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Dodge J, Sullivan K, Miech E, Clomax A, Riviere L, Castro C. Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives. J Racial Ethn Health Disparities 2024; 11:669-684. [PMID: 36952121 PMCID: PMC10933139 DOI: 10.1007/s40615-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization's SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity. METHOD This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (N = 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research. RESULTS Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup: non-Hispanic Black: employment and a history of adverse childhood events (ACEs); Hispanic: living off post and a recent childbirth; junior enlisted non-Hispanic White: high work-family conflict and ACEs; non-Hispanic other race: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other). DISCUSSION These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.
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Affiliation(s)
- Jessica Dodge
- Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Kathrine Sullivan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Edward Miech
- Regenstrief Institute, Center for Health Services Research, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Adriane Clomax
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
| | - Lyndon Riviere
- Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Carl Castro
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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Joseph JJ, Williams A, Azap RA, Zhao S, Brock G, Kline D, Odei JB, Foraker R, Sims M, Brewer LC, Gray DM, Nolan TS. Role of Sex in the Association of Socioeconomic Status With Cardiovascular Health in Black Americans: The Jackson Heart Study. J Am Heart Assoc 2023; 12:e030695. [PMID: 38038179 PMCID: PMC10727326 DOI: 10.1161/jaha.123.030695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study. METHODS AND RESULTS American Heart Association CVH components (non-high-density-lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross-sectionally at baseline (scale: 0-100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting for age, sex, and discrimination. Heterogeneity by sex was assessed. Participants had a mean age of 54.8 years (SD 12.6 years), and 65% were women. Lower income, education, occupation (non-management/professional versus management/professional occupations), and insurance status (uninsured, Medicaid, Veterans Affairs, or Medicare versus private insurance) were associated with lower CVH scores (all P<0.01). There was heterogeneity by sex, with greater magnitude of associations of SES measures with CVH in women versus men. The lowest education level (high school) was associated with 8.8-point lower (95% CI: -10.2 to -7.3) and 5.4-point lower (95% CI: -7.2 to -3.6) CVH scores in women and men, respectively (interaction P=0.003). The lowest (<25 000) versus highest level of income (≥$75 000) was associated with a greater reduction in CVH scores in women than men (interaction P=0.1142). CONCLUSIONS Among Black Americans, measures of SES were associated with CVH, with a greater magnitude in women compared with men for education and income. Interventions aimed to address CVH through SES should consider the role of sex.
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Affiliation(s)
| | | | | | - Songzhu Zhao
- The Ohio State University College of MedicineColumbusOHUSA
| | - Guy Brock
- The Ohio State University College of MedicineColumbusOHUSA
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNCUSA
| | - James B. Odei
- The Ohio State University College of Public HealthColumbusOHUSA
| | - Randi Foraker
- Department of Internal Medicine and Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMOUSA
| | | | - LaPrincess C. Brewer
- Department of Cardiovascular MedicineCenter for Health Equity and Community Engagement Research, Mayo ClinicRochesterMNUSA
| | - Darrell M. Gray
- Elevance Health (formerly of The Ohio State University Wexner Medical Center)IndianapolisINUSA
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Shim SY, Lee H. Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44569. [PMID: 38039072 PMCID: PMC10724809 DOI: 10.2196/44569] [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: 11/24/2022] [Revised: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. OBJECTIVE We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. METHODS The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. RESULTS Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). CONCLUSIONS Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance.
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Affiliation(s)
- Sun Young Shim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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McNeill E, Lindenfeld Z, Mostafa L, Zein D, Silver D, Pagán J, Weeks WB, Aerts A, Des Rosiers S, Boch J, Chang JE. Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review. J Am Heart Assoc 2023; 12:e030571. [PMID: 37929716 PMCID: PMC10727404 DOI: 10.1161/jaha.123.030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023]
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.
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Affiliation(s)
- Elizabeth McNeill
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Zoe Lindenfeld
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Logina Mostafa
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Dina Zein
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Diana Silver
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - José Pagán
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - William B. Weeks
- Microsoft Corporation, Precision Population Health, Microsoft ResearchRedmondWAUSA
| | - Ann Aerts
- The Novartis FoundationBaselSwitzerland
| | | | | | - Ji Eun Chang
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
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Thomas RD, Davis JW, Cuccaro PM, Gemeinhardt GL. Assessing associations between insecure income and US workers’ health: An IPUMS-MEPS analysis. Soc Sci Med 2022; 309:115240. [DOI: 10.1016/j.socscimed.2022.115240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/23/2022] [Indexed: 10/15/2022]
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Bucholz EM, Butala NM, Allen NB, Moran AE, de Ferranti SD. Age, Sex, Race/Ethnicity, and Income Patterns in Ideal Cardiovascular Health Among Adolescents and Adults in the U.S. Am J Prev Med 2022; 62:586-595. [PMID: 35012831 PMCID: PMC9279114 DOI: 10.1016/j.amepre.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Ideal cardiovascular health is present in <50% of children and <1% of adults, yet its prevalence from adolescence through adulthood has not been fully evaluated. This study characterizes the association of age with ideal cardiovascular health and compares these associations across sex, race/ethnicity, and SES subgroups. METHODS This study, conducted in 2020, analyzed adolescents and adults aged 12-79 years from the cross-sectional National Health and Nutrition Examination Survey 2005-2016 (N=38,706). Polynomial models were used to model the association of age with ideal cardiovascular health, defined using the American Heart Association's Life's Simple 7 criteria (scales 0-14, with higher values indicating better cardiovascular health). RESULTS Mean cardiovascular health was lower with increasing age, starting in early adolescence and dropping to a nadir by age 60 years before stabilizing. At age 20 years, only 45% of adults had ideal cardiovascular health (≥5 ideal cardiovascular health metrics), and >50% of adults had poor cardiovascular health (≤2 ideal cardiovascular health metrics) at age 53 years. Women had higher mean cardiovascular health than men in early life but lower mean cardiovascular health from age 60 years onward. Mean cardiovascular health scores were highest for non-Hispanic White and higher-income adults and lowest for non-Hispanic Black and low-income adults across all ages. Mean cardiovascular health scores fell from intermediate to poor levels approximately 30 years earlier for non-Hispanic Black than for non-Hispanic White adults and approximately 35 years earlier for low-income adults than in higher-income adults. CONCLUSIONS Cardiovascular health scores are lower with increasing age from early adolescence through adulthood. Race/ethnicity and income disparities in cardiovascular health are observed at young ages and are more profound at older ages.
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Affiliation(s)
- Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Neel M Butala
- Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Personalizing cholesterol treatment recommendations for primary cardiovascular disease prevention. Sci Rep 2022; 12:23. [PMID: 34996943 PMCID: PMC8742083 DOI: 10.1038/s41598-021-03796-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022] Open
Abstract
Statin therapy is the cornerstone of preventing atherosclerotic cardiovascular disease (ASCVD), primarily by reducing low density lipoprotein cholesterol (LDL-C) levels. Optimal statin therapy decisions rely on shared decision making and may be uncertain for a given patient. In areas of clinical uncertainty, personalized approaches based on real-world data may help inform treatment decisions. We sought to develop a personalized statin recommendation approach for primary ASCVD prevention based on historical real-world outcomes in similar patients. Our retrospective cohort included adults from a large Northern California electronic health record (EHR) aged 40–79 years with no prior cardiovascular disease or statin use. The cohort was split into training and test sets. Weighted-K-nearest-neighbor (wKNN) regression models were used to identify historical EHR patients similar to a candidate patient. We modeled four statin decisions for each patient: none, low-intensity, moderate-intensity, and high-intensity. For each candidate patient, the algorithm recommended the statin decision that was associated with the greatest percentage reduction in LDL-C after 1 year in similar patients. The overall cohort consisted of 50,576 patients (age 54.6 ± 9.8 years) with 55% female, 48% non-Hispanic White, 32% Asian, and 7.4% Hispanic patients. Among 8383 test-set patients, 52%, 44%, and 4% were recommended high-, moderate-, and low-intensity statins, respectively, for a maximum predicted average 1-yr LDL-C reduction of 16.9%, 20.4%, and 14.9%, in each group, respectively. Overall, using aggregate EHR data, a personalized statin recommendation approach identified the statin intensity associated with the greatest LDL-C reduction in historical patients similar to a candidate patient. Recommendations included low- or moderate-intensity statins for maximum LDL-C lowering in nearly half the test set, which is discordant with their expected guideline-based efficacy. A data-driven personalized statin recommendation approach may inform shared decision making in areas of uncertainty, and highlight unexpected efficacy-effectiveness gaps.
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Azap RA, Nolan TS, Gray DM, Lawson K, Gregory J, Capers Q, Odei JB, Joseph JJ. Association of Socioeconomic Status With Ideal Cardiovascular Health in Black Men. J Am Heart Assoc 2021; 10:e020184. [PMID: 34816728 PMCID: PMC9075410 DOI: 10.1161/jaha.120.020184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Black men are burdened by high cardiovascular risk and the highest all‐cause mortality rate in the United States. Socioeconomic status (SES) is associated with improved cardiovascular risk factors in majority populations, but there is a paucity of data in Black men. Methods and Results We examined the association of SES measures including educational attainment, annual income, employment status, and health insurance status with an ideal cardiovascular health (ICH) score, which included blood pressure, glucose, cholesterol, body mass index, physical activity, and smoking in African American Male Wellness Walks. Six metrics of ICH were categorized into a 3‐tiered ICH score 0 to 2, 3 to 4, and 5 to 6. Multinomial logistic regression modeling was performed to examine the association of SES measures with ICH scores adjusted for age. Among 1444 men, 7% attained 5 to 6 ICH metrics. Annual income <$20 000 was associated with a 56% lower odds of attaining 3 to 4 versus 0 to 2 ICH components compared with ≥$75 000 (P=0.016). Medicare and no insurance were associated with a 39% and 35% lower odds of 3 to 4 versus 0 to 2 ICH components, respectively, compared with private insurance (all P<0.05). Education and employment status were not associated with higher attainment of ICH in Black men. Conclusions Among community‐dwelling Black men, higher attainment of measures of SES showed mixed associations with greater attainment of ICH. The lack of association of higher levels of educational attainment and employment status with ICH suggests that in order to address the long–standing health inequities that affect Black men, strategies to increase attainment of cardiovascular health may need to address additional components beyond SES.
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Affiliation(s)
| | - Timiya S Nolan
- The Ohio State University College of Nursing Columbus OH.,The Ohio State University Wexner Medical Center Columbus OH
| | - Darrell M Gray
- The Ohio State University College of Medicine Columbus OH.,The Ohio State University Wexner Medical Center Columbus OH.,The Ohio State University James Center for Cancer Health Equity Columbus OH
| | - Kiwan Lawson
- The African American Male Wellness AgencyNational Center for Urban Solutions Columbus OH
| | - John Gregory
- The African American Male Wellness AgencyNational Center for Urban Solutions Columbus OH
| | - Quinn Capers
- The Ohio State University College of Medicine Columbus OH.,The Ohio State University Wexner Medical Center Columbus OH
| | - James B Odei
- The Ohio State University College of Public Health Columbus OH
| | - Joshua J Joseph
- The Ohio State University College of Medicine Columbus OH.,The Ohio State University Wexner Medical Center Columbus OH
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Baxter SLK, Chung R, Frerichs L, Thorpe RJ, Skinner AC, Weinberger M. Racial Residential Segregation and Race Differences in Ideal Cardiovascular Health among Young Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157755. [PMID: 34360047 PMCID: PMC8345482 DOI: 10.3390/ijerph18157755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Background: Race disparities in cardiovascular disease (CVD) related morbidity and mortality are evident among men. While previous studies show health in young adulthood and racial residential segregation (RRS) are important factors for CVD risk, these factors have not been widely studied in male populations. We sought to examine race differences in ideal cardiovascular health (CVH) among young men (ages 24–34) and whether RRS influenced this association. Methods: We used cross-sectional data from young men who participated in Wave IV (2008) of the National Longitudinal Survey of Adolescent to Adult Health (N = 5080). The dichotomous outcome, achieving ideal CVH, was defined as having ≥4 of the American Heart Association’s Life’s Simple 7 targets. Race (Black/White) and RRS (proportion of White residents in census tract) were the independent variables. Descriptive and multivariate analyses were conducted. Results: Young Black men had lower odds of achieving ideal CVH (OR = 0.67, 95% CI = 0.49, 0.92) than young White men. However, RRS did not have a significant effect on race differences in ideal CVH until the proportion of White residents was ≥55%. Conclusions: Among young Black and White men, RRS is an important factor to consider when seeking to understand CVH and reduce future cardiovascular risk.
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Affiliation(s)
- Samuel L. K. Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
- Correspondence: ; Tel.: +1-864-722-2004
| | - Richard Chung
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, NC 27710, USA;
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, SC 27599, USA; (L.F.); (M.W.)
| | - Roland J. Thorpe
- Hopkins Center for Health Disparities Solutions, Program for Research on Men’s Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, SC 27599, USA; (L.F.); (M.W.)
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Gold RS, Unkart JT, McClelland RL, Bertoni AG, Allison MA. Health insurance status and type associated with varying levels of glycemic control in the US: The multi-ethnic study of atherosclerosis (MESA). Prim Care Diabetes 2021; 15:378-384. [PMID: 33309035 PMCID: PMC7936947 DOI: 10.1016/j.pcd.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/24/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
AIMS To investigate associations of health insurance with measures of glucose metabolism, and whether associations vary by diabetes status or insurance type. METHODS Cross-sectional analysis of baseline data from the Multi-Ethnic Study of Atherosclerosis. Cohort a priori stratified by age <65 (N = 3,665) and ≥65 years (N = 2,924). Multivariable linear and logistic regression assessed associations between insurance and fasting glucose, HOMA-IR, and prevalent diabetes, controlling for relevant confounders, including age, sex, race/ethnicity, income, and education. RESULTS In participants <65, compared to uninsured, having any insurance was associated with lower fasting glucose in participants with diabetes (Mean Difference = -20.4 mg/dL, P = 0.01), but not in participants without diabetes. Compared to Private insurance, uninsured participants had higher fasting glucose (Mean Difference = 3.8 mg/dL, P = 0.03), while participants with Medicaid had higher HOMA-IR (Mean Difference = 3.5 mg/dL, P < 0.01). In participants ≥65, compared to Private insurance, uninsured participants (Mean Difference = 7.5 mg/dL, P = 0.02), and participants with Medicaid only (Mean Difference = 19.9 mg/dL, P < 0.01) or Medicare + Medicaid (Mean Difference = 5.2 mg/dL, P = 0.03) had higher fasting glucose. CONCLUSIONS In this large multiethnic cohort, having any insurance was associated with significantly lower fasting glucose for individuals with diabetes. Levels of fasting glucose and insulin resistance varied across different insurance types.
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Affiliation(s)
- Rebecca S Gold
- School of Medicine, University of California San Diego, La Jolla, California, USA.
| | - Jonathan T Unkart
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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13
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Rucker TW. Fanning the embers. Fam Med Community Health 2020; 7:e000209. [PMID: 32148721 PMCID: PMC6910756 DOI: 10.1136/fmch-2019-000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tinsley White Rucker
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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14
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Khambaty T, Schneiderman N, Llabre MM, Elfassy T, Moncrieft AE, Daviglus M, Talavera GA, Isasi CR, Gallo LC, Reina SA, Vidot D, Heiss G. Elucidating the Multidimensionality of Socioeconomic Status in Relation to Metabolic Syndrome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Int J Behav Med 2020; 27:188-199. [PMID: 31933127 DOI: 10.1007/s12529-020-09847-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model. METHODS A community-based cross-sectional probability sample (2008-2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy's education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually. RESULTS In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P < .001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps < .001). The income-MetSyn association was only significant for women and those with current health insurance. CONCLUSIONS Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population.
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Affiliation(s)
- Tasneem Khambaty
- Department of Psychology, University of Maryland Baltimore County, 1000 Hilltop Circle, Math/Psychology 326, Baltimore, MD, 21250, USA.
| | - Neil Schneiderman
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Maria M Llabre
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Tali Elfassy
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Ashley E Moncrieft
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Martha Daviglus
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Samantha A Reina
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Denise Vidot
- Department of Psychology and Behavioral Medicine Research Center, University of Miami, 5665 Ponce De Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Chen Z, Min J, Bian J, Wang M, Zhou L, Prosperi M. Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts. Int J Qual Health Care 2019; 31:325-330. [PMID: 30137334 DOI: 10.1093/intqhc/mzy175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/04/2018] [Accepted: 07/30/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU). DESIGN Retrospective analysis of secondary database. SETTING Ten years of public de-identified ICU electronic medical records from a large hospital in USA. PARTICIPANTS Patients (18-65 years old) who had private insurance or no insurance were extracted from the database. MAIN OUTCOME MEASURES Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities. RESULTS Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse. CONCLUSIONS Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.
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Affiliation(s)
- Zhaoyi Chen
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA
| | - Jae Min
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA
| | - Mo Wang
- Department of Management, Warrington College of Business, University of Florida, PO Box 117165, Gainesville, Florida, USA
| | - Le Zhou
- Department of Work and Organizations, Carlson School of Management, University of Minnesota, 321 19th Ave SE, Minneapolis, Minnesota, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA
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16
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Barghi A, Torres H, Kressin NR, McCormick D. Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study. J Gen Intern Med 2019; 34:1797-1805. [PMID: 31250367 PMCID: PMC6712137 DOI: 10.1007/s11606-019-05108-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/10/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (CVD) is the leading cause of death in the USA. Many with CVD or cardiovascular risk factors (CVRFs) lacked insurance coverage and access to care before enactment of the Affordable Care Act (ACA). OBJECTIVE To assess the effect of the ACA on insurance coverage, access to care, and racial/ethnic disparities among non-elderly adults with CVD or CVRFs. DESIGN Quasi-experimental policy intervention. PARTICIPANTS Nationally representative, non-institutionalized sample of 1,014,450 adults aged 18 to 64 years with CVD or at least 2 established CVRFs in the pre-ACA (2012-2013) and post-ACA (2015-2016) periods. INTERVENTION Implementation of ACA provisions on 1 January 2014. MAIN MEASURES Insurance coverage, having a check-up, having a personal physician, and not having to forgo a needed physician visit because of cost. KEY RESULTS Following ACA implementation, insurance coverage increased by 6.9 percentage points (95% CI, 6.6 to 7.2), not having to forgo a physician visit increased by 3.6 percentage points (CI, 3.3 to 3.9), having a check-up increased by 2.1 percentage points (CI, 1.8 to 2.6), and having a personal physician increased by 1 percentage point (0.6 to 1.3); changes were approximately doubled for those with lower incomes (< $35,000/year). Changes in coverage varied substantially by state and all outcomes improved more in Medicaid expansion states. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 13% black and 29% Hispanic adults continued to lack coverage and access to care post-ACA. CONCLUSION The ACA increased coverage and access for adults with CVD or multiple CVRFs; substantial gaps remain, particularly for minorities and those in Medicaid non-expansion states.
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Affiliation(s)
- Ameen Barghi
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
| | - H Torres
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - N R Kressin
- VA Boston Healthcare System, Boston, MA, USA
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - D McCormick
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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17
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Song C, Cao J, Zhang F, Wang C, Guo Z, Lin Y, Shi Y, Hu W, Ba Y, Xu H, Li W, Shi H. Nutritional Risk Assessment by Scored Patient-Generated Subjective Global Assessment Associated with Demographic Characteristics in 23,904 Common Malignant Tumors Patients. Nutr Cancer 2019; 71:50-60. [PMID: 30741002 DOI: 10.1080/01635581.2019.1566478] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Malnutrition is a problem affecting tumor patients greatly. This study aims to investigate whether demographic characteristics are related to the malnutrition of cancer patients. Twenty-three thousand nine hundred and four (23,904) patients with 16 common malignant tumors were enrolled in the study. Patient Generated Subjective Global Assessment (PG-SGA) was used as a screening tool to assess the nutritional risk of patients and analysis of variance was used to compare PG-SGA scores of patients. Correlations between PG-SGA scores and demographic characteristics were evaluated by correlation analysis. We observed that 57.88% tumor patients had some degree of malnutrition (score ≥4) and only 20.61% were well-nourished (score 0-1). Screening scores were higher among older patients for most of the tumors. PG-SGA scores showed the significant difference between females and males in some tumors. In addition, the PG-SGA scores of some tumors were significantly different in various types of medical insurances, education levels, occupations, regions, and nationalities. Correlation analysis indicated the existence of associations between PG-SGA scores and demographic characteristics. Understanding the distribution of nutritional risk of tumor patients and the correlations between the PG-SGA scores and demographic characteristics could help identify subgroups who may benefit from targeted interventions to improve the effect of clinical treatment and the quality of life for oncology patients.
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Affiliation(s)
- Chunhua Song
- a Department of Epidemiology and Statistics, College of Public Health , Zhengzhou University , Zhengzhou , PR China
| | - Jingjing Cao
- b Department of Preventive Medicine , Heze Medical College , Heze , PR China
| | - Feng Zhang
- a Department of Epidemiology and Statistics, College of Public Health , Zhengzhou University , Zhengzhou , PR China.,c Department of Immunology , Basic Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Chang Wang
- d Cancer Center of the First Hospital of Jilin University , Changchun , PR China
| | - Zengqing Guo
- e Department of Medical Oncology , Fujian Cancer Hospital, Fujian Medical University Cancer Hospital , Fuzhou , PR China
| | - Yuan Lin
- f Department of Gastrointestinal Surgery , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , PR China
| | - Yingying Shi
- g Department of Surgery , The First Affiliated Hospital of SunYat-sen University , Guangzhou , PR China
| | - Wen Hu
- h Department of Clinical Nutrition , West China Hospital of Sichuan University , Chengdu , PR China
| | - Yi Ba
- i Department of Gastrointestinal Oncology , Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy , Tianjin , PR China
| | - Hongxia Xu
- j Department of Nutrition , Daping Hospital & Research Institute of Surgery, Third Military Medical University , Chongqing , PR China
| | - Wei Li
- d Cancer Center of the First Hospital of Jilin University , Changchun , PR China
| | - Hanping Shi
- k Department of Gastrointestinal Surgery/Clinical Nutrition , Beijing Shijitan Hospital, Capital Medical University , Beijing , PR China
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18
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Connolly TM, White RS, Sastow DL, Gaber-Baylis LK, Turnbull ZA, Rong LQ. The Disparities of Coronary Artery Bypass Grafting Surgery Outcomes by Insurance Status: A Retrospective Cohort Study, 2007–2014. World J Surg 2018; 42:3240-3249. [DOI: 10.1007/s00268-018-4631-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Pilkerton CS, Singh SS, Bias TK, Frisbee SJ. Healthcare resource availability and cardiovascular health in the USA. BMJ Open 2017; 7:e016758. [PMID: 29247082 PMCID: PMC5735408 DOI: 10.1136/bmjopen-2017-016758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) remains the leading cause of death in the USA. Reducing the population-level burden of CVD disease will require a better understanding and support of cardiovascular health (CVH) in individuals and entire communities. The objectives for this study were to examine associations between community-level healthcare resources (HCrRes) and CVH in individuals and entire communities. SETTING This study consisted of a retrospective, cross-sectional study design, using multivariable epidemiological analyses. PARTICIPANTS All participants in the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey were examined for eligibility. CVH, defined using the American Heart Association CVH Index (CVHI), was determined using self-reported responses to 2011 BRFSS questions. Data for determining HCrRes were obtained from the Area Health Resource File. Regression analysis was performed to examine associations between healthcare resources and CVHI in communities (linear regression) and individuals (Poisson regression). RESULTS Mean CVHI was 3.3±0.005 and was poorer in the Southeast and Appalachian regions of the USA. Supply of primary care physicians and physician assistants were positively associated with individual and community-level CVHI, while CVD specialist supply was negatively associated with CVHI. Individuals benefiting most from increased supply of primary care providers were: middle aged; female; had non-Hispanic other race/ethnicity; those with household income <$25 000/year; and those in non-urban communities with insurance coverage. CONCLUSIONS Our results support the importance of primary care provider supply for both individual and community CVHI, though not all sociodemographic groups benefited equally from additional primary care providers. Further research should investigate policies and factors that can effectively increase primary care provider supply and influence where they practice.
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Affiliation(s)
- Courtney S Pilkerton
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, West Virgina, USA
| | - Sarah S Singh
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Thomas K Bias
- Department of Health Policy, Management & Leadership, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Stephanie J Frisbee
- Departments of Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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20
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Verma AA, Jimenez MP, Subramanian S, Sniderman AD, Razak F. Race and Socioeconomic Differences Associated With Changes in Statin Eligibility Under the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.003764. [DOI: 10.1161/circoutcomes.117.003764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Amol A. Verma
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Marcia P. Jimenez
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - S.V. Subramanian
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Allan D. Sniderman
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Fahad Razak
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
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21
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Retirement and Healthy Lifestyle: A National Health and Nutrition Examination Survey (NHANES) Data Report. J Am Board Fam Med 2017; 30:213-219. [PMID: 28379828 PMCID: PMC5494702 DOI: 10.3122/jabfm.2017.02.160244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of this study was to compare the rates of healthy lifestyle adherence among retired late-middle-aged adults with rates among those who are still working. METHODS A national cross-sectional study using data from the National Health and Nutrition Examination survey (NHANES). The main outcome was the proportion of retires versus nonretirees who were adherent to ideal or intermediate goals of the American Heart Association's Life's Simple 7, cardiovascular factors including physical activity, healthy diet, healthy weight, smoking status, total cholesterol, glucose, and blood pressure. RESULTS Retirees were more likely than nonretirees to have poorly controlled blood pressure (23.9% vs 15.1%; P = .05). However, there were no differences in healthy weight, smoking rates, healthy diet, or glucose or cholesterol control (P > .05). In controlled logistic regression analyses, retirees were more likely to be physically active than nonretirees (odds ratio, 1.85; 95% confidence interval, 1.11-3.09), but were not more likely to be following any other Life's Simple 7 factors. CONCLUSIONS Retired adults were more likely to be physically active but were not more likely to be adhering to most of the Life's Simple 7 lifestyle and cardiovascular risk factors. More public health attention to encouraging healthy lifestyles during the transition into retirement may be warranted.
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22
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Empana JP, Perier MC, Singh-Manoux A, Gaye B, Thomas F, Prugger C, Plichart M, Wiernik E, Guibout C, Lemogne C, Pannier B, Boutouyrie P, Jouven X. Cross-sectional analysis of deprivation and ideal cardiovascular health in the Paris Prospective Study 3. Heart 2016; 102:1890-1897. [PMID: 27354274 DOI: 10.1136/heartjnl-2016-309502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/04/2022] Open
Abstract
AIMS We hypothesised that deprivation might represent a barrier to attain an ideal cardiovascular health (CVH) as defined by the American Heart Association (AHA). METHODS AND RESULTS The baseline data of 8916 participants of the Paris Prospective Study 3, an observational cohort on novel markers for future cardiovascular disease, were used. The AHA 7-item tool includes four health behaviours (smoking, body weight, physical activity and optimal diet) and three biological measures (blood cholesterol, blood glucose and blood pressure). A validated 11-item score of individual material and psychosocial deprivation, the Evaluation de la Précarité et des Inégalités dans les Centres d'Examens de Santé-Evaluation of Deprivation and Inequalities in Health Examination centres (EPICES) score was used. The mean age was 59.5 years (standard deviation 6.2), 61.2% were men and 9.98% had an ideal CVH. In sex-specific multivariable polytomous logistic regression, the odds ratio (OR) for ideal behavioural CVH progressively decreased with quartile of increasing deprivation, from 0.54 (95% CI 0.41 to 0.72) to 0.49 (0.37 to 0.65) in women and from 0.61 (0.50 to 0.76) to 0.57 (0.46 to 0.71) in men. Associations with ideal biological CVH were confined to the most deprived women (OR=0.60; 95% CI 0.37 to 0.99), whereas in men, greater deprivation was related to higher OR of intermediate biological CVH (OR=1.28; 95% CI 1.05 to 1.57 for the third quartile vs the first quartile). CONCLUSIONS Higher material and psychosocial deprivation may represent a barrier to reach an ideal CVH. TRIAL REGISTRATION NUMBER NCT00741728.
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Affiliation(s)
- J P Empana
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - M C Perier
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - A Singh-Manoux
- INSERM, U1018, Epidemiology of Ageing and Age Related Diseases, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, France
| | - B Gaye
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - F Thomas
- Preventive and Clinical Investigation Center, Paris, France
| | - C Prugger
- Institute of Public Health, Charité University Medicine Berlin, Berlin, Germany
| | - M Plichart
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Department of Geriatry, APHP, Hopital Broca, Paris, France
| | - E Wiernik
- INSERM, U1018, Epidemiology of Ageing and Age Related Diseases, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, France
| | - C Guibout
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - C Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Psychiatry Department, APHP, Georges Pompidou European Hospital, Paris, France.,INSERM, Centre for Psychiatry and Neuroscience, Paris, France
| | - B Pannier
- Preventive and Clinical Investigation Center, Paris, France
| | - P Boutouyrie
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Pharmacology Departments, APHP, Georges Pompidou European Hospital, Paris, France
| | - X Jouven
- Department of Epidemiology, INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Cardiology Department, APHP, Georges Pompidou European Hospital, Paris, France
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