Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects

Addressing the smoking-hypertension paradox in pregnancy: insight from a multiethnic US birth cohort

Background

Smoking during pregnancy has been associated with reduced risk of a spectrum of hypertensive (HTN) disorders, known as the "smoking-hypertension paradox."

Objective

We sought to test potential epidemiologic explanations for the smoking-hypertension paradox.

Methods

We analyzed 8510 pregnant people in the Boston Birth Cohort, including 4027 non-Hispanic Black and 2428 Hispanic pregnancies. Study participants self-reported tobacco, alcohol, cannabis, opioids, or cocaine use during pregnancy. We used logistic regression to assess effect modification by race/ethnicity, and confounding of concurrent substances on hypertensive disorders or prior pregnancy. We also investigated early gestational age as a collider or competing risk for pre-eclampsia, using cause-specific Cox models and Fine-Gray models, respectively.

Results

We replicated the paradox showing smoking to be protective against hypertensive disorders among Black participants who used other substances as well (aOR: 0.61, 95% CI: 0.41, 0.93), but observed null effects for Hispanic participants (aOR: 1.14, 95% CI: 0.55, 2.36). In our cause-specific Cox regression, the effects of tobacco use were reduced to null effects with pre-eclampsia (aOR: 0.81, 95% CI: 0.63, 1.04) after stratifying for preterm birth. For the Fine-Gray competing risk analysis, the paradoxical associations remained. The smoking paradox was either not observed or reversed after accounting for race/ethnicity, other substance use, and collider-stratification due to preterm birth.

Conclusions

These findings offer new insights into this paradox and underscore the importance of considering multiple sources of bias in assessing the smoking-hypertension association in pregnancy.

Metabolic syndrome among individuals living with hypertension in Accra, Ghana

Metabolic syndrome (MetS) is a major risk factor to cardiovascular diseases. In this study, we investigate the prevalence and associated risky behaviour of MetS in resource-poor urban communities in Accra, Ghana. We analysed data on 111 persons with hypertension, screened and recruited for a therapeutic lifestyle intervention program in August 2015. MetS was measured using the International Diabetes Federation (IDF) and the World Health Organization definitions. The prevalence of MetS was 58.4% and 16.8% by the IDF and WHO definitions respectively. More women (61.8%) compared to men (31.8%) had MetS (p = 0.011). Approximately 31% of the hypertensive patients were engaged in moderate-intensity physical activity; 9.0% were current smokers, 42.0% consumed excess alcohol over the past month prior to the interview and 41.0% discontinued taking their antihypertensive medications without consulting with a doctor. About 42.0% and 37.0% of respondents always consumed fruits and vegetables respectively at least two times a day. The binary logistic regression showed that compared to women, men had lower odds of consuming two or more servings of vegetable in a day (OR: 0.2; 95% CI; 0.1, 0.8). Increase in age was associated with higher odds of consuming fruits at least twice a day (1.0; 1.0, 1.1) but with lower odds of engaging in moderate intensity physical activity (0.9; 0.8, 1.0). Being married was associated with higher odds of engaging in moderate physical activity (2.8; 1.0, 8.2). Therapeutic methods essential for the management of patients with hypertension and MetS should include non-pharmacological remedies targeting the promotion of medication adherence, Dietary Approaches to Stop Hypertension (DASH) and physical activities; these are vital to changing unhealthy lifestyle which worsens the underlying pathology.

Poor-Prognosis Metastatic Cancers in Adolescents and Young Adults: Incidence Patterns, Trends, and Disparities

Background

For adolescents and young adults (AYAs, aged 15-39 years) with cancer, metastatic disease at diagnosis is the strongest predictor of mortality, but its associations with age and sociodemographic factors are largely unexplored.

Methods

Using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, we collected incident cases of poor-prognosis metastatic cancer (5-year survival < 50%) and compared the proportion, incidence, time trends, and incidence rate ratios for race and ethnicity, sex, and socioeconomic status among AYAs, middle-aged adults (aged 40-64 years) and older adults (aged 65-79 years).

Results

From 2000 to 2016, a total of 17 210 incident cases of poor-prognosis metastatic cancer were diagnosed in AYAs, 121 274 in middle-aged adults, and 364 228 in older adults. Compared with older patients, the proportion of AYAs having metastatic disease was equivalent or substantially lower in nearly every site except stomach and breast cancers, which were statistically significantly higher for AYAs compared with middle-aged and older adults (stomach: 57.3% vs 46.4% and 39.5%; breast: 6.6% vs 4.4% and 5.6%, respectively; 2-sided P < .001 for all comparisons). Incidence rates rose significantly faster among AYAs for breast, stomach, and kidney cancers and among AYAs and middle-aged adults for colorectal cancer. Markedly higher incidence rate ratios were noted for AYA racial and ethnic minorities with breast, stomach, and especially kidney cancer, where only non-Hispanic Black AYAs were at considerably higher risk. For most sites, incidence rate ratios were higher among male patients and individuals of low socioeconomic status across age groups.

Conclusions

For most cancers, AYAs are not more likely to present with metastases than middle-aged and older adults. Further investigation is warranted for the disproportionate rise in incidence of metastatic breast, stomach, and kidney cancer among AYAs and their excess burden among AYA racial and ethnic minorities. The rising incidence of colorectal cancer among AYAs and middle-aged adults remains an additional concern.

Trends in osteoporosis and mean bone density among type 2 diabetes patients in the US from 2005 to 2014

This study aimed to examine how bone health changed among T2DM patients in the past decade. Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 to 2013-2014 were analyzed to examine the trends of bone mineral density (BMD) and the prevalence trends of osteoporosis osteopenia among T2DM patients and non-diabetic people aged 40 years and older. The age- and BMI-adjusted mean BMD of the femur neck for the four NHANES cycles decreased linearly in both T2DM patients and non-diabetic people (both Plinear trend ≤ 0.009). Among women with T2DM, the mean BMD in 2013-2014 was significantly lower than that in 2005-2006, even after adjusting for multiple covariates. During 2005-2014, the prevalence of osteoporosis among T2DM patients and non-diabetic people increased but with no significant linear trend (both Plinear trend > 0.05), while the prevalence of osteopenia in the two populations increased linearly (both Plinear trend < 0.04). Age- and BMI-adjusted mean BMD decreased in 2013-2014 in patients with T2DM and non-diabetic people, while the prevalence of osteoporosis and osteopenia increased in both groups.

Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009–2014

Aim: To examine the effect of race/ethnicity, insurance status and median household income on postoperative readmissions following colectomy. Patients & methods: Multivariate analysis of hospital discharge data from California, Florida, Maryland and New York from 2009 to 2014. Primary outcomes included adjusted odds of 30- and 90-day readmissions following colectomy by race, insurance status and median income quartile. Results: Total 330,840 discharges included. All 30-day readmissions were higher for black patients (adjusted odds ratio [aOR]: 1.07). Both 30- and 90-day readmissions were higher for Medicaid (aOR: 1.30 and 1.26) and Medicare (aOR: 1.30 and 1.29). The 30- and 90-day readmissions were lower in the highest income quartiles. Conclusion: Race, insurance status and median household income are all independent predictors of disparity in readmissions following colectomy.