/2019] [Indexed: 12/15/2022]
Abstract
Background Asian Americans are the fastest growing population in the United States, but little is known about their cardiovascular health (CVH). The objective of this study was to assess CVH among non-Hispanic Asian Americans (NHAAs) and to compare these estimates to those of non-Hispanic white (NHW) participants. Methods and Results Merging NHANES (National Health and Nutrition Examination Survey) data from 2011 to 2016, we examined 7 metrics (smoking, weight, physical activity, diet, blood cholesterol, blood glucose, and blood pressure) to assess CVH among 5278 NHW and 1486 NHAA participants aged ≥20 years. We assessed (1) the percentage meeting 6 to 7 metrics (ideal CVH), (2) the percentage meeting only 0 to 2 metrics (poor CVH), and (3) the overall mean CVH score. We compared these estimates between NHAAs and NHWs and among foreign-born NHAAs by birthplace and number of years living in the United States. The adjusted prevalence of ideal CVH was 8.7% among NHAAs and 5.9% among NHWs ( P<0.001). NHAAs were significantly more likely to have ideal CVH (adjusted prevalence ratio: 1.42; 95% CI, 1.29-1.55) compared with NHWs. Among NHAAs, there was no significant difference in ideal CVH between US- and foreign-born participants, nor by number of years living in the United States. With lower body mass index thresholds (<23, normal weight) for NHAAs, there were no statistically significant differences in the adjusted prevalence of ideal CVH (6.5% versus 5.9%, P=0.216) between NHAAs and NHWs. Conclusions NHAAs had a higher prevalence of overall ideal CVH compared with NHWs. However, when using a lower body mass index threshold for NHAAs, there was no difference in ideal CVH between the groups.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - Zefeng Zhang
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - Carma Ayala
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - Angela M. Thompson‐Paul
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
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