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Vu C, Arcaya MC, Kawachi I, Williams DR. In Search of the Promised Land: County-Level Disadvantage and Low Birth Weight among Black Mothers of the Great Migration. J Urban Health 2023; 100:1093-1101. [PMID: 37580548 PMCID: PMC10728401 DOI: 10.1007/s11524-023-00778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
The Great Migration was a movement of roughly eight million Black Southerners relocating to the North and West from 1910 to 1980. Despite being one of the most significant mass internal migrations during the twentieth century, little is known about the health outcomes resulting from migration and whether migrators' destination choices were potential mechanisms. This study measured the association between destination county disadvantage and odds of low birth weight during the last decade of the Great Migration. We used the US Census from 1970 as well as the birth records of first-time Black mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n = 154,145). We examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation. We used multilevel logistic regression, where mothers were nested within US counties, to quantify the relationship between county disadvantage and low birth weight. After adjusting for individual risk and protective factors for infant health, there was no relationship between county opportunity measures and low birth weight among migrators. Although high socioeconomic opportunity is typically associated with protection of low birth weight, we did not see these outcomes in this study. These results may support that persistent racial discrimination encountered in the North inhibited infant health even as migrators experienced higher economic opportunity relative to the South.
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Affiliation(s)
- Cecilia Vu
- Center for Antiracist Research, Boston University, Boston, MA, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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2
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Lin Z, Chen X. Place of Birth and Cognition among Older Americans: Findings from the Harmonized Cognitive Assessment Protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296954. [PMID: 37873447 PMCID: PMC10593039 DOI: 10.1101/2023.10.12.23296954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives Growing evidence suggests that place of birth (PoB) and related circumstances may have long-lasting and multiplicative contributions to various later-life outcomes. However, the specific contributions to different domains of cognitive function in late life remain less understood. This study aimed to investigate the extent to which PoB contribute to a wide range of later-life cognitive outcomes. Methods A nationally representative sample of Americans aged 65 and older (N=3,216) from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) was utilized. Cognitive outcomes were assessed in HCAP and linked to HRS state-level PoB data to explore the contribution of birthplace to later-life cognitive disparities. Regression-based Shapley decompositions were employed to quantify this contribution. Results PoB significantly contributed to all assessed cognitive outcomes including memory, executive function, language and fluency, visuospatial function, orientation, global cognitive performance, cognitive impairment and dementia. Geographic disparities in cognitive outcomes were evident, with individuals born in US southern states and foreign-born individuals performing worse than those born in other states. PoB overall accounted for 2.4-13.9% of the total variance in cognition after adjusting for age and sex. This contribution reduced by half when adjusting for a rich set of sociodemographic and health factors over the life course, but PoB still independently explained 2.0-7.1% of the total variance in cognition. Discussion PoB has lasting contributions to later-life cognitive health, with significant geographic disparities observed. Addressing these disparities requires promoting more equalized place-based policies, resources, and early-life environments to improve health equities over the life course.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, Yale University, New Haven, CT, USA
- Alzheimer’s Disease Research Center, New Haven, CT, USA
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3
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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4
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Wiegersma AM, Boots A, Langendam MW, Limpens J, Shenkin SD, Korosi A, Roseboom TJ, de Rooij SR. Do prenatal factors shape the risk for dementia?: A systematic review of the epidemiological evidence for the prenatal origins of dementia. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02471-7. [PMID: 37029828 DOI: 10.1007/s00127-023-02471-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Prenatal factors such as maternal stress, infection and nutrition affect fetal brain development and may also influence later risk for dementia. The purpose of this systematic review was to provide an overview of all studies which investigated the association between prenatal factors and later risk for dementia. METHODS We systematically searched MEDLINE and Embase for original human studies reporting on associations between prenatal factors and dementia from inception to 23 November 2022. Prenatal factors could be any factor assessed during pregnancy, at birth or postnatally, provided they were indicative of a prenatal exposure. Risk of bias was assessed using the Newcastle Ottawa Scale. We followed PRISMA guidelines for reporting. RESULTS A total of 68 studies met eligibility criteria (including millions of individuals), assessing maternal age (N = 30), paternal age (N = 22), birth order (N = 15), season of birth (N = 16), place of birth (N = 13), prenatal influenza pandemic (N = 1) or Chinese famine exposure (N = 1), birth characteristics (N = 3) and prenatal hormone exposure (N = 4). We observed consistent results for birth in a generally less optimal environment (e.g. high infant mortality area) being associated with higher dementia risk. Lower and higher birth weight and prenatal famine exposure were associated with higher dementia risk. The studies on season of birth, digit ratio, prenatal influenza pandemic exposure, parental age and birth order showed inconsistent results and were hampered by relatively high risk of bias. CONCLUSION Our findings suggest that some prenatal factors, especially those related to a suboptimal prenatal environment, are associated with an increased dementia risk. As these associations may be confounded by factors such as parental socioeconomic status, more research is needed to examine the potential causal role of the prenatal environment in dementia.
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Affiliation(s)
- Aline Marileen Wiegersma
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Amber Boots
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Susan D Shenkin
- Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Chari SV, Cui ER, Fehl HE, Fernandez AR, Brice JH, Patel MD. Community socioeconomic and urban-rural differences in emergency medical services times for suspected stroke in North Carolina. Am J Emerg Med 2023; 63:120-126. [PMID: 36370608 PMCID: PMC10425758 DOI: 10.1016/j.ajem.2022.10.039] [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: 08/05/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Our objectives were to describe time intervals of EMS encounters for suspected stroke patients in North Carolina (NC) and evaluate differences in EMS time intervals by community socioeconomic status (SES) and rurality. METHODS This cross-sectional study used statewide data on EMS encounters of suspected stroke in NC in 2019. Eligible patients were adults requiring EMS transport to a hospital following a 9-1-1 call for stroke-like symptoms. Incident street addresses were geocoded to census tracts and linked to American Community Survey SES data and to rural-urban commuting area (RUCA) codes. Community SES was defined as high, medium, or low based on tertiles of an SES index. Urban, suburban, and rural tracts were defined by RUCA codes 1, 2-6, and 7-10, respectively. Multivariable quantile regression was used to estimate how the median and 90th percentile of EMS time intervals varied by community SES and rurality, adjusting for each other; patient age, gender, and race/ethnicity; and incident characteristics. RESULTS We identified 17,117 eligible EMS encounters of suspected stroke from 2028 census tracts. The population was 65% 65+ years old; 55% female; and 69% Non-Hispanic White. Median response, scene, and transport times were 8 (interquartile range, IQR 6-11) min, 16 (IQR 12-20) min, and 14 (IQR 9-22) minutes, respectively. In quantile regression adjusted for patient demographics, minimal differences were observed for median response and scene times by community SES and rurality. The largest median differences were observed for transport times in rural (6.7 min, 95% CI 5.8, 7.6) and suburban (4.7 min, 95% CI 4.2, 5.1) tracts compared to urban tracts. Adjusted rural-urban differences in 90th percentile transport times were substantially greater (16.0 min, 95% CI 14.5, 17.5). Low SES was modesty associated with shorter median (-3.3 min, 95% CI -3.8, -2.9) and 90th percentile (-3.0 min, 95% CI -4.0, -2.0) transport times compared to high SES tracts. CONCLUSIONS While community-level factors were not strongly associated with EMS response and scene times for stroke, transport times were significantly longer rural tracts and modestly shorter in low SES tracts, accounting for patient demographics. Further research is needed on the role of community socioeconomic deprivation and rurality in contributing to delays in prehospital stroke care.
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Affiliation(s)
- Srihari V Chari
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Eric R Cui
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Haylie E Fehl
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Antonio R Fernandez
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; ESO, Austin, TX, USA
| | - Jane H Brice
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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6
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Jacobs MM, Ellis C. Stroke in women between 2006 and 2018: Demographic, socioeconomic, and age disparities. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199061. [PMID: 37735849 PMCID: PMC10515531 DOI: 10.1177/17455057231199061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Black Americans have a higher prevalence of stroke and stroke-related deaths than any other racial group. Racial disparities in stroke outcomes are even wider among women than men. Conventional studies have cited differences in lifestyle (i.e. smoking, alcohol consumption, etc.) and vascular risk factors between races as the source of these disparities. However, these studies fail to account for the higher prevalence of minoritized populations at the lower end of the socioeconomic distribution. OBJECTIVES This study explores differences in stroke risk factors across age and socioeconomic cohorts to determine whether comorbidities can sufficiently explain disparities at all ages and income levels. DESIGN Using the 2006-2018 National Health Interview Survey data, statistical analysis evaluated differences in risk factors among a full sample cohort (aged 18-85 years; n = 131,091) and a "young" subsample cohort (aged 18-59 years; n = 6183) of women. METHODS Logistics and unconditional quantile regression models assessed the relationship between stroke and comorbid, demographic, and behavioral characteristics across socioeconomic classes. RESULTS Results suggest that Black women had a 1.415-fold (confidence interval = 1.259, 1.591) higher likelihood of stroke compared with White women after controlling for age, behavior, and comorbidities. Racial disparities were not statistically significant at the higher income ranges for either the full (odds ratio = 1.404, p = 0.3114) or young samples (odds ratio = 1.576, p = 0.7718). However, Blacks had significantly higher odds of stroke in the lower quartiles (lower odds ratio: 1.329, p = 0.0242; lower middle odds ratio: 1.233, p = 0.0486; and upper middle odds ratio: 1.994, p = 0.0005). Disparities were larger among young women (odds ratio = 1.449, confidence interval = 1.211, 1.734). CONCLUSION While comorbidities were highly associated with stroke prevalence in all socioeconomic cohorts, Blacks only had higher relative odds in the lower income classes. Lack of biological or behavioral explanations for these findings suggests that unobserved or uncontrolled factors such as systemic racism, prejudicial institutions, or differential treatment may contribute to this.
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Affiliation(s)
- Molly M Jacobs
- Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
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7
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Pye HOT, Ward-Caviness CK, Murphy BN, Appel KW, Seltzer KM. Secondary organic aerosol association with cardiorespiratory disease mortality in the United States. Nat Commun 2021; 12:7215. [PMID: 34916495 PMCID: PMC8677800 DOI: 10.1038/s41467-021-27484-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
Fine particle pollution, PM2.5, is associated with increased risk of death from cardiorespiratory diseases. A multidecadal shift in the United States (U.S.) PM2.5 composition towards organic aerosol as well as advances in predictive algorithms for secondary organic aerosol (SOA) allows for novel examinations of the role of PM2.5 components on mortality. Here we show SOA is strongly associated with county-level cardiorespiratory death rates in the U.S. independent of the total PM2.5 mass association with the largest associations located in the southeastern U.S. Compared to PM2.5, county-level variability in SOA across the U.S. is associated with 3.5× greater per capita county-level cardiorespiratory mortality. On a per mass basis, SOA is associated with a 6.5× higher rate of mortality than PM2.5, and biogenic and anthropogenic carbon sources both play a role in the overall SOA association with mortality. Our results suggest reducing the health impacts of PM2.5 requires consideration of SOA.
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Affiliation(s)
- Havala O T Pye
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA.
| | - Cavin K Ward-Caviness
- Office of Research and Development, U.S. Environmental Protection Agency, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA
| | - Ben N Murphy
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
| | - K Wyat Appel
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
| | - Karl M Seltzer
- Oak Ridge Institute for Science and Education Postdoctoral Fellow in the Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
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8
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Ehrlich ME, Han B, Lutz M, Ghorveh MG, Okeefe YA, Shah S, Kolls BJ, Graffagnino C. Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally. Neurohospitalist 2021; 11:317-325. [PMID: 34567392 DOI: 10.1177/19418744211010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Bin Han
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Michael Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Yasmin Ali Okeefe
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Carmelo Graffagnino
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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Abstract
ABSTRACT Stroke, the most common form of cerebrovascular disease, is a leading cause of death and disability throughout the world. There have been no significant advances in the development of effective therapeutics for hemorrhagic stroke, and for ischemic stroke highly effective, evidence-based therapies such as alteplase and mechanical thrombectomy are widely underutilized. Improving outcomes for patients experiencing ischemic stroke requires faster recognition and appropriate intervention within the treatment window (the first 24 hours after symptom onset). This article discusses the pathophysiology underlying the various types of ischemic stroke; the risk factors for ischemic stroke; stroke presentation; and the evidence-based treatments, nursing assessments, and monitoring protocols that are critical to patient recovery.
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Affiliation(s)
- Heather H Washington
- Nneka Lotea Ifejika is an associate professor of physical medicine and rehabilitation and section chief of stroke rehabilitation at the University of Texas Southwestern (UT Southwestern) Medical Center, Dallas, where Heather H. Washington is an acute care NP in the Department of Neurology, and Kimberly R. Glaser is an acute care NP in the Division of Neurocritical Care. Contact author: Nneka Lotea Ifejika, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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10
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Xu W, Topping M, Fletcher J. State of birth and cardiovascular disease mortality: Multilevel analyses of the National Longitudinal Mortality Study. SSM Popul Health 2021; 15:100875. [PMID: 34345647 PMCID: PMC8319560 DOI: 10.1016/j.ssmph.2021.100875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/04/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading contributor to mortality in the United States. Previous studies have linked early life individual and family factors, along with various contemporaneous place-based exposures to differential individual CVD mortality risk. However, the impacts of early life place exposures and how they compare to the effects of an individual's current place of residence on CVD mortality risk is not well understood. Using the National Longitudinal Mortality Study, this research examined the effects of both state of birth and state of residence on individual's risk of CVD mortality. We estimated individual mortality risk by estimating multi-level logistic regression models. We found that during a follow-up period of 11 years, 18,292 (4.2%) out of 433,345 participants died from CVD. The impact of state of birth on subsequent CVD mortality risk are greater than state of residence, even after adjusting for socio-demographic factors. Individuals who were born in certain states such as Tennessee, Kentucky, and Pennsylvania on average had higher CVD mortality risk. Conversely, those born in California, North Dakota, and Montana were found to have lower risk, no matter where they presently live. This study implies that early life state-level environments may be more prominent to individual's CVD mortality risk, compared to the state in which one lives. Future research should address specific mechanisms through which state of birth may affect people's risk of CVD mortality. State of birth is a stronger predictor of CVD mortality than state of residence. Models including state of birth random effects better predict individual CVD mortality risk. Those born in Tennessee and Kentucky had the highest average CVD mortality risk while those born in California and North Dakota had the lowest risk. Tennessee, Kentucky, Virginia, West Virginia, and Pennsylvania are a cluster of high state of birth effects.
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Affiliation(s)
- Wei Xu
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Michael Topping
- Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Jason Fletcher
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA.,Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
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11
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Topping M, Kim J, Fletcher J. Association and pathways of birth in the stroke belt on old age dementia and stroke Mortality. SSM Popul Health 2021; 15:100841. [PMID: 34195346 PMCID: PMC8233219 DOI: 10.1016/j.ssmph.2021.100841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 10/31/2022] Open
Abstract
This paper uses data from the Diet and Health Study (DHS) to examine associations between being born in a "stroke belt" state and old age stroke and mortality outcomes. Adding to prior work that used administrative data, our paper explores educational and health mechanisms that are both stratified by geography and by mortality outcomes. Using logistic regression, we first replicate earlier findings of elevation in risk of dementia mortality (OR 1.13, CI [1.07, 1.20]) and stroke mortality (OR 1.17, CI [1.07, 1.29]) for white individuals born in a stroke belt state. These associations are largely unaffected by controls for educational attainment or by experiences with surviving a stroke and are somewhat attenuated by controls for self-rated health status in old age. The results suggest a need to consider additional life course mechanisms in order to understand the persistent effects of place of birth on old age mortality patterns.
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Affiliation(s)
- Michael Topping
- Department of Sociology, University of Wisconsin-Madison, USA.,Center for Demography of Health and Aging, University of Wisconsin-Madison, USA
| | - Jinho Kim
- Center for Demography of Health and Aging, University of Wisconsin-Madison, USA.,Department of Health Policy and Management, Korea University, Republic of Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Republic of Korea
| | - Jason Fletcher
- Department of Sociology, University of Wisconsin-Madison, USA.,Center for Demography of Health and Aging, University of Wisconsin-Madison, USA.,La Follette School of Public Affairs, University of Wisconsin-Madison, USA
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12
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Parcha V, Kalra R, Best AF, Patel N, Suri SS, Wang TJ, Arora G, Arora P. Geographic Inequalities in Cardiovascular Mortality in the United States: 1999 to 2018. Mayo Clin Proc 2021; 96:1218-1228. [PMID: 33840523 DOI: 10.1016/j.mayocp.2020.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/24/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. PATIENTS AND METHODS We evaluated the nationwide mortality data of all Americans from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2018. Cause-specific deaths were identified in the stroke belt and nonstroke belt populations using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The relative percentage gap was estimated as the absolute difference computed relative to nonstroke belt mortality. Piecewise linear regression and age-period-cohort modeling were used to assess, respectively, the trends and to forecast mortality across the 2 regions. RESULTS The cardiovascular mortality rate (per 100,000 persons) was 288.3 (95% CI, 288.0 to 288.6; 3,684,273 deaths) in the stroke belt region and 251.2 (95% CI, 251.0 to 251.3; 13,296,164 deaths) in the nonstroke belt region. In the stroke belt region, age-adjusted mortality rates due to all cardiovascular causes (average annual percentage change [AAPC] in mortality rates, -2.4; 95% CI, -2.8 to -2.0), IHD (AAPC, -3.8; 95% CI, -4.2 to -3.5), and stroke (AAPC, -2.8; 95% CI, -3.4 to -2.1) declined from 1999 to 2018. A similar decline in cardiovascular (AAPC, -2.5; 95% CI, -3.0 to -2.0), IHD (AAPC, -4.0; 95% CI, -4.3 to -3.7), and stroke (AAPC, -2.9; 95% CI, -3.2 to -2.2) mortality was seen in the nonstroke belt region. There was no overall change in heart failure mortality in both regions (PAAPC>.05). The cardiovascular mortality gap was 11.8% in 1999 and 15.9% in 2018, with a modest reduction in absolute mortality rate difference (~7 deaths per 100,000 persons). These patterns were consistent across subgroups of age, sex, race, and urbanization status. An estimated 101,953 additional cardiovascular deaths need to be prevented from 2020 to 2025 in the stroke belt to ameliorate the gap between the 2 regions. CONCLUSION Despite the overall decline, substantial geographic disparities in cardiovascular mortality persist. Novel approaches are needed to attenuate the long-standing geographic inequalities in cardiovascular mortality in the United States, which are projected to increase.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis
| | - Ana F Best
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Nirav Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sarabjeet S Suri
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Thomas J Wang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
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Annie FH, Bates MC, Khan M, Zahid S, Shah SI, Nanjundappa A, Wyner JR, Anderson E, Farooq A, Wood M, Challa A. Stroke Incidence and Outcome Disparity in Rural Regions of Southern West Virginia. J Emerg Trauma Shock 2021; 14:201-206. [PMID: 35125784 PMCID: PMC8780634 DOI: 10.4103/jets.jets_191_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION West Virginia has the highest incidence of obesity, smoking, and diabetes within the United States, placing its population at higher risk of stroke. In addition to these endemic risk factors, Appalachia faces various socioeconomic and health care access challenges that could negatively impact stroke incidence and outcomes. At present, there are limited data regarding geographic variables on stroke outcomes in rural Appalachia. We set out to quantify Appalachian geographic patterns of stroke incidence and outcomes. METHODS This is a retrospective analysis of all patients hospitalized with a diagnosis of stroke in West Virginia's largest tertiary hospital. During the study (2000-2018), 14,488 patients were analyzed, with an emphasis on those who died from stroke (n = 1022). We first used institutional ICD-9/10 data alongside demographics information and chart reviews to evaluate disease patterns while also exploring emerging hot spot pattern changes over time; we then exploited an emerging time series analysis using temporal trends to assess differing instances of stroke occurrence regionally with hot spots defined as higher than expected incidences of stroke and stroke death. RESULTS Data analysis revealed several hot spots of increasing stroke and mortality rates, many of which achieved statistically significant variance compared to expected norms (P = 0.001). Moreover, this study revealed high-risk zones in rural West Virginia wherein the incidence and mortality rates of stroke are suggestively higher and less resistance to economic change than urban centers. CONCLUSIONS Stroke incidence and mortality were found to be higher than expected in many areas of rural West Virginia. The higher stroke risk populations correlate with area that may be impacted by socioeconomic factors and limited access to primary care. These high-risk areas may therefore benefit from investments in infrastructure, patient education, and unrestricted primary care.
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Affiliation(s)
- Frank Harrison Annie
- CAMC Health Education and Research Institute, Charleston, WV, USA,Address for correspondence: Dr. Frank Harrison Annie, CAMC Health Education and Research Institute, 3200 MacCorkle Ave. SE, Charleston, WV 25304, USA. E-mail:
| | - Mark C. Bates
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Muhammad Khan
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Salman Zahid
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Syed Imran Shah
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Aravinda Nanjundappa
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Joshua R. Wyner
- CAMC Health Education and Research Institute, Charleston, WV, USA
| | - Elise Anderson
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Ali Farooq
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Megan Wood
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Abhiram Challa
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
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14
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Mayeda ER, Mobley TM, Weiss RE, Murchland AR, Berkman LF, Sabbath EL. Association of work-family experience with mid- and late-life memory decline in US women. Neurology 2020; 95:e3072-e3080. [PMID: 33148811 PMCID: PMC7734924 DOI: 10.1212/wnl.0000000000010989] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that life course patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among US women. METHODS Participants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially from 1995 to 2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment. RESULTS There were 6,189 study participants (n = 488 working nonmothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 nonworking single mothers, n = 526 nonworking married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was more than 50% greater among women whose work-family profiles did not include working for pay after childbearing, compared with those who were working mothers. CONCLUSIONS Women who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.
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Affiliation(s)
- Elizabeth Rose Mayeda
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA.
| | - Taylor M Mobley
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Robert E Weiss
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Audrey R Murchland
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Lisa F Berkman
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Erika L Sabbath
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
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15
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Marini S, Georgakis MK, Chung J, Henry JQA, Dichgans M, Rosand J, Malik R, Anderson CD. Genetic overlap and causal inferences between kidney function and cerebrovascular disease. Neurology 2020; 94:e2581-e2591. [PMID: 32439819 PMCID: PMC7455337 DOI: 10.1212/wnl.0000000000009642] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/26/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Leveraging large-scale genetic data, we aimed to identify shared pathogenic mechanisms and causal relationships between impaired kidney function and cerebrovascular disease phenotypes. METHODS We used summary statistics from genome-wide association studies (GWAS) of kidney function traits (chronic kidney disease diagnosis, estimated glomerular filtration rate [eGFR], and urinary albumin-to-creatinine ratio [UACR]) and cerebrovascular disease phenotypes (ischemic stroke and its subtypes, intracerebral hemorrhage [ICH], and white matter hyperintensities [WMH] on brain MRI). We (1) tested the genetic overlap between them with polygenic risk scores (PRS), (2) searched for common pleiotropic loci with pairwise GWAS analyses, and (3) explored causal associations by employing 2-sample Mendelian randomization. RESULTS A PRS for lower eGFR was associated with higher large artery stroke (LAS) risk (p = 1 × 10-4). Multiple pleiotropic loci were identified between kidney function traits and cerebrovascular disease phenotypes, with 12q24 associated with eGFR and both LAS and small vessel stroke (SVS), and 2q33 associated with UACR and both SVS and WMH. Mendelian randomization revealed associations of both lower eGFR (odds ratio [OR] per 1-log decrement, 2.10; 95% confidence interval [CI], 1.38-3.21) and higher UACR (OR per 1-log increment, 2.35; 95% CI, 1.12-4.94) with a higher risk of LAS, as well as between higher UACR and higher risk of ICH. CONCLUSIONS Impaired kidney function, as assessed by decreased eGFR and increased UACR, may be causally involved in the pathogenesis of LAS. Increased UACR, previously proposed as a marker of systemic small vessel disease, is involved in ICH risk and shares a genetic risk factor at 2q33 with manifestations of cerebral small vessel disease.
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Affiliation(s)
- Sandro Marini
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA.
| | - Marios K Georgakis
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jaeyoon Chung
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jonathan Q A Henry
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Martin Dichgans
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jonathan Rosand
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Rainer Malik
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
| | - Christopher D Anderson
- From the Center for Genomic Medicine (S.M., J.C., J.Q.A.H., J.R., C.D.A.), Department of Neurology (J.R., C.D.A.), and Henry and Allison McCance Center for Brain Health (J.R., C.D.A.), Massachusetts General Hospital, Boston; Institute for Stroke and Dementia Research (M.K.G., M.D., R.M.), University Hospital of Ludwig-Maximilians-University; Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-University, Munich, Germany; Department of Medicine (Biomedical Genetics) (J.C.), Boston University School of Medicine, MA; Munich Cluster for Systems Neurology (SyNergy) (M.D.); German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany; and Program in Medical and Population Genetics (J.R., C.D.A.), Broad Institute of Harvard and MIT, Cambridge, MA
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16
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Marini S, Merino J, Montgomery BE, Malik R, Sudlow CL, Dichgans M, Florez JC, Rosand J, Gill D, Anderson CD. Mendelian Randomization Study of Obesity and Cerebrovascular Disease. Ann Neurol 2020; 87:516-524. [PMID: 31975536 PMCID: PMC7392199 DOI: 10.1002/ana.25686] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To systematically investigate causal relationships between obesity and cerebrovascular disease and the extent to which hypertension and hyperglycemia mediate the effect of obesity on cerebrovascular disease. METHODS We used summary statistics from genome-wide association studies for body mass index (BMI), waist-to-hip ratio (WHR), and multiple cerebrovascular disease phenotypes. We explored causal associations with 2-sample Mendelian randomization (MR) accounting for genetic covariation between BMI and WHR, and we assessed what proportion of the association between obesity and cerebrovascular disease was mediated by systolic blood pressure (SBP) and blood glucose levels, respectively. RESULTS Genetic predisposition to higher BMI did not increase the risk of cerebrovascular disease. In contrast, for each 10% increase in WHR there was a 75% increase (95% confidence interval [CI] = 44-113%) in risk for large artery ischemic stroke, a 57% (95% CI = 29-91%) increase in risk for small vessel ischemic stroke, a 197% increase (95% CI = 59-457%) in risk of intracerebral hemorrhage, and an increase in white matter hyperintensity volume (β = 0.11, 95% CI = 0.01-0.21). These WHR associations persisted after adjusting for genetic determinants of BMI. Approximately one-tenth of the observed effect of WHR was mediated by SBP for ischemic stroke (proportion mediated: 12%, 95% CI = 4-20%), but no evidence of mediation was found for average blood glucose. INTERPRETATION Abdominal adiposity may trigger causal pathological processes, partially independent from blood pressure and totally independent from glucose levels, that lead to cerebrovascular disease. Potential targets of these pathological processes could represent novel therapeutic opportunities for stroke. ANN NEUROL 2020;87:516-524.
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Affiliation(s)
- Sandro Marini
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Boston University Medical Center, Boston, MA, USA
| | - Jordi Merino
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain
| | | | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Catherine L. Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Jose C. Florez
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Christopher D. Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
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17
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Ehrlich ME, Kolls BJ, Roettig M, Monk L, Shah S, Xian Y, Jollis JG, Granger CB, Graffagnino C. Implementation of Best Practices-Developing and Optimizing Regional Systems of Stroke Care: Design and Methodology. Am Heart J 2020; 222:105-111. [PMID: 32028136 DOI: 10.1016/j.ahj.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
The AHA Guidelines recommend developing multi-tiered systems for the care of patients with acute stroke.1 An ideal stroke system of care should ensure that all patients receive the most efficient and timely care, regardless of how they first enter or access the medical care system. Coordination among the components of a stroke system is the most challenging but most essential aspect of any system of care. The Implementation of Best Practices For Acute Stroke Care-Developing and Optimizing Regional Systems of Stroke Care (IMPROVE Stroke Care) project, is designed to implement existing guidelines and systematically improve the acute stroke system of care in the Southeastern United States. Project participation includes 9 hub hospitals, approximately 80 spoke hospitals, numerous pre-hospital agencies (911, fire, and emergency medical services) and communities within the region. The goal of the IMPROVE Stroke program is to develop a regional integrated stroke care system that identifies, classifies, and treats acute ischemic stroke patients more rapidly and effectively with reperfusion therapy. The project will identify gaps and barriers to implementation of stroke systems of care, leverage existing resources within the regions, aid in designing strategies to improve care processes, bring regional representatives together to agree on and implement best practices, protocols, and plans based on guidelines, and establish methods to monitor quality of care. The impact of implementation of stroke systems of care on mortality and long-term functional outcomes will be measured.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC.
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Lisa Monk
- Duke Clinical Research Institute, Durham, NC
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Ying Xian
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - James G Jollis
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Christopher B Granger
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
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Murchland AR, Eng CW, Casey JA, Torres JM, Mayeda ER. Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education. Int J Geriatr Psychiatry 2019; 34:1633-1641. [PMID: 31318472 PMCID: PMC7060021 DOI: 10.1002/gps.5176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity. METHODS We identified the prevalence of depressive symptoms among US-born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms. RESULTS In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12-1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99-1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87-1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural). CONCLUSIONS Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.
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Affiliation(s)
- Audrey R. Murchland
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Chloe W. Eng
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Joan A. Casey
- University of California, Berkeley School of Public Health, Division of Environmental Health Sciences
- Columbia Mailman School of Public Health, Department of Environmental Health Sciences
| | - Jacqueline M. Torres
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Elizabeth Rose Mayeda
- University of California, Los Angeles Fielding School of Public Health, Department of Epidemiology
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Association of baseline inflammatory biomarkers with cancer mortality in the REGARDS cohort. Oncotarget 2019; 10:4857-4867. [PMID: 31448052 PMCID: PMC6690671 DOI: 10.18632/oncotarget.27108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/29/2019] [Indexed: 12/27/2022] Open
Abstract
This study examines the association between inflammatory biomarkers and risk of cancer mortality by race. Data were obtained from 1,856 participants in the prospective REGARDS cohort who were cancer-free at baseline, and analyzed in relation to cancer mortality prospectively. Biomarkers were log-transformed and categorized into tertiles due to non-normal distributions, and Cox proportional hazard regression models were utilized to compute hazard ratios with 95% confidence intervals using robust sandwich methods. Individuals in the highest tertile of IL-6 had over a 12-fold increased risk of cancer mortality (HR: 12.97, 95% CI: 3.46–48.63); those in the highest tertile of IL-8 had over a 2-fold increased risk of cancer mortality (HR: 2.21, 95% CI: 0.86–5.71), while those in the highest tertile of IL-10 had over a 3-fold increased risk of cancer mortality (HR: 3.06, 95% CI: 1.35–6.89). In race-stratified analysis, each unit increase in IL-6 was associated with increased risk of cancer mortality among African-Americans (HR: 3.88, 95% CI: 1.17–12.88) and Whites (5.25, 95% CI: 1.24–22.31). If replicated in larger, racially diverse prospective cohorts, these results suggest that cancer patients may benefit from clinical or lifestyle approaches to regulate systemic inflammation as a cancer prevention strategy.
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Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia. JAMA Neurol 2017; 74:1056-1062. [PMID: 28759663 DOI: 10.1001/jamaneurol.2017.1553] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence. Objective To determine whether birth in 9 high stroke mortality states (HSMSs) is associated with dementia in a diverse cohort of individuals living in Northern California. Design, Setting, and Participants An observational cohort study included 7423 members of Kaiser Permanente Northern California (KPNC), an integrated health care delivery system, with health survey and clinical examination data available. Data were collected between 1964 and 1973 when the individuals were middle-aged and 1996 and 2015 when participants were in later life. Exposures Self-reported state of birth in an HSMS (top quintile of states for stroke mortality). Main Outcomes and Measures Dementia diagnoses obtained from electronic health records from January 1, 1996, to October 15, 2015. Place of birth, race, educational level, and midlife vascular risk factors data were collected between 1964 and 1973. Results Of the 7423 persons included in the analysis, 4049 (54.5%) were women; 1354 (18.2%) were black. The mean (SD) age of study participants at their first visit between 1963 and 1974 was 42.94 (1.73) years and mean (SD) age at the beginning of follow-up for dementia in 1996 was 71.14 (2.72) years. Dementia was diagnosed in 2254 (30.4%) of the participants and was more common among those born in an HSMS than those born outside of one (455 [39.0%] vs 1799 [28.8%]). Birth in an HSMS was 9.6 times more common for black participants (795 [58.7%]) than nonblack participants (371 [6.1%]). Overall, birth in an HSMS was associated with a 28% higher risk of dementia (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.13-1.46) adjusted for age, sex, and race. Compared with nonblack persons born outside of an HSMS, black individuals born in an HSMS had the highest dementia risk (aHR, 1.67; 95% CI, 1.48-1.88), followed by black individuals not born in an HSMS (aHR, 1.48; 95% CI, 1.28-1.72), and nonblack persons born in an HSMS had a 46% increased risk (aHR, 1.46; 95% CI, 1.23-1.74). Cumulative 20-year dementia risks at age 65 years were 30.13% (95% CI, 26.87%-32.93%) and 21.80% (95% CI, 20.51%-22.91%) for individuals born in and outside an HSMS, respectively. Conclusions and Relevance To our knowledge, this is the first study to date of place of birth and incident dementia and shows increased risk for individuals born in an HSMS, even though all participants subsequently resided in California. Birth in an HSMS was common among black participants. Place of birth has enduring consequences for dementia risk and may be a major contributor to racial disparities in dementia.
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Affiliation(s)
- Paola Gilsanz
- Division of Research, Kaiser Permanente, Oakland, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Rachel A Whitmer
- Division of Research, Kaiser Permanente, Oakland, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco
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Kavouras IG, Chalbot MCG. Influence of ambient temperature on the heterogeneity of ambient fine particle chemical composition and disease prevalence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2017; 27:27-39. [PMID: 27838926 DOI: 10.1080/09603123.2016.1257704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
In this study, we present the associations of fine particle nitrate, sulfate, and four organic carbon fractions with ambient temperature in urban and background monitoring sites in the United States for the 2011-2012 period. Nitrate concentrations increased for decreasing temperatures, while sulfate levels increased for temperatures higher than 14 °C. The profiles of organic carbon fractions for different temperatures were comparable to that observed for elemental carbon, a thermally stable and non-reactive component emitted from combustion-related sources. The trends for all parameters were comparable for the nine regions and independent to emission estimates of fine particles and their precursors. These patterns demonstrated that ambient temperature may manipulate fine particulate composition. These differences may be augmented by rising temperatures due to changing climate. Considering the causal associations between particulate pollution and pulmonary and cardiovascular diseases, changes in the composition of particulate pollution may imply adjustments on the human health impacts.
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Affiliation(s)
- Ilias G Kavouras
- a Department of Environmental Health Sciences , University of Alabama , Birmingham , AL , USA
| | - Marie-Cecile G Chalbot
- a Department of Environmental Health Sciences , University of Alabama , Birmingham , AL , USA
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Berchick ER, Lynch SM. Regional Variation in the Predictive Validity of Self-Rated Health for Mortality. SSM Popul Health 2017; 3:275-282. [PMID: 28983501 PMCID: PMC5624545 DOI: 10.1016/j.ssmph.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Self-rated health (SRH) is a commonly used measure for assessing general health in surveys in the United States. However, individuals from different parts of the United States may vary in how they assess their health. Geographic differences in health care access and in the prevalence of illnesses may make it difficult to discern true regional differences in health when using SRH as a health measure. In this article, we use data from the 1986 and 1989–2006 National Health Interview Survey Linked Mortality Files and estimate Cox regression models to examine whether the relationship between SRH and five-year all-cause mortality differs by Census region. Contrary to hypotheses, there is no evidence of regional variation in the predictive validity of SRH for mortality. At all levels of SRH, and for both non-Hispanic white and non-Hispanic black respondents, SRH is equally and strongly associated with five-year mortality across regions. Our results suggest that differences in SRH across regions are not solely due to differences in how respondents assess their health across regions, but reflect true differences in health. Future research can, therefore, employ this common measure to investigate the geographic patterning of health in the United States. Geographic differences in health care access and illness prevalence exist. Results show no regional variation in self-rated health's predictive validity. Regional differences in self-rated health are not only measurement artefacts.
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Affiliation(s)
- Edward R Berchick
- Duke University Population Research Institute, Duke University, Box 90989, Durham, NC 27708, USA
| | - Scott M Lynch
- Duke University Population Research Institute, Duke University, Box 90989, Durham, NC 27708, USA.,Department of Sociology, Duke University, Box 90088, Durham, NC 27708, USA
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Afkarian M, Katz R, Bansal N, Correa A, Kestenbaum B, Himmelfarb J, de Boer IH, Young B. Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study. Clin J Am Soc Nephrol 2016; 11:1384-1391. [PMID: 27340284 PMCID: PMC4974894 DOI: 10.2215/cjn.13111215] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR<60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio ≥30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years. RESULTS Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease. CONCLUSIONS The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.
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Affiliation(s)
- Maryam Afkarian
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Ronit Katz
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Adolfo Correa
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Bryan Kestenbaum
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Ian H. de Boer
- Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington
| | - Bessie Young
- Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington
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Ojike N, Ravenell J, Seixas A, Masters-Israilov A, Rogers A, Jean-Louis G, Ogedegbe G, McFarlane SI. Racial Disparity in Stroke Awareness in the US: An Analysis of the 2014 National Health Interview Survey. JOURNAL OF NEUROLOGY & NEUROPHYSIOLOGY 2016; 7:365. [PMID: 27478680 PMCID: PMC4966617 DOI: 10.4172/2155-9562.1000365] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIMS Stroke is a leading cause of premature death and disability, and increasing the proportion of individuals who are aware of stroke symptoms is a target objective of the Healthy people 2020 project. METHODS We used data from the 2014 Supplement of the National Health Interview Survey (NHIS) to assess the prevalence of stroke symptom knowledge and awareness. We also tested, using a logistic regression model, the hypothesis that individuals who have knowledge of all 5 stroke symptoms will be have a greater likelihood to activate Emergency Medical Services (EMS) if a stroke is suspected. RESULTS From the 36,697 participants completing the survey 51% were female. In the entire sample, the age-adjusted awareness rate of stroke symptoms/calling 911 was 66.1%. Knowledge of the 5 stroke symptoms plus importance of calling 911 when a stroke is suspected was higher for females, Whites, and individuals with health insurance. Stroke awareness was lowest for Hispanics, Blacks, and survey participants from Western US region. CONCLUSION The findings allude to continuing differences in the knowledge of stroke symptoms across race/ethnic and other demographic groups. Further research will confirm the importance of increased health literacy for Stroke management and prevention in minority communities.
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Affiliation(s)
- Nwakile Ojike
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Joe Ravenell
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Azizi Seixas
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Alina Masters-Israilov
- The Saul R. Korey, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - April Rogers
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Samy I McFarlane
- Division of Endocrinology, department of Medicine, SUNY-Downstate, Brooklyn, NY, 11203, USA
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25
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Rehkopf DH, Domingue BW, Cullen MR. The Geographic Distribution of Genetic Risk as Compared to Social Risk for Chronic Diseases in the United States. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2016; 62:126-142. [PMID: 27050037 PMCID: PMC4899969 DOI: 10.1080/19485565.2016.1141353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is an association between chronic disease and geography, and there is evidence that the environment plays a critical role in this relationship. Yet at the same time, there is known to be substantial geographic variation by ancestry across the United States. Resulting geographic genetic variation-that is, the extent to which single nucleotide polymorphisms (SNPs) related to chronic disease vary spatially-could thus drive some part of the association between geography and disease. We describe the variation in chronic disease genetic risk by state of birth by taking risk SNPs from genome-wide association study meta-analyses for coronary artery disease, diabetes, and ischemic stroke and creating polygenic risk scores. We compare the amount of variability across state of birth in these polygenic scores to the variability in parental education, own education, earnings, and wealth. Our primary finding is that the polygenic risk scores are only weakly differentially distributed across U.S. states. The magnitude of the differences in geographic distribution is very small in comparison to the distribution of social and economic factors and thus is not likely sufficient to have a meaningful effect on geographic disease differences by U.S. state.
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Affiliation(s)
- David H Rehkopf
- a School of Medicine, Division of General Medical Disciplines , Stanford University , Stanford , California , USA
| | - Benjamin W Domingue
- b Graduate School of Education , Stanford University , Stanford , California , USA
| | - Mark R Cullen
- a School of Medicine, Division of General Medical Disciplines , Stanford University , Stanford , California , USA
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26
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Rodopoulou S, Samoli E, Chalbot MCG, Kavouras IG. Air pollution and cardiovascular and respiratory emergency visits in Central Arkansas: A time-series analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 536:872-879. [PMID: 26232212 PMCID: PMC5286552 DOI: 10.1016/j.scitotenv.2015.06.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Heart disease and stroke mortality and morbidity rates in Arkansas are among the highest in the U.S. While the effect of air pollution on cardiovascular health was identified in traffic-dominated metropolitan areas, there is a lack of studies for populations with variable exposure profiles, demographic and disease characteristics. OBJECTIVE Determine the short-term effects of air pollution on cardiovascular and respiratory morbidity in the stroke and heart failure belt. METHODS We investigated the associations of fine particles and ozone with respiratory and cardiovascular emergency room visits during the 2002-2012 period for adults in Central Arkansas using Poisson generalized models adjusted for temporal, seasonal and meteorological effects. We evaluated sensitivity of the associations to mutual pollutant adjustment and effect modification patterns by sex, age, race and season. RESULTS We found effects on cardiovascular and respiratory emergencies for PM2.5 (1.52% [95% (confidence interval) CI: -1.10%, 4.20%]; 1.45% [95%CI: -2.64%, 5.72%] per 10 μg/m3) and O3 (0.93% [95%CI: -0.87%, 2.76%]; 0.76 [95%CI: -1.92%, 3.52%] per 10 ppbv) during the cold period (October-March). The effects were stronger among whites, except for the respiratory effects of O3 that were higher among Blacks/African-Americans. Effect modification patterns by age and sex differed by association. Both pollutants were associated with increases in emergency room visits for hypertension, heart failure and asthma. Effects on cardiovascular and respiratory emergencies were observed during the cold period when particulate matter was dominated by secondary nitrate and wood burning. CONCLUSION Outdoor particulate pollution during winter had an effect on cardiovascular morbidity in central Arkansas, the region with high stroke and heart disease incidence rates.
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Affiliation(s)
- Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27, Goudi, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27, Goudi, Athens, Greece
| | - Marie-Cecile G Chalbot
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, College of Public Health, 4301 West Markham St. Little Rock, AR 72205-7199, USA
| | - Ilias G Kavouras
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, College of Public Health, 4301 West Markham St. Little Rock, AR 72205-7199, USA.
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Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission. Phys Ther 2015; 95:1660-7. [PMID: 26089042 DOI: 10.2522/ptj.20140610] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions. OBJECTIVE The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission. DESIGN A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted. METHODS Patients (N=64,065) who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state. RESULTS Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy. LIMITATIONS The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates. CONCLUSIONS Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.
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Kaup AO, Santos BFCD, Victor ES, Cypriano AS, Lottenberg CL, Neto MC, Silva GS. Georeferencing deaths from stroke in São Paulo: an intra-city stroke belt? Int J Stroke 2015; 10 Suppl A100:69-74. [DOI: 10.1111/ijs.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
Abstract
Background The role of socioeconomic status in the worldwide stroke burden has been studied with various methods using vital statistics and research-generated data. Aim The objective of our study was to describe the stroke mortality rates and the stroke mortality distribution, and to evaluate the association between stroke mortality rates and geographical distribution with the human development index in São Paulo, Brazil. Methods This ecological study evaluated a historical series of stroke mortality in São Paulo, Brazil, from 2004 to 2010. Standard stroke mortality rate per 100 000 inhabitants at each year, the address of residence assumed as the place of living, and the human development index applied as a social indicator were used in order to evaluate if stroke mortality correlated with socioeconomic status. Results The mean standardized stroke mortality in São Paulo decreased from 66 to 46-7 per 100 000 inhabitants from 2004 to 2010. Stroke mortality differed according to human development index strata with an almost three times higher stroke mortality in the lowest when compared with the highest human development index stratum. Visual inspection of the map of the districts with high stroke mortality disclosed regional clusters with high mortality in the east, northwest, and south regions, a finding suggestive of the presence of a stroke belt inside the city of São Paulo. Conclusions In conclusion, between 2004 and 2010, stroke mortality rates decreased by 28-5% in São Paulo. A geographical pattern in stroke mortality could be observed, with considerable differences according the human development index level of the place of living.
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Affiliation(s)
- Alexandre O. Kaup
- Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Elivane S. Victor
- Institute de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Adriana S. Cypriano
- Divisão de Prática Médica, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | | | - Gisele S. Silva
- Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
- Disciplina de Neurologia Clinica, Universidade Federal de São Paulo, São Paulo, Brasil
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Jokela M. Does neighbourhood deprivation cause poor health? Within-individual analysis of movers in a prospective cohort study. J Epidemiol Community Health 2015; 69:899-904. [PMID: 25878354 DOI: 10.1136/jech-2014-204513] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 03/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neighbourhood deprivation has been associated with poor health. The evidence for social causation, however, remains scarce because selective residential mobility may also create neighbourhood differences. The present study examined whether individuals had poorer health when they were living in a deprived neighbourhood compared to another time when the same individuals were living in a less deprived neighbourhood. METHODS Participants were from the British Household Panel Survey prospective cohort study with 18 annual measurements of residential location and self-reported health outcomes between 1991 and 2009 (n=137 884 person-observations of 17 001 persons in England). Neighbourhood deprivation was assessed concurrently with health outcomes using the Index of Multiple Deprivation at the geographically detailed level of Lower Layer Super Output Areas. The main analyses were replicated in subsamples from Scotland (n=4897) and Wales (n=4442). Multilevel regression was used to separate within-individual and between-individuals associations. RESULTS Neighbourhood deprivation was associated with poorer self-rated health, and with higher psychological distress, functional health limitations and number of health problems. These associations were almost exclusively due to differences between different individuals rather than within-individual variations related to different neighbourhoods. By contrast, poorer health was associated with lower odds of moving to less deprived neighbourhoods among movers. The analysis was limited by the restricted within-individual variation and measurement imprecision of neighbourhood deprivation. CONCLUSIONS Individuals living in deprived neighbourhoods have poorer health, but it appears that neighbourhood deprivation is not causing poorer health of adults. Instead, neighbourhood health differentials may reflect the more fundamental social inequalities that determine health and ability to move between deprived and non-deprived neighbourhoods.
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Affiliation(s)
- Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland Department of Psychology, University of Cambridge, Cambridge, UK
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Ellis C, Boan AD, Turan TN, Ozark S, Bachman D, Lackland DT. Racial Differences in Poststroke Rehabilitation Utilization and Functional Outcomes. Arch Phys Med Rehabil 2015; 96:84-90. [DOI: 10.1016/j.apmr.2014.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW Racial, ethnic and socioeconomic disparities in chronic kidney disease (CKD) have been documented for decades, yet little progress has been made in mitigating them. Several recent studies offer new insights into the root causes of these disparities, point to areas in which future research is warranted, and identify opportunities for changes in policy and clinical practice. RECENT FINDINGS Recently published evidence suggests that geographic disparities in CKD prevalence exist and vary by race. CKD progression is more rapid for racial and ethnic minority groups compared with whites and may be largely, but not completely, explained by genetic factors. Stark socioeconomic disparities in outcomes for dialysis patients exist and vary by race, place of residence, and treatment facility. Disparities in access to living kidney donation may be driven primarily by the socioeconomic status of the donor as opposed to recipient factors. SUMMARY Recent studies highlight opportunities to eliminate disparities in CKD, including efforts to direct resources to areas and populations where disparities are most prevalent, efforts to understand how to best use emerging information on the contribution of genetic factors to disparities, and continued work to identify modifiable environmental, social, and behavioral factors for targeted interventions among high-risk populations.
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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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Socioeconomic Determinants of Cardiovascular Disease: Recent Findings and Future Directions. CURR EPIDEMIOL REP 2014. [DOI: 10.1007/s40471-014-0010-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nathenson PA, Nathenson SL, Divito KS. Implementing the new CARF wellness standards. J Stroke Cerebrovasc Dis 2014; 23:1118-30. [PMID: 24661644 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/14/2013] [Accepted: 09/21/2013] [Indexed: 10/25/2022] Open
Abstract
Our objectives in this article are to provide background and practical applications of the implementation of the new wellness standards developed by the Commission on Accreditation of Rehabilitation Facilities (CARF). The focus of rehabilitation in the stroke population ideally extends beyond maximizing functioning and prevention of further debilitation, by addressing wellness and the opportunity to create a healthy lifestyle. This concept has been recognized by CARF, which has included new wellness standards for stroke rehabilitation. This article provides a framework for implementing these standards and trends related to prevalence, incidence, and prevention of stroke. The Transtheoretical Model of Change, as described by James Prochaska, is discussed in relation to facilitating lifestyle changes in stroke patients in the rehabilitation setting. Additionally, the Six Dimensions of Wellness Model by Dr Bill Hettler is presented as a framework for developing a wellness tool. Finally, we discuss the development, barriers, and implementation of a wellness tool used at Madonna Rehabilitation Hospital to exemplify a tangible strategy to meet the new CARF standards.
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Affiliation(s)
- Paul A Nathenson
- Integrative Health and Community Services, Madonna Rehabilitation Hospital, Lincoln, Nebraska
| | - Sophia L Nathenson
- Department of Humanities and Social Sciences, Medical Sociology Oregon Institute of Technology, Klamath Falls, Oregon.
| | - Karen S Divito
- Rehabilitation Programs, Madonna Rehabilitation Hospital, Lincoln, Nebraska
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Balamurugan A, Delongchamp R, Bates JH, Mehta JL. The Neighborhood Where You Live Is a Risk Factor for Stroke. Circ Cardiovasc Qual Outcomes 2013; 6:668-73. [DOI: 10.1161/circoutcomes.113.000265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The excess stroke mortality in the southeastern states of the United States (stroke-belt states) is well known; however, the factors associated with this pattern have not been fully elucidated. We measured the contribution of several demographic factors by analyzing stroke mortality data (2005–2009) at the census block group (BG) level in the state of Arkansas.
Methods and Results—
Census BGs were used as proxies for neighborhoods. BGs were stratified using 5 census measures: poverty (percent of population below federal poverty level), population density (population per square mile), education (percent of population aged >25 years who did not graduate from high school), population mobility (percent of population who resided at the same address 1 year ago), and the percent of non-Hispanic blacks (percent of population that is black). Generalized additive models were used to estimate the variation in stroke mortality among BGs and to assess the impact of different demographic variables. From 2005 to 2009, there were 8930 stroke deaths in Arkansas. There was considerable variation in the relative risk even between adjacent BGs within a single county. The geographically weighted regression analyses indicated that 4.5% to 9% of deviance in stroke mortality among BGs could be explained by poverty, education, population density, and population mobility. Race/ethnicity (non-Hispanic blacks) explains <2% of the deviance in stroke mortality among BGs.
Conclusions—
Our study shows that primordial risk factors such as poverty and education drive disparities in stroke mortality among neighborhoods in Arkansas.
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Affiliation(s)
- Appathurai Balamurugan
- From the Arkansas Department of Health (A.B., R.D., J.H.B.), Little Rock; Department of Family and Preventive Medicine (A.B.) and Department of Internal Medicine, Division of Cardiology (J.L.M.), University of Arkansas for Medical Sciences College of Medicine, Little Rock; and Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock (A.B., R.D., J.H.B.)
| | - Robert Delongchamp
- From the Arkansas Department of Health (A.B., R.D., J.H.B.), Little Rock; Department of Family and Preventive Medicine (A.B.) and Department of Internal Medicine, Division of Cardiology (J.L.M.), University of Arkansas for Medical Sciences College of Medicine, Little Rock; and Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock (A.B., R.D., J.H.B.)
| | - Joseph H. Bates
- From the Arkansas Department of Health (A.B., R.D., J.H.B.), Little Rock; Department of Family and Preventive Medicine (A.B.) and Department of Internal Medicine, Division of Cardiology (J.L.M.), University of Arkansas for Medical Sciences College of Medicine, Little Rock; and Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock (A.B., R.D., J.H.B.)
| | - Jawahar L. Mehta
- From the Arkansas Department of Health (A.B., R.D., J.H.B.), Little Rock; Department of Family and Preventive Medicine (A.B.) and Department of Internal Medicine, Division of Cardiology (J.L.M.), University of Arkansas for Medical Sciences College of Medicine, Little Rock; and Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock (A.B., R.D., J.H.B.)
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Wetmore JB, Ellerbeck EF, Mahnken JD, Phadnis MA, Rigler SK, Spertus JA, Zhou X, Mukhopadhyay P, Shireman TI. Stroke and the "stroke belt" in dialysis: contribution of patient characteristics to ischemic stroke rate and its geographic variation. J Am Soc Nephrol 2013; 24:2053-61. [PMID: 23990675 DOI: 10.1681/asn.2012111077] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index >30 kg/m(2) was inversely associated with stroke (P<0.001 for each). After full multivariable adjustment, the three states with O/E rate ratios >1.0 were all in the South: North Carolina, Mississippi, and Oklahoma. Regional efforts to increase primary prevention in the "stroke belt" or to better educate dialysis patients on the signs of stroke so that they may promptly seek care may improve stroke care and outcomes in dialysis patients.
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Affiliation(s)
- James B Wetmore
- Department of Medicine, Division of Nephrology and Hypertension
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Kazley AS, Simpson KN, Simpson A, Jauch E, Adams RJ. Optimizing the Economic Impact of rtPA Use in a Stroke Belt State: The Case of South Carolina. AMERICAN HEALTH & DRUG BENEFITS 2013; 6:155-163. [PMID: 24991353 PMCID: PMC4031709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Stroke is the fourth leading cause of death in the United States, and its incidence is especially high in South Carolina. Recombinant tissue plasminogen activator (rtPA) has been given to patients with acute ischemic stroke since 1996 and has shown overall improved outcomes relative to patients who are not treated with rtPA. OBJECTIVE A 1998 study by Fagan and colleagues reported the economic impact of the use of rtPA. The purpose of this current article is to present an updated economic analysis of the impact of rtPA. METHODS In the current analysis, an updated estimate of the economic and health benefits of treatment with rtPA in South Carolina was provided using estimates of cost, incidence, and course of treatment from several data sources. The Markov model in the 1998 study was used as a guide in this current study; we sought to replicate the methodology, while providing updated economic figures and applying it to the state of South Carolina. We estimated the costs per 1000 patients who are eligible for treatment with rtPA compared with 1000 untreated patients, as well as routine medical practice and outcomes of quality-adjusted life-years (QALYs) and economic costs based on whether a patient was treated with rtPA or not. We calculated the number of stroke cases that would be treated with rtPA if the rate were to increase from 3% to 20%, using the most recent number of strokes in South Carolina and prorating for 5 years to estimate the total expected cost-savings with increased rtPA use. RESULTS The results indicate that the use of rtPA in South Carolina accounts for a cost-savings of $3454 per treated patient over a 6-year period. The model estimates an increase of 0.425 QALYs (or 5.1 quality-adjusted months) of survival per patient treated with rtPA. Over the lifetime of a treated patient, the estimated cost-savings are $4084, with an accrued health benefit of 0.692 QALYs (or 8.3 quality-adjusted months). For every 100 patients treated with rtPA, there is a gain of 69.17 QALYs and of $408,419 over the lifetime of 100 treated patients with acute ischemic stroke. We calculated that the cost-savings gained by increasing the rtPA treatment rate in a state with a high incidence of stroke from the current 3% rate to an achievable 20% rate over a 5-year period would be $16,615,723. CONCLUSIONS This new analysis demonstrates a significant savings associated with the use of rtPA for patients with stroke and provides great support for the increased systematic use of rtPA in the state of South Carolina for patients with acute ischemic stroke. For every additional 100 patients who are treated with rtPA in South Carolina, a robust savings supports the wider economic benefit that would be gained with an increased use of rtPA.
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Affiliation(s)
- Abby Swanson Kazley
- Program Director, Master of Health Administration Program, and Associate Professor, Department of Health Care Management and Leadership
| | - Kit N Simpson
- Professor, Department of Health Care Management and Leadership, Medical University of South Carolina
| | - Annie Simpson
- Assistant Professor, Department of Health Care Management and Leadership, Medical University of South Carolina
| | - Edward Jauch
- Professor, Department of Neurosciences, Medical University of South Carolina
| | - Robert J Adams
- Distinguished Professor and Co-Director, Comprehensive Stroke and Cerebrovascular Center, Medical University of South Carolina
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Howard VJ, McClure LA, Glymour MM, Cunningham SA, Kleindorfer DO, Crowe M, Wadley VG, Peace F, Howard G, Lackland DT. Effect of duration and age at exposure to the Stroke Belt on incident stroke in adulthood. Neurology 2013; 80:1655-61. [PMID: 23616168 PMCID: PMC3716470 DOI: 10.1212/wnl.0b013e3182904d59] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/19/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether there are differences in the strength of association with incident stroke for specific periods of life in the Stroke Belt (SB). METHODS The risk of stroke was studied in 24,544 black and white stroke-free participants, aged 45+, in the Reasons for Geographic and Racial Differences in Stroke study, a national population-based cohort enrolled 2003-2007. Incident stroke was defined as first occurrence of stroke over an average 5.8 years of follow-up. Residential histories (city/state) were obtained by questionnaire. SB exposure was quantified by combinations of SB birthplace and current residence and proportion of years in SB during discrete age categories (0-12, 13-18, 19-30, 31-45, last 20 years) and entire life. Proportional hazards models were used to establish association of incident stroke with indices of exposure to SB, adjusted for demographic, socioeconomic (SES), and stroke risk factors. RESULTS In the demographic and SES models, risk of stroke was significantly associated with proportion of life in the SB and with all other exposure periods except birth, ages 31-45, and current residence. The strongest association was for the proportion of the entire life in SB. After adjustment for risk factors, the risk of stroke remained significantly associated only with proportion of residence in SB in adolescence (hazard ratio 1.17, 95% confidence interval 1.00-1.37). CONCLUSIONS Childhood emerged as the most important period of vulnerability to SB residence as a predictor of future stroke. Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies in the SB.
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Affiliation(s)
- Virginia J Howard
- Departments of Epidemiology, School of Medicine, University of Alabama at Birmingham, USA.
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Plantinga L, Howard VJ, Judd S, Muntner P, Tanner R, Rizk D, Lackland DT, Warnock DG, Howard G, McClellan WM. Association of duration of residence in the southeastern United States with chronic kidney disease may differ by race: the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Int J Health Geogr 2013; 12:17. [PMID: 23518004 PMCID: PMC3606831 DOI: 10.1186/1476-072x-12-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/03/2013] [Indexed: 11/24/2022] Open
Abstract
Background Prior evidence suggests that longer duration of residence in the southeastern United States is associated with higher prevalence of diabetes and hypertension. We postulated that a similar association would exist for chronic kidney disease (CKD). Methods In a national population-based cohort study that enrolled 30,239 men and women ≥ 45 years old (42% black/58% white; 56% residing in the Southeast) between 2003 and 2007, lifetime southeastern residence duration was calculated and categorized [none (0%), less than half (>0-< 50%), half or more (≥50-< 100%), and all (100%)]. Prevalent albuminuria (single spot urinary albumin:creatinine ratio of ≥30 mg/g) and reduced kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) were defined at enrollment. Incident end-stage renal disease (ESRD) during follow-up was identified through linkage to United States Renal Data System. Results White and black participants most often reported living their entire lives outside (35.7% and 27.0%, respectively) or inside (27.9% and 33.8%, respectively) the southeastern United States. The prevalence of neither albuminuria nor reduced kidney function was statistically significantly associated with southeastern residence duration, in either race. ESRD incidence was not statistically significantly associated with all vs. none southeastern residence duration (HR = 0.50, 95% CI, 0.22-1.14) among whites, whereas blacks with all vs. none exposure showed increased risk of ESRD (HR = 1.63, 95% CI, 1.02-2.63; PraceXduration = 0.011). Conclusions These data suggest that blacks but not whites who lived in the Southeast their entire lives were at increased risk of ESRD, but we found no clear geographic pattern for earlier-stage CKD.
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Affiliation(s)
- Laura Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA, USA.
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Glymour MM, Benjamin EJ, Kosheleva A, Gilsanz P, Curtis LH, Patton KK. Early life predictors of atrial fibrillation-related mortality: evidence from the health and retirement study. Health Place 2013; 21:133-9. [PMID: 23454734 DOI: 10.1016/j.healthplace.2012.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 12/12/2012] [Accepted: 12/21/2012] [Indexed: 11/17/2022]
Abstract
Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality.
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Affiliation(s)
- M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 617, Boston, MA 02115, USA.
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Abstract
Southeastern part of United States has been called the Stroke Belt due to a much higher incidence of stroke compared to the rest of the country. In this article, I summarize my 2 weeks of observations as a clinical preceptor at the Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL. 57 patients were admitted during these 2 weeks, 61% had ischemic strokes, and 23% received intravenous recombinant tissue plasminogen activator (IV rt-PA). Endovascular neuro-interventionalists were performing diagnostic catheter angiography in 14% and emergent revascularization procedures in 7% of consecutive patients. Also, the stroke team enrolled 6 patients into National institute of health (NIH) funded clinical trials (3 Argatroban tPA stroke study (ARTSS), 2 Safety study of external counter pulsation as a treatment for acute ischemic stroke (CUFFS), 1 stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS). In my opinion, these observations provided me with useful knowledge how to develop a cutting edge, proactive stroke treatment system. In particular, availability 24 × 7 and consistent application of a curative, "finding reasons to treat approach" coupled with state-of the-art technologies and skilled operators could make a huge difference.
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Affiliation(s)
- Lokesh Bathala
- Department of Neurology, Narayana Medical College and Hospital, Nellore AP, India
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Ennen KA, Beamon ER. Women and Stroke Knowledge: Influence of Age, Race, Residence Location, and Marital Status. Health Care Women Int 2012; 33:922-42. [DOI: 10.1080/07399332.2012.673662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Datta GD, Glymour MM, Kosheleva A, Chen JT. Prostate cancer mortality and birth or adult residence in the southern United States. Cancer Causes Control 2012; 23:1039-46. [PMID: 22547136 DOI: 10.1007/s10552-012-9970-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/14/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE Although there are few confirmed risk factors for prostate cancer (PCa), mortality rates are known to vary geographically across the United States. PCa mortality is higher among black and younger white men in a band of states spanning from Washington DC to Louisiana (the "PCa belt"). This study assessed the associations of birth and adult residence in the PCa belt with PCa mortality among black and white men and trends in these associations over time. METHODS PCa-specific mortality rates in 1980, 1990, and 2000 for black and white men born in the continental US, aged 40-89, were calculated by linking national mortality records with population data based on birth state, state of residence at the census, race, and age. PCa belt (Washington DC, Virginia, North Carolina, South Carolina, Georgia, Mississippi, Alabama, and Louisiana) birth was cross-classified against PCa belt adult residence. RESULTS Black men born in the PCa belt had elevated PCa mortality in 1980, 1990, and 2000. Associations were independent of adult residence in the PCa belt. For example, in 2000, black men aged 65-89 who were born in the PCa belt but no longer lived there in adulthood had an odds ratio of 1.19 (1.14-1.24) for PCa mortality compared to black men born and residing outside the PCa belt. The PCa belt was not associated with PCa mortality among whites. CONCLUSIONS Geographically patterned childhood exposures, for example, differences in social or environmental conditions, or behavioral norms, may influence PCa mortality.
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Affiliation(s)
- Geetanjali D Datta
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, QC, Canada.
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Geographic distribution of dementia mortality: elevated mortality rates for black and white Americans by place of birth. Alzheimer Dis Assoc Disord 2011; 25:196-202. [PMID: 21297428 DOI: 10.1097/wad.0b013e31820905e7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We hypothesized that patterns of elevated stroke mortality among those born in the United States Stroke Belt (SB) states also prevailed for mortality related to all-cause dementia or Alzheimer Disease. Cause-specific mortality (contributing cause of death, including underlying cause cases) rates in 2000 for United States-born African Americans and whites aged 65 to 89 years were calculated by linking national mortality records with population data based on race, sex, age, and birth state or state of residence in 2000. Birth in a SB state (NC, SC, GA, TN, AR, MS, or AL) was cross-classified against SB residence at the 2000 Census. Compared with those who were not born in the SB, odds of all-cause dementia mortality were significantly elevated by 29% for African Americans and 19% for whites born in the SB. These patterns prevailed among individuals who no longer lived in the SB at death. Patterns were similar for Alzheimer Disease-related mortality. Some non-SB states were also associated with significant elevations in dementia-related mortality. Dementia mortality rates follow geographic patterns similar to stroke mortality, with elevated rates among those born in the SB. This suggests important roles for geographically patterned childhood exposures in establishing cognitive reserve.
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Pedigo A, Aldrich T, Odoi A. Neighborhood disparities in stroke and myocardial infarction mortality: a GIS and spatial scan statistics approach. BMC Public Health 2011; 11:644. [PMID: 21838897 PMCID: PMC3171373 DOI: 10.1186/1471-2458-11-644] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 08/12/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stroke and myocardial infarction (MI) are serious public health burdens in the US. These burdens vary by geographic location with the highest mortality risks reported in the southeastern US. While these disparities have been investigated at state and county levels, little is known regarding disparities in risk at lower levels of geography, such as neighborhoods. Therefore, the objective of this study was to investigate spatial patterns of stroke and MI mortality risks in the East Tennessee Appalachian Region so as to identify neighborhoods with the highest risks. METHODS Stroke and MI mortality data for the period 1999-2007, obtained free of charge upon request from the Tennessee Department of Health, were aggregated to the census tract (neighborhood) level. Mortality risks were age-standardized by the direct method. To adjust for spatial autocorrelation, population heterogeneity, and variance instability, standardized risks were smoothed using Spatial Empirical Bayesian technique. Spatial clusters of high risks were identified using spatial scan statistics, with a discrete Poisson model adjusted for age and using a 5% scanning window. Significance testing was performed using 999 Monte Carlo permutations. Logistic models were used to investigate neighborhood level socioeconomic and demographic predictors of the identified spatial clusters. RESULTS There were 3,824 stroke deaths and 5,018 MI deaths. Neighborhoods with significantly high mortality risks were identified. Annual stroke mortality risks ranged from 0 to 182 per 100,000 population (median: 55.6), while annual MI mortality risks ranged from 0 to 243 per 100,000 population (median: 65.5). Stroke and MI mortality risks exceeded the state risks of 67.5 and 85.5 in 28% and 32% of the neighborhoods, respectively. Six and ten significant (p < 0.001) spatial clusters of high risk of stroke and MI mortality were identified, respectively. Neighborhoods belonging to high risk clusters of stroke and MI mortality tended to have high proportions of the population with low education attainment. CONCLUSIONS These methods for identifying disparities in mortality risks across neighborhoods are useful for identifying high risk communities and for guiding population health programs aimed at addressing health disparities and improving population health.
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Affiliation(s)
- Ashley Pedigo
- The University of Tennessee, Department of Comparative Medicine, 2407 River Drive Knoxville, Tennessee 37996-4543, USA
| | - Tim Aldrich
- East Tennessee State University, Department of Biostatistics and Epidemiology, P.O. Box 70259, Johnson City, TN 37614-1709, USA
| | - Agricola Odoi
- The University of Tennessee, Department of Comparative Medicine, 2407 River Drive Knoxville, Tennessee 37996-4543, USA
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Early-life antecedents of atrial fibrillation: place of birth and atrial fibrillation-related mortality. Ann Epidemiol 2011; 21:732-8. [PMID: 21798760 DOI: 10.1016/j.annepidem.2011.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/09/2011] [Accepted: 06/03/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE Recent evidence suggests early-life factors correlate with atrial fibrillation (AF). We hypothesized that AF-related mortality, similar to stroke mortality, is elevated for individuals born in the southeastern United States. METHODS We estimated 3-year (1999-2001) average AF-related mortality rates by using U.S. vital statistics for 55- to 89-year-old white (136,573 AF-related deaths) and black subjects (8,288 AF-related deaths). We estimated age- and sex-adjusted odds of AF-related (contributing cause) mortality associated with birth state, and birth within the U.S. stroke belt (SB), stratified by race. SB results were replicated with the use of 1989-1991 data. RESULTS Among black subjects, four contiguous birth states were associated with statistically significant odds ratios ≥ 1.25 compared with the national average AF-related mortality. The four highest-risk birth states for blacks also predicted elevated AF-related mortality among white subjects, but patterns were attenuated. The odds ratio for AF-related mortality associated with SB birth was 1.19 (confidence interval 1.13-1.25) for black and 1.09 (CI 1.07-1.12) for white subjects when we adjusted for SB adult residence. CONCLUSIONS Place of birth predicted AF-related mortality, after we adjusted for place of adult residence. The association of AF-related mortality and SB birth parallels that of other cardiovascular diseases and may likewise indicate an importance of early life factors in the development of AF.
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