1
|
Gupta A, Mori M, Wang Y, Pawar SG, Vahl T, Nazif T, Onuma O, Yong CM, Sharma R, Kirtane AJ, Forrest JK, George I, Kodali S, Chikwe J, Geirsson A, Makkar R, Leon MB, Krumholz HM. Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012-2019. Am J Med 2024; 137:321-330.e7. [PMID: 38190959 PMCID: PMC11019903 DOI: 10.1016/j.amjmed.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients. Our objective was to examine differences in utilization of aortic valve replacement and outcomes by race/ethnicity in the US for patients with aortic stenosis. METHODS We performed a serial cross-sectional cohort study of 299,976 Medicare beneficiaries hospitalized with principal diagnosis of aortic stenosis between 2012 and 2019 stratified by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). Outcomes included aortic valve replacement rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day readmission, 30-day and 1-year mortality. RESULTS Within 6 months of an index admission for aortic stenosis, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent aortic valve replacement. Overall, compared with White people, Black (HR 0.87 [0.85-0.89]), Hispanic (0.92 [0.88-0.96]), and Asian (0.95 [0.91-0.99]) people were less likely to receive aortic valve replacement. Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI, 40.7-41.4) had a significantly higher aortic valve replacement rate compared with Black (29.6%, 95% CI, 28.3-30.9), Hispanic (36.6%, 95% CI, 34.0-39.3), and Asian patients (35.4%, 95% CI, 32.3-38.9). Aortic valve replacement rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race/ethnicity. CONCLUSIONS Aortic valve replacement rates within 6 months of aortic stenosis admission are lower for Black, Hispanic, and Asian people compared to White people. These race-related differences in aortic stenosis treatment reflect complex issues in diagnosis and management, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.
Collapse
Affiliation(s)
- Aakriti Gupta
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Makoto Mori
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Division of Cardiology, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Shubhadarshini G Pawar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Torsten Vahl
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Tamim Nazif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Oyere Onuma
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, Conn
| | - Celina M Yong
- Division of Cardiology, Department of Medicine, Stanford Medical Center, California and Veterans Affairs Palo Alto Healthcare System, Palo Alto
| | - Rahul Sharma
- Division of Cardiology, Department of Medicine, Stanford Medical Center, California and Veterans Affairs Palo Alto Healthcare System, Palo Alto
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - John K Forrest
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Isaac George
- Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn.
| |
Collapse
|
2
|
Santamaría-Ulloa C, Lehning AJ, Cortés-Ortiz MV, Méndez-Chacón E. Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States. BMC Public Health 2023; 23:1960. [PMID: 37817140 PMCID: PMC10563325 DOI: 10.1186/s12889-023-16900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Frailty is a common condition among older adults that results from aging-related declines in multiple systems. Frailty increases older adults' vulnerability to negative health outcomes, including loss of mobility, falls, hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in older adults from Costa Rica and the United States. METHODS This prospective cohort study uses secondary nationally-representative data of community-dwelling older adults from the Costa Rican Longevity and Healthy Aging Study (CRELES, n = 1,790) and the National Health & Aging Trends Study (NHATS, n = 6,680). Frailty status was assessed using Physical Frailty Phenotype, which includes the following five criteria: shrinking, exhaustion, low physical activity, muscle weakness, and slow gait. We used Cox proportional hazard models to examine the association between frailty and all-cause mortality, including sociodemographic characteristics and health behaviors as covariates in the models. Mortality follow-up time was right censored at 8 years from the date at baseline interview. RESULTS The death hazard for frail compared to non-frail older adults was three-fold in Costa Rica (HR = 3.14, 95% CI: 2.13-4.62) and four-fold in the White US (HR = 4.02, 95% CI: 3.04-5.32). Older age, being male, and smoking increased mortality risk in both countries. High education was a protective factor in the US, whereas being married/in union was a protective factor in Costa Rica. In the US, White older adults had a lower risk of death compared to all other races and ethnicities. CONCLUSIONS Results indicate that frailty can have a differential impact on mortality depending on the country. Access to universal health care across the life course in Costa Rica and higher levels of stress and social isolation in the US may explain differences observed in end-of-life trajectories among frail older adults.
Collapse
Affiliation(s)
| | - Amanda J Lehning
- School of Social Work, University of Maryland Baltimore, Maryland, United States of America
| | - Mónica V Cortés-Ortiz
- Graduate School Student Fellow, University of Maryland Baltimore, Maryland, United States of America
| | | |
Collapse
|
3
|
Bernstein SF, Sasson I. Black and white differences in subjective survival expectations: An evaluation of competing mechanisms. SSM Popul Health 2023; 21:101339. [PMID: 36785548 PMCID: PMC9918793 DOI: 10.1016/j.ssmph.2023.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
While black-white inequality in longevity is well documented in the United States, little is known about how individuals from different race/ethnic groups form their own personal survival expectations. Prior research has found that despite having higher mortality, blacks on average report higher survival expectations relative to whites. Using data from the Health and Retirement Study, we examined racial differences in subjective survival expectations across birth cohorts and provide explanatory mechanisms. We find that blacks-men in particular-were overly optimistic about their survival, but this effect had waned with successive birth cohorts. Furthermore, whereas subjective survival expectations and actual survival were correlated among white men, among black men the most optimistic fared worst. Blacks and whites differed not only in their response patterns, but also in how they weighed the different factors (socioeconomic, psychosocial, health, parental longevity) associated with expected survival. Importantly, those who estimated their survival probability with certainty had positive psychosocial characteristics, irrespective of race, but only whites had better health. These findings underscore the importance of group differences in subjective survival expectations as another potential form of inequality. Racial differences in how long individual expect to live may account for differences in social and economic behavior and outcomes, irrespective of actual longevity differentials.
Collapse
Affiliation(s)
- Shayna Fae Bernstein
- Department of Sociology and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel,Corresponding author.
| | - Isaac Sasson
- Department of Sociology and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel,Herczeg Institute on Aging, Tel Aviv University, Israel
| |
Collapse
|
4
|
Himmelstein KEW, Lawrence JA, Jahn JL, Ceasar JN, Morse M, Bassett MT, Wispelwey BP, Darity WA, Venkataramani AS. Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. JAMA Netw Open 2022; 5:e2240519. [PMID: 36342718 PMCID: PMC9641537 DOI: 10.1001/jamanetworkopen.2022.40519] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear. OBJECTIVE To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022. EXPOSURES Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated. RESULTS Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.
Collapse
Affiliation(s)
- Kathryn E. W. Himmelstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jourdyn A. Lawrence
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jaquelyn L. Jahn
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Joniqua N. Ceasar
- Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Morse
- Center for Health Equity and Community Wellness, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Bram P. Wispelwey
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - William A. Darity
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health Economics, Division of Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| |
Collapse
|
5
|
Rebok GW, Huang A, Smail E, Brichko R, Parisi JM, Marsiske M, Roth DL, Thorpe RJ, Felix C, Jones RN, Willis SL. Long-Term Effects of Cognitive Training on All-Cause Mortality in US Older Adults. J Aging Health 2022; 34:1135-1143. [PMID: 35510611 PMCID: PMC10069226 DOI: 10.1177/08982643221097681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cognitively and physically healthy, community-dwelling adults aged 65 and older. Cox proportional hazard models were used to investigate (1) the association between baseline cognition and mortality risk and (2) the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk 20 years post-intervention. Results: Higher baseline cognition predicted lower mortality risk 20 years post-intervention. No significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on mortality risk were observed. Discussion: More work is needed to identify cognitive training interventions that may lead to lower mortality risks in later adulthood.
Collapse
Affiliation(s)
- George W. Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Smail
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rostislav Brichko
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanine M. Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Marsiske
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - David L. Roth
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cynthia Felix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Sherry L. Willis
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Mene-Afejuku TO, Jeyashanmugaraja GP, Hoq M, Ola O, Shah AJ. Determinants of mortality among seniors acutely readmitted for heart failure: racial disparities and clinical correlations. J Geriatr Cardiol 2022; 19:719-724. [PMID: 36284676 PMCID: PMC9548051 DOI: 10.11909/j.issn.1671-5411.2022.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Affiliation(s)
| | | | - Mahfuz Hoq
- Yale New Haven Health System, Bridgeport hospital, CT, USA
| | | | - Amit J Shah
- Department of Cardiology, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
Santos CJ, Paciência I, Ribeiro AI. Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116745. [PMID: 35682327 PMCID: PMC9180257 DOI: 10.3390/ijerph19116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023]
Abstract
Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.
Collapse
Affiliation(s)
- Cláudia Jardim Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Correspondence: ; Tel.: +351-222-061-820
| | - Inês Paciência
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90570 Oulu, Finland;
- Biocenter Oulu, University of Oulu, P.O. Box 5000, 90570 Oulu, Finland
| | - Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| |
Collapse
|
8
|
Quach LT, Cho K, Driver JA, Ward R, Spiro A, Dugan E, Gaziano MJ, Djousse L, Rudolph JL, Gagnon DR. Social Characteristics, Health, and Mortality Among Male Centenarians Using Veterans Affairs (VA) Health Care. Res Aging 2022; 44:136-143. [PMID: 33779393 PMCID: PMC10756333 DOI: 10.1177/01640275211000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We studied male centenarian Veterans using VA health care to understand the impact of social characteristics on their annual mortality rate, adjusting for prevalent health conditions. This longitudinal study used VA Electronic Health Record data from 1997 to 2012 (n = 1,858). Covariates included age, race, marital status, and periods of military service. The mean age was 100.4 ± 1.4 years, 76% were white, and 49% were married. The average annual mortality rate was 32 per 100 person-years. The annual mortality rate was stable and not affected by race but did vary by marital status. Divorced or separated centenarians had a 21% higher rate of death than married centenarians. A diagnosis of dementia or of congestive heart failure each increased the mortality risk by 37%. Providers should consider prevalent health conditions, as well as marital status, in managing care of centenarian Veterans.
Collapse
Affiliation(s)
- Lien T. Quach
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Department of Gerontology, The University of Massachusetts Boston, MA, USA
- Providence VA Medical Center, Providence, RI, USA
| | - Kelly Cho
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jane A. Driver
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Providence VA Medical Center, Providence, RI, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel Ward
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Avron Spiro
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Brown University, Providence, RI, USA
| | - Elizabeth Dugan
- Department of Gerontology, The University of Massachusetts Boston, MA, USA
| | - Michael J. Gaziano
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Luc Djousse
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James L. Rudolph
- Providence VA Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - David R. Gagnon
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, MA, USA
- Brown University, Providence, RI, USA
| |
Collapse
|
9
|
Garcia M, Almuwaqqat Z, Moazzami K, Young A, Lima BB, Sullivan S, Kaseer B, Lewis TT, Hammadah M, Levantsevych O, Elon L, Bremner JD, Raggi P, Shah AJ, Quyyumi AA, Vaccarino V. Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients. J Am Heart Assoc 2021; 10:e020828. [PMID: 34431313 PMCID: PMC8649258 DOI: 10.1161/jaha.121.020828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Black patients tend to develop coronary artery disease at a younger age than other groups. Previous data on racial disparities in outcomes of myocardial infarction (MI) have been inconsistent and limited to older populations. Our objective was to investigate racial differences in the outcome of MI among young and middle‐aged patients and the role played by socioeconomic, psychosocial, and clinical differences. Methods and Results We studied 313 participants (65% non‐Hispanic Black) <61 years old hospitalized for confirmed type 1 MI at Emory‐affiliated hospitals and followed them for 5 years. We used Cox proportional‐hazard models to estimate the association of race with a composite end point of recurrent MI, stroke, heart failure, or cardiovascular death after adjusting for demographic, socioeceonomic status, psychological, and clinical risk factors. The mean age was 50 years, and 50% were women. Compared with non‐Black patients, Black patients had lower socioeconomic status and more clinical and psychosocial risk factors but less angiographic coronary artery disease. The 5‐year incidence of cardiovascular events was higher in Black (35%) compared to non‐Black patients (19%): hazard ratio (HR) 2.1, 95% CI, 1.3 to 3.6. Adjustment for socioeconomic status weakened the association (HR 1.3, 95% CI, 0.8–2.4) more than adjustment for clinical and psychological risk factors. A lower income explained 46% of the race‐related disparity in outcome. Conclusions Among young and middle‐aged adult survivors of an MI, Black patients have a 2‐fold higher risk of adverse outcomes, which is largely driven by upstream socioeconomic factors rather than downstream psychological and clinical risk factors.
Collapse
Affiliation(s)
- Mariana Garcia
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Zakaria Almuwaqqat
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Kasra Moazzami
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - An Young
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Bruno B Lima
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Samaah Sullivan
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Belal Kaseer
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Tené T Lewis
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Muhammad Hammadah
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Oleksiy Levantsevych
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - J Douglas Bremner
- Atlanta VA Medical Center Decatur GA.,Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta, GA.,Department of Radiology and Imaging Sciences Emory University School of Medicine Atlanta GA
| | - Paolo Raggi
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Amit J Shah
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,Atlanta VA Medical Center Decatur GA
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Viola Vaccarino
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| |
Collapse
|
10
|
Schulz AJ, Omari A, Ward M, Mentz GB, Demajo R, Sampson N, Israel BA, Reyes AG, Wilkins D. Independent and joint contributions of economic, social and physical environmental characteristics to mortality in the Detroit Metropolitan Area: A study of cumulative effects and pathways. Health Place 2020; 65:102391. [PMID: 32738606 PMCID: PMC7511424 DOI: 10.1016/j.healthplace.2020.102391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants. METHODS Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects. RESULTS Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality. CONCLUSIONS Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.
Collapse
Affiliation(s)
- Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Amel Omari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Melanie Ward
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Graciela B Mentz
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ricardo Demajo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Natalie Sampson
- College of Education, Health and Human Services, University of Michigan Dearborn, Dearborn, MI, USA
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | | |
Collapse
|
11
|
Taylor HA, Washington-Plaskett T, Quyyumi AA. Black Resilience - Broadening the Narrative and the Science on Cardiovascular Health and Disease Disparities. Ethn Dis 2020; 30:365-368. [PMID: 32346283 PMCID: PMC7186053 DOI: 10.18865/ed.30.2.365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The health of African Americans has been largely described in terms of deficits, disease and death. Little attention has been historically given to the fact that African Americans as a population show the sustained ability to survive an evolving array of social, economic and environmental adversities that date back to more than a century before the founding of the United States. While these inequities have indeed taken (and continue to take) a devastating toll, there is also wide heterogeneity in outcomes, suggesting the existence of substantial individual and collective resilience among African Americans. This Perspective aims to stimulate discussion and research that explores resilience in a population in which "overcoming" and "bouncing back" from adversities (ranging from minor incidents to legally ordained, chronic and horrific oppression) has been a requirement for survival. Rigorous scientific exploration of Black resilience may yield important insights into the phenomenon of human resilience that transcend race.
Collapse
Affiliation(s)
- Herman A Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | | | | |
Collapse
|
12
|
Wrigley-Field E. Multidimensional Mortality Selection: Why Individual Dimensions of Frailty Don't Act Like Frailty. Demography 2020; 57:747-777. [PMID: 32215838 DOI: 10.1007/s13524-020-00858-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models of mortality selection have great utility in explaining otherwise puzzling phenomena. The most famous example may be the Black-White mortality crossover: at old ages, Blacks outlive Whites, presumably because few frail Blacks survive to old ages while some frail Whites do. Yet theoretical models of unidimensional heterogeneity, or frailty, do not speak to the most common empirical situation for mortality researchers: the case in which some important population heterogeneity is observed and some is not. I show that, when one dimension of heterogeneity is observed and another is unobserved, neither the observed nor the unobserved dimension need behave as classic frailty models predict. For example, in a multidimensional model, mortality selection can increase the proportion of survivors who are disadvantaged, or "frail," and can lead Black survivors to be more frail than Whites, along some dimensions of disadvantage. Transferring theoretical results about unidimensional heterogeneity to settings with both observed and unobserved heterogeneity produces misleading inferences about mortality disparities. The unusually flexible behavior of individual dimensions of multidimensional heterogeneity creates previously unrecognized challenges for empirically testing selection models of disparities, such as models of mortality crossovers.
Collapse
Affiliation(s)
- Elizabeth Wrigley-Field
- Department of Sociology and Minnesota Population Center, University of Minnesota, Minneapolis, MN, 55455, USA.
| |
Collapse
|
13
|
Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Caste Groups. J Racial Ethn Health Disparities 2020; 7:987-995. [DOI: 10.1007/s40615-020-00723-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
|
14
|
Jung D, Kind A, Robert S, Buckingham W, DuGoff E. Linking Neighborhood Context and Health in Community-Dwelling Older Adults in the Medicare Advantage Program. J Am Geriatr Soc 2018; 66:1158-1164. [PMID: 29648689 DOI: 10.1111/jgs.15366] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine whether neighborhood context moderates the relationship between multiple chronic conditions (MCCs) and function in Medicare Advantage (MA) beneficiaries. DESIGN Cross-sectional study. SETTING Medicare Health Outcome Survey Cohort 16 baseline data from 2013. PARTICIPANTS MA beneficiaries aged 65 and older (N=187,434). MEASUREMENTS We defined disadvantaged neighborhoods as those with an Area Deprivation Index greater than the 85th percentile. MCCs was defined as having 2 or more chronic conditions. The primary outcome was any self-reported functional limitations with a basic or instrumental activity of daily living. We used survey-weighted multivariate linear probability regression to examine whether the neighborhood disadvantage moderates the relationship between MCCs and report of a functional limitation. RESULTS More than one third (35.6%) of the sample reported a functional limitation. Beneficiaries with MCCs were more likely to report a functional limitation those with 0 or 1 chronic condition (odds ratio (OR)=2.63, 95% confidence interval (CI)=2.50-2.77). Beneficiaries in more-disadvantaged neighborhoods were more likely to report a functional limitation than those in less-disadvantaged neighborhoods (OR=1.14, 95% CI=1.08-1.21). In older adults with MCCs, the probability of reporting a functional limitation was 12 percentage points greater in those living in more-disadvantaged neighborhoods than in those living in less-disadvantaged neighborhoods. CONCLUSION Neighborhood context is a significant predictor of functional limitation and moderates the association between chronic conditions and functional limitations. Health plans and public health officials could use publicly available indicators such as the ADI to target interventions to reduce functional impairment.
Collapse
Affiliation(s)
- Daniel Jung
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Amy Kind
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.,Geriatrics Research, Education, and Clinical Center, Department of Veterans Affairs, Madison, Wisconsin
| | - Stephanie Robert
- School of Social Work, University of Wisconsin, Madison, Wisconsin
| | - William Buckingham
- Department of Community and Environmental Sociology, Applied Population Laboratory, University of Wisconsin, Madison, Wisconsin
| | - Eva DuGoff
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.,Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland
| |
Collapse
|
15
|
Berridge C, Mor V. Disparities in the Prevalence of Unmet Needs and Their Consequences Among Black and White Older Adults. J Aging Health 2017; 30:1427-1449. [PMID: 28737106 DOI: 10.1177/0898264317721347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We document differential prevalence of need for assistance with personal, instrumental, and mobility tasks and adverse consequences of unmet needs, nursing home relocation, and mortality among Black and White older adults. METHOD Data are from the National Health and Aging Trends Study. Using logistic and multinomial logistic regression, we determine whether race is predictive of reporting need or adverse consequence and test the role of race as a moderator of the relationship between baseline need and three 1-year outcomes. RESULTS Black older adults are more likely to experience a consequence of unmet need (35.33% vs. 29.97%, p = .028) in unadjusted models. In adjusted models, we find no moderating effect of race on baseline need on nursing home placement (0.00, 95% confidence interval [CI] = [-2.43, 2.42], p = .991), mortality (0.73, 95% = [-1.58, 0.11], p = .089), or a Round 2 consequence of unmet (-0.51, 95% CI = [-1.15, 0.14], p = .121). DISCUSSION This work highlights the complex relationship between race, need, unmet need, mortality, and nursing home entry.
Collapse
Affiliation(s)
| | - Vincent Mor
- 2 Brown University, Providence, RI, USA.,3 Providence VAMC Health Services Research Service
| |
Collapse
|
16
|
Beydoun MA, Beydoun HA, Mode N, Dore GA, Canas JA, Eid SM, Zonderman AB. Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors. BMC Public Health 2016; 16:1113. [PMID: 27770781 PMCID: PMC5075398 DOI: 10.1186/s12889-016-3744-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/05/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce. METHODS Using prospective cohort data from the Third National Health and Nutrition Examination Survey (NHANES III), we examined all-cause and cause-specific mortality disparities by race, mediation through key factors and moderation by age (20-49 vs. 50+), sex and poverty status. Cox proportional hazards, discrete-time hazards and competing risk regression models were conducted (N = 16,573 participants, n = 4207 deaths, Median time = 170 months (1-217 months)). RESULTS Age, sex and poverty income ratio-adjusted hazard rates were higher among Non-Hispanic Blacks (NHBs) vs. Non-Hispanic Whites (NHW). Within the above-poverty young men stratum where this association was the strongest, the socio-demographic-adjusted HR = 2.59, p < 0.001 was only partially attenuated by SES and other factors (full model HR = 2.08, p = 0.003). Income, education, diet quality, allostatic load and self-rated health, were among key mediators explaining NHB vs. NHW disparity in mortality. The Hispanic paradox was observed consistently among women above poverty (young and old). NHBs had higher CVD-related mortality risk compared to NHW which was explained by factors beyond SES. Those factors did not explain excess risk among NHB for neoplasm-related death (fully adjusted HR = 1.41, 95 % CI: 1.02-2.75, p = 0.044). Moreover, those factors explained the lower risk of neoplasm-related death among MA compared to NHW, while CVD-related mortality risk became lower among MA compared to NHW upon multivariate adjustment. CONCLUSIONS In sum, racial/ethnic disparities in all-cause and cause-specific mortality (particularly cardiovascular and neoplasms) were partly explained by socio-demographic, SES, health-related and dietary factors, and differentially by age, sex and poverty strata.
Collapse
Affiliation(s)
- M. A. Beydoun
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - H. A. Beydoun
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - N. Mode
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - G. A. Dore
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - J. A. Canas
- Pediatric Endocrinology, Diabetes and Metabolism Nemours Children’s Clinic, Jacksonville, FL USA
| | - S. M. Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - A. B. Zonderman
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| |
Collapse
|
17
|
Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer. J Community Health 2016; 40:1287-99. [PMID: 26072260 DOI: 10.1007/s10900-015-0052-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed 1993-2007 in California with follow-up through 2010) from four racial/ethnic groups [African American, Asian American, Latina, and non-Latina (NL) White] using Cox proportional hazards models. Compared to NL White women with high-education/high-nSES, higher all-cause mortality was observed among NL White women with high-education/low-nSES [hazard ratio (HR) (95 % confidence interval) 1.24 (1.08-1.43)], and African American women with low-nSES, regardless of education [high education HR 1.24 (1.03-1.49); low-education HR 1.19 (0.99-1.44)]. Latina women with low-education/high-nSES had lower all-cause mortality [HR 0.70 (0.54-0.90)] and non-significant lower mortality was observed for Asian American women, regardless of their education and nSES. Similar patterns were seen for BC-specific mortality. Individual- and neighborhood-level measures of SES interact with race/ethnicity to impact mortality after BC diagnosis. Considering the joint impacts of these social factors may offer insights to understanding inequalities by multiple social determinants of health.
Collapse
|
18
|
Horvath S, Gurven M, Levine ME, Trumble BC, Kaplan H, Allayee H, Ritz BR, Chen B, Lu AT, Rickabaugh TM, Jamieson BD, Sun D, Li S, Chen W, Quintana-Murci L, Fagny M, Kobor MS, Tsao PS, Reiner AP, Edlefsen KL, Absher D, Assimes TL. An epigenetic clock analysis of race/ethnicity, sex, and coronary heart disease. Genome Biol 2016; 17:171. [PMID: 27511193 PMCID: PMC4980791 DOI: 10.1186/s13059-016-1030-0] [Citation(s) in RCA: 466] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/18/2016] [Indexed: 01/07/2023] Open
Abstract
Background Epigenetic biomarkers of aging (the “epigenetic clock”) have the potential to address puzzling findings surrounding mortality rates and incidence of cardio-metabolic disease such as: (1) women consistently exhibiting lower mortality than men despite having higher levels of morbidity; (2) racial/ethnic groups having different mortality rates even after adjusting for socioeconomic differences; (3) the black/white mortality cross-over effect in late adulthood; and (4) Hispanics in the United States having a longer life expectancy than Caucasians despite having a higher burden of traditional cardio-metabolic risk factors. Results We analyzed blood, saliva, and brain samples from seven different racial/ethnic groups. We assessed the intrinsic epigenetic age acceleration of blood (independent of blood cell counts) and the extrinsic epigenetic aging rates of blood (dependent on blood cell counts and tracks the age of the immune system). In blood, Hispanics and Tsimane Amerindians have lower intrinsic but higher extrinsic epigenetic aging rates than Caucasians. African-Americans have lower extrinsic epigenetic aging rates than Caucasians and Hispanics but no differences were found for the intrinsic measure. Men have higher epigenetic aging rates than women in blood, saliva, and brain tissue. Conclusions Epigenetic aging rates are significantly associated with sex, race/ethnicity, and to a lesser extent with CHD risk factors, but not with incident CHD outcomes. These results may help elucidate lower than expected mortality rates observed in Hispanics, older African-Americans, and women. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1030-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Steve Horvath
- Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA. .,Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Morgan E Levine
- Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Benjamin C Trumble
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Hillard Kaplan
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Hooman Allayee
- Department of Preventive Medicine and Institute for Genetic Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Beate R Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Brian Chen
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Ake T Lu
- Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Tammy M Rickabaugh
- Department of Medicine, Division of Hematology/Oncology, AIDS Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Beth D Jamieson
- Department of Medicine, Division of Hematology/Oncology, AIDS Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Dianjianyi Sun
- Department of Epidemiology, Tulane University, New Orleans, LA, 70112, USA
| | - Shengxu Li
- Department of Epidemiology, Tulane University, New Orleans, LA, 70112, USA
| | - Wei Chen
- Department of Epidemiology, Tulane University, New Orleans, LA, 70112, USA
| | - Lluis Quintana-Murci
- Unit of Human Evolutionary Genetics, Centre National de la Recherche Scientifique, URA3012, URA3012 Institut Pasteur, Paris, 75015, France
| | - Maud Fagny
- Department of Biostatistics, Harvard TH Chan School of Public Health and Department of Computational Biology and Biostatistics, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute and Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Philip S Tsao
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander P Reiner
- Department of Epidemiology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, 98109, USA
| | - Kerstin L Edlefsen
- Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, 35806, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
19
|
Roth DL, Skarupski KA, Crews DC, Howard VJ, Locher JL. Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study. Soc Sci Med 2016; 156:12-20. [PMID: 27015163 PMCID: PMC5084845 DOI: 10.1016/j.socscimed.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.
Collapse
Affiliation(s)
- David L Roth
- Center on Aging and Health, Johns Hopkins University, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, USA.
| | - Kimberly A Skarupski
- Center on Aging and Health, Johns Hopkins University, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, USA
| | - Deidra C Crews
- Center on Aging and Health, Johns Hopkins University, USA; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, USA
| |
Collapse
|
20
|
Bucholz EM, Ma S, Normand SLT, Krumholz HM. Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction. Circulation 2015; 132:1338-46. [PMID: 26369354 PMCID: PMC5097251 DOI: 10.1161/circulationaha.115.017009] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have been unable to disentangle the negative associations of black race and low socioeconomic status (SES) with long-term outcomes of patients after acute myocardial infarction (AMI). Such information could assist in efforts to address both racial and socioeconomic disparities. METHODS AND RESULTS We used data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized with AMI with 17 years of follow-up, to evaluate the relationship between race, area-level SES (measured by zip code-level median household income), and life expectancy after AMI. Life expectancy was estimated by using Cox proportional hazards regression with extrapolation using exponential models. Of the 141 095 patients with AMI, 6.3% were black and 6.8% resided in low-SES areas; 26% of black patients lived in low-SES areas in comparison with 5.7% of white patients. Post-myocardial infarction life expectancy estimates were shorter for black patients than for white patients across all socioeconomic levels in patients ≤ 75 years of age. After adjustment for patient and treatment characteristics, the association between race and life expectancy persisted but was attenuated. Younger black patients (<68 years) had shorter life expectancies than white patients, whereas older black patients had longer life expectancies. The largest white-black gap in life expectancy occurred in patients residing in high- and medium-SES areas (P=0.02 interaction). CONCLUSIONS Black and white patients residing in low-SES areas have similar life expectancies after AMI, which are lower than those living in higher-SES areas. Racial disparities were most prominent among patients living in high-SES areas.
Collapse
Affiliation(s)
- Emily M Bucholz
- From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Shuangge Ma
- From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Sharon-Lise T Normand
- From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From Yale School of Medicine, New Haven, CT (E.M.B.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B.); Department of Biostatistics, Yale School of Public Health, New Haven, CT (S.M.); Department of Biostatistics, Harvard School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.); and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT (H.M.K.).
| |
Collapse
|
21
|
Abstract
Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9% of the variance in years of schooling, 6% of memory, and 12% of language. Among HRS African Americans, state of school attendance accounted for 13% of the variance in years of schooling and also contributed to variance in cognitive function (7%), memory (2%), and vocabulary (12%). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education.
Collapse
|
22
|
Singh JA, Ramachandran R. Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes. J Racial Ethn Health Disparities 2015; 2015:1-8. [PMID: 26413459 PMCID: PMC4581980 DOI: 10.1007/s40615-015-0138-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose was to study whether racial disparities in total shoulder arthroplasty (TSA) utilization and outcomes have declined over time. METHODS We used the US Nationwide Inpatient Sample from 1998 to 2011.We used chi-squared test to compare characteristics, Cochran-Armitage test to compare utilization rates, and Cochran-Armitage test and logistic regression to compare time-trends in outcomes by race. RESULTS From 1998 to 2011, 176,141 Whites and 7694 Blacks underwent TSA. Compared to Whites, Blacks who underwent TSA were younger (69.1 vs. 64.2 years; p<0.0001), more likely to be female (54.9 vs. 71.0 %; p<0.0001), and have rheumatoid arthritis or avascular necrosis as the underlying diagnosis (1.7 vs. 3.0%and 1.7 vs. 6.1 %; p<0.0001 for both) and a Deyo-Charlson index of 2 or higher (8.5 vs. 16.7 %; p<0.0001). Compared to Whites, Blacks had much lower TSA utilization rate/100,000 in 1998 (2.97 vs. 0.83; p<0.0001) and in 2011 (12.27 vs. 3.33; p<0.0001); racial disparities increased from 1998 to 2011 (p<0.0001). A higher proportion of Blacks than Whites had a hospital stay greater than median in 1998-2000, 62 vs. 51.4 % (p=0.02), and in 2009-2011, 34.4 vs. 27.3 % (p<0.0001); disparities did not change over time (p=0.31). These disparities in utilization were borderline significant in adjusted analyses. There were no racial differences in proportion discharged to inpatient medical facility in 1998-2000, 15.2 vs. 15.0 % (p=0.95), and in 2009-2011, 12.3 vs. 11.1%(p=0.37), respectively. CONCLUSIONS We found increasing racial disparities in TSA utilization. Some disparities in outcomes exist as well. Patients, surgeons, and policy-makes should be aware of these findings and take action to reduce racial disparities.
Collapse
Affiliation(s)
- Jasvinder A. Singh
- Birmingham VA Medical Center, Birmingham, AL, USA
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rekha Ramachandran
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA
| |
Collapse
|
23
|
Shariff-Marco S, Yang J, John EM, Sangaramoorthy M, Hertz A, Koo J, Nelson DO, Schupp CW, Shema SJ, Cockburn M, Satariano WA, Yen IH, Ponce NA, Winkleby M, Keegan THM, Gomez SL. Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study. Cancer Epidemiol Biomarkers Prev 2014; 23:793-811. [PMID: 24618999 PMCID: PMC4018239 DOI: 10.1158/1055-9965.epi-13-0924] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups. METHODS We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), ages 18 to 79 years and diagnosed 1995 to 2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups. RESULTS In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (P trend = 0.03), Hispanics (P trend = 0.01), and Asian-Americans (P trend = 0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (P trend = 0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7 times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9 times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education. CONCLUSIONS Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity. IMPACT A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions toward reducing long-standing disparities in breast cancer survival.
Collapse
Affiliation(s)
- Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont CA
- Stanford University, School of Medicine, Stanford CA
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont CA
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont CA
- Stanford University, School of Medicine, Stanford CA
| | | | - Andrew Hertz
- Cancer Prevention Institute of California, Fremont CA
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont CA
| | - David O. Nelson
- Cancer Prevention Institute of California, Fremont CA
- Stanford University, School of Medicine, Stanford CA
| | | | | | - Myles Cockburn
- University of Southern California, School of Medicine, Los Angeles CA
| | | | - Irene H. Yen
- University of California, San Francisco School of Medicine, San Francisco CA
| | - Ninez A. Ponce
- University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles CA
| | | | - Theresa H. M. Keegan
- Cancer Prevention Institute of California, Fremont CA
- Stanford University, School of Medicine, Stanford CA
| | - Scarlett L. Gomez
- Cancer Prevention Institute of California, Fremont CA
- Stanford University, School of Medicine, Stanford CA
| |
Collapse
|
24
|
Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. PLoS One 2013; 8:e72656. [PMID: 24086262 PMCID: PMC3782490 DOI: 10.1371/journal.pone.0072656] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/12/2013] [Indexed: 12/01/2022] Open
Abstract
Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.
Collapse
|
25
|
Abstract
Gout affects 8.3 million Americans according to NHANES 2007-2008, approximately 3.9 % of the US population. Gout has substantial effect on physical function, productivity, health-related quality of life (HRQOL), and health care costs. Uncontrolled gout is also associated with significant use of emergency care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared with whites, racial and/or ethnic minorities, especially blacks, have higher prevalence of gout. Blacks are also less likely to receive quality gout care, leading to disproportionate morbidity. Women are less likely than men to receive allopurinol, and less likely to undergo joint aspirations for crystal analysis to establish diagnosis, but those on urate-lowering therapy are as likely as, or more likely than, men to undergo serum urate check within six months of initiation. Although a few studies provide the knowledge related to gender and race and/or ethnicity disparities for gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race and/or ethnicity. These should be investigated in future studies.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL 35294, USA.
| |
Collapse
|