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Ferrè S, Storfer-Isser A, Kinderknecht K, Montgomery E, Godwin M, Andrews A, Dunning S, Barton M, Roman D, Cuddeback J, Stempniewicz N, Chu CD, Tuot DS, Vassalotti JA. Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes. Mayo Clin Proc Innov Qual Outcomes 2023; 7:382-391. [PMID: 37680649 PMCID: PMC10480072 DOI: 10.1016/j.mayocpiqo.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Objective To evaluate the fulfillment and validity of the kidney health evaluation for people with diabetes (KED) Healthcare Effectiveness Data Information Set (HEDIS) measure. Patients and Methods Optum Labs Data Warehouse (OLDW) was used to identify the nationally distributed US population aged 18 years and older, with diabetes, between January 1, 2017, and December 31, 2017. The OLDW includes deidentified medical, pharmacy, laboratory, and electronic health record (EHR) data. The KED fulfillment was defined in 2017 as both estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio testing within the measurement year. The KED validity was assessed using bivariate analyses of KED fulfillment with diabetes care measures in 2017 and chronic kidney disease (CKD) diagnosis and evidence-based kidney protective interventions in 2018. Results Among eligible 5,635,619 Medicare fee-for-service beneficiaries, 736,875 Medicare advantage (MA) beneficiaries, and 660,987 commercial patients, KED fulfillment was 32.2%, 38.7%, and 37.7%, respectively. Albuminuria testing limited KED fulfillment with urinary albumin-creatinine ratio testing (<40%) and eGFR testing (>90%). The KED fulfillment was positively associated with receipt of diabetes care in 2017, CKD diagnosis in 2018, and evidence-based kidney protective interventions in 2018. The KED fulfillment trended lower for Black race, Medicare-Medicaid dual eligibility status, low neighborhood income, and low education status. Conclusion Less than 40% of adults with diabetes received guideline-recommended testing for CKD in 2017. Routine KED was associated with diabetes care and evidence-based CKD interventions. Increasing guideline-recommended testing for CKD among people with diabetes should lead to timely and equitable CKD detection and treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Mary Barton
- National Committee for Quality Assurance, Washington, DC
| | - Dan Roman
- National Committee for Quality Assurance, Washington, DC
| | | | | | - Chi D. Chu
- University of California at San Francisco, San Francisco, CA
| | | | - Joseph A. Vassalotti
- National Kidney Foundation, New York, NY
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
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Khatun MM, Rahman M, Islam MJ, Haque SE, Adam IF, Chau Duc NH, Sarkar P, Haque MN, Islam MR. Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference? Public Health 2023; 218:1-11. [PMID: 36933353 DOI: 10.1016/j.puhe.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/13/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. STUDY DESIGN Cross-sectional nationally representative household-based survey. METHODS We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. RESULTS In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM. CONCLUSIONS In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.
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Affiliation(s)
- M M Khatun
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh.
| | - M J Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | - S E Haque
- Uchicago Research Bangladesh, Bangladesh
| | - I F Adam
- Faculty of Public Health, University of Khartoum, Sudan
| | - N H Chau Duc
- Hue University of Medicine and Pharmacy, Hue University, Viet nam
| | - P Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - M N Haque
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M R Islam
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi 6205, Bangladesh
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Fayanju OM, Edmonds CE, Reyes SA, Arciero C, Bea VJ, Crown A, Joseph KA. The Landmark Series-Addressing Disparities in Breast Cancer Screening: New Recommendations for Black Women. Ann Surg Oncol 2023; 30:58-67. [PMID: 36192515 PMCID: PMC9742297 DOI: 10.1245/s10434-022-12535-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
Randomized, clinical trials have established the efficacy of screening mammography in improving survival from breast cancer for women through detection of early, asymptomatic disease. However, disparities in survival rates between black women and women from other racial and ethnic groups following breast cancer diagnosis persist. Various professional groups have different, somewhat conflicting, guidelines with regards to recommended age for commencing screening as well as recommended frequency of screening exams, but the trials upon which these recommendations are based were not specifically designed to examine benefit among black women. Furthermore, these recommendations do not appear to incorporate the unique epidemiological circumstances of breast cancer among black women, including higher rates of diagnosis before age 40 years and greater likelihood of advanced stage at diagnosis, into their formulation. In this review, we examined the epidemiologic and socioeconomic factors that are associated with breast cancer among black women and assess the implications of these factors for screening in this population. Specifically, we recommend that by no later than age 25 years, all black women should undergo baseline assessment for future risk of breast cancer utilizing a model that incorporates race (e.g., Breast Cancer Risk Assessment Tool [BCRAT], formerly the Gail model) and that this assessment should be conducted by a breast specialist or a healthcare provider (e.g., primary care physician or gynecologist) who is trained to assess breast cancer risk and is aware of the increased risks of early (i.e., premenopausal) and biologically aggressive (e.g., late-stage, triple-negative) breast cancer among black women.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- Rena Rowan Breast Center, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA, USA
| | - Christine E Edmonds
- Rena Rowan Breast Center, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Sylvia A Reyes
- Department of Surgery, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, New Hyde Park, NY, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Katz Institute for Women's Health, Northwell Health, New Hyde Park, NY, USA
| | - Cletus Arciero
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Vivian J Bea
- Department of Surgery, New York-Presbyterian, Brooklyn Methodist, Brooklyn, NY, USA
| | - Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
- NYU Langone Health's Institute for Excellence in Health Equity, New York, NY, USA.
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Sarver MM, Rames JD, Ren Y, Greenup RA, Shammas RL, Hwang ES, Hollenbeck ST, Hyslop T, Butler PD, Fayanju OM. Racial and Ethnic Disparities in Surgical Outcomes after Postmastectomy Breast Reconstruction. J Am Coll Surg 2022; 234:760-771. [PMID: 35426388 PMCID: PMC9347225 DOI: 10.1097/xcs.0000000000000143] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women of color with breast cancer are less likely to undergo post-mastectomy reconstruction compared with White women, but it is unclear whether their perioperative outcomes are worse. The goal of this study was to investigate differences in preoperative comorbidities and postoperative complications by race/ethnicity among women with breast cancer undergoing postmastectomy reconstruction. STUDY DESIGN Data were collected from the National Inpatient Sample database of the Healthcare Cost and Utilization Project from 2012 to 2016. Patient demographics, types of reconstruction, comorbid conditions, Charlson-Deyo Combined Comorbidity (CDCC) scores, length of stay (LOS), and perioperative complications were abstracted. Multivariate linear and logistic regression were performed to model LOS and likelihood of postoperative complications, respectively. RESULTS Compared with White women (n = 19,730), Black women (n = 3,201) underwent autologous reconstruction more frequently (40.7% vs 28.3%), had more perioperative comorbidities (eg diabetes: 12.9% vs 5.8%), higher CDCC scores (% CDCC ≥ 4: 5.5% vs 2.7%), and longer LOS (median 3 vs 2 days, all p < 0.001). Being Black (vs White: +0.13 adjusted days, 95% CI 0.06 to 0.19) was also associated with longer LOS and an increased likelihood of surgical complications (vs White: odds ratio 1.24, 95% CI 1.09 to 1.42, both p < 0.01), but this association did not persist when outcomes were limited to microsurgical complications. CONCLUSION Disparities in postmastectomy breast reconstruction between Black and White women extend beyond access to care and include perioperative factors and outcomes. These findings suggest an important opportunity to mitigate inequities in reconstruction through perioperative health optimization and improved access to and co-management with primary care.
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Affiliation(s)
- Melissa M Sarver
- From the Duke University School of Medicine, Durham, NC (Sarver, Rames)
- Divisions of Surgical Oncology (Sarver, Greenup, Hwang, Fayanju), Duke University School of Medicine, NC
| | - Jess D Rames
- From the Duke University School of Medicine, Durham, NC (Sarver, Rames)
- Plastic and Reconstructive Surgery (Rames, Shammas, Hollenbeck), Duke University School of Medicine, NC
| | - Yi Ren
- Duke Cancer Institute, Durham, NC (Ren, Greenup, Hwang, Hyslop, Fayanju)
| | - Rachel A Greenup
- Duke Cancer Institute, Durham, NC (Ren, Greenup, Hwang, Hyslop, Fayanju)
- Divisions of Surgical Oncology (Sarver, Greenup, Hwang, Fayanju), Duke University School of Medicine, NC
- Department of Surgery, and Departments of Population Health Sciences (Greenup, Fayanju), Duke University School of Medicine, NC
| | - Ronnie L Shammas
- Plastic and Reconstructive Surgery (Rames, Shammas, Hollenbeck), Duke University School of Medicine, NC
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, NC (Ren, Greenup, Hwang, Hyslop, Fayanju)
- Divisions of Surgical Oncology (Sarver, Greenup, Hwang, Fayanju), Duke University School of Medicine, NC
| | - Scott T Hollenbeck
- Plastic and Reconstructive Surgery (Rames, Shammas, Hollenbeck), Duke University School of Medicine, NC
| | - Terry Hyslop
- Duke Cancer Institute, Durham, NC (Ren, Greenup, Hwang, Hyslop, Fayanju)
- Biostatistics and Bioinformatics (Hyslop), Duke University School of Medicine, NC
| | - Paris D Butler
- Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA (Butler)
| | - Oluwadamilola M Fayanju
- Duke Cancer Institute, Durham, NC (Ren, Greenup, Hwang, Hyslop, Fayanju)
- Divisions of Surgical Oncology (Sarver, Greenup, Hwang, Fayanju), Duke University School of Medicine, NC
- Department of Surgery, and Departments of Population Health Sciences (Greenup, Fayanju), Duke University School of Medicine, NC
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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Pilla SJ, Pitts SI, Maruthur NM. High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. J Patient Saf 2022; 18:e217-e224. [PMID: 32569099 DOI: 10.1097/pts.0000000000000739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sulfonylureas, the second most common oral diabetes treatment, have interactions with antimicrobials that substantially increase the risk of hypoglycemia. The objectives of this study are to quantify the concurrent use of sulfonylureas and interacting antimicrobial in U.S. ambulatory care and to examine whether interacting antimicrobials are used for an appropriate indication. METHODS We analyzed the 2006-2016 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual probability samples of visits to U.S. office-based physicians. We determined nationally representative estimates of visits for adults with concurrent use of sulfonylureas and 7 antimicrobials with established interactions. We examined whether visit diagnoses included appropriate indications for antibiotics according to national guidelines. RESULTS There were 2.5 million visits per year (95% confidence interval [CI] 2.2-2.9) in which sulfonylureas were used with systemic antimicrobials, of which 1 million (95% CI, 0.8-1.2) or 38.0% (95% CI, 32.3%-44.0%) were interacting antimicrobials. Sulfonylurea users had similar odds of interacting antimicrobial use as patients using diabetes medications without antimicrobial interactions (adjusted odds ratio, 1.07; 95% CI, 0.82-1.40). The most common interacting antimicrobials used with sulfonylureas were fluoroquinolones, accounting for 59.9% (95% CI, 50.7%-68.2%) of antimicrobials, and sulfamethoxazole-trimethoprim, accounting for 21.1% (95% CI, 14.8%-29.2%). There was no appropriate antibiotic indication in 69.7% (95% CI, 55.2%-81.1) of visits with interacting antibiotic use. CONCLUSIONS Sulfonylureas and antimicrobials with potentially hazardous interactions are frequently used together. To reduce resultant hypoglycemic events, there is a need for interventions to increase physician awareness and promote antibiotic stewardship.
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Alexopoulos AS, Kahkoska AR, Pate V, Bradley MC, Niznik J, Thorpe C, Stürmer T, Buse J. Deintensification of Treatment With Sulfonylurea and Insulin After Severe Hypoglycemia Among Older Adults With Diabetes. JAMA Netw Open 2021; 4:e2132215. [PMID: 34726745 PMCID: PMC8564578 DOI: 10.1001/jamanetworkopen.2021.32215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Practice guidelines recommend deintensification of hypoglycemic agents among older adults with diabetes who are at high risk of hypoglycemia, yet real-world treatment deintensification practices are not well characterized. Objective To examine the incidence of sulfonylurea and insulin deintensification after a hypoglycemia-associated emergency department (ED) visit or hospitalization among older adults with diabetes and to identify factors associated with deintensification of treatment. Design, Setting, and Participants This retrospective cohort study included a random sample of 20% of nationwide fee-for-service US Medicare beneficiaries aged 65 years and older with concurrent Medicare parts A, B, and D coverage between January 1, 2007, and December 31, 2017. Individuals with diabetes who had at least 1 hypoglycemia-associated ED visit or hospitalization were included. Data were analyzed from August 1, 2020, to August 1, 2021. Exposures Baseline medication for the treatment of diabetes (sulfonylurea, insulin, or both). Main Outcomes and Measures Incidence of treatment deintensification (yes or no) in the 100 days after a severe hypoglycemic episode requiring an ED visit or hospitalization, with treatment deintensification defined as (1) a decrease in sulfonylurea dose, (2) a change from long-acting to short-acting sulfonylurea (glipizide), (3) discontinuation of sulfonylurea, or (4) discontinuation of insulin based on pharmacy dispensing claims. Results Among 76 278 distinct Medicare beneficiaries who had a hypoglycemia-associated ED visit or hospitalization, the mean (SD) age was 76.6 (7.6) years. Of 106 293 total hypoglycemic episodes requiring hospital attention, 69 084 (65.0%) occurred among women, 26 056 (24.5%) among Black individuals; 4761 (4.5%) among Hispanic individuals; 69 704 (65.6%) among White individuals; and 5772 (5.4%) among individuals of other races and ethnicities (comprising Asian, North American Native, unknown race or ethnicity, and unspecified race or ethnicity). A total of 32 074 episodes (30.2%) occurred among those receiving sulfonylurea only, 60 350 (56.8%) occurred among those receiving insulin only, and 13 869 (13.0%) occurred among those receiving both sulfonylurea and insulin. Treatment deintensification rates were highest among individuals receiving both sulfonylurea and insulin therapies at the time of their hypoglycemic episode (6677 episodes [48.1%]), followed by individuals receiving sulfonylurea only (14 192 episodes [44.2%]) and insulin only (14 495 episodes [24.0%]). Treatment deintensification rates increased between 2007 and 2017 (sulfonylurea only: from 41.4% to 49.7%; P < .001 for trend; insulin only: from 21.3% to 25.9%; P < .001 for trend; sulfonylurea and insulin: from 45.9% to 49.6%; P = .005 for trend). Lower socioeconomic status (as indicated by the receipt of low-income subsidies) was associated with lower odds of deintensification, regardless of baseline hypoglycemic regimen (sulfonylurea only: adjusted odds ratio [AOR], 0.74 [95% CI, 0.70-0.78]; insulin only: AOR, 0.71 [95% CI, 0.68-0.75]; sulfonylurea and insulin: AOR, 0.72 [95% CI, 0.66-0.78]). A number of patient factors were associated with higher odds of treatment deintensification: higher frailty (eg, ≥40% probability of needing assistance with activities of daily living among those receiving sulfonylurea and insulin: AOR, 1.50; 95% CI, 1.32-1.71), chronic kidney disease (eg, sulfonylurea and insulin: AOR, 1.29; 95% CI, 1.19-1.40), a history of falls (eg, sulfonylurea and insulin: AOR, 1.20; 95% CI, 1.09-1.33), and depression (eg, sulfonylurea and insulin: AOR, 1.11; 95% CI, 1.02-1.20). Conclusions and Relevance In this cohort study, deintensification of sulfonylurea and/or insulin therapy within 100 days after a hypoglycemia-associated ED visit or hospitalization occurred in fewer than 50% of older adults with diabetes; however, these deintensification rates may be increasing over time, and deintensification of insulin was likely underestimated because of challenges in capturing changes to insulin dosing using administrative claims data. These results suggest that greater efforts are needed to identify individuals at high risk of hypoglycemia to encourage appropriate treatment deintensification in accordance with current evidence.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Marie C. Bradley
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Joshua Niznik
- Department of Medicine, Division of Geriatrics and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
- Center of Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Carolyn Thorpe
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill
- Center of Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - John Buse
- Department of Medicine, Division of Endocrinology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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Shi Q, Lin Y, Fonseca VA, Shi L. Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/1/e002396. [PMID: 34675042 PMCID: PMC8532550 DOI: 10.1136/bmjdrc-2021-002396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Considerable confusions on treatment target have resulted from recent changes in guidelines. Evidence in medical guidelines came from clinical trials with highly selected patients, whereas treatment goals may differ in some subgroups. This study aimed to assess optimal treatment goals (A1C, blood pressure, low-density lipoprotein cholesterol (LDL-C)) for patients with type 2 diabetes mellitus (T2DM), which lead to optimal health outcomes by different treatment strategies. RESEARCH DESIGN AND METHODS A retrospective longitudinal study was conducted for veterans with T2DM by using US Veterans Affairs Administrative Database (2005-2015). Medical records were prepared for repeated evaluation performed at 6-month intervals and multivariate longitudinal regression was used to estimate the risk of microvascular and macrovascular complication events. Second-degree polynomial and splines were applied to identify the optimal goals in their associations with lowest risk of clinical outcomes, controlling for demographic characteristics, medical history, and medications. RESULTS A total of 124 651 patients with T2DM were selected, with mean of 6.72 follow-up years. In the general population, to achieve the lowest risk of microvascular and macrovascular complication, the optimal goals were A1C=6.81%, LDL-C=109.10 mg/dL; and A1C=6.76%, LDL-C=111.65 mg/dL, systolic blood pressure (SBP)=130.60 mmHg, respectively. The optimal goals differed between age and racial subgroups. Lower SBP for younger patients and lower LDL-C for black patients were associated with better health outcomes. CONCLUSIONS Optimal treatment goals were identified and multi-faceted treatment strategies targeting hyperglycemia and hyperlipidemia and hypertension may improve health outcome in veterans with T2DM. In addition to guidelines' recommended goals, health systems may examine their own large diverse patients with T2DM for better quality of care.
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Affiliation(s)
- Qian Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yilu Lin
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Vivian A Fonseca
- Department of Medicine and Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Pilla SJ, Park J, Schwartz JL, Albert MC, Ephraim PL, Boulware LE, Mathioudakis NN, Maruthur NM, Beach MC, Greer RC. Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes. J Gen Intern Med 2021; 36:1533-1542. [PMID: 33479925 PMCID: PMC8175615 DOI: 10.1007/s11606-020-06385-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypoglycemia is a common and serious adverse effect of diabetes treatment, especially for patients using insulin or insulin secretagogues. Guidelines recommend that these patients be assessed for interval hypoglycemic events at each clinical encounter and be provided anticipatory guidance for hypoglycemia prevention. OBJECTIVE To determine the frequency and content of hypoglycemia communication in primary care visits. DESIGN Qualitative study PARTICIPANTS: We examined 83 primary care visits from one urban health practice representing 8 clinicians and 33 patients using insulin or insulin secretagogues. APPROACH Using a directed content analysis approach, we analyzed audio-recorded primary care visits collected as part of the Achieving Blood Pressure Control Together study, a randomized trial of behavioral interventions for hypertension. The coding framework included communication about interval hypoglycemia, defined as discussion of hypoglycemic events or symptoms; the components of hypoglycemia anticipatory guidance in diabetes guidelines; and hypoglycemia unawareness. Hypoglycemia documentation in visit notes was compared to visit transcripts. KEY RESULTS Communication about interval hypoglycemia occurred in 24% of visits, and hypoglycemic events were reported in 16%. Despite patients voicing fear of hypoglycemia, clinicians rarely assessed hypoglycemia frequency, severity, or its impact on quality of life. Hypoglycemia anticipatory guidance was provided in 21% of visits which focused on diet and behavior change; clinicians rarely counseled on hypoglycemia treatment or avoidance of driving. Limited discussions of hypoglycemia unawareness occurred in 8% of visits. Documentation in visit notes had low sensitivity but high specificity for ascertaining interval hypoglycemia communication or hypoglycemic events, compared to visit transcripts. CONCLUSIONS In this high hypoglycemia risk population, communication about interval hypoglycemia and counseling for hypoglycemia prevention occurred in a minority of visits. There is a need to support clinicians to more regularly assess their patients' hypoglycemia burden and enhance counseling practices in order to optimize hypoglycemia prevention in primary care.
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Affiliation(s)
- Scott J Pilla
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA.
| | - Jenny Park
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica L Schwartz
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Albert
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA
| | - Patti L Ephraim
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Nestoras N Mathioudakis
- Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisa M Maruthur
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Health, Behavior & Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raquel C Greer
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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do Vale Moreira NC, Ceriello A, Basit A, Balde N, Mohan V, Gupta R, Misra A, Bhowmik B, Lee MK, Zuo H, Shi Z, Wang Y, Montenegro RM, Fernandes VO, Colagiuri S, Boulton AJM, Hussain A. Race/ethnicity and challenges for optimal insulin therapy. Diabetes Res Clin Pract 2021; 175:108823. [PMID: 33887353 DOI: 10.1016/j.diabres.2021.108823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
AIMS We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.
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Affiliation(s)
| | | | - Abdul Basit
- Baquai Medical University, Karachi, Pakistan
| | - Naby Balde
- Endocrinology and Diabetes Department, Donka Conakry University Hospital, Conakry, Guinea; Foundation Diabetes and NCD, Conakry, Guinea; International Diabetes Federation, IDF, Brussels, Belgium
| | - V Mohan
- Dr. Mohans Diabetes Specialties Centre, Chennai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Delhi, India
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Moon K Lee
- International Diabetes Federation, IDF, Brussels, Belgium; Division of Endocrinology & Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Hui Zuo
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Renan M Montenegro
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil
| | | | - Stephen Colagiuri
- International Diabetes Federation, IDF, Brussels, Belgium; Boden Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew J M Boulton
- International Diabetes Federation, IDF, Brussels, Belgium; University of Manchester, UK
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil; International Diabetes Federation, IDF, Brussels, Belgium; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh; Faculty of Health Sciences, Nord University, Bodø, Norway.
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11
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Eberly LA, Yang L, Eneanya ND, Essien U, Julien H, Nathan AS, Khatana SAM, Dayoub EJ, Fanaroff AC, Giri J, Groeneveld PW, Adusumalli S. Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US. JAMA Netw Open 2021; 4:e216139. [PMID: 33856475 PMCID: PMC8050743 DOI: 10.1001/jamanetworkopen.2021.6139] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status. OBJECTIVE To assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis. MAIN OUTCOMES AND MEASURES Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use. RESULTS Of 934 737 patients with type 2 diabetes (mean [SD] age, 65.4 [12.9] years; 50.7% female; 57.6% White), 81 007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income (≥$100 000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs <$50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD. CONCLUSIONS AND RELEVANCE In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.
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Affiliation(s)
- Lauren A. Eberly
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Lin Yang
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
| | - Nwamaka D. Eneanya
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Utibe Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Howard Julien
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
| | - Ashwin S. Nathan
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elias J. Dayoub
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
| | - Alexander C. Fanaroff
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Peter W. Groeneveld
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Srinath Adusumalli
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
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12
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Rand BG, Johnson TM, Ehrlich SF, Wideman L, Pivarnik JM, Richardson MR, Stone ML, Churilla JR. Diabetes risk status and physical activity in pregnancy: U.S. BRFSS 2011, 2013, 2015, 2017. BMC Pregnancy Childbirth 2020; 20:743. [PMID: 33256646 PMCID: PMC7708155 DOI: 10.1186/s12884-020-03434-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations. We sought to examine differences in aerobic activity (AA) and muscle strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States. METHODS The sample (n = 9,597) included pregnant women, age 18-44 years, who participated in the 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS include: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or pre-diabetes, and overt diabetes due to self-reported, clinically diagnosed diabetes (DM). Odds ratios (ORs) and 95% confidence intervals (CI) for meeting PA recommendations were obtained. Covariates included age, race, education, household child count, alcohol consumption, and smoking status. RESULTS Findings revealed that on average, DM had 46.5 fewer minutes of weekly AA compared to ND. Furthermore, a significantly lower OR (0.39; CI 0.19-0.82) for meeting both recommendations was observed in DM as compared to ND after adjustment. CONCLUSIONS We observed that pregnant women with overt diabetes had a lower odds of engaging in PA, while those at high risk were similar in their PA engagement to ND. Future studies aimed at assessing determinants of PA behavior may help guide efforts to promote exercise in pregnant women with diabetes.
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Affiliation(s)
| | | | | | - Laurie Wideman
- University of North Carolina at Greensboro, Greensboro, NC, USA
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13
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Li LT, Bokshan SL, McGlone PJ, Owens BD. Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015. Orthop J Sports Med 2020; 8:2325967120964473. [PMID: 33283006 PMCID: PMC7682220 DOI: 10.1177/2325967120964473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background Racial disparities in perioperative complications have been shown to exist for many procedures in orthopaedic surgery. Although anterior cruciate ligament reconstruction (ACLR) is commonly performed as an outpatient procedure, the rate of admission to the hospital postoperatively is not insignificant. Hispanic patients have been shown to have higher odds of admission compared with non-Hispanic patients. Hypothesis We hypothesized that racial disparities would decrease from 2007 to 2015, resulting in lower rates of hospital admission for Black and Hispanic patients. Study Design Descriptive epidemiology study. Methods This study represents a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database for patients undergoing ACLR between 2007 and 2015. We performed bivariate analysis as well as binary logistic regression, with postoperative admission as the primary outcome. Previously identified risk factors for admission were used as predictors in addition to a term for the statistical interaction between year of surgery and ethnicity. Results A total of 7542 patients undergoing ACLR were assessed. The logistic regression model showed that Hispanic patients had higher overall odds of admission (odds ratio [OR], 3.320; P < .001) than White patients; Black patients also had higher odds compared with White patients (OR, 1.929; P = .009). However, there was a significant interaction between year of surgery and both Black ethnicity (OR, 0.907; P = .026) and Hispanic ethnicity (OR, 0.835; P = .002), indicating a significant decrease in the admission rates for these minority patients compared with White patients over time. Other risk factors for admission were the use of regional anesthesia (OR, 3.482; P < .001), bleeding disorders (OR, 5.064; P = .002), a higher body mass index (OR, 1.029; P < .001), and longer operative times (OR, 1.012; P < .001). More recent surgery was associated with lower odds of admission (OR, 0.826; P < .001). Conclusion Admission rates after ACLR declined from 2007 to 2015. Black and Hispanic patients were more likely to be admitted overall, but they also saw a greater decrease in the odds of admission than White patients. This represents a reduction in disparity between the 2 groups and is a reassuring improvement in racial disparity trends after a common sports procedure.
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Affiliation(s)
- Lambert T Li
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Patrick J McGlone
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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14
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Khambule L, Snyman T, Norris SA, Crowther NJ, George JA. Branched-chain and aromatic amino acids and cardiometabolic risk in Black African and Asian Indian populations. Metabolomics 2020; 16:108. [PMID: 33033875 DOI: 10.1007/s11306-020-01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Studies have shown that systemic levels of branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) are elevated in cardiometabolic diseases (CMDs) in populations resident in high income countries. However, little is known about the association of BCAAs and AAAs with metabolic syndrome and its components in Asian Indian (AI) and Black African (BA) populations. OBJECTIVE The aim of this study was to describe the association of BCAAs and AAAs with the metabolic syndrome, its individual components and insulin resistance in AI and BA populations. METHODS Serum samples collected from AI (n = 349) and BA (n = 369) subjects were used to measure levels of BCAAs and AAAs by ultra-pressure liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Anthropometric, demographic and cardiometabolic variables were measured in all subjects. RESULTS The sum of BCAAs and AAAs was higher in AIs compared to BAs. The BCAAs and AAAs were positively associated with insulin resistance, metabolic syndrome and its individual components. This was particularly the case for AI subjects, in unadjusted regression models. However, these associations were non-significant after adjusting for co-variates, particularly visceral adipose tissue (VAT). Triglyceride levels were significantly associated with valine and leucine levels in BAs even after adjustment for co-variates. Lastly, we found that fasting circulatory BCAA and AAA levels are strongly correlated with VAT in both populations. CONCLUSION This study identified specific associations of serum valine and leucine levels with triglycerides in BAs. The association of amino acids with CMDs was observed in AIs, but was found to be the result of confounding by VAT. Further studies are required to determine whether BCAAs and AAAs are aetiological factors in CMDs and how VAT modulates their serum levels.
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Affiliation(s)
- Lungile Khambule
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Mutambudzi M, Díaz-Venegas C, Menon S. Association Between Baseline Glycemic Markers (HbA1c) and 8-Year Trajectories of Functional Disability. J Gerontol A Biol Sci Med Sci 2020; 74:1828-1834. [PMID: 30958520 DOI: 10.1093/gerona/glz089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/02/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study assessed whether baseline (i) HbA1c (low [<5.7%], intermediate [5.7%-6.4%], and high [≥6.5%]) and (ii) glycemic control (7% HbA1c cutoff) in participants with self-reported diabetes were associated with differential 8-year functional disability trajectories. METHODS We used data from the 2006-2014 waves of the Health and Retirement Study for adults aged 50 years and older. Latent class mixture modeling was used to identify distinct functional disability trajectory classes. Multinomial logistic regression analysis examined the association between the newly constructed trajectories and baseline HbA1c levels, and glycemic control, respectively. RESULTS All participants (N = 5,966) were classified into four functional disability trajectory classes (no disability, low disability, low-increasing, and high-increasing). Participants with elevated HbA1c were at greater risk of being classified into the high-increasing (relative risk ratios = 1.63, 95% confidence interval [CI] = 1.25-2.11) trajectory class. Results showed significant effect modification by age and race. Three functional disability trajectories (no disability, low-increasing, and high-increasing) were identified for participants with self-reported diabetes (n = 1,119). There was no significant association between glycemic control in adults with self-reported diabetes and functional disability trajectory classes. CONCLUSIONS Participants with intermediate HbA1c and elevated HbA1c were more likely to be classified into the trajectories with progressing disability over the study period. More research is needed to better understand the association between glycemic markers and functional disability trajectories. Such research may provide insights into improvements for clinical care, self-management, and public health interventions for both conditions.
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Affiliation(s)
- Miriam Mutambudzi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.,Department of Preventive Medicine and Community Health
| | - Carlos Díaz-Venegas
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Belgium
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16
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Mutambudzi M, Gonzalez Gonzalez C, Wong R. Impact of Diabetes and Disease Duration on Work Status Among U.S. Older Adults. J Aging Health 2019; 32:432-440. [PMID: 30767603 DOI: 10.1177/0898264318822897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: To examine the effects of diabetes and disease duration on work status over a 9-year period. Method: Multinomial logistic regression models examined the probability of retirement and disability impeding work, using data from the Health and Retirement Study (n = 5,576). Results: Among participants who had retired in 2012, almost 14% had incident diabetes (4.91 mean years with diabetes, 95% confidence interval [CI] = [4.67, 5.15]). Approximately 22% of participants who reported a disability impeded labor force participation had prevalent diabetes (17.1 mean years with diabetes, 95%CI = [16.41, 17.71]). Only prevalent diabetes that indicated longer disease duration was associated with disability (relative risk ratio [RRR] = 1.83, 95% CI = [1.30, 2.57]). There was evidence of effect modification among Hispanics only (p = .02). Discussion: Diabetes increased risk of exiting the workforce due to disability, and mean disease duration was associated with changes. Disease management and workplace interventions may enable older adults to continue being productive should they choose to remain in the workforce.
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Affiliation(s)
- Miriam Mutambudzi
- University of Antwerp, Belgium.,The University of Texas Medical Branch at Galveston, USA
| | | | - Rebecca Wong
- The University of Texas Medical Branch at Galveston, USA
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18
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Maciejewski ML, Mi X, Sussman J, Greiner M, Curtis LH, Ng J, Haffer SC, Kerr EA. Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries. J Gen Intern Med 2018; 33:34-41. [PMID: 28905179 PMCID: PMC5756160 DOI: 10.1007/s11606-017-4167-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/26/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase. OBJECTIVE We examined rates of overtreatment and deintensification of therapy for older adults with diabetes, and whether these rates differed by medical, demographic, and socioeconomic characteristics. DESIGN, SUBJECTS, AND MAIN MEASURES We analyzed Medicare claims data from 10 states, linked to outpatient laboratory values to identify patients potentially overtreated for diabetes (HbA1c < 6.5% with fills for any diabetes medications beyond metformin, 1/1/2011-6/30/2011). We examined characteristics associated with deintensification for potentially overtreated diabetic patients. We used multinomial logistic regression to examine whether patient characteristics associated with overtreatment of diabetes differed from those associated with undertreatment (i.e. HbA1c > 9.0%). KEY RESULTS Of 78,792 Medicare recipients with diabetes, 8560 (10.9%) were potentially overtreated. Overtreatment of diabetes was more common among those who were over 75 years of age and enrolled in Medicaid (p < 0.001), and was less common among Hispanics (p = 0.009). Therapy was deintensified for 14% of overtreated diabetics. Appropriate deintensification of diabetic therapy was more common for patients with six or more chronic conditions, more outpatient visits, or living in urban areas; deintensification was less common for those over age 75. Only 6.9% of Medicare recipients with diabetes were potentially undertreated. Variables associated with overtreatment of diabetes differed from those associated with undertreatment. CONCLUSIONS Medicare recipients are more frequently overtreated than undertreated for diabetes. Medicare recipients who are overtreated for diabetes rarely have their regimens deintensified.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Xiaojuan Mi
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Jeremy Sussman
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.,Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melissa Greiner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Lesley H Curtis
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Judy Ng
- National Committee for Quality Assurance, Washington, DC, USA
| | - Samuel C Haffer
- Office of Minority Health, U.S. Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Eve A Kerr
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.,Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
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Hitt JM, Velasquez-Mieyer P, Neira C, Cowan P. Factors Affecting Hemoglobin A1C in the Diagnosis of Diabetes and Prediabetes in Youth. J Pediatr Nurs 2016; 31:511-8. [PMID: 27132801 DOI: 10.1016/j.pedn.2016.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We sought to examine the correlation between variables and A1C levels to determine if prediction modeling could be used in the screening and diagnosis of diabetes and prediabetes in youth. We also sought to test relationships between A1C levels to insulin sensitivity indices and β-cell function indices. DESIGN AND METHODS We performed a retrospective review of 904 medical records from youth deemed at-risk for the disease. We performed Pearson correlation, multiple regression, and simple regression testing to determine the relationship between variables and A1C levels. In addition, we performed Pearson correlation testing on insulin sensitivity indices and β-cell function indices to determine the strength of correlation to A1C levels. RESULTS Statistical analysis did not show a strong relationship between the variables tested and the A1C. When racial and ethnic groups were tested together, the results from African American participants resulted in bias estimates, and as a result, a statistical model for the entire sample could not be performed. Results indicate that A1C is correlated with all β-cell function proxy measurements and correlated to the corrected insulin level at 30minutes, but not the fasting insulin or insulinogenic index. DISCUSSION The results from this study underline the multi-dimensional causes of diabetes and prediabetes and further stress the difficulties in predicting the diseases. The causes of diabetes and prediabetes are multifaceted, often individualized, and often difficult to ascertain. PRACTICE IMPLICATIONS Clinicians should continue to examine a variety of variables prior to determining the need for diabetes diagnostic testing.
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Affiliation(s)
| | | | | | - Patricia Cowan
- University of Tennessee Health Science Center, Memphis, TN
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20
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Babaei S, Taleghani F, Kayvanara M. Compassionate behaviours of clinical nurses in Iran: an ethnographic study. Int Nurs Rev 2016; 63:388-94. [PMID: 27312244 DOI: 10.1111/inr.12296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this research was to explore compassionate behaviour in Iranian nurses. BACKGROUND Nurses provide high-quality care with compassion. It is useful to improve relationships between nurses and patients to give them more confidence in the care process. It is important to consider how compassion is demonstrated by nurses and to explore different compassionate behaviours in different cultures. METHODS This ethnographic study was conducted with 20 nurses and 12 patients in six medical and four surgical wards in Iran in 2014-2015. Data were collected through fieldwork observations and semi-structured deep interviews and field notes. We analysed data using constant comparison based on Strauss and Corbin method. RESULTS Results of the present study showed four cultural themes; love expression and compassion in the form of non-verbal emotional behaviours, empathy with others, emotional supports of patients at bedside and non-caring behaviours. CONCLUSION The findings of this study described compassionate behaviours in nurses. Compassionate behaviours of nurses are closely related to the culture issues. These are formed by communication between nurses and patients, and nurses and patients' families during nursing care. Thus improving compassionate behaviours is highly significant in nursing. IMPLICATIONS FOR NURSING AND/HEALTH POLICY Nurses, instructors and policy-makers can use the results of this study. They should consider compassionate care as an important component of patient-centred care. Compassion should be considered in nursing and practical educational programmes. To develop the compassionate care, it is vital to make changes in the dominant philosophy and culture of caring environments. Nurses should receive appropriate training with focus on holistic and patient-centred approaches.
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Affiliation(s)
- S Babaei
- Nursing & Midwifery care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Taleghani
- Nursing & Midwifery care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Kayvanara
- Department of Health Services Management, Social Determinate of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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21
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Nocella JM, Dickson VV, Cleland CM, Melkus GD. Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes. Patient Relat Outcome Meas 2016; 7:19-28. [PMID: 27042150 PMCID: PMC4780393 DOI: 10.2147/prom.s93308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Using Donabedian’s structure-process-outcomes (SPO) framework, this descriptive, exploratory study examined the structure of a telemonitoring program in a population of patients with type 2 diabetes (T2D), the process of nurse–patient telephonic interactions, and patients’ clinical outcomes. Methods Secondary data analysis was conducted using data from 581 patients who participated in a home telemonitoring program for 12 months. Three point-biserial and six Pearson correlations were estimated to determine how patient demographics related to clinical characteristics. Mixed model regressions were conducted predicting hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels at 6, 9, and 12 months based on the frequency of contact in the earlier 3 months. Analysis of variances were conducted to assess if the frequency of contact was significantly different by change in HbA1c levels from 3 to 6, 6 to 9, and 9 to 12 months. Results Significant negative correlations were found between age and HbA1c (r=−0.10, P=0.015) and DBP (r=−0.16, P<0.001), a significant positive correlation was found between age and SBP (r=0.15, P=0.001). A significant correlation was found between sex and DBP (rpb=−0.11, P=0.015); female participants had lower DBP levels than males. Frequency of contact was not related to the change in clinical outcomes. However, the frequency of contact for the time period 3 to 6 months was associated with change in HbA1c for the 6- to 9- month period and frequency of contact during the 6- to 9- month period was associated with change in HbA1c from 9 to 12 months. Conclusion Examination of the SPO measures in the telemonitoring environment assisted in understanding the effectiveness of this type of unique intervention and the need for further in-depth exploration of self-management techniques among individuals with T2D.
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Affiliation(s)
- Jill M Nocella
- Department of Nursing, William Paterson University, Wayne, NJ, USA
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22
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Kalyva E, Abdul-Rasoul M, Kehl D, Barkai L, Lukács A. A cross-cultural study on perceived health-related quality of life in children and adolescents with type 1 diabetes mellitus. J Diabetes Complications 2016; 30:482-7. [PMID: 26809901 DOI: 10.1016/j.jdiacomp.2015.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study investigated whether culture can affect self- and proxy-reports of perceived diabetes-specific health-related quality of life of children and adolescents with type 1 diabetes when taking into account glycemic control, gender and age. METHODS A total of 416 patients aged between 8 and 18 years--84 (Greece), 135 (Hungary) and 197 (Kuwait)--and their parents completed the Pediatric Quality of Life Inventory 3.0. Diabetes Module. RESULTS Gender and age did not have any effect on perceived diabetes-specific health-related quality of life. Significant differences were detected among countries in self- and proxy-reports of diabetes-specific health-related quality of life when controlling for glycemic control. More specifically, Greek patients with type 1 diabetes and their parents reported significantly worse disease-specific health-related quality of life than their peers from Kuwait and Hungary. Moreover, culture affected the level of agreement between self- and proxy-reports with parents from Kuwait underestimating their children's diabetes-specific health-related quality of life. CONCLUSION The impact of culture on self- and proxy-reports of diabetes-specific health-related quality of life warrants further investigation, since it might suggest the need for differential psychosocial treatment.
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Affiliation(s)
- Efrosini Kalyva
- Department of Psychology, The International Faculty of the University of Sheffield, City College, Department of Psychology, 24 Proxenou Koromila Street, 546 22 Thessaloniki, Greece.
| | - Majedah Abdul-Rasoul
- Department of Pediatrics, Faculty of Medicine, Kuwait University, POBox 24923 Safat, P Code 13110, State of Kuwait
| | - Dániel Kehl
- Department of Statistics, Faculty of Business and Economics, University of Pécs, H- 7624 Pécs, Ifjúság Street 6, Hungary
| | - László Barkai
- Velkey László Center for Child Health, H-3526 Miskolc, Szentpéteri kapu 72-76, Hungary; Institute of Basic Health Sciences, Faculty of Health Care, University of Miskolc, H-3515 Miskolc-Egyetemváros, Miskolc, Hungary
| | - Andrea Lukács
- Institute of Basic Health Sciences, Faculty of Health Care, University of Miskolc, H-3515 Miskolc-Egyetemváros, Miskolc, Hungary
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Fayfman M, Vellanki P, Alexopoulos AS, Buehler L, Zhao L, Smiley D, Haw S, Weaver J, Pasquel FJ, Umpierrez GE. Report on Racial Disparities in Hospitalized Patients with Hyperglycemia and Diabetes. J Clin Endocrinol Metab 2016; 101:1144-50. [PMID: 26735258 PMCID: PMC4803176 DOI: 10.1210/jc.2015-3220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT A higher prevalence of diabetes-related complications is reported in minority populations; however, it is not known if there are racial disparities in diabetes care and outcomes in hospitalized patients. OBJECTIVE Our objective was to determine the association between hyperglycemia, in patients with and without diabetes mellitus (non-DM), and complications among different racial groups. DESIGN This observational study compared the frequency of hyperglycemia (blood glucose ≥ 180 mg/dL; 10 mmol/L) and DM and hospital complications between Black and White patients hospitalized patients between January 2012 and December 2013. SETTING AND PARTICIPANTS Adults admitted to medical and surgery services in two academic hospitals were included in this study. RESULTS Among 35 866 patients, there were 14 387 Black (40.1%) and 21 479 White patients (59.9%). Blacks had a higher prevalence of hyperglycemia (42.3% vs 36.7%, P < .0001) and DM (34.5% vs 22.8%, P < .0001) and a higher admission rate and mean daily blood glucose (P < .001). Blacks also had higher rates of complications (22.2% vs 19.2%, P < .0001), both in patients with DM (24.7 vs 22.9%, P = .0413) and non-DM with hyperglycemia (41.2% vs 37.2%, P = .0019). Using sequential modelling adjusted for age, gender, body mass index, comorbidities, and insurance coverage, non-DM Blacks with normoglycemia (odds ratio, 1.22; 95% confidence interval, 1.10-1.35) and non-DM Blacks with hyperglycemia (odds ratio, 1.18; 95% confidence interval, 1.04-1.33) had higher number of complications compared to Whites. CONCLUSIONS Black patients have higher rates of hyperglycemia and diabetes, worse inpatient glycemic control, and greater frequency of hospital complications compared to Whites. Non-DM Blacks with hyperglycemia are a particularly vulnerable group. Further investigation is needed to better understand factors contributing the racial disparities in the hospital.
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Affiliation(s)
- Maya Fayfman
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Priyathama Vellanki
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Anastasia-Stefania Alexopoulos
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Lauren Buehler
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Liping Zhao
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Dawn Smiley
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Sonya Haw
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Jeff Weaver
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Francisco J Pasquel
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
| | - Guillermo E Umpierrez
- Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322
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Janghorbani M, Papi B, Amini M. Current status of glucose, blood pressure and lipid management in type 2 diabetes clinic attendees in Isfahan, Iran. J Diabetes Investig 2015; 6:716-25. [PMID: 26543547 PMCID: PMC4627550 DOI: 10.1111/jdi.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS/INTRODUCTION To estimate the prevalence of meeting American Diabetes Association clinical practice recommendations for hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) among Iranian type 2 diabetes clinic attendees, and to identify the factors associated with therapeutic target achievement. MATERIALS AND METHODS A total of 2,640 patients with type 2 diabetes (944 men and 1,696 women) from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran, were examined. The main outcome measures were HbA1c, BP and LDLC, in accordance with the American Diabetes Association recommendations. The mean (standard deviation) age of participants was 49.6 years (9.3 years) with a mean (standard deviation) duration of diabetes of 5.0 years (4.9 years) at initial registration. RESULTS The percentages of patients who had HbA1c <7%, BP <140/90 mmHg and LDLC <100 mg/dL was 37.4% (95% confidence interval [CI] 35.6-39.3), 35.3% (95% CI 33.5-37.3) and 48.9% (95% CI 47.0-50.8), respectively. The proportion of patients meeting all three goals was 7.7% (95% CI 6.7-8.8). Lower BP, cholesterol level and higher education at registration, and higher follow up but lower number of follow-up visits affected achievement of all three goals. CONCLUSIONS The present study highlights that a substantial proportion of Iranian type 2 diabetes clinic attendees did not meet the American Diabetes Association clinical practice recommendations, and shows the difficult challenges physicians face when treating patients with type 2 diabetes.
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Affiliation(s)
- Mohsen Janghorbani
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Bahman Papi
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
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Patel I, Erickson SR, Caldwell CH, Woolford SJ, Bagozzi RP, Chang J, Balkrishnan R. Predictors of medication adherence and persistence in Medicaid enrollees with developmental disabilities and type 2 diabetes. Res Social Adm Pharm 2015; 12:592-603. [PMID: 26522400 DOI: 10.1016/j.sapharm.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of diabetes mellitus is high among patients with developmental disabilities (cerebral palsy, autism, Down's syndrome and cognitive disabilities). OBJECTIVES The purpose of this study was to examine the racial health disparities in medication adherence and medication persistence in developmentally disabled adults with type 2 diabetes enrolled in Medicaid. METHODS This was a retrospective cohort study using the MarketScan(®) Multi-State Medicaid Database. Adults aged 18-64 years with a prior diagnosis of a developmental disability (cerebral palsy/autism/down's/cognitive disabilities) and a new diagnosis of type 2 diabetes enrolled in Medicaid from January 1, 2004 and December 31, 2006, were included. Adults were included if they had a continuous enrollment for at least 12 months and were excluded if they were dual eligible. Anti-diabetes medication adherence and diabetes medication persistence were measured using multivariate logistic regression and the Cox-proportional hazard regression, respectively. RESULTS The study population comprised of 1529 patients. Although overall diabetes medication adherence in this population was optimal, African Americans had significantly lower odds (25%) of adhering to anti-diabetes medications compared to Caucasians (OR = 0.75, 95% CI = 0.58-0.97, P < 0.05). Also, after controlling for other covariates, the rate of discontinuation was higher in African Americans compared to Caucasians (hazard ratio = 1.03, 95% CI = 0.91-1.18, P < 0.629). CONCLUSION In this study, racial disparities were found in anti-diabetes medication adherence among Medicaid enrollees with developmental disabilities (DD). Studies conducted in the future should examine predictors that impact access to care, availability of primary and specialized care, social support as well as beliefs of racial minority populations with developmental disabilities and chronic conditions like diabetes to optimize medication use outcomes in this especially vulnerable population.
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Affiliation(s)
- Isha Patel
- Bernard Dunn School of Pharmacy, Shenandoah University, Winchester, VA, USA
| | | | | | | | | | - Jongwha Chang
- McWhorter College of Pharmacy, Samford University, Birmingham, AL, USA
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Rahman M, Nakamura K, Kizuki M. Socioeconomic differences in the prevalence, awareness, and control of diabetes in Bangladesh. J Diabetes Complications 2015; 29:788-93. [PMID: 25981122 DOI: 10.1016/j.jdiacomp.2015.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
AIMS To explore the association of the socioeconomic status (SES) in Bangladesh with diabetes prevalence, awareness, and control. METHODS A population sample of 7540 individuals from the 2011 Bangladesh Demographic Health Survey was used. A composite variable of education and wealth calculated the SES indicator. Besides prevalence (age-sex adjusted) of diabetes and pre-diabetes, three other points were analyzed with the socio-demographic characteristics: awareness of diabetes, diabetics receiving medication and adequacy of treatment (measured by achieving normal fasting plasma glucose). RESULTS The age-sex adjusted prevalence of diabetes and pre-diabetes were 10.8% and 25.0%, respectively, in the study population (n=7540). Prevalence of diabetes was 7.2% in the low SES (n=2147) and 17.9% in the high SES group (n=2,418). Among diabetics (n=879), 39.7% were aware of their disease, 35.5% were receiving medication, and 13.0% were receiving adequate medication. Diabetic patients from the medium or high SES group had an increased likelihood of being aware of their disease and of receiving medication. CONCLUSIONS Contrary to other developed countries, diabetes in Bangladesh is more prevalent among the higher SES group. Due to the high prevalence of pre-diabetes, lack of awareness of diabetes and less likelihood of receiving adequate treatment in lower SES group, there is potential for the rapid increase of diabetes. Urgent preventive measures are needed to control the impending diabetes epidemic.
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Affiliation(s)
- Mosiur Rahman
- Department of International Health and Medicine, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Keiko Nakamura
- Department of International Health and Medicine, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Kizuki
- Health Promotion, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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27
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Do EK, Matsuyama RK. Healthcare utilization among Hispanic immigrants with diabetes: investigating the effect of US documentation status. J Immigr Minor Health 2015; 16:189-94. [PMID: 23054546 DOI: 10.1007/s10903-012-9729-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies have not examined whether documentation status has an effect on healthcare utilization among US Hispanic immigrants with diabetes. A secondary analysis was conducted using data from the Pew Hispanic Center and Robert Johnson Wood Foundation's 2007 Hispanic Healthcare Survey. Hispanic immigrants diagnosed with diabetes were included in analyses. The association between documentation status and healthcare utilization was assessed using logistic regressions. Of N = 577 Hispanic immigrants with diabetes, 80 % were documented immigrants and 81% reported having visited a healthcare provider in the last 6 months. Adjusting for confounders, those who were undocumented faced higher odds of having seen a healthcare provider more than 6 months ago or never when compared to those who were documented (OR = 1.79; 95% CI 1.01, 3.14). Unique opportunities in addressing healthcare disparities can be found in focusing on the Hispanic immigrant population living with diabetes.
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Affiliation(s)
- Elizabeth K Do
- Department of Social and Behavioral Health, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23298-0149, USA,
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Das SK, Sharma NK, Zhang B. Integrative network analysis reveals different pathophysiological mechanisms of insulin resistance among Caucasians and African Americans. BMC Med Genomics 2015; 8:4. [PMID: 25868721 PMCID: PMC4351975 DOI: 10.1186/s12920-015-0078-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022] Open
Abstract
Background African Americans (AA) have more pronounced insulin resistance and higher insulin secretion than European Americans (Caucasians or CA) when matched for age, gender, and body mass index (BMI). We hypothesize that physiological differences (including insulin sensitivity [SI]) between CAs and AAs can be explained by co-regulated gene networks in tissues involved in glucose homeostasis. Methods We performed integrative gene network analyses of transcriptomic data in subcutaneous adipose tissue of 99 CA and 37 AA subjects metabolically characterized as non-diabetic, with a range of SI and BMI values. Results Transcripts negatively correlated with SI in only the CA or AA subjects were enriched for inflammatory response genes and integrin-signaling genes, respectively. A sub-network (module) with TYROBP as a hub enriched for genes involved in inflammatory response (corrected p = 1.7E-26) was negatively correlated with SI (r = −0.426, p = 4.95E-04) in CA subjects. SI was positively correlated with transcript modules enriched for mitochondrial metabolism in both groups. Several SI-associated co-expressed modules were enriched for genes differentially expressed between groups. Two modules involved in immune response to viral infections and function of adherens junction, are significantly correlated with SI only in CAs. Five modules involved in drug/intracellular transport and oxidoreductase activity, among other activities, are correlated with SI only in AAs. Furthermore, we identified driver genes of these race-specific SI-associated modules. Conclusions SI-associated transcriptional networks that were deranged predominantly in one ethnic group may explain the distinctive physiological features of glucose homeostasis among AA subjects. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0078-0) contains supplementary material, which is available to authorized users.
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Johns TS, Estrella MM, Crews DC, Appel LJ, Anderson CAM, Ephraim PL, Cook C, Boulware LE. Neighborhood socioeconomic status, race, and mortality in young adult dialysis patients. J Am Soc Nephrol 2014; 25:2649-57. [PMID: 24925723 PMCID: PMC4214533 DOI: 10.1681/asn.2013111207] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/14/2014] [Indexed: 12/28/2022] Open
Abstract
Young blacks receiving dialysis have an increased risk of death compared with whites in the United States. Factors influencing this disparity among the young adult dialysis population have not been well explored. Our study examined the relation of neighborhood socioeconomic status (SES) and racial differences in mortality in United States young adults receiving dialysis. We merged US Renal Data System patient-level data from 11,027 black and white patients ages 18-30 years old initiating dialysis between 2006 and 2009 with US Census data to obtain neighborhood poverty information for each patient. We defined low SES neighborhoods as those neighborhoods in U.S. Census zip codes with ≥20% of residents living below the federal poverty level and quantified race differences in mortality risk by level of neighborhood SES. Among patients residing in low SES neighborhoods, blacks had greater mortality than whites after adjusting for baseline demographics, clinical characteristics, rurality, and access to care factors. This difference in mortality between blacks and whites was significantly attenuated in higher SES neighborhoods. In the United States, survival between young adult blacks and whites receiving dialysis differs by neighborhood SES. Additional studies are needed to identify modifiable factors contributing to the greater mortality among young adult black dialysis patients residing in low SES neighborhoods.
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Affiliation(s)
- Tanya S Johns
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cheryl A M Anderson
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego, California; and
| | - Patti L Ephraim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Courtney Cook
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - L Ebony Boulware
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Buja A, Gini R, Visca M, Damiani G, Federico B, Donato D, Francesconi P, Marini A, Donatini A, Brugaletta S, Bardelle G, Baldo V, Bellentani M. Need and disparities in primary care management of patients with diabetes. BMC Endocr Disord 2014; 14:56. [PMID: 25011729 PMCID: PMC4107618 DOI: 10.1186/1472-6823-14-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management. METHODS A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care. RESULTS 1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship. CONCLUSIONS Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care.
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Affiliation(s)
- Alessandra Buja
- Department of Molecular Medicine of the University of Padova, Laboratory of Public Health and Population Studies, Via Loredan, 18, 35100 Padova, Italy
| | - Rosa Gini
- Toscana Region Healthcare Agency, Florence 50100, Italy
| | - Modesta Visca
- Healthcare Organization Department, National Health Agency, Rome 00100, Italy
| | | | - Bruno Federico
- University of Cassino and Southern Lazio, Cassino 03043, Italy
| | - Daniele Donato
- Local Health Unit 16 Padua, Veneto Region, Padua 35100, Italy
| | | | - Alessandro Marini
- Zona Territoriale Senigallia, Regione Marche, Senigallia 60019, Italy
| | | | | | - Giorgia Bardelle
- Department of Molecular Medicine of the University of Padova, Laboratory of Public Health and Population Studies, Via Loredan, 18, 35100 Padova, Italy
| | - Vincenzo Baldo
- Department of Molecular Medicine of the University of Padova, Laboratory of Public Health and Population Studies, Via Loredan, 18, 35100 Padova, Italy
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Kargar Jahromi M, Ramezanli S. Evaluation of barriers contributing in the demonstration of an effective nurse-patient communication in educational hospitals of Jahrom, 2014. Glob J Health Sci 2014; 6:54-60. [PMID: 25363103 PMCID: PMC4825499 DOI: 10.5539/gjhs.v6n6p54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/15/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Establishing an effective communication with patients is an essential aspect of nursing care. Nurse-patient communication has a key role in improving nursing care and increasing patient's satisfaction of health care system. The study aimed at evaluation of barriers contributing in the demonstration of an effective nurse-patient communication from their viewpoint. METHODS This was cross-sectional study, carried out in 2014, with a sample of 200 nurses and patients drawn from two educational hospitals in jahrom city. Data were collected by using two questionnaire structured by the researchers. Data were analyzed using SPSS software (version 16). RESULTS The results of this study showed that the greatest barriers of nurse-patient communication were characteristics of nursing job with an average score of 71.05 ± 10.18. The most communication barriers from patients viewpoint including: heavy work load of the nurses, age , sex and language difference between patient and nurse and the spicy morality of nurses. CONCLUSION It is concluded that overcome barriers to communication and support are needed to enable nurses to communicate therapeutically with patients in order to achieve care that is effective and responsive to their needs.
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Seligman R, Mendenhall E, Valdovinos MD, Fernandez A, Jacobs EA. Self-care and Subjectivity among Mexican Diabetes Patients in the United States. Med Anthropol Q 2014; 29:61-79. [DOI: 10.1111/maq.12107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca Seligman
- Department of Anthropology and Institute for Policy Research; Northwestern University
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program; Edmund A. Walsh School of Foreign Service; Georgetown University
| | | | - Alicia Fernandez
- Division of General Internal Medicine; San Francisco General Hospital
| | - Elizabeth A. Jacobs
- Division of General Internal Medicine & Health Innovation Program; University of Wisconsin-Madison School of Medicine and Public Health
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Zamanzadeh V, Rassouli M, Abbaszadeh A, Nikanfar A, Alavi-Majd H, Ghahramanian A. Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards. Indian J Palliat Care 2014; 20:12-20. [PMID: 24600177 PMCID: PMC3931236 DOI: 10.4103/0973-1075.125549] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims: The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication. Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach.
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Affiliation(s)
- Vahid Zamanzadeh
- Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rassouli
- Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Abbaszadeh
- Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Nikanfar
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Alavi-Majd
- Para Medicine School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Ghahramanian
- Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
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Raffel KE, Goddu AP, Peek ME. "I Kept Coming for the Love": Enhancing the Retention of Urban African Americans in Diabetes Education. DIABETES EDUCATOR 2014; 40:351-360. [PMID: 24525568 DOI: 10.1177/0145721714522861] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to investigate how retention strategies employed by the Diabetes Empowerment Program (DEP) contributed to retention. METHODS An experienced moderator conducted in-depth interviews (n = 7) and 4 focus groups (n = 29) with former DEP participants. Interviews were recorded, transcribed, and coded using iteratively modified coding guidelines. Results were analyzed using Atlas.ti 4.2 software. RESULTS Participants were African American and predominantly female, low income, and with more than 1 diabetes complication. Key retention themes included: (1) educator characteristics and interpersonal skills ("The warmth of the staff . . . kept me coming back for more."), (2) accessible information ("I didn't know anything about diabetes [before]. I was just given the medicine."), (3) social support ("I realized I wasn't the only one who has diabetes."), (4) the use of narrative ("It's enlightening to talk about [my diabetes]."), and (5) the African American helping tradition ("I went not just for myself but for my husband."). CONCLUSIONS While many interventions focus on costly logistics and incentives to retain at-risk participants, study findings suggest that utilizing culturally tailored curricula and emphasizing interpersonal skills and social support may be more effective strategies to retain low-income African Americans in diabetes education programs.
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Affiliation(s)
- Katie E Raffel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois (Dr Raffel)
| | - Anna P Goddu
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek)
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek),Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, Illinois (Dr Peek)
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Levine DA, Morgenstern LB, Langa KM, Skolarus LE, Smith MA, Lisabeth LD. Does socioeconomic status or acculturation modify the association between ethnicity and hypertension treatment before stroke? Stroke 2013; 44:3243-5. [PMID: 24046006 DOI: 10.1161/strokeaha.113.003051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Socioeconomic status and acculturation may modify the association between ethnicity and hypertension treatment before stroke. We assessed prestroke treatment of hypertension by ethnicity, education (proxy for socioeconomic status), and English proficiency (EP; proxy for acculturation) in a population-based stroke surveillance project. METHODS Among 763 patients with first-ever stroke aged ≥45 years in the Brain Attack Surveillance in Corpus Christi project from 2000 to 2006, we examined self-reported hypertension treatment at the time of the stroke by ethnicity (Mexican American [MA] versus non-Hispanic white [NHW]) in the overall sample, within education strata (<high school, high school, >high school), and after dichotomizing MAs by self-reported EP (limited versus proficient). Logistic regression adjusted associations for age, sex, education, diabetes mellitus, coronary artery disease, hypercholesterolemia, and health insurance. RESULTS NHWs and MAs reported similar hypertension treatment (84% versus 86%; P=0.53). Hypertension treatment was 84% for NHWs and 90% for MAs (P=0.18) in <high school stratum, 87% for NHWs and 75% for MAs (P=0.07) in high school stratum, and 81% for NHWs and 78% for MAs (P=0.73) in >high school stratum (ethnicity-by-education interaction, P=0.09). Hypertension treatment was 83% for NHWs, 87% for MAs with EP (PvsNHWs=0.35), and 90% for MAs with limited EP (PvsNHWs=0.13; ethnicity-by-EP interaction, P=0.22). Hypertension treatment was lower in uninsured patients (adjusted odds ratio, 0.13; 95% confidence interval, 0.03-0.60) or those with no physician visit ≤6 months (adjusted odds ratio, 0.09; 95% confidence interval, 0.03-0.24). CONCLUSIONS We found no evidence that socioeconomic status or acculturation modifies the association between ethnicity and hypertension treatment before stroke.
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Affiliation(s)
- Deborah A Levine
- From the Division of General Medicine and HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (D.A.L., K.M.L.); and Stroke Program (D.A.L., L.B.M., L.E.S., M.A.S., L.D.L.), Department of Epidemiology (L.B.M., L.D.L.), Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor, MI
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Wilcox S, Sharpe PA, Turner-McGrievy G, Granner M, Baruth M. Frequency of consumption at fast-food restaurants is associated with dietary intake in overweight and obese women recruited from financially disadvantaged neighborhoods. Nutr Res 2013; 33:636-46. [PMID: 23890353 PMCID: PMC3758906 DOI: 10.1016/j.nutres.2013.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 05/07/2013] [Accepted: 05/11/2013] [Indexed: 11/29/2022]
Abstract
Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods.
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Affiliation(s)
- Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Batch BC, Shah SH, Newgard CB, Turer CB, Haynes C, Bain JR, Muehlbauer M, Patel MJ, Stevens RD, Appel LJ, Newby LK, Svetkey LP. Branched chain amino acids are novel biomarkers for discrimination of metabolic wellness. Metabolism 2013; 62:961-9. [PMID: 23375209 PMCID: PMC3691289 DOI: 10.1016/j.metabol.2013.01.007] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 01/06/2013] [Accepted: 01/07/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify novel biomarkers through metabolomic profiles that distinguish metabolically well (MW) from metabolically unwell (MUW) individuals, independent of body mass index (BMI). MATERIALS/METHODS This study was conducted as part of the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) project. Individuals from 3 cohorts were classified as lean (BMI<25kg/m²), overweight (BMI≥25kg/m², BMI<30kg/m²) or obese (BMI≥30kg/m²). Cardiometabolic abnormalities were defined as: (1) impaired fasting glucose (≥100mg/dL and ≤126mg/dL); (2) hypertension; (3) triglycerides ≥150mg/dL; (4) HDL-C <40mg/dL in men, <50mg/dL in women; and (5) insulin resistance (calculated Homeostatic Model Assessment (HOMA-IR) index of >5.13). MW individuals were defined as having <2 cardiometabolic abnormalities and MUW individuals had≥two cardiometabolic abnormalities. Targeted profiling of 55 metabolites used mass-spectroscopy-based methods. Principal components analysis (PCA) was used to reduce the large number of correlated metabolites into clusters of fewer uncorrelated factors. RESULTS Of 1872 individuals, 410 were lean, 610 were overweight, and 852 were obese. Of lean individuals, 67% were categorized as MUW, whereas 80% of overweight and 87% of obese individuals were MUW. PCA-derived factors with levels that differed the most between MW and MUW groups were factors 4 (branched chain amino acids [BCAA]) [p<.0001], 8 (various metabolites) [p<.0001], 9 (C4/Ci4, C3, C5 acylcarnitines) [p<.0001] and 10 (amino acids) [p<.0002]. Further, Factor 4, distinguishes MW from MUW individuals independent of BMI. CONCLUSION BCAA and related metabolites are promising biomarkers that may aid in understanding cardiometabolic health independent of BMI category.
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Affiliation(s)
- Bryan C Batch
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA.
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Laiteerapong N, Karter AJ, John PM, Schillinger D, Moffet HH, Liu JY, Adler N, Chin MH, Huang ES. Ethnic differences in quality of life in insured older adults with diabetes mellitus in an integrated delivery system. J Am Geriatr Soc 2013; 61:1103-10. [PMID: 23796021 DOI: 10.1111/jgs.12327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To explore racial and ethnic (ethnic hereafter) differences in health-related quality of life (HRQL) in older adults with diabetes mellitus in an integrated delivery system. DESIGN Observational cross-sectional study. SETTING Kaiser Permanente Northern California. PARTICIPANTS Ethnic-stratified, random sample of 6,096 adults with diabetes mellitus aged 60 to 75 who completed a HRQL questionnaire. MEASUREMENTS Physical and mental HRQL were measured based on the Medical Outcomes Study 8-item Short Form Survey (range 0-100, mean 50). Age- and sex-adjusted weighted linear regression models estimated associations between ethnicity and HRQL and evaluated potential mediators (socioeconomic status, acculturation, health behaviors, diabetes mellitus-related conditions). Differences in ethnic-specific, adjusted mean HRQL scores were tested (reference whites). RESULTS Physical HRQL was better for Filipinos (48.3, 95% confidence interval (CI) = 47.0-49.6, P < .001), Asians (48.1, 95% CI = 46.8-49.3, P < .001), Hispanics (45.1, 95% CI = 44.2-46.0, P < .001), and blacks (44.2, 95% CI = 43.3-45.1, P = .04) than whites (42.9, 95% CI = 42.6-43.2). Adjusting for potential mediators did not change these relationships. Mental HRQL was better only for Asians (52.7, 95% CI = 51.6-53.7, P = .01) than for whites (51.0, 95% CI = 50.7-51.3), but this difference was small and became nonsignificant after adjustment for socioeconomic status, acculturation, health behaviors, and diabetes mellitus-related conditions. CONCLUSION In older adults with diabetes mellitus in a well-established integrated healthcare delivery system, ethnic minorities had better physical HRQL than whites. Equal access to care in an integrated delivery system may hold promise for reducing health disparities in diabetes mellitus-related patient-reported outcomes.
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Affiliation(s)
- Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
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Franch-Nadal J, Martínez-Sierra MC, Espelt A, Sagarra-Busquets E, Patitucci-Gómez F, Goday-Arno A. El diabético inmigrante: factores de riesgo cardiovascular y su control. Aportaciones del estudio IDIME. Rev Esp Cardiol 2013; 66:39-46. [DOI: 10.1016/j.recesp.2012.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/03/2012] [Indexed: 12/26/2022]
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Ryan JG, Jennings T, Vittoria I, Fedders M. Short and Long-Term Outcomes from a Multisession Diabetes Education Program Targeting Low-Income Minority Patients: A Six-Month Follow Up. Clin Ther 2013; 35:A43-53. [DOI: 10.1016/j.clinthera.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Abstract
The incidence of diabetic nephropathy (DN) is growing rapidly worldwide as a consequence of the rising prevalence of Type 2 diabetes mellitus (T2DM). Among U.S. ethnic groups, Mexican Americans have a disproportionately high incidence and prevalence of DN and associated end-stage renal disease (ESRD). In communities bordering Mexico, as many as 90% of Mexican American patients with ESRD also suffer from T2DM compared to only 50% of non-Hispanic Whites (NHW). Both socio-economic factors and genetic predisposition appear to have a strong influence on this association. In addition, certain pathogenetic and clinical features of T2DM and DN are different in Mexican Americans compared to NHW, raising questions as to whether the diagnostic and treatment strategies that are standard practice in the NHW patient population may not be applicable in Mexican Americans. This article reviews the epidemiology of DN in Mexican Americans, describes the pathophysiology and associated risk factors, and identifies gaps in our knowledge and understanding that needs to be addressed by future investigations.
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Shah AS, Dolan LM, Gao Z, Kimball TR, Urbina EM. Racial differences in arterial stiffness among adolescents and young adults with type 2 diabetes. Pediatr Diabetes 2012; 13:170-5. [PMID: 21790919 PMCID: PMC3210878 DOI: 10.1111/j.1399-5448.2011.00798.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND African-American adults demonstrate a higher prevalence of cardiovascular complications including myocardial infarction and stroke. Whether similar racial disparities are present to suggest African-Americans adolescents are at higher risk to develop cardiovascular disease is not known. Thus, we compared arterial stiffness, an early marker of cardiovascular disease, in African-American and Caucasian adolescents and young adults with type 2 diabetes. METHODS Demographic, anthropometric, laboratory data, and arterial stiffness measures including pulse wave velocity (PWV) and augmentation index (AIx) were collected in a cross-sectional study of 215 adolescents (average age 18 yr) with type 2 diabetes (55% African-American and 65% female). RESULTS Compared to Caucasians, African-Americans had increased PWV (6.21 ± 0.87 vs. 6.96 ± 1.30, p < .01) and AIx (4.44 ± 11.17 vs. 7.64 ± 12.02, p = 0.05). Regression modeling demonstrated age, lipids, blood pressure, and duration of diabetes were differently associated with arterial stiffness in each race group (p < 0.05). CONCLUSIONS African-American adolescents and young adults with type 2 diabetes have increased vascular stiffness than age-matched Caucasians. This process is mediated by different cardiovascular risk factors. These results suggest race-specific risk factor modification may be helpful to prevent early cardiovascular disease in this high risk population.
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Affiliation(s)
- Amy S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Wilcox S, Sharpe PA, Parra-Medina D, Granner M, Hutto B. A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS). Contemp Clin Trials 2011; 32:931-45. [PMID: 21864718 DOI: 10.1016/j.cct.2011.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 06/23/2011] [Accepted: 08/09/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population. OBJECTIVES STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. DESIGN A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. METHODS Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. RESULTS Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. SUMMARY STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.
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Affiliation(s)
- Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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Hausmann LRM, Ren D, Sevick MA. Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes. Patient Prefer Adherence 2010; 4:291-9. [PMID: 20859456 PMCID: PMC2943221 DOI: 10.2147/ppa.s12353] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We examined whether diabetes-related psychosocial factors differ between African American and white patients with type 2 diabetes. We also tested whether racial differences in glycemic control are independent of such factors. METHODS Baseline glycosylated hemoglobin (HbA(1c)) and survey measures from 79 African American and 203 white adult participants in a diabetes self-management clinical trial were analyzed. RESULTS Several psychosocial characteristics varied by race. Perceived interference of diabetes with daily life, perceived diabetes severity, and diabetes-related emotional distress were higher for African Americans than for whites, as were access to illness-management resources and social support. Mean HbA(1c) levels were higher among African Americans than whites (8.14 vs 7.40, beta = 0.17). This difference persisted after adjusting for demographic, clinical, and diabetes-related psychosocial characteristics that differed by race (beta = 0.18). Less access to illness-management resources (beta = -0.25) and greater perceived severity of diabetes (beta = 0.21) also predicted higher HbA(1c). DISCUSSION Although racial differences in diabetes-related psychosocial factors were observed, African Americans continued to have poorer glycemic control than whites even after such differences were taken into account. Interventions that target psychosocial factors related to diabetes management, particularly illness-management resources, may be a promising way to improve glycemic control for all patients.
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Affiliation(s)
- Leslie RM Hausmann
- Center for Health Equity Research and Promotion
- Correspondence: Leslie RM Hausmann, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206, USA, Tel +1 412 954 5221, Fax +1 412 954 5264 Email
| | | | - Mary Ann Sevick
- Center for Health Equity Research and Promotion
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Medicine
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Manka C, Gomes R, Reviere R, Lee C. Treatment options for hepatitis C and the rationale for low response rates in African Americans. J Natl Med Assoc 2010; 101:604-8. [PMID: 19585932 DOI: 10.1016/s0027-9684(15)30948-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatitis C virus (HCV), the leading cause for liver transplantation, is emerging as1 of the infections that pose public health problems in the world since about 170 million people worldwide are infected with this virus. Inequality in addressing racial/ethnic disparities in treatment for hepatitis C is a pressing problem. HCV is more common among African Americans than among other racial groups in the United States. Although African Americans have been shown to have a lower rate of viral clearance and a higher rate of chronic hepatitis C, they may have at the same time a much lower rate of fibrosis progression compared to Caucasians. The purpose of this study is to summarize treatment options available for hepatitis C in African Americans and to describe the different mechanisms thought to be the reasons for the disparate response to treatment in African Americans.
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Affiliation(s)
- Cheu Manka
- Department of Biology, Howard University, Washington, DC, USA.
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Pabon-Nau LP, Cohen A, Meigs JB, Grant RW. Hypertension and diabetes prevalence among U.S. Hispanics by country of origin: the National Health Interview Survey 2000-2005. J Gen Intern Med 2010; 25:847-52. [PMID: 20490949 PMCID: PMC2896588 DOI: 10.1007/s11606-010-1335-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 10/12/2009] [Accepted: 03/10/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite their diverse cultural origins, Hispanics in the US are generally studied as a single ethnic group. OBJECTIVES 1) Assess demographic and disease-related differences among U.S. Hispanics by country of origin, and 2) Examine the mediating roles of socioeconomic status and acculturation on disease prevalence in these subgroups. DESIGN AND PARTICIPANTS Using data from the 2000-2005 National Health Interview Survey (NHIS), we compared characteristics of Mexican-Americans with Hispanics originally from: Mexico, Puerto Rico, Central/South America, Cuba, and Dominican Republic (n = 31,240). We stratified the analysis by foreign versus US-born Hispanic subgroups and modeled hypertension and diabetes prevalence, adjusting for demographic and acculturation differences. MAIN RESULTS The six Hispanic subgroups were significantly diverse in all measured variables. Prevalence of hypertension (32%) and diabetes (15%) was highest in foreign-born Puerto Ricans. After adjusting for age, BMI, smoking, socioeconomic status and acculturation in foreign-born Hispanics, Puerto Ricans (OR = 1.76 [95% CI: 1.23, 2.50], p = 0.002) and Dominicans (OR = 1.93 [1.24, 3.00], p = 0.004), had higher prevalence of hypertension relative to Mexican-Americans. Adjusted diabetes prevalence among foreign-born Hispanics was half or less in Cubans (OR = 0.42 [0.25, 0.68] p < 0.001), Dominicans (OR = 0.48 [0.26, 0.91], p = 0.02) and Central/South Americans (OR = 0.51 [0.33, 0.78], p = 0.002) relative to Mexican-Americans. Among US-born Hispanic subgroups, Cubans had lower hypertension (OR = 0.53, [0.33, 0.83], p = 0.006) and Mexicans (OR = 0.76 [0.60, 0.98], p = 0.03) had lower diabetes prevalence compared to Mexican-Americans in adjusted models. CONCLUSIONS The prevalence of hypertension and diabetes varies significantly among Hispanics by country of origin. Health disparities research should include representation from all Hispanic subgroups.
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Affiliation(s)
- Lina P Pabon-Nau
- Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA.
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Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: perspectives of African-Americans with diabetes. Soc Sci Med 2010; 71:1-9. [PMID: 20409625 DOI: 10.1016/j.socscimed.2010.03.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 09/23/2009] [Accepted: 03/01/2010] [Indexed: 11/25/2022]
Abstract
Shared decision-making (SDM) is an important component of patient-centered healthcare and is positively associated with improved health outcomes (e.g. diabetes and hypertension control). In shared decision-making, patients and physicians engage in bidirectional dialogue about patients' symptoms and treatment options, and select treatment plans that address patient preferences. Existing research shows that African-Americans experience SDM less often than whites, a fact which may contribute to racial disparities in diabetes outcomes. Yet little is known about the reasons for racial disparities in shared decision-making. We explored patient perceptions of how race may influence SDM between African-American patients and their physicians. We conducted in-depth interviews (n=24) and five focus groups (n=27) among a purposeful sample of African-American diabetes patients aged over 21 years, at an urban academic medical center in Chicago. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was conducted iteratively; each transcription was independently coded by two research team members. Although there was heterogeneity in patients' perceptions about the influence of race on SDM, in each of the SDM domains (information-sharing, deliberation/physician recommendations, and decision-making), participants identified a range of race-related issues that may influence SDM. Participants identified physician bias/discrimination and/or cultural discordance as issues that may influence physician-related SDM behaviors (e.g. less likely to share information such as test results and more likely to be domineering with African-American patients). They identified mistrust of white physicians, negative attitudes and internalized racism as patient-related issues that may influence African-American patients' SDM behaviors (e.g. less forthcoming with physicians about health information, more deference to physicians, less likely to adhere to treatment regimens). This study suggests that race-related patient and physician-related barriers may serve as significant barriers to shared decision-making between African-American patients and their physicians. Finding innovative ways to address such communication barriers is an important area of future research.
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Affiliation(s)
- Monica E Peek
- The University of Chicago, Department of Medicine, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
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Lancaster K, Walker W, Vance T, Kaskel P, Arniella G, Horowitz C. Food for Life / Comida para la Vida: creating a food festival to raise diabetes awareness. Prog Community Health Partnersh 2010; 3:359-63. [PMID: 20097997 DOI: 10.1353/cpr.0.0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
African and Latino Americans have higher rates of diabetes and its complications than White Americans. Identifying people with undiagnosed diabetes and helping them obtain care can help to prevent complications and mortality. To kick off a screening initiative, our community-academic partnership created the "Food for Life Festival," or "Festival Comida para la Vida." This article will describe the community's perspective on the Festival, which was designed to screen residents, and demonstrate that eating healthy can be fun, tasty, and affordable in a community-centered, culturally consonant setting. More than 1,000 residents attended the event; 382 adults were screened for diabetes, and 181 scored as high risk. Fifteen restaurants distributed free samples of healthy versions of their popular dishes. Community residents, restaurateurs, and clinicians commented that the event transformed many of their preconceived ideas about healthy foods and patient care.
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Davis NJ, Wildman RP, Forbes BF, Schechter CB. Trends and disparities in provider diagnosis of overweight analysis of NHANES 1999-2004. Obesity (Silver Spring) 2009; 17:2110-3. [PMID: 19390515 DOI: 10.1038/oby.2009.129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rates of overweight and obesity are disproportionately high within minority populations. This study examined the trends in provider diagnosis of overweight from 1999 to 2004 and examined whether there were differences in provider diagnosis based on race/ethnicity. We examined data from 4,071 adults with BMI >or=30 who participated in the National Health and Nutrition Examination Surveys (NHANES) (1999-2004). Provider diagnosis was determined by self-report. From 1999 to 2004, the provider diagnosis of overweight decreased from 71 to 64% (P = 0.003). After controlling for potential confounders, non-Hispanic blacks and Mexican Americans were less likely to report a provider diagnosis of overweight compared to non-Hispanic whites. Odds ratio (OR) (95% confidence interval (CI)) for non-Hispanic blacks was 0.6 (95% CI, 0.4-0.8) and for Mexican Americans was 0.7 (95% CI, 0.4-1.0) compared to non-Hispanic whites. Reasons for this disparity warrant further investigation.
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Affiliation(s)
- Nichola J Davis
- Department of Medicine, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, North Bronx Health Care Network, Bronx, New York, USA.
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Winston GJ, Barr RG, Carrasquillo O, Bertoni AG, Shea S. Sex and racial/ethnic differences in cardiovascular disease risk factor treatment and control among individuals with diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2009; 32:1467-9. [PMID: 19435957 PMCID: PMC2713610 DOI: 10.2337/dc09-0260] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 04/22/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine sex and racial/ethnic differences in cardiovascular risk factor treatment and control among individuals with diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). RESEARCH DESIGN AND METHODS This study was an observational study examining mean levels of cardiovascular risk factors and proportion of subjects achieving treatment goals. RESULTS The sample included 926 individuals with diabetes. Compared with men, women were 9% less likely to achieve LDL cholesterol <130 mg/dl (adjusted prevalence ratio 0.91 [0.83-0.99]) and systolic blood pressure (SBP) <130 mmHg (adjusted prevalence ratio 0.91 [0.85-0.98]). These differences diminished over time. A lower percentage of women used aspirin (23 vs. 33%; P < 0.001). African American and Hispanic women had higher mean levels of SBP and lower prevalence of aspirin use than non-Hispanic white women. CONCLUSIONS Women with diabetes had unfavorable cardiovascular risk factor profiles compared with men. African American and Hispanic women had less favorable profiles than non-Hispanic white women.
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Affiliation(s)
- Ginger J. Winston
- Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - R. Graham Barr
- Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Olveen Carrasquillo
- Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Alain G. Bertoni
- Division of Public Health Sciences and Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Steven Shea
- Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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