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Lu Y, Liu Y, Dhingra LS, Massey D, Caraballo C, Mahajan S, Spatz ES, Onuma O, Herrin J, Krumholz HM. National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011-2018. Hypertension 2021; 79:207-217. [PMID: 34775785 DOI: 10.1161/hypertensionaha.121.18381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011-2018), we examined recent trends in racial and ethnic differences in awareness and antihypertensive medication use, and their association with racial and ethnic differences in hypertension control. Between 2011 and 2018, age-adjusted hypertension awareness declined for Black, Hispanic, and White individuals, but the 3 outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals had a similar awareness (odds ratio, 1.20 [0.96-1.45]) and overall treatment rates (1.04 [0.84-1.25]), and received more intensive antihypertensive medication if treated (1.41 [1.27-1.56]), but had a lower control rate (0.72 [0.61-0.83]). Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52-0.85] and 0.74 [0.59-0.89]), overall treatment rates (0.72 [0.57-0.88] and 0.69 [0.55-0.82]), received less intensive medication if treated (0.60 [0.50-0.72] and 0.86 [0.75-0.96]), and had lower control rates (0.66 [0.54-0.79] and 0.69 [0.57-0.81]). The racial and ethnic differences in awareness, treatment, and control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were significantly associated with lower control in Asian and Hispanic individuals (P<0.01 for all) but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.).,Department of Epidemiology (Chronic Disease), Yale School of Public Health, New Haven CT (E.S.S)
| | - Oyere Onuma
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Jeph Herrin
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Zhao H, Han L, Chang D, Ye Y, Shen J, Daniel CR, Gu J, Chow WH, Wu X. Social-demographics, health behaviors, and telomere length in the Mexican American Mano a Mano Cohort. Oncotarget 2017; 8:96553-96567. [PMID: 29228552 PMCID: PMC5722504 DOI: 10.18632/oncotarget.19903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022] Open
Abstract
In the current study, we examined cross-sectional associations among social-demographics, lifestyle behaviors, and relative telomere length (RTL) in peripheral blood leukocytes, as well as longitudinal relationships among major chronic diseases, weight gain, and RTL, among 12,792 Mexican Americans aged 20 to 85 years in the Mano-A-Mano, the Mexican American Cohort. As expected, RTL was inversely correlated with age (ρ=-0.15, ρ<0.001). In the multivariate analysis, we found that RTL was positively correlated with levels of education (ρ=0.021), self-insurance (ρ=0.041), body mass index (BMI) (ρ<0.001), and sleeping time per day (ρ for trend<0.001), and RTL was inversely correlated with sitting time per day (ρ for trend =0.001). In longitudinal analysis, we found that longer RTL was modestly but positively associated with increased risks of overall cancer (adjusted hazard ratio (adj.HR)=1.05, 95% conference interval (95%CI)=1.02-1.09). In quartile analysis, 4th quartile (longest RTL) was associated with 1.53-fold increased risk of overall cancer (adj.HR=1.53, 95%CI=1.11-2.10), compared to 1st quartile (shortest RTL). RTL was reversely associated with the risk of type-2 diabetes (adj.HR=0.89, 95%CI=0.82-0.94). In quartile analysis, 4th quartile (longest RTL) was associated with 48% decreased risk of typle-2 diabetes (adj.HR=0.52, 95%CI=0.32-0.70), compared to 1st quartile (shortest RTL). In addition, longer RTL was a positive predictor of at least 10% weight gain (adj.HR=1.03, 95%CI=1.00-1.05). In summary, our results in Mexican Americans support the notion that telomere length is a biological mechanism by which social demographics and health behaviors “get under the skin” to affect health.
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Affiliation(s)
- Hua Zhao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lixia Han
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Shen
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carrie R Daniel
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jian Gu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wong-Ho Chow
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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