1
|
Muntner P, Miles MA, Jaeger BC, Hannon III L, Hardy ST, Ostchega Y, Wozniak G, Schwartz JE. Blood Pressure Control Among US Adults, 2009 to 2012 Through 2017 to 2020. Hypertension 2022; 79:1971-1980. [PMID: 35616029 PMCID: PMC9370255 DOI: 10.1161/hypertensionaha.122.19222] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/09/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The National Health and Nutrition Examination Survey data indicate that the proportion of US adults with hypertension that had controlled blood pressure (BP) declined from 2013 to 2014 through 2017 to 2018. We analyzed data from National Health and Nutrition Examination Survey 2009 to 2012, 2013 to 2016, and 2017 to 2020 to confirm this finding. METHODS Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or antihypertensive medication use. BP control among those with hypertension was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. RESULTS The age-adjusted prevalence of hypertension was 31.5% (95% CI, 30.3%-32.8%), 32.0% (95% CI, 30.6%-33.3%), and 32.9% (95% CI, 31.0%-34.7%) in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively (P trend=0.218). The age-adjusted prevalence of hypertension increased among non-Hispanic Asian adults from 27.0% in 2011 to 2012 to 33.5% in 2017 to 2020 (P trend=0.003). Among Hispanic adults, the age-adjusted prevalence of hypertension increased from 29.4% in 2009 to 2012 to 33.2% in 2017 to 2020 (P trend=0.029). In 2009 to 2012, 2013 to 2016, and 2017 to 2020, 52.8% (95% CI, 50.0%-55.7%), 51.3% (95% CI, 47.9%-54.6%), and 48.2% (95% CI, 45.7%-50.8%) of US adults with hypertension had controlled BP (P trend=0.034). Among US adults taking antihypertensive medication, 69.9% (95% CI, 67.8%-72.0%), 69.3% (95% CI, 66.6%-71.9%), and 67.7% (95% CI, 65.2%-70.3%) had controlled BP in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively (P trend=0.189). Among all US adults with hypertension and those taking antihypertensive medication, a decline in BP control between 2009 to 2012 and 2017 to 2020 occurred among those ≥75 years, women, and non-Hispanic black adults. CONCLUSIONS These data confirm that the proportion of US adults with hypertension who have controlled BP has declined.
Collapse
Affiliation(s)
- Paul Muntner
- Department of Epidemiology (P.M., S.T.H.), University of Alabama at Birmingham
| | - Miriam A. Miles
- Department of Health Behavior (M.A.M., L.H.), University of Alabama at Birmingham
| | - Byron C. Jaeger
- Department of Biostatistics, Wake Forest University School of Medicine, Winston Salem, NC (B.C.J.)
| | - Lonnie Hannon III
- Department of Health Behavior (M.A.M., L.H.), University of Alabama at Birmingham
| | - Shakia T. Hardy
- Department of Epidemiology (P.M., S.T.H.), University of Alabama at Birmingham
| | - Yechiam Ostchega
- School of Nursing, Johns Hopkins University, Baltimore, MD (Y.O.)
| | | | - Joseph E. Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (J.E.S.)
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY (J.E.S.)
| |
Collapse
|
2
|
Brown AGM, Desvigne-Nickens PM, Redmond N, Barnes VI, Campo RA. National Heart, Lung, and Blood Institute: Social Determinants of Health Research, Fiscal Year 2008-2020. Am J Prev Med 2022; 63:85-92. [PMID: 35379518 DOI: 10.1016/j.amepre.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Social determinants of health influence the prevention, treatment, and progression of chronic diseases, including heart, lung, blood, and sleep diseases and conditions. Healthy People 2020 classifies Social Determinants of Health into 5 subcategories: (1) Neighborhood and Built Environment, (2) Education, (3) Economic Stability, (4) Social and Community Context, and (5) Health and Health Care. This study's goal is to characterize the National Heart, Lung, and Blood Institute's Fiscal Year 2008-2020 funding in overall Social Determinants of Health research and in the Healthy People 2020 subcategories. METHODS The Social Determinants of Health Research, Condition, and Disease Categorization code was used to identify funded grants in this area. Natural language processing methods further categorized grants into the 5 Healthy People 2020 Social Determinants of Health subcategories. RESULTS There were 915 (∼4.3%) social determinants of health‒funded grants from 2008 to 2020 representing $1,034 billion in direct costs. Most grants were relevant to cardiovascular diseases (n=653), with a smaller number relevant to lung diseases (n=186), blood diseases (n=47), and translational and implementation science (n=29). Grants fit multiple Social Determinants of Health subcategories with the majority identified as Health and Health Care (62%) and Economic Stability (61%). The number of National Heart, Lung, and Blood Institute social determinants of health grants awarded increased by 127% from Fiscal Year 2008 to Fiscal Year 2020. CONCLUSIONS This study identifies Social Determinants of Health grants funded by the National Heart, Lung, and Blood Institute during 2008‒2020. Enhancing the understanding of these determinants and developing effective interventions will ultimately help to advance the mission of the National Heart, Lung, and Blood Institute.
Collapse
Affiliation(s)
- Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | | | - Nicole Redmond
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Vanessa I Barnes
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Rebecca A Campo
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
| |
Collapse
|
3
|
Hood AM, Kölbel M, Stotesbury H, Kawadler J, Slee A, Inusa B, Pelidis M, Howard J, Chakravorty S, Height S, Awogbade M, Kirkham FJ, Liossi C. Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease. Front Psychol 2021; 12:681137. [PMID: 34594262 PMCID: PMC8476744 DOI: 10.3389/fpsyg.2021.681137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8-15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R 2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.
Collapse
Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - April Slee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom.,Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Moji Awogbade
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,Paediatric Psychology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Pearson TA, Califf RM, Roper R, Engelgau MM, Khoury MJ, Alcantara C, Blakely C, Boyce CA, Brown M, Croxton TL, Fenton K, Green Parker MC, Hamilton A, Helmchen L, Hsu LL, Kent DM, Kind A, Kravitz J, Papanicolaou GJ, Prosperi M, Quinn M, Price LN, Shireman PK, Smith SM, Szczesniak R, Goff DC, Mensah GA. Precision Health Analytics With Predictive Analytics and Implementation Research: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:306-320. [PMID: 32674794 DOI: 10.1016/j.jacc.2020.05.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Emerging data science techniques of predictive analytics expand the quality and quantity of complex data relevant to human health and provide opportunities for understanding and control of conditions such as heart, lung, blood, and sleep disorders. To realize these opportunities, the information sources, the data science tools that use the information, and the application of resulting analytics to health and health care issues will require implementation research methods to define benefits, harms, reach, and sustainability; and to understand related resource utilization implications to inform policymakers. This JACC State-of-the-Art Review is based on a workshop convened by the National Heart, Lung, and Blood Institute to explore predictive analytics in the context of implementation science. It highlights precision medicine and precision public health as complementary and compelling applications of predictive analytics, and addresses future research and training endeavors that might further foster the application of predictive analytics in clinical medicine and public health.
Collapse
Affiliation(s)
- Thomas A Pearson
- College of Medicine and College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida.
| | - Robert M Califf
- School of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Rebecca Roper
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael M Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Craig Blakely
- School of Public Health and Information Science, University of Louisville, Louisville, Kentucky
| | - Cheryl Anne Boyce
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marishka Brown
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas L Croxton
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kathleen Fenton
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Melissa C Green Parker
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Lorens Helmchen
- Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Lucy L Hsu
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Sackler School of Graduate Biomedical Sciences, Tufts University, Tufts Medical Center, Boston, Massachusetts
| | - Amy Kind
- Department of Medicine Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - George John Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mattia Prosperi
- College of Medicine and College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida
| | - Matt Quinn
- Health Technology, Telemedicine and Advanced Technology Research Center, Frederick, Maryland
| | - LeShawndra N Price
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paula K Shireman
- School of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
| | - Sharon M Smith
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Rhonda Szczesniak
- Division of Biostatistics & Epidemiology, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - David Calvin Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
5
|
Essien UR, Tipirneni R, Leung LB, Sterling MR. Surviving and Thriving as Physicians in General Internal Medicine Fellowship in the Twenty-First Century. J Gen Intern Med 2020; 35:3664-3670. [PMID: 32342480 PMCID: PMC7728835 DOI: 10.1007/s11606-020-05837-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
General internal medicine (GIM) fellowships play an important role in the development of physician scientists and clinical educators, as well as leaders in academic medicine. Nevertheless, the challenges of developing another novel aspect to one's career, along with balancing coursework, research productivity, clinical duties, and personal life during fellowship, can be overwhelming. Similarly, successfully securing a job at the end of fellowship can be a daunting process. In this article, we discuss the foundational tenets and themes of the GIM fellowship. These themes include (1) finding your purpose and passion, with a focus on selecting research coursework and developing an area of study; (2) the role and importance of mentorship, including the various kinds of mentorship that fellows require (traditional and peer mentorship, sponsors, and coaches), as well as how to be an effective mentee; (3) securing research funding; (4) landing a job; (5) and protecting time to meet personal goals. There is an increased need for a vibrant, diverse, and successful generation of general internal medicine researchers to advance our understanding of complex issues in clinical medicine and healthcare delivery and to inform health policy. It is our hope that this piece helps to support that mission.
Collapse
Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Renuka Tipirneni
- Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Madeline R Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW This review is an assessment of the state of the science on nutrition disparities and their contribution to disparities in cardiovascular health. RECENT FINDINGS Nutrition disparities remain pervasive by race/ethnicity, sex/gender, socioeconomic status, and geography. They are rooted in differences in social, cultural, and environmental determinants of health, behavioral and lifestyle factors, and the impact of policy interventions. Systematic differences in diet quality, dietary patterns, and nutrient intakes contribute to cardiovascular disparities and are mediated by microbiota, and CVD risk factors including high levels of blood pressure, low density lipoprotein cholesterol (LDL), and glucose; oxidative stress, pro-inflammatory cytokines, and endothelial dysfunction. Despite the progress made in nutrition research, important gaps persist that signal the need for more effective interventions at multiple levels to reduce cardiovascular disparities. Research opportunities include (1) exploring the gene-nutrient-environment interactions in the context of ancestral diversity; (2) investigating the causal link between diet and gut microbiota and impact of social determinants of health; (3) understanding resilience; (4) testing the effectiveness of multi-level interventions that address social and environmental determinants; and (4) supporting intervention research informed by validated implementation science frameworks.
Collapse
Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Suite 6070, Bethesda, MD, 20892, USA.
| | - Alison G M Brown
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
| | - Charlotte A Pratt
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
| |
Collapse
|