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Ma A, Campbell J, Sanchez A, Sumner S, Ma M. Racial Concordance on Healthcare Use within Hispanic Population Subgroups. J Racial Ethn Health Disparities 2024; 11:2329-2337. [PMID: 37479955 PMCID: PMC11236923 DOI: 10.1007/s40615-023-01700-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups. METHODS We estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007-2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance. RESULTS Hispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born. CONCLUSIONS In summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.
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Affiliation(s)
- Alyson Ma
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Jason Campbell
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Alison Sanchez
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA.
| | - Steven Sumner
- Knauss School of Business, Department of Economics, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA
| | - Mindy Ma
- Department of Psychology & Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA
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Zha A, Zhang C, Zhu G, Huang X, Anjum S, Talebi Y, Savitz S, Wu H. African American patients have a higher probability of cognitive impairment after incident stroke: An analysis of national electronic health record data. J Stroke Cerebrovasc Dis 2024; 33:107787. [PMID: 38806108 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107787] [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: 11/13/2023] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Cognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15-70 % but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race. METHODS This is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009-2018. We evaluated patients ≥40 years of age with a first time ischemic stroke (IS) diagnosis for PSCI using ICD9/10 codes for both conditions. Patients with first stroke in the Cerner database and no pre-existing cognitive impairment were included, we compared hazard ratios for developing PSCI for patient characteristics RESULTS: A total of 150,142 IS patients with follow-up data and no pre-existing evidence of CI were evaluated. Traditional risk factors of age, female sex, kidney injury, hypertension, and hyperlipidemia were associated with PSCI. Only African American stroke survivors had a higher probability of developing PSCI compared to White survivors (HR 1.347, 95 % CI (1.270, 1.428)) and this difference was most prominent in the South. Among those to develop PSCI, median time to documentation was 1.8 years in African American survivors. CONCLUSION In a large national database, African American stroke survivors had a higher probability of PSCI five years after stroke than White survivors.
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Affiliation(s)
- Alicia Zha
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, United States; Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States.
| | - Chenguang Zhang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States
| | - Gen Zhu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States
| | - Xinran Huang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States
| | - Sahar Anjum
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, United States
| | - Yashar Talebi
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States
| | - Sean Savitz
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, United States; Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, United States
| | - Hulin Wu
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston, TX, 77030, United States; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States
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Alhadeethi A, Atia A, Alkhawaldeh IM, Ibrahim AA, Afifi E, Elwekel A, Nouh A, Morsi MH. Risk Factors for Cardiovascular-Specific Mortality in Patients With Prostate Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Study. Cureus 2023; 15:e51279. [PMID: 38288190 PMCID: PMC10823189 DOI: 10.7759/cureus.51279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Prostate cancer (PC) is responsible for large numbers of cancer-related deaths in males worldwide, and it has been linked to an increase in cardiovascular morbidity and mortality (CVM). The purpose of this research is to identify the incidence and risk factors for CVM in PC patients. METHODS In this retrospective cohort study, we collected data from patients with PC diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. CVM among PC patients was identified and compared to the general population using the standardized mortality ratio (SMR). The multivariable competing risk model with subdistribution hazard ratio (SHR) was used to analyze the data in a more complex method to discover the risk factors associated with CVM among PC patients. RESULTS Of the 171,147 identified PC patients, the median survival time was 117 months, with 17,168 dying from cardiovascular disease (CVD). Patients diagnosed at age 45-54 had a higher CVM risk than the age-standardized general population (SMR (95% CI): 19.01 (17.17-21.0)). Using multivariate competing risk regression analysis, aged 85 and older (SHR (95% CI): 20.9 (18.628-23.467)), black ethnicities (SHR (95% CI): 1.3 (1.264-1.398)), and patients without surgical intervention (SHR (95% CI): 1.35 (1.305-1.410)) had higher CVM. On the other hand, being of Asian/Pacific Islander or American Indian/Native Alaskan ethnicity (SHR (95% CI): 0.94 (0.891-0.993)), being diagnosed between 2007 and 2014 (SHR (95% CI): 0.63 (0.613-0.655)), and having an advanced disease stage and a lack of disease differentiation in the histology were found to be related with a lower CVM. CONCLUSION Patients with PC have a greater likelihood of dying from CVD. Several important risk factors for CVD have been discovered, including advanced age, black ethnicity, and patients without surgical intervention. These findings are limited by the retrospective nature of the analysis, relying solely on the SEER database, which imposes restrictions on accessing comprehensive patient data, including lifestyle factors and medical history.
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Affiliation(s)
- Abdulhameed Alhadeethi
- General Medicine, Al-Salam Teaching Hospital, Mosul, IRQ
- General Medicine, Medical Research Group of Egypt, Negida Academy LCC, Arlington, USA
| | - Ahmed Atia
- Oncology, Faculty of Medicine Kasr Al-Ainy, Cairo University, Cairo, EGY
| | | | - Ahmed A Ibrahim
- Cardiology, Faculty of Medicine, Menoufia University, Shibin El Kom, EGY
| | - Eslam Afifi
- Urology, Faculty of Medicine, Benha University, Benha, EGY
| | - Ahmed Elwekel
- Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Abdallah Nouh
- Oncology, Faculty of Medicine, Sohag University, Sohag, EGY
| | - Maha H Morsi
- Urology, Misr University for Science and Technology, 6th of October City, EGY
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Okobi OE, Ezeamii PC, Ezeamii VC, Iyun OB, Okoye TO, Nwachukwu EU, Oghenebrume PI. A Comprehensive 16-Year Analysis of National Center for Health Statistics Data on the Top Three Causes of Death Before Age 75 by Sex, Race, and Hispanic Origin. Cureus 2023; 15:e49340. [PMID: 38146563 PMCID: PMC10749696 DOI: 10.7759/cureus.49340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE This study aimed to conduct a comprehensive 16-year analysis of years of potential life lost (YPLL) due to leading causes of death in the United States, focusing on disparities by sex, race/ethnicity, and specific causes of death using the National Center for Health Statistics (NCHS) data. METHODS Data from the NCHS spanning 2000-2016 were included. Age-adjusted YPLL rates per 100,000 population were analyzed, stratified by sex, race/ethnicity, and leading causes of death, including malignant neoplasms, heart disease, and cerebrovascular diseases. RESULTS Over 16 years, the total YPLL rate was 7,036.2 per 100,000 population. Males had a higher YPLL rate (8,852.5 per 100,000) than females (5,259.9 per 100,000). Among racial/ethnic groups, Black/African Americans had the highest YPLL rate (10,896.8 per 100,000), followed by American Indian/Alaska Natives (7,310.0 per 100,000), Hispanics/Latinos (5,256.8 per 100,000), and Asians/Pacific Islanders (3,279.7 per 100,000). Leading causes included malignant neoplasms (1,451.6 per 100,000), heart diseases (1,055.4 per 100,000), and cerebrovascular diseases (182.3 per 100,000). CONCLUSION This analysis spanning 16 years highlights notable disparities in YPLL rates among different demographic groups. These differences are evident in the YPLL rates for males, which are higher than those for females. The YPLL rate is most pronounced among Black/African Americans, followed by American Indian/Alaska Natives, Hispanics/Latinos, and Asians/Pacific Islanders. The primary contributors to YPLL are malignant neoplasms, heart diseases, and cerebrovascular diseases. These findings emphasize the importance of addressing these disparities to enhance public health outcomes and mitigate the premature loss of life. Despite progress, disparities persist, highlighting the need for targeted interventions and further research.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Patra C Ezeamii
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | - Victor C Ezeamii
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | - Oluwatosin B Iyun
- Epidemiology and Public Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town, ZAF
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [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: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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Cause-specific mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet 2023; 402:1065-1082. [PMID: 37544309 PMCID: PMC10528747 DOI: 10.1016/s0140-6736(23)01088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions. METHODS We applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial-ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population. FINDINGS From 2000 to 2019, across 3110 US counties, racial-ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2-1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5-958·8] per 100 000) than in the White population (802·5 [800·3-804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3-455·0] per 100 000) and Latino population (595·6 [583·7-606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties). INTERPRETATION Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities. FUNDING National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.
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Reddy KP, Eberly LA, Halaby R, Julien H, Khatana SAM, Dayoub EJ, Coylewright M, Alkhouli M, Fiorilli PN, Kobayashi TJ, Goldberg DM, Santangeli P, Herrmann HC, Giri J, Groeneveld PW, Fanaroff AC, Nathan AS. Racial, Ethnic, and Socioeconomic Inequities in Access to Left Atrial Appendage Occlusion. J Am Heart Assoc 2023; 12:e028032. [PMID: 36802837 PMCID: PMC10111439 DOI: 10.1161/jaha.122.028032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code-level racial, ethnic, and socioeconomic composition and age-adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non-LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197-$1629], P=0.01). Zip code-level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%-0.35%) lower for each $1000 zip code-level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients. Conclusions Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age-adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.
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Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA
| | - Lauren A Eberly
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Rim Halaby
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard Julien
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Sameed Ahmed M Khatana
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Elias J Dayoub
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | | | | | - Paul N Fiorilli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Taisei J Kobayashi
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | | | - Pasquale Santangeli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard C Herrmann
- Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA.,Division of General Internal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
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8
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Access to primary care physicians, race/ethnicity, and premature mortality: Analysis of 154,516 deaths in Washington State, United States. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01823-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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9
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Luck J, Govier D, Ðoàn LN, Mahakalanda S, Zhang W, Mendez-Luck C. Functional Limitations and Physical Health in Community-Dwelling Medicare Advantage Beneficiaries: Variation by Race and Hispanic Subgroup. J Aging Health 2022; 34:1269-1280. [PMID: 36175065 DOI: 10.1177/08982643221113133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The objective is to examine racial and ethnic heterogeneity in older adults' functional limitations and physical health. Methods: Data were from 2011 to 2015 Health Outcomes Survey of Medicare Advantage beneficiaries 65 and older (N = 828,946). Outcomes were Physical Component Summary (PCS) scores and need for assistance with activities of daily living (ADLs). Six non-Hispanic racial groups and five Hispanic subgroups were analyzed. Regression models adjusted for sociodemographic and health characteristics. Results: White and Asian respondents had the lowest unadjusted ADL difficulty rates and highest PCS scores. In adjusted analyses, Cuban respondents had the highest PCS scores and lowest rates of any ADL difficulty; White respondents had the lowest rates of specific ADL difficulties. Native Hawaiian or other Pacific Islander and multiple Hispanic respondents had the highest ADL difficulty rates. Discussion: Both the healthiest and highest need subgroups of Medicare Advantage beneficiaries were Hispanic. Understanding racial and ethnic subgroup differences may help target interventions to prevent or aid with functional limitations.
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Affiliation(s)
- Jeff Luck
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Diana Govier
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Lan N Ðoàn
- Department of Population Health, Section for Health Equity, 2694NYU Grossman School of Medicine, New York, NY, USA
| | - Shyama Mahakalanda
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Wei Zhang
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Carolyn Mendez-Luck
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
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Peper KM, Guo B, Leann Long D, Howard G, Carson AP, Howard VJ, Judd SE, Zakai NA, Cherrington A, Cushman M, Plante TB. C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: The REGARDS Study. J Clin Endocrinol Metab 2022; 107:e2523-e2531. [PMID: 35137178 PMCID: PMC9113826 DOI: 10.1210/clinem/dgac074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Black adults experience more type 2 diabetes mellitus and higher inflammatory markers, including C-reactive protein (CRP), than White adults. Inflammatory markers are associated with risk of incident diabetes but the impact of inflammation on racial differences in incident diabetes is unknown. OBJECTIVE We assessed whether CRP mediated the Black-White incident diabetes disparity. METHODS The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30 239 US Black and White adults aged ≥45 years in 2003-2007 with a second visit approximately 10 years later. Among participants without baseline diabetes, adjusted sex- and race-stratified risk ratios for incident diabetes at the second visit by CRP level were calculated using modified Poisson regression. Inverse odds weighting estimated the percent mediation of the racial disparity by CRP. RESULTS Of 11 073 participants without baseline diabetes (33% Black, 67% White), 1389 (12.5%) developed diabetes. Black participants had higher CRP at baseline and greater incident diabetes than White participants. Relative to CRP < 3 mg/L, CRP ≥ 3 mg/L was associated with greater risk of diabetes in all race-sex strata. Black participants had higher risk of diabetes at CRP < 3 mg/L, but not at CRP ≥ 3 mg/L. In women, CRP mediated 10.0% of the racial difference in incident diabetes. This mediation was not seen in men. CONCLUSION Higher CRP is a risk factor for incident diabetes, but the excess burden of diabetes in Black adults was only seen in those with lower CRP, suggesting that inflammation is unlikely to be the main driver of this racial disparity.
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Affiliation(s)
- Kaitlyn M Peper
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Boyi Guo
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - April P Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Long DL, Guo B, McClure LA, Jaeger BC, Tison S, Howard G, Judd SE, Howard VJ, Plante TB, Zakai NA, Koh I, Cheung KL, Cushman M. Biomarkers as MEDiators of racial disparities in risk factors (BioMedioR): Rationale, study design, and statistical considerations. Ann Epidemiol 2022; 66:13-19. [PMID: 34742867 PMCID: PMC8920757 DOI: 10.1016/j.annepidem.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Relative to White adults, Black adults have a substantially higher prevalence of hypertension and diabetes, both key risk factors for stroke, cardiovascular disease, cognitive impairment, and dementia. Blood biomarkers have shown promise in identifying contributors to racial disparities in many chronic diseases. METHODS We outline the study design and related statistical considerations for a nested cohort study, the Biomarker Mediators of Racial Disparities in Risk Factors (BioMedioR) study, within the 30,239-person biracial REasons for Geographic And Racial Differences in Stroke (REGARDS) study (2003-present). Selected biomarkers will be assessed for contributions to racial disparities in risk factor development over median 9.4 years of follow-up, with initial focus on hypertension, and diabetes. Here we outline study design decisions and statistical considerations for the sampling of 4,400 BioMedioR participants. RESULTS The population for biomarker assessment was selected using a random sample study design balanced across race and sex to provide the optimal opportunity to describe association of biomarkers with the development of hypertension and diabetes. Descriptive characteristics of the BioMedioR sample and analytic plans are provided for this nested cohort study. CONCLUSIONS This nested biomarker study will examine pathways with the target to help explain racial differences in hypertension and diabetes incidence.
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Affiliation(s)
- D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Boyi Guo
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania
| | - Byron C. Jaeger
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Tison
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia J. Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy B. Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont,Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
| | - Insu Koh
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
| | - Katharine L. Cheung
- Department of Medicine, Larner College of Medicine at the University of Vermont
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont,Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
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12
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Scott J, Cousin L, Woo J, Gonzalez-Guarda R, Simmons LA. Equity in Genomics: A Brief Report on Cardiovascular Health Disparities in African American Adults. J Cardiovasc Nurs 2022; 37:58-63. [PMID: 32649378 PMCID: PMC7775264 DOI: 10.1097/jcn.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND African Americans are more likely to die from cardiovascular disease (CVD) than all other populations in the United States. Although technological advances have supported rapid growth in applying genetics/genomics to address CVD, most research has been conducted among European Americans. The lack of African American representation in genomic samples has limited progress in equitably applying precision medicine tools, which will widen CVD disparities if not remedied. PURPOSE This report summarizes the genetic/genomic advances that inform precision health and the implications for cardiovascular disparities in African American adults. We provide nurse scientists recommendations for becoming leaders in developing precision health tools that promote population health equity. CONCLUSIONS Genomics will continue to drive advances in CVD prevention and management, and equitable progress is imperative. Nursing should leverage the public's trust and its widespread presence in clinical and community settings to prevent the worsening of CVD disparities among African Americans.
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Nimmo C, Behnke L, Creech C, Schellenberg K, Turkelson C, Cooper D. Using Simulation to Educate Rural NP students About Cultural Congruence. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Malawa Z, Gaarde J, Spellen S. Racism as a Root Cause Approach: A New Framework. Pediatrics 2021; 147:peds.2020-015602. [PMID: 33386339 DOI: 10.1542/peds.2020-015602] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
The field of public health has identified racial health disparities as a chief concern for decades. Although there has been a myriad of published articles in which researchers describe the severity and complexity of these disparities, they persist into present day relatively unchanged. We believe this lack of progress can be explained, in part, by a failure to acknowledge that racism is at the root of these racial disparities. Many children's health advocates believe more should be done to address our country's systemic racial inequities, but few of us feel able to create meaningful change, and even fewer feel that it is our responsibility. As a result, many opt to pursue programmatic fixes and Band-Aid solutions over addressing the underlying systemic, interpersonal, and historical racism. We hope to empower children's health advocates by introducing a solutions-centered framework for addressing racism as a root cause. This approach can help guide and structure the important work of dismantling racism so Black, Indigenous, and other racially marginalized families can finally have an equal opportunity for good health.
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Affiliation(s)
| | | | - Solaire Spellen
- Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, California; and
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15
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Venugopal V, Gronbeck C, Harvey L, Patel AP, Harrington MA, Halawi MJ. Time Trends in Perioperative Characteristics and Health Outcomes in Hispanic Patients Undergoing Primary Total Knee Arthroplasty. J Racial Ethn Health Disparities 2020; 8:1475-1481. [DOI: 10.1007/s40615-020-00910-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022]
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Henning-Smith CE, Hernandez AM, Hardeman RR, Ramirez MR, Kozhimannil KB. Rural Counties With Majority Black Or Indigenous Populations Suffer The Highest Rates Of Premature Death In The US. Health Aff (Millwood) 2020; 38:2019-2026. [PMID: 31794313 DOI: 10.1377/hlthaff.2019.00847] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among US rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group. Premature death rates were significantly higher in rural counties with a majority of non-Hispanic black or American Indian/Alaska Native (AI/AN) residents than in rural counties with a majority of non-Hispanic white residents. After we adjusted for community-level covariates, differences in premature death remained significant in counties with a majority of AI/AN residents but not those with a majority of non-Hispanic black residents. This study highlights the particular vulnerability of non-Hispanic black and AI/AN rural communities to high rates of premature mortality. Policies to improve rural health should focus on these racially diverse communities, addressing economic vitality and current and historical political context to mitigate health inequities and the harmful health effects of neglecting social determinants of health.
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Affiliation(s)
- Carrie E Henning-Smith
- Carrie E. Henning-Smith ( henn0329@umn. edu ) is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Ashley M Hernandez
- Ashley M. Hernandez is a PhD candidate in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Rachel R Hardeman
- Rachel R. Hardeman is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Marizen R Ramirez
- Marizen R. Ramirez is an associate professor in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
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Ajebo G, Patel SJ, Kota V, Guddati AK. A nationwide analysis of outcomes of stroke in hospitalized patients with essential thrombocythemia: 2006 to 2014. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:76-81. [PMID: 32923086 PMCID: PMC7486482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Essential thrombocythemia (ET) is a subtype of myeloproliferative neoplasm associated with an increased risk of thrombohemorrhagic complications such as stroke. However, studies of prevalence and outcomes of stroke in hospitalized patients with ET have been limited to case series. METHODS Data from the National Inpatient Sample was utilized to identify outcomes in hospitalized patient with ET who were admitted for stroke. Utilizing the current procedural terminology code (CPT) for ET, outcomes of patients with ET who were hospitalized with stroke were studied for the years 2006 to 2014. Patient demographics of age, gender and race were collected and hospital characteristics of location and size were correlated to outcomes. Chi square test was used to determine odds ratios and multiple logistic regression was used to determine independent predictors of mortality. RESULTS Between the years of 2006 to 2014, a total of 552422 hospitalizations involved patients with a diagnosis of ET, 20650 of which were due to stroke. The percentage of stroke in these hospitalizations varied between 3.64 to 4.29 over 9 years and mortality in these patients did not significantly change during this time period. The prevalence of stroke was highest amongst Asians and Caucasians (4.7% and 3.86%) with a statistically significant difference (P=0.0000). A majority of ET patients with stroke were discharged to skilled nursing facilities. Multiple regression showed that female gender, atrial fibrillation, stroke, higher Charlson's comorbidity score and 80+ age were independent predictors of mortality (OR: 0.75, 1.35, 1.8, 2 to 5.7, 13.9 respectively). CONCLUSIONS This study demonstrated that Female gender, atrial fibrillation, stroke, higher Charlson's comorbidity score and 80+ age group were found to be statistically significant independent predictors of mortality (OR: 0.75, 1.35, 1.8, 2 to 5.7, 13.9 respectively) in patients with ET and stroke. Inclusion of these factors in the risk stratification of patients with ET may decrease the morbidity and mortality associated with the disease.
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Affiliation(s)
- Germame Ajebo
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, USA
| | - Sunny J Patel
- Medical College of Georgia, Augusta UniversityAugusta, GA 30909, USA
| | - Vamsi Kota
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, USA
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, USA
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Wang ML, Behrman P, Dulin A, Baskin ML, Buscemi J, Alcaraz KI, Goldstein CM, Carson TL, Shen M, Fitzgibbon M. Addressing inequities in COVID-19 morbidity and mortality: research and policy recommendations. Transl Behav Med 2020; 10:516-519. [PMID: 32542349 PMCID: PMC7337775 DOI: 10.1093/tbm/ibaa055] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is the greatest global public health crisis since the 1918 influenza outbreak. As of early June, the novel coronavirus has infected more than 6.3 million people worldwide and more than 1.9 million in the United States (US). The total number of recorded deaths due to COVID-19 are growing at an alarming rate globally (³383,000) and nationally (³109,000) Evidence is mounting regarding the heavier burden of COVID-19 infection, morbidity, and mortality on the underserved populations in the US. This commentary focuses on this global health pandemic and how mitigation of the virus relies heavily on health behavior change to slow its spread, highlighting how the pandemic specifically affects the most socially and economically disadvantaged populations in the US. The commentary also offers short, intermediate and long-term research and policy focused recommendations. Both the research and policy recommendations included in this commentary emphasize equity-driven: (1) research practices, including applying a social determinants and health equity lens on monitoring, evaluation, and clinical trials activities on COVID-19; and (2) policy actions, such as dedicating resources to prioritize high-risk communities for testing, treatment, and prevention approaches and implementing organizational, institutional, and legislative policies that address the social and economic barriers to overall well-being that these populations face during a pandemic. It is our hope that these recommendations will generate momentum in delivering timely, effective, and lifesaving changes.
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Affiliation(s)
- Monica L Wang
- Boston University School of Public Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Megan Shen
- Weill Cornell Medicine, New York, NY, USA
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Mendez SEA, Mendez-Luck CA, Nylund-Gibson K, Ng B. Mental Health Attribution for Mexican-Origin Latinx and Non-Latinx Older Adults: A Latent Class Analysis. Innov Aging 2020; 4:igaa028. [PMID: 34136663 PMCID: PMC8202504 DOI: 10.1093/geroni/igaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing appropriate and culturally sensitive care to the rapidly growing number of
U.S. Latinx older adults with psychiatric conditions presents a major public health
challenge. We know little about older Latinx adults’ perceived causes of mental health
problems, offering clinicians limited insight to guide successful and culturally
congruent treatment. Moreover, there is a paucity of mental health research examining
heterogeneity in how Latinx individuals may attribute mental health symptoms. The
present study sought to identify how Latinx and non-Latinx older adults attributed the
sources of their mental health problems and how these types of attributions differ by
ethnicity. Research Design and Methods This study analyzed data collected from a retrospective chart review and survey of 673
adults aged 55–95 years (430 Mexican origin and 244 non-Latinx) from a rural psychiatric
outpatient clinic near the California–Mexico border. We conducted stratified latent
class analysis (LCA) by race/ethnicity to explore the mental health attribution beliefs
of Mexican-origin and non-Latinx clinic patients. Results Different LCA patterns for Mexican-origin Latinx versus non-Latinx groups were found.
For non-Latinx adults, there was a class of individuals who attributed their mental
health issues to social and financial problems. For Mexican-origin adults, there was a
class of individuals who attributed their mental health issues to spiritual and/or
supernatural factors, unaffected by acculturation level, depressive symptom severity,
and time spent in the United States, but differing by gender. We found within-group
heterogeneity: Not all Mexican-origin or non-Latinx older adults were alike in how they
conceptualized their mental health. Discussion and Implications Mexican-origin Latinx and non-Latinx older adults attributed their mental health issues
to different causes. More Mexican-origin older adults attributed their symptoms to
spiritual causes, even after controlling for contextual factors. Further research is
needed to determine whether attribution beliefs are affected by specific mental health
diagnoses and other cultural factors not measured in this study.
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Affiliation(s)
- Stephanie E A Mendez
- University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles
| | | | | | - Bernardo Ng
- Sun Valley Behavioral Research Center, Imperial, California
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Tajeu GS, Safford MM, Howard G, Howard VJ, Chen L, Long DL, Tanner RM, Muntner P. Black-White Differences in Cardiovascular Disease Mortality: A Prospective US Study, 2003-2017. Am J Public Health 2020; 110:696-703. [PMID: 32191519 PMCID: PMC7144446 DOI: 10.2105/ajph.2019.305543] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults.Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older.Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were women, 1549 CVD deaths occurred. Among participants younger than 65 years, the demographic-adjusted Black:White CVD mortality HR was 2.23 (95% confidence interval [CI] = 1.87, 2.65) and 1.21 (95% CI = 1.00, 1.47) after full adjustment. Among participants aged 65 years or older, the demographic-adjusted Black:White CVD mortality HR was 1.58 (95% CI = 1.39, 1.79) and 1.12 (95% CI = 0.97, 1.29) after full adjustment. When we used mediation analysis, socioeconomic status explained 21.2% (95% CI = 13.6%, 31.4%) and 38.0% (95% CI = 20.9%, 61.7%) of the Black:White CVD mortality risk difference among participants younger than 65 years and aged 65 years or older, respectively. CVD risk factors explained 56.6% (95% CI = 42.0%, 77.2%) and 41.3% (95% CI = 22.9%, 65.3%) of the Black:White CVD mortality difference for participants younger than 65 years and aged 65 years or older, respectively.Conclusions. The higher Black:White CVD mortality risk is primarily explained by racial differences in socioeconomic status and CVD risk factors.
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Affiliation(s)
- Gabriel S Tajeu
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Monika M Safford
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - George Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Virginia J Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Ligong Chen
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - D Leann Long
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Rikki M Tanner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Paul Muntner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
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Howard VJ, Madsen TE, Kleindorfer DO, Judd SE, Rhodes JD, Soliman EZ, Kissela BM, Safford MM, Moy CS, McClure LA, Howard G, Cushman M. Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors. JAMA Neurol 2019; 76:179-186. [PMID: 30535250 DOI: 10.1001/jamaneurol.2018.3862] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals. Objective To examine incidence and risk factors for ischemic stroke by sex for black and white individuals. Design, Setting, and Participants This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018. Exposures Sex and race. Main Outcomes and Measures Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors. Results A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors. Conclusions and Relevance For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.
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Affiliation(s)
- Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - J David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, North Carolina.,Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monika M Safford
- Department of Medicine, Weill-Cornell Medicine, New York, New York
| | - Claudia S Moy
- Department of Health and Human Services, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, Colchester, Vermont
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Howard VJ, Howard G, Cushman M. Inclusivity of Diverse Patient Groups—Reply. JAMA Neurol 2019; 76:984-985. [DOI: 10.1001/jamaneurol.2019.1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Virginia J. Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, Burlington, Vermont
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Affan M, Mahajan A, Modi S, Schultz L, Katramados A, Mayer SA, Miller DJ. Atrial fibrillation, not atrial cardiopathy, is associated with stroke: A single center retrospective study. J Neurol Sci 2019; 402:69-73. [DOI: 10.1016/j.jns.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
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Baltrus P, Malhotra K, Rust G, Levine R, Li C, Gaglioti AH. Identifying County-Level All-Cause Mortality Rate Trajectories and Their Spatial Distribution Across the United States. Prev Chronic Dis 2019; 16:E55. [PMID: 31050636 PMCID: PMC6513472 DOI: 10.5888/pcd16.180486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION All-cause mortality in the United States declined from 1935 through 2014, with a recent uptick in 2015. This national trend is composed of disparate local trends. We identified distinct groups of all-cause mortality rate trajectories by grouping US counties with similar temporal trajectories. METHODS We used all-cause mortality rates in all US counties for 1999 through 2016 and estimated discrete mixture models by using county level mortality rates. Proc Traj in SAS was used to detect how county trajectories clustered into groups on the basis of similar intercepts, slopes, and higher order terms. Models with increasing numbers of groups were assessed on the basis of model fit. We created county-level maps of mortality trajectory groups by using ArcGIS. RESULTS Eight unique trajectory groups were detected among 3,091 counties. The average mortality rate in the most favorable trajectory group declined 29.4%, from 592.3 deaths per 100,000 in 1999 to 418.2 in 2016. The least favorable mortality trajectory group declined 3.4% over the period, from 1,280.3 deaths per 100,000 to 1,236.9. We saw significant differences in the demographic and socioeconomic profiles and geographic patterns across the trajectory categories, with favorable mortality trajectories in the Northeast, Midwest, and on the West Coast and unfavorable trajectories concentrated in the Southeast. CONCLUSIONS County-level disparities in all-cause mortality rates widened over the past 18 years. Further investigation of the determinants of the trajectory groupings and the geographic outliers identified by our research could inform interventions to achieve equitable distribution of county mortality rates.
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Affiliation(s)
- Peter Baltrus
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
- Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310.
| | - Khusdeep Malhotra
- Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania
| | - George Rust
- Department of Behavioral Sciences and Social Medicine, Florida State University School of Medicine, Tallahassee, Florida
| | - Robert Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Anne H Gaglioti
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia
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Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples: a systematic review. BMC Med 2018; 16:145. [PMID: 30122155 PMCID: PMC6100719 DOI: 10.1186/s12916-018-1115-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/02/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations. METHODS We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations. RESULTS The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples. CONCLUSIONS This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.
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Affiliation(s)
- Nathaniel J Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada. .,Labrador Institute of Memorial University, P.O. Box 490, Stn. B, 219 Hamilton River Road, Happy Valley-Goose Bay, ,Newfoundland and Labrador, A0P 1E0, Canada.
| | - Kiyuri Naicker
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Alex Loro
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada
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Egan BM. Defining Hypertension by Blood Pressure 130/80 mm Hg Leads to an Impressive Burden of Hypertension in Young and Middle-Aged Black Adults: Follow-Up in the CARDIA Study. J Am Heart Assoc 2018; 7:JAHA.118.009971. [PMID: 30007937 PMCID: PMC6064851 DOI: 10.1161/jaha.118.009971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Brent M Egan
- Department of Medicine, University of South Carolina School of Medicine- Greenville and the Care Coordination Institute, Greenville, SC
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Xaverius PK, Wambuguh L, Ward C, Salas J, Alleman E, Young J, Berkemeier J. Are Statutory Requirements Followed in the Certification of Traumatic, Unexpected, and Unattended Deaths in Missouri? J Forensic Sci 2018; 63:1756-1760. [PMID: 29603226 DOI: 10.1111/1556-4029.13785] [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: 10/09/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross-sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined agreement between cause and manner of death by year and ME/C contact as well as 2010-2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97, p < 0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p =< 0.0001). There was a significantly higher proportion of ME/C-certified deaths using the electronic system in 2010-2012 (aOR = 1.18, 95% CI 1.15, 1.21) compared to the manual system in 2007-2009. Black, non-Hispanic (aOR = 1.50, 95% CI 1.43,1.57) and Hispanic (aOR = 1.31, 95% CI 1.13, 1.51) deaths, compared to White, non-Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.
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Affiliation(s)
- Pamela K Xaverius
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette, Saint Louis, MO, 63104
| | - Loise Wambuguh
- Missouri Department of Health and Senior Services, Jefferson City, MO
| | - Craig Ward
- Missouri Department of Health and Senior Services, Jefferson City, MO
| | - Joanne Salas
- School of Medicine, Saint Louis University, Saint Louis, MO
| | | | - Jeffrey Young
- Department of Microbiology, University of Florida, Gainesville, FL
| | - Jessica Berkemeier
- Vermont Department of Health and Emergency Preparedness, Response, and Injury Prevention, Burlington, VT
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Chippendale T, Gentile PA, James MK. Characteristics and consequences of falls among older adult trauma patients: Considerations for injury prevention programs. Aust Occup Ther J 2017; 64:350-357. [DOI: 10.1111/1440-1630.12380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tracy Chippendale
- Steinhardt School of Culture, Education, and Human Development; Department of Occupational Therapy; New York University; New York USA
| | - Patricia A. Gentile
- Department of Surgery; Jamaica Hospital Medical Center; Jamaica New York USA
| | - Melissa K. James
- Department of Surgery; Jamaica Hospital Medical Center; Jamaica New York USA
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Mohammed SA, Udell W. American Indians/Alaska Natives and Cardiovascular Disease: Outcomes, Interventions, and Areas of Opportunity. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0526-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature. Public Health Rev 2016; 37:31. [PMID: 29450072 PMCID: PMC5809877 DOI: 10.1186/s40985-016-0043-2] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/16/2016] [Indexed: 12/14/2022] Open
Abstract
Hispanics are the largest minority group in the USA. They contribute to the economy, cultural diversity, and health of the nation. Assessing their health status and health needs is key to inform health policy formulation and program implementation. To this end, we conducted a scoping review of the literature and national statistics on Hispanic health in the USA using a modified social-ecological framework that includes social determinants of health, health disparities, risk factors, and health services, as they shape the leading causes of morbidity and mortality. These social, environmental, and biological forces have modified the epidemiologic profile of Hispanics in the USA, with cancer being the leading cause of mortality, followed by cardiovascular diseases and unintentional injuries. Implementation of the Affordable Care Act has resulted in improved access to health services for Hispanics, but challenges remain due to limited cultural sensitivity, health literacy, and a shortage of Hispanic health care providers. Acculturation barriers and underinsured or uninsured status remain as major obstacles to health care access. Advantageous health outcomes from the "Hispanic Mortality Paradox" and the "Latina Birth Outcomes Paradox" persist, but health gains may be offset in the future by increasing rates of obesity and diabetes. Recommendations focus on the adoption of the Health in All Policies framework, expanding access to health care, developing cultural sensitivity in the health care workforce, and generating and disseminating research findings on Hispanic health.
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Affiliation(s)
- Eduardo Velasco-Mondragon
- College of Osteopathic Medicine, Touro University California, 1310 Johnson Lane; H-82, Rm. 213, Vallejo, CA 94592 USA
| | - Angela Jimenez
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - Dawn Davis
- St. Louis University School of Medicine, St. Louis, USA
| | - Jose A. Escamilla-Cejudo
- Regional Advisor on Health Information and Analysis, Pan American Health Organization/World Health Organization, Foggy Bottom, USA
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31
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Anderson KG, Spicer P, Peercy MT. Obesity, Diabetes, and Birth Outcomes Among American Indians and Alaska Natives. Matern Child Health J 2016; 20:2548-2556. [PMID: 27461020 PMCID: PMC5124395 DOI: 10.1007/s10995-016-2080-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives To examine the relationships between prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), and prepregnancy body mass index, with several adverse birth outcomes: preterm delivery (PTB), low birthweight (LBW), and macrosomia, comparing American Indians and Alaska Natives (AI/AN) with other race/ethnic groups. Methods The sample includes 5,193,386 singleton US first births from 2009-2013. Logistic regression is used to calculate adjusted odds ratios controlling for calendar year, maternal age, education, marital status, Kotelchuck prenatal care index, and child's sex. Results AI/AN have higher rates of diabetes than all other groups, and higher rates of overweight and obesity than whites or Hispanics. Neither overweight nor obesity predict PTB for AI/AN, in contrast to other groups, while diabetes predicts increased odds of PTB for all groups. Being overweight predicts reduced odds of LBW for all groups, but obesity is not predictive of LBW for AI/AN. Diabetes status also does not predict LBW for AI/AN; for other groups, LBW is more likely for women with DM or GDM. Overweight, obesity, DM, and GDM all predict higher odds of macrosomia for all race/ethnic groups. Conclusions for Practice Controlling diabetes in pregnancy, as well as prepregnancy weight gain, may help decrease preterm birth and macrosomia among AI/AN.
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Affiliation(s)
- Kermyt G Anderson
- Department of Anthropology, University of Oklahoma, 521 Dale Hall Tower, 455 West Lindsey, Norman, OK, 73019, USA.
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, 521 Dale Hall Tower, 455 West Lindsey, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Michael T Peercy
- Chickasaw Nation Department of Health, 1921 Stonecipher Blvd., Ada, OK, 74820, USA
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Xue Y, Intrator O. Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform. Policy Polit Nurs Pract 2016; 17:24-31. [PMID: 27166344 DOI: 10.1177/1527154416645539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform.
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Affiliation(s)
- Ying Xue
- University of Rochester School of Nursing, Rochester, NY, USA
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA Canandaigua VA Medical Center, Canandaigua, NY, USA
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Chippendale T, Gentile PA, James MK, Melnic G. Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes. Geriatr Gerontol Int 2016; 17:905-912. [PMID: 27138451 DOI: 10.1111/ggi.12800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/12/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients. METHODS A retrospective cross-sectional study using data from the trauma registry and electronic medical records at a level 1 trauma center in the USA was carried out. People aged 55 years or older, for whom fall location could be identified (n = 712), were included in the study. Demographic information, functional status before admission, comorbid conditions, activation level, Injury Severity Score, discharge disposition and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression. RESULTS Significant differences were found in patient characteristics between indoor and outdoor fallers. Significant differences in outcomes were found related to discharge disposition and injury type. Open wounds were more common among outdoor fallers (26.5%) as compared with indoor fallers (16.3%, P = 0.002). Although disorders of joints with difficulty walking were associated with fractures among both indoor (OR 7.20, CI 2.19-23.66) and outdoor fallers (OR 5.65, CI 1.27-25.06), sex was only associated with fractures among those who fell indoors (OR 1.69 CI 1.12-2.56). CONCLUSIONS Significant differences exist in characteristics of indoor and outdoor fallers, and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differ between indoor and outdoor fallers. Results can help to inform targeted primary and secondary prevention initiatives. Geriatr Gerontol Int 2017; 17: 905-912.
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Affiliation(s)
- Tracy Chippendale
- New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, New York, NY, USA
| | - Patricia A Gentile
- Jamaica Hospital Medical Center, Department of Surgery, Jamaica, NY, USA
| | - Melissa K James
- Jamaica Hospital Medical Center, Department of Surgery, Jamaica, NY, USA
| | - Gloria Melnic
- New York Presbyterian Hospital, Department of Surgery, New York, NY, USA
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Kamel H, Kleindorfer DO, Bhave PD, Cushman M, Levitan EB, Howard G, Soliman EZ. Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers. J Am Heart Assoc 2016; 5:e002492. [PMID: 26873685 PMCID: PMC4802468 DOI: 10.1161/jaha.115.002492] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/03/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Black US residents experience higher rates of ischemic stroke than white residents but have lower rates of clinically apparent atrial fibrillation (AF), a strong risk factor for stroke. It is unclear whether black persons truly have less AF or simply more undiagnosed AF. METHODS AND RESULTS We obtained administrative claims data from state health agencies regarding all emergency department visits and hospitalizations in California, Florida, and New York. We identified a cohort of patients with pacemakers, the regular interrogation of which reduces the likelihood of undiagnosed AF. We compared rates of documented AF or atrial flutter at follow-up visits using Kaplan-Meier survival statistics and Cox proportional hazards models adjusted for demographic characteristics and vascular risk factors. We identified 10 393 black and 91 380 white patients without documented AF or atrial flutter before or at the index visit for pacemaker implantation. During 3.7 (±1.8) years of follow-up, black patients had a significantly lower rate of AF (21.4%; 95% CI 19.8-23.2) than white patients (25.5%; 95% CI 24.9-26.0). After adjustment for demographic characteristics and comorbidities, black patients had a lower hazard of AF (hazard ratio 0.91; 95% CI 0.86-0.96), a higher hazard of atrial flutter (hazard ratio 1.29; 95% CI 1.11-1.49), and a lower hazard of the composite of AF or atrial flutter (hazard ratio 0.94; 95% CI 0.88-99). CONCLUSIONS In a population-based sample of patients with pacemakers, black patients had a lower rate of AF compared with white patients. These findings indicate that the persistent racial disparities in rates of ischemic stroke are likely to be related to factors other than undiagnosed AF.
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Affiliation(s)
- Hooman Kamel
- Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY
| | | | - Prashant D Bhave
- Division of Cardiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mary Cushman
- Departments of Medicine and Pathology, Cardiovascular Research Institute, University of Vermont, Burlington, VT
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, AL
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, AL
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC
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Puckrein GA, Egan BM, Howard G. Social and Medical Determinants of Cardiometabolic Health: The Big Picture. Ethn Dis 2015; 25:521-4. [PMID: 26673674 DOI: 10.18865/ed.25.4.521] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiometabolic diseases, including diabetes and heart disease, account for >12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental factors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hypertension, and Blacks are four times more likely than Whites to live in lowest SES neighborhoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk factors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interventions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbalance greater disease susceptibility. Place-based interventions on social and medical determinants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks.
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Affiliation(s)
| | - Brent M Egan
- 2. Care Coordination Institute, Greenville Health System, University of South Carolina School of Medicine, Greenville, South Carolina
| | - George Howard
- 3. University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama
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Kamel H, Hunter M, Moon YP, Yaghi S, Cheung K, Di Tullio MR, Okin PM, Sacco RL, Soliman EZ, Elkind MSV. Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study. Stroke 2015; 46:3208-12. [PMID: 26396031 DOI: 10.1161/strokeaha.115.009989] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke. METHODS We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels. RESULTS Mean P-wave terminal force in lead V1 was 4452 (±3368) μV*ms among stroke cases and 3934 (±2541) μV*ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up. CONCLUSIONS ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
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Affiliation(s)
- Hooman Kamel
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
| | - Madeleine Hunter
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Yeseon P Moon
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Shadi Yaghi
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Ken Cheung
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Marco R Di Tullio
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Peter M Okin
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Ralph L Sacco
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Elsayed Z Soliman
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
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Abstract
OBJECTIVES To evaluate the relationship between mechanism of injury and mortality in geriatric trauma patients and the ability of existing injury severity indices (ISIs) to assess mortality. DESIGN Retrospective review. SETTING Urban level 1 trauma center. PARTICIPANTS Four thousand five hundred forty-five trauma patients age ≥55 presenting between 2008 and 2011. INTERVENTION Low-energy (LE-GTP) and high-energy (HE-GTP) geriatric trauma patient cohorts were created based on ICD-9 injury codes. Existing ISIs were evaluated for their ability to predict in-hospital mortality using the area under the receiver-operating characteristic curve (AUROC). MAIN OUTCOME MEASURES Mortality. RESULTS The Trauma Score-Injury Severity Score (TRISS) was the most predictive ISI for both cohorts and was deemed to have moderate predictive capacity (AUROC: 0.82) in LE-GTP and excellent predictive capacity (AUROC: 0.91) in the HE-GTP. For, HE-GTP each 1-year increase in age was associated with a 12% increase risk of mortality versus 6% for LE-GTP. Preexisting conditions (PECs) were distributed differently between the cohorts with significantly more PECs in the LE-GTP (P < 0.01). CONCLUSIONS Existing ISIs have fair-to-moderate predictive capacity for in-hospital morality in LE-GTPs and moderate-to-excellent predictive capacity in HE-GTPs. LE-GTPs and HE-GTPs are distinct cohorts that should be evaluated separately. Combining the cohorts underestimates both the effect of age on HE-GTPs and the effect of PECs on LE-GTPs while overestimating the effect of PECs on HE-GTPs. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Daenen KEL, Martens P, Bammens B. Association of HO-1 (GT)n Promoter Polymorphism and Cardiovascular Disease: A Reanalysis of the Literature. Can J Cardiol 2015; 32:160-8. [PMID: 26483091 DOI: 10.1016/j.cjca.2015.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/27/2015] [Accepted: 06/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Heme-oxygenase 1 (HO-1), an inducible heme-degrading enzyme, has antiatherogenic effects through its enzymatic end products. HO-1 gene expression is modulated by a guanidine thymidine dinucleotide ([GT]n) repeat polymorphism in the promoter region. Shorter repeats with (GT)n < 25 are associated with higher inducibility and activity of HO-1. METHODS We performed a systematic review of all literature from 1997 to 2013 on the association of the HO-1 (GT)n and cardiovascular disease (CVD). On the basis of predefined criteria (patient characteristics, genotype data format, allelic distribution, repeat length cutoff) 41 articles were selected. Patients were redistributed into 4 homogeneous subpopulations: patients with CVD (CVD group), patients without CVD (nonCVD), 'controls' with unknown cardiovascular status (unspecified) and children younger than 20 years of age (unselected). Genotype distributions (homozygous short [SS] or long [LL], and heterozygous) of the 4 patient categories were compared and odds ratios (ORs) for CVD were calculated using logistic regression analysis. RESULTS Overall, the proportion of the SS genotype was lower in CVD compared with nonCVD and unspecified. The ORs for CVD was highest in patients carrying the LL genotype (OR LL vs SS, 1.769 [95% confidence interval, 1.594-1.963]). Furthermore, genotype distribution differed between Caucasian and Asian individuals, the latter having a much higher proportion of the SS genotype (22% vs 11%). CONCLUSIONS This review of the available literature on the epidemiological association between the HO-1 (GT)n repeat polymorphism and CVD supports the presumed protective effects of HO-1. The second but probably even more relevant finding of our review is that racial disparities in HO-1 (GT)n repeat length distribution exist and might influence the associations of the genotype with CVD status.
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Affiliation(s)
- Kristien E L Daenen
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium; Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Martens
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Bert Bammens
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium; Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
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