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Marte MJ, Addesso D, Kiran S. Association Between Social Determinants of Health and Communication Difficulties in Poststroke U.S. Hispanic and Non-Hispanic White Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:248-261. [PMID: 37956702 PMCID: PMC11000792 DOI: 10.1044/2023_ajslp-23-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE The relationship among ethnicity, social determinants of health (SDOH), and disparities in poststroke outcomes is complex, and the impact on communication difficulties is unclear. This study investigated the presence and nature of communication difficulties in poststroke non-Hispanic White (PsnHw) and Hispanic U.S. populations using population-level data. METHOD We performed a cross-sectional analysis of 2,861 non-Hispanic White and 353 Hispanic poststroke respondents included in the 2014-2018 National Health Interview Survey. Respondents self-reported difficulties communicating in their usual language, in addition to providing information relating to demographics and lifestyle, health care access and utilization, health status, and SDOH. We used univariate statistics, generalized linear models, and an exploratory mediation analysis, to characterize the pattern of differences between these cohorts, examine associations between variables and communication difficulties, and determine the potential intermediate role of cumulative SDOH on the likelihood of reporting communication difficulties. RESULTS Findings indicated a more challenging life context for the poststroke Hispanic population due to SDOH disparities. Poverty and Internet use were associated with greater and lower odds of communication difficulties for PsnHw, respectively. The mediation analysis showed that ethnicity significantly affected communication difficulties, but only when mediated by SDOH. SDOH accounted for approximately two thirds of the total effect on reporting communication difficulties. CONCLUSIONS This study underscores the need for uniform measures of SDOH in prospective research and for interventions aimed at mitigating health disparities through addressing disparities in SDOH. Future research should focus on evaluating the effectiveness of such strategies in diverse ethnic and socioeconomic poststroke populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24521419.
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Affiliation(s)
- Manuel Jose Marte
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - David Addesso
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Swathi Kiran
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
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Liang D, Guan Q, Huang M, He Y, Ou Y, Chen M, Zheng X, Lin X. Changing trends of disease burden of stroke from 1990 to 2019 and its predictions among the Chinese population. Front Neurol 2023; 14:1255524. [PMID: 37869143 PMCID: PMC10588696 DOI: 10.3389/fneur.2023.1255524] [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: 07/09/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aimed to understand the temporal trends in the disease burden of stroke and its attributable risk factors in China, along with the future trends in the next 25 years, that is important for effective prevention strategies and improvement, and to provide new insights into the age- and sex-specific incidence, prevalence, mortality, disability-adjusted life-years (DALYs) and their trends from 1990 to 2019, and the prediction in the next 25 years. Methods The Global Burden of Disease Study (2019) was used to extract the data on age- and sex-specific incidence, mortality, and disability-adjusted life-years (DALYs) of stroke in China, 1990-2019. We estimated the estimated annual percentage change (EAPC) to access the temporal trends of the disease burden of stroke. The R package called Nordpred was used to perform an age-period-cohort analysis to predict the prevalence of stroke. Results The number of incidence cases, deaths, and DALYs of stroke increased from 1990 to 2019. Overall downward trends were observed in the age-standardized incidence rate (ASIR) from 1990 to 2019. Significant temporal trends in mortality and DALYs of stroke were observed. High systolic blood pressure, smoking, and high-sodium diet were the main driving forces for stroke. The DALYs lost attributable to smoking were different for male and female patients. In the next 25 years, the number of new cases and deaths from stroke should continue to increase. The ASIR and age-standardized mortality rate (ASMR) should show a downward trend among male and female patients. Conclusion Despite the overall rates of stroke declined over the period from 1990 to 2019, the absolute number of people affected by stroke has substantially increased. There has been a substantial increase in the burden of stroke due to risk factors and will continue to increase in the next 25 years.
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Affiliation(s)
- Dong Liang
- The School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Guan
- The School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Minqing Huang
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yiyu He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yangjiang Ou
- “The 14th Five-Year Plan” Application Characteristic Discipline of Hunan Province (Clinical Medicine), Hunan Provincial Key Laboratory of the Traditional Chinese Medicine Agricultural Biogenomics, Changsha Medical University, Changsha, Hunan, China
| | - Min Chen
- The School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiuquan Lin
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
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Chen JZ, Wang HM, Zhu W. A Systematic Review and Meta-Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1926744. [PMID: 36060129 PMCID: PMC9439933 DOI: 10.1155/2022/1926744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Methods We thoroughly searched PubMed, Embase, and MEDLINE databases for the literature on stroke risk for immigrants and host populations by January 2022. Fourteen relevant cohort studies from eight countries met the inclusion criteria, and their data were included in this meta-analysis. Heterogeneity and publication bias were assessed. Results The results showed that the immigrant groups suffered from a lower incidence rate of stroke compared with the host populations (HR = 0.81, 95% CI 0.71-0.91, P = 0.001), but there was nonsignificant higher mortality of stroke in immigrants (HR = 1.07; 95% CI 0.84-1.36). However, the pooled adjusted incidence HR reduced to 0.67 (95% CI 0.60-0.75) after adjustment for publication bias. Immigrants had a lower stroke incidence compared to long-term residents, but the association varied with the country of origin, socioeconomic status, residence (urban vs. rural), and comorbid conditions. Discussion. The present systematic review and meta-analysis implicated that stroke risks are different for immigrants and the host populations; therefore, this knowledge may be useful for developing targeted stroke prevention strategies.
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Affiliation(s)
- Jun-zhen Chen
- Department of Encephalopathy, Zibo Hospital of Traditional Chinese Medicine, Zibo, Shandong 255300, China
| | - Hai-mei Wang
- Department of Oncology, Zibo Central Hospital, Zibo, Shandong 255300, China
| | - Wenhao Zhu
- Department of Encephalopathy, Zibo Hospital of Traditional Chinese Medicine, Zibo, Shandong 255300, China
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Shen YC, Sarkar N, Hsia RY. Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States. JAMA Neurol 2022; 79:777-786. [PMID: 35759253 PMCID: PMC9237804 DOI: 10.1001/jamaneurol.2022.1621] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 12/22/2022]
Abstract
Importance Stroke centers are associated with better outcomes. There is substantial literature surrounding disparities in stroke outcomes for underserved populations. However, the existing literature has focused primarily on discrimination at the individual or institutional level, and studies of structural discrimination in stroke care are scant. Objective To examine differences in hospitals' likelihood of adopting stroke care certification between historically underserved and general communities. Design, Setting, and Participants This study combined a data set of hospital stroke certification from all general acute nonfederal hospitals in the continental US from January 1, 2009, to December 31, 2019, with national, hospital, and census data to define historically underserved communities by racial and ethnic composition, income distribution, and rurality. For all categories except rurality, communities were categorized by the composition and degree of segregation of each characteristic. Cox proportional hazard models were then estimated to compare the hazard of adopting stroke care certification between historically underserved and general communities, adjusting for population size and hospital bed capacity. Data were analyzed from June 2021 to April 2022. Main Outcomes and Measures Hospitals' likelihood of adopting stroke care certification. Results A total of 4984 hospitals were included. From 2009 to 2019, the total number of hospitals with stroke certification grew from 961 to 1763. Hospitals serving Black, racially segregated communities had the highest hazard of adopting stroke care certification (hazard ratio [HR], 1.67; 95% CI, 1.41-1.97) in models not accounting for population size, but their hazard was 26% lower than among those serving non-Black, racially segregated communities (HR, 0.74; 95% CI, 0.62-0.89) in models controlling for population and hospital size. Adoption hazard was lower in low-income communities compared with high-income communities, regardless of their level of economic segregation, and rural hospitals were much less likely to adopt any level of stroke care certification relative to urban hospitals (HR, 0.43; 95% CI, 0.35-0.51). Conclusions and Relevance In this analysis of stroke certification adoption across acute care hospitals in the US from 2009 to 2019, hospitals in low-income and rural communities had a lower likelihood of receiving stroke certification than hospitals in general communities. Hospitals operating in Black, racially segregated communities had the highest likelihood of adopting stroke care, but because these communities had the largest population, patients in these communities had the lowest likelihood of access to stroke-certified hospitals when the model controlled for population size. These findings provide empirical evidence that the provision of acute neurological services is structurally inequitable across historically underserved communities.
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Affiliation(s)
- Yu-Chu Shen
- Naval Postgraduate School, Monterey, California
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Nandita Sarkar
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Renee Y. Hsia
- Department of Emergency Medicine, University of California, San Francisco
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Sharma AE, Khoong EC, Rivadeneira N, Sierra M, Fang MC, Gupta N, Pramanik R, Tran H, Whitezell T, Fontil V, Lee SY, Sarkar U. Warfarin Monitoring in Safety-Net Health Systems: Analysis by Race/Ethnicity and Language Preference. J Gen Intern Med 2022; 37:2703-2710. [PMID: 34993871 PMCID: PMC9411299 DOI: 10.1007/s11606-021-07283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Racial/ethnic disparities in anticoagulation management are well established. Differences in warfarin monitoring can contribute to these disparities and should be measured. OBJECTIVE We assessed for differences in international normalized ratio (INR) monitoring by race/ethnicity and language preference across safety-net care systems serving predominantly low-income, ethnically diverse populations. DESIGN Cross-sectional analysis of process and safety data shared from the Safety Promotion Action Research and Knowledge Network (SPARK-Net) initiative, a consortium of five California safety-net hospital systems. PARTICIPANTS Eligible patients were at least 18 years old, received warfarin for at least 56 days during the measurement period from July 2015 to June 2017, and had INR testing in an ambulatory care setting at a participating healthcare system. MAIN MEASURES We conducted a scaled Poisson regression for adjusted rate ratio of having at least one INR checked per 56-day time period for which a patient had a warfarin prescription. Adjusting for age, sex, healthcare system, and insurance status/type, we assessed for racial/ethnic and language disparities in INR monitoring. KEY RESULTS Of 8129 patients, 3615 (44%) were female; 1470 (18%), Black/African American; 3354 (41%), Hispanic/Latinx; 1210 (15%), Asian; 1643 (20%), White; and 452 (6%), other. Three thousand five hundred forty-nine (45%) were non-English preferring. We did not observe statistically significant disparities in the rate of appropriate INR monitoring by race/ethnicity or language; the primary source of variation was by healthcare network. Older age, female gender, and uninsured patients had a slightly higher rate of appropriate INR monitoring, but differences were not clinically significant. CONCLUSIONS We did not find a race/ethnicity nor language disparity in INR monitoring; safety-net site was the main source of variation.
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Affiliation(s)
- Anjana E Sharma
- Department of Family and Community Medicine, Center for Excellence In Primary Care, University of California San Francisco, San Francisco, USA.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Elaine C Khoong
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Natalie Rivadeneira
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Maribel Sierra
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Margaret C Fang
- Division of Hospital Medicine at UCSF Health, Department of Medicine, University of California San Francisco, San Francisco, USA
| | | | | | - Helen Tran
- Los Angeles County Department of Health Services, Charles R. Drew University College of Medicine, Los Angeles, CA, USA
| | | | - Valy Fontil
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Shin-Yu Lee
- San Francisco Department of Public Health (SFDPH), San Francisco Health Network (SFHN), San Francisco, USA
| | - Urmimala Sarkar
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA. .,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA.
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Gardener H, Sacco RL, Rundek T, Battistella V, Cheung YK, Elkind MSV. Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study. Stroke 2020; 51:1064-1069. [PMID: 32078475 PMCID: PMC7093213 DOI: 10.1161/strokeaha.119.028806] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 01/01/2023]
Abstract
Background and Purpose- An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods- The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results- Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13-2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13-1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85-1.62]) but remained significant for women age ≥70. Conclusions- This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.
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Affiliation(s)
- Hannah Gardener
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Ying Kuen Cheung
- Department of Biostatistics, Mailman Public School of Health, Columbia University, New York, NY, USA
| | - Mitchell SV Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Rodgers J, Valuev AV, Hswen Y, Subramanian SV. Social capital and physical health: An updated review of the literature for 2007-2018. Soc Sci Med 2019; 236:112360. [PMID: 31352315 DOI: 10.1016/j.socscimed.2019.112360] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Social capital is frequently indicated as a determinant of population health. Despite an increase in the frequency of public health studies including such measures, our understanding of social capital's effects on health remains unclear. In 2008, a systematic review of the "first decade" of research on social capital and health was published in the textbook Social Capital and Health. Our study intends to update and expand upon this original review to account for developments in the literature over the second decade of research on social capital and health. METHODS We employed a systematic review of empirical studies investigating the relationship between measures of social capital and physical health outcomes published between January 1, 2007 and December 31, 2018. To identify potential studies, we conducted searches of PubMed, Embase, and PsychINFO databases in January 2019 using combinations of "social capital" and "physical health" search terms. RESULTS We identified 1,608 unique articles and reviewed 145 studies meeting our inclusion criteria. The most frequently examined health condition was self-reported health (57%), followed by mortality (12%), cardiovascular diseases (10%), obesity (7%), diabetes (6%), infectious diseases (5%), and cancers (3%). Of these studies, 127 (88%) reported at least partial support for a protective association between social capital and health. However, only 41 (28%) reported exclusively positive findings. The majority (59%) of results were mixed, suggesting a nuanced relationship between social capital and health. This finding could also be indicative of differences in study design, which showed substantial variation. CONCLUSIONS Despite limitations in the literature, our review chronicles an evolution in the field of social capital and health in terms of size and sophistication. Overall, these studies suggest that social capital may be an important protective factor for some physical health outcomes, but further research is needed to confirm and clarify these findings.
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Affiliation(s)
- Justin Rodgers
- Department of Social and Behavioral Sciences, Harvard University, 310 Huntington Ave, Boston, MA, 02115, USA.
| | - Anna V Valuev
- Department of Global Health and Health Policy, Harvard University, 14 Story Street Cambridge, MA, 02138, USA
| | - Yulin Hswen
- Department of Social and Behavioral Sciences, Harvard University, 310 Huntington Ave, Boston, MA, 02115, USA
| | - S V Subramanian
- Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
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Tergas AI, Prigerson HG, Shen MJ, Bates LM, Neugut AI, Wright JD, Maciejewski PK. Latino Ethnicity, Immigrant Status, and Preference for End-of-Life Cancer Care. J Palliat Med 2019; 22:833-837. [PMID: 30973302 PMCID: PMC6648166 DOI: 10.1089/jpm.2018.0537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about how immigration status influences preference for life-extending care (LEC) at the end of life (EoL). Objective: The purpose was to determine how preference for LEC at the EoL for advanced cancer patients varied by Latino ethnicity and immigrant status, and over time between two large cohorts. Methods: Data were derived from two sequential multi-institutional, longitudinal cohort studies of advanced cancer patients, recruited from 2002 to 2008 (coping with cancer I [CwC-1]) and 2010 to 2015 (coping with cancer II [CwC-2]). Self-reported U.S.-born whites (whites) (N = 253), U.S.-born Latinos (US-L) (N = 34), and Latino immigrants (LI) (N = 65) with a poor-prognosis cancer were included. The primary independent variables were immigrant status, Latino ethnicity, and CwC cohort. The primary dependent variable was preference for LEC. Results: Within CwC-2, LI were 9.4 times more likely to prefer LEC over comfort care versus US-L (adjusted odds ratio [AOR] = 9.4; 95% confidence interval [CI]: 1.2-72.4), and US-L were 0.3 times less likely to prefer LEC versus whites (AOR = 0.3; 95% CI: 0.1-1.0). LI from CwC-2 were 11.4 times more likely to prefer LEC versus LI from CwC-1 (AOR = 11.4; 95% CI: 2.7-48.4). Within CwC-1, there was no difference in LEC preference between LI and US-L, nor between US-L and whites. Conclusions: Immigrant status had a strong effect on preference for LEC at the EoL among the more recent cohort of Latino cancer patients. Preference for LEC appears to have increased significantly over time for LI but remained unchanged for US-L. LI may increasingly want LEC near death.
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Affiliation(s)
- Ana I. Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
| | - Holly G. Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J. Shen
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lisa M. Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Paul K. Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Radiology, Weill Cornell Medicine, New York, New York
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Gupta P, Gan ATL, Man REK, Fenwick EK, Tham YC, Sabanayagam C, Wong TY, Cheng CY, Lamoureux EL. Risk of Incident Cardiovascular Disease and Cardiovascular Risk Factors in First and Second-Generation Indians: The Singapore Indian Eye Study. Sci Rep 2018; 8:14805. [PMID: 30287859 PMCID: PMC6172283 DOI: 10.1038/s41598-018-32833-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023] Open
Abstract
Population-based data investigating generational differences in the risk of incident cardiovascular disease (CVD) and its risk determinants are rare. We examined the 6-year incidence of CVD and its risk factors in first- and second-generation ethnic Indians living in Singapore. 1749 participants (mean age [SD]: 55.5 [8.8] years; 47.5% male) from a population-based, longitudinal study of Indian adults were included for incident CVD outcome. Incident CVD was defined as self-reported myocardial infarction, angina pectoris or stroke which developed between baseline and follow-up. CVD-related risk factors included incident diabetes, hypertension, hyperlipidemia, obesity and chronic kidney disease (CKD). For incident CVD outcome, of the 1749 participants, 406 (23.2%) and 1343 (76.8%) were first and second-generation Indians, respectively. Of these, 73 (4.1%) reported incident CVD. In multivariable models, second-generation individuals had increased risk of developing CVD (RR = 2.04; 95% CI 1.04, 3.99; p = 0.038), hyperlipidemia (RR = 1.27; 95% CI 1.06, 1.53; p = 0.011), and CKD (RR = 1.92; 95% CI 1.22, 3.04; p = 0.005), compared to first-generation Indians. Second-generation Indians have increased risk of developing CVD and its associated risk factors such as hyperlipidemia and CKD compared to first-generation immigrants, independent of traditional CVD risk factors. More stratified and tailored CVD prevention strategies on second and subsequent generations of Indian immigrants in Singapore are warranted.
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Affiliation(s)
- Preeti Gupta
- Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- National University of Singapore, Department of Ophthalmology, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- National University of Singapore, Department of Ophthalmology, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- National University of Singapore, Department of Ophthalmology, Singapore, Singapore.
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10
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Novak NL, Wang X, Clarke PJ, Hajat A, Needham BL, Sánchez BN, Rodriguez CJ, Seeman TE, Castro-Diehl C, Golden SH, Diez Roux AV. Diurnal salivary cortisol and nativity/duration of residence in Latinos: The Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology 2017; 85:179-189. [PMID: 28886460 PMCID: PMC5623131 DOI: 10.1016/j.psyneuen.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
Latino immigrants have lower prevalence of depression, obesity and cardiovascular disease than US-born Latinos when they are recently arrived in the US, but this health advantage erodes with increasing duration of US residence. Cumulative exposure to psychosocial stress and its physiological sequelae may mediate the relationship between nativity and duration of US residence and poor health. We used data from Latino cohort study participants ages 45-84 to examine cross-sectional (n=558) and longitudinal (n=248) associations between nativity and duration of US residence and features of the diurnal cortisol curve including: wake-up cortisol, cortisol awakening response (CAR, wake-up to 30min post-awakening), early decline (30min to 2h post-awakening) and late decline (2h post-awakening to bed time), wake-to-bed slope, and area under the curve (AUC). In cross-sectional analyses, US-born Latinos had higher wake-up cortisol than immigrants with fewer than 30 years of US residence. In the full sample, over 5 years the CAR and early decline became flatter and AUC became larger. Over 5 years, US-born Latinos had greater increases in wake-up cortisol and less pronounced flattening of the early diurnal cortisol decline than immigrants with fewer than 30 years of US residence. Immigrants with 30 or more years of US residence also had less pronounced flattening of the early decline relative to more recent immigrants, and also had a less pronounced increase in AUC. In sum, we saw limited cross-sectional evidence that US-born Latinos have more dysregulated cortisol than recently-arrived Latino immigrants, but over time US-born Latinos had slower progression of cortisol dysregulation.
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Affiliation(s)
- Nicole L Novak
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Xu Wang
- Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA.
| | - Philippa J Clarke
- Survey Research Center, Institute for Social Research, University of Michigan, 426 S. Thompson St., Ann Arbor, MI 48109, USA.
| | - Anjum Hajat
- University of Washington School of Public Health Department of Epidemiology, 4225 Roosevelt Way NE, Suite 303, Seattle, WA 98105, USA.
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, SPH II, Room 4164, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Carlos J Rodriguez
- Department of Internal Medicine, Section of Cardiology, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Teresa E Seeman
- Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
| | - Cecilia Castro-Diehl
- Departments of Medicine and Epidemiology, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, 630 West 168th Street PH9 105, New York, NY 10032, USA.
| | - Sherita Hill Golden
- Departments of Medicine and Epidemiology, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Division of Endocrinology, Diabetes,and Metabolism, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287, USA.
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA.
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11
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Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017; 120:472-495. [PMID: 28154098 PMCID: PMC5321635 DOI: 10.1161/circresaha.116.308398] [Citation(s) in RCA: 820] [Impact Index Per Article: 117.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Charles Esenwa
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY.
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12
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Lê-Scherban F, Albrecht SS, Bertoni A, Kandula N, Mehta N, Diez Roux AV. Immigrant status and cardiovascular risk over time: results from the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol 2016; 26:429-435.e1. [PMID: 27221804 DOI: 10.1016/j.annepidem.2016.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/28/2016] [Accepted: 04/11/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Despite cross-sectional evidence that foreign-born United States (US) residents often have better health than US-born residents of similar race and/or ethnicity, we know little about overall cardiovascular risk progression over time among immigrants as they age in the US. METHODS Using longitudinal data from the Multiethnic Study of Atherosclerosis on 6446 adults aged 45-84 years at baseline, we examined how nativity and length of US residence related to change in cardiovascular health (CVH) and cardiovascular event incidence over 11-year follow-up. CVH was measured using the American Heart Association's CVH measure (range, 0-14; higher is better). RESULTS Immigrants, particularly those with shorter US residence, had better baseline CVH and lower cardiovascular event incidence than the US born. Baseline CVH scores ranged from 8.67 (8.42-8.92) among immigrants living in the US less than 10 years to 7.86 (7.76-7.97) among the US born. However, recent immigrants experienced the largest CVH declines over time: 10-year declines ranged from -1.04 (-1.27 to -0.80) among immigrants living in the US less than 10 years at baseline to -0.47 (-0.52 to -0.42) among the US born. CONCLUSIONS Public health prevention efforts targeting new immigrants may help slow the deterioration of CVH and reduce future cardiovascular risk.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Sandra S Albrecht
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Alain Bertoni
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University, Winston-Salem, NC
| | | | - Neil Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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13
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Fedeli U, Pigato M, Avossa F, Ferroni E, Nardetto L, Giometto B, Saugo M. Large variations in stroke hospitalization rates across immigrant groups in Italy. J Neurol 2015; 263:449-54. [DOI: 10.1007/s00415-015-7995-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 11/24/2022]
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14
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Wing JJ, Adar SD, Sánchez BN, Morgenstern LB, Smith MA, Lisabeth LD. Ethnic differences in ambient air pollution and risk of acute ischemic stroke. ENVIRONMENTAL RESEARCH 2015; 143:62-7. [PMID: 26451880 PMCID: PMC4641766 DOI: 10.1016/j.envres.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/05/2015] [Accepted: 09/29/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To investigate the association between short-term changes in ambient pollution (particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and ozone (O3)) and the risk of ischemic stroke among individuals living in a bi-ethnic community and whether this association is modified by ethnicity. METHODS We identified incident ischemic stroke cases from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project between 2000 and 2012. Associations between PM2.5 (mean 24-h) and O3 (maximal 8-h) levels, measured on the same-day and lags of 1-3 days, and odds of ischemic stroke were assessed using a time-stratified case-crossover design and modeled using conditional logistic regression. We explored race/ethnicity (Mexican American versus non-Hispanic white) as a modifier by including interaction terms in the models. RESULTS There were 2948 ischemic strokes with median age 71 years (IQR: 59-80). We observed no overall associations between the air pollutants and odds of ischemic stroke at any lag. When stratified by ethnicity, higher O3 was consistently associated with greater odds of ischemic stroke for non-Hispanic whites, but not for Mexican Americans. Higher PM2.5 was generally associated with lower odds of ischemic stroke for non-Hispanic whites but modestly greater odds for Mexican Americans. CONCLUSION Ethnic differences in the associations between ischemic stroke and short-term exposures to O3 and PM2.5 were suggested indicating that further study in diverse populations may be warranted.
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Affiliation(s)
- Jeffrey J Wing
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States.
| | - Sara D Adar
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Brisa N Sánchez
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Lewis B Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States; Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
| | - Melinda A Smith
- Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
| | - Lynda D Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States; Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
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15
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Sohail QZ, Chu A, Rezai MR, Donovan LR, Ko DT, Tu JV. The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Badiel M, Cepeda M, Ochoa J, Loaiza JH, Velásquez JG. [Birth cohort effect on prevalence of cardiovascular risk factors in coronary artery disease. Experience in a Latin-american country]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:9-15. [PMID: 25660087 DOI: 10.1016/j.acmx.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/05/2014] [Accepted: 10/13/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of major risk factors associated to coronary artery disease has changed over time. Today, the frequency of dyslipidemia, hypertension and diabetes mellitus has increased, while smoking has decreased. The birth cohort effect for coronary artery disease in subjects as an approximation of the true prevalence over time has not been studied in Latin-America. OBJECTIVE To determine the trends in the prevalence of major risk factors for coronary artery disease by birth cohort effect in a high risk population. METHODS We estimate the prevalence of diabetes mellitus, smoking, hypertension and dyslipidemia from a prospective institutional registry (DREST registry) of patients who underwent percutaneous coronary intervention for acute coronary event. Birth cohort effect was defined as a statistical, epidemiological and sociological methodology to identify the influence of the environment in the lifetime from birth by each decade. Univariate and multivariate analyses were performed adjusted by gender. RESULTS Out of 3,056 subjects who were enrolled, 72% were male, with a median age of 61 years (interquartile range=53-69). Hypertension prevalence was 62.3%, for diabetes mellitus it was 48.8%, for smoking it was 18.8% and for dyslipidemia it was 48.8%. We observed an increase in prevalence for diabetes mellitus and dyslipidemia in each cohort according to birth decade, while there was a reduction in prevalence for hypertension in the same decades. CONCLUSIONS The prevalence of major cardiovascular risk factors has changed in time and the presence of time at birth effect is evident, possibly influenced by the environment's social conditions in each decade of life.
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Affiliation(s)
- Marisol Badiel
- Unidad de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
| | - Magda Cepeda
- Unidad de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Julián Ochoa
- Laboratorio de cateterismo cardiaco, Unidad cardiovascular, Fundación Valle del Lili, Cali, Colombia
| | - John H Loaiza
- Unidad de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Jorge G Velásquez
- Laboratorio de cateterismo cardiaco, Unidad cardiovascular, Fundación Valle del Lili, Cali, Colombia
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17
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 993] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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18
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Wing JJ, Baek J, Sánchez BN, Lisabeth LD, Smith MA, Morgenstern LB, Zahuranec DB. Differences in initial stroke severity between Mexican Americans and non-Hispanic whites vary by age: the Brain Attack Surveillance in Corpus Christi (BASIC) project. Cerebrovasc Dis 2014; 38:362-9. [PMID: 25427748 DOI: 10.1159/000366468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A wide variety of racial and ethnic disparities in stroke epidemiology and treatment have been reported. Race-ethnic differences in initial stroke severity may be one important determinant of differences in the outcome after stroke. The overall goal of this study was to move beyond ethnic comparisons in the mean or median severity, and instead investigate ethnic differences in the entire distribution of initial stroke severity. Additionally, we investigated whether age modifies the relationship between ethnicity and initial stroke severity as this may be an important determinant of racial differences in the outcome after stroke. METHODS Ischemic stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project. National Institutes of Health Stroke Scale (NIHSS) was determined from the medical record or abstracted from the chart. Ethnicity was reported as Mexican American (MA) or non-Hispanic white (NHW). Quantile regression was used to model the distribution of NIHSS score by age category (45-59, 60-74, 75+) to test whether ethnic differences exist over different quantiles of NIHSS (5 percentile increments). Crude models examined the interaction between age category and ethnicity; models were then adjusted for history of stroke/transient ischemic attack, hypertension, atrial fibrillation, coronary artery disease, and diabetes. RESULTS were adjusted for multiple comparisons. RESULTS There were 4,366 ischemic strokes, with median age 72 (IQR: 61-81), 55% MA, and median NIHSS of 4 (IQR: 2-8). MAs were younger, more likely to have a history of hypertension and diabetes, but less likely to have atrial fibrillation compared to NHWs. In the crude model, the ethnicity-age interaction was not statistically significant. After adjustment, the ethnicity-age interaction became significant at the 85th and 95th percentiles of NIHSS distribution. MAs in the younger age category (45-59) were significantly less severe by 3 and 6 points on the initial NIHSS than NHWs, at the 85th and 95th percentiles, respectively. However, in the older age category (75+), there was a reversal of this pattern; MAs had more severe strokes than NHWs by about 2 points, though not reaching statistical significance. CONCLUSIONS There was no overall ethnic difference in stroke severity by age in our crude model. However, several potentially important ethnic differences among individuals with the most severe strokes were seen in younger and older stroke patients that were not explained by traditional risk factors. Age should be considered in future studies when looking at the complex distributional relationship between ethnicity and stroke severity.
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Affiliation(s)
- Jeffrey J Wing
- Department of Epidemiology, University of Michigan, Ann Arbor, Mich., USA
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19
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Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, Palaniappan L, Piña IL, Ramirez SM, Rodriguez B, Sims M. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation 2014; 130:593-625. [PMID: 25098323 PMCID: PMC4577282 DOI: 10.1161/cir.0000000000000071] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers. METHODS Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches. CONCLUSIONS Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.
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Capistrant BD, Mejia NI, Liu SY, Wang Q, Glymour MM. The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. J Gerontol A Biol Sci Med Sci 2014; 69:860-70. [PMID: 24444610 PMCID: PMC4067116 DOI: 10.1093/gerona/glt191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 10/29/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. METHODS Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. RESULTS Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke. CONCLUSION Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.
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Affiliation(s)
- Benjamin D Capistrant
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Boston. Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Sze Y Liu
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Qianyi Wang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology & Biostatistics, University of California - San Francisco
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Gutierrez J, Williams OA. A decade of racial and ethnic stroke disparities in the United States. Neurology 2014; 82:1080-2. [PMID: 24663229 DOI: 10.1212/wnl.0000000000000237] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States. Stroke incidence and prevalence is not uniform. It occurs more frequently in some geographical areas of the United States and the rates are higher in minority groups.(1,2) Some proposed causes for these disparities include increased rate of vascular risk factors that disproportionally affect some minority groups, differential effect of hypertension on stroke risk across racial groups, lack of access to health care and other social determinants of health, suboptimal control of risk factors, and although lacking substantive data to date, an inherited predisposition to stroke associated with genetic differences. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) investigators found that the rate of suboptimal control of vascular risk factors and unhealthy lifestyles were significantly greater in African Americans compared to non-Hispanic whites (NHW).(2) Moreover, regarding high blood pressure (BP), a triple threat has been described: blacks are not only more likely to have high BP, they are less likely, once diagnosed, to have their high BP controlled, and this suboptimal control has been shown to confer a stroke risk that is 3 times higher among blacks compared to whites for every 10-mm Hg increase in systolic BP (SBP).(3.)
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Affiliation(s)
- Jose Gutierrez
- From the Department of Neurology, Columbia University Medical Center, New York, NY
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Cardiovascular health status among Caribbean Hispanics living in Northern Manhattan and Ecuadorian natives/mestizos in rural coastal Ecuador: a comparative study. J Community Health 2014; 38:634-41. [PMID: 23456686 DOI: 10.1007/s10900-013-9658-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Knowledge of cardiovascular health (CVH) status of a given population is mandatory to reduce the burden of vascular diseases in the region. We compared CVH of two distinct populations having similar ethnic backgrounds to understand the role of lifestyle and environment on their CVH, and to provide insights in the planning of cost-effective health strategies. CVH status was compared in two Hispanic populations living in Northern Manhattan and Atahualpa (rural coastal Ecuador) using the health metrics proposed by the American Heart Association. Both studies used similar definitions of CVH and similar inclusion criteria for participating subjects (age ≥40 years, cardiovascular disease-free status, and living at their respective localities for ≥3 months). The studied populations consisted of 1,617 Caribbean Hispanics living in Northern Manhattan (mean age 66 ± 9 years), and 616 Atahualpa residents (mean age 59 ± 13 years). Atahualpa residents had significantly better metrics than Caribbean Hispanics, with the exception of fasting glucose levels. Likewise, the odds for having 5-7 ideal metrics were also better in Atahualpa residents, irrespective of age. CVH is better in Atahualpa residents than in Caribbean Hispanics living in Northern Manhattan. These differences are likely related to a healthier lifestyle in a rural setting and provide insights for setting cardiovascular prevention priorities.
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Affiliation(s)
- George Howard
- From the Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.); and Neurologische Klinik, Klinikum Ludwigshafen aRh, Ludwigshafen aRh, Germany (A.G.)
| | - Armin Grau
- From the Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.); and Neurologische Klinik, Klinikum Ludwigshafen aRh, Ludwigshafen aRh, Germany (A.G.)
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Del Brutto OH, Mera RM, Montalván M, Del Brutto VJ, Zambrano M, Santamaría M, Tettamanti D. Cardiovascular health status and metabolic syndrome in Ecuadorian natives/Mestizos aged 40 years or more with and without stroke and ischemic heart disease--an atahualpa project case-control nested study. J Stroke Cerebrovasc Dis 2013; 23:643-8. [PMID: 23834848 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/05/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Knowledge of regional-specific cardiovascular risk factors is mandatory to reduce the growing burden of stroke and ischemic heart disease in Latin American populations. We conducted a population-based case-control study to assess which risk factors are associated with the occurrence of vascular events in natives/mestizos living in rural coastal Ecuador. METHODS We assessed the cardiovascular health (CVH) status and the presence of the metabolic syndrome in all Atahualpa residents aged 40 years or more with stroke and ischemic heart disease and in randomly selected healthy persons to evaluate differences in the prevalence of such risk factors between patients and controls. RESULTS A total of 120 persons (24 with stroke or ischemic heart disease and 96 matched controls) were included. A poor CVH status (according to the American Heart Association) was found in 87.5% case-patients and 81.3% controls (P = .464). The metabolic syndrome was present in the same proportion (58.3%) of case-patients and controls. Likewise, both sets of risk factors (poor CVH status and the metabolic syndrome) were equally prevalent among both groups (58.3% versus 49%, P = .501). CONCLUSIONS This case-control study suggests that none of the measured risk factors is associated with the occurrence of vascular events. It is possible that some yet unmeasured risk factors or an unknown genetic predisposition may account for a sizable proportion of stroke and ischemic heart disease occurring in the native/mestizo population of rural coastal Ecuador.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| | | | - Martha Montalván
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Victor J Del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | - Mauricio Zambrano
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | | | - Daniel Tettamanti
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Research Department, Hospital Luis Vernaza, Guayaquil, Ecuador
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Capistrant BD, Wang Q, Liu SY, Glymour MM. Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset. J Am Geriatr Soc 2013; 61:931-938. [PMID: 23668393 DOI: 10.1111/jgs.12270] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke. DESIGN Prospective, observational study. SETTING Community-dwelling Health and Retirement Study (HRS) cohort. PARTICIPANTS HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441). MEASUREMENTS Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates. RESULTS Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards. CONCLUSION In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.
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Affiliation(s)
- Benjamin D Capistrant
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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Arce CM, Goldstein BA, Mitani AA, Winkelmayer WC. Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System. Am J Kidney Dis 2013; 62:312-21. [PMID: 23647836 DOI: 10.1053/j.ajkd.2013.02.375] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/26/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation. STUDY DESIGN National retrospective cohort study. SETTING & PARTICIPANTS Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007. PREDICTORS Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier). OUTCOMES All-cause and cause-specific mortality. RESULTS We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83). LIMITATIONS Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes. CONCLUSIONS Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.
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Affiliation(s)
- Cristina M Arce
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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